nutrition during the first year of life. breast feeding definition: breastfeeding is infant`s...

NUTRITION DURING THE NUTRITION DURING THE FIRST YEAR OF LIFEFIRST YEAR OF LIFE

BREAST FEEDINGBREAST FEEDING

Definition:Definition: Breastfeeding is infant`s nutrition Breastfeeding is infant`s nutrition during the first 4 – 6 months of life with human milk during the first 4 – 6 months of life with human milk only.only.

Methods:Methods: breast feedingbreast feeding bottle feeding with human pumped milkbottle feeding with human pumped milk with teaspoonwith teaspoon gavagegavage


The mechanism of milk secretion:The mechanism of milk secretion:

Endocrine factorEndocrine factor:: - estrogens, - estrogens, - placental lactogen hormone. - placental lactogen hormone.

Nervous factorNervous factor

The mechanism of milk secretionThe mechanism of milk secretion

Endocrine factor: Prolactin controls the beginning and milk secretion. In pregnancy: actual ↑ ↑ ↑ h estrogen inhibits prolactin. After removal of the placenta: ↓ ↓ → h estrogen prolactin acts freely → lactation.

Estrogens through pituitary hormones (mamogeni factors 1 and 2) determine changes in the mammary gland lactation.

The mechanism of milk secretionThe mechanism of milk secretion

Factor Nervous

- reflex act by excitations from the nipple and areola

- contribute to the formation and maintenance of milk secretion.

HUMAN MILK COMPOSITIONHUMAN MILK COMPOSITION

Mammary gland secretion: - colostrum - transitional milk, - mature milk.

Colostrum: - lactation within 5 days after birth - opaque yellow liquid, - Ig richer in protein than human milk and mature.

ColostruColostrumm

Protein - varies between 27-41 g / l - diminishes as soon as the milk flow. Immunoglobulins: - initially very high, which decrease during the first days after birth. - 90% of total Ig are IgA (Ac polio Anticoli, antistaphylococcal, anticoxakie).

Action from colostrum (resistant to digestive enzymes) + Ac secreted by the gut destroy pathogens in the digestive tract → high degree of local immunity.

ColostruColostrumm

Colostrum is adapted to the needs of the newborn in the first days of life, with increased quantities of: - lactoferrin - secretory IgA, - protein bound vitamin B12

- zinc - lipase, alpha-amylase, phosphatase, protease inhibitors - taurine

ColostruColostrumm

Carbohydrates: - total of 55-60 g / l - proportion of lactose is small (37 g / l) - oligosaccharides (23g / l), promotes implantation of the newborn intestine of the Bacillus bifidus.

ColostruColostrumm

Total lipids: - initial 30g / l, in conjunction with low activity of intestinal lipase n.b then increase their level - unsaturated fatty acids are essential especially those in large quantities and have a role in nervous system development.

ColostruColostrumm

Mineral salts: - the amount of 3.9 g / l - the Na, P, Ca, Fe, Zn, Cu more in line with that of protein.

Vitamins A, E, C, B12 are well represented in colostrum compared with mature milk.

Caloric value = 58 kcal/100ml.

Transitional milkTransitional milk

on the 6th and 10th postpartum, although biochemical and immunological changes continue until one month;

- decreases the protein, mineral salts, pH,- increase the level of lipids and lactose.

Mature human milk (h.m.)Mature human milk (h.m.)

Water - 87%.

Total Protein - 10g / l: 4g / l casein 6g / l of whey protein (lactalbumin and lactoglobulin)

Human milk is a milk type albumin.

Mature human milkMature human milk

Human casein:

- mammary gland synthesis of amino acids in the blood three fractions (alpha, beta and kappa)

- kappa - casein has a role in colonization of the intestinal bifidus Bacilus in breastfed infant.


