Implementation of natural feeding of a newborn baby. Natural feeding. Hypogalactia. Methods for Determining the Amount of Milk Needed for a Breast Child

19.05.2020

An important role in the development of lactation in a woman who has given birth is played by the time of the first attachment of the baby to the breast, which is currently recommended to be carried out immediately after birth, directly in the delivery room in the first 30-60 minutes after childbirth, taking into account the condition of the newborn and the woman in labor. Early attachment to the breast has a positive effect on the condition of both the mother and the baby, accelerates the onset of milk production, and increases its production. It is important to emphasize that the first portions of breast milk (colostrum) contain significant amounts of immunoglobulins and other protective factors, and therefore their intake into the child's body increases the infant's resistance to infections and other unfavorable external factors that he encounters immediately after birth.

Another key factor in ensuring full lactation is the free-feeding regime of the newborn, in which the children themselves set the intervals between feedings, which can be achieved when the mother and child are together in the same room.

At present, it should be recognized that "free" feeding, or, in other words, feeding on the "baby's demand," is significantly more effective, which means latching on the baby to the breast as many times and at such times as the baby requires, including at night. Feeding frequency depends on the newborn's reflex activity and birth weight. A newborn baby may "require" from 8-10 to 12 or more breastfeeding per day. Feeding time can be 20 minutes or more. By the end of the first month of life, the frequency of feeding usually decreases (up to 7-8 times), and the duration of feeding decreases. Night feedings with free feeding of newborns are not excluded: the child must refuse night feedings himself. Free breastfeeding contributes to the formation of optimal lactation and the establishment of close psycho-emotional contact between the mother and the child, which is very important for the correct emotional and neuropsychic development of the infant.

Correct breastfeeding technique is essential. In the first days after birth, you can feed the babies in one feeding with one breast. After the milk "arrives", the baby can be fed each feed from both breasts, so that the feed ends from the breast from which the feed began.

Feed should be done in a comfortable position for the mother, in a relaxed environment. The most comfortable sitting position is so that the child is in an upright position (preventing air from entering the baby's stomach). At night and if it is impossible to feed the baby while sitting, you can feed it lying on your side. It is desirable that during feeding the child has the opportunity to contact the mother as closely as possible (skin-to-skin contact, eye-to-eye contact). With such close contact, not only the formation of the child's attachment to the mother occurs, but also additional hormonal stimulation of lactation, which is especially important both during its formation in the first days and weeks after childbirth, and with a temporary decrease in lactation in connection with the so-called lactation crises.

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Health to you and your children !!!

Everything that is written in this article applies only to a baby who is breastfed in a natural way!

When to start complementary feeding for a breastfed baby? Now there are many opinions on this issue. From some doctors you can still hear the recommendation to start injecting apple juice, starting at three weeks. Many still continue to insist on the introduction of mashed vegetables, fruit and cereals from 3-4 months of age. There is also an opinion that the child should be fed after the first teeth appear.

Consultants for breastfeeding it is recommended to begin acquaintance of the baby with new food only after the baby has an interest in it. Such complementary foods are called pedagogical, because the main purpose of complementary foods is not to feed the child, but to acquaint him with new food, teach him how to chew, teach him how to get food not only from the mother's breast.

At about six months of age, babies begin to show interest in the contents of their mother's plate, and try to taste it, it is this behavior that is called active food interest and indicates the baby's readiness to get acquainted with new food. The baby's nutritional interest is not associated with the feeling of hunger that arises in him, but with the desire to imitate his mother. He wants to do what she does, take some pieces from the plate and put them in his mouth.

What are the principles of introducing complementary foods with natural feeding, if the mother wants to follow the biological line of behavior of the child? Here they are:

An acquaintance of the baby begins with the introduction of microdoses (microprobes) of products, namely, acquaintance, without the goal of feeding the child with some kind of portion. A microdose for soft food is about as much as the mother fits between the pads of a large and forefinger if she squeezes them, or on the tip of a teaspoon. For liquid products - one sip, poured into a small cup on the bottom.

1 ... The child can "in one sitting" taste what the mother eats and what he is interested in in the amount of up to three micro doses.

2 ... Only hard pieces are given to the baby's hand, from which he himself will not eat much (hard apples, carrots, stump, drying, etc.)

3 ... Microsamples are given within 3-4 weeks. During this time, the baby can already get acquainted with many products used in his family, and learn to drink from a cup.

4 ... Complementary feeding never replaces latching on to the breast! The child may be introduced to new foods before, after, and during breastfeeding... Children often wash down microsamples with their mother's milk.

5 ... Gradually, the amount of food is increased, allowing the child to eat more.

6 ... Mom needs to keep the child's interest in food, keep the desire to try. From six months to one and a half years, the child should get acquainted with all the products that are eaten in his family. To keep the desire to try, the mother must limit the child's food interest until 8-11 months: if the child has eaten 3-4 teaspoons of one product and asks for more, he needs to be given something else.

7 ... From the side, the introduction of complementary foods should look something like this: the baby begs for pieces, and the mother dresses him, sometimes. In such a situation, the child is always happy to get acquainted with new food and does not overeat.

8 ... The child must learn to work with cutlery. Up to 8-11 months, these are spoons (there should be a lot of them, because they fall all the time), the child's plate appears when he begins to eat separately, usually after 8-11 months. Until this age, the baby can eat while sitting in the mother's arms and from her plate.

9 ... If the child is tired of eating, has lost interest, it is necessary to take him away from the table.

The introduction of complementary foods to a child requires certain knowledge and experience. There will be no problems if the baby is healthy, breastfeeding is properly organized, and his mother was shown how to introduce such complementary foods. This really needs to be shown, as with anything about the practice, such as breastfeeding and caring for a toddler. If another experienced mother did not show her mother how to start feeding the baby correctly, she may make some mistakes, not even suspecting that she is making them. Some mums succeed. These are the lucky moms. How lucky, for example, mothers who have never seen how to breastfeed a baby correctly, but who managed to arrange feeding. You can make mistakes related not to feeding itself, but to the behavior of the baby at the table. For example, a baby eats for some time, to put it mildly, not very carefully, prefers to take food with his hand, put it in a spoon, and then carry it into his mouth. Many mothers consider this behavior unacceptable, take away the spoon from the child and begin to feed him. The baby loses the desire to eat on his own. The child may really like some product and he may demand more and more for himself and the mother concedes to him, getting the baby's digestive upset the next day. With the correct introduction of complementary foods, the baby's well-being does not deteriorate, the tummy is not “upset”, it continues to develop normally. If the mother knows the options for the normal behavior of the baby and adequately assesses them and corrects them in time if necessary, the baby never grows out of the baby who does not know how to behave correctly at the table, is sloppy or with poor appetite... Unfortunately, what all women knew how to do 150 years ago, now almost no one remembers ...

