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Pitanja & odgovori
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Jedno dijete, bezbroj pitanja

Biti mama nije lako. Pogotovo kad ste početnik u tome. Diše li dijete noću? Jede li previše? Trebam li mu očistiti nosić, zagrijati hranu, oprati igračke?

Nemate razloga za brigu. Zamolili smo slovenskog pedijatra dr. Denisa Baša da nam odgovori na nekoliko najčešćih pitanja koja roditelji postavljaju o novorođenoj djeci i dojenčadi.

Doktor Denis Baš je specijalist pedijatar koji radi s djecom školske i predškolske dobi u dječjoj dnevnoj bolnici u kamničkome medicinskom centru. Obavlja ultrazvučne preglede kukova novorođenčadi, predaje budućim majkama i velik je pobornik racionalne uporabe antibiotika u djece.

Provedite manje vremena u istraživanju i više vremena uživajući u sretnim trenucima koje majčinstvo donosi.

IZDOJENO MLIJEKO

Kako pripremiti mlijeko za novorođenče koje zbog nekih okolnosti ne može biti dojeno?
Majčino je mlijeko najpoželjnija hrana za novorođenčad zbog više razloga, no unatoč velikim istraživačkim naporima njegov sastav još nije potpuno objašnjen. Mnogi se proizvođači trude proizvesti zamjensko mlijeko sa sastavom najbližim majčinu mlijeku, ali dojenje i majčino mlijeko ostaju zlatni standard za novorođenčad i dojenčad. Postoje razne okolnosti zbog kojih majke ne mogu dojiti (prerano rođena djeca, abnormalnosti dojki, povratak na posao itd). U tim slučajevima preporučujemo izdajanje majčina mlijeka rukom te ručnim ili električnim pumpicama. Izdojeno je mlijeko potrebno pravilno pohraniti.

Dijete je lako dojiti. Ali kad probam sama istisnuti mlijeko, izlazi samo mala količina. Što radim pogrešno?

Ako ste već probali izdojiti mlijeko, ali nije izašlo u većim količinama, to ne znači da nemate dovoljno mlijeka. Istiskivanje i ručno izdajanje potpuno je različito od osjećaja kada dijete sisa i za uspješno je izdajanje potrebna vježba. Isprobajte različite načine, primjerice izdajanje rukom te izdajanje ručnom ili električnom pumpicom. Kako biste potaknuli proizvodnju mlijeka prije izdajanja, možete staviti vruće obloge na prsa dok slušate opuštajuću glazbu i nježno masirate svoje dojke.

Kako ispravno pohraniti izdojeno majčino mlijeko?

Kako biste bili sigurni da je djetetova hrana sigurna, pohranite izdojeno mlijeko na pravilan način kako biste ga mogli iskoristiti u trenucima kad ne možete dojiti dijete. Prije izdajanja operite ruke i očistite svu opremu kojom se pri izdajanju služite kako biste izbjegli kontaminaciju bakterijama. Izdojeno mlijeko pohranite u manjim bočicama (60 ‒ 120 ml), dovoljnima za jedan obrok, a na bočici zapišite datum i vrijeme izdajanja. Izdojeno majčino mlijeko sigurno je za uporabu do šest sati nakon izdajanja ako je pohranjeno na sobnoj temperaturi, od tri do pet dana ako je pohranjeno u hladnjaku pri temperaturi od 4 °C i do tri mjeseca ako je pohranjeno u zamrzivaču na temperaturi od -18 °C. Jedanput odmrznuto majčino mlijeko možete staviti u hladnjak i iskoristiti unutar 24 sata, ali se ne smije ponovo zamrzavati.

Kako pripremiti izdojeno i pohranjeno majčino mlijeko?

Pohranjeno majčino mlijeko mora biti pravilno zagrijano prije nego što ga ponudite djetetu za obrok. Najbolja temperatura mlijeka za hranjenje djeteta je 37 °C. Provjerite toplinu tako da istisnete nekoliko kapi na podlakticu, na mjesto gdje se uobičajeno mjeri puls. Izdojeno mlijeko ne smijete zagrijavati na temperaturu iznad 40 °C jer se time uništavaju hranjive tvari.