Proteins in whey: Alfalactalbumina - contains lactosintetaza, an enzyme involved in lactose synthesis;

Lactoferrin - glycoprotein capable of reversibly bind iron milk → Fe absorption in the intestines and stomach. - iron chelator → bacteriostatic action. - additional factor of protection against intestinal pathogens, with IgAs, Lactobacilus lysozyme and bifidus.


Proteins in whey:- Betalactoglobulina milk is absent → human milk are nealergizant.- serum albumin → ligand role for folate, vit. B12, tyrosine, zinc.

Immunoglobulins: IgAs - agglutinate of food antigens, bacterial enterotoxins and viruses, blocking their adhesion to epithelial surfaces,- Ac containing anti E. coli, Shigella, Salmonella, Klebsiella, Coxackie, Echo, polio virus, hepatitis B and measles virus.

Mature human milkMature human milkIg G and Ig M:

- small quantities in milk,- serum Ig does not differ structurally.

Enzymes in human milk - a role in:- digestion of milk components- antibiotic protection.

Lysozyme:- contribute to lysis of intestinal bacteria,- enhances antibody formation.

Mature human milkMature human milk - - EnzEnzymesymes

LipasesLipases have a role in digestion of human milk have a role in digestion of human milk triglycerides.triglycerides.

AlfaamilazaAlfaamilaza::- catalyzes the hydrolysis of starch into maltose- catalyzes the hydrolysis of starch into maltose- pancreatic and intestinal amylase offset deficit in the - pancreatic and intestinal amylase offset deficit in the infant.infant.

Proteases and protease inhibitorsProteases and protease inhibitors::- greater amount compared with cow's milk- greater amount compared with cow's milk- catalyzes the hydrolysis of proteins. - catalyzes the hydrolysis of proteins.


Amino acids:taurine - a role in absorption of lipids and brain development.

Human milk proteins are absorbed and used by the infant with optimal efficiency.No physical or chemical process does not allow for similar proteins in human milk.

BREST FEEDINGBREST FEEDING


Carbohydrates - 70 g / l: - lactose (beta-lactose - 60 g / l) - a source of galactose(cerebrozidelor composition of the brain);

- oligosaccharides (10 g / l) - role in the defense of non-specific antibiotic (promotes intestinal colonization with Lactobacilus bifidus).


Lactobacilus bifidus - roles: - causes acidification of the intestinal environment → inhibits the growth of pathogens - anemic and antirickets (promotes absorption of Fe, Ca, vit. D and lipid) - synthesis of vitamins B and K.


LipidsLipids: 36 - 40 g / l: 36 - 40 g / l

fatty acids fatty acids (FA), mono and polyunsaturated fats (oleic (FA), mono and polyunsaturated fats (oleic acid, palmitoleic and linoleic)acid, palmitoleic and linoleic) -over half of the total FA h.m.-over half of the total FA h.m. - role in CNS maturation in the newborn - role in CNS maturation in the newborn periodperiod

triglyceridestriglycerides - report equally between unsaturated and - report equally between unsaturated and saturated FA.saturated FA.


Cholesterol and lecithinCholesterol and lecithin:: large quantities h.m. than c.m. large quantities h.m. than c.m.

The presence of The presence of lipaselipase in human milk: in human milk: - facilitates lipid hydrolysis - facilitates lipid hydrolysis - FA promote rapid release of usable energy - FA promote rapid release of usable energy metabolism. metabolism.


Mineral salts and trace elements:- content four times lower than c.m., less influenced by maternal dietary intake, being provided by maternal stores.

- thus, if sufficient phosphorus and calcium are the mother's diet, they are obtained through its mobilization from bone deposits.


SodiumSodium: → low amount of renal function overloading is : → low amount of renal function overloading is avoided.avoided.

CalciumCalcium four times and four times and phosphorusphosphorus 6-7 times less than 6-7 times less than the c.m., but the Ca : P = 2 : 1 is favorable for their the c.m., but the Ca : P = 2 : 1 is favorable for their proper use.proper use.

