MATERNAL AND CHILD NUTRITION

INTRODUCTION TO MATERNAL AND CHILD NUTRITION

Definition of Terms
Conception – Fertilization of an ovum by a sperms
Zygote – a fertilized ovum undergoes cell division and it also becomes implanted in the
uterus
Embryo – the number of cells doubles within 24 hours. The embryo size differs very little
for eight weeks, it is only 3cm. long. The embryo has a complete central nervous system, a
beating heart, a digestive system, well identified fingers and toes and the beginnings of facial
features
Foetus – by 7 months each organ grows to maturity and the weight increases to 3500 grams
Gestation – this is the period from conception to birth (38-42 weeks), pregnancy is divided
into three trimesters
Placenta – this is the organ that develops in the uterus in early pregnancy. Maternal and fatal
blood circulates closely to allow for exchange of materials. Nutrients and oxygen are
delivered to the foetus and carbon dioxide and other waste materials are taken to the mother
Amniotic sac – this is the bag of water in the uterus where the foetus floats
Umbilical cord – is the rope-like structure through which the fetus veins and arteries reach
the placenta. It is also the route for nourishment and oxygen and waste disposal
Maternal and child health care: is the health service provided to mothers (women in their
childbearing age) and children. The targets for MCH are all women in their reproductive age
groups i.e. 15-49 years of age, children, school age population and adolescents
Maternal health: This refers to the health of women during pregnancy, childbirth and the
postpartum period. It encompasses the healthcare dimensions of family planning,
preconception, prenatal, and postnatal care in order to ensure a positive and fulfilling
experience in most cases and reduce maternal morbidity and mortality in other cases. While
motherhood is often a positive and fulfilling experience, for too many women it is associated
with suffering, ill-health and even death.
The targets for MCH are all women in their reproductive age groups, i.e., 15 - 49 years of
age, children, school age population and adolescents.
Maternal mortality or maternal death: Is the death of a woman while pregnant or within
42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy,
from any cause related to or aggravated by the pregnancy or its management but not from
accidental or incidental causes (WHO 2011)
Maternal morbidity: is defined as chronic and persistent ill-health occurring as a
consequences of complications of pregnancy and childbirth .
Postnatal care: is healthcare provided following childbirth to both the mother and the
infant..
Child spacing: The practice of maintaining an interval between pregnancies
Child: A young human from stage of birth to puberty

PRE NATAL-CARE
Prenatal care is the health care the pregnant mother gets while she are pregnant. It includes
your check-ups and testing. At each prenatal care visit, your health care provider checks on
you and your growing baby. .Prenatal Care Services needed include dietary and lifestyle
advice, weighing to ensure proper weight gain, and examination for problems of pregnancy
such as oedema and preeclampsia.

Prenatal care can help prevent complications and inform women about important steps they
can take to protect their infant and ensure a healthy pregnancy.

Babies born to mothers who lack prenatal care have tripled the chance of being born at a low
birth weight. New-borns with low birth weight are five times more likely to die than those
whose mothers received prenatal care. Prenatal care ideally starts at least three months before
you begin trying to conceive.

What Happens at a Prenatal Check-up

Several tests are performed during these visits. Tests performed during the first visit include

 blood tests to check blood type,

 Rh factor,
 Hemoglobin-anemia,
 Immunity to several diseases including rubella (German measles) and hepatitis B.
 Urine tests to check for sugar and protein as signs of diabetes and kidney changes,
respectively, are also performed.

Importance of pre-natal care

Having a healthy pregnancy is one of the best ways to promote a healthy birth. Getting early
and regular prenatal care improves the chances of a healthy pregnancy. This care can begin
even before pregnancy with a preconception care visit to a health care provider.

a) Reduce the risk of pregnancy complications. Following a healthy, safe diet; getting
regular exercise as advised by a health care provider;
b) Reduce the infant's risk for complications. Alcohol use also increases the risk for fetal
alcohol spectrum disorders, which can cause a variety of problems such as abnormal
facial features, having a small head, poor coordination, poor memory, intellectual
disability, and problems with the heart, kidneys, or bones..

Some healthy habits to follow during this period include:

 quitting smoking and drinking alcohol

 taking folic acid supplements daily (400 to 800 micrograms)
 talking to your doctor about your medical conditions, dietary supplements, and any
over-the-counter or prescription drugs that you take.
 avoiding all contact with toxic substances and chemicals at home or work that could
be harmful.
c) Get accurate nutritional information. Your diet may have to go through some changes
in order to meet the nutritional needs of your baby.
d) Keep track of your baby’s development. Your baby’s growth is a major indicator of
how well he or she is doing in there..
e) Learn about labour and delivery. Your prenatal visits offer you the chance to discuss
these procedures, potential scenarios, questions and concerns with your doctor. This
includes learning about the risks and benefits of every intervention or treatment
available to you

Aspects of pre-natal care

1. Medical history

Your health care provider will ask many questions, including details about:

 Your menstrual cycle

 Past pregnancies
  Your personal and family medical history
 Medication use, including prescription and over-the-counter medications or
supplements
 Your lifestyle, including your use of tobacco, alcohol and caffeine

2. Physical exam

Your health care provider will check your weight and height and use this information to
calculate your BMI. He or she will use your BMI to determine the recommended weight gain
you need for a healthy pregnancy.

Your health care provider will measure your blood pressure, heart rate and breathing rate and
do a complete physical exam.

3. Lab tests

At your first prenatal visit, blood tests might be done to:

Check your blood type. This includes your Rh status. Rhesus (Rh) factor is an inherited trait
that refers to a specific protein found on the surface of red blood cells. Your pregnancy needs
special care if you're Rh negative and your baby's father is Rh positive.

Measure your hemoglobin. Hemoglobin is an iron-rich protein found in red blood cells that
allows the cells to carry oxygen from your lungs to other parts of your body, and to carry
carbon dioxide from other parts of your body to your lungs so that it can be exhaled. Low
hemoglobin is a sign of anemia — a lack of healthy red blood cells.

Check immunity to certain infections. This typically includes rubella and chickenpox
(varicella) — unless proof of vaccination or natural immunity is documented in your medical
history.

Detect exposure to other infections. Your health care provider might suggest blood tests to
detect various other infections, such as hepatitis B, syphilis, gonorrhea or chlamydia, and
HIV, the virus that causes AIDS. A urine sample will be tested for signs of infection.

4. Lifestyle issues
Your health care provider will discuss the importance of proper nutrition and prenatal
vitamins. Your first prenatal visit is a good time to discuss exercise, sex during pregnancy
and other lifestyle issues..

5. Due date

Few women actually give birth on their due dates. Still, establishing your due date — or
estimated date of delivery — is important. An accurate due date allows your health care
provider to monitor your baby's growth and the progress of your pregnancy, as well as
schedule certain tests or procedures at the most appropriate time

Complications of during pregnancy

During the course of the pregnancy the pregnant mother experiences physiological changes
that affect the function of the body.

1. Bleeding

Bleeding means different things throughout your pregnancy. “If you are bleeding heavily and
have severe abdominal pain and menstrual-like cramps or feel like you are going to faint
during first trimester, it could be a sign of an ectopic pregnancy. Ectopic pregnancy, which
occurs when the fertilized egg implants somewhere other than the uterus, can be life-
threatening.

Heavy bleeding with cramping could also be a sign of miscarriage in first or early second
trimester. By contrast, bleeding with abdominal pain in the third trimester may indicate
placental abruption, which occurs when the placenta separates from the uterine lining.

