Premature babies: feeding features.

It is especially important to feed premature babies with mother's milk - it contains all the necessary substances that meet the baby's needs. A premature baby has its own characteristics - the digestive system of such children is not yet sufficiently developed, and the sucking reflex may be weak - therefore they need to be fed more often, in small portions. You may have to resort to supplementary feeding and special feeding methods. If breastfeeding is impossible for some reason, the doctor will recommend a special milk formula for premature babies.

How to position the baby correctly at the breast?

There are feeding positions that take into account the characteristics of premature babies. One of the most effective positions for application is “from under the arm”. This position provides good support for the baby's shoulders and neck, helping him to latch onto the nipple more comfortably. Due to poor regulation of breathing and swallowing, as well as decreased muscle tone, premature babies often swallow too much air. To avoid this, it is recommended that a woman lean back during feeding so that the baby lies on top of her chest: this position will reduce the pressure of the milk and it will be easier for the baby to swallow it.

How to help your baby keep the nipple in his mouth?

Premature babies often have difficulty keeping the nipple in their mouth because they have not yet developed the ridges on the palate and the fatty pads of the cheeks. In such cases, the mother, putting the baby to the breast, can support his cheeks with her thumb and forefinger, put her middle finger under her chin, and hold her breast with her little and ring fingers.

How much should a premature baby eat at one feeding?

If the baby weighs more than 2500 g, the total amount of food per day is determined at the rate of 150 ml of milk or formula per kilogram of weight. If the child is on, the resulting amount is divided into eight feedings (every three hours). A child weighing less than 2500 g at birth should receive 60 ml of milk on the first day, then the total volume increases by 20 ml per kilogram of weight daily until the daily portion is 200 ml. The following formulas are also used: daily feeding volume = (n+10) for every 100 g of body weight at birth (n-days of life); or one-time feeding volume = 3 x m x n, (m-birth weight in kg). It should be taken into account that adjustments are needed for the individual needs of the child.

How many times a day should a premature baby be fed?

The number of feedings of the baby depends on his weight and general condition, as well as on the type of feeding (or). With artificial feeding, premature babies can have up to seven to eight feedings per day, with a six-hour night break. With extreme prematurity, the number of feedings can be increased to ten. When the baby weighs 3.5–4 kg, he can switch to six feedings a day. The mother needs to remember that such a baby may have difficulty sucking, and during feeding he may take breaks for a few minutes to rest. If the mother is breastfeeding, then she needs to combine feeding according to the schedule and “on demand”, avoiding long breaks between feedings.

How to choose formula for premature babies?

Most manufacturers have in their arsenal special formulas for premature and low birth weight babies. However, before choosing one of them, you should consult your pediatrician. If the child in the maternity hospital has already been supplemented with some kind of formula, and he reacted positively to it, it is worth focusing on it.

How does a premature baby gain weight?

Any positive dynamics indicate that everything is fine with the child. Mom should be wary of weight loss or prolonged stagnation (lack of weight gain).

Is it necessary to give extra food to a premature baby?

If the baby is fully breastfed, there is no need to supplement him. If we are talking about artificial or mixed feeding, then he can be given clean water from a spoon or pipette. Many modern adapted mixtures may not require additional fluid administration.

Does my child need additional vitamins and minerals?

It is believed that premature babies need additional vitamins, especially when bottle-fed. In the first three days of life, premature babies are prescribed vitamin K and vitamin C. Two to three weeks after birth, additional vitamin D is given to prevent rickets. To prevent anemia, a premature baby also needs iron (its supply is formed precisely at the end of pregnancy, and the more premature the child is, the less iron it has).

Does a nursing mother of a premature baby need to take vitamins?

Apart from the vitamin complex prescribed by the doctor, no other medications are required. A normal balanced diet is quite enough for a nursing mother.

What are the features of breastfeeding premature babies?

It is better to put the baby to the breast in the delivery room, and immediately express the first drops of colostrum into his mouth. However, this can be difficult - premature babies often require intensive care or resuscitation immediately after birth. But even in this case, it is advisable to try to put the baby to the breast as soon as possible or give colostrum through a feeding tube. As soon as the baby gets stronger and is transferred from the intensive care unit to a regular ward, you can begin to put him to the breast regularly - this will help the rapid formation of the sucking reflex, which is less developed in premature babies than in those born at term. Premature babies are weakened and may not have enough strength to suck. Weak babies born at low birth weight or less than 32 weeks' gestational age are nursed using a nasogastric tube. When the baby is strong enough, he can be put to the breast more often: this way he will have more opportunities to learn to latch onto the nipple correctly. You can feed the baby from a bottle, and if the sucking reflex is weak - from a special soft spoon, cup, syringe without a needle or a Habermann sippy cup, as well as using the SNS system (a capillary coming from a bottle with expressed milk or formula, it is placed in the baby’s mouth along with the nipple).

Should a premature baby be fed on demand?

It is important to remember that feeding a premature baby “on demand” usually does not work: such children hardly express the desire to eat and sleep a lot. The mother of a newborn needs to combine scheduled feeding and response to “demand”, and make sure that there are no long gaps between feedings. Most likely, additional pumping will be needed: the baby may rarely attach to the breast and suck weakly, so even with frequent feedings, milk production will not be sufficiently stimulated. Regular pumping will increase and allow you to supplement your baby with breast milk.

The organization of feeding premature babies consists of timely and adequate provision of nutrients and energy from the first days of life. A timely and balanced diet can ease the adaptation period and further reduce the risk of developing a number of diseases.

The basic principles of feeding premature babies are:

choosing a feeding method depending on the severity of the child’s condition, birth weight and gestational age;

preference for an early start of nutrition, regardless of the chosen method (within the first 2-3 hours after the birth of the child and no later than 6-8 hours);

mandatory minimal enteral nutrition with total parenteral nutrition;

use enteral feeding to the maximum extent possible;

at the end of the early neonatal period, enriching the diets of very premature infants receiving breast milk with “boosters” or using mixed feeding with the introduction of formulas based on highly hydrolyzed milk protein or specialized formulas for premature infants into the diet;

When artificially feeding, use only specialized milk formulas intended for premature babies.

Ways to feed premature babies

FEEDING CHILDREN BORN WITH A BODY WEIGHT MORE THAN 2000 G (GESTATIONAL DATE 33 WEEKS OR MORE)

Newborn babies weighing more than 2000 g with an Apgar score of 7 points or higher can be placed on the mother's breast in the first day of life. Typically, in a maternity hospital or hospital, a feeding regimen of 7-8 times a day is established. For premature babies free feeding is unacceptable Due to the inability of such children to regulate the volume of sucked milk and the high incidence of perinatal pathology, night feeding is possible. When breastfeeding, it is necessary to closely monitor the appearance of signs of fatigue (perioral and periorbital cyanosis, shortness of breath, etc.). Their appearance is an indication for less frequent breastfeeding or a complete transition to feeding expressed breast milk from a bottle. The doctor’s efforts should be aimed at maintaining breastfeeding to the maximum extent possible, taking into account the special biological value of mother’s native milk for an immature child and the important role of mother-newborn contact during feeding.

