Abstracts

Complementary feeding in developing countries: factors affecting energy intake

This interesting review article discusses the significance of appropriate age of introduction of complementary foods and the importance of this period of feeding for infants in developing countries, in light of the 1994 World Health Assembly resolution urging member states to “promote sound infant nutrition by fostering appropriate complementary feeding practices from the age of about six months”. Concern exists that the level of energy intake of children from 6 months to 24 months is less than the recommended standards. Brown gives the following reasons for the low energy intake:

Effect of illness on energy intake:
Most studies observing intake during illness report a reduction in energy intake. Some report a 15 to 20% reduction in energy consumption during common illnesses.
Studies reporting where infants continue to receive breastmilk during the “weaning period” note substantially smaller illness-related decrements in energy intake than for infants who were no longer receiving breastmilk.

Energy density and frequency of feeding:
Studies of differences in frequencies in feeding showed that when the number of meals increased from 3 to 4 daily 16 % more food was eaten and 7% when the number of meals increased from 3 to 5. Total amount of feeding time was also important in that regardless of frequency of meals, 15 to 20 minutes were required per meal to attain satiety.

Breastfeeding and Shorter Hospital Stays

With decreases in postpartum hospital stay, nurses working with new mothers need to be “aware of all aspects of breastfeeding management, including the impact of labour and delivery experiences on a woman’s motivation toward breastfeeding.”
Some of these are highlighted as follows:

• The more obstetrical interventions, the more likely a new mother will experience breastfeeding difficulties
• The importance of initiating breastfeeding immediately after birth, when mother begins lactating and the infant is in a state of readiness. The article gives valuable and practical information on holding the baby, latching, the baby’s jaw movements as well as the benefits to baby and mother, such as the maternal-infant relationship.
• The postpartum stay is an important time for maternal teaching. Teaching the new mother meaningful skills such as manual expression and breast massage and useful information on the number of wet diapers to expect can easily be done while the postpartum nurse observes feedings for sustained latch and rhythmic sucking.
• The importance of keeping mother and baby together during this short and crucial time for successful continuous breastfeeding. As well mother and infant learn important behaviours about each other that act as cues for a successful breastfeeding relationship.
• Discharge policies of assessment, community resources and home visits all increase support for the new mother.

Recommendations for the implementation of Kangaroo Mother Care for low birth weight infants

This paper summarizes the recommendations of a meeting in Trieste, Italy of health professionals from 15 countries experienced in the KMC method for low birth weight infants. The group identified three types of setting within which KMC is practised:

• rural hospitals or health centres in very low income countries. Here infants are kept with their mothers and exclusive breastfeeding is the rule.
• district and provincial hospitals in settings with very limited resources; Some equipment and resources are available but not reliable and infants are often kept in nurseries with limited access to their mothers.
• health facilities with adequate resources and infant mortality rates of less than 15/1000 and highly sophisticated neonatal care. Such care often implies limited contact between mother and infant for long periods of time and formula feeding with bottle or gastric tube. The shift to breastfeeding, if any is difficult.

The group has set up the International Network on KMC (INK) to promote the use of KMC as an evidence-based and humanistic approach to child care and newborn care. INK will also provide technical expertise and training materials to institutions, professional associations, national and international agencies and lay associations.