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Mixed feeding baby. The right mixture is the key to good health. How to determine the need for feeding

There are frequent cases when experienced moms after childbirth, they fall into a nervous state characteristic of primiparas. Out of nowhere, they have a bunch of doubts about their abilities. This is facilitated by many psychological factors leading astray from the true path. Here, our mother regularly visits an Internet forum, reads articles about the benefits of breastfeeding, actively participates in the “scandal” of his opponents, and advocates progressive methods of education. Here she becomes pregnant again, gives birth - and suddenly ... Suddenly there are questions from her, it would seem, experienced person: “What should I do, the child gained more than a kilogram in the first month, and only 300 g in the second?”, “Why is my breast always “empty”?”, “The child is worried when he sucks - not enough milk?”

Increased suspiciousness that develops after childbirth has not been canceled. She is involved in hormones and maternal instinct, but most of all she depends on the psychological environment. A couple of wrong remarks can give rise to doubt in their ability to feed for a long time. And then nervous mom I want to urgently reassure myself (first of all) and the child with something reliable. For example, a mixture. Breast milk is in disgrace - it is “low-fat”, it is “little”, it is “something not like that”. And with the mixture, everything is very clear. Supplemented - the child calmed down and "finally" sleeps, is silent, and even gains weight. Oh that weight! Until now, we have a stereotype in our heads: weight equals health. This approach leaves no individual development no chance to bypass polyclinics and laboratory tests.

The main reasons why a child is transferred to mixed feeding, according to breastfeeding experts, are low awareness of mothers, subconscious reluctance to breastfeed, as well as rash (without prior diagnosis) advice from doctors.

What is mixed feeding?

mixed feeding- this is a system of feeding a child, in which supplementary feeding with a mixture is carried out on a par with breastfeeding without a clear regimen (on demand), while the volume of the mixture occupies no more than half of the total nutrition. It is recommended for the following reasons:

Insufficient weight gain;

prematurity;

Mom's illness, her taking medications that are incompatible with breastfeeding;

Life situation: for example, the family is low-income, and the mother needs to immediately go full-time.

Is mixed feeding always the road to artificial? Not at all. Everything depends on the goals. If a mother wants to keep breastfeeding, it means that she fulfills (to the best of her ability) all the recommendations for increasing lactation, feeding the baby with a mixture in the amount of no more than 30-50% of the daily amount of food. With the proper implementation of all the advice, and most importantly - the restoration of psychological comfort lost due to doubts and fears about the "loss of milk" - breastfeeding will definitely be restored. In many cases, the child completely switches to pure breastfeeding by the age of 6 months.

Competent transfer to mixed feeding

To switch to CB, you need to calculate the missing amount of food in grams per day, and you will supplement the calculated amount of formula several times a day. Your doctor or lactation consultant will help you with the calculations. If you are not going to transfer the child to the mixture in the future, be sure to ask for recommendations to increase lactation. As a rule, these are regular nightly attachments to the breast (especially pre-morning ones), skin-to-skin contact - when supplementing with a formula, the child is held near the breast; regular expression of milk, as well as supplementary feeding with a mixture not from a bottle, but from a spoon or syringe. The use of nipples should be avoided whenever possible. The mixture flows quickly from the nipple, the baby does not have to bother and he quickly gets used to it. After sucking on a bottle, babies cannot properly regulate their breathing when suckling at the breast and become anxious. For working mothers, in order not to lose milk, it is very important to breastfeed the baby at least in the morning and evening.

Supplement with the mixture only after applying the baby to the breast (both breasts). Over time, gradually reduce the amount of the mixture in favor of the chest. The number of attachments to the chest should be at least three to five times a day.

How to choose a mixture and calculate its correct amount? Recommendations Zabelina Tamara Alexandrovna, pediatrician medical center"XXI century", experience of medical practice - 20 years. (source: http://mama.mc21.ru)

Approximately, you can use the following calculation: for a child under 10 days old, the daily volume of milk is equal to 2% of body weight at birth, multiplied by the child's age in days. Example: a child born with a body weight of 3200 on the 5th day of life should receive about 320 ml of milk per day (3200: 100x2x5 = 320), that is, with an average frequency of feedings from 8 to 10, the volume of each feeding is from 30 to 40 ml average. After 10 days to 2 months of life, the calculation is even simpler: the daily amount of food is 1/5 of body weight. Example: a child of 1 month with a body weight of 4500 per day should receive about 900 ml of milk. At this age, as a rule, the frequency of feedings is about 8 times a day, that is, on average, the child receives about 110 ml of milk per feeding (from 100 to 120 ml). The missing volume is filled with supplementary food - a mixture for baby food. When choosing a mixture, the age of the child is taken into account, as well as the presence of any problems when it becomes necessary to prescribe specialized, that is, therapeutic mixtures.

