Newborn

An infant during the first month after birth.

Infant
A child between 1 and 23 months of age.

Premature birth or Preterm birth

Birth of an infant before 37 weeks of gestation.

NB, A full-term or normal pregnancy lasts 40 weeks.

 Provides superior nutrition for optimum growth.
(e.g. Fatty acids important to brain/visual development)
Provides adequate water for hydration.
Protects against infection and allergies.

bactericidal compounds
Lactoferrin:
iron-binding protein, inhibits growth of some bacteria by competing for
available iron.
High quantities in human milk, but in very low amounts in bovine milk

Lysozyme-enzyme:
Has bacteriolytic properties
Much greater quantities in human milk than bovine milk

Promotes bonding and development.

 Can see some deficiencies
Iron
Vitamin D
Vitamin B12

These are present in adequate amounts in commercially available

formulas
 Term newborns have sufficient iron stores to sustain them for 3 to
4 months
even when the mother has anemia
So they dont need supplements until 4 mos of age

Human milk contains lower quantities of iron but bioavailability is

greater
 Protects mothers health
helps reduces risk of uterine bleeding and helps the uterus to
return to its previous size
reduces risk of breast and
ovarian cancer
Helps delay a new pregnancy
Helps a mother return to pre-pregnancy weight
Property Importance
Antibody-rich (IgM) protects against infection and allergy

Many white cells protects against infection

Purgative clears meconium; helps prevent
jaundice
Growth factors helps intestine mature; prevents
allergy, intolerance
Vitamin-A rich reduces severity of some infection
(such as measles and diarrhea);
prevents vitamin A-related eye
diseases
Percent with diarrhoea

25 22.3 22.4
19.5 19.1
20
15 12.9 11.9
10 7.1
5 3.6

0
0-13 14-26 27-39 40-52
Incidence of diarrhoeal illness by age in weeks

Bottle-fed Breastfed

Adapted from: Howie PW, Forsyth JS, Ogston SA, Clark A, Florey CV. Protective effect
of breastfeeding against infection. Br Med J, 1990, 300: 11-15.
Percent with respiratory

60 54.1
50 47.1 45.5 42.4
38.9 40
40 36.2
illness

30 23.1
20
10
0
0-13 14-26 27-39 40-52
Incidence of respiratory illness by age in weeks

Bottle-fed Breastfed

Adapted from: Howie PW, Forsyth JS, Ogston SA, Clark A, Florey CV. Protective
effect of breastfeeding against infection. Br Med J, 1990, 300: 11-15.
Percent with acute otitis

20 20

14
15 13
media

10 7
5 6
5 4
1
0
1-3 4-7 8-12
months

breastfed mixed fed weaned

Adapted from: Aniansson G, Alm B, Andersson B, Hakansson A et al. A prospective

coherent study on breast-feeding and otitis media in Swedish infants. Pediat Infect Dis J,
1994, 13: 183-188.
16 15.1
14
12 exclusive
10 breastfeeding
partial
8
breastfeeding
6 no breastfeeding
4.1
4
2.2
2 1 1
0
Diarrhoea 0-3 mo Diarrhoea 4-11 mo

Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of
breast feeding on infant mortality in Latin America. BMJ, 2001, 323: 1-5.
4.5
4
4
3.5
2.9 exclusive
3 breastfeeding
2.5 2.1 partial
2 breastfeeding
1.5 no breastfeeding
1 1
1
0.5
0
ARI 0-3 mo 4-11 mo

Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect
of breast feeding on infant mortality in Latin America. BMJ, 2001, 323: 1-5.
108
106
106
104 < 1 months
104
102.3 2-3 months
101.7
102 4-6 months
99.4 7-9 months
100
> 9 months
98

96
Duration of breastfeeding in months

Adapted from: Mortensen EL, Michaelsen KF, Sanders SA, Reinisch JM. The association
between duration of breastfeeding and adult intelligence. JAMA, 2002, 287: 2365-2371.
 Human milk Animal milks Infant formula
correct amount, easy too much, difficult to
Protein partly corrected
to digest digest
enough essential fatty lacks essential fatty
Fat no lipase
acids, lipase to digest acids, no lipase

Water enough extra needed may need extra

Anti-infective
present absent absent
properties
Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993
(WHO/CDR/93.6).
 exclusive human milk feeding for first 4-6 months of life
breastfeeding may continue until two years of age and beyond
vitamin D supplementation of 400 IU to all human milk fed infants from
birth until diet provides a source of vitamin D
may take 7-10 days to establish breastfeeding
frequent feedings will help establish milk supply
number of wet diapers in a 24 hour period good indicator of whether
baby is getting enough milk
supplemental formula may obstruct establishment breastfeeding

NB,
- Pasteurized whole cows milk may be introduced between 9-12 months of age and
continued throughout the second year of life
- Skim milk is inappropriate in the first 2 years of life as it may compromise the
intake of energy and EFA and affect growth and development
- By 1 year, a variety of foods should be consumed with less dependency on milk
as major source of nutrition
 Whey to casein ratio varies
Amino acid profile varies
Taurine and carnitine are added to some

% Whey % Casein
Breast milk 70 30

Enfamil 60 40
Similac 18 82
Carnation 100 0
Good Start
Soy 0 0
 Energy: slightly higher
Protein: Lower, but higher quality (whey and casein)
Renal Solute load: Lower (BM ; 260 mOsm/kg H20)

Carbohydrate: Mainly lactose

Fats: Long chain (lipases increase absorption)
 Cows Milk-Based Formulas
Enfamil (lipil, AR), Similac (advance, lactose free)

Soy Based Formulas

(beneficial in post-diarrheal transient lactase deficiency)
Isomil, ProSobee

Amino Acid Formulas

(beneficial for specific metabolic illnesses:
phenylketonuria (leads to mental
hereditary tyrosinemia Retardation)
EleCare, Neocate

Casein Hydrolysate Formulas

(beneficial in cows milk protein allergy)
Alimentum, Pregestimil

Preemie Formulas
(more protein, less carbs, same fat, different electrolyte concentration, more Ca)
Enfamil Premature, Similac Special Care
 introduction recommended between 4 and 6 months of age

risks of introducing early

potential choking in an infant who has an immature swallow and the
reduction of human milk intake
in some countries in the developing world, solid foods may be
contaminated and a source of infection

One benefit of introducing solids such as iron-fortified cereal is a

potential reduction in iron deficiency

NO benefit to introducing juices before 6 months

if juice introduced too early, carbohydrate load may result in
diarrhea
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