Infant Feeding Practice dr.Lanang

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    09-Jul-2016

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RSUP Sanglah Denpasar Indonesia

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<p>INFANT FEEDING PRACTICE</p> <p>INFANT and young child FEEDING PRACTICEDIVISI NUTRISI DAN PENYAKIT METABOLIKBAG/SMF ANAK FK UNUD/RSUP SANGLAH DENPASAR1Soal:seorang bayi laki,diajak ibunya ke praktek untuk imunisasi, usia 3 bulan, BB 5,5 kg, PB 59 cm, saat ini minum ASI dan sudah diberikan susu formula sejak 2 minggu yang lalu. Status nutrisi:Antropometri: BB/U -2SD s/d -1SD; PB/U -1SD s/d -2SD; BB/PB -1SD s/d medianKlinis baikDiet: ASI + susus formulaStatus gizi baik + perawakan baik Kebutuhan nutrisi:BB ideal 5,7 kg; usia PB 2-3 bulanEnergi= 5,7 x 120 kkal = 684 kkal/hari = 977 ml ASIProtein = 5,7 x 2,5 g = 14,25 g/hariRute pemberian:Oral Jenis nutrisi:ASI + susu formula dilanjutkanMonitoring:Kontrol sebulan lagi saat imunisasi berikutnya</p> <p>Soal:seorang bayi laki,diajak ibunya ke praktek untuk imunisasi, usia 3 bulan, BB 5,5 kg, PB 59 cm, saat ini minum ASI dan sudah diberikan susu formula sejak 2 minggu yang lalu, BBL 3,3 kg, BB 1 bl 4,2 kg, usia 2 bl 5,1 kg. </p> <p>Konseling tehnik menyusui yang benar, jelaskan cara/penggunaan ASI simpan dan pertanyakan pemberian susu formula???</p> <p>Status nutrisi:Antropometri: BB/U -2SD s/d -1SD; PB/U -1SD s/d -2SD; BB/PB -1SD s/d medianKlinis baikDiet: ASI + susus formulaStatus gizi baik + perawakan baik + risiko gagal tumbuh Kebutuhan nutrisi:BB ideal 5,7 kg; usia PB 2-3 bulanEnergi= 5,7 x 120 kkal = 684 kkal/hari = 977 ml ASIProtein = 5,7 x 2,5 g = 14,25 g/hariRute pemberian:Oral Jenis nutrisi:ASI + susu formula dilanjutkan ???Monitoring:Kontrol sebulan lagi saat imunisasi berikutnyaOptimal infant and young child feeding (rekomendasi WHO, 2002)Early initiation of breastfeeding (within 1 hour after birth)Exclusive breastfeeding (0-6 months)Continuous breastfeeding for 2 years or beyondComplementary feeding (6-24 months)</p> <p>Why breastfeeding ?Cost : dengan angka kelahiran 21 per 1000 maka akan ada bayi yang lahir sebesar 4,7 juta setahun. Dalam 6 bulan bayi membutuhkan 60 box SF apabila harganya Rp 60 rb per box maka akan dibutuhkan dana 4,7 juta x 60 x 60 rb yaitu sebesar 16,9 triliun7Early initiation of breastfeeding</p> <p>Skin-to-skin-contactMother and baby feel more calm.Reduced risk of infectionWarmth, love, security and food.Smell of nipple = amnioticGet first milk = colostrumSupport growth and bowel function without allergy substanceMore successful of exclusive breastfeedingOxytocin release, reduced bleeding</p> <p>Colostrum: first 3-5 days of life Low in fat, high in CH, protein and antibodies.Easily digested, laxative effect, prevent jaundice.IgA contents protect mucous membranes in the throat, lungs and intestines: protection against GIT and respiratory tract infection.Initiating breastfeeding reduced neonatal mortality rates by 22%</p> <p>Oligosaccharides: 3-9 sugar unitsPolysaccharides oligosaccharides disaccharides monosaccharide.Fiber: those polysaccharides we are not able to digest.InsolubleSoluble: oligosaccharides, digested by bacteria (microbiome), into short chain carboxylic acids for enrgy by cells lining of intestines first prebiotic of breast milk.Prebiotic = functional foods.Oligosaccharides concentration in colostrum more than 20 g/L, mature milk 12-14 g/L, compare with cows milk less than 1 g/L.</p> <p>Protein Breast milk: whey protein dominantWhey protein: rich of -lactalbuminEasily digested and absorbed Cows milk: casein protein dominantWhey protein: rich of -lactoglobulin, low in amino acid tryptophan.