The mammary gland reaches its greatest development during pregnancy and after childbirth. 4 phases can be distinguished in the development of the mammary gland:

Mammogenesis (phase of breast development);

Lactogenesis (milk secretion);

Galactopoiesis (accumulation of secreted milk);

Automatic secretion of the mammary gland.

WHO/UNICEF Declaration.

SECURITYANDSUPPORTCHESTFEEDING, SPECIALROLEMATERNITY CARESERVICES (1989 G.)

The Declaration proclaims ten principles of successful breastfeeding

infant feeding:

Strictly adhere to the established rules of breastfeeding and regularly bring these rules to the attention of medical staff and women in labor.

Train medical staff in the necessary skills to practice breastfeeding.

Inform all pregnant women about the benefits and techniques of breastfeeding.

Help mothers initiate breastfeeding within the first half hour after birth.

Show the mother how to breastfeed her baby and how to maintain lactation.

Do not give newborns any food or drink other than breast milk.

Practice keeping mother and newborn in the same room 24/7.

Breastfeed at the baby's request, not on a schedule.

Do not give breastfed newborns any sedatives or breastfeeding devices.

10. Encourage the organization of breastfeeding support groups and refer mothers to these groups after discharge from the maternity hospital.

BIOLOGICAL FEATURES OF WOMEN'S MILK

Breastfed children are 3 times less likely to suffer from intestinal infections, 2.5 times less likely to suffer from infectious diseases, and 1.5 times less likely to suffer from respiratory diseases.

Colostrum and human milk contain antibodies to intestinal infections (to the O-antigen of salmonella, Escherichia, Shigella, cholera, rotoviruses, enteroviruses), respiratory infections (influenza, reovirus infection, hemophilus, influenza, chlamydia, pneumococcus, etc. ), pathogens of viral diseases (poliomyelitis virus, cytomegalovirus, mumps, herpes, rubella, coxsackie and ECHO, etc.), bacterial infections (M-staphylococcus, streptococcus, pneumococcus, tetanus toxin, etc.).

Human milk and especially colostrum contain immunoglobulins of all classes (A, M, G, D), and the content of Jg A in colostrum is significant. This immunoglobulin acts as the body's first defense against invasion of pathogenic microbes.

In the colostrum of postpartum women, the Jg M content is 1.2 times less than in the blood. A child receives about 100 mg of Jg M per day, which is 40-50 times less than Jg A.

Jg D was found in colostrum, but its role has not been sufficiently studied.

In the first month of lactation, human milk contains lactoferrin, which activates phagocytosis and binds iron to intestinal bacteria and thereby blocks the formation of bacterial flora. In cow's milk its content (lactoferrin) is 10-15 times less.

Colostrum contains complement components C 3 and C 4, lysozyme in human milk is 100-300 times higher than in cow's milk. The latter damages the membrane of gram-positive and some gram-negative bacteria. Lysozyme stimulates the formation of salivary amylase and increases acidity in the stomach.

Human milk contains bifidus - a factor, its activity is 100 times higher than in cow's milk. This carbohydrate promotes the formation of milk and acetic acid, due to which the acidic reaction of feces prevents the growth of staphylococcus, shigella, salmonella and escherichia. With natural feeding, the ratio of lactobacilli in the intestines to other microorganisms is 1000:1, with artificial feeding - 10:1. Lymphocytes and monocytes in human milk can produce interferon. Plasma cells, macrophages, neutrophils, lymphocytes are also found in milk; macrophages retain their activity in the stomach and intestines of the child and they are able to synthesize interferon, lactoferrin, lysozyme, complement components C3, C4 and stimulate the growth of intestinal epithelium. Thus, macrophages retain their importance as a protective factor against intestinal infections.

rami, suppressors, memory cells, they produce lymphokines that pass into the child’s blood.

Human milk, unlike cow's milk, contains many hormones of the pituitary gland (GH, TSH, gonadotropin), thyroid gland (T3 and T4), etc.

In addition, human milk contains more than 30 enzymes that are involved in the hydrolysis of milk (proteolytic, lipolytic, etc.), which promotes the autolysis of human milk, ensuring it high level assimilation. Special attention deserves the rapid neuropsychic development of children who are breastfed than children who are bottle-fed. The ability of children to learn at school is higher in children who received mother's milk (they learn mathematics better). This is due to the child receiving essential fatty acids, galactose, as well as the child’s close contact with the mother.

