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 adverse 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 considering the 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 significantly 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. Female 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 immuno-biological protection infant, in connection with which the morbidity and mortality of children who are breastfed are significantly lower than those of 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, helps to regulate 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 a 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 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 lifelong 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 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 considering the 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.

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 significantly 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 included in 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 be the cause of vegetative 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 lifelong relationship to the mother is laid, her subsequent influence on the child's behavior, as well as the future parenting behavior is formed.

2.2 Mode and technique breastfeeding.

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 child 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 child, 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 the child are together in the same room.

At the present time, it should be recognized that the "free" feeding or, otherwise, feeding on the "baby's demand", which is understood as latching on the baby to the breast as many times and at such time as the baby requires, including at night, should be recognized. 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.

Proper breastfeeding technique is essential. In the first days after birth, you can feed the babies in one single breastfeeding. 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 in a position comfortable 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, 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.

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, supplementation with a mixture is the closest option to breastfeeding for mixed feeding. But, unfortunately, it is not always possible 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 a mixture, and in 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 applied 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, a bottle is used 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 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 at each change in connection with the fact that bottle feeding is possible both underfeeding of the child and his overfeeding. The indicator of the suitability of the mixture is the data normal development child.

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

3.Conduct artificial feeding recommended with adapted infant formula "Malyutka". "Baby", "NAN" and others, which are as close as possible to human milk in their composition. 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 a nursing 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.

Natural such feeding is called when the child in the first year of life receives only mother's milk. However, if before the introduction of complementary foods, milk is not less 4/5 the total amount of food taken, feeding is also called natural.

Breastfeeding is provided by the mammary glands during their normal functioning. Breasts begin to develop in girls as they get older school age are finally formed during pregnancy.

Composition and features of breast milk

At the end of pregnancy and in the first days after the birth of the child, the mammary glands are secreted colostrum (colostrum) - thick yellowish liquid, with a relative density of 1.040-1.060. The milk that a baby receives from 4-5 days of age is called transitional, a with 2- 3 weeks - mature(relative density 1.030).

Milk that is released during one inc pocketing, divided by:

- early- at the beginning of feeding; it stands out a lot, has a blue tint; contains a lot of protein, lactose; with him the child gets the required amount of water;

- later- at the end of feeding; in comparison with early milk, it has a whiter color; it is enriched fats(there can be 4-5 times more of them than in early milk).

Table 1 shows the average indicators of the amount of proteins, fats and carbohydrates in different types breast milk and its caloric content, as well as for comparison, similar data are indicated for cow's milk.

Milk type		Ingredients			Calorie content
		Protein	Fats |	Carbohydrates
Feminine	Colostrum	7-5	2,0	4-5	150
	Transitional	2,5	3,2	5, 5-6,6	60-80
	Mature	1, 1-1,5	3, 5-4,5	7	65-70
Cow		2, 8-3,5	3, 2-3,5	4, 5-4,8	60-65

Number of ingredients (g) and calorie content (kcal) 100 ml of milk.

As you can see from the table. 1, the composition of the main ingredients in breast milk changes significantly in the neonatal period of a child's life.

Talking about PROTEIN, it should be said that it is most of all in colostrum before the baby is attached to the breast - 10-13 g / 100 ml. Then the amount of protein decreases - in colostrum 5 g / 100 ml, in transitional milk - 2.5 g / 100 ml.

Protein in mature human milk 1, 1-1.5 g / 100 ml. However, the amount may vary. If necessary, you need to accurately determine the amount of protein in breast milk. In cow's milk protein 2, 8-3.5 g / 100 ml. Thus, when receiving cow's milk, the baby is overfed with protein.

In addition, human milk proteins differ not only in quantity, but also quality features:

Whey proteins are the main component - albumins and globulins; since they are similar to the proteins of the child's blood serum, they can be absorbed in the intestine unchanged;

An important distinctive feature of the protein composition of breast milk from cow's milk is the ratio between albumin-globulin fractions and casei nogenome. The latter appears in colostrum on the 4-5th day of lactation, its amount gradually increases. The ratio between albumin-globular fractions and caseinogen in breast and cow's milk, respectively, is 4: 1 and 1: 4;

Caseinogen in the stomach under the influence of gastric juice thickens and turns into casein; the molecules of casein in human milk are smaller than in cow's milk, and therefore, when it is thickened, the flakes become even smaller; it is one of the factors for better digestion and assimilation of human milk proteins in comparison with cow's milk;

Colostrum contains leukocytes, most of which, are lymphocytes, synthesize immunoglobulins; especially a lot of Ig A (up to 1.2 g / 100 ml);

Mother's milk contains a large amount of taurine - an amino acid necessary to combine bile salts (this affects the absorption of fats), for the formation of tissue in a newborn, primarily the retina of the eye and brain (in an adult, taurine is synthesized from cystine and methionine, which does not occur in a child).

Quantity FAT increases in colostrum, transitional and mature human milk (Table 1). The amount of fat in mature breast milk (3.5-4.5 g / 100 ml) not much more than the amount in cow's milk (3.2-3.5 g / 100 ml). A daily fluctuation in fat was established with a maximum, which is recorded late in the morning and immediately after noon.

The main part of fats is triglycerides - 98%. The amount of fat remains almost constant throughout the breastfeeding period. Nevertheless, its individual indicators can fluctuate in a wide range, not only in the ratio of the total amount of fats, but also in the composition of fatty acids.

To the main peculiarities of breast milk fat relate:

· there is an enzyme in human milk lipase, which takes part in the absorption of 90-95% of breast milk fat (cow's milk fat - less than 60%); in infants, this is of particular importance, in which fats are the main source of energy (up to 50%); especially since the secretion of lipase by the pancreas and the secretion of bile in early childhood are insufficient;

· high degree of dispersion;

· low content of saturated fatty acids, which irritate the gastrointestinal tract (their small amount in breast milk is one of the factors of fewer gastrointestinal dysfunctions during breastfeeding);

· high content (0.4 g / 100 ml) of unsaturated (essential) fatty acids, the main ones are linolenic and especially important for a young child arachidonic; these acids are not synthesized in the human body (in cow's milk there are only 0.1 g / 100 ml).

Acids affect a large number of physiological functions: they significantly increase the absorption of proteins, the body's resistance to infections, many of their derivatives play the role of hormones, they are important for brain development (arachidonic acid is part of the nervous tissue), and is also the basis of vitamin P;

• it is believed that an increase in the amount of fat in late milk acts like saturation regulator.

Quantity CARBOHYDRATES little changes in colostrum, transitional and mature milk (Table 1). On average, in breast and cow's milk, carbohydrates are respectively 7,0 g / 100 ml and 4.5-4.8 g / 100 ml.

Carbohydrates in human milk are mainly milk sugar in the form batta -lactose, which is 90% of its total.

Functional features beta-lactose breast milk are as follows:

She reaches the large intestine, as it is slowly absorbed in the small intestine;

- creates a slightly acidic environment in the large intestine(pH 5-5.5), which has a detrimental effect on putrefactive bacteria;

Part of the beta-lactose was named "Bifidus factor", its action in the large intestine - bifidogenicity- causes an intensive reproduction of the bifidum flora, which normalizes the composition of the flora in the intestinal tract (the growth of the physiological bifidum flora is simultaneously promoted by a weakly acidic environment); this feature of breast milk carbohydrates largely determines the infrequent occurrence of dysbiosis in children who are naturally fed;

Stimulates the synthesis of B vitamins.