FEEDING CHILDREN BORN WITH A BODY WEIGHT OF 1500-2000 G (GESTATION DATE 30-33 WEEKS)

Children with a body weight of 1500-2000 g, who are in a state of moderate severity after birth, are given a trial feeding from a bottle, and the baby may be latched to the breast. If sucking activity is unsatisfactory, tube feeding is prescribed in full or partial volume (Fig. 6).

FEEDING CHILDREN BORN WITH BODY WEIGHT LESS THAN 1500 G (GESTATION LESS THAN 30 WEEKS)

Very premature newborns are fed through a tube. Tube feeding can be portioned or carried out using a long-term infusion method (Fig. 5). At portioned meals Depending on tolerance, the frequency of feedings is 7 times a day. Very premature infants with this method of feeding receive an insufficient amount of nutrients, especially in the early neonatal period, which dictates the need for additional parenteral administration of nutrients.

Long-term tube feeding carried out using syringe infusion pumps. There are various schemes for long-term infusion (Table 54).

During the night break, glucose solutions and Ringer's solution are administered if necessary. For children weighing more than 1000 g, the initial rate of milk administration can be 1.5-3 ml/kg/h. The rate gradually increases, reaching 7-9 ml/kg/h by the 6-7th day. This provides very premature or

Rice. 6. Ways and methods of feeding premature babies depending on body weight

more mature newborn children in serious condition receive a larger volume of nutrition than with portion feeding.

The advantages of long-term tube feeding compared to portioned administration of human milk or infant formula are as follows:

the volume of enteral nutrition increases;

the time of catabolic metabolic processes is reduced;

it is possible to reduce the volume, and in some cases, completely eliminate parenteral nutrition;

reducing congestion in the gastrointestinal tract;

reduction in the intensity and duration of conjugation jaundice;

maintaining a constant level of glucose in the blood;

reduction in the frequency of regurgitation and breathing disorders associated with feeding.

If the severity of the child’s condition does not allow enteral nutrition, parenteral introduction of nutrients. The required volume of solutions for partial parenteral nutrition is selected individually and gradually decreases as the premature newborn's resistance to enteral nutrition increases.

Total parenteral nutrition is prescribed to children who are in very serious condition, regardless of their gestational age. But even in these cases, trophic (minimal) enteral nutrition is carried out in parallel with parenteral nutrition. Minimum enteral nutrition is prescribed to:

formation and maintenance of normal functioning of the intestinal wall (enzymatic activity, motility);

preventing atrophy of the intestinal mucosa;

preventing congestion in the gastrointestinal tract.

It should begin in the first 6-24 hours after the birth of the baby. The initial volume of nutrition is no more than 10 ml/kg/day and increases gradually. It is preferable to carry out a long-term infusion of native mother's milk using infusion pumps, since a slow and prolonged introduction of food, unlike fractional feeding, stimulates intestinal motility.

Nutritional and energy requirements of premature infants

Taking into account energy expenditure, the energy needs of premature babies during the first 2 weeks of life amount to up to 120 kcal/kg/day. The calorie content of enteral nutrition for a prematurely born child should increase gradually and daily (Table 55).

By the 17th day of life, the energy value of a premature baby’s diet increases to 130 kcal/kg/day. When artificial feeding, it should not exceed 130 kcal/kg/day. The use of human milk in the nutrition of premature infants, as well as mixed feeding, implies an increase in calorie content by the age of one month to 140 kcal/kg/day.

When calculating nutrition for premature babies, you should use only the calorie method. Nutrition calculations for artificial feeding are made taking into account the energy value of the mixtures used.

Starting from the 2nd month of life of a premature baby born weighing more than 1500 g, the calorie content of the diet is reduced monthly by 5 kcal/kg to the norms accepted for mature children and amounts to 115 kcal/kg. Reducing the calorie content of the diet of very premature infants (body weight less than 1500 g) is carried out at a later date - after 3 months of age.

According to international recommendations, premature babies should receive 3.8-3.0 g/kg/day squirrel. Consumption of more than 4 g/kg/day of protein leads to severe metabolic disorders. It has been established that even very premature babies digest, absorb and utilize protein quite well, and the younger the child’s gestational age, the higher his need for protein.

For premature babies, the quality of the protein component is of particular importance. The predominance of casein in food products leads to low protein absorption and an imbalance of amino acids. Therefore, when feeding immature children, only mixtures with a predominance of whey protein fraction can be used.

Formulas based on soy protein isolate should also not be used in the nutrition of children born prematurely, since the absorption of nutrients from them, especially minerals, is difficult.

The most optimal intake for premature babies is 6-6.5 g/kg fat per day. To facilitate the process of assimilation of the fat component of specialized products intended for feeding premature babies, medium-chain triglycerides are introduced into their composition, which are absorbed into the portal vein system without preliminary splitting, bypassing the lymphatic system.

Prematurely born babies are not able to sufficiently synthesize long-chain polyunsaturated fatty acids from linoleic and linolenic acids, so arachidonic and docosahexaenoic fatty acids are included in specialized foods for premature babies.

It is assumed that prematurely born children, regardless of the type of feeding, should receive about 10-14 g/kg carbohydrates. Reduced lactase activity, amounting to 30% of its level in a mature newborn at 28-34 weeks of gestation, makes it difficult for premature infants to break down lactose. To improve the digestibility of the carbohydrate component in specialized dairy products, part of the lactose (15-30%) is replaced with dextrin maltose.

Types of feeding premature babies

FEEDING PREMATURE BABIES WITH WOMAN'S MILK

Women's milk after premature birth has a special composition that is more consistent with the nutritional needs of premature babies and is consistent with their ability to digest

and assimilation. Compared to the milk of women who gave birth at term, it contains more protein (1.2-1.6 g per 100 ml), especially in the first month of lactation, slightly more fat and sodium and less lactose with the same total level of carbohydrates. The milk of women after premature birth is also characterized by a higher content of a number of protective factors, in particular lysozyme. Human milk is easily digestible and well tolerated by premature babies.

Despite the special composition, the milk of women who gave birth prematurely can satisfy the nutritional needs of only premature infants with a relatively large body weight - more than 1800-2000 g, while premature infants with a lower body weight after the end of the early neonatal period gradually begin to experience a deficiency in protein, a number of minerals (calcium, phosphorus, magnesium, sodium, copper, zinc, etc.) and vitamins (B 2, B 6, C, D, E, K, folic acid, etc.)

