Transcript 20 Mixed feeding

Mixed feeding
by Svitlana Nykytyuk
Mix-feeding
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– 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:
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Mix-feeding closed to
breast-feeding
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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:
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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).
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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.
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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
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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.
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There are two methods of mixfeeding:
classic
 Interchanging (rotate) method.
 Classic method is used in babies
younger than 3 mo. In this method for
each feeding the formula is given.
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For example: the child 2 mo 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 breastfeeding that the quantity of human milk must be
2/3 and formula 1/3. So, the quantity of human milk
will be 130:32=86 ml and formula 44 ml.
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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
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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 mo is in mix-feeding closed to formulafeeding. 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)
115kcal5.875kg=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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Milk continues to be the main source of calories but a 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
Volume dependent of mounth
of
Weanin
6
7
8
9 10-12
g
Juice
(fruicts/vege
tables), ml
Fruct , ml
5/5
30-50 50-70 5070
80
100
5/5
Vegetable
pure, g
5/5
40-50 50-70 50- 80 9070
100
50150
170 180 200
150
Milk cereals, g 6-6.5
50-100
150
180 200
Kefir, мl
7.5-8
50-150 150-200
5-50
-
10-50
Cheese, g 6,5-7,5
egg, шт.
7,0-7,5
3/
4
Мeat, g
6,5-7,0
50-60
feesh, g
9-10 ½ ч.л
Оil, g
6
5-25 10-3030 30 50
1 1/ ¼-½ ¼-½ ½/8- 4
5-30 30
-
50
50
10-2030-5050-60
½ ч.л. 1 t.s 1 ч.л 1 ч.л
Верш- 6-7
кове
масло,
г
Хліб
пшеничний, г
8-9
½
ч.л
-
½
ч.л
-
1 ч.л 1 ч.л
5
5
1 ч.л
10
Test
Mixed feeding
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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