The document provides methodological recommendations for students on the topic of feeding techniques for children in their first year of life. It discusses feeding with a spoon, bottle, and feeding tube. The key learning objectives are for students to understand the anatomical features of the digestive system in young children, learn various feeding techniques, and be able to properly evaluate and advise on feeding methods. The document also outlines the structural organization and content of the educational materials on this topic.

1. THE MINISTRY OF HEALTH OF UKRAINE
NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY
VINNYTSYA
«Approved»
at the methodological meeting
of Department of Propadeutics
of Pediatric Diseases with
Patient Care
Head of the department
_____________Prof. Bulat L.M.
«27»__August__ 2021y.
METHODOLOGICAL RECOMMENDATIONS
for student’s independent work in course of preparation
Scientific discipline Patient care
Topic 8 Technique of feeding a child in the first year of life with
a spoon, bottle and using a tube (zond).
Year of study II
Faculty Medical faculty
Vinnytsya

2. Methodological recommendations for student’s independent work in course of
preparation Topic № 8 «Technique of feeding a child in the first year of life
with a spoon, bottle and using a tube (zond)». Methodical recommendations are
developed by redactor: associate, PhD. in medical science Medrazhevska Ya. A.
27.08.2021 y. Protocol №1.
Department of Propedeutics
of Pediatric Diseases with Patient Care Prof. L.M. Bulat
Head of the department

3. 1. Relevance of the topic of the lesson
Breastfeeding of children of all ages is an extremely important problem of modern
pediatrics and nutrition. The influence of children's nutrition on growth, physical and
psychomotor development is proved. The nature of breastfeeding is an important
factor in the formation and implementation of the immune response, the genetic
potential of morphological and functional development of the child. Malnutrition can
be an important cause of protein-energy deficiency, immune disorders, various
allergic reactions. One of the scientific assumptions is that not only the development
and health of a person depends on his nutrition in the first years, but also the life
expectancy itself depends on the duration of breastfeeding and the adequacy of the
child's nutrition in general.
2. Learning objectives of the lesson
I. Introductory level of theoretical knowledge
- to get acquainted with the anatomical and physiological features of the
gastrointestinal tract in young children;
- have an idea of the traditions of breastfeeding children under 1 year in Ukraine.
ІІ. Level of reproductive theoretical knowledge
The student must know: anatomical and physiological features of the gastrointestinal
tract in young children; the technique of breastfeeding a child in the first year of life;
the technique of feeding a child in the first year of life with a spoon; the technique of
feeding a child of the first year of life from a bottle; the technique of feeding a child
in the first year of life with a probe; features of the organization of nutrition of young
children
III. Level of practical skills (professional)
The student must master:
• Technique of feeding children of the first year;
• The technique of feeding children spoons;
• The technique of feeding the first year of children from a bottle;
• Technique of feeding children with a nasogastric tube;
• Methods of organizing nutrition for young children
The student must be able to:
• Evaluate breastfeeding techniques and, if deficiencies are identified, adjust the
mother's breastfeeding technique;
• be able to feed children in alternative ways;
• be able to organize meals for young children.
3. Objectives of personal development of the specialist (educational)
Based on the materials of the topic, the student must develop a sense of responsibility
for the timeliness and correctness of professional actions on the recommendation of
the organization of nutrition of young children

