Weaning of the premature child
After the sixth month of age the milk alone cannot ensure the nutrients needed for the optimal growth and development of the child’s system. This requires adding to the infant diet various semi-liquid, non-milk foods that will prepare it for having transient food and later on for the diverse typical adult food.
In the different countries there are variations in regard to: the time of weaning, the use of the most common foods, the sequence of their introduction. Since the scientifically based nutrition requirements for infants are the same worldwide, universal recommendations for weaning made by various international organisations – the World Health Organisation (WHO) and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) - are available, including the weaning of premature children as well.
Four principles of weaning according to the WHO
- In due time – to be performed at the most appropriate age;
- Adequate – to ensure the needed energy and nutrients;
- Safe – this depends on the product choice, their preservation and way of food processing;
- Proper – to attend to the food quantity and quality. The number of meals should meet the needs of the child’s system. The most appropriate age for weaning is the period between 16-24 weeks (4-6 full months).
Early weaning (before 4 full months) results in increased incidence of food allergy, risk of overweight and overload of the immature system with electrolytes, especially cooking salt. Late weaning (after 6 full months) results in nutrient deficiency and growth and development retardation of the child.
Premature children have special nutrient needs in the first months upon their discharge from the neonatology wards. They have greater needs of energy, protein, polyunsaturated fatty acids, iron and calcium in comparison with the children born on term. On the other hand, food digestion is impeded by the immaturity of the digestive system and the frequent chronic diseases, associated with prematurity.
Sequence of introducing foods during weaning
Fruit juices – according to the current WHO and ЕSPGHAN guidances giving fruit juices and sauces is considered as weaning and is not recommended up to 4 months of age. During this period, milk or its substituents are adequate source of vitamins and minerals. After the 4th month, fruit juice and subsequently fruit sauce should be given between two of the meals, its quantity gradually increasing to about 30-50 ml. Apple juice is the most beneficial one. Carrot, peach, apricot juices and sauces are appropriate for the following months. The sweet fruits: grapes, pears, plums have laxative effect, and the sour ones – morello cherries and apples – have constipating effect. Imported fruits that are not growing in our country – citruses, kiwi, mango etc. – are offered after 1 year of age.
Juices are given between, not instead of meals. Recommended quantity should not be exceeded, and habituation of the child to drink juice instead of water is harmful.
Milk-vegetable purée is traditionally the first food for weaning in our country. Potato-carrot purées are best tolerated, since they facilitate digestion and have anti-diarrhea effect. Ready-for-use commercial products are being increasingly used. Vegetable purées, containing milk, are ready for consumption. Milk should be added to those, containing only vegetables, to make the food completely nourishing. After the 6th month the content of the vegetable puréesis varied. Addition of hard-boiled egg yolk is useful; it is a valuable source of iron, fats and fat-soluble vitamins. Vegetable puréeis given at midday meals.
Milk gruel. The first gruel should be gluten-free – usually rice-based, with no additional components or only with one kind of fruit. Commercial gruels, containing milk, are ready for consumption after dissolving in water. Non-milk gruels are dissolved in the milk that is fed to the child. The gruel should be given once daily and should substitute the afternoon breast-feeding. It may also be the first weaning food in the premature children. Gluten-containing gruels, containing wheat, rye, maize should be introduced after the 6th month. Both early giving of gluten – before 6 months of age - and avoiding it after 8 months of age is harmful, since the child cannot get used to taking this protein widely present in the main cereals.
Further foods are also introduced up to 1 year of age as follows:
|Meat-vegetable purée||7th month|
|Sop with cheese||7th-8th month (substitutes the second meal in the morning)|
|Bouillon and soup within the midday meal||9th month|
|Gradual introduction of transient food||10th-12th month.|
Some basic rules during weaning
- The child is weaned only when it is healthy.
- Any change in nutrition is made alone, with no further changes in the following 3-5 days.
- The time for weaning and introduction of the respective foods is observed.
- Introduction of new foods is gradual, aiming at adaptation of digestion. Full portion is reached within a week.
- If the child refuses a food or if indigestion occurs, the respective food is temporarily stopped.
- The child’s food should always be tasted. At that, the temperature, the consistency and the taste are assessed.
Nutrition in the infant period is especially important for the premature children and has a long-term effect on health. Adequate breast-feeding, along with timely weaning with appropriate foods, ensures maximum development of the physical and mental potential of the child in the following years.