Ways to supplement your baby's nutrition. Mixed feeding of newborns

Mixed feeding is the feeding of a child with breast milk (at least 150-200 ml per day) in combination with its artificial substitutes.

Introducing a newborn into the diet, especially in the first months of life, is a real stress for the little person, because not even the most expensive and modern milk formula can fully replace the baby.

Transferring a newborn to mixed feeding must be strictly justified. This is done only if neither the prevention of hypogalactia nor the stimulation of lactation lead to the desired result.

There are many possible reasons for decreased breast milk production, but the most common are:

• physical fatigue of a woman;
• temporary fluctuations in the level of hormones in her body or so-called lactation crises;
• chronic lack of sleep in the mother;
• nervous, mental stress (including postpartum depression);
• stress (loss of loved ones, problems with my husband’s work, housing issues, etc.);
• , insufficient amount of fluid to drink;
• unreasonable supplementation of the baby with water, sweet drinks, and formula.

However, in practice, pediatricians are more often faced with the fact that a woman simply does not want to breastfeed her child.

How to choose a formula for mixed nutrition

The mixture must be selected based on the child’s age and existing health problems.

With mixed feeding, the approach to choosing a milk substitute does not differ from that when switching to artificial feeding. That is why you need to choose a modern adapted mixture, taking into account the following points:

• Child's age. Each manufacturer's milk formulas have a category for children up to 6 months, they are encrypted with the number 1. From the second half of life - formulas with the number 2. For children older than one year, the formulas are marked with numbers 3 and 4. Some manufacturers produce specialized food for premature and low birth weight babies with the number 0.
• Some formulas contain probiotics (live milk bacteria), these products are needed to prevent digestive disorders. Note! In the first month of life, children are recommended to be given only unleavened formula. Children from 1 to 6 months should be given in a ratio of 1:1, 1:2 with fresh water, especially with digestive disorders. Feeding only fermented milk formula can cause the child to regurgitate, refuse to eat, and shift the acid-base state of the body.
• The younger the baby is, the more urgently he needs highly adapted, modern milk nutrition.
• There are mixtures, the latter are more convenient to use.
• For children with allergies, specialized low-sugar mixtures containing soy protein are produced. These mixtures change the color and consistency of stool, and children do not like their taste.
• For frequent and heavy regurgitation, it is necessary to choose an anti-reflux mixture.

How to feed

It would be a good idea to remind mothers of a few useful rules:

1. Each feeding, the mother should first offer the baby the breast, and then supplement him with formula, since alternating natural and artificial feeding leads to. To know how much formula a baby should eat, you need to monitor each breastfeeding on a scale, subtracting this volume of milk from the baby’s daily nutritional needs.
2. If there is a small amount of milk at one feeding, the baby should be applied to both breasts.
3. When feeding from a baby bottle, it is necessary to use tight nipples with small holes. The mixture should drip in drops through the nipple from the inverted bottle, and not flow out in a stream. The easier it is for a baby to drink formula from a bottle, the less desire he will have to suck milk from the breast.
4. When the baby grows up, it is better to feed him with the mixture from a spoon or cup; the baby should still be fed every feeding in order to prolong lactation longer and prevent the baby from weaning.
5. The baby's formula must be prepared fresh for each feeding; the prepared formula must not be stored or reheated.

Methods for calculating the volume of formula

First 10 days of life

The amount of milk a child needs in the first 10 days of life can be calculated using the formula: volume of daily milk = 2% of the child’s weight at the time of birth * number of days of the child’s life.

This means that if the baby’s weight after birth is 3500 g, then on the 5th day of life the daily amount of milk for him is 70 (this is 2% of 3500 g) * 5 = 350 ml. To calculate how much formula is required for one feeding, you need to divide the total daily amount of milk into 8-10 feedings and subtract the amount of milk that the baby sucks from the breast.

The amount of formula required for one feeding is calculated by the formula: day of life of the child* 10, i.e. on the 3rd day of life the child should eat 30 ml of milk, on the 8th - 80 ml.

After the first week of life

It is most convenient to calculate the amount of milk based on the baby’s age and weight:

In general, understanding that some babies are more plump, while others are underweight, when calculating the amount of nutrition, you can take into account the child’s need for energy - in the first half of life it is 115 kcal/kg, in the second – 110 kcal/kg per day. The calorie content of the mixture is indicated on the packaging, on average it is about 700 kcal/1 liter.

Example: if a two-month-old baby weighs 5 kg, then he needs to eat 115 * 5 = 575 kcal per day. Calculation: in one liter of milk mixture (1000 ml) – 700 kcal, which means (575 * 1000) / 700 = 820 ml of mixture. Next, the resulting amount of milk should be divided by the number of feedings and subtract from it the amount of breast milk that the baby sucks from the mother’s breast.

How to understand that nutrition is organized correctly

With properly organized mixed nutrition, the child is active, cheerful, sleeps well and gains weight.

Indicators of properly organized mixed feeding and correct choice of formula.

The lactation period for many mothers is accompanied by nervous tension, which is often accompanied by fatigue. Not all women have the knowledge to help organize feeding correctly. Due to constant worries, the volume and quality of milk produced decreases. When breastfeeding, formula supplementation is needed when the baby really does not get enough to eat and does not receive enough microelements and vitamins.

If a child is constantly hungry, his body is not saturated with the substances necessary for development and growth.

Women need to supplement breast milk during lactation when:

1. The baby is not gaining weight.
2. Born prematurely.
3. The mother is being treated with drugs that are harmful to the child.

If supplementary feeding is necessary, pediatricians advise giving the baby formula in an amount not exceeding half the volume of breast milk. The woman needs to determine the portion that the baby is missing. If she doesn't know how to calculate this on her own, she can consult a doctor.

The volume of milk increases when expressing and putting the newborn to the breast. To prevent the baby from stopping sucking it, it is better to give the mixture with a spoon or inject it with a syringe. If a child drinks from a bottle, breathing problems arise, which is why the baby often cries.

