I. Purpose
To improve the rate of exclusive breastfeeding of infants within 6 months, prevent nutritional diseases and promote children’s health by providing guidance to parents of children in the district on scientific feeding knowledge such as breastfeeding, food conversion, rational diet and eating behavior.
II. Service targets
Children aged 0-6 years old (under 7 years old) and their parents in the district.
III. Content and methods
(A) Infant feeding guidance
1.Exclusive breastfeeding
Infants should be exclusively breastfed within 6 months of age, no need to add water, juice and other liquid and solid foods to infants, so as not to reduce the infant’s breast milk intake, which in turn affects the mother’s milk production. From 6 months of age onwards, breastfeeding should be continued until 2 years of age on the basis of reasonable addition of other foods.
(1) Establish good breastfeeding methods
1, prenatal preparation: the mother’s weight is increased appropriately during pregnancy (12-14 kg), and fat is stored for the consumption of energy for breastfeeding. Mother’s weight gain during pregnancy to maintain within the normal range can reduce the risk of gestational diabetes, hypertension, cesarean section, low birth weight babies, huge babies and birth defects and perinatal death.
2.Early breastfeeding: 2 weeks after birth is a critical period for establishing breastfeeding. It is important to help the newborn to achieve the first sucking as early as possible within 1 hour after delivery to successfully establish breastfeeding.
3.Promote breast milk secretion
①Lactation on demand: infants should suck frequently within 3 months of age, no less than 8 times a day, which can make the mother’s nipples get enough stimulation and promote milk secretion.
②Breast emptying: the “ejection reflex” produced by sucking can make the baby get a lot of milk in a short time; each time you breastfeed, you should emphasize feeding the empty side of the breast and then the other side, and the next time you breastfeed, start with the unfed side of the breast.
③Breast massage: apply hot compresses to the breasts before breastfeeding, pat or massage the breasts from the outer edge towards the areola, which can promote breast blood circulation, breast sensory nerve conduction and lactation.
④Mother’s living arrangement: happy mother, adequate sleep, reasonable nutrition (need to increase energy by 500 kcal/day), can promote lactation.
4. Proper breastfeeding techniques
①Preparation for breastfeeding: The baby should be awake, hungry and have a clean diaper change. Before breastfeeding, let the baby push or lick the mother’s breast with its nose. The smell and body contact of the baby while breastfeeding can stimulate the mother’s ejection reflex.
②Nursing method: Before each nursing session, the mother should wash her hands. The correct position for breastfeeding is reclining, horizontal, and ball-holding. Regardless of the position, the baby’s head and body should be in a straight line, with the baby’s body close to the mother, the baby’s head and neck supported, and the baby close to the breast, with the nose to the nipple. The correct sucking position is with the baby’s chin on the breast, mouth wide open, with the nipple and most of the areola in the mouth, the baby’s lower lip turned outward, and more of the areola above the baby’s mouth than below. The infant sucks slowly and deeply, and the sound of swallowing can be heard, indicating correct breast-holding posture and effective sucking. Pay attention to mother-infant interaction and communication during breastfeeding.
③Frequency of breastfeeding: Infants should be breastfed on demand within 3 months of age, and gradually feed at regular intervals from 4 to 6 months of age, once every 3 to 4 hours, about 6 times a day, and gradually reduce nighttime breastfeeding to help infants develop the ability to sleep continuously at night. However, there are individual differences and need to be treated differently.
(2) Common breastfeeding problems
1. Insufficient milk: The daily lactation of normal mothers within 6 months after delivery gradually increases with the growth of the infant’s age, and the average amount of mature milk can reach 700 to 1000 ml per day. Insufficient breast milk intake of infants can appear as follows.
(1) Insufficient weight gain, slow growth curve or even decline, especially in the neonatal period when weight gain is less than 600 grams;
② Urine output is less than 6 times a day;
(3) Inability to hear swallowing sounds when sucking;
④Cry often after each feeding and cannot sleep quietly, or sleep for less than 1 hour (except for newborns).