2. Severe Nausea and Vomiting

It's very common to have some nausea when you're pregnant. If it gets to be severe, that may
be more serious.

3. Anemia

Anemia is having lower than the normal number of healthy red blood cells. Treating the
underlying cause of the anemia will help restore the number of healthy red blood cells.
Women with pregnancy related anemia may feel tired and weak. This can be helped by taking
iron and folic acid supplements.
 4. Hypertension (High Blood Pressure)

High blood pressure, also called hypertension, occurs when arteries carrying blood from the
heart to the body organs are narrowed. This causes pressure to increase in the arteries. In
pregnancy, this can make it hard for blood to reach the placenta, which provides nutrients and
oxygen to the fetus. Reduced blood flow can slow the growth of the fetus and place the
mother at greater risk of preterm labour and preeclampsia.

Women who have high blood pressure before they get pregnant will continue to have to
monitor and control it with medications throughout their pregnancy. High blood pressure that
develops in pregnancy is called gestational hypertension.

5. Gestational Diabetes Mellitus (GDM)

GDM is diagnosed during pregnancy and can lead to pregnancy complications. GDM is when
the body cannot effectively process sugars and starches (carbohydrates), leading to high sugar
levels in the blood stream. Most women with GDM can control their blood sugar levels by a
following a healthy meal plan from their health care provider and getting regular physical
activity. Some women also need insulin to keep blood sugar levels under control. Doing so is
important because poorly controlled diabetes increases the risk of—

 Preeclampsia.
 Early delivery.
 Caesarean birth.
 Having a big baby, this can complicate delivery.
 Having a baby born with low blood sugar, breathing problems, and jaundice.

Assignment
Discuss nutritional requirements during pregnancy.
Nutrition requirements in pregnancy
During pregnancy, the body goes through a lot of hormonal, physiological, and physical
changes thus has increased nutritional needs. Although the old saying "eating for two" isn't
entirely correct, more macronutrients and micronutrients are indeed required during
pregnancy. Generally, most women can meet these increased nutritional needs by choosing a
 diet that includes a variety of nutritious foods, including 8 to 10 glasses of water a day, and
by taking a nutrient supplement prescribed by their health care provider. A simple way to
ensure that mother and baby are getting all the nutrients needed is by taking a variety of foods
from each of the food groups daily.
Additional daily requirements for a pregnant woman
Nutrient Additional daily requirements for a pregnant woman
Calories 300- 350gms (in the second and third trimesters)
Protein 60 gms
Calcium 1200 mg
Folate 15 mg
Iron 30 mg

Essential Fatty Acids

Essential fatty acids (linoleic acid and linolenic acid) are very important for the baby's normal
retinal and brain development. Pregnant women are encouraged to include some sources of
essential fatty acids in their daily eating pattern. Sources of essential fatty acids include:
soybean, non-hydrogenated margarines, oily fish, nuts and seeds.
Calories
It is recommended that pregnant women eat an average of 150 calories more per day in the
first trimester and 350 calories more per day in the two subsequent trimesters than they did
before becoming pregnant. This is so as to ensure adequate weight gain throughout the
pregnancy. Calories are required for normal growth and birth weight, and for fat stores to be
used during lactation.
Complex Carbohydrates
A pregnant woman's calories should come from all three energy sources (Macro-nutrients) -
proteins, fats, and complex carbohydrates. A carbohydrate restricted diet during pregnancy
puts the foetus at risk. Without carbohydrates, the body will burn proteins and fat for fuel.
This will lead to:
Protein
Adequate protein is vital since they are the building blocks of all materials in the growing
foetus (brain cells, hair, nails and other tissues). It is also needed for the buildup of the
mother’s muscles, uterus, breasts and blood supply. Low protein intake is related to smaller-
than-average weight babies who may have health problems.
Animal products have all the essential amino acids and are considered complete proteins.
Vegetarian sources lack in one or more of the essential amino acids and are considered
incomplete proteins unless they are combined properly. About 60-80 grams of protein is
required daily by pregnant women (6-8 servings).Vegetarians should combine a serving form
the bean column with complex carbohydrates and nuts or dairy to have a "complete" protein
meal.
Zinc
Inadequate levels during pregnancy can cause prolonged labour and low birth weight babies
with health problems. The dietary intake for zinc should be 11-12 milligrams per day.
Calcium and Vitamin D
Adequate Calcium and vitamin D are important for both mother and baby during pregnancy.
The two nutrients work together to build strong bones and teeth for the baby. They also help
to keep the mother’s bones and teeth strong throughout pregnancy, preventing maternal bone
loss. When the mother’s diet is low in calcium during the pregnancy, the baby will draw off
maternal stores to get the calcium it needs to develop. This can put the mother at increased
risk for osteoporosis and dental problems. A low calcium diet can also lead to insomnia,
irritability and leg cramps. About 1200-1500mg of calcium is required daily. Some good
sources of calcium and vitamin D include: milk, yogurt, cheese, broccoli, orange juice with
added calcium and fortified soymilk. Kales, almonds, and fishes eaten with bones like
‘omena’, sardines and salmons are also rich in calcium. It is however important to remember
that phosphorus in sodas, and oxalic acid in spinach, beet greens, and chocolate decrease the
absorption of calcium. Also important to know, is that some vitamin D is made by the skin
from exposure to the sun.
Iron
Pregnant women need more iron than usual because their body is manufacturing more blood -
blood volume increases by 60% in pregnancy. Iron supplies oxygen and nutrients to the
foetus, supports placental function, manufactures red blood cells, and acts as insurance
against blood loss during delivery. Iron from meat is better absorbed than from plants. Iron
from plants is absorbed better if taken with vitamin C or meat protein. Coffee, tea, bran, and
calcium decrease absorption.
It is practically not possible to get enough iron from food and so supplements are usually
recommended. The dietary reference intake for iron is 27 milligrams per day for all pregnant
women. Without adequate iron, the foetus will draw its supply from the mother, often leaving
her anaemic. Routine preventive iron supplementation for all pregnant women is
recommended. In the third trimester the baby will begin creating its own iron reserve for its
first six months of life when it will be primarily living on milk which is low in iron.
Folate/folic acid
As we saw in the previous lecture, Folate/folic acid helps to decrease the risk of neural tube
defects that affect a baby's spine and brain, such as spina bifida. Folate is the form of the
vitamin found in food and folic acid is the form found in pills. It is especially important for
women to take a multivitamin that contains 0.4mg of folic acid before becoming pregnant
and during the first few months of pregnancy. Although a multivitamin is recommended this
does not reduce or replace the need to make healthy food choices. In the previous lecture, we
looked at the consequences of folate deficiency.
Iodine
As we discussed in the previous lecture, Iodine is required for the synthesis of thyroid
hormones that in turn are required for the regulation of cell metabolism throughout the life
cycle. We said that thyroid hormones ensure normal growth, especially of the brain, which
occurs from foetal life to the end of the third post-natal year.

Postnatal care
Postnatal care is the service given to the mother and the baby in the first six weeks after
delivery. These six weeks constitute the postnatal period. During the postnatal period, the
organs related with child bearing return to their pre-pregnancy state.
Why do we provide Postnatal care?
We provide postnatal care for the following reasons:
 To find out whether the mother’s reproductive organs have returned to their pre-
pregnancy state;
 To check the mother's condition;
 To check the baby's condition.

Activity 5.
List five (5) services that you should give at a postnatal clinic.