Signs of incorrectly introduced complementary foods: the child eats very well for a while and then refuses to try or eat anything. So, the child was overfed, he overeat. A way out of the situation: take the child with you to the table for 5 days, do not offer him anything, do not give him and eat with appetite in his presence.

Very often, mothers do not cope with the introduction of complementary foods just because they really want to feed the baby with other food. In the minds of modern mothers, there is a firm conviction that breast milk, in terms of its qualitative composition, is not a very reliable liquid and it must be supplemented with other food. The fact that milk is a perfect product created by evolution specifically for feeding human babies is completely ignored, absolutely complete in its digestibility and nutritional value. Studies have shown that the early introduction of other food impairs the absorption of nutrients from milk, and the child begins to fully absorb these substances from other food only after a year. The feeding behavior of the baby is not artificially invented, but is due to the peculiarities of the development of his body, primarily the gastrointestinal tract... Mothers should remember that their task is not to feed the child with food, but to introduce him to it and keep the child interested in food. If you want your baby to have a good appetite in the future, never try to feed a baby after he has lost interest in the process of eating. For a mother who has spent half a day making mashed potatoes or opening a ready-made jar, it is difficult to watch the child run away after eating two spoons. I just want to catch him, distract him with a book, toy or TV, just to open his mouth. Do not do this! A baby who has the opportunity to kiss his mother's breast will never suffer from hunger and thirst! If breastfeeding is organized correctly, then everything that the child needs will be taken from the mother's breast.

What about the pieces of food, if the baby's food is not mashed, he can choke?

Food for the baby does not need to be chopped, but you need to start with small pieces, micro doses. If the child is given something from which he can potentially bite off a large piece, the child sits on his mother's lap and the mother watches him and as soon as the large piece bites off, the mother makes a crochet finger and takes it out of her mouth. The child is actively learning and gradually learns to chew with his still toothless jaws, and then toothy ones.

What if the baby spits out even very small pieces, or tries to regurgitate them, instead of swallowing?

Many children behave this way: for a week or two they spit out all the pieces and periodically “choke”, then they begin to spit out the pieces “after one”, they swallow half of them, then, finally, they begin to swallow all the pieces. Mom needs to be patient and not insist. At the same time, the child must definitely observe how other people eat without spitting out pieces.

When does complementary food stop being just an introduction to new products and begin to replace feeding?

Breastfeeding and the transition to food from a common table are parallel processes. There are no substitutions for complementary foods. The fact is that the main feedings from the breast in a child of 6 months and older are associated with dreams. Babies suck a lot when falling asleep for day and night dreams, apply to the breast when waking up from daytime dreams and in the morning, suck at night, especially closer to morning. And acquaintance with complementary foods and food from the common table take place during mother's breakfasts, lunches and dinners. A child eats relatively large portions of food already at the age of about a year and older. But even at this age, babies can often drink food from the breast. The child continues to receive vitamins and other useful substances with breast milk in sufficient quantities and in optimal forms for assimilation, provided that his breastfeeding is properly organized, and the mother does not lack nutrients.

What about salt, sugar, spices, and, possibly, harmful substances (for example, nitrates) contained in adult food, which the baby will try? In baby food, all this is not, and therefore it can be healthier for the baby than food from the common table?

Food does contain salt, sugar, nitrates, and more. And baby food contains. Baby food is made in such a way that the child assimilates it without adapting to the products that make it up. There is no adaptation of the digestive system to taste, consistency, or ingredients. The mother's task is not to feed the child with other food, which can be done with baby food, but to continue the slow process of adaptation of the child's gastrointestinal tract to other foods. This adaptation began when the child began to swallow amniotic fluid, the taste of which changed depending on the mother's nutrition, and continued with the beginning of breast milk, the taste and composition of which changes not only during the day, but even during one feeding, and the mother eats not baby food. While the child eats small amounts of food, he adapts to its components: to salt, and to sugar, and to nitrates, as well as to its other components. And when he eats significant amounts of food, he will already be quite able to cope with all this.

Does the baby need extra fluid in connection with the initiation of complementary foods?

The baby continues to receive the main liquid from breast milk... The child usually begins to take an interest in water and drinking itself after a year. Usually, the baby is interested in the contents of his mother's cup and tries it if you pour a little drink into his cup, on the bottom.

How to be with a child over a year old with no nutritional interest? Until a year, all attempts to introduce complementary foods did not lead to anything. The child cried, turned away, even vomiting. Now he eats very poorly and not everything, but only certain types of canned food. How to accustom a child to adult food and increase appetite?

This is how children usually behave when they have not seen what other people eat and how. Often this happens if a separate process is arranged from feeding the child and he is fed with something special.

You need to stop feeding the baby separately. It is necessary to put him at the table with everyone, or at least with his mother, not to try to feed him. Everyone should become indifferent whether the child eats or not, at least it is necessary to "pretend" that this is so ... Let him watch for several days how other family members eat. If he starts asking to try something - go ahead. Put on a plate the same as everyone else. In the presence of the baby, it is necessary to eat with appetite. Do not try to distract you with TV, books, or toys. Do not scold or punish if the child spills or smears something, remove immediately and demonstrate that everyone is eating carefully.

If the baby is almost 5 months old, he is very interested in any food, looks into everyone's mouth and demands to try, is it possible to introduce pedagogical complementary foods to him now?

The kid is a developed and inquisitive child. He really wants to do with food the same as his mother. But we must remember that the child's gastrointestinal tract, in not the full 5 months, is not yet very ready to get acquainted with other food. Enzyme systems are just beginning to mature. The situation in the intestines is now stable, it is rather dangerous to intervene in it ahead of time. It is the mom's job to protect this stability from premature interventions. Food interest in a baby of this age should be limited, in other words, take him out of the kitchen and not eat in his presence. If you don't really like this advice, you can do something, but only at your own peril and risk. We have already encountered a situation when a mother, even who knows how to correctly introduce complementary foods, is impatient and as a result of which the child received a breakdown in digestive system, with which I had to fight for a long time. If the mother has the opportunity to introduce complementary foods under the full-time guidance of a breastfeeding consultant (the best option), then it will be possible to do this from 5.5 months of age. If you can only act on your own, it is not recommended to introduce complementary foods before the baby is six months old.

