.

1. Feeding of healthy child
in the first year of life

2. RELATION OF
MATERNAL & FETAL NUTRITION
• Maternal diet ultimate source of fetal nutrients as
evidenced by distinctly lower average birth weight among
babies in low-income than from high-income groups
• With poor maternal diet, less fat & protein storage in fetus,
less vitamin A & iron storage in fetal liver & less Ca+2
deposition in fetal skeleton
• Poor maternal diet also increases incidence of abortions,
stillbirths & developmental abnormalities in fetus
• Whatever physical, biochemical, physiologic & behavioral
defects due to poor maternal diet intensified during
neonatal period

3. AT BIRTH & NEONATAL PERIOD
• After birth when infant can safely tolerate enteral nutrition
judged by normal activity, alertness, suck & cry, feedings
started
 To maintain normal metabolism during transition from
fetal to extrauterine life
 To promote maternal-infant bonding
 To decrease risks of hypoglycemia, hyperkalemia,
hyperbilirubinemia & azotemia
• Most infants can start breast-feeding immediately almost
always within 1–4 hr
• An infant's stomach’s emptying time varies from 1–4 hr or
more during a single day

4. GENERAL GUIDELINES
• By end of 1st wk, most healthy infants will be taking 60–
90 ml/feeding and want 6–9 feedings/24 hr
• By end of 1st month, >90% of infants will have
established a suitable & reasonably regular schedule
• Most will wake for a middle-of-the-night feeding until 3–6
wk of age though some will never desire this feeding
while others continue it beyond 3–6 wk of age
• Between 4–8 mo of age, many infants will lose interest in
the late evening feeding
• By 9–12 mo of age, most will be satisfied with 3
meals/day plus snacks
• Not all infants conform to these general guidelines

5. REASONS FOR AN INFANT’S CRY
OTHER THAN HUNGER
• May not be receiving enough milk
• May have discomfort such as
uncomfortable clothing, colic or “gas”,
wet diapers or feeling hot or cold
• To gain sufficient or additional attention
• Simply need to be held
• Sick infants (uninterested in food and
continue to cry even when held)

6. BREAST-FEEDING
• Breast milk: the most ideal, safe &
complete food
• Breast milk protein of good biological
value
• Lactation may continue to 18-24
months (WHO)

7. PHYSIOLOGY OF LACTATION
• Nipple stimulation from
baby’s breast sucking
• Message sent to spinal
cord, then brain
• Increased prolactin
levels released by
anterior pituitary for
milk production
• Increased oxytocin
levels released by
posterior pituitary for
milk ejection reflex

8. TYPE TIMING QUANTITY CHARACTERISTICS
COLOSTRUM 1st 2-4
days
10-40
ml/day
• Yellow fluid
• More protein (95% globulins & more IgA)
• Less fat & sugar
• More vitamins esp. vitamin A
• More salt (Na+ & K+)
• Sp. gr. 1.040-1.060
• Alkaline pH of 7.7
TRANSITIONAL From 4th-
10th day
to 1st
month
Increases
to <600 ml
• Fall in protein, decreasing cells/mm3 &
concentration of immunoglobulins but
total volume increases
• Gradual increase in fat & lactose
• Na+, K+ & Cl- concentrations decrease but
Ca+2 & PO4- constant
MATURE By end
of 1st
month of
lactation
About 600
ml in 1st mo
to 800 ml in
the 6th mo
after which
falls to 25-
400 ml on
the 2nd yr
• About 5% fat, 1.1% protein & 7%
lactose that is fairly consistent, fatty
acids generally reflect maternal diet, total
N2 of 1.2% includes significant portion of
non-protein N2
• Sp. gr. 1.026-1.036 average being 1.031
• PH 6.8-7.4 average of 7
**In poorly nourished women, composition
constant but total yields lower

9. FACTORS INFLUENCING COMPOSITION
1. Time of day - Fat content highest early in the day &
lowest at night
2. Mother’s diet - Milk usually light blue but the more fat
the more yellowish
3. Mother’s emotional state - milk ejection reflex often
absent or erratic during periods of pain, fatigue, or
emotional distress
4. Whether fore or hind milk - . “Fore” milk, 1st milk
expressed is clear, thin & bluish reflecting low fat & high
water content but “Hind” milk or end milk is thick &
creamy white reflecting higher fat content
5. Drugs - Atropine, opium, lead, iodides, barbiturates,
sulfonamides, INH & some antibiotics may be found in
milk after prolonged use or in maximum doses
6. Smoking

