see artificial nutrition and hydration; nutrition.
The purpose of enteral feeding is to give a liquid, low-residue food through a naso-gastric feeding tube. It has the advantage over parenteral nutrition that the septic complications of insertion of CATHETERS into veins are avoided. Enteral feeding may either take the form of intermittent feeding through a large-bore naso-gastric tube, or of continuous gravity-feeding through a ?ne-bore tube.
A number of proprietary enteral foods are available. Some contain whole protein as the nitrogen source; others – and these are called elemental diets – contain free amino acids. DIARRHOEA is the most common problem with enteral feeding and it tends to occur when enteral feeding is introduced too rapidly or with too strong a preparation.... enteral feeding
Tube feeding may be necessary for people who have gastrointestinal disorders (for example, conditions resulting in malabsorption) or disorders affecting the nervous system or kidneys. Premature babies often require tube feeding if their sucking reflexes are undeveloped, as do critically ill patients due to their increased nutritional requirements. Intravenous feeding is usually given when large areas of the small intestine have been damaged by disease or have been surgically removed.... feeding, artificial
During the first 4 to 6 months, most babies’ nutritional requirements are met by milk alone, whether by breast-feeding or bottle-feeding. Both human milk and artificial milk contain carbohydrate, protein, fat, vitamins, and minerals in similar proportions. However, human milk also contains antibodies and white blood cells that protect the baby against infection. From 6 weeks, supplementary vitamin D should be given to breast-fed babies. Formula milk already contains vitamin supplements.
At 1 year of age, a baby can be safely fed with full-fat cow’s milk. Vitamin supplements should then be given until the baby is established on a mixed diet. Solids, initially in the form of purees and wheat-free cereals, should be introduced between 4 and 6 months of age,depending on the birth weight, rate of growth, and contentment with feeding. By 6 months, the baby should be eating true solids, such as chopped-up meat and vegetables.
A few babies have an intolerance to certain foods such as lactose or cow’s milk protein (see food intolerance; nutritional disorders).... feeding, infant
Commonly known as a drip, an intravenous injection is used to give blood (see blood transfusion) or, more commonly, fluids and essential salts.
Other uses include providing nutrients to people unable to digest food (see feeding, artificial) and the administration of certain drugs.... intravenous infusion
Breast feeding Unless there is a genuine contraindication, every baby should be breast fed. The nutritional components of human milk are in the ideal proportions to promote the healthy growth of the human newborn. The mother’s milk, especially colostrum (the ?uid secreted before full lactation is established) contains immune cells and antibodies that increase the baby’s resistance to infection. From the mother’s point of view, breast feeding helps the womb to return to its normal size and helps her to lose excess body fat gained during pregnancy. Most importantly, breast feeding promotes intimate contact between mother and baby. A ?nal point to be borne in mind, however, is that drugs taken by a mother can be excreted in her milk. These include antibiotics, sedatives, tranquillisers, alcohol, nicotine and high-dose steroids or vitamins. Fortunately this is rarely a cause of trouble. (See also main entry on BREAST FEEDING.)
Arti?cial feeding Unmodi?ed cows’ milk is not a satisfactory food for the human newborn and may cause dangerous metabolic imbalance. If breast feeding is not feasible, one of the many commerciallly available formula milks should be used. Most of these are made from cows’ milk which has been modi?ed to re?ect the composition of human milk as closely as possible. For the rare infant who develops cows’-milk-protein intolerance, a milk based on soya-bean protein is indicated.
Feeding and weight gain The main guide as to whether an infant is being adequately fed is the weight. During the ?rst days of life a healthy infant loses weight, but should by the end of the second week return to birth weight. From then on, weight gain should be approximately 6oz. (170g) each week.
The timing of feeds reffects social convention rather than natural feeding patterns. Among the most primitive hunter-gatherer tribes of South America, babies are carried next to the breast and allowed to suckle at will. Fortunately for developed society, however, babies can be conditioned to intermittent feedings.
As the timing of breast feeding is ?exible – little or no preparation time being required – mothers can choose to feed their babies on demand. Far from spoiling the baby, demand feeding is likely to lead to a contented infant, the only necessary caution being that a crying baby is not always a hungry baby.
In general, a newborn will require feeding every two to four hours and, if well, is unlikely to sleep for more than six hours. After the ?rst months, a few lucky parents will ?nd their infant sleeping through the night.
Weaning Weaning on to solid foods is again a matter of individuality. Most babies will become dissatis?ed with a milk-only diet at around six months and develop enthusiasm for cereal-based weaning foods. Also at about this time they enjoy holding objects and transferring them to their mouths – the mouth being an important sense organ in infants. It is logical to include food items that they can hold, as this clearly brings the baby pleasure at this time. Introduction of solids before the age of four months is unusual and best avoided. The usual reason given for early weaning is that the baby appears hungry, but this is unlikely to be the case; crying due to COLIC, for example, is more probable. Some mothers take the baby’s desire to suck – say, on their ?nger – as a sign of hunger when this is, in fact, re?ex activity.
Delaying the start of weaning beyond nine months is nutritionally undesirable. As weaning progresses, the infant’s diet requires less milk. Once established on a varied solid diet, breast and formula milks can be safely replaced with cows’ milk. There is, however, no nutritional contraindication to continued breast feeding until the mother wishes to stop.
It is during weaning that infants realise they can arouse extreme maternal anxiety by refusing to eat. This can lead to force-feeding and battles of will which may culminate in a breakdown of the mother-child relationship. To avoid this, parents must resist the temptation to coax the child to eat. If the child refuses solid food, the meal should be taken away with a minimum of fuss. Children’s appetites re?ect their individual genetic structure and a well child will eat enough to grow and maintain satisfactory weight gain. If a child is not eating properly, weight gain will be inadequate over a prolonged period and an underlying illness is the most likely cause. Indeed, failure to thrive is the paediatrician’s best clue to chronic illness.
Advice on feeding Many sources of con?icting advice are available to new parents. It is impossible to satisfy everyone, and ultimately it is the well-being of the mother and infant and the closeness of their relationship that matter. In general, mothers should be wary of rigid advice. An experienced midwife, health visitor or well-baby-clinic nursing sister are among the most reliable sources of information.
Protein Fat per Sugar Calories per cent cent per cent per cent
Human milk 1·1 4·2 7·0 70 Cows’ milk 3·5 3·9 4·6 66
Composition of human and cows’ milk... infant feeding
Formula milk contains similar proportions of protein, fat, lactose (milk sugar), and minerals as those in human milk, but it lacks the protective antibodies that are present in breast milk.
Vitamins are added.
Bottle-fed babies are at higher risk of gastrointestinal infections than breast-fed babies and may be more likely to develop allergic disorders.
(See also feeding, infant.)... bottle-feeding
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