If the infant’s growth is really affected by insufficient milk, the mother should be advised not to give up breastfeeding easily, and to supplement the insufficient milk with formula after each nursing session.
2, nipple inversion or crack: nipple inversion requires prenatal or postnatal simple nipple care, daily scrubbing with water (avoid using soap or alcohol or the like), squeezing, pinching nipples, mothers can also use nipple correction device to correct nipple inversion. Mothers should learn to “breast feed” rather than “nipple feed”, as most babies can still suckle from flat or sunken nipples. The rich protein and antibacterial substances in the milk can protect the epidermis of the nipple and prevent nipple cracking and infection.
3.Milk overflow
①Reason for occurrence: Small infants have a small gastric capacity, are horizontally positioned, and have anatomical and physiological characteristics of the digestive tract such as a relaxed cardia sphincter and a well-developed pyloric sphincter, which often cause milk overflow in small infants within 6 months of age. Milk overflow can also occur due to excessive swallowing of gas or overfeeding due to improper feeding methods.
②How to relieve: After feeding, it is advisable to hold the baby’s head upright on the mother’s shoulder and pat the back, which can help prevent overflow by expelling swallowed air. The infant should be placed on the right side during sleep to prevent suffocation caused by milk overflow during sleep. If the symptoms of milk spillage do not improve after instruction, or if the infant has poor weight gain, he/she should be referred to the doctor in time.
(4) Breast milk jaundice: Breast milk jaundice refers to jaundice that occurs 2 weeks after birth in healthy full-term or near-full-term infants who are exclusively breastfed. Breast milk jaundice infants generally grow well physically, without any clinical symptoms, no treatment is needed, jaundice can naturally subside, should continue to breastfeeding. If jaundice is obvious and involves the extremities and the heart of the hands and feet, prompt medical attention should be sought. If the serum bilirubin level is greater than 15-20mg/ml and there is no other pathology, it is recommended to stop breastfeeding for 3 days and resume breastfeeding after the jaundice is reduced. During the period of breastfeeding suspension, the mother should express milk regularly to maintain lactation, and the baby can be temporarily fed with formula instead. When breastfeeding again, jaundice may recur, but will not reach the original level.
(5) Breastfeeding when the mother is away from home: When the mother is away from home or at work, she should be encouraged to insist on breastfeeding. Breastfeed not less than 3 times a day, and express breast milk when going out or going to work to maintain the amount of breast milk secretion.
(3) Breast milk preservation method
When mothers go out or have too much breast milk, breast milk can be expressed and stored in a clean container or a special “breast bag”, properly stored in the refrigerator or ice pack, the storage time of breast milk at different temperatures can be found in the table below, and breast milk can be heated to about 40℃ with warm water before feeding.
Table 1 How to store breastmilk
Storage conditions
Maximum storage time
Room temperature (25℃)
4 hours
Refrigerator freezer (4°C)
48 hours
Refrigerator freezer(-20℃)
3 months
(4) Cases in which breastfeeding is not appropriate
The mother is receiving chemotherapy or radiation treatment, suffering from active tuberculosis and not effectively treated, suffering from hepatitis B and the newborn was not vaccinated with hepatitis B vaccine and hepatitis B immunoglobulin at birth, HIV infection, herpes on the breast, drug addiction, etc. should not be breastfed. When the mother is suffering from other infectious diseases or taking drugs, she should consult her doctor and decide whether she can breastfeed according to the situation.
2.Partial breastfeeding
Breast milk and formula or other milk type at the same time feeding infants for part of the breastfeeding, which breast milk and formula at the same time feeding methods are the following two.
(1) supplemental teaching method: 6 months of age infants with insufficient breast milk, should still maintain the necessary number of sucking to stimulate breast milk secretion. At each feeding, breast milk is fed first and then formula is used to supplement the breast milk deficiency. The amount of milk to be supplemented depends on the infant’s appetite and the amount of breast milk secretion, i.e. “how much is missing to supplement”.
(2) Substitute teaching method: generally used for 6 months of age after the inability to adhere to the situation of breastfeeding, can gradually reduce the number of breastfeeding, with formula instead of breast milk.
