difference between "brain" and "brawn", (a) PROTEIN : One of the striking difference is the low protein content

of human milk; this is about 3 times less than in cow's milk and lower than in most mammals. The proteins in human breast milk and in cow's milk are completely different. Human milk contains more cystine, essential for the prematures, and less methionine than cow's milk. It is rich in taurine, indispensable for infants, but which they, unlike adults, are unable to synthesize. Breast milk is almost completely digested and utilized for growth, whereas much of cow's milk protein is excreted by the infant undigested producing whitish curdy stool. Breast milk contains other proteins whose functions are not nutritive, but antiinfective, e.g., IgG, lysogyme, living cells, etc. Human milk is virtually a "living" fluid. (b) FATS : Mother's milk is especially rich in fats, which represents between 35-50 per cent of total energy value. There are two main ways in which the fats of human milk differ from those of other milks - first, levels of essential polyunsaturated fatty acids, especially linoleic acid and alpha-linoleic acid are higher in human milk than in cow's milk; secondly, the fats of human milk are easier for the baby to digest and absorb than are those of cow's milk. With cow's milk, unabsorbed fatty acids tend to bind with calcium and prevent it from being absorbed. Although there is less calcium in human milk than in cow's milk, it is much better absorbed, (c) CARBOHYDRATES : Human milk contains more lactose than most other milks. It may be specially useful for the growing brain. In the intestine, lactose helps the "right" kind of bacteria (i.e., Lactobacillus bifidus) to grow. Lactobacillus and lactose help to keep the intestinal contents acidic, which inhibits the growth of harmful bacteria. Lactose plays an important role in maintaining low electrolyte concentration. (d) VITAMINS AND MINERALS : If the mother takes adequate amount of vitamins, there is no reason why the child should have a vitamin supplement. The earlier teaching that human milk was deficient in vitamin D is no longer accepted. Vitamin D is present in human milk in water-soluble form. Human milk contains more vitamin A and vitamin C than cow's milk. Another factor which was supposed to be deficient in human milk was iron, but again recent work has shown that iron contained in human milk has a high level of bioavailability, thanks to complex phenomena (the action of lactoferrin, acidity of the digestive track, presence of appropriate proportions of zinc and copper). The coefficient of uptake of the iron in breast milk may be as high as 70 per cent, whereas it is only 30 per cent for cow's milk and infant formulas (49), and no iron supplement is necessary for the baby reared on human milk. Human milk is richer in copper, selenium and cobalt than cow's milk. It contains less sodium than cow's milk and does not put any unnecessary strain on the infant's kidneys. The calcium/phosphorus ratio is high. so that the uptake of calcium is better than cow's milk. The high phosphorus content of cow's milk causes this mineral to be assimilated to the detriment of calcium. It has the added disadvantage of combining with certain fatty acids to form non-soluble calcium soaps. WEANING : Weaning is not sudden withdrawal of child from the breast. It is a gradual process starting around the age of 6 months, because the mother's milk alone is not sufficient to

sustain growth beyond 6 months. It should be supplemented by suitable foods rich in protein and other nutrients. These are called "supplementary foods". These are usually cow's milk, fruit juice, soft cooked rice, suji, dhal and vegetables. The weaning period is the most crucial period in child development, for during the weaning process children are particularly exposed to the deleterious synergistic interaction of malnutrition and infection. Weaning. if not done properly, is often followed by diarrhoea and months of growth failure leading to kwashiorkor, marasmus and immunodeficiency marked by recurrent and persistent infections which may be fatal. A knowledge of weaning foods and practices is an i mportant aspect of preventive and social paediatrics. At the age of one year, the child should receive solid foods consisting of cereals, pulses, vegetables and fruits. There is now enough evidence to show that children can be properly weaned by local foods of a kind usually consumed by the older children and adults in their families. Efforts should therefore be made to design and promote the use of adequate home-made weaning foods. Baby friendly hospitals initiatives Since 1993 WHO's efforts to improve infant and young child nutrition have focused on promoting breast feeding. It has been calculated that breast feeding could prevent deaths of at least one million children a year. A new "baby-friendly hospital initiative" (BFHI), created and promoted by WHO and UNICEF, has proved highly successful in encouraging proper infant feeding practices, starting at birth (50). BFHI is supported by the major professional medical and nursing bodies in India. The global BFHI has listed ten steps which the hospital must fulfil. This includes: (1) helping the mother initiate breast-feeding within the first hour of birth in normal delivery and 4 hours following caesarean section; (2) encourage breast-feeding on demand; (3) allow mothers and infants to remain together 24 hours a day, except for medical reasons; (4) give newborn infants no food or drink, other than breast-milk unless medically indicated; exclusive breast-feeding should be promoted till 4-6 months of age; (5) no advertisement, promotional material or free products for infant feeding should be allowed in the facility; (6) show mother how to breast-feed, PREVENTIVE ME DICINE IN OBSTETRICS, PAEDIATRICS AND GERIATRICS and how to maintain lactation even if she is separated from her infant; (7) give no artifical teats or pacifiers (also called dummies or soothers) to breast feeding infants; (8) encourage mothers to assist each other and to develop breast feeding support groups; (9) nursing staff should be available to counsel families and mother in support of exclusive breast feeding. The "Baby friendly" hospitals in India are also expected to adopt and practice guidelines on other interventions critical for child survival including antenatal care, clean delivery practices, essential new-born care, immunization and ORT (51). National guidelines on infant and young child feeding In view of the vulnerability of young infant to the risk of breast milk substiutes, the Govt. of India enacted the Infant Milk Substitutes, Feeding Bottles and Infant Food (Regulation of Production, Supply and Distribution) Act 1992. It came into force on 1st Aug. 1993. It prohibits the promotion of infant food, infant milk substitutes and feeding bottles as Govt. of India is committed to promote breastfeeding. The new norms of infant and young child feeding i.e.,

exclusive breast feeding for the first 6 months (replacing the 4-6 months age range of earlier guidelines), introduction of complementary foods at 6 months while continuing breast feeding upto the age of 2 years or beyond; replaces the previous policy. The infant milk substitutes, feeding bottles and infant foods (Regulation of Production, Supply and Distribution) Amendment Act 2003, was passed and came into action since 1st January 2004 (47). Goals set to be achieved by year 2007 were : 1. Intensify nutrition and health education to improve infant and child feeding and caring practices so as to (a) bring down the prevalence of under-weight children under three years from the current level of 47 per cent to 40 per cent; (b) reduce prevalence of severe undernutrition in children in the 0-6 years age group by 50 per cent; 2. Enhance early institution of breast feeding (colostrum feeding) from the current level of 15.8 per cent to 50 per cent; 3. Enhance the exclusive breast feeding rate for the first six months from the current rate of 55.2 per cent (for 0-3 months) to 80 per cent; and 4. Enhance the complementary feeding rate at six months from the current level of 33.5 per cent to 75 per cent.