Are there any peculiarities in the management of pedagogical complementary foods, if the baby or his parents are allergic?

There are, of course, features. For such a baby, foods are introduced more slowly, starting with hypoallergenic ones, the amount of complementary foods is increased much more slowly than usual. The rate of introduction of products can be characterized as follows: "one step forward, two steps back." Mom should follow a hypoallergenic diet, excluding foods that cause her allergies or any other inconvenience. A mother who is breastfeeding should not introduce new products to her baby against the background of an exacerbation of her own disease. All food samples should be completed with attachment to the breast. It is necessary to introduce no more than one product per day and monitor the baby's reaction to it for at least 3 days.

Why babies eating baby food at 7-8 months can eat 100-200 g of mashed potatoes or cereals, but children who started with pedagogical feeding do not do this?

A child in the second half of his life eats little because he does not want to fill up yet. He only imitates his mother in her actions. He eats milk. Perhaps the human baby has a genetically built mechanism that does not allow him to eat much at this age. A couple of thousand years ago, a child probably would have gotten big problems in the digestive system if he had been fed 100 g of game meat brought by dad from the hunt. Another thing is that then no one would have thought of doing this to a child. Even our great-grandmothers, 100 years ago, who cooked food for a family of 5-10 people on a stove or wood-burning stove, did not think (and it was not possible), on the one hand, to feed the child with something specially prepared separately from everyone, but with on the other hand, it was not even in my thoughts to give the baby more common porridge or soup to eat ... Baby food is made in such a way that the child can eat a lot of it. And any baby can be fed with it, but is it necessary? There are children who, for the time being, eat this "baby food" a lot and with pleasure, however, most of them have to be entertained during the feeding process to open their mouths. It takes a long time to entertain many in the process of eating, some - until adolescence... Often there is a situation when a child, who has eaten with pleasure and a lot, up to a year or a little over a year, after becoming older, begins to refuse food and turns into a baby, feeding which is simply torture for the parents. Such children are not at all interested in food. There are, of course, children who pass the stage relatively "safely" baby food... "Safely" is put in quotation marks, since Now the long-term consequences of introducing large amounts of baby food to a child are just beginning to be studied when he is biologically not quite ready for such a load, the results will not be soon ...

Proper feeding of babies early age- this is not only the harmonious development and growth of the baby, but also laying the foundation for his health and resistance to infectious diseases and unfavorable environmental factors. Parents should pay the greatest attention to the nutrition of children of the first year of life. This is mainly due to the peculiarities of their body (lack of a supply of nutrients, unformed metabolic processes and an undeveloped defense mechanism), which complicates the process of assimilating nutrients from food. The conversation about the nutrition of children in the first year of life should begin with a consideration of 3 main types of feeding: natural, artificial and mixed.

2.Natural feeding

Natural (breast) feeding - form nutrition of a newborn child, is the only physiologically adequate nutrition for a newborn and an infant.

Breastfeeding is called natural. Human milk is a unique and most balanced food product for a baby in the first year of life; The composition of each mother's breast milk exactly matches the needs of her baby in various substances: proteins, fats, carbohydrates, vitamins and minerals; Mother's milk contains special substances - enzymes that promote the digestion and assimilation of proteins, fats and carbohydrates; The mother's milk contains immunoglobulins and immune cells that protect the child from most infectious diseases: intestinal infections, infectious hepatitis, diphtheria, tetanus and others;

2.1. Benefits of human milk:

1. Human milk is completely devoid of antigenic properties, while cow's milk proteins have a pronounced antigenic activity, which contributes to the appearance and intensification of allergic reactions in infants.

2. The total amount of protein in breast milk is much less than in cow's milk, in structure it is close to the proteins of the baby's cells. It is dominated by fine fractions, particles of coarse protein casein are several times smaller than in cow's milk, which ensures that breast milk is curdled in the stomach with more delicate flakes and thereby more complete digestion.

3. Women's milk contains such a unique substance as taurine - a sulfur-containing amino acid with neuro-active properties. With artificial feeding, protein overloads inevitably occur, since cow's milk contains three times more amino acids. These overloads are accompanied by intoxication, kidney damage due to metabolic disorders.

4. Human milk, especially colostrum, excreted in the first 3-4 days, is very rich in immunoglobulins, especially class A, with 90% being secretory IgA, which plays a fundamental role in the local immunity of the gastrointestinal tract of newborns. Leukocytes of breast milk synthesize interferon: it contains a large number of macrophages, lymphocytes. The lysozyme level is 300 times higher than in cow's milk. It contains the antibiotic lactofelicin. Thanks to this, natural feeding provides the formation of the immuno-biological protection of an infant, and therefore the morbidity and mortality of children who are breastfed are significantly lower than with artificial ones.

5. The amount of fat in human and cow's milk is practically the same, but there is a significant difference in its composition: breast milk contains several times more unsaturated fatty acids... The breakdown of fat in infants begins in the stomach under the influence of breast milk lipase; it stimulates the appearance of active acidity in the stomach, contributes to the regulation of the evacuation function of the stomach and earlier release of pancreatic juice. All this facilitates the digestion and assimilation of fat, the individual components of which are part of the cells of all tissues and biologically active substances, are spent on myelination of nerve fibers, providing an increased need for fats in a 1-year-old child.

6. Carbohydrates in breast milk are relatively high. They largely determine the intestinal microbial flora. They include B-lactose (up to 90%), which, together with oligoaminosaccharides, stimulates the growth of normal flora with a predominance of bifidobacteria, thereby suppressing the proliferation of pathogenic microorganisms and Escherichia coli. In addition, B-lactose is involved in the synthesis of B vitamins.

7. Human milk is exceptionally rich in various enzymes: amylase, trypsin, lipase (lipase in breast milk is almost 15 times more than in cow's milk, amylase - 100 times more). This compensates for the temporary low enzymatic activity of the child and ensures the assimilation of a fairly large amount of food.

