A complete balanced diet is a prerequisite for the normal development of all organs and systems of the baby. It is important that children receive a certain amount of macronutrients (proteins, fats, carbohydrates), minerals and vitamins every day. Thanks to this, they will grow up healthy, cheerful and quick-witted. How to properly organize the feeding of children up to a year? Let's look into this issue, which interests all conscious parents.
Types of nutrition for children up to a year
There are three types of feeding children up to a year: natural, artificial and mixed. Each of them has its own diet. Consider the features of different types of menus for newborns. General schemes are given for healthy babies. In case of violations of the norm of food consumption, the doctor determines.
natural feeding
A breastfed baby from 0 to 6 months receives only mother's milk. According to WHO recommendations, solid food (complementary foods) is gradually introduced into his diet after this age. The proportion of breast milk in the daily amount of food is decreasing, but remains high. The famous children's doctor E.O. Komarovsky insists that the introduction of complementary foods at an earlier period is not advisable.
With natural feeding, most experts recommend feeding the baby freely, that is, at his request. This approach allows you to maintain lactation at the required level. After 2-3 months, even in the case of free feeding, a flexible feeding schedule for the newborn is established: meals occur at intervals of 2-2.5 hours.
Artificial feeding
With artificial feeding, the child receives an adapted milk formula. Breast milk may be present in its menu, but in a small amount - up to 20% of the total food volume.
Artificial feeding requires adherence to a clear feeding schedule with certain intervals between meals. E.O. Komarovsky reminds that they must be kept, as the mixture is digested more slowly than mother's milk.
mixed feeding
The need for mixed feeding occurs when the mother produces breast milk, but it is not enough for the child. The shortage is compensated with the help of artificial mixtures.
The proportion of mother's milk with mixed feeding is more than 20% of the daily diet. The feeding regimen with this type of diet depends on the level of lactation in the mother. If breast milk is the basis of the diet, then the schedule approaches free. In the case of the predominance of the mixture, feeding occurs by the hour.
How to calculate the required amount of food?
First 7-10 days
The calculation of the daily volume of formula or breast milk for children in the first 7-10 days of life is carried out in one of two ways:
- Zaitseva formula. It is necessary to multiply the body weight of the child at birth by the number of days of his life and find 2% of this number. The result is the required amount of food per day.
- Finkelstein formula. To determine the daily amount of milk or formula for a child weighing less than 3.2 kg, multiply his age in days by 70. If the weight of the crumbs is less than 3.2 kg, you need to find the product of the number of his days of life and 80.
Regardless of the formula used, the resulting daily volume must be divided by the number of feedings. So you can find out the amount of milk or mixture sufficient for one meal.
Older than 7-10 days
To calculate the amount of nutrition for a newborn older than 7-10 days up to 12 months, the method according to Geibener and Czerny or volumetric is used. The method of Geibener and Czerny allows you to find the required total amount of liquid per day, including formula, milk, water, juice, tea, and so on. This takes into account the weight of the child and his age. The main recommendations are presented in the table.
For example, a baby at 3 months weighs 5.2 kg. He needs 5200÷6=867 ml of milk or mixture per day. This figure should be divided by the number of meals. The total volume of liquid should not exceed 1 liter in 24 hours.
In modern conditions, the technique according to Geibener and Czerny is rarely used, since it is not designed for children with increased body weight, of which more and more have been born lately. The volumetric method is considered more rational.
The norms of food consumption, depending on the age of the child, are shown in the table.
The introduction of complementary foods
There are special WHO instructions that contain information on the sequence of introducing solid food into the diet of children in the first year of life. Recommendations are broken down by month below.
Porridge must be boiled in water. Starting from 6 months, vegetable oil should be added to mashed potatoes and porridge. For the first time, it is recommended to limit yourself to 1 drop, gradually bringing the volume to 1 teaspoon. Butter is introduced into the diet at 7 months. The initial dose is 1 g, the average is 10 g. It is advisable to add it to ready-made cereals.
The above feeding scheme is relevant for breastfed children. If the baby is receiving formula, then solid food can be introduced from 5 months, as his body needs vitamins and minerals for normal development. The same table is used, but all rows are shifted by a month.
Detailed information on how to feed your baby with "adult" products can be found in the table. All recommendations are general in nature. Before introducing complementary foods, you should consult with your pediatrician.
| Product | Term | Quantity | Dishes to start weaning |
| Vegetables | With normal or overweight from 6 (sometimes from 5-5.5) months. | Puree of 1 white or green vegetable. | |
| Kashi | With normal or overweight from 6-7 months. If the weight is insufficient, then they are introduced from 4-5 months. | Initial - ½ teaspoon. Maximum - 100-200 g. | Gluten-free cereals boiled in water - buckwheat, rice, corn, oatmeal. After entering each porridge separately, you can cook cereal mixes. |
| Vegetable oil | 6 months | Initial - 3-5 drops. Maximum - 1 teaspoon. | Sunflower, corn, olive oils. They should be added to mashed vegetables or meat. |
| Butter | 7 | Initial - 1/3 teaspoon. Maximum - 10-20 g. | High-quality butter without vegetable ingredients should be added to vegetable purees and cereals. |
| Fruit | 8 | Initial - ½ teaspoon. Maximum - 100-200 g. | Monopure of soft fruits. Gradually, you can make multi-component dishes. |
| Meat | 8 | Initial - ½ teaspoon. Maximum - 50-100 g. | Puree from one component - rabbit, turkey, veal, beef. |
| Yolk | 8 | Initial - 1/4 teaspoon. Maximum - ½ yolk of a chicken egg. | It is necessary to boil the egg and add the crushed yolk to the puree or porridge. |
| Dairy products* | 9 | Initial - ½ teaspoon. Maximum - 150-200 g. | Children's yogurt, kefir or biolact. After 10 months, products with fillers can be introduced (we recommend reading:). |
| Cottage cheese* | 9 | Initial - ½ teaspoon. Maximum - 50 g. | Children's cottage cheese in its purest form. From 10 months it should be supplemented with fruit puree. |
| Baby biscuits | 9-10 | Initial - 1/3 cookies. Maximum - 5 pieces. | |
| A fish | The average period of introduction is 10 months (we recommend reading:). If the child has a tendency to allergies - 1 year. | Initial - ½ teaspoon. Maximum - 60 g. It is worth feeding the baby with fish 1-2 times a week. | Low-fat varieties of fish - river perch, hake, cod. It should be boiled or steamed and then mashed. |
| Juices | 10-12 | Initial - 2-3 drops. Maximum - 100 ml. | Clarified juices from green and white fruits. |
*Note that the approach of Dr. E.O. Komarovsky regarding complementary foods differs from the WHO recommendations. He suggests starting acquaintance with adult food with the help of sour milk - kefir and cottage cheese.
A new product should be given to the baby in the morning. It is recommended to increase the amount very slowly, gradually bringing it to the age norm and monitoring the reaction of the child's body. Every week, the child should be introduced to one new dish. If an allergy or malfunction of the gastrointestinal tract occurs, the product must be removed from the menu.
Nutrition after a year
The baby's menu after 12 months includes all major food groups. He no longer needs breast milk as food, so many mothers decide to stop lactating. However, it contains substances valuable for the baby, and the reasons to continue breastfeeding remain.
