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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
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.
How long should I be giving my child
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
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.
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
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
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.
How do I know my child is
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.
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
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.
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
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.
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.
What is the
formula in relation to body weight to calculate the amount of ml of formula we
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
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!
#PreTermChats #Preemies #PreemiesAreAmazing #PreemiePower #PreemiePowerCanada #PrematureBabies #Diet #BabyNutrition #NICU #InfantNutrition #PreemieNutrition #PrematureNutrition #WhatDoIFeedMyPreemie