PEMBERIAN MAKAN PADA BAYI

Dr. Julius Anzar, Sp.A(K)

Divisi Nutrisi dan Penyakit Metabolik
Bagian IKA FK Unsri / RSMH Palembang
2013
 Makanan bayi
• 1. ASI (0 – 24 bulan)
• 2. MP-ASI ( 6 – 24 bulan)
Periode 1: ASI
Mengapa ASI?
Komposisi ASI berubah sesuai
kebutuhan bayi Faktor protektif

Kolostrum Enzim

Hind Biofaktor
milk/foremilk'

ASI prematur Limfosit

Susu formula tidak mungkin menyamai ASI

Mengapa harus diberi MP-ASI
mulai usia 6 bulan ?
Kandungan Protektif pada ASI

Disusun oleh: Mexitalia dan Yoga D; UKK

NPM-IDAI
Perbandingan Komposisi
 Kapan ASI?
Segera setelah lahir (IMD) hingga 1 - 2 tahun

Bayi kembar Operasi Caesar

Bagaimana Caranya?
L
A
T
C
H
I
N
G

O
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 CARA MENYUSUI
Posisi

• 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

Latch on

• Buka mulut bayi dengan menyentuhkan puting ke bibir bawah bayi (rooting reflex)
• Areola masuk sebanyak mungkin ke mulut bayi (2,5 – 3,7 cm)

Terdengar bunyi menelan

Lama menyusui

• 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
 POSISI

• Making sure that you’re comfortable and relaxed

• Try to feed in a chair that offers good back support;
• use cushions or pillows to prop up yourarms;
• if necessary, rest your feet on a telephone book or footstool
• It’s also good to experiment with the different feeding positions
 POSISI

•Telinga, bahu, paha dalam satu garis

lurus:
• Dekat dengan ibu
• Disangga seluruh badan
•Menghadap payudara; hidung ke
puting
Dikutip: Satgas ASI IDAI
Markers of Successful Breastfeeding

•70% or less weight loss in first few days after birth

•Return to birthweight by at least 2 weeks
•Weight gain per day of 20 to 30 g during first 3
postnatal month
•Lactation established in mother by 2 to 4 days after
birth
•At least eight breastfeeding events every 24 hours
•Baby is latching onto breast easily
•Three to six stools and four to six voids by 5 to 7 days
of age
 Bagaimana Menilai
Kecukupan ASI?
 BAK 4-6 kali/hari
 Kenaikan BB adekuat

 Menyusu ≥ 8 kalisehari
Masa g/hari g/bulan
waktu
Trimester 25 – 30 750 - 900
1
Trimester 20 600
2
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)

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According to the Global Strategy 2/3rd deaths
are related to inappropriate feeding practices

“Malnutrition has been responsible, directly or

indirectly for 60% of the 10.9 million deaths
annually among children under five. Well over
two-thirds of these deaths, which are often
associated with inappropriate feeding practices,
occur during the first year of life.....” Global
Strategy for IYCF

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 The “Window of Opportunity” forImproving
Nutrition is very small…pregnancy until18-24
months of age
0.50
0.25
Latin America and Caribbean
0.00
Africa
-0.25 Asia
Weight for age Z-score

-0.50
-0.75
-1.00
-1.25
(NCHS)

-1.50
-1.75
-2.00
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60
Age ( m o n t h s )
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WHO Global Infant Feeding Recommendations,
2002

• Start BF early (<1 hr after birth)

• Exclusive breast feeding for 6 months
• Start complementary feeding at 6 months with
continued breast feeding to ≥2 yrs
• Provide appropriate complementary feeding
•Timely
•Adequate
•Safe
•Properly fed
Complementary Feeding.......