Lactation can be maintained even if the mother goes to work. The frequency of breastfeeding will decrease, but the baby will receive valuable elements. If there is a need to stop lactation, doctors advise not to do this during the period of illness of the child, when his body is weakened, as well as in the summer, since at this time there is a high probability of contracting an intestinal infection.
The nutrition of a baby at 1 year old does not differ from its menu at 11 months old, but portions increase slightly (we recommend reading:). For breakfast and afternoon snack, it should be fed with porridge or mashed vegetables. Dinner and lunch should be hearty. For dessert, you can offer marmalade, marshmallows, marshmallows, and as a drink - water, tea, jelly, compote or fruit drink.
Preferably artificial, but not all women have the opportunity to breastfeed. In such situations, it is necessary to consult a pediatrician in order to choose the most suitable milk formula for the baby, corresponding to his age and health status.
Advantages and disadvantages of artificial nutrition
Many babies from the first days of life are on artificial feeding, and every year their number increases. The increase in the percentage of "artificial" is directly related to the deterioration of the environment, malnutrition of the adult population, which affects the state of health, as well as the inability of mothers to be constantly close to their children. There is, perhaps, one single advantage in feeding a newborn child with milk mixtures - such a baby will not have to be transferred from breastfeeding to artificial and his body will not need to adapt to a new nutritional composition. In the event that a mother has a choice between artificial and natural feeding, before starting to feed her baby with milk mixtures, she needs to familiarize herself with their positive and negative sides:
pros
- The ability to leave the child with relatives or a nanny due to employment;
- In the case, it is enough to simply replace the milk formula with a more suitable one, and not look for the cause in your own diet;
- The ability to see the amount of formula drunk by the child from the bottle. A breastfeeding woman can find out about the missing amount of milk only if the baby is underweight;
- The frequency of feeding is less than with natural feeding. The fact is that breast milk is digested by the baby's body much faster than formula milk.
Minuses
- The absence in the milk mixture of special enzymes contained only in mother's milk. In children who are bottle-fed, allergic reactions and colds are much more common than in infants;
- Frequent regurgitation and. When eating through a bottle, the baby swallows excess air, which causes bloating and discomfort;
- Bottle disinfection and formula preparation. It is customary to feed children who are bottle-fed according to a certain regimen, but each baby has an individual need for the number and frequency of meals, and this depends on many factors. A suddenly hungry baby can be fed much faster;
- Mixture selection. It takes time to choose the right mixture, and if it does not fit, the child suffers;
- Financial expenses. Good quality formula does not come cheap, and as the child grows older, more is needed.
Monthly formula feeding table
The data in the table is approximate. The pediatrician who monitors the child's weight gain will help you determine the individual daily need of the baby for milk formula.
Start of complementary foods
The first complementary foods of a formula-fed baby can be carried out when they reach 3 months. The best product to start complementary foods is apple juice. You need to start with 0.5 teaspoon per day, diluting it with half boiled water. If the baby feels fine, you can try other natural juices as complementary foods, but not from exotic fruits.
With normal digestibility of natural juices, fruit and vegetable puree can be introduced into complementary foods at 4-5 months. You need to start with 0.5 teaspoon per day, gradually increasing the amount.
3-4 weeks after the baby has met the puree, you can introduce cereals (corn, buckwheat and rice) into the diet. If you are not allergic to lactose, you can cook them in milk. After 6-7 months, the baby's digestive system becomes quite strong, so you can also use oatmeal, semolina, wheat and barley groats to make porridge.
After 8 months, you can gradually introduce boiled meat into the baby's complementary foods, first chicken and turkey, then beef.
After 9 months, the child's menu can be varied with boiled fish.
Complementary feeding scheme
Video: Dr. Komarovsky about artificial feeding
Menstruation with artificial feeding
Postpartum discharge from the uterus is natural for every woman who has given birth, and they last about 6 weeks. In women whose children are bottle-fed from the first days of life, menstruation may begin from the third month of the child's life, but they will not become regular immediately. If after 5 months after giving birth, the menstrual cycle has not begun, or the periods are too plentiful, immediately consult a doctor for help.
GBOU VPO TVER STATE MEDICAL
ACADEMY OF THE MINISTRY OF HEALTH AND DEVELOPMENT OF RUSSIA
DEPARTMENT OF PEDIATRICS
MEDICAL AND DENTAL FACULTY
MIXED AND LITTLE FEEDING
Guidelines for independent work of students
4 courses of the Faculty of Medicine
Compiled by:
Doctor of Medical Sciences, Professor A.F. Vinogradov
Candidate of Medical Sciences, Associate Professor A.V. Koptseva
Tver, 2012
Name of the topic: Feeding mixed and artificial. Nutrient mixtures used for mixed and artificial feeding. Canned, adapted products. Peculiarities of feeding premature babies. Principles of nutrition for children older than a year. The role of the local pediatrician in the organization of rational nutrition of children.
Examination of children who are on various types of feeding. Development of the survey methodology. Drawing up a diet and menu layout for children of the first year of life on mixed and artificial feeding on the instructions of the teacher.
The purpose of studying the educational topic: To study modern aspects of mixed and artificial feeding of children of the first year of life at the level of knowledge and skills to draw up a nutrition map for children of the first year of life who are on mixed and artificial feeding, as well as to solve situational problems on this topic. To master the concepts of supplementary feeding, canned and adapted products. To acquaint students with the basic principles of feeding premature babies and children older than a year. To determine the role of the district pediatrician in organizing the rational nutrition of children.
Basic terms:
1) Mixed feeding
2) The concept of "supplementary feeding"
3) Artificial feeding
4) Adapted milk formula
Topic study plan:
Definition and principles of mixed feeding
Definition and principles of artificial feeding
Classification of adapted milk formulas
AMS selection criteria
Sour-milk mixtures
Consequences of artificial feeding
Features of nutrition of premature babies
Principles of nutrition for children older than a year
Presentation of educational material:
Under mixed feeding understand breastfeeding with forced (non-physiological) supplementation in the form of cow's milk (milk of animals and plants) or its dilutions (mixtures) in the amount from 1/5 to 4/5 of the daily requirement.
Mixed feeding is a type of feeding when, along with women's milk, milk mixtures are given to children, because due to the age of the child, he cannot yet be given complementary foods. Supplementation with artificial milk formulas is called supplementary feeding.
Indications for mixed feeding is a lack of milk in the mother (hypogalactia) or some diseases of the mother. The clinical symptoms of a fasting child are flattening or falling of the weight curve, restlessness, infrequent urination, and stool changes. The stool is usually at first reduced or, conversely, speeded up.
In order to find out if the mother has enough milk, it is necessary to weigh the baby in the early hours before and after feeding, i.e. spend control weighing child. By the difference in weight, you can judge how much milk the baby sucked. Having calculated the required amount of milk according to the formulas, and knowing the amount of milk received by the child from the mother, it is possible to calculate the required amount of supplementary feeding.
When mixed. feeding before feeding is prescribed depending on the amount of milk in the mother, that is, after each feeding, or some of them, or by alternating full feedings with breast milk and formula. As a supplement in modern dietetics, adapted milk mixtures are used, which are used for artificial feeding, and are described in the corresponding section.
Principles of mixed feeding:
The introduction of supplementary feeding not earlier than 4-7 days of the fight against hypogalactia.
The choice of supplementary feeding, taking into account age, appetite.
Supplementary feeding is prescribed after breastfeeding.
