Supplementation of a breastfed baby can happen for a variety of reasons, but contrary to popular belief, it does not have to be a bottle formula. In each specific case, the question of whether it needs to be introduced, how and how to implement it should be decided individually, taking into account the possible negative consequences.

What is supplementation

Supplementary feeding is expressed milk (mother's or donor's) and / or formula (), which are introduced in order to compensate for breast milk in case of its lack. Many people confuse supplementation with complementary foods, which are given to the child not as a forced measure, but to supplement breast milk with all the necessary substances in connection with the child's reaching a certain age. In other words, a child needs supplementary feeding if necessary, and complementary feeding is necessary for all children.

Supplementing a newborn in a maternity hospital

After the birth of the child, in the first three days, the mother secretes colostrum, the volume of which is only a few milliliters. Due to its high calorie content and valuable biological properties, it is that irreplaceable food that a newborn needs and to which he is physiologically most adapted in the first days of his life. A small amount of food helps the baby to properly master the technique of sucking, swallowing and breathing during breastfeeding. After 2-3 days, the newborn's weight loss occurs in the amount of 5.5-6.6% of the birth weight, but not due to lack of nutrition, but due to the child's adaptation to living conditions that differ from the conditions of the intrauterine period. All these features of the first days can confuse a young mother, making them doubt the ability to feed the child, and lead to the introduction of supplementary feeding. Therefore, it is important to figure out when supplementation in the hospital is necessary and when not. In any case, the decision on supplementation is made by the doctor, evaluating each case individually after observing breastfeeding.

Supplementation is not required.

1. The child is sleepy. This is normal after a child is awake for the first time in his life. The next 10 hours include 1-2 waking periods with or without feeding. If the baby's sleep is long, it is better to wake him up by trying to give a breast. Longer pauses between feedings require more food for the baby, and this is problematic in the initial period of formation. Therefore, it is better to try to feed more often than to feed the baby after a long sleep. The main rule for the first seven days is: "A child is awake if hungry."
2. The child is healthy. Healthy, full-term infants less than 18 mol / L after 72 hours of age, breastfeeding well, bowel movements regularly, and weight loss of less than 7%.
3. Restless child. Even in the case of very strong anxiety at night or many hours of wakefulness.
4. The mother is tired or wants to sleep.

Absolute indications for supplementary feeding.

1. Separation of the child and the mother due to the mother's illness.
2. The baby has a disease associated with the assimilation of breast milk.
3. The baby has developmental defects that prevent breastfeeding.
4. The mother is taking medications that are contraindicated for breastfeeding.

Relative indications when prescribing supplements

Child's testimony	Maternal indications
A decrease in blood glucose levels without overt symptoms (hypoglycemia), confirmed by tests and remaining unchanged after breastfeeding	Insufficient amount of milk five days after childbirth, caused by placental residues in the uterus, after the removal of which, lactation returns to normal.
Significant dehydration (over 10% weight loss, high blood sodium levels, lethargy) despite proper breastfeeding.	Insufficient milk supply due to Sheehan's syndrome.
Weight loss of 8-10% in an infant against a background of delayed milk production in the mother after five days.	Insufficient milk production by the mammary glands due to their underdevelopment (primary hypoplasia).
Stool retention or excretion of meconium after five days.	Disorders of milk production due to previous breast surgery or breast abnormalities.
The child receives little milk, despite the sufficient amount of it from the mother.	Sharp pain during feeding does not disappear after attempts to eliminate it.
Jaundice of newborns associated with insufficient breast milk production or jaundice of breast milk (bilirubin level 20-25 mol / l).
If necessary, additional introduction of micronutrients (vitamins, minerals, amino acids).

How to identify a lack of breast milk

If, in the case of absolute contraindications to supplementation, everything is clear, then with relative ones, the question arises about the amount of breast milk or colostrum that the child does not get. The first thing to do is to make sure there is really not enough food. Several methods are used for this:

• counting the amount of urine;
• counting the number of urinations;
• method of expected gains;
• weighing before and after feeding;
• method of increments per week;
• "Intuitive" method.

The calculation of the amount of milk that a child should eat in one feeding can also be carried out by several methods that can take into account not only the age, but also the weight, state of health of the child. The difference between the norm and the milk actually consumed by the child will be the amount of supplementary feeding that the child needs.

Introduction of supplementary feeding in case of a lack of breast milk

Depending on the amount of milk that the child does not receive, supplementation can be prescribed immediately or after.

Lack of milk 25-50% of the norm. Supplementation is prescribed only after additional measures to increase lactation. To do this, within 3-4 days, a more frequent attachment to the baby's breast is carried out, and if this does not help, the baby is fed with one feeding alternately from two breasts. Only after exhausting all the possibilities to restore lactation, after 7 days, supplementation is prescribed.

Milk deficiency is up to 75% or more. Supplementation is prescribed immediately, but measures are taken to restore lactation.

Thus, in all cases, supplementation is only a temporary measure, which makes it possible in the future to return to breastfeeding.

The amount of supplementation should compensate for the lack of breast milk. At the same time, intermediate control is periodically carried out, since once a certain amount of supplementary feeding gradually changes up or down. More if measures to restore breastfeeding give a negative result and less if positive. Accordingly, if you do not carry out control, then over time, overfeeding or underfeeding of the child may occur.

Supplementary feed selection

The best solution is to use expressed breast milk. At the beginning of lactation, it is better to pump by hand as it is more efficient and can increase milk production. To additionally enrich breast milk with useful components for premature and low birth weight babies will help

The situation is more complicated with colostrum, of which very little is excreted and it is problematic to collect it. In this case, the use of pasteurized donor milk is optimal.

Among artificial mixtures, they are the best for supplementation, as they reduce the risk of allergic reactions and the level of bilirubin.