If the child is healthy, you can use as a supplement the following mixtures: Nutrilon, Humana, Heinz, Nan, Nestozhen, Mamex, Hipp. If there are signs of digestive disorders - colic, stool retention, unstable stool, to correct dysbiosis, with increased risk the development of infections, mixtures of "nan sour-milk 1" for children of the first six months of life and "nan sour-milk 2" from 6 months are good; At high risk allergies to cow's milk - if its intolerance is detected in the parents, brothers or sisters of the baby - mixtures containing partially hydrolyzed protein are prescribed: "nan hypoallergenic 1" in the first half of the year and "nan hypoallergenic 2" after 6 months, "nutrilak hypoallergenic", "hipp hypoallergenic 1", "hipp hypoallergenic 2", "humana hypoallergenic 1" and "humana hypoallergenic 2". If the child already has signs of allergy to cow's milk, it is necessary to prescribe therapeutic - hydrolyzate mixtures as a supplement, in which the main allergens responsible for the development of food intolerance are destroyed by hydrolysis: "nutrilak peptidi sst", "frisopep", "alfare", " Nutrilon Pepti TSC”, “Pregestimil”, “Nutramigen”, “Damil Pepti”.

For children with lactase deficiency, including as diet food with acute intestinal infections, mixtures with a low lactose content are recommended: “low-lactose nutrilon”, “low-lactose nutrilak”, “humana lp” (these are milk mixtures), mixtures based on protein hydrolysates - “frisopep”, “hipp ha 1”, “humana ha 1”. Besides, fermented milk mixtures contain less lactose due to the lactase activity of microorganisms. Mixtures in which lactose is completely absent - lactose-free dairy - “lactose-free mamex”, “lactose-free nan”, “lactose-free nutrilak”; lactose-free mixtures based on soy protein - "enfamil soy", "heinz soy", "soy sample", "nan soy", "nutrilon soy", etc. ”, “nutramigen”, “nutrilon pepti tsc”. With persistent regurgitation, sometimes the pediatrician considers it necessary to prescribe an antireflux mixture. These mixtures have an increased viscosity due to the inclusion of thickeners (gum or starch) in their composition: “Nutrilak ar antireflux”, “Semper lemolak”, “Fries”, “Humana ar”, “Nutrilon antireflux”, etc.

Non-objective reasons for supplementary feeding: do not doubt yourself!

Consider the reasons that can be attributed to a hasty choice. That is, when the child actually did not need to be translated into ST, but his parents decided otherwise.

1. Lack of information. The facts below are NOT reasons to supplement with formula immediately.

The child worries about the chest, throws the chest;

The chest has ceased to be filled, no tides are felt;

Not enough milk when expressing;

The child in the first month of life added more than the norm (more than 600-800 g), and in the second he added little (less than 600 g);

Control weighing showed that the child sucks milk a little;

The child has a stomach ache, he has a rash (diathesis).

If a young mother cites them as an argument, it means that she urgently needs to refresh her knowledge with the right information. For example, read materials from the archive of our site:.

2. Breastfeeding Mistakes: improper grip on the breast, discomfort when sucking, accustoming to strict regime feeding. You need to contact a lactation consultant.

3. Unshakable faith in the pediatric scheme for feeding children up to a year and blind obedience to medical recommendations. It should be clearly understood that this scheme was developed many years ago on the basis of statistics on the health status of children who are mixed or artificially fed. New pediatric norms based on infant statistics have just taken over the world. Babies are still measured by artificials, hence the inflated norms for increases, early introduction of complementary foods, and so on. It is still more convenient for doctors to deal with artificial people, since they have everything in grams and in time. Children on breastfeeding are uncontrolled nutrition, unknown grams, incomprehensible composition of milk. Everything is in a fog. Many doctors make hasty advice about supplementing formula in order to make it easier for themselves to understand the daily routine. this child and the amount of food they eat. modern mom must understand that all outdated schemes do not take into account the individual characteristics of children.

Pediatric approach in our country for a long time meant instilling in mothers many fears, doubts, stereotypes. The system is gradually changing, becoming a thing of the past, but the remnants are tenacious. A good doctor should not "pull" the child to the scheme, but assess the individual situation. Any mother has a choice - to allow her child to be assessed on the assembly line or to find a doctor who has time to take into account individual characteristics. Such doctors come across in ordinary district clinics. Do not take it for granted if you are told that your child is obliged at 3 months to sleep all night until six in the morning without waking up - or weigh 200 g more, based on the plate. This is not the ultimate truth, but a pediatric approach that applies to all children equally. No one knows your child better than you - do not shift ALL responsibility to doctors!

4. Reluctance to breastfeed. One of the most common reasons. It can be camouflaged, expressed indirectly. Our body is a very smart system. When we inspire ourselves with fear that we are cold, he agrees and freezes. When we really, really don’t want something, he again agrees and reduces the influx of power in the indicated place. In particular, it reduces the production of milk and helpfully offers some sort of ailments in the assortment that help to end lactation - for example, my mother starts to have a headache from lack of sleep. A young mother can do her best to demonstrate the struggle with “fading” lactation, waving a list of lactogenic drugs and talking about her struggle for breastfeeding, but sooner or later she will be betrayed by irritation. In this case, there is a proverb: “It is better to feed a child artificial nutrition, but from pure heart than breast milk without goodwill."