QUANTITATIVEANDQUALITYPECULIARITIESFEMALEMILK

At the end of pregnancy, the first three days after birth, colostrum is released - a sticky, thick yellow liquid caused by fat. Colostrum contains more protein, 2-10 times more vitamin A and carotene, 2-3 times more ascorbic acid, more vitamin B^ and E, 1.5 times more salts than in mature milk. Albumin and globulin fractions of proteins prevail over casein. There is especially a lot of immunoglobulin A in colostrum. The fat and milk sugar content in colostrum is lower than in mature milk. There are colostrum bodies filled with fat droplets, these are degenerated leukocytes, macrophages and lymphocytes, B-lymphocytes, secretory Jg A, forming local immunity of the intestines and mucous membranes. Colostrum proteins can be absorbed unchanged in the stomach and intestines, because they are identical to the proteins in the child's blood serum.

As can be seen from Table 1, human milk contains almost 2 times less protein and ash, but more carbohydrates (lactose) than cow's milk. The amount of fat is no different from cow's milk. Human milk from

It has low ash content, which is important for the functioning of the kidneys. The ratio of the amount of whey lactoalbumin and lactoglobulin to caseinogen is 3:2, in cow's milk - 1:4. This affects the curdling of milk in the stomach, casein produces large flakes, and albumin produces small flakes, as a result of which the surface available for hydrolysis by enzymes increases.

Table 1

Dynamics chemical composition human milkduring its maturation (per 100 ml)

Due to the biological proximity of the structure of human milk proteins to the proteins of the child’s blood serum, 1/3 of them are absorbed by the gastric mucosa and pass into the blood in a slightly changed form.

The main components of human milk fat are triglycerides (stearic and palmitic acid); in breast milk, the content of palmitic acid is lower, which facilitates easy hydrolysis. The nutritional value of cow's milk triglycerides is lower than that of human milk. The fat composition of human milk is dominated by unsaturated essential fatty acids; they are not synthesized in the human body, and cow's milk contains a negligible amount of them. Significantly more essential content fatty acids, which is important for the development of the brain, the retina of the eyes, the processes of electrogenesis in the muscle tissue of the heart and nerve cells of the brain.

The source of milk sugar (lactose) formation in the mammary gland is glucose. Human milk contains prostaglandins E and F. Great importance has a high concentration of phosphatides in human milk fat; colostrum contains 6.1% phosphatides, and cow milk contains 0.049-0.0058%. Phosphatides cause the pylorus to close when food passes into the duodenum, which ensures uniform evacuation from the stomach. Among phosphatides, lecithin occupies the main place; it limits the deposition of ballast fat and promotes protein synthesis in the body.

The fat absorption coefficient of human milk is 90%, and that of cow's milk is less than 60%. This is due to the content of the enzyme lipase, which breaks down the fat of milk, which is why fat digestion and absorption are easier during natural feeding.

The amount of milk sugar (lactose) in human milk is greater than in animal milk. Human milk contains -lactose, while cow's milk contains -lactose. -lactose is absorbed more slowly in the small intestine and has time to reach the colon, where it stimulates the growth of gram-positive bacterial flora. -lactose stimulates the synthesis of B vitamins and affects the composition of lipids.

Of great importance is the presence of oligoaminosaccharide in human milk, which stimulates the growth of bifidobacteria (bifidus factor). Bi-fidogenicity breast milk 40 times higher than cow's. The predominant content of lactose among sugars has an important biological significance due to the presence of galactose, which promotes the synthesis of galactose-cerebrosides in the brain.

Human milk has low ash content, the ratio of calcium and phosphorus in human milk is 2 - 2.5: 1, in cow's milk 1:1. This affects their absorption and assimilation.

Human milk contains significantly more fat-soluble vitamins (A, D, E) than cow's milk.

Thus, in the process of evolution, human milk has acquired a number of biological properties that contribute to the normal development of the child. Human milk is for the baby. Cow's milk is for the calf!

Breastfeeding is the “gold standard” of nutrition for children under one year of age.

NUTRITIONPREGNANTANDNURSINGWOMEN

In the 2nd half of pregnancy and during breastfeeding, a woman’s need for basic food ingredients, minerals, vitamins and energy increases. The calorie content of a pregnant woman's diet should increase by 300 kcal by the 2nd - 3rd trimester due to additional protein (15%), fat (31%), and carbohydrates (55%).

