infant and young child feeding

how long does formula/breast feeding last for?

birth-6 months

when does complementary feeding start?

at 6 months

what is a quote from UNICEF 2020 about the importance of early years nutrition?

‘the quality of children’s diets is more important before the age of 2 than at any other time in life’

what period of growth is especially present in infants:

period of rapid growth- especially linear growth- length/height

describe neonatal weight loss and when it is considered excessive:

• immediately after birth all infants lose weight

• 8-10% is considered excessive - clinical concern

• it is typically regained by 7-10 days

describe briefly how infancy and young childhood is a time of neurodevelopment :

• connecting of neurons

• formation of synapses between neurons

• functional complexity occurs

outline the high energy needs of infants:

infants and young children have higher-energy needs per kg body weight than any other time in life

from birth to 6 months - what is >50% of energy needed for?

• increase basal metabolic rate to increase the proportion of muscle

• regulation of body temperature

what are the WHO and UNICEF recommendations for breastfeeding:

-early initiation fo breastfeeding within 1 hour of birth - to promote exclusiveness and duration of BF

exclusive breastfeeding for the first 6 months of life - WHO and SACN endorsed

introduction of nutritionally adequate and safe complementary foods at 6 month with breastfeeding continued up to 2 years of age or beyond = UK policy

describe why early initiation of breast feeding is promoted and the mechanisms involved:

• often promoted in combination with skin to skin contact

• promotes early weight gain and higher rates of exclusive breastfeeding

• ensures that newborns receive the colostrum - produced 3-4 days after birth

• often described as an infants first immunisation - it is rich with antibodies and nutrients

describe what exclusive breastfeeding is:

• infants receives only breast milk for the first 6 months - no other liquids even water - expect medicine or oral rehydration solution

describe the composition of breast milk:

• it is very dynamic

• contains all the nutrient required during the first 6 months of life - expect vitamin D

• in a form that is hygienic and easy to digest for infants

• low in protein but contains over 400 different proteins

• 2 types fore and hind milk

• fore-when baby just starts feeding - to hydrate

• hind more nutrient dense - develops over time

what other elements does breast milk contain?

• digestive enzymes, hormones, antibodies, immune factors, bacteria and numerous other bioactive molecules e.g human milk oligosaccharides

outline the evidence supporting breastfeeding recommendations:

• -prevents necrotizing enterocolitis

• prevents sudden infant death syndrome -SIDS

• protects against infection- e.g respiratory or gastrointestinal- dialarhoea

• can meet most of the nutrient needs of a full term baby

outline the evidence for breastfeeding and prevention of SIDS:

• meta-analysis

• duration of BF for in min 2 months- confers a significant protective effect against SIDS

• an almost halving of risk

• protective effects increase as duration increases

describe the evidence for BF and risk of infection-related mortality:

• meta - analysis

• risk of all cause mortality was higher in predominantly, partially and non-breastfed infants- compared to exclusively breastfed infants

• older infants who were not breastfed beyond 6 months of age had a 2 fold higher risk of mortality

what are some of the maternal benefits of breastfeeding - short and long term

• studies show BF reduces maternal risk for developing breast and ovarian cancer

• associated with reduced risk of TD2 for women without a history fo gestational diabetes

• promotes weight loss and lifelong maternal overweight or obesity

• associated with no cost

why else might BF be superior to infant formulae?

in situations of shortages - due to global supply chain crisis - by large scale product recall- in 2022 in the US

describe some evidence for BF protecting against childhood obesity

WHO COSI initiative 22 countries - associations between BF practises and obesity during childhood

• found the odds of obesity were higher among children never breastfed or breastfed for shorter period

• confounding variables may have influence - can have some biological mechanisms that could explain this

describe the early protein hypothesis and the link to breast feeding:

• early protein hypothesis: high protein intakes in early childhood in excess of metabolic requirements may increase blood and tissue concentrations of AA capable of stimulating insulin and IGF-1

• may trigger high weight gain and induce adipogenesis

• high protein content in infant formulae

describe evidence for BF decreasing risk of TD2:

meta-analysis

reported breast feeding protects against TD2

describe global breastfeeding rates including UK:

in LIC there is a higher tendency for breast feeding than HIC

UK-among the lowest in the world

but there is an increasing trend

outline some of the reasons mothers dont breastfeed in the UK:

• mothers feel unsupported find BF:

• very difficult , not acceptable in public, difficult to combine with work and lifestyle

• families live in a culture where formulae feeding is seen as normal and nearly as good as BF

describe some of the reasons why women STOP breastfeeding

• self reported insufficient milk → intro of formulae milk

• crying and unsettled behaviour and short sleep durations misconceived as signs of feeding problems

• CMF exploits these behaviours with unfounded product claims and advertising

what are examples of 2 policies in place to promote breast feeding?

The code international code of marketing- place aiming to stop aggressive and inappropriate marketing of BF substitutes

• baby friendly hospital initiative - launched by UNICEF and WHO- in health facilities to better support BF

why does complementary feeding occur?

at 6 months the infants needs for energy and nutrition exceed what is provided by breast milk

food introduced ALOGNSIDE milk

what are the WHO guidelines surrounding complementary feeding?