IronIron:: - amount of two times higher in h.m. - amount of two times higher in h.m. - intestinal absorption and incorporation into the - intestinal absorption and incorporation into the hemoglobin molecule is much higher in infants hemoglobin molecule is much higher in infants breastfed.breastfed.


VitaminsVitamins:: solublesoluble (A, D, E, K) (A, D, E, K) solublesoluble (C, folic acid, vitamin complex. B) (C, folic acid, vitamin complex. B)

- varying proportions, in relation to food intake. - varying proportions, in relation to food intake. - a balanced diet of the mother provides adequate - a balanced diet of the mother provides adequate intake of these vitamins, except vitamin D. intake of these vitamins, except vitamin D.


The amount of vitamin D in human milk does not provide even if your baby needs a proper sun exposure, but is higher than that of cow's milk, which explains the lower incidence of rickets in infants breastfed.

The energy value of h.m. mature = 65-68 kcal/100ml.

Factors of human milk

1. Antiinfectious protection factors:- immunological- biological

- provide protection against infectious agents from the environment until the baby develops its own immunity. breastfed infants versus artificially fed infants:

-low rate of hospitalization-low incidence of respiratory infections, diarrhea, a rash, etc. sites.

Factors of human milk Antiinfectious protection factors

Cellular factors Cellular factors (macrophages, neutrophils, Ly B and (macrophages, neutrophils, Ly B and T):T): anti-infective role in maternal mammary gland and anti-infective role in maternal mammary gland and infant's digestive tract (protects against enterocolitis infant's digestive tract (protects against enterocolitis ulceronecrotics).ulceronecrotics).

ImmunoglobulinsImmunoglobulins - IgAs: - IgAs: - opsonizant role, - opsonizant role, - mobilize and agglutinate bacteria, viruses and antigens - mobilize and agglutinate bacteria, viruses and antigens of food,of food, Ly stimulates the formation of intestinal mucosal IgA Ly stimulates the formation of intestinal mucosal IgA in the infant. in the infant.


LactoferrinLactoferrin - bacteriostatic role. - bacteriostatic role.

LysozymeLysozyme - a role in combination with complement - a role in combination with complement and antimicrobial IgAs, which potentiates the action.and antimicrobial IgAs, which potentiates the action.

LactoperoxidaseLactoperoxidase - bactericidal action against germs - bactericidal action against germs like Pseudomonas, E. coli, Salmonella, Streptococcus.like Pseudomonas, E. coli, Salmonella, Streptococcus.


MucinMucin - prevent adhesion of germs and rotaviruses to - prevent adhesion of germs and rotaviruses to the surface of intestine.the surface of intestine.

CC33 and and CC44 fractions of complement - role in fractions of complement - role in

chemoattraction of phagocytes and intracellular chemoattraction of phagocytes and intracellular incorporation of particles.incorporation of particles.

Bifidogens factors Bifidogens factors (glycoproteins and (glycoproteins and oligosaccharides) - role in promoting growth of oligosaccharides) - role in promoting growth of Lactobacilus bifidus in the intestine of breastfed infant.Lactobacilus bifidus in the intestine of breastfed infant.

Factors of human milk

2. 2. Modulators of growth factors:- stimulates growth of mammary gland- acting on the baby's organs. Epidermal growth factor (epidermal GrowthFactor - EGF) and insulin-like growth factor (Insulin-like growth factor: IGF-1) - role in the maturation of the gastrointestinal tract.

Factors of human milk Modulators of growth factors

Nervous growth factor Nervous growth factor - essential for the - essential for the development of sympathetic neurons and sensory development of sympathetic neurons and sensory cells.cells.

B-cellB-cell stimulating factor - role in the proliferation of stimulating factor - role in the proliferation of Ly B and production of immunoglobulins.Ly B and production of immunoglobulins.

TaurineTaurine - improves fat absorption and promotes - improves fat absorption and promotes intestinal colonization of Lactobacilus bifidus.intestinal colonization of Lactobacilus bifidus.

