1. exclusive breastfeeding

Babies should be exclusively breastfed when they are 6 months old, and there is no need to add liquid and solid food such as water and fruit juice to the baby, so as not to reduce the baby's breast milk intake and thus affect the mother's milk secretion. From the age of 6 months, on the basis of adding other foods reasonably, continue breastfeeding until the age of 2.

(1) Establish a good breastfeeding method.

1) Prenatal preparation: The mother gains weight during pregnancy (12 ~ 14 kg), and stores fat for the consumption of lactation energy. The risk of gestational diabetes, hypertension, cesarean section, low birth weight infants, macrosomia, birth defects and perinatal death can be reduced by controlling the weight gain of mothers during pregnancy within a normal range.

2) Start breastfeeding as soon as possible: 2 weeks after birth is the key period for establishing breastfeeding. It is very important for the successful establishment of breastfeeding to help newborns suck for the first time as soon as possible after delivery 1 hour.

3) promote milk secretion

(1) Breastfeeding on demand: Babies within 3 months should suck frequently, at least 8 times a day, which can stimulate the mother's nipples and promote milk secretion.

② Breast emptying: The "milk ejection reflex" caused by sucking can make the baby get a lot of milk in a short time; Every time breastfeeding, it should be emphasized that one breast should be fed empty first, and then the other breast. The next breast-feeding should start with breasts that have never been empty-fed.

③ Breast massage: Hot compress the breast before breast-feeding, patting or massaging from the outer edge of the breast to the areola direction can promote the blood circulation of the breast, the conduction of breast sensory nerves and lactation.

④ Life arrangement of lactating mothers: The lactating mothers are happy physically and mentally, get enough sleep and have reasonable nutrition (need to increase energy by 500 kcal/day), which can promote lactation.

4) Correct feeding skills

① Preparation before breastfeeding: Babies waiting for breastfeeding should be awake and hungry, and have changed into clean diapers. Before breastfeeding, let the baby push or lick the mother's breast with his nose. When breastfeeding, the baby's smell and physical contact can stimulate the lactation reflex.

2 breastfeeding methods: mothers should wash their hands before breastfeeding. The correct holding posture includes oblique holding, horizontal holding and holding the ball. No matter what posture you use, your baby's head and body should be in a straight line. The baby's body clings to the mother and supports the baby's head and neck. The baby clings to the breast and the nose faces the nipple. The correct posture is that the baby's chin is attached to the breast, the mouth is wide open, the nipple and most of the areola are contained in the mouth, the baby's lower lip is turned outwards, and the areola above the baby's mouth is more than below. The baby sucks slowly and deeply, and can hear the swallowing sound, indicating that the posture of the breast is correct and the sucking is effective. Pay attention to mother-infant interaction during lactation.

③ Breastfeeding frequency: Babies within 3 months should be breastfed as needed. Feeding regularly at the age of 4 ~ 6 months, once every 3 ~ 4 hours, about 6 times a day, can gradually reduce breastfeeding at night and help the baby form the ability to sleep continuously at night. But there are individual differences and need to be treated differently.

(2) Common breast-feeding problems

1) Insufficient milk quantity: The daily milk quantity of normal lactating mothers gradually increases with the growth of the baby's age within 6 months after delivery, and the average mature milk quantity can reach 700 ~ 1000 ml per day. Insufficient breast milk intake of infants can be manifested as follows:

① The weight gain is insufficient, and the growth curve is flat or even declining, especially in the neonatal period, the weight gain is less than 600g g.

② The urine output is less than 6 times a day;

③ No swallowing sound can be heard when sucking;

(4) Frequent crying after breastfeeding, unable to sleep peacefully, or sleeping less than 1 hour (except for newborns).

If the lack of milk really affects the baby's growth, it is suggested that mothers should not give up breastfeeding easily, and can supplement the lack of breast milk with formula milk after each breastfeeding.

