Mixed feeding
by Svitlana Nykytyuk
Mix-feeding
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– the feeding of the babies of first 5-6
mo with human milk and formula in
which the volume of formula is more
than 1/5 of daily volume (or the daily
volume of the human milk is less than
4/5).
•
There are two kinds of mix feeding:
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Mix-feeding closed to
breast-feeding
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Mix-feeding close to
formula feeding
Mix-feeding closed to breast-feeding – the feeding
of the babies with human milk and formula in
which the ratio between them in daily volume are
2:1 (or 2/3:1/3).
Mix-feeding close to formula feeding - the feeding
of the babies with human milk and formula in
which the ratio between them in daily volume are
1:2 (or 1/3:2/3).
Mix-feeding indication:
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In causes of mother’s diseases:
hypogalactia (oligogalactia);
Some diseases in that mother must
decreased the quantity of feeding:
mastitis;
anemia of severe degree;
using of medicine (medicament);
erythroderma.
Human milk inferiority (fat’s, protein’s or
carbohydrate’s inferiority).
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In social and living conditions
Mother is working and can’t nurse a baby
for all feeding.
Closed children institution in which the
amount of donor human milk is not in
enough quantity.
In causes of baby’s diseases:
Congenital malabsorption syndrome:
hypolactasia
Hypogalactia (oligogalactia)
Hypogalactia (oligogalactia) – is
decreasing human milk secretion.
 Hypogalactia is divided into primary and
secondary.
 Primary hypogalactia – is very rarely
diseases (only 1-3 %). It is connected with
neuro-humoral disorders in mother’s
organism or undeveloped breast or carried
mastitis during previous deliveries.
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Hypogalactia
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(from the Greek hypo - low and gala milk), or insufficient milk production
breasts.
• true (or primary) hypogalactia (5% of
women)
- Associated with serious hormonal
disorders, or some other reason
• Early - to 2-3rd week of life;
• Late - on the 4th week of life and later;
Lactation crisis
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• A condition in which a sudden
decrease milk supply
• There are 3-6 weeks, 3, 4, 7 and 8
months of lactation
• lasts 3-4 days, not a danger to the
child's health.
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A child that is growing rapidly, more and
more need of milk, with little appetite can
not increase gradually, and jumps. In this
case, the mother "did not have time to"
adapt to the growing demands of the
child.
• arise due to temporary changes in
hormonal levels.
The main symptoms are lack of breastmilk:
- Inadequate weight gain per month;
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Reducing the daily volume of breast milk
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Worry Baby
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Symptom "dry pampers", indicating a
decrease in daily urine volume
• The main specialized products are recommended for women
during pregnancy and lactation to stimulate lactation
 - "Femylak" ("Nutritek", Russia) - dry vitaminized milk
formula enriched with polyunsaturated fatty acids and
taurine;
- "Enfa-mama" ("Mead Johnson", U.S.) - same with
taurine;
- "Mom Dumil plus« ("International Nutrition",
Denmark) - the same with taurine;
- "Olympic" (JSC "Istra", "Nutricia") - vitaminized dry
mix based on soy protein;
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Dry mixture enriched with the addition of
lactogenic - ("Milky Way" LLC "Vitaprom"
Guni food RAMS) - vitaminized dry
mixture from milk and soy protein isolate
enriched with herbal extracts halehi.
For improving lactation
Juices, beverages, teas
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, Fruit juices and drinks ("hippies", Austria
"Nestle", Germany) - juices and drinks enriched with
vitamins and iron;
• Tea for pregnant and lactation women ("hippies"
Austria, "Kruger", Poland) - soluble herbal teas with
the addition of herbs, fruit and powdered sugar;
• Infusions and decoctions of food and spice and
flavoring vegetables and herbs (home cooking) infusions and decoctions of lactogenic vegetables and
herbs.
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"Apilaktin", "Laktohon"
("Leovo nutria" Russia, Kazakhstan) based on the products of bees and
spicy-flavoring plants.
Vitamin and mineral complex,
multivitamin, mineral
substances ("Centrum", "belly", etc.)
Apilak
Secondary hypogalactia - can
appear in case of
not correct day regimen during
pregnancy and delivery;
 not correct carrying for breasts
(nipple crack, erosion, mastitis);
 incorrect mother’s nutrition
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There are four degree of hypogalactia:
I-st degree – deficiency of the human milk
is less than 25 % of the daily requirements;
 II-nd degree – deficiency of the human milk
is between 25 and 50 % of the daily
requirements;
 III-d degree – deficiency of the human milk
is between 50 and 75 % of the daily
requirements;
 IV-th degree – deficiency of the human milk
is more than 75 % of the daily
requirements.
