Complementary feeding of a premature baby on artificial feeding and breastfeeding (table)

Types of feeding premature babies

Breastfeeding

After premature birth, mother's milk has a special composition that better suits the nutritional needs of premature babies and is suitable for digestion and absorption. Compared to the milk of women who gave birth at term, it contains more protein, especially in the first month of lactation, contains more sodium and fat, and less lactose. This milk is quite easy to digest.

Enriching the diets of breastfed premature infants

You can preserve the main advantages of breastfeeding, as well as meet the high nutritional needs of a premature baby, with the help of:

• enrichment of mother's milk with doctor-recommended enhancers - protein-mineral or protein-vitamin-mineral supplements;
• in the absence of breast milk - the introduction of specialized mixtures based on whey proteins, for example, from the Nutrilak line. They are well tolerated by premature babies and are easily digestible

Artificial feeding of premature babies

This is another important way of feeding babies. The main indications for artificial feeding (diluted formula in a bottle) for premature infants are insufficient or complete absence of mother's milk or the child's intolerance to it. In the nutrition of children who were born ahead of schedule, exclusively specialized formulas should be used, the nutritional value of which is higher than standard adapted products.

The abolition of specialized products, as well as the transfer to regular infant formula, should be carried out gradually. Doctors believe that when a baby reaches a body weight of 2500 g or more, it does not serve as a serious contraindication to the further use of formula for premature babies.

When feeding a child in case of insufficient weight gain, such mixtures in a limited volume can be used in combination with classic formulas for full-term babies for several months. The use of infant formula for premature infants in a small volume (1/3–1/4 of the daily volume) can better provide infants born prematurely with nutrients, prevent the development of iron deficiency anemia and osteopenia, and increase the growth rate.

Complementary feeding for premature babies: nutritional skills

At the same time, we should not forget that new products are only an addition to the baby’s main dish, that is, mother’s milk or formula. It’s good if the mother managed to maintain full lactation, because breast milk is the most desirable type of feeding for all children, including premature ones.

But very often breastfeeding an “early” baby is complicated due to various psycho-emotional and physiological reasons. Therefore, most babies at the time of discharge from the hospital receive an adapted milk formula for premature babies. So are there any differences regarding the introduction of complementary foods to infants and babies who eat formula?

By and large there are none. Sometimes babies who receive formula are introduced to complementary foods a couple of weeks earlier, but this is far from a general rule. To make such a decision, the pediatrician must assess the general condition of the child: his height, weight, hemoglobin and iron levels in the blood. But in any case, the decisive factor in this matter is whether the baby has food skills.

Introduction of complementary feeding to premature babies

Complementary foods can be introduced from 4–5 months of age. The order of introduction of products has its own characteristics. This is due to the fact that some low birth weight children have certain gastrointestinal motility disorders, including after treatment.

Expanding the baby’s diet should begin with the introduction of porridge or vegetable puree. It is better to give preference to industrially produced products. This is due to the fact that their production uses environmentally friendly and proven raw materials, they have a guaranteed composition and proper degree of grinding, and are enriched with minerals and vitamins. Complementary feeding should be introduced with monocomponent products. As for porridges, dairy-free and gluten-free ones (rice, buckwheat, corn) are introduced first. They can be diluted with milk formulas that the baby receives. Porridges should not contain fruit, sugar or other additives. If the doctor has noted that the baby is at risk of developing iron deficiency anemia, meat puree can be given as early as 5.5 months (taking into account the good absorption of heme iron from it). Cottage cheese can be given only after 6 months. It is advisable to introduce juices after 8–9 months. Their early introduction can lead to negative consequences: provoke colic, regurgitation, allergic reactions, diarrhea.

Introduction of complementary foods to full-term and premature infants

The ideal feeding for an infant is mother's milk. It best suits your child’s needs, depending on his maturity and full-term maturity, and is most suitable for your child. However, every child comes a time when he must try “adult food.” As a rule, this occurs at the age of 4-6 months. For each baby, it is necessary to choose an individual scheme for introducing complementary foods , which will best suit the characteristics of your child.

