Infant Nutrition
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The document emphasizes the importance of breastfeeding as the optimal feeding method for infants, advocating for early initiation and exclusive breastfeeding for the first six months, followed by continued breastfeeding with complementary foods until at least two years. It outlines recommendations for maternal support, proper feeding practices, and childcare guidance, while also addressing vaccination schedules for newborns and young children. Additionally, it discusses the introduction of complementary foods and the need for hygiene in food preparation to prevent undernutrition and promote healthy development.
Infant Nutrition
- 4. Breastfeeding should be promoted to mothers and other caregivers as the gold standard feeding option for babies. Pre-birth counseling individually or in groups organized by maternity facility regarding advantages of breastfeeding and dangers of artificial feeding should prepare expectant mothers for successful breastfeeding. Breastfeeding must be initiated as early as possible after birth for all normal newborns (including those born by caesarean section) avoiding delay beyond an hour. Colostrum must not be discarded but should be fed to newborn as it contains high concentration of protective immuno-globulins and cells. No pre-lacteal fluid should be given to the newborn. Baby should be fed “on cues”- The early feeding cues includes; sucking movements and sucking sounds, hand to mouth movements, rapid eye movements, soft cooing or sighing sounds, lip smacking, restlessness etc. Crying is a late cue and may interfere with successful feeding.
- 5. Every mother, specially the first time mother should receive breastfeeding support from the doctors and the nursing staff, or community health workers (in case of non institutional birth) with regards to correct positioning, latching and treatment of problems, such as breast engorgement, nipple fissures and delayed ‘coming-in’ of milk. Exclusive breastfeeding should be practiced from birth till six months requirements. Mean intakes of human milk provide sufficient energy and protein to meet requirements during the first 6 months of infancy. After completion of six months of age, with introduction of optimal complementary feeding, breastfeeding should be continued for a minimum for 2 years and beyond depending on the choice of mother and the baby. Mothers need skilled help and confidence building during all health contacts and also at home through home visits by trained community worker, especially after the baby is 3 to 4 months old when a mother may begin to doubt her ability to fulfill the growing needs and demands of the baby. Mothers who work outside should be assisted with obtaining adequate maternity/breastfeeding leave from their employers, should be encouraged to continue exclusive breastfeeding for 6 months by expressing milk for feeding the baby while they are out at work, and initiating the infant on timely complementary foods. Mothers who are unwell or on medication should be encouraged to continue breastfeeding unless it is medically indicated to discontinue breastfeeding. Health and Nutrition (ICDS) workers should be trained in various skills of counseling and especially in handling sensitive subjects like breastfeeding and complementary feeding. If the breastfeeding was temporarily discontinued due to an inadvertent situation, “relactation” should be tried as soon as possible. Such cases should be referred to a trained lactation consultant/health worker. The possibility of “induced lactation” shall be explored according to the situation. Adoption of latest WHO Growth Charts is recommended for monitoring growth.
- 8. There is no substitute for breast milk but sometimes there is a need for alternative milk for the neonate, that may include: Expressed breast milk Unmodified animal milk Commercial infant formulas
- 10. Complementary feeding is defined as the process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast milk. The transition from exclusive breastfeeding to family foods – referred to as complementary feeding – typically covers the period from 6–24 months of age, even though breastfeeding may continue to two years of age and beyond. This is a critical period of growth during which nutrient deficiencies and illnesses contribute globally to higher rates of undernutrition among children under five years of age.
