Kangaroo Mother Care Method
Feeding strategies for preterm and
Low birth infants
Module 3
Table of contents
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Introduction and goal of the KMC feeding strategy
Suction in newborns
Breastfeeding preterm infants
Adaptation to the KMC feeding strategy
Feeding modes in preterm infants
Feeding preterm infants from the breast
Alternative feeding methods
Stimulation of feeding in preterm infants
Milk extraction
Maternal difficulties to breastfeed
Problems with insufficient milk production
Transition from hospital to home after discharge
Preterm infant formula
2
KMC Components
• 1st : Kangaroo position
– The infant is placed almost naked in strict upright ventral position
between the mother´s breast, in direct contact with her skin, as long
as possible
• 2nd : Kangaroo Feeding and Nutrition strategy
− Ideally exclusive breastfeeding to have a weight gain similar to the
growth during the intra uterine life ( 15 g/Kg/day )until full term
•
3rd : Early Discharge and strict ambulatory follow up
− Discharge in kangaroo position regardless of weight and gestational
age when the child is able to coordinate sucking, swallowing and
breathing , gaining weight for 3 days and have parents informed ,
trained and ready to come to follow up visits
3
Introduction
• The kangaroo nutrition strategy is intended for children who are
in the “stable growth period”, after the transition period until
the infant reaches full term
– This period is considered similar to the period of intra uterine growth
which may have occurred if the infant was not born prematurely
• Children during this period face a double challenge: having to
grow at the rate they would have grown while still “in utero”,
and to recover from the deficits accumulated during the
transition period
• KMC feeding strategy focusses on successful breastfeeding
4
Breast milk is the “must”
• “Human milk is species-specific ,and all substitute feeding
preparations differ markedly from it, making human milk
uniquely superior from infant feeding.
• Exclusive breastfeeding is the reference or normative model
against which all alternative feeding methods must be
measured with regard to growth, health , development , and
all short and –and long terms outcomes.
• In addition, human milk-fed preterm infants receive significant
benefits with respect to protection and improved development
outcomes compared with formula fed preterm infants “
5
Goals for the KMC Nutrition
• Obtain adequate growth and short term nutrient retention, which allow
the preterm infant to come close to the intra uterine growth charts and to
the fetal composition of reference
• Decrease neonatal morbidity by improving food tolerance; reduce the
incidence of necrotizing enterocolitis (NEC) and minimize nosocomial
infection
• Achieve a nutrition that contributes to optimal short and long term
neurological development
• Reduce atopy and allergy index
• Decrease the potential risk of hypertension, cardiovascular disease and
hypercholesterolemia in adulthood
• For the preterm infant, milk from the infant’s own mother is the “must”
and will be used whenever possible; the mother’s milk is always
supplemented with A, D, E and K vitamins up to term. Mother milk may be
also fortified and supplemented whenever it may be necessary
6
Nutrition goal to the KMC method
• Obtain adequate growth and short term nutrient retention,
which allow the preterm infant to come close to the intra
uterine growth charts and to the fetal composition of
reference
• The goal is to reach a weight gain similar to the usual growth
during the intra uterine life 15 g/kg/ day until full term
– If this goal is not reached through exclusive breast feeding it is
necessary to identify and to correct conditions which may explain
inadequate weight gain
– Once the abnormal condition is corrected, growth must improve. If
not, or if there was no any secondary cause for inadequate growth,
breast milk should be fortified or supplemented with special preterm
formula
7
Nutritional Supplements
• ‘Kangaroo’ children who are not getting weight being fed by
breast milk with or without hind milk and who do not present
any pathologies, may receive a supplement, for a limited
period of time in order to avoid losing the initial growth
potential and preventing them to become malnourished
Supplement starts with 25 to 30% of the daily quantity, based
on 180 to 200 ml /kg/day
• The mother must give the supplement using a syringe, a cup
or a dropper but not a baby bottle and always before nursing
the infant, so that the baby only takes what he needs from the
breast
8
Suction in Newborns
• The tongue fills the oral cavity and protrudes outside the mouth in
response to the rooting reflex, it goes beyond the limit of the gums,
envelops the nipple-areola complex, compressing it against the
hard palate and making an undulating back and forth movement:
“tongue slither” which generates positive pressure
– Lips have a sealing function generating negative pressure during
suction; by being everted and well adapted to the mother’s breast,
they provide a hermetic seal
– Eminences in the inner side of the lips have an anti-slid function
– Bichat’s fat pads in the cheeks, prevent them to collapse due to
negative pressure
– The nipple is elongated to allow the ejected milk to flow laterally to
the air way on a zone called “comfort zone”, in the union of soft and
hard palate
9
Feeding Reflexes (1)
•
•
•
Fetus in utero sucks and swallows amniotic fluid
The rooting reflex explored by rubbing, stroking or touching the corner of the mouth
– The infant turn his lips, head and open his mouth to follow and "root" in the
direction of the stimulus
– This helps the infant to find the breast opening widely the mouth allowing a
correct attachment
– It is present from week 32 of gestation.