The importance of postnatal care includes::

 Support of breastfeeding
 Educate on nutrition and supplementation
 Counseling on contraception and resumption of sexual activity
 Immunization for infants
 Prevention, early diagnosis and treatment of complications
 Support mother and the family
Benefits of proper postpartum care
 Ease of the body returning to pre pregnancy state
 Enjoy motherhood
 Feel less tired and fatigued
 Better milk supply
 Gain self-confidence. Happier baby due to the bond between mother and child
 ASPECTS OF GROWTH AND DEVELOPMENT
Growth is the increase in weight and height with age, or size that comes about as a result of
the multiplication of cells and their differentiation for many different functions in the body.
Growth is a continuous but not a uniform process from conception to full maturity. The
potential for optimal development of the body from one stage of growth to another is
dependent among other things on the nutrition and health status of the child which requires
the understanding of their overall development.

Factors affecting the rate of growth and development

a) Genetic factors: This relates inborn capacity to grow, as a result of hereditary traits
inherited from parents. However certain circumstances e.g. radiation and drugs may alter
gene structure and interfere with normal development of fetal tissues. Genetic disorders
e.g. PKU (phenylketonuria) affect growth (brain development). Acquired defects;- when
normal genes are made defective by factors like deficiencies, infections and toxicity of
certain drugs
b) Environmental Factors: Adequate nutrition and good health are key optimal growth and
development in children. During pregnancy several factors affect growth and
development of fetus by progression of hyperplasia (increase in number of cells e.g. in
case of cancer) and hypertrophy (increase in size of cells) this increases energy
requirements of the mother thus affecting growth and development of fetus.
Examples;
 Rubella, pre-eclampsia and insufficient dietary intake leads to impaired fetal growth
and may lead to congenital malformations
 Renal disorders, hypertension & infections can lead to still births
 Pregnancy diabetes can lead to preterm births, too big or congenital malformations
 Blood incompatibility-rhesus factor, if rhesus negative woman conceives with rhesus
positive man then there is potential risk to babies health, antibodies of the mother will
attack rhesus factor in neonatal blood as a foreign substance during delivery first child
are normally safe, treatment women are given injection of positive rhesus
immunoglobulin during pregnancy.
c) Psychosocial factors- Relates to parental child care practices coupled with interactions
with surroundings.
d) Nutrition- Diet of foetus is not necessarily related to mother’s food intake, although
congenital malformation is associated deficiencies in folic acid, it is normally rich in
carbohydrates and poor in lipids, other factors besides maternal nutrition also affect
development of the foetus and they include;
 Interference with transfer of nutrients between mother and foetus eg placental
malformation
 Reduction of utero placental flow due to maternal eclampsia or liver damage
 Inability of foetus to absorb nutrients
 Failure of pituitary gland to synthesize hormones adequately
e) Radiation - Most malformations occurs between second and seventh week of gestation,
since this is the critical period of organ development, CNS which is highly susceptible to
radiation continues to develop even after delivery, and is likely to develop defects ie
hydrocephaly (large head) common companion of spina-bifida and microcephaly (small
head) occurs mostly to mothers irradiated after fifth month.
f) Endocrine glands - Pituitary gland produces growth hormones. Thyroid gland produces
hormone thyroxine which is responsible growth and development in first year.
Malfunction of the gland results in cretinism.
g) Maternal age - Very young mothers and parents nearing 40s are likely to have bad
pregnancy outcomes especially congenital abnormalities due to inability to synthesize
chemical substances required for healthy offspring, down-syndrome, hydrocephalus &
anencephalus are associated with increased age; maternal age is also associated with
abortions, stillbirths and premature deliveries.
h) Diseases - Diseases increase nutrient requirement and affect food digestion, absorption
and metabolism of nutrients. Example Chronic diseases like TB hinder growth of child at
any stage, diarrhoea and meningitis slows down child development,
i) Social economic factors - This influences access to good health services, water and
sanitation, food and proper maternal care.
j) Psychological factors - Emotions affect appetite which in-turn affects growth and
development, for example separation of baby from the mother and in cases where mother
neglects the child will affects the dietary intake of a child.
k) Age- There is rapid growth and development in first six months which slows down after
two years and increases at adolescence .
 Stages of growth
Physical Development
During Infancy (0-2yrs)
This describes both physical and psychomotor development, at this stage physical
development is rapid, generally neonate is 18-20 inches long & 3kgs in weight in one year
time the baby is about 3 times that, at birth brain is ¼ of its final weight.
At birth upper part of the body is well developed while lower part fully develops after birth at
accelerated rate. During first two months a baby shows postural changes, sits at 7 months,
creeps at 10 months, stands at 13 months & walks at 15 months. Teeth appear at 6 months.
Early childhood (2-7 years)
Rate of growth is slow in comparison to infancy stage, there is increase in weight of 3-5
pounds/year, at 6 years head is 90% adult size and child is 109-114cm tall weighing at 16-20
kgs, at this stages hands and feet grow bigger in conjunction with muscles, fine motor and
gross motor skills are fully developed for the child can write, draw, run, jump, dance etc. at
this stage children acquire gender identity with environment being the major factor.
Late childhood (6-12 years)
Arms & legs grow faster than trunk making child appear tall and thin, milk teeth are lost and
permanent teeth start appearing, sense organs, muscles and brains are more or less mature, at
12 child is almost 140cm in height with boys being taller than girls, sex differences start
appearing, and there is increase in speed, strength and coordination needed for motor skills
this increases precision in athletic ability, climbing etc.
Adolescence stage (12-21 years)
At early stages most children experience growth spurt, a rapid increase in weight and height,
it usually lasts 2 years where boys gain 8-9 inches in height and girls 6-7 inches in height, by
age of 17(girls) and 18(boys) most have reached 98% final height. Sex differences become
apparent at this stage, sex glands start secreting resulting in appearance of primary and
secondary sex characteristics, hormonal changes increase sexual drive, and capacity to
develop heterosexual relationships and true intimacy increases at later stages.

Measuring Growth
How do we measure growth?
There are various measurements that are used to measure growth. These are:
 Weight,
 Height,
 Head circumference,
 Mid Upper Arm Circumference (MUAC)
 The eruption of teeth.
To be useful, these measurements must be taken accurately using reliable equipment and
correct measuring techniques.
For measuring the weight, a beam balance or spring balance is used. Before weighing a child,
check the weighing scale to ensure it is working properly. You can do this by weighing a
known weight and noting whether the scale has obtained the same weight.

Measuring the Head Circumference

The head circumference is measured by encircling the head with an unstretchable tape
measure, or a piece of string in the absence of a tape measure. This is passed over the most
prominent part of the occiput posteriorly and just above the supraorbital ridges anteriorly to
obtain the greatest distance around the head. The piece of string used in the absence of a tape
measure is then measured with a ruler to obtain the head circumference.

Measuring the mid upper circumference

Measuring the mid upper arm circumference (MUAC) The mid upper arm circumference is
measured using a tape or string in the absence of a tape. The tape or string is placed around
the upper arm, midway between the olecranon and acromion processes. Care is taken not to
pull the tape or string too tightly. The measurement is read. The string used in the absence of
a tape measures is then measured with a ruler to obtain the mid upper arm circumference

Measuring height.
The length of a child is measured in the first 3 years and the height is measured after 3 years
of age. The length is measured using a horizontal measuring board put on the ground or on a
table. The child is laid on his back with the head against the fixed head board. A helper holds
the child’s head so that the eye angle- external ear canal line is vertical and also keeps the
body straight. With one hand of the health worker, the child’s knees are pressed down to
straighten the child’s legs fully while, with the other hand, the sliding foot board is placed to
touch the child’s heels firmly. With the foot board in place, the child’s length is read on the
metre scale.
To measure the height, a bare foot child stands with the feet together.
The heels, the buttocks and the occiput lightly touch the measuring device. The head is
aligned so that that the external eye angle- external ear canal plane is horizontal. The child is
told to stand tall and is gently stretched upward by pressure on the mastoid processes with the
shoulders relaxed. The sliding head piece is lowered to rest firmly on the head. The height is
read and recorded.
An average term new-born weighs 3.5 kg (range 2.5 kg- 4.6 kg). The birth weight must be
plotted in the first box of the growth chart and recorded in the appropriate space on the
growth chart. The birth month should be written in the first box of the growth chart. Within
the first 3-4 days, a term newborn loses 5-10 % of the birth weight. This weight loss is
usually regained in 2 weeks by term babies and longer by premature babies. An average term
baby doubles the birth weight in 4-6 months, triples it by one year and quadruples it by two
years of age.

