Mixed feeding

1. Mixed feeding by Svitlana Nykytyuk

2. Mix-feeding • – the feeding of the babies of first 5-6 mo with human milk and formula in which the volume of formula is more than 1/5 of daily volume (or the daily volume of the human milk is less than 4/5).

3. There are two kinds of mix feeding: • Mix-feeding closed to breast-feeding • Mix-feeding close to formula feeding • Mix-feeding closed to breast-feeding – the feeding of the babies with human milk and formula in which the ratio between them in daily volume are 2:1 (or 2/3:1/3). • Mix-feeding close to formula feeding - the feeding of the babies with human milk and formula in which the ratio between them in daily volume are 1:2 (or 1/3:2/3).

4. Mix-feeding indication: • In causes of mother’s diseases: • hypogalactia (oligogalactia); • Some diseases in that mother must decreased the quantity of feeding: • mastitis; • anemia of severe degree; • using of medicine (medicament); • erythroderma. • Human milk inferiority (fat’s, protein’s or carbohydrate’s inferiority).

5. In social and living conditions • Mother is working and can’t nurse a baby for all feeding. • Closed children institution in which the amount of donor human milk is not in enough quantity. • In causes of baby’s diseases: • Congenital malabsorption syndrome: hypolactasia

6. Hypogalactia (oligogalactia) • Hypogalactia (oligogalactia) – is decreasing human milk secretion. • Hypogalactia is divided into primary and secondary. • Primary hypogalactia – is very rarely diseases (only 1-3 %). It is connected with neuro-humoral disorders in mother’s organism or undeveloped breast or carried mastitis during previous deliveries.

7. Secondary hypogalactia - can appear in case of • not correct day regimen during pregnancy and delivery; • not correct carrying for breasts (nipple crack, erosion, mastitis); • incorrect mother’s nutrition

8. There are four degree of hypogalactia: • I-st degree – deficiency of the human milk is less than 25 % of the daily requirements; • II-nd degree – deficiency of the human milk is between 25 and 50 % of the daily requirements; • III-d degree – deficiency of the human milk is between 50 and 75 % of the daily requirements; • IV-th degree – deficiency of the human milk is more than 75 % of the daily requirements.

9. There are two methods of mix-feeding: • classic • Interchanging (rotate) method. • Classic method is used in babies younger than 3 mo. In this method for each feeding the formula is given.

10. For example: the child 2 mo is in mix-feeding closed to breast-feeding. The weight at birth was 3300 gm • The normal weight of the child is 3300+600+800=4700 gm • Daily volume is (will use volume method of calculations) • 4700/6=783 ml • Volume for one feeding is 783/6=130 ml • If the child is in mix-feeding closed to breast-feeding that the quantity of human milk must be 2/3 and formula 1/3. So, the quantity of human milk will be 130:32=86 ml and formula 44 ml.

11. Menu • 6.00 o’clock86 ml of human milk + 44 ml of Hipp 1 • 9.30 o’clock86 ml of human milk+ 44 ml of Hipp 1 • 13.00 o’clock86 ml of human milk+ 44 ml of Hipp 1 • 14.30 o’clock86 ml of human milk+ 44 ml of Hipp 120.00 o’clock86 ml of human milk+ 44 ml of Hipp 1 • 23.30 o’clock86 ml of human milk+ 44 ml of Hipp 1

12. Interchanging method is used in babies older than 3 months. In this method the human milk is given for first and last feeding. In others feeding formula or human milk is given (it depend of kind of feeding). • For example: the child 3.5 mo is in mix-feeding closed to formula-feeding. The weight at birth was 3300 grams • The normal weight of the child is 3300+600+800+800+375=5875 g • Daily volume is (will use caloric method of calculations) • 115kcal5.875kg=676 kcal/day • 700 kcal – 1000 ml of human milk • 676 kcal – X ml of human milk • X=956 ml – that is the daily volume • Volume for one feeding is 956/5 = 190 ml • If the child is in the mix-feeding closed to formula-feeding, so the first and last feeding is human milk and other - formula

13. Menu • 6.00 o’clock190 ml of human milk 10.00 o’clock190 Hipp 1 +20 ml apple juice • 14.00 o’clock190 ml of Hipp 2 +15 ml of apple juice • 18.00 o’clock185 ml of Hipp 1+5 ml of apple puree • 22.00 o’clock190 ml of human milk

14. Bottle feeding • Some mothers choose to bottle feed from the start and others will change over from breast to bottle feeding after weeks or months, so they need practical advice.

15. Bottle feeding • A cows’ milk formula specially modified for infants should be used in which the protein has been reduced, the casein partly replaced by whey protein, the fat made more unsaturated, the lactose increased, sodium and calcium reduced, and enough of all the essential micronutrients added.

16. Bottle feeding • Bottles and teats should be washed in water and detergent (the bottle brush used only for this), rinsed and sterilised by boiling in water or by standing covered in sterilising solution (usually hypochlorite) in a plastic container. It saves time to prepare several bottles at once. Empty the water out of each bottle, without touching the inside, then fill to the mark with recently boiled water that has cooled some minutes, not too hot or it will destroy some vitamins and may produce clumping.

17. Bottle feeding • Exactly the amount of power in the manufacturer’s instructions should be put into the (wide mouthed) bottle, using the scoop provided (levelled with a clean knife, not pressed down). “One for the pot” can lead to obesity. Mothers and even nurses are often found to prepare feeds inaccurately. Screw on the cap and shake the bottle well. Bottles may be kept in the refrigerator for up to 24 hours.

