Supplementary feeding during breastfeeding: how to introduce formula and supplementary feeding to the baby?

How to determine lack of breast milk

A lack of breast milk can be easily determined by regularly measuring the baby's weight. Therefore, you need to go to the pediatrician for examinations every month. In the first week, the baby should gain up to 150 grams; in the second to fourth month, it is considered normal if the child gains up to 800 grams per month. Starting from 4 months, the baby is already moving, and therefore gains less; the norm per month can be called 400-650 grams. But all these are conditional indicators of weight gain, and minor deviations are considered the norm. To understand whether your baby is gaining weight normally, you need to regularly visit the doctor and look at the weight gain chart for up to one year.

You can tell whether a child is eating enough or not by looking at his urine. If a newborn urinates less than 10 times a day, his biological fluid has an orange tint and the smell of acetone, which means he is not getting enough food and needs to be fed additionally.

When to supplement

There are several signs by which it can be determined that a child needs supplemental feeding. You need to give your baby formula and breast milk in the following cases:

Premature baby. Such children are born weak, not all their organs are developed, and therefore they do not have enough strength to suckle at the breast. If there are neurological problems, the newborn will not be able to grasp the nipple and will not coordinate movements.
Lack of weight. It is necessary to make sure that the baby eats while suckling. The numbers on the scale can tell you this, and you should hear swallowing.
Long-term use of medications incompatible with lactation. When selecting drug therapy, a woman must tell the doctor that she is a nursing mother, and he will adjust the treatment.
Separation from mother. And even if the mother goes to work, the child needs to get used to the formula, because few people can strain enough milk to last for the whole day.
Lack of milk. Most often, this is a temporary phenomenon and the mother needs to establish proper feeding by constantly putting the baby to the breast.

If you want to maintain both breastfeeding and artificial feeding, then the volume of the mixture eaten should be no more than 30-50% of the total volume of food.

When supplementary feeding is not required

You should not feed your baby before the required age. If he has enough food, he will feel good. Factors indicating that the child is not hungry include the following:

When suckling the breast, the baby throws it and cries a lot. Most often this happens because the baby has difficulty producing milk and does not want to make an effort to eat. The mother should establish the feeding process by showing the baby how he should take the breast so that he does not completely refuse it.
The baby sleeps a lot. For the first month of life, long sleep is considered normal. The maximum waking time for a newborn is 1 hour, the rest of the time he sleeps.
Frequent application. After birth, a child can be attached to the mother’s breast up to 4 times, as he feels completely safe. After 2-3 months it can decrease up to 15 times. However, when he is scared, sick or upset, the baby may nurse more often.

Even if you express milk, but you have very little of it, it is still too early to introduce complementary feeding to your baby. In general, if the baby constantly sucks at the breast and you are next to him, then you should not express milk, the newborn will suck as much as he needs, and if he remains hungry, he will tell you about it.

For what reasons is a child transferred to formula feeding?

Since the transition from guards to livestock occurs for a number of reasons, it is customary to divide them into the following categories:

Mom and related reasons

Clinical health indications do not allow a woman to continue breastfeeding: HIV disease, tuberculosis, hepatitis C, heart disease or kidney failure, cancer development.
Taking antibiotics.
Recorded mental disorders in a woman.
Breast milk is contaminated with staphylococcus.
Stopping breastfeeding due to imminent return to work.
Reluctance to breastfeed the baby for aesthetic reasons (the woman does not want to spoil her breasts).
Newfangled trends for a young mother - some women are susceptible to other people's opinions and consider breastfeeding to be an unfashionable activity.

Breastfeeding and causes associated with it

Genetic diseases - phenylketonuria or galactosemia, that is, problems with metabolism in a newborn.
Introduction of supplementary feeding - the baby does not get enough of the milk available from the mother.
The baby does not accept mother's milk well - he is often tormented by colic and constantly regurgitates healthy food. Then the milk is replaced with artificial feeding with medicinal analogues of mother's milk.
Lack of stable and sound sleep at night - constant waking up, the baby constantly asks for the breast.
A newborn may simply refuse to nurse, then he is switched to formula and bottle-fed.

