Mixed feeding

by Svitlana Nykytyuk

Mix-feeding

– the feeding of the babies of first 5-6 mo with human milk and formula in which the volume of formula is more than 1/5 of daily volume (or the daily volume of the human milk is less than 4/5).

•

There are two kinds of mix feeding:

Mix-feeding closed to breast-feeding

Mix-feeding close to formula feeding

Mix-feeding closed to breast-feeding – the feeding of the babies with human milk and formula in which the ratio between them in daily volume are 2:1 (or 2/3:1/3).

Mix-feeding close to formula feeding - the feeding of the babies with human milk and formula in which the ratio between them in daily volume are 1:2 (or 1/3:2/3).

Mix-feeding indication:

In causes of mother’s diseases: hypogalactia (oligogalactia); Some diseases in that mother must

decreased the quantity of feeding: mastitis; anemia of severe degree; using of medicine (medicament); erythroderma. Human milk inferiority (fat’s, protein’s or

carbohydrate’s inferiority).

In social and living conditions Mother is working and can’t nurse a baby

for all feeding. Closed children institution in which the

amount of donor human milk is not in enough quantity.

In causes of baby’s diseases: Congenital malabsorption syndrome:

hypolactasia

Hypogalactia (oligogalactia)

Hypogalactia (oligogalactia) – is decreasing human milk secretion.

Hypogalactia is divided into primary and secondary.

Primary hypogalactia – is very rarely diseases (only 1-3 %). It is connected with neuro-humoral disorders in mother’s organism or undeveloped breast or carried mastitis during previous deliveries.

Hypogalactia (from the Greek hypo - low and gala - milk),

or insufficient milk production breasts.• true (or primary) hypogalactia (5% of women)    - Associated with serious hormonal disorders, or some other reason• Early - to 2-3rd week of life;• Late - on the 4th week of life and later;

Lactation crisis 

• A condition in which a sudden decrease milk supply• There are 3-6 weeks, 3, 4, 7 and 8 months of lactation• lasts 3-4 days, not a danger to the child's health.

A child that is growing rapidly, more and more need of milk, with little appetite can not increase gradually, and jumps. In this case, the mother "did not have time to" adapt to the growing demands of the child.• arise due to temporary changes in hormonal levels.

 The main symptoms are lack of breastmilk:- Inadequate weight gain per month;

 Reducing the daily volume of breast milk

Worry Baby

Symptom "dry pampers", indicating a decrease in daily urine volume

• The main specialized products are recommended for women

during pregnancy and lactation to stimulate lactation

- "Femylak" ("Nutritek", Russia) - dry vitaminized milk formula enriched with polyunsaturated fatty acids and taurine;- "Enfa-mama" ("Mead Johnson", U.S.) - same with taurine;- "Mom Dumil plus« ("International Nutrition", Denmark) - the same with taurine;- "Olympic" (JSC "Istra", "Nutricia") - vitaminized dry mix based on soy protein;

Dry mixture enriched with the addition of lactogenic - ("Milky Way" LLC "Vitaprom" Guni food RAMS) - vitaminized dry mixture from milk and soy protein isolate enriched with herbal extracts halehi.

For improving lactation

Juices, beverages, teas

, Fruit juices and drinks ("hippies", Austria"Nestle", Germany) - juices and drinks enriched with vitamins and iron;• Tea for pregnant and lactation women ("hippies" Austria, "Kruger", Poland) - soluble herbal teas with the addition of herbs, fruit and powdered sugar;• Infusions and decoctions of food and spice and flavoring vegetables and herbs (home cooking) - infusions and decoctions of lactogenic vegetables and herbs.

"Apilaktin", "Laktohon"    ("Leovo nutria" Russia, Kazakhstan) - based on the products of bees and spicy-flavoring plants.Vitamin and mineral complex, multivitamin, mineralsubstances ("Centrum", "belly", etc.)

 

Apilak

Secondary hypogalactia - can appear in case of

not correct day regimen during pregnancy and delivery;

not correct carrying for breasts (nipple crack, erosion, mastitis);

incorrect mother’s nutrition

There are four degree of hypogalactia:

I-st degree – deficiency of the human milk is less than 25 % of the daily requirements;

II-nd degree – deficiency of the human milk is between 25 and 50 % of the daily requirements;

III-d degree – deficiency of the human milk is between 50 and 75 % of the daily requirements;

IV-th degree – deficiency of the human milk is more than 75 % of the daily requirements.