4. 4. Interdisciplinary integration.
Disciplines Know Be able
Previous (providing)
1.histology
2. anatomy
3.physiology
Next (provided)
1. pediatrics
Intra-subject integration
(between topics of this
discipline)
1. sanitary and hygienic
regime
2. the structure of the
pediatric hospital
Anatomical and
physiological features of
the gastrointestinal tract
in young children
Methods of breastfeeding
young children
Rules of preparation of
mix, rules of use of dairy
kitchen
To determine the age features
of the organization of
nutrition of young children
Evaluate breastfeeding
techniques, feed children in
alternative ways;
Bottle feeding technique,
disinfection of nipples,
bottles after use
5. Selection of the content of the educational material of the topic and its
structuring
Structural and logical scheme № 1.
For young children is characterized by relative immaturity of the digestive system. In
the process of growth there is a gradual improvement of the structure and function of
the digestive glands, increasing the ability to adapt to qualitatively new food. In the
child's body, food undergoes a series of successive transformations, as a result of
which it becomes a source of energy and plastic material for the construction of
structural elements of tissues. To ensure optimal digestion, it is necessary that food
be adequate to the level of development and functional maturity of the digestive
organs, as well as the enzyme systems of the child's body.
A healthy newborn baby sucks well, effectively coordinating this act with breathing
and swallowing. With the appearance of teeth in a child, attempts to chew begin,
although this process becomes effective only at the age of 18-24 months.
In young children, a sensitive indicator of sufficient calorie intake is a steady increase
in body weight. Energy expenditure is related to basal metabolism (50-60% of total
energy expenditure), physical activity (30-40% of total energy expenditure) and
thermogenesis (approximately 5-8%). The share of energy spent on growth needs
decreases rapidly from 35% of all birth costs to 5% at 1 year of age. Fats determine
more than 50% of the energy value of breast milk and are the main source of energy
for children in the first 6 months of life. With the introduction of supplementary fat,
fat, as the main source of energy, is gradually replaced by carbohydrates. Dietary
proteins can also be oxidized to form energy, but their main role is to meet the needs

5. of growth and the formation of new tissues. Compared to an adult, a breastfed baby
consumes 2.3 times more calories per kilogram of weight, almost the same amount of
protein, four times more fat and twice as many carbohydrates.
Feeding regime of children: up to 2 weeks of life - 6-7 feedings in 3-3.5 hours. from
5-6 hours night break; from 2 weeks of life to 4.5 months - 6 feedings in 3.5 hours.
with a night break of 6 hours; from 4.5 months up to 12 months - 5 feedings in 4
hours. with a night break of 8 hours. Keep in mind that a child in the first year of life
should receive no more than 1 liter of food per day, and the volume of one feeding
should not exceed 200 ml. Signs of proper attachment of the baby to the breast,
regardless of the method of application: the chin touches the mother's breast, the
baby's mouth is wide open, the lower lip is turned, the cheeks are rounded or spread
over the mother's breast, most of the areola (lower part) is captured by the baby's
mouth. pain even with prolonged sucking, hear the baby swallowing milk.
Structural and logical scheme № 2.
Bottle feeding
If the baby has sucked less milk than necessary, the doctor decides to feed the baby
expressed breast milk or formula. Feeding is made from a graduated bottle. If a child
who is in hospital is transferred to artificial feeding (or received it before
hospitalization), feeding it is carried out from a special baby graduated bottle with a
capacity of 200-250 ml with a division price of 10 ml.
Care should be taken to ensure that it fits the size of the child's mouth and is elastic
enough, with 4-5 small holes at the end. To check the correct size of the holes, you
need to turn the bottle with the milk mixture nipple down: if the milk first flows in a
thin stream, and then drops - then everything is fine, when the frequency of drops is
low or no, then the holes are too small, the child will be dissatisfied, quickly get
tired; if the milk flows in a continuous stream, the holes are too large, feeding
through the pacifier is dangerous, the baby may choke or even choke. After feeding
the baby empty bottles soaked in 2% baking soda solution, then washed inside with a
special brush, rinsed twice with water and boiled for 20-25 minutes, or placed in a
special sterilizer. This is especially important for utensils used in the diet of children
in the first 3 months of life. In the hospital, sterilization of bottles is performed in an
oven for 45 minutes. Nipples for feeding after each feeding should be washed and
digested for 10-15 minutes. Reusable nipples, after feeding, are first cleaned of
mixture or milk residues, then degreased by soaking in 2% baking soda solution, or
one of the specially designed products, rinsed well and disinfected by boiling for 30
minutes.
Structural and logical scheme № 3.
Feeding with a spoon
You need to use a teaspoon, give food in small portions (on the tip of a spoon) and
carefully put the child in the middle of the tongue, then it will easily swallow it.
Never feed a baby while lying down, she may choke or choke on a lump of food.
During feeding, the baby should be in an upright position, in a comfortable position
on your arms, knees or sitting in a special high chair. Food for feeding should always