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Supplementation
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a correction of the amount of food the
child infants with insufficient breast milk
(Additional input milk mixture)
• always given after the mother's breast;
• the number of mixture supplementation
determined by the difference between
the required age for the number of breast
milk and its actual number in chewing.
Rules of supplementation
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Held after applying baby to the breast;
• Takes into account the amount of milk that
the child received from his mother, and you
want to get your child to one feeding;
• Breast milk should be saved for the child as
long as possible;
• supplementation should be administered
after all feedings or individual, as well as
separate feedings;
• You must leave at least 2-3 feedings breasts
(if rarely attachment to the breast lactation
quickly fades.)
Methods supplementation
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The classic method (applied to 3
months.):
Baby is weighted before and after sucking;
* The difference of these parameters set intake quantity of
milk;
* Finish feeding each child an artificial mixture to the proper
volume.
Advantages of the method:
- Frequent application of the child to the breast stimulates
lactation;
- Relieves stress on the digestive system, as the baby gets
human milk and mix.
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Rotating methods
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- used after 3 months.;
- per child feeding is breast milk (sucks
both breasts), the second - just mix the
following - again, breast milk, etc.;
- convenient method for the mother;
breast feeding should not be less than 3, the first and the
last breast
Technology of supplemental
feeding
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• finish feeding with a spoon,
• Carefully and precisely follow
preparation technology mix: mixture
must be sterile, heated to 35-40 ° C,
• unacceptable overfeed or undernourish
child;
• Every 2 weeks to control body weight.
supplemental feeding with spoon
Mixtures that are used for feeding children with mixed
feeding
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Adapted: Sweet - "Baby", "Malish"
Detolakt "," Vitalakt "," Nan "," Nutrilon ","
Humana "" Lazana "," Nestozhen "; sour
- acidophilus" Baby, "" Malish ""Vitalakt"
• not adapted (simple): mixture № 1,2,3,
"dill", acidic - A-yogurt, kefir B-, B-yogurt,
"Biolakt", "Narine" "Baldyrhan" and
others.
What kind of mixture you choose?
Artificial feeding
The daily requirement infants in basic food
ingredients (1 kg) in mixed feeding
• Protein 4 months to 2.0 - 2.5 g 3.5 4.0 g
• 4-9 months 3.0 - 3.5 g 3.5 - 4.0 g
• 9-12 months 3.0 - 3.5 g 3.5 - 4.0 g
• Fats up to 4 months 6.5 - 6.0 g 6.5 6.0 g
• 4-9 months 6.0 - 5.5 g 6.0 - 5.5 g
• 9-12 months 5.5 - 5.0 g 5.5 - 5.0 g
• Carbohydrate during the year 12.0 14.0 g
Energy needs for children who are in mixed
feeding
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• close to the natural:
• 1-6 months - 115 kcal / kg / day;
• 7 - 12 months - 110 kcal / kg / day;
• close to artificial:
• 1 - 6 months - 125 kcal / kg / day;
• 7 - 12 months - 120 kcal / kg / day.
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Diet for mixed feeding are:
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- Individual,
- Depending on the amount of milk in the
mother.
• It is advisable to stick to the "free"
principle
- Breastfeed on demand baby
When we finish feeding by milk
mixture.
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With a significant decrease in the
number of breast milk feeding regime
should be fixed in time as in artificial
feeding. Because artificial mixtures
trapped in the belly of the child longer
than
When mixed feeding supplement best given with a spoon or bottle
with a teat with a small hole to take the child stopped breastfeeding
Feeding with a spoon
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• When mixed feeding for 2 weeks earlier
than natural, is correction of food: fruit,
vegetable and berry juices, fish oil and
vegetable oil, egg yolk, homogenised
vegetables and fruits.
There are two methods of mixfeeding:
classic
 Interchanging (rotate) method.
 Classic method is used in babies
younger than 3 months. In this
method for each feeding the formula
is given.
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For example: the child 2 months is in mix-feeding
closed to breast-feeding. The weight at birth was
3300 gm
The normal weight of the child is
3300+600+800=4700 gm
Daily volume is (will use volume method of
calculations)
4700/6=783 ml
Volume for one feeding is 783/6=130 ml
If the child is in mix-feeding closed to breastfeeding that the quantity of human milk must be
2/3 and formula 1/3. So, the quantity of human milk
will be 130:32=86 ml and formula 44 ml.