Table 2

A woman’s daily requirement in the 2nd half of pregnancy and during lactation for basic nutrients and energy

Table 3

Approximate daily food intakein the second half of pregnancy and lactation

NATURAL FEEDING

Table 4

Nutrient needs of children of the first year of lifeand their content in breast milk (per 100 ml)

When breastfeeding, the main source of micronutrients for the baby is mother's milk.

If the intake of iodine through breast milk decreases, the child develops a goiter, which in turn leads to impaired physical and intellectual development and reduces its resistance to damaging environmental factors. The problem of adequate provision of a child with iodine in the first year of life is a priority task. It is generally accepted to carry out iodine prophylaxis among nursing mothers throughout the entire lactation period. For this purpose, the drug “Iodide-200” produced by MERK (Germany) is used in a dose of 1 tablet per day. This ensures that the child’s need for iodine is met and prevents the development of goiter in mothers, covering the increased need for iodine during lactation.

What WHO recommendations on breastfeeding should every expectant and established mother know? What are the tips? World Organization Healthcare? How are they justified and supported? Ten principles for successful breastfeeding in recommendations adopted by the international community.

In 2003, at the international conference of the World Health Organization in Geneva, the Global Strategy for Infant and Young Child Feeding was adopted. The document is intended to systematize and organize the knowledge of the international community about the value of breastfeeding. And to convey to medical personnel in all countries of the world the need to maintain it through training and informing mothers.

Ideal nutrition - saving lives

In 2000, WHO and UNICEF specialists began a large-scale study to find out how breast milk actually affects children in the first year of life. The results of the study were stunning.

• Depriving children of the first six months of life from breastfeeding greatly increases the risk of mortality as a result of dangerous diseases. About 70% of children in the first year of life living in developing, socially disadvantaged countries of the world, suffering from diarrhea, measles, malaria, and respiratory tract infections, received artificial food.
• Breast milk is a complete source of nutrition and reduces mortality among malnourished children. Studies have confirmed that until the child reaches six months of age, it covers 100% of the necessary nutrients. Up to twelve months it serves as a supplier of 75% of valuable substances, and up to twenty-four months it supplies the child’s body with almost a third of the necessary substances.
• Breast milk protects against obesity. Excess weight- a global problem for humanity. Creates the prerequisites for it artificial feeding newborns. These children are 11 times more likely to become obese in the future.
• Breast milk develops intelligence. Naturally fed children exhibit higher intellectual abilities than artificially fed children.

The main message given by the World Health Organization in the Strategy is the promotion of breastfeeding in order to reduce child mortality among children from birth to five years of age. This problem is especially acute in socially disadvantaged regions of the planet. But even in developed countries its relevance is high. After all, breastfeeding is the basis healthy life person.

The strategy includes ten points, representing practical guide for medical staff of maternity hospitals and women in labor. Let's take a closer look at WHO advice on breastfeeding.

The basic postulates of the Strategy are based on the principles of widely informing mothers about the benefits natural feeding.

Supporting breastfeeding rules and regularly bringing them to the attention of medical personnel and mothers

A feature of medical institutions that adhere to the principles of the Strategy in their daily activities is their focus on creating favorable conditions for women in order to stimulate lactation in the first days after the birth of a child. It will be much easier for young mothers to establish natural feeding in such conditions. Health centers that use the WHO Strategy are considered Baby Friendly Hospitals.

Training of medical personnel in breastfeeding techniques

Past medical education programs paid minimal attention to breastfeeding issues. Over seven years of training for maternity ward doctors, literally several hours were devoted to this topic. It is not surprising that “old-school” doctors do not know the basics of natural feeding and cannot give professional advice to mothers.

In Russia, the issue of advanced training for doctors has not been resolved. Additional funds are needed for retraining and courses. Ideally, every employee of a Baby-Friendly Hospital, from the doctor to the nurse, should provide the woman after childbirth with all the information she needs about breastfeeding.

Informing pregnant women about the benefits of breastfeeding

A pregnant woman makes a decision about how exactly the baby will be fed long before giving birth. This decision may be influenced by various factors. For example, often deciding to formula feed future mother encourage " horror stories» from older relatives about the constant crying of a hungry child or mastitis due to stagnation of milk.

