The daily fluid and caloric requirements vary with age and is relatively larger than in older children and adults (calorie needs of different ages *) in neonates and infants. The relative need for protein and energy (g or kcal / kg body weight) increases from the end of infancy to adulthood more and more from (reference values ??for the supply * of some macronutrients, “Food and Nutrition Board, Institute of Medicine of the National Academies “), but the absolute requirement increases. So the demand for proteins of 1.2 g / kg / day in age from one year to 0.9 g / kg / day with 18 drops; the average energy demand increases by 100 kcal / kg from a year to 40 kcal / kg in late adolescence. Dietary recommendations are not evidence-based in general. The vitamin requirements are dependent on the food source (eg. As breast milk vs. standard infant formula), maternal nutritional factors and daily dosing.
If the birth went straightforward and the baby shows a normal vigilance and is healthy, it can transfer the mother and be satisfied immediately. The success of breastfeeding can be improved by the newborn is applied as soon as possible after birth. Spitting of mucus after feeding is not unusual and is associated with a certain laxity of gastroesophageal smooth muscle; this should h after 48 but have returned to normal. If or spitting of phlegm or vomiting is also then have to observe if it is bilious, a detailed examination of the upper gastrointestinal tract and the respiratory system is necessary to eliminate congenital malformations (congenital anomalies of the gastrointestinal tract). The daily fluid and caloric requirements vary with age and is relatively larger than in older children and adults (calorie needs of different ages *) in neonates and infants. The relative need for protein and energy (g or kcal / kg body weight) increases from the end of infancy to adulthood more and more from (reference values ??for the supply * of some macronutrients, “Food and Nutrition Board, Institute of Medicine of the National Academies “), but the absolute requirement increases. So the demand for proteins of 1.2 g / kg / day in age from one year to 0.9 g / kg / day with 18 drops; the average energy demand increases by 100 kcal / kg from a year to 40 kcal / kg in late adolescence. Dietary recommendations are not evidence-based in general. The vitamin requirements are dependent on the food source (eg. As breast milk vs. standard infant formula), maternal nutritional factors and daily dosing. Caloric needs of different ages * Age requirement kcal / kg / day kcal / kg / day <6 months 50-55 110-120 95-100 1 year 45 15 years 20 44 * When proteins and calories are supplied through breast milk and be fully digested and absorbed, the need between three and nine months may be lower. Feeding problems Slight deviations in our daily food intake amount are normal. If the parents are worried, they often just need advice and reassurance, unless additional symptoms indicate an illness or prosperity, is paying particular attention to the weight, impaired (changes in percentile in standardized percentile are of greater important than absolute changes). A weight loss of> 5-7% over the birth weight in the first week of life points to an insufficient food intake. Birth weight should be reached again after two weeks. As a result, one can expect an increase in weight of 20-30 g / day and a doubling of birth weight with about six months during the first months of life. Infants should have after about 6 months reached double their birth weight. Breastfeeding Breast milk is the diet of choice. The American Academy of Pediatrics (AAP) recommends breastfeeding for at least six months to exclusively and to begin between the ages of 6 and 12 months with appropriate solid food. After the first birthday can be as long weitergestillt as mother and child wish, even if then breastfeeding should only be made in addition to a complete diet with solid and liquid foods. In order to promote breastfeeding, talks about to take place even before birth, in which the multiple benefits are mentioned: For the child: nutritional benefits, benefits for cognitive development as well as protection from infections, allergies, obesity, Crohn’s disease and diabetes for the mother : Reduced fertility during lactation, faster return to normal antepartum condition (. eg uterine involution, weight loss) and protection against osteoporosis, obesity and ovarian cancer and premenopausal breast cancer for first-time mothers milk production reaches its full extent after 72-96 h in Mehrgebährenden earlier , The first milk is colostrum, a thin yellow liquid with high calorie and protein content, which is immunoprotective due to the large amount of antibodies, lymphocytes and macrophages; Colostrum also encourages the passage of meconium. Subsequent breast milk has the following characteristics: Has a high content of lactose and provides a readily available energy source that is compatible with neonatal enzymes. Contains large amounts of vitamin E, an important antioxidant that can prevent anemia by increasing the lifespan of the erythrocyte has a calcium-protein ratio of 2: 1, the Modified prevents calcium deficiency tetany the pH of the chairs and the beneficial flora and protects against bacterial diarrhea Transmits protective antibodies from the mother to the child contains cholesterol and taurine, which are important for brain development is a natural source of ?