Calculation of nutrition of a full-term newborn with artificial feeding. Calculation of nutrition for children of the first year of life. The introduction of complementary foods

According to WHO terminology, the following types of breastfeeding are distinguished:

· Full breastfeeding (according to domestic terminology - natural feeding). With it, the child does not receive anything other than breast milk or, along with the mother’s breast, receives juices or water in the amount of not more than 1-2 sips no more than 1-2 times a day.

· Partial breastfeeding (according to domestic terminology, it approaches the term "mixed feeding").

The third degree of partiality is distinguished:

1. "High level" - breast milk is more than 80% of the daily volume.

II. "Average level" - breast milk is 20-79% of the daily volume.

III. "Low level" - breast milk makes up to 20% of the daily volume.

Premature babies include babies born before the expiration of 37 weeks of pregnancy and having a body weight of less than 2500 g and a height of less than 45 cm. Anthropometric indicators due to their significant individual variability can be classified as conditional criteria for prematurity, as many full-term babies are born with a body weight of less than 2500 g, at the same time, a premature baby may have a mass of more than 2500 g.
  4 degrees of prematurity according to body weight are conventionally distinguished: I - 2001-2500 g, II - 1501-2000 g, III -1001-1500 g, IV - less than 1000 g.
  Since 1974, WHO has proposed that children born with a body weight of more than 500 g with a gestational age of at least 22 weeks be considered viable.

There are 4 degrees of prematurity:

1. The weight of the child from 2 to 2.5 kg and height from 36 to 37 cm.

2. The child's weight is from 1.5 to 2 kg and height is from 32 to 35 cm.

3. The weight of the child is from 1 to 1.5 kg and height is from 28 to 31 cm.

4. The weight of the child is up to 1 kg and height is up to 28 cm.

Features of the development of premature babies. Physical development is characterized by higher growth rates of body weight and length during the first year of life. The smaller the body weight and the length of the premature at birth, the more intense the increase in these indicators throughout the year. By the end of the first year of life, body weight increases as follows:
  with a body weight of a newborn 800-1000 g - 8-10 times
  1001-1500g-b6-7
  1501-2000g-b5-7 2001-2500g-b4-5
  In the same age period, the growth of premature is 65-75 cm, i.e. increases by 30-35 cm.
Body weight increases unevenly. The first month of life is the most difficult period of adaptation, especially for a premature baby. The initial body weight in it decreases by 10-12% (in full-term by 5-7%); recovery is slow: in premature III-IV degrees, body weight often reaches the initial figures only by the end of the 1st month of life and begins to increase more intensively from the 2nd month.
  Despite the high pace of development, in the first 2-3 years of life, premature babies in terms of body weight and height lag behind peers born full-term. In the future, children born prematurely more often have asthenia and infantilism, but physical development indicators characteristic of full-term peers are also possible.

In psychomotor development, healthy premature babies are compared with their full-term peers much earlier than in the physical.
  Children with prematurity of the II-III degree begin to fix their gaze, hold their heads, roll over, stand up and walk on their own, pronounce the first words 1-3 months later than the full-term ones and “catch up” them in the 2nd year of life, I degree - by the end of the 1st- of the year.

Features of feeding and care.   Feeding prematurely has significant features. They are due to the increased need for nutrients in connection with intensive physical development, as well as the functional and morphological immaturity of the gastrointestinal tract, requiring careful introduction of food.

The beginning of feeding is determined by the condition of the child and the degree of prematurity. With prematurity I degree, you can start feeding breast milk or its substitutes after 6-9 hours, II degree - after 9-12 hours, III degree - after 12-18 hours, the fetus - after 24-36 hours. 5% are prescribed before feeding a glucose solution of 3-5 ml after 2-3 hours. Longer fasting is undesirable, as it leads to hypoglycemia, hyperbilirubinemia, hypoproteinemia, enhances metabolic acidosis.

The method of feeding is established depending on the severity of the condition. Children with prematurity of the III-IV degree, as well as all premature infants with respiratory distress syndrome, asphyxia, a weak sucking reflex, receive breast milk through a disposable stomach tube. With a satisfactory general condition and a sufficiently pronounced sucking reflex, feeding in the first 3-4 days is carried out through the nipple. Before this period, it is not advisable to apply the baby to the breast, since breastfeeding is a heavy physical load for him and can lead to secondary asphyxia or intracranial hemorrhage. Premature birth weights of less than 1,500 g are applied to the breast from the 3rd week of life. Nutrition calculations are made in accordance with the needs of the child's body per 1 kg of weight per day: 1-2nd day of life - 125.604 kJ (30 kcal), 3rd day - 146.538 kJ (35 kcal), 4th day - 167.472 kJ (40 kcal), then daily 41.868 kJ (10 kcal) more until the 10th day; on the 14th day - 502.416 kJ (120 kcal), from the 21st day - 586.152 kJ (140 kcal). When determining the volume of food, the individual characteristics of the child should be taken into account: deeply premature babies from the 2nd month sometimes assimilate the volume of breast milk corresponding to 628.02-753.624 kJ (150-180 kcal).
  Nursing premature infants is carried out in two stages: in the maternity hospital and in a specialized department. Then the child comes under the supervision of a clinic.
  Immediately after birth, a premature baby should be taken in a sterile, warm diaper (“optimal comfort”). The cooling of a premature baby right after birth, even in the maternity ward, often dooms all his further care to failure. So, if the body temperature of a premature baby only dropped once to 32 ° C and lower, then mortality reaches almost 100% even with the right use of all modern care and treatment methods in the future.

In the first days and weeks of life, deeply premature babies or prematurely in serious condition are kept in incubators. They maintain a temperature from 30 to 35 ° C (taking into account the individual characteristics of the child), humidity on the first day up to 90%, and then up to 60-55%, oxygen concentration about 30%. The body temperature of a premature baby can also be maintained in a heated bed or using heating pads in a regular bed. The optimum indoor temperature should be around 25 ° C.

