{"id":3589,"date":"2024-11-19T18:01:21","date_gmt":"2024-11-19T16:01:21","guid":{"rendered":"https:\/\/pagim.net\/?p=3589"},"modified":"2024-11-19T18:01:21","modified_gmt":"2024-11-19T16:01:21","slug":"%d7%a7%d7%a9%d7%99%d7%99-%d7%90%d7%9b%d7%99%d7%9c%d7%94-%d7%91%d7%a4%d7%92%d7%99%d7%9d-%d7%9c%d7%90%d7%97%d7%a8-%d7%a9%d7%97%d7%a8%d7%95%d7%a8","status":"publish","type":"post","link":"https:\/\/pagim.net\/en\/%d7%9e%d7%90%d7%9e%d7%a8%d7%99%d7%9d-%d7%9e%d7%a7%d7%a6%d7%95%d7%a2%d7%99%d7%99%d7%9d\/%d7%a7%d7%a9%d7%99%d7%99-%d7%90%d7%9b%d7%99%d7%9c%d7%94-%d7%91%d7%a4%d7%92%d7%99%d7%9d-%d7%9c%d7%90%d7%97%d7%a8-%d7%a9%d7%97%d7%a8%d7%95%d7%a8\/","title":{"rendered":"Eating difficulties in premature babies after discharge"},"content":{"rendered":"

Written by: Liraz Zion-Por, clinical dietitian for infants and children, Maccabi Health Insurance Fund, private clinic.<\/strong><\/h3>\n

September 2024<\/p>\n

Eating development in infants is an acquired process in all infants. The rate of progress in the process varies from child to child. When it comes to premature infants, it should be remembered that the rate of progress in the process can be different, since it is related to general development - which depends greatly on the week of birth of the premature infant. Therefore, in the entire process of eating development, the standardized age of the premature infant must be taken into account.<\/p>\n

In order to understand how eating difficulties arise and how they are related to prematurity and manifest after discharge from prematurity, we will need to return to the earliest stages of eating development.<\/p>\n

In full-term babies, even after birth, the main purpose of food is survival. Without food, there is no growth, no development, and no life.<\/p>\n

The first parental task is to provide food for the baby. And in the first days of life, the bond between the baby and the parent is expressed primarily through eating, which occurs frequently throughout the day.<\/p>\n

It is also known that listening to a baby's hunger and satiety signals is associated with a feeling of security.<\/h4>\n

Everything I have just described, in most cases, is not expressed in premature babies after birth.<\/p>\n

Depending on the week of birth, most premature babies do not receive oral feedings immediately after birth (since the coordination between sucking and swallowing begins to develop around 32-34 weeks of gestation.)<\/p>\n

During the stay in the neonatal intensive care unit, feeding will usually be provided by the neonatal intensive care unit staff. In such cases, feeding is usually done by clock and not according to the baby's demand. Sometimes continuous feeding is done at a low feeding rate and later feeding is done at a higher rate in separate meals with a gap between them.<\/p>\n

Eating and growth play a significant role in the premature baby's progress toward discharge from the hospital.<\/p>\n

In general, the amount of food required for infants and children varies from child to child and is based on various criteria such as the child's age, weight, appetite, frequency of eating, and eating style. The responsibility for the amount of food eaten lies with the baby and, assuming he is healthy, he knows how to regulate the amount he needs to reach satiety.<\/p>\n

The most important rule is that not all babies eat exactly the same thing.<\/h4>\n

Therefore, it is important to have personalized growth monitoring with a pediatric dietitian specializing in premature babies immediately after discharge from the hospital and according to growth.<\/p>\n

The dietitian will adjust the daily volume of food needed by the premature infant according to his personal needs and medical history. She will build a personalized feeding plan that will include the appropriate volume of food at each meal, the number of meals per day, and the type of formula he will receive.<\/p>\n

It is important to note that the provision of breast milk is of great importance for preventing NEC (necrotic enteritis) and strengthening the premature infant's immune system.<\/p>\n

During nutritional monitoring, it is important to promote the premature infant's eating skills according to his ability.<\/p>\n

The transition from a reflexive stage of sucking to the voluntary act of eating and swallowing, and to the acquisition of mature eating skills, is actually an ongoing process. The process is expressed in constant and progressive learning that occurs as the baby grows, depends on the experiences he has with food and depends on the experiences he has with parents and\/or primary caregivers.<\/p>\n

The process of learning to eat in premature babies can be longer and more continuous. It is usually a gradual process of transitioning from passive feeding (through a tube) to active feeding (through the mouth). It is important to remember that each premature baby has his own learning pace, and a calm and pleasant experience is necessary for his continued desire to eat.<\/p>\n

When bottle-feeding, it is recommended to pay attention to the baby's signs of fullness, such as turning his head away from the bottle nipple. Sometimes vomiting or spitting up can occur due to overfeeding.<\/p>\n

