PEMBERIAN MAKAN PADA BAYI
Dr. Julius Anzar, Sp.A(K)Divisi Nutrisi dan Penyakit Metabolik
Bagian IKA FK Unsri / RSMH Palembang2013
Makanan bayi
1. ASI (0 24 bulan)
2. MP-ASI ( 6 24 bulan)
Mengapa ASI?
Susu formula tidak mungkin menyamai ASI
Mengapa harus diberikan MP-ASI
pada usia 6 bulan?
Disusun oleh: Mexitalia dan Yoga D; UKK NPM-IDAI
Kandungan Protektif pada ASI
Perbandingan Komposisi
Kapan ASI?
Bayi kembar Operasi Caesar
Segera setelah lahir (IMD) hingga 1 - 2 tahun
Bagaimana Caranya?
LA
T
C
H
I
N
G
O
N
CARA MENYUSUI
Dianjurkan menggunakan minimal 3 posisi bergantian
Semua duktus laktiferus dapat dikosongkan
Mencegah bagian tertentu puting menjadi worn-out karena lebih sering terpakai
Mencegah kelelahan/kram bagian tertentu tubuh ibu
Posisi
Buka mulut bayi dengan menyentuhkan puting ke bibir bawah bayi (rooting reflex)
Areola masuk sebanyak mungkin ke mulut bayi (2,5 3,7 cm)
Latch on
Terdengar bunyi menelan
Bayi baru lahir: 5 -10 menit/payudara; tiap 2 -3 jam 10-12 kali/hari
> 1 bulan: kapasitas lambung bertambah, menyusu lebih jarang tapi lebih lama, misalnya 20 menit/payudara, tiap 3-4 jam
6 bulan: 20 menit/payudara; 3-5 kali/hari
Lama menyusui
POSISI
Making sure that youre comfortable and relaxed Try to feed in a chair that offers good back support;
use cushions or pillows to prop up your arms; if necessary, rest your feet on a telephone book or footstool
Its also good to experiment with the different feeding positions
Telinga, bahu, paha dalam satu garis lurus: Dekat dengan ibu Disangga seluruh badan Menghadap payudara; hidung ke puting
Dikutip: Satgas ASI IDAI
POSISI
Disusun oleh: Mexitalia dan Yoga D; UKK NPM-IDAI
Bagaimana Menilai
Kecukupan ASI?
BAK 4-6 kali/hari
Kenaikan BB adekuat
Menyusu 8 kali sehari
Masa waktu
g/hari g/bulan
Trimester 1
25 30 750 - 900
Trimester 2
20 600
Trimester 15 450
Bila ASI tidak cukup?
Evaluasi
Apakah cara menyusui sudah benar?
Apakah anak sakit?
Apakah ibu sakit?
Suplementasi
Formula bila < 4 bulan
Formula/MPASI bila > 4 bulan (lihat kesiapan motorik & psikologik)
Complementary feeding(MP-ASI)
17
18
The Window of Opportunity for Improving Nutrition is very smallpregnancy until 18-24
months of age
-2.00
-1.75
-1.50
-1.25
-1.00
-0.75
-0.50
-0.25
0.00
0.25
0.50
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60
Age (months)
Weig
ht
for
ag
e Z
-sco
re (
NC
HS
) Latin America and Caribbean
Africa
Asia
19
20
21
INFANT FEEDING PERIODs
Exclusive Breast Feeding (EBF)
EBF + Complementary Foods
Family Foods
22
23
Periode 2 : ASI + MP-ASI
24
Proses penyapihan (weaning) :
proses dimulainya pemberian makanan khusus selain ASI secara bertahap jenis, konsistensi,
tekstur, sampai seluruh kebutuhan nutrisi anakdipenuhi oleh makanan keluarga
Makanan khusus :
bentuk : cair, lunak, padat jenis : jus, biskuit, bubur susu, nasi tim pemberian bertahap : jenis, konsistensi, tekstur,
jumlah/kali dan frekuensi/hari
Pemenuhan kebutuhan nutrisi bayi
0 6 bulan :ASI Eksklusif
6 bulan :65 80% ASI, sisanya MP-ASI
12 bulan :65-80% MP-ASI, sisanya ASI
24 bulan : seluruhnya makanan keluarga
25
26
27
Kapan mulai diberikan MP-
ASI?