Oxygen therapy, correction of RKO by administering glucose solutions with ascorbic acid and cocarboxylase are carried out. The elimination of hypoglycemia, hypoproteinemia is provided using glucose and albumin solutions. In case of acute need, plasma transfusions and blood transfusions are performed.
  Most babies with prematurity of the III-IV degree receive antibiotics. Indications for their appointment are the poor general condition of the child, purulent-inflammatory diseases in the mother, premature discharge of amniotic fluid, childbirth outside the medical facility.
Only 8-10% of premature babies are discharged from the maternity hospital - these are healthy babies with a birth weight of more than 2000 g. The rest are transferred to specialized institutions for the second stage of nursing. In these institutions, children receive the necessary treatment, hygienic baths, they are prevented from rickets and anemia. The range of therapeutic measures includes massage and gymnastics. A healthy premature baby can be discharged home when it reaches a body weight of more than 2000 g, its positive dynamics and a good sucking reflex.

Mandatory vaccinations for newborns in the hospital

Compulsory vaccinations in the hospital are free. The vaccination schedule is approved by the Ministry of Health. Two days after birth, the baby is vaccinated with BCG - for tuberculosis, and at discharge from the medical institution hepatitis B vaccine is administered.

This is a dangerous fallacy. The smaller the child, the less food he needs.

Features of preterm nutrition

Moreover, such children have a poorly developed digestive system. Overfeeding, especially in the first weeks of life, can only do harm - therefore, it is recommended to weigh such crumbs during the first month before and after each feeding. So you can determine the amount of milk that the baby ate.

In the first two weeks, the daily amount of food for premature babies is calculated using the Rommel formula. According to this formula, the amount of milk (mixture) for every 100 g of the baby’s body weight is 10 plus the number of days the baby’s life (in ml). For example, if a child on the seventh day of life has a mass of 2000 g, then he needs 340 ml of milk per day (for 100 g of body weight - 10 + 7 \u003d 17 ml; for 2000 g - 17 * 20 \u003d 340 ml).

Number of feedings

The amount of milk per feed is determined by the number of feeds. In our example, if a child eats 8 times a day, he should eat 42 ml of milk (340/8 \u003d 42) for one feeding, with 6 meals a day, 56 ml of milk (340/6 \u003d 56). By the end of the second week, the daily intake of milk should already be 1/5 of the child’s body weight. So, a two-week-old baby weighing 2500 g should eat 500 ml of milk per day. Of course, in practice it is impossible to maintain accuracy to 1 ml. Therefore, pour 10-15 ml more in the bottle, because the child will not be able to finish eating everything.

Premature Mixes

Unfortunately, for various reasons, not all women can breastfeed. In this case, the most important thing is to choose the right substitute for it. A premature baby experiences a greater (compared to a full-term baby) need for basic nutrients and, first of all, for protein - the main plastic material for building cells and body tissues. In addition, premature babies have a deficiency of calcium and phosphorus in the skeletal system. Accordingly, children have a high predisposition to rickets.

Milk substitutes

Conventional breast milk substitutes are not suitable for premature babies. Now a huge selection of special adapted mixtures intended for “prematurely born” has appeared on sale. Almost every major baby food company produces a mixture for feeding premature and small babies. It is recommended to prepare such a mixture on children's bottled water, the quality and composition of which are tested.

When choosing a mixture, you need to consult a pediatrician. When prescribing nutrition for such a baby, the doctor always takes into account his individual need for nutrients, the degree of prematurity, state of health, developmental features and hereditary factor. Indeed, even with the same body weight and term of prematurity, children can significantly differ in terms of health and degree of adaptation to the environment.

CALCULATION OF VOLUME OF FOOD FOR PREMATURE CHILDREN:

Preference for the caloric method.

Note: if the birth weight is more than 1500 g, from the 2nd month. caloric intake is reduced by 5 kcal / kg, gradually approaching 115 kcal / kg / s. With a birth weight of less than 1,500 g, calorie reduction begins from the 3rd month.

With natural feeding(calorie content of human milk 70 kcal / 100 ml) the required volume of breast milk can be calculated by the formula:

child weight x kcal (see table) x 100\u003d the required amount of breast milk per day.

With artificial feeding(calorie content of the milk mixture "nutrilac pre" 75 kcal / 100 ml):

Baby weight x kcal (see table) x 100\u003d required volume of mixture per day

The frequency of feeding is determined by the general condition and degree of maturity of the newborn. Newborns - 7-8 single feeding. With deep prematurity up to 10 r / day.

Nutritional Needs for Young Children:

Need in squirrelat prematurerelatively high. However, if introduced excessively with food, a toxic effect may occur due to immaturity of metabolic processes. In the 1st month. the amount of protein is 2.5-3 g / kg. For children older than 1 month. 3-3.5 g / kg

Need in fats- at prematureas in full-term six months, 6.5-7 g / kg, in the second half of 6.5-5.5 g / kg, a mixture of vegetable and animal fats should provide 40-50% of the caloric needs of the body.

Need in carbohydrates- at premature12-14 g / kg

• at the age of 0-7 days -1 g / kg / day;
• at the age of 1 month - 2.2-2.5 g / kg / day;
• at the age of 1 month 3-2.5 g / kg / day, and for the very premature - up to 3.6-3.8 g / kg.

The need for fat in premature babies

The need for fat is growing - from 0.5 g / kg / day at the age of 0-7 days with an increase to 2-3 g / kg / day.

Energy needs of premature babies

• 1-3 days; weight 900-2000 g - 30-40 kcal / kg / day; weight more than 2000 g - 30-40 kcal / kg / day.
• 6 days, weight 900-2000 g - 70-80 kcal / kg / day; weight more than 2000 g - 110 kcal / kg / day.
• 9 days, weight 900-2000 g - 100-110 kcal / kg / day; weight more than 2000 g - 130 kcal / kg / day.
• 12-13 days; weight 900-2000 g - 120 kcal / kg / day; weight more than 2000 g - 130 kcal / kg / day.
• 3-4 weeks; weight 900-2000 g - 140 kcal / kg / day; weight more than 2000 g - 140 kcal / kg / day.

