When breastfeeding, it can be difficult to determine whether the baby is getting enough mother's milk. What are the signs that your baby is not eating enough? And how to calculate the amount of supplementary feeding?

How to determine that your baby needs supplemental feeding

You can, of course, weigh the baby before and after each feeding, but babies usually don’t like this, and breastfeeding should be pleasant for both mother and baby and take place in a calm environment. Therefore, it is possible to determine whether the baby has enough breast milk in indirect ways.

• you breastfeed your baby on demand or 6-8 times a day;
• the baby wets diapers at least 8-10 times a day;
• When feeding, the baby takes the breast well and sucks vigorously;
• after feeding, the baby looks happy;
• during the waking period, the baby is active, seems happy and prosperous;

then, most likely, his mother’s milk is enough for him.

But what if this is not the case? Let's turn to the experts. The WHO breastfeeding guide provides reliable and probable signs that a baby is not getting enough breast milk.

Possible signs that the baby is not getting enough breast milk (as defined by WHO):

• The baby cries very often.
• Doesn't look satisfied after breastfeeding.
• Feeding on demand becomes too frequent.
• Each feeding lasts a very long time.
• The baby refuses to breastfeed.
• The child's stool is too dense or very rare.
• There is almost no milk when expressing.
• After childbirth, the milk “did not arrive” and the breasts did not increase in size.

The given signs are indirect and not 100% reliable. For example, a baby may cry for various reasons: often asks for the breast, for example, not because he is hungry, but experiences some discomfort, and being close to his mother calms him down. WHO identifies only two reliable signs of milk shortage:

Reliable signs that your baby is not getting enough breast milk:

• Very slow weight gain.

After birth, all babies lose weight, but normally they catch up in the first two weeks. They should then add 150-200g per week or approximately 0.5kg per month. If your newborn does not regain weight loss or gains little or no weight in subsequent weeks, this may be due to insufficient nutrition. But poor weight gain can also be caused by illness, so you should definitely discuss the situation with your pediatrician.

• The baby wets diapers less than 8-10 times a day or there is little urine, it is very concentrated and has a strong odor.

Normally, the volume of urine should be from 1/2 to 3/4 of the volume of fluid received by the baby. According to WHO, an infant weighing more than 2.5 kg requires approximately 150 ml of milk per 1 kg of body weight per day. Accordingly, the amount of urine per day should be approximately 75-115 ml per 1 kg of body weight of the baby. With a weight of 3.5 kg this is approximately 390 ml, with a weight of 4 kg - 450 ml. Taking into account the fact that in the first year of life the physiological need to pee arises in the baby when 20-40 ml of urine accumulates in the bladder, he must wet the diapers at least 10 times a day. The number of urinations is better seen in diapers; it is more difficult to assess the situation in diapers. And if the mother drops off the baby and does this often, then he can write not as needed, but when he is offered. Then a large number of discharges can create an impression of false well-being, although the total volume of urine will be small.

There is also this subtlety: breast milk is not the same everywhere. Milk from the anterior lobes of the breast, the so-called “anterior”, is more liquid and quenches thirst. Milk from the posterior lobes - “hind” - is more nutritious, containing more fat and enzymes necessary for the absorption of nutrients. Therefore, sometimes a baby can produce enough wet diapers while remaining underfed. This happens when he sucks out a lot of "fore" milk and gets enough fluid, but does not get enough "back" milk and does not receive enough nutrients. So it’s worth counting not only wet diapers, but also dirty ones. Although it happens that breastfed babies do not do “big things” for 2-3 days and feel great. Because breast milk is very well absorbed.

Watch your baby and pay attention to all the signs together, especially changes in the baby’s weight.

WHO experts believe that cases when a nursing mother really has little milk are very rare. Most often, a baby does not get enough milk when he is rarely put to the breast or does not suckle effectively.

Therefore, before resorting to supplementary feeding, this reason must be ruled out. With rare application it is clear, but with more details.

The rhythm of sucking and the duration of feeding are different for each baby, but you can judge whether the baby is getting enough milk by the nature of the sucking. Breastfeeding is not a passive process; the baby makes active sucking movements. His mouth opens wide, then, after a pause, begins to close. If the baby has latched onto the breast correctly, you may notice how his ears move slightly in time with the swallowing movements, and at the very moment of swallowing his chin seems to freeze motionless. The longer this pause lasts, the more milk your baby gets in this sip.

If this is not possible, then the second step is to try to find one from a nurse.

And only then consider the option of supplementary feeding with an age-appropriate adapted milk formula. If you choose the latter option, be sure to consult with your pediatrician about the specific type of formula!

How to calculate the amount of supplementary feeding?

The general rule: the amount of supplementary feeding should be the minimum necessary. That is, it should be enough to meet the baby’s nutritional needs, but not so much as to affect lactation. When calculating the amount of supplementary feeding,

We have already talked about supplementary feeding and ways to determine the lack of milk. In a situation where the amount of milk is really reduced, it is necessary to decide on the advisability of introducing supplementary feeding and then, if necessary, correctly introduce the formula and quickly leave it, returning to full breastfeeding.

