We Are What We Eat

al
The Mission Hospit

Durgapur

Jump to a Healthy Start

Before this year is over, 10.9 million of the world’s children
< 5 years of age will die of conditions that would be largely
prevented by Optimal Infant and Young Child Feeding .

Before this day is over 3,500 children will be lost from such
causes.
Malnutrition in the Developing World
Malnutrition in the Developing World
Malnutrition in the Developing World
Factors that contribute to hunger and
malnutrition
Political disruptions and natural disasters
War

Refugees

Sanctions

Floods, droughts, mudslides, hurricanes

Inequitable food distribution

 MOTHE R AND CHILD
SURV IVAL
MMR 301/100,000 live births
IMR* 58/1000 live births
Child Mortality 85/1000 Children
Rate(Under 5 years)

A whopping 45.9 per cent of India's under-three kids are underweight, 39 per
cent are stunted, 20 per cent severely malnourished, 80 per cent anaemic while
infant mortality hovers at 67 per 1,000. More than 6,000 Indian children below
five years die everyday due to malnourishment or lack of basic micronutrients
like Vitamin A, iron, iodine, zinc or folic acid. Overall, India hosts 57 million -
or more than a third - of the world's 146 million undernourished children.

Vijayaraghavan
NUTRI TI ON PRO BLEMS IN
INDIA
WHO IS AT RISK??

PREGNANT WOMEN
LACTATING WOMEN
INFANTS
.
PRESCHOOL CHILDREN
ADOLESCENT GIRLS
ELDERLY
SOCIALLY DEPRIVED
(SC & ST Communities)

Vijayaraghavan
 NUT RITION P ROBLEMS IN
INDI A
WHAT ARE THE COMMON PROBLEMS?

WO MEN CH ILDREN
• POO R W T. GA IN LO W BIRT H WE IGH T
DURIN G • GRO WTH
PR EGN ANCY FALT ERI NG
• CE D • PEM
• MI CRO NUTR IEN T • MI CRO NUTR IEN T
DE FI CI EN CIES DE FI CI EN CIES
 FLUOROSIS, LATHYRISM
 DIET RELATED CHRONIC DISEASES
OBESITY, CARDIOVASCULAR
DISEASES, DIABETES
Vijayaraghavan
Nutrition in the Life Cycle
 Achieving Optimal Infant
and Young Child Feeding: A
Global Responsibility
Is it really possible to promote
Optimal Infant and Young
Child Feeding in the 21st
Century?
b

Yes!!!
Optimal Infant and Young Child Feeding

Fetal Infant and Young

e Child
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d
Breastfeeding
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Health BB ?? (weaning) ?
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child’s age ©Adapted by Wellstart from
WHO, 1998
Optimal Infant and Young Child Feeding

Fetal Infant and Young

e Child
Nutrit
n ion NutritionFamily
Special foods
e and Transition
r Healt al foods
g h
mixe
y Matern exclusive
d
Breastfeeding
al feed
Nutriti
Gestation ing Complementary
on and feeding
C
Health BB 6?mo (weaning) ?
?
child’s age ©Adapted by Wellstart from
WHO, 1998
Optimal Infant and Young Child Feeding

Fetal Infant and Young

e Child
Nutrit
n ion NutritionFamily
Special foods
e and Transition
r Healt al foods
g h
mixe
y Matern exclusive
d
Breastfeeding
al feed
Nutriti
Gestation ing Complementary
on and feeding
C
Health BB 6?mo (weaning) 2-7? you
child’s age ©Adapted by Wellstart from
WHO, 1998
 Characteristics of Infants
 Digestion, absorption & metabolism is
similar to older children except:

– Pancreatic amylase deficient until around 4th

month
– Fat absorption is inadequate
– Stomach acidity is low
 Calories
 Milk : sole source
 110-120 Kcal/kg/day = 0-2 mos.
 8.5 Kcal/kg = 2-6 mos.
 105 Kcal/kg BW = 6-12 mos.
 Cow’s/Human milk = 67 kcal/100ml
 Infant formula = 64-72 kcal/100 ml
 Calories
Reasons for increased need:
 Rapid growth rate
 Great heat loss due to large body surface
area
 Activity of the infant
 Protein