Typical behavior against the background of a subconscious reluctance to breastfeed is a constant appeal to some kind of schemes. Trying to establish lactation, mommy uses scales (control weighing), adjusts the regime according to books and advice, calculates grams and minutes. She needs all these events to demonstrate her “goodness”. They protect her from possible attacks by "GV fans" and future complexes. Another mother, unsure of herself, choosing supplementary feeding with a mixture, as it were, relieves herself of responsibility. She's so much easier. She is not to blame for the child's empirical need for a mixture - tables, norms, grams are to blame. Here I would like to separately note: breastfeeding should be pleasant for both mother and child. “Evil” feeding through “I don’t want” will not bring any benefit to the child. Harmonious translation into IV will correct the situation.

5. The more (in time) the child is separated from the mother after birth, the worse the “mother-baby” bond, the mother’s body reacts less to the needs of the child. They didn’t attach to the breast after childbirth, they discovered some problems - they took them to the ICU, kept them in the hospital for some time - all these reasons can lead to hormonal imbalance, lactation will begin to fade. The centuries-old experience of breastfeeding shows that breast milk appears even in nulliparous women who breastfeed other people's children (nurses in Rus' often did not have their own children). The desire to breastfeed overcomes many obstacles: if it is not possible to breastfeed, the child is supplemented not with formula, but with expressed milk. In general, the child is your personal. If you are separated from your baby after childbirth, demand that you be provided with the conditions for normal breastfeeding. Often he is hindered by common sense, but the human factor (a disgruntled nurse).

6. Misinterpretation of lactation crises. At certain periods (usually in the third month of breastfeeding, sixth and ninth), there is a feeling of lack of milk. The baby begins to suck more often and longer - or vice versa, he drops his breast, is naughty, gains weight a little (less than in the first three months). It is at THREE MONTHS that the child begins to be supplemented with a mixture, transferring to mixed feeding (and later to artificial feeding). Mothers should learn timely information about lactation crises which should only be endured as an inevitable natural phenomenon.

Important: by the behavior at the breast it is impossible to determine whether the baby is full or hungry. This can be done by counting the daily number of urination, conducting a "wet diaper test" (at least 10-12 wet diapers per day). The most wrong action is to calm your nerves by feeding the baby with a mixture. You need to calm the nerves with valerian or persen - directly inside yourself. And also use all options for psychological relief.

6. Pressure from relatives. It is clear that the desire of grandmothers / neighbors / girlfriends to look smarter against the backdrop of an ever-doubting young mother. We all assert ourselves at the expense of someone or something, if there is not enough strength for self-realization. In this case, we can advise attending postpartum courses (in some schools, mothers are allowed to come with children), organizing forum parties - meet like-minded people more often, discuss common problems, rest assured that you are not alone.

Some statistics: "one bottle of the mixture will not hurt" - or will it hurt?

* Breastfeeding and formula fed babies have different gut flora.

* Breastfeeding babies have a lower pH environment (acidic environment) in the intestine at approximately 5.1-5.4 pH during the first six weeks, represented mainly by bifidobacteria with a small amount of pathogenic flora - microbes such as E coli, bacteroides, clostridia, and streptococci. And formula-fed babies have a high intestinal pH of about 5.9-7.3, with a variety of putrefactive bacterial flora.

* In breastfeeding infants who are supplemented with formula, the average pH is approximately 5.7-6.0 during the first four weeks, and decreases to 5.45 by the sixth week.

* When formula supplementation is given to breastfeeding infants during the first seven days of life, the production of the necessary acidic intestinal environment is delayed and can never be achieved thereafter.

* Breastfeeding infants supplemented with formula develop intestinal flora similar to formula-fed infants.

* As soon as formula supplementation begins, the bacterial flora of infants becomes similar to that of artificial babies, in which bifidobacteria no longer dominate, and colonization of anaerobic flora develops.

* Even small amounts of formula supplementation (one feeding every 24 hours) will lead to changes in the microflora in the intestines of the child.

* Administering formula to a breastfed infant results in disruption in the gut ecosystem.

* In allergy-prone families, breastfeeding infants can become sensitive to cow's milk protein even after one bottle of formula, (occasional supplementation, or scheduled supplementation in the nursery during the first three days of life).

Which is better: mixed feeding or artificial?

There is no consensus on this issue. It seems logical that formula supplementation in the amount of no more than 50% of the total nutrition is better, since at the same time the child continues to receive healthy breast milk. On the other hand, imagine: the baby has just been born. Nutrition is the building of the body, all vital systems. It is very important that the child immediately adapts to the proposed nutrition and begins to assimilate it harmoniously. In the case of mixed feeding, it turns out that the child is adapted to breast milk, but then he is offered a mixture, which also needs to be separately accustomed to. Often the children's body is lost from the periodic attack of "foreign" food and begins to weaken.

Supplementary feeding with a mixture is sometimes treated too lightly, prescribing it without the participation of a doctor. Breast milk and any (the most expensive and high-quality) mixture are not equal to each other. Compound breast milk unique, it is fully adaptable to specific child, has a different composition depending on its age, season, state of health and even time of day. No mixture will ever have these properties. Supplementation with a mixture must be discussed with a sane doctor practicing individual approach and not prescribing a mixture of advertising. Transferring a child to mixed feeding is a very serious step! An allergy may occur to the mixture, it is selected individually.