Medical personnel should not only inform the young mother about the advantages of natural feeding. But also teach the technique of breastfeeding, which ensures full feeding without problems and discomfort.

Helping mothers in labor start breastfeeding early

The baby's first breastfeeding should occur within thirty minutes of birth. These WHO recommendations for breastfeeding are difficult to overestimate.

Nature has designed the activation of the sucking reflex in a baby during the first hour after birth. If the baby does not receive the breast now, he will probably fall asleep later to rest from the difficult work done. And he sleeps for at least six hours.

At this time, the woman will not receive stimulation of the mammary glands, which is a signal to the body: it’s time! The beginning of breast milk production and its quantity directly depend on the time of the first contact of the woman with the baby. The longer the first latch is delayed, the less milk the mother will receive and the longer she will have to wait for it - not two or three days, but seven to nine...

The first attachment provides the baby with the first and most valuable food for him - colostrum. And even though there is very little of it, literally drops, it has a colossal effect on the newborn’s body:

• populates the food tract with friendly microflora;
• provides immune, anti-infective protection;
• saturates with vitamin A, which facilitates the course of infectious diseases;
• cleanses the intestines of meconium containing bilirubin.

The first application, which took place within half an hour after birth, forms the body's immune defense against environmental hazards. The duration of suckling on each breast for a newborn should be 20 minutes.

Helping mothers conserve breast milk if they are temporarily separated from their babies

Some women are unable to start breastfeeding immediately after giving birth. However, waiting for doctors to allow breastfeeding is disastrous! Lack of breast stimulation leads to delayed lactation: milk comes later and in a much smaller volume than the baby needs.

Babies separated from their mothers are given formula before they are even breastfed. This leads to sad consequences. Once near the mother, the baby stubbornly refuses to take the breast, demanding to be fed from a familiar bottle. The minimum amount of milk in the mother’s breast is an additional factor in the baby’s dissatisfaction. After all, milk needs to be “extracted”, sucked out with effort, and the mixture flows on its own.

When mother and child are separated, breastfeeding recommendations suggest an alternative to feeding - pumping. They should be regular, every two to three hours for 10-15 minutes on each breast. Hand expression after childbirth is uncomfortable and painful. It is better to use a clinical or individual breast pump with a two-phase operating mode.

The amount of milk released is not indicative; do not pay attention to how much came out during pumping. A woman’s task is not to express as much as possible, but to give a signal to the body that it is time to produce milk in full.

Its success and duration largely depend on whether the start of breastfeeding is correct. However, after being discharged from the maternity hospital, the young mother is faced with many questions. WHO breastfeeding recommendations help answer some of these questions.

Lack of food and food other than breast milk

Unless otherwise indicated by individual medical conditions, WHO does not recommend giving children any other food or water until they are six months old.

In the first days of life, the child receives colostrum, rich in nutritional value. The small amount that is produced is enough to satisfy all his needs. There is no need to supplement your baby with anything! Moreover, this is fraught with negative consequences.

• Too much water overloads the kidneys. Supplemental feeding with formula creates an unjustified load on the child’s immature kidneys, which have not yet adapted to living conditions in environment. Adding water works similarly. The baby does not need additional water during the first days of life. He is born with a supply sufficient until the arrival of the mother's first full milk. Colostrum contains very little water, so it is ideal for the baby’s body.
• The mixture disrupts the intestinal microflora. Usually on the second day after birth, the baby begins to actively suckle at the breast. Inexperienced mothers immediately come to the conclusion that he is hungry and urgently needs to be “fed” with formula. In fact, this is how the baby encourages the mother's body to begin producing primary milk, which comes with colostrum. Neither the baby nor your body needs any help, everything will happen by itself! If you give the baby formula at this moment, the microflora of his intestines will change. Dysbacteriosis will develop, which is the main cause of intestinal colic and crying in infants up to three months of age. It will be possible to normalize the child’s condition, even if you adhere to exclusive breastfeeding, no earlier than in two to four weeks.

Of course, there are situations in which supplementary feeding is necessary. But only a doctor should give recommendations for its administration. Spontaneous decisions of the mother to feed her with formula “one time” are dangerous for the baby.

24/7 shared stay

In practice, it has been confirmed that babies who are constantly in the same room with their mothers are calmer, do not scream or cry. Women who have had time to get to know their children are more confident in their abilities. And even if it is their first baby, upon returning home the mother will not face the problem “I don’t know what to do with him.”