The following methods of nutrition for premature babies are distinguished: parenteral, enteral, a combination of enteral and parenteral nutrition.

Parenteral nutrition

Parenteral nutrition is performed when enteral feeding is not possible. 5% and 10% glucose solutions, protein hydrolysates and fat emulsions are used. The total volume of injected fluid is calculated based on the weight and age of the child.

Fluid requirement

Enteral nutrition

The problem of nutrition for premature babies is related

1. with immaturity and dysfunctions of the maturation of the gastrointestinal tract;
2. lack of coordination of sucking, swallowing and breathing;
3. frequent and profuse regurgitation, vomiting;
4. the presence of high morbidity (intrauterine infections, etc.).

Despite all the benefits, breast milk does not always meet the needs of a premature baby for protein and certain minerals. To enrich breast milk, supplements made on the basis of cow's milk protein are used, or a combination of breast milk and infant formula is possible for premature babies (Alprem, Nenatal, Pre-Tutteli, Frisopre, Humana-O, Pre-Nutrilak).

The rationale for prescribing such mixtures is

1. Rapid growth, a high need for protein, as well as a limited ability to metabolize and excrete nitrogen metabolites from organs, do not allow to increase the protein load above 3.5-4 g / kg / day;
2. The need for certain amino acids in premature babies is higher than in term babies;
3. In the last weeks of pregnancy, there is an active accumulation of iron and calcium in the fetus, therefore prematurely born children suffer from their deficiency, often there is insufficient supply of zinc, folic acid, fat-soluble vitamins;
4. The ability of premature fats to be absorbed is reduced due to the low activity of gastric lipase and a low concentration of bile salts, however, the need for fat as a source of energy, essential fatty acids is very high.
5. Premature babies have a deficiency of enzymes that break down carbohydrates - primarily lactose, as well as salivary and pancreatic amylase, with a relatively high activity of maltase.

Enteral Nutrition Start

The onset of enteral nutrition depends on the weight of the child at birth, the severity of the condition, age, degree of maturity of the central nervous system. Roughly the first feeding is carried out:

With a mass of up to 1250 g - 18-36 hours after birth;
  with a mass of 1250-2000 g - after 17-24 hours;
  with a mass of more than 2000 g - after 8-12 hours

Before the first giving of breast milk, 5% glucose is introduced into the stomach testly. The volume of the first feeding depends on the weight: up to 2000 g - 3-5 ml, more than 2000 g - 5-7 ml. A subsequent increase in the amount of nutrition depends on the individual characteristics of the child.

Calculation of nutrition for premature babies by volumetric method

1. in the first 10 days of life, a single volume V \u003d 3 x m x n (where m is the mass in kilograms, n is the day of life);
2. after 10 days - the daily volume is 1/7, 1/6 of body weight;
3. after 1 month - 1/5 of body weight.

The number of feedings in the first 1.5-2 months is 7-10 times / day. They switch to 6 meals a day when the child reaches a mass of 3 kg, and at 6-7 months - to 5 meals a day.

1. probe (constant, one-time probe) - power is injected jet, slowly or drip using an infusion pump;
2. from a spoon of Cremauer;
3. from a bottle - with good coordination of sucking and swallowing reflexes.

Breastfeeding of premature babies

Actively sucking children weighing more than 1700 are applied to the mother’s breast. The criterion for the correct feeding is an increase of 10-15 g / kg / day in the first six months of absence of moderate anemia and severe, normal level of blood serum protein.

See also: Mixtures for children with various pathologies - CATALOG

Tags:   breastfeeding mixtures for lightweight

Premature children are those born between 28 and 37 weeks of gestation, having a body weight of 1000-2500 g and a body length of 35-45 cm.

Nursing premature babies implies the organization of special care - temperature, humidity, level of oxygenation, feeding, and if necessary, intensive care.

Organization of feeding premature infants

Difficulties   Feeding premature babies has significant features due to

• weak severity or absence (up to 32 - 34 weeks of gestation are not developed) of sucking and swallowing reflexes and their coordination due to neuropsychic immaturity, which correlates with the degree of prematurity;
• increased need for nutrients due to intensive physical development,
• morphological and functional immaturity of the gastrointestinal tract, requiring careful introduction of food:
  • small volume of the stomach
  • the predominance of the tone of the pyloric section over the underdeveloped sphincter of the cardiac part of the stomach,
  • enzyme deficiency: decreased secretion of gastric juice, the ability of acid formation and pepsinogen production, and as a result incomplete protein breakdown, decreased lactase activity   (However, the function of the pancreas, even in very premature infants, is at a sufficient level). Intestinal enzymes involved in carbohydrate and protein metabolism are formed at earlier stages than lipolytic enzymes, which is why it is often observed in premature infants increased excretion of fecal fat,
  • low activity of intestinal motility, which leads to bloating, overstretching of the intestine.

When organizing the feeding of premature babies, it is necessary to answer 4 questions:

1. when;
2. in what volume;
3. what method.

When?

Preterm infants born in a long gestation period (35 and\u003e weeks) in a relatively satisfactory condition, it is advisable to start the first feeding no later than 2-3 hours after birth. In children with gestational age less than 34 weeks and weighing less than 2000, the basic principles are caution and gradualness.

In relatively satisfactory condition

with prematurity of the first degree, you can start feeding breast milk or its substitutes 6-9 hours after birth,

with II degree - after 9-12 hours,

when III - after 12−18 hours

with IV - after 36 hours

Premature birth weights of less than 1,500 g are applied to the breast from the 3rd week of life.

Requirements for the natural (breast or horn) feeding of a premature baby: it should be sucking reflex.