Some mothers begin to supplement the baby with a mixture at night according to "grandmother's" advice, so that the child sleeps better. All children after birth need to relieve birth stress. Imagine what a child has to experience during childbirth. He felt bad, hurt, scared. He was pulled out of a nine-month rest. For another 2-3 months, he will relieve stress through sleep or contact with his mother. The child needs to constantly feel the mother to make sure: she did not leave him. Therefore, newborns are able to "hang" on the chest for several hours. Any mixture is a very sweet satisfying product. It takes longer to digest and “nails” the child to a long sleep. There is nothing natural and harmonious in such a dream, except for the convenience of the mother.

Exceptional harm is supplementary feeding infants kefir or goat milk. These products are not adapted, not identical to breast milk or formula, and up to six months (goat milk is contraindicated up to a year) harm the body, providing a load on the kidneys, pancreas, reducing immunity.

And finally. If you had to transfer the baby to mixed feeding, and then to artificial feeding, under pressure of circumstances, this is not a reason for further complexes. This is your individual situation. Of course, breastfeeding perfect choice for a child. Without being able to support him, you still give your child no less love, worries, you constantly think that he is the best in the world. Here's what's most important.

On the photos: 1. Miroslava (mother Hryunichka), 2. Marusya (mother Valkyrie), 3. Polina (mother

Now every woman knows that for a baby there is no better nutrition than breast milk. Complete mother's milk contains not only all the nutrients necessary for the baby, but also enzymes for normal functioning. gastrointestinal tract, as well as antibodies that provide immune protection. Any artificial mixtures, no matter how high-quality they may be, cannot become a full-fledged replacement for breast milk. That is why breastfeeding is so valued, because it is the easiest and most natural way give the baby the best food.

However, in some cases it is necessary to apply the technique of the so-called mixed feeding. What is it, what is it for and how to do it correctly, we will consider in this article.

- this is the feeding of a child with breast milk together with artificial mixtures, while the content of breast milk in the infant's diet should be at least 50%. In case when mother's milk less than half of the total nutrition, we are already talking about artificial feeding.

The basic principle of mixed feeding is to give the child the maximum amount of breast milk. It is better to consider this system as a temporary measure, necessary until breastfeeding is established, and make every effort for this. That is why, before giving the baby a mixture (supplementary feeding), he must first be given a breast, and only then, if the milk is over, and the baby is still hungry, they are supplemented with a mixture.

Reasons and indications for mixed feeding

Transfer from breastfeeding to mixed, may be due to several reasons:

Lack of breast milk is the most common cause. It is possible to determine whether the child has enough milk by weighing before and after feeding. In addition, with malnutrition, the baby becomes restless or, conversely, lethargic, poorly or does not gain weight at all, rarely urinates ( normal frequency urination - 10-12 times a day). Milk may not be enough even if twins or triplets were born;
- the second most common reason is the mother's going to work/school when the expressed milk is not enough for full feeding;
- sometimes they switch to mixed feeding after a difficult birth, caesarean section, large blood loss of the mother;
- the mother is taking medications that suppress lactation.

The decision to switch to mixed feeding can only be made together with a pediatrician, and even better, a breastfeeding consultant. Only experts can say for sure whether the baby really needs to be fed, or “not enough milk” is nothing more than a mother’s anxiety.

But most common cause there is a lack of milk. You can suspect or determine it before going to the doctor, even at home.

To do this, you can use the following methods:

For example, checkweighing method when the child needs to be weighed before and after feeding and determine the rate that he should eat, according to his age. If it does not eat, then you need to supplement the mixture to the norm.

The second way is urination counting method, they should be at least 12 per day, if less means not eating enough.

Third method based on weight gain, i.e. the child should gain weight on their own age norms, if it does not gain the prescribed grams, then the baby does not have enough milk.

The following signs will also help you suspect a lack of milk:

  • as we have already said, the baby pees little, less than 7 times a day, the urine is dark yellow and has a pungent odor
  • child is not gaining weight
  • the child cannot adhere to the approximate feeding regimen, requires to eat in less than 1.5-2 hours
  • changes in the nature of the stool, liquid, or its absence

How to calculate supplementary feeding with mixed feeding?

But you will have to calculate the volume of supplementary feeding each time on your own.

There are several methods for calculating supplementary feeding.
Below are schemes for calculating supplementary feeding that you can offer.

