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WEANING PRETERM BABIES Around 10% of babies are born prematurely; this means that they have missed some or all of the third trimester of pregnancy when nutritional stores are laid down. This article provides advice on weaning a preterm infant, including ready-for-weaning cues and steps for ensuring that it is a positive experience for all involved. Nutritional care on the special care baby unit has improved over the last decade and many baby’s will have achieved catch-up nutritional status. Some, however, may still be at risk of malnutrition and poor growth and will require individualised weaning guidance. There is a lack of government guidance on how and when parents should wean their preterm baby, which means that personalised weaning advice is often needed due to parental anxiety and uncertainty about whether their baby has adequate motor skills.
Sarah Almond Bushell MPhil, BSc, RD, MBDA
Preterm babies who have other medical needs, or who have had a complex neonatal period, may be at higher risk of nutrition and feeding problems linked to the developmental delay of eating and drinking skills. CORRECTED AGE AND ACTUAL AGE
WHAT IS CONSIDERED PRETERM?
A preterm baby is one who is born before 37 weeks gestation. However, if they were born after 34 weeks, are growing well and are otherwise healthy, they may be able to follow general weaning guidance rather than the specialist information given here.1
Actual age is the baby’s age from the date they were born, whilst corrected age takes into account how preterm they were and is counted from their due date. For example, a baby born at 32 weeks who is 14 weeks old, would be six weeks corrected. The corrected age allows healthcare professionals to assess the baby’s development appropriately. In this example, the expectation would be for the baby to be reaching the usual milestones of a six-week old rather than a 14-week old baby. Both actual and corrected are used by healthcare professionals.
WHY ARE PRETERM BABIES MORE COMPLEX?
WHAT AGE SHOULD YOU START WEANING A PRETERM BABY?
Some babies may be smaller than expected, weighing less than 2.5kg at birth, referred to as low birth weight (LBW). Other babies may have Inter uterine growth retardation (IUGR) which can occur at any gestation. These babies will need their weaning diet carefully planned to achieve catch-up growth without altering body composition.
Sarah is a children’s nutritionist and baby weaning expert with 20 years’ experience in nutrition and dietetics. She is a trained SOS feeding therapist and is passionate about helping families improve their nutrition to optimise health. www.childrensnutrition.co.uk
@thechildrensnutritionist @feedingbabies
REFERENCES Please visit: https://www. nhdmag.com/ references.html
NHS guidelines advising that weaning should start at around six months of age don’t apply to most preterm babies. There is very little research specifically for preterm babies and a recommended age is not suggested.2 The key is to understand the baby’s developmental milestones and to look out for their readiness cues. Consider the following www.NHDmag.com December 2019 / January 2020 - Issue 150
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