Newborn baby aged from 10 days to 1 month Motor developmentOne of the most important indicators motor development The baby is in a prone position. Let us characterize the position on the baby’s stomach at the end of the first month of life. Hands at elbow joints

1.5.1. Natural feeding The question of whether the mother will have milk or not, as a rule, is not worth it. Everyone always has milk, but not all children are satisfied with its quantity. Unfortunately, there is a factor that determines the amount of milk and is completely beyond control

1.5.3.1. Supplementary feeding and complementary feeding Two very frequently used words that require explanation, since they are not at all the same thing. If there is not enough mother’s milk, the child is supplemented with either formula, donor milk, or milk from farm animals

What is complementary feeding? Complementary feeding during breastfeeding is an integral part proper development child. It does not replace mother’s milk, which remains the main nutrition during the first year of life, but only supplements

Natural feeding Natural (or breast) feeding is the most important stage of feeding the baby, and the mother should do everything possible to maintain lactation, while focusing on a balanced diet. In the event that for some reason

Purpose of the lesson:

To develop students’ knowledge about the types of feeding and the benefits of natural feeding of a child in the first year of life; terms and rules for introducing basic types of baby food into the diet; principles of menu design; types of milk formulas and rules for feeding a child.

Plan for presenting the material:

1. Types of feeding children in the first year of life, the advantages of natural feeding.

2. Early breastfeeding of a newborn.

4. Rules for breastfeeding, calculation of a child’s daily and one-time nutritional needs, diet for a child in the first year of life.

5. Difficulties with breastfeeding (the concept of hypogalactia).

6. Criteria for determining the optimal time for introducing food additives and complementary foods into a child’s diet.

7. Main types of baby food: timing and rules of administration, preparation technology.

8. Rules for weaning.

9. The concept of mixed and artificial feeding.

10. Types of milk formulas, criteria for choosing the optimal milk formula for a child.

11. Rules for preparing formula and feeding a baby from a bottle.

After studying the topic, the student must:

Imagine and understand:

1. The benefits of early breastfeeding.

2. The concept of hypogalactia.

3. The role of the nurse in maintaining natural feeding of the child.

4. Criteria for the timing of introducing complementary foods and nutritional supplements into the child’s diet.

5. Rules for weaning a child.

6. Criteria for choosing the optimal type of milk formula.

Know:

1. Timing and rules for the first breastfeeding.

2. Benefits of breastfeeding.

3. Breastfeeding rules.

4. Dietary regimens for a child of the first year of life, depending on age, calculation of his daily and one-time nutritional needs.

5. Rules of nutrition and regime for a nursing mother.

6. Rules for creating a menu for a child of the first year of life.

7. Rules for mixed and artificial feeding (the concept of “supplementary feeding”).

8. Types of milk formulas.

9. Rules for feeding a baby from a bottle.

10. Time limits for administering the main types of baby food to a breastfed and bottle-fed child; rules of introduction and preparation technology.

Natural feeding of a newborn and infant is breastfeeding. Breast milk is the ideal food product created by nature itself for feeding a child. Lack of breastfeeding is an environmental disaster.

Benefits of breastfeeding:

1. Breast milk contains all the necessary ingredients in optimal ratios B: F: U = 1: 3: 6
2. Cow's milk contains more protein, but it is coarsely dispersed (casein), so it is difficult to break down and digest, while the protein of breast milk is finely dispersed, practically does not require enzymes for breakdown and, accordingly, is very well absorbed, so allergic reactions develop in infants much less often
3. Human milk proteins contain all essential amino acids
4. Human milk contains protective antibodies against various infections
5. Contains significantly more unsaturated fatty acids, which increase resistance to infections
6. More milk sugar (lactose), which promotes brain development and normalizes intestinal microflora
7. Fewer mineral salts compared to the composition of cow's milk (salts overload the kidneys and contribute to the further development of hypertension)
8. Optimal amount of vitamins, microelements, enzymes
9. Breast milk is sterile (lower risk of developing intestinal infections)
10. Contains lecithin, which promotes the proliferation of brain cells
11. Artificial feeding perpetuates an increased need for food - the risk of obesity at an older age.
12. Physical (biological maturation and aging) and sexual development are faster in artificial babies, but mental development is the opposite (intelligence, talent - for their implementation, breastfeeding is necessary for at least 6 months)
13. The child accumulates (deposits) better components of breast milk in subcutaneous fat and then uses them for several years (for brain function)
14. Sucking promotes correct articulation and the correct formation of the maxillofacial skull. Infants are less likely to have speech disorders.

