1. ARTIFICIAL FEEDING, SUPPLEMENTED BREASTFEEDING, and COMPLEMENTARY FEEDING Prof. Dr. Emel Gür İÜ CTF Çocuk Sağ ve Hast ABD

2. ARTIFICIAL FEEDING

3. Artificial Feeding In this type of feeding, the baby receives only non-breastmilk

4. İf the family can afford it, it is best to substitue breast- feeding with industrial milk formulae which all have composition similar to maternal milk.

5. If cow’s milk must be used, the milk must be diluted with water in proportions of 1:1 in the first month, 2:1 between 1 and 4 months. No dilution is necessary after 4 months. To increase calorie content, 5g. (1 teaspoon) of sugar is added to each 100g. diluted or nondiluted milk.

6. AMOUNT OF MILK PER MEAL 1-2 week 60-90 ml 3 wk - 2 mo. 120-150 ml 2-3 mo. 150- 180 ml 3-4 mo. 180-210 ml 5-12 mo. 210-240 ml

7. The number of feedings per day 0-1 week 6-10 1 week-1 mo. 6- 8 1-3 mo. 5- 6 3-7 mo. 4- 5 4-9 mo. 3- 4 8- 12 mo. 3

8. Principles of artificial feeding Fruit juıces can be started after the first month. Artificially fed babies do not need solid foods, such as milk pudding before 4 months It is best to prepare milk formulae fresh at each feeding Adequate preparation of the food, cleanliness of the water, and the containers and utensils is essential

9. Principles of artificial feeding Artificially fed babies do not need solid foods, such as milk pudding before 4 months

10. Principles of artificial feeding Bottles and nipples must first be washed with soap and water using a long brush, than sterilized in boiling water for 10 minutes and left to cool on upside down position For the uneducated mothers, it is best to recommended spoon feeding, using cups or glasses even in very young babies. The nipple hole must be checked for size by looking at milk flow

11. Adequacy of intake is assessed by weight monitoring

12. SUPPLEMENTED BREAST-FEEDİNG (MIXED FEEDING )

13. Supplemented BREAST-FEEDİNG (MIXED FEEDING ) An infant in his first 6 months is offered breast milk and in addition, other milks and milk products as supplements.

14. The main indication for supplementing breast- feeding is an arrest weight gain in a healthy breastfed infant which is not corrected despite all efforts to increase the maternal milk supply. The main indication for supplementing breast- feeding is an arrest weight gain in a healthy breastfed infant which is not corrected despite all efforts to increase the maternal milk supply.

15. The decision for supplementation is taken only after one or two weeks of monitoring.

16. Principles of supplemented feeding When the need for supplementation is established, this is done gradually At first, the supplement is given once a day preferably in the evening (6.00-7.00 pm.), a time when the mother’s milk supply is usually the lowest. The baby is breast-fed for 5-10 minutes and the supplement (milk formula and cow’s milk) is offered by spoon. İf the baby is not satisfied by one supplementation, two or more meals may be supplemented.

17. Principles of supplemented feeding Spoon feeding must be preferred to bottle feeding. This is important for the continuation of breast-feeding and prevention of infections. Fruit juices are started at 4 weeks and milk pudding at 4 months in babies on supplemented feedings

18. COMPLEMENTARY FEEDING

19. FEEDING BETWEEN 6-12 MONTHS

20. Breastfeeding will not meet the requirements of the babies over 6 months

21. After 6 months, breast- feeding is supplemented with more concentrated foods. After 6 months, breast- feeding is supplemented with more concentrated foods.

