How correctly and when is it better to introduce the first complementary foods for premature babies on artificial feeding?

Every pregnant woman knows that the “interesting situation” lasts for 9 months. The expected period for the birth of a small miracle is considered to be the period from the 37th to the 42nd week. However, not all babies are born at this time. For some reasons, birth may occur earlier.

If a baby is born at less than 37 completed weeks, it will be considered premature. Such a baby requires close attention to himself, because in the process of nursing him various problems can arise (for example, diseases can be detected in premature babies).

Nutritional Features

Premature babies are low weight. But, as a rule, over time they move into a phase of active growth and catch up with their peers. This process requires intensive energy intake into the body. However, the digestive system in premature babies is not fully developed, some of its abilities are limited, and reflexes associated with food intake, such as sucking or swallowing, are often poorly expressed.

The diet and composition of nutrition for each premature baby is prescribed strictly individually. In this case, the initial weight of the newborn is taken into account. A baby weighing up to 1.5 kg is significantly different in development from a two-kilogram baby, which will also affect nutrition. At first, it will be parenteral (nutrients are administered intravenously), because the baby does not yet know how to eat on its own.

Is the baby ready for complementary feeding?

When a child reaches six months of age, he begins to lack the nutrients found in mother's milk. To replenish their number, complementary foods are introduced. Complementary feeding also helps to form taste preferences and promotes the development of chewing reflexes. You can understand that your child is ready to accept new food by the following signs:

Reaching six months of age;

The baby has cut several teeth;

The child begins to chew a pacifier or toy;

The baby knows how to sit and begins to show interest in food;

The child digests small portions of new food well without a negative reaction to it.

Important first feeding

The baby was born premature. When is he fed? Here you need to focus on the general condition of the baby. If the condition is assessed by specialists as normal, the first feeding begins a few hours later. Provided that the baby is able to suck. Here the time may vary, but, according to doctors’ recommendations, it should not exceed a day from the moment of birth.

But if a child has hypoxia, it is necessary to extend the “hungry” period. Also, premature babies are often given intravenous glucose solution (a type of parenteral nutrition).

Table of products by baby's age

For clarity, we have placed products by child’s age, but do not forget that everyone’s body is individual. It is impossible to say unequivocally that this and only this is correct; it is necessary to focus on how the child reacts to new foods (does he sleep well, is he not capricious, are there any rashes or upset bowel movements) and, depending on this, make changes to the diet.

Feeding frequency

When it comes to feeding premature babies, several factors influence the frequency of feedings:

• general condition of the baby;
• body weight immediately after birth;
• degree of immaturity.

If the baby has pathologies, he needs to be fed often - up to 10 times a day. The norm is 7 or 8 meals a day with 3-hour breaks.

Babies who cannot swallow and suck are fed using special tubes - they are inserted into the ventricle through the nose. As the baby grows, he is transferred to bottle feeding or breastfeeding.

Doctors' advice

There is no consensus among pediatricians about starting complementary feeding for such children. You need to look at the child’s development and the presence of associated health problems. Some believe that you can start complementary feeding from the age of 4 months, others adhere to the principle of not rushing and waiting until the body is better formed.

For example, the famous doctor Komarovsky recommends starting complementary feeding with fermented milk products at the age of 6 months . In his opinion, it is necessary to continue after a month and add milk porridges, then by 9 months soups and vegetables are allowed, and by 10 months the baby can learn about lean varieties of meat.

Mother's milk

It is no secret that the best nutrition option for any baby under one year old (including premature babies) is breast milk. The protein composition of colostrum, which is produced in the first 3-5 days after birth, as well as transitional and especially mature milk of a nursing mother, is optimal for a premature baby.

Such food is rich in lactose, which is quickly broken down, absorbed and absorbed by the child’s body. Mother's milk has a number of important functions, including:

• provides reliable protection of the intestinal mucous membranes;
• prevents the attack of viruses and bacteria;
• minimizes the negative impact of allergens.

