FEEDING OF INFANTS

THE MIXED FEEDING

Ariana Szilágyi, MD, PhD
 Definition
 The infant’s feeding
in the first 4-6
months of life with
human milk and a
milk supplement
 Indications

 Maternal
hypogalactia
 Professional and
social reasons
(engaged mother)
 Malnourished
infants (higher
caloric intake)
Order of preference for formula
 adapted milk
 partially adapted
 conventional
formula
 cow’s milk
 Mixed Feeding Schedules

 1. supplement method: after emptying both

breasts (eventually measure the infant’s weight
before and after sucking) – for prematures
 2. alternative method: once breastfeeding, next
bottle feeding (aggravates the hypogalactia)
FEEDING OF INFANTS -
THE COMPLEMENTARY
FEEDING
Definition
 Change of the infant’s feeding from an
exclusive milk feeding to a varied food
diet
 Gradual replacement of the milk meals
with semisolid or fluid foods (baby food)
 Between 17 -26 weeks
 Risks for Early Diversification
 Incompletely developed enzymes
 Predominance of protrusion reflex (the food
placed on the anterior part of tongue is pushed out)
 Increase of global osmotic pressure
 Allergy risk because of high intestinal
permeability
 Overfeeding and obesity
Increased
intestine
permeability
Bowel inflammation /increased
permeability /lactase deficiency
Disadvantages of Exclusively
Prolonged Milk Feeding

 Milk cannot provide enough nutritive

factors intake
 Prenatal reserves are already exhausted
DIVERSIFICATION
 Principles of Diversification
 Selectivity - the most indicated food for age
 Eutrophic infant: vegetables or fruits
 Malnourished infant: gluten free cereals
 Progressiveness – graduated introduction in the
menu of the new food
 initial 1-2 teaspoons at the beginning of the
meal and proportionately reduction of the milk
 separately, not mixed with milk
Principles of Diversification
 only one new food introduced once, 2 weeks
between
 contraindicated when illness
 a systematically refused food must be given
up for a while
 a preferred food must not be offered at several
meals
 the same meal schedule
 replace the day meals, not the first or the last
 Recommended Age for Diversification
 6-8 weeks juice as a fluid
and vitamin supplem.
 not genuine diversification
 4 mo: gluten free cereals
(rice, corn), carrot soup
(30-50%), apple, peach,
banana as puree
 Vegetable purée is
introduced 2 weeks
after soup
 Recommended Age for Diversification
 5 mo: meat (chicken)
20-30 grams/day,
mixed and incorporated
in the vegetables, oil
 6 mo: cereals with
gluten, boiled potatoes,
fresh cow’s cheese,
boiled egg yolk, bone
soup, white fish
 Recommended Age for Diversification
 7 mo: yoghurt, fruit
compote, fresh fruits
(pears, cherries), chicken
liver, milk cream,
spinach
 8 mo: “junior” products,
not mashed
 8-10 mo: bread, biscuits
as self feeding, boiled
pressed ham, pasta,
boiled meat balls
 Recommended Age for Diversification

 12 mo: brain,
puddings, home
made cakes
 Maximum 2‰ salt
 After 1 year: egg
white, sausages
Diversification order

 First replaced meal – 10 o’clock with fruits ±

cereals
 Second replaced meal – 2 o’clock with soup,
vegetables
 Third replaced meal – 6pm with floury products
 After 6-7 mo: 5 meals, 3 diversified and 2 milk
(the first and the last)
FEEDING OF THE
CHILD
FEEDING OF THE TODDLER
 Reduced growth rate – reduced food
intake
 Daily requirements:
 Caloric: 90/kg
 Proteins: 2g/kg
 Fats: 3-4g/kg
 Carbohydrates: 12g/kg
 Fluid: 90-100ml/kg
 Five meals/day at 3-4 hours interval
 Proteins
 2 g/kg/day
 Beef, chicken, lean
fish, liver, brain
 After 2 years daily
intake of 50-60g/day
 Egg at 2-3 days
interval
 Milk max. 500 ml/day
 Cheese
Fats
 3-4 g/kg/day
 Butter 15g/day
 Milk cream
 Vegetable oil 10g/day
 Satturated/unsatturated fatty acids=1
 Carbohydrates
 12 g/kg/day
 Fruits, vegetables, floury
pastes sugar
 Fruits 150g/day
 All kinds of vegetables
after 2 years of age,
including dry ones
 Bread 100g/day, biscuits,
pasta, rice
 Sugar products max
30g/day
 Principles
 Water, sweets only
after meals, not
between
 Foods well-prepared,
tasty, attractively
served
 5 meals/day: 3 main
and 2 snacks
 Fix feeding time
 Self-feeding
encouraged despite dirt
 Daily menu
 Breakfast: 200-250 ml
milk, cocoa + 30-50g
bread, butter, honey, jam
 10 o’clock: fruits,
cracker, biscuits,
pudding, or bread,
cheese, jam
 Lunch: vegetable or meat
soup + boiled meat, rice,
vegetables, pasta + cakes
with fruits, cheese
Daily menu