As can be seen from Table 1, the most CALORIE is colostrum. On average, the calorie content of human milk is higher than the calorie content of cow's milk.

Another feature of human milk is its OSMOLARITY, which equals 260-270 mOsm / l. It is very close to the osmolarity of blood plasma. This contributes to the normal digestion of food and the physiological state of homeostasis, since in infancy it is still immature renal mechanisms its regulation.

In human milk there is a composition of VITAMINS necessary for the development of a child's body, which is much more than in cow's milk. However, the amount of vitamins depends on the season of the year and the mother's diet.

Accumulation fat soluble vitamins occurs in the fetus in the last months of pregnancy. Therefore, with inappropriate nutrition of the expectant mother and premature babies, hypovitaminosis often develops.

Normally, mature human milk contains vitamin D insignificant -0.15 mcg / 100ml.

Quantity vitamin A A, very necessary for a newborn, in colostrum is 2 times more than in mature milk.

Vitamin K also in colostrum more than in mature milk, and also in early milk more in comparison with late milk. Nevertheless, after 2 weeks in children who are on natural absorption, vitamin K is already formed by the intestinal flora.

Quantity vitamin E b human milk fully meets the needs of the child.

The child's needs for water-soluble vitamins are provided mainly with adequate nutrition for the mother, and on the basis of this, the composition of breast milk. And also the intake of juices matters (see below).

The amount of MINERAL SALTS AND MICROELEMENTS in human milk (calcium, phosphorus, magnesium, iron, iodine, copper, zinc, manganese, sodium, potassium, chlorine, etc.) is prone to fluctuations, and also significantly depends on the composition of the food taken by the woman during pregnancy and breastfeeding. The total amount of mineral salts in human milk is less than in cow's milk. The ratio between them also differs. Key Features mineral composition:

1) in breast milk, the ideal ratio between calcium and phosphorus - 2: 1, which ensures the normal growth and development of the child's bone tissue;

in cow's milk less calcium and more phosphorus; the latter is better absorbed, and this leads to hypocalcemia in a child who is on artificial feeding;

2)gland in milk less than 1 mg / l, nevertheless, its resorption is 50-70%, which is significantly higher than the iron of any other food; in cow's milk, its amount is insignificant and about 30% is absorbed;

Therefore, a child who is naturally fed almost never develops iron deficiency anemia by 6-8 months; only those children whose mothers suffered from iron deficiency before pregnancy can have such a blood disease;

3) for young children, of particular importance are zinc and copper; in human milk, their amount is adequate; zinc affects the growth of the child, the immune system at the cellular level; the biological value of copper lies in the fact that it binds to proteins of low molecular weight.

Breast milk also contains:

Active ENZYMES (protease, trypsin, diastase, lipase);

HORMONES of the thyroid gland, adrenal glands, pituitary gland, intestinal tract;

Hormone-like substances (eritropoietin, calcitonin, prostaglandins);

SPECIFIC PROTECTION FACTORS (Ig A, Ig M, Ig C; their amount in milk gradually decreases; so immunoglobulin SIg A in colostrum and mature milk, respectively, 20 g / l and 0.5 g / l);

NON-SPECIFIC PROTECTION FACTORS (lysozyme, macrophages);

ANTIBODIES (To Escherichia, Shigels, Kokova and other flora). As mentioned above, most of the immune bodies are in colostrum, which ensures the adaptation of the newborn to environmental conditions and protects him from diseases, especially in the first days of life. In mature milk (1 liter) there are fewer immune factors, nevertheless, the amount of substances that enter the child's body remains the same, since with age, the baby sucks out more milk, compensating for his needs. It has been proven that mother's milk at the same time stimulates endogenous synthesis of factors of specific and nonspecific protection.

Breast milk is characterized by a complete lack of antigenic properties, while cow's milk proteins are highly antigenic.

Breast milk is always WARM - optimal for the baby's intake.

Baby feeding mode

After a normal delivery, the baby is first applied to the breast while still in the delivery room.

For 2-3 months the child usually receives food after 3 hours, those. fed 7 times a day: 6.00.9.00.12.00,15.00,18.00,21.00 and 24.00. After that, the night break is 6 hours. Some babies wake up at night crying - at the same time, the mother individually decides whether to feed the newborn at night. Gradually, the baby will bother at night less and less and in 2-3 months will stop waking up.

Do I need to feed my baby strictly by the hour? In the neonatal period, conditioned reflexes are just beginning to form, and one of the first is the reflex to feeding. If the exact hour of appointment has come, and the child is still asleep, you should not bother him. In a short time, the child will wake up and "demand" to feed him with his cry.

Such a regime inwith pocketing is called free. This is the rule when the baby suckles as often and for as long as he wants , considered the most rational in the first months of a child's life. The number of feedings can be 8-12 times a day (according to the latest data from American scientists - up to 18 times a day).

In the future, gradually, as lactation is established in the mother, the formation of conditioned reflexes in the child, frequent feeding develops into a more regular regime and is not difficult. Of course, allowable fluctuations between meal times on a regimen and unplanned later or early feedings should not exceed 1 hour. If the child is constantly waking up through short period after feeding - 1-1.5 hours, the doctor should assess the baby's pocketing: perhaps the mother does not have the required amount of milk, and hypogalactia that develops leads to constant starvation? In case of prolonged sleep of the child - more than 4 hours after feeding - it is necessary to establish the state of his health: is he sick?

Approximately until the end of the second - in the third month of life baby

begins to receive breast milk across 3,5hours, i.e. 6 times per day: 6.00, 9.30, 13.00, 16.30, 20.00 and 23.30. Night break - 6.5 hours.

WITH 4.5 months of age, when complementary foods are introduced (see below), and until the end of the 1st year of life, the interval between feedings increases to 4 hours and the child takes food 5 once a day: 6.00, 10.00, 14.00, 18.00 and 22.00. Night break - 8 hours.

Introduction of complementary foods

Complementary feeding is gradual replacing breast milk with cooked food. At the time of the introduction of complementary foods, the child's intestinal enzyme system is already mature enough to fully digest and absorb all additional food, except milk.

The need for complementary foods is due to the following;

Gradually, the amount of milk in the mother decreases;

In breast milk, the amount of proteins, fats, carbohydrates, sufficient for the normal development of the child, is available only by 4-5 months of the baby;

Vegetable products contain minerals, the need for which increases until the end of the first half of the year;

For the proper functioning of the gastrointestinal tract, fiber is needed, which is not found in breast milk;

- chewing during complementary feeding is one of the factors for the correct development of the speech apparatus;

Thanks to complementary foods, the child gradually becomes accustomed to cooked food and weaned from mother's milk.

I complementary foods it is usually introduced at 4, 5-5 months, or when the child's body weight doubles in comparison with birth weight.