In women who gave birth to a child earlier than planned, the composition of the milk is slightly different from the standard. The fat content is much lower than normal, but the percentage of proteins, on the contrary, is increased. But this is exactly what a premature baby needs.

How to prepare

By about 4-5 months, the pancreas is already actively working, digestive microflora appears in the intestines, and chewing reflexes develop. All this allows the body to calmly accept thicker food and digest it well.

The main task of introducing complementary foods is to strengthen chewing skills, get used to new tastes, and train the digestive tract. A growing body needs many beneficial substances that are not found in sufficient quantities in breast milk.

External signs of a child’s readiness:

• Age more than 6 months.
• The appearance of the first teeth.
• The appearance of chewing movements.
• Ability to sit.
• Showing emotions towards different foods.
• Sufficient development of the digestive system and readiness to accept thicker food consistencies.

A premature baby requires a smaller portion. They begin to supplement with cereals, then vegetable and fruit purees. Every meal starts with a supplement and ends with breast milk. This makes it easier for the digestive tract to cope with unfamiliar food.

In case of malaise, allergies or dysbacteriosis, innovations are suspended until the condition improves.

Attaching to the breast

As soon as the premature baby develops a sucking reflex and doctors note that he is feeling well, the baby begins to be breastfed.

To save the strength of a baby weighing more than 2 kg, latching onto the mother’s breast is carried out only 1-2 times a day. Other feedings are done using a pacifier.

With the appearance of signs of fatigue, which are manifested by sluggishness of sucking, as well as blueness of the area around the mouth, breastfeeding is temporarily suspended and a bottle of pre-expressed milk is used. At this time, the doctor should monitor the amount of milk the baby eats by weighing the baby before and after feeding.

Dairy products

The third complementary food is introduced after 9 months. Cottage cheese, kefir, and yogurt are added to the menu of a premature baby. They start feeding with half a teaspoon, gradually building up to a whole portion, which will replace one of the feedings, usually in the evening. It is better to try cow's and goat's milk after six months, since the proteins in its composition are poorly absorbed. Fermented milk products should be prepared from pasteurized milk or taken from a dairy kitchen.

Closer to the year, you can try hard cheese that will not have a strong smell and will have a delicate taste, for example, Russian, Dutch or Adyghe.

Quantitative norms

On the first day of the baby’s life, the volume of each subsequent feeding should be 5 ml greater than the volume of the previous one. Ideally, on the 3rd day, the amount of breast milk drunk at one time reaches 15-20 ml. But this is only average data.

Acceptable portions are determined by the pediatrician on an individual basis. To calculate whether a child has received the norm of basic nutrients, doctors use the so-called “calorie” calculation method.

According to the data, when a premature baby reaches the 1st month, the energy value of food per day should be 130-140 kcal per 1 kg of weight. Whereas a timely born baby will need only 115 kcal.

By the end of 2 months, children who weighed more than 1.5 kg at birth can reduce their caloric intake by 5 kcal per kg of weight per day. For babies who weighed only 1-1.5 kg at birth, it is not recommended to reduce caloric intake until they reach 3 months.

Next, calorie content can be reduced by 5-10 kcal/1 kg with each subsequent month until the indicators are equal to those for full-term babies.

The volumes of food required specifically for your baby are prescribed by your pediatrician during a general examination.

Development of a premature baby by month

When a baby is born ahead of schedule, parents begin to worry about how premature babies develop. So, in the first month of life, a baby is susceptible to various infectious diseases, the course of which can be accompanied by serious complications. This is why parents should protect their child. During the first month after birth, the baby gains very little weight. With normal development, a sucking-swallowing reflex appears. In its absence, feeding is carried out using a tube. If the respiratory reflex is poorly developed, artificial oxygen supply is required.