ENRICHMENT OF THE DIETS OF PREMATURE BABIES RECEIVING HUMAN MILK

Preserving the main benefits of natural feeding and at the same time meeting the high nutritional needs of a premature baby becomes possible by enriching human milk with enhancers (for example, Breast milk fortifier, Friesland Foods). They are specialized protein-mineral or protein-vitamin-mineral supplements, the addition of which to freshly expressed or pasteurized human milk can eliminate nutritional deficiencies.

Another way to enrich the diet, which allows preserving a sufficiently large volume of human milk in the diet of premature infants, is the introduction of specialized formulas based on highly hydrolyzed proteins. It is necessary to use products that meet the following requirements: hydrolyzed whey protein fraction, content of medium chain triglycerides in the fat component, absence of lactose. Alfare (Nestlé, Switzerland), Nutrilak Peptidi SCT (Nutritek, Russia), Nutrilon Pepti TSC (Nutrizia, Holland) have this composition. They organically replenish the insufficient content of essential nutrients in breast milk, are easily digestible and well tolerated by premature babies, especially those with low body weight. It is sufficient to introduce into the diets of children receiving human milk products based on whey protein hydrolysates in a volume of 20-30%. This type of feeding should be given preference when caring for extremely premature babies and children in serious condition. However, the use of formulas based on protein hydrolyzate should not be long-term, and after stabilization of the nutritional status of children, it is necessary to use specialized formulas for premature infants that best meet the mineral needs of such children.

In the absence of the possibility of using these specialized additives and medicinal mixtures based on highly hydrolyzed proteins in the nutrition of prematurely born children, it is necessary to carry out mixed feeding with the administration of specialized dairy products intended for premature babies (Fig. 7-9).

ARTIFICIAL FEEDING OF PREMATURE BABIES

Indications for artificial feeding of premature babies are only the complete absence of mother's or donor milk, as well as intolerance to human milk.

In the nutrition of children born prematurely, only specialized formulas intended for feeding premature infants, the nutritional value of which is increased compared to standard adapted products, should be used. In recent years, long-chain poly and unsaturated fatty acids, nucleotides and oligosaccharides have been introduced into the composition of such specialized mixtures (Table 56).

Rice. 7. Algorithm for feeding children weighing less than 1300 g

* - Preference is given to adding “hydrolyzate” to pasteurized milk compared to “enhancer” and special

R is. 8. Algorithm for feeding children weighing from 1300 to 1800 g

Prescribing dairy products intended for full-term infants to premature babies leads to a slower increase in “lean mass” (the increase occurs mainly due to adipose tissue), and the growth rate is also slower. Soy formula should also not be used in the nutrition of premature infants, since the absorption of a number of nutrients from them, especially minerals, is difficult.

The abolition of specialized products in premature infants and their transfer to standard formulas is carried out gradually. Reaching the weight limit of 2500 g cannot serve as a contraindication to the further use of specialized dairy products intended for premature babies. When feeding very premature infants in case of insufficient weight gain, these formulas in a limited volume should be used in combination with formulas for full-term infants for several months (up to 6-9 months of age). Long-term use of specialized infant formula in a small volume (1/3-1/4 daily volume) makes it possible to provide premature infants with a birth weight of less than 1800-2000 g with nutrients to the greatest extent, increase growth rate and prevent the development of osteopenia and iron deficiency anemia. In this case, it is mandatory to calculate diets not only by calorie content, but also by the content of essential nutrients (especially protein).

Currently, special formulas are being developed for premature babies, which must be used after discharge from the hospital. In terms of composition, they occupy an intermediate position between specialized formulas for premature babies and standard milk formulas. Such products will make it possible to optimally meet the needs of premature babies during this period.

INTRODUCTION OF COMPLEMENTARY FEEDING TO PREMATURE BABIES

Complementary feeding products are introduced to premature babies from 4-5 months of age. Since low birth weight children who have received massive therapy, including antibacterial therapy, are characterized by dysbiotic changes and various disorders of gastrointestinal motility, the order of introduction of products has its own characteristics.

Expansion of the diet begins with the introduction of fruit puree, vegetable puree or porridge. Preference should be given to industrially produced products for baby food, since their preparation uses environmentally friendly raw materials, they have a guaranteed composition and an appropriate degree of grinding, and are enriched with vitamins and minerals. The introduction of complementary foods begins with monocomponent products. Porridges can be prescribed before vegetable or fruit purees (especially if the child has malnutrition or iron deficiency anemia), but not earlier than 4 months of age. Gluten-free (buckwheat, rice, corn) and dairy-free porridges are introduced first. They are bred with the milk formulas that the child is currently receiving. Porridges should not contain any additives (fruits, sugar, etc.).

If there is a tendency to develop iron deficiency anemia, meat can be introduced from 5.5 months of age, given the good absorption of heme iron from it. Cottage cheese is prescribed after 6 months, since the protein deficiency in the first half of the year is compensated for by the partial use of high-protein formulas intended for feeding premature babies, which is preferable.

It is advisable to introduce juices later, after 5-6 months, since if administered early, they can provoke regurgitation, colic, diarrhea, and allergic reactions.

Materials for this chapter were also provided by: Doctor of Medical Sciences, Prof. Baibarina E.N., Doctor of Medical Sciences Stepanov A.A. (Moscow), Ph.D. Lukoyanova O.L. (Moscow), Andreeva A.V. (Moscow).

Babies born before 37 weeks are considered premature. Such babies need increased care and special attention, and caring for them becomes much more complicated. Parents may be frightened by the size of the baby, because their further actions depend on the weight of the premature baby. If you follow all the doctors’ recommendations, you can overcome any difficulties, and after a few months all the hardships will be forgotten.

Many babies are now born premature. There is no need to panic: with proper care, doctors promise a gradual equalization of the pace of development to that of their peers and a full healthy life

Main stages of development

Children born prematurely develop differently from their mature peers. On average, there is a lag of 1-3 months, depending on the period at which the child was born. Important parameters are displayed in the table of increase in height and weight of children during the first year of life:

Age by month	1 group (up to 2500 g)		Group 2 (up to 2000)		Group 3 (up to 1500 g)		Group 4 (up to 1000 g)
	Weight, g	Height, cm	Weight, g	Height, cm	Weight, g	Height, cm	Weight, g	Height, cm
1	300	3,7	190	3,8	190	3,7	180	3,9
2	800	3,6	700-800	3,9	650	4	400	3,5
3	700-800	3,6	700-800	3,6	600-700	4,2	600-700	2,5
4	700-900	3,3	600-900	3,8	600-700	3,7	600	3,5
5	700	2,3	800	3,3	750	3,6	650	3,7
6	700	2	700	2,3	800	2,8	750	3,7
7	700	1,6	600	2,3	950	3	500	2,5
8	700	1,5	700	1,8	600	1,6	500	2,5
9	700	1,5	700	1,8	600	1,6	500	1,5
10	400	1,5	400	0,8	500	1,7	450	2,5
11	400	1,0	500	0,9	300	0,6	500	2,2
12	300	1,2	400	1,5	350	1,2	450	1,7
Annual increase in height and weight	9450	25,3	8650	27,5	8450	31,7	7080	33,7

The information is provided based on long-term observations of the growth and weight of premature babies. More detailed development of a premature baby by month is presented below.