Breast feedingBreast feeding

Other qualities of human milk

- - is always fresh and available (immediately available);is always fresh and available (immediately available); - does not involve special training (breast care is - does not involve special training (breast care is required);required); - is the ideal temperature; - is the ideal temperature; - is aseptically; - is aseptically; - not cause allergies or intolerance; - not cause allergies or intolerance; - has an optimum power distribution, the total energy - has an optimum power distribution, the total energy being supplied by fat (55%), carbohydrates (38%) and being supplied by fat (55%), carbohydrates (38%) and protein (7%).protein (7%).

Evolution of milk secretionEvolution of milk secretion

"Anger milk" "Anger milk" = colostrum transformation in transition = colostrum transformation in transition milk and then mature h.m.milk and then mature h.m.

Clinical ManifestationsClinical Manifestations:: turgescence of mammary glands ± pain, local turgescence of mammary glands ± pain, local hyperthermia,hyperthermia, fever, headache, tachycardia. fever, headache, tachycardia.

ParaclinicalParaclinical: leukocytosis with lymphocytosis and : leukocytosis with lymphocytosis and eosinophilia.eosinophilia.


"Psychosis lactation" "Psychosis lactation" = mental status changes that may= mental status changes that mayup to manic states - depression.up to manic states - depression.

- these phenomena disappear spontaneously in most - these phenomena disappear spontaneously in most cases.cases.- mothers rarely requires admission to psychiatric - mothers rarely requires admission to psychiatric hospitals.hospitals.


MaximumMaximum intensity of milk secretion: intensity of milk secretion: - between day 15 and 3 months after birth; - between day 15 and 3 months after birth; - may take a year or more, if stimulated by sucking or - may take a year or more, if stimulated by sucking or squeezing the breast.squeezing the breast.

CompositionComposition of human milk varies: of human milk varies: - according to the stages of lactation - according to the stages of lactation - after the time of day (diurnal variations / nocturnal) - after the time of day (diurnal variations / nocturnal) - from one breast to another, - from one breast to another, - the same breast over the meal. - the same breast over the meal.


At the same table at the end of meal milk (“hindmilk “) At the same table at the end of meal milk (“hindmilk “) is richer in fat and protein than that of the beginning of is richer in fat and protein than that of the beginning of the meal ("foremilk"), so it's hearty and nourishing.the meal ("foremilk"), so it's hearty and nourishing.

Administration only h.m. after the age of 6 months is Administration only h.m. after the age of 6 months is not sufficient quantity and quality for infant not sufficient quantity and quality for infant development. development.

Factors influencing lactation

-- ageage: young women → more abundant milk secretion;: young women → more abundant milk secretion;- - parityparity: primiparous lactation to be installed with a : primiparous lactation to be installed with a delay of several days;delay of several days; - - kinds of birthkinds of birth: interventions from birth (cesarean, : interventions from birth (cesarean, forceps, perineorafie) by trauma and postoperative diet forceps, perineorafie) by trauma and postoperative diet are important factors in milk secretion inhibitors;are important factors in milk secretion inhibitors; - - feedingfeeding, , restingresting, , graded exercise graded exercise and especially and especially psychological factor psychological factor contributing to maintaining a good contributing to maintaining a good milk secretion;milk secretion;

Milk secretionMilk secretion

StimulationStimulation of milk secretion: of milk secretion: - sucking - sucking - mammary gland drained, - mammary gland drained, - ensuring physical comfort of the mother. - ensuring physical comfort of the mother.

AgalacticAgalactic: extremely rare.: extremely rare.HipogalacticHipogalactic: more common in primiparous, the : more common in primiparous, the intellectual, women who do not comply with resting.intellectual, women who do not comply with resting.Spontaneous flow of milk secretion: this may be a sign Spontaneous flow of milk secretion: this may be a sign of hipogalactic.of hipogalactic.