8. The mineral composition of food, the content of bioelements in it is of great importance for the growing organism. The concentration of calcium and phosphorus in breast milk is lower, but their absorption is two times better than from cow's milk. Therefore, with natural feeding, children are much easier and less likely to get sick with rickets. The content of bioelements (sodium, magnesium, chlorine, iron, copper, zinc, cobalt, sulfur, etc.) in breast milk is optimal and meets the needs of the child. Breast milk contains four times less sodium than cow's milk. Excessive sodium loads can cause vegetative-vascular dystonia with fluctuations in blood pressure during puberty, as well as more severe and more frequent crises in adult hypertension.

9. Breast milk differs from cow's milk in a higher content and higher activity of vitamins, in particular vitamin D, which also helps to prevent rickets.

10. It has been shown that with natural feeding, sexual potency is better in the future, and fertility is higher.

11. With natural feeding, a life-long relationship to the mother is laid, her subsequent influence on the child's behavior, as well as the future parenting behavior is formed.

10. Feeding children of the first year of life. Natural, formula and mixed feeding. Modes and rules.

Correct feeding of young children is not only the harmonious development and growth of the baby, but also laying the foundation for his health and resistance to infectious diseases and adverse environmental factors. Parents should pay the greatest attention to the nutrition of children in the first year of life. This is mainly due to the peculiarities of their body (lack of a supply of nutrients, unformed metabolic processes and an undeveloped defense mechanism), which complicates the process of assimilating nutrients from food. The conversation about the nutrition of children in the first year of life should begin with a consideration of 3 main types of feeding: natural, artificial and mixed.

2.Natural feeding

Natural (breastfeeding) feeding is a form of nutrition for a newborn child, it is the only physiologically adequate nutrition for a newborn and an infant.

2.1. Benefits of human milk:

5. The amount of fat in human and cow's milk is practically the same, but there is a significant difference in its composition: breast milk contains several times more unsaturated fatty acids. The breakdown of fat in infants begins in the stomach under the influence of breast milk lipase; it stimulates the appearance of active acidity in the stomach, contributes to the regulation of the evacuation function of the stomach and earlier release of pancreatic juice. All this facilitates the digestion and assimilation of fat, the individual components of which are part of the cells of all tissues and biologically active substances, are spent on myelination of nerve fibers, providing an increased need for fats in a 1-year-old child.

8. The mineral composition of food, the content of bioelements in it is of great importance for the growing organism. The concentration of calcium and phosphorus in breast milk is lower, but their absorption is two times better than from cow's milk. Therefore, with natural feeding, children are much easier and less likely to get sick with rickets. The content of bioelements (sodium, magnesium, chlorine, iron, copper, zinc, cobalt, sulfur, etc.) in breast milk is optimal and meets the needs of the child. Breast milk contains four times less sodium than cow's milk. Excessive sodium loads can be the cause of vegetative-vascular dystonia with fluctuations in blood pressure during puberty, as well as more severe and more frequent crises in adult hypertension.

9. Breast milk differs from cow's milk in a higher content and higher activity of vitamins, in particular vitamin D, which also helps to prevent rickets.

10. It has been shown that with natural feeding, sexual potency is better in the future, and fertility is higher.

11. With natural feeding, life-long relationships with the mother are laid, her subsequent influence on the child's behavior, and also the future parenting behavior is formed.

2.2. Regime and technique of natural feeding.

3.Mixed feeding

Mixed feeding is a feeding system for a child in which supplementary feeding with a mixture is carried out on an equal basis with breastfeeding without a clear regimen (on demand), while the volume of the mixture takes up no more than half of the total volume of food.

Insufficient weight gain

· Prematurity;

Mother's illness, her taking medications incompatible with breastfeeding;

· Life situation: mom needs to work or study.

The diet for mixed feeding is individual and depends to a greater extent on how much of the food the baby receives with breast milk, and what part with the formula.

The main rule of mixed feeding is to offer the baby formula only after breastfeeding. In this case, supplementary feeding is not a separate feeding. In this case, it is assumed that the mother has enough milk and only small amounts of supplementation are introduced. Each feeding of the baby then begins with latching to the breast, which stimulates increased lactation. If you first give the baby a mixture, then he may well refuse to breastfeed because of satiety or because it is much more difficult than drinking from a bottle. The diet corresponds to the regime for breastfeeding, that is, the breast is given to the baby on demand. If, after latching on to the breast, the mother sees that the baby has not eaten, then feeds him with a mixture.

The option of compulsory attachment to the breast, and then, if necessary, supplemental feeding with a mixture is the closest option to breastfeeding for mixed feeding. But, unfortunately, not always, and it is possible.

If there is not enough breast milk for the whole day, you have to alternate between breastfeeding and bottle feeding. The greatest influx of milk from the mother occurs in the morning, and by the evening, with a strong decrease in lactation, it practically does not remain. In this case, one feeding completely or two or three feedings are partially replaced with a mixture. The diet should be relatively fixed: the mixture is not recommended to be given to the baby more often than 2 hours after the previous feeding. Most often, feeding is replaced with a mixture before bedtime, then the child eats up and sleeps soundly, calmly.

If a mother is forced to work or study, then during her absence, the baby is fed with formula, and during the rest of the feedings he receives breast milk.

3.1. Rules for mixed feeding

1. Supplementary feed (artificial mixture) should be given only after the baby is attached to the volume of the mammary glands and after they have been completely emptied, even with a minimal amount of milk. This is done due to the fact that at the beginning of feeding, the baby has the most pronounced appetite and he actively sits on the breast. If you first give an artificial mixture, then, firstly, you do not know in what quantity to give it, and secondly, after satisfying the appetite, the child will not want to suckle, since it is much more difficult than eating from a bottle.

In the case of social and living conditions, when the mother is forced to be absent for a certain amount of time, or in the treatment of certain diseases of the mother, you can resort to the following method of feeding. The child receives an artificial mixture 2-3 times during the day, and the rest of the feeding is breast milk;

2. It is better to give supplementary food from a spoon (if its volume is not very large), since the easier flow of the mixture from the bottle can cause the child to give up the goodie. With a large amount of supplementation, use a bottle as a rule. The bottle should have a sufficiently elastic nipple with small holes (so that the baby makes an effort while sucking);

3.Power mode. The most optimal is a free feeding regimen. But you can feed the baby and according to the schedule, in this case the frequency of feeding can be reduced by one feeding in comparison with natural feeding;

4. The mixture, bottles, nipples must be sterile. The temperature of the finished mixture is 37-38 degrees;

5. Complementary foods with mixed feeding should be introduced 2-3 weeks earlier than with natural feeding.

To calculate the child's needs for food ingredients, the age of the child is taken into account, what type of feeding is close to the nutrition (artificial or natural), the type of mixture used (adapted, unadapted).

