Baby Nutrition. Normal drinking behavior of the infant - Part I

02.04.2021
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Baby Nutrition. Normal drinking behavior of the infant - Part I

Infants and children with illnesses require extra individual consultations and partly nutrition training and nutrition plans; only the guidelines for healthy children are presented here.

General Recommendations: Information DGE(German Nutrition Society) according to FGE (Research Department of Child Nutrition) and the BzgA (Federal Center for Health Education),  and Federal Institute for Risk Assessment.

 

Not only the choice of milk, but also breast drinking reduces the risk of later gaining weight excess (breastfeeding and prevention of obesity)

As already shown in previous teaching letters, there is a risk of developing obesity in childhood in connection with feeding infants if too high protein content is present in the milk (e.g. in unsuitable formula milk or feeding with cow's milk).

The development of a healthy gut microbiome (germ spectrum) that infants receive with breast milk but also the form of the feeding conditions is one of the best outcomes, but an even better effect was seen in the studies in children who not only received breast milk but were fed directly through the breast for at least 3 months. That means explicit breastfeeding seems to have an extra benefit to the prevention of obesity.

When feeding through breasts, children do not drink too much as they were fed by bottles – where they are more often pushed to finish the bottle. By breastfeeding, they tend to drink only the amount they need. At the breast, the children are more likely to learn to consume only the amounts they need and to pay attention to saturation.

In order for mothers to be able to feed breasts for at least the first 3 months, it is necessary to enable the mothers to do so.

In addition to the conditioning of children into healthy foods and sufficient physical activities, the above factors show that the problem of developing overweight or even obesity should be seen in a broader context and that such socio-economic factors of the “work-life balance” can have a negative impact, because at such an early stage in life the working conditions like the mother's ability to breastfeed regularly can condition important functions of the thechild's later nutritional behavior (e.g. the feeling of satiety).

 

Normal drinking behavior of the infant - promoting breast drinking

It is best for the expectant mother to prepare for the breast breastfeeding of the baby in the long term before childbirth and to clarify all questions about it. If the experience cannot be used in one's own family, professionals should be consulted, or the advice from the National Breastfeeding Commission should be used.

 

Overview of recommendations

·         The first application of the baby to the breast should take place as soon as possible after the birth and then be repeated every 2 - 3 hours (with low suction behavior, the baby can be applied more frequently at the beginning if necessary).

In case of breastfeeding difficulties, it may be necessary to act quickly and feed an extra bottle, or thus, the additional administration of maltodextrin (a sugar solution) may also be indicated.

Discuss all problems and abnormalities with your pediatrician and the midwife looking after you.  

·         In the first weeks of life, most babies are putto the breast 10 to 12 times within 24 hours.

·         Weight control is recommended daily in the first days of life (for weight development and if necessary extra presentation to the pediatrician -see below)

·         Later, the baby is breastfed on demand – it should usually be about 6 - 8 – (10) meals per day.

·         The single breastfeeding time should preferably not extend too long (usually about 10 minutes per breast).

·         It is best to let drink one breast completely (over the time of a breastfeeding meal, the breast milk composition changes) and, if necessary, switch to the other breast.  The next breastfeeding starts with the not-emptied breast.

 

If the baby does not drink a full breast because it is still too full, stop and let it drink it the next time.  When it is too little and must be fed with bottled milk, see below topic complementary foods.

·         Good infant nutrition can also be recognized by normal breast milk feces (the stool looks golden yellow, is soft - and smells sour-sweet (after whey) – a stool analysis shows the typical flora with over 90% Bifidusbacteria.

·         The stool emptying usually takes place several times a day but can also be suspended for 1-2 days. In case of frequently reduced stool emptying and especially raised abdomen, the baby should be examined by the pediatrician.

·         At least until the beginning of the 5th month of life, baby should be fully breastfed (better even longer).

·         Complimentary food (mash) should be fed at the earliest at the beginning of the 5th month (at the latest from the beginning of the 7th month - see below). Even after that, mothers should continue breastfeeding as far as possible. 

 

In healthy newborns, routine feeding is not necessary for the first 4 months.

 

Complementary feeding from bottled milk (mother's milk or formula milk) only if justified (indications):

Ø  For weight loss of more than 5 - 10% in the first 3 days (weight loss at the beginning is normal).

Ø  If after the first weight loss, no weight gain takes place until the 9th day of life.

Ø  If the birth weight has not been reached again after 10-14 days, then introduce the baby to the pediatrician for safety reasons; for other abnormalities*  already before!

*(absolutely and immediately e.g. in case of infection signs, in case of thin stinking stool, in case of loss of skin turgor, in case of too pale, bluish, or too yellow skin discoloration; in an apathetic baby, or in a baby that cannot sleep a long time peacefully; and in the case of numerous other signs of an unhealthy infant)

In case of abnormalities, the U2 examination should take place immediately at the pediatrician (normally between the 3-10 day of life); if U2 has already been made and only after that abnormalities occur a further examination should be made.

Ø  Bottles of complementary milk feeding are also necessary, if sufficient breast milk production starts only on the 3rd-5th day after birth.

Ø  Whenever the breastfeeding woman has an illness or disease and needs to take the medication, in particular, advice from the treating physicians is necessary. In many cases, breastfeeding is then restricted or is contraindicated because of the medication. 

Ø  Also in the premature or too small newborn (hypertrophic or malnourished babies), it is required to feed complementary.

 

In these cases, always discuss the conditions with your pediatrician and the midwife who is caring for you.  Depending on the indication, babies get extra feeding e.g.:

        Maltodextrin (pre-split starch as a sugar form)

        Initial food (pre-milk)

        Corresponding supplements (see below)


How can you see that your baby is getting enough breast milk?

When attached to the breast, the baby first does short quick suction movements to stimulate the milk flow; after that, it eats calmer and rhythmically with sometimes short breaks. Make sure that the baby swallows well, as this is a sign of sufficient milk flow.

When the baby has enough, it relaxes, the whole body becomes looser and, it may fall asleep right away.

Indications for the sufficient amount of drinking can be seen with good growth, and the satisfaction of the baby lively between the sleep phases. Also, the wetness of the nappies gives a hint; within 24 hours it should be about 6-8 well-soaked nappies.

In the case of a dissatisfied-looking baby (often squealing or screaming baby), this does not have to be due to too little milk, which can have numerous other causes. The first point of reference lies in the proper growth of the child.

If you have any insecurities, contact your pediatricians, midwives, or gynecologist.

Prof. Dr. Werner Seebauer is Dean of Studies – Association of German Preventologists, Head of Preventive Medicine Department of Institute of Transcultural Health Sciences (European University Viadrina) and Head of Preventive Medicine – NESA (The New European Surgical Academy). Since 2000, prof. dr. Werner Seebauer worked only in preventive medicine, after ten years spent at the Frankfurt University Hospital. He is also involved in the medical professionals training for nutrition and prevention.


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