2) Nipple invagination or chapped nipple: Nipple invagination requires simple nipple care before or after delivery, and the nipple is scrubbed and squeezed with clean water (soap or alcohol is prohibited) every day. Mom can also use nipple orthosis to correct nipple inversion. Mothers should learn to "breastfeed" instead of "nipple feeding". Most babies can still suck milk from flat or invaginated nipples. After each lactation, you can squeeze out a little milk and apply it evenly on the nipple. Protein and antibacterial substances rich in milk can protect nipple epidermis and prevent nipple chapping and infection.

3) Spilled milk

① Cause: The baby's stomach is small and horizontal, with the anatomical and physiological characteristics of digestive tract such as relaxation of cardia sphincter and better development of pyloric sphincter, which often leads to galactorrhea in infants within 6 months. Overfeeding caused by excessive swallowing or improper feeding methods can also lead to galactorrhea.

2 Relief method: After feeding, it is advisable to hold the baby's head vertically on the mother's shoulder and pat the back to help discharge the swallowed air and prevent the milk from overflowing. The baby should lie on the right side when sleeping, which can prevent the milk from overflowing during sleep and lead to suffocation. If the symptoms of galactorrhea do not improve after the guidance, or the weight gain is not good, it should be referred in time.

4) Breast-milk jaundice: Breast-milk jaundice refers to jaundice that occurs 2 weeks after the birth of a healthy full-term or nearly full-term baby who is exclusively breastfed. Babies with breast milk jaundice generally grow well without any clinical symptoms and need no treatment. Jaundice can subside naturally, and breastfeeding should continue. If jaundice is obvious, involving limbs, hands, feet and heart, you should seek medical advice in time. If the serum bilirubin level is higher than 1.5-20 mg/ml, and there are no other pathological conditions, it is recommended to stop breastfeeding for 3 days and resume breastfeeding after jaundice is relieved. During the period of stopping breastfeeding, the mother should milk regularly to maintain lactation, and the baby can temporarily replace feeding with formula milk. When breastfeeding again, jaundice can appear repeatedly, but it will not reach the original level.

5) Breastfeeding when mother goes out: Mother should be encouraged to insist on breastfeeding after going out or going to work. Breast-feed at least three times a day, and squeeze out breast milk when going out or going to work to maintain breast milk secretion.

(3) breast milk preservation method

When the mother goes out or has too much breast milk, the breast milk can be squeezed out and stored in a clean container or a special "milk bag" and properly stored in a refrigerator or an ice bag. Please refer to the table below for the storage time of breast milk at different temperatures. Before eating breast milk, you can heat it to about 40℃ with warm water before feeding it.

Table 1 Maximum storage conditions of breast milk Room temperature (25℃) 4 hours Refrigerator freezer (4℃) 48 hours Refrigerator freezer (-20℃) 3 months (4) Not suitable for breast feeding.

If the mother is receiving chemotherapy or radiotherapy, suffering from active tuberculosis without effective treatment, suffering from hepatitis B and the newborn is not vaccinated with hepatitis B vaccine and hepatitis B immunoglobulin at birth, infected with HIV, herpes on the breast, drug abuse, etc. , not suitable for breastfeeding. When the mother suffers from other infectious diseases or takes drugs, she should consult a doctor and decide whether she can breastfeed according to the situation.

2. Partial breastfeeding

Feeding babies with breast milk and formula milk or other milk is part of breast feeding, and there are two ways to feed breast milk and formula milk at the same time.

(1) Supplementary feeding method: When the baby's breast milk is insufficient within 6 months, the necessary sucking times should still be maintained to stimulate breast milk secretion. Every time you feed, you should breast-feed first, and then use formula milk to supplement the lack of breast milk. The amount of milk supplement depends on the baby's appetite and the amount of breast milk secreted, that is, "how much is missing".

(2) Substitution method: Generally, it can be used when breastfeeding cannot be adhered to after 6 months of age, and the frequency of breastfeeding can be gradually reduced, and breast milk can be replaced by formula milk.