The number of feedings remains the same as with natural feeding, but if the milk deficit is more than 50%, then the number of feedings is reduced by 1.
Supplementary feeding can not be introduced into all feedings if the milk deficit is 50% or less.
Do not change supplement.
Carry out weekly control feedings (2-3 times a day 2-3 days a week at different hours of the day).
Change in the need for food ingredients when using non-adapted mixtures up to 3.5-4.0 g/kg per day of protein.
Supplementation is introduced in a spoon or through a small hole in the nipple.
Taking into account modern views (National program for optimizing the feeding of children in the first year of life, 2010), the timing of the introduction of complementary foods with mixed and artificial feeding does not change.
Artificial feeding - this is the feeding of a child in the first months of life with animal or plant milk (soybean, almond) with a deficiency of breast milk, which is 4/5 or more of the daily diet.
Principles of artificial feeding:
The frequency of feeding when prescribing adapted formulas can be the same as when prescribing non-adapted formulas - the number of feedings is reduced by 1 and you can switch to 5 meals a day from 3-4 months.
The volumes of nutrition during artificial feeding are calculated in the same way as with natural feeding (the volumes do not depend on the type of feeding, but on the capabilities of the gastrointestinal tract).
Complementary foods are introduced at the same time as with natural feeding.
The need for protein increases when feeding with non-adapted mixtures up to 4-4.5 g / kg, when receiving adapted mixtures, the amount of protein is the same as in natural.
Calorie increases by 10% when using non-adapted mixtures.
Any attempt to switch to mixed and natural feeding is encouraged.
The transfer of a child to artificial feeding is a "metabolic stress" and in this regard, doctors should pay great attention to the correct choice of "substitutes" for women's milk, taking into account individual characteristics of health, physical development and even appetite.
The basis of most "replacement" or mixtures is cow's milk, which differs significantly from human milk in its composition and properties. In cow's milk, the content of protein, calcium, potassium, sodium and other mineral salts is significantly higher than in women's milk. At the same time, the level of carbohydrates, a number of fatty acids and vitamins, on the contrary, is lower than in human milk. In order to bring the composition of cow's milk closer to the composition of women's milk (or otherwise "adapt" its composition to the characteristics of the immature body of the child, hence the name "adapted milk formulas"), it is necessary to reduce the content in cow's milk. protein and salts, but to increase the level of carbohydrates (lactose), some vitamins and fatty acids. Currently, various substitutes for women's milk, both domestic and imported, are widely represented on the Russian market. "Substitutes" for women's milk can be dry or liquid (ready-to-drink), unleavened or sour.
Milk mixtures are divided into 2 large groups - adapted and non-adapted, in turn, mixtures in each of these groups - into sweet and sour-milk.
Adapted milk formula(AMS) - a food product in liquid or powder form, made on the basis of cow's milk, milk of other farm animals, intended for use as a substitute for women's milk and as close as possible to it in chemical composition in order to meet the physiological needs of children of the first year of life in nutrients and energy. The content of protein, fats, carbohydrates, minerals and vitamins in mixtures must comply with domestic and international standards for adapted milk formulas. There is a modern classification of children's adapted milk formulas (Fig. 1). This mainly concerns the division of mixtures, depending on the age of the children, into “initial” (from 0 to 6 months), “subsequent” (from 6 to 12 months) and for children from 0 to 12 months.
Particular attention is paid to the "initial" mixtures, the composition of which is maximally adapted to the physiological needs and characteristics of the metabolism of children in the first six months of life. Recently, there has been a tendency to reduce the level of protein in modern dairy products in order to bring it closer to human milk quantitatively. So, in most "initial" mixtures, the amount of protein is 1.4-1.6 g / 100 ml, and the minimum level is 1.2 g / 100 ml, the ratio of whey proteins and casein is 60:40, 50:50, in separate mixtures 70:30. almost all modern mixtures contain taurine, α-lactalbumin, and some contain nucleotides.
To adapt the fat component of the "initial" mixtures, vegetable oils (sunflower, corn, soybean, rapeseed, coconut, palm), rich in polyunsaturated fatty acids (PUFAs), are introduced into their composition. To improve the emulsification of fats, a small amount of natural emulsifiers lecithin, mono- and diglycerides are introduced into the mixtures. Almost all mixtures contain L-carnitine, which promotes the assimilation of fatty acids at the cellular level. The current trend is the enrichment of mixtures of DSHIFA (arachidonic and docosahexaenoic), which are precursors of prostaglandins, thromboxanes and leukotrienes,
As a carbohydrate component, mainly lactose and maltodextrin are used. A number of mixtures contain galacto- and fructooligosaccharides, which have a prebiotic effect and promote the selective growth of bifidobacteria. Some formulas contain lactulose, which is also a prebiotic.
All mixtures include the necessary set of vitamins and minerals in accordance with the physiological needs of children in the first months of life. This is primarily iron, copper, zinc, iodine. selenium, which has antioxidant properties, was introduced into a number of mixtures. The ratio of calcium and phosphorus is in the range of 1.5:1 - 2.0:1.
The level of vitamins in AMS exceeds that in women's milk by 15-20% on average. their digestibility is lower than from human milk. At the same time, much attention is paid to vitamin D. Its content in 100 ml of the finished mixture should be 40-50 MB according to the standards. Vitamins of group B, vitamin A, β-carotene are added to all mixtures.
"Subsequent" mixtures, unlike the initial one, contain a higher amount of protein (up to 2.1 g/100 ml). The predominance of whey proteins over casein is no longer mandatory. Products for children of this age group are distinguished by a higher content of iron, calcium, zinc.
Formulas "from 0 to 12 months" can be used in the nutrition of children throughout the first year of life. However, this group of products is not numerous and is used to a limited extent under modern conditions, due to the wide range of initial and subsequent formulas.
In a number of dry fresh mixtures, probiotics were introduced: bifidobacteria and lactobacilli. Modern technologies make it possible to ensure the safety of microorganisms in the product throughout the entire shelf life.
Criteria for the selection of adapted milk formulas (AMC):
the age of the child;
socio-economic conditions of the family;
allergic history;
individual intolerance to the product.
The criterion for the correct choice of the mixture is the good tolerance of the child to this product.
As a result of all these changes, a fairly good substitute for breast milk is obtained, but it is necessary to strive to minimize the risk of sensitization to a foreign protein by using protein hydrolysates and providing the child with non-specific protection against intestinal infections by adding substances such as lactoferrin, lactoperoxidase, lysozyme, etc.
Among the adapted women's milk substitutes are domestic liquid ones - "Agu-1" (Lianozovsky baby food plant, Russia), "Baby Milk" (Lianozovsky dairy plant, Russia) and dry mixes - "Mikamilk" (Kofranleit / Rosdetspecprodukt, France / Russia ), as well as imported ones - Nan (Nestlé, Switzerland), Nutrilon (Nutricia, Holland), Efamil-G (Bristol Mayer Squibb's Mead Johnson Branch), Pre-HiPP and HiPP (KhiPP, Austria ), Humana-1 - taurine-containing mixture for children from the first days of life up to 3-6 months, whey protein / casein ratio 60:40, does not contain glucose, sucrose and gluten, Humana-2 - from 3-4 months to 1 year, Humana-Baby-fit - from 6 to 12 months, gluten-free, enriched with iron, protein component 80:20, good content of vegetable oils, banana pectins in combination with starch increase the viscosity of the mixture and have an anti-dyspeptic effect, Frisolak - from 0 to 12 months , has a good ratio of linoleic and linolenic acids, protein component 60 :40, fermented milk mixtures - "Gallia" and "Lactofidus" (Danone, France).