When should you think about supplementary feeding?

If you have tested for wet diapers, and according to the results there are 6-8 of them, or at the next visit to the pediatrician the baby has gained little weight, less than 500 grams per month, then you should consult a pediatrician who supports breastfeeding, or invite a consultant on breastfeeding at home. Sometimes it is enough to receive advice over the Internet, sometimes by calling a hotline, but in most cases a consultant must be invited to your home. The consultant will assess the correctness of breastfeeding, look at the baby’s activity and ask you about all the details of the feeding process. If, after eliminating all factors that affect sucking and the amount of milk - improper attachment, introducing more frequent attachments and stimulating lactation, there is no effect, the issue of supplementary feeding is resolved.

With the help of a consultant or doctor, you will decide which type of supplementation is preferable in your situation - expressed milk or formula, and also determine which type of formula should be chosen.

Where to start if there is a problem with milk?

First of all, a young mother needs to calm down and pull herself together, not scold herself or get nervous - from stress and your worries, the milk that is in the breast is more difficult to separate due to the blocking of oxytocin. Then even the milk that is available is difficult for the baby to obtain, and he begins to get nervous and cry, and be capricious. Read materials on breastfeeding on the Internet from trusted resources - the AKEV website, La Leche League, or regional breastfeeding support sites. There are many detailed and detailed recommendations, photographs and valuable advice, where experienced consultants can contact you.

Check the breastfeeding, if you find errors, try to correct them, latch the baby more often, change the feeding position, try the nesting technique, carry the baby in a sling, let it literally “hang” on your chest.

Feed your baby as often as possible, at the first request, without waiting for the moment when the baby starts crying and cannot feed normally due to screaming. Sometimes in the first days it may seem as if the baby is hanging from your chest. In fact, babies simply pump their own volume of milk.

Feeding is required when falling asleep, at night - at least once every two to three hours, upon awakening, and during the day, make the maximum interval no more than one and a half to two hours. If the baby is asleep, gently place him on the breast; babies have highly developed sucking reflexes - they can sleep and eat at the same time. If at night it is difficult for you to get up often and feed for a long time, it will be more convenient to organize a joint sleep, then you can rest, and the baby will always be able to eat as much as he needs.

Try to temporarily limit visits with your child to crowded places and frequent absences from the baby, limit visits to your home by guests, dim the lights and give up noise stimuli - this is called “nesting”, constantly being with the baby, constantly feeding him and carrying him in your arms.

When carrying out all these activities, monitor the number of wet diapers per day, possibly for several days. But there is no need to weigh the child every day - weight control is carried out once a week. If the weight is stable, it is necessary to decide on supplementary feeding, but if the weight increases at the level of 100-120 g per week, intensify actions to enhance lactation. If the weight deficit is pronounced, and there is no weight gain at all, the introduction of supplementary feeding is indicated - ideally this should be breast milk (expressed or donor), but usually supplementary feeding is given in the form of a mixture.

How to calculate the amount of milk needed?

How much milk or formula should be given in one supplementary feeding, how much supplementary feeding is needed per day, how to stimulate lactation, how not to go completely to artificial feeding, but to return full breastfeeding - these questions immediately arise when prescribing supplementary feeding. So, it is necessary to carry out special nutrition calculations in order to determine the amount of supplementary feeding and its administration. It is necessary to establish the exact lack of milk in order to supplement it with formula, but not to overfeed the baby with formula, not to reduce the amount of breast milk, but to stimulate lactation. Attention, it is impossible to give the mixture “by eye”, by the mother herself, without making calculations - this will lead to a quick transition to artificial feeding.

Power calculations

For children over 10 days old, three calculation options are used that give very similar results. The first method is volumetric, according to which the daily volume of food is:
- for a baby up to one and a half months leaves 1/5 of the body weight,
- for a baby from one and a half to 4 months is 1/6 of the mass,
- from 4 to 6 months – is 1/7 of body weight,
After six months, 1/8 of the mass,
but not more than 1000 ml for children under one year old. This is the maximum daily volume of milk for children of the first year of life; you cannot give more of it - there will be overfeeding.

There is also a calorie calculation method and calculation of the amount of food based on protein, but only doctors can carry them out. These methods are complex and require tables, but the voluminous method is used most often in practice because of its simplicity and clarity.

The volume of one feeding is calculated by dividing the daily volume by the number of feedings. Children under six months should have at least 7-8 of them per day. At each feeding, it is permissible to fluctuate the feeding volume in each direction by 10-20 ml, due to the difference in appetite during the day.