- 11. Appropriately thick homogenous complementary foods home-made from locally available foods should be introduced at six completed months while continuing breastfeeding ad libitum. To provide more calories from smaller volumes, food must be thick in consistency– thick enough to stay on the spoon without running off, when the spoon is tilted Foods can be enriched by making a fermented porridge, use of germinated or sprouted flour and toasting of grains before grinding Parents must identify the staple homemade food (as these are fresh, clean and cheap), comprising of cereal-pulse mixture in the ratio 2:1, and make them caloric and nutrient rich with locally available products Research has time and again proved the disadvantages of bottle feeding. Hence bottle feeding shall be discouraged at all levels. The food should be a balanced diet consisting of various (as diverse as possible) food groups / components in different combinations. Hygienic practices are essential for food safety during all the involved steps viz. preparation, storage and feeding. Self-feeding should be encouraged despite spillage. Each child should be fed under supervision in a separate plate to develop an individual identity. Forced feeding, threatening and punishment interfere with development of good/ proper feeding habits Consistency of foods should be appropriate to the developmental readiness of the child in munching, chewing and swallowing. Avoid foods which can pose choking hazard. Introduce lumpy or granular foods and most tastes by about 9 to 10 months.
- 13. Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease.
- 14. BCG About-BCG stands for Bacillus Calmette-Guerin vaccine. It is given to infants to protect them from tubercular meningitis and disseminated TB. When to give – BCG vaccine is given at birth or as early as possible till 1year of OPV About-OPV stands for Oral Polio Vaccine. It protects children from poliomylitis. When to give- OPV is given at birth called zero dose and three doses are given at 6, 10 and 14 weeks. A booster dose is given at 16-24 months of age. Hepatitis B vaccine About – Hepatitis B vaccine protects from Hepatitis B virus infection. When to give- Hepatitis B vaccine is given at birth or as early as possible within 24 hours. Subsequently 3 dose are given at 6, 10 and 14 weeks in combination with DPT and Hib in the form of pentavalent vaccine. Pentavalent Vaccine About-Pentavalent vaccine is a combined vaccine to protect children from five diseases Diptheria, Tetanus, Pertusis, Haemophilis influenza type b infection and Hepatitis B. When to give - Three doses are given at 6, 10 and 14 weeks of age (can be given till one year of age).
- 15. Rotavirus Vaccine About -RVV stands for Rotavirus vaccine. It gives protection to infants and children against rotavirus diarrhoea. It is given in select states. When to give - Three doses of vaccine are given at 6, 10, 14 weeks of age. PCV About- PCV stands for Pneumococcal Conjugate Vaccine. It protects infants and young children against disease caused by the bacterium Streptococcus pneumoniae. It is given in select states. When to give - The vaccine is given as two primary doses at 6 & 14 weeks of age followed by a booster dose at 9 months of age fIPV About- fIPV stands for Fractional Inactivated Poliomylitis Vaccine. It is used to boost the protection against poliomylitis. When to give- Two fractional doses of IVP are given intradermally at 6 and 14 weeks of age. Measles/ MR vaccine About-Measles vaccine is used to protect children from measles. In few states Measles and Rubella a combined vaccine is given to protect from Measles and Rubella infection. When to given- First dose of Measles or MR vaccine is given at 9 completed months to12 months (vaccine can be given up to 5 years if not given at 9-12 months age) and second dose is given at 16-24 months. JE vaccine About- JE stands for Japanese encephalitis vaccine. It gives protection against Japanese Encephalitis disease. JE vaccine is given in select districts endemic for JE. When to given- JE vaccine is given in two doses first dose is given at 9 completed months-12 months of age and second dose at 16-24 months of age.
- 16. DPT booster About-DPT is a combined vaccine; it protects children from Diphtheria, Tetanus and Pertussis. When to give -DPT vaccine is given at 16-24 months of age is called as DPT first booster and DPT 2nd booster is given at 5-6 years of age. TT About- Tetanus toxoid vaccine is used to provide protection against tetanus. When to give- Tetanus toxoid vaccine is given at 10 years and 15 years of age when previous injections of pentavalent vaccine and DPT vaccine are given at scheduled age. Pregnant women-TT-1 is given early in pregnancy; and TT-2 is given 4 weeks after TT-1.TT booster is given when two doses of TT are given in a pregnancy in last three years.