PEMBERIAN MAKAN PADA BAYI

Dr. Julius Anzar, Sp.A(K)

Divisi Nutrisi dan Penyakit Metabolik
Bagian IKA FK Unsri / RSMH Palembang
2013

Makanan bayi
1. ASI (0 24 bulan)
2. MP-ASI ( 6 24 bulan)

Mengapa ASI?

Susu formula tidak mungkin

menyamai ASI

Mengapa harus diberikan MP-ASI

pada usia 6 bulan?

Kandungan Protektif pada ASI

Disusun oleh: Mexitalia dan Yoga D; UKK

NPM-IDAI

Perbandingan Komposisi

Kapan ASI?
Segera setelah lahir (IMD) hingga 1 - 2 tahun

Bayi kembar

Operasi Caesar

Bagaimana Caranya?

L
A
T
C
H
I
N
G
O
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CARA MENYUSUI
Posisi
Dianjurkan menggunakan minimal 3 posisi bergantian
Semua duktus laktiferus dapat dikosongkan
Mencegah bagian tertentu puting menjadi worn-out karena lebih sering terpakai
Mencegah kelelahan/kram bagian tertentu tubuh ibu

Latch on
Buka mulut bayi dengan menyentuhkan puting ke bibir bawah bayi (rooting reflex)
Areola masuk sebanyak mungkin ke mulut bayi (2,5 3,7 cm)

Terdengar bunyi menelan

Lama menyusui
Bayi baru lahir: 5 -10 menit/payudara; tiap 2 -3 jam 10-12 kali/hari
> 1 bulan: kapasitas lambung bertambah, menyusu lebih jarang tapi lebih lama, misalnya 20
menit/payudara, tiap 3-4 jam
6 bulan: 20 menit/payudara; 3-5 kali/hari

POSISI

Making sure that youre comfortable and relaxed

Try to feed in a chair that offers good back support;
use cushions or pillows to prop up your arms;
if necessary, rest your feet on a telephone book or footstool
Its also good to experiment with the different feeding positions

POSISI

Telinga, bahu, paha dalam satu garis

lurus:
Dekat dengan ibu
Disangga seluruh badan
Menghadap payudara; hidung ke
puting
Dikutip: Satgas ASI IDAI

Disusun oleh: Mexitalia dan Yoga D; UKK

NPM-IDAI

Bagaimana Menilai
Kecukupan ASI?
BAK 4-6 kali/hari
Kenaikan BB adekuat
Menyusu 8 kali sehari

Masa
waktu
Trimester
1
Trimester
2

g/hari

g/bulan

25 30

750 - 900

20

600

Bila ASI tidak cukup?

Evaluasi
Apakah cara menyusui sudah benar?
Apakah anak sakit?
Apakah ibu sakit?
Suplementasi
Formula bila < 4 bulan
Formula/MPASI bila > 4 bulan
(lihat kesiapan motorik & psikologik)

Complementary feeding
(MP-ASI)

17

18

The Window of Opportunity for Improving

Nutrition is very smallpregnancy until 18-24
months of age
0.50

Weight for age Z-score (NCHS)

0.25
Latin America and Caribbean

0.00

Africa
Asia

-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
0

9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60
Age (m onths)
19

20

21

INFANT FEEDING PERIODs

Exclusive Breast Feeding
(EBF)
EBF + Complementary
Foods
Family Foods
22

23

Periode 2 : ASI + MP-ASI

Proses penyapihan (weaning) :
proses dimulainya pemberian makanan khusus
selain ASI secara bertahap jenis, konsistensi,
tekstur, sampai seluruh kebutuhan nutrisi anak
dipenuhi oleh makanan keluarga

Makanan khusus :
bentuk : cair, lunak, padat
jenis : jus, biskuit, bubur susu, nasi tim
pemberian bertahap : jenis, konsistensi, tekstur,
jumlah/kali dan frekuensi/hari
24

Pemenuhan kebutuhan nutrisi bayi

0 6 bulan :
ASI Eksklusif
6 bulan :
65 80% ASI, sisanya MP-ASI

12 bulan :
65-80% MP-ASI, sisanya ASI
24 bulan :
seluruhnya makanan keluarga
25

26

Kapan mulai diberikan MPASI?

Kesiapan
fisik

Refleks
ekstrusi

Dapat
menahan
kepala
tetap
tegak

Kesiapan
psikologis

Dapat
duduk
dgn
sedikit
bantuan

Menunjuk
kan minat
terhadap
makanan

Membuka
mulut jika
diberi
sendok

Tanda
lapar/
kenyang
27

Memulai Makanan Padat

Tidak terlalu dini (<4 bln):
- berisiko tersedak
- mengurangi asupan zat gizi
- risiko alergi lebih besar

Perhatikan perubahan pada bayi yg

sedang tumbuh-kembang :
- keterampilan motorik oral
- fisiologi tubuh
(fungsi saluran cerna, hati, ginjal, dll)
28