For children in the first 10 days of life the amount of milk required is calculated using the following formulas
1. The amount of milk per day (ml) \u003d 2% of body weight x n, where n is the day of life
For example, a child is 7 days old, body weight 3500 g
3500 x 2 x 7: 100 = 490 ml the baby should eat per day

2. The amount of milk per 1 feeding = 3 x day of life x body weight (kg)
Take the same child 7 days and 3500 g
3 x 7 x 3.5 = 73.5 ml should be eaten by the baby in one feeding

For children over the 10th day of life The most popular method for determining the amount of milk required is the Heibner-Czerny "volumetric" method.
According to this method, the daily amount of food is:
from 10 days to 6 weeks - 1/5 of body weight
from 6 weeks to 4 months - 1/6 body weight
from 4 months to 6 months - 1/7 body weight
older than 6 months - 1/8 body weight

For example, a child is 2 months old, body weight is 5 kg
5000 g (weight in grams): 6 (1/6 body weight) = 833 ml per day

Mixed breastfeeding scheme

It is better to follow a free diet with mixed feeding, giving the baby a breast as soon as possible, that is, on demand. But the minimum must be at least 3 breastfeeding, since with a more rare attachment to the breast, lactation quickly fades away. This is especially important at night and morning time when prolactin hormone activity is at its highest. This technique, in addition to the obvious convenience for the mother, is also very important for improving lactation. But during the day you can already feed the baby with a mixture. It should be borne in mind that with mixed feeding, the number of feedings will be on average one less than with breastfeeding, this is due to the fact that the mixtures are more slowly evacuated from the stomach and therefore the feeding intervals increase. The recommended break between feedings is 3.5 hours. By the time of the introduction of complementary foods, children should be on 5 meals a day.

Types of mixtures for newborns

When supplementing, as a rule, artificial mixtures are used, which are very similar in composition to the mother's breast milk. Milk mixtures are adapted and non-adapted. Which, in turn, are divided into sour and fresh (sweet) mixtures.

Unadapted (simple) mixtures consist of cow's milk and its components, they are not processed and therefore their composition remains almost unchanged. Therefore, these mixtures are used in extreme cases, in the absence of adapted ones.

Adapted Blends- These are mixtures that are very close in composition to mother's breast milk. In them cow's milk corrected and enriched with vitamins and minerals, i.е. adapted for breast milk.

Well-adapted mixtures include Nutrilak-1 (Russia), Nan-1 (Nestlé), Nutrilon-1 (Holland), Humana-1 (Germany), etc.

Less adapted are "Nestozhen" (Switzerland), "Semilak" (USA), "Baby", "Kid" (Russia).

There are also acidic mixtures, they are good because they are more evenly evacuated from the stomach, are better digested, and also suppress the putrefactive flora in the intestines of the child. But they are not without a number of shortcomings. When feeding with exclusively acidic mixtures, the loss of some trace elements increases, for example, salts, calcium, ammonia is lost in the urine, etc. Therefore, feeding only sour mixtures is not recommended.

When choosing mixtures, consider:
- the degree of adaptation of the mixture (as we found out, they can be unadapted, adapted and partially adapted);
-individual reaction of the child to the mixture, i.e. how he bears it;
- a combination of mixtures (sour should not exceed 1/2 - 1/3 of the daily amount of food)
- the use of the mixture in accordance with the age of the child (usually the number 1,2 or 3 is indicated on the package, which corresponds to the following age 1 - from 0 to 6 months, 2 - from 6 months to 1 year and 3 - from a year)

But remember that all mixtures are suitable for feeding and it is not necessary to purchase the most expensive and adapted one, if the child tolerates the selected mixture well and has optimal developmental characteristics, then you should not change the selected mixture.

The choice of milk formula must be made together with the pediatrician, not focusing on advertising, advice from other mothers and sellers. Only a doctor will be able to determine which milk formula is best for your baby according to his age, health and individual needs. In addition, a competent doctor will give recommendations on establishing full breastfeeding.
The choice of milk formula must be made together with the pediatrician, not focusing on advertising, advice from other mothers and sellers. Only a doctor will be able to determine which milk formula is best for your baby according to his age, health and individual needs. In addition, a competent doctor will give recommendations on establishing full breastfeeding.

How to feed a child on mixed feeding?

With mixed feeding, there are several ways to supplement. One, as mentioned above, is spoon-feeding. This method is good for small amounts of supplementary feeding, which retains the ability to switch to breastfeeding after a while.

The second method, which is used if necessary to give the baby large volumes of the mixture, is feeding through a thin catheter coming from the bottle and fixed at the nipple. At the same time, contact between the mother and the child is not lost, which is very important for the preservation of breast milk, and the baby does not wean from the breast. This method is also good because it allows you to give supplementary food without stress for the child.

And, finally, the third method, which is used in the absence of the mother, is bottle feeding. If you have to give your baby a pacifier, choose the thickest one and make small holes in it so that the baby makes an effort, sucking out the food.

Problems with mixed feeding

One of the main problems with mixed feeding is the baby's refusal to breastfeed, since it is much more difficult for him to suckle the breast than to receive formula from a bottle. That is why it is better to supplement not from a pacifier, but from a spoon in order to prolong breastfeeding as much as possible.

In addition to breastfeeding, with mixed feeding, one of the most common troubles is a problem with digestion. The body of the child is adapted to mother's milk, which, in turn, is the ideal food for the baby. Artificial mixtures have a different composition and require a different intestinal microflora. That is why mixed-fed babies often experience constipation, colic, and there may be traces of undigested milk in the stool - white lumps.

