The process of screening interventions for infant milk spill 1. Ask for medical history and clinical assessment ①Milk spill The frequency and time of milk spill (e.g., after meal or fasting, immediately after meal or after lh), the duration of a milk spill, the volume of milk spill, and the position of the infant during the spill. ②Concomitant symptoms Whether the milk spill is accompanied by painful expression or abnormal posture (Sandifer posture), whether it is accompanied by feeding difficulty, swallowing difficulty, nausea, rather complicated vomiting, vomiting blood, irritability, easy crying, and episodic cough. If necessary, ultrasound examination of the abdomen may be performed to exclude hypertrophic pyloric stenosis, and routine stool and occult blood tests may also be performed. ③Feeding condition Include feeding method, feeding amount, feeding interval, feeding posture, supplemental food addition time, and whether new supplemental food has been added recently. ④Growth and development: To find out the gestational age, birth mass, current body mass and length to assess the presence of body mass, poor length growth and growth retardation. 2. Red flags The presence of pathological conditions such as gastroesophageal reflux disease, food allergy such as milk protein, eosinophilic esophagitis, hypertrophic pyloric stenosis, etc. should be considered if one of the following symptoms is present and prompt referral or consultation is required. These include: ① nausea, frequent vomiting, blood vomiting; ② feeding difficulties, swallowing difficulties; ③ irritability, crying; ④ episodic cough; ⑤ painful expression/abnormal posture; ⑥ poor growth (poor body mass, length growth). 3. Soothing education ① Most infants will have milk spillage after feeding, i.e. a small amount of milk will be spit out from the mouth, or a small amount of sour milk will be spit out after eating milk for a period of time, which is a normal physiological phenomenon. Artificially fed children are more likely to have milk spillage than breastfed children. The symptoms of overflow will decrease as the infant’s age increases, and the number of overflows will decrease after 6-8 months of age, and most of them will disappear around 1 year of age. Infants who have more frequent milk spills should be closely monitored for physical growth. If the infant’s body mass and length growth are normal and there are no other symptoms, the incidence of milk spillage can be reduced through proper feeding and care methods. 4. Nursing guidance ①Infants should be nursed while awake, in a semi-sitting or reclined position. ②Baby should be allowed to hold most of the areola when breastfeeding, and the milk in the bottle should be filled with the nipple when feeding manually to reduce excessive gas swallowing into the stomach. Don’t put the baby down in a hurry after breastfeeding. You can let the baby lie on the adult’s shoulder and pat the back with your hand (it is better if you can burp the gas in the stomach); you can also try to pause breastfeeding after 3-5 min, pat the baby’s back, and then continue breastfeeding. ④For newborns or small infants who spill milk frequently, raise the head of the bed by 15-30° when lying on the back to reduce spillage. ⑤ Change a clean diaper before the infant nurses to reduce milk spillage due to position change after nursing. If the infant must be changed after breastfeeding due to defecation, be careful not to let the infant’s lower limbs and abdomen be higher than the torso to reduce intragastric pressure. When washing the infant’s perineum and anus, the buttocks should also be placed in a low position. 5.Feeding guidance and dietary intervention Advocate breastfeeding and compliant feeding. Exclusive breastfeeding is the best way to prevent infant overflow. Observe the baby’s movements, expressions, sounds and other signals when feeding, and make timely, appropriate and targeted responses to meet the baby’s real needs. Add complementary foods at the right time and reasonably, and follow the principles of complementary food addition to avoid overfeeding. After 4-6 months of age, infants can continue to breastfeed or formula feed on the basis of reasonable addition of complementary foods. Adding pureed complementary foods may help to reduce infant overflow, while excessive feeding of water and addition of juice and vegetable juice may aggravate the occurrence of overflow. For infants who cannot be exclusively breastfed, special formulas such as partially hydrolyzed protein formula can be tried. Evaluate the effect after 2 weeks of observation and if it is effective, use it for a long time, if not, refer or consult. Studies have shown that partially hydrolyzed protein formula accelerates gastric emptying and reduces gastric retention in infants, thereby reducing the incidence of milk spillage. Small, repeated feedings can be used to prevent overflow due to too much milk being fed at once and stomach fullness. Avoid force-feeding and overfeeding. After the baby is full-term, feed once every 2-3 hours during the day, generally with a slightly shorter interval between breastfeeding and a slightly longer interval between formula feedings; the time between night feedings should depend on the baby’s sleeping condition. After the baby is full term, the feeding interval can be more than 4h. After the baby is full term, each feeding should not exceed 20 min to avoid overfeeding and increase the risk of overflow. There is a lack of anti-spill formula in the domestic market. The mechanism of action of anti-overflow formula is: by adding rice, corn, potato starch, guar gum, acacia bean gum, etc. to increase the thickness of the formula without increasing the heat, it can have the effect of effectively reducing infant overflow. Some studies have also shown that there is an increased risk of necrotizing small intestinal colitis in preterm infants with anti-spill formula. Homemade thickened formula made from regular formula with additional rice flour has the potential to reduce infant overflow, but can significantly increase infant caloric intake and increase the risk of overweight with long-term feeding. In addition, this homemade thickened formula can lead to high osmotic pressure of the formula and stimulate the lower esophageal sphincter, which may in turn aggravate gastroesophageal reflux and milk spillage. Infants with high suspicion of milk protein allergy should be referred to a specialist, or diagnosed and intervened in accordance with the Evidence-Based Recommendations for the Diagnosis and Treatment of Milk Protein Allergy in Infants and Children in China, etc. Exhibit: