Breastfeeding of premature babies / baby differs from what is needed and how it is done for babies born on time. From the first day of life, the baby needs special care. Today we consider the main issues relating to premature babies: signs of prematurity, feeding of premature babies. Let's talk about how to feed a baby born prematurely, about methods - breast and artificial, about the introduction of complementary foods in the baby’s diet.
Features of a premature baby
Features of care and feeding of premature babies add up to the characteristics of the body of crumbs born in the early stages. The physical signs of prematurity are obvious, it is low weight and height, if born at a very early stage, then the impossibility or difficulty of independent breathing. In addition, there are also features of the organism itself, which differ significantly from those characteristic of a child born on time. The principles of feeding premature babies consist of the following features of a small organism:
- The sucking reflex is underdeveloped. Premature babies have a weak or completely absent sucking reflex, and this greatly complicates breastfeeding. A common mistake when feeding premature babies / babies is to use a bottle. Milk comes from the nipples easier, you don’t need to make every effort to eat, and therefore, over time, the babies stop completely perceiving the mother’s breast. It is better to use a syringe (of course, without a needle), feed from a spoon or by the method of "finger". The latter option is the most preferable, since with it a sucking reflex develops. The principle of feeding premature babies "out of the finger" is as follows: the baby should be in the arms of the mother only to remember her smell, touch. A finger is placed in the child’s mouth, and when he starts to suck, you need to slowly introduce milk with a syringe.
- The volume of the stomach of children born before the deadline is less than that of those who have waited in the wings. Therefore, such babies cannot physically consume the norm of milk by age. The organization of feeding premature babies is mandatory: feeding every 2 hours, and on demand is simply unacceptable.
In women who gave birth earlier, milk begins to appear later. But it has a more saturated composition, it is provided by nature itself. To feed premature babies / children, nature has provided in breast milk a double dose of vitamins, trace elements and protein. In addition to many nutrients, antibodies appear in milk that protect the baby from various infectious diseases. That is why breastfeeding of premature babies is more preferable, artificial mixtures are used only in extreme cases: contraindications, no milk at all. If a woman has little milk, then you can only feed the baby with a mixture, but at the same time continue to establish the flow of breast milk.
The basic principles of feeding premature babies
From the very first hours of a baby’s life, when feeding it, you must adhere to the following principles:
- The type of feeding and the method of feeding are selected according to several factors: gestational age, the weight of the baby, the severity of his condition.
- Feeding should be started no later than three hours after birth, regardless of which feeding and technique were chosen.
- With parenteral feeding, it is necessary to carry out the maximum enteral feeding of premature babies.
- At the end of the early neonatal stage, children who are very premature and receive breast milk should be enriched with protein.
- If it is not possible to feed the baby with mother's milk, then artificial feeding is chosen. Mixtures for feeding premature babies should be specialized, designed specifically for babies born before the deadline. Such products contain the maximum amount of nutrients, proteins, vitamins and antibodies to strengthen the immunity of crumbs.
What products and devices are needed for enteral feeding?
- Nasogastric tubes.
- Infusion pumps.
- Adapters are only disposable.
- Breast milk or specialized artificial mixtures.
- Products for saturating milk.
Key points in catering
Features of feeding premature babies just need to be considered. The baby organism, which was born on the due date, needs more trace elements, especially in the first two weeks of life. With a lack of nutrients, a violation in the development of organs begins. For example, due to a lack of carbohydrates, nerve tissue matures with a delay.
Key points in catering:
- When to feed for the first time?
- Can a premature baby be applied to the breast?
- How much milk is needed for one time?
- What to choose for feeding: specialized mixtures or still breast milk?
First feeding
There are several methods for first feeding. At the first stage of prematurity, when the baby can independently suck, his body weight is close to normal, then the baby immediately after birth or after a couple of hours is applied to the mother’s breast. Doctors help a woman lay the baby in her hands in a convenient way, and the baby - to take the breast.
In the case of the code, the weight of the baby is less than 2 kilograms, and the delivery term has come earlier than the 33rd week, the first feeding is performed as follows:
- First, doctors must prepare the digestive system of the crumbs for a new kind of nutrition for him.
- Next, you need to make up for the lack of fluid, for this, intravenous administration of solutions is carried out.
- The first few times the baby is fed a glucose solution. If the child perceives it well, then they proceed directly to feeding.
Toddlers born earlier than they can’t absorb all the necessary amount of food, so the portions are very small at first, gradually increasing them. But, like babies born on time, premature babies need to get the necessary amount of calories and fluids, and this is impossible with small portions. To make up for the deficiency, intravenous administration of nutrient solutions into the body is performed.
What to feed?
Feeding premature babies / baby can be done with the following products:
- mother's milk;
- artificial mixtures;
- fortifier mixtures;
- another woman’s milk is donated.
Let's consider all points separately.