This is caused by a violation of the acidity of the intestinal environment (in children on breastfeeding intestinal acidity is 5.1-5.4 pH, while artificial feeding is 5.9-7.3 pH), which, in turn, inhibits the development of bifidobacteria useful for digestion and creates a favorable environment for anaerobic putrefactive microflora. In addition, allergy-prone children may develop intolerance to milk protein, which will create many problems in the future.

In the video below, you can listen to your pediatrician's advice on how to combine breastfeeding with bottle feeding.

In conclusion, it should be recalled once again that early introduction supplementary feeding is an extreme measure, the need for which is determined by objective indicators, and not by the mother’s anxiety and the desire to supplement “just in case”. consult with a good doctor, which focuses not only on tables, norms and graphs, but also takes into account individual characteristics child. Breastfeeding consultants are very good at helping to establish breastfeeding. It may be enough to correct a couple of mistakes, and breastfeeding will improve, providing not only good nutrition baby, but also peace of mind and confidence.

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  • Development by months to a year
  • Complementary foods according to Komarovsky

    • Nothing is better than breast milk for a baby. However, it is not always possible to feed a baby 100% with this, nature-approved product. Sometimes the mother does not have enough milk, and then there is a need for mixed feeding. Thus, the baby receives both breast milk and something else so as not to remain hungry. Does such nutrition harm the baby and how to properly organize it, says the well-known children's doctor Evgeny Komarovsky.

    Do I need to fight for breast milk

    Insufficient lactation mother can be observed completely different reasons- from hormonal failure to a neuro-psychological state. It is this second reason that is usually the leading one. The mother does not have enough milk, she begins to blame herself for not being able to give the child the nutrition necessary for his health and development, and thus the vicious circle closes. A woman is in constant stress, which, in turn, adversely affects the mechanisms of lactation.

    Of course, breast milk is very important for a baby, but a normal, healthy and smiling mother is no less important for him, says Yevgeny Komarovsky. Therefore, if milk is barely collected for one feeding out of five, then special meaning keep mixed feeding no, you can switch to artificial. After all, if the total volume of mother's milk in the diet of the crumbs does not exceed one fifth, then it has almost no effect on health, and it can be safely abandoned.



    The second option is to change your attitude to the problem.

    If the mother stops punishing herself mentally for a lack of milk, and begins to calmly express or breastfeed at least once a day, and carry out the rest of the feedings with mixtures, then you can leave everything as it is (if this suits all parties - both the child and the mother, and dad).

    Mixed feeding is optimal if the proportion of mother's milk exceeds the volume of one feeding. For example, if half of the daily ration or a little less than that makes up breast milk. The volume can also be considered quite acceptable. natural nutrition in the amount of 30% of the daily diet.



    About the dangers of mixed feeding

    Until recently it was believed, and still some medical reference books indicate that the mixture of breast milk with another product when mixed feeding is harmful to the baby. Some doctors even interpret it as an "environmental disaster for the child's body." Yevgeny Komarovsky is in a hurry to reassure mothers who do not have enough milk of their own. The modern industry that produces formula and baby food, he says, has done everything to minimize this harm. And she succeeded.

    Thus, the composition of the majority of milk formulas available today ( we are talking about adapted mixtures) as close as possible to the composition of breast milk.

    Yes, this is not the same thing, and the mixture is not able to replace mother's milk, but it is better than giving cow or goat milk to a child, which are actually biologically alien products for him.


    Kinds

    Mixed feeding, despite its name, should not be chaotic. It also needs to be organized properly.

    There are two main types of mixed feeding: alternate and sequential.

    With alternate feeding, the mother will make it completely natural, and the other or several subsequent ones will be artificial. At consistent feeding the baby can suckle the breast until the milk runs out, after which visible signs anxiety (if the baby cries, reaches for the chest, smacks and demands the continuation of the "banquet"), he is given a certain amount of the mixture so that he does not feel hungry. It is important not to overfeed the baby.

    To know exactly how much formula he needs for supplementary feeding, it is advisable to weigh the child before and after feeding.

    Mom can choose one or another type on her own. Much depends on the amount of milk - whether it is enough for a whole feeding, and on other circumstances, for example, how often a woman can express. It is no secret that mixed feeding is often chosen when the mother needs to go to work and she is absent during the day. The most optimal is feeding every other time - at 6 am with a mixture, at 9 am - with a breast, at 12.00 - with a mixture, and so on.



    Rules

    The milk mixture saturates the baby faster and is digested a little longer, and therefore, with mixed feeding, you should not take long breaks between meals. A gap of 3-4 hours is enough. Even if you used to breastfeed on demand or every 2-2.5 hours, when you switch to mixed food feed correctly with longer intervals and according to the regimen.

    If the circumstances are such that the child has to switch to mixed feeding, then you should observe certain rules to help your little one stay healthy.

    • For baby up to 6 months you have to choose completely. adapted mixtures. They are marked with the number "1" on the package.
    • For toddlers from 6 to 12 months there are special mixtures - partially adapted. They are marked on the box with the number "2".
    • Children from one year mixes with the number "3" on the package are suitable.



    Irina Ferganova
    Pediatrician

    When and to whom

    It is believed that feeding a baby is considered mixed if breast milk substitutes take up no more than half of the total nutrition of the child. There are not so many situations in which the baby receives formula milk simultaneously with breast milk, or rather, only two.

