The document discusses the importance of breastmilk for infant nutrition and health, outlining the composition and benefits of breastmilk compared to formula. It provides guidance on managing lactation, including determining infant food requirements, addressing breastfeeding problems, and establishing feeding schedules. The overall message is that breastmilk is the best and most complete food for infants.
The document discusses the importance of breastmilk for infant nutrition and health, outlining the composition and benefits of breastmilk compared to formula. It provides guidance on managing lactation, including determining infant food requirements, addressing breastfeeding problems, and establishing feeding schedules. The overall message is that breastmilk is the best and most complete food for infants.
The document discusses the importance of breastmilk for infant nutrition and health, outlining the composition and benefits of breastmilk compared to formula. It provides guidance on managing lactation, including determining infant food requirements, addressing breastfeeding problems, and establishing feeding schedules. The overall message is that breastmilk is the best and most complete food for infants.
The document discusses the importance of breastmilk for infant nutrition and health, outlining the composition and benefits of breastmilk compared to formula. It provides guidance on managing lactation, including determining infant food requirements, addressing breastfeeding problems, and establishing feeding schedules. The overall message is that breastmilk is the best and most complete food for infants.
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Breastmilk
& Management of Lactation
1 FOOD ARRANGEMENT FOR INFANT Step for food arrangement 1. Determine the Nutrient requirement 2. Determine the kinds of food according to the requirement 3. Determine the menu 4. Determine eat schedule, kind of dishes and food administration ( Oral, Sonde ) 5. Watch the Intake like/dislike factor
2 FACTORS NEEDED TO MAKE A RIGHT FOOD ARRANGEMENT : 1. Age 2. Weight 3. Diagnosis & stadium of illness 4. Mouth condition (Stomatis, Candidiasis, Trismus) 5. Eating habit, favourite, acceptability and tollerantion of food
3 INFANT FOOD - Important because malnutrition problem Macronutrition Deficienci KKP Micronutrition Deficienci Nutritional anemia - Main food: breast milk Addition:milk porridge, rice boiled, fruit, biscuit - Breast milk programme ( 22 Dec1990 ) by President Soeharto
4 - Breast feeding Natural Mother ability for breast feeding is enough, but lack of self confidence & mother feel it is enogh by adding formula milk breast milk is not use optimally need to be promoted because: 1. great formula milk promotion 2. lack of chance for breast feeding 3. lack of knowledgement of breast feeding 4. esthetic 5 BREAST MILK COMPOSITION According to the time of breast feeding : 1. COLOSTRUM • Produced in day 1 – 5 • Yellowish, viscous, little volume • Protein and antibody 2. TRANSITION BREAST MILK • Produced in day 5 – 10 • Higher fat and sugar milk • volume is more than colostrum 3. MATURE BREAST MILK • Produced after day 10 • volume increase, but in month 6 – 9 • Consistent nutrient 6 BREAST MILK : ENOUGH 4 – 6 MONTHS ADDITIONAL FOOD BREAST MILK IS GIVEN 2YEARS