3.Formula feeding
(1) Feeding frequency: Because of the small stomach capacity of newborn infants, they may not be fed regularly within 3 months after birth. 3 months later, infants can establish their own feeding routine, and should start feeding regularly at this time, once every 3 to 4 hours, about 6 times/day. Allow the amount of milk to fluctuate each time, and avoid inappropriate methods that require infants to consume a fixed amount of milk.
(2) Feeding methods: Feed in the correct position while the infant is awake, and pay attention to mother-infant interaction. Special attention should be paid to the use of appropriate teats, appropriate milk temperature, clean bottles, and the position of the bottle at 45° to the infant’s jaw when feeding.
(3) Milk powder mixing: Milk powder should be mixed in strict accordance with the product instructions, avoiding over-dilution or over-concentration, or adding extra sugar.
(4) Milk quantity estimation: When formula is used as the main source of nutrition for infants up to 6 months of age, frequent estimation of infant milk intake is required. milk quantity for infants up to 3 months of age is approximately 500-750 ml/day, and for infants 4-6 months of age is approximately 800-1000 ml/day, gradually reducing nighttime nursing.
(5) Therapeutic formula selection
1. Hydrolyzed protein formula: For infants diagnosed with cow’s milk protein allergy, breastfeeding should be insisted on and can be continued until 2 years of age, but the mother should limit the intake of milk products. If breastfeeding is not possible and infants with cow’s milk protein allergy should prefer amino acid formula or deeply hydrolyzed protein formula, it is not recommended to choose partially hydrolyzed protein formula or soy formula.
2. Lactose-free formula: Lactose-free formula (formula with sucrose, glucose polymer, maltodextrin, corn syrup as carbohydrate source) should be used for infants with lactose intolerance.
3. Low phenylalanine formula: Infants with confirmed phenylketonuria should use low phenylalanine formula.
4.Food conversion
With growth and development, digestive capacity gradually improves, and simple milk feeding cannot fully meet the growth and development needs of infants after 6 months of age, so infants need to gradually switch from pure milk-based liquid food to solid food, a process called food conversion (formerly known as complementary food addition). If weaned from breast milk during infancy, infants still need to maintain a total milk intake of about 800 ml/day. Nutritional needs of children include nutrients, nutritional behaviors and nutritional environment. In the liquid food feeding stage, pureed food introduction stage and solid food feeding stage of infant and young child feeding process, not only nutrient intake should be considered, but also feeding or eating behaviors and eating environment should be considered so that infants and young children can develop good eating habits while getting sufficient and balanced intake of nutrients. Nutrient supplements or high-density nutrient-fortified foods based on soy or cereal can be used when resources are scarce and the daily diet cannot meet the nutritional needs of infants.
(1) Age: The recommended age to begin introducing non-dairy pureed foods is 6 months of age and no earlier than 4 months of age. At this time, the infant has a stable milk intake of about 180 ml/time and good growth and development, suggesting that the infant has the digestive capacity to accept other foods.
(2) Types.
(1) Stage 1 food: Cereals that can meet growth needs, are easily absorbed and not easily allergic should be chosen first, preferably iron-fortified rice flour, and rice flour can be blended with milk; the second food introduced is root vegetables and fruits, with the main purpose of training the infant’s sense of taste. Food should be spoon fed to help train swallowing function.
(2) Second-stage food: The second-stage food for infants is gradually introduced from 7 to 9 months of age, including animal foods such as meat, eggs, fish and soy products. The foods introduced should be based on local foods, paying attention to the texture, nutrient density, hygiene and variety of preparation methods.
(3) Method: Infant food conversion period is the process of gradually getting used to other foods, the introduced food should be from little to much, first feed the infant a small amount of iron-fortified rice flour, from 1 to 2 spoons to several spoons, until a meal; the introduced food should be one to many, infants accept a new food generally need to try 8 to 10 times, about 3 to 5 days, until the infant is used to the taste before changing to another, in order to stimulate the development of taste. The introduction of single foods one at a time can help keep track of whether infants have food allergies and identify allergens.