Tes Makanan Pertama

Umumnya : berupa bubur
tepung beras yang diperkaya zat
besi
Hanya 1 jenis (bukan
kombinasi), bergizi, tekstur
halus dan konsistensi agak encer
Diberikan setelah minum ASI atau formula,
kecuali bila bayi menolak berulang atau
tampak tidak berminat berikan
sebelumnya
29

PANDUAN DASAR
1. Urutan pemberian :
AAP : tidak ada urutan khusus

2. Tekstur :
halus dan konsistensi encer pada awal
pemberian yang ditingkatkan bertahap

3. Besar porsi :
mulai dgn jumlah sedikit (1-2 sdk teh)
bertahap ditambah 1 sdm atau lebih
sampai jumlah yang sesuai

30

PANDUAN DASAR
4. Jarak waktu antara pemberian makanan baru :
- makanan baru berjarak 4-7 hari (riwayat alergi +)

- perhatikan adanya reaksi simpang

- dicoba satu-persatu jenis makanan

- dicoba pada pagi hari, oleh ibu

5. Keamanan :
Cuci tangan dan semua peralatan
Tidak menggunakan peralatan makan
bersama-sama, atau mengunyah makanan
terlebih dahulu
31

HATI HATI !!
Wortel, bit, bayam, sawi hijau dan lobak:
kandungan nitrat tinggi methemoglobinemia
tidak boleh diberikan kpd bayi < 6 bulan

Madu:
tidak boleh diberikan pada bayi < 12 bulan
C. botulinum

Susu SAPI (Whole Milk, susu segar):

tidak boleh diberikan kpd bayi < 12 bulan
kandungan zat besi rendah, tinggi kadar
Natrium, Kalium dan Chlor ( beban ginjal)
32

Bantu bayi untuk lebih

mandiri:
beri finger foods
minum dari cangkir sejak
usia 6-8 bulan
memegang sendiri cangkir /
botol susu
buat jadwal makan
sedemikian rupa sehingga
terjadi rasa lapar dan
kenyang yg teratur
33

Family Foods

34

Meals Frequency

35

Tujuan akhir praktek pemberian makan

(periode 3)

Susu

Susu

(Susu)

36

Bagan pengaturan
makan pd bayi
&
Tahapan penyapihan
:
anak

R.hisap
R.telan

Mengunyah
Menggigit

R.ekstrusi </M,cair

M.lumat

M.Lunak/padat

Gerak memutar
Rahang stabil
Koordinasi
tangan baik
M.keluarga
37

Infant Formula

Objectives
To reviews the history of infant formula
To reviews the health risks associated with infant
formula
To know the the WHO/FAO Codex Alimentarius for
Standard Composition of Infant Formula
To know the WHO/FAO recommendation of how to
prepare formula for bottle feeding for food safety
To know International Code of Marketing of Breastmilk Substitutes (WHA 1981)

Disusun oleh:Damayanti RS, UKK-NPM IDAI

Definition
The term infant formula is defined
asa food which intended to be or is
represented for special dietary use
solely as a food for infants by reason of
its suitability as a complete or partial
substitute for human milk.

Disusun oleh:Damayanti RS, UKK-NPM IDAI

History of Infant Formula

Mothers who could not (or chose not to)
breastfeed their babies either employed the
use of a wet nurse or, less frequently,
prepared food for their babies, a process
known as "dry nursing."
In Europe and America during the early 19th
century, the prevalence of wet nursing began
to decrease, while the practice of feeding
babies mixtures based on animal milk rose in
popularity.
Disusun oleh:Damayanti RS, UKK-NPM IDAI

Disusun oleh:Damayanti RS, UKK-NPM IDAI

Disusun oleh:Damayanti RS, UKK-NPM IDAI

Disusun oleh:Damayanti RS, UKK-NPM IDAI

Reasons for using infant formula

Lack of education:

The mother believes that her breast milk is of low quality or

in low supply, or that breastfeeding will decrease her energy,
health, or attractiveness. The mother is not trained
sufficiently to breastfeed without pain and to produce
enough milk.

Financial pressures:

Maternity leave is unpaid, insufficient, or lacking. The

mother's employment interferes with breastfeeding.

Societal structure:

Breastfeeding is difficult or forbidden at the mother's job,

school, place of worship or while commuting. The mother
feels infant formula is socially preferable.

Disusun oleh:Damayanti RS, UKK-NPM IDAI

Reasons for using infant formula

Personal beliefs:

The mother feels that breasts are too sexual for a baby or
feels uncomfortable breastfeeding around other people.
Nursing by a relative or paid wet-nurse is socially
unsupported, believed to be unhygienic, or too expensive.
Also, the mother does not want to breastfeed or prefers to
use both breast milk and infant formula.

Dietary concerns:

The contents of breastmilk are influenced by the dietary

habits of the mother.
If the mother consumes a food that contains an allergen
breastfeeding may, for a brief period after consumption,
provoke an allergic reaction in the infant.

