NUTRITION DURING THE FIRST YEAR OF LIFE

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NUTRITION DURING THE FIRST YEAR OF LIFE
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BREAST FEEDING

• Definition Breastfeeding is infants nutrition
  during the first 4 6 months of life with human
  milk only.
• Methods
• breast feeding
• bottle feeding with human pumped milk
• with teaspoon
• gavage

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BREAST FEEDING
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BREAST FEEDING

• The mechanism of milk secretion  Endocrine
  factor - estrogens, - placental lactogen
  hormone.  Nervous factor

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The 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.

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The mechanism of milk secretion

• Factor Nervous
•  - reflex act by excitations from the nipple and
  areola  
• - contribute to the formation and maintenance of
  milk secretion.

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HUMAN 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.

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Colostrum

• 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.

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Colostrum

• 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

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Colostrum

• 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.

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Colostrum

• 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.

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Colostrum

• 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.

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BREAST FEEDING
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Transitional 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.

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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.

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Mature 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.

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Mature human milk

• 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.

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Mature human milk

• 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.

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Mature human milk

• Ig 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.

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Mature human milk - Enzymes

• Lipases have a role in digestion of human milk
  triglycerides.Alfaamilaza- catalyzes the
  hydrolysis of starch into maltose- pancreatic
  and intestinal amylase offset deficit in the
  infant.Proteases and protease inhibitors-
  greater amount compared with cow's milk-
  catalyzes the hydrolysis of proteins.

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Mature human milk

• Amino acidstaurine - 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.

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BREST FEEDING
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Mature human milk

• 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).

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Mature human milk

• 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.

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Mature human milk

• Lipids 36 - 40 g / l  fatty acids (FA), mono
  and polyunsaturated fats (oleic acid, palmitoleic
  and linoleic)  -over half of the total FA
  h.m.  - role in CNS maturation in the newborn
  period  triglycerides - report equally between
  unsaturated and saturated FA.

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Mature human milk

• Cholesterol and lecithin  large quantities h.m.
  than c.m.The presence of lipase in human
  milk - facilitates lipid hydrolysis - FA
  promote rapid release of usable energy
  metabolism.

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Mature human milk

• 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.

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Mature human milk

• Sodium ? low amount of renal function
  overloading is avoided.Calcium four times and
  phosphorus 6-7 times less than the c.m., but the
  Ca P 2 1 is favorable for their proper
  use.Iron - amount of two times higher in
  h.m. - intestinal absorption and incorporation
  into the hemoglobin molecule is much higher in
  infants breastfed.

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Mature human milk

• Vitamins  soluble (A, D, E, K)  soluble (C,
  folic acid, vitamin complex. B)  - varying
  proportions, in relation to food intake.  - a
  balanced diet of the mother provides adequate
  intake of these vitamins, except vitamin D.

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Mature human milk

• 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.

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BREAST FEEDING
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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.

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Factors of human milk Antiinfectious protection
factors

• Cellular factors (macrophages, neutrophils, Ly B
  and T)  anti-infective role in maternal mammary
  gland and infant's digestive tract (protects
  against enterocolitis ulceronecrotics). 
  Immunoglobulins - IgAs - opsonizant role, -
  mobilize and agglutinate bacteria, viruses and
  antigens of food,  Ly stimulates the formation
  of intestinal mucosal IgA in the infant.

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Factors of human milk Antiinfectious protection
factors

• Lactoferrin - bacteriostatic role.  Lysozyme -
  a role in combination with complement and
  antimicrobial IgAs, which potentiates the
  action.  Lactoperoxidase - bactericidal action
  against germs like Pseudomonas, E. coli,
  Salmonella, Streptococcus.

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Factors of human milk Antiinfectious protection
factors

• Mucin - prevent adhesion of germs and
  rotaviruses to the surface of intestine.  C3
  and C4 fractions of complement - role in
  chemoattraction of phagocytes and intracellular
  incorporation of particles.  Bifidogens factors
  (glycoproteins and oligosaccharides) - role in
  promoting growth of Lactobacilus bifidus in the
  intestine of breastfed infant.

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Factors of human milk

• 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.

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Factors of human milk Modulators of growth
factors

• Nervous growth factor - essential for the
  development of sympathetic neurons and sensory
  cells.  B-cell stimulating factor - role in the
  proliferation of Ly B and production of
  immunoglobulins.  Taurine - improves fat
  absorption and promotes intestinal colonization
  of Lactobacilus bifidus.

