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 Formula Feeding
(Artificial Feeding or Bottle Feeding)

By
Prof. Samir M. Abou Elhassan
Indications of Formula Feeding:
 Contraindication of breast feeding.
 Abscent mother.
 Twins.
 Insufficient breast milk Supply.
Types of milk used for Formula Feeding:
 Fresh animal milk (Liquid milk).
– Raw.
– Pasteurized.
 Dried (Powdered) milk.

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 What are the differences between human and cow’s milk

Nutrient / 100 ml Breast milk Cow’s milk

Protein (gm) 1.0 3.3
Casein 30% 80%
Whey 70% 20%
Fats (gm) 3.5 4
Uns. Fatty acids 60% 40%
Sat. Fatty acids 40% 60%
Lactose (gm) 7.0 4.5
Minerals (gm) 0.2 0.8
Ca** (gm) 35 115
Phos. (mg) 15 95
Ca / P 2:1 1:1
Iron (mgm) 1.5 1.0

Sodium (MEq/L) 7 22
Potassium (MEq /L) 15 35
 1- Fresh animal milk
Animal milk Without modification is not Suitable for
infant feeding for the following reasons

1. High protein Content mostly Casein.

2. Fat higher in volatile fatty acids and less in polyunsaturated
jatty acids.
3. Less CHO ate than human milk.
4. High content of sodium (3 times that of human milk) →Hyper-
natremia.
5. High phosphorus Content (7 times) → Neonatal Tetany.
6. High mineral Content (4 times) that of human milk →Renal
over Load.
7. Bioavilabitily of iron less than human milk →iron deficiency
anemia.
8. Human milk is rich in enzymes e.g. lipase easy digestion of fat
9. Higher Content of biologically active Vit. D in human milk→
lower risk of rickets.
 Modification of animal milk

Nut. gm /dl Breast milk Fresh Modified Adapted

Buf. Milk Buf. milk Dried milk
Protein 1 4 2 1.5
Fat 3.5 7 3.5 3.5
Lactose 7 4 2+5 gm 7
sugar
Minerals 0.2 0.8 0.4 0.25
Cal / dl 67 100 67 67
 2- Dried Milk
Advantages:
Easy store.
Sterile.
Constant Composition.
Modified to be suitable for infant feeding.
Types of dried milk
Adapted (Humanized)
Follow – on Formula.
Dried whole milk
Modified special Formulas.
 Calculation of the quantity of milk
Needed for Feeding

Age method
Weight method
– 100 ml / milk →67 Cal.
– Need 100- 110 Cal /Kg/ day →150 ml of milk /
Kg / day.
– WT Kg X 150 / Number of feeds = amount per
feed
 Management of Formula Feeding

Select type of milk .

Modification of the Used milk.
Calculate the amount of milk per feed.
Use cup & spoon in mixed feeding.
Use bottle in exclusive formula feeding.
Check the hole of the teat
Check temp of milk.
Right position & burping.
Discard any left milk.
Clean bottles and teats.
 Weaning
Definition:
To accustom the infant to take food other
than milk.
 Weaning
When to start?
Principles of Weaning.
– Should be gradual
– Not in hot season
– Infant not ill or convalescence from illness.
 Weaning

What types of food should be given?

– Start with liquids and semisolids
– Solid foods
– Start with small amount and ↑ gradually
– Don’t start with more than one type of food
 Weaning

What types pf food should be avoided?

– Seeds – nuts – bones
– Spicy food
– Salted – food
– Foods with additives
– Junk food
 Weaning

Problems of Weaning.
– G.I. upset
– G.E.
– PEM
– Allergic reaction
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Mumps (Epidemic Parotitis)
 Etiology
Mumps is caused by a paramyxovirus

Mode of Transmission
From person to person
– Direct contact
– Aerosolization of respiratory secretions
– Contaminated articles (fomites)
 Contagiousness
Contagious 1 day before to 9 days after start of parotitis
(until swelling disappears).
Transplacental immunity protects for 6 months
Active disease gives life-long immunity

Incubation Period
2-3 weeks
 Clinical picture

Age:
– 5-15 years, both sexes are affected
– Subclinical infection occurs in 30-40% of cases→long lasting
immunity
– Infection can occur without involvement of salivary glands
Classical clinical picture:
– Prodrome: 1-2 days
– Fevere, malaise, headache, vomiting, neck pain, pain behind the
ear on chewing or swallowing
 Clinical picture

Salivary glands involvement:

– Parotids are involved (unilaterally or bilaterally) in 60% of cases
– Submaxillary and sublingual glands may be involved±parotid
affection
– Characteristics of parotid enlargement
Pain is aggravated on opening the mouth, chewing,
swallowing or tasting sour substances (like lemon juice)
Swelling may be also present in pharynx, larynx and
over manubrium sterni and upper chest (probably as a
result of lymphatic obstruction)
 Laboratory

Leukopenia with relative lymphocytosis

Serum amylase: commonly ↑(irrespective of
presence of pancreatitis)
Rise of serum antibody to mumps or virus
culture from saliva, urine, CSF, blood
 Complications