The suction reflex is assessed by placing a finger inside the infant’s mouth
– The infant begins to suck placing his tongue under the finger and applying
pressure against the palate
– The sucking reflex appears and develops in parallel with the rooting reflex.
– The suckling reflex creates negative pressure which associated to the positive
pressure of the palate allows suction, swallowing and breathing.
10
Feeding Reflexes (2)
• The swallowing reflex is visualized by the movements of the
larynx
– It refers to the set of actions allowing the passage of solid or
liquid from the mouth to the stomach
– It appears from week 16 of gestation
• Non-nutritive suction (NNS) as stimulation is recommended to
develop suction reflexes
• At 34 weeks of gestational age, the suction/breathing pattern
approximates 1:1
11
Suction Disorders in Preterm Infants
Oral motor dysfunction (OMD) is the alteration of the infant' capacity to
attach himself to the breast it can be primary or secondary and may generate
functional and anatomical distortions
•
Primary OMD: due to transitory or permanent neurological problems or to
anatomical abnormalities
•
•
•
Hypertonicity: when suckling , the infant bites the nipple
• massaging the baby’s gums before nursing, and straddling him on the mother’s lap
while breastfeeding are recommended
Hypotonicity: infants with low vitality falling asleep while nursing
• The ” dancer hand position” and milk extraction are recommended
Secondary OMD: occur when original sucking and swallowing reflexes are modified
due to use of artificial teats or bottles
•
•
This causes pain for the mother and inhibiting the let-down reflex making milk extraction
difficult.
It can be corrected by massaging the child’s mouth with the finger pad, applying pressure
on his tongue and gradually withdrawing the finger
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Prerequisites to Adaptation to the KMC
Nutrition
• The kangaroo adaptation to the nutrition of a preterm infant is “a process of
social and physical adjustment for the mother and family to the Kangaroo
Mother Care Method”
– It is done through an education process with social and emotional support
– It is vital for the success of the kangaroo nutrition
• Existing open door policy for parent to stay with their child
•
•
The mother should be recognized as the baby’s primary care provider
her stay next to her child should be done comfortable
• The health team is a central person to advocate and promote satisfactory
breastfeeding
• The support given during the breastfeeding period should:
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–
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Develop the mother’s confidence ,paying attention to the mother’s problems,
Provide precise and practical information about the child’s needs
Offer options and allow the mother to make decisions
Give timely pertinent information on technical and scientific content
13
Breastfeeding preterm infants
•
•
The American Academy of Pediatrics recommended officially since 2005
administering breast milk from the babies’ own mothers, to preterm and other highrisk babies
– Since then, breastfeeding has been the recommended mode of enteral
nutrition for preterm and LBW infants
Breast milk has digestive enzymes, direct immune protective, immunomodulation,
antioxidant and anti-inflammatory factors, hormones bioactive factors and multiple
cellular elements
– Breast milk allows a better cognitive ability development, better neurobehavioral
organization and decrease infection
•
Benefits of breast milk are recognized but it is still difficult to establish successful
breastfeeding in Neonatal Units due to:
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–
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–
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the fragility of preterm babies and their illnesses
their different nutritional needs , the complexity of their care
Infant- mother separation and mother’ anxiety jeopardizing regular milk production
No open door policy allowing parents to stay with children
Fixed schedules for feeding
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Characteristics of preterm breast milk
•
•
•
•
•
The Colostrum is produced during the first 3 - 4 days of life
– It is a thick, yellowish liquid of high density
– From birth to day 3, the volume is from 2 to 20 ml per feeding
– It contains less lactose, fat and water soluble vitamins than mature milk but
more protein, E, A and K vitamins carotene and zinc
Preterm colostrum contains more immunoglobulin A, lysozyme, lactoferrin and
cells
Mature milk The mature milk not only vary from woman to woman but also from
one breast to the other, from one nursing to the next and, varies also during the
same feeding. The hind milk is richer in fat
The preterm mother’s milk contains 2 time more proteins, more sodium , it
provides important amounts of taurine, glycine, leucine and cysteine, more fat ,
more calories and more calcium and phosphorus
Only during the first 4 weeks after birth , mothers of preterm babies produce milk