22. Time of introduction of supplemental foods (6 months or earlier) should be decided by weight monitoring

23. Until 9th month breast-milk is the primary diet of the baby. Foods initially supplement breast-feeding gradually replace breast-feeding and at 9-12 months become the primary diet of the baby

24. RESULTS OF EARLY AND LATE INTRODUCTION OF THE SUPPLEMENTAL FOODS EARLY Decreasing of breast- milk Gastroenteritis Allergy Malnutrition Obesity LATE Growth retardation Infection Gastroenteritis Malnutriion Vitamin ve mineral deficiency

25. REQUIREMENT OF ENERGY ACCORDING TO AGE Age Energy (kcal/kg/day) <3 mo. 120 3-6 mo. 115 6-8 mo. 110 9-1 mo. 105 1-3 mo. 100 4-6 mo. 85 7-10 mo. 85 11-14 yr. E 60 K 50 15-18 yr. E 45 K 40

26. Supplementary foods must be foods of high energy content, easy to digest, low in fiber, in puree consistency, easy to prepare and free of spices.

27. Supplementary foods are best given by cup and spoon, and introduced one at a time and in small amounts (1-2 teaspoons), and the amount increased every day

28. Fruit juice and fruit puree (apples or peaches) and milk pudding prepared with rice flour are the first supplementary foods to be started. Vegetable purees, yoghurt, eggs, meats are gradually introduces

29. The nitrat content of spinach must be given as soon as prepared. Fava beans are not recommended becouse of favism, eggplants are not recommended because they are poor in minerals and vitamins

30. Points to remember when starting supplements They must be prepared fresh, kept in a cool place away from insects Some babies prefer a salty taste, while others like sweet taste. The choice of the food must be done with some flexibility to suit the baby’s preference The baby must not be forced. İf the baby refuses the food, that particular food is withheld for a few days

31. Points to remember when starting supplements Water given to babies younger than 12 months must always be boiled. Water used in the preparation of supplemental foods must also be clean In preparing the foods, attention must be paid to measure the right amounts (1 teaspoon=5ml; 1 tablespoon =15ml; 1 cup or 1 water glass=200ml; 1 tea glass=100ml)

32. AMOUNT OF SUPPLEMANTARY FOODS PER MEAL Age (month) Tablespoon 6 6 7 7 8 8 9 9 10 10 11 11 12-24 at least 10

33. Time of introduction of supplemental foods 6th-7th months 7th-8th months Fruit juice and puree Vegetable purees Milk pudding Yoghurt Meat, chicken, fish Lentile, chickpea, bean Egg yolk (It ıs initially is given hard boiled and started in small amount)

34. Time of introduction of supplemental foods 8th-9th months 9th-12th months Cereals (rice, wheat, macaroni, bread ) Children can be introduced to the family table

35. FEEDİNG BETWEEN 1-5 YEARS FEEDİNG BETWEEN 1-5 YEARS

36. After 9 months, breast- feeding ceases to be the basic diet of the baby. The baby should be completely weaned at 2 years

37. Children can be trained to self feed by spoon starting at age 12 months and can be introduced to the family table The child must have his/her own separate plate and must be carefully observed to note what he/she eats and how much

38. Between 1 and 5 years, children need to have four meals a day The diet should include basic foodstuffs which are; milk and milk foods, meats and eggs, fruits and vegetables, starchy foods

39. A child of this age must receive 500g milk daily Two servings of either meats An egg every day (on alternate days if eating meats regularly) Vegetables once or twice a day Fruits once or twice a day One or two servings of starchy food and 3 slices of bread

40. Food requirements are different in induvidual children and children must never be forced to eat

41. Children should not eat candies and other sweet frequently Tea and coffee are stimulants which should not be given to young children

42. All children should have their own tooth-brush starting at age 18 month

43. FEEDING AT SCHOOL AGE

44. Breakfast is an important meal Usually the reason for this is faulty family eating habits and neglect of meeting around the breakfast table regularly Parents should abstain from negative comments on the food at meals Serving should not be too large and each member of the family must try to finish his serving

45. FEEDING AT SCHOOL AGE It must be remembered that a child under 5 can eat only half the amount of an adult, and a 12 year old boy only 2/3 the amount of the teenager The child is encouraged to finish his plate by educating him about changing food requirements by age, sex, size and physical activity School age children also need to have a balanced diet including the basic foods