3.2 There are 2 methods of feeding supplements:

1. The classical method - the baby in each feeding is applied to the breast, and then supplemented with a mixture to the required volume.

2. Method of alternation - the baby is applied to the breast through feeding and completely covers the required amount of food with human milk; and through feeding the required amount of milk is covered with artificial formula.

4 artificial feeding

Artificial feeding is a type of feeding in which the baby does not receive mother's milk in the first year of his life and feeds only on artificial mixtures.

Artificial feeding can be used if the mother has no milk at all or the baby for some reason cannot or does not want to drink breast milk.

4.1. Rules of artificial feeding

1. Artificial feeding provides for a systematic calculation of the energy value of food, the content of proteins, fats and carbohydrates with each change due to the fact that artificial feeding it is possible both underfeeding of the child and overfeeding. The indicator of the suitability of the mixture is the data on the normal development of the child.

2. The volume of food per day with artificial feeding should correspond to the volume of natural feeding.

3. It is recommended to carry out artificial feeding with adapted milk formulas "Malyutka". "Baby", "NAN" and others, which in their composition are as close as possible to human milk. Currently, unadapted milk formulas are practically not used in the nutrition of children.

4. Mixes are always given only freshly prepared and warmed up to a temperature of 35-40 ° C. The opening of the nipple should not be too large, milk should flow through it from the overturned bottle in drops. It is strictly forbidden to prepare mixtures for long periods of time.

5. When feeding, the bottle is kept at an angle so that the neck of it is always filled with the mixture to prevent the baby from swallowing air.

4.2 Mode

the first week of life - 7-10;

1 week - 2 months - 7-8;

2-4 months - 6-7;

4-9 months - 5-6;

9-12 months - 5.

4.3 The most common bottle-feeding mistakes are:

Too frequent changes in food. Replacing one mixture with another should be done in case of allergic reactions, prolonged cessation of weight gain, the child's refusal from this mixture. Even infant baby has the right to have his own tastes and does not always agree with what is offered to him;

Restricting the diet and transferring the child to a new mixture at the slightest deterioration in the stool;

The appointment of fermented milk mixtures in large quantities, especially in the first 7 days of life, although they are more easily tolerated by babies with latent lactase deficiency and have antibiotic activity. However, when feeding only fermented milk mixtures metabolic disorders are noted.

4.4. When feeding a baby with milk formula, it is recommended to observe the following rules:

1. Cook it immediately before feeding in a pre-sterilized container.

2. In the process of mixing the mixture, follow the instructions attached to the package or printed directly on it.

3. Dilute it with water specially designed for baby food: it does not contain any harmful substances.

4. Before giving the mixture to the baby, be sure to check its temperature: it must correspond to the body temperature.

Lactation in its natural development goes through a number of periods.
With the birth of a child comes adaptation period. It begins with the appearance of the first drops of colostrum in the mother's mammary gland and ends with a steadily growing production of mature milk and the formation of a certain rhythm - from irregular attachments to the breast to the formation of a stable feeding regime with alternating rhythm of hunger and satiety. The duration of the adaptation period is on average 2-3 weeks.
Main period - successful feeding with gradually increasing or constant intervals between feedings, consistent with free feeding of the infant.
The normal lactation process is characterized by lactation crises. This is a short-term decrease in lactation, accompanied by anxiety in the child, a decrease in the number of urinations. Crises occur periodically - on the 3rd-6th week, 3rd, 4th, 7th, 8th months. lactation. Their duration is on average 3-4 days, and they do not pose a danger to the health of the child. If the mother is instructed by the doctor about this possibility and in a timely manner increases the frequency of latching to the breast, then thereby she successfully increases the volume of lactation.

Definition of the concept of "natural feeding" and its varieties

Natural feeding this is feeding the baby with breast milk when it is applied to the breast of the biological mother. From the standpoint of delineating the amount of food, according to the traditional domestic classification, with natural feeding, the daily volume of food is 80% or more represented by breast milk.
According to the terminology of WHO (1993), there are several types of breastfeeding:
Exclusive breastfeeding - breastfeeding without supplementation with other food or drink. It is allowed to take vitamins, mineral salts, medicines.
Predominantly breastfeeding - when the baby, in addition to the mother's milk, receives a small amount of water or a drink containing water (tea).
Predominantly breastfeeding allows the use of "training" thick complementary foods (no more than 30 g per spoon) or the child irregularly receives limited amounts of adapted formulas (no more than 100 g per day).
Supplemented breastfeeding - mother's breast and regular pre-feed mixtures of more than 100 ml per day or the introduction of complementary foods more than 30 g per day.
Optimal breastfeeding - it is exclusive breastfeeding with no intervals between feedings of more than 4–6 hours, complete absence of the use of horns and nipples, and preservation of attachment to the breast for 6 months.
Breastfeeding is optimal when the nursing mother is well nourished.

10 principles, or steps, for successful breastfeeding, developed by UNICEF (1991)

1. Strictly adhere to the established rules of breastfeeding and regularly bring these rules to the attention of medical personnel and women in labor.
2. Train health care personnel in the necessary skills to practice breastfeeding.
3. Inform all pregnant women about the benefits and techniques of breastfeeding.
4. Help mothers start breastfeeding within the first half hour after giving birth. This provision only applies to healthy children and mothers.
5. Show mothers how to breastfeed and how to maintain lactation, even if they are temporarily separated from their babies.
6. Give newborn infants no food or drink other than breast milk unless medically indicated.
7. To practice around the clock finding the mother and the newborn side by side in the same ward.
8. Encourage breastfeeding as requested by the infant rather than scheduled.
9. Do not give breastfed infants any sedatives or devices that simulate the mother's breast (nipples, etc.).
10. Encourage the organization of breastfeeding support groups and refer mothers to these groups after discharge from maternity hospital or hospitals.