Supplementationa correction of the amount of food the child

infants with insufficient breast milk     (Additional input milk mixture)• always given after the mother's breast;• the number of mixture supplementation determined by the difference between the required age for the number of breast milk and its actual number in chewing.

Rules of supplementation

Held after applying baby to the breast;• Takes into account the amount of milk that the child received from his mother, and you want to get your child to one feeding;• Breast milk should be saved for the child as long as possible;• supplementation should be administered after all feedings or individual, as well as separate feedings;• You must leave at least 2-3 feedings breasts     (if rarely attachment to the breast lactation quickly fades.)

Methods supplementation

The classic method (applied to 3 months.): Baby is weighted before and after sucking;

    * The difference of these parameters set intake quantity of milk;    * Finish feeding each child an artificial mixture to the proper volume.     Advantages of the method:   - Frequent application of the child to the breast stimulates lactation;   - Relieves stress on the digestive system, as the baby gets human milk and mix.

 

Rotating methods - used after 3 months.;

- per child feeding is breast milk (sucks both breasts), the second - just mix the following - again, breast milk, etc.; - convenient method for the mother;

breast feeding should not be less than 3, the first and the last breast

Technology of supplemental feeding

• finish feeding with a spoon,• Carefully and precisely follow preparation technology mix: mixture must be sterile, heated to 35-40 ° C,• unacceptable overfeed or undernourish child;• Every 2 weeks to control body weight.supplemental feeding with spoon

Mixtures that are used for feeding children with mixed feeding

Adapted: Sweet - "Baby", "Malish" Detolakt "," Vitalakt "," Nan "," Nutrilon "," Humana "" Lazana "," Nestozhen "; sour - acidophilus" Baby, "" Malish ""Vitalakt"• not adapted (simple): mixture № 1,2,3, "dill", acidic - A-yogurt, kefir B-, B-yogurt, "Biolakt", "Narine" "Baldyrhan" and others.

        

What kind of mixture you choose?

Artificial feeding

The daily requirement infants in basic food ingredients (1 kg) in mixed feeding

• Protein 4 months to 2.0 - 2.5 g 3.5 - 4.0 g• 4-9 months 3.0 - 3.5 g 3.5 - 4.0 g• 9-12 months 3.0 - 3.5 g 3.5 - 4.0 g• Fats up to 4 months 6.5 - 6.0 g 6.5 - 6.0 g• 4-9 months 6.0 - 5.5 g 6.0 - 5.5 g• 9-12 months 5.5 - 5.0 g 5.5 - 5.0 g• Carbohydrate during the year 12.0 - 14.0 g

Energy needs for children who are in mixed feeding

• close to the natural:• 1-6 months - 115 kcal / kg / day;• 7 - 12 months - 110 kcal / kg / day;• close to artificial:• 1 - 6 months - 125 kcal / kg / day;• 7 - 12 months - 120 kcal / kg / day.

 

Diet for mixed feeding are:

• - Individual,- Depending on the amount of milk in the mother.• It is advisable to stick to the "free" principle  - Breastfeed on demand baby

When we finish feeding by milk mixture.

With a significant decrease in the number of breast milk feeding regime should be fixed in time as in artificial feeding. Because artificial mixtures trapped in the belly of the child longer than

When mixed feeding supplement best given with a spoon or bottle with a teat with a small hole to take the child stopped breastfeeding

Feeding with a spoon

• When mixed feeding for 2 weeks earlier than natural, is correction of food: fruit, vegetable and berry juices, fish oil and vegetable oil, egg yolk, homogenised vegetables and fruits.

There are two methods of mix-feeding:

classicInterchanging (rotate) method.Classic method is used in babies

younger than 3 months. In this method for each feeding the formula is given.

For example: the child 2 months is in mix-feeding closed to breast-feeding. The weight at birth was 3300 gm

The normal weight of the child is 3300+600+800=4700 gm

Daily volume is (will use volume method of calculations)

4700/6=783 ml Volume for one feeding is 783/6=130 ml If the child is in mix-feeding closed to breast-

feeding that the quantity of human milk must be 2/3 and formula 1/3. So, the quantity of human milk will be 130:32=86 ml and formula 44 ml.