Breast-feeding
It is clinically recommended to feed preterm infants with breast milk. As already written earlier, it has a richer composition than milk of women who gave birth on time. Antibodies contained in breast milk cannot be compared in quality with any substitutes contained in the mixtures. Babies who are breast-fed are less likely to suffer from infectious diseases and gain weight better.
If the sucking reflex is poorly developed, then do not use a bottle for feeding, use a syringe and a finger, the baby will learn to suck in this way.
Artificial Feeding
It is not always possible to breastfeed the baby. Many premature babies are contraindicated in mother's milk due to Rhesus conflict, which most often leads to premature birth. There are diseases of the mother, in which she can not feed her baby. It happens that a woman simply does not have milk, the cause of this can be diseases, nervous shocks.
If an artificial way of feeding is chosen, the pediatrician will recommend using mixtures designed specifically for feeding premature babies. Guidelines for feeding and formula, and breast milk will be considered in the future content of the article.
Milk formula for children born earlier than the deadline is more expensive than regular, but you can not save on this. The specially developed formula provides for the presence of more nutrients, vitamins and trace elements that are necessary for the baby to grow healthy. With such mixtures, the baby will catch up with his peers in the shortest possible time!
Fortifier mixes
This is not a nutritious diet, but specialized additives to the artificial or natural diet of crumbs. These mixtures contain polyunsaturated fatty acids, they have a beneficial effect on the mental and physical development of the baby, help in the development of the nervous system.
Donor milk
Many women who cannot feed their babies on their own resort to the help of other mothers who have an excess of breast milk. Here, almost everyone makes one mistake: they give milk to the child fresh. This can not be done, since the baby can be infected by a strange woman with infectious diseases, which she may not know about. How to act? Milk should be given only after freezing. Here there are some nuances:
- milk should be poured only in specialized containers;
- subject to rapid freezing;
- Do not add fresh to the container with frozen milk;
- do not heat in the microwave;
- thaw at room temperature or under pressure of water, and heat only on gas.
Milk that has passed through freezing is no longer as useful as "living", but still it has much more components necessary for the baby than even in the most expensive mixture.
Volume of one feeding
In particular, feeding a premature baby includes a dosage of one feeding, and it depends on the weight of the baby.
- Babies up to one kilogram of weight begin to be fed with milk or a mixture only a few hours after giving birth, an average of 12 to 24 hours. For the first feeding of such crumbs, only 2-3 milliliters of milk is required. Gradually, the portion is increased by a couple of milliliters.
- Babies born with a weight of one kilogram to one and a half, are fed at a time with a portion of 2-3 milliliters of milk, but gradually increase the dose from 3 to 5 milliliters.
- With a weight of one and a half to two kilograms, five milliliters of milk is required at a time, a gradual increase is 2-5 milliliters.
- If the baby was born weighing more than two kilograms and can suck on its own, then it is applied to the female breast or given a bottle. At once, such an infant requires 5 to 7 milliliters of milk.
You need to feed every 2-3 hours, on demand, food is not issued. There should not be night breaks in the diet.
Feeding methods
The way a baby is fed depends on the degree of prematurity. If the baby was born no earlier than the 33rd week of pregnancy, then he can already take food on his own. It can be breastfed, and if not possible, with a mixture using a bottle or syringe.
If the baby decided to be born before the 33rd week, then the sucking reflex is weakly expressed or completely absent.
With a weak sucking reflex, milk or mixture is given with a syringe, from a horn or from a small spoon.
If the baby cannot suck at all, then a glucose solution, and then milk, is injected into the stomach by inserting a probe. There are two ways to feed this:
- A probe is inserted into each power supply and removed at the end.
- The probe can be in the stomach around the clock, milk is introduced into the stomach slowly, in small droplets, gradually and evenly.
How to breastfeed?
Breastfeeding of premature babies is often not possible immediately after birth. The baby is examined for the presence of a Rhesus conflict with the mother, and only after that a verdict is passed: it is possible or impossible to feed with milk. During these studies, or while the baby is in the incubator and does not consume a lot of food, breast milk may simply disappear. To prevent this from happening, it is necessary to perform decantation every couple of hours, stimulating the production of food for the baby. The same expressions are done when the baby has not yet learned to suck and cannot stimulate the breast itself.
If the baby is in the same ward with her mother, then it is recommended that the woman often hold him in her arms so that her body temperature is stable. But this is not the only reason. The closer and more adjusted the contact will be, the faster the baby will begin to attach itself to the chest.
In no case is it possible to force to take a breast, the child will simply refuse and begin to act up. On average, it takes half an hour to an hour for one feeding, because premature babies are very weak, they will get tired and eat with breaks for rest.
If the baby didn’t eat the norm at one feeding (this is clearly seen if feeding not with the breast, but with a syringe or spoon), then at the next feeding you should try to give the baby a little more, but not twice! In the case when the baby does not eat the norm, refuses supplements, then doctors will be forced to feed the baby by force using a probe. It is necessary that the child gain weight faster, catching up with peers.