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Menu
6.00 o’clock86 ml of human milk + 44 ml of Hipp 1
9.30 o’clock86 ml of human milk+ 44 ml of Hipp 1
13.00 o’clock86 ml of human milk+ 44 ml of Hipp 1
14.30 o’clock86 ml of human milk+ 44 ml of Hipp
120.00 o’clock86 ml of human milk+ 44 ml of Hipp
1
23.30 o’clock86 ml of human milk+ 44 ml of Hipp 1
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Interchanging method is used in babies older than 3 months. In this
method the human milk is given for first and last feeding. In others
feeding formula or human milk is given (it depend of kind of
feeding).
For example: the child 3.5 months is in mix-feeding closed to
formula-feeding. The weight at birth was 3300 grams
The normal weight of the child is 3300+600+800+800+375=5875 g
Daily volume is (will use caloric method of calculations)
115kcal5.875kg=676 kcal/day
700 kcal – 1000 ml of human milk
676 kcal – X ml of human milk
X=956 ml – that is the daily volume
Volume for one feeding is 956/5 = 190 ml
If the child is in the mix-feeding closed to formula-feeding, so the
first and last feeding is human milk and other - formula
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Menu
6.00 o’clock190 ml of human milk 10.00
o’clock190 Hipp 1 +20 ml apple juice
14.00 o’clock190 ml of Hipp 2 +15 ml of
apple juice
18.00 o’clock185 ml of Hipp 1+5 ml of
apple puree
22.00 o’clock190 ml of human milk
Bottle feeding
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Some mothers choose to
bottle feed from the start and
others will change over from
breast to bottle feeding after
weeks or months, so they
need practical advice.
Bottle feeding
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A cows’ milk formula specially modified for infants should be used
in which the protein has been reduced, the casein partly replaced
by whey protein, the fat made more unsaturated, the lactose
increased, sodium and calcium reduced, and enough of all the
essential micronutrients added.
Bottle feeding
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Bottles and teats should be washed in water and detergent (the
bottle brush used only for this), rinsed and sterilised by boiling in
water or by standing covered in sterilising solution (usually
hypochlorite) in a plastic container. It saves time to prepare
several bottles at once. Empty the water out of each bottle,
without touching the inside, then fill to the mark with recently
boiled water that has cooled some minutes, not too hot or it will
destroy some vitamins and may produce clumping.
Bottle feeding
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Exactly the amount of power in the manufacturer’s instructions
should be put into the (wide mouthed) bottle, using the scoop
provided (levelled with a clean knife, not pressed down). “One for
the pot” can lead to obesity. Mothers and even nurses are often
found to prepare feeds inaccurately. Screw on the cap and shake
the bottle well. Bottles may be kept in the refrigerator for up to 24
hours.
Bottle feeding
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If the hole in the teat is too small it can lead to aerophagia or
underfeeding. Milk should drip from the inverted teat at about one
drop per second. Teats need replacing every few weeks.
Bottle feeding
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Babies do not mind cold milk but usually prefer it warm. The
bottle should be not warmed for too long and the milk’s
temperature should be checked by dropping some on the parent’s
skin. Infant feed should be not warmed in a microwave oven once
it is in the feeding bottle. Very hot fluid at the centre of the bottle
may be missed and may scald the baby. For about the first eight
weeks of life babies need to be fed every three to four hours,
including the small hours of the morning. (Fathers can bottle feed
as well as mothers.) By the end of the first week most babies are
taking 120-200ml/kg per day (160ml/kg corresponds to the 1 old 2
fluid ounces per lb bodyweight).
Bottle feeding
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Cereals or rusks should not be added to milk in the bottle and
babies should not be left to sleep with a bottle in their mouth.
Vitamin drops, fruit juices, are not required as supplements to
modern infant formulas.
Uncles, grannies, and baby sitters can give a bottle feed but
parents should feed their infant themselves as much as possible
with the same sort of closeness, cuddling, and communication as
in breast feeding.
Weaning
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In the first six months
Young infants cannot deal properly with solid foods (in reality
semisolid foods at first) for the first four months. The natural time
for starting solids (beikost) is when the energy provided by well
established breast feeding starts to become insufficient. The
Department of Health and other authorities advise that the
introduction of any food to the baby, other than milk, should be
unnecessary before the age of 4 months, but mothers may be
tempted to jump the gun. Most babies should start a mixed diet
not later than the age of 6 months.