3. Formula feeding

(1) Feeding frequency: Because the newborn baby has a small stomach capacity, it can be fed irregularly within 3 months after birth. After 3 months, the baby can establish his own eating rules. At this time, they should start feeding regularly, once every 3 to 4 hours, about 6 times a day. Allow the milk quantity to fluctuate every time, and avoid using improper methods to force the baby to take a fixed amount of milk.

(2) Feeding method: When the baby is awake, adopt the correct posture to feed, and pay attention to the mother-infant interaction. Special attention should be paid to choosing the right nipple, the milk temperature should be appropriate, the bottle should be clean, and the position of the bottle should be 45 with the baby's jaw when feeding. At the same time, the milk should be ready-to-eat, and it is not advisable to heat the milk in a microwave oven to avoid uneven heating or overheating of the milk.

(3) Milk powder blending: Milk powder should be blended in strict accordance with the product instructions to avoid being too thin or too thick, or adding extra sugar.

(4) Milk quantity estimation: When formula milk is the main source of nutrition for infants within 6 months, it is necessary to estimate the intake of infant milk frequently. The milk quantity of 3-month-old infants is about 500 ~ 750ml/ day, and that of 4 ~ 6-month-old infants is about 800 ~ 1000ml/ day, and breastfeeding at night gradually decreases.

(5) Selection of therapeutic formula milk

1) Hydrolyzed protein formula: For infants diagnosed with milk protein allergy, breast-feeding should be continued until they are 2 years old, but mothers should limit the intake of dairy products. If infants who are allergic to milk protein cannot breastfeed, amino acid formula or deeply hydrolyzed protein formula should be preferred, and partially hydrolyzed protein formula and soybean formula are not recommended.

2) Lactose-free formula: Lactose-intolerant infants should use lactose-free formula (formula with sucrose, glucose polymer, maltodextrin and corn syrup as carbohydrate sources).

3) Low phenylalanine formula: Infants diagnosed with phenylketonuria should use low phenylalanine formula.

4. Food transformation

With the growth and development, the digestive ability is gradually improved, and the simple milk feeding can not fully meet the needs of the baby's growth and development after 6 months. Babies need to gradually change from pure milk liquid food to solid food. This process is called food conversion (formerly called complementary food addition). If breast milk is cut off in infancy, it is still necessary to maintain the baby's total milk volume at around 800ml/ day. Children's nutritional needs include nutrients, nutritional behavior and nutritional environment. In the process of feeding infants, we should not only consider the intake of nutrients, but also consider the feeding or eating behavior and eating environment, so that infants can get adequate and balanced intake of nutrients and develop good eating habits. When resources are scarce and the daily diet can not meet the nutritional needs of infants, nutritional supplements or high-density nutritional fortified foods based on soybeans and cereals can be used.

(1) month age: it is suggested that the month age of introducing non-creamy food should be 6 months, not earlier than 4 months. At this time, the baby's milk quantity is stable, about 180ml/ time, and it grows well, suggesting that the baby has the digestive ability to accept other foods.

(2) Type:

1) First-stage food: First, choose cereal food that can meet the growth needs, is easy to absorb and is not easy to produce allergies, preferably iron-fortified rice flour, which can be mixed with milk; Secondly, the foods introduced are root vegetables and fruits, and the main purpose is to train the baby's taste. Food should be fed with a spoon to help train swallowing function.

2) Second-stage foods: The second-stage foods for infants are gradually introduced from 7 to 9 months, including animal foods such as meat, eggs, fish and bean products. Imported food should be mainly local food, and pay attention to the diversity of food texture, nutritional density, hygiene and production methods.

(3) Method: The baby's food transition period is a process of gradually getting used to other foods, and the introduction of food should be from less to more. First, feed the baby a small amount of iron-fortified rice flour, from 1 ~ 2 spoonfuls to several spoonfuls until a meal; The introduction of food should be from one kind to many kinds. Generally, the baby needs to try a new food 8 ~ 10 times, about 3 ~ 5 days, and then change to another one after the baby gets used to this taste to stimulate the development of taste. Introducing the method of single food one by one is helpful to know whether the baby has food allergies and determine allergens in time.