 RDA: 6 mos = 2.2 g/kg

12 mos = 2.0 g/kg
 Human milk = 1.2 gms/100 ml
 Cow’s milk = 3x more CHON
Disadvantage:
– increase blood urea
– high renal solute load
– AA pattern different from human milk
 Protein
Deficiency:
 Marasmus
 Mental retardation
– irreversible
– Poor reading/writing skills
– Less able to grasp knowledge
 Carbohydrate
 Prevent hypoglycemia & ketosis
 Lactose: sole source
 Improves CHON, Ca 2+ & Mg 2+ absorption
 Provides galactosides: brain & nerve cell
formation
 Laxative
 Human milk = 42% of total caloric value
 Cow’s milk = 20%
 Fat
 Must constitute 35-55% of TER
 Essential fatty acids: linoleic & alpha-
linolenic acid (omega 3 series)
 EFA: retina & brain
 Ratio of lenoleic to alpha-linolenic : 5-15
 Breastmilk = 30-40 mg/ml
 Cow’s milk = 10-15 mg/ml
 Vitamins
 Vit.A
– RDA is 325 g retinol equivalents
– Adequate: 850 ml BM w/ 170 IU/100ml
– Formulas: 750 IU/100 kcal
 Vit.C
– Gen low content in both CM & BM
– BM: 5 mg/ml
– Vit. C –rich beverages @ 6 mos to get at least
30 mcg daily
 Vitamins
 Vit. D
– Sunlight exposure
 Thiamine
– RDA: 0.4 mg/day
 Riboflavin
– Same as thiamine
 Niacin
– 0.25/100 kcal
 Vitamins
 Vit B12
– 0.5 mcg during 1st 5 mos. Of life
 Vit. E
– 1/3 of adult RDA
– 0.7 IU/100kcal for artificially-fed infants
 Vit. K
– All infants: single IM/oral dose ASAP post-
partum
 Minerals
 Iron
– 0.15-0.2 mg/100 ml
– 4th month: RDA 15 mg/day
– Iron fortification of milk formula after 4-6 mos.
 Calcium
– BM = 33mg/100ml; Ca:P ratio is 2.3
– Milk formula = 1.2 only
 Phosphorus
– Intake of infants is quite low
 Water & Electrolytes
 70-75% of BW
 Mostly extracellular: prone to dehydration
 Special attention: fever, polyuria, diarrhea
& during hot weather
 Na+ : K+ not ≥ 1.0
 Na+ : K+ = at least 1.5

Cl-
 Factors Affecting
Nutritional Status
 Mother’s attributes
 State of nutrition during pregnancy
 Feeding pattern
 Weaning & supplementation
 Illness
 BM: rich in long-chain polyunsaturated fatty acids
 LCPUFA – component of structural lipids in
membranes of all organs
 Indications of Good
Nutrition
 Body weight gain
 BMI:
wt. in kg/ height in m2
 MUAC(mid upper arm circumference)
 Behavioral development
 Bowel movements
 Sleeping habits
 Indications of Good
Nutrition
 Developed motor coordination
 Well-formed muscles
 Grave’s study
– Vigor in any activity
– Establishes interaction w/ mother at a distance
– Less irritable
 RDA @ 1 year
 Green leafy = 2 & ½ cups; yellow = 2 tbsp
 Vit C-rich foods = 2 tbsp
 Other fruits & vege = 2 tbsp each for both
 Fat = 2 tsp
 Meat, fish, poultry = 1 matchbox size
 Milk = 2 cups
 RDA @ 1 year
 Eggs =¼
 Dried beans = ¼ cup
 Nuts = 2 tbsp
 Rice (lugaw) = 2 ½ cups
 Rootcrops (mashed) = 2 tbsp
 Sugar = 6 tsp

*RDA : pls refer to handouts

NUTRITION IN PRESCHOOL
AGE
 Early preschool age
– Toddler
– 1-3 years old

 Late preschool age

– 4-6 years old
 RDA by FNRI

Body Protei Calciu Iron Retinol Vit. A B1 B2 Niaci Vit. C

n m Equivale n
Wt. Cal mg. I.U. mg. g. mg.
Ag gram grams nt
mg.
Kg.
e s Act.
Equi
1–3 13 1 26 0.5 6 250 1800 0.7 0.7 9 35
years 310 v.