Supplementary feeding methods

There are several methods of supplementation, each of which has its own advantages and disadvantages. The choice of this or that method depends on many factors, but in any case, the key to the success of their application is the mother's patience and determination.

Bottle

Advantages: requires a minimum of effort and training.

Disadvantages: there is a risk of breast rejection.

To reduce the risk of breastfeeding and improper grip of the breast, leading to cracked nipples, it is necessary to:

1. Choose the right bottle and nipple. The bottle should be straight without tapering in the middle. The nipple should not have a wide base, as this forces the baby to squeeze the gums. The shape of the nipple should be round, as it is closer to the shape of the mother's nipple, the material of the nipple is as soft as possible, otherwise orthodontic problems may arise. The hole in the nipple is made small so that the sucking process takes 15-20 minutes.
2. Correct feeding technique. If possible, give the baby a breast first, and then a bottle. They put the baby on their knees, holding them with their hand and raising the upper body. The bottle is held horizontally and the nipple is placed in the infant's wide-open mouth almost to the ring of the bottle. When everything is ready, the top of the bottle is raised to prevent air from trapping in the teat. As the bottle is emptied, the baby is tilted back to empty the bottle completely.

Syringe without needle or extended syringe

Advantages: inexpensive, can be used one-time.

Disadvantages: the volume of the syringe is not enough for older children, so it takes a long time to complete the feeding. There is a danger of getting used to sucking the syringe instead of the breast.

For feeding, it is better to take a 5-10 ml syringe. The principle of milk delivery is the same as for injections - with gentle pressure on the plunger, milk flows out of the syringe. The needle can be used to draw milk from a narrow-necked container.

The ways to use the syringe can be different:

1. The child sucks on a syringe through which milk is injected;
2. The milk flows through the tube at the end of the syringe into the corner of the baby's mouth.
3. The baby sucks on the mother's thumb, pad up, and milk is injected with a syringe into the corner of his mouth.
4. Milk enters the corner of the baby's mouth through a syringe with a tube right during breastfeeding.

You can buy a syringe with a straw at a pharmacy or make your own. The pharmacy sells a "long cannula" syringe that is used by dentists. You can make it yourself by attaching a nasogastric probe or a venous catheter purchased at a pharmacy to a regular syringe.

Tea spoon

Advantages: does not require material costs. No hindrance to breastfeeding as the spoon does not satisfy the need for sucking. A spoon can be used in case of a cold in an infant, as the sucking process is difficult at this time.

Disadvantages: using it requires skill, as at first most of the milk will spill by.

Usage. When the child opens his mouth, with a quick and confident movement, slightly tilt the spoon, pour its contents onto the middle part of the child's tongue. You can also try pouring milk over your cheek. According to mothers using this method of feeding, it takes only 2-3 days to learn how to use it effectively.

Medela Soft Spoon

Advantages: is more convenient to use than a teaspoon, since you do not have to scoop milk from the container every time. It is one of the simplest and most effective feeding methods.

Disadvantages: relatively high price of the device.

Usage. It is a soft silicone spoon combined with a bottle. When you press on the protrusions located in front of the spoon, milk begins to flow into it. So you can easily dose the amount of food. However, there is a possibility that if a child does not like a teaspoon, then a soft one will not work for him.

Cup

Advantages: easy handling between feedings (for convenience, Medela produces sterile cups with rounded edges and a scale). Feeding takes even less time than bottle feeding. Due to the fact that no air is swallowed during the use of the cup, the number of and is reduced. The weight gain is greater, and the tongue and jaws learn to work properly.

Disadvantages: should not be used in newborns with a weak swallowing reflex. As with using a spoon, it may take some time to adjust.

Any cup will do, but better with thin walls (coffee, pile). According to the WHO, all babies, even premature babies, can be cup fed. Premature babies lap up milk, and full-term babies sip.

Important! Cup feeding is optimal if the baby has not yet breastfed. Otherwise, it is better to use other feeding methods.

Usage.

1. Sit the child upright or half-sitting on your lap, supporting the head with a hand that also supports the child's shoulders and neck.
2. Touching slightly, place the edge of the cup on the baby's lower lip.
3. Tilt the cup so the milk touches the baby's lips. The baby will begin to lap or sip lightly on the milk.
4. The liquid level in the cup must remain the same so that the baby does not stop. To do this, you need to very smoothly gradually tilt the cup.

Attention! Never pour milk down the throat of a child! Let him control the sipping and swallowing himself.

Habermann's cup

Advantages: no breast rejection occurs after using the sippy cup. A special system allows you to regulate the flow of milk, reducing the risk of air ingestion.

Disadvantages: high price.

The main purpose of this sippy cup is feeding children who are unable to create a vacuum during sucking due to cleft lip and palate, Pierre-Robin syndrome and some neurological diseases.

Usage. Before feeding, milk is drawn into a bottle, air is released from the bottom of the teat and the cup is filled with milk after pressing the wide part of the tip using the pipette mechanism. When the tip is full, start feeding the baby. The milk flow is regulated by turning the sippy cup.

Finger feeding

Advantages: the child works with the tongue as when sucking on the breast. There is skin-to-skin contact between the baby and the mother. Suitable for sleepy newborns before breastfeeding and with cracked nipples to replace part of the feedings.

Disadvantages: personal hygiene rules are required. Not suitable for flat nipples, as the breast can be abandoned in favor of the toe.

Usage. You will need a probe dipped in a container of milk. The other end is attached to the finger. Alternatively, you can use a syringe with a tube at the end. When sucking a finger through a tube dipped in a container with milk, food is supplied to the child. If a syringe is used, milk is injected through a tube.