Breastfeeding and artificial feeding are necessary if the woman continues to work. The baby needs to be supplemented when he remains hungry, and milk has to be added with formula after breastfeeding. When the baby grows up, porridge is introduced into the diet, which must be alternated with meat or vegetable puree.

Advantages and disadvantages

Mixed feeding has advantages, but additional supplementary feeding is not without its disadvantages.

The formula can be given to the baby not only by the mother, but also by any other family member. The baby receives nutrients when suckling, which helps strengthen the immune system and protects against diseases.

When the father takes part in feeding, a close bond develops between him and the baby.

Due to a decrease in lactation, a woman often:

• milk stagnates;
• there is chest pain;
• mastitis develops.

Additional complementary feeding is also difficult for the baby, which affects behavior and appetite. Having tried the formula from a bottle, some children do not want to suckle, do not allow their mother to sleep at night, are capricious and cry. They often have stomach pain, and painful colic occurs due to the accumulation of gases.

Pediatricians recommend giving breast milk or formula at the same time if the baby is malnourished, as indicated by lack of body weight. This kind of nutrition is especially necessary for children who were born much earlier than their due date.

When to introduce supplementary feeding to an infant

When the baby does not have enough mother's milk, he is fed the same product of animal origin, from another woman, or a ready-made formula.

Supplementary feeding is necessary if the child does not eat what he is supposed to. This is determined by weighing the baby monthly. In 1 month, the baby should gain at least 0.5 kilograms. The fact that the baby does not have enough mother's milk is indicated by the fact that he constantly cries and pees less than 12 times a day.

If the baby is no more than 2 months old, it should be simultaneously applied to the breast and given 60 milliliters of the mixture per day, the amount should be 1/5 of the body weight. Even when a child gains weight slowly, but has bowel movements as many times as normal, complementary foods are not needed.

If the baby is 4 months old and pees 8 times a day, it is recommended to give 160 milliliters of nutritional formula, distributing this amount over equal periods of time. It is better to start feeding the child at 6 am and give the formula every 4 hours.

If the baby is 5 months old, the dose of complementary foods is increased by 10 milliliters, and the same amount is added after the next 4 weeks. Pediatricians do not recommend giving formula to a baby at night, since it is during this period of the day that the mother produces more breast milk.

After 6 months and up to a year, the amount of complementary foods should not exceed a ninth of the baby’s body weight. You need to weigh him before and after putting him to the breast, which will help you find out the amount of milk you drink and calculate whether the baby is getting enough proteins and fats.

Frequent reasons for introducing supplementary feeding

Often after giving birth, women, worried that the baby is crying because he is hungry, begin to feed him. If an infant calms down after an additional portion, mothers believe that he is full, and supplementary feeding with formula is necessary.

In infants, the digestive system is just beginning to adapt to changes in the external environment, so such children are not yet able to absorb a lot of liquid. A woman who gives birth to a baby immediately receives thick and nourishing colostrum, which is enough for the baby. In order for lactation not to stop, but to intensify, it must be applied to the breast.

In parallel with mother's milk, the formula must be given to a baby who was born prematurely, when it is very difficult for a tiny person to suck.

There are other reasons why additional nutrition is introduced. These include the birth of twins, different Rh factors, and cesarean section. Many women refuse to breastfeed because they do not want to ruin their figure, and cracked nipples cause pain when touched.

When supplementary feeding is not required

The baby may cry and be nervous not because he is hungry, but because of severe colic and abdominal pain, which is not uncommon in babies. The baby is capricious when he doesn’t know how to take the nipple, and his mother didn’t teach him how to do it. In this case, it is necessary for the infant to be carefully examined by a doctor.

Sometimes it is enough not to give your baby a pacifier, and the problem will disappear on its own.

An abnormal tongue frenulum prevents the baby from latching onto the nipple. The surgeon performs a simple operation in just 5 minutes. Combining formula and breast milk is not advisable until the baby is six months old. A woman should decide whether to feed her child together with her pediatrician, based on medical indications.

Blend selection

Some parents don’t pay much attention to the nutrition of newborns, buying the first package they come across. Supplementary feeding for a child up to 6 months must be taken according to a prescription. The composition of the mixture should contain the largest amount of substances present in breast milk.

For babies with lactose allergies, soy-based foods are selected. For abdominal pain and problems with bowel movements, children are fed mixtures with probiotics.

It will take about 3 days to determine whether the composition of the package is suitable for an infant. You should not buy food with palm oil, since such a substance interferes with the absorption of calcium.

When choosing a mixture, you need to pay attention to whether it contains components in the form of:

• whey from milk;
• taurine;
• Omega 6 and 3 acids.

If there is a 1 on the package, this indicates that the composition of the product is close to human milk.

In addition to these components, the Semilak 1 mixture contains taurine. It is produced by a Spanish company and is suitable for infants who suffer from colic and constipation.

Nutrilon 1 is produced by a German company based on whey, but with the addition of palm oil. The powder dissolves well, is quickly absorbed, and helps strengthen the immune system.

Not every woman can afford Nanny 1. The cost of a package exceeds a thousand rubles, but this mixture does not cause allergies in an infant and is valued for the presence of prebiotics. This food is made from goat milk. For premature babies, doctors advise buying a mixture called Humana Expert.

Infants like it when they are given Hipp 1 as complementary food because it has a pleasant smell and taste, but pediatricians do not recommend this food for babies.

Agusha fermented milk mixture is produced in Russia. When consumed, an infant’s digestion is normalized and constipation goes away, but due to the presence of palm oil, there is a risk of allergies. Many positive reviews have been written about Nutrilak Premium, but buying it is problematic.

Nestozhen 1 has a beneficial effect on the digestive organs of the baby; the disadvantage of the mixture is the presence of soy lecithin.