(4) Training of eating skills: Food conversion is helpful to the neuropsychological development of infants, and attention should be paid to the texture of food and the cultivation of children's eating skills in the process of introduction. For example, eating with a spoon and a cup can promote the coordination of oral movements and learn to swallow; The transition from mushy food to minced food can help you learn to chew and increase the energy density of food; Grasping food by hand can not only increase the baby's interest in eating, but also help to promote hand-eye coordination and cultivate the child's ability to eat independently. In the process of food conversion, the texture and types of food that babies eat are gradually close to those of adults, and their eating skills are gradually mature.

Table 2 Food conversion methods for infants 6 months old, 7 to 9 months old, 10 to 12 months old.

The frequency of powder eating, broken eating, diced eating and hand eating gradually increased to 1 meal. Milk 4~5 times, 65438+ other food 0~2 meals. Milk 2~3 times, other food 2~3 meals. Milk pure breast milk, partial breast milk or formula milk;

Breast-feeding regularly (3-4 hours), 5-6 times/day, with milk volume of 800- 1000ml/ day;

Gradually reduce breastfeeding at night. Breast milk, partial breast milk or formula milk;

4~5 times/day, the milk quantity is about 800ml/ day. Part of breast milk or formula milk;

About 2~3 times/day, and the milk quantity is 600~800 ml/day. For cereals, iron-fortified rice flour is selected and mixed with water or milk;

At first, a small amount (1 spoon) gradually increased to 1 meal every day. Rice flour, thick porridge or noodles with iron, about 30 ~ 50g per day. Soft rice or pasta, about 50 ~ 75g per day. vegetables

For fruit, try 1~2 spoonfuls of vegetable puree (melon, root and pod) first, and then try 1~2 spoonfuls of fruit puree twice a day. 25 ~ 50g of cut vegetables and 20 ~ 30g of fruit every day. 50 ~ 100g of cut vegetables and 50g of fruit every day. Try to add meat, and start adding animal food such as meat paste, liver paste and animal blood. Animal liver, animal blood, fish and shrimp, chicken and duck meat and red meat (pork, beef, mutton, etc. ) are added, 25-50g per day. Temporarily do not add eggs, add egg yolk, and gradually increase from 1/4 to 1 every day. Feeding 1 egg

Technical spoon feeding can sit in a high chair and eat with adults, and begin to learn to feed yourself by hand. Babies can learn to chew by holding "strips" or "fingers" of food in their hands. Learn to eat with a spoon; Drink milk from a cup; Dine at the same table with adults every day 1~2 times. Note: you can drink milk after eating, and naturally form a meal instead of a meal of milk. The food introduced should not affect the total milk quantity; Food is light, salt-free, less sugar and less oil; Don't eat honey water or sugar water, and try not to drink juice.

5. Premature/low birth weight infants are fed after discharge.

Birth weight: Premature/low birth weight infants with 4 weeks or slow weight gain should be followed up regularly in medical and health institutions with diagnosis and treatment conditions after discharge, and fed with fortified breast milk, premature infant formula or premature infant formula under the guidance of specialists after discharge.

Premature/low-birth-weight infants with birth weight ≥ 2000 g and without the above-mentioned high-risk factors are still the first choice for exclusive breastfeeding after discharge, and infant formula is only considered when there is insufficient or no breast milk. A balanced diet and nutrition for lactating mothers is particularly important for premature/low birth weight infants.

There are individual differences in the age of premature/low birth weight infants introducing other foods, which is related to their maturity level. The introduction time of premature/low birth weight infants less than gestational age is relatively late, generally not earlier than 4 months and not later than 6 months.