Neurological complications:
– Meningoencephalitis: occurs in 10% of patients
– Aseptic meningitis
– Encephalitis
– Less commonly: Guillain-Barre syndrome, bilateral
nerve deafness, optic neuritis, transient facial palsy
Orchitis, epididymitis

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 Complications

Oophoritis:
– Occurs in 7% postpubertal females
– Presents as pelvic pain and tenderness. Does NOT
affect fertility
Pancreatitis:
– Usually mild or subclinical
– Epigastric pain & tenderness±fever, chills, vomiting,
prostration
– Polymorphonuclear leukocytosis of moderate degree
 Complications

Other less frequent complications:

– Nephritis, myocarditis, mastitis, thyroiditis, arthitis,
thrombocytopenic purpura
 Diagnosis

Depending on clinical findings, it should be

differentiated from:
– Other causes of swelling in parotid area as cervical
adenitis, lymphomas, recurrent parotitis, salivary
calculus, salivary gland tumors
– Other causes of viral parotitis: enterovirus, influenza
A, cytomegalovirus
– Suppurative parotitis due to Staph. Aureus: pus can
be expressed from Stensen’ duct and cultured
 Prevention

Live attenuated vaccine given with Measles &

Rubella (MMR) at 15 months
 Treatment
No specific therapy, only supportive:
– Isolation (from 1 day before till disappearance of swelling)
– Antipyretics, analgesics, soft diet
– Scrotal suspension in orchitis, IV fluids for pancreatitis,..etc
Poliomyelitis
 Etiology

Any one of 3 poliovirus: I,II, or III (each type is

immunologically distinct from others).

Infection with one type results in immunity to that

specific type ONLY.

Affected children SHOULD be vaccinated for

other types.
 Mode of Transmission

Fecal-oral route via milk, food, water,…etc.

Droplet infection may occur (virus is present in or

pharyngeal secretion early in the disease).
 Contagiousness

Throat: virus is present shortly before and 1 week

after onset.

Stools: virus is present shortly before and

intermittently 3-4 weeks after onset.
 Incubation Period

7-14 days.
 Clinical Manifestations
Asymptomatic infection (silent).

Abortive poliomyelitis (a non specific febrile

illness).

Non-paralytic poliomyelitis (aseptic meningitis

syndrome).

Paralytic Poliomyelitis (spinal, bulbar,

encephalitic & mixed).
 Laboratory Findings
Rise in antibodies in paired serum samples, one in
the acute and one 2 to 3 weeks later.

Isolation of the virus.

CSF: normal or↑ pressure, clear or opalescent, ↑

Cells (polymorphs in early stage and lymphocytes
later), Proteins: 30-60mg% protein (later may rise
to 100-600), Sugar: normal.
 Differential Diagnosis
A. Other causes of lower motor unit disease:.

2. Paralysis due to other enter viruses (rare, usually mild).

3. Guillain-Barre syndrome: idiopathic peripheral neuropathy characterized.

4. Werding-Hoffmann disease (spinal muscular atrophy).

5. Spinal cord lesions: transverse myelitis, tumor.

6. Diphtheritic paralysis (see diphtheria).

7. Poisoning: organophosrus and lead poisoning.

8. Muscle dystrophies.

9. Myasthenia gravis.
 Differential Diagnosis
B. Pseudo-paralysis:

Arthritis, toxic synovitis, osteomyelitis

Unrecognized trauma, dislocation, fracture

Scurvy, congenital syphilis.

 Complications
Gastrointestinal: acute gastric dilatation, perforations
and edema.

Cardiovascular: hypertension, hypotension,

arrhythmias, moycarditis and acute cardiac failure

Urinary: transient bladder paralysis, nephrocalcinosis

(due to immobilization and hyper-calcemia) and calculi
(due to hypercalcuria)

Respiratory: aspiration, pneumonias, atelectasis

 Prophylaxis
Active immunization

Passive immunity: 0.2 ml/kg IM of pooled human

immune globulin

During febrile viral illness of undetermined etiology:

avoid overexertion, fatigue, IM injections and keep
patients in bed during any febrile episode

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 Treatment
General
– Bed rest with splinting of limbs
– Dry heat or hot packs may relax tender and toght muscles,
ligaments and fasciae
– Analgesics foe fever and to relieve pain and tenderness
– Diet: simple, nutritions and attractive
– Physiotherapy is the most important single factors in treatment
– It is started after termination of acute phase (usually after 2-3
weeks)
– Passive movements at first, then active exercises when pain
subsides
– Orthopedic measures: special boards, splints or braces
Specific: none
 Treatment
Treatment of special problems and complications:
– Respiratory difficulty, may need respirator
– Tracheostomy, is done in paralysis of muscles of swallowing
– Tranquilizers for irritability and apprehension
– Enemas and laxatives, for constipation
– Bladder paralysis: bethanechol, intermittent catheterization +
prophylactic sulfa
– Gastric dilatation: aspiration, and ice bags
– Convulsions: anticonvulsant therapy
– Cardiovascular: treatment of hypertension, digitalization, ..etc
– Psychologic guidance
– Deformities: orthopedic surgical correction