IN FA N T A N D YO U N G

C H ILD FEED IN G P R A C TIC E

DIVISI NUTRISI DAN PENYAKIT METABOLIK
BAG/SMF ANAK FK UNUD/RSUP SANGLAH
DENPASAR

Soal:seorang bayilaki,diajak ibunya ke praktek untuk

im unisasi,usia 3 bulan,BB 5,5 kg,PB 59 cm ,saatinim inum ASI

dan sudah diberikan susu form ula sejak 2 m inggu yang lalu.
1. Status nutrisi:

Antropometri: BB/U -2SD s/d -1SD; PB/U -1SD s/d -2SD; BB/PB -1SD
s/d median
Klinis baik
Diet: ASI + susus formula
Status gizi baik + perawakan baik

2. Kebutuhan nutrisi:

BB ideal 5,7 kg; usia PB 2-3 bulan

Energi= 5,7 x 120 kkal = 684 kkal/hari = 977 ml ASI
Protein = 5,7 x 2,5 g = 14,25 g/hari

3. Rute pemberian:

Oral

4. Jenis nutrisi:

ASI + susu formula dilanjutkan

5. Monitoring:

Kontrol sebulan lagi saat imunisasi berikutnya

Soal:seorang bayilaki,diajak ibunya ke praktek untuk

im unisasi,usia 3 bulan,BB 5,5 kg,PB 59 cm ,saatinim inum ASI

dan sudah diberikan susu form ula sejak 2 m inggu yang lalu,B B L
3,3 kg,B B 1 bl4,2 kg,usia 2 bl5,1 kg .

Konseling tehnik m enyusuiyang benar,jelaskan

cara/penggunaan ASIsim pan dan pertanyakan
pem berian susu form ula???
1. Status nutrisi:

Antropometri: BB/U -2SD s/d -1SD; PB/U -1SD s/d -2SD; BB/PB
-1SD s/d median
Klinis baik
Diet: ASI + susus formula
Status gizi baik + perawakan baik + risiko gagal tumbuh

2. Kebutuhan nutrisi:

BB ideal 5,7 kg; usia PB 2-3 bulan

Energi= 5,7 x 120 kkal = 684 kkal/hari = 977 ml ASI
Protein = 5,7 x 2,5 g = 14,25 g/hari

3. Rute pemberian:

Oral

4. Jenis nutrisi:

ASI + susu formula dilanjutkan ???

5. Monitoring:

Kontrol sebulan lagi saat imunisasi berikutnya

O ptim alinfant and young child feeding

(rekom endasiW H O ,2002)
Early initiation of

breastfeeding (within
1 hour after birth)
Exclusive
breastfeeding (0-6
months)
Continuous
breastfeeding for 2
years or beyond
Complementary
feeding (6-24 months)

W hy breastfeeding
?
Perpect

nutrient
Easily
Brea
digested,
efficienly
st
milk used
Protect
Help bonding
against
and
development
Breas infection
Help delay a
t
new
feedi
pregnancy
Protect
ng
mothers
health
Cost less
than artificial
feeding

Cos
t

Early initiation ofbreastfeeding

Skin-to-skin-contact
Mother and baby feel more

calm.
Reduced risk of infection
Warmth, love, security and
food.
Smell of nipple = amniotic
Get first milk = colostrum
Support growth and bowel
function without allergy
substance
More successful of exclusive
breastfeeding
Oxytocin release, reduced
bleeding

Colostrum : fi
rst 3-5 days oflife
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%

O ligosaccharides:3-9 sugar units

Polysaccharides oligosaccharides disaccharides

monosaccharide.
Fiber: those polysaccharides we are not able to
digest.
Insoluble
Soluble: 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.

Protein
Breast milk: whey protein dominant
Whey protein: rich of -lactalbumin
Easily digested and absorbed

Cows milk: casein protein dominant

Whey protein: rich of -lactoglobulin, low

in amino acid tryptophan.

Positioning and attachm ent

Cara bayim engeluarkan ASI

Tekanan negatif
dalam rongga
mulut ketika
rahang terbuka

Tekanan positif
ketika rahang naik
untuk memfasilitasi
gerakan peristaltik
lidah pada
puting/payudara

Suckling H orm onalRefl

ex Arc

More prolactin
Secreted at nigh
Source: Lactation Education Program Nutrition Policy and Education