10. DETERMINING ADEQUACY
• If infant is satisfied after each nursing
period
• Contented and sleeps 2-4 hours between
feedings
• Regularly and adequately gaining weight
• The “let-down” or milk ejection reflex in
the mother is an important sign

11. ADVANTAGES OF BREAST-FEEDING
1. Proper quality & quantity
of nutrients
2. Rates of growth better in
the 1st 3-4 months
3. Anti-infective properties
universally accepted
4. Prevents allergy due to
high IgA preventing
antigen absorption
5. Contraceptive property,
high levels of prolactin
inhibit synthesis of
ovarian steroids causing
delay of ovulation &
pregnancy
6. Psychological advantages
a. Fosters mother-child relationship
b. Tactile contact makes babies
more secure, emotionally stable
c. A sense of fulfillment,
satisfaction & joy for the mother
7. Protective against
a. Necrotizing enterocolitis
b. Otitis media
c. Dental caries
8. Others:
a. Safe, contains no pathogens
b. Always at the right temperature
c. Convenient & always available

12. ANTI-INFECTIVE PROPERTIES
a. Breast milk esp. colostrum
contains plenty of
antibodies
b. E. coli antibodies present
c. High % of lactose
stimulates Lactobacillus
bifidus
d. Lactoferrin binds iron &
inhibits growth of E. coli,
staphylococci & Candida
albicans
e. Lysozyme bacteriostatic
against
enterobacteriaceae &
staphylococcus species
f. Anti-staphylococcus factor
g. Lactoperoxidase kills streptococci &
enteric bacteria
h. Secretory IgA against intestinal
bacteria
i. Macrophages 90% of leucocytes,
involved in phagocytosis & synthesis
of bacteriostatic proteins:
lactoferrin, lysozyme &
complements C3, C4
j. Lymphocytes comprise 10%,
approximately 34% B-lymphocytes
responsible for synthesis of IgA
k. T-lymphocytes 50% against E. coli,
rubella, CMV & mumps viruses &
transfer delayed hypersensitivity

13. CONTRAINDICATIONS
1. Absolute: chronic diseases like open TB, cardiac
diseases, thyrotoxicosis, advanced nephritis, mental &
seizure disorders
2. Relative: when mother is taking anticoagulants,
antibiotics, steroids or potentially toxic substances like
benzene products
3. Mechanical contraindications on the part of the
mother: retracted or oversized nipples
4. Mechanical contraindications on the part of the
baby: congenital anomalies like harelip & cleft palate
but breast milk may be pumped & given
5. Allergy should be proven

14. REASONS FOR NOT OR
STOPPING BREAST-FEEDING
1. Lack of motivation or preparation of mothers
2. Anxiety, fear & uncertainty in the mother
3. Aesthetic reasons
4. Status seeking & effective promotion of infant foods
5. Mothers work to increase & augment family income
6. Separate maternity & nursery wards
7. Milk formula easily sucked from the bottle nipple
8. Cultural milieu
9. Mothers who can’t despite all desires & attempts
10. Presence of contraindications

15. ANTENATAL TECHNIQUES
1. Wear fitted maternity bra from 5th month
2. Daily bath enough for cleaning nipples, avoid soap,
alcohol & drying agents
3. Rub nipples & areolae with little anhydrous lanolin to
make more supple
4. Express colostrum from 7th month by squeezing areola
between index finger & thumb about 3x each side
5. Practice Hoffman’s maneuver (tactile stimulation by
thumb & opposing forefinger in the horizontal & vertical
planes) for flat or pseudo-inverted nipple

16. POSTNATAL PROCEDURES
1. Breast-feeding maybe started about 30 min after NSD & 3-4 hrs
after C/S
2. The baby should be comfortable, in semi-sitting position with lips
engaging considerable areola & breast not obstructing breathing
3. The mother should be seated comfortably & relaxed (recumbent
position if preferred) with areola held between her index & middle
fingers or between thumb & index finger to control milk flow
4. Baby obtains 95% of milk in the 1st 5 min & frequent feeds as well
as short feeds on alternate breasts ideal then burp after
5. Teach mother how to break suction of baby when time to stop by
pressing on a portion of the breast near baby’s lips to let air into
mouth to prevent painful tagging between mother & child
minimizing sore nipples