Absolute contraindications for breastfeeding

Contraindications to breastfeeding are very limited and are divided into 2 groups: contraindications on the part of the child and on the part of the mother.
1. From the side of the child.
♦ Congenital metabolic diseases - phenyl-ketonuria, galactosemia, “maple syrup-smelling urine” disease.
♦ Congenital lactase deficiency.
In these cases, it is necessary to feed the child with artificial mixtures, including medicinal ones.
2. From the mother's side.
♦ The state of decompensation in chronic diseases of the heart, liver, kidneys.
♦ Acute mental illness.
♦ Malignant neoplasms.
♦ HIV infection, especially dangerous infections (smallpox, anthrax), tetanus.
♦ Open form of tuberculosis with bacillus excretion. In case of tuberculosis - the child is vaccinated, the mother should receive courses of anti-tuberculosis drugs. Breastfeeding is possible in 1.5–2 months.
♦ Syphilis with maternal infection after 6–7 months. pregnancy.

Absolute contraindications for early breastfeeding are limited. They should be considered as temporary restrictions on breastfeeding. In these cases, the mother should express milk to maintain the breast's ability to lactate.

Contraindications to early breastfeeding

1. From the side of the child.
♦ Severe violation cerebral circulation.
♦ Birth trauma with depression of the central nervous system.
♦ Lack of sucking and swallowing reflex in prematurely born (premature) babies.
♦ Hemolytic disease due to the incompatibility of the erythrocytes of the mother and the fetus for the Rh factor or the ABO system.
♦ Assessment of the condition of the newborn on the Apgar scale below 7 points.
♦ Severe malformations (of the maxillofacial apparatus, heart, gastrointestinal tract).
2. From the mother's side.
♦ Operative delivery, postpartum hemorrhage, severe forms gestosis.
♦ Lack of consciousness.
♦ Infectious diseases of the mother (Appendix 1).
The presence of a number of infectious diseases in the mother requires tactics of use different options feeding, including “subnatural” bottle feeding, and options for sterilizing and pasteurizing breast milk.
Relative contraindication to early attachment of the baby to the breast is the use in the treatment of the mother of a number of medicines: antibiotics (chloramphenicol, tetracycline), isoniazids, nalidixic acid, sulfonamides, estrogens, cytostatics, antithyroid drugs, diazepam, seduxen, lithium salts, meprobamate, phenylin, reserpine, atropine, ergotamine, iodine preparations, hexamidine.

Breastfeeding rules

1. Immediately after transfer from the delivery room, the mother and child must be provided with joint stay in one room, where the baby's bed is placed directly next to the mother's bed. In such conditions, the mother has unlimited access to the baby at any time of the day and can feed on demand, that is, adhere to free mode of feeding. An important advantage of being together for mother and child is to minimize the risk of infection in the newborn. If the mother is caring for the child, his body is colonized by the mother's microbes, and the milk contains specific antibodies to them. In the event that the child is in the ward for newborns, then his body is colonized by microbes of "strangers". Safe for them, they may be pathogenic for the newborn, and the corresponding antibodies may not be found in the mother's milk.
2. Feeding the baby on demand. Lying on the baby to the breast from the first day of life should be carried out for any sign of discomfort and hunger. Hunger signs there may be rotational movements of the head, active sucking movements of the lips, smacking lips, loud, persistent crying. The experience of the mother is very important, she should be able to differentiate the "hungry" cry of the child. However, you should be aware that the child may cry and worry for other reasons (discomfort due to heat, cold, wet diapers, fatigue, illness). In such cases, the mother's attempts to eliminate the cause of crying by frequently latching on the baby to the breast can lead to overloading the amount of food, which can serve as a risk factor for the development of gastrointestinal dysfunction, excessive weight gain. In some cases (colic), frequent feeding will increase the baby's discomfort.
3. One of the key factors in the development and provision of full lactation is free feeding regimen, in which the children themselves set the intervals between feedings. During the first days and weeks (colostrum and transitional milk stage) can be 12–20 or more times a day and determined by the need child. The break between daytime feedings may not even reach 2 hours, and between nighttime feedings there should be no more than 3-4 hours. Nighttime feedings are especially important, since the peak of prolactin production occurs in the evening and at night. However, it should be noted that the interval between feedings should not exceed 4 hours.
4. The duration of feeding is not limited, and this is important even when the child already practically does not suck anything, but simply slumbers. The need for contact and sucking can often be independent, relatively independent of the child's feeding behavior. Most children are full in 5-10 minutes, some take 20-30 minutes. Lazy suckers eat the same amount of milk as other babies. If their breasts are removed prematurely, they will not receive the hindmilk they need for normal development and will remain hungry. Sometimes breastfed babies are overweight. These are, as a rule, children with lymphatic-hypoplastic constitutional anomaly. It is often recommended to lift these babies from the breast a few minutes after the start of feeding so that they do not "overeat". However, this cannot be done, since they add excessively in body weight, not because of overeating, but precisely because of their constitution.
These children are characterized by an increased allergic disposition, which, on the contrary, requires the preservation of breastfeeding. If, when the child is overweight, the mother feeds him with something, then it is necessary to remove this supplement.
5. With sufficient lactation, the baby receives milk from only one breast, and in the next feeding - from the other. With prolonged breastfeeding and its active emptying, the child should be offered a second breast, that is, during feeding, the child can be applied to both mammary glands. Such feeding contributes to a better development of lactation, a more complete mutual adaptation of the mother and child. The next feed begins at the second breast. However, the use of two breasts for feeding carries the risk that the baby will not receive some of the difficult-to-suck hindmilk from the first breast. So by no means you can't change breasts quickly when feeding.
6. Child do not give a pacifier or pacifier, since the mechanisms for squeezing milk from the breast and nipple are different. In the first case, the child acts with his tongue, in the second, with the help of his cheeks. Having learned one way, he will not be able to switch to another.
7. It is important not to relieve the child's anxiety caused by starvation, supplementation between feedings, especially milk formula. Healthy newborn breastfed should not receive any nutritional supplements - glucose solution, saline, boiled water. This is unacceptable for two reasons: drinking from a bottle increases the risk of infection, and drinking sweet drinks forms other, different from physiological, ways of carbohydrate metabolism. With a sufficient amount of milk from the mother, the baby's need for fluid is fully satisfied, even in hot climates.
8. During the formation of lactation (stage of colostrum and transitional milk) breast is not pumped, this is carried out only if there is evidence (lactostasis, etc.). During the period of established lactation after feeding, the breast should be emptied. The breast is expressed if, after feeding, there is a lot of milk in it and it is dense. Expressing manually requires skill, time and preparation, so simple, comfortable and non-traumatic breast pumps (eg Avent.Isis manual breast pump or Avent. Isis Uno electric breast pump - see below) are optimal.