6. be freshly prepared, have a tender, soaked (no lumps) consistency. Before feeding,
cool the baby to body temperature (36-37 degrees Celsius), mix well and double
check that it has cooled evenly. You can not force feed a child. Her behavior during
feeding should be closely monitored. If the baby pushes food out of the mouth,
"spits" it, turns his face away from the spoon with food, feeding in vain to continue.
The reasons for this behavior can be different: the child is not hungry, the food is
unfamiliar to him to taste or very warm, you hurt your baby and many other reasons.
Next time, she will be more willing to eat the food offered.
Feeding a newborn baby from a cup:
• Use a small cup containing 10-20 ml of breast milk. It can be glass or plastic
• The cup is filled so that it is enough for feeding,
• It is advisable to prepare several cups, because the rhythm of feeding should not
be interrupted
• A napkin should be placed under the baby's chin to prevent milk from spilling
during feeding
• Put the child on his knees in a vertical or semi-recumbent position
• The cup should rest on the baby's lower lip
• Milk in the baby's mouth should be kept in a "calm lake", avoiding tides and
even minor waves.
Spoon and cup feeding:
• Put the child on his knees in a vertical or semi-recumbent position
• Fill a spoon with milk, bring it to the baby's lips, put it on the baby's lower lip
• When the newborn opens his mouth, tilt the spoon slightly, allowing him to take
milk and take sips at his own pace.
Structural and logical scheme № 4.
Probe feeding
Indications for use of a nasogastric tube: impossibility of breastfeeding or cup
feeding. Stasis of gastric contents, intestinal obstruction, suspected bleeding from the
upper parts of the gastrointestinal tract, enteral nutrition through a gastric tube,
enlargement and bloating (eg, after ventilation with an Ambu bag with a face mask).
Contraindications: stenosis or rupture of the esophagus; lack of pharyngeal reflex (in
an unintubated patient). Be careful and consult a surgeon if you have recently had
surgery on your stomach or esophagus. Do not insert the probe through the nose if
the nasal passages have limited patency (usually due to curvature of the nasal
septum). Methods of probe insertion: orogastric, nasogastric (if the child has no
respiratory disorders). Measure the distance from the nose or mouth to the earlobe on
the probe, then from the ear to the stomach so that the last hole is at the level of the
xiphoid process (in an adult patient gastric cardia is usually ~ 40 cm from the tooth
line). Moisten the tip of the probe with sterile water or saline. Apply lidocaine gel to
the end of the probe. Insert the probe carefully through the lower nasal passage
perpendicular to the front plane; in case of failure, try through the second nostril.
Insert the probe to the specified depth. Then enter through a probe - 1-2 ml of air
from a syringe with a stethoscope at the same time to listen to the movement of air
over the stomach. Gurgling in the epigastric region indicates the correct placement of