• 1 month

Parents may be concerned about the weight of their premature baby. Despite well-established nutrition, the baby does not gain the first grams well due to reduced sucking activity and a difficult swallowing reflex.

In a hospital ward it is easier to provide children with proper care in the first month, but parents can do this at home. It is enough to limit contact with the outside world and protect the baby from cooling or overheating.

• 2 months

When establishing nutrition for premature babies, the only obstacle is their weakness. In the second month there is more strength, but sucking is given to the baby with great difficulty. With healthy development, there is an increase in the weight of the premature baby, so pediatricians allow it gradually - this will allow you to begin training the back muscles and will be an excellent prevention of colic in children.

• 3 months

In terms of basic needs, premature babies are no different from normal newborns. They also need food and restful sleep. For proper formation of the skull and prevention of torticollis, you need to monitor the position of the child’s head. Parents will be pleased with the appearance of the first facial reactions. The baby is not yet able to smile, but he will react to touch: he tries to raise his head and keeps his gaze on his mother’s face. The development of premature babies at this stage concerns auditory and visual attention, as well as the grasping reflex. The baby's weight from the moment of birth should double during this period.

A three-month-old premature baby does not yet know how to smile, but will be able to please his mother with his first emotional reactions, and is actively mastering the grasping reflex

• 4 months

The child can not only raise his head, but holds it quite confidently. He gurgles and is able to grab a toy with his hand. Some children may experience muscle tone, which only a specialist can diagnose. It is easy to get rid of increased tone with a course of massage or simple exercises. It is advisable to entrust all procedures to a professional.

• 5 months

The toy is not just grabbed reflexively, but is held well in the child’s hand. The first smile and interest in everything that surrounds the baby appears. Visual and auditory reactions increase noticeably. If no abnormalities are detected in the child, then at this age the baby already turns his head in the right direction towards the sound.

• 6 months

The baby's weight increases 3 times in 6 months. The toddler makes his first attempts to roll over onto his stomach from his back. As they grow, communication becomes more active, which is facilitated by recognition of relatives. When he sees a loved one, the child makes sounds and waves his legs and arms. With support in the armpits, he can rest his legs against the surface, squatting a little.

Komarovsky notes that after 6 months, premature babies require the same care and nutrition as their mature peers. At this stage, the baby’s development gradually levels out and reaches the pace of his peers in most cases.

• 7 months

By the 7th month, the baby becomes even more active, turning over from back to stomach and back is easy. The toy rests confidently in the hand, and the child takes his first journey, trying to crawl funny, pushing off with his legs. If the baby was born at 35-37 weeks and receives all the important microelements from food, at 7 months his first teeth erupt.

• 8 months

The toddler tries to sit without the help of adults, gets on all fours and tries to swing. Thanks to proper development, movements are skillful and performed consciously. The child is interested in his own activities, simple games and communication with loved ones. Responds to a request to show a certain object, listens with pleasure to fairy tales and poems, lullabies and nursery rhymes, catching changes in intonation.

At 8 months, the baby will be happy to listen to a fairy tale or a story invented by his mother, and will be able to distinguish the voices of different characters if read by role

• 9-10 months

Sits confidently, begins to crawl, requires more communication. Teeth appear if the baby is born between 32 and 34 weeks. Repeats sounds and syllables after adults. He stands more confidently, he can move with support, but for now he thinks that crawling is easier and faster. Obsessively watches moving objects. Instantly reacts to sound, recognizes its own name, listens to the world around it. The first teeth appear in those born before 31 weeks.

• 11 months

The period of active crawling and exploration by children of the surrounding world continues, despite the acquired ability to sit down and stand up. Without support, the baby is able to stand for a very long time and even takes the first steps without holding on to support. Pyramids, cubes and all toys that move are useful for development. He makes good contact with family and recognizes familiar faces.

After one year of age, the toddler can walk on his own. This is proof that premature babies are able to catch up with their peers in development. In some cases, the process drags on for up to 1.5 years, but physical development is easier than neuropsychic development. Full maturity is usually formed by 2-3 years, so parents have nothing to worry about before this period.

At the age of one year, the baby is able to learn to walk, like most of his peers. By this time, the mother will practically cease to remember that her child was born prematurely

Nutrition after birth

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It is very problematic to establish feeding a baby at first. The baby needs to receive nutrients, but his body is not able to fully absorb them. The optimal way to feed premature babies is selected by a specialist, taking into account the period at which the baby was born, assessment of condition and weight.

If a baby was born with a body weight of 2000 g or more, then doctors may allow him to be put to the breast immediately. The mother is required to carefully monitor the baby while breastfeeding. The slightest signs of fatigue and the appearance of shortness of breath indicate that less time should be allocated to breastfeeding, and the remaining amount should be supplemented.

When a newborn's body weight is from 1500 to 2000 g, he is offered breast milk in a bottle. Test feeding allows you to determine the baby’s readiness for independent feeding. If sucking activity is unsatisfactory, then tube feeding is prescribed.

For children weighing up to 1500 g, only tube feeding is allowed for weight gain. Feeding premature babies is possible in two ways:

• portioned;
• by long-term infusion.

Portioned meals mean 7-10 feedings per day. Due to the small volume of the premature baby's stomach, parenteral administration of nutrients is often carried out.

If the mother does not have milk or the baby is intolerant to it, he is bottle-fed. The milk formula must have its own characteristics that allow it to be used in the diet of a premature baby.

First introduction to new food

Complementary feeding is introduced into the diet of babies born prematurely after six months. The digestive system matures later, metabolic processes are not stable, so earlier introduction of new products can end sadly. Calculating the correct age for complementary feeding is simple: the starting point is the date when the baby should be born. If the baby came into this world a month earlier, then complementary foods should be introduced 1 month later.

Some mothers decide to play it safe and hold off on complementary feeding, which is also wrong. Premature babies have a meager supply of nutrients, so they cannot do without enriching the diet. After introducing complementary foods, breast milk cannot be excluded from the daily menu. Feeding new foods should be completed by latching on to the breast or offering a bottle of formula.

First, porridge appears in the diet, and then you can add fruit and vegetable purees. The order is explained by underweight, which is often found in babies born prematurely. It is better to use hypoallergenic cereals in the menu of premature babies:

• buckwheat;
• corn;
• rice

Porridges are diluted with mixtures or mother's milk so that the baby gets used to the new taste. In the absence of allergic reactions, the following is introduced into complementary foods:

• vegetables;
• meat;
• fermented milk products.