BenefitsBenefits of breast feeding

Benefits for childrenBenefits for children::

- optimal growth and physical development - h.m. - optimal growth and physical development - h.m. has all the nutrients needed, in quantities and has all the nutrients needed, in quantities and proportions ideal for a child's needs and maximum proportions ideal for a child's needs and maximum bioavailability;bioavailability;

- mother - child bonding - solid and sustainable - mother - child bonding - solid and sustainable with long-term consequences of child mental health. with long-term consequences of child mental health.

BenefitsBenefits of breast feeding Benefits for childrenBenefits for children

low morbidity bylow morbidity by::- much lower risk of malnutrition, acute diarrheal - much lower risk of malnutrition, acute diarrheal diseases, intestinal parasites, dental disease (caries, diseases, intestinal parasites, dental disease (caries, malocclusion, periodontal disease);malocclusion, periodontal disease); - incidence lower than 50% of the malignant process - incidence lower than 50% of the malignant process during 0-16 years;during 0-16 years; - respiratory and ENT pathology rarer and less - respiratory and ENT pathology rarer and less serious;serious;

BenefitsBenefits of breast feeding Benefits for childrenBenefits for children

low morbidity bylow morbidity by:: - allergic asthma and different more rare and mild - allergic asthma and different more rare and mild forms;forms; - diabetes mellitus and risk of sudden death in infants - diabetes mellitus and risk of sudden death in infants less than 2-3 times;less than 2-3 times; -urinary infections 5 times more rare in the first 6 -urinary infections 5 times more rare in the first 6 months of life;months of life; - protective role against hypertension and - protective role against hypertension and ateromatosis.ateromatosis.


Benefits for the motherBenefits for the mother::

- affective (psycho-emotional) - affective (psycho-emotional)

- direct physical contact (skin to skin ") parent - child - direct physical contact (skin to skin ") parent - child positive emotional reactions → ↓ risk of abuse, neglect positive emotional reactions → ↓ risk of abuse, neglect or mistreatment of children and ↓ risk of postpartum or mistreatment of children and ↓ risk of postpartum depression; depression;

BenefitsBenefits of breast feeding Benefits for the motherBenefits for the mother

- contraception → tasks spacing → effects on - contraception → tasks spacing → effects on reproductive health of the mother;reproductive health of the mother;

- decreases the risk of breast cancer, ovary cancer; - decreases the risk of breast cancer, ovary cancer;

- a lower incidence of osteoporosis is whether breast - a lower incidence of osteoporosis is whether breast lasted more than nine months.lasted more than nine months.


3. 3. Family Benefits:

fed infant develops smoothly, thus representing an emotional bond for the family;

economic - to avoid the high costs, concerns and loss of time for preparation of milk, saves heat, detergents, etc..

BenefitsBenefits of breast feeding Benefits for the familyBenefits for the family

-- fewer illnesses → fewer doctor visits, fewer treatments;

- increased comfort - no need to purchase travel, training maneuvers, sterilization, contamination risks, egs..

Breast feedingBreast feeding

IIncidents and complications in breastfeedingncidents and complications in breastfeeding

RegurgitationRegurgitation:: - appears at the end of the meal, when eructation - appears at the end of the meal, when eructation - should not be confused with vomiting - should not be confused with vomiting - small quantity of milk is eliminated without running - small quantity of milk is eliminated without running and does not affect the weight curveand does not affect the weight curve - not occur during sleep - not occur during sleep - is isolated, transient, without concomitant symptoms, - is isolated, transient, without concomitant symptoms, - resolve spontaneously in the 2nd semester. - resolve spontaneously in the 2nd semester.


Diarrhea (post) prandial = diarrhea driving, the irritable bowel syndrome n.b. and infant breastfeeding. - is not a gastroenteritis; - semi-emission chairs, yellow, acid, during the feeding or immediately after meal, often accompanied by screaming, agitation; - can cause nappy rash; - weight curve remains upward; - general condition is good.