When feeding an infant with a balanced composition of Nan 1 Premium, immunity improves (fish oil is added to it).

Quantity calculation

To know the amount of supplementary feeding for your baby, you need to contact a pediatrician who, taking into account the patient’s body weight, will calculate the amount of formula in milliliters for each age.

When artificial feeding:

• up to 2 months, 20% of the baby’s weight is taken;
• up to 4 – 1/6 of this value;
• up to six months – 1/8.

If the child is breastfeeding, the amount of supplementary feeding should not exceed 50% of the total nutrition. The daily volume calculated by the pediatrician is divided into 5 parts and the baby is given the mixture after the same number of hours. Milk - goat's or cow's, fermented baked milk or kefir - is not suitable for this purpose.

Having calculated the infant's need for additional feeding, they determine how much nutrients he needs. A four-month-old baby needs in grams per kilogram of weight:

• squirrel – 3;
• carbohydrates – 12;
• fats – 6.

Before buying food for an infant, it is advisable to find out reviews about it and carefully read the annotation. The mixture will have to be changed if the baby develops a rash, suffers from colic, diarrhea begins, or is constipated.

What to feed from

Many mothers prefer to give the mixture to the baby in a bottle with a nipple. This is very convenient, but it is dangerous because he will stop taking the breast, because then you have to work, the milk itself will not flow into the mouth. There are other ways to satisfy a little person’s hunger.

teaspoon

In pharmacies and specialized stores you can purchase not only medicinal mixtures from domestic and foreign manufacturers, but even devices and systems for feeding. A teaspoon is a good and fairly simple option for a small amount of nutrition. If you feed the baby with it, the baby will not stop suckling.

Syringe pipette

When, for some reason, your little son uses the formula only reclining on his mother’s lap or in an upright position, it makes sense to purchase a product such as a plastic syringe pipette. True, in order to feed the baby, you will need a lot of time and patience.

Cup

If the tongue muscles work normally in infancy, it will be possible to avoid both abnormal bite and incorrect diction in the future. The baby's cup forces them to develop, because in order to eat, the baby has to work. This device, like a spoon, is easy to wash, but the liquid spills out of such dishes, making it impossible to use it while walking.

SNS system

A technology is popular in foreign countries, thanks to which, according to experts, an infant receives the required volume of formula and has direct contact with the mother. The SNS system has been developed for feeding babies.

A small tube is inserted into a bottle filled with formula and directed towards the nipple. This option has its drawbacks, since it cannot be used if a woman temporarily stops putting her son or daughter to her breast. The baby often spits out the tube. It takes a long time to wash and clean the system.

bottle

Neither a cup, nor a syringe, nor a spoon will help your son stop suckling. Only a bottle can provoke refusal. In order to satisfy hunger in this way, by drinking milk, the baby does not need to work.

Rules for introducing supplementary feeding

The baby’s digestive organs have not yet adapted to the use of special food, and may react to its intake with stool disorders, allergies and other unpleasant phenomena. Before introducing supplementary feeding with a mixture, you need to study the basic rules.

Regardless of how much milk a mother has, her son or daughter should be breastfed immediately, and only when there is nothing left in her, should she be given formula. Otherwise, the baby will satisfy his hunger and will not take the nipple.

Many women, without waiting for the end of lactation, go to work and do business. The feeding process should be organized so that the infant consumes formula 2 times a day, and the remaining time the mother should feed him milk.

It is better to give additional nutrition to the baby from a spoon so that he does not refuse the breast. If there is a large amount of mixture, the beloved child is fed from a bottle, but they put a tight nipple on it and make a small hole. In this case, he will have to work hard with his tongue and lips to eat.

It is not necessary to use the proposed diet, but if an infant eats formula, the number of feedings should be reduced by one.

Cups, spoons, systems must be sterilized, and not just washed with boiling water. Food cannot be prepared in advance; this must be done before the actual process of feeding the baby.

Before going to work, a woman should check whether her son can handle a bottle. It is advisable to start supplementary feeding 2 weeks before the mother’s frequent and long-term absences.

What you can’t supplement with

You should not give formula to an infant without consulting a pediatrician. It can cause allergies, diarrhea or constipation. The doctor selects additional nutrition based on the baby’s age and indications. If the baby cannot tolerate milk protein, the pediatrician will recommend a soy-based formula; for colic and abdominal pain, a diet containing prebiotics. During breastfeeding (breastfeeding), it is forbidden to give infants milk from animals.

What to do if your baby doesn't like the bottle

It is often very difficult to understand why a baby is capricious, cries, or refuses supplementary feeding. The transition from breastfeeding to formula feeding often becomes a serious problem. If your little son refuses the bottle, sometimes you just need to change the nipple or start pouring expressed breast milk into it.

The mixture must be heated to 37°. Your beloved child will enjoy the food better if it is warm. When he still doesn't want to drink from a bottle, the woman will have to withhold breastfeeding from him for a day. When very hungry, the baby will take up the mixture.

Some children enjoy supplementary feeding when they are in the position in which they suck mother's milk.

What to do if your baby doesn't latch on after a bottle?

Much more often the opposite happens. Having tried a tasty mixture, which does not require work to obtain, the baby turns away from the nipple and does not want to take the breast, since it is much more difficult to obtain nutrition from it than from a bottle. Not always, even when very hungry, the little son will begin to suck breast milk, and the woman will have to switch him to artificial feeding.

In any case, you need to try to do something. If you make the hole in the nipple very small, your son or daughter will have to make an effort. Then the baby often takes the breast again.

They start complementary feeding no earlier than their beloved child turns 4 months old. The diet does not include formula milk, but pureed vegetables and meat, and liquid porridge. When consuming such products, the baby quickly gets used to adult food.

When a baby is born, a woman should try not to worry, then she will not have problems with lactation, her beloved child will drink breast milk and grow and develop well.