If it is impossible to apply to the breast early (immediately after birth), it is necessary to introduce a few drops of mother's milk into the oral cavity of the baby's intestine with normal microflora.

Feed frequency   depends on body weight, degree of maturity, condition. Apply 7-8 single feeding, but according to indications, the frequency can be increased up to 12 times / day.

Product selection. For premature babies, as for term babies, the ideal food is breast milk   without any correction. In the absence of breast milk, use adapted milk formulas, preferably - specialized for premature infants.

Baby mixes: “Robolact” or “Linolact” for the first week of life, then to adapted mixtures of “Prepilti”, “Prehuman”, “Novolact-MM”. From 1.5−2 months - sour milk mixture.

In what volume?

Nutrition Calculation for Premature

Which method?

Types of feeding premature infants and methods of administering nutrition:

• natural: breastfeeding mother or nurse,
• natural, artificial and mixed: pacifier - expressed by mother   or donor,
• probe: for each feeding - one-off   - or permanent,
• parenteral nutrition (vomiting, flat or negative weight curve, intestinal paresis, gastrointestinal tract pathology, etc.).

The feeding method is set depending on the severity of the condition and the degree of maturity.

Indications for breastfeeding:

• possible in premature infants 35 to 37 weeks of gestation in satisfactory condition:
• when breastfeeding, systematic control weighings are required before and after feeding: the loss should not be\u003e 1.5−2%, diuresis 1 ml / kg × hour.

Indications for pacifier feeding:

• it is used in premature babies born after 33 - 34 weeks of pregnancy or II degree of prematurity (the sucking reflex of which is reduced but pronounced enough for the nipple), in the absence of disorders during postnatal adaptation - in the first 3-4 days. Before this period, it is not advisable to apply the baby to the chest, since breastfeeding is a heavy physical load for him and can lead to secondary asphyxia or intracranial hemorrhage;
• GBN - donor milk.

Indications for probe nutrition:

breast milk through a disposable gallbladder:

• spitting up;
• weakness or absence of sucking and swallowing reflexes;
• premature with asphyxia, RDS 5 points; with mechanical ventilation;
• deep prematurity - III-IV degree of prematurity, less than 32 - 33 weeks;
• slow increase in weight;

through a constant probe:

• with a mass of less than 1500 g;
• the sucking process prevents breathing and hemodynamics:
  • the appearance of persistent cyanosis during sucking,
  • defects of hard and soft palate;
• suspicion of birth intracranial injury.

The probe is introduced to a length equal to the distance from the nose to the xiphoid process, or orogastric (preferred)either nasogastric   (creates additional resistance to air passage, can provoke apnea and bradycardia).

Types of tube feeding:

a) bolus (intermittent). The probe is used for a single serving of milk, and then immediately removed. Milk is fed effortlessly, slowly, by gravity. The method is more physiological than drip, because contributes to the cyclical release of hormones, which stimulates the growth and development of the digestive tract.

b) prolonged (drip, microjet). The probe is inserted for up to 3 to 7 days. It is usually used in children with a body weight of less than 1500 g, as well as in larger ones, in case of a serious general condition with a tendency to stagnation in the stomach. The adapted mixture is delivered to the stomach using an infusion pump. In this case, it is preferable to breast milk, because it is easier to maintain its sterility throughout the time of administration.

When feeding through a probe, before each feeding it is necessary to check residual volume of the stomach. If it is more than 10% of the volume of the previous feeding, the portion of milk is reduced by 50%, followed by a gradual increase in volume.

In order to correct lipid metabolism - lipofundin 10% 5ml / kg / day.

In preterm labor, breast milk has special nutritional and energetic properties. So, the milk of women who gave birth prematurely contains a greater amount of protein, polyunsaturated fatty acids, which are necessary for the growth and development of the body of a premature baby, primarily for the maturation of the central nervous system. Also, in preterm birth, breast milk contains more carbohydrates, vitamins A, E, C in comparison with breast milk in women who gave birth on time. It is very important that breast milk in women with premature pregnancy contains more trace elements necessary for the development of the baby, namely: iron, chlorine, zinc, iodine. The milk of women who gave birth prematurely is higher in protein component and contains 1.8-2.4 g / 100 ml.

According to published data, the amount of fat in breast milk in women who gave birth prematurely does not differ from that in women who gave birth on time, the average level is 3.2-3.4 g / 100 ml. Breast milk fats are fully absorbed.

Lactose in the milk of women who gave birth prematurely is 5.96-6.95 g / 100 ml. Calcium and phosphorus are slightly higher. The calcium / phosphorus ratio in breast milk is more physiological (1: 2) than in the mixture, a lower level of phosphorus leads to loss of calcium in the urine.

Thus, nature itself provided the physiological feasibility of feeding preterm infants with mother's milk.

The need of a premature baby for basic food ingredients (proteins, fats, carbohydrates)

The protein requirement of premature babies varies depending on the degree of maturity and age from 2.5-3.0 to 4.0 g / kg per day.

The need for fats is approximately 6.5 g / kg per day.

The need for carbohydrates is 12-14 g / kg per day.

The energy needs of premature babies are gradually increasing: on the first day they are 20-25 kcal / kg, on the 2nd - 40, in the 3rd - 50, in the 5th - 70, in the 7th - 90, in 10- e - 110 kcal / kg per day. This need increases on the 20th day to 130 kcal / kg, by the 30th day - to 135-140 kcal / kg.

What should be considered when feeding a prematurely born baby?

The rapid growth rate of a premature baby leads to higher body needs for protein, trace elements, and vitamins. Therefore, in order to satisfy the physiological needs of such a child, breast milk is used as the basis for the addition of nutrients that are in short supply.

Such additional provision with proteins, some microelements, vitamins, especially for children with gestational age less than 32 weeks, and body weight of 1,500 g or less, can be carried out by partial parenteral nutrition.