-3 and ?-6 fatty acids it is believed out that these substances and their very long-chain polyunsaturated derivatives (LC-PUFAs) arachidonic acid (ARA) and docosahexaenoic acid (DHA) help to ensure that the children who are fed with breast milk, visually and cognitively outperform those with commercial infant formula-fed. Most commercial formulas are now fortified with ARA and DHA to resemble breast milk more and reduce these potential differences in development. At a sufficiently varied diet of mother’s food or vitamin supplements for the mother and the child born ripe are not required. However, bone soft due to vitamin D to avoid deficiency, 200 units 1 times are given daily during the first 2 months all infants who are exclusively breastfed. Premature infants, dark-skinned and those infants who have limited exposure to sunlight (residents northern climates) are at increased risk of vitamin D deficiency. After 6 months should breast-fed infants when the water does not have enough fluoride (complementary or natural fluoride) has, fluoride drops are placed. Doctors can obtain information about the fluoride content of a local dentist or a health authority. Children <6 months of life, no additional water should be given, as this is a risk of hyponatremia. Still Technology The mother should assume a comfortable and relaxed position and support the breast with her hand to ensure that this is the center of the mouth of the infant to minimize skin irritation. The center of the lower lip of the child should be stimulated with the nipple so that the rooting reflex (chest Search) is triggered and the mouth opens wide. The child should be encouraged to take as much as possible of breast and areola into his mouth so that the lips 2.5-4 cm come to rest from the base of the nipple. The tongue of the infant then compress the nipple against the hard palate. At the beginning, it takes at least two minutes until the margin reflex occurs (n. D. Red .: by oxytocin). The milk yield increases with the growth of the child and the stimulation by sucking. The duration of breastfeeding is usually determined by the child. Some mothers have with the help of a breast pump to try to increase milk production or to maintain; with most mothers is a total pumping time of 90 min / day, divided into 6-8 pump units, sufficient to provide enough milk for a breast-fed not directly at the chest baby. The infant should be nursed on one breast until this soft and sucking weakens or stops altogether. The mother can interrupt sucking a finger then, before she takes the baby from one breast and the other offers. It is possible that after the birth of only one breast enough in the first few days, so then the breasts should be alternated. If the child tends to fall asleep before recording an adequate fluid intake, the mother may interrupt breastfeeding as soon as the sucking slows down to let the infant burp and finally to apply again to the other side. This change keeps alive the infant and stimulates milk production on both sides. Mothers should be encouraged, at the request of the child or about breastfeeding (8 -12 feedings / day) every 1.5-3 h; over time, the feeding frequency decreases. but it may also be necessary to feed infants weighing <2500 g to avoid hypoglycemia frequently. In the first days newborns need to be awakened and stmuliert; small children and late preterm infants should not be left to sleep for long periods at night. Large full-term infants, the breast milk well assume (as determined by the pattern of bowel movements occupied) can not be left to sleep longer. Ultimately, in the long run, a schedule that allows the infant to sleep as long as possible at night, best for the child and the family. Mothers who are employed outside the home environment can pump out the milk to maintain milk production as long as they are separated from the child. The incidence varies, but should be based on the normal feeding times of the child. If expressed milk is drunk within 48 hours, enough for an immediate cooling; in a subsequent feeding, d. h., after more than 48 hours, the breast