17. CONTENT BREAST MILK COW’S MILK
pH Both have pH 6.8-7.4 w/ average of 7
Water content &
Specific gravity
Both have water content of 87-87.5% w/ sp. gr.
1.026-1.036 average being 1.031
Proteins 1-1.5% 3.3%
a. Whey-to-casein
ratio
60:40 20:80
b. Whey proteins a-lactalbumin (40%)
lactoferrin (25%)
lysozyme (0.08%),
albumin (0.08%), IgA,
IgG, IgM (0.15%)
Mostly b-lactoglobulin,
some a-lactalbumin &
traces of lactoferrin
c. Casein Low ratio of methionine
to cystine, lower levels
phenylalanine & tyrosine
High ratio of methionine
to cystine, higher levels
phenylalanine & tyrosine
d. Curds Softer, smaller Less digestible

18. CONTENT BREAST MILK COW’S MILK
Fats 3.5% but varies w/ maternal
diet
a. Neutral fat or
triglycerides
palmitin, stearin &
olein
Twice as much of the more
absorbable olein
b. Volatile fatty acids
butyric, capric,
caproic & caprylic
1.3% 9%
c. Linoleic acid 4-5% of fat calories, hence,
better source of this
d. Digestion &
absorption
Contains bile-salt stimulated
lipase plus specific fatty acids,
hence, more efficient
Steatorrhea may
occur
Carbohydrates
mainly lactose
7% 4.8%

19. CONTENT BREAST MILK COW’S MILK
Mineral content 0.15-0.25% 0.7-0.75%
a. And water Ensures free water Need for extra water
b. With diarrhea Hypotonic dehydration Hypertonicity & acidosis
common
c. Ca+2/P- ratio 2:1 Neonatal hypocalcemia
may occur
d. Iron Although low, sufficient
because better absorbed
Lower & lesser absorbed
Vitamins
a. Fat-soluble
vitamins
Both contains large amounts of vitamin A, minimal
vitamin D & should be given vitamin K to prevent
hemorrhagic disease of the newborn
b. B complex More niacin More thiamine & riboflavin
c. Ascorbic acid More vitamin C Lesser

20. ARTIFICIAL FEEDING
• Isocaloric: Infant formulas or breast milk substitutes contain
about 20 kcal/oz like breast milk
• Caloric requirements: The average caloric requirement of a FT
infant is about 80-120 kcal/kg during the 1st few months of life &
100 kcal/kg by 1 yr
• Fluid requirements: During the 1st 6 months of life, about 130-
190 ml/kg/day; as a rule, the infant regulates his or her own fluid
requirement provided adequate amounts mostly from orange juice
& other foods or water offered
• Number of feedings daily: For the 1st month or 2, feedings
throughout 24-hr period, about 8 feedings/day but as quantity
increases, number of feedings decrease adjusting to family pattern
& by 9-12 months most infants satisfied with 3 meals a day

21. MILK FORMULAS
• Certified Milk. Milk drawn cooled to <70 C immediately & kept at
this temperature till delivery
a. Eliminates bovine tuberculosis, typhoid & other salmonella,
dysentery, streptococcus & staphylococcus
• Pasteurized Milk. Heating milk at 630 C for 30 min or for 15 sec
at 720 C followed by rapid cooling to 650 C.
a. Destroys all pathogenic bacteria but only 99% of saprophytes
b. Destroys 20% of vitamin C & 10% of thiamine
c. Standards range from 5,000-10,000/ml to 50,000 non-
pathogenic bacteria/ml
d. Should be kept at 100 C & do not use after 48 hrs
e. Only fresh milk is pasteurized