Breast feeding

The most commonly used for these purposes is the Supplementary Nursing System (SNS)
and the Lact-Aid system.

Advantages: the most convenient and physiological feeding method. The baby learns to suckle correctly and stimulates milk production in the breast. Breast rejection is reduced to nothing.

Disadvantages: not suitable for babies who refuse to breastfeed. Difficulties with the processing of tubules, since they cannot be boiled. The inconvenience associated with adding new portions of milk to the container. At the same time, excess milk will have to be discarded due to precautions. Some species clog the probes.

Consists of a container into which supplementary food is poured and from where a long thin tube comes out. An important feature of this method is that the baby receives supplementary food while sucking, even if there is no milk at all. This method is often used in the case of adoption of very young children, which allows a woman to feel like a full-fledged mother, and in some cases even start lactation.

Several use cases are possible.

You can breastfeed your baby first and then gently insert a tube into the corner of your mouth, or start breastfeeding with a tube right away. When the tube is inserted into the corner of the mouth, it is guided inward and slightly upward. Sometimes it needs to be supported while feeding, as some babies may gradually push it out of the mouth. The milk flow in the straw is regulated by raising or lowering the milk container. For 15 minutes of supplementation, the baby sucks out 30 ml of milk. For maintenance, it is advisable to use a breastfeeding system at each feeding.

The Medela breastfeeding system consists of a graduated bottle that is hung around the mother's neck and the probes coming out of her - one on the breast. The set includes several probes of different sizes and a patch for fixing them on the chest.

If it is impossible to buy a ready-made system, you can make it yourself by inserting a thin probe through the nipple into a bottle (5-10 ml syringe) with milk. A nasogastric tube or venous catheter is used as a tube. You cannot boil them, just wash and dry them, and after 24 hours use a new straw. If you do not have a thin tube, you can use a wide one, pre-tying a knot on it to reduce milk flow.

Pipette

Used as a last resort when others are not working or for feeding newborns. The main difficulty is obvious - the volume of the pipette is very small, and the process of feeding can take a long time.

Medela soft spoon supplement video

Haberman's cup video

How to drink from a glass video

Spoon feeding videos

Which feeding method to choose

The optimal solution is to choose a supplementary feeding system at the breast, as the baby will continue to suckle, and your milk supply will not decrease due to its constant stimulation. It is also the best solution in case of a large milk shortage or if you want to resume lactation. With a slight shortage of milk or the need for supplementary feeding for a short time, you can get by with a syringe, pipette, spoon, cup.

Potential negative consequences of supplementation

1. Changes in intestinal microflora and increased risk of allergic reactions when formula feeding.
2. The risk of developing diarrhea and infectious diseases if hygiene standards are not sufficiently followed.
3. Decreased milk production due to insufficient breast emptying by the baby.
4. If the child receives additional water or glucose at the hospital, the risk of increased bilirubin levels and excess weight loss increases.
5. Formula feeding contributes to the formation of a longer feeling of satiety in the baby and less frequent latching on to the breast.
6. Supplementation can make it difficult to return to breastfeeding.
7. Before breastfeeding begins, supplementation has a negative effect on its duration.
8. The introduction of supplementary feeding in the early postpartum period leads to excessive engorgement of the breast associated with rare attachments.

In contact with

Breastfeeding supplements are a special type of nutrition that is used for babies up to six months of age. Thanks to this, all the substances and components necessary for growth and development enter the child's body. There are a number of reasons why it is necessary to make up for a lack of breast milk. In the feeding technique, it is necessary to adhere to a number of rules, only in this case the baby will feel good and gain weight correctly.

How to properly introduce supplementary feeding to a baby?

A common mistake most young parents make is to feed their baby with additional food too early. It should be noted that after the birth of a baby, breast milk does not appear immediately in the required volume. When crying occurs, the cause is not always malnourished.

Immediately after childbirth, the situation with insufficient feeding is considered normal even by specialists in this matter. During this period, all women are struggling to adapt to the new mode of functioning. Colostrum always appears first, which has a high calorie content. The kid needs very little of it. In the first three days after the birth of a baby, his needs for food are minimal.

If a newborn is bottle fed, it instantly calms down. From this, parents conclude that the baby lacks the volume or quality of milk. That is why a mistake is made with the complete transfer of the child to formula feeding.

Supplementation with a mixture should be introduced in the following situations:

• The kid constantly cries and behaves restlessly. In such a situation, it is not at all necessary that there is not enough milk, perhaps the baby simply does not know how to eat correctly. A woman should teach him to take the nipple well and not trap air when feeding. In this case, in no case should you use bottles and pacifiers. Because of them, the child learns to make the wrong nipple grip. The situation may even lead to its damage. The woman is advised to increase the number of breast attachments. At the same time, the kid becomes too nervous and irritable. A child often cries if he has a small frenulum in his mouth.
• Frequent breastfeeding can also play a cruel joke. However, immediately after childbirth, the number of approaches per day can be up to forty years. Later, the intensity will decrease up to twelve times. Physiological needs are different for everyone. The main thing is to make sure that the baby has no disease. Mom should not forget that warmth and affection will also help remove whims and crying.
• Expressing produces a small amount of milk. In the event that feeding is carried out exclusively at the expense of the breast, then the woman should completely abandon this procedure.

The correct diet for up to six months does not involve the use of water. The mixture should be introduced into the diet only as a last resort, and first it is necessary to consult a specialist in this area. Most often, the situation occurs only for medical reasons.