7. the probe (the appearance of cough, respiratory disorders, hypoxia and air flow
through the probe may indicate the presence of the probe in the trachea or bronchi).
Secure the probe with adhesive tape to the nose (nasogastric) or to the corner of the
mouth (orogastric), respectively. Then attach a sterile syringe without a plunger to the
probe and pour the calculated amount of expressed breast milk into it. Keep the
syringe with milk at a distance of 5-10 cm above the child, continue feeding for at
least 10-15 minutes. During feeding, the milk should flow slowly from the syringe. It
is necessary to observe and, if necessary, adjust the flow rate of milk during feeding,
gradually changing the distance between the syringe and the child (raising and
lowering it). Do not use the injection of milk under pressure! When feeding through
a tube is important: carefully monitor the condition of the child and its color of skin
and mucous membranes, frequency and nature of respiration. It is not advisable to
install a new probe for each feeding, because it increases the risk of injury, apnea,
infection: if all the provisions of the probe can operate for up to 3 days. As the child's
condition improves during the first 2-3 weeks of life, as well as the revival of the
sucking and swallowing reflex, it is advisable to switch to breastfeeding or bottle
feeding. Probe care: If the probe is used to feed the patient, the stomach should be
monitored regularly. The unused probe should be rinsed regularly and filled with
clean water.
6. Plan and organizational structure of the lesson.
№
п/
п
The main stages of the lesson,
their functions and content
Obj
ectiv
es
Methods of control
and training
Materials of methodical
maintenance: (control,
clarity, instructional)
Time
1 2 3 4 5 6
Preparatory stage 10%
-
25%
І Organizational arrangements
ІІ Setting learning goals and
motivation
see item 2 "Learning
objectives"
see item 1 "Relevance of the
topic"
ІІІ Control of the initial level of
knowledge, skills, abilities:
- anatomical and physiological
features of the gastrointestinal
tract in young children;
• technique of breastfeeding a
child in the first year of life;
• the technique of feeding a
child in the first year of life with a
spoon;
• bottle feeding technique of the
first year of life;
ІІ
Methods of control of
theoretical
knowledge:
-Individual.
theoretical survey,
discussion, textbook.
conference;
-Solution of typical
problems;
-Test control;
-Written theoretical
Question
Problems
Tasks.
Tests
Written
theoretical tasks
Pictures
Structur
al and
logical
schemes
Models
Video
material
s

8. • technique of feeding the child
of the first year of life by means of
a probe;
-features of the organization of
nutrition of young children
control.
The main stage
60%
-
90%
Formation of professional skills
and abilities:
- evaluate the technique of
breastfeeding and, in case of
defects, adjust the technique of
application to the mother's breast;
- be able to feed children in
alternative ways;
- be able to organize meals for
young children.
Master: - the technique of feeding
children of the first year;
-methods of organizing nutrition
of young children
ІУ
ІІІ
Method of
professional skills
formation: training in
solving typical and
atypical situational
problems (real
clinical, simulated,
textual)
in interactive forms.
Method of forming
practical skills:
practical training
Professional algorithms for
the formation of
professional skills and
practical skills;
Simulation, role-playing
games;
Video materials;
Equipment (sterile gloves,
bottles of different volumes,
nipples with different holes
and sizes, spoons of different
materials, nasogastric tube)
The final stage 10 %
-
20 %
V Control and correction of the level
of professional skills
and practical skills (see 7.1,7.3.).
ІV-
ІІІ
Methods of control of
professional skills:
Analysis and
evaluation of
students' clinical
work results
Solution of atypical
situational problems,
tasks
Methods of control of
practical skills:
individual control of
practical skills and
their results
The results of clinical work
Atypical situational tasks,
tasks, etc.
Equipment (sterile gloves,
bottles of different volumes,
nipples with different holes
and sizes, spoons of different

