POPLHLTH 206 L9 - Nutrition in Infancy

Benefits of Breastfeeding for mother

- Saves time preparing formula - Saves money - Reduces risk of breast and ovarian cancer - Reduces risk of hip fracture in older age .

Risk of early introduction of complementary foods (before 4 months)

- Vulnerability of gut to infection - Diarrhea and dehydration - Impaired iron absorption from breastmilk - Infant malnutrition, including iron deficiency > intake of vegetables increase digestion process meaning not enough time to absorb nutrients from breastmilk. - Possible eczema, childhood asthma, and food allergies .

Advertisement for Nestle's milk 1895

- 1867 Nestle commercial first infant formula - Commercial milk formulas did not become common until 1950s - Marketing campaigns in 1950s provided inexpensive formula to hospitals and paediatricians - by 1970s, over 75% of babies in US were fed on commercially produced formulas. .

Nestle Boycott

- 1970s saw a resurgence of breastfeeding in industrialised countries along with declining birth rates - Infant formula companies heightened marketing campaign in developing countries, alongside increased infant mortality rates. - 1977 start of call for boycott of Nestle products. .

Breastfeeding in NZ

2015 > 6 weeks 57% exclusively breastfeed > 3 months 44% exclusively > 6 months 19% exclusively >> Big drop off of exclusive breastfeeding with time, from 96.3% (first day) to 6% (6+ months)

Infant stomach capacity

Day 1 - Size of a cherry - 5-7ml - 1-1.4 tablespoon Day 3 - Size of a walnut - 22-27ml - 0.75-1oz Week - Size of an apricot - 45-60ml - 1.5-2 oz One Month - Size of a large egg - 80-150ml - 2.5-5 oz .

International Parental Leave and Breastfeeding rates

Denmark: Leave - 18 weeks maternity - 2 weeks paternity - 32 week family > 96% initiation > Mean duration 6-8 months Finland: Leave - 18 weeks maternity - 18 days paternity - 26 weeks family > 90-95% initiation > 65% >4 months Norway: - 9 weeks maternity - 6 weeks paternity - 39 weeks family > 98% initiation > 92% at 3 months New Zealand - 0 maternity - 0 paternity - 14 weeks family (extended to 16 weeks from 1st April 2015)* * 18 weeks at 1 April 2016 and extension to other caregivers.

Breastfeeding Guidelines

World Health Organization - "Exclusive breastfeeding is recommended up to 6 months of age with continued breastfeeding along with appropriate complementary foods up to two years of age and beyond." > WHO recognises breast feeding for a longer period of time is more beneficial for health NZ Ministry of Health - "Babies should be breast fed until around 6 months of age, then it's time to introduce other foods. You should continue breastfeeding until they are one year of age or beyond." .

Guidelines on safety

2015 - reports of a threat to contaminate infant and other formula produces with 1080 - MoH - NZ infant formula is safe - best food safety model in the world

MOH guidelines statement for healthy infants and toddlers on drinks

3. Provide your toddler with plenty of liquids each day such as water, breast milk, or cow's milk (but limit cow's milk to about 500 mL per day) 4. Do not give your infant or toddler alcohol, coffee, cordials, juice, soft drinks, tea( (including herbal teas), and other drinks containing caffeine - MOH does not recommend children consume juice, cordial, or powdered drinks - Consume water, milk, and fresh fruit - If consuming juice dilute 50:50 with water - Acidic nature contributes to dental caries, tooth erosion, and obesity .

When to introduce foods?

MoH: When baby is ready, introduce him or her to appropriate complementary foods and continue to breastfeed until they are at least one year of age or beyond WHO: When breastmilk is no longer enough to meet the nutritional needs of the infant, foods should be added to the diet Developmental cues - Baby can sit up without support - Lose tongue-thrust (extrusion) reflex - Baby ready and willing to chew - Baby developing 'pincer' grasp - Baby eager to participate in mealtimes and tries to grab food and put it in their mouth. .

MOH - Feeding your baby formula

- Babies up to six months of age who aren't breastfed must only have formula - other drinks can make them sick - Babies over six months may also be offered water - Most babies will start eating around six months but will still need formula - No evidence one formula is better than another - Choose correct formula for age/stage - Cows milk formula usually recommended unless baby is allergic or intolerant - can try soy - Wash and sterilise all bottles and teats until baby is at least 3 months old, then regular washing sufficient - Check to make sure mixing correctly

Summary

- Breast milk only for 6 months then complementary feeding may start - Infant formula up to one year if infant is not breastfed - Complementary foods when baby is developmentally ready - Commercial baby foods are not healthier or cheaper than home-made > but could be nutritionally better due to making process, and is cheaper. - Do not feed infants and toddlers junk food or beverages other than milk and water - Still some work to do to ensure New Zealand infants and toddlers are meeting the guidelines .

Breastfeeding in public

- Discomfort with the idea of breastfeeding in public has been cited as a reason for some women choosing.. ... not to initiate breastfeeding or planning a shorter duration of breastfeeding. ...expressing breast milk and feeding in a bottle - In order to increase breastfeeding initiation and duration and to reduce health inequities breastfeeding needs to be more visible. .