Supplementing with formula while breastfeeding seems to be common when feeding infants. Every mother has heard about this. Let’s take a closer look at what it is and whether it should be avoided.

Complex Concepts of an Easy Process

Pediatrics contains many terms that are not clear to mothers. To avoid ambiguous conclusions, let’s look at the names of the processes:

• Breastfeeding (BF) is feeding the baby at the breast;
• Mixed feeding of newborns (MF) - feeding with mother's plus artificial nutrition;
• Artificial (IV) – cultivation with artificial mixtures;
• Supplementary feeding - additional feeding to the main one before the introduction of complementary foods;
• Complementary feeding is the gradual introduction of adult food into the baby’s diet.

You can supplement with your own expressed milk

Very simple, but mistakes have consequences. After all, formula for feeding newborns is not the same as formula for supplementing newborns.

Let's consider supplementing baby food with a mixed diet. In this article we will not describe what formula to feed a newborn if there is no milk. After all, if there is no milk at all, then this is artificial cultivation.

If you are interested in the choice of formulas for feeding, then we talk about it in the article at the link, in the next one - about the options, and a general overview of the mixtures -.

Describing all processes in detail and preventing possible complications is a task at the state level. Rather, it is a global issue.

Global strategy

The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) created the Global Strategy for Infant and Young Child Feeding in 2003.

Based on scientific facts, it has been substantiated that only breastfeeding is necessary for the first 6 months of life, because the introduction of any other food during these months is an important risk factor for illness and death in children. 45% of all child deaths are from poor nutrition.

This suggests that by thoughtlessly supplementing with artificial formula for the first 6 months, the mother is endangering her child. Yes, of course it sounds cruel, but it's true.

After all, only 35% of children on the planet receive only breast milk until 6 months of age. Increasing this figure means reducing the mortality rate of children on the planet. Every mother in any city, all over the world can do this.

My milk is not enough

When the baby cries, the first thing the mother thinks about is that he is not full. When he lingers on the arms for a long time, doubts creep in that there is probably nothing there anymore.

If the scale in the pediatrician's office shows a small increase in weight, then the mother is ready to immediately run to the pharmacy for a jar of food.

Why does this happen, and is it really necessary to supplement?

Almost any mother can feed her baby exclusively with her breasts. The only important thing is to want it. Don't be lazy or panic, and there will be enough milk.

What to do

If a mother feels like she doesn’t have enough colostrum or milk in her breasts, she needs to do the following:

1. Calm down;
2. Put everything aside;
3. Analyze weight gain;
4. Place the baby frequently on the nipple;
5. Express after each feeding and supplement with a spoon;
6. Use the services of breastfeeding consultants or a pediatrician if these steps do not help. They will analyze the situation and be able to tell you what exactly the problem is and how to solve it.

The options may be different:

• Increased tactile contact;
• Drinking lactation teas and/or medications;
• Breast massage, etc.

Indications for mixed feeding

Mixed feeding is prescribed only for medical reasons. There are few such indications, but only a doctor can establish it for specific reasons.

	Indications	Description	Laboratory confirmation	Clinical symptoms
Child	Hypoglycemia	Reduced blood glucose levels	Below 3.5 mmol/l	None
	Dehydration		Reduced sodium	Weight loss more than 10%, lethargy
	Delayed lactogenesis in mother	Lack of colostrum for more than 5 days		Weight loss 8-10%
	Retention of stool			Continuation of meconium passage on the 5th day
	Hyperbilirubinemia
Mother	Delay of second lactogenesis	Lack of milk for 3-4 days		Remnants of the placenta in the uterus
	Sheehan syndrome			Postpartum uterine bleeding
	Primary mammary hypoplasia	Less than 5% women		Insufficient breast growth during pregnancy
	Pathologies of the mammary glands			Operations
	Soreness	Unbearable

Supplementary feeding during breastfeeding - treatment, and self-medication can cause irreparable harm to your baby’s health.

If you still need it

Supplementary feeding with formula during breastfeeding Komarovsky E.O. considers it a normal thing, but only because he is a doctor. If the doctor prescribed supplementary feeding with formula, gave recommendations on which formula is best to supplement the newborn baby, in what quantities, the mother should use her common sense.

3 questions about artificial baby food

To understand how to supplement with formula while breastfeeding, you need to have a good understanding of this issue. We will not describe in detail the brands and composition of artificial nutrition, since this contradicts the International Code of Practice for the Marketing of Mother's Milk Substitutes, let's look at the overall picture.

Which formula is best to feed a newborn?

For this age, the use of highly adapted milk nutrition is a prerequisite. Its composition is as close as possible to mother's milk.

Which formula is best to feed a newborn baby depends on each specific situation. You must clearly know why the substitute is prescribed. Manufacturers are required to clearly state on the label the purpose of this food.

Glagolova S.A. family doctor, Kyiv

If a child gains 150 g per week, then there is no talk of any supplementary feeding.

How to calculate volume

In the maternity hospital, the average colostrum consumption rates are used:

• 1st day of life – 2-10 ml per feeding;
• 2nd – 5-15 ml;
• 3rd day – 15-30 ml;
• 4th – 30-60 ml.

Also, to calculate the first week use:

Zaitseva formula

Amount of daily milk = 2% of birth weight * number of days to live;

For example: you need to find out how much to give on the first day after discharge from the hospital.

2%(3200)*4 = 3200*2/100*4 = 64*4 = 256 ml for the 4th day of the baby’s life;

If the baby eats every 3 hours, then it turns out:

• 24/3 = 8 feedings per day;
• 256/8 = 32 ml per feeding.

These calculations do not work after 7-10 days of life. From now on, use the following formula:

Shkarin's formula

The milk mixture should be neither hot nor cold

A child aged 2 months should receive 800 ml of food per day. For every week that is not enough until this age, 50 ml is subtracted from this volume.

And for each month above this period, 50 ml is added.