(4) Eating skills training: food conversion helps infants’ neuropsychological development, and the process of introduction should pay attention to the texture of food and develop children’s eating skills, such as eating with spoons and cups can promote oral coordination and learning to swallow; transition from pureed food to minced food can help learn to chew and increase the energy density of food; grasping food with hands can increase infants’ interest in eating, and is also conducive to promoting Hand-eye coordination and the development of children’s independent eating ability. In the process of food transition, infants gradually approach adult food in terms of texture and variety, and their eating skills gradually mature.
Table 2 Infant food transition methods
6 months of age
7 to 9 months of age
10~12 months of age
Food
Nature
Pureed food
Finely ground food
Crumbly, diced, finger food
Number of meals
Try, gradually increase to 1 meal.
4~5 times milk, 1~2 meals of other foods.
2~3 times milk, 2~3 meals of other foods.
Milk
Exclusive breast milk, partial breast milk or formula milk;
Breastfeeding at regular intervals (3~4 hours), 5~6 times/day, 800~1000 ml/day;
Gradually reduce nighttime nursing.
Breast milk, partial breast milk or formula;
4~5 times/day, 800ml/day.
Partial breast milk or formula;
About 2~3 times/day, milk quantity 600~800ml/day.
Cereals
Choose iron-fortified rice flour and mix it with water or milk;
Try a small amount (1 scoop) at first and gradually increase to 1 meal per day.
Iron-fortified rice flour, thick porridge or noodles, about 30~50g/day.
Soft rice or pasta, about 50~75 grams per day.
Vegetables
Fruits
Try vegetable puree (melon, root, pod) 1~2 spoons at first, then fruit puree 1~2 spoons twice a day.
25~50 grams of grated vegetables and 20~30 grams of fruits per day.
50~100 grams of grated vegetables and 50 grams of fruit daily.
Meat
Try to add
Start adding animal foods such as meat puree, liver puree, animal blood, etc.
Add animal liver, animal blood, fish and shrimp, chicken and duck meat, red meat (pork, beef, lamb, etc.), 25~50g daily.
Eggs
Do not add for now
Start adding egg yolk, gradually increase from 1/4 to 1 per day.
1 egg
Feeding
Technique
Spoon feeding
Sit in a high chair with an adult and begin to learn to self-feed with your hands. Infants can learn to chew by holding “strips” or “fingers” of food in their hands.
Learn to feed themselves with a spoon; drink milk from a cup; eat with an adult at the same table 1 to 2 times a day.
Note: You can drink milk after eating, naturally form a meal instead of a milk, the introduction of food should not affect the total amount of milk; food is light, no salt, less sugar, oil; do not consume honey water or sugar water, try not to drink juice.
5, premature / low birth weight infant feeding after discharge
Premature/low birth weight infants with birth weight < 2000 g, critical condition or complications after birth, complete parenteral nutrition > 4 weeks, or slow weight gain, need to be discharged to a health care institution with consultation conditions for regular follow-up, under the guidance of a specialist for intensive breastfeeding, formula for preterm infants or formula feeding for preterm infants after discharge.
For preterm/low birth weight infants with birth weight ≥ 2000 g and without the above risk factors, exclusive breastfeeding is still preferred after discharge, and infant formula is only considered when breast milk is insufficient or unavailable. The mother’s diet and nutritional balance are especially important for preterm/low birth weight infants.
The age at which preterm/low birth weight infants are introduced to other foods varies individually and is related to their level of developmental maturity. Premature/low birth weight infants with small gestational age are introduced relatively late, generally not earlier than 4 months of corrected age and no later than 6 months of corrected age.
(B) Dietary guidance for toddlers and preschoolers
1. Food varieties and eating quantity
(1) The variety and amount of food for toddlers: 350-500 ml of milk should be consumed daily, and formula is recommended for toddlers under 2 years old who cannot continue breastfeeding. Pay attention to the diversity of dietary varieties, advocate natural food and balanced diet, and consume 1 egg, 50 grams of animal food, 100 to 150 grams of cereals, 150 to 200 grams of vegetables, 150 to 200 grams of fruits, and 20 to 25 grams of vegetable oil per day. Young children should eat home-cooked food of appropriate volume, slightly soft texture, less salt and easy to digest. Avoid giving young children fried food, less fast food and less sweet drinks, including lactic acid drinks.