Infants who have a gestational age of 32-34 weeks may be supplemented with enteral protein by adding special protein-fortified supplements to breast milk. Newborns who received fortified mother's milk have a greater weight gain, linear growth, significantly higher levels of urea nitrogen.

Methods for calculating the amount of food needed for a premature newborn baby

They begin to feed premature babies with a body weight of 2,000 - 1,500 g with 5-7 ml with a gradual increase of 5 ml. In premature infants with a body weight of 1,500 - 1,000 g, the volume of the first feeding is 2-4 ml with a gradual increase of 3-5 ml. Children with a body weight of less than 1,000 g begin to be fed with 1-2 ml and gradually increase the volume by 1-2 ml.

With tube feeding of children with very low and extremely low body weights, 3-hour milk injections with hourly intervals and a 5-hour night break are common. Thus, 5 infusions are carried out per day. The initial milk injection rate is 1.5-3 ml / kg per 1 hour. On the 6-7th day, it gradually increases to 7-9 ml / kg in 1 hour.

Criteria for determining the period of the first feeding of a premature baby are gestational age, body weight at birth, general condition of the baby. In the absence of severe pathology, you can feed on the first day, depending on maturity by different feeding methods.

Functionally mature newborns, whose gestational age is more than 34 weeks, can begin to feed 2-3 hours after birth.

First feeding-enteral feeding tolerance test- held distilled water(because glucose aspiration causes inflammatory changes in the lungs similar to milk aspiration) then several injections of 5% glucose solution,after which - use breast milk (or milk mixture).

In premature babies up to the 10th day of life, the daily volume is included, milk is determined by the Rommel formula:

or in a caloric way in accordance with the daily requirement.

Example: A child is 3 days old and weighs 1,800 g. Calculate the daily and one-time volume of milk.

V \u003d (3 + 10) x18 \u003d 234 ml;

The number of feedings is 10.

Volume per feed \u003d 234: 10 \u003d 23.4 \u003d 24 ml.

Given the tolerance of the body of a premature baby to food, on the 1st day for one feeding - 5-7 ml, on the 2nd - 10-12 ml, on the 3rd - 15-17ml, on the 4th - 24 ml.

After 10 days of life, the daily amount of food is determined by body weight by the volumetric method, as in full-term babies.

Monitoring the adequacy of feeding

Spitting up, vomiting, bloating are indications of rejection of the standard feeding regimen and require clarification of the causes that caused these symptoms. The most effective criterion for proper feeding is the daily positive dynamics of weight (approximately 15 g / kg per day).

The volume of milk eaten by the child depends on the developmental characteristics, age and state of health. Most often, mothers of babies who are breast-fed are worried about this. Indeed, when feeding, they can clearly control the amount of mixture that the child sucks, and in which case sound the alarm. It’s more complicated with properly organized breastfeeding - the baby himself regulates the amount of milk he needs and determining the amount of breast milk eaten is no longer so simple. Nevertheless, in either case, the child must consume a volume of food that meets the standards derived from years of observation and the experience of pediatricians to ensure the needs of his body.

Average age of milk or mixture

During the first breast attachment, the baby eats very little. The fact is that some time after giving birth, a woman is not secreted milk, but colostrum, which has a high calorie content. Even a few drops are enough for the baby to eat. It takes several days and colostrum turns into milk. At this time, it is important not to waste time and establish breastfeeding correctly so that for a long time the baby is provided with breast milk. But not always and not at all it turns out without problems and for a number of reasons, milk may not be enough. The reasons for the lack of breast milk and how to increase its quantity read in this article. A shortage of breast milk means its quantity below the norm, which is established taking into account the general and individual characteristics of the baby.

Norms for one feeding for children up to 10 days

On the first day, the newborn eats 7-9 ml of food in one feeding. To calculate the amount of food that a child should eat up to 10 days, you need to take the child's age in days and multiply it by 10. That is, in 3 days, the baby is supposed to suck out 30 ml of milk or mixture for one feeding.

Daily allowance for children up to 1 year old

These standards, developed on the basis of the volumetric calculation method, do not take into account the individual characteristics of the child, which must also be taken into account. So for babies with a birth weight of more than 4 kg, this norm may be insufficient, but for small children it is too large.

The recommendations set out in the table below can be considered a transitional option between the average and individual milk rates.

Norms for a large birth of a child and a child with high rates of physical development

How to calculate the amount of a mixture or milk by weight of a child

To determine how much milk your child needs specifically, simple calculations will help, taking into account, in addition to age, such individual characteristics of the child as weight, height, and state of health. Using them for children of the first days of life, you need to remember that they can give inflated results of the amount of milk.

Children of the first 10 days of life

1. The Finkelstein formula in the modification of A.F. Tour.
     The amount of milk per day (ml) \u003d Day of the child’s life × 70 or 80, where
     70 - with a body weight of less than 3200 g,
     80 - with body weight above 3200g.
2. Formula N.F. Filatova in the modification of G.I. Zaitseva   (It is considered the most optimal for calculating this age category of children).
     The amount of milk per day (ml) \u003d 2% of body weight × Day of life of the child.
3. Formula N.P. Shabalova.
     The amount of milk per 1 feeding (ml) \u003d 3.0 × Day of the child’s life × body weight (kg).

For children over 10 days of life

1. Reich Method.
     The amount of milk per day (ml) \u003d Body weight (g) / height of the child (cm) × 7.
2. The method of calculation according to Heibener and Czerny (volumetric method).   It takes into account the daily volume of milk or mixture without additional drinking.
   

   10 days - 2 months	1/5
   2 - 4 months	1/6
   4 - 6 months	1/7
   from 6 months	1/8

3. Calorie Counting Method.It is considered the most acceptable for calculating the nutrition of children over 10 days old and before the first introduction of complementary foods.

The calorie counting method assumes that a child should consume a certain number of calories per 1 kg of body weight per day. Different literary sources contain unequal information on this subject. The maximum values \u200b\u200bare contained in the WHO recommendations, which also take into account the energy value of breast milk changing with the age of the child.