When feeding premature babies, you cannot do without consulting a pediatrician. It can determine the optimal period to begin introducing new products.

Since the baby needs to gain weight as quickly as possible, complementary feeding begins not with fruit purees, but with cereals, which have a higher nutritional value

Proper care

The harmonious development of a premature baby directly depends on the conditions in which he grows. It is important to provide him with appropriate care at home:

• Temperature

It is necessary to set a suitable temperature in the room within 23-25 ​​C. Next to the baby it should reach 28-32 C. You can use heating pads with water at 60-65 C. The heating pads are first wrapped in a diaper or towel to eliminate the risk of burns. It is better to place them in the legs under the blanket and on top of the blanket on the sides at a palm's distance. It is necessary to change the water every 1.5-2 hours. Additional heating will not be required after the first month of life, as the baby will learn to regulate its body temperature on its own. Acceptable humidity level is 50-70%.

• Bathing

If the baby is at risk and was born weighing less than 1500 g, pediatricians do not recommend bathing him for another 3 weeks. It is enough to carry out daily hygiene. The rest of the toddlers are allowed water treatments 7-10 days after birth. During the first 3 months, premature babies should only be bathed in boiled water at a temperature of 38 C. The bathroom should be heated to at least 25 C for the baby to feel comfortable.

• Walks

If the baby weighs more than 1500 g, you can start walking with him 2 weeks after birth (we recommend reading:). This recommendation applies to the summer period, when the air temperature has risen to +25-26 C. The duration of the first “outing” should not exceed 10-15 minutes. With each walk, the time spent in the fresh air gradually increases until it reaches 1-1.5 hours. In the spring-autumn period, it is allowed to walk with babies aged 1-1.5 months at an outside temperature of +10 C. The weight of the baby must be at least 2500 g. If the thermometer drops below +8-10 C, you can take walks with babies aged from 2 months and weighing 2800-3000 g. In the future, walks are planned according to the same scenario as for ordinary children.

Feeding a premature baby/baby is different from what is needed and how it is done for full-term babies. From the first day of life, the baby needs special care. Today we will look at the main issues related to premature babies: signs of prematurity, feeding premature babies. We'll talk about how to feed a baby born prematurely, about methods - breast and artificial, about introducing complementary foods into the baby's diet.

Features of a premature baby

The peculiarities of caring for and feeding premature babies depend on the characteristics of the body of the baby born in the early stages. The physical signs of prematurity are obvious: low weight and height, and if born at a very early stage, the inability or difficulty of breathing independently. In addition, there are characteristics of the body itself that differ significantly from those characteristic of a child born at term. The principles of feeding premature babies consist of the following features of a small organism:

1. The sucking reflex is underdeveloped. Premature babies have a weak or absent sucking reflex, and this makes breastfeeding much more difficult. A common mistake when feeding a premature baby/baby is using a bottle. Milk comes from the nipple more easily; you don’t need to make every effort to eat, and therefore, over time, babies stop accepting their mother’s breasts altogether. It is better to use a syringe (without a needle, of course), feed from a spoon or using the finger method. The last option is the most preferable, since it develops the sucking reflex. The principle of finger-feeding premature babies is as follows: the baby should be in the arms of only the mother so that he remembers her smell and touch. A finger is placed in the child's mouth, and when he begins to suck, milk must be slowly introduced using a syringe.
2. The stomach volume of babies born prematurely is less than that of those who waited in the wings. Therefore, such babies cannot physically consume the norm of milk according to their age. Organizing the feeding of premature babies is mandatory: feeding every 2 hours, and on demand is simply unacceptable.

In women who give birth prematurely, milk begins to appear later. But it has a richer composition; this is provided by nature itself. To feed premature babies/children, nature has provided a double dose of vitamins, microelements and protein in human milk. In addition to many nutrients, milk contains antibodies that protect the baby from various types of infectious diseases. That is why breastfeeding premature babies is more preferable; artificial formula is used only in extreme cases: contraindications, lack of milk at all. If a woman has little milk, then you can only feed the baby with formula, but at the same time continue to improve the flow of breast milk.

Basic principles of feeding premature babies

From the very first hours of a baby’s life, when feeding him, you need to adhere to the following principles:

1. The type of feeding and method of feeding is selected based on several factors: gestational age, weight of the baby, severity of his condition.
2. Feeding must begin no later than three hours after birth, regardless of which feeding and technique was chosen.
3. With parenteral feeding, it is imperative to provide maximum enteral feeding to premature infants.
4. After the early neonatal stage, severely premature infants receiving breast milk need a protein-rich diet.
5. If it is not possible to feed the baby with mother's milk, then artificial feeding is chosen. Formulas for feeding premature babies must be specialized, intended specifically for babies born prematurely. Such products contain the maximum amount of nutrients, proteins, vitamins and antibodies to strengthen the baby’s immunity.

What products and equipment are needed for enteral feeding?

• Infusion pumps.
• Adapters are disposable only.
• Breast milk or specialized artificial formulas.
• Products for milk saturation.

Key points when organizing catering

The peculiarities of feeding premature babies simply need to be taken into account. The body of a baby who was born at the wrong time needs more microelements, especially in the first two weeks of life. With a lack of nutritional components, a disruption in the development of organs begins. For example, due to a lack of carbohydrates, nervous tissue matures with a delay.

Key points in catering:

1. When should you feed for the first time?
2. Is it possible to put a premature baby to the breast?
3. How much milk is required for one serving?
4. What to choose for feeding: specialized formula or breast milk?

First feeding

There are several methods of first feeding. In the first stage of prematurity, when the baby can suck on his own and his body weight is close to normal, the baby is placed on the mother’s breast immediately after birth or a couple of hours later. Doctors help the woman place the baby in her arms in a comfortable way, and help the baby latch onto the breast.

If the baby's weight is less than 2 kilograms and the due date is earlier than the 33rd week, the first feeding is performed as follows:

1. First, doctors must prepare the baby’s digestive system for a new type of diet.
2. Next, you need to replenish the lack of fluid; for this, intravenous solutions are administered.
3. The first few times the baby is fed a glucose solution. If the child accepts it well, then proceed directly to feeding.

Babies born prematurely cannot absorb the entire required amount of food, so the portions are very small at first and are gradually increased. But, like babies born at term, premature babies need to get the required amount of calories and fluids, and this is not possible with small portions. To compensate for the deficiency, nutrient solutions are administered intravenously into the body.

What to feed?

Feeding premature babies/child can be done with the following products:

• mother's milk;
• artificial mixtures;
• fortifying mixtures;
• Another woman's milk is donor milk.

Let's consider all points separately.