Najbolji način zagrijavanja mlijeka je držati bočicu s mlijekom ispod mlaza vruće vode ili je staviti neko vrijeme u posudu s vrućom vodom. Možete upotrijebiti i posebne uređaje za zagrijavanje dječjih bočica i njihova sadržaja. Kad je bočica zagrijana, nježno je protresite. Na taj ćete način ujednačiti temperaturu sadržaja i istodobno izmiješati masnoće odvojene tekućine od preostale u pohranjenome mlijeku.

Može li se majčino mlijeko zagrijati u mikrovalnoj pećnici?

Podgrijavanje majčina mlijeka u mikrovalnoj pećnici nije preporučljivo jer mikrovalovi mogu uništiti njegova blagotvorna svojstva i hranjive tvari. Također se ne smije pregrijavati ili kuhati. Najjednostavniji način nadzora nad temperaturom mlijeka je zagrijavanje mlijeka parom ili uranjanje bočice s mlijekom u vruću vodu te stalno praćenje temperature na vašoj podlaktici.
Koliko dugo bočica s mlijekom mora biti uronjena u vruću vodu?
Bočicu s mlijekom potrebno je držati uronjenu u vruću vodu do 15 minuta kako bi se njezin sadržaj zagrijao na temperaturu prikladnu za hranjenje djeteta. Temperaturu mlijeka prije hranjenja provjerite na svojoj nadlaktici. Za vrijeme zagrijavanja povremeno protresite bočicu kako bi sadržaj bio ravnomjerno zagrijan, a masnoće izmiješane s preostalom tekućinom.

ZAŠTITA

Moje dijete stavlja u usta sve do čega može doći? Moram li ga spriječiti u tome?
Roditelji su često zabrinuti jer njihova mala djeca stavljaju u usta sve što prime u ruke. U razvoju djeteta korištenje usta je važan stadij u stjecanju iskustava i istraživanju okolnog svijeta. Dijete svojim ustima pronalazi nove poticaje te otkriva nove oblike, teksture i okuse. Nema ništa loše u tome. Naravno, morate biti sigurni da su predmeti veliki kako ih dijete ne bi moglo progutati, da nisu oštri i da su izrađeni od materijala koji nisu štetni. Roditelji se često brinu da će se njihovo dijete na taj način zaraziti. U svakom je slučaju preporučljivo sve predmete kojima se dijete svakodnevno koristi povremeno i temeljito očistiti i dezinficirati. Jedan od prirodnih načina dezinfekcije je zagrijavanjem. Posebno osmišljeni parni sterilizatori mogu se jednostavno koristiti za dezinfekciju.

Kako biste trebali očistiti dječje igračke?

Djeca su svakodnevno u dodiru s najdražim igračkama. Druga djeca se također igraju njima i nerijetko igračke završe na podu ili nečijim ustima. Igračke su uz djecu dok jedu i dok spavaju. Neprocjenjive su dok je dijete bolesno. Zato je važno da ih često čistite.

Gumene su igračke stalni pratitelji prvih koraka vašeg djeteta u istraživanju novog svijeta. Te su igračke također vrlo korisne jer pomažu pri ublažavanju boli tijekom nicanja prvih zubića. S obzirom na to da su često u djetetovim ustima, važno ih je redovito i temeljito čistiti. Operite ih pod mlazom vruće vode koristeći se i deterdžentom za pranje te povremeno dezinficirajte u parnom sterilizatoru.

Plišane igračke i one od tkanine operite u perilici rublja. Koristite se programom za ručno pranje i ne upotrebljavajte previše deterdženta. Upotrijebite sredstvo za dezinfekciju namijenjeno pranju dječje odjeće.

Ako igračke ne možete oprati vodom, očistite ih povremeno sprejem za dezinfekciju koji nije potrebno ispirati. Prije upotrebe pročitajte upozorenje smije li proizvod doći u dodir s malom djecom.

SOLID FOOD

When can I begin to introduce my child to solid food?
The best time to introduce complementary (mixed) food to a baby who is still being breastfed is when the child is older than 4 months. Before this age, the introduction of mixed food must be absolutely discouraged, because the baby's digestive organs have not yet developed sufficiently. Research hasshown that it does not make any sense to wait too long and that it is necessary to begin introducing solid food before the age of6 months. Breast milk does not provide any more optimal coverage of the baby's increased demand for macro and micro nutrients (iron, zinc).

How should I go about introducing children to solid food?