0,5	124	120
1-2	116
2-3	109
3-4	103	115
4-5	99
5-6	96,5
6-7	95	110
7-8	94,5
8-9	95
9-10	99	100
10-11	100
11-12	104,5

It is most simple and easy to use this method to calculate the volume of the mixture, since its caloric value is indicated on the package in advance. Read how to choose a mixture for a newborn in this article. With breast milk, everything is more complicated. The composition and energy value of breast milk are unstable and change throughout the entire lactation period. For this reason, in relation to breast milk, this method is more approximate. But still, you can use it, knowing the average energy value of breast milk, which is 53-80 kcal / 100 ml.

Example

Suppose you want the volume of the mixture for a two-month-old baby weighing 4600 g with a calorie content of 680 kcal / l.

Calculation Procedure

1. We calculate the number of calories for a child per day, using data on the daily needs of the child in calories per 1 kg of body weight, for example, according to V. Maslov:

   The number of kcal \u003d Daily needs of the child in energy, kcal / kg × Weight of the child, kg.   The number of kcal \u003d 115 kcal / kg × 4.6 kg \u003d 529 kcal.

2. We calculate the volume of the mixture per day necessary for the child:

   The volume of the mixture, ml \u003d Number of kcal × 1000 / calorie content 1 l of the mixture.   The volume of the mixture, ml \u003d 529 kcal × 1000/680 kcal \u003d 780 ml

When using this method, it is also necessary to take into account the correspondence of the weight of the child to his age.

Regardless of what norms you use, remember that the baby that the mother had to feed or who eats exclusively baby formulas should consume the same amount of food that any other baby receives - being breastfed.

The amount of food per day in children of the first year of life should not exceed 1000 ml, and in children of the second half of the year 1000-1100 ml.

Nutrition calculation for premature babies

The nutrition of a premature baby is made taking into account the needs of the body and the capabilities of the digestive system, since the energy requirements are very high, and the digestion capabilities are not yet sufficient.

The number of calories per 1 kg of body weight for a premature baby in the first days of life is presented in the table.

From the second month of life, children born with a weight of more than 1500 g, calorie content decreases by 5 kcal / kg / day (compared with the first month of life), and in children born with a weight of 1000-1500 g calorie intake is maintained up to 3 months at the same level as in the first month of life. Then they begin to reduce calorie content by 5-10 kcal / kg / body weight, taking into account the state of health and well-being of the child.
An increase in the amount of nutrition in premature infants should be done gradually and carefully. If the child's condition worsened, then the amount of food should be reduced.
  Feeding in the first 1.5-2 months. produced 7-10 times / day. Six meals a day are transferred when the child reaches a body weight of 3 kg. At 6-7 months, the child will be ready to switch to 5 meals a day.

About mixes for premature and small babies read in this article.

Calculation of nutrition for small and sick children (WHO recommendations)

These recommendations apply to children in the first 10 days of life. Underweight children are infants born weighing less than 2500 g. This can include both premature babies and babies just small for their age.

For such children, the volume of milk per kg of body weight should first be 60 ml. Then every day it is necessary to increase the total volume of milk by 20 ml per 1 kg of weight, until the child begins to receive 200 ml per 1 kg of weight per day.

Sick children are children whose weight is over 2500 g and which, due to illness, cannot breast-feed. For such children, the amount of milk should be 150 ml per 1 kg of body weight per day.

Norm of milk or mixture for one feeding

A single volume of the mixture should be calculated based on the number of feeds per day. However, here mothers often come to a standstill, not knowing how many feedings are considered normal. To do this, you can refer to the table in which the number of feedings is given taking into account the age of the child.

Premature babies require special and more thorough care than babies with normal weight. Prematurely called a child who was born earlier than 37-38 weeks of pregnancy and has a weight of less than 2.5 kilograms. Such children are characterized by a thin skin and reddish wrinkled skin, lethargy and decreased muscle tone, immobility and slow weight gain.

Often, early babies begin later to learn various skills. Therefore, such crumbs can lag behind in development by 1.5-4 months. However, with proper care and nutrition, regular monitoring by a doctor, the child will soon catch up with peers. Subject to the recommendations, the condition of the baby will approach normal to the year. In this article, we will look at the rules for caring for and feeding premature babies.

Rules for caring for premature babies

• For children born prematurely, a weak development of swallowing and sucking reflexes is often characteristic, therefore, in the first weeks of life, the baby can be prescribed feeding through a probe;
• After the birth of a premature baby, they are not immediately applied to the chest, but examined and put into the incubator with automatic oxygen supply and maintaining optimal conditions for the life of the baby;
• Try, because mom’s milk is the best food and medicine. It strengthens the immune system and promotes weight gain, gives strength and accelerates the development of the baby;
• If nutrition so far occurs only through a probe or a bottle, regularly offer the baby a breast to develop a urostatic swallowing reflex;
• Create comfortable conditions for babies in the children's room. The suitable room temperature for premature and lightweight babies is 22-25 degrees Celsius;
• Bathing a baby weighing less than 1.5 kg is possible only after two to three weeks from the moment of birth. In other cases, swimming is allowed for 7-10 days. At the same time, a suitable water temperature is 38 degrees above zero, and the air temperature in the bathroom is at least + 25 ° C;
• You can start walking with the baby only in warm weather 1.5-2 weeks after birth. The first walk should be short and take no more than ten minutes. Gradually increase the time spent in the air to 1.5 hours. It is not recommended to walk in the heat or cold with a premature baby;
• The doctor makes an individual schedule of vaccinations and makes a personal calculation of the nutrition of premature babies, depending on indicators of weight, height and developmental features of the baby;
• An invaluable benefit in the development of a small baby is massage. More than half of these babies begin to gain weight faster. In addition, this procedure strengthens muscles and immunity, promotes the development of reflexes and improves the physical condition of the child. However, it is important that the massage is performed by a professional;
• Before starting a massage or gymnastics, be sure to consult a doctor! Massage can be entered already in the second week of life, and special gymnastics in 1-1.5 months from the moment of birth;
• If the baby weighs less than two kilograms, it is important to dress the child warmer. With a higher body weight, infants are dressed in the same way as children born on time. How to dress a newborn, read.