At the 2nd month, the baby begins to gain weight. This is a sign of good development. When breastfeeding, premature babies become very tired. It is necessary to supplement with expressed mother's milk from a spoon.

At the 3rd month, weight increases 1.5 times. The baby sleeps more, so parents should take care of the climate in the children's room and the change in the position of his body during sleep and wakefulness.

A child who is 4 months already begins to try to raise his head and hold it, make sounds, fix his eyes, and at the 5th month he is already smiling and trying to grab toys with his hands.

In 6-month-old babies, weight increases by 2–2.5 times. They are already turning their heads, playing with toys, reacting to various sounds, distinguishing relatives from strangers. At this age, premature babies are already catching up with their peers in development.

At the 7th month, the baby can independently roll over onto his back from his tummy. He is already playing more actively.

At 8 months of age, the baby easily rolls over, makes the first attempts to crawl, and at 9 months he can stand on his feet, while holding onto a barrier, plays more actively with toys, and independently picks up pieces of food with his hands.

Babies at 10–11 months become even more active. They make different sounds, respond to their name, and crawl.

One-year-old premature babies catch up in development with their peers who were born on time. They are already beginning to pronounce syllables. Parents should not teach them to walk yet, because babies should develop gradually.

Vitamins

There is an opinion that breast milk contains a complete set of all substances necessary for growth and development. Even if the baby does not need to be given special vitamin preparations directly, a nursing mother may need to think about it, especially if her baby was born premature.

But! Taking vitamins by a breastfeeding woman is associated with high risks and requires medical supervision. Do not neglect consultation with your doctor!

About iron deficiency

Premature babies often suffer from iron deficiency in the body. Moreover, this mineral substance is not present in sufficient quantities either in mother’s milk or in most types of special baby food.

Therefore, you have to rely on drugs in the form of syrups and drops, but with a limited course of administration. Here, too, you cannot do without medical advice, otherwise you can harm the baby.

In addition, on the recommendation of a specialist, iron-fortified mixtures can be introduced into the children's diet. This will make up for the mineral deficiency in the body of a premature baby and avoid negative consequences.

When should you introduce food to your toddler?

The tactics of complementary feeding on artificial feeding are determined by the doctor, but parents must also navigate the basic issues. It depends on the weight at which the newborn was born. If his weight was more than 2 kilograms, then the child’s main menu consisted of mother’s milk. For a toddler whose birth weight was less than two kilograms, the diet from the first days included additional components (fortifiers with added minerals, protein, vitamins).

Important! In what quantity and for how long to add fortifiers to food, only a qualified specialist can determine.

1. The first complementary feeding product is baby porridge, enriched with minerals and vitamins.
2. After porridge, the baby should be introduced to vegetables. Preference should be given to local products, so zucchini, cauliflower and carrots are a sufficient list of products for the first time.
3. Fruits. The turn has come to the first fruits; they can be a pear and a ripe green apple. If the child responds well to them, you can allow him to give him a banana and a peach.
4. The next main product that a child should receive is meat, preferably industrially produced (the consistency of such products is such that an immature child can assimilate and digest them more easily). Usually the turn for meat comes at the age of 8 months.
5. Do not forget about oils; a premature baby must receive 1-2 teaspoons of vegetable oils and 1 tsp of butter.
6. Last but not least, they give eggs and non-fatty fish; this happens already at the age of 9 months, or even one year.

Formula feeding

Artificial nutrition of premature infants involves the use of special infant formula. But this can only be done after the doctor’s approval.

Large baby food companies have started producing formulas for low-weight babies who are in a hurry to be born ahead of schedule. The most famous brands for children under one year old:

• "Humana O";
• "Pre-Nan";
• "Pre piltti";
• "Frisopre";
• "Novalak-MM".

It is necessary to dilute the mixture with special bottled baby water, since simple boiled water is “heavy” for the baby’s stomach.