For example: baby is 1.5 months old = 6 weeks = 800-100 = 700 ml daily.

If he is 5 months old = 800+150 = 950 ml per day.

How much artificial nutrition is needed?

Not everyone understands how to feed correctly during mixed feeding, if it is not known how much was drunk from the mother’s breast. You can try to figure it out in the following ways:

1. Weighing the diaper. It is known that in children under 3 months the urine volume is 175-590 ml per day. This is approximately 50% of total food intake. By weighing the diaper before and after, the weight of the urine is calculated. The percentage determines how much milk the child drank. This method is not official and is rarely used.
2. Control weighing of the child. The baby is weighed before and after feeding, and the amount of food consumed is calculated.
3. Give as much as the baby wants.

When mixed feeding, feed children on demand, first on one breast, then on the other, then give artificial nutrition until completely saturated.

What to give from

The baby receives supplementary feeding from a tube while sucking at the breast

If supplementing your baby is a temporary forced action, then try your best to maintain breastfeeding.

For additional feeding, use a cup, spoon or syringe (without a needle). This will allow you to follow all the doctor's instructions, but will not allow your baby to stop breastfeeding because of the bottle.

The breastfeeding system will make this task easier. The idea is very simple - a bag of food is hung on the mother's neck and, through a tube attached to the chest, enters the baby's mouth during breastfeeding. This system can be purchased or made independently. The main thing is not to forget about hygiene. Take proper care of it.

What to do if the baby doesn't want to

If you follow all the recommendations and there is no other way out, then you need to get together and help your baby during this difficult time. Children always feel their mother’s mood; if their mother gives him a cup with confidence and a smile, he will definitely eat if he is hungry.

If the little one refuses, you can change the method, try feeding at the breast or using a bottle with a pacifier.

Krovets E.O. pediatrician, Moscow

Supplementing your baby with artificial baby food indicates that the mother does not know about the risks and problems that may arise.

Helping and guiding is the task of every doctor.

The norms of breastfeeding and artificial feeding are described.

conclusions

Only a doctor should decide whether to give artificial baby food. The mother, under any circumstances, is obliged to take responsibility for establishing breastfeeding. And it is better to avoid giving formula for supplementary feeding of newborns, because mother's milk is the best that a child can receive in infancy, and it is also completely free.

Before giving supplementary food to an infant, make sure that it is. Breast milk contains the necessary elements and vitamins for the full development of the baby. Breast milk contains 500 nutrients that normalize the functioning of cells in the body, form and strengthen the immune system. Breast milk is an ideal food that fully satisfies the needs of newborns.

When to supplement

There are a number of signs when mixed feeding is necessary. Mixed feeding involves feeding with artificial formula and breast milk in half. Supplementary feeding is necessary for the following problems:

• Insufficient weight gain or weight loss;
• Birth of a baby prematurely;
• Mother's illnesses and long-term use of medications incompatible with lactation;
• Separation of mother and baby (work, departure, etc.);
• Lack of breast milk, premature termination of lactation.

Weight will help determine whether your baby has enough breast milk. In the first month, the rate of weight gain is 90-150 grams in seven days, in the second to fourth month the baby gains 140-200 grams per week, and after the fourth month - 100-160 grams. Please note that these are conditional indicators, and each baby develops individually. A table and formulas for weight gain in children under one year will help you calculate normal weight.

Often, nursing mothers are faced with the problem of a reduction or complete cessation of milk production. Milk is lost for various reasons: stress and overwork, poor diet, illness and medication. Do not rush to introduce supplementary feeding, but try to establish lactation. This will help with plenty of warm drinks, proper diet and daily routine. You will find specific methods for increasing lactation in the article “How to increase milk production.”

Before introducing supplementary feeding, be sure to consult your doctor. If mixed feeding is necessary, do not despair. Many mothers believe that supplementary feeding while breastfeeding will lead to a complete transition to artificial feeding. If you maintain lactation and follow recommendations to increase milk production, this will not happen.

To maintain breastfeeding, formula supplementation should be no more than 30-50% of the baby’s daily nutrition!

How to supplement your baby's feeding

A bottle with a nipple is a common remedy for nursing mothers. But despite the popularity of the method, the pacifier should be used in extreme cases. This method threatens breastfeeding. Practice proves that if a baby tries a pacifier, he gradually refuses and often no longer takes the breast. Do not use pacifiers if you want to continue breastfeeding.

A special supplementary feeding system consists of a tube that is inserted into the bottle with the mixture and leads to the nipple. So the baby receives additional nutrition along with breast milk. However, this method is not suitable if the mother is forced to completely stop breastfeeding for a while due to illness and medication.

A teaspoon is an easy and quick way to feed your baby without threatening natural feeding. The spoon is suitable for the first feeding period and small amounts of food.

A syringe or pipette is also suitable for small amounts of supplementary feeding. In addition, the process takes a long time and requires effort. However, it does not interfere with the lactation process.

A small cup is a simple method, but not very convenient. Without skills and experience, milk will spill out of the container. In addition, you will not understand how much the baby drank.

Finger feeding is safe for lactation, but a labor-intensive process. It is better to use the finger to develop the sucking reflex.

Way	Advantages	Flaws
Bottle with nipple	The baby gets full quickly, a convenient way to supplement food	Baby may refuse breastfeeding
Disposable syringe	Sterility and preservation of breastfeeding	A long and labor-intensive process with a large volume of supplementary feeding
teaspoon	Accessibility, easy to clean, teaches baby to eat from a spoon	Requires dexterity and skills, you cannot feed on the road or on the street
Cup	Stimulates the tongue muscles, easy to wash	Milk is spilled without skill; cannot be used while walking or traveling
System (tube)	Natural feeding, skin-to-skin contact, continued breastfeeding	Costs, the child may push the tube out, cannot be used during forced breaks in breastfeeding, difficult to wash and clean

Which mixture to choose for supplementary feeding?