Until now, a huge number of nutrients in breast milk have not been deciphered (for example, taurine is needed for brain development, the formation of the retina, it is not found in cow's milk because calves do not need to go to school).

It is also impossible to create a full-fledged substitute for human milk because, depending on the age of the child, the composition of human milk changes, reflecting the changing needs of the growing body, and feeding with donor milk will still not be natural, but pseudo-natural.

Benefits of early breastfeeding within the first 30 minutes after birth:

For mother:

1. Promotes rapid contraction of the uterus, reducing the risk of bleeding, and rapid restoration of strength;

2. Stimulates long-term lactation;

3. Reduces the risk of developing mastitis

4. Early contact stimulates the feeling of motherhood.

For a child:

1. Promotes the formation of normal intestinal microflora

2. Reliable immunological protection is formed (on the second day of a child’s life, the number of antibodies in mother’s milk decreases by 2 times)

3. Stimulation of the sucking reflex

4. Close psychological and emotional contact with the mother in the first hours after the stress of birth

Rules for first breastfeeding.

For the first time, the child is laid naked on the mother’s stomach and covered with a sterile sheet even before the end of the umbilical cord pulsation (if the health of the child and mother allows it)

Applying to the breast or creating skin contact after 2 to 3 hours is ineffective.

1. Correct daily routine: sleep at least 8 hours a day, nap 1.5 - 2 hours during the day, walks in the fresh air, moderate physical activity, positive emotional attitude, avoidance of stressful situations
2. The amount of liquid in the diet increases by about 1 liter
3. The calorie content of the daily diet should be increased by 50% compared to the diet of a non-lactating woman of this age. Meat and (or) fish, dairy products (cottage cheese, cheese), and vitamins are needed daily. Feed 4-5 times a day (as many times as the baby feeds), in small portions; to stimulate milk production, drink a glass of tea with milk and cheese 10-15 minutes before feeding.
4. Refrain from taking foods that change the smell and taste of milk (fresh onions, garlic)
5. No medications before consulting your doctor
6. Do not overuse gas-forming (cucumbers, grapes), laxatives (plum, beets) and fixatives (nuts, pear), allergenic (strawberries, pineapple, red fish, eggs, honey) and tonic (strong tea, coffee, chocolate) products.
7. The duration and fullness of lactation significantly depend on the feeding history of the woman herself.

Breastfeeding rules:

1. Wash your breasts under running water, remove long hair
2. Take a comfortable position - sitting, lying on your side
3. Make sure that the child is in a comfortable environment and nothing distracts him from the feeding process (clean, dry, warmly dressed)
4. Make sure that the child’s nasal breathing is free (if necessary, remove crusts from the nose)
5. Make sure that when sucking the baby grasps not only the nipple, but also the isola and that it does not rest its nose on the mammary gland
6. If there is greedy sucking and (or) active flow of milk in a stream, periodically hold the baby upright for several minutes, and then apply it to the breast again
7. If there is sluggish sucking or the baby falls asleep during feeding, wake him up (stroke the cheek, tickle the heels)
8. The duration of the first feedings is usually 30-40 minutes (this is the period of formation of lactation), then on average it takes 20 minutes (in the first 5 minutes of feeding the baby sucks out 50% of the milk volume)
9. If the amount of milk in one mammary gland is not enough to meet the baby’s needs, then it is applied to the other, and the sequence is changed at the next feeding
10. After feeding, the baby must be held upright for 3-5 minutes to prevent regurgitation.
11. Wash the mammary gland

