2. Pontianak -Complementary Feeding

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Transcript of 2. Pontianak -Complementary Feeding

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    dr. Sri Sudaryati Nasar SpA(K) Tempat/tanggal lahir : Rangkasbitung, 31 Desember 1942 Pekerjaan/Jabatan : Sekretaris UKK Nutrisi dan Peny. Metabolik IDAI Riwayat Pendidikan formal Dokter Umum : Fakultas Kedokteran UI, lulus Desember 1967 Spesialis Anak : Fakultas Kedokteran UI, lulus Oktober 1973 SpA (K) : September 1987 Riwayat Pend. Tambahan : Kobe University: Inborn of Metabolism (1985) Osaka University: Parenteral Nutrition (1987) Kobe University (research) - Prealbumin (1992) - IGF-1 (1993) Bangladesh: WHO Course on PEM (2002) Riwayat Pekerjaan :

    Diperbantukan di Bagian Gizi FKUI (1968 ) Asisten Ahli /PPDS (1969-1973) Staf Pengajar di Dept. IKA FKUI-RSCM (1974-2007) Jan 2008 : Purnabakti Agustus & Oktober 2010: Konsultan WHO di Timor Leste

    CURRICULUM VITAE

    Feeding skill development

    Dr. Sri S.Nasar, SpA(K) UKK Nutrisi dan Penyakit Metabolik

    I D A I

    Organs and its function: mouth,

    tongue, oropharynx, esophagus

    Foods

    Brain and mind

    Body position

    Feeding process = a complex of activities, involving : Oral cavity enlarges and

    tongue fills up less

    Tongue grows differentially at the tip and attains motility in the larger oral cavity.

    Elongated tongue can be protruded to receive and pass solids between the gum pads and erupting teeth for mastication.

    Mature feeding is characterized by

    separate movements of the lip, tongue, and gum

    pads or teeth

    Anatomic Developmental

    Changes

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    Anatomic differences of oropharynx Sequence of Development and Feeding Skills in Healthy, Full-term Infant

    Age approx./mo

    Mouth Patterns Hand and body skills Feeding Skills / Abilities

    Birth

    5 mo

    Suck and

    swallow reflex

    Tongue thrust

    reflex

    Rooting reflex

    Gag reflex

    Poor control of

    head, neck, trunk

    Needs head

    support

    Brings hand to

    mouth (+ 3 mo)

    Swallow liquids

    but pushes solid

    objects from the

    mouth

    Coordinates

    suck- swallow-

    breath while

    breast / bottle

    feeding

    Moves tongue

    forward and back

    to suck

    Sequence of Development and Feeding Skills in Healthy, Full-term Infant

    Age approx

    ./mo

    Mouth Patterns Hand and body skills

    Feeding Skills / Abilities

    4 - 6

    mo

    Up-n-Down munching movement

    Transfer food from front to back to swallow

    Draws in upper/lower lips as spoon removed

    Tongue thrust & rooting begin to

    disappear

    Gag diminished

    Open mouth when sees spoon approaching

    Sits with support

    Good head

    control

    Uses whole hand

    to grasp objects

    (palmar grasp)

    Recognizes

    spoon and holds

    mouth open as

    spoon approaches

    Takes in a

    spoonful of

    pureed / strained

    food and

    swallow without

    choking

    Drinks a small amount from cup

    when held by

    another person,

    with spilling

    Sequence of Development and Feeding Skills in Healthy, Full-term Infant

    Age approx.

    /mo

    Mouth Patterns Hand and body skills Feeding Skills / Abilities

    5 - 9

    mo

    Begins to

    control position

    of food in the

    mouth

    Up-n-down

    munching

    movement

    Positions food between jaws

    for chewing

    Begins to sit

    alone unsupported

    Follows food with eyes

    Transfers food from one hand to

    the other

    Tries to grasp food with all fingers

    and pull them into

    the palm

    Begins to

    eat mashed

    foods

    Eats from spoon easily

    Drinks from

    cup with some

    spilling

    Begins to feed self with

    hands

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    Sequence of Development and Feeding Skills in Healthy, Full-term Infant

    Age /mo

    Mouth Patterns Hand and body skills Feeding Skills / Abilities

    8 - 11

    mo

    Moves food from side to side

    in mouth

    Begins to use jaws and tongue

    to mash food

    Begins to curve lips around rim

    of cups

    Begins to chew in rotary pattern

    Sits alone easily

    Transfers objects from hand to mouth

    Begins to use thumb

    and index finger to pick up objects

    (pincer grasp)

    Feeds self finger foods

    Plays with spoon at mealtimes, but

    does not spoon-feed

    yet

    Begins to eat ground or finely

    chopped food and

    small pieces of soft

    food

    Begins to experiment with

    spoon but prefers to

    feed self with hands

    Drinks from a cup with less spilling

    Sequence of Development and Feeding Skills in Healthy, Full-term Infant

    Age approx

    /mo

    Mouth Patterns Hand and body skills Feeding Skills / Abilities

    10-12

    mo

    Rotary chewing

    (diagonal move-

    ment of the jaw)