Menu 6.00 o’clock86 ml of human milk + 44 ml of Hipp 1 9.30 o’clock86 ml of human milk+ 44 ml of Hipp 1 13.00 o’clock86 ml of human milk+ 44 ml of Hipp 1 14.30 o’clock86 ml of human milk+ 44 ml of Hipp

120.00 o’clock86 ml of human milk+ 44 ml of Hipp 1

23.30 o’clock86 ml of human milk+ 44 ml of Hipp 1

Interchanging method is used in babies older than 3 months. In this method the human milk is given for first and last feeding. In others feeding formula or human milk is given (it depend of kind of feeding).

For example: the child 3.5 months is in mix-feeding closed to formula-feeding. The weight at birth was 3300 grams

The normal weight of the child is 3300+600+800+800+375=5875 g Daily volume is (will use caloric method of calculations) 115kcal5.875kg=676 kcal/day 700 kcal – 1000 ml of human milk 676 kcal – X ml of human milk X=956 ml – that is the daily volume Volume for one feeding is 956/5 = 190 ml If the child is in the mix-feeding closed to formula-feeding, so the

first and last feeding is human milk and other - formula

Menu 6.00 o’clock190 ml of human milk 10.00

o’clock190 Hipp 1 +20 ml apple juice 14.00 o’clock190 ml of Hipp 2 +15 ml of

apple juice 18.00 o’clock185 ml of Hipp 1+5 ml of

apple puree 22.00 o’clock190 ml of human milk

Bottle feeding

Some mothers choose to bottle feed from the start and others will change over from breast to bottle feeding after weeks or months, so they need practical advice.

Bottle feeding

A cows’ milk formula specially modified for infants should be used in which the protein has been reduced, the casein partly replaced by whey protein, the fat made more unsaturated, the lactose increased, sodium and calcium reduced, and enough of all the essential micronutrients added.

Bottle feeding

Bottles and teats should be washed in water and detergent (the bottle brush used only for this), rinsed and sterilised by boiling in water or by standing covered in sterilising solution (usually hypochlorite) in a plastic container. It saves time to prepare several bottles at once. Empty the water out of each bottle, without touching the inside, then fill to the mark with recently boiled water that has cooled some minutes, not too hot or it will destroy some vitamins and may produce clumping.

Bottle feeding

Exactly the amount of power in the manufacturer’s instructions should be put into the (wide mouthed) bottle, using the scoop provided (levelled with a clean knife, not pressed down). “One for the pot” can lead to obesity. Mothers and even nurses are often found to prepare feeds inaccurately. Screw on the cap and shake the bottle well. Bottles may be kept in the refrigerator for up to 24 hours.

Bottle feeding

If the hole in the teat is too small it can lead to aerophagia or underfeeding. Milk should drip from the inverted teat at about one drop per second. Teats need replacing every few weeks.

Bottle feeding

Babies do not mind cold milk but usually prefer it warm. The bottle should be not warmed for too long and the milk’s temperature should be checked by dropping some on the parent’s skin. Infant feed should be not warmed in a microwave oven once it is in the feeding bottle. Very hot fluid at the centre of the bottle may be missed and may scald the baby. For about the first eight weeks of life babies need to be fed every three to four hours, including the small hours of the morning. (Fathers can bottle feed as well as mothers.) By the end of the first week most babies are taking 120-200ml/kg per day (160ml/kg corresponds to the 1 old 2 fluid ounces per lb bodyweight).

Bottle feeding

Cereals or rusks should not be added to milk in the bottle and babies should not be left to sleep with a bottle in their mouth.

Vitamin drops, fruit juices, are not required as supplements to modern infant formulas.

Uncles, grannies, and baby sitters can give a bottle feed but parents should feed their infant themselves as much as possible with the same sort of closeness, cuddling, and communication as in breast feeding.

Weaning

In the first six months Young infants cannot deal properly with solid foods (in reality

semisolid foods at first) for the first four months. The natural time for starting solids (beikost) is when the energy provided by well established breast feeding starts to become insufficient. The Department of Health and other authorities advise that the introduction of any food to the baby, other than milk, should be unnecessary before the age of 4 months, but mothers may be tempted to jump the gun. Most babies should start a mixed diet not later than the age of 6 months.