with a special composition that adapts to the estimated nutritional requirements
of their children
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Feeding modes for preterm infants
• Feeding based on maternal milk from his own mother plus
vitamins A,D,E and K:
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–
–
–
Exclusive, with no fortifiers or supplements
Fortified (fortifiers added to extracted milk)
Supplemented with artificial milk for preterm infants
Supplemented with fortified and pasteurized human milk from a
donor (preterm or full term)
• Feeding based on artificial formula for preterm infants
– Exclusive or supplementary use of other forms or oral or enteral
nutrition; protein hydrolysats, element and semi-element
preparations
• For infants less than 1500g or born before 32 weeks GA breastfeeding is
probably not sufficient to cover the calcium, phosphorus and occasionally,
protein requirements and milk must be fortified with these elements
16
Feeding on schedule preterm infants
• Preterm babies do not demand to be fed until they reach full term
nursing must be done on a schedule rather than on demand
• Infants weighing less than 2000 g or less than 37 weeks of GA, need
short intervals between feedings in order to receive enough nutrients
and to allow for adequate thermoregulation, growth and
development
– Feeding intervals must be approximately every 1 hour and ½
during the day and 2 hours during the night
• Controlling the frequency of feedings is useful:
– Decrease energy loss by suction
– Provide the needed nutrients in sufficient quantities
– Create a routine for mother and child strengthening their bond
– Give the mother a clear timeline.
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Breastfeeding a preterm infant (1)
The transfer of maternal milk to the infant depends of the
interaction between the volume of breast milk, the let-down
reflex and the preterm infant’s suction
• Check signs of readiness for breastfeeding:
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–
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Gestational age 32 weeks
Baby able to coordinate breathing, sucking and swallowing
Baby’s health is clinically stable (no serious breathing problems)
Baby can suckle with rare episodes of apnoea and bradycardia
Apparent signs of being alert/ready to attach
• Breastfeeding a small baby requires patience and dedication because
he/she:
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–
–
–
Suckles for a short time then rests
Can fall asleep while breastfeeding
Can take frequent pauses making breastfeeding longer
Is not always awake for breastfeeding
WHO EURO, 2002
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Breastfeeding a preterm infant
(2)
• Reassure the mother that she is able to feed her baby
– Train the mother to watch the baby completes at least 6 suctions,
alternated with pauses to breathe
– The weight test can be used to determine the volume of ingested breast
milk, but it may stress the mother, daily weight is enough
• Actively counsel her to:
– Feed the baby every 1½ -2 hours
– Wake the baby up for feeding
– Keep the baby at the breast longer
– Let the baby takes long pauses and breastfeed more slowly
– Do not interrupt breastfeeding if the baby is still trying to suckle
– Express some milk before the baby attaches if milk flow needs to
be reinforced
– Breastfeed the baby with hind milk if the baby does not gain
weight
WHO, 2003
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Oral breastfeeding through suction -1
•
•
Skin-to-skin contact has a positive effect on milk production, even before suckling
begins
– Putting children to the breast for the non nutritive suction, increases the
rooting response and stimulates the suckling functions
Direct oral breastfeeding
– Promote the milk let-down reflex by a gentle massage of the breast
– Awake the baby and placed him in a recommended nursing position
– The mother must surround the base of her breast with 4 of the 5 fingers and
place the 5th finger on the edge of the areola forming the letter “C”
– The mother must hold the child’s neck base to control it and to bring the baby
close to the breast, offering him a secure position and orient the nipple in the
direction of the child’s nose , stimulating the rooting reflex
– When the baby naturally tilts his head back and opens his mouth wide, the
mother must bring him to the breast in one single swift and gentle motion of
her hand or arm
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Oral breastfeeding through suction -2
• The baby’s lower lip must be turned outward, the tip of his nose
near the mother’s breast, his chin touching it. The child will be able
to breathe effortlessly.
• Nursing must not cause pain
• The newborn will begin suckling, according to his maturity, from 5
to 15 successive suctions, followed by a breathing pause as long as
the suckling period, and then resuming the activity
• 10 minutes after beginning nursing, it is possible for the child to fall
asleep or to slow down the suckling rate.