Attention:

Even with a doubling of body weight, complementary foods are introduced not earlier than 4 months;

According to modern data, in the case of normal development of the child, complementary foods can be entered at 6 months (but not later!).

Most children receive their first complementary food in the form of vegetable mashed potatoes.

In cases where the child is not gaining weight well or has unstable stools(tendency to dyspeptic disorders) it is advisable to start the introduction of complementary foods with cereal milk porridge.

General rules for the introduction of complementary foods:

At 4, 5-5 months, the child is transferred to 5- one-time feeding; and at the second feeding, i.e. at 10 o'clock, I complementary foods are given;

First time cooked food is given before breastfeeding, in this case, you need to give a small amount of the mixture - 15-20 ml, and then feed the baby with mother's milk; then, throughout the day, you should observe how the child reacted to the new food, what kind of stool he has, the condition of the skin;

in the absence of violations, on the second day you can give the baby 50 ml of complementary foods and supplement with breast milk;

on the third day, the baby receives 70-80 ml of cooked food and the necessary, but less, volume of breast milk;

throughout 1-2 weeks one whole feeding is replaced by the first complementary food;

Complementary feeding you need give with a spoon, and not through the nipple, since the child, easily sucking food from the bottle, can refuse the mother's breast, the sucking of which requires great considerable effort;

Cooked food should be homogeneous;

Gradually eat food by consistency rare need to replace thick that teaches the child to chew;

- in general, the full introduction of the first complementary foods takes one month.

When giving the first complementary foods in the form vegetable puree the first time the dish is usually prepared from potatoes(cooked in water, preferably in vegetable broth; to prepare a homogeneous mass, you can add a little boiled cow's milk). As already discussed, it takes 1-2 weeks to get used to the first complementary foods.

Then mom gradually after 3-5 days adds one species to the potatoes other vegetables - carrots, cabbage, zucchini, pumpkin,beet.

On 6 month in mashed potatoes is gradually introduced vegetable, at 6- 7month butter.

With the introduction of I complementary foods in the form milk porridge the most rational are the following cereals: rice, buckwheat, corn.

In addition to adhering to the specified common methods the introduction of the first complementary foods, the following rules must be followed cooking and gradual changes in the composition of porridge:

Throughout first week baby gets 5 % porridge cooked on half milk those. half of the liquid is milk and the other half is water; or, better yet, a vegetable broth;

Then on the second- fourth week 5% porridge is gradually replaced by 8- 10% porridge(in half milk); after which 10% porridge is cooked on whole milk and 3% butter and 5% sugar are added to it:

In general, the child's addiction to one type of cereal also goes 1 month.

At this time, it is convenient dry instant porridge, for the preparation of which you only need to mix the dry powder with warm boiled water and stir (the dynamics of the change in the percentage of porridge is the same). The advantage of these products is the guaranteed composition, the safety of infection, as well as the enrichment with essential vitamins, calcium and iron.

After the child has fully adapted to the first type of cooked food, II lure- at approximately 5.5-6 months. If the first was vegetable puree, then the second - porridge and vice versa. II complementary foods gradually replace fourth feeding, those. at 18.00.

Sample nutrition for a child of 6.5 months:

6.00	10.00	14.00	18.00	2200
Gr. Milk -200ml	Vegetable puree -200ml	Gr. Milk -200ml	Rice porridge 10% -200ml	Gr. milk -200md

Thus, with the appointment of I and II complementary foods, the child receives breast milk 3 times a day. It is advisable to divide 2 types of complementary foods, providing the breast between them once feeding, since:

At 6 o'clock in the morning, the mother feeds the baby with one breast, and a lot of milk stagnates in the other breast, which she fed the day before;

You should not load the baby's gastrointestinal tract after the first feeding at 10.00 with the second complementary food at 14.00, and thus give him a rest.

In the morning, it is desirable for both the child and the mother to rest, breastfeeding is easier for the mother, and the baby will quickly fall asleep after that. Getting a solid meal at night is a strain on the gastrointestinal tract, and he also needs to rest.

When the second complementary food is introduced in its entirety (for the first and second complementary foods, the child receives vegetable puree at 10.00 and porridge at 18.00, respectively), the time for receiving such types of complementary foods usually changes - at 10.00 the child receives porridge, at 18.00 - vegetable puree.

For 7 months II complementary foods expands and takes the form of a lunch:

child gets a lean broth that is gradually replaces soup, and vegetable puree. The ratio between them by volume approximately 1:2 (soup - 60-70 ml, vegetable puree - 140-130 ml). The food received is called cream soup vegetable.

From 6 months ration II complementary foods are introduced crackers, biscuits (the amount gradually increases from 3-5 g to 10-15 g at the end of 1 year of life). From 7 months baby gets wheat bread - from 5 g to 10 g, respectively. Usually flour products are softened in broth.

From 7 months introduced into feeding chopped meat (from chicken, pork, beef). Starting with small portions -5 g, gradually the one-time reception of minced meat increases to 20 - 30 g.

From 8-9 months a child 1-2 times a week instead of meat can be recommended minced fish.

Given the enzymatic immaturity of the child's gastrointestinal tract, the absence or beginning of teething, the meat must first be given in a well-grated, better homogeneous, form. With age, it is cooked more densely, and by the end of the year the child receives meatballs, cutlets. The maximum amount at this age at one time is 70 g.

At 7-8 months the child is introduced into the diet ІП complementary foods; Until this time, less milk is formed in the mother's breast, its stagnation in the mammary glands is not dangerous, so there is no need to alternate breast milk and complementary foods. The child grows and both d, which she received at 18.00, is transferred to an adult's lunchtime -14.00.

At 18.00 baby gets III complementary foodswhich is already diverse:

Low-fat, 9%, 20% fat cheese (30 g and 50 g until the end of 1 year) and kefir;

Crackers, biscuits, buns drenched in hot milk; thus, whole cow's milk can be given to a child at 7 months;

- for 10 months life can be given the second time a day porridge, nevertheless from other cereals.

Additional nutritional supplements:

Introduction of juices and purees. Fruit and vegetable juices, as a source of vitamins, minerals, trace elements, are shown to a child with the aim of:

Prevention of hypovitaminosis, rickets and anemia;

Positive effect on the secretory and motor functions of the digestive system;

A beneficial effect on the intestinal microflora. This is especially true for water-soluble vitamins. С, В и Р, which are in fruits. Carrot juice rich in carotene - a provitamin of vitamin A.

Juice application rules:

Child gets juice for the first time at 3- 3,5months(i.e. at the 4th month of life); since the child must be very carefully taught to the first completely new product for him, the juice intake begins with several drops per day. At normal child's reaction the number of drops gradually increases, reaching 5 ml, 10 ml; and until the end of 4 months, the child takes 20 ml of juice per day; further monthly volume; the maximum volume of juice until the end of 1 year is 100 ml.