Growth Monitoring Growth monitoring is the process of maintaining regular close

observation of a child’s growth. It starts with measurements of weight daily, weekly,
monthly, bimonthly etc. The successive weights are plotted on the growth chart of the child
health card. To monitor growth, you must use the growth chart on the back of the child health
card. You need to study a blank growth chart to be thoroughly familiar with its contents . To
start with, note: the top line represents the average growth line of healthy boys and the
bottom line is the 3rd percentile for girls (the lower limit of normal weight-for-age of healthy
girls).
To determine an individual child’s growth pattern, weight measurements from birth are
plotted on the growth chart of the child health card. The plotting produces a line or graph.
This line constitutes that individual child’s growth pattern or curve.
Road to Health Chart
A constantly upward curve parallel to the printed lines shows GOOD growth. You should
inform the mother or caretaker that the child is growing well and praise her for her good
efforts.
By looking at the direction of the child’s growth curve, the health worker and the mother can
see at a glance whether the child is gaining weight appropriately or not. Let us briefly look at
how to interprete a child’s growth curve or pattern..
Interpretation of the growth curve It is important to know how to interpret the individual
child’s Growth Curve or pattern on the Child Health Card. Interpretation simply means
determining whether the child is growing appropriately or not. The interpretation is done by
watching the direction of the child’s growth pattern. The direction of the growth curve
indicates how the child is growing.
The weight growth pattern of the larger term infants will be above the pattern of the average
term infant. On the other hand, the weight growth pattern of the smaller term infants will be
below the pattern of the average term infant. A small baby whose growth pattern is below the
bottom line in the growth chart is healthy if that child’s growth pattern is parallel to the
bottom percentile line. As long as the baby is gaining weight, however, at an acceptable rate,
the mother should not worry
A horizontal (flat) growth a curve like the one in Fig. 5.6 means DANGER! It means the
child is not growing and is sign of disease, especially malnutrition. A child who is
malnourished cannot grow properly, cannot resist diseases, and is in danger of getting killer
diseases. You should take a thorough history from the mother to establish the cause of growth
failure and then advise the mother. You should also encourage the mother to give the child
food containing enough calories, protein, vitamins and minerals.
A static growth curve
A curve deviating downwards, indicates a VERY DANGEROUS situation. The child is
losing weight. The child needs extra care immediately. The baby may be suffering from
malnutrition, tuberculosis, AIDS or other medical conditions. The mother is advised to take
the baby to hospital for investigations and treatment.
Any infant who does not gain weight for one month or a child who does not gain weight for
two months should receive urgent attention. Such an infant or child is becoming
malnourished.
you should record important events that affect the child’s growth above the curve in the
Growth Chart. Such events include diseases, weaning, introduction of solids and stopping of
breastfeeding.
THE NEW BORN BABY
The new born or neonatal period is the period from birth to 28 days. The neonatal period
deals with infants who are live born .
Definition A normal new born is a baby born at 37 completed weeks or thereafter, has birth
weight of 2500gm or more and has no complications. All health care levels including the
community should be able to look after a normal neonate.

Signs of a physically Healthy Child:

 Good Appetite
 Bright Eyes,
 Clear skin,
 Plenty of Energy, Active,
 Alert,
 Well-Developed Muscles,
 Teeth in Good Condition,
 Few Aches and Pains,
 Often Noisy,
 Sleeps Soundly, Gains Steady in Height and Weight Over period of Months.

Common problems of a new born baby within the first 24 hours

1. Birth Asphyxia
This is defined as Failure to initiate and sustain breathing at birth.
Prevention of asphyxia
 All pregnant women should be encouraged to attend ante-natal care
 Educate people at all levels on the importance of delivering under the care of skilled birth
attendants
 Equip all skilled birth attendants with adequate neonatal resuscitation skills
 Promote identification of women, with danger signs during pregnancy, labor and delivery
 Predisposing factors
 Prolonged labour/difficult/instrument delivery
 Pre-eclampsia/eclampsia
 Ante-partum haemorrhage
 Malaria/fever
 Pre-term deliveries
 Previous foetal or neonatal death
 Meconium stained liquor (due to foetal distress)
 Maternal sedation (anaesthesia, analgesic)
 Cord-prolapse
 Prolonged rupture of membranes
 Breech or other abnormal presentation
 Multiple births

2. Neonatal jaundice
It is the yellow discoloration of the skin and mucous membranes as a result of raised
bilirubin levels occurring in the first 28 days of life. It may be classified as physiological or
pathological jaundice.
Physiological Jaundice
 This is a common problem in the newborn especially the pre-term
 Usually appears after 48 hours of birth and resolves in 7-10 days or a little longer in the
pre-term
 Mainly occurs in the skin and eyes
 Baby looks and feeds well

On examination check on:

 Yellowness of skin and mucus membranes
 Colour of urine and stools
 General behavior and activity
 Signs of infection
 Ability to suck properly
 Check for pallor
 Monitor bilirubin levels

management
 No treatment is necessary for most cases of physiological jaundice but encourage
breastfeeding
 Keep baby warm
 Continue breastfeeding or give EBM
 Give antibiotics when indicated
3. Oral thrush
This is diagnosed when there are thick white patches on tongue or inside the mouth

Management:
 Wash hands
 Clean baby‘s mouth with a clean soft cloth
 Continue breast feeding
 Treat mother‘s breast with the same medicine
 Follow up after 2 days
 Review after 2 days: If worse, refer to hospital, if improving, continue treatment for 5
days

4. Cord infection
Definition; Cord infection is inflammation of the umbilical stump usually occurring in the
first week of life.

Diagnosis
Signs and symptoms may be early or late Early signs
 Redness at base of stump
 Wetness of Stump
 Offensive smell
Late Signs
 Baby looks ill
 Temperature may be elevated
 Baby may refuse to feed
 Pus discharge from the umbilicus
 Jaundice

Management
 Wash hands before handling the cord
 Wear clean gloves
 Clean the cord with antiseptic solution e.g. povidine (tincture) iodine with clean gauze/
cotton wool
 Apply Gentian Violet four times a day
 Keep cord dry
 Keep baby clean
 Continue breast feeding
If improved continue antibiotic for 5 days

Care of a new born baby

Handling a New-born

If you haven't spent a lot of time around new born’s, their fragility may be intimidating. Here
are a few basics to remember:

 Wash your hands (or use a hand sanitizer) before handling the baby. New-borns don't
have a strong immune system yet, so they are susceptible to infection. Make sure that
everyone who handles your baby has clean hands.
 support the baby's head and neck. Cradle the head when carrying the baby and support
the head when carrying the baby upright or when you lay your baby down.
 Be careful not to a new-born, whether in play or in frustration. Shaking that is
vigorous can cause bleeding in the brain and even death. If you need to wake your infant,
don't do it by shaking — instead, tickle your baby's feet or blow gently on a cheek.
 Make sure your baby is securely fastened into the carrier, stroller, or car seat. Limit any
activity that could be too rough or bouncy.
 Remember a new-born is not ready for rough play, such as being jiggled on the knee or
thrown in the air.