Kesiapanfisik
Refleks
ekstrusi
Dapatmenahan
kepalatetaptegak
Dapat
duduk
dgnsedikit
bantuan
Kesiapanpsikologis
Menunjuk
kan minat
terhadap
makanan
Membuka
mulut jika
diberi
sendok
Tanda
lapar/
kenyang
Memulai Makanan Padat
28
Tidak terlalu dini (
29
Umumnya : berupa buburtepung beras yang diperkaya zatbesi
Hanya 1 jenis (bukankombinasi), bergizi, teksturhalus dan konsistensi agak encer
Diberikan setelah minum ASI atau formula, kecuali bila bayi menolak berulang atautampak tidak berminat berikansebelumnya
Tes Makanan Pertama
PANDUAN DASAR
1. Urutan pemberian :
AAP : tidak ada urutan khusus
2. Tekstur :
halus dan konsistensi encer pada awalpemberian yang ditingkatkan bertahap
3. Besar porsi :
mulai dgn jumlah sedikit (1-2 sdk teh)
bertahap ditambah 1 sdm atau lebihsampai jumlah yang sesuai 30
PANDUAN DASAR
4. Jarak waktu antara pemberian makanan baru :
- makanan baru berjarak 4-7 hari (riwayat alergi +)
- perhatikan adanya reaksi simpang
- dicoba satu-persatu jenis makanan
- dicoba pada pagi hari, oleh ibu
5. Keamanan :
Cuci tangan dan semua peralatan Tidak menggunakan peralatan makan
bersama-sama, atau mengunyah makananterlebih dahulu
31
HATI HATI !!
32
Wortel, bit, bayam, sawi hijau dan lobak:
kandungan nitrat tinggi methemoglobinemia tidak boleh diberikan kpd bayi < 6 bulan
Madu:
tidak boleh diberikan pada bayi < 12 bulan
C. botulinum
Susu SAPI (Whole Milk, susu segar):
tidak boleh diberikan kpd bayi < 12 bulankandungan zat besi rendah, tinggi kadarNatrium, Kalium dan Chlor ( beban ginjal)
Bantu bayi untuk lebihmandiri: beri finger foods
minum dari cangkir sejakusia 6-8 bulan
memegang sendiri cangkir / botol susu
buat jadwal makansedemikian rupa sehingga
terjadi rasa lapar dan
kenyang yg teratur
33
34
Family Foods
Meals Frequency
35
Tujuan akhir praktek pemberian makan (periode 3)
Susu
Susu
(Susu)
36
Tahapan penyapihan :
R.hisapR.telan
R.ekstrusi
Infant Formula
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Objectives
To reviews the history of infant formula
To reviews the health risks associated with infant formula
To know the the WHO/FAO Codex Alimentarius for Standard Composition of Infant Formula
To know the WHO/FAO recommendation of how to prepare formula for bottle feeding for food safety
To know International Code of Marketing of Breast-milk Substitutes (WHA 1981)
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Definition
The term infant formula is defined asa food which intended to be or is represented for special dietary use solely as a food for infants by reason of its suitability as a complete or partial substitute for human milk.
Disusun oleh:Damayanti RS, UKK-NPM IDAI
History of Infant Formula
Mothers who could not (or chose not to) breastfeed their babies either employed the use of a wet nurse or, less frequently, prepared food for their babies, a process known as "dry nursing."
In Europe and America during the early 19th century, the prevalence of wet nursing began to decrease, while the practice of feeding babies mixtures based on animal milk rose in popularity.
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Reasons for using infant formula
Lack of education: The mother believes that her breast milk is of low quality or
in low supply, or that breastfeeding will decrease her energy, health, or attractiveness. The mother is not trained sufficiently to breastfeed without pain and to produce enough milk.
Financial pressures: Maternity leave is unpaid, insufficient, or lacking. The
mother's employment interferes with breastfeeding.
Societal structure: Breastfeeding is difficult or forbidden at the mother's job,
school, place of worship or while commuting. The mother feels infant formula is socially preferable.
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Reasons for using infant formula
Personal beliefs: The mother feels that breasts are too sexual for a baby or
feels uncomfortable breastfeeding around other people. Nursing by a relative or paid wet-nurse is socially
unsupported, believed to be unhygienic, or too expensive. Also, the mother does not want to breastfeed or prefers to
use both breast milk and infant formula.
Dietary concerns: The contents of breastmilk are influenced by the dietary
habits of the mother. If the mother consumes a food that contains an allergen
breastfeeding may, for a brief period after consumption, provoke an allergic reaction in the infant.