• should be timely, safe and adequate- tailored to meet the age specific needs of an infant

• appropriate texture and apply responsive feeding

• also about experiencing taste and texture

define responsive feeding:

involves a caregiver responding to the child’s appetite and satiety signals with care

describe what a child should eat during complementary feeding

• high nutrient dense food

• SACN- introduction of food containing common allergens - e.g peanuts and eggs

• goal is to achieve adequate nutrient density and dietary diversity

outline foods/behaviours to avoid:

• SACN and BDA:

• salt, sugar limited

• milk as main drink - but skimmed milk not given until;5 years

• avoid sugar sweetened beverages

• and energy dense food

what is the best way to introduce solid foods?

baby led weaning

outline the benefits and concerns of BLW:

• promotes healthier eating behaviour - less picky and better appetite control

• promotes motor development

• chocking

• not consuming sufficient energy and micronutrients

describe a piece of evidence on BLW vs traditional spoon feeding:

• systematic review on 4 RCTs

• no difference in chocking risk or iron status

• its effect on growth remains limited

• there is need for objective assessment to measure infant feeding

what si new research surrounding fussy/picky eaters:

• twins born - cohort study

• found individual difference in food fussiness were strongly influenced by genetic factors at all ages

• environmental influences were only significant during toddlerhood

to meet minimum dietary diversity what needs to be eaten?

5/8 food groups are required

what is a challenge for meeting dietary diversity?

• in LMICs complementary diets are often monotonous and dominated by cereal based porridges

what are the reasons for declines in height-for-age (HAZ) and when does it occur?

during the complementary feeding period due to 🇦

inadequate quality and/or quantity of first foods

, poor feeding practices

increased rates of infection

describe the 3 main factors to why infants and young children are at risk of micronutrient deficiecy :

• inadequate dietary intake

• poor bioavailability

• poor health status

describe the mechanisms feeding into poor bioavailability

• dietary matrix

• animal vs plant based sources

• disease associated inflammation

what are 3 strategies to optimize MN intake during complementary feeding

promotion of adequate feeding practices

MN supply in form of syrup or oil capsule

addition of MN to complementary foods

describe the pros and cons of the strategy to promote adequate feeding practises?

-sustainable

but

-affordability and accessibility

describe the pros and con of MN supply in the form of syrup or oil capsule?

-targeted and efficacious

-costly, difficulty in reaching optimal coverage

give some examples of how MN can be added to complementary foods and the pros and cons of this strategy

• commercial foods

• large scale fortification of staple foods

• biofortification of foods

pro- targeted or untargeted, wide coverage, effective

con- one fortification dose might not be suitable for all, some approaches can be expensive

outline dietary modifications for iron interventions:

increase intake of flesh foods

increase intake of bioavailable haem iron

challenge- affordability- or veggie/vegan diet

solution- consumption of iron rich plant sources, ideally with iron enhancers

outline iron fortification challenges and solutions

challenges- choice of iron compound, food matrix effect and bioavailability

solutions- addition of vitamin C and phytase, fermentation and germination

outline challenges and solutions for iron supplementation

con-dose/side effect

solutions- absorption enhancing and/or inflammation reducing interventions

outline some facts about iodine deficiency:- requirements, sources, challenges

• infants are born with very small intra-thyroidal stores

• iodine requirements are highest during infancy (per kg/BW)

• sources include- iodised salt, cows milk and dairy products, salt water fish and seafood, breast milk

• challenge is the main source being iodised salt not reaching infants less than 12 months

what are the 3 roles of zinc during young childhood:

-development of brain

-development of immune system

-growth

what are the sources of zinc and an associated challenge

sources: meat, fish, legumes, whole grains

challenge- low bioavailability in plant based sources- animal sources are less accessible and expensive -low concentration of zinc in breast milk

outline the roles of vitamin A during infancy and young childhood:

• organ development e.g eyes and brain

• development of immune system

• production of red blood cells

what are the sources of vitamin A and the associated challenges:

• breast milk, liver, eggs diary - orange and yellow fruits and veg

• monotonous diets low in Fand V , limited intake of retinoids from animal source foods with pro vit A its need fat to be absorbed

what is the WHOs solution for vitamin A deficiency:

• high dose- vitamin A supplement - infants and young children -6-59 months in settings where prevalence is higher than 20%

what are the roles of vitamin D during infancy and young childhood

• bone development

• severe deficiency can lead to rickets

• development of immune system

what are the sources and associated challenges with vitamin D

• produced by skin in sunlight, oily fish, eggs, mushrooms

• challenge- infants at particular risk of deficiency as they shouldn’t be exposed to direct sunlight AND breast milk is a poor source of vitamin D

what are solutions to vitamin D deficiency:

• several govs. and scientific bodies including the UK recommended preventative daily vitamin D supplementation of all infants if breast feed and rece4iving less than 500 ml’/d of formula

overall why are infants and young children at risk for deficiencies?

because it is a period of increased nutrient requirements