Somewhat less adapted mixtures are the so-called "casein formulas". Their name is due to the fact that they are made on the basis of powdered cow's milk, the main protein in which is casein, without the addition of demineralized whey. As a result, such mixtures are less close to the protein composition of human milk. At the same time, for all other components (carbohydrate, fat, vitamin, mineral, etc.), these mixtures, as well as the adapted ones described above, are as close as possible to the composition of human milk. Casein formulas include such well-known blends as Similac (Abbot Laboratories, USA), Nestogen (Nestlé, Switzerland) and others.
Finally, partially adapted blends. Their composition is only partially close to the composition of human milk - they lack demineralized whey, the fatty acid composition is not fully balanced, not only lactose, but also sucrose and starch are used as a carbohydrate component. These mixtures include "Aptamil", "Milumil" (Milupa, Germany). These substitutes can be used in the nutrition of children of the first year of life, starting from 2-3 months.
All modern women's milk substitutes and "follow-up" mixtures are among the instant (instant) products. For their use in children's nutrition, it is only necessary to mix a strictly defined amount of dry powder with pre-boiled warm (50-60 ° C) water and mix thoroughly, avoiding the presence of lumps.
Benefits of fermented milk formulas:
improve digestion processes;
have a partially cleaved protein that loses its allergic properties;
vitamins produced by bacteria;
they partially destroy lactose, which some children do not tolerate well;
displace pathogenic flora;
there is no more ethyl alcohol in them than in bread, juice, breast milk; it is necessary for the metabolic processes taking place in the body.
Disadvantages of fermented milk mixtures:
have a high calcium content;
the ratio of whey protein to casein 20:80;
when they are used, a shift in acid-base balance occurs in the acidic direction.
Thus, milk formulas are considered good if:
Protein 1.2 - 1.5 g/dl;
The ratio of whey protein to casein is 60:40;
The composition contains taurine;
Vegetable fat - 1%;
Carbohydrates - dextrinmaltose;
Vitamins A, D, E;
Osmolarity = 280 mOsm/l.
Currently, in the diet of patients with food allergies, dairy-free mixtures prepared on the basis of soy protein isolates of foreign production are widely used: Humana SL (Germany), Nutrisoy and Frisosoy (Holland), Prosobi (USA), Alsoy (Sweden), as well as domestic product - Nutrilak-soy. The protein component of these products is represented by soy protein isolate; fatty - formed due to vegetable oils; carbohydrate - represented by dextrinmaltose, which has a positive effect on intestinal microbiocenosis. The products are enriched with a complex of vitamins and minerals in accordance with the requirements of young children. The mixtures do not contain milk protein, lactose and gluten.
Formula-fed children, like their peers, need complementary foods. Given that modern adapted milk formulas contain the necessary set of vitamins and minerals, there is no need to correct for these substances with complementary foods at an earlier date than when breastfeeding.
Consequences of artificial feeding
Shortening of average life expectancy by 10 years (min);
Sensitization of 75% of children;
Dysbacteriosis 100% of children;
Chronic diseases of the gastrointestinal tract - 45-55%;
The development of early sclerosis (there is no activator of cholesterol utilization enzymes);
Early hypertension;
Early coronary artery disease, strokes, etc.;
Children are at risk for oncology and hemoencology (leukemia);
The ratio of diseases of children on natural: mixed: artificial feeding as 1:3:6. 2-3 times more group of FBI;
Children "artists" are prone to mechanical, uncreative labor, nihilism and aggression.
Features of nutrition of premature babies
A premature baby should be admitted to the pediatric site with a well-formed sucking reflex and diet. Usually this is 7 feedings with a 6 hour night break. For 6 meals a day, it is transferred upon reaching a body weight of 3,000 gr.
The most optimal type of feeding a premature baby is breastfeeding. The amount of milk absorbed by the child should be strictly monitored. Therefore, a premature baby should be provided with scales, which the clinic should provide him. In cases of insufficient absorption of breast milk, additional feeding with a spoon is required. This should be told to the mother and taught to her. In this case, special dry adapted mixtures for premature babies are used. A feature of these mixtures is a higher content of protein and carbohydrates, and, accordingly, calorie content, compared to conventional adapted mixtures. Special adapted formulas for preterm infants should be used until they reach 4 kg, and then switch to regular adapted formulas.
Types of feeding premature babies
Women's milk after premature birth has a special composition that is more consistent with the nutritional needs of premature babies and is consistent with their ability to digest and assimilate. Compared to the milk of women who have given birth at term, it contains more protein (1.2-1.6 g per 100 ml), especially in the first month of lactation, slightly more fat and sodium and less lactose, with the same total level of carbohydrates. The milk of women after premature birth is also characterized by a higher content of a number of protective factors, in particular, lysozyme. Human milk is easily digestible and well tolerated by premature babies.
Despite the special composition, the milk of women who gave birth prematurely can satisfy the nutritional needs of only premature babies with a relatively large body weight - more than 1800-2000 g, while premature babies with a lower body weight after the end of the early neonatal period gradually begin to experience a deficiency in protein, a number of minerals (calcium, phosphorus, magnesium, sodium, copper, zinc, etc.) and vitamins (B 2, B 6, C, D, E, K, folic acid, etc.).
It is possible to preserve the main advantages of natural feeding and, at the same time, to meet the high nutritional needs of a premature baby when fortifying human milk with "amplifiers" or fortifiers (for example, "Pre-Semp", Semper, Sweden, "Breast milk fortifier, Friesland Foods, Holland, etc.). They are specialized protein-mineral or protein-vitamin-mineral supplements, the addition of which to freshly expressed or pasteurized human milk eliminates nutritional deficiencies.
Indications for the appointment of artificial feeding for premature babies are only the complete absence of mother's or donor milk, as well as intolerance to women's milk. In the nutrition of premature babies, only specialized formulas intended for feeding premature babies, the nutritional value of which is increased compared to standard adapted products (Pre-NAN, Pre-Nutrilak, Pre-Nutrilon with prebiotics, Humana-O-G A, Friso-pre, Enfamil premature).
Complementary foods are prescribed to premature babies starting from 4-5 months of age. The introduction of complementary foods up to 4 months is unacceptable due to the immaturity of both the digestive system and metabolic processes. Later (from 6 months) the appointment of complementary foods is also unacceptable, since the supply of nutrients (minerals and individual vitamins) in children born prematurely is sharply limited.
The introduction of complementary foods is carried out slowly and gradually. Until children reach 7-8 months of age, each feeding should end with the baby being attached to the breast or using milk formulas.
Organization of rational nutrition and the role of the district pediatrician
The organization of breastfeeding in primary health care is of paramount importance, because:
the preservation of natural feeding is the protection of the child's right to health; it is the official policy of the WHO and the government of the Russian Federation and, finally, it is the main positive factor determining health;
the leading organizer in this process is the KZR (healthy child's office);
in a children's polyclinic, one of the leading criteria for the qualification of a doctor and the effectiveness of his work is the proportion of breastfeeding.