    The first of them is the state of the baby in which he did not receive mother's milk for health reasons in the first days or weeks of life. Then, with the improvement in the condition of the crumbs, they gradually begin to give him mother's milk, which ideally should replace artificial mixtures.

    Another reason for switching to mixed feeding is the lack of mother's milk (hypogalactia).

    In addition to these two reasons, one can also mention some kind of force majeure situation when the mother has to leave the house, but there is no supply of breast milk.

    Let us dwell in more detail on the second reason for switching to mixed feeding, in particular, we will determine how to figure out that the baby does not have enough breast milk.

    1. The baby urinates less than 6-8 times a day - while a disposable diaper lasts more than 6 hours. In order to determine the frequency of urination of the baby within one day, it is quite possible to use uncomfortable disposable diapers but with routine cloth diapers. With insufficient milk supply, the baby's urine is concentrated - intensively yellow color, with a pronounced characteristic odor. (Other causes of these symptoms may include vomiting and frequent loose stools.)
    2. A lack of milk can be suspected if the baby does not regain its original weight within two weeks after birth, and also if weight gain is slower than 500 g per month during the first six months of life or 250 g in two weeks. Weighing your baby more than once every two weeks is not advisable. Please note that the so-called control weighings (before and after feeding), even after each feeding during the day, are not an objective indicator of the sufficiency of breast milk.
    3. The baby does not withstand the intervals between feedings of 1.5-2 hours.
    4. The child has a "hungry stool". It is different from the normal dark color(brownish or greenish) and thicker consistency.

    Please note that any other manifestations that mothers may mistake for a lack of milk are not a reason for transferring to mixed feeding.

    Thus, mixed feeding is a transitional state that can last from several days to several weeks. At the same time, a favorable outcome of mixed feeding is the transition to breastfeeding.

    If, nevertheless, the issue of feeding is resolved in favor of a mixed one, it is necessary to consult a pediatrician for the competent choice of one or another mixture, based on the developmental characteristics of your child.

    What are the mixtures?

    Modern milk formulas are as close as possible in composition to women's milk, although they are prepared on the basis of cow or goat milk subjected to special processing. Formulas are usually classified according to the degree of adaptation to breast milk.

    The maximum degree of adaptation is characterized by the so-called adapted mixtures - dry and liquid, fresh and sour-milk. Components similar to breast milk components are introduced into modern adapted mixtures - whey proteins, vegetable fats, carbohydrates in the form of lactose and dextrin-maltose, minerals, vitamins in adequate and balanced amounts.

    The second degree of adaptation is adapted mixtures based on casein without the addition of whey proteins. Casein is a protein produced during the curdling of milk. Babies who are prone to spitting up are usually recommended casein-based formulas with a reduced whey protein content.

    For the nutrition of older children, starting from the second half of life, the so-called transitional mixtures (or “following formulas.

    In the first 2-3 weeks of life, unleavened mixtures are suitable for the baby, since sour-milk at this age can cause (or increase) regurgitation.

    Products such as sterilized milk, baby kefir, biokefir are not adapted and can only be used as complementary foods for children in the second half of life.

    Among artificial mixtures a large group is made up of mixtures for medicinal purposes. There are a number of diseases in which, already in infancy, high-quality nutrition of the baby cannot be provided without the use of mixtures with medicinal properties: for premature and small babies, for babies with allergies, for babies suffering from abdominal pain, regurgitation, constipation, unstable stools. There are strict indications for the appointment of these mixtures, certain schemes for their introduction into the diet. Starting to give the child medicinal mixtures on your own, without consulting a specialist, you may not achieve the desired effect and even harm your baby.

    How much mixture is needed

    With mixed feeding, the diet remains free. That is, the baby is recommended to breastfeed on demand. In this case, it is necessary to control the amount of breast milk using control weighing, and compensate for the missing volume with a mixture. Supplementary feeding (mixture) should be given only after the baby is attached to both breasts. At the same time, the number of attachments to the breast is likely to be many times greater than the number of feedings with an adapted milk formula.

    Practically it looks like this. For example, according to the recommendation of the pediatrician, the child should receive the mixture every 3 hours. During these 3 hours, for example from 6.00 to 9.00, the baby can be attached to the breast several times. Each application must be accompanied control weighing, at the end of the 3-hour interval, you need to add up the entire amount of breast milk received by the baby, and supplement the missing amount with milk formula.

    Calculate the volume of milk and formula that the baby should receive for certain period time can be as follows: for a child under 10 days old, the daily volume of milk is equal to 2% of body weight at birth, multiplied by the child's age in days. Example: a child born with a body weight of 3200 on the 5th day of life should receive about 320 ml of milk per day (3200: 100x2x5 = 320), that is, with an average frequency of feeding from 8 to 10, the amount of food should be from 30 to 40 ml for every 3 hours. After 10 days to 2 months of life, the calculation is even simpler: the daily amount of food is 1/5 of body weight. Example: a child of 1 month with a body weight of 4500 per day should receive about 900 ml of milk. At this age, as a rule, the frequency of feeding is about 8 times a day, that is, for every 3 hours the baby receives from 100 to 120 ml of milk and formula.