Juices need give immediately or 1-1.5 hours after meals - they contain sugar, which can reduce appetite;

Juice injection begins with one type of fruit, since in the case of an allergic reaction, it will be possible to establish its genesis; addiction takes at least 1, sometimes 2-3 months;

Later other fruit juices are gradually introduced; after getting used to it, it is better to give different juices throughout the day;

In the absence of fresh fruits and vegetables, canned juices can be used;

If the child is prone to constipation better to give carrot, cabbage, beetroot, plum juices:

2-4 weeks after the introduction of the juice the child needs to enter fruit puree... Usually they start with apple. Having accustomed to it, they prepare mashed potatoes from other fruits. Gradually, the amount of puree increases from ½ -1 teaspoon to 30 - 50g in the first half of the year and up to 100 g at the end of the first year.Juice volume is not related to the required daily food volume. Received by the kid mashed potatoes reduce the volume of the other one-time (including other total daily) portion of food for the appropriate amount.

Egg yolk for the first time given to the baby at 6 months together with complementary foods, in one day. It is a source of water-soluble vitamins, fat-soluble A and D, calcium (which is especially effective for the prevention of rickets), iron. The dose is gradually increased from 1/5 up to 1/2 part.

Egg yolk contraindicated children with exudative catarrhal diathesis, as well as in case of an allergic reaction to the yolk.

WITH 5 months a child, especially for the prevention of rickets, rationally introduce boiled liver cooked in the form of minced meat and obtained simultaneously with vegetable complementary foods 2-3 once a week. The daily dose is gradually increased from 5 to 30 g.

Cottage cheese, as a source of proteins, the child receives from 5.5-6 months. The daily dose is gradually increased. from 10 g to 50 g(at the end of 1 year of life).

NATURAL

Rationality in infants is the key to their adequate growth and development, as well as a high quality of life, both in early childhood and in subsequent years.

Composition of human milk

The optimal food product for a child during the first months of life is mother's milk, which corresponds to the characteristics of his digestive system and metabolism, and ensures the adequate development of the child's body with a rational diet of a nursing woman. All nutrients in human milk are easily absorbed, since their composition and ratio correspond to the functional capabilities of the gastrointestinal tract of an infant, as well as due to the presence of enzymes (amylase, lipase, phosphatase, proteases, etc.) and transport proteins in human milk. Breast milk is a source of hormones and various growth factors (epidermal, insulin-like, etc.), which play an important role in the regulation of appetite, metabolism, growth and differentiation of tissues and organs of the child.

Due to the presence of immune complexes, active leukocytes, lysozyme, macrophages, secretory immunoglobulin A, lactoferrin and other biologically active substances, breast milk increases the protective functions of the child's body. Oligosaccharides and low levels of protein and phosphorus in human milk promote the growth of healthy intestinal flora. V last years bifidobacteria and lactobacilli, which determine the development of immunity, are found directly in human milk (Fig. 2).

Therefore, breastfed children are much less likely to suffer from infectious diseases, develop a more persistent post-vaccination.

The protective properties of human milk are not limited only to anti-infective protection. The chest reduces the risk of developing in subsequent years such diseases as atherosclerosis, hypertension, diabetes, obesity, leukemia, etc. Cases of sudden death are less frequently recorded in breastfed children.

Natural feeding has a beneficial effect on the development of the child's central nervous system and his mental status. The union of mother and baby during breastfeeding has a deep, mutual emotional impact. It is noted that children who were fed with mother's milk are distinguished by a harmonious physical development, they are calmer, more balanced, welcoming and kindly desirable compared to children who were bottle-fed, and later they themselves become attentive and caring parents.

According to some reports, children who received breastfeeding have a higher coefficient intellectual development, which is possibly partly due to the presence of long-chain polyunsaturated fatty acids (LPSFAs) in breast milk, which are necessary for the development of brain and retinal cells. In the blood of children who are breastfed, the amount of DPUFA is significantly higher than that of children receiving artificial feeding

Human milk protein consists mainly of whey proteins (70-80%), which contain essential

amino acids in the optimal ratio for the child, and casein (20-30%). Protein fractions of human milk are divided into metabolizable (food) and non-tabolizable proteins (lactoferrin, lysozyme, etc.), which are 70-75% and 25-30%, respectively.

In human milk, unlike cow's milk, there is a large amount of alpha-lactalbumin (25-35%), which is rich in essential and conditionally essential amino acids (tryptophan, cysteine). Alpha-lactalbumin promotes the growth of bifidobacteria, the absorption of calcium and zinc from the child's gastrointestinal tract.

Human milk contains nucleotides, which account for about 20% of all non-protein nitrogen. Nucleotides are the initial components for the construction of ribonucleic and deoxyribonucleic acids; they play an important role in maintaining the immune response, stimulating the growth and differentiation of enterocytes.

The main components of human milk fat are triglycerides, phospholipids, fatty acids, and sterols. Its fatty acid composition is characterized by a relatively high content of essential polyunsaturated fatty acids (PUFA), the concentration of which in human milk is 12-15 times higher than in cow's milk. PUFA - precursors of arachidonic, eicosapentaenoic and docosahexaenoic fatty acids, which are an important component of cell membranes, are formed from different classes prostaglandins, leukotrienes and thromboxanes, they are also required for myelination of nerve fibers and the formation of the retina.

Long chain polyunsaturated fatty acids - arachidonic and docosahexaenoic are found in human milk in small amounts (0.1-0.8% and 0.2-0.9% of the total fatty acids, respectively), but significantly higher than in cow's milk.

Fats from mother's milk are digested more easily than cow's milk, since they are more emulsified, in addition, the enzyme linden is contained in breast milk, which is involved in the digestion of the fatty component of milk, starting from the oral cavity.

The cholesterol content in human milk is relatively high, ranging from 9 to 41 mg%, stabilizing by 15 days of lactation at the level of 16-20 mg%. Breastfed babies have higher cholesterol levels than infant formula. Cholesterol is essential for the formationcell membranes, tissues of the nervous system and a number of biologically active substances, including vitamin D.

Human milk carbohydrates are represented mainly by the disaccharide L-lactose (80-90%), oligosaccharides (15%) and a small amount of glucose and galactose. Unlike a-lactose in cow's milk, b-lactose in human milk is slowly broken down in the baby's small intestine, partially reaching the large intestine, where it is metabolized to lactic acid, promoting the growth of bifidobacteria and lactobacilli. Lactose promotes better absorption of minerals (calcium, zinc, magnesium, etc.).

Oligosaccharides are carbohydrates containing from 3 to 10 monosaccharide residues that are not degraded by digestive tract enzymes, are not absorbed in the small intestine and reach the lumen of the large intestine unchanged, where they ferment, being a substrate for the growth of bifidobacteria. In this case, there is a competitive inhibition of the development of conditionally pathogenic flora. In addition, human milk oligosaccharides have receptors for bacteria, viruses (rotaviruses), and toxins, thereby blocking their binding to the enterocyte membrane. The considered functions of oligosaccharides, as well as lactose, underlie the prebiotic effects of human milk, largely determining its protective effect against intestinal infections in infants.

The mineral composition of human milk significantly differs from cow's milk, which contains 3 times more salts, mainly due to macronutrients. The relatively low mineral content in human milk ensures its low osmolarity and reduces the burden on the immature excretory system. Macronutrients include calcium, phosphorus, potassium, sodium, chlorine and magnesium. The rest of the minerals are trace elements and are present in the tissues of the human body in small quantities. Ten of them are currently classified as essential: iron, zinc, iodine, fluorine, copper, selenium, chromium, molybdenum, cobalt and manganese.