Expressing can increase lactation

You can start feeding formula while breastfeeding only in the following cases:

• The baby was born prematurely and has a weak body. In this case, he is simply physically unable to suckle well. When supplementing, all the necessary substances enter the child's body, so it quickly recovers.
• Neurological abnormalities were diagnosed. In this case, not all babies have a sucking reflex. It does not appear even with regular breastfeeding. The diagnosis can be made in the hospital. It is important for parents to fully follow the recommendations of doctors who suggest switching to an artificial feeding option.
• The mother does not produce the required amount of milk. Most often, this symptom is considered temporary and indicates the presence of errors. The reason lies in the insufficient number of attachments to the breast. You should not try to immediately force the child to live according to the regime. Over time, all biological processes are synchronized, and a sufficient amount of breast milk will be produced in the mother's body.

Infants are allowed to be fed with formula only temporarily. Parents should make every effort to keep breastfeeding possible. To fix the problem, you should be constantly with the baby, even in a dream. It does not need to be limited in the time it is at the breast. This allows the problem to be resolved within a maximum of seven days.

What should be included in complementary foods?

At the first stage of introducing a new diet, it is necessary to determine its composition. It is convenient to use a bottle or nipple to enter it into the body. However, it should be understood that these attributes will permanently put an end to a woman's attempt to continue breastfeeding.

It all lies in the difference in techniques. Although, for all external characteristics, this attribute completely repeats the anatomical features of a woman's breast. A kid who simultaneously gets access to these two ways of eating almost always chooses a bottle. doesn't exist for a long time.

A bottle with a spoon is used for easy feeding

What is the difference between a bottle and a mother's nipple:

• Deep grip is not needed when using the nipple. This technique should only be performed on the mother's nipple.
• With natural feeding, the baby helps the tongue absorb food. When using the nipple, it is stimulated with the gums.
• Any liquid flows out of the nipple without any effort. When trying to feast on breast milk, the baby should actively move his mouth.

By its very nature, eating from a bottle is much easier. That is why babies prefer to give up breast. They stop feeding on breast milk completely, and switch to formula. Therefore, if there is an opportunity to establish lactation, then the baby should not know the sensations from feeding from a bottle.

This method should be used only in the case of certain medical indications. In other cases, everything should be done to establish a natural feeding option.

Additional artificial feeding tools

Using a spoon

You can introduce supplementary food into the baby's body using a special silicone spoon. It is allowed to fill it only halfway and pour the composition over the cheek. Avoid contact with the root of the tongue, because in this case, the risk of involuntary vomiting increases. The next portion is allowed to be given only after there is no previous one left in the mouth.

Today, spoons are very popular, which are sold complete with a bottle. Thanks to the device, it is possible to correctly control the supply of the composition at the time of sucking from the bottle

Using a syringe or pipette for feeding

The method is based on a similar principle of operation. In this case, the composition is infused in small portions into the cheek area. Mom can help the baby to open his mouth slightly. For convenience, it is recommended to use a special pipette. A syringe from which the needle is previously removed is also suitable. You can also use a dispenser with any medication for a child.

Using a custom cup

Any child will not be comfortable drinking from a large adult cup. It is recommended to use a vessel made of safe material that is small in size.

At the first stage of feeding, you only need to slightly moisten the lip with the composition. The baby should react to this with intense movement of the lips and tongue. Next, a small amount of feeding is applied to the sponges again. Mommies claim that this is one of the easiest ways to teach your baby to new food.

It is convenient to use a special cup for complementary foods.

Unique SNS system

This unusual development is used for supplementary feeding of the baby. It is customary to use a silicone bottle in it. For ease of use, a tube is inserted into it. The process consists in the fact that the woman puts the vessel around her neck and fixes the tube next to the nipple. At the time of latching on to the breast, the child must take in his mouth and a tube through which the additional composition for feeding will be transferred. As a result, the child simultaneously receives milk and mixture.

This method is not often used in our country. It was invented by foreign experts. They find it ideal for introducing new food into the baby's diet. At the same time, the mother manages to constantly maintain contact with the baby, which receives all the necessary components for proper growth and development.

Basic rules for supplementation

It is very important to correctly introduce the artificial food option. For this, it is recommended that the mother first familiarize herself with the following rules:

• For a child, mother's milk is the only source of nutrition. It contains several times more components useful for growth and development. That is why doctors recommend giving the breast only before the mixture.
• If the baby does not finish the entire composition to the end, then you should not insist either. Parents should only make sure that he is completely full. This is easy to control by observing his behavior. He turns away from mom and no longer sucks.
• The portion should always be the same size. If a woman noticed that part of the composition was spilled during feeding, then this volume should be added already during the next feeding.
• The child will eat better if he is in a good mood. When crying, he will constantly have to be reassured. To do this, it is recommended to change the position or use special devices for greater comfort for the baby.

The sucking reflex can only be fully realized by the mother's breast. That is why, to solve many problems, it is recommended to often attach the baby to the breast. In this case, the woman receives additional stimulation of the mammary gland. Thanks to this, it is possible to get stimulation directly of the lactation itself. For this purpose, it is recommended to completely exclude supplementary feeding from the child's diet for a certain period.

How to determine the required amount of the mixture?

The mixture is most often used to help the baby gain weight. For this, the woman is voiced all the standards, which must be adhered to throughout the entire period of feeding.

The norm of the volume of food, depending on the age of the baby:

• two months - 60 grams;
• three months - 90 grams;
• six months - 240 grams.

The reasons why the real needs of the baby cannot be indicated:

• It is difficult to determine the amount of milk that the baby drinks from the mother's breast per day.
• Thanks to this approach, you can completely switch to artificial feeding.

Today, there is another approach to solving the problem in this area. On his side are American and European scientists with extensive experience in this field.