Methods for correct administration of the mixture

Supplementary feeding is prescribed in the first six months, when due to age it is still impossible to introduce complementary foods to the baby in the form of porridge or puree. After six months, the issue of supplementary feeding is decided individually, depending on the situation; usually it is no longer required; supplementary feeding can be done with porridge. If they decide on supplementary feeding, they give preference to hydrolyzed formulas; they do not taste as pleasant as breast milk, and the baby will not refuse the breast in favor of the formula.

The mixture is administered strictly under the control of urination, and feedings are carried out strictly by the hour. The entire volume of the mixture for the day is divided into equal volumes, and given exclusively during the daytime - usually from six in the morning to 21-22 hours, every three hours. Breastfeeding, unlike supplementary feeding, is given on demand, and before supplementary feeding it is necessary to give the child both breasts at once, and only then the formula is introduced. At night, from at least midnight until six or nine in the morning, only the breast is given, even if the child practically sleeps on the breast. Thus, the mother’s milk production is stimulated, and supplementary feeding is gradually eliminated.

We begin to give the baby a minimum amount of mixture, about 30 ml; if the baby urinates less than 8-10 times a day with this amount of mixture, another 20-30 ml of mixture is added. If the baby urinates a lot with a given volume of formula, more than 15 times a day, at least 50-100 ml of the mixture can be removed from his diet at once. On average, a sufficient amount of nutrition is indicated by the number of urinations 12-15 times per day.

If after breastfeeding the baby does not finish the entire volume of the formula, it is poured out, and the next portion of supplementary feeding is given at the next scheduled time. If this time the baby again does not finish the volume, the volume of the mixture is completely reduced by this amount. We give breastfeeding to the baby constantly, without time control. If the daily volume of supplementary feeding is small, up to 200 ml per day, you can quite safely remove about 50 ml of the formula or one of the formula feedings.

While the child is receiving formula, it is necessary to monitor the volume of urination and weight gain. As weight stabilizes and active gains occur, as well as with a sufficient number of urinations, they proceed to gradually withdrawing the mixture using the above methods.

Any supplementary feeding to a child is given only from a spoon, cup or special system, but not from a bottle with a nipple. Pacifier sucking and breast sucking are very different in mechanism, and bottle sucking can lead to breast refusal. Supplementary feeding and its volume are monitored by a pediatrician or lactation consultant, who will help you introduce the formula and remove it as your weight and urination normalize.

Is it possible to return to full breastfeeding?

Of course it is possible, moreover, this must be achieved in the end. Today, lactation consultants have already accumulated enough practical experience in the transition from mixed feeding to full breastfeeding. But it’s impossible to do this in one day, mom needs to be patient, be calm and confident in her abilities, then everything will work out. In any case, it is necessary to strive to minimize the amount of supplementary feeding in each case of mixed feeding, since every drop of breast milk is priceless for the baby’s health. The timing of the return to full breastfeeding will directly depend on the amount of supplementary feeding, but you can return to full breastfeeding even from completely artificial feeding - the main thing is a sincere desire and patience.

If the volume of supplementary feeding is approximately 100 ml, it can be removed in two to three days, and if the baby actively sucks, then at the same time, simply by abandoning the formula in favor of frequent feeding. With a daily volume of the mixture of 150-250 ml, you can gradually remove the mixture by 50 ml over the course of about a week, or reduce the volume of each additional feeding and, having reached 100 ml, gradually eliminate them altogether.

Formula volumes of more than 300 ml per day are canceled for two to three weeks with a gradual reduction in the volume of the formula in favor of more frequent breastfeeding. Reduce the volume of the mixture by half, and then, having consolidated on this result, gradually cancel the mixture completely.

In parallel with avoiding formula, it is necessary to make efforts to stimulate lactation - this is not only proper nutrition and special drinks, but also adequate sleep, calmness and frequent and adequate breastfeeding.

When to introduce supplementary feeding while breastfeeding? Which babies need it vitally? How to feed formula correctly? What should you offer it to your child from? How much mixture is needed? And when should you stop? Let's consider the main issues related to the introduction of supplementary feeding during breastfeeding.

Supplementary feeding is the use of formula in feeding an infant up to six months of age. Its purpose is to provide the baby’s body with nutrients that, for various reasons, cannot be compensated for by mother’s milk. In natural feeding techniques, supplementary feeding is the exception to the rule rather than the norm. There are many prejudices associated with the need for its introduction.

When to introduce supplementary food

Often young mothers begin early introduction of supplementary feeding due to lack of confidence in their own abilities. Immediately after birth, when milk has not yet come in sufficient volume, it seems that there is simply nothing to feed the baby. The situation is aggravated by frequent baby crying, which is why an inexperienced mother concludes that the baby is hungry.

Fed from a bottle, the baby calms down and sleeps for a long time. Thus, an incorrect conclusion leaves an imprint on the entire period of breastfeeding. Mom thinks that she has very little milk or that it is “not filling” or “not fatty.” But you can “really” feed a child only with formula.