    In any case, it is more expedient to give supplementary feeding from a spoon so that the child does not refuse the breast at all.

    The mixture should be diluted only with boiled water (preferably special water for baby food) and preferably immediately before feeding the child in full accordance with the instructions on the mixture packaging.

    In conclusion, we recall once again that both in the case of a shortage of milk and when switching from artificial to breastfeeding, the decision to introduce or cancel the mixture is made together with the pediatrician, who will further evaluate the correctness and success of the process.

    Every woman dreams not only of bearing a child, but also of fully feeding him with her milk. But sometimes the baby has to be supplemented with mixtures. The nutrition of the child should be balanced, since growth and weight gain depend on it. A mother can worry about what a newborn’s mixed nutrition should be like and how to properly transfer a baby to this type of feeding.

    Some mothers confuse artificial feeding with mixed. At artificial feeding the baby’s diet includes exclusively mixtures, and the milk in the diet of the crumbs is completely absent.

    mixed, or combined type nutrition is much healthier and better for the development of the child.

    The main food for such a newborn is. Only the missing amount of nutrition the child receives from artificial supplementary feeding.

    Signs of an undernourished child

    Mixing breast milk and artificial formulas is done when it becomes clear that the baby is not getting the necessary nutrients. Children's body You must eat well, otherwise the following symptoms may occur:

    • after feeding, hungry crying begins;
    • the child becomes less active;
    • in behavior there is lethargy and lethargy;
    • frequent causeless crying;
    • an abnormal reaction to the smell of the mother;
    • the baby does not fall asleep well, and the dream is restless;
    • decreased frequency of urination;
    • stool rare, possible;
    • the baby is slowly gaining weight;
    • the newborn actively sucks everything that comes into his hands.

    You can determine the malnutrition of a newborn with breast milk by the state of his skin. If they become too dry, the reason may be weak lactation.

    Mixed feeding of the baby (the scheme is described below) may be required if a woman plans to go to work and in daytime hours breastfeeding becomes impossible. Mom's non-compliance with the diet or the presence of any diseases can force a woman to supplement her baby with mixtures at the same time so that he receives all the nutrients. Such a measure is also necessary with a lack of breast milk, or if the baby refuses to breastfeed.

    Rules for organizing mixed feeding

    So we decided to start mixed feeding baby: how to feed? First you need to choose the right mixture.

    The composition of the mixture should be as close as possible to the composition of mother's milk. This will allow the baby's body to absorb it better. The composition should not cause allergies or malfunctions of the digestive system.

    It is important to consider that dry mixes are stored longer than liquid ones. In the process of preparing portions of food, it is important to strictly follow the instructions indicated on the package. The composition of the supplement should include the following substances:

    • milk serum;
    • carnitine;
    • linoleic acid;
    • taurine.

    So that the baby's body does not suffer from shortages nutrients, should be correct ratio in the diet of milk and formula. Follow the nutritional recommendations in the table below:

    • 1 day of life - age 2 months, the weight of supplementary feeding is 20%;
    • 2-4 months - 16%;
    • 4-6 months - 14%;
    • 6-8 months - 12%;
    • 8-12 months - 11%.

    Not only the amount of supplementary feeding, but also the frequency of meals depends on the age of the baby. In the first week of life, it is necessary to supplement the crumbs 7-8 times a day. At the age of 4 weeks, the frequency of supplementary feeding is reduced to 6-7 times. From a month to four, the minimum number additional tricks food is 5 times. Up to six months and older, supplementary feeding can be introduced 4-5 times a day.

    For complementary foods, you can use the following mixtures:

    • "Similac";
    • "Unstable";
    • "Nan";
    • "Nutrilon";
    • "Baby".

    Knowing what mixed feeding is, how to properly organize feeding, the mother will be able to fully take care of the baby's health.

    Problems with mixed feeding of a newborn

    The most common problems are that when complementary feeding is introduced, babies become picky and may even. They can distinguish the taste, and also be lazy to suck milk, because more effort is needed. To avoid all these problems, you should listen to the following recommendations:

    • give the newborn only after breastfeeding;
    • do not give a bottle until the breast is completely emptied;
    • if formula feeding is associated with the absence of a woman, make it a rule that all meals while she is at home will be breastfeeding;
    • if possible, supplementation should be given from a spoon or pipette, and not from a bottle;
    • if a nipple is used, the holes in it should be minimal;
    • it is better to feed the baby on demand, and not according to the schedule, since with the presence of supplementary feeding, children do not need food so badly.

    In order not to burn the mucous membrane of the child's mouth and not to chill his throat, it is important to check the temperature of the mixture given. The optimum temperature range is 37-38 degrees. When introduced into the diet pure water, it can be a little cooler. With mixed feeding, a woman should take into account that the introduction of complementary foods begins earlier. If during breastfeeding it is administered from six months of age, then with combined it is done 2-3 weeks earlier.

    If parents follow simple rules feed and carefully care for the baby, then they will grow up a strong and healthy person!