When feeding, it is important to choose a comfortable pose not only for the mother, but also for the baby. In order for the baby's head to fit more tightly to the chest, and this facilitates sucking and reduces the pressure of milk, you need to lean back a little. With this position, the baby takes less air.
Memo for feeding premature babies: the area of the chin and lips is weakened in such babies, while sucking, the baby may accidentally release a breast. To prevent this from happening, you need to help him. Mom's index finger should lie on one cheek, and the thumb on the other. Hold your chin with your middle or ring finger.
Expression rules
An essential part of breastfeeding is pumping. This procedure is necessary so that milk continues to be produced more and not remain at the same level. Every day the baby will need to take more and more food, and if milk is not enough, you will have to resort to mixed feeding of the premature baby - feeding with mixtures. This is highly discouraged, because there are strong differences in the composition of breast milk, and the baby needs to consume a maximum of nutrients.
Every 2-3 hours, you need to perform pumping from both breasts. At night, you can skip this moment to get enough sleep and rest, because a tired mother has problems with lactation. Be sure to pump through from 4 to 7 in the morning, because at this time, the synthesis of milk in the body increases!
To express milk, you can use the manual method, but a breast pump will be much more convenient. Before the procedure, wash your breasts and hands with soap, wipe dry. Dishes must be sterile!
Artificial feeding of premature babies
For a variety of reasons, not every mother can breastfeed her baby. Whatever the reason, the main thing is to choose the optimal milk mixture. The child’s body weight should increase faster, so it is especially important that he receives the maximum amount of nutrients with food. Proteins should become the main component of the diet, because they are the main plastic material for the growth of a healthy body.
The skeletal system of premature babies is very weak, the body lacks calcium and phosphorus. It is for this reason that babies born earlier string are most prone to rickets. It is necessary to select a mixture enriched with vitamin D.
Conventional mixtures for feeding infants are inexpensive, but for premature babies they are too saturated and not suitable for a permanent menu. Today, on the shelves you can find anything, including a huge assortment of infant formula for such children. Almost every modern baby food manufacturer makes adapted hypoallergenic mixtures for feeding babies who were born with low weight and prematurely. It is recommended to breed such food for a baby with high-quality water without impurities, it is better to use a nursery. Tap water, even boiled 10 times, will not work. Children's water is expensive, you can use ordinary bottled.
You need to choose a mixture only after consulting a pediatrician. The specialist will evaluate the baby’s health status, reveal his need for nutrients, trace elements and vitamins. Each child is individual, especially the one that was born prematurely. If a mixture came up for one baby and he is gaining good weight, it is not a fact that the same brand will suit another child.
Next, we propose to move on to the introduction of complementary foods for premature babies with artificial feeding, breastfeeding or mixed.
Digestive Features of a Premature Infant
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Feeding a premature baby while breastfeeding or artificial, begins with cereals, fruit and vegetable purees. Giving these products can only begin if the baby is completely healthy, and vaccinations are not planned in the near future. In order of product introduction, the following rules must be observed:
- The earliest possible introduction of complementary foods can start at 4 months for full-term babies, and at 5-6 months for premature babies. Such restrictions are set for a reason. It is at this age that the pancreas is connected to the work, and the intestinal microflora is already more dense, and the body can digest other products besides the usual milk.
- Priority of products: cereals in milk and dairy-free, baby purees from fruits and vegetables, sour-milk products, juices, dishes fortified with protein.
- For the first time, you can give a new product only half a teaspoon. You need to do this before the main meal, and after that control the stool and the behavior of the child. It is possible that the child will appreciate the new taste and will require more, but you can not abuse the product new to his body.
- Up to 8 months, any food should be washed down with milk.
Nutrition for children with allergies
If the baby suffers from allergies, he often has dysbiosis, then the idea of complementary foods will have to be postponed until a later date. Kids are allowed to try only those mashed potatoes and cereals that consist of one component, so that you can easily identify the allergen.
The feeding rule for prematurely allergic children is one: one week - one new product. Ideal for the first lures will be: mashed squash or potato, rice porridge, green apple baked in the oven. Additives should not be any, including salt and sugar. After the baby has tasted a new dish, feed only the mixture or breast milk for a week, observing the condition of the baby and its skin.
To analyze the reaction you need to keep a diary. which will record what products and how the child reacted. Until the age of one year, the baby needs to try no more than two types of fruits, for the same number of types of cereals and vegetables, one type of lean meat.
As for the introduction of eggs, red fruits, berries and vegetables, fish into the diet, this is allowed only after a year.
Do not worry if you have to postpone the introduction of complementary foods. The main task of introducing new products is the development of chewing skills, taste buds. If a child gains weight well, then nutrients are quite enough for him that he receives from milk or a mixture.
It is important to follow the clinical guidelines for feeding premature babies and the introduction of complementary foods! Only in this case, the baby will grow up healthy and strong.