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Supplementing feeding of newborns and infants

"May he grow healthily", this is parent's greatest wish from the moment of baby's birth. Ensuring the baby eats and gains weight correctly is a challenge taken by mothers, and a very difficult and stressful problem when it does not happen so.
consultation Danuta Chrzanowska-Liszewska MD, neonatologist | 17 March 2014
KONSULTACJA MERYTORYCZNA
 
 
 
 
lek. med. Danuta Chrzanowska - Liszewska MD,
 
neonatologist

Trends in gaining weight

After birth, baby's weight usually drops a little, to increase after a few days, and then rise steadily. This increasing weight is one of the indicators for baby's wellbeing.

According to the standards, a breastfed baby should gain about 120–210 grams per week (i.e., 765–945 grams per month) in the first three months of his life. After the third month, infants gain about 110–120 grams per week (i.e., 500–540 grams per month). Usually, between fourth and sixth month of his life baby's weight at birth is doubled. In the next six months of baby's life, he will gain weigh slower, first about 370 grams per month, and then about 250–300 grams per month around his first birthday. In the second year of his life the toddler gains about 225 grams per month. It should also be remembered that body weight, particularly in very small children, also depends on when he has eaten, urinated or passed stool.

Beside regular monitoring of baby's weight, values for baby's weight and height should be verified against percentile charts for height and weight, appropriate for baby's sex. During his development, the baby should remain roughly on the same percentile, and that percentile should be similar for weight and height.

Supplementation


Supplementation means
 

giving extracted mother's milk or infant formula additionally to breastfeeding.

What should be done, when the baby does not gain weight regularly or loses it? You must consult a pediatrician. The doctor will check and examine the baby, interview his parent, order additional tests, when necessary, or verify correctness of the breastfeeding technique, and possibly will recommend supplementation. Supplementation means giving extracted mother's milk or infant formula additionally to breastfeeding.

Indications for supplementation

Supplementation with formula is recommended for newborns, and later for infants, with excessive loss of or insufficient gaining on weight. In some cases the baby has problems with suckling, refuses to suckle, has a suckling disorder of various origins, or was born with a defect hindering correct grasping of a breast. Sometimes a premature baby is too weak to suck a breast effectively, he can get tired and refuse to suck, or fall asleep at the breast too early. In such cases, apart from supplementation, preferably with extracted mother's milk, also important is cooperation with a pediatrician, neurologists, speech therapists, midwife or lactational advisor, as necessary, aiming at developing a correct suckling reflex, if possible.

Some women have small amount of milk in their breasts, so the latched on baby is angry and frustrated because his efforts are futile, so eventually he can  refuse to suck. Here supplementation is a method used to satisfy baby's hunger. Stimulation of lactation is emphasized, by latching the baby on to the breast as often as possible, extraction of milk with a pump, continuing with night feedings and by mother's diet rich in fluids. It should also be checked whether the baby grasps and sucks the breast correctly, as only then he can stimulate it adequately to milk production.

Supplementation is also started for medical reasons, e.g., due to dehydration or during treatment for hypoglycemia.

Methods for supplementing

Cup for feeding newborns and infants
A cup should be of transparent material, so a milk level at baby's mouth can be seen; it should also be relatively soft, so it can be squeezed to make drinking easier for the baby. Its edge should be sightly turned out and rounded. You must hook a special edge of the cup on baby's lower lip with the cup placed on the lower lip, and wait until the baby starts to skim portions of milk with his upper lip. By pressing and tilting the cup slightly, let the baby suck the milk from the cup himself.

Spoon
The spoon should be small, flat and, preferably, plastic. The best way is to place baby's head on your forearm, so he is in a semi-inclined position, and use the spoon to delicately put milk in baby's mouth.

Pipette
Similarly, when the baby is in the semi-inclined position, you can feed him with a pipette. The pipette is safer and more recommended than a syringe, which requires more practice and  is more hazardous, because when the piston is pushed too strongly, too much milk with flow and the baby can choke on it.

Bottle with a dynamic teat
When supplementing, the more you want the baby to smoothly return to breastfeeding, the more a choice of a teat is important. Apart from a material of the bottle and the teat that must be safe for babies, another precondition is that the teat should not disturb the natural suckling pattern and rhythm. It is important for a technique of teat suckling to remain as close as possible to the one used during suckling of a breast; the teat should elongate and contract in baby's mouth like a nipple, and, at the same time, its base should offer a stable support for lips (it should not be too soft). This function is not ensured by teats of homogeneous silicone, because hard ones do not have an elongating tip, and in soft ones the baby bites the teat base. So a dynamic teat, of heterogeneous silicon layers, with a thin, soft tip and hard base, is the best choice. The teat design should allow baby's lips to adhere tightly to the teat and stay there throughout suckling. During eating the baby should not swallow air, as this may result in colics.

When there is no need to supplement


 

The baby gaining weight correctly does not need supplementation.

The breastfed baby gaining weight correctly does not need supplementation. Sometimes parents think about it, when the baby demands food more frequently. Apparently, he needs more milk at that moment; he may go through a developmental leap, and natural mother's milk is quickly digested by the baby. Sometimes, the baby cries, latched on to the breast will eat, and then he cries again. When he gains weight correctly, you should look for reasons of his crying other than hunger; the baby can have colic, be teething, feel uncomfortable because of a wet diaper or uncomfortable clothes, or just wants to be close to his guardians.

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