Mineral substances enter the body with food and water, and are excreted in urine, feces, sweat, desquamated epithelium and hair.

It is assumed that iron, calcium, magnesium, zinc are absorbed much better from human milk than from cow's milk. This is primarily due to their optimal ratio with other minerals (in particular, calcium with phosphorus, iron with copper, etc.). High bioavailability of microelements is also provided by transport proteins of human milk, in particular, lactoferrin - an iron carrier, ceruloplasmin - copper. The low level of iron in human milk is compensated by its high bioavailability (up to 50%).

Lack of microelements, which are regulators of metabolic processes, is accompanied by a decrease in the adaptive capabilities and immunological protection of the child, and their pronounced deficiency leads to the development of pathological conditions: disruption of the processes of building the bone skeleton and hematopoiesis, changes in the osmotic properties of cells and blood plasma, a decrease in the activity of a number of enzymes.

All water and fat-soluble vitamins are present in human milk. The concentration of vitamins in milk is largely determined by the nutrition of the nursing mother and the intake of multivitamin preparations. It should be emphasized, however, that the level of vitamin D in human milk is extremely low, which requires additional administration to breastfed children.

Vitamin deficiency leads to disorders of enzymatic activity, hormonal dysfunctions,

decrease in the antioxidant capabilities of the child's body. In children, polyhypovitaminosis is more common, and isolated deficiency of one micronutrient is less common.

The composition of human milk changes during lactation, especially during the first days and months of breastfeeding, which makes it possible to fully meet the needs of the infant. A small volume of milk (colostrum) in the first days of lactation is compensated by a relatively high content of protein and protective factors; in the following weeks, the concentration of protein in human milk decreases and remains practically unchanged in the future. The most labile component of human milk is fat, the level of which depends on its content in the diet of a nursing mother and changes both during each feeding, increasing towards its end, and throughout the day. Carbohydrates are a more stable constituent of human milk, but their levels also change during feeding, being highest in the first milk portions.

Organization of breastfeeding

In the maternity hospital with the aim of becoming a sufficient volume and duration of lactation healthy newborn the baby should be laid on the mother's breast in the first 30 minutes after an uncomplicated birth for a period of at least 30 minutes.

THE ARGUMENTATION OF THIS METHOD INCLUDES THE FOLLOWING PROVISIONS:

1. Early attachment of the baby to the mother's breast ensures a quick activation of the mechanisms of milk secretion and a more stable subsequent lactation;
2. Sucking the baby promotes vigorous release of suoxytocin and thereby reduces the risk of blood loss in the mother, promotes earlier contraction of the uterus;
3. Mother-child contact: - has a calming effect on the mother, disappears

stress hormonal background; - promotes through imprinting mechanisms the strengthening of the feeling of motherhood, increasing the duration of breastfeeding; - ensures that newborns receive mothers

Coy microflora. The volume of colostrum on the first day is very small, but even drops of colostrum are extremely important for a newborn baby. It has a number of unique properties:

• contains more leukocytes and other protective factors than mature milk, which largely protects the child from intensive bacterial contamination, reduces the risk of purulent-septic diseases;
• has a mild laxative effect, thanks to this, the child's intestines are cleansed of meconium, and with it of bilirubin, which prevents the development of jaundice;
• promotes the formation of optimal intestinal microflora, reduces the duration of the phase of physiological dysbiosis;
• contains growth factors that affect the maturation of the child's intestinal functions. To ensure that the baby can receive as much colostrum as possible, the frequency of breastfeeding should not be regulated. For the purpose of free feeding on demand, healthy

the child must be in the same room as the mother. It has been shown that with free feeding, the volume of lactation is higher than with feeding by the hour. Early latching on to the breast and "free feeding" are key factors in ensuring full lactation and promote the establishment of close psycho-emotional contact between mother and child.

Night feeds are especially important for maintaining lactation, since prolactin levels are higher at night. The duration of the attachment of a healthy baby to the breast in the first days should not be limited, even when he practically does not suck anything, but slumbers at the breast. The need for contact and sucking can be independent, relatively independent of eating behavior. However, in the future, excessively frequent attachment of the baby to the mother's breast at the slightest anxiety can lead to overfeeding. In this regard, one of the important tasks of pediatricians, especially district ones, is to teach the mother to differentiate the “hungry” cry of the child from the cry caused by other reasons: infant colic, discomfort, change of environment, overheating or cooling of the child, pain, etc. ...

Assessment of the adequacy of lactation requires a careful analysis of the child's behavior, the nature of the stool, and the frequency of urination. Likely signs of insufficient lactation are:

• restlessness and cry of the baby during or immediately after feeding;
• the need for frequent breastfeeding;
• long-term feeding, in which the child performs many sucking movements, in the absence of swallowing;
• a feeling by the mother of a quick complete emptying of the mammary glands during active sucking of the child, when expressing after feeding there is no milk;
• restless sleep, frequent crying, "hungry" cry;
• scanty sparse stools However, the most reliable signs of malnutrition are low weight gain and infrequent urination (less than 6 times per day) with the release of small amounts of concentrated urine. The final conclusion about insufficient lactation can be made on the basis of the results of weighing the child at home after each feeding during the day ("control" weighing).

In some cases, even with a sufficient amount of milk, the mother cannot breastfeed:

• baby breastfeeds but does not suck, swallow, or suck very little;
• when the mother tries to breastfeed, the child screams and resists;
• after a short sucking, it comes off the breast, choking from crying;
• the baby picks up one breast but refuses the other. The reasons can be different, among which the most common are:
• violations of the organization and technique of feeding (incorrect position of the baby at the breast);
• excess milk from the mother, in which it flows too quickly;
• teething,
• diseases of the child (perinatal damage to the nervous system, partial lactase deficiency, gastrointestinal food allergy, acute respiratory viral infection, otitis media, thrush, stomatitis, etc.). Finding out the reason and carrying out if necessary

True (or) hypogalactia is rare, in no more than 5% of women. In other cases, a decrease in milk production is caused by various reasons, the main of which are: the absence of a dominant lactation (psychological mood) in a woman due to poor preparation during pregnancy, as well as emotional stress, early and unreasonable introduction of supplementary feeding with infant formula, the need for going to work, child's illness, mother's illness, etc.

In a number of cases, hypogalactia is of a transient nature, manifesting itself in the form of so-called lactation crises, which are understood as a temporary decrease in the amount of milk that occurs for no apparent reason. Lack of information about them and lack of knowledge of methods of correction are the most frequent factors of termination of breastfeeding.

Lactation crises are based on the features of hormonal regulation of lactation. They usually appear at 3-6 weeks, 3, 4, 7, 8 months of lactation. The duration of lactation crises is on average 3-4 days, and they do not pose a danger to the health of the child. In such cases, more frequent latching to the breast in combination with feeding from both breasts is sufficient. Peace and rest of the mother is necessary; varied, nutritious food with high taste; Warm drinking of beverages, especially with the use of lactogonic herbs or preparations 15-20 minutes before feeding, as well as special products of lactogonic action.