At the beginning, when introducing solid food, parents should be particularly patient and persistent. During this time, mixed solid food represents a new experience; exploring is not the main source of food. It is important that the child gets used to different tastes, densities and textures of food. Traditionally, in our environment, we begin to introduce vegetable-meat-potato porridge first. Fruit and cereal grains are introduced some time later, because children prefer sweet taste and might refuse vegetables. Food must be introduced at an interval of one week. Thisway, children usuallyget used to new flavours easily. At the same time it is possible to notice ifchildren have problems with specific foods.

At the beginning they will eat less than one teaspoon of food, some of them just two to three, while others will eat more. It is all right. Food should be at room temperature or a little warmer.

From 10 months of age upwards (if he already has teeth) a child can be offered solid foods in addition to liquid and pureed foods. Meat, fish, vegetables and fruit do not need to be mashed or pureed anymore but just cut into small pieces.

What kind of porridges or purees should be introduced as solid foods first?

At the beginning, low allergenic food should be introduced: vegetables (courgettes, carrots, potatoes, cauliflower, wild cabbage), rice, corn flakes, meat (poultry, veal, colt, rabbit meat). Then we can proceed with fruit (apple, banana, pear). For the first baby food we can prepare a rice porridge that, due to its mild neutral taste, can be mixed with breast milk. When children get used to the feeding spoon, after a week, it is possible to continue with a mashed carrots or courgetteporridge, prepared as a separate vegetable puree or added in to rice and breast milk. At weekly intervals, new foods can be gradually introduced. It is better to introduce cereals containing gluten (wheat, oats), when the child is predominantly breastfed or fed with extracted breast milk, therefore between 4 and 6 months. This way, the possibility ofthe child developing coeliac disease (intolerance to gluten) is reduced.

What if the child doesn't like vegetable-based purees?

Patience and perseverance must be our primary consideration in the implementation of nutrition. Studies say that we have to offer a child a new flavor 7 to 11 times and that we should not give up if the child sprinkles porridge on us and on himself. When you offer your child the first spoonful of food, yet you do not know exactly what he thinks about the new taste. During the first attempt, most children initially tighten their lips and do not care about the importance of that particular food taste. Therefore proceed only when the child opens his/her mouth again. Be aware that at the time of the introduction of food nutrients the child still receives the essential part of them from his/her mum's milk or formula milk. Many parents give up after three attempts of food refusal, but perseverance will pay off.

How do I prepare my baby's first solid food?

The best thing to do is to use fresh seasonal vegetables and fruits but frozen vegetables may be also used. Vegetables are usually cooked in water or steamed. When cooking, do not use salt or spices. When the food is cooked, mix it until is soft or mash it into a thick porridge. Child development and growth need high quality fats, therefore it is recommended to add vegetable oil (canola, olive, corn ) to vegetable- cereal- and meat-based foods. A teaspoon of oil must be added to the porridge prepared for one meal portion (150-200 ml).

How do I prepare foods that my baby will love to eat?

In introducing the baby to solid food, the first and mostimportant thing is to choose the ingredientswisely to start with. For the first meals, choose flavors that are not too strong or too unusual. For vegetables select, for example, carrots, potatoes or courgettes, and for fruit an apple or a banana. Citrus fruits are probably too sour to start with. Itis also not advisable to prepare food with cow's milk until the baby is at least six months old.

Food porridges can be prepared in a kitchen blender or with a fork. The consistency must be dense and compact, but not liquid. Harder fruits and vegetables must be steamed first. Avoid adding sugar or salt and stronger taste spices. If you want to sweeten the porridgeslightly, add a teaspoon of apple or pear pulp. Add vegetable oil to give flavor to vegetable dishes.

What is the best food for babies?

In addition to food taste, we must ensure that the baby's food contains all the necessary nutrients. Here are some general guidelines for introducing foods:

  • Bread: after 10 months old
  • Cow's milk: a standalone drink after 1 year old, small quantities even previously (preparation of cereal porridge, mashed potatoes)
  • Gluten (wheat, wheat meal, rye, barley, oats, oat flakes, spelt, pasta): after 4 months together with breastfeeding
  • Eggs (yolk and white): after 6 months old
  • Sugar, salt: after 1 year old
  • Honey: after 1 year old
  • Fish: possible after 6 months old, as fresh as possible, young fish (e.g. mackerel, herring, sardines, salmon)
  • Seafood: after 1 year old