Benefits of breastfeeding for baby

- Easily digestible, available, and fresh - With a (mothers) healthy diet provides baby with perfect blend of nutrients and protective antibodies - Helps baby grow and develop physically and emotionally > helps bond mother and baby - Helps protect baby from chest infections, meningitis, ear infections and urinary infections > dis-eases which can affect babies early in life. - Reduces risk of SID and hospitalisation - May reduce risk of stomach problems, allergies, some childhood cancers, and Type I and II diabetes - Reduces risk of obesity - Reduces risk of diabetes later in life. .

International Code of Marketing of Breast-milk substitutes

- Established in 1981 by the general assembly of the WHO - Places restrictions on the marketing of breast milk substitutes, such as infant formula, to ensure that mothers are not discouraged from breastfeeding - Includes: - Forbids direct contact between commercial representatives and medical personnel or mothers or pregnant women - Baby food companies may not distribute free samples of substitute milk in hospitals and other places providing public health services - Advertisements for baby foods must not target infants younger than six months - No promotional distribution of pacifiers or bottles for babies - Manufacturers of breast milk substitutes may not distribute promotional gifts to health workers - Images of mothers and children on the packets or labels are forbidden. .

Guidelines on responsive feeding

- Feed infants directly and assist older children when they feed themselves - Feed slowly and patiently, encourage child to eat, but do not force them - If child refuses many foods, experiment with different combinations, tastes, textures, and methods of encouragement - Minimise distractions during mealtimes - Remember that feeding times are periods of learning and love - talk to children during feed, with eye contact .

Follow on Formula

- Follow-on formulas are designed for older bottle-fed babies and most are casein-dominant - Contain higher levels of iron, protein and other nutrients compared with starter infant formulas > not suitable for younger baby due to under-developed digestive system, more suitable for babies aged 12-24 months - Because of the higher nutrient levels, follow-on formula is not suitable for infants under the age of 6 months - It is not necessary to change to a follow-on formula at 6 months if your baby is happy on starter infant formula. .

Baby food

- Food given to infants designed for ease of eating - Pureed, mashed, or easily chewed - Can be produced at home or commercially

Making Baby food

- Homemade food may cut food costs and provide baby with more nutritious foods than commercial - Requires little equipment: fork, masher, or food processor - Helps baby get used to foods the family eats - Can be stored in small quantities in freezer - Take care with food safety - Avoid adding salts and sugars. .

Recommendations from the american academy of paediatrics on fruit juice

- Juice should not be introduced into the diet of infants before 6 months of age > acidic and can erode enamel. - Infants should not be given juice from bottles or easily transportable covered cups that allow them to consume juice easily throughout the day. Infants should not be given juice at bedtime. - Intake of fruit juice should be limited to 4 to 6 oz/d (1/2 to 3/4 cup) for children 1 to 6 years old. - For children 7 to 18 years old, juice intake should be limited to 8 to 12 oz (1 cup) or 2 servings per day .

Baby-Led weaning

- Let's baby feed themselves from ~6 months - Baby given finger food versions of adult meals (minus additives) - Avoided: Hard pieces of fruit/vegetabless and meat with bone/gristle and letting other help baby (such as siblings) - Increasing popularity since UK public health nurses published guidance in 2008 - Milk considered main nutrition until 1 yr - possible source of disagreement given baby needs more iron - Not recommended by MoH or WHO - little research to date - Otago - currently underway

Colostrum (Early Breast Milk)

- Low in fat, and high in carbohydrates, protein, and antibodies - Extremely easy to digest > baby not born with developed stomach and able to digest many foods, gradually develops into fully functioning stomach - Low in volume (measurable in teaspoons), but high in concentrated nutrition - Large quantities of an antibody called secretory immunoglobulin A (IgA) - High concentration of leukocytes, protective white cells which can destroy disease-causing bacteria and viruses - Gradually changes to mature milk during the first two weeks after birth .

Barriers to Breastfeeding (especially during first weeks)

- Sore breasts - Difficulty in getting baby to latch on > anxiety associated to whether or not baby is getting enough nutrients - Returning to paid work and possibly childcare - Tiredness - Generational differences - Lack of support for dealing with initial problems > e.g. with latching - Lack of support and education

Families Commission recommended in 2007 that by 2015 parents are provided with a total of 13 months paid leave, including a month's paid leave for fathers

> Paid leave is capped, only a fraction is provided.

MOH guidelines statement for healthy infants and toddlers on food

1. Each day offer your toddler a variety of nutritious foods from each of the four major food groups: - vegetables and fruit - breads and cereals, including some wholemeal - milk and milk products or suitable alternatives - lean meat, poultry, seafood, eggs, legumes, nuts and seeds 2. For your toddler, prepare foods or choose pre-prepared foods, drinks and snacks that: - are low in salt, but is using salt, use iodised salt - have little added sugar (and limit your toddler's intake of high-sugar foods) .

Infant feeding in NZ

Growing up in NZ study (n~7,000 families) - most common foods introduced Early: baby rice, fruit, vegetables Later: meat, bread, toast, milk pudding, rice pudding, yoghurt, custard, baby breakfast cereals. > % of infants consuming foods, weekly or more often - 77% receive biscuits - 36% potato chips - 33% hot chips - 37% sweets - 62% fruit juice > In America at 7-8 months 45.8% of infants are receiving desserts, sweet, sweetened beverages. .