• Once the baby is awake, he can settle again to resume nursing or to
make sure he is satisfied
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Breastfeeding Techniques
The breastfeeding technique is a procedure by which suckling is carried out
• The mother’s position:
– The mother can nurse sitting or lying down
– The mother should be in a comfortable and relaxed position able to hold the
baby close to her without undue effort, her feed be supported
• Check the infant’s position:
– The baby’s head and body must be perfectly line up
– The baby’s face must face the mother’s chest, with his nose in front of the
nipple
– The baby’s body must be close to the mother’s , turned towards her
– If the baby is newly born, the mother must cradle him with one arm and give
support to the buttocks, not just to the head and shoulders
• Check the Infant attachment to the breast:
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–
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The mouth is wide open
The chin touches the breast (or close to)
The lower lip turn outwards
More areola is visible above the infant’ top lip
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Nursing Positions for preterm infants -1
The preterm baby must be nursed in a position supporting his head and neck
to prevent the obstruction of airway causing apnea and bradycardia during
breastfeeding
Football or watermelon position
The baby faces the mother while his body is tucked under
one of her arm. The baby’s upper back rests on the mother’s
forearm, while she holds his neck with her hand. The baby’s
hips rest against the back of the chair or bed.
Crossed or inverse cradling position
The hand opposite the breast offered to the baby is placed
behind the baby’s head, in order to support and guide it. The
hand of the same side may support the breast.
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Nursing Positions for preterm infants -2
Modified football position. The baby sits
facing the mother, by her side, on the sofa or a
pillow, with his legs at his mother’s side and his
feet at her back.
The “dancer hand “position. This is a
technique that supports the child’s jaw in
order to improve the up and down
excursions during suckling, made difficult
by hypotonia.
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Alternative Feeding Methods
1.Cup/spoon/syringe/dropper
•
•
•
•
Does not interfere with breastfeeding
Cup is easy to wash
Safe
Small baby gets the quantity she/he
needs
• Cup-feeding can complement
breastfeeding if the baby is weak or
tired
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Alternative feeding techniques
Cup-Feeding Technique
•
Measure the quantity of milk needed into
a cup
•
Hold the baby in semi-upright position
•
Touch the baby’s lips with the cup
•
Do not pour the milk into the baby’s
mouth
•
Allow the baby to lap or sip the milk and
swallow at own rate
•
The baby stops feeding when his/her
mouth closes and doesn’t show further
interest in feeding
WHO EURO, 2002
BMJ, 2004
26
Gavage-Feeding Technique (1)
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•
•
•
•
•
•
Used to feed very low-weight or sick baby
Tube insertion
Select a thin gastric tube
Measure the distance from the tip of nostril to the lower tip
of the ear and from the ear to the stomach
Mark this distance on the tube
Insert the tube gently into the stomach through the nose
Check the correct position of the tube by:
– Aspirating some stomach content, or
– Blowing air (1-2 ml) in the stomach and listening with
stethoscope
Leave the tube in the stomach maximum 3 days
WHO, 2003
27
Gavage-Feeding Technique (2)
• Use colostrum or expressed breast milk
• During gavage feeding:
• Mother holds syringe 5-10 cm above baby; milk
runs down tube by gravity
• Stimulate the baby’s suckling reflex and taste
• Encourage mother-baby skin-to-skin contact
• Feed slowly over 15-20 minutes
• Intermittent feeding for at least 15-20 minutes is
considered to be similar to “physiological
feeding”
• When it is possible, start cup-feeding
• Continuous enteral milk infusion method
requires constant monitoring of the baby’s
tolerance
WHO, 2003
Premji S et al, 2004
28
Teach the Mother Colostrum/Milk Expression
Techniques
Click to edit
Master title style
If the mother extracts manually her milk, it is recommended to extract it 8 to 10 times a
day
Mothers must extract their milk until it no longer flows, usually after 10 or 15 min
The last drops have a high lipid concentration and may significantly contribute to caloric
intake
WHO EURO, 2002
BMJ , 2004
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Hygiene for milk extraction
• Breast milk is not sterile since it has its own micro flora
• The mother must follow strict hygienic measures:
– Hand washing with soap and water and brush under the fingernail
– Wash the milk container, with hot soapy water and rinse it with boiled
water
– The container must have a wide opening and a cap
• it must be made of glass or hard polycarbonate suitable for food
preservation
• it must never be a polypropylene bag because of the risk of
liberating toxic substances into the milk
– Previous cleansing of the nipples is not necessary
– It is also unnecessary to discard the first drops of milk
– Recommend the mother not to talk during extraction and only touch
the exterior of the containers and the breasts.