To prevent or heal diaper rash, try these tips:

 Change your baby's diaper frequently, and as soon as possible after bowel movements.

 After cleaning the area with mild soap and water or a wipe, apply a diaper rash or "barrier"
cream. Creams with zinc oxide are preferred because they form a barrier against moisture.
 If you use cloth diapers, wash them in dye- and fragrance-free detergents.

 Let the baby go un-diapered for part of the day. This gives the skin a chance to air out.

Bathing

Undress the baby and then place him or her in the water immediately, in a warm room, to
prevent chills. Make sure the water in the tub is no more than 2 to 3 inches deep, and that the
water is no longer running in the tub. Use one of your hands to support the head and the other
hand to guide the baby in feet-first. S-peaking gently, slowly lower your baby up to the chest
into the tub.

Use a washcloth to wash his or her face and hair. Gently massage your baby's scalp with the
pads of your fingers or a soft baby hairbrush, including the area over the fontanels (soft spots)
on the top of the head. When you rinse the soap or shampoo from your baby's head, cup your
hand across the forehead so the suds run toward the sides and soap doesn't get into the eyes.
Gently wash the rest of your baby's body with water and a small amount of soap

Feeding of a new born baby

Feeding a new-born is a round-the-clock commitment. It's also an opportunity to begin

forming a bond with the newest member of your family. Consider these tips for feeding a
new-born.

1. Stick with breast milk or formula

Early initiation of feeds .
Breast milk is the ideal food for babies with rare exceptions. If breast-feeding isn't possible,
use infant formula. Healthy new-born don't need water, juice or other fluids.

2. Feed your new-born on demand

Most new-born need to feed 8 to 12 feedings a day about one feeding every two to three
hours.

Look for early signs of hunger, such as stirring and stretching, sucking motions and lip
movements. Fussing and crying are later cues. The sooner you begin each feeding, the less
likely you'll need to soothe a frantic baby.
When your baby stops sucking, closes his or her mouth, or turns away from the nipple or
bottle, he or she might be full or simply taking a break. Try burping your baby or waiting a
minute before offering your breast or the bottle again.

As your baby gets older, he or she will take in more milk in less time at each feeding.

3. Consider each feeding a time to bond with your new born

Hold the new born close during each feeding. Look him or her in the eye. Speak with a gentle
voice. Use each feeding as an opportunity to build your new born's sense of security, trust
and comfort.

4. Know when to ask for help

If having trouble breast-feeding, ask a lactation consultant or your baby's doctor for help
especially if every feeding is painful or your baby isn't gaining weight. If you haven't worked
with a lactation consultant, ask your baby's doctor for a referral or check with the obstetrics
department at a local hospital.

Continuing health education and promotion for the care giver

Counsel the caregiver on continuing care of the baby:
 Optimum infant feeding
 Initiate breastfeeding within one hour after delivery
 Encourage exclusive breastfeeding for at least 6 months (or replacement feeding where
indicated)
 Show the mother how to position the baby for proper attachment to the breast
 Wash hands after changing the baby and before feeding Start complementary feeding
after 6 months
PREMATURITY

This is when an infant is born prior to 37 weeks of gestation. A normal pregnancy lasts about
40 weeks, measured from the first day of the last period (38 weeks after fertilisation). A
premature birth is a birth that takes place more than three weeks before the baby is due.
Uterine contractions and dilation, which is the opening of the cervix, before the 37th week of
pregnancy is called premature or preterm labour. Babies born before the 37th week of
pregnancy are called premature babies.
Low Birth weight baby: Any baby whose weight is below 2500gms at birth. Very low birth
weight infant. Any baby whose weight is below 1500gms at birth. Extremely Low Birth
Weight (ELBW) Birth weight < 1000 grams and greater than 750grams
Pre-term Baby: Any baby born before 37 completed weeks of gestation.

Causes of premature baby

a) Multiple pregnancy:

The overstretching of the womb that occurs in the case of twin or triple pregnancies increase
the risk of premature labour

b) Lifestyle factors:

The mother's lifestyle can increase the risk of having a premature baby. For example,
smoking, using recreational drugs, having a high caffeine intake, having a poor die or
drinking alcohol or using street drugs during pregnancy

c) Maternal weight

You were significantly underweight or overweight when you became pregnant

d) Maternal age

Mothers under 20 or over 35 years old have a slightly higher risk of preterm labour.

e) Fetal development:

If the baby is not thriving in the womb, for example, if the placental blood supply is impaired
or there is evidence of growth retardation, then this can lead to premature birth.
 f) Previous gynaecological history:

Women who have had surgery on their cervix may have suffered damage to the opening of
the womb. This can cause the cervix to open too soon in pregnancy, resulting in premature
labour.

g) Infection:

This is another potential trigger of preterm labour. Vaginal infections, such as gonorrhoea,
chlamydia, trichomoniasis, bacterial vaginosis and group B streptococci have all been linked
to preterm labour. Bladder infections can also trigger early labour if left untreated.

h) Pregnancy-specific maternal disease:

Examples of this include pregnancy-induced high blood pressure, preeclampsia, and diabetes

i) Not getting good prenatal care

Not receiving antenatal care from a qualified healthcare provider.

Characteristics of a premature baby

The following are the most common symptoms of a premature baby. But each baby may
show slightly different symptoms. Symptoms may include:

 Small size. Premature babies often weighing less than 5 pounds, 8 ounces.
 Thin, shiny, pink or red skin. You are able to see veins through the skin.
 Little body fat
 Little scalp hair.
 Weak cry
 Poor muscle tone
 Male and female genitals are small and underdeveloped
Management of a premature baby

Thermoregulation

Maintenance of the neutral thermal environment is critical for minimizing stress and
optimizing growth of the premature infant. The neutral thermal environment is defined as the
environmental temperature in which the neonate maintains a normal temperature and is
consuming minimal oxygen for metabolism.

Kangaroo Mother Care

KMC consists of various preterm infant care practices that include skin-to-skin contact,
breastfeeding, and close post discharge follow-up. Rationale Kangaroo Mother Care (KMC)
is the care of a small baby who is continuously kept in skin-to-skin contact with the mother.
It provides the new born low birth weight or preterm baby with the benefits of incubator care
and is cheaper.
It is the best way to keep a small baby warm and it also helps establish breastfeeding. KMC
can be started in the hospital as soon as the baby‘s condition permits i.e. the baby does not
require special treatment, such as oxygen or IV fluids. KMC, however, requires that the
mother stays with the baby or spends most of the day at the hospital until baby is feeding and
gaining weight well. Thereafter it can be continued at home with regular outpatient
monitoring.
Advantages of Kangaroo Mother Care to the baby
 Keeps the baby warm  Infections are prevented
 The baby feeds more easily  Baby grows very well
 Episodes of apnoea are less frequent

Methods of feeding a premature baby

There are three ways to feed premature babies: intravenously, through a feeding tube, and
directly by mouth. They may receive three different kinds of nutrition: total parenteral
nutrition (TPN), breast milk, and infant formula designed for premature babies. How and
what a premature baby is fed depends on their gestational age and whether there are
complications with any part of the gastrointestinal tract.

