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Your Baby & Toddler - - YOUR NEW BORN -

a re­sult of a chro­mo­so­mal ab­nor­mal­ity, the pri­mary cause for fail­ure to thrive in small ba­bies is poor breast­feed­ing.

This is due partly to a lack of knowl­edge and sup­port for breast­feed­ing moth­ers in South Africa. “Be­cause of so­ci­etal dis­ap­proval about breast­feed­ing in pub­lic, most women don’t see other women breast­feed­ing, so they never get shown how to breast­feed suc­cess­fully,” says Heather. This un­cer­tainty leads to anx­i­ety in the new mother, and this has a neg­a­tive ef­fect on her milk sup­ply, es­pe­cially in new moth­ers who don’t have emo­tional sup­port and nur­tur­ing from those around them.

“Go­ing back to work can also have a neg­a­tive ef­fect,” says Heather, as women who are sep­a­rated from their ba­bies suf­fer emo­tion­ally, in ad­di­tion to be­ing un­der pres­sure to ex­press enough milk. “And the crèche en­vi­ron­ment, with its many bugs and viruses, isn’t an ideal en­vi­ron­ment for a child un­der one year old,” she adds. Ill­ness in the in­fant, such as di­ar­rhoea and/or vom­it­ing, also has a neg­a­tive ef­fect on his abil­ity to ab­sorb nu­tri­ents.

In South Africa, there are ad­di­tional cir­cum­stances that con­trib­ute to fail­ure to thrive in in­fants – poverty be­ing chief among them. “Women who aren’t able to breast­feed suc­cess­fully, for what­ever rea­son, are forced to put their ba­bies on for­mula, but be­cause it’s ex­pen­sive, they of­ten over-di­lute the for­mula, which means their ba­bies don’t get enough nu­tri­ents,” says Heather.

More than half of the ba­bies in South Africa are born to sin­gle moms, ac­cord­ing to Sta­tis­tics South Africa, and at least half of work­ing moms in South Africa are sin­gle, ac­cord­ing to the an­nual Old Mu­tual Sav­ings and In­vest­ment Mon­i­tor. This of­ten means that new moms have very lim­ited sup­port, and breast­feed­ing moth­ers who are un­der stress or ex­hausted of­ten strug­gle to pro­duce enough milk for their ba­bies.

Epi­demic dis­eases such as HIV and TB may also cause fail­ure to thrive: ac­cord­ing to Unicef, about 300 000 ba­bies are born ev­ery year in South Africa to Hiv-pos­i­tive moth­ers; about 72 000 of these ba­bies are HIV pos­i­tive at birth and 21 000 more are in­fected by HIV from their mother.

Poor ed­u­ca­tion, lim­ited ac­cess to clean wa­ter and san­i­ta­tion, and over­flow­ing pub­lic health clin­ics are ad­di­tional South African prob­lems, adds Tanya. “The clin­ics are of­ten so busy that in­fants aren’t as­sessed prop­erly, and the signs of fail­ure to thrive are missed.”

WHAT YOU CAN DO

It’s vi­tally im­por­tant that a good milk sup­ply is es­tab­lished in the first six weeks. And for this to hap­pen, the mom needs “sup­port, sup­port, sup­port!” says Heather. New moms need to be ed­u­cated about breast­feed­ing, need to have sup­port­ive part­ners and/or help from friends and fam­ily, and need to be nur­tured. “Take your baby for a weigh-in once a week for the first six weeks, so you can pick up any prob­lems early,” Heather sug­gests.

“Moth­ers of young chil­dren must have ac­cess to good food and health­care,” says Tanya, and Heather adds, “More com­pas­sion and dig­nity for new moms at lo­cal clin­ics and hospi­tals would im­prove these out­comes.”

HOW IS FAIL­URE TO THRIVE TREATED?

Usu­ally, the health prac­ti­tioner will get a di­etary his­tory, in­clud­ing the feed­ing sched­ule and tech­niques for the prepa­ra­tion and feed­ing of for­mula or ad­e­quacy of breast­milk sup­ply; and a fam­ily and med­i­cal his­tory, to en­sure there are no un­der­ly­ing prob­lems to do with ei­ther ge­net­ics or dis­ease. “A nu­tri­tious diet con­tain­ing ad­e­quate calo­ries for catch up growth – about 150 per­cent of nor­mal caloric re­quire­ment – and in­di­vid­u­alised med­i­cal and so­cial sup­ports are usu­ally nec­es­sary,” says Tanya. “The child’s weight will be mon­i­tored fre­quently, and the mom may need to bring the in­fant to the clinic for weekly weigh-ins. A child who doesn’t gain weight ad­e­quately in spite of this is usu­ally ad­mit­ted to the hos­pi­tal, so that all nec­es­sary ob­ser­va­tions can be made and di­ag­nos­tic tests can be done quickly.” YB

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