Disusun oleh:Damayanti RS, UKK-NPM IDAI

Acceptable medical reasons for

using infant formula
The mother's health:
The mother is infected with HIV or tuberculosis.
The mother is extremely ill
HSV type 1 lesions direct contact lesion on the mother
breast.
Maternal medication

Taking any kind of drug that could harm the baby, or drinks
unsafe levels of alcohol.

The baby is unable to breastfeed:

The child has a birth defect or inborn error of metabolism
such as galactosemia that makes breastfeeding difficult or
impossible.

Disusun oleh:Damayanti RS, UKK-NPM IDAI

Acceptable medical reasons for

using infant formula
Absence of the mother:
The child is adopted, orphaned, or in the sole
custody of a man.
The mother is separated from her child by being in
prison or a mental hospital.
The mother has left the child in the care of
another person for an extended period of time,
such as while traveling or working abroad.
The mother has abandoned the child.
Family pressures:
Family members, such as mother's husband or
boyfriend encourage use of infant formula.
Disusun oleh:Damayanti RS, UKK-NPM IDAI

Infant formula safety

Disusun oleh:Damayanti RS, UKK-NPM IDAI

How to Prepare Formula for

Bottle-Feeding at Home
(FAO & WHO 2006)

Powdered infant formula is not sterile.

It may contain bacteria that can cause
serious illness in infants.
By preparing and storing powdered
infant formula correctly, you can reduce
the risk of illness.

Disusun oleh:Damayanti RS, UKK-NPM IDAI

Cleaning

Disusun oleh:Damayanti RS, UKK-NPM IDAI

Sterilizing

Disusun oleh:Damayanti RS, UKK-NPM IDAI

Storing
Wash and dry your hands before handling sterilized
equipment.
It is recommended that you use sterilized forceps
for handling sterilized equipment.
If you remove feeding and preparation equipment
from the sterilizer before you need it, keep it
covered in a clean place.
Fully assemble feeding bottles if you remove them
from the sterilizer before you need them.
This prevents the inside of the bottle, and the inside
and outside of the teat becoming contaminated again.

Disusun oleh:Damayanti RS, UKK-NPM IDAI

How to prepare a bottle feed (1)

Disusun oleh:Damayanti RS, UKK-NPM IDAI

How to prepare a bottle feed (2)

Disusun oleh:Damayanti RS, UKK-NPM IDAI

Disusun oleh:Damayanti RS, UKK-NPM IDAI

Can I store bottle feeds to use later?

It is safest to prepare a fresh feed each
time one is needed, and to consume
immediately.
This is because prepared feeds provide ideal
conditions for bacteria to grow - especially
when kept at room temperature.
If you need to prepare feeds in advance for
use later, they should be prepared in
individual bottles, cooled quickly and placed in
the refrigerator (no higher than 5C).
Throw away any refrigerated feed that has
not been used within 24 hours.
Disusun oleh:Damayanti RS, UKK-NPM IDAI

Disusun oleh:Damayanti RS, UKK-NPM IDAI

How do I re-warm refrigerated

bottle feeds?

Remove a bottle of feed from the refrigerator just before it is needed.

Re-warm for no more than 15 minutes. Feeds can be re-warmed by
placing in a container of warm water, making sure the level of the water
is below the top of the cup. Occasionally shake or swirl the bottle to
make sure that it heats evenly
Check the temperature of the feed by dripping a little onto the inside
of your wrist.It should feel lukewarm, not hot.
Throw away any re-warmed feed that has not been consumed within two
hours.

Disusun oleh:Damayanti RS, UKK-NPM IDAI

Can I bring preprepared feeds

when travelling?
Yes - but make sure the feed is cold before it is transported,
and is kept cold during transport. This will slow down or stop the
growth of harmful bacteria.
Prepare feeds as normal, cool quickly and place in the
refrigerator (no warmer than 5C).
Immediately before you leave home, remove the cold feeds from
the refrigerator and place in a cool bag with ice packs.
You can then place the feeds in a refrigerator at your
destination,or re-warm a feed when you need one.
If your trip is longer than two hours, you may not be able to
keep the pre-prepared feeds cold. In this case, you should
prepare feeds as you need them. Bring individual portions of
powdered formula with you in a cleaned and sterilized container,
and prepare feeds as normal using boiled water that has been
cooled to no less than 70C.

Disusun oleh:Damayanti RS, UKK-NPM IDAI

What if I do not have access to boiling

water?
The safest way to prepare a feed is using water that
has been boiled and cooled to no less than 70C.
If you do not have access to boiling water, you may
wish to use sterile liquid infant formula.
Alternatively, you can prepare feeds using fresh, safe
water at room temperature and consume immediately.
Feeds prepared with water cooler than 70C should
not be stored for use later.
Throw away any left-over feed after two hours.

Disusun oleh:Damayanti RS, UKK-NPM IDAI

Breast is best
The World Health Organization (WHO)
recommends that infants are exclusively
breastfed for the first six months of life.
Babies who are exclusively breastfed will get
the best start for growth, development and
health.
Infants who are not breast fed need a
suitable breast-milk substitute, for example,
infant formula.
Disusun oleh:Damayanti RS, UKK-NPM IDAI

THANKYOU.

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