Weaning
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Weight in the lower half of the standard percentiles without other
symptoms is not an indication to augment breast feeding. Breast
fed babies tend to put on weight (and length) a little more slowly
than bottle fed infants. Indeed, the standard percentiles, derived
mostly from bottle fed babies, may not be ideal. The time to start
thinking about adding solids is when the infant still seems hungry
after a good milk feed. But by six months body stores of several
nutrients, such as iron, zinc, and vitamin C, are often falling in
exclusively milk fed infants, whether from breast or bottle.
Mean consumption of energy
In the second six months
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In the second six months other liquids can be given from a cup,
especially citrus fruit juices. Untreated cows’ milk can sometimes
cause gastrointestinal bleeding from irritation by the bovine serum
albumin. This does not happen with boiled milk or infant formulas
(which have been heat treated). Iron-fortified infant formula
contributes to iron intake, which is critical in the second six
months of life. It is wrong to add any salt to the foods given to
infants. A fully breast fed infant receives only about one-twentieth
of the sodium in a typical British adult diet. There has been a
quiet revolution in commercial baby foods; most contain no added
salt or colours and only up to 4% sugar (needed with sour fruits).
Infants’ sodium intakes have been found to shoot up after six
months but more from home prepared rather than commercial
baby foods.
In the second six months
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An increasing range of foods is given in the second six months.
Variety is likely to cover the needs for most nutrients and provide
a basis for healthy food habits. Some fruits or vegetables should
be given each day, but the most critical nutrients at this stage are
protein and iron: finely minced beef and legumes should be given
regularly and the protein in cereal foods should not usually be
diluted by refining or by added fat or sugar. Foods should become
progressively more chewy and fibrous and include rusks and
other finger foods like bread or cheese. Babies do not usually like
strongly flavoured foods like pickled onions. Nuts, popcorn, raw
peas, and similar small hard foods should be avoided; they can
be breathed in accidentally. Commercial baby food manufacturers
offer a succession of “strained”, “junior”, and “toddler” foods for
maturing babies, and similar meals are usually made at home.
Some cookbooks for babies are more sensible than others.
In the second six months
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Milk continues to be the main source of calories but diminishing
one. Sweetened fruit juices should be given by cup not bottle
because the latter can promote dental caries. Infantile obesity is
probably becoming less common in the United Kingdom now that
people are aware of it. It is not usually caused by bottle feeding or
early introduction of solids in themselves, but by more
concentrated feeds, by pushing food at mealtimes, or by snacks
in between. Between feeds, water for thirst and a minimum of
snacks or sweets are good general rules.
A suggested timetable of the
introduction of solid foods
Products
Term
Volume dependent of mounth
of
Weanin
6
7
8
9 10-12
g
Juice
(fruits/veget
ables), ml
5/5
30-50 50-70 5070
80
100
Fruct , ml
5/5
40-50 50-70 5070
80
90100
Vegetable
pure, g
5/5
50150
150
170 180 200
Cheese, g 6,5-7,5
5-25 10-3030 30 50
1 1/ ¼-½ ¼-½ ½-3/
egg, . 7,0-7,5
/8- 4
4
Мeat, g
6,5-7,0
5-30 30 50 50
50-60
fish, g
9-10 10-2030-5050-60
½ t.s ½ t.s. 1 t.s 1 t.s 1 t.s
Оil, g
6
Milk cereals, g 6-6.5
50-100
150
180 200
Kefir, мl
7.5-8
50-150 150-200
5-50
-
10-50
Organization and principles of nutrition for
children older than one year
Features of food in Toddlers
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• Nutrition children aged 1 to 3 years as a transitional stage
features infant feeding with a gradual approach to diet adult.
• There is the further development and improvement of all
functions of the child's body, especially the digestive system:
salivary glands, the walls of the esophagus, stomach, and
intestines;
• increases the activity of digestive enzymes;
• gradually increasing the capacity of the stomach - from 250 ml
of a child 1 years of age to 300-400 ml by the third year of life;
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Up to 2.5 - 3 years of life in children
already well developed masticatory
apparatus: there are 20 milk teeth, 8 of
which erupt to one year of age, and 12 after. Thanks chewing enhanced
production of digestive juices, food is
better absorbed.
than one year
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• It should gradually replace liquid and
semi-liquid food more dense and solid.
• Without this skill in the future baby will
not reveal much desire for products such
as fresh fruits, raw vegetables, meat
slices, etc.
Recommended food for children older than one year
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Children over 1.5 years of age with the
advent of native deciduous teeth are
able to chew soft pieces of food the size
of 2-3 cm (salads, vegetables, salad,
vegetable stew, goulash, meatballs,
sausages, pasta dishes).
