Formula Feeding.mansfans.com

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Formula Feeding (Artificial Feeding or Bottle Feeding)

By Prof. Samir M. Abou Elhassan

Indications of Formula Feeding:  Contraindication of breast feeding.  Abscent mother.  Twins.  Insufficient breast milk Supply. Types of milk used for Formula Feeding:  Fresh animal milk (Liquid milk). – Raw. – Pasteurized.  Dried (Powdered) milk. www.mansfans.com

What are the differences between human and cow’s milk Nutrient / 100 ml

Breast milk

Cow’s milk

Protein (gm) Casein Whey

1.0 30% 70%

3.3 80% 20%

Fats (gm) Uns. Fatty acids Sat. Fatty acids

3.5 60% 40%

4 40% 60%

Lactose (gm)

7.0

4.5

Minerals (gm) Ca** (gm) Phos. (mg) Ca / P Iron (mgm)

0.2 35 15 2:1 1.5

0.8 115 95 1:1 1.0

7 15

22 35

Sodium (MEq/L) Potassium (MEq /L)

1- Fresh animal milk Animal milk Without modification is not Suitable for infant feeding for the following reasons 1. 2. 3. 4. 5. 6. 7. 8. 9.

High protein Content mostly Casein. Fat higher in volatile fatty acids and less in polyunsaturated jatty acids. Less CHO ate than human milk. High content of sodium (3 times that of human milk) →Hypernatremia. High phosphorus Content (7 times) → Neonatal Tetany. High mineral Content (4 times) that of human milk →Renal over Load. Bioavilabitily of iron less than human milk →iron deficiency anemia. Human milk is rich in enzymes e.g. lipase easy digestion of fat Higher Content of biologically active Vit. D in human milk→ lower risk of rickets.

Modification of animal milk

Nut. gm /dl Breast milk

Fresh Buf. Milk

Modified Buf. milk

Adapted Dried milk

1

4

2

1.5

3.5

7

3.5

3.5

Lactose

7

4

2+5 gm sugar

7

Minerals

0.2

0.8

0.4

0.25

Cal / dl

67

100

67

67

Protein Fat

2- Dried Milk Advantages: Easy store. Sterile. Constant Composition. Modified to be suitable for infant feeding. Types of dried milk Adapted (Humanized) Follow – on Formula. Dried whole milk Modified special Formulas.

Calculation of the quantity of milk Needed for Feeding Age method Weight method – 100 ml / milk →67 Cal. – Need 100- 110 Cal /Kg/ day →150 ml of milk / Kg / day. – WT Kg X 150 / Number of feeds = amount per feed

Management of Formula Feeding Select type of milk . Modification of the Used milk. Calculate the amount of milk per feed. Use cup & spoon in mixed feeding. Use bottle in exclusive formula feeding. Check the hole of the teat Check temp of milk. Right position & burping. Discard any left milk. Clean bottles and teats.

Weaning Definition: To accustom the infant to take food other than milk.

Weaning When to start? Principles of Weaning. – Should be gradual – Not in hot season – Infant not ill or convalescence from illness.

Weaning What types of food should be given? – Start with liquids and semisolids – Solid foods – Start with small amount and ↑ gradually – Don’t start with more than one type of food

Weaning What types pf food should be avoided? – Seeds – nuts – bones – Spicy food – Salted – food – Foods with additives – Junk food

Weaning Problems of Weaning. – G.I. upset – G.E. – PEM – Allergic reaction

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Mumps (Epidemic Parotitis)

Etiology Mumps is caused by a paramyxovirus

Mode of Transmission From person to person – – –

Direct contact Aerosolization of respiratory secretions Contaminated articles (fomites)

Contagiousness Contagious 1 day before to 9 days after start of parotitis (until swelling disappears). Transplacental immunity protects for 6 months Active disease gives life-long immunity

Incubation Period 2-3 weeks

Clinical picture Age: – – –

5-15 years, both sexes are affected Subclinical infection occurs in 30-40% of cases→long lasting immunity Infection can occur without involvement of salivary glands

Classical clinical picture: – –

Prodrome: 1-2 days Fevere, malaise, headache, vomiting, neck pain, pain behind the ear on chewing or swallowing

Clinical picture Salivary glands involvement: – – –

Parotids are involved (unilaterally or bilaterally) in 60% of cases Submaxillary and sublingual glands may be involved±parotid affection Characteristics of parotid enlargement

Pain is aggravated on opening the mouth, chewing, swallowing or tasting sour substances (like lemon juice) Swelling may be also present in pharynx, larynx and over manubrium sterni and upper chest (probably as a result of lymphatic obstruction)

Laboratory Leukopenia with relative lymphocytosis Serum amylase: commonly ↑(irrespective of presence of pancreatitis) Rise of serum antibody to mumps or virus culture from saliva, urine, CSF, blood