Take your mixture choice very seriously. An incorrectly selected mixture can lead to a number of problems, including allergies (rash and redness) and digestive disorders (flatulence, frequent colic and stool disorders). The choice is influenced by the age of the baby. For babies up to six months, take a special highly adapted mixture. Formulas for children under six months must necessarily include iodine, taurine, nucleotides and polyunsaturated fatty acids.

In case of impaired digestion (colic, constipation, etc.), choose Nan fermented milk 1 for babies up to six months and Nan fermented milk 2 for children over six months. For a child with an acute intestinal infection and lactase deficiency, a mixture with a low lactose content is necessary. Also, if regurgitation occurs for a long time, the doctor may prescribe feeding with an anti-reflux mixture with high viscosity.

Newborn formulas

Name and country-manufacturer	Characteristic	Flaws	Price
Malyutka 1 (Russia)	Dry adapted mixture with prebiotics and without sugar, easily diluted	Palm oil and soy lecithin in the composition sometimes cause allergies	240 rubles (350 grams)
Similac 1 (Spain)	Dry adapted mixture without palm oil, easily digestible and helps with colic and constipation	May have a bitter taste and does not dissolve well	250 rubles (350 grams)
Nestozhen 1 (Switzerland)	The composition of the dry mixture dissolves quickly and is easily absorbed, improves digestion	Skim cow's milk powder and soy lecithin cause allergies	250 rubles (350 grams)
Nanny 1(New Zealand)	Dry adapted mixture based on goat milk with prebiotics, easily digestible and does not cause allergies	Insufficient content of iodine and taurine in the composition, high cost	1100 rubles (400 grams)
Nutrilon 1 (Germany)	Balanced composition is easily dissolved and absorbed, strengthens the immune system	Contains palm oil and soy lecithin, which cause allergies	400 rubles (400 grams)
Nan 1 Premium (Netherlands, Switzerland)	Premium dry mixture contains fish oil, is highly soluble, improves digestion and immunity	The composition on the package does not indicate vegetable oils; it contains allergenic soy lecithin	350 rubles (400 grams)
Agusha 1 (Russia)	Adapted fermented milk mixture with 3.4% fat content, ready for use, helps with constipation	Contains palm oil and skim milk, which increases the risk of allergies	30-40 rubles (0.2 liters)
Nutrilak Premium 1 (Russia)	Complete milk formula to improve digestion and strengthen the immune system without palm or rapeseed oil	Sold in few places, cannot be bought within walking distance, sometimes causes colic	250-260 rubles (350 grams)
Hipp1(Germany)	Milk mixture with prebiotics dissolves well with a pleasant taste and aroma	Contains palm oil and potato starch, which are not advisable for infants' diets	380-400 rubles (350 grams)
Humana Expert 1 (Germany)	Adapted dry formula is suitable for premature babies, does not cause allergies	Does not contain probiotics, which improve digestion	500-550 rubles (350 rubles)

• Supplement your baby after he has completely emptied both breasts;
• Be sure to breastfeed at every feeding;
• Remember that supplementary feeding should not exceed half the daily feeding volume;
• The temperature of the mixture should be comfortable for the baby and be 37-38 degrees;
• While feeding with a syringe or pipette, let your baby suck his thumb. Make sure that the tips of the devices do not touch the cheeks or palate of the baby;
• If you find it difficult to choose a formula, contact your pediatrician for help;
• When you find the right food, then feed your baby the same formula;
• If your baby develops colic or allergies, change the formula;
• Prepare the mixture immediately before feeding. Do not prepare ahead of time or leave for the next day!
• Sometimes pediatricians, if there is a shortage of breast milk, allow the introduction of complementary foods as early as the fourth month. The difference between complementary feeding is that the baby begins to eat regular adult food. It can be vegetable purees or liquid cottage cheese. When to give your baby the first solid food, read

Supplementary feeding for a breastfed baby can be introduced for various reasons. Newborns are fed with expressed breast milk or donor milk, but more often, of course, they use it.

In which case supplementary feeding should be introduced and in which not, only a pediatrician can decide; an individual approach and weighing of all "behind" And "against".

Supplementary feeding, what is it?

Supplementary feeding- This is additional nutrition for the child, which is introduced to compensate for the lack of breast milk. Do not confuse supplementary feeding and complementary feeding; supplementary feeding is prescribed if necessary according to indications, more often due to the absence or shortage of breast milk, and complementary feeding is additional nutrition that is administered to all children from a certain age, when the mother has enough milk, but it no longer can meet the child's nutritional needs.

Supplementary feeding of newborns in the maternity hospital

In the first few days after birth, the mother secretes colostrum; its volume is only a few milliliters, but this small amount is enough to provide the newborn baby with the necessary nutrients; colostrum is quite high in calories and contains vitamins and antibodies valuable for the newborn. Due to the small volume of food, the baby does not have difficulty eating from the mother's breast, and his swallowing, sucking and breathing skills develop. On the third or fourth day, when milk appears, the child is able to eat fully. But every young mother periodically wonders whether the baby has enough milk or should resort to supplementary feeding. I will give the most common fears in which supplementary feeding is not required.

• A child losing 5-7% of his birth weight in the first days, which worries the mother, is the norm and does not happen because the child is not getting enough to eat, it’s just that the little body gets used to the new “living conditions”, very soon the little one will again begin to intensively gain weight. weight And by the time he leaves the maternity hospital, his weight will be the same as at birth, this is one of the conditions for discharge.
• The newborn sleeps a lot. This is also absolutely normal; the baby gets as tired as the mother during childbirth, so she sleeps a lot. If the mother still thinks that the baby is sleeping for too long, then it is better to try to wake him up and feed him, otherwise he will become very hungry, and the mother may not have enough milk. In the worst case scenario, you will have to supplement with formula while breastfeeding. And for the development of lactation it is much better to take it as often as possible.
• The child is restless. The baby does not always cry when he is hungry; later the mother will understand that there are many reasons for crying - (wet diaper, the baby is cold, hot, etc.)
• The baby cries and turns away from the breast; this fact does not necessarily indicate that the mother does not have milk; more often, the baby simply does not yet know how to eat milk from the breast. The mother needs to be patient and teach him, she needs to put the baby to the breast for a short time, the more often the better.
• The baby attaches to the breast too often. In fact, if a child is upset or sick, he can put himself to the breast up to 40 times a day, and this does not mean at all that he is hungry every time and it is necessary to introduce supplementary feeding while breastfeeding. This is simply a physiological need for a baby to be close to his mother, to feel her warmth and love.