In fact, in the first days after childbirth there should not be a lot of milk. The child's kidneys have not yet adapted to life in external conditions and cannot process large amounts of fluid. The mother's body knows this well, so it does not produce liquid milk, but thick colostrum in small quantities. And it is quite enough to compensate for all the food needs of the baby’s body in the first three days of his life.

Here are other situations that do not mean that the child needs supplemental feeding.

• The baby is restless at the chest and cries. This does not mean that the breast is “empty”, but rather that the baby is unsure of how to handle the breast. The mother’s task is to eliminate everything that may interfere with the baby’s ability to suck properly. The main pests of proper breastfeeding are nipples and pacifiers. They develop the incorrect skill of grasping the nipple, as a result of which the child cannot extract anything from it and injures the delicate skin. Calm behavior at the breast is eliminated by rare attachments, because of which the baby is nervous and too upset to properly latch onto the nipple. Crying can also be caused by a short frenulum in the baby’s mouth, which does not allow him to grasp the breast correctly.
• The baby latches on too often. The normal frequency of breastfeeding after childbirth can reach forty times a day. Over time, it decreases to twelve to fifteen times, but can increase if the baby is upset or sick. What seems too frequent to you is a physiological need of the child’s body, not only for food, but also for maternal warmth and affection.
• Too little milk is expressed. The amount of milk expressed does not mean anything. If you are exclusively breastfeeding, there is no need to pump.

In accordance with WHO recommendations, the introduction of supplementary feeding and water supplementation is not justified for breastfed children up to six months of age. It is necessary to use formula for supplementary feeding of children only for medical reasons.

The need to introduce formula feeding during breastfeeding exists in the following situations.

• Premature baby. These babies are too weak to breastfeed productively. Supplemental feeding with the mixture helps the body get stronger faster.
• A child with neurological disorders. Babies cannot coordinate their actions to suckle properly. As a rule, such diseases are diagnosed in the maternity hospital, so the mother is sent home with clear recommendations for supplementary formula feeding.
• Lack of milk in mother. The phenomenon of hypolactation in women is rare and temporary. It is caused by mistakes in organizing breastfeeding, when it was started too late due to the separation of mother and baby. Or they practice rare breastfeeding “according to a schedule.” Frequent feeding of the baby to the breast will help normalize lactation, since the volume of milk production is affected solely by its consumption.

In most cases, formula supplementation during breastfeeding is required temporarily. The mother’s task in this situation is not to completely transfer the child to artificial nutrition, but to maintain lactation. Frequent communication with the baby, sleeping together, and tactile skin-to-skin contact will help with this. And of course, the baby’s unlimited access to the breast, which allows milk production to reach the required level within a week.

What to feed from

When the need to introduce supplementary feeding is established and recommended by a pediatrician, another question arises: how to do this. The simplest solution seems to be to use a “classic” baby bottle with a nipple. But in practice, such a simple solution puts an end to breastfeeding.

The fact is that the technique of sucking a breast and a bottle is completely different, despite the assurances of manufacturers of children's accessories about the ideal anatomical shape of the nipple. Until now, nipples that completely replicate the mother’s breast do not exist. And a child who receives both has to make a choice at some point.

What is the difference between breast sucking and pacifier sucking? Absolutely everyone!

• Grip depth. Correct attachment to the breast requires grasping the entire nipple, including the areola. There is no need to swallow the pacifier so deeply.
• Work of gums and tongue. While sucking at the breast, the baby helps himself with his tongue, while he chews the pacifier with his gums.
• Application of effort. The mixture flows freely from the nipple, while milk must be “extracted” from the breast.

It is much easier to suck on a bottle with a nipple than on the breast. This causes a complete refusal of breastfeeding or provokes improper attachment to the breast. The mixture completely replaces mother's milk, the benefits of which for the child are many times higher than artificial nutrition.

Using other feeding devices rather than a bottle will help prevent your baby from refusing to breastfeed.

spoon

You can use a regular teaspoon, but a soft silicone one is better. It should be filled halfway and its contents poured into the baby's open mouth by the cheek. You cannot pour it on the root of the tongue, as the baby will spit out the mixture. Before serving the next portion, make sure that the baby has swallowed the previous one.

It is convenient to use special baby spoons for supplementary feeding with a bottle. These are produced by Medela. The mixture is poured into a bottle, and during feeding you can control the intensity of its delivery into the spoon.

Syringe, pipette

The principle of operation is the same. Take a small amount of the mixture and pour it into the baby’s cheek. You can help him open his mouth slightly by inserting a clean little finger behind his cheek. Use a dropper with a rounded tip or a syringe without a sharp tip (for example, a children's antipyretic syrup dispenser).

Cup

A regular cup will be too big for supplementary feeding. Use a sterilized doll, small cap, plastic beaker. It is important that the cup is made of safe material.

Tilt it towards your baby's lower lip and moisten it with the mixture. Wait until the baby begins to make movements with the sponge and tongue. Re-wet the sponge with a small portion of the mixture. Cup feeding, according to mothers, is one of the simplest and most convenient ways to supplement breastfeeding during breastfeeding.