In addition, only staying together after childbirth provides the opportunity for the normal development of lactation.

Feeding on demand

Lactation consultants advise looking at your baby, not the clock. Your baby knows better when he's hungry than you or the hospital staff. Breast-feeding On-demand provides several benefits.

• The baby is always full, is gaining weight well.
• The child is calm because he has no reason to worry or be upset. His mother is always nearby, and the breast, which has taken on the “role” of the umbilical cord during intrauterine development, will warm him up, help him sleep and cope with fear.
• There is more milk. The amount of milk in women who feed “on demand” is twice as much as in women who adhere to the regime. This conclusion was made by doctors at Moscow perinatal centers based on an analysis of the condition of women in labor upon discharge home.
• The quality of the milk is better. Feeding “on demand” enriches milk with valuable substances. It has been established that the level of proteins and fats in it is 1.6-1.8 times higher than in the product for “regular” feeding.
• Prevention of lactostasis. The risk of milk stagnation in mothers who breastfeed “on demand” is three times lower.

The practice of feeding at the child's request should also be followed at home. Gradually, the baby will develop an individual feeding regimen that will be convenient for the mother.

Refusal of products and devices that imitate breasts

The use of pacifiers is possible in artificial babies, who should be offered an alternative to the mother's breast to satisfy the sucking reflex. For infants, this alternative is unacceptable, as it changes the sucking technique and becomes a reason for choosing between the nipple or the breast.

Feeding up to two years

WHO breastfeeding advice includes recommendations to breastfeed until age 2. At this age, mother’s milk plays a primary role in the formation of the baby’s brain, the formation of his nervous system, and the final development of the gastrointestinal tract to fully digest and assimilate “adult” food.

WHO recommends supporting breastfeeding after 2 years in developing countries with insufficient levels of medicine, hygiene, and a simple lack of quality products. It is better to continue feeding mother's milk than dangerous food that can lead to life-threatening diseases, say WHO and UNICEF experts.

It is necessary to maintain breastfeeding after 1 year, according to WHO recommendations. The complementary foods that a child receives are not intended to displace or replace mother's milk. He must introduce the baby to new tastes, unusual textures of foods, and teach him to chew. But the child should still receive the most important substances for the development of his body from his mother’s breast.

Following the recommendations of the World Health Organization will allow every mother to gain confidence in her own abilities. After all, it is from her, and not from doctors, manufacturers baby food or experienced grandmothers, the health of her baby depends. It is based on " White gold"-breast milk produced by a mother's body in the ideal quantity and composition for her baby.

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The need to change the practice of obstetric institutions in accordance with modern principles of successful breastfeeding was formulated in the Innocenti Declaration “Protection, promotion and support of breastfeeding” (1990), adopted by the heads of more than 30 states. In order to consolidate the provisions of the Innocenti Declaration, in 1991, WHO and UNICEF launched the Baby-Friendly Hospital Initiative. The Initiative to create a breastfeeding-friendly environment in obstetric hospitals and to promote exclusive breastfeeding (feeding only breast milk without additional food or drink, excluding medicines, vitamins and mineral supplements for medical reasons) is now being implemented over than in 22,000 hospitals in 157 countries. In 36 industrialized countries, 37% of births take place in infant-friendly health facilities.

To qualify as a Baby-Friendly Hospital, each facility providing obstetrics and newborn care is committed to implementing the Ten Principles for Successful Breastfeeding. These include activities to train medical personnel, educate pregnant women, provide conditions for early initiation of breastfeeding, mother-child cohabitation, infant feeding on demand, exclusive breastfeeding, avoidance of pacifiers and nipples, bottle feeding, and follow-up support for nursing mothers. mothers after discharge from the maternity hospital.

C. Vallenas, F. Savage (WHO, 1998) prepared a special review of the available scientific evidence of the effectiveness of the Ten Principles. The results of the latest scientific research on this issue are also presented in the WHO update on the implementation of the Baby-Friendly Hospital Initiative (2009). Considering that in developed countries the bulk of infant mortality occurs in the first week and month of life, early breastfeeding (in the first hour after birth) and exclusive breastfeeding from birth are one of the factors in reducing infant mortality.