milk is frozen. Cooled milk that is not consumed within 96 hours should be disposed of due to the high risk of bacterial contamination. Frozen milk should be thawed in a warm water; the use of a microwave oven is not empfehlenswert.Komplikationen by the child The main complication is insufficient food intake, leading to a dehydration and hyperbilirubinemia (neonatal hyperbilirubinemia) may result. An increased risk of an insufficient food intake have small or premature infants and children erstgebärender mothers, children of mothers who are sick, or those who have undergone a severe or surgical delivery. A rough guide for the assessment of breastfeeding success, the number of daily diaper changing. At the age of five days resulting in a normal infant at least 6 wet and at least 4 chair-filled diapers per day. A lower number implies a too low liquid and calorie intake. In addition, the color of the chairs should have changed after dark meconium at birth on light brown to yellow. The weight is a reasonable indication (feeding problems). Malnutrition must also be suspected if milestones of physical development can not be achieved. Finally, ongoing unrest leaves before the sixth week of life when it comes independently from hunger and thirst to colic, suggests an insufficient amount of nutrients. If the child cries less vigorous or skin turgor is reduced, should be thought of dehydration; Lethargy and sleepiness are advanced signs of dehydration and should immediate control of serum sodium (n. D. Talk .: possible hypernatremia) to be ziehen.Komplikationen in the mother Some common maternal problems include chest congestion, sore nipples, clogged milk ducts, mastitis and anxiety. The engorgement that occurs in the early stages of lactation and may take 24 to 48 hours, can be minimized by early, frequent breastfeeding. Still a comfortable bra that is worn 24 hours a day, can also help as cold compresses after breastfeeding and taking a mild analgesic (eg., Ibuprofen). It may be necessary that the mother massaged her breast before breast-feeding, hanging up warm compresses and expressing milk manually so that the child can take the whole swollen areola into his mouth. To intense expressions of milk between feedings can cause engorgement, so it should be done only so far until the discomfort has become less or disappeared. For sore nipples, the drinking position of the infant must be checked; some children suck on their lip is turned inwardly, which can lead to an irritation of the nipples. The mother can then out put on the lip of the child with his thumb again. After feedings, they can express some milk from the nipple and let them dry there. After breastfeeding cold compresses prevent congestion and provide more relief. Clogged milk glands manifest as nodes slightly sensitive in the breast, the women have no symptoms beyond. Continuous breastfeeding ensures adequate emptying of the breast. Also, warm compresses and massage of the affected area before breastfeeding can help a better drainage. Since different areas emptied vary depending on the position of the child at the breast, it may be advantageous to vary the down position. Also helpful is a good breastfeeding bra can lead particularly normal bra with rods or constricting carriers to a gain of milk jam in the compressed domain. Mastitis is common and is perceived as a firm warm wedge-shaped swelling in the chest. It is caused in a localized region of the breast by congestion (congestion), stasis, clogged or misplaced gland ducts; secondary can cause an infection, then usually with a penicillin-resistant Staphylococcus aureus and Streptococcus sp rare. or Escherichia coli. With an infection fever may occur ? 38.5 ° C, chills and flu-like pain. The diagnosis can be set from history and examination findings. The number of leukocytes (leukocytosis> 106 / ml) and cultures of breast milk (bacteria count> 103 / ml) can help to distinguish infectious from a non-infectious mastitis. If the symptoms are weak and there are <24 hours, conservative management (emptying the breast by breastfeeding or pumping, compresses, analgesics, supportive bra and reduce stress) may suffice. If the symptoms do not improve within 12-24 hours or if the woman is sick, an antibiotic that is effective effectively safe for breastfed infants and S. aureus (z. B. dicloxacillin, cloxacillin or cephalexin should 500 mg of 4- be administered twice daily po). The duration of treatment is from 10 to 14 days. Community-acquired methicillin-resistant S. aureus should be considered if the treatment is working not promptly or if an abscess is present. Complications of late treatment initiation are recurring infections and abscesses. During treatment can be weitergestillt. Maternal anxiety, frustration and