Even in the last century, it was recommended to feed premature babies with kefir, but today pediatricians do not advise giving this product to prematurely born babies. Breast milk or formula is a much safer choice.

about complementary feeding with kefir.

Basic cooking rules

It is important to adhere to a certain sequence of dishes and strictly monitor the serving size. Uncontrolled introduction of complementary foods to premature babies can lead to stomach upset and refusal of new food.

Simple rules help parents effectively develop their premature baby:

• The first portions should be only a few grams. The portion increases gradually and within a month reaches the recommended daily amount.

• Products are introduced separately. Only after getting used to it for several days, the next one is offered.

• The best time is the first half of the day.

• Breast milk is the best nutrition, so it is advisable to pamper your child with it for as long as possible.

• Feed exclusively hypoallergenic food. A nursing mother must monitor her diet and avoid suspicious ingredients in food.

In addition to preparing new children's dishes yourself, you can use ready-made goods. A wide range of baby food is offered in almost every grocery store. It is necessary to carefully check the shelf life and choose the composition in accordance with the age of the baby.

Complementary feeding tactics

Photo: Depositphotos.com. Author: oksun70.

Premature, weak, and underweight babies need to introduce complementary foods as carefully as possible, taking into account all the physiological parameters of the baby.

In case of prematurity, it is better to start complementary feeding with cereals (oatmeal, rice or buckwheat) with the addition of a small amount of breast milk or an adapted formula.

It is very important to strictly follow the steps to increase the concentration of porridge, which is introduced into the children's diet:

• At first, only 5% is given (100 ml of water per 1 tsp of crushed cereal).
• Next, the baby is allowed 7-8% (100 ml of water per 1.5 tsp).
• The final stage is 10% (100 ml of water per 2 tsp).

Closer to one year, you can add a drop of olive or sunflower oil to this baby dish, and only then add butter (3-4 g per serving). But oil should not be included at all in ready-made packaged instant porridges.

Juices

As a rule, pediatricians recommend that their patients begin complementary feeding with vegetable and fruit juices at the age of 3 months with one or two drops, gradually increasing the amount. However, today some experts question this technique and do not recommend giving juices at all for up to six months.

If you support the idea of ​​early complementary feeding, learn a few simple rules that will help you avoid problems.

1. Babies under 6 months should not be offered undiluted juices. This can be bad for a weak stomach. Usually the juice is diluted with warm boiled water in a 1:1 ratio.
2. The main type of juice used for early complementary feeding is apple juice.
3. For babies prone to constipation, it is recommended to try blackcurrant or beetroot juice.
4. There is no need to rush into introducing carrot, tomato and grape drinks. A child will try them after a year, and a tomato one after 3 years.
5. Children with allergies should avoid red juices (strawberry, raspberry, strawberry, etc.).

Puree

Fruit or vegetable puree is introduced only after the baby gets used to the juices. They usually start with 1/4 tsp.

From 3-4 months, you can add a quarter of chopped boiled yolk to the vegetable puree. For several days after this, it is necessary to observe the reaction of the child’s body to the new product.

It is undesirable to introduce two or more new products into the diet at the same time. Otherwise, if an allergic reaction occurs, you will not be able to determine its source.

At approximately the same age, a premature baby begins to be introduced to cottage cheese: about 10 g during the first month, then up to 20 g and so on - up to a single serving of 50 g.

From vegetables to meat

To prevent anemia, meat puree is included at the age of 5 months. Portions should not exceed 10 g, they should not be given more than 2-3 times during the week.

At 7 months, a premature baby must eat meat purees. At this time, the single portion increases and reaches 50 g by one year.

Already at 8 months, it is quite logical to supplement the baby’s menu with unsweetened cookies or bread. At the same time, vegetable soups are introduced, which are replaced by meat broths by the year.

When planning nutrition for premature babies, attention should be paid to the child’s physical parameters, not forgetting to monitor his weight gain monthly. The growth and development of premature babies often occurs more intensively. And therefore, at 2 years old, such children often “catch up” and even “overtake” their peers.