Ways according to which you can easily calculate the required amount of formula for a child:

• Take a close look at the volume and frequency of urination over a 24-hour period. On average, their number should be 12. In this case, the child receives a sufficient amount of food. In some cases, it is not advisable to introduce supplementation at an early age of the baby. It is important to pre-count the number of wet disposable diapers.
• The volume of the mixture is calculated taking into account the age of the child. For example, at three months, the baby should urinate about ten times a day. In this case, it is advisable to additionally give 60 ml of the mixture. It is important to get advice on this from your primary care physician or hepatitis B counselor. They will be able to correctly form the general picture and the need for a child in supplementary feeding.
• All remedies should be used to stimulate natural milk production. First of all, the baby must have constant access to the breast. Restrict his access to nipples and pacifiers completely. You should also feed your baby at night. The optimal period for this is 3-8 o'clock in the morning.
• If the baby's urination was sufficient, then the mixture is not given in full. To get a complete picture, the diaper count is carried out within a few days. As soon as this figure reaches 12 times, then the mixture decreases in volume.

How to properly give the mixture to your baby:

• The total volume is divided into five equal parts and is given in accordance with a specific schedule. The time span must be the same and is divided between six in the morning and twelve in the morning. Experts do not recommend giving the mixture at night.
• The mixture is offered to the child not only before falling asleep, but also after he wakes up. The main task of any parent is to control that the entire volume is consumed within 24 hours.

Supplementation is completely abandoned if the amount of urination has become normal. The mixture can be used only if all harmful factors that can negatively affect natural lactation are absent. The woman should increase the frequency of latching the baby to the breast, teach him how to properly grip the nipple, eliminate the pacifier and the bottle. It is advisable to constantly hold the child in your arms. In this case, a specific bond is formed between him and his mother.

Supplementation during breastfeeding cannot completely eliminate the need for infant formula. It is recommended that you first try to fix basic errors. In this case, the mixture can only temporarily solve the problem. Hepatitis B specialists recommend not feeding your baby until six months old. The only exception can be the presence of a certain disease or the inability of a woman to breastfeed.

Introduction of complementary foods

The issue of nutrition must be approached very responsibly. It is easy for young mothers to get confused about the rules for introducing complementary foods, supplements and nutritional supplements. Don't be scared. We will try to figure everything out.

If there is a lack of milk in the mother, supplementation is prescribed. Supplementary food is a special infant formula for nutrition. There are a huge number of infant formulas (powdered, milk-based, ready-to-drink, etc.). Ask your doctor what formula is best for your child. The main thing here is to observe one rule, supplementation is given after breastfeeding.

Up to one year, three complementary foods are introduced into the child's diet. Lure Is a substitute for feeding with foreign food.

You should pay attention to the fact that when introducing complementary foods, there are important rules that must be remembered.

Lure- this is the first step towards the formation of the baby's health, acquaintance with the variety of tastes and the formation of the skill of independent food consumption. From 4-6 months, mother's milk or its substitute cannot fully meet the needs of a growing body for energy and nutrients. By 3 months of age, digestive enzymes mature. At 3-4 months, local intestinal immunity and swallowing mechanisms are formed. Complementary foods introduce your baby to a variety of flavors and textures.

Start complementary foods with one-component purees, juices, and cereals that do not contain flavor enhancers. Any new product should be given when the child is healthy. Offer a new product in the morning before breastfeeding so you can track your reaction to it throughout the day. The new product needs to be introduced gradually, starting from? tsp and gradually increasing its volume by 10-30 g for 7-10 days. In case of poor tolerance, it is necessary to stop the introduction of the product and try to introduce it again after a while. In case of a repeated negative reaction, you should discard the product and try to replace it with a similar one. (for example, applesauce - pear). Feed your baby with each new product for 5 - 7 days before introducing another, otherwise, in case of rejection of food, you will not be able to understand which particular product provoked a negative reaction. If your baby doesn't like the dish, try offering it a few days later. Be patient when suggesting a new product up to 10 - 15 times. You should feed with a spoon, warming the product to 37 degrees Celsius.

ALWAYS CONSULT YOUR PEDIATOR WHEN AND WITH WHAT PRODUCTS TO START FEEDING : one-component fruit or vegetable purees, juices or one-grain cereals.

1. Complementary foods are introduced gradually. Start with one teaspoon. The dose is increased gradually. Do not rush to increase the amount of food. Give your baby a chance to get used to it.

2. Complementary foods are given before breastfeeding.

3. Complementary foods should be uniform.

4. Porridge must be alternated. Take the time to cook different types of cereals.

5. It is better to give complementary foods in the second feeding. Do not start your baby's day right away with foreign food.

6. Do not start introducing complementary foods when you are sick.

7. Do not give two new foods at once. The child must first get used to one, then to another dish.

8. Introduce all new dishes in due time. If you introduce foreign food ahead of time, the child's body may not yet be ready to assimilate it.

Complementary feeding schedule

Age

Lure

3.5 months

Monocomponent juices: apple, pear, plum with pulp.

4 months

Monocomponent fruit purees: apple, pear, plum, peach, apricot.

4.5 months

Monocomponent vegetable puree: zucchini, cauliflower, broccoli, potatoes, carrots.

5 months

Juices and nectars from black and red currants, raspberries, cherries, quince, cherries, blueberries, lingonberries (up to 20% berry juice)
Mono and multicomponent fruit puree: black and red currant, raspberry, sweet cherry, quince, cherry.
Mono and multicomponent vegetable puree: pumpkin, beet, white cabbage
Porridge: gluten-free: rice, buckwheat; corn mixed with buckwheat and rice, and gluten-containing: wheat, semolina, oatmeal, oatmeal, instant cookies.

6 months

Juices and nectars from citrus fruits, tropical fruits (pineapple), strawberries, strawberries, tomatoes (!!! Products of a high degree of allergenicity - enter with caution and monitor the body's reaction !!!)
Fruit - grain and fruit - milk (yoghurt) puree, as well as with citrus products.
Vegetable purees with the addition of tomatoes.
Multi-component cereals (3 types of grain each).
Curd: This product is introduced into the baby's diet gradually, starting from 3-5 g. By the year, the amount of curd should be 50 g.