MATUR PREMATUR 1 Week 4 Week Energy Kcal 700 670 700 Protein 13 24 18 Carbohydrate 70 61 70 Fat 42 38 40 Sodium 6,5 22 13 Potassium 15 18 16 Calsium 8,7 6,2 6,4 Phosfor 4,8 4,6 4,6 Ca/p Ratio 1,8 1,4 1,2 10 IMMUNOLOGIC FACTOR INFANT WITH BREASTFEEDING IS RARELY GOTILLNESS PROTECTOR AGENT IN BREASTMILK 1. Growth Factor– Lactobacilus Bifidus 2. Lactoferin 3. Lisozym 4. Complement : C3 , C4 5. Humoral Immunity : SIgA, IgM, IgG 6. Celullar Immunity : Macrofag ( 90 % ) Limfosit Epithel cell 11 BENEFIT OF BRESTFEEDING FOR INFANT 1. Natural food perfect 2. Appropriate nutrient for infant growth and development 3. Love feeling comfort 4. Prevent infection, diarrhoea 5. Not cause allergy 6. Help the growth of jaw 7. Decrease insidences of caries dentis 12 BENEFIT OF BRESTFEEDING FOR MOTHER 1. Love relationship between mother – infant 2. Simple 3. Stimulate involution of uterus 4.Support family planning 5. Prevent breast cancer BENEFIT OF BRESTFEEDING FOR FAMILY 1. Simple 2. Decrease family cost 13 BENEFIT OF BRESTFEEDING FOR NEGARA 1. Decrease morbidity/mortality
2. Decrease hospital subsidy for mother
and child care
3. Decrease cost of ill child care
4. Decrease devisa for formula milk
5. Increased quality of next generation
14 FORMULA MILK
1. CONTAMINATION ô BACTERY 2. INFANT BECOME VULNERABLE OF INFECTION 3. MALNUTRITION / OVERNUTRITION 4. EXPENSIVE
15 LACTATION MANAGEMENT A. PERINATAL PERIODE CARE 1. Patient and family care 2. Family support 3. Medical workers support 4. Preparation of breast and nipple (TRIM. II) 5. Examination of breast and nipple 6. Nutritious food ( 300 cal addition ) 7. Keep body & spiritual health 8. 5 T :Blood pressure, Fundal height, Weight measurement, TT ( 2X ), Fe Tablet 16 B. EARLY NIFAS PERIODE CARE 1. Mother and infant must be ready for breastfeeding 2. Infant get breastfeeding soon after birth( ½ hour 3. Rooming in 4. Right breastfeeding technic 5. Often breastfeeding according to infant requirement 6. No formula and bottled milk 7. Do not use artificial nipple 8. Use both of breast 9. Breast care 10. Keep good psychis condition 11. Nutritious food > pregnant periode (+500cal) 12. Enough rest 17 C. NEXT EFFORT FOR BREASTFEEDING 1. Exclusive breastfeeding : only breastfeeding for 4-6 months, breastfeeding in 30´ after birth, give colostrum, breastfeeding without schedule, include the day 2. In 7 days after discharge from hospital,mother is visited in home 3. Keep good psychis condition 4. Nutritious food & Enough rest 5. Additional food after 4 months of age
18 BREASTFEEDING PROBLEM - Breastfeeding problem occure after the mother discharge first 2 weeks - The problem comes from mother ,child and enviroment a. ANTENATAL PERIODE Nipple abnormality: 1. Flat nipple 2. Buried Nipple 3. Rigid Nipple
treatment:breast examination and care (nipple) 19
EARLY NIFAS PERIODE 1. Flat nipple 2. Excoriated nipple (wrong breastfeeding technic) 3. Swelling breast 4. Obstruction of milk tract 5. Mastitis 6. Breast Abscess LATE NIFAS PERIODE 1. Lack of breastmilk syndrome 2. Nipple confused infant 3. Crying infant 4. Working mother 20 CONTRA INDICATION OF BREASTFEEDING :
1. Allergy rare if exist check the mother food: alergen ? 2. Severe illness of mother : Nefritis, actif TBC ,Severe cardiac illness, Hepatitis – B.
21 SCHEDULE OF BREASTFEEDING INFANT KIND OF FOOD ADMINISTRATION/ 24 HOURS 0–6 breastmilk Infant desire 6-7 breastmilk Infant desire fruit& biscuit 1 – 2 times Milk porridge 2 – 3 times 7– 8 breastmilk Infant desire fruit& biscuit 2 times Milk porridge 2 times Filtered boiled rice 1 – 2 times 8 – 10 breastmilk Infant desire fruit& biscuit 2 times unfiltered boiled rice 3 times 11 – 12 breastmilk Infant desire fruit& biscuit 2 times rice 3 times 22 FOOD SCHEDULE IN INFANT 0 – 6bln 6 – 7bln 7 – 9bln 9 – 12bln > 12 bln (bertahap) (bertahap) (bertahap) Pkl.06.00 ASI ASI/PASI ASI/PASI ASI/PASI ASI/PASI on pkl.08.00 demand bubur susu bubur