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Breast feeding
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Other qualities of human milk

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

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Evolution of milk secretion

• "Anger milk" colostrum transformation in
  transition milk and then mature h.m.Clinical
  Manifestations  turgescence of mammary glands
  pain, local hyperthermia,  fever, headache,
  tachycardia.Paraclinical leukocytosis with
  lymphocytosis and eosinophilia.

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Evolution of milk secretion

• "Psychosis lactation" mental status changes
  that mayup to manic states - depression.-
  these phenomena disappear spontaneously in most
  cases.- mothers rarely requires admission to
  psychiatric hospitals.

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Evolution of milk secretion

• Maximum intensity of milk secretion - between
  day 15 and 3 months after birth - may take a
  year or more, if stimulated by sucking or
  squeezing the breast.Composition of human milk
  varies - according to the stages of
  lactation - after the time of day (diurnal
  variations / nocturnal) - from one breast to
  another, - the same breast over the meal.

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Evolution of milk secretion

• At the same table at the end of meal milk
  (hindmilk ) is richer in fat and protein than
  that of the beginning of the meal ("foremilk"),
  so it's hearty and nourishing.Administration
  only h.m. after the age of 6 months is not
  sufficient quantity and quality for infant
  development.

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Factors influencing lactation

• - age young women ? more abundant milk
  secretion-  parity primiparous lactation to be
  installed with a delay of several days - kinds
  of birth interventions from birth (cesarean,
  forceps, perineorafie) by trauma and
  postoperative diet are important factors in milk
  secretion inhibitors - feeding, resting, graded
  exercise and especially psychological factor
  contributing to maintaining a good milk secretion

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Milk secretion

• Stimulation of milk secretion - sucking -
  mammary gland drained, - ensuring physical
  comfort of the mother.Agalactic extremely
  rare.Hipogalactic more common in primiparous,
  the intellectual, women who do not comply with
  resting.Spontaneous flow of milk secretion this
  may be a sign of hipogalactic.

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Benefits of breast feeding

• Benefits for children - optimal growth and
  physical development - h.m. has all the nutrients
  needed, in quantities and proportions ideal for a
  child's needs and maximum bioavailability -
  mother - child bonding - solid and sustainable
  with long-term consequences of child mental
  health.

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Benefits of breast feeding Benefits for children

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

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Benefits of breast feeding Benefits for children

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

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Benefits of breast feeding

• Benefits for the mother - affective
  (psycho-emotional)
•  - direct physical contact (skin to skin ")
  parent - child positive emotional reactions ? ?
  risk of abuse, neglect or mistreatment of
  children and ? risk of postpartum depression

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Benefits of breast feeding Benefits for the
mother

• - contraception ? tasks spacing ? effects on
  reproductive health of the mother - decreases
  the risk of breast cancer, ovary cancer - a
  lower incidence of osteoporosis is whether breast
  lasted more than nine months.

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Benefits of breast feeding

• 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..

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Benefits of breast feeding Benefits for the
family

• - fewer illnesses ? fewer doctor visits, fewer
  treatments - increased comfort - no need to
  purchase travel, training maneuvers,
  sterilization, contamination risks, egs..

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Breast feeding
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Incidents and complications in breastfeeding

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

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Incidents and complications in breastfeeding

• 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.

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Incidents and complications in breastfeeding

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

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Incidents and complications in breastfeeding

• Jaundice - early form (early onset
  breast-feeding jaundice") - appears in the first
  week of life - late-onset form - start by end
  of first week of life

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Incidents and complications in breastfeeding

• Early-onset jaundicemilk intake ? ? relative
  starvation ? ? bilirubinPreventing the rise of
  physiological jaundice  - breastfeeding, early
  and frequent  - temporarily supplement the diet
  with formula milk.

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Incidents and complications in breastfeeding

• 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.

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Incidents and complications in breastfeeding

• Hipogalactia tongue - rarely primary - often
  secondary, related physical, mental, maternal
  diet and poor food technique.The child does not
  increase weight is stirring (hungry), is rare
  stools and dark, then gets drowsy and have signs
  of dehydration.

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Incident and complications in breastfeeding

• Mastitis and breast abscess
• - consequence of milk stasis and breast small
  cracks,
• - occurring as a result of inadequate sucking.