If there is repeated vomiting at every meal, or significant restlessness during meals, reduced eating volume, and avoidance of eating, you should seek medical attention to rule out conditions such as reflux or an allergy to milk protein.<\/p>\n

Later in life - the development of eating solid foods - depends on the overall development of the premature baby - therefore the appropriate age for starting solids should be based on the standardized age and not the chronological age.<\/p>\n

The transition from breastfeeding to independent eating is an important stage in contributing to the development of the toddler\/child. It is recommended to have repeated experiences of eating foods that are appropriate for the baby's motor development.<\/p>\n

Motor readiness to transition from sucking movements to pushing food to the back of the tongue for swallowing will usually be manifested when the following signs of readiness appear:<\/p>\n

The baby's ability to sit up straight (with support), eye-hand-mouth coordination (putting objects in the mouth) and, most importantly, interest in food and the people eating around him are required. The best example is to hold your child in your arms while you are eating - and see if he does everything he can to snatch the food from you and put it in his mouth himself.<\/p>\n

Around 6 months of age (standardized) - the child begins to gradually discover his or her own identity, while psychologically separating from the caregiver (Margaret Mahler). A process that continues until the age of 3 years.<\/p>\n

Sensitive parents will allow independence while maintaining safe boundaries. When there is no sensitivity and understanding on the part of the parents, there is a need for control and a struggle to achieve the toddler's will.<\/p>\n

Another challenge in toddlers' eating is neophobia (fear of trying unfamiliar foods). It is characteristic of toddlers aged 2-3 years. Various studies conducted on the subject have shown that after about 15 exposures to a new food, along with watching others eat it, toddlers are willing to try the new food (Birch).<\/p>\n

In order to deal with these challenges, it is important to understand the division of responsibility for eating between parents and their children. This term of division of responsibility for eating was coined by Elaine Sutter, an American dietitian. It refers to the division between the parents' responsibility and the children's responsibility during eating.<\/p>\n

Parents' responsibility is in 3 areas:<\/h4>\n
    \n
  1. When will the meal occur? The recommendation is to create sufficient intervals between meals (usually about 3 hours) to improve the feeling of hunger leading up to the meal.<\/li>\n
  2. Where will the meal take place? The recommendation is to maintain a regular eating environment as much as possible, around a shared dining table, and to create a pleasant and enjoyable experience. The emphasis is on parents and children eating together. Watching others eat next to the child allows him to feel confident about new foods, and to dare to taste them later.<\/li>\n
  3. What will be served at the dinner table? The recommendation is to serve foods from all food groups (proteins, carbohydrates, fats and vegetables\/fruits) in the center of the table. With at least one food that is familiar and loved by the child. It is important to diversify from the variety of foods that the child is currently okay with. Throughout life, children change their preferences.<\/li>\n<\/ol>\n

    And that's it. This is where the parents' responsibility ends and the children's responsibility begins:<\/p>\n

      \n
    1. Choose what to eat from what is served on the table. Children should not be forced to eat certain foods, even if they are healthy or important for growth.<\/li>\n
    2. The child is responsible for the amount of food he eats at a meal. Do not force a baby or toddler to finish the entire portion that was served to him. Finishing eating should stem from the child's inner feeling.<\/li>\n<\/ol>\n

      And this is usually the stage where the question arises \u2013 so how do I know that my baby or child is eating enough?<\/p>\n

      Early in life, the signs are regular urination and defecation, normal weight and height gain, and the child's vitality and calmness between meals.<\/p>\n

      If there is any doubt about any of these parameters, it is recommended to seek formal advice from a pediatric dietitian within the framework of a health insurance plan or privately.<\/p>\n

      The writer \u2013 Liraz Zion-Pour, is a clinical dietitian RD for infants and children.<\/p>","protected":false},"excerpt":{"rendered":"

      Written by: Liraz Zion-Por, Clinical Dietitian for Infants and Children, Maccabi Health Insurance Fund, Private Clinic. September 2024 Eating development in infants is an acquired process in all infants. The rate of progress in the process varies from child to child. When it comes to premature babies, it should be remembered that the rate of progress in the process can be different, since it is related to general development - which depends greatly on the week of birth of the premature baby. Therefore, in every developmental process [\u2026]<\/p>","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[73],"tags":[],"class_list":["post-3589","post","type-post","status-publish","format-standard","hentry","category-73"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/pagim.net\/en\/wp-json\/wp\/v2\/posts\/3589","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pagim.net\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pagim.net\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pagim.net\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/pagim.net\/en\/wp-json\/wp\/v2\/comments?post=3589"}],"version-history":[{"count":0,"href":"https:\/\/pagim.net\/en\/wp-json\/wp\/v2\/posts\/3589\/revisions"}],"wp:attachment":[{"href":"https:\/\/pagim.net\/en\/wp-json\/wp\/v2\/media?parent=3589"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pagim.net\/en\/wp-json\/wp\/v2\/categories?post=3589"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pagim.net\/en\/wp-json\/wp\/v2\/tags?post=3589"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}