Intravenous feeding and parenteral nutrition

Although even the most premature gut is capable of accepting and digesting milk, sometimes
the baby may be too unwell to be fed this way. In such cases, premature babies are fed in a
way that bypasses the digestive system altogether and delivers nutrition directly to the baby’s
bloodstream through an intravenous line (IV) or a catheter.

Through this line, a premature baby is initially fed sugar water with essential electrolytes for
a few days, followed by a solution called total parenteral nutrition (TPN). Made up of
proteins, vitamins, minerals, sugar, fat and water, TPN feeding may go on for days or weeks
depending on the maturity of the baby and her ability to feed in an alternative way.

Gavage feeding

Once the premature baby is stable enough to receive feeding through the gut, she can be
given gavage or nasogastric (NG) feedings. A small tube is inserted through the nose or
mouth and run directly into the baby’s stomach. Small amounts of expressed breast milk or
formula are then gently allowed to flow into the stomach. If the baby handles these feedings,
she is fed progressively larger quantities.

Breastfeeding and bottle feeding

Once the baby has developed the co-ordination to begin sucking and swallowing, the team
will make an effort to help the parents with breast feeding. Most mothers are encouraged to
pump their milk right away so that the flow of milk begins and continues. Pumped breast
milk can be given to the baby when he is ready for either gavage, breastfeeding or bottle
feeding. Many parents have a great desire to feed their child themselves, which enhances
their parenting role and helps with the bonding process.

For Children 6-59 months

 Breast milk continues to be the most important part of the baby’s diet.
 At 6 months the baby is developmentally ready and begins to need other foods in
addition to breast milk.
 Gradually increasing the variety, amounts and frequency of food given to a growing
child helps to keep pace with their increased nutritional needs
 Foods given to baby’s must be prepared and stored in hygienic conditions to avoid
contamination and illness
 Continue frequent on demand breastfeeding until 2 years of age or beyond

Expressing breast milk

The mother should express as much as she can as often as her baby would breastfeed. This
should be at least every three hours, including during the night. If she expresses only a few
times, or if there are long intervals between expressions, she may not be able to produce
enough milk.
A mother should:
 Wash hands
 Prepare a sterile/clean container
 Gently massage breasts in a circular motion with her fingers
 Position thumb on the upper edge of the areola and the first two fingers on the
underside of the breast behind the areola
 Press behind the nipple and areola between the finger and thumb
 Compress and release the breast with the fingers and the thumb a few times
 Press from all the sides to empty all segments
 If no milk is expressed, move thumb and fingers towards or further away from the
nipple and try again
 Repeat compressing and releasing rhythmically
 Rotate the thumb and finger positions to remove milk from other parts of the breast
 Avoid squeezing the breast, pulling out the nipple and breast, and sliding the finger
along the skin
 Some mothers find that pressing in towards the chest wall at the same time as
compressing helps the milk to flow. Use the following rhythm: position, push, press;
position, push, press.

help the mother understand;

 Milk removal stimulates milk production.
 The amount of breast milk removed at each feed determines the rate of milk
production in the next few hours.
 Milk removal must be continued during separation to maintain supply.

To keep up her milk supply: She should express at least every three hours.
To build up her milk supply, if it seems to be decreasing after a few weeks: Express very
often for a few days (every 2 hours or even every hour), and at least every three hours during
the night.
Cup feeding
When a LBW baby is fed by cup, he or she initially “laps” the milk with the tongue. This
action does not interfere later with attachment when the baby is ready to feed at the breast.
•To feed expressed breast milk/formula milk by cup, the mother should:
•Swaddle the baby to prevent the baby’s hands from knocking the cup and hold the baby
closely
•Support the baby’s head and sit the baby upright or semi upright in her lap
•Hold the small cup to the baby’s lips; the baby might make sucking motions• Hold the rim
of the cup to the baby’s upper lip and tip it slightly so that the milk just m reaches the baby’s
mouth; the baby will then star lapping the milk with the tongue
•Tip the cup so that the milk just reaches the baby’s lips and allows the baby to take the milk
•Keep the cup tilted so that the milk just reaches the baby’s mouth; let the baby control the
pace at which the milk is taken
•Try to estimate the amount of milk that has been spilt (e.g., trickling down the baby’s chin or
cheek) and give the baby that much more
Spoon feeding
Spoon feeding is safe, but many people find it more difficult than using a cup. For babies
with breathing problems, spoon feeding may be the best approach until the breathing problem
has lessened. Preterm babies can have breathing problems because of immature lungs. LBW
babies born at term may have breathing problems from other causes, such as a severe
infection (pneumonia) or meconium aspiration. Care should be taken not to pour the milk
from the spoon into the baby’s mouth. The baby should be allowed to sip the milk from the
spoon, or very small amounts can be put into the baby’s mouth

Complications associated with premature babies

Some of the problems premature babies may have include:

 Keeping their body temperature steady or staying warm

 Breathing problems, including serious short- and long-term problems
 Blood problems. These include low red blood cell counts (anemia), yellow-colour to
the skin from breaking down old red blood cells (jaundice), or low blood sugar levels
(hypoglycaemia).
 Kidney problems
 Digestive problems, including difficulty feeding and poor digestion
 Nervous system problems, including bleeding in the brain or seizures
 Infections
LACTATION

Lactation is the process of producing and releasing milk from the mammary glands in the
breasts. Lactation begins in pregnancy when hormonal changes signal the mammary glands
to make milk in preparation for the birth of your baby. It’s also possible to induce lactation
without a pregnancy using the same hormones that your body makes during pregnancy.
Lactation ends once your body stops producing milk.
Feeding the baby directly from the breasts is called breastfeeding or nursing. You can also
feed the baby milk that the mother has expressed or pumped from their breast and saved in a
bottle.
These glands have several parts that work together to produce and secrete milk:
 Alveoli: These tiny, grape-like sacs produce and store milk. A cluster of alveoli is
called lobules, and each lobule connects to a lobe.
 Milk ducts: Each lobe connects to a milk duct. You can have up to 20 lobes, with one
milk duct for every lobe. Milk ducts carry milk from the lobules of alveoli to your
nipples.
 Areola: The dark area surrounding your nipple, which has sensitive nerve endings that
lets your body know when to release milk. To release milk, the entire areola needs
stimulation.
 Nipple: Your nipple contains several tiny pores (up to about 20) that secrete milk.
Nerves on your nipple respond to suckling (either by a baby, your hands or a breast
pump). This stimulation tells your brain to release milk from the alveoli through the
milk ducts and out of your nipple.
Hormones for lactation
The hormone prolactin controls the amount of milk you produce, and your body begins
producing prolactin early in pregnancy. At first, the high levels of estrogen, progesterone and
other pregnancy hormones suppress prolactin. Once you deliver the placenta, those
pregnancy hormones drop and prolactin takes charge.
When your baby suckles, it stimulates nerves that tell your body to release prolactin and
oxytocin. Prolactin causes the alveoli to make milk and oxytocin causes muscle contractions
that push out of the alveoli and through the milk ducts.
When milk is released, it’s called a “letdown,” and it takes about 30 seconds of suckling
before the letdown occurs. Because you can’t control which breast receives the hormones, the
letdown can cause milk to drip from both nipples.
Inducing lactation in people who aren’t pregnant requires medication that mimics hormones
your body makes during pregnancy. Suckling from the nipple can initiate lactation, either
with a breast pump or by a baby. This is a complex process that involves working closely
with a healthcare provider who understands the needs of non-pregnant people and has
experience initiating lactation
Breast feeding
Breastmilk is the ideal food for infants. It is safe, clean and contains antibodies which help
protect against many common childhood illnesses. Breastmilk provides all the energy and
nutrients that the infant needs for the first months of life, and it continues to provide up to
half or more of a child’s nutritional needs during the second half of the first year, and up to
one third during the second year of life.
Breastfed children perform better on intelligence tests, are less likely to be overweight or
obese and less prone to diabetes later in life. Women who breastfeed also have a reduced risk
of breast and ovarian cancers.
 Exclusive breastfeeding for 6 months ensures optimal health,reduced infections, proper
growth and development for your baby.
 Exclusive breastfeeding is possible for all women to do, whetheryou are working or not.
It simply requires planning and a bit of time.
 It’s important for a pregnant mother to think about and plan howshe will exclusively
breastfeed for the first 6 months of life.
 If a mother is working away from her baby, then she will have to planto express breast
milk and store it appropriately for the caregiver to feed the baby in her absence.
 Take time during the work day to express breast milk for your baby.
 Women can express breast milk and freeze it for future use.
 If a mother does plan well, exclusive breastfeeding is not that difficult. You canexpress
breast milk during breaks or lunch at work in a privateroom or area, or express breast
milk in the evenings.
 If a mother does not exclusively breastfeed your baby for the first 6 months, she will put
her baby at risk/ of illness, malnutrition and poor cognitive development leading to low
performance in school. Don’t risk your child’s life.