4–6 18 1 32 0.5 8 325 2300 0.8 0.8 11 45

years 640
 ENERGY
 55% - metabolic activities
 25% - physical activities
 12% - growth needs
 9% - fecal loss (90- 100Kcal/kg)

FNRI estimate
1350 Kcal/day – 1-3 yr old children
250 Kcal/day – 4-6 yr old children
 Protein Energy Malnutrition
(PEM)
 Marasmus
 Kwashiorkor
 Protein
 FAO recommendation Deficiency symptoms
- 1.5- 2g/kg body wt.  Retarded growth
 Anemia
 Pigmentary changes of
hair and skin
 Edema (kwashiorkor)
 Vitamins
 vitamin A
 vitamin C
 vitamin B1
 vitamin B2
 Minerals
 Calcium and iron Zinc deficiency
 Trace elements  Dwarfism

- iodine  Retarded sexual

- fluoride development
-zinc
 TYPES OF AT- RISK
FACTOR
BIOLOGICAL EARLY WARNING
 Mother SIGNALS
 Young child  Community
 Individual
ENVIRONMENTAL
 Cultural
 Socio- economic
 Geographic- climactic
 Miscellaneous
 Reasons for nutritional vulnerability
 His mother may have another baby to whom she lavishes more attention
 He gets a small share of whatever food is on the table in proportion to his size
 He may choose from a common dish at the table foods that are not Nutritionally
protective
 The previous major source of his protein intake in which is breast milk maybe
suddenly withdrawn from him because mother is pregnant
 Mother may go back to work and he is left in the care of others
 Food Recommended
Food Groups Amount Allowed Foods
1. Vegetables 2 servings, one should be leafy or All except strongly flavored for the
yellow younger children; chopped or cut in
pieces
4. Fruits 2 servings, one should be Vit. C-
rich All; skin, seeds and long fibers, and if
any removed

7. Rice or
1 ½ to 2 ½ cups cooked All except for whole kernel corn and
substitute
malagkit

10. Milk At least 2 cups

Chopped or ground lean meat liver,
11. Meat or 3-5 servings more if milk is
chicken; flaked fish; eggs; mashed
substitute refused; liver twice a week
beans; mild cheese

13. Fat As needed

Cream, butter or margarine

15. Sugar 1 tablespoon

Sucrose, syrup, jams or jellies

17. Desserts As needed or made from food
allowance
Plain pudding, gelatin, ice cream, cakes
and cookies
SCHOOLCHILD
 CHARACTERISTICS

 Between 7 and 12 years

 Slow steady growth
 Increase body proportions
 Enhanced mental capabilities
 More motor coordination
 Body reserves are being laid down in preparation for the increased needs during the
adolescent stage
 Growth rates vary within this period
 NUTRIENT ALLOWANCES

 RDA classification of Filipino

 His nutritional needs differ from that of school children
an adult on the ff. points
– He is actively growing (girls at – 7 – 9 years old
prepuberty stage experiences
Spurts of growth) – 10 – 12 years old / pre-
– He is constantly active adolescence
– He is changeable in his attitudes
towards food
– He cannot afford to eat foods poor
in essential nutrients
 Age Energy Protein Vitamins and minerals
8% Vitamin C Calcium Iodine
7 -9 80 – 90 35 gm 55mg
Kcal/kg 600 – 700 mg 70 – 80
10 -12 70 – 80 45 – 49 65-70 mg mcg
Kcal/kg gm
FEEDING THE SCHOOL CHILD

1. Psychological factors

– Let him feel responsible for his own well-being

– Make him accountable for his diet
– Parents should take time out and spend time with the
children

“ A HAPPY CHILD IS A HEALTHY CHILD”

2. School environment
Goals of School feeding programs
– To improve the nutrition of school children by furnishing
them wholesome food at the lowest possible cost
– To aid in strengthening the nutrition and health education
program of the public schools
– To foster proper eating habits