(2) Preschool children should eat 300-400 ml of milk and milk products, 180-260 grams of cereals, 120-140 grams of meat and eggs, 25 grams of beans and soy products, 200-250 grams of vegetables, 150-300 grams of fruits, and 25-30 grams of vegetable oils every day.
(3) Dietary arrangement: The daily diet can be arranged with 3 main meals, 2 to 3 dairy and nutritious snacks, and controlled snacks between meals. Parents are responsible for providing children with safe, nutritious, easily digestible and tasty healthy food, allowing children to decide on the amount of food to eat and eating regularly so that children can experience hunger and a sense of satiety.
2.Eating behavior
(1) Eating style: 12-month-old children should start practicing eating on their own with utensils to develop their independence and ability to respond correctly. 1 to 2-year-olds should share meals and encourage themselves to eat, and after 2 years of age, children should eat independently.
(2) Eating Behavior: Meals should be eaten at regular intervals, at regular intervals, and in quantitative amounts, with each meal lasting 20 to 30 minutes. The eating process should avoid playing or watching TV while eating, not chasing feeding, and not using bottles to drink milk. Parents’ eating behavior has a greater influence on young children. Avoid force-feeding and overfeeding to prevent children from refusing to eat, partial eating and overfeeding. Parents should provide less high-fat and high-sugar foods, fast foods, carbonated beverages and sugary drinks.
(3) Food preparation: Food should be processed separately, cooked mainly by steaming, boiling, stewing and stir-frying, paying attention to the color, aroma and taste of food. Children can be involved in the food preparation process to enhance their interest in food.
(4) The appropriate amount of water: according to the season and the amount of children’s activities to decide the amount of water to drink, in order not to affect the intake of milk and daily diet of young children.
3.Eating environment
Family dining around is the best way for children to learn to eat on their own, should provide children with a relaxed, pleasant and good eating environment and atmosphere, avoid noisy eating environment. Avoid intimidating, reprimanding and scolding children during meals.
(C) Food safety
1. Food selection
Avoid giving children under 3 years old foods that can easily cause choking and injury, such as small round candies and fruits, nuts, jelly, popcorn, chewing gum, and fish and meat with bone spines.
2. Food hygiene
The process of preparing and preserving food for infants and children needs to ensure the cleanliness and hygiene of food, eating utensils and water. Both children and caregivers should wash their hands before preparing food and feeding, and provide children with fresh food to avoid contamination of food. Animal foods such as meat and fish should be cooked to kill harmful bacteria. Remaining food should be heated to avoid contamination, solid food should be heated thoroughly, and liquid food should be boiled.
3.Food storage
Food should be consumed immediately after preparation and avoid leaving food for too long, especially at room temperature. Leftover food should be stored in the refrigerator and sealed with a lid to slow down the reproduction of bacteria.
IV. Work requirements
1.During the children’s health checkup, carry out guidance on child feeding and nutrition according to the age stage of children and the results of physical evaluation.
2.Carefully do the consultation and guidance on breastfeeding, food conversion and reasonable nutrition for children, guide parents to adopt scientific feeding methods, cultivate healthy eating behavior of children as early as possible, and promote children’s growth and development.
3.To carry out various forms of feeding and nutrition health knowledge health education activities, popularize children’s nutrition knowledge.
V. Assessment indicators
1.Exclusive breastfeeding rate within 6 months = (number of babies exclusively breastfed 24 hours before the survey / number of babies within 6 months of the survey) × 100%
2, breastfeeding rate within 6 months = (the number of babies breastfed 24 hours before the survey / the number of babies within 6 months of the survey) × 100%
3.Knowledge rate of parents about scientific feeding = (the number of parents of children aged 0-6 years who have knowledge of feeding and nutrition in the district at the time of the survey / the number of parents of children aged 0-6 years in the district surveyed) × 100%