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Manual milk extraction technique
a) Stimulating the let-down reflex : The mother may stimulate gently the breast
– She may roll it gently between thumb and index finger, or have a pleasant
beverage , or might imagine herself as a “fountain of milk”
– With practice, the mother gets used to stimulate the let-down reflex
b) Locating the milk ducts : The mother is asked to gently feel her breast, 3-4 cm
behind the nipple to find the milk ducts similar to a cord with knots or a string of
peas
– The mother must place her hand as to form the letter C, with her thumb
over the milk ducts and the index in the opposite side
c) Compression over the breast ducts : The mother applies pressure on the milk
ducts with her thumb and index finger. Then, she releases the nipple and repeats
the motion of pressure and release until milk begins to drip
- When the milk flow diminishes, the thumb and index finger are moved
around the areola towards another section and the pressure-release motion is
repeated
- When the flow stops, the technique is repeated on the other breast
31
Mechanical milk extraction technique
• A pump does not really pump, suction, or express milk from the breast
• The negative pressure of the pump reduces the milk’s resistance to flow
and allow the breast internal pressure to push milk outward
• The milk let-down reflex produces an initial rise of the pressure inside the
mammary gland, the periodic rise of the pressure in the ducts maintain a
constant pressure gradient
– Induce the let-down reflex before using the pump
– Use only the necessary negative pressure to maintain the milk flow
– Massage the breast’s quadrants before and during extraction to
increase the pressure inside the mammary gland
– Take as long as necessary to avoid anxiety
– Maintain an the pump adequately fixed to the breast
– Avoid prolonged periods of continuous negative pressure
– Suspend the extraction if the milk flow is minimal or if it stops
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Preserving the extracted milk (1)
Consider 2 basic principles when storing and handling breast
milk
1.Breast milk is a live fluid it must be handled as if it was
blood.
• It must be packed in plastic or glass container to avoid
contamination and to preserve its qualities.
• The container must be clearly labeled, milk without
proper labeling must never be administered
2. All the milk to be given o a baby must be kept in the
hospital under control
– it is not recommended to receive milk stored outside of
the hospital, as its quality is not guaranteed
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Preserving the extracted milk (2)
Fresh milk:
• Colostrum: at room temperature 27- 32º C( 80-90 ºF) , 12 to 24
hours
• Mature milk
- At 15º C (59ºF): 24 hours ; at 19-22º C (66 -72 ºF): 10 hours; 25º C
(77 º F), 4 to 8 hours
At 27- 32º C (80-90 ºF): 4 to 6 hours; at 0º
C and 4ºC (32-39 º F): 5 to 8 days
• Frozen milk ( - 18 º C = 0 º F)
-In a freezer inside of a refrigerator: 2 weeks; in refrigerator with a
freezer with a separate door: 3 to 4 months ; in a separate freezer
with a constant temperature of - 19ºC: 6 months
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Milk banks
When there is not enough milk for an infant from his own mother,
milk from a donor is an excellent alternative
•
•
•
There are numerous milk banks in the world; the majority of them directly linked
to Neonatal Units.
There are no international regulations but working guides edited by each different
association of milk Banks
Safety and traceability systems have been established, just as strict as they are for
blood banks
– The milk should be safe and insure the best nutritional conditions
• Milk is classified according to acidity and calories content
• Pasteurization is individual, no “pooling “ of different donors.
– Comprehensive microbiologic control is performed only sterile milk is suitable
for consumption
• Selection criteria used for donors are similar to those used in blood banks
– An extensive health survey and serology for HIV, hepatitis B and C and syphilis
is conducted
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Maternal difficulties to breastfeed-1
Nipple cracks
• If the infant is not correctly attached to the breast, nipple
cracks could occurs; they are extremely painful and bleeding
when feeding
• If the crack is small or recent, it may resolve in 24 hours
– By insuring an adequate attachment to the breast
– By applying some breast milk on the areola and nipple, after each nursing,
drying it with air blow dryer or exposing it to sunlight, for a few minutes.
•
If the crack is extensive and deep, the mother must:
– Insure an adequate attachment trying different positions to find the less
painful position and begin feeding from the least painful breast, a natural
treatment based on calendula can be recommended
– if there is excessive pain or bleeding worsen, extract the milk every 3 to 4
hours and give it to the baby with a cup or syringe for 24 to 48 hours.