•Timely: CFs introduced when need for energy

and nutrients exceeds that provide by BF
•Adequate : CFs should provide sufficient energy,
protein, and micronutrients.
•Safe: CFs that they are hygienically stored and
prepared and fed
•Properly fed: CFs given in line with child’s signals
for appetite and safiety and that meal frequency
and feeding method (active) are suitable for age
INFANT FEEDING PERIODs

Exclusive Breast Feeding

(EBF)

EBF + Complementary
Foods

Family Foods
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23
Periode 2 : ASI + MP-ASI

Proses penyapihan (‘weaning’) :

• proses dimulainya pemberian makanan khusus
• selain ASI secara bertahap jenis, konsistensi, tekstur,
sampai seluruh kebutuhan nutrisi anak dipenuhi 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

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Energy Required from Complementary Foods (CF)
Pemenuhan
Assuming kebutuhan
Average Breast Milk (BM)nutrisi
Intake 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
Percent of Recommended Nutrient Intake
Required from CFs by 9-11 Mo of Age
(not provided by breast milk)

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Increase meal frequency with age

• On average, provide CFs

2-3 x per day by 6-8 mo
3-4 x per day by 9-11 mo, and
By 12-24 mo add 1-2 snacks (soft fruit, bread w/ nut paste)
•Nutritional principles
•Number of feeds based on estimaned gastric capacity of 30
g of food per kg per day & minimum CF energy density of 0.8
kcal per gram
•When amount eaten per feed or energy density are lower,
increase meal frequency
•Key: Be mindful not to displace breast feeds
 Kapan mulai diberikan MP-
ASI?

Kesiapan Kesiapan
fisik psikologis

Dapat Dapat Menunjuk Membuka

Refleks menahan duduk Tanda
kan minat mulut jika
ekstrusi kepala dgn lapar/
tetap terhadap diberi
sedikit kenyang
tegak bantuan makanan sendok

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Memulai Makanan Padat

Tidak terlalu dini (<4 bln):

- berisiko tersedak
- mengurangi asupan zat gizi
- risiko alergi lebih besar

Perhatikan perubahan pada bayi yg

sedang tumbuh-kembang :
- keterampilan motorik oral
- fisiologi tubuh
(fungsi saluran cerna, hati, ginjal, dll)

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Tes “Makanan Pertama”
Umumnya : berupa bubur
tepung beras yang diperkaya zat
besi

Hanya 1 jenis (bukan kombinasi),

bergizi, tekstur halus dan konsistensi
agak encer

Diberikan setelah minum ASI atau formula,

kecuali bila bayi menolak berulang atau
tampak tidak berminat  berikan
sebelumnya
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PANDUAN DASAR
1. Urutan pemberian :
• AAP : tidak ada urutan khusus

2. Tekstur :
• halus dan konsistensi encer pada awal
pemberian yang ditingkatkan bertahap

3. Besar porsi :
• mulai dgn jumlah sedikit (1-2 sdk teh)
• bertahap ditambah  1 sdm atau lebih
sampai 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 makanan
terlebih dahulu
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 HATI – HATI !!
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 bulan 
kandungan zat besi rendah, tinggi kadar
Natrium, Kalium dan Chlor ( beban ginjal)
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Bantu bayi untuk lebih
mandiri:
• beri finger foods

• minum dari cangkir sejak

usia 6-8 bulan

• memegang sendiri cangkir /

botol susu

• buat jadwal makan

sedemikian rupa sehingga
terjadi rasa lapardan
kenyang yg teratur
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Family Foods

35
Meals Frequency

36
Tujuan akhir praktek pemberian makan
(periode 3)

Susu

Susu

(Susu)

37
 Tahapan penyapihan
Bagan pengaturan :
makan pd bayi &
anak

R.hisap Gerak memutar

Mengunyah
R.telan Rahang stabil
Menggigit
Koordinasi
R.ekstrusi </- tangan baik

M,cair M.lumat M.Lunak/padat M.keluarga

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Infant Formula
 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
as“a 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
 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 for
Bottle-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 5ºC).
• 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
placing in for no more of
a container than 15 minutes.
warm Feedssure
water, making can be
there-warmed bywater
level of the
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 5ºC).
• 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 70ºC.

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 70ºC.
• If you do not have access to boiling water, youmay
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 70ºC 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.

Disusun oleh:Damayanti RS, UKK-NPM IDAI

THANKYOU….

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