General Practice How to feed preterm babies, giant babies and twins appropriately? For full-term babies, premature babies, huge babies and twins, appropriate feeding methods should be adopted. Infants with a family history of allergies or a history of allergies should be fed in a special way. This article introduces several feeding methods for special babies. Feeding methods for full-term small-sized infants Infants whose gestational age is between 38 and 42 weeks and whose birth weight is <2,500 g are called full-term small-sized infants. The main manifestation of the small sample of infants is wasting, which is intrauterine malnutrition affecting the normal growth of the fetus. Therefore, small samples of infants should be fed according to the principles of malnourished children, taking into account that the metabolism of small samples of infants is higher than that of preterm infants of the same weight, and the caloric needs are also more, and it is very important to feed them early and adequately. This not only prevents hypoglycemia and facilitates weight gain, but also facilitates the growth of brain glial cells and reduces the occurrence of mental retardation and other sequelae. Modality: Adequate nutrition and weight gain as soon as possible The main nutritional characteristic of the small child is to increase its weight as soon as possible. Restoring the normal rate of growth in utero is the key to the child's future health. Small samples of children are easier to feed than preterm infants of similar weight, because full-term small samples of children in the mother's body is not a lot of weeks of gestation, so the development of various organs and physiological maturity is basically similar to the full-term newborn, the main difference is the supply of nutrients by the uterus is insufficient and hypoxia, in the fetus to the exhaustion of hepatic glycogen, the subcutaneous fat is also mobilized, due to the hypoxia led to the discharge of fecal matter into the amniotic fluid, which contaminated the skin or was inhaled and swallowed, when delivered Often presenting with asphyxia, acidosis and hypoglycemia. Small samples of children's stomach capacity is larger than preterm infants, liver function is more mature than preterm infants, if the timely supplementation of nutrition, the occurrence of physiological weight loss is also less. Small samples were hospitalized after birth and were already treated with glucose supplementation and appropriate amounts of minerals. Different feeding regimens are used for different birth weights. Samples close to 2500 g can be breastfed directly, while those <2300 g who have difficulty with breastfeeding can be fed by expressing human milk into a bottle and attaching an old soft rubber nipple. Breastfeeding, the beginning of the daily feeding 8 to 10 times, each time 5 to 10min, such as the baby in the suckling without fatigue and loss of appetite phenomenon, can be appropriate to extend the sucking time. If the mother does not have breast milk, full-term small samples of children can also be used for artificial feeding, should choose small samples of formula milk, semi-skimmed is more desirable, because it is poor digestion and absorption of fat, and good digestion and absorption of sugar, protein for the second. Artificial feeding bottle nipple is also good to the old soft nipple, open hole 2 to 3, the size of the hole to inverted when the milk into a drop out as appropriate. If the flow of milk is too fast, the baby can not swallow in time, easy to cause choking and coughing or even the risk of choking; if the flow of milk is too slow, sucking effort, easy to fatigue the baby and refuse to eat. Full-term small sample of the baby body vitamins, inorganic salt storage is small, the growth rate is fast, should be under the guidance of the doctor in a timely manner to supplement vitamin D, calcium, phosphorus, iron and other nutrients. Feeding method of preterm infants Preterm infants are those whose gestational age is <37 weeks, whose birth weight is <2500 g, and whose height is <46 cm. There are many reasons for infants to be born prematurely, pregnant women with high blood pressure, acute infections, heavy physical labor or multiple births can cause premature birth. Ways: small amount of meals, try to breastfeed Preterm infants are small, low weight, some of the body development is not very mature, the ability to adapt to the survival of the environment is relatively weak, in the feeding should be used in a special way. Preterm infants should be fed as early as possible, and those with a strong ability to live can be fed from 4 to 6 h after birth. For those weighing <2,000 g, feeding can be started at 12 h after birth, and for those in poorer condition, feeding can be started at 24 h after birth. The first feeding is 5%-10% glucose solution, 1-3 spoons every 2 h. After 24 h, milk can be fed. Due to the preterm baby mouth and tongue muscle strength is weak, poor digestive ability, stomach capacity is small, and the daily energy requirement is relatively large, so a small amount of multiple meals can be used to feed the method. In general, for infants weighing less than 1,500 to 2,000 g, they should be fed 8 times a day, and those who can't tolerate it can be fed 12 times. Breast milk is best suited to the taste and digestive ability of preterm infants, and every effort should be made to feed them with breast milk (including colostrum). Breastfed preterm infants have a lower chance of developing indigestible diarrhea and other infections, and the infant will gradually gain weight; if artificially fed, preterm formula should be preferred. Some preterm babies tend to suck poorly in the first few days, you can express breastmilk first, and then use a dropper to drop it into the mouth. Be careful to be gentle and don't let the dropper cut the child's oral mucosa. Feed every 2-3 hours. After a few days, feed the child directly with breast milk. Artificial feeding is similar. In the neonatal period, you can feed from 10 to 60 mL of milk per day. If the infant's growth is good, the interval can be appropriately extended at night, so that the habit of not feeding at night can be gradually developed on the basis of ensuring intake. The amount of breastfeeding can be fed according to the instructions of the recommended amount of formula for preterm infants. Early preterm infants should be supplemented with vitamin E, 10 mg per day in 2 divided doses. Vitamin B complex, 1 tablet/dose, 2 times/d; vitamin C, 50 mg/dose, 2 times/d. Supplementation with a concentrated vitamin AD preparation should be given daily from the 2nd week, starting with 1 drop per day and gradually increasing thereafter. After 3 months of life, iron supplementation, preferably ferrous sulfate, 0.3 g/d in 3 doses. The above supplements should be administered under medical supervision. Feeding pattern of gigantic babies Babies weighing >4 000 