Feeding mode

The period of formation of the child's diet after discharge requires a certain amount of flexibility. If the child was in a maternity hospital with a separate stay of the mother and the child, then from birth he was fed according to the schedule (6-7 times a day). In this case, 2 feeding options are possible.
1. Save the existing feeding regime. This is possible if the mother's lactation is sufficient, and the baby is developing well and easily maintains the intervals between feedings. Night feedings are possible if the child has a need for them.
2. Feed the baby on demand when the baby does not keep up with the intervals between feedings or his rate of weight gain is lagging behind. This period will continue until a sufficient, stable lactation occurs in the mother and until the child's weight and height indicators grow.
The number of feedings, including night feedings, can vary widely depending on the state of lactation in this moment, the degree of physical activity, energy consumption of the child, his health and mood.
During the first days and weeks (colostrum and transitional milk stage) breastfeeding frequency can be 12–20 or more times a day and is determined by the child's needs.
After establishing lactation in the mother and good growth the child's need for such frequent feedings disappears. The baby, as a rule, breastfeeds less often, and the frequency of feedings decreases from 10-15 in the first days and weeks to 7-6-5 in subsequent periods. The transition from an indefinite feeding rhythm to a relatively regular regimen takes from 10-15 days to 1-1.5 months. Free feeding does not exclude the possibility of reasonable regulation of the regimen.
With good lactation in the mother healthy child by the age of 1-1.5 months, as a rule, it can withstand three-hour intervals well (since around this time milk is retained in the stomach for 2.5-3 hours) and feeds 7 times during the day, adhering to certain feeding hours (6-9 -12-15-18-21-24 hours). This does not exclude the possibility of night feedings or deviations by 30–60 minutes. from the time of feeding, depending on the needs of the child.
In general, a sensible feeding schedule is preferable to random feedings for both the baby and the mother. Moreover, if the child after the neonatal period ™ develops well and "wakes up" night feedings, then they should not be considered strictly obligatory. Night sleep and adequate rest is important for the mother as well, as it promotes good lactation. In the event that the child does not need night feedings, he himself will refuse them, he should not be prevented from doing so.
By 2 months, if the baby is kept at the 3.5-hour interval, he can feed 6 times. With 6 meals a day, the recommended feeding time: 6-9 30 -13-16 30 -20-23 30.
From 4.5-5 months (1–2 weeks before the introduction of complementary foods) the child is transferred to 5-time feeding with an interval between feedings of 4 hours.

Evaluating breastfed nutrition

One of the main indicators of the sufficiency of milk received by a child is its behavior. If after feeding the baby calmly lets go of the breast, looks pleased, sleeps well until the next feeding, then he has enough milk.
For the vast majority of children, nutritional control is carried out on the basis of clinical health assessment child: compliance with the length and weight of the body to the reached age, adequate weight-and-height gains, age-appropriate psychomotor development, good skin condition, elastic turgor of soft tissues, adequate in frequency of urination and stool, good functioning of all organs and systems. This nutritional state of the child corresponds to the concept of normotrophy or, more optimal, to the eutrophic development of the child (G.N.Speransky, A.F. Tur).
With a shortage of milk received by the baby, the number of urinations decreases (less than 6 times), so the simplest test is for wet diapers.
If you suspect malnutrition(lactation crisis, hypogalactia) it is necessary to be able to assess the dynamics physical development and the daily volume of milk received by the child in accordance with age norms... For this, the length and, above all, the weight of the child's body are assessed. Weight is the most responsive to feeding disturbances and is considered a reliable indicator of "current" nutritional status, while stunting indicates chronic nutritional deficiencies.
Weighing is necessary for accounting for daily weight gain. A decrease in these indicators below the standard age values, and even more their approach to the 10th centile, indicates malnutrition (Appendix 2). Given that a child does not always gain weight evenly, frequent, especially daily, weighing only disorients parents. Therefore, the first three months of life with well-being It is enough to weigh the child once every 2 weeks, then in the first year - once a month. If you suspect a lack of milk, weighing can be carried out once a week. with the subsequent calculation of daily increments.
Ascertaining the fact of malnutrition, in order to solve practical problems, it is necessary estimation of the daily milk volume, received by the child by carrying out "control feedings". By themselves, "control feedings" are not sufficient to judge the lack of milk and "hypogalactia", especially during the formation of lactation or during its natural course during lactation crises. With individual feedings, the amount of milk varies so much that it is difficult to determine the amount of milk sucked out per day from one or two weighings.
To assess the volume of milk received by the child, "control" feedings are carried out during the day, preferably at home. The daily data obtained during control weighings are compared with the calculated values. On natural feeding, with good health of the child, adequate increases in length and body weight, no nutritional calculations are necessary.
The calculations below are focused only on those situations when there is an inadequate development of the child or when feeding him, in addition to breast milk received during sucking, other types of food are used (expressed, donor milk, milk formulas) - that is, the options for "subnatural" feeding are implied, or supplementary feeding situation with hypogalactia of the 2-3rd degree.

Meals calculation methods

The amount of milk a newborn needs for the first 10 days can be calculated:
1. According to Finkelstein's formula modified by A.F. Tour

Amount of milk per day (ml) = n × 70 or 80,

Where n is the day of life;
70 - with a birth weight below 3200 g;
80 - with a birth weight of more than 3200 g.

2. According to N.F. Filatov's formula modified by G.I. Zaitseva

Amount of milk per day (ml) = 2% of body weight × n,

Where n is the day of life.

3. Based on the functional capacity of the stomach - according to the formula of N.P. Shabalov:
Amount of milk per feeding = 3.0 x day of life x body weight (kg).

An example is the following calculation of the amount of food.
Child 7 days old, body weight 3500 g.
According to the Finkelysptein formula: 80 × 7 = 560 ml;
according to the formula of N.F. Filatov and G.I. Zaitseva:

according to the formula of N.P. Shabalov, the volume of one feeding: 3 × 7 × 3.5 = 73.5 ml.
With 7 meals a day (73.5 × 7), the daily volume will be 514 ml.
When calculating each of the proposed methods, the amount of food is slightly different. In actual practice of feeding, these differences cannot be considered significant. In our opinion, only in the Filatov-Zaitseva formula and N.P. Shabalov's formula, the individual body weight of the child is taken into account, therefore these methods of calculation are preferable.
In children over the 10th day of life use the following methods for calculating the daily amount of food:

1. "Volumetric" method according to Geibner - Czerny.
The daily amount of food is:
from 10 days to 6 weeks - 1/5 of the actual body weight;
from 6 weeks up to 4 months - 1/6 of the actual body weight;
from 4 to 6 months - 1/7 of the actual body weight;
over 6 months - 1/8 of the actual body weight.
This method has some limitations, since in many healthy children, after six months or even earlier, the calculated amount of food is more than 1000 ml. However, a child in the first year of life should not receive more than 1000-1100 ml of food per day.

2. "High-calorie" method of MS Maslov.
According to this method per day, the child should receive per 1 kg of body weight:
1st quarter of the year - 120 kcal;
2nd quarter - 115 kcal;
3rd quarter - 110 kcal;
4th quarter - 100 kcal.

3. Calculation of the volume based on the child's need for protein.
The most reasonable calculation of nutrition is based on taking into account the need for basic food ingredients (Order of the Ministry of Health of the Russian Federation, 1991, Appendix 3).
With an optimal ratio of proteins, fats and carbohydrates in breast milk, the calculation is carried out only for protein. It is known that with natural feeding before the introduction of complementary foods, the child's need for protein is 2-2.2 g / kg per day, for fat 6-7 g / kg per day, for carbohydrates 12-14 g / kg per day.

EXAMPLE OF CALCULATION OF DAILY FOOD VOLUME
The child is 2 months old, body weight 5 kg.
1. According to the "volumetric" method, the amount of breast milk will be 1/6 of the body weight:
5000: 6 = 833 ml / day.
2. "Caloric" method: the child's energy requirement is 120 kcal / kg:
120 kcal × 5 = 600 kcal / day.
The required amount of milk is calculated based on the proportion:
1000 ml breast milk - 700 kcal.
X ml - 600 kcal.

3. Finally, when calculating based on the child's protein requirements (2.2 g / kg), the sequence is as follows:
2.2 g / kg × 5 kg = 11 g of protein a child needs per day.
Considering the average amount of protein in 1 liter of breast milk (12 g / l); the required daily volume will be:
1000 ml - 12 g
X ml - 11 g

The given example convincingly shows that all of the above calculation methods give very close results. From our point of view, because of its simplicity, it is preferable to use the "volumetric" method.
These methods are necessary to determine the daily amount of food. To determine the volume of one feeding, it is necessary to divide the daily amount of food by the total number of feedings. For example, a child aged 2 months. should receive 840 ml of milk per day, with 7 meals the volume of each feeding will be 120 ml, and with 6 meals 140 ml.
I would like to draw your attention to the position that all calculations of food volumes should always be considered as indicative. So, for example, in the given
the examples of calculating the daily amount of food received approximately the same figures. Fluctuations by 10–20 ml in one direction or another do not sin against the truth, since with good lactation, the child actually sucks the volume of milk he needs within the calculated range.
By way of illustration possible problems arising from natural feeding, some of them can be cited.
Problem 1... The child was born at term with a body weight of 3500 g and a length of 50 cm. Applied to the breast immediately after birth, then was in free feeding mode with a frequency of feeding 10-11 times a day. Physiological loss was 150 g, body weight was restored by the 5th day. After discharge from the hospital, on the advice of relatives, the mother transferred the baby to 7 meals a day. She went to the pediatrician on the 9th day with complaints of the child's anxiety, aggravated 1.5-2 hours after feeding and at night. It is not possible to drain milk from the breast after feeding the baby. On examination, the child is restless, body weight 3.5 kg. The somatic status of a child without pathology.
Doctor's tactics. It is necessary to explain to the mother that complaints of anxiety and lack of weight gain are most likely associated with a sharp decrease in the number of feedings, including at night, that is, it is necessary to return to the free feeding regime. Subsequently (after a month), a decrease in the number of feedings should be carried out gradually, focusing on the development and behavior of the child.
Objective 2. The child is 1.5 months ... Born with a body weight of 3200 g, a length of 48 cm. Before this visit to the doctor, he developed normally. At present, the body weighs 4100 g, the child begins to hold his head, smiles at the mother. The number of feedings was 6 times a day, after feeding the mother was able to express 10–15 ml of milk. For the last two days, the child has become restless, does not maintain the intervals between feedings, after feeding, the mother cannot express milk.
Doctor's tactics. It is necessary to explain to the mother that at the 6th week of lactation, a lactation crisis may have occurred, which is a physiological phenomenon. It usually lasts 3-4-5 days. In this regard, it is recommended to increase the number of feedings by 1-2 times a day and, if the child stops worrying, return to the previous diet.
Possible and another solution. While maintaining the number of feedings after the baby has completely emptied the mother's breast, offer him another breast and start the next feeding with her.
In cases where such measures do not help, you can raise the question of complementary feeding of the child (see section "Mixed feeding").
Task 3. The child is 3 months old, was born with a body weight of 3400 g, a length of 49 cm. Before this visit to the doctor, the child developed according to his age. At present, the body weight is 5800 g, the length is 60 cm. Lying on his stomach, raises his chest, holds the toy, laughs at the sight of his mother. The number of feedings is 6 times a day, it maintains the intervals between feedings well, receives a correction for vitamin D (400 IU) per day, every other day a 5% solution of calcium gluconate, 1 teaspoon 2 times a day. The mother noticed that during the first feeding at 6 am the baby suckles worse than during the day. When controlling the milk sucked out during one feeding, its volume at different hours of the day was from 90 to 100 ml.
Doctor's tactics. It is necessary to reassure the mother and explain to her that any child can suck out an unequal amount of milk during the day. Since the baby is developing optimally, there is no cause for concern and let the baby feed as before.

Correction of breastfeeding

The most common deficiency states during breastfeeding are deficiencies of vitamins K, D, as well as iron and fluoride.
1. Vitamin K. In view of the low content of vitamin K in human milk and the possibility of bleeding, the tactic of a single parenteral administration of vitamin K 3 - vicasol (1 mg) immediately after birth in the maternity hospital was adopted.
2. Vitamin D. From 4 weeks of age, specific prophylaxis of rickets is carried out. Vitamin D is administered orally at a daily dose of 400 IU. Prevention is carried out in the autumn, winter and spring periods. In the summer months, specific prophylaxis of rickets is not carried out due to sufficient natural insolation at this time of the year. During the year, it is advisable to conduct two courses of preventive general UFO (10-12 sessions every other day). At the time of the UFO and further 3-4 weeks. vitamin D is not given to the child.

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