Features of nutrition of premature babies

Features of feeding premature babies are associated with the fact that such babies have a poorly developed digestive system, sucking and swallowing reflexes. In no case should you overfeed your baby, trying to achieve the right weight! This can seriously damage the digestive system and cause severe intoxication.

To control the nutrition of the newborn, it is recommended to regularly weigh the baby and carefully measure the amount of food. For convenience, you can keep a diary of nutrition for a premature baby by month. It is important to establish a comfortable feeding schedule and follow the recommendations.

Modern pediatricians advise to introduce for infants feeding on demand, and not according to the regimen. However, it is quite difficult to do this for premature babies, since such babies sleep most of the time and do not express a desire to eat. In this case, it is recommended to combine the modes on demand and on the mode. It is important that there are no long intervals between feedings. But do not force the baby!

In addition to basic nutrition, the doctor may recommend the inclusion of additional vitamins in the child’s diet. In the first three days of life, vitamins C and K are needed, after two to three weeks - vitamin D. In addition, it is important for a premature baby to take iron. These useful elements can be included in special medical nutrition or administered separately.

Norm and frequency of feedings

In the first two weeks of life, the daily norm of food for the baby is calculated according to the Rommel formula. For every hundred grams of body weight, 10 ml of milk or mixture is necessary, to which you need to add the number of days the baby lives.

For example, to determine the amount of food for a weekly newborn weighing 2 kg, we use the following calculations: 10 ml + 7 (days of the child's life) - 17 ml for every 100 grams. Thus, for 2000 gr 17 * 20 and we get 340 ml.

Artificial feeding and milk formula

If for some reason a nursing mother cannot feed her baby with breast milk, you need to choose the right milk formula. It should be a quality and suitable diet with the necessary set of vitamins and nutrients. When choosing a mixture, it is important to take into account all the features of the child, including premature birth, weight and height, age, reaction to certain components.

Choose special adapted infant formula for premature or small babies. Such compositions are distinguished by increased energy value and increased calorie content, which contributes to rapid weight gain. This nourishes the child with energy and gives strength.

Adapted mixtures for premature or small babies often contain calcium and phosphorus, which strengthens bones and teeth, stimulates growth and weight gain. In addition, the composition includes high protein content, fast-digesting carbohydrates, various vitamins, macro- and microelements. Mixtures include nucleotides for the normal functioning of digestion and the formation of a healthy intestinal microflora, as well as polyunsaturated fatty acids for mental abilities and the full functioning of nerve cells.

Probe Feeding

Feeding a premature baby through a probe is carried out if the baby was born before 33-34 weeks. The doctor prescribes this method of nutrition with deep or extreme immaturity, when there is no sucking-swallowing reflex, in a critical condition of the child after birth and with abnormal development of the nasopharynx.

When feeding through a tube, sterility is important. The device is installed by professional doctors. As a rule, it serves three days, after which it is replaced. When the probe is introduced, the baby is fed with warmed milk or a mixture with a temperature of up to 40 degrees drip through a syringe. The process is carried out under the strict supervision of a physician.

This method feeds until the child's condition is stabilized. When the baby has a sucking and swallowing reflex, and it gains weight, you can switch to a normal diet. It is important that infants do not experience nausea and vomiting, profuse belching and bloating. To determine the sucking-swallowing reflex, periodically apply the baby to the chest or put a bottle with a pacifier on the mouth.

The introduction of complementary foods for premature babies

Feeding a premature baby should be a little different than babies born on time. In this case, the first complementary foods begin at 5-6 months with 5% buckwheat porridge, and not with mashed vegetables. Do not start feeding your baby if he is sick and does not feel well, during active teething, with severe colic and stomach problems!

The first cereals are prepared on water or vegetable broth in the ratio of 5 grams of cereal per 100 ml of water. A few drops of breast milk or milk mixture are added to the dish, then gradually switch to 7.8 and 10% porridge. After buckwheat, rice is introduced and sunflower or olive oil is added to the porridge. It is not recommended to switch to milk porridges earlier than eight months.

At six months of age, include mashed potatoes made from cauliflower and broccoli, potatoes and zucchini. At the eighth month, the baby is given mashed meat from rabbit and turkey, then they include chicken and mashed egg yolk.

At the age of eight months, they also begin to give complementary foods in the form of fruit and vegetable juices. The main juice is apple juice, and crumbs can also be given drinks from pears, cherries and black currants, a little later carrot juice is introduced. By the ninth month, you can give baby cookies and vegetable soup.

The table below describes the timing of the introduction and the amount of food in the feeding of a premature baby.

Lure	Age	Serving Size
Dairy-free porridge (buckwheat and rice, later - corn)	6 months
(zucchini, potatoes, cauliflower and broccoli)	6-7 months	From 10 gr and increase by the year to 180-200 gr
Fruit puree (Apples, pears, apricot)	Seven months	From 5 gr and increase by the year to 100 gr
Vegetable oil (olive or sunflower)	Seven months	From 1 g and to nine months increase to a teaspoon
Mashed potatoes (rabbit, turkey, chicken)	7-8 months	From 10 gr and increase by ten months to 80 gr
Butter	7-8 months	From 1 g and to nine months increase to 5 g
Cottage cheese	7-8 months	From 10 gr and increase by nine months to 50 gr
Fruit and vegetable juice (apple, pear, cherry)	8 months	From 10 ml and increase by ten months to 80-100 ml
Egg yolk	8 months	C ¼ and gradually increase to ½
Milk porridge (buckwheat, rice, corn, oat)	8-9 months	From 5-10 grams and increase by the year to 180-200 gr
Kefir and yogurt	9-10 months	From 10 ml and increase by the year to 150-200 ml
Fish puree (pollock, hake)	9-10 months	From 10 gr and increase by the year to 50-70 gr

Introduce each new product gradually and carefully. For the first time, let's try the crumbs no more than half a teaspoon, and then wait two days. If there are no negative consequences in the form of allergies, poisoning, indigestion or stool, the product can be included in the diet of the child. You can find the general rules for introducing complementary foods for babies here.