It is important to remember the basic rules when introducing complementary foods:

1. You can start introducing complementary foods only against the background of complete health; it is also undesirable to introduce complementary foods during the period when the child is scheduled for preventive vaccinations or climate change, and also if your baby is unwell;

2. The principle of gradually increasing the dose of new complementary foods , since your baby’s enzymatic systems must get used to the new food for him;

3. When introducing complementary foods, allergic reactions or intolerance to certain components of the products are possible, therefore a new product (or component) for the child should be introduced no more than once every 3 days, since very often the reactions are dose-dependent (for small volumes of the reaction no, the reaction appears only when the volume of the product increases). If a child has an allergic reaction to some component, then allergic antibodies are produced upon the first encounter with the allergen. Therefore, it is very important not to even try this product for 6 months, not to perpetuate an allergic reaction in the child’s body, then, perhaps, the child’s body will mature, intestinal permeability will decrease, the child’s enzymatic systems will be activated and the child will not react to repeated administration of this product. This favorable option occurs in 80-90% of cases. It is important to know that allergic reactions when introducing complementary foods (food allergies) usually manifest themselves in the area of ​​the cheeks, buttocks, and, less often, the anterior abdominal wall and are accompanied not only by redness of the skin, but also by its dryness.

In addition, with the help of rationally selected introduction of complementary foods , problems such as insufficient weight gain, constipation in a child, vitamin deficiency and some other problems can be corrected.

scheme for introducing complementary foods for a premature baby is especially important . In this case, it is very important to know that complementary foods are introduced not according to the actual age of the child, but to an age adjusted to the degree of prematurity. That is, it is necessary to add to the actual age of the child the period that is not full-term until 40 weeks. For example: if you gave birth to a baby at 30 weeks of pregnancy, then the period that is not enough to reach 40 weeks is 2.5 months. Therefore, if, for health reasons, the child was planned to be introduced to complementary foods at 4.5 months, then in your case, complementary foods should be introduced only at the age of 7 months.

It is very important that the pediatrician observing your child select an individual scheme for introducing complementary foods that is optimal for your baby. For all the necessary help in selecting an individual scheme for introducing complementary foods to full-term and premature babies, you can contact the Uralskaya Clinic at the address: st. Chekistov, 16 or by phone (343) 288-5-200.

Formulas for artificial feeding of premature babies from Nutrilak

The line of formulas for children includes a special product – Nutrilak Premium Pre. This is a specialized milk powder mixture that has a high protein content, a maximum predominance of fat and whey proteins, medium chain triglycerides (MCTs), a reduced lactose content and an increased calorie content. All this can help ensure that the baby catches up with growth compared to feeding with classic formulas.

Complementary feeding of premature babies

Is the baby big enough for complementary feeding? Doctors have good reasons why a premature baby should start introducing complementary foods later than a full-term baby. At the same time, there is no single age for the first complementary feeding - the date of premature birth and baby weight will largely determine the baby’s readiness for solid food. We discussed when and what to feed a premature baby with the deputy head of the Mother and Child Center on Savelovskaya, Ph.D., doctor of the highest category, pediatrician Alla Anatolyevna Shcherbakova.

Premature babies are babies born before the 37th week of gestation. Prematurity is not determined by birth weight, but by the date of preterm birth.

— Alla Anatolyevna, premature babies have special nutritional needs from the first days of life. What factors influence the initiation of complementary feeding in premature infants and when should complementary feeding be introduced to a premature infant?

— Prematurity comes in varying degrees, so the principles of feeding and feeding children will also be different.

Timing of introduction of complementary feeding in premature infants

— From birth, a premature baby receives only breast milk or powdered milk formula, but a time comes when he can no longer satisfy his needs with them. The main task of complementary feeding is to diversify the diet and increase the amount of nutrients - proteins, fats, carbohydrates - so that the baby can fully grow and develop.

When a baby is born on time, he begins to be fed solid food at 5.5-6 months. When it’s time to feed a premature baby, pediatricians determine this: the period of prematurity is added to the baby’s age. For example, a child was born at 35 weeks, 5 weeks ahead of schedule: the start of complementary feeding is shifted by these five weeks.

The main signs of readiness for complementary feeding:

• the child has a healthy appearance, feels good, smiles, and is cheerful;
• the child is active, has muscle tone, and is physically quite well developed;
• double weight gain from birth;
• good dream;
• a chewing reflex appears - the child begins to chew and bite;
• good appetite - if the child wants to eat, he will be happy to receive vegetables;
• the baby sits independently - the child should receive complementary foods while sitting at the table; it is desirable that he sees the product he is eating;
• active interest in what parents eat, desire to participate in family meals.