22. MILK FORMULAS
• Homogenized Milk. Processing of milk through a fine aperture at
high pressure at pasteurization temperature so that fat globules
are broken down into a fine emulsion
a. Prevents creaming & renders fat more easily assimilated
b. Method used to incorporate vitamin D in milk
• Evaporated Milk. Cow’s milk vaporized at 55-600 C to about 50%
of its volume, homogenized, sealed in cans & autoclaved at 1160 C
for some time to destroy spores
a. Process can damage quality of protein
b. If can unopened, can keep for months without refrigeration
c. Lactalbumin less allergenic
d. 30 ml or 1 fl oz = 40 kcal

23. MILK FORMULAS
• Condensed Milk. Cow’s milk to which 45% cane sugar added
a. Carbohydrate content 60% when diluted 1:4
b. Percentage composition of proteins 1.6%, fat 1.6%,
carbohydrate 11% & minerals 0.36%
c. Used only for short periods of time if high caloric formula
needed since nutritionally “out of balance”
d. Less fat-soluble vitamins & vitamin C
e. Main advantages are keeping quality & cheap cost
• Dried Milk. Prepared by spraying whole or pasteurized milk into a
hot chamber at a very high speed so that water is volatized
immediately or by freeze-drying
a. Fine curds produced because protein altered
b. Vitamin C not affected

24. MILK FORMULAS
• Skimmed Dried Milk. Fat removed before milk is dried so that fat
content only 0.05%
a. Half-skimmed dried milk has fat content of 1.5%
b. Useful for fat intolerance, diarrhea or some prematures
• Fermented Milk. Acidity of sour milk responsible for changing of the
casein curds
a. Buttermilk. Milk allowed to turn sour by nature & its fat removed
by churning; since frequently contaminated, sterile skimmed milk
is inoculated with some lactic-acid producing organisms
(Lactobacillus acidophilus, L. bulgaricus, or Streptococcus lacticus)
b. Fermented Whole milk. After inoculation, milk incubated at 27-
30o C for 6-12 hrs after which refrigerated for several days
c. Protein Milk. Introduced by Finkelstein for treatment of diarrheas

25. MILK FORMULAS
• Acid Milk. Prepared by addition of dilute mineral or organic acids
to the milk, such as lactic acid milk popularized by Marriott
a. Overcomes buffer value of cow’s milk
b. Bactericidal effect in stomach & duodenum
c. May cause acidosis in infants
• Filled Milk. Fat content of whole milk is replaced by vegetable oil,
coconut oil & corn oil & this increases the amount of saturated
fatty acids
• Recombined Milk. Separated non-aqueous ingredients mixed
together with or without water, e.g. in condensed milk
recombination, butterfat & non-fat milk solids are put together
again

26. MILK FORMULAS
• Reconstituted Milk. Remaking of any milk product to
approximate the composition of fresh cow’s milk, hence, for
powdered milk, all that is needed is water
• Follow-on Milk Formulas. Food intended for use as a liquid part
of the weaning diet for the infant from the 6th month onwards & for
children between 12-36 months of age
a. Questions raised about the high protein content
b. Risk of hypernatremic dehydration due to high potential renal
solute load
c. However, beneficial in places where supplementary foods are
low in protein

27. MILK FORMULAS
• Special Milk Formulas. Where either the carbohydrate, protein,
fat or all these components have been altered to address specific
needs
a. Phenylalanine-free. Milk formula for phenylketonuria
b. Lactose-free Formulas. For lactose intolerance or
galactosemia
c. Soy formulas/Protein Hydrolysates. For infants with cow’s
milk allergy
d. Powdered Protein. For prematures or debilitated infants or
those with diarrhea

28. NOT RECOMMENDED
FOR INFANTS
• Whole Cow’s Milk
a. Protein content much higher than in breast milk 21% versus 7-
16%, thus, increasing solute load
b. Low in iron
c. Use may result in occult blood loss in stools
• Skimmed Milk & Low Fat Milk
a. Very low fat content
b. Deficient in vitamin C & iron
• Goat’s Milk
a. Just as antigenic as cow’s milk
b. High protein content may result in increased renal solute load
c. Deficient in folic acid & iron
d. Carbohydrate content 25% versus 35-65% in breast milk

29. SUPPLEMENTARY AND
COMPLEMENTARY FEEDINGS
• Supplementary Feedings
 Feedings provided in place of breastfeeding
 Any food given prior to 6 months, the
recommended duration of exclusive feeding
 May include expressed or banked breast milk
• Complementary Feedings
 Milk feedings given in addition to breastfeeding
or replacement foods (non-milk feedings)
 Foods given in addition to breastfeeding after 6
months needed for adequate nutrition