SNS system

Or a supplementary feeding system. It is a soft silicone bottle designed to be filled with a mixture, with a thin tube. The bottle is placed around the mother's neck, and the tube is fixed to the skin of the nipple. The baby, when attached to the breast, grabs both the nipple and the tube. Thus, he eats milk and formula at the same time.

The prevalence of SNS systems in our country is low, although, according to foreign pediatricians, they are the ideal solution for introducing supplementary feeding. They maintain close contact between the baby and the mother, support lactation and provide formula feeding in the required volume.

Regardless of how you offer supplementation while breastfeeding, follow these guidelines.

• Breasts before and after. Your baby's main food remains your milk. It is many times more valuable and healthier than the most expensive mixture. Therefore, offer the breast before and after formula.
• Don't insist. Do not force your child to eat all of the formula. Let him determine how full he is. If the baby stops opening his mouth or starts to turn away, stop.
• Do not increase the portion. If something was spilled during feeding, there is no need to add this amount of mixture to either the current or the next supplementary feeding.
• Feed only a calm baby. If the child cries, shows dissatisfaction, or spins around, first calm him down. Try feeding in a different position or using a different device.

Neither a spoon nor a cup allows the child to compensate for the sucking reflex. Therefore, frequent breastfeeding will solve two important issues. The baby will be able to fulfill the need for sucking. And the mother will receive additional stimulation of the mammary glands, as the main factor in increasing lactation. And after a while you can completely abandon supplementary feeding.

Mixture volume

The introduction of supplementary feeding involves the use of a certain amount of formula for feeding infants in order to prevent weight gain. Previously, mothers were offered clear standards. For example, at 2 months, supplementary feeding during breastfeeding should be 60 grams per day, at 3 months 90 grams, at 6 months - 240 grams. However, the formula volume table does not reflect the baby’s real needs for a number of reasons.

The main one is that it does not take into account the amount of milk that the mother has. A standardized approach encourages a complete transition to artificial feeding. Breastfeeding specialists from the La Leche League and AKEV associations insist on a completely different approach. He is supported by American and European pediatricians.

How to determine how much formula your baby needs? Follow the following tactics.

• Count the number of times your child urinates per day. Normally, it should be 12 times the baby’s monthly age and older. This means that the child receives a sufficient amount of food. Check this amount before introducing supplementary feeding; you may not need it. To test for “wet diapers” for a day, remove the disposable diaper from the baby and count how many times he peed during the day.
• Compensate for any insufficient urination with a mixture based on the child’s age. If at the age of three months the baby pees 10 times a day, you need to add 60 ml of the mixture to his diet. If the baby is four months old and pees 8 times a day, the volume of complementary foods should be 160 ml per day.
  • 3 months - 30 grams;
  • 4 months - 40 grams;
  • 5 months - 50 grams;
  • 6 months - 60 grams.
• Take emergency measures to stimulate lactation. Apply to the breast as often as possible, exclude any substitutes (pacifiers, pacifiers), and be sure to feed at night, especially between three and eight o’clock in the morning.
• Reduce the amount of mixture when urination is sufficient. Do the next wet diaper test after a few days. If there are more than twelve urinations, the amount of mixture can be reduced.

The child should be offered supplementary feeding according to the schedule.

• By the hour. Divide the total volume of the mixture into 5 parts. Feed the baby by the hour, at equal intervals from six in the morning to twenty-four hours. That is, supplementary feeding will be present at the first morning six-hour feeding, then at 10, 14, 18 and 22 hours. Do not supplement with formula at night.
• Around dreams. The total volume of the mixture is divided into equal portions, which are offered to the child before falling asleep and after waking up. In this case, the mother should control that the baby receives all the amount of formula he needs per day.

If there is a sufficient level of urination per day, there is no need for additional feeding, even if the child is not gaining weight. In addition, before introducing the mixture, it is important to eliminate all negative factors that inhibit lactation: normalize the frequency of latches, monitor the correct latch on the breast, give up pacifiers, and spend as much time as possible with the baby in your arms.

The question of how to introduce formula during breastfeeding should not be resolved solely by the use of supplementary feeding. As a rule, it indicates that there are problems and errors in breastfeeding that require correction. Eliminating them will make the use of the mixture a temporary measure. It is possible to recommend maintaining supplementary feeding until the age of six months only for medical reasons, if the baby has diseases that preclude the possibility of full breastfeeding.

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Nutrition is not only pleasure, but also replenishment of energy reserves that the body spends on maintaining vital functions, studying, and performing mental and physical work. The child's body is extremely sensitive to lack of food: anorexia or insufficient intake of food from outside has an adverse effect on his health.

First, let's understand the concepts of “supplementary feeding” and “complementary feeding”, because many inexperienced parents do not see the difference between them, although they are fundamentally different:

D feeding- the amount of food that needs to be given to the child in addition to mother's milk in case of insufficient milk production. As a rule, if a woman produces insufficient milk, the baby is supplemented with formula milk, milk from another nursing woman, or animal milk. All these products are classified as supplementary foods.