Diarrhea (post) prandialDiarrhea (post) prandial:: - source of anxiety for the mother and family → - source of anxiety for the mother and family → medical consultations, antibiotics unnecessarily;medical consultations, antibiotics unnecessarily; - breast milk diet will not be interrupted; - breast milk diet will not be interrupted; - may recommend taking calcium carbonate, 0.5 - 1g/zi - may recommend taking calcium carbonate, 0.5 - 1g/zi prior to administration of milk. prior to administration of milk.


JaundiceJaundice::

- - early form early form (“early onset breast-feeding jaundice") - (“early onset breast-feeding jaundice") - appears in the first week of lifeappears in the first week of life

- - late-onset form late-onset form - start by end of first week of life - start by end of first week of life


Early-onset jaundiceEarly-onset jaundice::milk intake ↓ → relative starvation → ↑ bilirubinmilk intake ↓ → relative starvation → ↑ bilirubin

PreventingPreventing the rise of physiological jaundice: the rise of physiological jaundice: - breastfeeding, early and frequent; - breastfeeding, early and frequent; - temporarily supplement the diet with formula milk. - temporarily supplement the diet with formula milk.


Late-onset jaundice: - 4th - 7th day of life, peak in the 3rd week and persists until 10 weeks; - unconjugated hyperbilirubinemia (BI) - absence of other signs of disease.

Diagnostic tests and therapeutic: - BI values ↓ quickly, within days, if you stop feeding with h.m. and ↑ to resume. - Breastfeeding is recommended to further ± phenobarbital few days.


Hipogalactia tongueHipogalactia tongue:: - rarely primary - rarely primary - often secondary, related physical, mental, maternal - often secondary, related physical, mental, maternal diet and poor food technique.diet and poor food technique.

The child does not increase weight is stirring (hungry), The child does not increase weight is stirring (hungry), is rare stools and dark, then gets drowsy and have signs is rare stools and dark, then gets drowsy and have signs of dehydration.of dehydration.

IIncident and complications in breastfeedingncident and complications in breastfeeding

Mastitis and breast abscessMastitis and breast abscess::

- consequence of milk stasis and breast small cracks, - consequence of milk stasis and breast small cracks,

- occurring as a result of inadequate sucking.- occurring as a result of inadequate sucking.

Obstacles in breast feedingObstacles in breast feeding

From the childFrom the child:: - malformations of the oral cavity (“lip rabbit”, “wolf's - malformations of the oral cavity (“lip rabbit”, “wolf's mouth”, retrognathic)mouth”, retrognathic) - infections (rhinitis, otitis, pneumonia); - infections (rhinitis, otitis, pneumonia); - neurological diseases (meningocerebral bleeding, - neurological diseases (meningocerebral bleeding, meningitis, encephalitis); meningitis, encephalitis);


From the childFrom the child::- prematurity;- prematurity; - haemolytic disease of the newborn; - haemolytic disease of the newborn; - jaundice; - jaundice; - vomiting - vomiting ..


From the motherFrom the mother:: - anger milk; - anger milk; - temporary hypogalactia; - temporary hypogalactia; - inverted nipples; - inverted nipples; - abrasions of the nipple; - abrasions of the nipple; - lymphangitis, mastitis; - lymphangitis, mastitis;

Permanent contraindicationsPermanent contraindications

Maternal factorsMaternal factors:: - severe progressive visceral disease: tuberculosis, - severe progressive visceral disease: tuberculosis, hepatitis, AIDS, malaria, septicemia, cancer / hepatitis, AIDS, malaria, septicemia, cancer / chemotherapy treatment, heart failure, renal failure;chemotherapy treatment, heart failure, renal failure; - neuropsyhic disease: severe mental disorder / - neuropsyhic disease: severe mental disorder / psychosis of lactation, multiple sclerosis, epilepsy / psychosis of lactation, multiple sclerosis, epilepsy / anticonvulsant therapy;anticonvulsant therapy; - other situations / diseases: diabetes mellitus, a new - other situations / diseases: diabetes mellitus, a new task with age> 20 weeks.task with age> 20 weeks.