Breast-feeding

It is clinically recommended to feed premature infants with breast milk. As was written earlier, it has a richer composition than the milk of women who gave birth at term. The antibodies contained in breast milk cannot be compared in quality with any substitutes contained in formulas. Breastfed babies are less susceptible to infectious diseases and gain weight better.

If the sucking reflex is poorly developed, then do not use a bottle for feeding, use a syringe and your finger, the baby will learn to suck in this way.

Artificial feeding

It is not always possible to breastfeed a baby. For many premature babies, breast milk is contraindicated due to Rh conflict, which most often leads to premature birth. There are also diseases of the mother in which she cannot feed her baby. It happens that a woman simply does not have milk, the reason for this may be illness or nervous shock.

If artificial feeding is chosen, the pediatrician will recommend using formulas designed specifically for feeding premature babies. Guidelines for feeding both formula and breast milk will be discussed in the further content of the article.

Formula milk for babies born prematurely is more expensive than regular formula, but you can’t skimp on it. The specially developed formula provides for the presence of more nutrients, vitamins and microelements that the baby needs for healthy growth. With such mixtures, the baby will quickly catch up with his peers in development!

Fortifier mixtures

This is not a complete diet, but specialized additives to the baby’s artificial or natural diet. Such mixtures contain polyunsaturated fatty acids, they have a beneficial effect on the mental and physical development of the baby, and help in the development of the nervous system.

Donor milk

Many women who cannot feed their baby on their own resort to the help of other mothers who have an excess of breast milk. Here, almost everyone makes one mistake: they give fresh milk to the child. This cannot be done, since the baby can become infected with infectious diseases from a stranger, which she may not even know about. How to proceed? Milk should be given only after freezing. There are some nuances here:

• milk should be poured only into specialized containers;
• freeze quickly;
• Do not add fresh milk to a container with frozen milk;
• do not reheat in the microwave;
• You need to defrost at room temperature or under water pressure, and reheat only on gas.

Milk that has been frozen is no longer as healthy as “live” milk, but it still contains many more components necessary for the baby than even the most expensive formula.

Volume of one feeding

In particular, feeding premature babies includes the dosage of one feeding, and it depends on the weight of the child.

1. Babies up to one kilogram in weight begin to be fed with milk or formula only a few hours after birth, on average from 12 to 24 hours. For the first feeding of such babies, only 2-3 milliliters of milk are required. Gradually increase the portion by a couple of milliliters.
2. Babies born weighing from a kilogram to one and a half are fed with a portion of 2-3 milliliters of milk at a time, but the dose is gradually increased from 3 to 5 milliliters.
3. With a weight of one and a half to two kilograms, five milliliters of milk is required per time, a gradual increase is by 2-5 milliliters.
4. If the baby was born weighing more than two kilograms and he can suck on his own, then he is applied to the woman's breast or given a bottle. Such a baby requires from 5 to 7 milliliters of milk at a time.

You need to feed every 2-3 hours; food is not provided on demand. There should be no night breaks in the diet.

Feeding methods

The method of feeding the baby depends on the degree of prematurity. If the baby was born no earlier than the 33rd week of pregnancy, then he can already feed himself. He can be breastfed, or, if not possible, formula fed using a bottle or syringe.

If the baby decided to be born before the 33rd week, then his sucking reflex is weakly expressed or completely absent.

If the sucking reflex is weak, milk or formula is given with a syringe, from a bottle or from a small spoon.

If the baby cannot suck at all, then a glucose solution, and then milk, is injected into the stomach by inserting a probe. There are two ways of feeding this way:

1. At each feeding, the tube is inserted and removed upon completion.
2. The probe can be in the stomach around the clock, milk is introduced into the stomach slowly, in small drops, gradually and evenly.

How to breastfeed correctly?

Breastfeeding premature babies is often not possible immediately after birth. The baby is examined for the presence of Rh conflict with the mother, and only after that a verdict is made: can or cannot be fed with milk. During these studies or while the baby is in an incubator and does not consume much food, mother's milk may simply disappear. To prevent this from happening, it is necessary to pump every couple of hours, stimulating the production of food for the baby. The same pumping is done when the baby has not yet learned to suck and cannot stimulate the breast on his own.

If the baby is in the same room with his mother, the woman is advised to hold him in her arms more often so that the body temperature is stable. But this is not the only reason. The closer and more established the contact, the faster the baby will begin to latch onto the breast on its own.

Under no circumstances should you be forced to take the breast; the baby will simply refuse and begin to be capricious. On average, one feeding takes from half an hour to an hour, since premature babies are very weak, they will get tired and take food with rest breaks.

If during one feeding the baby did not eat the required amount (this is clearly visible if you feed not by breast, but with a syringe or spoon), then at the next feeding you should try to give the child a little more, but not twice as much! If the baby still does not eat the norm and refuses supplements, doctors will be forced to force-feed the baby using a tube. It is necessary for the child to gain weight faster, catching up with his peers.

When feeding, it is important to choose a comfortable position not only for the mother, but also for the baby. In order for the baby's head to fit more tightly to the breast, which makes sucking easier and reduces the pressure of milk, you need to lean back a little. With this position, the baby swallows less air.

A reminder for feeding premature babies: these babies have a weakened chin and lip area; while sucking, the baby may accidentally release the breast. To prevent this from happening, you need to help him. The mother's index finger should lie on one cheek, and the thumb on the other. Use your middle or ring finger to support your chin.

Pumping rules

An integral part of breastfeeding is pumping. This procedure is necessary so that milk continues to be produced more and more, and does not remain at the same level. Every day the baby will need to take more and more food, and if there is not enough milk, then you will have to resort to mixed feeding of the premature baby - feeding with formulas. This is extremely unwelcome, because with breast milk there are strong differences in composition, and the baby needs to consume the maximum amount of nutrients.

Every 2-3 hours you need to pump from both breasts every day. At night, you can skip this moment to get enough sleep and rest, because a tired mother has problems with lactation. Be sure to pump from 4 to 7 o'clock in the morning, as at this time the synthesis of milk in the body increases!

To express milk, you can use the manual method, but a breast pump will be much more convenient. Before the procedure, wash your breasts and hands with soap and wipe dry. The dishes must be sterile!

Artificial feeding of premature babies

For a variety of reasons, not every mother can feed her baby breast milk. Whatever the reason, the main thing is to choose the optimal milk formula. The child’s body weight should increase faster, so it is especially important that he receives the maximum amount of nutrients from food. The main component of the diet should be proteins, because they are the main plastic material for the growth of a healthy body.

The skeletal system of premature babies is very weak; the body lacks calcium and phosphorus. It is for this reason that children born earlier are more susceptible to rickets. You need to choose a mixture enriched with vitamin D.