36
Maternal difficulties to breastfeed-2
Flat or inverted nipples
• The most effective intervention is to stimulate and form the nipple just
before nursing
– Massage a flat nipple or apply a cold compress to help the nipple come out
– If inverted nipple teach the mother to form her nipple by placing her thumb 4 -5 cm
behind her nipple and pushing backward, towards her chest
– An extracting pump or a syringe with an inverted plunger might help “evert” the nipple
before nursing.
Breast congestion or engorgement: 3 elements are involved:
1. congestion and increased vascularization
2. accumulation of milk
3. edema secondary to swelling and obstruction of lymphatic drainage
•
Primary congestion: The breasts are enlarged and hardened, but milk
•
extraction is still possible. It is due to infrequent or insufficient nursing.
Secondary congestion: The breasts are hard, painful, hot; milk extraction is
not possible.
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Maternal difficulties to breastfeed-3
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•
•
•
•
•
•
Breast congestion or engorgement: Treatment
Apply clean, warm-water compresses to the breasts and gently
massage in a circular movement, before nursing
Extract some milk before nursing to help the child to attach to the
breast
Apply cold compresses or ice bag on the breasts, between feedings,
to relieve pain
The mother needs to rest and must nurse more often from the
congested breast.
Insure a correct breastfeeding technique
Use analgesics and relaxation techniques
A rather untraditional but effective approach is to use the warm
blow hair dryer to soften the congested breasts at the beginning of
nursing.
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Insufficient milk production
•
Breast milk production is influenced by many factor including the frequency
and intensity of infant’s suckling, especially during the immediate post-partum
period
Causes of low milk production
Mother
Insecurity and lack of confidence of the mother.
Breast surgery
The mother is using rubber nipples or nipple
shields.
Use of contraceptives
Nursing from only one side
Shortened feedings
Low frequency of feedings
Maternal tiredness or illness
Discontinued night feedings
Child
Additional milk formula in a bottle.
Incorrect position of child at the breast.
Nipple confusion in the child
Decrease in extracted volume.
.
Presence of drowsiness
Low weight gain. Strict feeding schedule
(Every3 hours) as in many Neonatal Units.
Total or partial absence of nursing.
Decrease in the daily volume due to lack of
stimulation.
Cracks and pain while nursing
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Difficulties at discharge from hospital
• At discharge from the hospital , sometimes advantages of exclusive
breastfeeding may be misunderstood by parents or health staff
• The mother may show resistance to breastfeeding asking questions: “Why
I must try to breastfeed my child as he was bottle fed in hospital?” ”Is my
baby really getting all that he needs from my milk?”
– When babies were bottle fed in hospitals
– When where may be not enough time to help the mother to nurse
her baby
• Several factors may cause resistance to breastfeeding but in case of
breastfeeding failure, especially for preterm infants, the responsibility lies
usually on the health professionals and on the restrictive schedules used
in Neonatal Units contributing to the mother’s inability or resistance to
nurse
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Preterm infant milk formula (PBF)-1
• The right of every mother to breastfeed her baby and of every
baby to receive breast milk is becoming widely recognized
• There are 2 main factors harming natural breastfeeding
– The 1st one is the promotion of breast milk formula made
by manufacturers
– The 2nd one has to do with the inability of the health
professionals to defend, protect, support and understand
the benefits of breastfeeding
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Preterm infant milk formula (PBF) -2
• Preterm milk formulas are developed with modified
cow’s milk or based on soy proteins
– The proteins of the cow's milk are one of the nutrients
producing frequent food allergies when administered in the
1st year of life.
• There are some indications to the use of preterm baby
formulas
– The mother is ‘disabled’: oncological cases, active TB, HIV mother
– The mother’s milk production is insufficient with poor gain weight. It is a
medical decision whether to supplement breastfeeding with a special
PBF before 40 weeks, and later, with a milk formula for the 1stsemester.
– The mother does not want to nurse, regardless of all the advice given to
her on the benefits of mother’s milk.
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Conclusion
• It is vital to point out that maternal breastfeeding represents
a ‘dynamic feeding’, which responds to the constantly
changing needs of the infant from his birth to the months
following it, in contrast with formula feeding, which is a
synonym of a ‘static feeding’
• It is impossible to match the ‘dynamism’ of mother’s milk in
relation to variation, from one woman to another, within the
same woman and throughout the day; nor the changes that
take place between colostrum, transition milk and mature
milk
43