susu nasi tim makanan nasi tim mak. kel keluarga Pkl. 10.00 buah segar/ buah segar/ buah segar/ snack biskuit biskuit biskuit Pkl 12.00 ASI bubur susu nasi tim makanan nasi tim mak. Kel keluarga Pkl. 14.00 ASI ASI/PASI ASI/PASI Pkl 16.00 buah segar/ buah segar/ buah segar/ snack biskuit biskuit biskuit Pkl.18.00 bubur susu bubur susu nasi tim makanan nasi tim mak. Kel keluarga Pkl.21.00 ASI ASI/PASI ASI/PASI ASI/PASI 23 ADDITIONAL FOOD TO BREASTMILK Milk porridge cows milk 150 ml rice powder 10 gr sugar 10 gr Contain Calory 165 kkal Protein 5 gr animal86 % vegetable30 % Vit A 210 IU B 52 mgr C 1mg Kalsium 136 mg Phosphor 64 mg 24 Ferrum 0,3 mg Cook instruction: ~ PUT RICE POWDER AND SUGAR INTO MILK ~ SHAKE ~ COOK ABOVE FIRE BOILED ~ WAIT UNTIL COOL
25 BOILED RICE I 7-9 MONTHS • Rice 25 gr • Kalori 150 kkal Liver 20 gr Protein 8 gr Tempe 15 gr Vit. A 8960 IU Spinach 10 gr Pro Vit A 1150 gr Tomato 10 gr B1 148 gr Carrot 20 gr C 19 mg Mineral : Ca, P, Fe
26 BOILED RICE II • Rice 25 gr • Kalori 220 kkal Liver 20 gr Protein 12 gr Tempe 15 gr Vit. A 9780 IU Egg 30 gr Pro Vit. A 1150 gr Spinach 10 gr B1 148 gr Tomato 10 gr C 19 mg Carrot 10 gr Mineral : Ca, P, Fe INSTANT •> Milk porridge: Sun, Promina add hot water •> Boiled rice : Promina Cook above fire 27 TO KNOW WETHER BREAST MILK IS ENOUGH Measure weight before and after breastfeeding increased100 – 200 gr Weight 2 week infant rech B. B. L and decreased
weight in first week 10 %
Measure weight every month : KMS
Weight 5 months = 2 x BBL
12 months = 3 x BBL
28 TO KNOW WETHER BREAST MILK IS ENOUGH Objective : • weighbirth reached in 2 weeks after birth • good growth curve Subjective : • infant is satisfied / sleep after breastfeeding • mother’s breast stiffness WEIGHT INCREASED ACCORDING TO AGE Age( month ) weight increased 1–3 150 – 250 gr / weeks 4–6 500 – 600 gr / months 7–9 350 – 450 gr / months 10 – 12 250 – 350 gr / months 29 BREAST MILK SUBSTITUTION (PASI) IN INDONESIA PASI / formula milk/ artificial milk cow milk which modified so the composition is like ASI (less protein,fat become vegetable fat) EARLY FORMULA
a. Full Early Formula : 0 – 6 months
sweet : SGM1, LACTOGEN 1 Acid : ELEDON, CAMELPO rare b. Modified Early Formula : NAN, VITALAC, S26, DUMEX SB, NUTRILON FOLLOW-ON FORMULA : 6 months – 2/3 years
SGM2, LACTOGEN2, PROMIL, BEBELAC2
30 SPECIFIC FORMULA a. Free / low Lactose : Al 110, Almiron, Bebelac fl, LLM, Olac b. Medium Chain Trigliceride : Portagen, Caprilon c. Hydrolisat Protein : Nutramigen, Pregestimil d. Specific Protein Lofenalac SOYA BEAN MILK FORMULA : Prosobee, Nutrisoya, Nursoy PREMATURE FORMULA : Enfalac, Prenan, Nenatal 31 NOT RECOMMENDED MILK FOR INFANT 1. Full cream milk = Whole milk cow milk composition : Bendera, Dancow for > 1 year 2. Sweet viscous milk for adult,contains 40 % sugar 3. Skim milk (low fat) :fat ½ % a 1 ½ % 4. Fresh milk : - Fresh cows milk - Pasteurisasi milk
32 BEFORE GIVING PASI : WATCH Age, general condition,social economy, administration, sterility, consentration. Measurement : Full cream milk = 15 gr / 100 cc formula milk = 1 spoon / 30 cc ( Except S26 1spoon / 60 cc water) NEGATIVE IMPACT OF PASI 1. Diarrhoea 2. Malnutrition 3. Obesity 4. Psychic relationship between mother-child 33 FOOD OF CHILD> 1 YEAR Age group Preschool : - 1 – 3 years - 4 – 6 years School : 6 – 12 years Adolescents: 12 – 18 years This classification is based on change of digestive power, nutrition requirement,eating habit, etc Snack : 10.00 – 16. 00 wib age group 1 – 3 years 1. High risk for nutritional problem 2. necessary to give separate food with eat time for older children 34