feelings of inadequacy can caused by lack of breastfeeding experience in mechanical problems in holding and applying the child in fatigue and concern whether the amount of food the child is sufficiently well lie in postpartum physiological changes. These factors and emotions are the most common reasons why mothers stop breastfeeding. Early follow-up appointments with the pediatrician or consult with a lactation specialists are useful and effective for early weaning to verhindern.Medikamente The medication should be avoided by nursing mothers as much as possible. If medical treatment is necessary, the mother contraindicated medications and drugs that inhibit breast-feeding should be avoided (eg. As bromocriptine, levodopa, trazodone). The US National Library of Medicine maintains an extensive database of medications and breastfeeding on the Drugs and Lactation Database that can be consulted regarding the ingestion or exposure to certain drugs or classes of drugs. Some common medications that are contraindicated for nursing mothers Some medications that are contraindicated for nursing mothers. If drug treatment is required, the safest known alternative should be used; if possible, most of the drugs should be taken immediately after nursing or before the longest period in which the child is asleep. However, this strategy is not very helpful in newborns, which are often breastfed exclusively. The knowledge about the side effects of most drugs comes from case reports and small studies. The safety of some drugs (eg, acetaminophen, ibuprofen, cephalosporins, insulin.) Has been demonstrated by extensive research; other medicines but only therefore classified as safe as there are no reported side effects. Drugs that have long been used, are safer than newer agents for which there are few data in the rule. Some medications that are contraindicated for nursing mothers drug class Examples General concerns and specific effects in infants anticoagulants dicumarol warfarin can be given careful, but at very high doses it can bleeding cause (heparin does not go into the milk) Cytotoxic drugs cyclophosphamide cyclosporine doxorubicin Methotrexate can the cellular metabolism a breastfed child beeinträch term, which can cause immune suppression and neutropenia. Unknown effects on the growth and an association with cancer. , Psychoactive drugs anxiolytics including benzodiazepines (alprazolam, diazepam, lorazepam, midazolam, Prazepam, quazepam, temazepam) and Perphenazine antidepressants (tricyclics, SSRIs, bupropion) antipsychotics (chlorpromazine, Chlorprothixen, clozapine, haloperidol, mesoridazine trifluoperazine) For most psychotropic drugs that the effects on infants are unknown; However, since drugs and metabolites are detectable in breast milk and in plasma and tissue of the infant, it is assumed that a possible change in short-term and long-term CNS function. Fluoxetine: is associated with colic, irritability, disturbances in breastfeeding and sleeping as well as slower weight gain chlorpromazine: The substance may cause drowsiness, lethargy and developmental delay haloperidol: developmental delays Individual drugs that are detectable in breast milk and a theoretical risk represent amiodarone Possible hypothyroidism Chloramphenicol Possible idiosyncratic bone marrow clofazimine possibility of transmission of a high percentage of maternal dose possible increase Skin pigmentation corticosteroids With a high maternal dose over weeks or months, high concentrations can occur in the milk that may prevent the growth and inhibit endogenous corticosteroid production of the infant. Lamotrigine Possible impact on the therapeutic serum concentrations of the infant metoclopramide No side effects described metronidazole tinidazole In vitro mutagens Can breastfeeding prevent about 12-24 hours to allow the elimination of the dose if a mother was given a single dose of 2 g Safe if the child is> 6 months old sulfapyridine sulfisoxazole caution is advised when infants have jaundice or G6PD deficiency or are sick, restless or were born prematurely Some medications that are detectable in breast milk whose risk is documented acebutolol hypotension, bradycardia, tachypnea aminosalicylic diarrhea atenolol cyanosis, bradycardia bromocriptine suppresses lactation Can the mother be dangerous aspirin (salicylates) Metabolic acidosis Large maternal doses with continued set application can cause plasma levels (compete salicylates for albumin binding sites) the risk of hyperbilirubinemia and hemolysis only with G6PD deficiency infants <1 month Clemastine (drowsiness, irritability, food refusal, high-pitched crying, neck stiffness Ergotamines vomiting, diarrhea, convulsions at doses that are common in migraine) estradiol vaginal bleeding decline in iodides iodine