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Obstacles in breast feeding

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

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Obstacles in breast feeding

• From the child- prematurity - haemolytic
  disease of the newborn - jaundice - vomiting
  .

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Obstacles in breast feeding

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

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Permanent contraindications

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

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Permanent contraindications

• Child - related cases (rare, some even
  exceptional)
•  - congenital galactosemia
•  - hereditary / primary intolerance to lactose
•  - phenylketonuria.

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Supliments required during breast feeding

• The child  - vitamin D (rickets prophylaxis) 
  - iron (oral preparations)
•   infants born at term  1-2 mg elemental Fe /
  kg / day from the age of 5-6 months (for 3
  months).  premature  2 to 2.5 mg elemental Fe
  / kg / day, from 1 ½ - 3 months to 1 year of age.
• Iron injection are contraindicated.

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Supliments required during breast feeding

• The childIn 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.

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Supliments 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.

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Supliments required during breast feeding

• Vegetarian Mothers
•  - will consume milk daily
•  - will supplement the diet with vitamin B12
  which is found almost exclusively in animal
  products.

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Weaning

• Will be made as late as possible.
• There are considerable advantages to provide even
  small amounts of h.m until the age of 1 year, 1
  ½, even 2 years.

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BOTTLE FEEDING
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BOTTLE FEEDING

• Definition bottle feeding is infants nutrition
  during the first 4 months of life with other milk
  than human milk.  The recommended industrial
  preparations are made of cow's milk because the
  process they tend to be as close is possible to
  h.m
•   The administration will use cow milk only when
  it is absolutely impossible to use formula milk.

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

• Protein 32-34 g / l casein - 28 g (lv casein is
  a milk type) whey protein (lactalbumin and
  lactoglobulin) 4-6 g.ß-lactglobulin is highly
  antigenic / allergy.Casein c.m precipitates in
  the stomach of infants in large clots, difficult
  digestible ? longer intervals of time between
  lunches.

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The composition of cow's milk

• Carbohydrates 48-50 g / l (vs. 68-70 g / l
  h.m)  represented only lactose ? low intake of
  galactose ? slow myelination of CNS. 
  oligosaccharides missing ? absence of bowel
  colonization with bacillus bifidus in bottle fed
  infant

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The composition of cow's milk

• Lipids 36 g / l - saturated, indigestible,
  deficient in essential fatty acids - five times
  lower amount of linoleic acid - cholesterol in
  amounts less than h.m

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The composition of cow's milk

• Mineral salts - amount of four times higher
  than in h.m.  with high protein content ?
  metabolites and osmolarity ? ? ? ? baby's water
  needs. - amounts of phosphate and citrate ? ? ?
  pH gastric ? prevents absorption and promotes Ca
  elimination

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The composition of cow's milk Mineral salts

• The ratio Ca / P 1
• - inappropriate for absorption - rickety -
  putrefaction (intestinal flora - E. coli)  ?
  effort to remove the liver and kidney
  metabolites.

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The composition of cow's milk

• Iron  Fe deficiency l.v. explains its poor
  absorption frequency and iron deficiency anemia
  in infants fed cow's milk.Vitamins - smaller
  quantities than in human milk and by boiling the
  milk a good part of them are destroyed.

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Disadvantages administration of cow milk

• - iron deficiency, the intake / absorption low
  intestinal absorption (occult bleeding) due
  allergenicity of cow's milk - various
  nutritional deficiencies (rickets, etc.) -
  dehydration through increased renal load -
  increased risk to allergy.

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COWS MILK PROTEIN ALLERGY

• Definition hypersensitivity reaction caused by
  any of the protein components of c.m (most likely
  ß lactoglobulin).Allergic reaction
•  - immediate - mediated IgE - delayed -
  mediated cell.

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COWS MILK PROTEIN ALLERGY

• Clinical Manifestations - leather (infant
  eczema, allergic first manifestation) -
  digestive system (vomiting, diarrhea, colic, poor
  growth, RGE, chronic constipation) - respirator
  (recurrent wheezing).Hint iron deficiency
  anemia (occult gastrointestinal bleeding).

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COWS MILK PROTEIN ALLERGY

• The most important diagnostic test used in
  therapeutic practice (investigations infant
  allergy is hard)is removal of the feeding of cow
  milk and cow milk 's derivatives ? improvement of
  symptoms.Drug treatment is not necessary.Just
  replace c.m with a hypoallergenic formula milk.