Local pediatrician:
conducts constant preventive work to maintain a high proportion of natural feeding (at least 75% of all nursing mothers of children under 1 year of age) at all stages: before pregnancy, before childbirth, intranatal and postnatal.
identifies risk groups for hypogalactia;
uses all components of the diagnosis of hypogalactia: anamnestic, clinical, control feeding;
in case of a threat of hypogalactia, it immediately takes measures (algorithm for combating hypogalactia);
informs the head of the pediatric department in advance about the reasons for the possible transfer of each child to mixed and artificial feeding for a collegiate decision;
plans centralized or decentralized provision of breast milk for hypogalactic mothers (breast milk bank, lactating mothers' circle for mutual assistance);
organizes an increase in medical literacy (medical "education") of parents through various forms of education: "health universities", "school for young parents" (there is also a "school for a young father"), where they teach, among other things, the basics of feeding.
The doctor should convey to the mother's mind the importance of following the regimen:
daily routine;
work and rest;
sleep and wakefulness;
loads (from general sports to strict bed);
nutrition (especially in terms of the frequency of feeding, the amount of food, the timing of the introduction of complementary foods and the duration of breastfeeding).
Nutrition for children older than a year:
Each period of childhood is characterized by its own characteristics of growth and development, the degree of morphological and functional maturity of individual organs and systems, and the specifics of physiological and metabolic processes.
Principles of nutrition for children older than a year:
Adequate energy value of daily food rations, corresponding to the energy consumption of children.
A balanced diet for all interchangeable and indispensable nutritional factors, including amino acid proteins, dietary fats and fatty acids, vitamins, mineral salts and trace elements, as well as minor food components (flavonoids, nucleotides, etc.).
The maximum variety of the diet, which is the main condition for ensuring its balance.
Rational diet.
Optimal technological and culinary processing of products and dishes, ensuring their high taste and preservation of the original nutritional value.
Accounting for the individual characteristics of children (including their intolerance to certain foods and dishes).
Ensuring sanitary and hygienic food safety, including compliance with sanitary requirements for the state of the catering unit, supplied food products, their transportation, storage, preparation and distribution of dishes.
Educational and methodical material:
It is not in vain that nature laid down the wise principle of breastfeeding - together with mother's milk, the baby receives not only all the microelements necessary for proper growth and development, but also the first communication skills, emotions, learns to trust and love. However, what to do if the newly-made mother does not have milk or doctors forbade breastfeeding for health reasons?
Artificial feeding of the newborn comes to the rescue. How to choose the right formula, how much to feed the baby, how to create an emotional connection when feeding from a bottle? Read the answers to these and many other questions below.
From this article you will learn:
By definition, artificial feeding is a type of nutrition for a child in which breast milk in the diet is less than 20% or not at all. Doctors do not recommend it - in mother's milk there are many essential substances that are not in cow's milk, from which most mixtures are made.
In addition, caring mothers often overfeed their children, which creates a certain risk of obesity, and this is impossible when breastfeeding. Even complementary foods are introduced to artificial babies earlier in order to somehow make up for the lack of certain substances.
Of course, artificial feeding of the baby has its advantages: not only the mother, but also the rest of the family can feed the child. You can easily control the amount of food you eat, there are no painful sensations or problems with allergies - you can eat whatever you want. But if your decision to stop breastfeeding is due to one of the following reasons, it is worth considering:
- It seems to you that the child is gaining little weight - if the doctor does not give any recommendations on this matter, then everything is in order;
- It seems to you that there is not enough milk - the same thing;
- You go to school or work - if breastfeeding is not at all possible, practice at least mixed feeding;
- You just don't want to - maybe it's worth a little patience for the sake of your child's physical and mental health?
The objective reasons for refusing HB are:
- lack of milk;
- refusal of the child from the breast;
- difficult childbirth, after which it is necessary to restore strength;
- infectious diseases of the mother;
- medical indications;
- the birth of twins or triplets.
If this is your case, don't panic and don't blame yourself. Modern conditions for artificial feeding of crumbs are optimal and can minimize the consequences for the child, but this will require some effort.
The first step - choose a mixture
First, and most importantly, do not use regular cow's milk and other dairy products instead of formula. They are completely unsuitable for a newborn and can cause a bunch of problems. Set them aside for at least eight months of age.
When choosing a mixture, be sure to read all the information written on the package. Usually it contains information about the composition, the age of the children for whom it is intended, the recommended method of preparation and the expiration date. Please note that the packaging must not be damaged or opened.
Pediatricians usually use the following classification of products:
- adapted;
- partially adapted;
- physiological;
- medical.
This means the following:
- Adapted variations are recommended for use from the first days of life. They are as close to natural as possible and adapted to the needs of babies - hence the name. Partially adapted mixtures can be called "transitional". They are used from 12 months, and in their composition they are already slightly moving away from breast milk towards ordinary food.
- Physiological mixtures are only suitable for completely healthy children from a year old and cost an order of magnitude less than the previous ones.
- Therapeutic analogues should not be used without consulting a doctor.
Another more well-known classification is classification according to the age of the child. It has 3 categories, and it is very easy to determine whether the mixture belongs to one of them - the number on the package will tell you.
Number 1 corresponds to a sweep that can be used from the first days of life, 2 - for children from the age of six months, 3 - for children from one year old.
How is it possible to artificially feed a newborn?
In the same way as with GV, there are two options: on demand and on a schedule . You can feed your baby on demand for the first time until a comfortable diet is established for him. But in no case do not overfeed - in this case, underfeeding is even safer, because the baby will not get an upset stomach.
If you want to stick to the exact schedule from the first days of life, feed your baby every 3-3.5 hours 6-7 times a day. A monthly baby needs no more than 90 gr. sweep at a time. In the first week, the required amount of food is calculated as follows: the child's age in days is multiplied by 10. Thus, a baby who is 4 days old needs 40 grams of the mixture at a time.
after a week calculated differently: The baby's weight is divided by 5 and then by the number of feedings. That is, if a child weighs 4000, he needs 800 grams of formula per day, which corresponds to about 120 grams of formula at a time.
There is another way to calculate the required amount of food - use the recommended calorie table, which is given below. All information about the content of calories, proteins, fats and carbohydrates in the mixture is indicated on the package. Remember that you can not exceed the calorie content by more than 50 kcal and the norm of proteins, fats and carbohydrates by more than 1.5 grams.
| Age | Energy kcal/kg | Proteins g/kg | Fats g/kg | Carbohydrates g/kg |
| 0-3 months | 120 | 2,3 | 6,5 | 13 |
| 4-6 months | 115 | 2,5 | 6,0 | 13 |
| 7-12 months | 110 | 3,0 | 5,5 | 13 |
Wash your hands with hot water before feeding. It is advisable to give a mixture of the same temperature each time so that the child gets used to it. Also, do not save what he has not eaten - throw it away immediately or store in the refrigerator (in the refrigerator, not in the door) for no more than six hours. Otherwise, the use of the product can lead to poisoning, because the product is not absolutely sterile, and microbes can begin to multiply in it.
Make sure that instead of the mixture the child does not receive air - this will create a false feeling of satiety. Holding the baby in the classic position in which mothers sit with breastfeeding, tilt the bottle, making sure that there is always food in the nipple. After feeding, in order for the air to leave the ventricle, hold the baby in an upright position for several minutes.