goiter Lithium 1/3 to 1/2 therapeutic concentration in the blood of infants phenobarbital sedation, infantile spasms after weaning, methemoglobinemia phenytoin methemoglobinemia Primidone sedation, problems with feeding Sulfasalazine (salicylazosulfapyridine) Bloody diarrhea Nitr ofurantoin, sulfapyridine sulfisoxazole hemolysis in infants with G6PD deficiency, certain other drugs abuse * Amphetamine irritability, poor sleep patterns alcohol in <1 g / kg daily, the reflex reduces the milk ejection For large quantities dizziness, sweating, deep sleep, weakness, loss of linear growth, abnormal weight gain in infants cocaine cocaine poisoning: irritability, vomiting, diarrhea, tremors, convulsions Heroin tremors, restlessness, vomiting, breastfeeding problems marijuana components detected in breast milk, but impact unclear Phencyclidine hallucinogen * effects of smoking are unclear; Nicotine is found in breast milk detectable smoking decreased milk production and weight gain of the infant, but it can reduce the incidence of respiratory diseases. Adapted from: Committee on Drugs of the American Pediatric Association: The transfer of drugs and other chemicals into human milk. Pediatrics 108 (3): 776-789, 2001. weaning weaned, when the mother and the child by mutual agreement have the desire to, but preferably until the child is at least 12 months old. In general, the weaning takes place gradually over weeks and months during the time that is inserted into the solid food. Some mothers and children stop breast-feeding abruptly without problems, others silent once or twice daily for 18 to 24 months or even longer. There is no universal "right" schedule. The only acceptable alternative to breast-feeding during the first year of life finished infant formula are commercially available infant formulas. Water can cause hyponatremia, cow's milk is not balanced in terms of the food components. The benefits of the diet with commercial infant formulas are for a fact that the amount of food is better quantify, on the other, that family members can also feed them. In otherwise virtually equivalent properties of these benefits but are more than outweighed by the unquestionable health benefits of breast milk. Commercially available to formulas are available in powder, concentrate and diluted liquid (final use); they all contain vitamins, most contain a Eisensupplementation. It is recommended to prepare the foods with fluoridated water. In areas where there is no fluoridated water or even if pre-diluted foods are used which are prepared with nichtfluoridiertem water should be available from the age of 6 months, fluoride drops are placed (po 0.25 mg / day) (n. D. Red .: in Germany is carried out at correspondingly not fluoridated drinking water fluoride prophylaxis in the first year of life, this is also a combination preparation, vitamin D fluoride, available). The choice of convenience foods depends on the needs of the child. To formulas based on cow's milk, are the standard, unless doing the spitting, diarrhea (with or without blood), rash (hives) or poor weight gain, a cow's milk protein allergy or lactose intolerance (in newborns very rare) likely that a soy milk-based convenience food should be selected. All soy finished foods in the US are lactose-free, but some children who are allergic to cow's milk protein, may also be allergic to soy protein; in this case, we recommend a hydrolysed infant formula. Hydrolysierte Formeln werden aus Kuhmilch abgeleitet, aber die Proteine werden in kleinere Ketten aufgebrochen, sodass sie weniger allergen sind. Wahre elementare Nahrungen, die aus freien Aminosäuren hergestellt sind, eignen sich für die wenigen Kinder, die allergisch auf hydrolysierte Säuglingsnahrung reagieren. Die mit der Flasche ernährten Kinder werden auf Verlangen gefüttert; aber da die kommerzielle Säuglingsnahrung langsamer als Muttermilch verdaut wird, lassen sie längere Perioden zwischen zwei Mahlzeiten zu, anfangs 34 h. Die Nahrungsmenge liegt anfangs bei 1560 ml (0,52 oz) und kann während der ersten Lebenswoche gleichmäßig auf 90 ml (3 oz) etwa sechsmal täglich gesteigert werden, was bei einem 3 kg schweren Kind im Alter von einer Woche eine Energiezufuhr von etwa 120 kcal/kg bedeutet. Feste Nahrung Die WHO empfiehlt für die ersten 6 Lebensmonate ausschließliches Stillen mit anschließender Zufütterung fester Nahrung. Andere Organisationen schlagen vor, feste Nahrung zwischen dem 4. und 6. Lebensmonat parallel zum Stillen oder zur handelsüblichen Säuglingsnahrung zu beginnen. Vor dem 4. Lebensmonat besteht kein Bedarf an fester Nahrung, und der Extrusionsreflex, bei dem die Zunge alles, was im Mund ist, wieder herausdrückt, macht das Füttern fester Nahrung schwierig. Um eine ausreichende Ernährung zu gewährleisten, sol