18. Bottle feeding • If the hole in the teat is too small it can lead to aerophagia or underfeeding. Milk should drip from the inverted teat at about one drop per second. Teats need replacing every few weeks.

19. Bottle feeding • Babies do not mind cold milk but usually prefer it warm. The bottle should be not warmed for too long and the milk’s temperature should be checked by dropping some on the parent’s skin. Infant feed should be not warmed in a microwave oven once it is in the feeding bottle. Very hot fluid at the centre of the bottle may be missed and may scald the baby. For about the first eight weeks of life babies need to be fed every three to four hours, including the small hours of the morning. (Fathers can bottle feed as well as mothers.) By the end of the first week most babies are taking 120-200ml/kg per day (160ml/kg corresponds to the 1 old 2 fluid ounces per lb bodyweight).

20. Bottle feeding • Cereals or rusks should not be added to milk in the bottle and babies should not be left to sleep with a bottle in their mouth. • Vitamin drops, fruit juices, are not required as supplements to modern infant formulas. • Uncles, grannies, and baby sitters can give a bottle feed but parents should feed their infant themselves as much as possible with the same sort of closeness, cuddling, and communication as in breast feeding.

21. Weaning • In the first six months • Young infants cannot deal properly with solid foods (in reality semisolid foods at first) for the first four months. The natural time for starting solids (beikost) is when the energy provided by well established breast feeding starts to become insufficient. The Department of Health and other authorities advise that the introduction of any food to the baby, other than milk, should be unnecessary before the age of 4 months, but mothers may be tempted to jump the gun. Most babies should start a mixed diet not later than the age of 6 months.

22. Weaning • Weight in the lower half of the standard percentiles without other symptoms is not an indication to augment breast feeding. Breast fed babies tend to put on weight (and length) a little more slowly than bottle fed infants. Indeed, the standard percentiles, derived mostly from bottle fed babies, may not be ideal. The time to start thinking about adding solids is when the infant still seems hungry after a good milk feed. But by six months body stores of several nutrients, such as iron, zinc, and vitamin C, are often falling in exclusively milk fed infants, whether from breast or bottle.

23. Mean consumption of energy

24. In the second six months • In the second six months other liquids can be given from a cup, especially citrus fruit juices. Untreated cows’ milk can sometimes cause gastrointestinal bleeding from irritation by the bovine serum albumin. This does not happen with boiled milk or infant formulas (which have been heat treated). Iron-fortified infant formula contributes to iron intake, which is critical in the second six months of life. It is wrong to add any salt to the foods given to infants. A fully breast fed infant receives only about one-twentieth of the sodium in a typical British adult diet. There has been a quiet revolution in commercial baby foods; most contain no added salt or colours and only up to 4% sugar (needed with sour fruits). Infants’ sodium intakes have been found to shoot up after six months but more from home prepared rather than commercial baby foods.

25. In the second six months • An increasing range of foods is given in the second six months. Variety is likely to cover the needs for most nutrients and provide a basis for healthy food habits. Some fruits or vegetables should be given each day, but the most critical nutrients at this stage are protein and iron: finely minced beef and legumes should be given regularly and the protein in cereal foods should not usually be diluted by refining or by added fat or sugar. Foods should become progressively more chewy and fibrous and include rusks and other finger foods like bread or cheese. Babies do not usually like strongly flavoured foods like pickled onions. Nuts, popcorn, raw peas, and similar small hard foods should be avoided; they can be breathed in accidentally. Commercial baby food manufacturers offer a succession of “strained”, “junior”, and “toddler” foods for maturing babies, and similar meals are usually made at home. Some cookbooks for babies are more sensible than others.

26. In the second six months • Milk continues to be the main source of calories but a diminishing one. Sweetened fruit juices should be given by cup not bottle because the latter can promote dental caries. Infantile obesity is probably becoming less common in the United Kingdom now that people are aware of it. It is not usually caused by bottle feeding or early introduction of solids in themselves, but by more concentrated feeds, by pushing food at mealtimes, or by snacks in between. Between feeds, water for thirst and a minimum of snacks or sweets are good general rules.

27. A suggested timetable of the introduction of solid foods

29. Milk cereals, g 6-6.5 5-50 50-100 150 180 200 Kefir, мl 7.5-8 - - 10-50 50-150 150-200

30. Cheese, g6,5-7,5 5-25 10-30 30 30 50 egg, шт.7,0-7,5 - 1/8-1/4 ¼-½ ¼-½ ½-3/4 Мeat, g6,5-7,0 5-30 30 50 50 50-60 feesh, g9-10 - - 10-20 30-50 50-60 Оil, g6 ½ч.л ½ч.л. 1 t.s1 ч.л 1 ч.л

32. Test Mixed feeding • Choose the term of giving fruit juices for the child on mixed feeding: • 2 weeks • 1 month • 3 month • 4 month • elder than 6 month • Advisable term of giving egg yolk for the child on mixed feeding: • from 3 month • 4 month • 5 month • 6 month • 7 month • What does it mean accessory feeding : • milk formula • vegetable puree • fruit juices • porridge • Advisable term of giving fruit puree for the child on mixed feeding: • 1month • 2 month • 3 month • 4 month • 5 month • Most better formula for mixed feeding 2-month baby: • “NAN” • “Detolact” • Acidofile milk • “Krepish” • easy formule N3