g at birth are medically called gigantic babies, which may be related to genetic factors and the nutritional status of the pregnant woman. Mothers who are diabetic or who ate an unusually large amount of food during pregnancy are often prone to giving birth to huge babies. Adjusting the diet according to the baby’s condition It is in the interest of both the mother and the fetus to work with the doctor to control the weight of the fetus appropriately during pregnancy. Huge babies are not always pathological. For those babies who are overweight at birth and have solid musculoskeletal strength, the amount of feeding should be calculated as the average of the baby’s weight and normal weight. If the average birth weight of a normal newborn is 3 kg and the infant weighs 5 kg, then feedings are given at the rate of a 4 kg infant. Of course this is a recommendation and you can refer to your doctor’s advice to determine your infant’s feeding regimen. If the infant eats a lot and his body grows strongly and proportionately, and his height and weight increase at the same time, then the infant should be given a sufficient amount of feeding to fully meet his growth and development needs. If the infant only gains weight but does not grow, and the muscles are flabby and not strong, then we should consider whether there is a problem with the feeding. The babies who are fat due to unreasonable feeding are usually not strong in muscle and have anemia symptoms. The digestive function of such infants is not normal, and their ability to resist various diseases is not strong, so they are easy to get sick. To such infants should be appropriate to increase the supply of protein, vitamins and minerals, if necessary, under the guidance of the doctor can be supplemented with iron, zinc preparations, vitamin A, vitamin D or fishmeal, etc., and at the same time appropriately reduce the amount of starch feeding. After the infant reaches 5 to 6 months, the supply of fish and eggs can be increased appropriately, so that the infant’s weight can be increased slowly and the infant’s muscles and bones can be made solid. Huge babies tend to eat more and breast milk may not be enough, so mixed feeding can be adopted. Some parents, fearing that their babies will not have enough to eat, add rice flour and milk pudding to their babies’ milk. These complementary foods, which are mainly starch, are inappropriate for huge babies because of their low nutrient density. Feeding of twins Most twin babies are born prematurely so that they are congenitally deficient and have a lower body weight (around 50% at <2 500 g); because of their small size, immaturity, and poorer ability to live than normal single-born babies, they should be fed in a special way. Eat small meals, breastfeeding is preferred Preterm twins are different from full-term babies, their sucking ability is poor, swallowing function is incomplete, easy to choking, and the stomach capacity is small, poor digestive ability, very easy to overflow milk. Therefore, it is advisable to adopt the feeding method of small meals. Twins 12 h after birth, should be fed sugar water 20 ~ 50 g. This is because the twin children's body glycogen storage is insufficient, if the starvation time is too long, may occur hypoglycemia, affecting the development of the brain, and even life-threatening in serious cases. Breastfeeding should be started as early as possible after delivery, and in the case of full-term twins, early attempts at breastfeeding can also be made if conditions allow. One to three breastfeedings can be given within the first 2 hours. Thereafter, newborns weighing <1,500 g are fed once every 2 h, and 12 times every 24 h. Newborns weighing 1,500-2,000 g can be reduced to 2 times at night, and 10 times every 24 h. Newborns weighing >2,000 g are fed 8 times every 24 h, and 1 time every 3 h. The newborns weighing >2,000 g should be fed once every 24 h, and 1 time every 3 h. This method of breastfeeding is used because twin newborn infants are thin and light, with more caloric loss and more caloric needs by weight than singleton full-term infants. Breastfeeding is preferred for twins because only breast milk can be adapted to the preterm infant’s digestive insufficiency. If the preterm twin has poor sucking and swallowing ability, breast milk can be sucked out with a breast pump and then fed with a dropper or infant gastrostomy tube. If breastmilk is unavailable or insufficient, it can be fed with formula. The breast milk of a mother with two fetuses is enough for 2 newborns. The method of feeding should be such that one breast is used to feed one small child. However, at each feeding, the 2 children should be allowed to exchange sucking on one breast with each other, because there are differences in the sucking ability and the amount of food of the children, and exchanging sucking each time will help both breasts to produce more milk evenly. Nursing mothers are responsible for the milk supply of 2 children, which requires a fortified nutrient-rich liquid diet, such as fish soup, pig trotter soup, and chicken soup. At least 3,000 mL per day is needed to meet the needs of the infant. When there is insufficient milk, the lighter weight or weaker infant should be breastfed and the other fed with formula. Since nutrient intake is often inadequate when a pregnant woman is trying to conceive 2 fetuses during pregnancy, resulting in lower stores of various nutrients in the twin babies, it is important to add nutrients to the twin babies as early as possible. Twin children born in the 2nd week of life began to increase the vitamin C-rich fresh orange juice, vegetable soup. In order to prevent rickets in twin children, from the 2nd week of life, can be supplemented with cod liver oil, 1 time / d, 1 drop / times, and later gradually increased to 3 times / d, 2 drops / times. After 1 month of life, twins can be given sun exposure to increase their own vitamin D synthesis. To prevent iron deficiency anemia in twins, iron drop supplementation can be considered from week 5 onwards. In addition, twins have poor resistance, and bottles and spoons should be sterilized to prevent gastrointestinal diseases. Triplets can also be exchanged for breast milk as described above, but most mothers’ milk cannot satisfy all three children at the same time, and milk and milk substitutes should be added to varying degrees. It is generally accepted that for triplets, it is best to have 2 children fed mother’s milk and the other child on formula at each feeding, rotating each time. In other words, all 3 children should be able to have breastmilk in turn, and mothers should not neglect this because of the trouble. In this way, although the amount of breastmilk eaten is not much, but breastmilk is rich in nutrients, containing a large number of immune substances and antibodies, which can enhance the resistance of the child’s body and reduce the incidence of disease.