Caring for a premature baby

Premature babies require careful care. Mothers should pay special attention to the following factors:

1. The climate in the children's room.
2. Newborn clothes.
3. Bathing.
4. Take a walk.

1. Climate in the children's room

The climate in the room where they are located has a huge impact on the development of a newborn child over the months. The room should be regularly ventilated. If it’s hot outside, you don’t have to close the window, but you need to make sure that there are no drafts.

The optimal air temperature in a children's room is 23–25 degrees. Near the baby (under his blanket) the temperature should be higher - about 28–32 degrees. Often there is a need for additional heating. Your doctor may recommend the use of rubber heating pads, the water temperature of which should be about 60–65 degrees.

They are placed under the blanket at the feet and on top of the blanket on the sides at a palm's distance from the body. Hot water bottles should not burn the baby, so they should be wrapped in towels, diapers or placed in special bags. Caring for a premature baby should include changing water in heating pads every 1.5–2 hours. At the same time, you cannot completely deprive the baby of heat. The heating pads need to be changed one at a time.

Artificial heating can be abandoned by the end of the 1st month of the child’s life, since by this time he will already be able to “maintain” body temperature on his own.

Air humidity plays an important role . Indoors, its optimal level should be about 50–70%. You can monitor this parameter using a special device - a hygrometer. During operation of central heating radiators, air humidification may be necessary. A special humidifier will be an excellent help. It can be replaced by wet towels or fabrics hung around the room, or placed vessels with water.

2. Newborn clothes

If the child's weight is more than 2000 g, then the newborn does not need additional clothing or blankets. It can be dressed in the same way as a full-term baby. If the baby weighs less than 2000 g, then he needs more things. The baby needs products for premature babies, such as a blouse with sewn-up sleeves and a hood, a knitted cap, a diaper, and rompers.

Mothers should not swaddle their child tightly, because this will make it harder for him to breathe. In addition, the baby needs to be regularly shifted from one side to the other.

3. Bathing

Babies whose body weight is less than 1500 g are not recommended to be bathed during the first 2 or 3 weeks of life. Other premature babies can be bathed 7–10 days after birth.

Bathing a premature baby during the first 3 months should be done using boiled water. In the bath, the water temperature should be about 38 degrees, and in the room - at least 25 degrees.

4. Walks

Mothers with premature babies should be very careful when walking. A sharp change in temperature can affect the health of the baby. If the child weighs more than 1500 g, then you can go for a walk with him after more than 2 weeks have passed since his birth. The weather should be warm outside, and the air temperature should be about 25–26 degrees. The first walk between mother and baby should be short – 10–15 minutes. Gradually, the time spent in the fresh air should be increased to 1–1.5 hours.

In spring and autumn, when the air temperature is at least 10 degrees, you can walk with babies whose age is 1–1.5 months, and whose body weight is not less than 2500 g. If the thermometer on the street shows less than 8–10 degrees, then you can go out at that time only with 2-month-old babies whose body weight is 2800–3000 g.

Vaccinations for premature babies

For babies born at the wrong time, the pediatrician draws up an individual vaccination schedule, paying attention to the baby’s health status, as well as its psychomotor development. If the baby is absolutely healthy and his birth weight is more than 2000 g, then the vaccination schedule will be the same as for full-term children.

Newborns born weighing less than 2000 g are not given the tuberculosis vaccine (BCG) in the maternity hospital. The pediatrician will perform it after the child’s weight reaches 2500 g. Vaccinations are not given to newborn children weighing less than 1500 g during the 1st year of life.

Massage for premature babies

Babies born too early are developmentally behind their peers. To catch up with them according to age standards, it is recommended to carry out a massage. It can be started from the 1st month of life if the child weighs more than 2500 g.