P recorm– gradual expansion of the infant’s diet, which consists of the additional introduction of a variety of foods, starting from the 6th month of the baby’s life. Dairy products, vegetables, meat, fish - the main list of additional diets.

How to understand whether you need to supplement your baby's feeding

Some mothers practice weighing the baby before and after feeding, but for some babies this causes discomfort, and both the mother and her baby should enjoy the feeding process. Therefore, you can determine the lack of breast milk in alternative ways.

For example, signs of enough food for a child are the following:

• the baby eats on demand about 6-8 times a day;
• urination is regular (8-10 times a day);
• during feeding, the baby tightly covers the nipple with his lips and sucks vigorously;
• after feeding the baby is happy;
• When awake, the baby appears happy.

According to the latest WHO definitions Possible signs of a lack of breastfeeding with human milk are the following:

1. After breastfeeding, the baby does not seem satisfied;
2. The baby behaves restlessly and often cries;
3. Feeding requirements are observed more than 10 times a day;
4. Each intake of mother's milk lasts a very long time;
5. The baby refuses to suckle at the breast (read more about this problem);
6. The child's stool becomes too formed or, on the contrary, too liquid;
7. During pumping there is almost no milk;
8. After childbirth, the breasts increased slightly or not at all in size.

The signs described above are not always objective and are not 100% reliable, but if they occur, you should seek help from a pediatrician. Feeding a child is the key to his health from the first days of life. Every mother should remember that breast milk is the best protection for the baby from all childhood diseases, therefore the slightest lactation disturbances should be discussed with a doctor.

When and how to introduce supplementary feeding

Supplementary feeding should be introduced in the following situations and in accordance with the advice received from specialists:

You can supplement your baby's feeding during primary breastfeeding using a special SNS system (read about it further)

• When a baby is born prematurely. These babies are extremely weak and cannot breastfeed productively, so bottle feeding helps them put less effort into eating.
• Presence of neurological complications (pay attention to how the child behaves, doesn't he throw his head back?– this can be a worrying symptom) . Children with such symptoms may lack the ability to perform coordinated movements, so breastfeeding is an impossible task for them. Often such diseases are diagnosed by neonatologists, so the mother will be informed in advance about the peculiarities of feeding her baby.
• Lack of breast milk. The occurrence of hypolactation in some women is observed temporarily and, as a rule, is quite rare. The main reason for its development is a violation of the organization of feeding, excessively long separation of the baby and mother. You can normalize lactation by putting your baby to the breast frequently., since it is this manipulation that promotes milk production due to its frequent consumption. If milk has disappeared and you do not know the reasons why this happened, and lactation needs to be resumed, then we advise you to read the information from this.

The correct assessment of insufficient milk supply is determined by weight gain. Parents should independently or with the help of a pediatrician calculate and correctly assess the child’s weight gain. After birth, the baby loses about 10% of its body weight and after a few days only gains back the lost amount. You can understand in more detail when the mother’s milk is enough to feed the baby.

It is important to remember that children experience rapid weight gain., so you need to weigh them no more than once a week.

5 ways to feed babies

The most common feeding tools: a regular spoon and a spoon with a silicone bottle

1. bottle. Since time immemorial, absolutely all parents have become accustomed to buying a bottle even before the birth of their first child and thinking that this is the only attribute that is used for additional feeding. However, pediatricians say that the bottle has a negative effect on the baby's feeding. The fact is that it is much easier to consume food from a nipple than from a woman’s breast, so after a while the baby will completely refuse breast milk.
2. Syringe and pipette. Supplementary feeding can be done using a regular pipette or syringe without a needle. To do this, it is best to buy a syringe with a volume of up to 60 ml at the pharmacy. During feeding, the baby's head should be raised and the contents of the syringe should be injected into the corner of the mouth. If the formula gets on the tongue, the baby will most likely spit it out.
3. spoon. You can use any spoon for feeding, the main thing is to choose a comfortable position in order to make feeding the baby easier for yourself. The baby should be placed on a bent arm in the position that is used when he is attached to the breast. The second hand is free at this time and brings food to the child’s lower lip; it is tedious to give food after the baby has opened his mouth and wait until he swallows it. Saturation is quite easy to see: the baby will begin to spit out food or will not open his mouth at all.
4. Cup. In order to feed a child with such a dish, you need to position it almost vertically, and place your hand under the neck and back. After this, you need to touch the lower lip with the cup and after the baby opens his mouth, tilt it so that the liquid touches his mouth. You need to wait until the baby starts drinking or lapping milk and only then begin to tilt the cup a little. There is no need to pour liquid into a crying baby; first you need to calm him down and only then continue feeding. If your child has intestinal colic, he is recommended to do a special massage, about the technique of which we write.
5. SNS system. This complex is an additional system with a reservoir, which is filled with a nutritional mixture. Using a tripod or the mother's breast, you can secure it and then begin feeding. Thin tubes are attached to the nipple area, and it is from them that food comes in while the baby is sucking.