Complications Neurological complications: – – – –

Meningoencephalitis: occurs in 10% of patients Aseptic meningitis Encephalitis Less commonly: Guillain-Barre syndrome, bilateral nerve deafness, optic neuritis, transient facial palsy

Orchitis, epididymitis

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Complications Oophoritis: – –

Occurs in 7% postpubertal females Presents as pelvic pain and tenderness. Does NOT affect fertility

Pancreatitis: – – –

Usually mild or subclinical Epigastric pain & tenderness±fever, chills, vomiting, prostration Polymorphonuclear leukocytosis of moderate degree

Complications Other less frequent complications: –

Nephritis, myocarditis, mastitis, thyroiditis, arthitis, thrombocytopenic purpura

Diagnosis Depending on clinical findings, it should be differentiated from: –

– –

Other causes of swelling in parotid area as cervical adenitis, lymphomas, recurrent parotitis, salivary calculus, salivary gland tumors Other causes of viral parotitis: enterovirus, influenza A, cytomegalovirus Suppurative parotitis due to Staph. Aureus: pus can be expressed from Stensen’ duct and cultured

Prevention Live attenuated vaccine given with Measles & Rubella (MMR) at 15 months

Treatment No specific therapy, only supportive: – – –

Isolation (from 1 day before till disappearance of swelling) Antipyretics, analgesics, soft diet Scrotal suspension in orchitis, IV fluids for pancreatitis,..etc

Poliomyelitis

Etiology Any one of 3 poliovirus: I,II, or III (each type is immunologically distinct from others). Infection with one type results in immunity to that specific type ONLY. Affected children SHOULD be vaccinated for other types.

Mode of Transmission Fecal-oral route via milk, food, water,…etc. Droplet infection may occur (virus is present in or pharyngeal secretion early in the disease).

Contagiousness Throat: virus is present shortly before and 1 week after onset. Stools: virus is present shortly before and intermittently 3-4 weeks after onset.

Incubation Period 7-14 days.

Clinical Manifestations Asymptomatic infection (silent). Abortive poliomyelitis (a non specific febrile illness). Non-paralytic poliomyelitis (aseptic meningitis syndrome). Paralytic

Poliomyelitis

encephalitic & mixed).

(spinal,

bulbar,

Laboratory Findings Rise in antibodies in paired serum samples, one in the acute and one 2 to 3 weeks later. Isolation of the virus. CSF: normal or↑ pressure, clear or opalescent, ↑ Cells (polymorphs in early stage and lymphocytes later), Proteins: 30-60mg% protein (later may rise to 100-600), Sugar: normal.

Differential Diagnosis A.

Other causes of lower motor unit disease:.

2.

Paralysis due to other enter viruses (rare, usually mild).

3.

Guillain-Barre syndrome: idiopathic peripheral neuropathy characterized.

4.

Werding-Hoffmann disease (spinal muscular atrophy).

5.

Spinal cord lesions: transverse myelitis, tumor.

6.

Diphtheritic paralysis (see diphtheria).

7.

Poisoning: organophosrus and lead poisoning.

8.

Muscle dystrophies.

9.

Myasthenia gravis.

Differential Diagnosis B. Pseudo-paralysis:

Arthritis, toxic synovitis, osteomyelitis Unrecognized trauma, dislocation, fracture Scurvy, congenital syphilis.

Complications Gastrointestinal: acute gastric dilatation, perforations and edema. Cardiovascular:

hypertension,

hypotension,

arrhythmias, moycarditis and acute cardiac failure Urinary: transient bladder paralysis, nephrocalcinosis (due to immobilization and hyper-calcemia) and calculi (due to hypercalcuria) Respiratory: aspiration, pneumonias, atelectasis

Prophylaxis Active immunization Passive immunity: 0.2 ml/kg IM of pooled human immune globulin During febrile viral illness of undetermined etiology: avoid overexertion, fatigue, IM injections and keep patients in bed during any febrile episode

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Treatment General – – – – – – – –

Bed rest with splinting of limbs Dry heat or hot packs may relax tender and toght muscles, ligaments and fasciae Analgesics foe fever and to relieve pain and tenderness Diet: simple, nutritions and attractive Physiotherapy is the most important single factors in treatment It is started after termination of acute phase (usually after 2-3 weeks) Passive movements at first, then active exercises when pain subsides Orthopedic measures: special boards, splints or braces

Specific: none

Treatment Treatment of special problems and complications: – – – – – – – – – –

Respiratory difficulty, may need respirator Tracheostomy, is done in paralysis of muscles of swallowing Tranquilizers for irritability and apprehension Enemas and laxatives, for constipation Bladder paralysis: bethanechol, intermittent catheterization + prophylactic sulfa Gastric dilatation: aspiration, and ice bags Convulsions: anticonvulsant therapy Cardiovascular: treatment of hypertension, digitalization, ..etc Psychologic guidance Deformities: orthopedic surgical correction