    Feeds self easily

    with fingers

    Begins to put spoon

    in mouth

    Dips spoon in food rather than scooping

    Demands to spoon-

    feed self

    Begins to hold cup

    with two hands

    Drinks from a straw

    Good eye-hand-

    mouth coordination

    Begins to eat

    chopped food and

    small pieces of

    soft cooked table

    food

    Begins to spoon-

    feeding self with

    help

    Bites through a variety of textures

    Posisi tubuh The physiology and genetic of taste

    The 4 basic tastes

    Taste development starts since in utero

    Since born : infants prefer sweet tastes, avoid bitter and sour

    4 months : preference for salt develops

    Odor activation of olfactory receptors

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    TASTE

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    Complementary Feeding ( MP-ASI)

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    Hidup, tumbuh-kembang, aktivitas, dll

    Pemenuhan kebutuhan

    zat gizi

    Keterampilan makan, pembinaan selera, sarana pembelajaran, disiplin

    Pendidikan

    Kepuasan keluarga, orangtua dan anak Psikologis

    Tujuan Pemberian Makan

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    17

    Malnutrisi ikut andil pd lebih dari 50% kematian anak balita

    Lebih dari 80% kematian tsb terjadi pada anak dengan malnutrisi

    ringan sedang

    Perlambatan pertumbuhan / gagal tumbuh kebanyakan terjadi pada masa bayi pencegahannya harus berupa

    perbaikan pada nutrisi bayi

    Faktor yg berkontribusi pada kematian

    balita terkait malnutrisi tsb :

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    Praktek pemberian ASI kurang optimal

    Kualitas MP-ASI yang rendah / buruk

    Praktek pemberian makan pada bayi yang kurang baik

    Makanan yang tercemar

    Rekomendasi GSIYCF 2002: 1. Setiap bayi seharusnya mendapat ASI Eksklusif selama 6 bulan pertama kehidupannya (tmsk IMD)

    2. Untuk memenuhi kebutuhan nutrisinya, setiap bayi harus mendapat MP-ASI yang cukup serta aman, sementara ASI diteruskan sampai usia 2 tahun atau lebih.

    PERIODE PEMBERIAN MAKAN PADA BAYI

    ASI Eksklusif

    ASI + MP-ASI

    Makanan Keluarga 20

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    Makanan Pendamping ASI

    (MP-ASI)

    Untuk memenuhi kebutuhan nutrisinya, setiap bayi harus mendapat MP-ASI yang cukup serta aman, sementara ASI diteruskan sampai usia 2 tahun atau lebih. 22

    Makanan yang mengandung energi yang menggantikan tempat / jadwal pemberian ASI serta mengurangi asupan ASI

    AAP

    Makanan atau minuman selain ASI yang mengandung nutrien yang diberikan kepada bayi selama periode pemberian MP-ASI .(saat) makanan / minuman lain diberikan bersama pemberian ASI

    WHO

    Makanan / minuman selain ASI atau formula yang diberikan kepada bayi selama 12 bulan pertama kehidupannya.

    Healthy Start Guidelines

    Definisi MP-ASI

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    MP-ASI mulai diberikan saat kebutuhan Energi dan nutrien melebihi yg didapat dari ASI

    Tepat waktu

    MP-ASI harus mengandung cukup Energi, Protein dan mikronutrien Adekwat

    Penyimpanan, penyiapan dan sewaktu diberikan MP-ASI harus higienis Aman

    MP-ASI diberikan sejalan dgn tanda lapar dan nafsu makan serta frekuensi dan cara pemberiannya sesuai dengan usia bayi

    Tepat cara pemberian

    MP-ASI harus...

    Damayanti Rusli Sjarif 2009

    Energi dari ASI Senjang energi

    Kalori

    Bulan

    Mengapa harus diberi MP-ASI mulai usia 6 bulan ?

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    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

    200

    550 300

    2-3x makan/hr 3-4x makan/hr 3-4x makan/hr

    Umur, bulan

    En

    erg

    i, k

    ka

    l/h

    ari

    Energi dari MP-ASI dengan perkiraan energi rata-rata dari ASI

    MP-ASI

    ASI

    Berapa banyak zat gizi yang harus dipenuhi MP-ASI pada usia 12-23 bln?

    Percentage of daily needs

    0

    25

    50

    75

    100

    Energy Protein Iron Vitamin A

    %

    Gap

    Provided by

    550 ml breast

    milk

    % dari kebutuhan/hari

    Dipasok oleh

    550 ml ASI

    Dari MP-ASI

    Mengapa mulai pemberian MP-ASI harus tepat waktu?

    Terlalu dini :

    Risiko diare, dehidrasi Produksi ASI menurun Sensitisasi alergi? Gangguan tumbuh-

    kembang

    Terlambat :

    Potensial untuk terjadinya g