If the reasons for switching to formula are not critical and do not greatly depend on the mother and baby, then it is better to continue breastfeeding. After all, choosing a mixture is also not always easy; the process can take quite a long time, during which a woman’s lactation will completely fade away. This applies to those cases when a caring mother is in a hurry to switch the child to formula in order to feed him enough, fearing that there may be little milk or that the child is hungry. The way out of this situation most often lies in changing feeding tactics and frequent breastfeeding.

When to introduce supplementary feeding to an infant

The most striking signs indicating that the baby does not have enough milk are the following:

urinating less than 6-8 times;
severe crying;
poor weight gain;
rare bowel movements.

If a child gains less than 400 grams in the first month of his life, it means that he needs to be fed additionally; he does not get enough of his mother’s milk.

How to supplement a newborn's feeding if there is not enough milk, what formula to choose for supplemental feeding?

If you decide to start supplementary feeding, you need to be careful when choosing the formula so as not to provoke an allergic reaction. It is worth choosing baby food in accordance with the weight and age of the baby and the characteristics of its health. If after eating a rash appears on the body, then it is necessary to change it, it is not suitable for him. Children often exhibit reactions to different formulas, and then they are prescribed medicated foods—lactose-free formulas.

If a child begins to cry after introducing complementary foods, most likely he has tummy problems and the formula is not suitable for him. In this case, you need to eat foods with probiotics. When choosing a mixture, you should not change it every day; you should introduce a new product no more than once a week. It is important to be gradual. If, after introducing a new diet, stools become up to 10 times more frequent and diarrhea occurs more often, then most likely the reason is that the mixture was prepared or stored inappropriately.

The most common mixtures are the following:

Nutrilak;
Nan;
Baby;
Nestozhen;
Similak.

The most important thing when buying a mixture is to look at its expiration date; if there are several, weeks or even a couple of months left, you should abandon this food. It may harm the newborn.

How to calculate the amount of formula?

The amount of formula per day is calculated based on weight, age and type of milk supply. You can determine whether he is full or not based on how much the baby urinates per day. If it is less than 12 times, it means that the mixture is not enough for him and it is necessary to increase the single dosage according to his age. Each unfinished time you need to add:

1 month - 10 grams;
2 months - 20 grams;
3 months - 30 grams;
4 months - 40 grams.

Example! If the child is three months old and he urinates 8 times a day, then it is necessary to add up to 90 ml of the mixture per day, divided into several doses.

How to prepare baby formula

Before you begin preparing the mixture, you must wash your hands well with soap. It is necessary to look at the packaging for the ratio of the mixture and water, according to age. Each manufacturer's data differs, but on average they are as follows:

Age	Water volume, ml	Number of measuring spoons
Up to two weeks	90	3
2 weeks - 2 months	120	4
2 months	150	5
3-4 months	180	6
Over 5 months	210	7

The first time, you should give your child no more than a teaspoon of the mixture to try to monitor for an allergic reaction. If even minor rashes appear, it is necessary to select a mixture with a different composition. The optimal cooking temperature is 36 degrees, but before you give your baby food, you need to try it yourself so that he doesn’t get burned or get it on his wrist. The finished mixture can be stored in the refrigerator for no more than a day, and warmed up before giving it to the child.

Artificial feeding: rules and techniques

Now let's figure out how to feed formula correctly.
First of all, you need to understand whether the child receives artificial nutrition immediately or whether he switches from breastfeeding to another type of feeding. Babies who have recently been born are fed from a bottle or syringe, taking into account his weight. A neonatologist will tell you which mixture is best for newborns. You should follow the instructions on the package or use a special formula provided by your doctor. The feeding rate for a newborn is calculated based on the weight and age of the baby.

If the child received breast milk, the formula should be introduced gradually. First, give a smaller amount of food than expected and be sure to watch the baby’s reaction. Gradually replace breastfeeding one at a time. Try to adapt to your baby to make him more comfortable. It is also possible to breastfeed first and then supplement with formula. After some time, replace one feeding, after three days - another, etc.

If the milk suddenly disappears, it will be more difficult. The baby may be capricious and refuse the bottle. Here you need to be patient, perhaps try different types of nipples.

First, give your baby half or one third of the prescribed portion. Make up the rest with water. Gradually increase portions if baby responds well.