The introduction of new principles of protection and support for breastfeeding has a positive impact on a mother’s decision to breastfeed her baby and helps to increase the prevalence of breastfeeding, including exclusive breastfeeding in the first 6 months of life. For example, in Sweden for the period from 1993 to 1997, when all maternity countries were involved in the Initiative and received the title of “Baby-Friendly Hospital”, breastfeeding rates increased among children 6 months old. from 50% to 73%. According to WHO, over the past 10 years, the rate of exclusive breastfeeding has increased by 20% or more in a number of countries, which is a remarkable success. However, the progress observed is uneven and, globally, the proportion of exclusive breastfeeding remains unchanged. Globally, only 34.6% of infants under 6 months of age are exclusively breastfed. This figure varies from 43.2% for the South-East Asia region to 17.7% for the European region.

The special role of the health sector and the Baby-Friendly Hospital Initiative in breast health and support was confirmed in the resolutions of the 63rd and 65th World Health Assembly (WHA, 2010, 2012).

International Breastfeeding Week, celebrated annually from 1-7 August by the International Alliance for Breastfeeding Action (WABA) with the support of WHO and UNICEF, was dedicated in 2010 to the Baby-Friendly Hospital Initiative. The 2010 week was held under the slogan “Breastfeeding: Only 10 steps - the path to a friendly attitude towards the child.”

Increasing the level of breastfeeding, introducing modern organizational technologies to encourage, support and protect breastfeeding in the work of obstetric services and children's medical institutions is one of the main objectives of the “National Program for Optimizing Feeding of Children in the First Year of Life in Russian Federation", adopted by the Union of Pediatricians of Russia and the National Association of Dietetics and Nutritionists (2009).

As of March 1, 2013, 288 maternity care institutions in 51 constituent entities of the Russian Federation were awarded the international title of “Baby-Friendly Hospital” by WHO and UNICEF. These institutions account for about 21% of all births performed annually in Russia. Currently, the Initiative also involves antenatal clinics and children's clinics, of which 153 and 197 institutions are certified, respectively. Work has begun to introduce the principles of the Initiative into the practice of children's hospitals - pathology departments of newborns and premature infants. In 2010, the first such department was certified in the Tambov Regional Children's Clinical Hospital, in 2011 - in the Tula Children's Regional Clinical Hospital, and in 2013 - the neonatal pathology department of the Taimyr Central District Hospital, Dudinka, Krasnoyarsk Territory. In 2012, the first perinatal centers in the cities were certified. Krasnodar and Tomsk. During the implementation of the Baby-Friendly Hospital Initiative, breastfeeding rates increased by 1.5-2.5 times in areas that are actively implementing new organizational principles for the protection and support of breastfeeding. These are the Republics of Bashkiria, Kalmykia and Komi, Volgograd region. In 1999, the breastfeeding rate among children 6-12 months. accounted for 32.9% in these territories; 56.7%; 25.0% and 49.4%, and in 2011 – 80.2%; 76.5%; 68.0% and 71.2% respectively. In general, in the Russian Federation there has been a trend towards improving breastfeeding rates: over the past ten years, the proportion of children receiving mother's milk at the age of 6-12 months has increased from 27.6% in 1999 to 40.7% in 2011.

Article from detailed description types of complementary foods, tables, timing and examples was created to help young parents transfer their baby to a balanced diet and develop healthy habits in the most early age.

Children from birth and up to 6 months don't need complementary feeding. Nature's ideal food for babies- This mother's breast milk, with which he receives the necessary nutrients, vitamins, minerals and antibodies. If the mother does not have or does not have enough milk, then to kid it is necessary to introduce complementary foods in the form artificial mixtures. But now this is no longer a problem, since manufacturers of most artificial formulas have brought the product to the proper level, which can fully replace breast milk. In this article we will not touch on the psychological and tactile connection between the child and the various pros and cons between breastfeeding and artificial formula, since this topic is quite sensitive, capacious and requires independent disclosure in another article. And regardless of what type of feeding the child chooses - breastfeeding or artificial formula, baby's main complementary foods must begin no earlier than 6 months according to WHO recommendations(World Health Organization) and UNICEF(UN Children's Fund), unless otherwise provided by medical recommendations for the condition health child. Early complementary feeding(before 6 months) is administered on the recommendation of a pediatrician according to medical indications, which is why it is also called pediatric.