How to combine GW and IV

Combining breastfeeding and artificial feeding is widely practiced among all mothers who experience insufficient breast milk production. To do this, you need to calculate in detail the required daily caloric intake of food that will satisfy all the energy expenditure of the child and after each breastfeeding, weigh the baby, after which the missing amount of food is replaced with milk formula.

Combining breastfeeding and artificial feeding is a common feeding tactic. Thanks to this technique, the baby will receive the necessary substances from breast milk and the missing calories from infant formula. You can additionally learn about the rules of supplementary feeding and supplementation of infants from the video:

Rules for choosing a mixture

When choosing formula for artificial feeding You should immediately pay attention to its age restrictions(this information is indicated on the packaging). Mixtures are best purchased from pharmacies and specialized retail chains that can guarantee compliance with all rules and storage conditions.

At the moment, a variety of supplementary feeding mixtures allows you to choose one that will help strengthen the protective properties of the immune system, normalize the functioning of the digestive system, and help small patients prone to anemia, colic, and constipation. If so, it is necessary to understand its reasons. The use of infant formula should be carried out only after consultation with a specialist.

Thanks to his qualified advice, the mother will know how much artificial formula to use after her own milk reserves are depleted.

Hypotrophy is a common problem among babies whose mothers cannot provide enough milk. However, it is easy to correct with the help of artificial mixtures; you just need to contact a specialist with this complaint in time.

Conclusion

The main thing that every mother should remember is to systematically show the child to specialists to record the dynamics of his growth and development. If the child is noticeably thin or there is no weight gain, the mother should immediately show the child to the doctor. The fact is that in some situations, insufficient nutrition may not be noticed by parents, and only after collecting an anamnesis (obtaining information about the lack of secretion of a sufficient amount of mother's milk) will a specialist be able to prescribe formula for supplementary feeding.

Consultation with a specialist regarding the use of artificial formula may also be necessary if there is a violation of the absorption of breast milk, anemia, constipation or colic. In such situations, only special mixtures will help.

You can see how to properly introduce the formula (and which one you should choose) into your baby’s diet from this video:

Mixed is called feeding a child with breast milk and artificial milk formulas.

Artificial feeding is feeding only with formula milk.

The indication for transferring a child to mixed feeding is the presence of clinical signs of underfeeding (restlessness of the child between feedings, flattening of the weight curve, thicker stools, rare urination) and the results of control feeding.

Indications for transferring to artificial feeding are the mother's health condition or lack of milk.

Supplementary feeding is called additional nutrition with milk formulas.

Rules for introducing supplementary feeding:

1. Supplementary feeding is given after breastfeeding;

2. Depending on the amount of breast milk, supplementary feeding is prescribed after each feeding, after 2 - 3 feedings, in the form of independent feeding.

3. The baby should be put to the breast at least 3-4 times a day (otherwise lactation will decrease).

4. A child should receive no more than 2 different formulas per day as supplementary feeding.

5. If the volume of supplementary feeding is small (30-50 ml), it should be given from a spoon, if the volume is more than 50 ml - from a bottle with a nipple.

6. Supplementary feeding is given immediately after feeding (if the child has not eaten, supplementary feeding should not be given again after a while).

8. If digestive processes are disrupted, preference is given to fermented milk mixtures. Their quantity should not exceed ½ daily food intake.

9. The mixture is prepared immediately before use.

Rules for mixed and artificial feeding:

1. Control over the quantity and quality of food should be more strict than with breastfeeding.

3. The timing of the introduction of corrective additives and complementary foods is the same when using adapted mixtures as when breastfeeding and is prescribed in the same sequence. When feeding a child with non-adapted formulas, complementary foods are introduced 1 month earlier.

4. It is necessary to strictly observe sanitary and hygienic requirements for food preparation.

5. Breast milk should be preserved for as long as possible, even in small quantities.

So, with mixed and artificial feeding, formula milk should be used.

Types of milk formulas:

Adapted mixtures- These are mixtures similar in composition to human milk. These include:

Sweet - (“Nutrilon”, “Vitolakt”, “Similak”, “Bona”, “Tutelli”, “Pilti” and etc.);

Fermented milk products (“Vitolact fermented milk”, “Biolact adapted”,“Bifilakt”, “Lactolin”, etc.)

To unadapted mixtures also include sweet (whole milk, “Krepysh”, “Zdorovye”, etc.) and fermented milk (acidophilus milk, children’s kefir, “Biolakt-1,2”, etc.). Satisfactory development of children can only be achieved using adapted formulas. Fermented milk formulas are recommended for children with unstable stools.

Simple unadapted milk formulas, due to their inferior composition and not meeting the age-related needs of children, cannot be recommended for long-term use as the main source of nutrition. They can be used in exceptional cases, subject to mandatory correction of the diet with missing food ingredients.

