FEEDING OF INFANTS A detailed discussion of the feeding of infants is outside the scope of this book.

However, a brief mention may be made of some of the important aspects of the problem. (1) Breast-feeding Under any circumstances, breast milk is the ideal food for the infant. No other food is required by the baby until 6 months after birth. Under normal conditions, Indian mothers secrete 450 to 600 ml of milk daily with 1.1 gm protein per 100 ml. The energy value of human milk is 70 kcals per 100 ml. A child who is breast-fed has greater chances of survival than a child artificially fed. Prolonged breast feeding does protect the infant from early malnutrition and some infections. The data suggest that infant mortality rates in developing countries are 5-10 times higher among children who have not been breast-fed or who have been breast-fed for less than 6 months. Despite the marked advantages of breast-feeding, its popularity has declined significantly in many parts of the world. Advantages of breast feeding Among the advantages of breast milk are the following : (1) it is safe, clean, hygienic, cheap and available to the infant at correct temperature (2) it fully meets the nutritional requirements of the infant in the first few months of life (3) it contains antimicrobial factors such as macrophages, lymphocytes, secretory IgA, anti-streptococcal factor, lysozyme and lactoferrin which provide considerable protection not only against diarrhoeal diseases and necrotizing enterocolitis, but also against respiratory infections in the first months of life (4) it is easily digested and utilized by both the normal and premature babies (5) it promotes "bonding" between the mother and infant (6) sucking is good for the baby - it helps in the development of jaws and teeth (7) it protects babies from the tendency to obesity (8) it prevents malnutrition and reduces infant mortality (9) it provides several biochemical advantages such as prevention of neonatal hypocalcemia and hypomagnesaemia (46) and (10) it helps parents to space their children by prolonging the period of infertility. (11) special fatty acids in breast milk lead to increased intelligence quotients and better visual acuity. A breast-fed baby is likely to have an IQ of around 8 points higher than a non-breast fed baby (47). Early initiation of breast feeding lowers the mother's risk of postpartum haemorrhage and anaemia, boosts mother's immune system, delays next pregnancy and reduces the insuline of diabetic mothers. It protects mothers from ovarion and breast cancers and osteoporosis (47). It is neither necessary nor desirable to train a baby to "feed by the clock". It should be explained to the mother, however, that intervals between feeds are necessary for herself and for the baby, though they may vary between 1 to 4 hours, according to the baby's needs, size, strength of sucking and the mother's milk supply. (2) Artificial feeding The main indications for artificial feeding are failure of breast milk, prolonged illness or death of the mother. It is crucial for the baby to be fed "breast-milk substitutes" - e.g., dried whole milk powder, fresh milk from a cow or other animal, or commercial formulae.

PRINCIPLES OF ARTIFICIAL FEEDING In planning an artificial feed, the nutritional needs of infants should be kept in view. These include : 1. Infants require an average of 100 kcal of energy kg of body weight per day, i.e., about 150 n i l 0 1 milk per kg of body weight each day. 2 The estimated protein requirement is about 2 n o of body weight during the first 6 months; it declines to about 1.5 g/kg by the end of one year Th is works out to 13-14 g protein daily during the fi rst year of life. In terms of calories, 8 to 10 per cent o f calories are given as protein 3. The carbohydrate requirement is about 10 g/kg of body weight daily 4. After 4 months of age, undiluted boiled and cooled milk should be given 5. Infants need feeding at frequent intervals about 6-8 times a day; older babies 5 times a day 6. During illness (e.g., fevers) the calorie need is increased, and it should be met. (a) DRIED MILK : The safest milk is undoubtedly dried whole milk, which is scientifically prepared for infant feeding. It is free from bacteria; there is little danger from flies; it does not become sour and is simple to reconstitute. It is usually fortified with vitamins. But it is expensive and, therefore. beyond the reach of many Indian families. (b) COW'S MILK : A cheaper alternative which is well within the reach of many Indian families is cows milk, which in fact is widely used for infant feeding. Most health workers give very conflicting advice on the use of cow's milk for infant feeding. A small minority of over-enthusiastic paediatricians recommend undiluted cow's milk right from the birth, forgetting the fact that human milk is made for the human baby and cow's milk for the calf. Both cannot be equated. Most authorities in India and abroad including the World Health Organization have persistently recommended dilution of cow's milk during the first 2 months in order to reduce the solute load on neonatal kidneys. The Govt. of India in the Ministry of Health and Family Welfare in the `Manual for Health Worker (Female) Vol. 1 (1978) have also recommended dilution of cow's milk during the first two months. A suggested schedule for infant feeding with cow's milk is given in