3. Food Preference
 FEEDING PROBLEMS
1. Inadequate meals
2. Poor appetite
3. Sweet tooth
4. Fast foods
 INDICATIONS OF GOOD
NUTRITION
1. Clinical examination 3. Anthropometric
– EENT test examination
– SE – Weight-for-age
– UA
– – Height-for-age
PE
2. Dietary analysis – Weight-for-height
– Diet history/food
record
– General Eating habits
– Nutrient intake
 FOODS TO BE INCLUDED DAILY
Food item Serving
Milk, whole One or more cups
Meat, fish, poultry 3 or more servings
Dried beans and nuts 1/3 cup or more, cooked
Enriched rice and other cereals 4 or more cups, cooked
Rootcrops 1 or more medium pieces
Fat- butter, margarine, oil 6 teaspoon
Green and leafy vegetables ½ cup or more
Vitamin C-rich foods One or more
Other fruits and vegetables 2 medium fruits or 8 or more
tbsp vegetables
Eggs 2-3 a week
Sweets 6 teaspoons
 Food Allergies
 Resultin immunologic reactions
 Caused by common foods
– eggs, milk, peanut, soy, wheat, fish, tree nuts, shellfish
 Lead to
– diarrhea, vomiting, wheezing, anaphylactic shock,
abdominal pain, gas, hives, skin rashes
 Can be avoided (at least in part)
– slowly introduce new foods
– delay introduction of common food allergens until at
least 1 year of age, longer depending on allergen
 Fruit Juice
 Too much of a good thing?
– Nutrient density and displacement of nutrients
– Diarrhea
– Dental cavities
 Know the limits
≤ 8 oz diluted 100% fruit juice (4 oz fruit juice
and 4 oz water)
 Feeding Infants Cow Milk
 Not recommended during the first year.
 Fluid cow milk consumption can lead to:
– GI bleeding
– Iron deficiency
– Displacement of nutrients
 Other dairy products  at 8 months
– Yogurt and cheese
 Benefits of Healthy Gut Flora
 Infants with a healthy gut flora (i.e. one dominated by
beneficial bacteria, such as Bifidobacterium and/or
Lactobaccillus) have reduced risk of infection, disease and
later development of food allergy.

 Decreased prevalence of eczema in high risk infants given

probiotics/lactobacillus.

 Certain species of gut bacteria down regulate inflammation

 Conditions for which non-
optimally fed infants and young
children are likely be at an
increased risk:
 Diarrhea/gastoenteritis  Childhood Leukemia
 Serious Respiratory and lymphoma
Infections  SIDS
 Recurrent Ear  NEC
Infections  Lowered IQ
 Obesity  Chronic GI Tract
disorders
 Type I Diabetes
 Allergic disorders
 Mortality between 28
days and 1 year of age
Influences on Food Choices
Cognitive
Habits
Comfort foods
Cravings
Advertising
Social factors
Nutritional value
Health beliefs
Influences on Food Choices
Culture
Beliefs and
traditions
Religion
“Indian diet”
 Getting off to the right start:
infants
 Calorie needs are highest in infancy; met w/milk
 Respect hunger and satiety cues
 Delay introduction of complimentary foods (juice,
cereal) till 6 months
 Juice—≤4 oz/day of 100% juice; work towards
mashed whole fruit after 6-9 months; juice in a
cup, not in bottle
 Cereal: 1 T/2 oz breastmilk or formula; 1-2 times
a day; not in bottle
 Milk: whole for 1st 2 years; 24 oz a day
by 12 months
 Baby and table foods:
 Evaluate infant’s readiness for solids
 Begin with vegetables, then fruits, then meats
 No more than 1 new food every 3-5 days
 1 tsp at first, then move up to 2 and beyond;
maximum of 5 T. of any one item
 after age of 12 months, 1 tablespoon/year of age
of any one food is a serving
--ex. 1.5 tablespoon carrots, 1.5 T chicken, 1.5 T
green beans for 18 mon old
 Table foods:
 Mashed up and appropriate consistency for baby’s
age, abilities and #teeth
 Sit at family table, no TV
 Respect satiety cues
 Know parent’s and child’s jobs (Satter):
 “It is the parent’s responsibility to provide a
variety of healthy foods. It is the child’s
responsibility to decide whether they are going to
eat and how much to
eat.”
 Model the right plate:
 Make it colorful—eat the rainbow
 www.5aday.com
 2/3 vegetables, fruit, whole grains, beans
 1/3 protein source
 Eating out:
 Eatat home as often as possible
 Teach children about correct portion sizes,
“Mighty Kids” meals too big for anyone!
 Avoid supersizing yourself—model
 Avoid “all you can eat” buffets
 Eating and behavior:
 Being a good role model is #1
 Do not use food as a reward or withhold treats as a
punishment—these elevate the position of food in
the child’s mind
 Instead, reward with time spent with caregiver
 Do not refer to certain foods as good or bad
 Do not over-regulate child’s eating
Child’s self-regulation:
Park et al, 1994