(2) Dietary guidance for infants and preschool children

1. Food types and food intake

(1) Variety and quantity of milk consumed by children: 350 ~ 500ml of milk should be consumed every day. For children under 2 years old who cannot continue breastfeeding, it is recommended to use formula milk. Pay attention to the diversity of diet, advocate natural food and balanced diet, and take eggs 1, animal food 50g, grain 100 ~ 150g, vegetables 150 ~ 200g, fruits 150 ~ 200g and fruits 20 every day. Children should eat home-cooked dishes with appropriate size, slightly soft texture, less salt and easy digestion, avoid giving them fried food, eat less fast food and drink less sweet drinks, including lactic acid drinks.

(2) Variety and quantity of preschool children: 300-400 ml of milk and dairy products, 65,438+080-260 grams of cereals, 65,438+020-65,438+040 grams of meat and eggs, 25 grams of beans and bean products, 200-250 grams of vegetables and 65 foods should be ingested every day.

(3) Diet arrangement: 3 meals of staple food, 2 ~ 3 times of milk and nutritious snacks can be arranged every day, and snacks can be controlled between two meals. Parents have the responsibility to provide their children with safe, nutritious, digestible and delicious healthy food, so that children can decide how much food to eat and eat regularly, so that children can experience hunger and satiety.

2. Eating behavior

(1) Diet: 1.2-month-old children should start to practice eating with their own tableware, which can cultivate their independent ability and correct reaction ability. 1 ~ 2-year-old children should eat separately and encourage themselves to eat. Children after 2 years old should eat independently.

(2) Eating behavior: eat regularly, regularly and quantitatively, and each meal lasts for 20-30 minutes. During eating, you should avoid playing and watching TV while eating, don't chase after feeding, and don't drink milk with a bottle. Parents' eating behavior has a great influence on young children. Avoid forced feeding and overfeeding, and prevent children from refusing to eat, being partial to food and overeating. Parents should provide less high-fat and high-sugar foods, fast food, carbonated drinks and sugary drinks.

(3) Food cooking method: Food should be processed separately, mainly by steaming, boiling, stewing and frying. Pay attention to the color, smell and taste of food. Children can be involved in the food preparation process and their interest in food can be improved.

(4) Appropriate drinking water: The amount of drinking water depends on the season and children's activity, and boiled water is the best, so as not to affect children's milk intake and daily diet.

3. Eating environment

Sitting around with family is the best way for children to learn to eat independently. We should provide a relaxed and pleasant dining environment and atmosphere for children and avoid noisy dining environment. Avoid threatening, scolding and beating children while eating.

(3) Food safety

1. Food selection

Avoid providing children under 3 years old with foods that are easy to cause suffocation and injury, such as small round candy and fruits, nuts, jelly, popcorn, chewing gum, fish with bone spurs, etc.

2. Food hygiene

The preparation and preservation of infant food should ensure the cleanliness and hygiene of food, utensils and water. Children and caregivers should wash their hands before preparing food and feeding, and provide fresh food for children to avoid food pollution. Animal foods such as livestock meat and aquatic products should be cooked to kill harmful bacteria. Residual food should be heated to avoid pollution, solid food should be thoroughly heated, and liquid food should be boiled.

3. Food storage

Food should be eaten immediately after cooking, and should not be left for too long, especially at room temperature. The remaining food should be stored in the refrigerator and sealed to slow down the proliferation of bacteria. 1. In children's physical examination, according to children's age stage and physical assessment results, children's feeding and nutrition guidance are given.

2. Conscientiously do a good job in consulting and guiding breastfeeding, food conversion and children's reasonable nutrition, guide parents to adopt scientific feeding methods, cultivate children's healthy eating behavior as soon as possible, and promote children's growth and development.

3. Carry out various forms of feeding and nutrition health education activities to popularize children's nutrition knowledge. The exclusive breastfeeding rate within 1. 6 months = (number of infants exclusively breastfed within 24 hours before investigation/number of infants within 6 months after investigation) × 100%.

Breastfeeding rate within 2.6 months = (number of babies breastfed within 24 hours before investigation/number of babies within 6 months after investigation) × 100%.

3. Parents' awareness rate of scientific feeding knowledge = (number of parents of all children aged 0-6 in the survey area/number of parents of children aged 0-6 in the survey area) × 100%.