30. WEANING
• Definition: The process of introducing any non-milk food
into the infant’s diet, irrespective of whether or not
breast- or bottle-feeding continues
• Introduction of solids usually done at about 4-6
months of age because:
a. Milk supply may no longer meet the nutrient
requirements for growth
b. Intestinal tract better able to handle foreign proteins
c. Kidneys better able to tolerate increased protein
loads
d. The infant exhibits developmental readiness

31. DEVELOPMENTAL READINESS
FOR WEANING
• Able to sit with support or briefly
• Better head control
• Better oral motor coordination (loss of
extrusion reflex)
• Better able to communicate degree of
satisfaction

32. WEANING FOODS
• Initial weaning foods are usually cereals, pureed or mashed
fruits & vegetables and semi-solids
• Ground fresh beef, liver or strained canned meats may be
given initially by 6 months of age
• When infant shows “gumming” or develops chewing motions,
usually at 6-8 months of age, chewable biscuits & succulent
solids may be introduced
• Egg white, chicken & similar highly antigenic foods should be
introduced with caution during the second 6 months to
observe for & minimize allergic manifestations
• Lifelong dietary habits may become established at weaning
periods, hence, excessive salt & sugar intake should be
discouraged

33. WEANING FOODS
• By 8 months, most infants can also eat "finger foods" (snacks
that can be eaten by children alone)
• By 12 months, most children can eat the same types of foods
as consumed by the rest of the family
• Avoid foods that may cause choking (i.e., items that have
shape and/or consistency that may cause them to become
lodged in the trachea like nuts, grapes, raw carrots)
• Avoid giving drinks with low nutrient value, such as tea, coffee
and sugary drinks such as soda
• Limit the amount of juice offered so as to avoid displacing more
nutrient-rich foods

34. Daily Intakes of Each Food Group
Needed by a
6-yr-old Boy
Inactive
(<30 min of
vigorous
activity/day)
Moderately Active
(30–60 min of
vigorous activity/day)
Very
Active
Energy
(kcal/day)
1,400 1,600 1,800
Grains
(oz/day)
5 5 6
Vegetables
(cups/day)
1.5 2 2.5
Fruits
(cups/day)
1.5 1.5 1.5
Milk (cups/day) 2 3 3
Meat, beans
(oz/day)
4 5 5

35. Daily Protein Requirement
2005 Dietary Reference Intakes, U. S. Food and
Nutrition Board, National Academy of Sciences
(g/kg BW/day)
1978 FNRI Publications, Daily
Requirements of Filipinos
(g/kg BW/day)
0-6 mo (AI) 1.52 0-5 mo 3.5
7-12 mo (RDA) 1.2 (or 11 g/day of protein) 6-11 mo 3
1-3 yr (RDA) 1.05 (or 13 g/day of protein) 1-2 yr 2.5
4-8 yr (RDA) 0.95 (or 19 g/day of protein) 3-6 yr 2
9-13 yr (RDA) 0.95 (or 34 g/day of protein) 7-15 yr 1.5
Males 16-19 yr 1.2
14-18 yr (RDA)
19-30 yr (RDA)
0.85 (or 52 g/day of protein)
0.80 (or 56 g/day of protein)
Females
14-18 yr (RDA)
19-30 yr (RDA)
0.85 (or 46 g/day of protein)
0.80 (or 46 g/day of protein)
As point of reference: 3 ounces lean beef (the size of a deck of cards) or poultry =
25 g protein; 3 ounces fish or 1 cup soybeans = 20 g protein; 1 cup milk or yogurt
= 8 g protein; 1 egg or 1 ounce cheese=6 g protein; 1 cup legumes=15 g protein;
cereals, grains, nuts and vegetables = 2 g protein per serving

37. References
• Feeding Guide for the First Year
(nationwidechildrens.org)
• UNHCR_SENS_Module_4_IYCF_v3_EN.pdf
• Infant and young child feeding (who.int)
• Lactation | Anatomy and Physiology II
(lumenlearning.com)