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Thank you for joining us this afternoon as we chat about diet and nutrition for your Preemie. We are lucky to be joined by not only one, but two Registered Dietitians, Kirsten and Karen, from Mount Sinai Hospital in Toronto. 

K&K:  I'm Kirsten and I have been a clinical dietitian in the NICU at Mount Sinai Hospital for 18 years and I am Karen, I have been a dietitian in the NICU at Mount Sinai for 2 years, previously in obstetrics for 8 years.

1.   My breastmilk was fortified with Formula in the NICU. Now that we're home, do I have to continue this? When will I know I can stop this? 

K&K: Often an infant will be discharged with formula in breastmilk or a higher strength formula to support optimal growth.  Reassessment of this plan will be an ongoing discussion with your physician post discharge. As infants get bigger, they get stronger and may feed more effectively so supplementation may be decreased either in number of bottles fortified and amount of formula added. The physician will look at the infant’s growth compared to target recommendations.  Recommendations for weight gain for the first 4 months post term is 20-30 grams/day.  Weight gain above or below this recommendation should prompt reevaluation of the feeding plan. 

2.   How long should I be giving my child Vitamin D? 

K&K: Your child should be given vitamin D until at least 1 year corrected age and consuming adequate cow’s milk.  Cow’s milk is fortified in Canada with vitamin D.  Other “milk” products are not recommended until 2 years of age.

3.   When do I know it's time to start the transition to solids? 

K&K: Health Canada and Dietitians of Canada recommend in the Healthy Term Nutrition Statement that solids should be started around 6 months of age.  For preterm infants, this would be six months corrected age.  Your child should be able to sit up in a chair and hold his/her head up on their own to be able to swallow safely.  Around 4 months corrected age, start having the discussion with your physician about what developmental milestones your child should be doing to show that they are ready for solid food.

4.   What is the best way to start the transition to solids? 

K&K: The first food to start with is a food with a high source of iron such as meat or iron fortified cereals.  There are no longer specific guidelines about which type of food to introduce in what order.  Introduce one new food every 3 days in order to watch for signs of allergic reaction. 

5.   How long is it ok to feed my child using a bottle vs. a cup?  

K&K: As fluids other than breastfeeding are introduced, they can be offered in an open cup. Older infants can be offered water from an open cup along with complementary feedings. At first, they will need help with the cup from the parent or caregiver. The older infant will develop a coordinated sucking action and will begin to hold the jaw in a stable open position as the cup approaches. Older infants can pace their own intake, which makes it easier for them to control their breathing and swallow when they are ready.

It is common for training cups such as 'sippy cups' to have no-spill valves. An infant gets liquids out of these training cups by sucking, these cups do not support the development of mature drinking skills. An open cup is the most appropriate choice to encourage skill development.

Encouraging use of an open cup for older infants can help avoid prolonged bottle-feeding. Use of bottles among young children has been associated with the consumption of excess calories and may contribute to the risk of obesity in childhood.

 

5.   How do I know my child is eating/drinking enough? 

K&K: If your child is growing and following their growth curve they are getting enough to eat and drink.  Ask your physician to show you at your child’s next appointment.  Offer foods from all the food groups throughout the day to ensure your child is receiving all the vitamins and minerals they require.

6.   What is important in regards to food groups when it comes to ensuring my child has proper nutrition at 6 months old? 

K&K: From six months of age, your child’s foods can be many of the same nutritious foods enjoyed by the family. Choose iron-rich meat and meat alternatives, and iron-fortified cereals first. Aside from iron-rich foods being the first foods introduced, there is no particular order for the introduction of other foods or food groups. Vegetables, fruit, and milk products such as cheese and yoghurt can be introduced, between 6 to 9 months, along with a variety of iron-rich foods.

Encourage the offering of new foods. This ensures a variety of flavours and foods from Canada's Food Guide are being consumed by 12 months. Encourage parents and caregivers to include infants and young children at the family meal table, even if their feeding times do not always align. Meal times provide exposure to tastes, colours, and textures. Family meals create an opportunity for modelling healthy eating habits.

6.   And 12 months? 

K&K: It is important to offer your child a regular schedule of meals and snacks, offering a variety of foods from the four food groups every day. Recommend foods prepared with little or no added salt or sugar.  Nutritious, higher-fat foods are an important source of energy for young children.  Infants should not be offered low fat foods.  Continue to breastfeed, or offer 2 cups per day of homogenized (3.25% M.F.) cow milk.  Limit fruit juice and sweetened beverages. Offer water to satisfy thirst.

7.   Hello, my name is Gabrielle, my son stayed in Mount Sinai NICU for almost 4& a half months than transferred to a level 2 hospital for a bit. My baby was born at 24 weeks 5 days. He is now almost 7months, however 3 months + 1 week corrected. My son is in his early signs of teething(drooling, putting fist in mouth, etc) What are some signs that he would be ready for eating(puree, etc)? I would still be looking towards his corrected 6 months but confident signs are.

K&K: Some of the key signs that a baby is ready for solids include: ability to sit up (supported) in a high chair), able to hold food in mouth, reaching/showing interest during family meal times.  You are correct to plan to introduce solids around the 6 month corrected age, when your son will likely be showing these signs.  Review with your physician to come up with a plan.

8.   My 19 month old corrected baby has a g-tube. We would like to wean her off of it. She refuses to take regular homogenized milk or any milk orally. It might be a food aversion. Although she used to be continuous feeding through her g-tube, she no longer requires to be hooked up to her feeding pump during the day. She eats what we eat albeit in smaller pieces and drinks water but for some reason won't take enough milk to help her gain weight or grow orally. As per her dietitian at Sick Kids, she is currently on 300-400mL at night through her feeding pump/g-tube each day. We noticed she's eating more but we are afraid to completely wean her off of milk via her g-tube. However, she's getting more active and would like to remove the g-tube soon. Due to her Pierre Robin Sequence, she is overall small in stature otherwise proportional. She's 19 months corrected but only weighs 17 lbs at most. If we were to wean her off her g-tube, what can we give her to make sure she doesn't lose weight.

K&K:  As you are already connected with a dietitian and program at Sick Kids, I would contact him/her with this question.  The dietitian would be more familiar with your daughter and her needs.

9.   What is the formula in relation to body weight to calculate the amount of ml of formula we should feed?

K&K: This is a difficult question that would be different for every baby’s unique situation.  In the unit we estimate fluid and feed requirements based on body weight and a pre-calculated volume that will meet their needs.  A healthy baby discharged home is typically encouraged to be fed on an on demand schedule, allowing baby to determine his or her own needs.  In some situations a baby may be on a prescribed volume when they go home in order to support growth.  If this is your situation your doctor/NP and dietitian should work with you and provide you with specific guidelines.

Thank you so much to Kirsten and Karen, for taking the time to join us and for your expertise. It has certainly been an informative session! 

Thank you to all the parents who participated live and via email/private message. We hope you all learned a lot and look forward to seeing you in July for our next #PreTermChats!

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