In no case do not leave a newborn alone with a bottle - at this age, contact with you is important for him, this will lay the foundation for his behavior for life. In addition, the baby may lose the bottle or choke. From 4-5 months you can already give the baby to hold the bottle, but you must carefully monitor the feeding process:
- You can't feed a sleeping baby.
- It is impossible to force-feed, even if the child has not eaten the prescribed norm, but if he has not eaten this norm, it is permissible to give another 30-50 ml if he has a normal body weight.
Preparation for artificial feeding of a newborn
When preparing food, follow the instructions completely and follow the dosage exactly. If you overdo it - there may be problems with the digestive system, if you don't give it - the child will be capricious, and, possibly, will bring down the regime.
If you have problems with this, take a closer look at specially packaged formulas for one feeding. However, as practice shows, for most parents, cooking comes to automatism after a month of daily practice.
Remember that the mixture is already diluted directly in the bottle, after which it is shaken, looking to see if any lumps have formed in it. There are also liquid milk analogues, with the preparation of which you do not need to bother at all. Do not forget about sterility when cooking - the measuring spoon should be clean, the water should be boiled. It is also important to comply with all product storage conditions.
- The manifestation of allergic reactions in a child;
- The mixture causes problems with the digestive tract;
- The child has already left the age category for which the mixture is intended;
- There was a need for a medicinal mixture.
The pacifier is an important detail
A lot in artificial feeding of a newborn depends on how comfortable the nipple is for him. If the hole in it is too large - the baby will choke, if it is too small - it will be very difficult for him to drink, he will slowly empty the bottle and, most likely, be nervous at the same time.
A convenient size is individual for each child, but if it is chosen correctly, one bottle is drunk in about 20 minutes, and the liquid pours out in drops, not a stream.
Bought the wrong pacifier? No problem! The size of the hole can be enlarged at home. Just use a heated needle. Now on sale you can find nipples with an indication of the recommended age for which they are intended. In general, nipples wear out fairly quickly, so be sure to buy new ones.
Hygiene rules, or how not to harm health
Naturally, when artificially feeding a newborn from a bottle, very strict hygiene rules must be observed, because the baby's body is still very weak and fragile. Bottles must be sterilized using a special device - a sterilizer, or in the old proven way - a water bath. Before sterilization, food remains are removed with a brush.
Particular attention should be paid to carvings and other details where food can get stuck. For a child up to a month old, it is necessary to sterilize the “dishes” after each feeding. From a month - it is enough to sterilize no more than once a week, if you rinse both the bottle and the nipple with boiling water immediately before each feeding.
It is also imperative to sterilize a new, just bought bottle. Of course, it’s better not to take risks and not use unboiled water for feeding - even if it is filtered, it’s better to play it safe, because the baby’s health depends on it.
Complementary foods with artificial feeding
As already mentioned, with artificial feeding, complementary foods are introduced earlier than with breastfeeding - at 4.5-5 months (against 5-6 months). This is due to the lack of some and an excess of other substances in mixtures. The indicated terms are approximate, to establish more accurate ones, a consultation with a pediatrician is necessary. Complementary foods start with tiny portions of the product, gradually increasing them.
So, on the first day, the child eats a teaspoon, and after a couple of weeks - already quite a full portion. Complementary foods are given before feeding with a mixture, usually from a spoon. The product must be crushed to a puree state, carefully making sure that there are no lumps or pieces - the child is not yet ready for their use.
In addition, you should not introduce two products at the same time - it is difficult for the body, and if a negative reaction occurs, there will be problems with determining which product it is.
Emotions during artificial feeding
You can create the right atmosphere when feeding a child by adhering to a few simple rules:
- First of all, you should feel comfortable, not feel uncomfortable, have a good and calm mood. Relax, put away your mobile phone, and with it all your business. Now you are a mother, and this is the main thing.
- Choose a cozy and comfortable place to feed.
- Take the baby in your arms, talk to him, smile, look into his eyes while feeding.
- To add realism to the process, it is sometimes recommended to heat the milk to the temperature of the human body or a little more - about 37-38 degrees. If you don't have a temperature measuring device, put some of the mixture on your shoulder - the drop should be neither cold nor hot.
Remember that your child requires more love and affection than a child on breastfeeding, so spend more time with him, play, massage.
It is good when other relatives help in feeding, but at first, when the newborn is still very small, the constant change of faces during feeding can cause stress. Therefore, either the mother or two people should feed him in turn.
To drink or not to drink?
Most parents are not in vain worried about the problem of supplementation - the child may really need more water than he gets with the mixture, especially in summer. It is possible to supplement the child only in very small portions, in no case before feeding, so that there is no feeling of false satiety. Use exclusively boiled water. Also, water can help if the child has constipation or a fever.
Chair for artificial feeding of the baby
The stool of an artificial child is usually less frequent than the stool of a breastfed child, but in a newborn it should not be less than once or twice a day, otherwise you should consult a doctor. To avoid constipation, which is also often a problem for children on IV, it is recommended to do gymnastics and massage the abdomen.
In total, we can distinguish a list of basic rules for artificial feeding of a newborn:
- Choose a quality mixture, taking into account the age and individual needs of the baby;
- Follow the instructions exactly when preparing the mixture and do not store the finished product;
- Watch how the baby eats;
- Watch how much he eats;
- Be responsible in choosing the right nipple;
- Sterilization is the key to your child's health;
- Soldering is a perfectly appropriate practice;
- Take care of the correct emotional development of the baby.
Subject to these rules, losses from the lack of breast milk will be minimal, the health and immunity of the baby will be strong, and development will be fast and correct. Isn't that what makes any parent happy?
Artificial feeding is a complete replacement (or 2/3 of the baby's diet) of breast milk with artificial milk mixtures. Most maternity hospitals in our country include artificial nutrition in the list of items that a woman in labor should take with her. This does not mean that the medical staff will supplement the newborn with formula from the very first day. If the mother has started breastfeeding, no one will give the baby a bottle. Moreover, if necessary, they will help to compete for milk. But not all children, especially premature ones, are able to fully suckle. Many of them are so weak that they need the help of doctors, end up in the intensive care unit and receive food through a tube. In such cases, adapted nutrition is indispensable.
Reasons for transferring a baby to artificial or mixed feeding.
- Medical circumstances: cases of severe pregnancy and childbirth, requiring the restoration of the mother's strength, taking medications that penetrate into breast milk, infectious diseases, etc.
- Insufficient production of breast milk (control weighings show that the baby is not gaining enough weight, and attempts to stimulate lactation are unsuccessful).
- The impossibility of constant breastfeeding in situations where the mother is forced to leave the child under the supervision of someone, and expressed or frozen milk is not enough.
Types of mixtures for artificial nutrition of infants. How to choose a mixture.
The pediatrician prescribes the most suitable milk formula for the baby, but parents also need to know some simple rules for choosing it.
Up to 6 months, only adapted substitutes are acceptable for a baby: in their protein, fat and carbohydrate composition, they are as close as possible to human milk and are enriched with all the vitamins and minerals necessary for a baby. Mixtures can be dry and liquid, fresh and sour-milk. Most breast milk substitutes are divided into initial– for children under 4–6 months of age and subsequent- For children over 6 months old. On the packaging of the initial mixtures there should be the number "1", the subsequent ones - the number "2". The energy value of subsequent mixtures is higher - they contain an increased content of protein, iron and other important nutrients. All initial mixtures are adapted. There are also mixtures of the second degree of adaptation - less adapted("casein formula") and partially adapted- for feeding children from 2-3 months. A number of mixtures that contain an average amount of all the nutrients necessary for a child in the first year of life can be called universal. They can be used to feed babies from birth up to one year (the package says "0-12"). For children with special dietary needs, there are therapeutic mixtures. They may contain in the name not only numbers, but also various combinations of letters (“PRE”, “SOYA”, “AR”, “GA”) characterizing the therapeutic and prophylactic purpose of the mixture.