Conventional formulas for feeding infants are inexpensive, but for premature babies they are too weak in nutrition and are not suitable for a regular menu. Today you can find anything on store shelves, including a huge assortment of milk formulas for such children. Almost every modern manufacturer of baby food produces adapted hypoallergenic formulas for feeding babies who were born with low birth weight and prematurely. It is recommended to dilute such food for the baby with high-quality water without impurities; it is better to use children's water. Tap water, even boiled 10 times, will not work. Baby water is expensive, you can use regular bottled water.

You should choose a mixture only after consulting a pediatrician. The specialist will assess the baby’s health condition and identify his need for nutrients, microelements and vitamins. Each child is individual, especially one born premature. If one baby is suitable for formula and is gaining good weight, it is not a fact that the same brand will suit another child.

Features of digestion of a premature baby

Babies born earlier do not gain weight quickly. The fact is that the ability to digest and assimilate food is limited, and the sucking and swallowing reflexes are poor, since the nervous system is not yet fully formed. There is no need to rush into introducing complementary foods so that the child begins to gain weight faster. The substances in milk are quite sufficient, and it does not matter whether premature babies are breastfed or bottle-fed. As we wrote earlier, both mother’s milk and adapted formulas for babies born prematurely are richer than regular formulas or milk at term for the mother who gave birth.

If you can introduce other foods for children born on time from 4 months, then premature babies begin to be fed even later.

At what age should complementary foods be introduced?

Children born at term can begin to be fed from the age of four months, but many pediatricians still advise waiting until six months. When it comes to a baby who was born earlier, you should wait even longer. For example, if childbirth occurred in the 8th month, then a month is added to the standard six-month age for complementary feeding, and the first new foods can be tried at 7 months. If the baby was born at seven months, then you need to add extra food for two months, and introduce complementary foods only at eight months.

Complementary feeding of a premature baby, whether breastfed or bottle-fed, begins with cereals, fruit and vegetable purees. You can start giving these products only when the baby is completely healthy and no vaccinations are planned in the near future. In order of introduction of products, the following rules must be observed:

1. The earliest time for introducing complementary foods can begin at 4 months for full-term babies, and at 5-6 months for premature babies. Such restrictions are put in place for a reason. It is at this age that the pancreas comes into play, and the intestinal microflora is already denser, and the body will be able to digest other products in addition to the usual milk.
2. Order of products: cereals with milk and dairy-free, baby fruit and vegetable purees, fermented milk products, juices, protein-enriched dishes.
3. For the first time, you can give only half a teaspoon of a new product. This should be done before the main meal, and after that, monitor the child’s stool and behavior. It is possible that the child will appreciate the new taste and demand more, but you should not abuse a product that is new to his body.
4. Up to 8 months, any food should be washed down with milk.

Complementary foods for children with allergies

If the baby suffers from allergies or often experiences dysbacteriosis, then the idea of ​​complementary feeding will have to be postponed until a later date. Children are allowed to try only those purees and cereals that consist of one component, so that the allergen can be easily identified.

The rule of complementary feeding for premature babies with allergies is one: one week - one new product. Ideal for first feedings would be: zucchini or potato puree, rice porridge, green apple baked in the oven. There should be no additives, including salt and sugar. After the baby has tried a new dish, feed only formula or breast milk for a week, observing the condition of the baby and his skin.

To analyze the reaction you need to keep a diary. which will record which products the child reacted to and how. Until the age of one, the baby needs to try no more than two types of fruits, the same number of types of cereals and vegetables, and one type of lean meat.

As for introducing eggs, red fruits, berries and vegetables, and fish into the diet, this is allowed only after a year.

Don't worry if you have to delay introducing solid foods. The main task of introducing new products is to develop chewing skills and taste buds. If a child is gaining weight well, then the nutrients he receives from milk or formula are sufficient.

There is no need to rush into feeding infants - mother's milk absolutely covers their nutritional needs for up to 6-7 months. Even later, premature babies are fed, who need more vitamins and microelements. At birth, they weigh up to 2.5 kg, but often catch up with their peers while breastfeeding or mixed feeding.

Premature babies require later introduction of complementary foods

Features of the digestive system of a baby born prematurely

Weight gain by a premature baby does not always happen quickly. The ability of the digestive system to absorb nutrients in such children is limited, and the sucking and swallowing reflexes are poorly regulated by the newly formed nervous system.

Premature babies have decreased salivation and low secretion of gastric juice, and low activity of intestinal enzymes. They often experience dysbacteriosis, since there is practically no resistance to pathogenic microorganisms. Mom can help the baby by establishing breastfeeding, because her milk helps populate the gastrointestinal tract with beneficial bacteria.

The frequency of feedings of a prematurely born baby is influenced by its condition, birth weight, and degree of maturity of organs and systems. It is advisable that he receives his mother's colostrum and milk. When breastfeeding is not possible, you should express. Before introducing complementary foods, it is recommended to breastfeed the baby or select a special formula.

If necessary, a premature baby is prescribed a special nutritional formula (we recommend reading:)

When to offer complementary foods to a premature baby?

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The earliest age for feeding premature babies is 4 months, but most experts recommend not rushing until 6 months. The calculation of the readiness of the digestive system is determined by the time of birth. If the child was born a month earlier, one more is added to the standard time of first feeding (6 months). When the baby was born at seven months, complementary foods are introduced at 8 months, adding another 2 months to the standard period.

Purees, juices and cereals are offered to the baby during the period when he is healthy and vaccination is not planned. In this case, it is advisable to consult a pediatrician who will evaluate weight gain and clinical test data. The introduction of new dishes requires compliance with certain rules:

• early period of complementary feeding - from 4 months, since by this time the pancreas is included in the digestive system, and the intestines are populated with microflora that can digest not only milk;
• feeding order: cereals, vegetable and fruit purees, fermented milk products, juices, protein dishes;
• the first doses are half a teaspoon, which it is advisable to offer before lunch and monitor the baby’s condition (behavior, stool);
• it is possible that the baby will like the dish offered, but it is forbidden to abuse it and give more than what is prescribed at first;
• It is important to supplement with milk or formula for at least 8 months.

Complementary foods are introduced in small portions so that the child’s body adapts to it.

Complementary feeding for babies with allergies

When a child has dysbacteriosis, allergic manifestations, complementary feeding is postponed to a later date. A premature baby is allowed to try one-ingredient purees and cereals without flavoring additives. Rice porridge, zucchini or mashed potatoes, and a baked green apple are ideal. It is allowed to introduce only one product per week, observing the baby’s digestion and skin reaction.

To analyze the reactions of premature babies to specific foods, a food diary should be kept. By the time a child with allergies is one year old, it is enough to try 2 types of cereals, fruits and vegetables, and 1 type of dietary meat. Eggs, fish, red vegetables and fruits are allowed to be introduced after one year.

