Dietician for babies and children

During the hospitalization in Fegia, you received new instructions for feeding your children every day, according to their health condition and according to their ability, according to the doctors' instructions. After the release, the follow-up is not as close as in Fegia. The needs and abilities of premature babies are very different from each other and therefore there are no comprehensive guidelines that are correct for all released premature babies, but nevertheless there are guidelines that can greatly help and reduce the concern around the issue of nutrition and these will be presented in this article. In the letter of release from the maternity leave, there will be instructions for the first days/weeks/weights, and these instructions are the determining instructions for this time. It is important to monitor laboratory parameters and monitor growth (weight/height/head circumference) arranged in a drop of milk, at the attending physician and the institutes for child development, according to the instructions for release from labor.

Who is a dietician and does every dietician monitor and treat premature infants?

A dietitian is someone who has completed a bachelor's degree in nutritional sciences, has undergone professional training and successfully passed the Ministry of Health's licensing exam to obtain a nutritionist/dietitian certificate. You can find out in advance whether the dietitian to whom an appointment has been made for you is a baby and children's dietitian and whether she has experience in treating premature infants. Ideally, it is desirable that the treating team work in cooperation and therefore it is also advisable for the dietician to be part of the multi-professional team that performs medical or developmental follow-up of a child.

Can breast milk be sufficient nutrition for a premature baby?

אכן כן, במידה ואפשרי ואין הנחיות מיוחדות או הנחיות נגד, חלב אם הינו התזונה המומלצת לפגים אשר משגשגים היטב.

Breastfeeding: There is no need to weigh before and after breastfeeding - the result test is the determining factor (whether the baby is thriving well - this is according to the growth monitoring indicators). If necessary, you can and should consult with a certified lactation consultant who has experience with premature babies.

Pumping: you can continue to pump breast milk at home as well. There is information on this topic in the LHB brochure.

In special cases, instructions will be given at the release to enrich breast milk with a special additive (HMF - human milk fortifier), it should be taken into account that this additive is expensive and currently most health insurance funds do not participate, therefore it is advisable to compare prices before buying.

And if my baby is not fed breast milk?

Premature babies whose weight corresponds to the corrected age, they thrive well and there is no special recommendation, they can be fed with a normal baby food compound (Taml).

For premature babies who are released at a weight that does not correspond to the corrected age or need enrichment for other reasons (for example, bone health), it is recommended to use a special follow-up formula for premature babies after discharge. After several months of follow-up with a drop of milk, the attending physician should evaluate together whether there is still a need to continue using the continuation formula Or you can switch to TML for the mature baby.

Recommendations for other special formulas are often given before discharge according to various health conditions (premature babies after gastrointestinal surgeries, allergies, gastroesophageal reflux, GERD, also known to parents as "reflux", increased nutritional needs due to heart defects/chronic lung diseases, metabolic diseases, etc. ).

What is the amount my baby needs to eat at home? (breast milk/ enriched breast milk/ TML)

The amounts eaten vary greatly between premature babies and even vary between the different hours of the day. Although there are recommended average amounts that your child should eat according to the professional literature, it should be remembered that these amounts are based on a large population and there are great ranges and variations between babies and certainly between premature babies. The eating ability of a pig together with the "result test" (the indicators of growth, development, vitality of a pig) - are the determinants.

When there are no more special recommendations regarding feeding hours (feeding every 3-4 hours, etc.), you can "feed on demand". For this purpose, you should start getting to know your children's hunger and satiety signals. This stage may be accompanied by concerns since it is a stage in which the control of quantities passes from the parent to the baby.

Giving the meal when the hunger signals start, and stopping the meal when the baby shows signs of satiety (stopping eating, turning the head away from the bottle/breast, trying to move away from the bottle/breast).

In order to reduce the concerns, it is possible to conduct regular weight monitoring in a clinic/drop of milk/ with the help of a dietician. At the same time, you should pay attention to whether Pagia is essential, responsive, and there is no significant decrease in the need to change diapers.

I feel that the baby is not eating enough, what should I do?

First, it should be emphasized that feeding against the baby's will is not recommended and may even lead to unwanted results.

If there is concern about the amount of food and/or the rate of growth, it is recommended to contact a doctor and ask to consult a dietician for the purpose of diagnosing the difficulty, receiving feeding instructions or nutritional intervention such as weight gain and closer growth monitoring.

In situations where feeding difficulties persist, you can consult with a multi-professional team specializing in this issue (eating clinics), for this purpose it is advisable to request a referral from the pediatrician.

How will I know if my child is gaining enough weight and when is my child expected to catch up?

For the purpose of monitoring the growth of premature babies, we use growth curves (or as they are known as "percentiles") of mature babies with age correction. Often, certainly in the first stages, the growth trend and the rate of progress are more important to us than the comparison with the rest of the population.

Most premature babies will catch up with the growth rate (weight, length/height) in relation to their chronological peers until around the age of two. At this age we will also stop correcting their age when placing the growth indices on top of the growth curves. If the growth rate is not achieved by the age of two, it is worthwhile to start counseling and follow-up on this topic and check with the pediatrician whether there is a need for counseling and follow-up by an endocrinologist on this topic.

Food tasting/ presentation of complementary foods

For premature babies, the guideline for starting food tasting by age is often not relevant. Tastings begin according to corrected age and not chronological age.

It is not recommended to change a meal of breast-feeding before the age of 6 months corrected. Tasting is up to 2 teaspoons a day (you can use your finger, you don't need a teaspoon), in the morning/afternoon, each new food separately and at least 3 times before you are sure there is no reaction Allergic (if we give a number of foods at the same time and there is an allergic reaction, we will not know to which of the foods the reaction should be associated!).

When there are no instructions to the contrary, the signs of readiness for tasting are:

Control of the head (when the baby is held by the parent/caregiver, the head does not swing, the head and upper back are stable).

Bringing your hands to your mouth, reaching for an object and putting it in your mouth.

Expressing curiosity, inquiry and interest in eating when food is approached by the baby using the parent's/caregiver's fingers.

The baby is able to move the food in his mouth from side to side.

In premature babies with special medical or developmental needs, it is important to consult with the medical and paramedical staff before starting to introduce complementary foods.

In conclusion

Eating is a major part of treating babies in general and the premature population in particular. It is natural that a premature parent will need professional guidance on this sensitive issue. Please make sure that, if necessary, you receive all the assistance you need in order to be able to provide the best nutrition and the appropriate eating environment for the piglet.