Caregivers as
providers
of opportunities

Caregivers as Caregivers as
direct interactive
instructors partners
 Caregivers as interactive
partners:
 Caregivers transmit messages and values about
eating and food by their interaction with their
children
 By your words and actions, children will learn
what foods are healthy
 “Junk” foods—mixed message if you say they’re
junk food but then eat them
 Caregivers’ attempts to lose weight, preoccupation
with food or body may lead
to same in child (Thelen, Stice et al,
Francis et al)
 Caregivers as direct
instructors:
 Show children how to choose healthy foods
in grocery store, at restaurant
 Reinforce children for making healthy
choices
 If you overeat or exhibit “out of control”
eating, they may, too (Cutting et al)
 Caregivers as providers of
opportunities:
 Limiting intake of and/or access to foods of lower
nutritional value
 Providing healthy food choices
 Children have natural preference for sugar, salt
and fat
 Caregivers may respond with controlling feeding
strategies—either to restrict or to pressure child to
eat
 Parents as direct instructors,
cont:
 This promotes further problems
 Disordered eating
 Enticement of the “forbidden”
 Overweight in child may result, esp. girls
 Too much food presented decreases child’s ability
to self-regulate, encourages overeating (Birch,
Rolls et al)
 Appropriate portion size is important
 Picky eaters:
 Research demonstrates that it takes 10-15 times of
offering a new food before an infant or toddler
makes a decision
 Try, try and try again
 Make new food the 1st food toddler tries
 Eat it yourself, talk positively about it
 Allow preschoolers to help choose and prepare
new foods
 Toddler and preschooler eating
habits:
 Growth rate slows after 12 months, so they do not
need as many calories to grow
 100-120 cals/kg of body weight in 1st year
 ~100 cals/kg of body weight from 2-3 yrs
 90 cals/kg of body weight from 4-6 years
 They don’t need as many calories as they did
when they were infants
 Make the calories they do need healthy
 Toddler/preschooler diet:
 One tablespoon/year of age is a serving of any one
food item
 Switch to lowfat or skim milk at age 2
 3 meals and 2 snacks a day
 Same diet as is recommended for adults is
recommended for kids 2 and older (<30% of
calories from fat, <10% from sat. fat)
 Eating habits of young children:
What do we know?
J Amer Diet Assn 1/04; Vol. 104 Number 1
 Gerber-sponsored “Feeding Infants and Toddlers”
Study or FITS
 30% of infants have solid food introduced before
the recommended 4-6 months of age
 31% of toddlers ages 12-24 months have a mean
energy intake exceeding their estimated mean
energy requirement
 Intake of “adult” high energy density/low
nutritional value foods is prevalent
among toddlers
 FITS Highlights, cont:
 18-33% of 7-24 month olds consume no
servings of vegetables, and 23-33%
consume no fruits
 French fries are the most commonly
consumed vegetable beginning at 15
months of age
 FITS Highlights, cont:
 ~50% of 7-8 month olds consume some
type of dessert, sweet or sweetened
beverage
 Infants and toddlers in WIC are more likely
to consume 100% fruit juice (vs. whole
fruit), desserts, sweets and fruit drinks than
their
non-WIC peers
 Eating habits of young children:
Why do we care?
 Rapid infant weight gain is associated with
increased risk of being overweight at age 4
(Guo)
 Mothers of overweight young children are
unlikely to view their child as such
(Baughcum et al)
 Restrictive parental feeding practices are
associated with
increased child eating and weight
status (Birch, Fisher)
Most children do not “outgrow”
extra weight:
 Children who are at-risk for overweight or
overweight at any time during the preschool years
are more than 5 times more likely than their peers
to be overweight 12 year olds (Nader et al)
 >75% of overweight and obese 10-15 year olds
will become obese adults (Whitaker et al)
 Childhood obesity affects
more than looks:
 Many medical complications
--cardiovascular
--endocrine
--pulmonary
--orthopedic
--liver
 Childhood obesity
complications, cont:
 Psychosocial complications most common
--poor self-esteem
--decreased quality of life
--depression
--teasing and bullying
 Children prefer normal weight peers to be their
friends more often, even at age 5
 Role of early child care
professionals:
 Child Care Champions Best Practices
 CO Physical Activity and Nutrition/ CO