Types and order of complementary feeding for a premature baby

The purpose of introducing complementary foods is to form new taste habits and develop chewing skills in older children. Additionally, at six months of age, breast milk cannot meet infants' nutritional needs. The following signs indicate readiness to introduce cereals, purees and other products into the diet of a premature baby:

• age from 6 months;
• teething;
• chewing movements of the baby when a pacifier or teether gets into the mouth;
• Confident sitting, ability to react emotionally to food;
• maturity of the gastrointestinal tract, the ability to absorb a small amount of complementary foods without indigestion or an allergic reaction.

Confident sitting indirectly indicates the child’s readiness to accept adult food

First priority complementary foods - grain porridge

The first complementary food for a low birth weight baby is hypoallergenic porridge - rice, buckwheat, corn. First, he should be introduced to the taste of buckwheat cooked in vegetable broth, breast milk or water. A little later, corn and rice are introduced, thanks to which the baby’s body will replenish its supply of zinc and iron.

After 1-1.5 months, a portion of porridge can replace one feeding. Prepare a dish from cereal ground in a coffee grinder or buy porridge that needs to be diluted with liquid. After the baby tries simple porridges, it is worth adding butter to them. You should start with 1 gram (at the tip of a knife), increasing the dose to 4 grams per day.

Secondary complementary foods - hypoallergenic vegetables and fruits

For vegetable complementary feeding, only fresh vegetables grown in the region of residence should be selected. You should start with boiled cauliflower, broccoli, zucchini, preparing one-component purees from them, and then mixed purees. At 8 months, it is advisable to offer children potatoes, pumpkin and carrots, carefully monitoring the reaction (carotene in orange vegetables can provoke allergies) (more details in the article:). From 9 months, a low birth weight baby can be offered soups with vegetable broth. Cereals and herbs are added to them, and before serving they are blended (the dish should not be too thick). Over time, soup replaces daytime feeding.

At 7-8 months you are allowed to try fruits - green apples, bananas, pears (we recommend reading:). They are introduced with caution into the diet of a small allergy sufferer, taking into account that pears have a fixing effect. Little by little, one breastfeeding can be replaced with vegetable (fruit) feeding. By the age of one year, the baby can try berries, prunes, and apricots.

Pears have a strong fixing effect

Complementary foods of the third priority - dietary meat and yolk

Dietary meat is offered to a stronger baby at 8-9 months. It is advisable that he try it in the following order: rabbit, turkey, veal, beef, pork, chicken. Unsalted, pureed meat is added to porridge or puree. Starting with ½ teaspoon, the portion is adjusted to 3 grams per 1 kg of child’s weight.

Chicken eggs are allergenic; first, it is advisable to choose quail eggs. Their yolk can be mixed into food from 7 months (see also:). Chicken eggs are offered to a premature baby no earlier than 10 months old, mixing ¼ of the boiled yolk with the main dish. By 1-1.2 years of age, the volume is increased to 1 yolk, and crushed whites are offered.

Quail eggs with a low level of allergenicity are more suitable for feeding a child

Complementary foods of the fourth priority - fermented milk products, fish

Kefir, cottage cheese, and homemade yogurt are introduced into the baby’s diet from 9 months. At first, they are offered little by little (from ½ teaspoon), gradually replacing one feeding with a fermented milk product. It is not recommended to introduce cow's and goat's milk into the diet of a prematurely born baby until the age of 1.5 years. It contains difficult-to-digest proteins, so at first it is diluted with water.

It is advisable to check with your pediatrician for the address of the dairy kitchen, where fermented milk products are prepared for babies up to one year old. If mom plans to make them herself, she should use only pasteurized milk. At 10-12 months you can introduce your baby to hard cheese. You should choose Dutch, Russian varieties or soft Adyghe cheese without a strong smell or specific taste.

Adyghe cheese is perfect for introducing a child to solid dairy products

From 10-11 months, a premature baby is offered fish (1-2 times a week). You should carefully select fish, giving preference to delicate white varieties. A child can try it in the following order: pike perch, cod, saury, hake, pollock, salmon. The fish can be boiled or baked, then chopped and added to the side dish.

Vegetable and fruit juices

By the age of one year, children can be offered fresh juices as an addition to one of the feedings. They are given from ½ teaspoon, bringing the volume to 100 ml by year. They start with the juice of green apples, plums, peaches, and gradually introduce mixed juices: peach-pear, carrot-apple and others. It is not advisable to offer juices from exotic fruits.

Table of priority for introducing complementary foods

The time for introducing complementary feeding to premature infants is determined individually, based on the state of health, type of feeding (breastfeeding, mixed or artificial) and the baby’s willingness to try new foods. The optimal timing of complementary feeding given in the table will help young parents “not be late” with the introduction of new dishes:

Complementary feeding chart for premature babies

The introduction of complementary foods should be coordinated with your pediatrician. Based on the child’s tests, he can recommend this or that product. For example, in case of anemia, meat is introduced before cereals and vegetables, and in case of poor weight gain, fermented milk products are preferred. The presented chart indicates how much and at what age complementary foods should be given to children born prematurely.

The best option would be to develop an individual complementary feeding table together with a pediatrician.

Standard complementary feeding regimen for children of normal weight:

Product type	Volume	6 months	7 months	8 months	9 months	10 months	11 months	12 months
Porridge on the water	ml.	10-150	150-180	180	200	-	-	-
Porridge with milk	ml.	-	-	-	180-200	180-200	180-200	200
Vegetable purees	gr.	10-80	80-200	150	170	180	200	200
Fruit purees	gr.	5-50	60	60	70	70-80	100	110
Vegetable oil	ml.	1	3	5	5	5	5	5
Drying, crackers, cookies	gr.	-	5	5	5	10	10	10
Juices	ml.	-	-	10-30	50	60	80	100
Wheat bread	gr.	-	-	5	5	10	10	10
Butter	gr.	-	-	1-3	3	5	5	5
Meat puree	gr.	-	-	10-30	40	60	70	80
Fish puree	gr.	-	-	-	-	10-20	50	60
Yolk	pcs.	-	-	-	¼	¼	½	½
Cottage cheese	gr.	-	-	-	5-30	40	50	50-100
Kefir	ml.	-	-	-	10-30	40	90	150

Milk porridges are introduced into the child’s diet only after 9 months

Pediatricians' opinion

Doctors have different opinions regarding the start of complementary feeding for low birth weight babies. Some people advise feeding from 4 months, explaining that the baby needs a lot of nutrients for development. Some mothers follow these tips and introduce vegetable purees with porridges as early as possible, but not all babies refuse to eat complementary foods at 4 months; readiness for new foods is important.

Monitoring monthly weight gain, as well as biochemical blood parameters (erythrocytes, hemoglobin, hematocrit), protein content in the blood serum and other tests prescribed by the pediatrician will help evaluate the effectiveness of complementary feeding for premature infants. With proper organization of feedings, the child will gradually catch up with his peers and will grow healthy and strong.