— Proper feeding of premature babies increases the nutritional value of their diet and certainly helps them catch up. Then why can’t you start feeding babies earlier?

— A premature baby has an immature gastrointestinal tract and an immature enzyme system. It matures not in the womb, but on its own. Therefore, in the complementary feeding tables for premature infants, the time for introducing complementary feeding is, as a rule, postponed for the period that the child did not sit in the tummy. With age, the number of villi in the intestines increases, the pancreas begins to work better, and more saliva is produced: this means that it is time to introduce complementary foods - gradually, consistently, under the supervision of a doctor.

Don't worry if your baby hasn't tried solid foods yet. The attending physician will tell you when to start feeding a premature baby.

— Will complementary feeding of a premature baby on breastfeeding and complementary feeding of a premature baby on artificial feeding be different?

— There are many recommendations regarding the introduction of complementary feeding for premature babies; they can be found in print and electronically on the Internet. But before introducing complementary foods to a child who was born prematurely, especially a very premature one, it is necessary to visit a pediatrician. The doctor who cares and observes the baby prescribes complementary feeding products taking into account his individual characteristics.

— Let’s say a child cannot gain weight for a long time. Are the start dates for complementary feeding pushed back even further?

— The weight curve of premature babies is more pronounced, they gain weight better than full-term babies. If a child has not gained the required weight by the age of introducing complementary foods, this means that his nutrition was chosen incorrectly or insufficiently, or there are some problems with digestion. In this case, you first need to establish basic nutrition, select supplementary foods, double your weight and get into good physical shape - and only then start complementary feeding.

Complementary feeding is additional nutrition for healthy children who have no complaints. Therefore, digestive problems should not be solved with the help of complementary foods, and it will not be possible to increase weight with the help of complementary foods.

— What complementary foods should I give to a premature baby?

— The first feeding of premature babies consists of two main types of products:

Complementary feeding for a premature baby will not be much different from complementary feeding for a full-term baby, because by the time solid food is introduced, the premature baby should get rid of problems with the gastrointestinal tract, become stronger, and grow. And parents begin complementary feeding, almost forgetting that the baby was born prematurely.

— How to properly give complementary foods to such a child?

— The basic rule for introducing complementary foods for all babies (premature babies are no exception) is gradualism.

• How much complementary feeding to give
  ? Complementary feeding starts with a teaspoon. Each subsequent portion can be doubled, so they come to full feeding only after two to three weeks (full-term babies receive a full portion after five to seven feedings).
• What time to give complementary foods
  - It is more correct to give a new product in the first half of the day. If you don’t like something or the baby burps, there will be time to calm him down, observe and decide what to do next.

— In addition to the situation with underweight, when should you delay or stop giving your child new foods when starting complementary feeding?

— Pediatricians pay special attention to the following signs:

• the child has not doubled his birth weight;
• if you were underweight, complementary foods were introduced and abdominal problems began - regurgitation, bloating, anxiety when feeding, a different character of the stool - liquid, foamy, with a changed color and smell;
• When we started introducing complementary foods, skin problems appeared: dryness, redness, itching.

If you have an unfavorable reaction to complementary foods, you should stop feeding them, see a doctor, and continue to introduce new foods under his supervision.

— Baby food made with goat milk is better absorbed by the body of children. Is it suitable for premature babies?

— The good digestibility of goat's milk helps premature babies gain weight better at the stage when the PRE formula is no longer used. And here goat milk mixtures can be recommended for artificial and mixed feeding. Gluten-free fortified cereals with goat milk MAMAKO® can be used for the first feeding of premature babies (they do not need to be boiled, there is no need to prepare formula or expressed milk as an additive). For further complementary feeding, you can recommend multigrain porridges, fruit curds and cream soups. The same milk base of formulas and complementary foods helps the digestive organs adapt more quickly when moving from one product to another.

Premature babies are born before 37 weeks of gestation. And they need more time to mature for solid food, so complementary foods are introduced a little later than for healthy babies. New food is given gradually, taking into account the characteristics that the doctor reveals during the examination.

Pediatrician Alla Anatolyevna Shcherbakova

*The ideal food for an infant is mother's milk. WHO recommends exclusive breastfeeding for the first 6 months. MAMAKO® supports this recommendation. Before introducing new foods into your baby’s diet, consult a specialist.