How to choose milk formula
Before you buy a mixture, be sure to check with the pediatrician who is watching your baby. The health of the child will depend on the correct choice of the mixture. For artificial feeding in the first year of life you need to use only adapted milk formulas . In the first 2-3 months, it is better to use unleavened mixtures, sour-milk ones can increase regurgitation. In the future, the mixture can be combined: 50% fermented milk and 50% fresh.
If the baby takes the mixture well, it does not need to be changed. If for some reason it is necessary to introduce a new mixture, do it gradually. When switching to a subsequent formula at 6 months, it is best to choose a formula from the same manufacturer as the original formula.
Artificial feeding is an exact science. It is necessary to observe the regimen, withstand breaks between meals and give a strictly allotted portion of milk. So, there are several formulas for calculating the amount of mixture needed by the baby.
Volume formula
Daily amount of food (without additional drinking) and frequency of feeding
depending on the age of the baby is given in table 1.
| Age | The volume of the mixture relative to body weight | The volume of the mixture in ml | Feeding frequency. |
| Up to 7-10 days | For children first ten days life, the required daily amount of food is calculated by the formula: (Number of days of a newborn's life) x 70 (or 80). coefficient 70 - for children born weighing 3200 g or less, coefficient 80 - for children weighing more than 3200 g. | 7-10 feedings; | |
| from 10 days to 2 months | 1/5 body weight | or 600-850 ml | 7-8 feedings; with 6 hour night break |
| 2 to 4 months | 1/6 body weight | or 750-900 ml | 6-7 feedings; 6.5 hour night break |
| 4 to 6 months | 1/7 body weight | or 850-1000 ml | 5-6 feedings; |
| 6 to 12 months | 1/8-1/9 body weight | or 950-1100 ml | 4-5 feedings; with 8.5 hour night break |
The daily volume must be divided by the number of feedings, and then you get the amount of food that the child should eat in one feeding.
It should be noted that with artificial and mixed feeding, it is permissible to additionally supplement the child with boiled water, and the volume of water is not taken into account in the total volume of food.
Ingredient formula
So there is a formula for calculating nutrition, based on the daily need of the child for the main food ingredients (this formula is more often used to correct nutrition).
Nutritional and energy requirements of children under 12 months of age.
The content of ingredients in artificial mixtures - grams per 100 ml (data are available on the package)
Example. Child 2 months old, birth weight 3600 g, 6 meals a day (6:00, 9:30, 13:00, 16:30, 20:00, 23:30). The child receives a mixture of "Nutrilon":
Due body weight = 3600 g + 600 g + 800 g = 5000 g
Daily food volume \u003d 16 of body weight \u003d 5000: 6 \u003d 833.3 (840 ml);
Food volume per feeding = 840: 6 = 140 ml;
The difference between the needs of the child and the amount of ingredients received should not exceed 1-1.5 g, and 50 kcal in energy. In this case, the child receives a sufficient amount of ingredients. If there is a big difference between the needs of the child and the amount received, then nutritional correction is carried out.
Formula Zaitseva
Zaitseva's formula is used for an approximate calculation of the daily amount of food. For the first time 7-10 days As a child grows, his need for human milk or infant formula increases rapidly. You can calculate the daily volume of the mixture using the formula:
Milk volume per day (ml) = 2% of body weight (g) at birth x N (number of days of a child's life).
To determine the amount of infant formula needed per feeding, divide the daily volume by the number of feedings.
After 7-10th day of life a child when calculating the amount of food, you can use the calorie method or Shkarin's formula.
calorie method.
When calculating nutrition in a caloric way, the energy needs of children are taken into account, which in the first half of the year is 115 kcal / kg, and in the second half of the year - 110 kcal / kg. Knowing the child's body weight and the approximate calorie content of infant formula (680 kcal per 1 liter), it is possible to calculate its required daily volume.
So, a child aged 2 months with a body weight of 4.6 kg (4600 g) needs 115 kcal / kg x 4.6 kg = 529 kcal per day.
Volume of milk = (529 x 1000): 680 = 780 ml.
Shkarin formula
Using Shkarin's formula suggests that
a child at the age of 8 weeks (2 months) should receive 800 ml of milk per day.
When calculating nutrition in any way, it must be remembered that its daily amount of nutrition in children in the first half of life should not exceed 1000 ml, in the second half of the year - 1000-1100 ml.
Free artificial feeding
The idea of free artificial feeding is based on the fact that a child eats different amounts of food at different times of the day, and his need for food is not the same. Free-fed babies gain weight better than formula-fed babies.
However, with artificial feeding, doctors advise using partially free feeding - a method in which there are certain hours of feeding, the amount of food is given at the request of the child, but within certain limits.
The bottle is poured into the bottle for each feeding, usually 20-30 ml more, but food is given at fixed hours (a deviation of 30 minutes is acceptable). This allows you to more correctly determine the optimal need for the baby in food. If the child does not fully eat the amount of food offered to him, he should not be force-fed.
After a year, adapted milk is not completely excluded from the child's diet, but switches to a different formula of the mixture and a feeding regimen - approximately twice a day. The child's menu will consist mainly of complementary foods.
Mixture preparation.
To prepare the mixture, it is recommended to use only high-quality water, ideally - special children's water, at the rate of one bottle per day, then the water will always be fresh. It is not advised to boil it, because this destroys all the beneficial properties. Filtered tap water, water from a well, well or pump room must be boiled.
Most artificial formulas come in dry form, but there are also liquid formulas that are ready to use after heating. There are soluble mixtures (not requiring cooking) - "Detolact"; and mixtures requiring cooking (boiling), for example, "Baby".
Before preparing the mixture, carefully read the instructions on the package!
Strictly follow the dosage of the mixture! In case of an overdose of the powder, the child will receive an excess amount of nutrients, due to which he may experience digestive disorders (excessive spitting up, vomiting, stool instability, food allergies, excessive weight gain). When using an insufficient amount of dry mix, the baby, on the contrary, will not receive the required amount of proteins, fats and carbohydrates, which may affect its development (the baby, remaining hungry, will be naughty, sleep worse, gain less weight).
Most mixtures are prepared as follows: cool boiled water to a temperature of 50-60 ° C (a higher temperature cannot be used, live bifidobacteria die and some vitamins are destroyed). Pour it into a bottle, add the exact amount of dry mixture there. Close the bottle and mix the mixture thoroughly by shaking the contents of the bottle. Look at the light so that there are no lumps, the milk should turn out homogeneous. To check the temperature of food - put a few drops on your wrist or elbow crease (the most sensitive place). The mixture should be slightly warmer than body temperature - i.e. practically not felt.
To prepare a mixture that requires cooking, you will need to dilute the required amount of powder in a certain amount of water and boil for 3-5 minutes (for more information, see the package). Cool the mixture to 37-38 degrees, and you can give it to the child.