There are also dietary dairy products for therapeutic nutrition, also used in infants for various pathological conditions and diseases.

For premature babies -“Detolakt-MM”, “Humana-O”, “Novolakt-MM”.

For children allergic to cow's milk- “Nutri-Soya”, “Similac - Isomil”, “Bellakt - Soya”, etc.

For children with anemia- “Nan-Nan”, “Detolact”, “Similak”, etc.

For children with genetic disorders- low-lactose mixtures.

For enteral nutrition- enpits, inpitan.

Biologically active additives:

Dietary supplement - 1b (with bifidumbacteria)

Dietary supplement - IG (with specific anti-staphylococcal immunoglobulin)

Dietary supplement - 1l (with lysozyme) and others.

“Infancy period” (physical and neuropsychic development).

Infancy lasts from the 29th day of life to 1 year. The name itself emphasizes that during this period of life the contact between mother and child is the closest; the mother breastfeeds her child. The main processes of adaptation to extrauterine life have already been completed, the mechanism of breastfeeding is sufficiently formed and very intensive physical and neuropsychic development is taking place, motor skills are established, and intelligence begins to form.

Features of the infancy period can be considered:

1. A pronounced anabolic orientation of metabolism, as there is very intensive growth - body length increases by 50% (from 50-52 cm to 75-77 cm), body weight triples (from 3-3.5 kg to 10-10, 5 kg). The energy need of a child exceeds the need of an adult by 3 times (per 1 kg of weight). If an adult had the same energy needs as a child, then an adult would need to receive 10-12 liters of food per day. The high intensity of metabolism explains its frequent disorders in infancy:

- diathesis (exudative-catarrhal, lymphatic-hypoplastic);

- hypovitaminosis;

Anemia;

- rickets;

Hypotrophy and paratrophy

And etc.

2. The relatively large volume of food (per kg of body weight) received by the child places increased demands on the functioning of the child’s gastrointestinal tract. However, at this age, the nervous regulation and enzyme system of the gastrointestinal tract are not yet mature enough. The combination of these factors quite often leads to gastrointestinal disorders.

3. The child’s intestines are abundantly supplied with blood, its mucous membrane has increased permeability, so it can be easier for harmful agents to enter the body and cause a general reaction of the body (disease-causing bacteria, toxins, allergens, etc.).

4. Unstable immune status. The newborn has passive immunity (received antibodies from the mother in utero). At 4-6 months, passive immunity decreases, there are no active ones yet, so in infancy children are prone to infectious diseases (ARVI, streptoderma, etc.)

5. In infancy, the child lies down a lot, so the parts of the lungs are poorly ventilated. The child's airways are narrow, and the protective properties of the mucous membrane are reduced. These factors explain the frequent pathology of the respiratory system in infants.

6. The skin and mucous membranes of an infant are rich in blood and lymphatic vessels, easily vulnerable, and have increased penetration for harmful agents (viruses, microbes, toxins, allergens).

7. In infancy, preventive vaccination is actively carried out.

Knowledge of the characteristics of the infancy period will allow the average medical worker to competently organize care for a child of this age and protect him from possible complications associated with these characteristics.

The main areas of care are:

Control over physical and neuropsychic development;

Rational feeding;

Hygienic care;

Physical education and hardening;

Aesthetic education.

Under physical development is understood as a set of morphological and functional characteristics of an organism, determined by hereditary factors and specific environmental conditions.

Physical development- a complex of genetically determined traits, the implementation of which depends on environmental conditions.

For example: if the parents of a child are tall, then the child’s genotype suggests that he will be tall, but if the child is often sick, eats poorly, or lives in poor conditions, then he will have a much shorter stature than determined by the genotype.

The role of hereditary factors And environmental conditions in physical development is clearly visible in the phenomenon called acceleration (earlier puberty, physical and mental development).

Acceleration caused by a change in genotype as a consequence of large population migration. The average height of children in cities with all-Russian construction projects is higher than in cities with a stable population. The role of social conditions cannot be excluded - the rate of acceleration in developed countries is higher than in underdeveloped ones. The term “Physical development” in clinical pediatrics is understood as a dynamic process of growth (increase in body length and weight) and biological maturation.

It is most clear and simple to assess the physical development of a child by its anthropometric indicators.

Anthropometric measurements were introduced into medical practice in the 30s of the 19th century. The main anthropometric indicators are:

Body mass;

Body length;

Head circumference;

Chest circumference.

To assess physical development it is necessary:

1. Determine age

2. Conduct anthropometry

3. Determine the somatotype (hyposomia-low stature, normosomia-normal height, hypersomia-high stature) using tables of growth series at different ages

4. Determine the harmony of development (correspondence between mass and height) using tables of mass values ​​​​at different lengths

5. Determine the option of physical development using tables of options

6. Make a final record of the anthropometric study.