 5 o’clock: tartines,
pressed cheese,
yoghurt, crackers,
bread, tea, compote
 Evening: 250 ml
milk, porridge,
macaroni pudding,
cheese, pancakes,
jam
Not recommended
 To give comfort by offering food -
obesity
 Excessive insistence – stress
 Distraction of the child’s attention by
food means to accept food – neurotic
behaviour
Unbalanced diet risks
 Iron deficiency anemia when mainly milk and
floury products
 Anomalies of deciduous teeth (position,
enamel) caused by prolonged bottle feeding
 Overfeeding – obesity
 Nervous anorexia
 Infections when sanitary rules are not respected
FEEDING OF THE PRESCHOOL CHILD
 Lower caloric intake
 Daily requirements:
 Caloric: 80/kg
 Proteins: 1-2g/kg
 Fats: 2-3g/kg
 Carbohydrates: 10g/kg
 Fluid: 80ml/kg
 Five meals/day at 3-4 hours interval
Proteins
 2 g/kg/day
 Beef, chicken, lean fish, pork, mutton
 Liver, organs, salami, sausages
 Daily intake of 65-75g/day (12g/year/day)
 Egg at 1-2 days interval
 Milk max 500 ml/day
 Cheese
Fats
 2-3 g/kg/day
 Butter 20g/day
 Milk cream
 Vegetable oil 10g/day
 Bacon and pork fat
Carbohydrates
 10 g/kg/day
 Fruits, vegetables, floury pastes sugar
 Fruits 200g/day, vegetables 200g/day

 Bread 130-150g/day (25g/kg/day)-all types

 Potatoes 150 g/day
 Sugar products max 40g/day
Principles
 Food additives, salted, spicy, smoked products
should be avoided
 Acid, gaseous juices, coffee, alcohol
contraindicated
 Diverse foods served together with family
 Repeated refuse of a certain food: suspicion of
food allergy or selective digestive intolerance
 Normal physical activity increases appetite
Avoid

 Irregular meal schedule

 Offering only the preferred foods
 Conflicts, fights during meal hours
 Reading stories or TV watching during meals
FEEDING OF THE SCHOOLCHILD
 Similar to that of the adult
 Daily requirements:
 Caloric: 50-60/kg
 Proteins: 2g/kg (13-16% of the total caloric intake)
 Fats: 1.5-2g/kg (30-35%)
 Carbohydrates: 8g/kg (50-55%)
 Fluid: 60ml/kg
 4-5 meals/day according to the school
program
Principles
 No coffee, alcohol
 Breakfast is compulsory to avoid
hypoglycemia at school
 Snack at school sandwich made at home
 Lunch in school provides balanced food
 Discourage the quarrels, TV watching,
reading during feeding
 Dinner contains 2 courses
FEEDING OF THE ADOLESCENTS
 Significant acceleration of the growth and
development rate (earlier in girls)
 Most increased nutritional requirements
 Differences between the two genders needs
(increase of fat tissue in girls and muscle mass
in boys)
 Increased protein synthesis
Daily requirements
 Ca 200-400mg/kg/day,
 Fe 40mg/kg growth
 5 meals/day according to the school program
 Greater amounts of fluids, especially when
the teenager is practicing sports
 Adolescents become reasonable and they will
promote a proper feeding schedule
Nutritional pathology in adolescents
 Iron deficiency anemia (especially in girls
where aggravated by menstrual losses)
 Calcium and vit. D rickets or osteomalacia
 Nervous anorexia, bulimia due to vegetative
instability specific when sexual maturation
 Obesity
 Trace minerals deficiency