9. VІ
VІ
І
Summarizing the lesson:
theoretical, practical,
organizational
Домашнє завдання
1. Катілов О.В., Дмитрієв Д.В.,
Дмитрієва К.Ю., Макаров С.Ю.
Клінічне обстеження дитини,
2017. – 520 стор.
2. Pediatric physical examination:
textbook for students of higer
educational
institutions/O.V.Katilov, D.V.
Dmytriiev, K.Yu. Dmytriieva,
S.Yu. Makarov – Vinnitsia Nova
Knyha, 2018.-504 p.
3. Капітан Т.В. Пропедевтика
дитячих хвороб з доглядом за
дітьми. Вінниця: Винницька
газета, 2012. – 868 с.
4. Пропедевтична педіатрія.
Підручник для студентів вищих
нав. закл. / Під редакцією акад..
НАМН України, проф. В.Г.
Майданника.- Вінниця: Нова
книга, 2012.- 880 с.
Final assessment of
students according to
the criteria of
knowledge, skills,
abilities
materials, nasogastric tube)
Література:
1) основна
1.О. Беденко-Зваридчук
Культура поведінки та етика
взаємовідносин у роботі
медичної сестри / Новости
медицины и фармации в
Украине // №9(460), -2013
2. Лікує слово. Проблеми
медичної деонтології в
художній літературі: Навч.
посібник /Укладачі:
Золотухін Г. О., Литвиненко
Н. П., Жебка І. І. та ін. — К.:
Нац. мед. ун-т ім. О. О.
Богомольця, 1999. — 264 с.
3. Громов А. П.
Деонтология в медицине. —
В 2 т. — М.: Медицина,
1988. — Т. 1. — 348 с.; Т. 2.
— 324 с.
2) допоміжна: 1. сайт
кафедри
http://www.vnmu.edu.ua
2. сайт бібліотеки
http://library.vsmu.edu
7. Materials of methodical providing of employment.
7.1 Control materials for the preparatory stage of the lesson:
Questions for self-control:
- AFO of the gastrointestinal tract of young children
- The concept of the gastrointestinal immune system
- Recommended methods of breastfeeding in accordance with the gestational age
- Breastfeeding techniques for children
- The concept of alternative methods of feeding
- Methods of alternative feeding of newborns.
7.2. Materials of methodical maintenance of the main stage of employment:
• professional algorithms for the formation of practical skills and professional
skills;
Master: -The technique of feeding children of the first year;
-The technique of feeding children spoons;
-The technique of feeding children in the first year from a bottle;

10. -The technique of feeding children with a nasogastric tube;
-Methods of organizing nutrition of young children
• equipment (sterile gloves, bottles of different volumes, nipples with different
holes and sizes, spoons of different materials, nasogastric tube).
7.3. Control materials for the final stage:
1) For the antenatal period is characterized by the type of nutrition:
a) amniotrophic,
b) lactotrophic,
2. At the age of 1 year the child has a predominant type of digestion:
a) cavity;
b) wall;
c) intracellular;
d) autolytic digestion.
3. Approximate volume of the stomach in newborns:
a) 20 ml / kg;
b) 30 ml / kg,
c) 20 ml;
d) 10ml;
4. The duration of the passage of food in the gastrointestinal tract, on average is:
a) about 15 hours,
b) 7-8 years,
c) 4-12 years,
5. In the absence of opportunities to establish breastfeeding, alternative methods of
breastfeeding are allowed:
a) TG up to 30-31 weeks, body weight 1300g and less - tube feeding using breast
milk,
b) TG31-34 week - feeding from a cup of breast milk,
c) TG 34-36 weeks - application to the mother's breast, breastfeeding
6. Newborns with TG 37-42 weeks are characterized by:
a) tube feeding using breast milk,
b) feeding from a cup of breast milk
c) application to the mother's breast, breastfeeding
7. Probe feeding is used:
a) in sick newborns who are in serious condition
b) in the absence of reflexes
c) in newborns with MMT and NMMT,
d) with congenital malformations
7.4. Materials of methodical maintenance of independent work of students with
the literature on a subject of employment:
1) Katilov OV, Dmitriev DV, Dmitrieva K.Yu., Makarov S.Yu. Clinical
examination of the child, 2017. - 520 pages.
2) Pediatric physical examination: textbook for students of higer educational
institutions / О.В.Катилов, Д.В. Dmytriiev, K.Yu. Dmytriieva, S.Yu. Makarov -
Vinnitsia Nova Knyha, 2018. - 504 p.

11. 3) Captain TV Propaedeutics of children's diseases with child care. Vinnytsia:
Vinnytsia newspaper, 2012. - 868 p.
4) Propaedeutic pediatrics. Textbook for students of higher nav. lock / Edited by
Acad. NAMS of Ukraine, prof. V.G. Майданника.- Вінниця: Нова книга, 2012. -
880 с.
5) Order of the Ministry of Health of Ukraine dated 20.03.2008 №149 "On approval
of the Clinical Protocol of medical care for a healthy child under 3 years of age". - К
.: 2008. - 82 с.
Auxiliary:
5) 1. site of the department http://www.vnmu.edu.ua
6) 2. library site http://library.vsmu.edu