If the mother is not prepared in advance for such a situation, then at the first signs of a decrease in lactation, she tries to feed the baby with formulas. Therefore, one of the important tasks of the district doctor and nurse of the children's polyclinic is to explain the safety of short-term lactation crises.

Measures used for secondary hypogalacia (lactation crises):

• more frequent breastfeeding;
• regulation of the mother's regimen and nutrition (including the optimal drinking regime due to the additional use of at least 1 liter of liquid in the form of tea, compotes, water, juices);
• impact on the psychological mood of the mother;
• orientation of all family members (father, grandmothers, grandfathers) to support breastfeeding;
• cold and hot shower on the area of ​​the mammary glands, gently rubbing the breast with a terry towel;
• the use of special drinks with lactogonic action; At the same time, infant milk formulas are not introduced into a child's diet without a doctor's recommendation.

Numerous observations show that sufficient production of breast milk mainly depends on the mother's “attitude” towards breastfeeding her baby, her conviction that it is important and necessary and that she is able to do it .. More successful development of lactation and its continuation take place in conditions where, in addition to the mother's desire and confidence, she is actively supported by all family members, as well as professional advice and practical assistance from medical workers. It is advisable that training for women on breastfeeding takes place during pregnancy in the "School of Pregnant Women".

Doctors and nurses play an important role in promoting breastfeeding, who should actively encourage family and social support for breastfeeding, provide parents with

complete information about its comprehensive positive effect on the child's body and advantages over infant formula. To carry out activities for the successful establishment and maintenance of natural feeding practices, all medical workers those related to childbirth and medical supervision of infants should have the ability to provide practical assistance to the mother on breastfeeding.

In accordance with the international WHO / UNICEF program “Protection, promotion and support of breastfeeding practices”, which sets out the main provisions in the form of ten principles of successful breastfeeding, the Ministry of Health of the Russian Federation has developed a breastfeeding support program and approved a number of normative methodological documents (1994, 1996, 1998, 1999, 2000). According to these documents, it is recommended to carry out the following work to support natural feeding in medical and prophylactic institutions for obstetrics and childhood:

• have readily available printed information on breastfeeding practices that should be communicated regularly to all health care personnel;
• inform all pregnant women about the benefits of breastfeeding and the need for early attachment of the newborn to the mother's breast (within the first 30 minutes after birth);
• to provide round-the-clock joint stay of mother and child in the ward "mother and child" maternity hospital and encourage breastfeeding as requested by the child;
• teach mothers how to breastfeed and maintain lactation;
• strive to carry out exclusive breastfeeding during the first 4-6 months of life, that is, do not give healthy newborn babies any food other than breast milk, except for cases due to medical reasons;
• to ensure continuity in the work of the women's consultation, the obstetric hospital, the children's polyclinic and the children's hospital. These activities must be carried out taking into account the health status of both the mother and the child.

Possible contraindications to breastfeeding on the part of the mother are: eclampsia, severe bleeding during childbirth and in the postpartum period, an open form, a state of severe decompensation in chronic diseases of the heart, lungs, kidneys, liver, as well as hyperthyroidism, acute mental illnesses , especially dangerous infections (typhus, etc.), herpetic eruptions on the nipple of the mammary gland (before their further treatment), HIV infection.

It has now been established that an HIV-infected woman has a 15% chance of infecting her baby through breast milk. In this regard, in the Russian Federation, children born to HIV-infected mothers are recommended to be fed with adapted formulas.

With such diseases of a nursing mother as rubella,,, epidemic, cytomegalovirus infection, herpes simplex, acute intestinal and acute respiratory viral infections, if they proceed without pronounced, breastfeeding, subject to the rules of general hygiene, is not contraindicated. The presence of hepatitis B and C in women is currently not a contraindication to breastfeeding

feeding, however, feeding is carried out through special silicone pads. In case of acute hepatitis A in the mother, breastfeeding is prohibited.

With mastitis, breastfeeding continues. However, it temporarily stops when a massive growth of Staphylococcus aureus in breast milk is detected in the amount of 250 CFU or more in 1 ml and single colonies of representatives of the Enterobacteriacae family or the species Pseudomonas aeruginosa (Guidelines for bacteriological control of breast milk, Moscow, 1984). breast is a possible complication of mastitis and is most likely when breastfeeding is abruptly interrupted. Feeding from the healthy gland should continue, and milk from the infected breast should be carefully expressed and discarded.

Stop breastfeeding when the mother takes therapeutic doses of cytostatics, immunosuppressive drugs, anticoagulants such as phenindione, radioisotope contrast agents for treatment or examination, lithium preparations, most antiviral drugs (except for acyclovir, zidovudine, zanamivir, limovudine, oseltamivir - caution), anthelmintic drugs, as well as some: (, midecamycin, roxithromycin, spiramycin), tetracyclines, quinolones and fluoroquinolones, glycopeptides, nitroimidazoles, chlorine mphenicol,. However, drugs alternative to the listed antibiotics are not contraindicated for breastfeeding.

Short courses of paracetamol, acetylsalicylic acid, ibuprofen, used in medium doses, are usually safe; most antitussive medicines; - and other penicillins,; (except for rifabutin and); antifungal agents (except for fluconazole, griseofulvin, ketoconazole, intraconazole); antiprotozoal drugs (except for metronidazole, tinidazole, dihydroemetin, primaquine); bronchodilators (); corticosteroids; antihistamines; antacids; antidiabetic agents; most antihypertensive drugs, digoxin, as well as single doses of morphine and other drugs. At the same time, while the mother is taking medications, it is necessary to carefully monitor the child in order to detect their side effects in a timely manner.

It is possible to suppress lactation when a woman takes estrogens, including estrogen-containing contraceptives, thiazode diuretics, ergometrine.

Transfer of an infant, especially a newborn, to artificial feeding due to drug treatment mothers with medicinal preparations in a therapeutic dosage carries a certain threat to his health and quality of life.

Given the negative effects of tobacco smoke, tar and nicotine on the child's body and on lactation, women who smoke during lactation are advised to quit smoking. Nicotine can reduce the volume of milk produced and inhibit its production, as well as cause irritability in the baby, intestinal cramps and lead to low rates of weight gain during infancy. Women who smoke have lower prolactin levels, which can shorten the lactation period, and have a lower concentration of vitamin C in breast milk compared to nonsmokers. Women who smoke should be motivated to quit smoking, or at least significantly reduce the number of

smoked cigarettes. The content of harmful substances in breast milk will be less if a woman smokes a cigarette after breastfeeding, and not before.

Mothers suffering from alcohol and drug addiction (heroin, morphine, methadone or their derivatives) should not breastfeed.

Breastfeeding may continue during a new pregnancy.

Contraindications to early attachment to the mother's breast by the child - assessment of the condition of the newborn on a scale below 7 points in severe newborn, birth trauma, convulsions, respiratory distress syndrome, as well as deep prematurity, severe malformations (gastrointestinal tract, maxillofacial apparatus, heart, etc.).