After the baby gets lure, feed it with breast milk. Do not stop breastfeeding for at least 8-9 months, and it is better to continue feeding along with the introduction of complementary foods until 1.5-2 years. This improves the absorption of new food and normalizes digestion, reduces the risk of poisoning and worsening stools. Milk continues to provide the necessary elements for the full development of the baby, as it changes along with the growth of the baby and adapts to its needs.

Features of feeding premature babies are associated on the one hand with the immaturity of the gastrointestinal tract and low enzymatic activity, and on the other hand with an increased need for nutrients, vitamins and microelements, because the baby needs strength to grow and get stronger. The ability depends on the degree of its full-term.

Deeply premature babies weighing up to 1500 grams and who were born on 29- can not independently suck and swallow, because their feeding occurs through a probe. These babies usually begin to suckle a breast or a bottle by the end of the first month of life. Children with a weight of 1500-2000 grams (II stage of prematurity - 32-34 weeks) can independently receive food from a bottle or suckle. But often these babies do not have enough strength to suckle their breasts, and at first they are fed from the bottle with expressed milk or a mixture, and then they gradually try to transfer exclusively to breastfeeding. Babies with I degree of prematurity, born at 35 - with a weight of 2000-2500 grams, may well suckle and develop well.

Since the acidity of the gastric juice is reduced, delayed bowel motility, dysbiosis, then during this period they need to be fed exclusively either breast milk or special adapted formulas for premature babiesthey usually have the word Pre in their name. Studies of breast milk of mothers of premature babies showed that, depending on the degree of prematurity, their milk changed its composition. This milk has an increased content of proteins, which are so necessary for enhanced growth of the baby, as a building material, an increase in the content of essential amino acids, a higher degree of fat, for the breakdown of which does not require additional energy costs. In addition, mother's milk contains prebiotic substances that contribute to the growth of beneficial intestinal microflora, antibodies to various infections, which are particularly susceptible to premature babies, enzymes that improve milk absorption. The energy value of "preterm" milk is higher than that of "full-term" milk. Therefore, a woman should make every effort to preserve milk and establish, in the end, full breastfeeding.

Although with all the desire to feed many women who have had premature births, hypogalactia is observed, that is, a shortage or absence of breast milk. therefore from the first days, mother should express milk and try to give breast-feeding to her baby. Because of their weakness, babies often suck hard on their breasts. If you see that the baby is tired, he has a blue stain around his mouth, then stop feeding and feed with expressed milk from a bottle. Usually, by the 2nd - 4th week, children grow stronger and are already able to switch to pure breastfeeding. In order not to lose milk, be sure to express every 3 hours, including at night, and after each feeding.

To prevent aspiration, the first feeding of a premature baby is carried out 3-6 hours after birth with sterile water. In the future, the child begins to receive a 5% glucose solution and already from 5-6 feeding (premature babies I-II degree of prematurity), he is transferred to breast milk and a special milk mixture. Babies with a deep degree of prematurity are transferred to breast milk only 18-36 hours. Children are fed every 3 hours, with more frequent feedings (every 2 hours), the amount of food received is carefully calculated so as not to overload the infant's immature gastrointestinal tract. With a deep degree of prematurity (IV degree), sick children receive continuous nutrition through a probe, like a dropper. If the baby spits up or for other reasons cannot receive food by mouth, then the nutrient solutions are administered to him intravenously - parenteral nutrition.

If the baby cannot get breast milk for any reason, then it is fed with a special mixture, which does not change until it reaches a weight of 4-5 kg. This mixture has a balanced composition of proteins, fats and carbohydrates for premature babies, contains an increased amount of taurine for the development of the brain, calcium and phosphorus, necessary for mineralization of the skeleton and bones of the child, vitamins and other trace elements, prebiotics and probiotics to prevent the development of intestinal dysbiosis.

The calculation of the amount of the mixture or breast milk is based on the caloric needs of a small organism. On the first day, the child receives 5 ml of the mixture (nutrient solution) in one feeding, the amount increases to 15-20 ml by the 3rd day of life. Further, the diet is calculated based on the daily norm for premature babies 130-140 kcal per 1 kg of weight (for full-term babies this figure is 115 kcal). The calorific value of breast milk is 70 kcal per 100 ml, and the mixture is 80 kcal per 100 ml.

Premature babies are especially prone to rickets, anemia. Therefore, even if the baby is breast-fed, from the first month (from 2-3 weeks) he needs an additional intake of vitamin D in the form of special drops. Also, these babies have very scarce reserves of iron in the body, which are usually depleted by the 1st month. Iron in breast milk is not enough for children, despite the fact that it is very well absorbed from it, because the doctor, having assessed the condition of the baby, can decide on the additional intake of iron-containing drugs.

The first lure to premature babies is usually administered earlier at 4-4.5 months. To prevent the development of anemia and rickets to premature babies, fruit and vegetable juices, mashed potatoes, meat, and yolk are introduced earlier than full-term babies. Nutrition in the form of porridge is also important for a premature baby, as it helps him quickly gain the necessary weight for age. Monitoring the effectiveness of feeding a premature baby and the state of his health should be done only by a doctor, he will, depending on the child, change or supplement the diet.

Now every mother uses diapers to care for her newborn. One of the good, proven diapers is Libero. The kid in them will be dry and comfortable. You can buy Libero without leaving your home by going to the Mercy.ru website.