</p> <p>Positioning and attachment</p> <p>Cara bayi mengeluarkan ASI</p> <p>21Suckling Hormonal Reflex Arc</p> <p>Source: Lactation Education Program Nutrition Policy and Education</p> <p>More prolactin Secreted at night22Inhibitor in breast milkIf breast remains full of milk, secretion stops</p> <p>23Marker of Successful Breastfeeding 7% or less weight loss in first few days after birthReturn to birth weight for at least 2 weeksWeight gain per day of 20 to 30 g during first 3 postnatal months Lactation established in mother by 2 to 4 days after birthAt least eight breastfeeding events every 24 hoursBaby is latching unto breast easilyThree to six stools and four to six voids by 5 to 7 days of age</p> <p>24</p> <p>Damayanti Rusli Sjarif 2009</p> <p>Complementary foodsPemenuhan kebutuhan nutrisi bayi </p> <p>28200550300</p> <p>29Breast milk in the second year of life</p> <p>Gap : hati hati terhadap kecukupan nutrisi setelah usia 6 bulan 30Some Considerations in Complementary feedingsToo Earlydiarrheal disease &amp; risk of dehydrationdecreased breast-milk productionAllergic sensitization? developmental concernsToo Latepotential growth failureiron deficiencydevelopmental concernsWHEN??32Fluid Needs33Food Consistency 34Responsive Feeding 35The 1st Test FeedingsBasic guidelinesBasic guidelinesPrecautions when introducing solid foodSafety Issues Regarding Feeding Infants:40AAP: Specific Recommendations41Help baby become more independent:Give finger foodsDrink from cup since 6-8 months of ageHold his/her own cup or bottleMake feeding schedule so that baby will feel hungry and full regularly42</p> <p>42</p> <p>43</p> <p>44Codex Standard for Infant Formula and Formulas for Special Medical Purposes for Infant (CODEX STAN 72-1981)Infant formula, like no other food, is regulated by its own law, the Codex Standard for Infant Formula and Formulas for Special Medical Purposes for Infant.(CODEX STAN 72-1981) The act sets upper and lower limits on important nutrientsIt requires that the formula supports normal growth and that contents are clearly labeled.Manufacturers are required to follow good manufacturing practice,45Codex Standard for Infant Formula and Formulas for Special Medical Purposes for Infant (CODEX STAN 72-1981)Section A refers to Infant FormulaSection B deals with Formulas for Special Medical Purposes Intended for Infantsmeans a substitute for human milk or infant formula that complies with Section 2, Description, of the Codex Standard for the Labelling of and Claims for Foods for Special Medical Purposes (CODEX STAN 180-1991) and is specially manufactured to satisfy, by itself, the special nutritional requirements of infants with specific disorders, diseases or medical conditions during the first months of life up to the introduction of appropriate complementary feeding. </p> <p>46FORMULA FOR SPECIAL MEDICAL PURPOSES INTENDED FOR INFANT AND YOUNG CHILDRENFormula for premature infantFortified human milksPremature infant formulaPremature-discharged formulaFormula for cow-milk allergy "predigested" formulas Extensively hydrolyzed formulas Amino-acid based formulaFormula for inborn errors of metabolismPhenylalanine free formula (PKU), branc-chain amino acids free formula (MSUD, MMA), etcFormula for gastrointestinal disordersAcid Reflux: Thickened Formulas Lactose-free formulas: lactose intolerance, Enteral nutrition 47World Health Organization 2009</p> <p>48</p> <p>49</p> <p>50</p> <p>51Cleaning</p> <p>52Sterilizing</p> <p>53How to prepare a bottle feed (1)</p> <p>54How to prepare a bottle feed (2)</p> <p>55Terima Kasih</p>

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