Permanent contraindicationsPermanent contraindications

Child Child - related cases (rare, some even exceptional)- related cases (rare, some even exceptional)

- congenital galactosemia;- congenital galactosemia;

- hereditary / primary intolerance to lactose- hereditary / primary intolerance to lactose

- phenylketonuria.- phenylketonuria.

Supliment’s required during breast feedingSupliment’s required during breast feeding The childThe child:: - vitamin D (rickets prophylaxis) - vitamin D (rickets prophylaxis) - iron (oral preparations) - iron (oral preparations)

■ ■ infants born at term:infants born at term: 1-2 mg elemental Fe / kg / day from the age of 5-6 1-2 mg elemental Fe / kg / day from the age of 5-6 months (for 3 months).months (for 3 months). ■ premature: ■ premature: 2 to 2.5 mg elemental Fe / kg / day, from 1 ½ - 3 months 2 to 2.5 mg elemental Fe / kg / day, from 1 ½ - 3 months to 1 year of age.to 1 year of age.

Iron injection are contraindicated.Iron injection are contraindicated.

Supliment’s required during breast feedingSupliment’s required during breast feeding

The child:In general, while being breast fed, no extra fluid intake needed (water / tea, fruit juice, etc..), especially in newborn and small infant.

New born at term, healthy weight with a constant upward curve does not need anything other than human milk.

Supliments required during breast feedingSupliments required during breast feeding

Mother - for lactation: - extra calories - avoid consumption of alcohol - avoid strong smelling foods (onions, garlic, spices) and those rich in cellulose (peas, beans, cabbage) that can give diarrhea in children - avoid canned.

Supliment’s required during breast feedingSupliment’s required during breast feeding

Vegetarian MothersVegetarian Mothers

- will consume milk daily- will consume milk daily

- will supplement the diet with vitamin B- will supplement the diet with vitamin B1212 which is which is found almost exclusively in animal products.found almost exclusively in animal products.

WeaningWeaning

Will be made as late as possible.Will be made as late as possible.

There are considerable advantages to provide even There are considerable advantages to provide even small amounts of h.m until the age of 1 year, 1 ½, small amounts of h.m until the age of 1 year, 1 ½, even 2 years.even 2 years.

BOTTLE FEEDINGBOTTLE FEEDING

BOTTLE FEEDINGBOTTLE FEEDING

DefinitionDefinition: bottle feeding is infant`s nutrition during the : bottle feeding is infant`s nutrition during the first 4 months of life with other milk than human milk.first 4 months of life with other milk than human milk.

The recommended industrial preparations are made of The recommended industrial preparations are made of cow's milk because the process they tend to be as close cow's milk because the process they tend to be as close is possible to h.mis possible to h.m

The administration will use cow milk only when it is The administration will use cow milk only when it is absolutely impossible to use formula milk.absolutely impossible to use formula milk.

The composition of cow's milk (c.m)The composition of cow's milk (c.m)

ProteinProtein: 32-34 g / l: 32-34 g / l casein - 28 g (lv casein is a milk type) casein - 28 g (lv casein is a milk type) whey protein (lactalbumin and lactoglobulin): 4-6 g. whey protein (lactalbumin and lactoglobulin): 4-6 g.

β-lactglobulin is highly antigenic / allergy.β-lactglobulin is highly antigenic / allergy.Casein c.m precipitates in the stomach of infants in Casein c.m precipitates in the stomach of infants in large clots, difficult digestible → longer intervals of large clots, difficult digestible → longer intervals of time between lunches.time between lunches.