Of course, a tired mother sometimes wants to feed her baby with formula and rest, but there is no need to do this. There are indications for introducing supplementary feeding; they can be symbolically divided into unconditional and conditional.

Unconditional indications for the introduction of supplementary feeding:

• For some reason, the mother cannot be near the child;
• The baby has intolerance to mother's milk;
• The mother is taking medications that may harm the baby.

Conditional indications for the introduction of supplementary feeding

Indications from the child:

• Low blood glucose levels in the newborn that do not rise even after breastfeeding;
• Severe dehydration with weight loss greater than 10% and elevated sodium levels, regardless of breastfeeding;
• Weight loss in a child due to lack of breast milk from the mother;
• Retention of stool in a newborn;
• Milk is not digested enough, despite the mother’s normal amount;
• There is a need for additional administration of vitamins and other nutrients.

Indications from the mother:

• Lack of milk that remains even five days after removal of the placenta;
• Lack of milk due to Sheehan syndrome, which can occur due to severe blood loss during childbirth;
• Underdevelopment of the mammary glands or disruption of their function as a result of surgery or pathology;
• Unbearable pain during feeding, which doctors cannot relieve despite all attempts.

How to determine lack of breast milk

If everything is clear with unconditional indications for the introduction of supplementary feeding, then with conditional indications the question arises of how to determine that the child really does not have enough milk and that supplementary feeding is necessary for a breastfed child. For this purpose, pediatricians, together with young mothers, usually use the following methods:

• Calculation of urine volume.
• Counting the number of urinations.
• Expected weight gain method.
• Measuring the baby's weight before and after feeding.
• Intuitive method.

How much milk a child should eat is calculated based on his age, weight and health status of the baby. The most general calculation method is the dependence of the volume of nutrition on the child’s body weight. At the age of up to 2.5 months, the child should eat 1/5 of his body weight, from 2.5 to 4 months - 1/6 and 1/7 from 4 to 6 months.

The amount of formula supplementation when breastfeeding will depend on the difference between the amount of milk the baby eats and the amount he should consume.

Introduction of supplementary feeding in case of lack of breast milk

The decision to immediately introduce supplementary feeding if there is a shortage of breast milk depends on what percentage of the daily ration the child is not receiving. If the deficiency is no more than 50%, then doctors first take all necessary measures to stimulate lactation and introduce supplemental feeding of children with formula no earlier than a week later, only if the situation does not change. A deficiency of more than 75% forces doctors to immediately decide to introduce supplementary feeding, but at the same time, the mother should not leave the attempt. If the amount of mother's milk increases, then the amount of supplementary feeding decreases.

Choice of supplementary food

Here all doctors give a clear answer - breast milk. Theoretically, if possible, then it is necessary to use the mother’s expressed milk; if not, then feed the baby with donor milk. But in practice, in maternity hospitals they often use supplementary feeding of children with formula. The most hypoallergenic are mixtures based on protein hydrolysates. They are well tolerated by almost all newborns. Upon returning home, the mother, under the supervision of a pediatrician, can change the formula or leave the one that was given to the child in the maternity hospital.

Supplementary feeding methods

There are many ways to supplement formula feeding while breastfeeding, each of them has its own pros and cons. I propose to consider each of the methods in more detail.

bottle


pros: One of the simplest methods, does not require special skills from both mother and child.

Minuses: If a breastfed baby is supplemented with a bottle, there is a risk of breast abandonment. The baby takes the bottle and the breast in various ways, the baby uses his tongue to feed from the breast, he presses the breast against his palate with it, the cheeks are mainly involved in feeding from the bottle, it is easier to eat from the bottle, and the baby subsequently chooses it.

To minimize this danger, several conditions must be met:

• Be sure to choose a bottle of the correct rectangular or oval shape, without narrowing in the center. The nipple should be small, not very hard and round in shape, as close as possible to the shape of a female nipple. There is no need to make large holes in the nipple; this interferes with the sucking reflex in the newborn. The milk should not flow too quickly, the child should make a small effort, the optimal bottle feeding process should be 15-20 minutes
• The correct feeding technique is that if the mother has milk, then you need to first feed the baby with milk from the breast, and then give a bottle. Bottle feeding should be done in the same position as breastfeeding.

Syringe without needle


pros: Cheap method, can be used as a disposable method

Minuses: The volume of the syringe is small, there is a risk of extinction of the sucking reflex when supplementing a breastfed baby.

For supplementary feeding, the largest syringes of 5-10 ml are used; the principle of feeding is similar to injections - milk flows out of the syringe when pressed.

Options for supplementary feeding with a syringe may be the following:

• The baby sucks on a syringe through which milk flows slowly
• Milk enters the baby's mouth through a tube at the end of the syringe
• The baby sucks the mother's finger or breast, and milk is introduced into the corner of the mouth through a tube. This option is most preferable when supplementing children with formula with partial breastfeeding.

Syringes with a tube can be bought at a pharmacy; dentists use these in their work; it is not difficult to build one yourself by putting a venous catheter on the end of the syringe. But here it is necessary to remember that the catheter must be changed after each feeding, because a mixture remains in the tube, which can deteriorate and harm the baby.