The range of products for infants should
be varied, with the right combination of
products of animal and vegetable origin.
Food for children older than one year
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The recommended range of products for
children aged 1 to 3 years:
• bread, rye, wheat flour,
• cereals, pasta, potatoes, vegetables,
different, fresh fruits, dry pastry
• sugar, egg, milk, cheese, meat, fish,
sour cream, salt, tea, coffee drink.
Candies for children
Vegetables and herbs in baby food
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• Sometimes it is expedient to provide
food garlic green onions with
antibacterial and anti-inflammatory
effect.
• You need to give children fruits and
vegetables that are designed specifically
for baby food, especially in autumn and
winter.
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The main source of valuable protein and
essential amino acids, minerals, trace
elements and many B vitamins are: milk
and dairy products, meat and byproducts, fish and fish products, eggs.
Milk and milk products
in baby food
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With the lack of animal protein children
are stunted and overall development.
The value of milk
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Cheese and varieties of children:
cheese, pasta and other products nutritional foods high in protein and
minerals, especially calcium and
phosphorus.
• young children a day to 40-50 grams of
cheese, 3-5 grams of cheese, 5-10 g
sour cream or cream.
• These products are used within 1-2
days, respectively, in a binary number
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• sour milk every day appointed
Meat in baby food
• Mainly used beef, veal, lean pork,
poultry (chicken, turkey), rabbit meat,
offal (liver, tongue, brain).
• Children over 1.5-2 years - sausages
"Milk", some varieties of cooked sausage
("Drug", "dietary", "Children").
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Fish in baby food
Proteins fish easily digested and
absorbed by the body. The diet include
several species of low-cost sea and river
fish: perch, cod and hake.
Not recommended for young children,
smoked, salted, dried fish and canned
fish (except for special canned baby
food).
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• In the diet include meat or fish daily.
Child aged 1-3 years to 60-70 grams per
day of meat and 20-30 g of fish. During
the week the child can get 2-3 fishes (70100 g) and meat 4-5 times (in 100-120
g).
• Meat - a source of iron, which is
important for the prevention of anemia.
Perhaps the use of meat and fish in one
day, but by a lesser amount
Eggs
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Eggs - products of high nutritional value.
• Children over 1 year old should not be given only the
yolk, but the whole egg. On one day a child 1-3 years
should consume 1/2 eggs (or one egg every other
day) in cooked or baked form
• Adverse reactions in children - a rash, itchy skin,
which encourages the use of restriction or exclusion of
eggs from the diet.
Fats in the diet of children
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Fats - an important source of energy
(calories) and fat-soluble vitamins A, E
and D.
• Use butter and vegetable oils
(sunflower, corn, olive oil).
• As a result of heat treatment, the
beneficial properties of fat lost, because
butter is better to use slices of bread or
put in the finished dish.
Sunflower oil
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• Vegetable oil added to salads, salads,
vegetable stews and more.
• For children aged 1-3 years is
prescribed daily 15-20 grams of butter
and 6-7 grams of vegetable oil.
•
Bread in the diet of children
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must be different varieties - from rice
and wheat flour, preferably coarse.
• Bread - healthy product, rich in
vegetable proteins, carbohydrates
(polysaccharides), dietary fiber
(cellulose) that has a positive effect on
digestion and vitamin B.
• Every day, a child aged 1-3 years
should be given up to 20 g and 40-50 g
rice and wheat bread.
Sugar in the diet of children

Sugar must include the child's diet.
• It is easily absorbed, improves the taste
of many dishes.
• Excess sugar is bad for children: this
leads to obesity, diseases related to
metabolic disorders (diabetes, diseases
of the musculoskeletal system).
• The need for child 1-3 years in sugar of
30-40 grams per day.
eets in the diet of infants
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Chocolate and chocolate candies which
is consumed by young children is not
recommended (increased arousal of the
nervous system and is one of the
strongest allergens).
Vegetables, fruits, berries in baby food
Test
Mixed feeding
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Choose the term of giving fruit juices for the child on mixed feeding:
2 weeks
1 month
3 month
4 month
elder than 6 month
Advisable term of giving egg yolk for the child on mixed feeding:
from 3 month
4 month
5 month
6 month
7 month
What does it mean accessory feeding :
milk formula
vegetable puree
fruit juices
porridge
Advisable term of giving fruit puree for the child on mixed feeding:
1month
2 month
3 month
4 month
5 month
Most better formula for mixed feeding 2-month baby:
“NAN”
“Detolact”
Acidofile milk
“Krepish”
easy formule N3