Basic principles of complementary feeding for children according to UNICEF:

1. From birth to 6 months, breastfeed, and starting at 6 months of age, introduce complementary foods while continuing breastfeeding.
2. Continue frequent breastfeeding on demand until age 2 or longer.
3. Feed your baby based on his needs and in accordance with the principles of psychosocial care.
4. Maintain proper hygiene and adhere to food storage and handling rules.
5. From 6 months, start giving your baby small amounts of complementary foods, and as the baby gets older, increase the portions, while continuing frequent breastfeeding.
6. As your child gets older, gradually increase the consistency and variety of food based on his needs and capabilities.
7. As your child gets older, increase the daily number of meals during which he or she consumes complementary foods.
8. Give your child a variety of nutritious foods.
9. If necessary, give your child complementary foods fortified with vitamins and minerals.
10. When sick, give your baby plenty of fluids, including more breast milk, and encourage him to eat light foods that he likes. After illness, feed your child more often than usual and encourage him to eat more.

Starting from 6 months of age, the need child's body in nutrients is no longer satisfied only by mother's milk and must be gradually introduced lure. At this age, babies begin to show interest in adult food. Complementary feeding should be introduced with small amounts of foods new to the child and gradually increased as the child gets older.

The child is introduced to new food gradually, starting with very small portions (see table below). A new type of baby nutrition includes nutritional supplements And lure.

Nutritional supplements:

• fruit and berry juices;
• fruit and berry purees;
• chicken or quail egg yolk;
• cottage cheese

Nutritional supplements should be introduced gradually and after the main feeding or between feedings. But this rule does not apply to egg yolk; it is recommended to give it at the beginning of feeding.

Lure It is a qualitatively new type of nutrition that satisfies the needs of a growing child’s body in all food ingredients and accustoms him to thick food. This includes:

• vegetable purees;
• cereals;
• dairy products (kefir, yogurt, biolact...)

Rules for introducing complementary foods:

1. Complementary foods should be given before breastfeeding
2. Each type of complementary feeding should be introduced gradually, starting with a small amount (10-15 g) and increasing it to the required volume over 7-10 days, completely replacing one breastfeeding.
3. You cannot introduce two or more new dishes at the same time. You can switch to a new type of food only when the child gets used to the previous one.
4. The consistency of complementary foods should be homogeneous and not cause difficulty in swallowing.
5. Complementary foods should only be given from a spoon.
6. The number of feedings with the introduction of complementary foods is reduced to 5 times, then to 3 main and 2 snacks at the request of the child.
7. The temperature of the dish should be equal to the temperature of the mother's milk received (approximately 37 C).

Against the background of the introduction of food additives and complementary foods, strict monitoring of the child’s health is necessary.

Scheme for introducing food additives

Fruit and berry juice(introduced from 7-8 months)

The juice should be started with drops. Within 7-10 days, bring to the required daily volume, calculated by the formula n x 10, where n is the number of months, but not more than 100 ml in the second half of the year. Example: child 7 months x 10 = 70 ml. Give after feeding or between feedings. It is advisable to use freshly prepared juices (must be diluted with water in a 1:1 ratio), but packaged juices specifically designed for baby food are also suitable. The sequence of introducing juices from berries, fruits and vegetables: apple, plum, apricot, peach, cherry, blackcurrant, pomegranate, cranberry, lemon, carrot, beetroot, cabbage. Citrus fruits, tomato, raspberry, strawberry juices, juices from tropical fruits (mango, papaya, guava...) - these juices should be given no earlier than 11-12 months. It is not recommended to include grape juice in a child's diet at such an early age, as it can cause bloating.

Fruit and berry puree(introduced from 7 months)

Puree should be started with 0.5 teaspoon. Within 7-10 days, bring to the required daily volume, calculated by the formula n x 10, where n is the number of months, but not more than 100 ml in the second half of the year. The calculation is carried out in the same way as for juices (see above). Give after feeding or between feedings. Both freshly prepared purees and in the form of canned fruits and berries for baby food are used.

Yolk(introduced at 8-9 months)

You need to start with 1/4 yolk. You can give 1/2 yolk every day until the end of the year at the beginning of feeding, after grinding it with milk or with a complementary feeding dish.

Cottage cheese(introduced at 9-10 months)

Start with 5 grams (1 teaspoon). Gradually, over the course of a month, increase to 20 grams. By the end of the first year - 50-70 g. Cottage cheese should be given at the end of feeding.

