FEEDING

Ekawaty Lutfia Haksari

Department of Child Health, Perinatology,
Sardjito Hospital,
Medical faculty, Gadjah Mada University

Infancy Age Period (Birth - 12 months)

Neonatal - Birth - 4 weeks
Infancy - 1 month - 12 months
- fastest growth period
5 mos.= Double the birth weight
12 mos. = Triple the birth weight
12 mos. = increase of birth length by 50%
(Surjono, 2005)

GROWTH DURING THE FIRST YEAR

WEIGHT
Weight gain is a sign of good health.
First 6 months: Gain 750 g per month
Last 6 months: Gain 450 g per month
A babys weight doubles in the 5 months and
triples by the end of the first year.
May differ depending on hereditary, feeding
habits, and level of physical activity

GROWTH DURING THE FIRST YEAR

Height
Avg. newborn is 50 cm long
Avg. 1 yr old is about 75 cm long
Hereditary more strongly influences height than weight

GROWTH DURING THE FIRST YEAR

PROPORTION
The size relationship between different parts
of the body
What is the name of the space on the skull of
a newborn? Fontanels
What do they do?
They allow the head to grow

FEEDING
Infant nutrition is important
because growth is more rapid in infancy
than during any other period after birth
Infants double their weight by four months;
triple their weight by 1 year
Must consume large number of calories
relative to weight

TO BREAST-FEED OR NOT?
Breast-feeding ensures proper nourishment
Proteins, fats, carbohydrate, vitamins,
minerals
Contains antibodies
Better transition to solid foods

NUTRITION
Growing research
supports nutrition
programs for infants
which will supply needed
nutrients for proper
physical, cognitive &
emotional development
Breast/Bottle Feeding
Breast-feeding is
nutritional is better for
infants

(Surjono, 2005)

Malnutrition
Infants who are
malnourished in their 1st
year
may suffer marasmus
wasting of body tissues
severe proteincalorie deficiency
severe
underdevelopment of
childs cognitive,
physical & emotional
growth

TEN STEPS TO SUCCESSFUL

BREASTFEEDING
Baby Friendly Hospital Initiative
Every facility providing maternity services
and care for newborn infants should apply
Ten Steps To Successful Breastfeeding

TEN STEPS TO SUCCESSFUL

BREASTFEEDING
1.
2.
3.
4.
5.

Have written breastfeeding policy that is routinely

communicated to all health care staff
Train all health care staff in skills necessary to
implement this policy
Inform all pregnant women about the benefit and
management of breastfeeding
Help mothers initiate breastfeeding within half an
hour of birth
Show mothers how to breastfeed, and how to
maintain lactation even if they should be separated
from their infants

Early initiation of breastfeeding (UNICEF, 2003)

Opening his mouth, ready to suck (UNICEF, 2003)

Crying (Unicef, 2003)

Rooming in (Unicef, 2003)

ADVANTAGES OF ROOMING IN
Mother can respond to baby, helps bonding
Baby cries less, less temptation to give bottle
feeds
Mother more confident about breastfeeding
Breastfeeding continues longer

Show mothers how to breastfeed (Unicef, 2003)

Rooming in (Sardjito Hospital, 1982)

Newborn by secarean (UNICEF, 2003)

TEN STEPS TO SUCCESSFUL

BREASTFEEDING
6. Give newborn infants no food or drink other

than breast milk,unless medically indicated

7. Practice rooming in; that is, allow mothers &
infants to remain together 24 hours a day
8. Encourage breastfeeding on demand
9. Give no artificial teats or pacifiers (also
called dummies or soothers) to
breastfeeding infants
10. Foster the establishment of breastfeeding
support groups and refer mothers to them
on discharge from the hospital /clinic

Dangers of
pre-lacteal feeding

- REPLACE COLOSTRUM
-greater risk of infection
- risk of intolerance,
allergy
-INTERFERE SUCKLING
- artificial feeds
satisfy hunger
- bottles interfere
attachment
- baby suckless
- difficult to establish
breastfeeding

Too far, lack of attachment (Unicef,2003)

4. HELP MOTHERS INITIATE BREASTFEEDING

WITHIN HALF AN HOUR OF BIRTH

Early initiation of breastfeeding

Breast crawl is the natural instinctive
behaviour of the human newborn
The mother & newborn dyad are mutually
responsive in the most sensitive period of half
to one hour following delivery
This period is crucial for laying the
foundation for successful breastfeeding
Significant in mortality, morbidity &
malnutrition among the children

( Marshall (Klaus: Mother and Infant : Early Emotional

Ties Ped 1998 UNICEF INDIA : The Breast Crawl
2007)
5 stages behavior to breastfeed
In the 1st 30:
Alert rest. Intermittent look at
his mother.
Adjusting to the environtment

30-40: producing sound,

Sucking movement, putting hands
Into mouth
(Utami Rusli 2007)

Delayed breastfeeding initiation increases

risk of neonatal mortality
( Edmond KM et all, 2006)

16% neonatal death could be saved if all

infants were breastfed from day 1, &
22% if breastfeeding started within
the 1st hour
Breastfeeding promotion programs should
emphasize - early initiation
- exclusive breastfeeding

SIGNS THAT BABY IS GETTING

ENOUGH BREAST MILK

Passed urine at least 6 times/24 hours

Hear the baby swallow when feeding
The mothers breast feel softer after feed
The baby gains weight over time (after the
first week)
The baby seems contented after feeding. She
has times when she is hungry, quiet, awake &
sleep during the day