Also be sure to consider these rules:

Prepare the formula before each feeding. You cannot store prepared food for more than an hour, even in the refrigerator.
Be sure to thoroughly wash and sterilize all utensils, the spoon you use to scoop the mixture, and wash your hands.
Read the instructions to understand how much formula your baby should eat at one feeding.
Dilute the mixture according to the instructions on the package. Use only boiled water!
Mix the food thoroughly so that there are no lumps.
The finished food should be warm, about 37–40 °C. If you don't have a thermometer, place a drop of the mixture on the inside of your wrist. The hand should feel nice and warm.
The hole in the nipple on the bottle should not be large. Let the nutrition drip, not trickle.
Hold the bottle so that the nipple is completely filled with nutrition.
Be sure to supplement your baby with water or special baby tea.
Do not feed a sleepy or sleeping baby.
You shouldn’t force your baby to finish the mixture if he doesn’t want to anymore. However, if the baby remains hungry, then he can be given about 30–50 ml of additional food.
After feeding, hold your baby in a column for 15 minutes. This is necessary to release excess air, which still enters the stomach during feeding.

How often to feed a newborn? Formula is harder to digest than mother's milk. Therefore, if breastfeeding can be done on demand, then the baby should receive artificial nutrition hourly. Feeding of newborns usually occurs after two to three hours. How much formula should a 1 month old baby eat at one feeding? Usually it is about 80–100 ml. Then the amount of nutrition increases.

Photo: Bashkirova N. Baby from birth to three years. Everything parents need to know. — St. Petersburg, 2010

Until six months of age, a child eats on average six times a day. With the introduction of complementary foods, the number of formula intakes is reduced to five times.

I have already said that often artificial nutrition is not suitable for the baby. How to transfer the child to another formula in this case? The transition must be carried out gradually. At any age, the baby should start with 10 ml per day. Give a new product first, and then the usual food. On the second day, introduce 20 ml of the mixture, on the third - 30. On the fourth day, you can introduce 40 ml, dividing them into two feedings.

If the baby responds well to the change in diet, continue to increase the dose until the change is complete. Study the information well - then the question of how to introduce a new mixture will not confuse you.

Feeding your baby formula is not as difficult as it seems. In a few days you will completely adapt to the process.

How to supplement your baby's feeding if there is not enough milk

In total, several devices have been identified for introducing complementary foods. You should not stop at a bottle with a nipple, it greatly threatens weaning. There are other methods for the first supplementary feeding.

Pacifier

Many mothers begin to supplement their baby's feeding from a bottle with a nipple; this method is very convenient; the baby can drink the formula himself without the participation of the mother. But this method of feeding greatly threatens breastfeeding. The fact is that it is very easy to get food from the nipple, but when sucking the breast you have to make an effort. And when the baby realizes that he can eat without effort, he will demand a bottle of formula, refusing to breastfeed.

If you want to use a bottle, you will need to use other tube feeding methods. It is inserted into the bottle and guided to the nipple. So the baby has to actively suck, and he simultaneously feeds on breast milk and the family.

spoon

A teaspoon is used by many mothers for the first feeding, since this method does not affect breastfeeding in any way. This method is suitable for the first feeding when using a small amount of food. It is necessary to choose silicone devices. The mixture should be poured into the baby's cheek; if you put it on the root of the tongue, the baby will spit it out. Today you can find bottles on sale that have a small spoon instead of a nipple.

Syringe and pipette

You can also supplement a newborn’s feeding with such devices, but only if the amount of food is small. It is worth knowing that this method of eating is long-lasting, but does not affect breastfeeding in any way.

Cup

It is worth using such dishes for feeding with children who are older than one year. If the child is smaller, he simply will not be able to drink from a cup. Or the whole mixture will spill. For such cases, you can use glasses or beakers that are smaller in size. And the risk of swallowing a lot of milk increases; it is impossible to calculate how much the baby has eaten, which is very important when feeding formula.

CALCULATE VOLUME

With mixed feeding, the volume of the mixture depends on the degree of hypogalactia and corresponds to the difference between the required daily amount of nutrition and the amount of breast milk. To determine the degree of hypogalactia, and therefore the amount of supplementary feeding, a control weighing of the baby is carried out - before and after feeding. Each feeding starts with breast milk and then supplemented with formula.

Be careful when calculating the amount of formula so as not to overfeed your baby

This is especially important in the first weeks of life. Overeating during this period can disrupt the metabolic process and cause a tendency to become overweight in the future.