Scheme for introducing complementary foods

I complementary foods - Vegetable puree (or porridge). Start at 6 months.

It is administered as a 5% concentration.

1 Week- increasing the volume to 130-150 ml with the simultaneous exclusion of one breastfeeding;

2 weeks- concentration thickening up to 8-10%;

3 week- getting used to one type of vegetables;

4 week- variety (introduction of new vegetables).

4 left breastfeeding(approximately!)

II complementary foods -Porridge (or vegetable puree). Start a week after the first feeding.

Immediately administered as a 10% concentration in 2-3 days. We start with gluten-free, dairy-free, unsweetened cereals (buckwheat, rice, corn). With the introduction of complementary foods, another breastfeeding is replaced. 3 breastfeedings left (approximately!)

Expansion II complementary foods - meat puree. Start a week after the second feeding. Added to vegetable puree, starts with 5 g, by 7 months it is increased to 30 g, then to 50 g, by the end of the year - to 60-80 g. 3 breastfeedings remain (approximately!)

III complementary foods - kefir (fermented milk products). Start at 8 months. The third breastfeeding is displaced. 2 breastfeedings left (approximately!)

Instead of breast milk for formula-fed or mixed-fed children, human milk substitutes (formulas) are used.

Note:

1. To maintain lactation after complementary feeding, it is advisable to offer the baby the breast.
2. Subject to good health, optimal indicators of physical and neuropsychic development, stable and sufficient lactation in the mother, and high-quality nutrition, the first complementary foods can be introduced no earlier than 6 months.
3. When preparing complementary foods (dairy-free cereals, purees), the optimal liquid for diluting them is breast milk or an adapted milk formula.

Note: instead of vegetable puree The first complementary food can be porridge (rice, buckwheat, corn, gluten-free).

When feeding your baby, you must adhere to the principles sensitive feeding, respond to signs of hunger and satiety. These signs must be taken into account to determine the amount of food a child will eat at one time, as well as the need for snacks.

Feeding based on the baby's needs (sensitive feeding):

• Feed infants and help older children feed on their own. Feed slowly and patiently, stimulate your baby's interest in food, but do not force him.
• If your child refuses most foods, try different combinations of foods, flavors, textures, and different methods feeding.
• If your baby quickly loses interest in food during feeding, keep distractions to a minimum.
• remember, that feeding time This is a time to teach and show love: talk and maintain eye contact with your baby while feeding.

• Food must be clean.
• Raw and prepared food should be kept separate.
• Food must be prepared carefully.
• Food must be stored at a safe temperature.
• To prepare food, you need to use clean water and food.

Additional Information:

The amount of food indicated in the table is recommended in cases where energy density of this food ranges from 0.8 to 1.0 kcal/g. If the energy density of food is about 0.6 kcal/g, it is necessary to increase the number of calories in food (adding certain foods) or increase the amount of food that the child eats at one meal. For example:

• for children 6-8 months: gradually increase the amount of food to 2/3 cup;
• for children 9-11 months: give baby 3/4 cup;
• For children 12-23 months: Give your baby a full cup.

If your baby is not breastfed, give him an extra 1-2 cups of milk per day and 1-2 extra meals per day.

The energy density of food products given to children as complementary foods should be higher than that of breast milk - that is, at least 0.8 kcal per gram. The food quantity indicators given in the table assume that complementary foods contain 0.8-1.0 kcal per gram. If the energy density is higher, then less food is needed to meet energy needs. If the energy density of the food is lower than that of breast milk, the total number of calories the baby receives may be lower than when he was exclusively breastfed. This is one of the common reasons malnutrition.

Small child's appetite often serves as a good indicator required amount food. However, illness and malnutrition reduce appetite, so a sick child may eat less than he actually needs. When a child is recovering from illness or malnutrition, he may need extra help with feeding to make sure he is getting enough food. If during this recovery the child's appetite improves, he needs to be given more food.

Optimal food consistency for a child depends on his age and level of neuromuscular development. Starting at 6 months, the baby can eat pureed, mashed and semi-solid foods. At 12 months, most children can eat the same foods as other family members. But they need foods rich in nutrients, and foods that can cause choking (for example, whole peanuts) must be avoided. Weaning food should be thick enough so that it stays on the spoon and does not drip off it. In general, thick or firmer foods are more nutritious and energy dense than thin, watery or soft foods.

Crisis of the first year of life- look