Assignment:
Infant formulas and other milk sources

Management of Breast problems:

Prevention
 Proper attachment and positioning of the baby during breastfeeding
 Frequent emptying of the breasts
 Not giving pre-lacteal feeds e.g. glucose, water or other types of milk
 Educate women on how to breastfeed during antenatal clinic, and how to manage simple
breast problems
Sore or cracked nipples
Diagnosis
 Mother reports pain on breastfeeding
 Cracks may be seen on nipples
Management
 Counsel on personal hygiene and how to keep the nipples clean
 Express the milk from the affected breast to prevent engorgement
 Show mother how to position and attach baby
 Apply milk on the cracks and encourage exposure to air or sunshine if possible
 Continue breastfeeding both breasts
 Check for oral thrush in baby

Breast Engorgement
Breast engorgement occurs when there is congestion as well as over accumulation of milk
Diagnosis
The breasts feel hard with distended vessels. They are also warm and tender. The areola may
look oedematous.
Management
Mother is breastfeeding:
 If the baby is not able to suckle encourage the woman to express the milk
 Encourage the woman to breastfeed more frequently, using both breasts at each feeding
 Show the woman how to hold and attach baby to breast
 Relief measures before breastfeeding may include:
Applying warm/ cold compresses to the breasts just before breastfeeding, or
encourage the woman to take warm shower .
Massage the woman‘s neck and back
Have the woman express some milk manually prior to breastfeeding and wet the
nipple area with breast milk to help the baby latch properly and easily.

Mastitis
Mastitis is defined as inflammation of the breast.
Management:
 Treat with antibiotics e.g. Cloxacillin 500mg every six hours for 5-10 days Or
Erythromycin 500mg every six hours for 5 – 10 days
 Analgesics e.g. Paracetamol 500mg orally as needed
 Encourage the woman to:
Continue breastfeeding on the unaffected side
Support breast with brassiere
Apply cold/ warm compresses to the breast between feeds to reduce swelling and pain
Express the milk from affected side several times a day and discard
 Follow up three days later to ensure response.
Breast Abscess
A breast abscess is a localized collection of pus in the breast.
Management
 Treat with antibiotics as in mastitis
 Drain the abscess - general anaesthesia e.g. Ketamine is usually required; you may also
use Local anaesthetic spray
 Make the incision radially extending from near the alveolar margin towards the periphery
of the breast to avoid injury to the milk ducts
 Wear sterile gloves and use a finger or tissue forceps to break up the pockets of pus
 After draining the pus loosely pack the cavity with gauze
 Remove the gauze pack after 24 hours and replace it with a small gauze pack
 If there is still pus in the cavity place a small gauze pack in the cavity and bring the edge
out through the wound as a wick to facilitate drainage of any remaining pus
 Encourage the woman to:
Continue breastfeeding from the unaffected breast o Support breast with a binder or
brassiere
Apply cold/ warm compresses to the breast between feeds to reduce swelling and pain
o Give analgesics e.g. Paracetamol 500mg orally 8hrly for 7 days
Follow up 3 days after initiating management to ensure response
Educate the mothers on the importance of emptying the breasts

Inverted nipple

Inverted nipples are nipples that point inward or lie flat, rather than pointing out. It’s also
called retracted nipples. It can happen in one breast or both. may have been born this way.
But if it starts to happen later in life, it could be a sign of a medical problem that needs to be
checked by a doctor.

Treatment of Inverted Nipples

Hoffman technique. This exercise can be useful if your nipples are flat or mildly inverted and
you want to get ready for successful breastfeeding. You place your thumbs on either side of
the base of the nipple and press downward while pulling your thumbs apart. Work your way
around to all sides of the nipple. Your nipple should then stand out.
Nipple eversion devices. the nipple outward with a syringe or suction cup device. Hard
plastic breast shells worn inside your bra put pressure around the nipple, forcing it forward.

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Surgery. The treatment for most inverted nipples is surgery. If you plan to breastfeed in the
future, talk to your surgeon about the risk that the operation might harm your milk ducts.
Also, keep in mind that some nipples go back to being inverted even after the procedure

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COMPLIMENTARY FEEDING AND WEANING
Complementary feeding means giving other foods in addition to breast milk. These other
foods are called complementary foods

These additional foods and liquids are called complementary foods, as they are additional or
complementary to breastfeeding, rather than adequate on their own as the diet.
Complementary foods must be nutritious foods and in adequate amounts so the child can
continue to grow. The term ‘complementary feeding’ is used to emphasize that this feeding
complements breast milk rather than replacing it. Effective complementary feeding activities
include support to continue breastfeeding.

Food selection for complementary feeding

Starting other foods in addition to breast milk at 6 completed months helps a child to grow
well.

After six months, babies need to learn to eat thick porridge, puree and mashed foods.

These foods fill the energy gap more than liquids. At six completed months of age it
becomes easier to feed thick porridge and mashed food because babies:

 show interest in other people eating and reach for food

 .like to put things in their mouth
 can control their tongue better to move food around their mouth
 Start to make up and down ‘munching’ movements with their jaws.

Complementary foods should meet the basic criteria of: Frequency ,Amount Texture
(thickness) ,Variety, Adequacy, active feeding , Hygiene Abbreviated as FATVAH

 One criterion for the selection of complementary foods is that they be rich sources of
zinc and iron because both of these essential micronutrients are critical for normal
growth and development, and requirements are not met by exclusive breast-feeding
after 6 months
 specifically foods choices that should be considered for meeting the nutritional needs
of infants and toddlers
 choose foods that are free of contamination (pathogens, toxins or harmful chemicals)

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  Foods without much salt or spices, easy to eat and easily accepted by the infant, in an
appropriate amount
 Easy to prepare from family foods, and at a cost that is acceptable by most families.

Stages of weaning

Stage 1 (around 6 months, not before 17 weeks)

 This stage is all about exploration where your baby becomes familiar with taking
foods from a spoon.
 One new food should be introduced at a time with each new food spaced 1-2 days
apart. New foods should ideally be given early in the day.
 The food offered should become increasingly varied so that your baby can experience
different tastes and flavours.
 Start by offering a runny texture, and gradually move to slightly thicker purées
without lumps. Offer 2-3 meals per day of about 5-10 teaspoons per meal.
 Continue to breastfeed on demand or the give usual amount of formula, offering
solids during or after the milk feed.
 Suggestions for first foods: gluten free cereal e.g. baby rice, pureed fruit, pureed
vegetables and pureed chicken or fish (remember to remove any bones and make sure
they are well cooked).