6.5 months

Hard boiled egg yolk. The yolk is injected very carefully. With good tolerance to a year, a child can eat half the yolk a day.
Meat puree: beef, pork, lamb, chicken, turkey, rabbit.

7 months

Papaya, kiwi, guava juices.
Vegetable purees with the addition of green peas.
Dairy products. The first baby can try kefir and acidophilic mixtures. Use only special fermented milk mixtures.

8 months

Vegetable purees with spinach.
Meat puree with the addition of offal (liver, heart and tongue).
Fish-based products: Puree from cod, hake, pike perch, salmon, haddock. Fish puree is substituted for 2 meat feeds per week.

Older than 9 months

Clarified grape juice.
Porridge type "Muesli" (for children)

First feedingbest given at 5 months of age. For children on artificial feeding, the first complementary foods can be given a little earlier, at about 4 months. It is better to give vegetable puree as the first complementary food. it contains trace elements and fiber. For a start, it is advisable to start cooking vegetable puree with some product. You can, for example, cook from carrots.

Then vegetable puree can be prepared from several products. Try to keep the potatoes no more than half their volume. Mashed potatoes are too heavy for a baby. You can use zucchini, pumpkin, turnips, cabbage. Focus on the tastes of the baby. Like an adult, he may not like a particular product.

Second complementary foodadministered at 6 months. With artificial feeding from 5 months.

It is better to start the second feeding with 5% semolina. To prepare it, you need to take about 200 ml. cow's milk and add 70 ml. water. This mixture must be heated to a boil. When the mixture starts to boil, stirring occasionally, pour 10 grams into it. semolina. Cook the porridge for about 10 minutes. At the end of cooking, you can add 1 teaspoon of sugar.

Third complementary foodbegin to give at 7 months. Bottle-fed babies at 6 months. The third complementary food begins with meat broth. Better to give pork or beef. Can be given before mashed vegetables. In this case, do not give more than 30 ml so that the child does not lose his appetite. At 8 months. (with artificial feeding at 7 months.) You can give meat. It is necessary to make minced meat from it by passing it twice through a meat grinder. Cooked minced meat can be added to vegetable puree. At 9-10 months, fish can be given. It can be boiled and kneaded well. When preparing it, carefully free it from the bones. Don't serve oily fish.

Food additives include:

Juices. They start to give from about 3 months. They begin to give a few drops of juice, gradually increasing its amount. To find out how much juice you can give your child. You need to use a simple formula. The age of your child should be multiplied by 10. The answer in milliliters will be the required amount.

For example, your child is 7 months old. 7 multiply by 10 and get 70 ml.

It is desirable to give clear juices (apple, grape). Citrus or red fruit juices can cause allergies.

From 2-3 months. you can give a grated apple. With it, the child receives vitamins and minerals.

From 3 months. you can try to give the yolk. Do not give a child of this age more than a few crumbs. With the yolk, the child gets iron. This is very important for preventing iron deficiency anemia.

From 5-6 months They give cottage cheese. Do not give more than 20 grams. By 1 year, this amount can be increased to 50 grams. With cottage cheese, the child receives protein and calcium.

Butter can also be given at 5 months.

When starting to give your child foreign food, keep in mind that the child must get used to it. Sometimes children are happy to eat a new product, and sometimes they refuse. In this case, do not force the child. Wait another 1 - 2 weeks and try again. Monitor your baby's reactions to foods. Something may cause an allergy and a tummy ache. Do not feed your child exclusively with cereals. Don't eat foods that are too sweet or fatty. Don't overfeed your baby. Do not be discouraged if the child has not eaten the amount of food that he should eat according to calculations. If he normally gains weight, if he is healthy, cheerful, cheerful, active, then he eats the amount that he needs.

Currently, there are a lot of disputes and disagreements about the rules and timing of the introduction of complementary foods. Basically, they begin to deviate from the usual complementary feeding schedule in favor of its later introduction. Of course, breast milk is undoubtedly a very important form of nutrition for a baby, but a healthy baby cannot be satisfied with breast milk alone, even if there is enough of it. There is a need to provide the baby with vitamins and other important elements, as well as to ensure sufficient caloric intake.

When to add supplements while breastfeeding? Which kids need it vital? How to properly feed with formula? From what to offer it to the child? How much mix is ​​needed? And when should you stop? Let's consider the main issues related to the introduction of supplementary feeding during breastfeeding.

Supplementation refers to the use of a formula in feeding an infant up to six months of age. Its purpose is to meet the needs of the baby's body for nutrients, which, for various reasons, cannot be compensated by breast milk. In natural feeding techniques, supplementation is the exception rather than the norm. There are many prejudices associated with the need to introduce it.

When to add supplements

Often, young mothers start early introduction of supplementary feeding due to lack of self-confidence. Immediately after childbirth, when milk has not yet arrived in sufficient volume, it seems that there is simply nothing to feed the baby. The situation is aggravated by frequent crying of children, which is why an inexperienced mother concludes that the child is hungry.

Fed from a bottle, the baby calms down and sleeps for a long time. Thus, the wrong conclusion leaves an imprint on the entire period of breastfeeding. Mom thinks that she has very little milk or that it is “not satisfying”, “not fat”. And to feed a child "for real" is possible only with the help of a mixture.

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

There are other situations that do not mean that the baby needs supplementation.