Inhibitor in breast m ilk

If breast

remains full of
milk, secretion
stops

M arker ofSuccessfulBreastfeeding
7% or less weight loss in first few days after

birth
Return to birth weight for at least 2 weeks
Weight gain per day of 20 to 30 g during first
3 postnatal months
Lactation established in mother by 2 to 4
days after birth
At least eight breastfeeding events every 24
hours
Baby is latching unto breast easily
Three to six stools and four to six voids by 5 to
7 days of age

n ta
e
lem ds
p
o
m
Co ry fo

Damayanti Rusli Sjarif 2009

Pemenuhan kebutuhan nutrisi

bayi
0 6 bulan :
ASI Eksklusif
6 bulan :
300 MP-ASI
65 200
80% ASI, sisanya

550

12 bulan :
65-80% MP-ASI, sisanya ASI
24 bulan :
seluruhnya makanan keluarga
28

29

Breast m ilk in the second year oflife

Some Considerations in
Complementary feedings
Too Early
diarrheal disease
& risk of
dehydration
decreased breastmilk production
Allergic
sensitization?
developmental
concerns

Too Late
potential
growth failure
iron deficiency
developmental
concerns

WHEN??
GI readiness: 3-4 months
Developmental readiness: varies,
between 4 and 6 months
Nutritional needs beyond breast milk
: not before 6 months, after that varies
Need for variety and texture:
within
first year, order not
important
32

Fluid Needs
Offer plain, clear water several times
per day once infants are eating solids.
Additional fluids needed:

400 - 600 ml / day in temperate

climates

800 - 1200 ml / day in hot climates.

Without additional water dehydration

becomes a threat.
33

Food Consistency
Increase food consistency and
variety as infant gets older.
Infants can eat pureed,
mashed and semi-solid food
from 6 months.
By 12 months, family foods
suitable.
34

Responsive Feeding

Practice responsive feeding,

applying the principles of
psychosocial care.
Remember that: Feeding times
are
periods of learning and love talk to
children during feeding, with
eye to
eye contact.

35

The 1st Test Feedings

Iron fortified infant rice cereal as 1st food
Should be a single food (not
combination), nutritious, smooth texture
and thin consistency
Best to offer after feeding some BM or
Formula, except who repeatedly no
interest offer before

Basic guidelines
Sequence
of solid
foods :

AAP : no special order to follow

The key : make sure foods are safe,
nutritious, suitable texture

Texture :

smooth texture and thin

consistency
increase the texture and
consistency gradually

Serving
amount :

start with a small amount (1-2 tsp)

gradually work up to tbsp or more

Basic guidelines
Time
between
new foods :

introduce every 4-7 days between

each new foods
watch for signs of an adverse reactions
before trying mixed foods, try each of
the food individually.
best to offer a new food early in the
day plenty of time to watch for any
reaction

Food
safety :

parents should wash their hands, the

babys hands, any utensils dishes, etc.
parents shouldnt share eating utensils
with the baby or pre-chew food before
giving it to the baby

Precautions when introducing solid food

Home-prepared beets, carrots, collard greens,
spinach and turnips :

high in nitrates methemoglobinemia

should not be fed babies < 6 months

Honey :
may contain C.botulinum causing infant
botulism

Cows milk :
infant < 1 yr should not get cows milk low in Fe, high in
Na, K, Cl and other minerals

Safety Issues Regarding

Feeding Infants:

Honey and corn syrup, are the only

food sources in infants diet of
Clostridium botulinum spores,
which lead to Botulism. They
should not be fed to infants less
than 1 year of age.
Cook eggs and chicken well to
avoid salmonella.

Small, hard, round , and sticky solid

foods may lead to choking and
aspiration

40

AAP: Specific
Recommendations
Home prepared spinach, beets, turnips,
carrots, collard greens not recommended due
to high nitrate levels Methemoglobinaemia

Canned foods with high salt levels and

added
sugar are unsuitable for
preparation of
infant foods

Honey not recommended for infants

younger than 12 months Botulism
41

Help baby become

more independent:

Give finger foods

Drink from cup since 6-8

months of age
Hold his/her own cup or

bottle
Make feeding schedule so

that baby will feel hungry

and full regularly
42

Codex 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
nutrients
It requires that the formula supports normal growth
and that contents are clearly labeled.
Manufacturers are required to follow good
manufacturing practice,

Codex Standard for Infant Formula and Formulas

for Special Medical Purposes for Infant
(CODEX STAN 72-1981)

Section A refers to Infant Formula

Section B deals with Formulas for Special

Medical Purposes Intended for Infants

means 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.

FORMULA FOR SPECIAL MEDICAL PURPOSES

INTENDED FOR INFANT AND YOUNG CHILDREN
Formula for premature infant
Fortified human milks
Premature infant formula
Premature-discharged formula

Formula for cow-milk allergy "predigested" formulas

Extensively hydrolyzed formulas
Amino-acid based formula

Formula for inborn errors of metabolism

Phenylalanine free formula (PKU), branc-chain amino acids

free formula (MSUD, MMA), etc

Formula for gastrointestinal disorders

Acid Reflux: Thickened Formulas
Lactose-free formulas: lactose intolerance,
Enteral nutrition

World Health Organization 2009

Cleaning

Sterilizing

How to prepare a bottle feed (1)

How to prepare a bottle feed (2)

Terim a Kasih