The composition of cow's milkThe composition of cow's milk

CarbohydratesCarbohydrates: 48-50 g / l (vs. 68-70 g / l h.m): 48-50 g / l (vs. 68-70 g / l h.m)

represented only lactose → low intake of galactose → represented only lactose → low intake of galactose → slow myelination of CNS.slow myelination of CNS.

oligosaccharides missing → absence of bowel oligosaccharides missing → absence of bowel colonization with bacillus bifidus in bottle fed infantcolonization with bacillus bifidus in bottle fed infant


LipidsLipids: 36 g / l: 36 g / l

- saturated, indigestible, deficient in essential fatty - saturated, indigestible, deficient in essential fatty acidsacids

- five times lower amount of linoleic acid - five times lower amount of linoleic acid

- cholesterol in amounts less than - cholesterol in amounts less than h.m h.m


Mineral saltsMineral salts:: - amount of four times higher than in h.m. - amount of four times higher than in h.m.

with high protein content → metabolites and with high protein content → metabolites and osmolarity ↑ ↑ → ↑ baby's water needs.osmolarity ↑ ↑ → ↑ baby's water needs.

- amounts of phosphate and citrate ↑ → ↑ pH gastric → - amounts of phosphate and citrate ↑ → ↑ pH gastric → prevents absorption and promotes Ca elimination prevents absorption and promotes Ca elimination

The composition of cow's milk The composition of cow's milk Mineral saltsMineral salts

The The ratioratio Ca / P ~ 1: Ca / P ~ 1:

- inappropriate for absorption- inappropriate for absorption - rickety - rickety - putrefaction (intestinal flora - E. coli) - putrefaction (intestinal flora - E. coli) ↑ effort to remove the liver and kidney metabolites. ↑ effort to remove the liver and kidney metabolites.


IronIron:: Fe deficiency l.v. explains its poor absorption Fe deficiency l.v. explains its poor absorption frequency and iron deficiency anemia in infants fed frequency and iron deficiency anemia in infants fed cow's milk.cow's milk.

VitaminsVitamins:: - smaller quantities than in human milk and by boiling - smaller quantities than in human milk and by boiling the milk a good part of them are destroyed. the milk a good part of them are destroyed.

Disadvantages administration of cow milkDisadvantages administration of cow milk

-- iron deficiency, the intake / absorption + low intestinal iron deficiency, the intake / absorption + low intestinal absorption (occult bleeding) due allergenicity of cow's absorption (occult bleeding) due allergenicity of cow's milk;milk;

- various nutritional deficiencies (rickets, etc.); - various nutritional deficiencies (rickets, etc.);

- dehydration through increased renal load; - dehydration through increased renal load;

- increased risk to allergy. - increased risk to allergy.

COW`S MILK PROTEIN ALLERGYCOW`S MILK PROTEIN ALLERGY

DefinitionDefinition: hypersensitivity reaction caused by any of the : hypersensitivity reaction caused by any of the protein components of c.m (most likely protein components of c.m (most likely ββ lactoglobulin). lactoglobulin).

Allergic reaction:Allergic reaction:

- immediate - mediated IgE- immediate - mediated IgE - delayed - mediated cell. - delayed - mediated cell.


Clinical ManifestationsClinical Manifestations:: - leather (infant eczema, allergic first manifestation) - leather (infant eczema, allergic first manifestation) - digestive system (vomiting, diarrhea, colic, poor - digestive system (vomiting, diarrhea, colic, poor growth, RGE, chronic constipation)growth, RGE, chronic constipation) - respirator (recurrent wheezing). - respirator (recurrent wheezing).

Hint: iron deficiency anemia (occult gastrointestinal Hint: iron deficiency anemia (occult gastrointestinal bleeding). bleeding).


The most important diagnostic test used in The most important diagnostic test used in therapeutic practice (investigations infant allergy is therapeutic practice (investigations infant allergy is hard)hard)is removal of the feeding of cow milk and cow milk 's is removal of the feeding of cow milk and cow milk 's derivatives → improvement of symptoms.derivatives → improvement of symptoms.

Drug treatment Drug treatment is not necessary.is not necessary.Just replace c.m with a hypoallergenic formula milk. Just replace c.m with a hypoallergenic formula milk.

nutrition during the first year of life. breast feeding definition: breastfeeding is infant`s...

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