• The baby is restless at the chest, crying. This does not mean that the breast is "empty", but rather that the baby is not confident in handling the breast. The task of the mother is to exclude everything that can interfere with the child from sucking her correctly. The main pests of proper attachment to the breast are nipples and pacifiers. They form the wrong skill to grip the nipple, as a result of which the baby cannot extract anything from it and injures the delicate skin. Exclude calm behavior at the breast, rare attachments, due to which the baby is nervous, too upset to properly capture the nipple. The reason for crying can also be a short frenulum in the baby's mouth, which does not allow him to properly grasp the breast.
• The kid kisses too often. The normal frequency of breastfeeding after childbirth can be up to forty times a day. Over time, it decreases to twelve to fifteen times, but it can increase if the baby is upset or sick. What seems too frequent to you is the physiological need of the child's body, and not only for food, but also for maternal warmth and affection.
• Too little milk is being expressed. The amount of milk you have expressed is not telling. If you are exclusively breastfeeding, you do not need to express.

In accordance with the WHO recommendations, the introduction of supplementary feeding and supplementation with water is not justified for breastfed babies 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 complementary foods with formula while breastfeeding exists in the following situations.

• Premature baby. These babies are too weak to suckle productively. Supplementing with a mixture helps the body to get stronger faster.
• A child with neurological disorders. Babies cannot coordinate their actions for proper breastfeeding. As a rule, such diseases are diagnosed even in the hospital, so the mother goes home with clear recommendations for supplementing with the mixture.
• Lack of milk in mom. The phenomenon of hypolactation in a woman 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 rare latching to the breast "according to the regime" is practiced. Frequent application of crumbs to the breast will normalize lactation, since the volume of milk production is influenced exclusively by its consumption.

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

What to feed from

When the need for 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 the final point in breastfeeding.

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

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

• Capture depth. Correct attachment to the breast requires grasping the entire nipple, including the areola. You don't need to swallow the nipple that deep.
• The work of the gums and uvula. While sucking the breast, the baby helps itself with the tongue, while the nipple chews with the gums.
• Effort. The mixture flows freely from the nipple, while milk must be “extracted” from the breast.

Sucking a nipple bottle is much easier than breastfeeding. This becomes the reason for the complete refusal of breastfeeding or provokes improper attachment to the breast. The formula completely replaces mother's milk, the benefits of which for the child are many times higher than artificial nutrition.

To exclude the refusal of the crumbs from breastfeeding will allow the use of not a bottle, but other feeding devices.

Spoon

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

It is convenient to use special baby feeding spoons with a bottle. These are produced by Medela. The mixture is poured into a bottle and you can control how much it is fed into the spoon as you feed.

Syringe, pipette

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

Cup

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

Tilt it towards the baby's lower lip and wet it with the mixture. Wait for the baby to start making movements with the sponge and tongue. Re-wet the sponge with a small portion of the mixture. Feeding from a cup, according to mothers, is one of the easiest and most convenient ways to supplement with hepatitis B.

SNS system

Or a supplementary feeding system. It is a soft silicone bottle for filling with a mixture, with a thin tube. The bottle is put on the mother's neck, and the tube is fixed on the skin of the nipple. The baby, applying to the breast, captures both the nipple and the tube. Thus, he eats milk and mixture at the same time.

The prevalence of SNS systems in our country is not high, although, according to foreign pediatricians, they are the ideal solution for introducing supplementary feeding. They maintain close contact of the baby with the mother, support lactation and provide feeding with the necessary amount of formula.

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

• Breast before and after. Your milk remains the main food for your baby. It is many times more valuable and useful than the most expensive mixture. Therefore, offer breasts before and after the mixture.
• Don't insist. Don't force your child to eat the entire mixture. Let him determine how full he is. If the crumb stops opening its mouth or starts to turn away, stop.
• Do not increase the portion. If something has been spilled during feeding, you do not need to add this amount of mixture to either the current or the next supplement.
• Feed only a calm baby. If the child is crying, showing discontent, spinning, calm him down first. Try feeding in a different position or with a different device.

Neither a spoon nor a cup allows the baby to compensate for the sucking reflex. Therefore, frequent breastfeeding will be the solution to 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, it will be possible to completely abandon supplementary feeding.

Mix volume

The introduction of supplementary feeding involves the use of a certain amount of formula for feeding the baby in order to eliminate weight loss. Previously, mothers were offered clear standards. For example, at 2 months supplementation with HB should be 60 grams per day, at 3 months 90 grams, at 6 months - 240 grams. However, the mix volume table does not reflect the actual needs of the baby 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 formula feeding. The breastfeeding experts of the La Leche Liga associations, AKEV, insist on a completely different approach. He is supported by American and European pediatricians.

How do you know how much formula your child needs? Follow the next tactic.

• Count the number of times your baby urinates per day. Normally, it should be 12 times by the month's age of the baby and older. This means that the baby is getting enough food. Check this amount before adding supplements, you may not need it. For the test for "wet diapers" remove the disposable diaper from the crumbs for a day, count how many times he peed during the day.
• Compensate for each insufficient urination with a mixture, taking into account 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 he writes 8 times a day, the amount 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 (nipples, pacifiers), be sure to feed at night, especially between three and eight in the morning.
• Reduce the amount of formula while urinating sufficiently. Do the next wet diaper test a few days later. If there are more than twelve urinations, the amount of the mixture can be reduced.

Supplementary feeding should be offered to the child according to the scheme.

• By the hour. Divide the total volume of the mixture into 5 parts. Feed the baby by the hour, at regular intervals from six in the morning to twenty-four hours. That is, supplementation will be present at the first six o'clock morning feeding, then at 10, 14, 18 and 22 hours. Do not feed the mixture 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 so that the baby gets all the amount of mixture he needs per day.

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

The question of how to administer the formula while breastfeeding should not be decided solely by using supplements. 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 preserving supplementary feeding until the age of six months only for medical reasons, if the baby has diseases that exclude the possibility of full-fledged natural feeding.

