37-57 WHAT ARE THE ADVANTAGES OF CUP FEEDING OVER BOTTLE FEEDING?
If an infant cannot be breast fed it is better to cup feed than to bottle feed. The greatest advantage of cup feeding is that a cup can be easily cleaned with soap and water. A cup also dries easily, especially if placed in the sun, which helps to sterilise the cup. This is most important when clean or boiling water is not available for washing bottles. A cup feed usually takes less time than a bottle feed. It is also easier to wean a preterm infant from tube feeds onto cup feeds than onto bottle feeds as many infants can swallow well before being able to suck. Any small plastic cup or dish can be used to feed an infant. Breast milk can be expressed directly into the cup before a feed is given to a preterm infant. Mothers who do not breast feed should be shown how to cup feed before they are discharged home after delivery.
In some infants bottle feeding may cause problems with breast feeding as the mechanism of sucking from a bottle is different from feeding at a breast. This is often called "nipple confusion".
37-58 IRON AND VITAMIN SUPPLEMENTS NEEDED?
A normal term infant born to a healthy mother on a good, mixed diet and regularly exposed to sunlight does not need supplements in the first 6 months of life. Additional iron and vitamin supplements may, however, be of benefit in poor communities when iron drops 0,3 ml (or syrup 5 ml) and multivitamin drops 0,3 ml (or syrup 5 ml) can be given daily. Supplements given to well term infants are not harmful. Remember that all preterm infants need supplements (0,6 ml).
37-59 WHEN SHOULD SOLIDS BE INTRODUCED?
Normally breast milk or formula feeds will meet all the infant's nutritional needs until 6 months of age. Thereafter, milk alone is not enough and solids should be introduced. If possible, an infant should be entirely breast fed for at least 4 months. Even if the mother can only breast feed for a few weeks or months, this will be of benefit to both her and her infant. Introducing solids reduces the anti-infectious properties of breast milk.
Some mothers continue to partially breast feed up to 2 years. It is best to continue breast feeding after solids have been introduced. This practice is particularly important in poor communities as breast milk provides the infant with a good source of protein and helps reduce the risk of pregnancy in the mother. Weaning should be done over a few weeks by dropping one feed per week.
| WHENEVER POSSIBLE INFANTS SHOULD BE ENTIRELY BREAST FED FOR 4 TO 6 MONTHS |
THE BABY FRIENDLY APPROACH
37-60 WHAT IS A BABY FRIENDLY HOSPITAL?
The idea of a "Baby Friendly Hospital" or clinic was introduced by the World Health Organisation to promote the advantages of breast feeding. An agency is available to registers hospitals as baby friendly. To become registered as a Baby Friendly Hospital all the "Ten steps to successful breast feeding" have to be implemented.
37-61 WHAT ARE THE TEN STEPS TO SUCCESSFUL BREAST FEEDING?
- Have a written breast feeding policy that is frequently communicated to all the health care staff.
- Train all the health care staff in the skills needed to implement successful breast feeding.
- Inform all pregnant women about the benefits of breast feeding.
- Help mothers to start breast feeding within 30 minutes of delivery.
- Show mothers how to breast feed and teach them how to maintain lactation even if they are separated from their infants.
- Do not give newborn infants formula or water feeds unless this is indicated for medical reasons.
- Allow mothers and their infants to remain together all the time from delivery to discharge.
- Encourage demand feeding.
- Discourage the use of dummies, teats and nipple shields.
- Promote the formation of breast feeding support groups and refer mothers to these groups on discharge from hospital or clinic.
37-62 WHAT ARE THE ADVANTAGES OF THE BABY FRIENDLY APPROACH TO THE CARE OF INFANTS?
It promotes exclusive breast feeding and bonding between mother and infant. This is particularly important in communities where malnutrition, gastroenteritis and child abuse are common. The baby friendly way of infant care is also kinder, gentler, cheaper and better. Every effort must be made to make all hospitals and clinics baby friendly.
If HIV positive mothers decide to breast feed, then exclusive breast feeding may reduce the risk of mother to child transmission of HIV. If they decide to formula feed, many of the practices which encourage bonding can still be practised.
DISCHARGING A NORMAL INFANT
37-63 WHEN CAN AN INFANT BE DISCHARGED FROM THE HOSPITAL OR CLINIC?
Most normal newborn infants can be discharged 6 hours after delivery. Before discharging an infant from either a hospital or clinic, you should ask yourself the following questions:
- Does the infant appear normal, active and healthy?
- Does the infant feed well?
- Can the mother feed and care for her infant?
- Does the infant weigh 1800 g or more.
If the answer to any of these questions is NO the infant should not be discharged.
37-64 WHAT ADVICE SHOULD THE MOTHER BE GIVEN ABOUT AN INFANT AT DISCHARGE?
Before discharge all mothers must be advised about:
- Feeding their infant.
- Bathing and dressing their infant.
- Follow-up appointments and arrangements.
- Reporting immediately if the infant appears ill or behaves abnormally.
- The importance of the road-to-health card (preschool card).
37-65 SHOULD NORMAL INFANTS BE FOLLOWED UP AFTER DISCHARGE?
If the infant is discharged before 7 days of age, the infant should be seen at home or at a clinic on days 2 and 5 to assess whether:
- The infant appears healthy or sick.
- The infant is feeding well and receiving enough milk.
- The mother is managing to care for her infant.
- The cord is clean and dry.
- The infant is jaundiced.
- The mother has any problems with her infant.
After the age of one week, the normal infant should be followed at the local "well baby" clinic to assess the infant's weight gain and general development, and to receive the required immunisations. These details must be noted on the road-to-health card.
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