If the baby’s body weight corresponds to the average age norm, then the daily amount of food will be approximately the following:

from 10 days to 2 months – 600-900 ml
from 2 to 4 months – 800-1000 ml
from 4 to 9 months – 900-1000 ml
from 9 to 12 months – 1000-1200 ml

The missing volume of breast milk is replenished with supplementary feeding - baby formula.

What can you do to prevent your mother from losing milk?

Very often, many mothers have to stop breastfeeding early, before the child is even six months old. Some parents do this deliberately, and sometimes it is an unexpected situation. In order not to waste milk, you must adhere to the following recommendations:

stop being nervous, worrying;
Healthy food;
do not overwork;
do not take medications that are incompatible with lactation.

In some cases, lactation has to be canceled due to the mother's illness, when she needs to take medications that can cause harm. If the child himself turns away from the breast for no known reason, you should not deny him this delicacy; you need to establish the lactation process. If little milk is produced, you need to drink more warm liquids, follow the correct daily routine and do not bottle feed your baby. Supplementation of the baby should be done only when necessary.

Types of mixtures

Infant formulas come in powder, concentrated and ready-to-use. In terms of nutritional value, they are absolutely the same.

Powdered mixtures are the most economical option.

Ready-to-eat ones are expensive, but very convenient. They just need to be warmed up. At the same time, sealed containers last longer than open jars of powder.

Concentrated mixtures, like powder ones, require preparation strictly according to the instructions. If it is too diluted, the baby will not be able to get enough, and if it is too concentrated, it will have a bad effect on the baby’s kidneys.

Frequent difficulties

It would be wrong to say that the transition to artificial feeding is an extremely easy process. Often, parents, for one reason or another, are forced to resort to adaptive nutrition and face some problems. Let's look at some of them in more detail.

The first difficulty that parents of a bottle-fed newborn may encounter is the child’s refusal to take that very bottle. Those children who switch to adaptive nutrition from breastfeeding are especially susceptible to this problem. Their pickiness is understandable: the mixture smells completely different from mother’s milk, and the bottle does not give a feeling of closeness to the mother.

To avoid difficulties, in addition to the feeding rules described above, parents should take into account some other factors.

First, feeding time. The baby will perceive the container with the formula as a foreign object if it receives it at the wrong time.
Secondly, the hunger factor. While some mothers use breastfeeding as a way to soothe their baby, this technique will not work with adaptive nutrition. Feed your baby only when he asks for it, so that he takes the bottle with pleasure.
Affects the perception and timing of feeding. After sleep, a child, as a rule, is not very selective - he eats with pleasure, having felt only the smell.
Let us also note the fact that often the baby begins to perceive the bottle as a toy, and consequently, he stops eating the formula itself. To avoid this, take it away immediately after eating.

Another common problem that many parents face is the child’s allergy to formula. Abnormal bowel movements, vomiting, redness and rash - all this can be part of the symptoms of an allergic reaction of an infant to an analogue of mother's milk. You should think about this in advance, even in consultation with a pediatrician. After all, he is the one who can choose for you the mixture that will not entail negative consequences. The doctor may also recommend an anti-allergy drug that you should give to your child as first aid if an allergy occurs.

Note that some of the factors causing allergies cannot be diagnosed by a doctor in advance. Thus, the heredity of allergic parents often plays a cruel joke on children who are forced to eat formula. You should talk to your pediatrician about this factor in advance.

In addition, the child may experience an overload reaction. This is a state of excessive stress on the liver, kidneys and gastrointestinal tract. However, this condition has simple prevention. It is enough just not to overfeed the newborn. The optimal volume of mixture per meal should also be checked with your pediatrician.

Experts:

Nikolai Vladimirovich Komov

Mixture volume

If a baby does not have enough milk while breastfeeding, he must be supplemented with an artificial formula, the volume of which must be calculated correctly, but how to do this? There are two ways.

To find out how much breast milk the baby receives during the day, he is weighed before and after feeding. Based on the difference obtained and the child’s age needs in terms of food volume, an appropriate conclusion is made. This method helps to quickly and easily determine whether supplementary feeding is necessary and how much formula the child needs.

You can also find out whether the mother has a lack of milk by counting wet diapers. To this end, you need to give up disposable diapers for one day and swaddle your newborn the old fashioned way. On average, an infant urinates 12 times a day. If this happens less often, you should add 30 ml of the mixture to each feeding until the number of wet diapers corresponds to the norm.