EXPRESSED BREAST MILK

Premature
Sick
Unable to suck
feeding tubes, spoon, small glass

Expressing breast milk &

premature baby drink by small glass (Unicef,2003)

SELECTED NUTRITION NEED IN A DAY

---------------------------------------------------------------------------NUTRIENT

NORMAL NEED
FULLTERM
PRETERM

---------------------------------------------------------------------------ENERGY
Total (kcal/kg)
Carbohydrat (g/kg)
Fat (g/kg)
Protein(g/kg)

100
10
3,3 -6
1,5-2,2

120
12-14
4-7
3,0 - 4,0

---------------------------------------------------------------------------VITAMIN
A (IU/kg)
333
700 - 1500
E (IU)
3 - 25
5 - 25

NUTRIENT

NORMAL REQUIREMENT
FULL TERM*
PRETERM

-----------------------------------------------------------------------Mineral & trace elements

100
120
Sodium (mEq/kg)
1-3
2-4
Potassium (mEq/kg)
1-2
2-4
Calcium (mg/kg)
45-60
120-230
Ortofosfat (mg/kg)
25-40
60 - 140
Magnesium (mg/kg)
6-8
7,9 - 15
Iron (mg/kg)
1 **
2 - 4**
-----------------------------------------------------------------------* Breastfed infant
**Breast milk supplement starts at 2 weeks old

SUMMARY
DIFFERENCE BETWEEN BREAST MILK & OTHER MILK
-----------------------------------------------------------------------BREAST MILK

COW MILK

ARTEFICIAL MILK

------------------------------------------------------------CONTAMINATION
no
possible
possible
BAKTERIA
when mixed
------------------------------------------------------------------------------------------ANTI INFECTIOUS
yes
not available
not available
FACTOR
------------------------------------------------------------GROWTH
yes
not available
not available
FACTOR
------------------------------------------------------------PROTEIN
good quantity
too much
partly improved
easy to digest
difficult to digest
-------------------------------------------------------------------------------------------

BREAST MILK

COW MILK

ARTEFICIAL MILK

------------------------------------------------------------------------------------

LIPID
Lipid esensial
Lipase

less
yes

enough
not available

IRON
Amount
Absorbsion

small
good

small
not good

VITAMIN

enough

less
not available

------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------------

not enough
A&C

added

need to added

need to added

---------------------------------------------------------------------------------------------------

WATER

enough

-----------------------------------------------------------

HORMON

enough:

added
not good

cortisol & insulin

----------------------------------------

not for human

not available

COMPOSITIONOF BREAST MILK

FULL TERM & PRETERM

Energi (kkal)
Protein (g)
Karbohidrat (g)
Lemak (g)
Natrium(mMol)
Kalium (mMol)
Kalsium(mMol)
Fosfor
Rasio Ca:P

ASI
CUKUP BULAN KURANG BULAN
1 minggu 4 minggu
700
670
700
13
24
18
70
61
70
42
38
40
6,5
22
13
15
18
16
8,7
6,2
6,4
4,8
4,6
4,6
1,8
1,4
1,2

PRETORIA PASTEURIZATION
( Jeffrey BS, et al. J Trop Ped 2001,2003)

Eliminatating HIV
Killing pathogenic bacteria during breast
milk express
Can be stored for 12 hours
out of refrigerator
with less possibility of contamination
(Ramasethu J, 2004)

Pretoria Pasteurization

( Jeffrey BS, et al. J Trop Ped 2000)

Immerse glass bottle containing

75 to 150 ml of milk for 15 minutes

1 liter aluminium pot with 450 ml water

heated to boiling
Keep temperature of breast milk on 56- 625 C for 15 menit
(Ramasethu, 2004)

STORAGE OF BREAST MILK

Room temperature: 250 C: 6 to 8 hours
380 C:

not safe

Insulated cooler with ice packs: 24 hours

Refrigerator 40 C
24 - 48 hours
(up to 5 days?)
(Ramasethu, 2005)

Storage of breast milk

Refrigerator/ Freezer with separate doors:
-180 C : 3 to 6 months
Freezer compartment inside the refrigerator:
-150 C : 2 weeks only

Deep freezer opened infrequently:

-200 C : 6 to 12 months
(Ramasethu, 2005)

INTERNATIONAL CODE OF MARKETING OF BREAST-MILK

SUBSTITUTES

Code

Art
icle
1

Aim of the Code

Scope of the Code

Definitions

Information & Educations

General public & mothers

Health care systems

Health workers

Persons employed by
manufactures &
distributors

Labelling

10 Quality
11 Implementation &
monitoring

WHO,1981

REFFERENCE
Surjono A. Kuliah IKAInternasional 2005
Premer DM Georgieff MK. Nutrition for ill neonates.
Neoreview e56-62, Sept 1999
WHO dan Unicef. Konseling menyusui, manual pelatih . Versi
Indonesia Departemen Kesehatan dan BKPPASI WHO dan
Unicef . 2002
WHO. International Code of Marketing of Breast-milk
substitues. 1981
Sjaaf AC. Upaya implementasi International Code of
Marketing of Breast-milk substitues di Indonesia. 2003
Walker M. Core Curriculum for Lactation Consultant
Practice. Jones & Bartlett Publishers. Sudbury,
Massachusetts, 2002
Pelatihan Laktasi & Manajemen menyusui. Modul 2. IBCLC
Indonesia. 2008.