Until very recently, delivery by cesarean section was also among the contraindications to the early attachment of the child to the mother's breast. However, if this operation is performed under epidural anesthesia, it is possible to attach the baby to the breast in the delivery room. If the delivery was carried out under anesthesia, then after the end of the operation the postpartum woman is transferred to the intensive care unit of the maternity hospital, and the baby to the children's ward of the postpartum department. A few hours (no more than 4) after the end of the anesthesia, the nurse brings the newborn to the mother and helps her attach it to the breast. This is repeated several times during the first day. On the second day, when the mother and baby are in a satisfactory condition, they are reunited in the postnatal department of the joint stay of the mother and child.

With a number of severe congenital disorders (heart defects with decompensation, cleft palate, cleft lip, etc.), when latching on to the breast is impossible, the child should receive expressed breast milk. Absolute contraindications to breastfeeding by a child at subsequent stages of lactation are very limited - hereditary enzymes (and others). In phenylketonuria, the volume of breast milk in combination with medicinal products is set individually.

It is necessary to dwell on the issues of supplementing children who are exclusively breastfed. The practice of domestic pediatricians shows that newborns and older children who are breastfed sometimes need liquid. This condition may be associated with low humidity in the apartment, high ambient temperature, abundant fatty foods eaten by the mother the day before, etc. In these situations, you can offer the child water from a spoon, and if he began to drink willingly, it means he needed it. ... In addition, supplementation is necessary for sick children, especially in diseases accompanied by high fever, diarrhea, vomiting, hyperbilirubinemia.

Currently, there are more than 50 diseases that in children in the neonatal period can manifest as icteric staining of the skin. Therefore, long-term preservation of jaundice in a newborn requires mandatory examination.

Even with severe physiological jaundice in children in the first days of life, breastfeeding should not be abandoned. Early attachment of the baby to the breast and frequent feedings are an important factor in the prevention of jaundice, since colostrum, having a laxative effect, leads to a more rapid passage of meconium. With insufficient nutrition of the newborn child, it can be more intense and prolonged due to the thickening of bile. Supplementation with water or glucose solutions does not help to prevent jaundice, but reduces the degree of its severity. It is important that the baby gets an adequate amount of milk, as bile thickening syndrome develops with inadequate nutrition.

Associated with breastfeeding - from breast milk or jaundice of Arias develops in 1-4% of children after the first week of life, is characterized by an increase in the level of unbound bilirubin and does not affect the child's condition. The pathogenesis has not been sufficiently studied, it is assumed that it is associated with various components of breast milk. You can get confirmation of the diagnosis by stopping the attachment of the baby to the breast and using pasteurized breast milk for feeding for 1-2 days. During this time, the intensity of jaundice is significantly reduced and breastfeeding can be continued.

It is advisable to breastfeed a child with hyperbilirubinemia due to ABO incompatibility from birth, since those contained in milk are destroyed by hydrochloric acid and enzymes of the digestive system. In case of Rh conflict, if the child has not undergone a replacement blood transfusion, then during the first 10-14 days he is fed with pasteurized (antibodies are destroyed during pasteurization) mother's or donor milk. In cases of replacement blood transfusion, the child can be applied to the breast 3-5 hours after the operation.

It is advisable to continue breastfeeding until 1-1.5 years of age, and the frequency of breastfeeding after a year decreases to 1-3 times a day.

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 corresponds to 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;
• Breast milk contains substances that regulate the growth, development of the child and ensure the correct formation of his brain and intelligence (hormones, growth factors, taurine, zinc, iodine, etc.);
• In the process of breastfeeding between mother and baby there are very special close relations, the warmth of which remains throughout the rest of life;
• Breastfeeding is good for the health of the mother because it contributes to the contraction of the uterus after childbirth, helps to restore the figure and is the best prevention of mastopathy and breast cancer.

Breastfeeding is a physiological phenomenon for mothers and babies and therefore cases of true milk shortages are rare. The period of recovery of lactation in the mother is most responsibly observed - the first 3-4 months after childbirth. The following guidelines can be recommended for successful breastfeeding:

• early attachment of the baby to the breast (in the delivery room);
• in the first weeks, it is advisable to provide the child with a free feeding regime (at the request of the child) and only later transfer the child to food by the hour, which he himself chose;
• when introducing complementary foods, to prevent the extinction of lactation, it is recommended to put the baby to the breast at the end of each feeding;
• if there is not enough milk, it is necessary to frequently breastfeed the baby. It must be remembered that for nursing baby every drop of mother's milk is priceless. However, frequent breastfeeding can increase milk production in the breast.

NUTRITION OF A NURSING MOTHER. A nursing mother must necessarily receive a full-fledged balanced diet, since a woman spends additional energy and nutrients for the formation of milk, and, therefore, it is necessary to replenish these costs.

The calorie content of the mother's diet during lactation should be increased by an average of 30-40% and be 2500-3000 kcal / day. The amount of protein should be about 100 g (60-70% of animal origin), fats - 85-90 g (15-20 g - vegetable fat), carbohydrates - 300-400 g. power supply RAMS an approximate daily set of products, which includes: 200 g of meat or poultry, 70 g of fish, up to 600 ml. milk in any form (preferably the use of fermented milk products, 50 g of cottage cheese, 20 g of cheese, 400 g of various vegetables, 200 g of potatoes and 200-300 g of fruits and berries.

Vegetables are best consumed in their natural form or in the form of salads and vinaigrettes. Of the cereals, it is most advisable to use oatmeal and buckwheat. We recommend coarse bread with the addition of bran. Avoid hot spices, excess spices, large amounts of onions and garlic, which give the milk a specific taste and smell. During breastfeeding, it is necessary to limit the use of foods with increased allergenic properties: chocolate, cocoa, natural coffee, citrus fruits, honey, nuts. Alcoholic drinks, including beer, are strictly prohibited for a nursing mother.
A woman is recommended to eat 5 times a day for 30-40 minutes. Before breastfeeding.
The amount of liquid (including soups, vegetables, etc.) should be an average of 2 liters.
During breastfeeding, mothers should take any multivitamin preparation containing vitamin D (for example, Gendevit - 2 tablets per day).

LURE. VIEWS. RULES OF INTRODUCTION. Complementary feeding is an independent type of nutrition that replaces one, and then several feedings with breast milk or mixtures. Talk to your pediatrician about prescribing complementary foods. The introduction of complementary foods is due to:

• an increase in the growing baby's need for energy and basic food ingredients (P.Zh.U.);
• an increase in the child's body needs for minerals (iron, calcium, magnesium) and vitamins;
• the need to train the chewing apparatus;
• the need to stimulate the digestive glands and their gradual adaptation to the digestion of adult food;
• the need to introduce plant fibers that play important role in the correct functioning of the child's gastrointestinal tract;
• the need to educate the child in the skills of consuming new types of food, including a thicker consistency, which prepares him for weaning.

BASIC RULES FOR INTRODUCING BAITS.

• Start introducing complementary foods only to a healthy child or, in extreme cases, during the recovery period, with normal stool;
• it is recommended to give the first complementary food during the second feeding;
• complementary foods are introduced warm before breastfeeding or formula;
• complementary foods are given from a spoon, vegetable puree can first be added to a bottle of milk, so that the child can more easily get used to the new taste;
• each meal of complementary foods is introduced gradually, with small amounts (1-2 teaspoons) and within two weeks is brought to the age dose;
• they switch to a new type of complementary foods 1.5-2 weeks after the introduction of the previous one;
• the density of complementary foods should gradually increase;
• as the first complementary food, it is recommended to introduce vegetable puree;
• the second complementary food - cereal porridges - you need to start with gluten-free cereals (rice, corn, buckwheat) and cook them in the milk or milk mixture that the child receives;
• canned baby food contains an optimal amount of salt and sugar and therefore should not be added.