The ideal temperature of the milk mixture is 36-37°C.
To make sure the mixture is the right consistency, tip the bottle down without shaking. The mixture should first pour in a thin stream, then pass through the nipple at a speed of 1 drop per second. Currently on sale are nipples with holes corresponding to the month of a child's life.
Food should be prepared immediately before feeding. Information about whether it is possible to prepare food for the baby "for the future" is always contained on the packaging of the mixture.
Is it possible to prepare the mixture in advance, and how to store the prepared mixture?
In special cases, the mixture can be diluted for several feedings at once, bottled and stored in the refrigerator (no more than 24 hours) or in a special thermos (no more than 4 hours). If the mixture was stored in the refrigerator, before offering it to the baby, it, of course, must be heated to 36-38 ° C. For this, a special heater is suitable, or a bowl of hot water (flowing is also suitable). The use of a microwave oven is not recommended (food is heated unevenly), and reheating is generally contraindicated.
If necessary go on a trip with your baby, the mixture can be prepared in advance and the bottle with the finished mixture placed in a thermal bag. But in such conditions, milk can be stored no more than 2-4 hours. Another option is to take a thermos of hot water with you and prepare meals on the road. If you have to eat out more than once or twice, you need to have a supply of clean bottles and nipples (there should be different dishes for milk, water or tea). As a rule, 3-4 large bottles of 250-260 ml and 2-3 small bottles of 120-150 ml are required. A drinker will not be superfluous (for an older child).
Do not forget about safety measures: wash your hands thoroughly or disinfect them with wet wipes and a special tool.
Feeding technique
If the baby is deprived of breastfeeding, try to make the process of bottle feeding become for him that pleasant moment when he can feel the physical closeness of the mother, feel her tenderness and affection. In order to make it comfortable not only for the baby, who should be in a semi-vertical position, but also for the mother during feeding, you can use additional pillows by placing them under your back. The position of the mother's legs can be different: you can cross your legs, you can put a low bench under your feet, you can feed the baby in the prone position, while gently holding the baby. Since the mixture lingers in the stomach longer, artificial feeding is carried out according to the regimen, but if the child is worried 15-20 minutes before the scheduled feeding, you can slightly change the feeding time. To reduce air swallowing, tilt the bottle so that the milk fills the nipple and the air rises to the bottom of the bottle. Hold your baby upright for a few minutes after feeding to reduce the chance of spitting up.
It is unacceptable to leave a child with a horn alone, as he can burp and choke on milk. And even more so, you can’t feed a sleeping baby.
After feeding: hygiene rules
If the baby falls asleep soundly at the end of the feeding, without sucking everything out of the bottle, discard the contents. In no case should the rest of the mixture be left until the next feeding, it is better to pour it out - after all, various microorganisms multiply rapidly in it. All items necessary for artificial feeding, as well as baby dishes, should be washed immediately after feeding under running warm water, removing the remnants of the mixture with a brush for the bottle and nipple. After that, the dishes must be sterilized (either by boiling for 10-15 minutes, or using an electric sterilizer). Next, all feeding accessories are cooled to room temperature and put on a clean towel. This should be done within the 1st month of the child's life, then it is enough to rinse the bottle with boiled water.
Don't put off cleaning your bottles: In addition to being a breeding ground for bacteria, bottles are easier to clean right after feeding than when the formula is dry.
Rules for switching to another mixture.
Artificial nutrition should meet the needs of the child. Any new mixture (regular or therapeutic) should be started in very small amounts, increasing its volume due to the volume of gradually replaced food.
Situations in which you have to change the mixture:
- individual intolerance to the mixture, often manifested by an allergic reaction;
- to reach the age at which you can move from the first stage to the second (5-6 months); moreover, if the child tolerated this or that mixture well, then it is desirable that the subsequent mixture be of the same series from the same manufacturer;
- the need for the introduction of therapeutic mixtures (in the event of an allergy, regurgitation, etc.), therapeutic mixtures should be administered only as directed by a doctor;
- transition from therapeutic mixtures to adapted ones, after the elimination of the condition, the purpose of which correction was introduced by the therapeutic mixture.
Table 1. How to introduce a new mixture into the child's diet. Approximate scheme for the introduction of a new mixture.
Often, the mother herself decides to change the mixture to “some better” and introduces it in one day at once in full. After a few days, the situation repeats itself, and it’s good if the baby does not react to this in any way, but sometimes the child may have an allergic reaction or some kind of digestive upset. And not only because the food may not have been chosen correctly, but to a greater extent - because of its illiterate introduction into the child's diet.
Adaptation of the body to an unfamiliar diet occurs within a few days. Therefore, on the 2-3rd day, a reaction from the gastrointestinal tract may occur (pain in the abdomen, change in stool consistency). Usually on the 4-5th day, the condition returns to normal. If after 6-7 days the child has a rash, rough cheeks, diarrhea or constipation, let the doctor examine the baby. Probably this mixture is not suitable for the baby.
During the transition to the subsequent mixture, many changes occur in the baby’s life: he can already sit, stand on all fours and crawl a little, his teeth erupt, complementary foods are introduced into the baby’s menu. There is a big load both on the emotional sphere and on the physiological one. All events in a child's life must be carefully planned and take place against a generally favorable background. Therefore, you should not introduce complementary foods when, for example, teeth erupt. Not that indigestion caused by poor health due to pain in the gums can be taken as an intolerance to a particular product. It is also undesirable to simultaneously switch from one mixture to another and introduce complementary foods or be vaccinated. Nothing, if at the same time the deadlines are slightly shifted, you will catch up.
Medicinal and special mixtures.
If the child does not fit the usual adapted diet, he is prescribed a therapeutic one. The doctor who observes the child, and determines the need and timing of taking the treatment mixture. One month of sparing nutrition is enough, while the other needs more time. Medicinal mixtures are prescribed only for strict indications:
- lactose-free - with a deficiency of an enzyme that breaks down lactose;
- low-lactose or soy - with intolerance to cow's milk proteins;
- semi-elementary - with severe manifestations of food allergies, violation of the processes of absorption and digestion;
- anti-reflux mixture or mixtures with thickeners - for regurgitation and vomiting.
The result of successful artificial feeding should be an adequate weight gain for the baby (see table).
| Month | Monthly weight gain, g | Weight gain over the entire period | Monthly increase in height, cm | Growth increase over the entire past period |
| 1 | 600 | 600 | 3 | 3 |
| 2 | 800 | 1400 | 3 | 6 |
| 3 | 800 | 2200 | 2,5 | 8,5 |
| 4 | 750 | 2950 | 2,5 | 11 |
| 5 | 700 | 3650 | 2 | 13 |
| 6 | 650 | 4300 | 2 | 15 |
| 7 | 600 | 4900 | 2 | 17 |
| 8 | 550 | 5450 | 2 | 19 |
| 9 | 500 | 5950 | 1,5 | 20,5 |
| 10 | 450 | 6400 | 1,5 | 22 |
| 11 | 400 | 6800 | 1,5 | 23,5 |
| 12 | 350 | 7150 | 1,5 | 25 |
Check with your pediatrician if:
- the baby is not gaining enough weight and height;
- the child often spit up;
- the baby's stool happens more often 3 times a day, with undigested white lumps;
- the baby is worried after eating, or, conversely, calms down, and then again requires food and calms down after additional feeding.