Tea spoon


pros: The method is simple and inexpensive; it can be used for a runny nose and in other cases when sucking is difficult. The spoon is easy to disinfect.

Minuses: At first, using a spoon when feeding children with formula is quite difficult, because the child will spit out most of the milk or formula. This method is least suitable for supplementing small children with formula while breastfeeding, as it does not develop the sucking reflex. It is best to use it when there is little time left to introduce complementary foods and accustom the child to an “adult” diet.

To help your child learn to eat from a spoon faster, you can try:

• Quickly pour the contents of the spoon into the middle of the tongue;
• Pour milk over the cheek;

The next portion of milk should be given only when the baby has swallowed the previous one. You can tell that your baby is full when he stops opening his mouth or starts spitting out the formula.

Soft spoon


pros: The material is more pleasant for the baby, plus the spoon is inserted into the bottle, there is no need to constantly scoop up a new portion with the danger of spilling.

Minuses: It costs more than the above devices.

It’s easy to use a soft spoon; milk pours out when you press on the protrusions located on the sides of the spoon; you don’t need to press too hard so that the mixture flows into the spoon in a small amount.

But here we cannot exclude the possibility that if a child does not eat from an ordinary spoon, then he may not eat from this one either.

Cup

pros: The cup is very easy to wash between feedings; the baby eats from a cup even faster than from a bottle. Cup feeding reduces the likelihood of air being swallowed, resulting in less regurgitation and colic.

Minuses: Cup feeding also requires some skill. Not suitable for children with a weak sucking reflex.

To supplement your children with formula, you can use any cup, but it is better to purchase a special one with thin walls and made of a material that can be easily sanitized. But doctors recommend supplementary feeding from a cup if the baby does not breastfeed at all. Supplementing babies with formula from a cup while breastfeeding can negatively affect their desire to feed from the breast. It is better to feed when the child is upright or half-sitting; you cannot pour milk into the child’s mouth; he must drink it himself. Premature babies mostly lap up the milk, while those born on time sip it. The cup must be constantly tilted carefully so that the child does not stop eating or swallow air.

pros: The form and method of feeding are as close as possible to breastfeeding, low risk of swallowing air.

Minuses: High price. Mainly used for feeding babies with genetic abnormalities, due to which the child does not have a sucking reflex.

Using a sippy cup is not difficult, the main thing is to pour the required portion of milk and release the air. The flow of milk can be adjusted by turning the cup.

Finger feeding

pros: One of the most physiological of all methods of formula supplementation during breastfeeding, during feeding there is always tactile contact between the baby and the mother.

Minuses: May cause breast refusal due to the fact that when using this method the child does not need to make any effort to "get" milk.

Milk is supplied through a syringe or probe into the baby's mouth while he sucks his finger; you can use a syringe with a straw.

Supplementary feeding at the breast

pros: The most natural method of supplementing a breastfed baby. The baby gets used to eating from the breast, which additionally stimulates milk production in the mother.

Minuses: Not suitable for babies who do not want to breastfeed. Difficulties with sterilizing tubes.

The system of use is not simple, and usually consists of a bottle and a tube attached to it, with the bottle slightly raised so that milk flows into the tube. The baby is placed to the breast and a tube is inserted into his mouth, the child simultaneously sucks the breast and milk from the tube. Sometimes the baby is first fed simply from the breast, then a probe is inserted into the corner of the mouth.

Such a system can be purchased in a store; there are several options from different manufacturers, or you can make it yourself by attaching a straw to a feeding bottle. The tube must be washed, boiled, or better yet, changed after each feeding. Many mothers use this particular system to introduce supplementary feeding, because physical contact with the newborn is important for them, and because the baby suckles, milk comes in. The strength of the milk flow in the system can be adjusted.

Pipette


Pros: Can be used when other means cannot be used, mainly for feeding premature or weak newborns

Minuses: very small volume, feeding even a very small child takes a long time.

For supplementary feeding, you need to use a pipette with a blunt tip; before feeding, you can give the baby a clean finger, and inject milk into the corner of the mouth.

Which supplementation method to choose?

If possible, doctors advise choosing a method of supplementary feeding at the breast; this guarantees the development of the baby's sucking reflex and gives a great chance of increasing the mother's breast milk production.

If the lack of breast milk is small, or only periodic supplementary feeding is required for a breastfed baby, then you can use a syringe or spoon. Periodic supplementary feeding may be required when "crises" lactation, which often occurs from 3 to 6 weeks, at 3,4,7,8 months of lactation, such periods do not last long, only 3-5 days.

Negative consequences of introducing supplementary feeding

The negative consequences of supplementary feeding mainly occur when breast milk is abandoned.

• Supplementing children with formula can cause a lack of antibodies and microflora beneficial for the newborn’s intestines.
• Poisoning or infectious diseases due to non-compliance with hygiene conditions.
• Reduced milk production when supplementing with formula during breastfeeding.
• An incorrectly selected formula can cause a significant loss of body weight in the child and an increase in bilirubin levels.
• Supplementing children with formula while breastfeeding may eliminate the possibility of returning to breastfeeding, since formula saturates the child for a longer period, and he is put to the breast less often, as a result, the mother has less milk.

Basic rules for supplementary feeding

Regardless of which supplementary feeding option you choose, you must follow the general rules.

• Breast before and after feeding. No matter how much milk the mother has, it is still the most valuable source of nutrition for the baby, so it is necessary to give the breast to the baby, even if there is little milk there.
• Don't force the child forcefully eat the whole mixture, let him decide when he is full. Next time make a little less mixture.
• Feed only a calm baby. If the newborn is upset, you should first calm him down and then offer him something to eat.
• And the most important thing that young mothers should remember is that even if you had to introduce supplementary feeding, there is still an opportunity to return to breastfeeding, often supplementary feeding with the mixture is introduced as a temporary measure and if you follow the pediatrician’s advice, you can return to full lactation within 7-10 days.

Health to you and your children!