Print

Supplementary food is additional food, given to a child of the first year of life, who is naturally breastfed with insufficient amount of human milk.

The role of supplementary feed is usually adapted dry mixes and products of plant origin.

Lure- this is the introduction to the infant of any new thick food, except milk and milk mixtures, more concentrated and qualitatively varied

Thick food includes: milk porridge, vegetable puree, cottage cheese, meat puree, kefir, fish puree, yolk, etc.

Supplementary feeding rules

Supplementation can be given one or more times a day in the form of independent feedings, alternating with the attachment of the baby only to the breast, or supplementation can be given immediately after attachment to the breast in several or all feedings.

If the amount of supplementation is small, then it is advisable to give it with a small spoon, because the easier flow of milk through the nipple can contribute to the baby's refusal from breast. For large amounts of supplementation, you can use the elastic teat with a small opening at the end.

If the baby does not eat the suggested amount during one feeding, more frequent feedings in smaller portions are required. This method is recommended for hypogalactia, when it is possible to stimulate lactation by frequent attachments to the breast.

Supplementation is given after breastfeeding. For supplementary feeding, the same milk mixtures are used as with artificial feeding.

It is desirable that the number of breastfeeding be at least three times a day, because with less frequent breastfeeding, the mother's milk disappears very quickly and the child is transferred to artificial feeding.

When choosing a formula for complementary feeding of a child, both with artificial feeding and with mixed feeding, the age of the child and the degree of adaptation of the mixture should be taken into account. The smaller the child, the more he needs highly adapted formulas.

Juices, fruits and complementary foods for a child with mixed feeding (as with artificial feeding) are introduced 2 weeks earlier than with natural feeding.

If the volume of human milk is more than ⅔– ¾ of the daily volume, then this variant of mixed feeding is close to natural. If the volume of human milk is less than ⅓, then it approaches artificial.

Rules for the introduction of complementary foods.

Complementary foods should be introduced when the baby is healthy;

It is impossible to combine the introduction of complementary foods and new complementary foods with preventive vaccinations. This is due to the fact that with diseases or reactions to vaccinations, there is a significant decrease in the enzymatic activity of the digestive glands. At this time, the processes of enzymatic adaptation to new types of food are significantly hampered.

The first complementary food should be monocomponent;

Each type of complementary food is introduced gradually over 5-7 days, and in some cases even longer up to 10-12 days.

The product should be offered repeatedly, at least 8-10 times, an increase in the positive perception of food occurs after 12-15 times.

Start introducing complementary foods with a small amount, gradually (from 1 teaspoon), since enzymatic adaptation to qualitatively diverse proteins (dairy, vegetable, meat) takes time and develops gradually, over 7-10 days. In the first days of the introduction of new food in the fasting secretion of the stomach there is still no ability of pepsin to completely digest the corresponding protein substrate. It manifests itself only by the end of the first or second week due to conditioned reflex influences on the secretion of pepsin in the phase of "ignition" juice secretion and the activation of digestive enzymes.

Complementary foods should be given before breastfeeding, starting with small amounts, in the morning, switching to another type of complementary foods only after the child gets used to the first type.

Only one new dish can be introduced at a time in order to assess the reaction of the child's body.

It is important to observe the principle of mechanical sparing. Food should be homogeneous (until the period when the child can chew food), not cause difficulty in swallowing. As the child gets used to the new dish and the age increases, one should move on to thicker foods, teaching the child to eat from a spoon.

When prescribing complementary foods, it is necessary to monitor the quality of the child's food, keep records of the food actually eaten, if necessary, calculate the intake of food ingredients per 1 kg of weight, and in case of a deficiency, carry out the necessary correction.

Cottage cheese and yolk should be prescribed no earlier than 7 months of life, since early introduction of a foreign protein leads to allergization, damage to functionally immature kidneys, metabolic acidosis and dysmetabolic nephropathy.

Meat broths are removed from complementary foods because they contain a lot of purine bases, which leads to damage to functionally immature kidneys.

Puree soups are prepared with vegetable broths. Food should be lightly salted: the kidneys of an infant poorly remove sodium salt from the body. In mashed potatoes produced by an industrial method, the sodium content should not exceed 150 mg / 100 g - in vegetables and 200 mg / 100 g - in mixtures of meat and vegetables.

From 8 months, kefir or other fermented milk mixture can be prescribed as complementary foods. Unreasonable widespread use of kefir as a complementary food in the first months of life can cause a violation of acid-base balance in a child, acidosis and create an additional load on the kidneys. It is not recommended to dilute cottage cheese with kefir, as this dramatically increases the amount of protein consumed. Cottage cheese should be used with fruit or vegetable puree.

The timing of the introduction of complementary foods

Earlier than 4 months, the child's body is not physiologically prepared for the perception of new dense food. And after six months it is undesirable to start, as there may be problems with adaptation to food of a denser consistency than milk. Therefore, according to most experts in the field of baby food, the first complementary foods should be introduced during the period from 4 to 6 months of age. With artificial feeding, you can start complementary feeding from 4.5 months, with breastfeeding - from 5-6 months. Remember that the timing of the introduction of complementary foods is individual.

Inadequate energy and nutrient intake from breast milk alone can lead to stunted growth and malnutrition; due to the inability of breast milk to meet the needs of the baby, micronutrient deficiencies, especially iron and zinc, may develop; optimal development of motor skills, such as chewing, and a positive perception of the new taste and structure of food by the child may not be ensured.

Therefore, it is necessary to introduce complementary foods in due time, at the appropriate stages of development.

1 complementary food - 5 months.

2 complementary foods - 6 months.

3 complementary foods - 8 months.