There is no need to calculate the required amount of supplementary feeding “by eye”. Such actions can lead to digestive problems, increased stomach volume and excess body weight of the child if you make a mistake and overfeed the baby.

Important feeding rules

Specially prepared dishes

Bottles used for feeding must be washed with a brush and sterilized in advance. This can be done by boiling them for 5 - 10 minutes or using a special sterilizer. The bottle in which the mixture is diluted must be dry.

The pacifier should be selected with the expectation that the mixture will flow out of it not in a stream, but drop by drop. This will ensure active sucking, and not just swallowing of the pouring mixture

What is important for the development of the maxillofacial apparatus

Diet and routine

This is a very important point. The baby receives his food on demand. How many times does a child need to eat on IV? The schedule depends on age. So, a newborn eats 7 - 9 times a day, a child 2 - 5 months old - 6 - 7 times, a six-month-old child needs to eat 5 - 6 times a day.

How much formula should I give at one feeding?

To do this, you first need to determine the daily amount of food. How much a baby should eat depends on his weight and age. So, up to two months, a child needs a volume of food in the amount of 1 - 5 of his body weight, at 2 - 4 months - 1 - 6, at 4 - 6 months 1 - 7 of his body weight, over six months - 1 - 8.

For example, a 1 month old baby weighs 4.5 kilograms, then he needs 900 milliliters of formula per day. It must be remembered that this volume should not exceed 1 liter.

To determine the volume of mixture required for one feeding, divide the daily amount by the required number of feedings. This will be 100 - 130 milliliters of the mixture.

It happens that a child eats a little less or more. A slight run-up is possible. Systematic overfeeding or underfeeding should not be allowed. For a child, this is fraught with obesity or malnutrition.

The volumetric method described above is the simplest and most convenient to use. If necessary or if there are problems with weight, the doctor can calculate the volume of a certain mixture for a particular child using the caloric method and taking into account the age-related needs for proteins, fats and carbohydrates.

How to prepare the mixture?

Only boiled water should be used. The volume of water required for one feeding at a temperature of 50˚C is poured into the bottle and the prescribed amount of mixture is poured (indicated in detail on the packaging). Everything is thoroughly shaken and mixed.

How to feed formula?

How to feed a child correctly? Before feeding, you need to make sure that the prepared mixture is at the optimal temperature. To do this, drop it on your wrist (on the palmar surface). Its temperature should not be felt by the skin.

Wash your hands with soap. Find a comfortable position. Special pillows will help with this, using which you can comfortably position both yourself and the child. In this case, feeding will become a pleasant relaxation for the nursing mother and a source of necessary tactile contact for the baby.

Therefore, it is better to take it in your arms. If your baby is prone to excessive spitting, it is best to hold him upright. In other cases - semi-vertical.

Turn the bottle upside down so that the mixture completely fills the nipple and neck, and the air rushes to the bottom. This will prevent the baby from swallowing air and developing colic.

It is necessary to ensure that the mixture drips from the nipple and does not flow. Over time, nipples wear out and need to be replaced.

If there is any ready-made mixture left

According to the rules, the mixture remaining after feeding must be poured out. But it can still be stored for a little while. At room temperature for one to two hours and no more than half a day in the refrigerator. Before feeding this mixture, it must be heated to an acceptable temperature.

Additional soldering

The child's artificial nutrition must be supplemented with liquid - water, weak infusions of rose hips and tea (not the regular one that you and I drink every day, but children's herbal tea).

In the heat and in a room with dry air, the amount drunk should be increased by 50 - 100 ml. It is also worth monitoring the child’s health.

Introduction of complementary foods

Formula-fed babies begin to introduce complementary foods earlier than infants. From 4 - 4.5 months they begin to be given vegetable puree, from 5 - porridge.

Be sure to read the information from your pediatrician about how complementary feeding progresses month by month in bottle-fed children.

Properly storing and preparing the mixture

Heat the mixture in a saucepan with water or a special device. Don't use the microwave!

Turning to the bottle every time will lead to gradual weaning.

At room temperature, try to store the mixture for no longer than 2-4 hours.

Refrigerated – 48 hours. Freezing is not recommended: this significantly reduces the nutritional value of the product.

If your baby doesn't finish the portion, throw away the rest. After all, it already contains bacteria that live in saliva - once in milk, they quickly multiply and spoil it.