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Acceptable medical reasons for using infant formula
The mother's health: The mother is infected with HIV or tuberculosis. The mother is extremely ill HSV type 1 lesions direct contact lesion on the mother
breast. Maternal medication
Taking any kind of drug that could harm the baby, or drinks unsafe levels of alcohol.
The baby is unable to breastfeed: The child has a birth defect or inborn error of metabolism
such as galactosemia that makes breastfeeding difficult or impossible.
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Acceptable medical reasons for using infant formula
Absence of the mother: The child is adopted, orphaned, or in the sole
custody of a man. The mother is separated from her child by being in
prison or a mental hospital. The mother has left the child in the care of
another person for an extended period of time, such as while traveling or working abroad.
The mother has abandoned the child. Family pressures:
Family members, such as mother's husband or boyfriend encourage use of infant formula.
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Infant formula safety
Disusun oleh:Damayanti RS, UKK-NPM IDAI
How to Prepare Formula forBottle-Feeding at Home
(FAO & WHO 2006)
Powdered infant formula is not sterile. It may contain bacteria that can cause serious illness in infants.
By preparing and storing powdered infant formula correctly, you can reduce the risk of illness.
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Cleaning
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Sterilizing
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Storing
Wash and dry your hands before handling sterilized equipment.
It is recommended that you use sterilized forceps for handling sterilized equipment.
If you remove feeding and preparation equipment from the sterilizer before you need it, keep it covered in a clean place.
Fully assemble feeding bottles if you remove them from the sterilizer before you need them.
This prevents the inside of the bottle, and the inside and outside of the teat becoming contaminated again.
Disusun oleh:Damayanti RS, UKK-NPM IDAI
How to prepare a bottle feed (1)
Disusun oleh:Damayanti RS, UKK-NPM IDAI
How to prepare a bottle feed (2)
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Can I store bottle feeds to use later?
It is safest to prepare a fresh feed each time one is needed, and to consume immediately.
This is because prepared feeds provide ideal conditions for bacteria to grow - especially when kept at room temperature.
If you need to prepare feeds in advance for use later, they should be prepared in individual bottles, cooled quickly and placed in the refrigerator (no higher than 5C).
Throw away any refrigerated feed that has not been used within 24 hours.
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Disusun oleh:Damayanti RS, UKK-NPM IDAI
How do I re-warm refrigerated bottle feeds?
Remove a bottle of feed from the refrigerator just before it is needed. Re-warm for no more than 15 minutes. Feeds can be re-warmed by
placing in a container of warm water, making sure the level of the water is below the top of the cup. Occasionally shake or swirl the bottle to make sure that it heats evenly
Check the temperature of the feed by dripping a little onto the inside of your wrist.It should feel lukewarm, not hot.
Throw away any re-warmed feed that has not been consumed within two hours.
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Can I bring preprepared feeds when travelling?
Yes - but make sure the feed is cold before it is transported, and is kept cold during transport. This will slow down or stop the growth of harmful bacteria.
Prepare feeds as normal, cool quickly and place in the refrigerator (no warmer than 5C).
Immediately before you leave home, remove the cold feeds from the refrigerator and place in a cool bag with ice packs.
You can then place the feeds in a refrigerator at your destination,or re-warm a feed when you need one.
If your trip is longer than two hours, you may not be able to keep the pre-prepared feeds cold. In this case, you should prepare feeds as you need them. Bring individual portions of powdered formula with you in a cleaned and sterilized container, and prepare feeds as normal using boiled water that has been cooled to no less than 70C.
Disusun oleh:Damayanti RS, UKK-NPM IDAI
What if I do not have access to boiling water?
The safest way to prepare a feed is using water that has been boiled and cooled to no less than 70C.
If you do not have access to boiling water, you may wish to use sterile liquid infant formula.
Alternatively, you can prepare feeds using fresh, safe water at room temperature and consume immediately.
Feeds prepared with water cooler than 70C should not be stored for use later.
Throw away any left-over feed after two hours.
Disusun oleh:Damayanti RS, UKK-NPM IDAI
Breast is best
The World Health Organization (WHO) recommends that infants are exclusively breastfed for the first six months of life.
Babies who are exclusively breastfed will get the best start for growth, development and health.
Infants who are not breast fed need a suitable breast-milk substitute, for example, infant formula.
THANKYOU.
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