DIFFERENT FEEDING PERIODS FOR A CHILD. The processes of assimilation of food in the human body are quite complex, and in children of the first year of life, given their intensive growth, insufficient maturation of the formations of all organs and systems, they proceed with a particularly heavy load.

We can conditionally distinguish several periods of nutrition for children:
1.from 0 to 3-6 months when the baby receives only milk;
2. from 3-6 months to 1 year - transitions, during which complementary foods are gradually introduced into the child's diet;
3.from 1 to 3 years old - early childhood when the child gradually and carefully gets used to traditional family dishes;
4.5. preschool (from 3 to 6 years old) and school (from 7 to 14 years old), characterized by a wide range of foods and dishes used in nutrition, which basically do not differ from those that adults receive.

1 period.
If a child is breastfed, then up to 3 months it is impractical and even harmful to include other products in the diet in addition to milk. It may be necessary to include vitamin D. In the absence of human milk, commercial substitutes should be the staple food.

2 period.
Breast milk or breast milk substitutes continues to be the mainstay of the baby's nutrition. The recommended daily dose, depending on the age of the child, ranges from 400 to 800 ml. milk. The number of foods that are primarily included in the diet of children as a supplement to breast milk or its substitutes are fruit juices. This is primarily due to the fact that they have the same liquid consistency familiar to a baby as milk. At the same time, the introduction of juice allows you to provide the child with a number of new nutrients for him, which he needs; sugars new to the baby (glucose, fructose), organic acids (citric, malic); promotes the assimilation of milk nutrients, as well as additional amounts of vitamin C, potassium, iron. Taking into account the unfavorable environmental situation, it is most advisable to introduce natural juices of industrial production into the diet of babies. Juices should be introduced into the diet gradually, starting with two teaspoons, and increased within 2-3 weeks to 30-40 ml, and then by 8-10 months to 80-100 ml. in a day.
With natural feeding, juices should be introduced into the child's diet no earlier than 3 months of life.
It is advisable to introduce ordinary juice into the child's diet first, which is characterized by low acidity and low potential allergenicity, then pear, plum, apricot, peach, raspberry, cherry, blackcurrant, orange, tangerine, strawberry juices, which are among the products with potentially high allergenicity, can be recommended that should not be given earlier than 6-7 months. This also applies to tropical juices and juices from other exotic fruits (papaya, mango). The introduction of juices should be made from one type of fruit (to exclude its possible allergenic effect) and only after getting used to it, you can introduce mixed fruit juices into the diet of babies.

3 period, 4 period, 5 period.
From one year on, the baby usually no longer receives breast milk and can eat the same foods as an adult. However, one should avoid giving dried fruit, which can only be introduced after 18 months. Shrovetide fruits (peanuts, almonds and others) are practically prohibited for up to 5 years. Sausages can be given in very small quantities. It is better to give chocolate and chocolates to children after 5 years of age, but before this age, crush the child with marshmallows, marmalade, marshmallow, honey, jam, jam. In order to instill good habits in a future adult, you do not need to add too much sugar and salt to food, you should limit the consumption of fatty foods and sauces. Eggs are best used no more than twice a week, boiled or fried.

Fruit puree should be recommended for breastfed babies 2-3 weeks after juicing, that is, at 3.5-4 months, using roughly the same range of fruits as for juices. And in this case, we recommend baby puree industrial production, guaranteeing the desired composition and safety.

At 4.5-5 months, a thicker food can be introduced into the child's diet - complementary foods. Vegetable purees are prescribed in the amount of the first complementary foods. The introduction of vegetable complementary foods from one type of vegetables (for example, potatoes, zucchini), then moving on to a mixture of vegetables with a gradual expansion of the range and introduction into the diet: cauliflower, pumpkin, white cabbage, carrots, later tomatoes, green peas.

It is better to start introducing cereal complementary foods (milk porridge) 3-4 weeks after the introduction of vegetable puree. However, in cases where the child is poorly gaining body weight, there is an unstable stool, you can begin the introduction of complementary foods with milk porridge, and only then introduce vegetable puree. The first to give cereals that do not contain gluten (a special type of proteins, cereals) that can cause a child's intestinal disease - sticking - rice, corn, buckwheat. Porridge should be included in the diet gradually. In the beginning, you should add one teaspoon in the evening feeding, 2-3 teaspoons to increase the calorie content of food.

Then, within two weeks, cereals are introduced into the morning feeding in the form of a thick milk mixture, which is given to the child from a spoon. After the introduction of the first type of cereal porridge, having endured a two-week period of adaptation, the child is taught to a different kind of porridge.

Cottage cheese should be prescribed to healthy, normally developing children no earlier than 5-6 months, since mother's milk, in combination with complementary foods already assigned by this time, can, as a rule, satisfy the child's need for protein, an additional source of which is cottage cheese.

When breastfed, the yolk should be prescribed from 6 months of age. Its earlier introduction quite often leads to the occurrence of allergic reactions in children.

Meat should be introduced into the child's diet from 7 months, starting with meat or meat-vegetable puree (meat with vegetables and cereals), which are later replaced by meatballs (8-9 months) and steam cutlets (by the end of the first year of life). From 8-9 months, fish can be recommended.

From 7.5-8 months, a child can be given kefir, cow's milk or other fermented milk mixture as complementary foods. Instead of cow's milk, it is better to use specialized milk formulas, the so-called "follow-up formulas", which are special products instead of milk, but with a reduced protein level compared to cow's milk and an optimized fatty acid and vitamin composition.

TEN GOLDEN RULES FOR BABY FOOD.

1. Mother's milk or its milk substitutes for babies first age group, and then milk formulas for children of the second age group (subsequent formulas) are given a primary role in the nutrition of children up to 12 months.
2. It is also better for children from one to 3 years old to give not ordinary cow's milk, but special powdered milk for children, or continue to give special milk formulas intended for children over 6 months old (subsequent formulas).
3. It is necessary from the very first months of a child's life to limit the consumption of salty, fatty and sweet foods. Correct education of taste is the key to preventing obesity and other diseases.
4. A child should drink relatively much, more than an adult.
5. A balance is needed in both the quality and quantity of the products used. Food intake should not be increased under the pretext of stimulating the growth of the child.
6. The food of a child under three years of age, in quality, quantity and consistency, should be different from the food of an adult.
7. Premature, ahead of the child's needs, the introduction of foods that do not correspond to his age into the diet is not only inexpedient, but, moreover, entails many undesirable consequences.
8. When organizing food, it is necessary to adapt to the individual natural rhythm of the child's life.
9. You cannot force a child to eat. For a child, the satisfaction of food and the variety of food should be inextricably linked.
10. You should not prematurely give up food, the recipe of which is specially designed for children (instant porridge, canned puree in jars).