If the child is 1–1.5 months old, then it is recommended to limit yourself to simple stroking. After the baby is 2-3 months old, you can move on to more intense massage techniques for premature babies: kneading, rubbing, tapping, passive gymnastics (bending legs and arms, etc.).

If you weigh more than 2000 g, it is recommended to start exercises from 2 or 3 months, and if you weigh less than 1500 g - from 6 months.

Parents of premature babies should consult a pediatrician and a professional massage therapist. Experts will recommend individual exercises that will not harm the baby and will be beneficial to him.

In conclusion, it is worth noting that nursing a premature baby is an important and rather complex undertaking. Recommendations for specific actions should be given by a pediatrician. Only he can advise what will benefit the baby and will not harm him. And remember that the most important thing for a baby is your love. If he feels it, then soon you will no longer remember that the child was born prematurely and lagged behind other children in development.

Features of feeding children prone to allergies

A tendency to allergic reactions is not a reason for delaying the start of complementary feeding. You just need to listen to the doctor’s recommendations and carefully monitor the reaction of the child’s body. The pediatrician always warns about the possible consequences of eating disorders and recommends gentle diets.

Some feeding rules:

• Close observation for several days after introducing a new product.

• Gradual increase in volume. Keeping a food diary.

• During an exacerbation, it is necessary not only to exclude the product containing the allergen, but also to postpone introducing new ones.

• Fish and yolk are usually excluded from the diet.

If you are allergic to cow protein, the child's body requires low-lactose or soy foods. Limiting dairy foods leads to micronutrient deficiencies. In addition, beef is excluded. In this case, dishes made from turkey and lean pork are considered safe. Instead of fermented milk food, vegetables are prepared for the second complementary feeding.

In infancy, allergies are mainly caused by dairy derivatives. Towards the end of 1 year of life, it can be provoked by fruits, vegetables, seafood, and yolk. The peculiarity of complementary feeding is to promptly identify dangerous products and replace them with ones of equal importance. This is necessary for the full physical and mental development of the child.

A premature newborn requires close attention not only in relation to nutrition. Regular examinations, vaccinations, hardening, water and air baths help him get stronger and gain weight. And a mother’s healthy lifestyle, her varied diet, and proper rest help restore health and strengthen the nervous system.

Rules for introducing complementary foods for premature babies

When a mother begins to introduce complementary foods to a premature baby, her greatest fear is an allergic reaction. Fortunately, premature babies are not at increased risk of developing allergies. Although you should still be careful and prudent.

There is no need to give your baby everything at once; it is better to start with hypoallergenic vegetables (zucchini, cauliflower, peas, spinach, pumpkin, carrots). Vegetable dishes are rich in vitamins, but have low calorie content. Therefore, to make your little one’s lunch more satisfying, mix vegetables with potatoes.

Once your baby has become familiar with vegetables, you can introduce pureed meat into your diet. Premature babies require a lot of protein, and therefore doctors prescribe them meat purees a little earlier than other babies. Choose easily digestible and hypoallergenic meats. This is a rabbit and a turkey. Then try chicken and veal. Meat puree can be mixed with vegetable puree to create a light but satisfying soup.

The first porridge for a premature baby should be gluten-free, dairy-free, mono-ingredient, sugar-free and without fruit and vegetable additives. It's best to start with corn, buckwheat or rice. Remember that a reaction can also occur to hypoallergenic porridge, so introduce it gradually.

Does your baby already eat vegetables, meat and porridge? It's time to introduce him to sweets! Your little one will surely love fruit puree. Choose the safest ones - from apple, pear, plum and banana. They can be mixed with breast milk, formula or porridge.

But there is no need to rush with cow's milk: it is administered to premature babies no earlier than 15 months of corrected age. This applies to cottage cheese, yoghurt and kefir. It is better to give fermented milk products at night, and you need to carefully examine the baby for possible rashes.

The same applies to fish, which is the strongest allergen. Start introducing it closer to the year.