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.