Dept. of Health document
 7 “Best Practices” for prevention of
childhood overweight
 Goals which are attainable, realistic and
proven to be effective
 #1: Model healthy eating
behaviors
 When you eat the same foods as the children you
serve, you are saying, “Do as I do” rather than
“Do as I say”
 Sit with children at meals, eat same food
 Try new foods with children
 Start with “adventurous” eaters to model trying
new foods to picky peers
 Avoid negative facial expressions, body language
or words re: food served
 #2: Integrate nutrition/PA into
curricula
 Provides repeated exposures to topics
 “Normalizes” healthy eating and PA
 Emphasizes their importance daily
 New PAT curriculum, High Five, Low Fat, preK
school wellness resource guide, Movement
Exploration
 Other ideas listed in CC Champions
 #3: Practice division of
responsibility (Satter)
 Caregiver’s job=what to offer child to eat
 Child’s job=how much, what and whether to eat
 Caregiver provides regularly scheduled meals and
snacks at appropriate intervals
 Allow children to help in preparation, table
setting, serving and clean up if possible
 Offer a variety of healthy foods repeatedly
 Avoid verbal or nonverbal prompts to eat
 #4: Provide the best start for
infant feeding:
 Breastfeeding, developmentally appropriate
1st foods offered at the right time,
recognition of hunger and satiety
 Promote breastfeeding to all parents
 How can you help?
 Be welcoming to breastfeeding moms
 For 1st 6 months, offer only breastmilk to breastfed
infants unless mom wishes otherwise
 Provide private place to nurse for moms before
they leave their infant and when they return
 Provide adequate and safe storage space for
breastmilk (COPAN resource kit)
 Appropriate 1st foods:
 In addition to delaying solids till 6 months…
 Avoid added sugars (desserts, cookies, cakes, fruit
drinks, pop) and do not add sugar, molasses,
honey, syrup to baby food, cereal, milk or water
 Do not allow “grazing” from plate, cup or bottle
 #5: Become partners in
prevention
 Partner with the parent to avoid giving children
mixed messages about eating and physical activity
 Communicate feeding policies to parent
 Alert parent to feeding problems quickly and
enlist their ideas
 Use resources/newsletter to educate parents on
common feeding issues
 #6: Promote physical activity
and free play
 Young childhood is key time when PA behaviors,
preferences are being set
 Infants should play interactive games and safely
explore their environment
 Toddlers need safe opportunities to learn running,
jumping, throwing, kicking; refine skills as
preschoolers
 Toddlers need ≥30 min of structured PA and ≥60
min of free play
 Preschoolers need ≥60 min structured PA
and ≥60 min of free play
 Physical activity, cont:
 No TV/screens for children ≤2 years old
 1-2 hours/day of educational programs for those
>2, preferably movement-promoting
 Dance or move to music instead of TV
 Use Hip Hop to Health, Jr, Movement
Exploration, other resources
 Examples in Child Care
Champions:
 How to provide activity opportunities for infants
 What counts as structured physical activity?
 What counts as free play?
 How to ensure play spaces are safe
 How to create an indoor activity space
 #7: Plan meals w/childrens’
nutrition needs in mind
 Ittakes time and planning
 Use guidance learned during conference
 Use Child and Adult Care Food Program
Guidelines and 2005 Dietary Guidelines
 Provide written menus to parents
 Educate parents on balanced meals if they send
food
 Establish positive eating environment
 Positive eating environment:
 Children should help with food prep and cleanup
as developmentally able
 Children should sit with caregiver and each other
 Chairs, table, utensils suitable for children
 Pleasant social and learning experience with no
conflict
 Food not a reward or punishment
 Allow sufficient time to eat (>20 min)
 Common Disorders
 Diarrhea
 Vomiting
 Constipation
 Colic
 Measures:
– Determine underlying cause
– Maintain water & electrolyte balance
– Modify milk formula
 Summary:
 Young children are establishing eating and
activity patterns for life
 You have an important role to play in
promoting breastfeeding as best 1st feeding,
promoting and providing opportunities for
healthy eating and activity for young
children, families
There is always more to
come!

Thank you
OK135S053
OK135S057
And we know what to do
Optimal Infant Feeding and
Maternal Health