Weaning

Weight in the lower half of the standard percentiles without other symptoms is not an indication to augment breast feeding. Breast fed babies tend to put on weight (and length) a little more slowly than bottle fed infants. Indeed, the standard percentiles, derived mostly from bottle fed babies, may not be ideal. The time to start thinking about adding solids is when the infant still seems hungry after a good milk feed. But by six months body stores of several nutrients, such as iron, zinc, and vitamin C, are often falling in exclusively milk fed infants, whether from breast or bottle.

Mean consumption of energy

In the second six months

In the second six months other liquids can be given from a cup, especially citrus fruit juices. Untreated cows’ milk can sometimes cause gastrointestinal bleeding from irritation by the bovine serum albumin. This does not happen with boiled milk or infant formulas (which have been heat treated). Iron-fortified infant formula contributes to iron intake, which is critical in the second six months of life. It is wrong to add any salt to the foods given to infants. A fully breast fed infant receives only about one-twentieth of the sodium in a typical British adult diet. There has been a quiet revolution in commercial baby foods; most contain no added salt or colours and only up to 4% sugar (needed with sour fruits). Infants’ sodium intakes have been found to shoot up after six months but more from home prepared rather than commercial baby foods.

In the second six months

An increasing range of foods is given in the second six months. Variety is likely to cover the needs for most nutrients and provide a basis for healthy food habits. Some fruits or vegetables should be given each day, but the most critical nutrients at this stage are protein and iron: finely minced beef and legumes should be given regularly and the protein in cereal foods should not usually be diluted by refining or by added fat or sugar. Foods should become progressively more chewy and fibrous and include rusks and other finger foods like bread or cheese. Babies do not usually like strongly flavoured foods like pickled onions. Nuts, popcorn, raw peas, and similar small hard foods should be avoided; they can be breathed in accidentally. Commercial baby food manufacturers offer a succession of “strained”, “junior”, and “toddler” foods for maturing babies, and similar meals are usually made at home. Some cookbooks for babies are more sensible than others.

In the second six months

Milk continues to be the main source of calories but diminishing one. Sweetened fruit juices should be given by cup not bottle because the latter can promote dental caries. Infantile obesity is probably becoming less common in the United Kingdom now that people are aware of it. It is not usually caused by bottle feeding or early introduction of solids in themselves, but by more concentrated feeds, by pushing food at mealtimes, or by snacks in between. Between feeds, water for thirst and a minimum of snacks or sweets are good general rules.

A suggested timetable of the introduction of solid foods

Products Term

of Weaning

Volume dependent of mounth

6 7 8 9 10-12

Juice (fruits/vegetables), ml

5/5 30-50 50-70 50-70

80 100

Fruct , ml 5/5 40-50 50-70 50-70

80 90-100

Vegetable pure, g

5/5 50-150

150 170 180 200

Cheese, g 6,5-7,5 5-25 10-3030 3050

egg, . 7,0-7,5 - 1/8-

1/4 ¼-½ ¼-½ ½-3/4

Мeat, g 6,5-7,0 5-30 30 50 5050-60

fish, g 9-10 - - 10-2030-5050-60

Оil, g 6 ½ t.s ½ t.s. 1 t.s 1 t.s 1 t.s

Milk cereals, g 6-6.5 5-50

50-100

150 180 200

Kefir, мl 7.5-8 - - 10-5050-150 150-200

Organization and principles of nutrition for children older than one year

Features of food in Toddlers

• Nutrition children aged 1 to 3 years as a transitional stage features infant feeding with a gradual approach to diet adult.• There is the further development and improvement of all functions of the child's body, especially the digestive system: salivary glands, the walls of the esophagus, stomach, and intestines;• increases the activity of digestive enzymes;• gradually increasing the capacity of the stomach - from 250 ml of a child 1 years of age to 300-400 ml by the third year of life;

Up to 2.5 - 3 years of life in children already well developed masticatory apparatus: there are 20 milk teeth, 8 of which erupt to one year of age, and 12 - after. Thanks chewing enhanced production of digestive juices, food is better absorbed.

 

Chewing apparatus child older than one year 

• It should gradually replace liquid and semi-liquid food more dense and solid.• Without this skill in the future baby will not reveal much desire for products such as fresh fruits, raw vegetables, meat slices, etc.

Recommended food for children older than one year

Children over 1.5 years of age with the advent of native deciduous teeth are able to chew soft pieces of food the size of 2-3 cm (salads, vegetables, salad, vegetable stew, goulash, meatballs, sausages, pasta dishes).The range of products for infants should be varied, with the right combination of products of animal and vegetable origin.