A child’s nutrition must be balanced and must include a lot of vegetables, fruits and cereals. Red meat is the most important source of iron for our body. Here are some foods that contain a lot of certain vitamins or minerals:

  • Vitamin A: carrots, kale, spinach
  • Vitamin D: fish oil, oily sea fish, egg whites (we recommend replacing it with preparations of 400I vitamin D per day)
  • Vitamin E: rapeseed, sunflower and corn oil, wheat sprouts, hazelnuts
  • Vitamin K: green vegetables
  • Vitamin B1: legumes, some fish, potatoes, oat flakes
  • Vitamin B2: milk, milk products, eggs
  • Vitamin C: fresh fruit (citrus fruits, gooseberries, blackcurrants), vegetables (peppers, broccoli, fennel, cabbage, spinach, tomato)

RESPIRATORY SYSTEM

How can I check if my child is breathing during the night?

The child's body slows down its functions at night, therefore it is sometimes very difficult to see if the child is breathing. There is a trick you can use, to be  sure that everything is all right: dampen your index finger and place it just before the sleeping baby's nose. You will feel his/her breath like a slight breeze.
I have noticed that my child often coughs during the night. What can I do to make him/her sleep peacefully?
Coughing is a common companion of children. It is generally associated with respiratory viral infections, and, therefore, is very frequent in autumn and winter. First, we must ensure that the child can breathe through his/her nose and not through his/her mouth, because this will dry out the mucous membranes of the throat further, causing the cough to worsen. We must ensure that our child consumes enough fluids and that the placeswhere he/she sleeps are well ventilated. A relative humidity of between 40-60% is recommended in living spaces. Due to the heating, the air in our rooms is often too dry, causing the cough symptoms to get worse while skin and mucous membranes become drier. Therefore, it is advisable to maintain an adequate level of humidity. The trick that has been used since immemorial times, is to place wet towels or even containers with water on the radiator. Now, however, special devices are available - humidifiers - that promptly supply humidity and provide favorable conditions in the room.

How should I clean my baby's stuffy nose?

A frequent nuisance for small children is a stuffy and runny nose. The nose must be relieved from congestion to make the child happy, breathe better and eat. If the child has a stuffy nose or can't breathe through it properly, it is recommended to clean it with a saline solution or with a hypertonic saline solution. It is important that the solution is dripped or lightly sprayed into the nose and NOT injected with high pressure. If we inject the solution into the nose with heavy pressure, we'll push all the dirt into the tube that connects the ear to the nose area, which will increase the risk of ear infection. When a child does not know how to blow out the contents from his/her nose, these can be gently sucked out and the dried secretions, visible at the end of the nasal openings, can be removed by applying a gauze pad. To prevent a stuffy nose with dried nasal mucus, it is important to have the right degree of humidity in the room where the child is.

Winter is at the door. How can I keep my baby healthy?

In autumn and winter, we stay indoors longer. With favourable temperatures for viruses spreading, we are more under attack from pathogens of various infections. These viral infections can be especially hard for babies and young children who do not yet have a fortified immune system. In order to protect our little ones as much as possible against infections, we should keep in mind a few simple principles.

Anyway, it is wise to avoid areas with a large flow of people (shopping centres, playgrounds etc), especially in periods when there is a high probability that there are quite ill or contagious people in the crowd. Most viruses are transmitted through the air and many are spread by the touch of our hands. Therefore, it is important to wash hands, stay in the open air and avoid sick children. For newborns and babies, visits by children who are in collective institutes must be avoided.

Strengthen your immune system by eating a balanced diet, with plenty of fruits, vegetables and, if necessary, nutritional supplements (vitamin D). Physical activity as well as a sufficient amount of sleep strengthen our immune system cells.

Can a dummy harm my child?

Like every medal, using a dummy also has two sides. Above all, there is no evidence that children who suck dummies breastfeed for less time or less successfully. But it is known that children who used a dummy after 1 year old have more irregularities in forming their bite. However, the choice whether the child should have a dummy or not is up to the parents. If the child doesn't feel the need to have a dummy or doesn't want one, it should not be pushed into his/her mouth. The best thing to do is to not overdo it and offer the dummy to the child when he really needs it. After 1 year old, using a dummy is not recommended because of its impact on the development of the teeth. It is also important that the child takes the dummy out of his/her mouth when going to sleep. Dummies must be washed repeatedly and disinfected periodically, in order to remove all (in)visible impurities accumulated on them.