Stage 2 (6-9 months)

 You and your baby are ready; you can start to increase the amount of solid food. At
this stage you should try offering approximate. 3 meals a day of about 2-4 tablespoons
per meal (build it up gradually over these months).
 Continue to breastfeed on demand or give 600-800ml formula milk every day. Space
spoon and milk feeds apart.
 At this stage of weaning, it is also important to start introducing slightly lumpier
consistencies to your baby. The consistency of food should be minced or mashed
textures and soft finger foods.
 In addition to vegetables, fruit and meat/fish, you can now start to incorporate well-
cooked eggs, bread, pasta, cheese (pasteurised) and yogurt into your baby’s diet.
 This is also a great time to experiment with flavour combinations so try giving
different foods together.

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  Suitable soft finger foods include chopped banana, softly cooked carrot sticks, softly
cooked pasta pieces or fingers of soft toast.

Stage 3 (9-12 months)

 At this stage, your baby should be able for a wider variety of foods in greater textures,
and should be able to manage more than 2 textures in one meal.
 You should base your baby’s meals and snacks around normal family foods and
mealtimes.
 Increase the variety of foods to allow your baby to experience more tastes and
flavours. Offer 3 meals plus 2-3 nutritious snacks. The approximate size of each meal
should be 4-6 tablespoons but this will depend on your baby’s appetite.
 Foods should be more lumpy foods, and you can also offer chopped foods in bite-
sized pieces and harder pieces of finger food that your baby can pick up and feed
himself should also be offered.
 Continue to breastfeed on demand or give your baby their usual milk feeds per day
(maximum of 600ml/20oz). Space solid and milk feeds apart.

Effects of early complimentary feeding

Adding foods too soon may

 Take the place of breast milk, making it difficult to meet the child’s nutritional needs
 Result in a diet that is low in nutrients if thin, watery soups and porridges are used
 Increase the risk of illness because less of the protective factors in breast milk are
consumed increase the risk of diarrhoea because the complementary foods may not be
as clean or as easy to digest as breast milk
 Increase the risk of wheezing and other allergic conditions because the baby cannot
yet digest and absorb non-human proteins well
 Increase the mother’s risk of another pregnancy if breastfeeding is less frequent.

Complications of late complimentary feeding

Adding foods too late may

 Result in child not receiving required nutrients

 Slow child’s growth and development
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  Risk causing deficiencies and malnutrition such as anaemia from lack of iron.

IMMUNIZATION

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.

Aspects of immunity

Immunity is the balanced state of multicellular organisms having adequate biological

defences to fight infection, disease, or other unwanted biological invasion, while having
adequate tolerance to avoid allergy, and autoimmune diseases. The immune system is the
collection of cells, tissues and molecules that protects the body from numerous pathogenic
microbes and toxins in our environment

Types of Immunity:

There are two major types of immunity: innate or natural or nonspecific and acquired or
adaptive.

(A) Innate or Natural or Nonspecific Immunity (L. innatus = inborn):

Innate immunity is inherited by the organism from the parents and protects it from birth
throughout life. For example humans have innate immunity against distemper, a fatal disease
of dogs.

(B) Acquired Immunity (= Adaptive or Specific Immunity):

The immunity that an individual acquires after the birth is called acquired or adaptive or
specific immunity. It is specific and mediated by antibodies or lymphocytes or both which
make the antigen harmless.

Characteristics of Acquired Immunity:

(i) Specificity:

It is the ability to differentiate between various foreign molecules (foreign antigens).

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(ii) Diversity:

It can recognise a vast variety of foreign molecules (foreign antigens).

(iii) Discrimination between Self and Non-self:

It can recognise and respond to foreign molecules (non-self) and can avoid response to those
molecules that are present within the body (self) of the animal.

(iv) Memory:

When the immune system encounters a specific foreign agent, (e.g., a microbe) for the first
time, it generates immune response and eliminates the invader. This is called first encounter.
The immune system retains the memory of the first encounter. As a result, a second
encounter occurs more quickly and abundantly than the first encounter.

The cells of the immune system are derived from the pluripotent stem cells in the bone
marrow. Pluripotent means a cell that can differentiate into many different types of tissue
cells. The pluripotent stem cells can form either myeloid stem cells or lymphoid stem cells.

Importance of immunization

 Immunizations can save your child’s life. Because of advances in medical science,
your child can be protected against more diseases than ever before. Some diseases that
once injured or killed thousands of children, have been eliminated completely and
others are close to extinction– primarily due to safe and effective vaccines. Polio is
one example of the great impact that vaccines had have in the United States. Polio
was once America’s most-feared disease, causing death and paralysis across the
country, but today, thanks to vaccination, there are no reports of polio in the United
States.
 Vaccination is very safe and effective. Vaccines are only given to children after a
long and careful review by scientists, doctors, and healthcare professionals. Vaccines
will involve some discomfort and may cause pain, redness, or tenderness at the site of
injection but this is minimal compared to the pain, discomfort, and trauma of the
diseases these vaccines prevent.
 Vaccines have an expansive reach: they protect individuals, communities, and entire
populations to help keep them safe, it is important that you and your children who are

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 able to get vaccinated are fully immunized. This not only protects your family, but
also helps prevent the spread of these diseases to your friends and loved
 Immunizations can save your family time and money. A child with a vaccine-
preventable disease can be denied attendance at schools or child care facilities. Some
vaccine-preventable diseases can result in prolonged disabilities and can take a
financial toll because of lost time at work, medical bills or long-term disability care.
In contrast, getting vaccinated against these diseases is a good investment and usually
covered by insurance. The Vaccines for Children program is a federally funded
program that provides vaccines at no cost to children from low-income families.
 Immunization protects future generations. Vaccines have reduced and, in some
cases, eliminated many diseases that killed or severely disabled people just a few
generations ago. For example, smallpox vaccination eradicated that disease
worldwide. Your children don’t have to get smallpox shots anymore because the
disease no longer exists.

The immunization schedule

The immunization schedule is being followed according to the age of the child. Every child

has the right to complete vaccination before the first birthday. The following is the

immunization schedule as per the age of the child:

At birth

 BCG (BacilleCalmette Guerin) vaccine to prevent TB

6 weeks ( 1 ½ months)

 Rota Virus

 Oral polio vaccine ( OPV)

 DPT/H HCPB/HB (Diphthelus Pertusis, Tetanus/Hepatitis B/Hemophilis Influenza

Type B ) PVC (Pneumoccocal Conjugate Vaccine)

10 weeks (2 ½ months)

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  Rota virus

 Oral polio vaccine ( OPV)

 DPT/H HCPB/HB (Diphthelus Pertusis, Tetanus/Hepatitis B/Hemophilis Influenza

Type B ) PVC (Pneumoccocal Conjugate Vaccine)

14 weeks (3 ½ months)

 Oral polio vaccine ( OPV)

 DPT/H HCPB/HB (Diphthelus Pertusis, Tetanus/Hepatitis B/Hemophilis Influenza

Type B ) PVC (Pneumoccocal Conjugate Vaccine)

6 months

 Give vitamin A supplement (100,000 IU) to the child (blue capsule)

 Vitamins and mineral powder, 10 sachets for a month

9 months

 Meascles vaccine

12 months

Give vitamin A supplement (200,000 IU), red capsule.

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