Food for children older than one year

The recommended range of products for children aged 1 to 3 years:• bread, rye, wheat flour,• cereals, pasta, potatoes, vegetables, different, fresh fruits, dry pastry• sugar, egg, milk, cheese, meat, fish, sour cream, salt, tea, coffee drink.

Candies for children

Vegetables and herbs in baby food 

• Sometimes it is expedient to provide food garlic green onions with antibacterial and anti-inflammatory effect.• You need to give children fruits and vegetables that are designed specifically for baby food, especially in autumn and winter.

The main source of valuable protein and essential amino acids, minerals, trace elements and many B vitamins are: milk and dairy products, meat and by-products, fish and fish products, eggs.   

Milk and milk products in baby food

With the lack of animal protein children are stunted and overall development.

The value of milkCheese and varieties of children: cheese,

pasta and other products - nutritional foods high in protein and minerals, especially calcium and phosphorus.• young children a day to 40-50 grams of cheese, 3-5 grams of cheese, 5-10 g sour cream or cream.• These products are used within 1-2 days, respectively, in a binary number

• sour milk every day appointedMeat in baby food• Mainly used beef, veal, lean pork, poultry (chicken, turkey), rabbit meat, offal (liver, tongue, brain).• Children over 1.5-2 years - sausages "Milk", some varieties of cooked sausage ("Drug", "dietary", "Children").  

  Fish in baby food     Proteins fish easily digested and absorbed by the body. The diet include several species of low-cost sea and river fish: perch, cod and hake.    Not recommended for young children, smoked, salted, dried fish and canned fish (except for special canned baby food).

• In the diet include meat or fish daily. Child aged 1-3 years to 60-70 grams per day of meat and 20-30 g of fish. During the week the child can get 2-3 fishes (70-100 g) and meat 4-5 times (in 100-120 g).• Meat - a source of iron, which is important for the prevention of anemia. Perhaps the use of meat and fish in one day, but by a lesser amount

Eggs Eggs - products of high nutritional value.

 • Children over 1 year old should not be given only the yolk, but the whole egg. On one day a child 1-3 years should consume 1/2 eggs (or one egg every other day) in cooked or baked form • Adverse reactions in children - a rash, itchy skin, which encourages the use of restriction or exclusion of eggs from the diet.

Fats in the diet of children

Fats - an important source of energy (calories) and fat-soluble vitamins A, E and D.• Use butter and vegetable oils (sunflower, corn, olive oil).• As a result of heat treatment, the beneficial properties of fat lost, because butter is better to use slices of bread or put in the finished dish.

Sunflower oil• Vegetable oil added to salads, salads,

vegetable stews and more.• For children aged 1-3 years is prescribed daily 15-20 grams of butter and 6-7 grams of vegetable oil.

•

Bread in the diet of children

must be different varieties - from rice and wheat flour, preferably coarse.• Bread - healthy product, rich in vegetable proteins, carbohydrates (polysaccharides), dietary fiber (cellulose) that has a positive effect on digestion and vitamin B.• Every day, a child aged 1-3 years should be given up to 20 g and 40-50 g rice and wheat bread.

Sugar in the diet of children

Sugar must include the child's diet.• It is easily absorbed, improves the taste of many dishes.• Excess sugar is bad for children: this leads to obesity, diseases related to metabolic disorders (diabetes, diseases of the musculoskeletal system).• The need for child 1-3 years in sugar of 30-40 grams per day.

Sweets in the diet of infants

Chocolate and chocolate candies which is consumed by young children is not recommended (increased arousal of the nervous system and is one of the strongest allergens).

Vegetables, fruits, berries in baby food

Test Mixed feeding

Choose the term of giving fruit juices for the child on mixed feeding: 2 weeks 1 month 3 month 4 month elder than 6 month Advisable term of giving egg yolk for the child on mixed feeding: from 3 month 4 month 5 month 6 month 7 month What does it mean accessory feeding : milk formula vegetable puree fruit juices porridge Advisable term of giving fruit puree for the child on mixed feeding: 1month 2 month 3 month 4 month 5 month Most better formula for mixed feeding 2-month baby: “NAN” “Detolact” Acidofile milk “Krepish” easy formule N3