Currently new to born child and children in the first months of life, free feeding is recommended - the baby is put to the breast at the first sign or request (up to 12-16 times a day). This is done because in the first weeks after birth, the nursing mother’s body adapts to the needs of the child and frequent feeding solves the problem of the child’s hunger and stimulates lactation in the mother. Until 3-4 days of a child’s life, the mammary glands secrete very little milk, but it contains a large number of protein and fat in order to somehow satisfy the child’s needs.

This milk is called colostrum. Then, gradually, lactation increases and the composition of milk (transitional) approaches the composition of mature milk: protein - about 2.5 g, fat - on average 3 g, carbohydrates - 7 g. The composition of a nursing woman’s milk is very individual and variable, depending on the quality and frequency her nutrition, emotional state, hereditary characteristics of lactation. Nobody knows milk standards. For each “mother-child” pair it is individual (in “final” milk there is up to 17% fat, so it is impossible to calculate). All nutritional corrections should come through breast milk (nutrition for a nursing woman)

Calculation of the daily amount of milk:

1. In the first 2 weeks of a child's life:

The amount of milk per day is 70 x n if the body weight at birth is less than 3200 grams and 80 x n if the body weight is more than 3200 grams, where n is the day of life

1. From 2 weeks to 2 months - 1/5 body weight:

2 months - 4 months - 1/6 body weight

4 months - 6 months - 1/7 body weight

From 5 months The daily volume is approximately 1 liter, and a single dose is 200 ml.

Brief feeding (when feeding according to the regimen)

Newborn - 6-7 times a day (every 3 hours with a night break of 6 hours)

From 1 month up to 5 months - 6 times/day

From 5 months up to 1 year - 5 times/day (interval between feedings 4 hours)

Difficulties with breastfeeding:

From the child's side:

1. Rhinitis with impaired nasal breathing (suction of secretions, removal of crusts from the nose, use of vasoconstrictor drops before feeding)
2. Thrush (candidal stomatitis) - treatment of the oral mucosa with a 2% solution of baking soda after each feeding
3. Lack of sucking reflex (premature baby) - spoon feeding or tube feeding

Mother's side

1. Flat, inverted nipple (special shields are used to make it easier for the baby to latch on)
2. Scuffs and cracks of the nipple (correct attachment to the breast so that the baby puts pressure on the areola and does not pull the nipple, special ointments - bipanten)
3. Milk stagnation - proper feeding and expressing milk, using a breast pump

Hypogalactia is a decrease in lactation, a very common problem among lactating women today.

Possible signs of the development of hypogalactia:

1. The child has become restless, sleeps poorly, cannot maintain the interval between feedings
2. Daily diuresis decreased (urination became less frequent)
3. Low weight gain, flat weight curve
4. Subjective feeling of an “empty” mammary gland in a woman

Diagnosis of hypogalactia - carrying out control feeding, when the child is weighed before breastfeeding and after, the difference in weight is compared with the nutritional norm obtained for this child using the formula

Prevention and treatment of hypogalactia:

1. Breastfeeding promotion, psychotherapy
2. Prevention of cracks and mastitis
3. Compliance with diet and daily routine, support of other family members
4. Nettle decoction (20 grams of dried leaves per liter of boiling water, leave for 45 minutes and drink 1 tablespoon 3 times a day), anise, dill, oregano, lactogenic herbal teas
5. Medications: vitamins “E”, “A”, “PP”, “C”, Gendevit, Aevit, Prenatal, Materna, dried brewer’s yeast, apilak, microdoses of iodine
6. More frequent latching to the breast, latching on both breasts at one feeding
7. Quartz irradiation, UHF, massage, acupuncture

We have already talked in some detail about breastfeeding and natural feeding of a newborn. But infancy is considered the age of a child up to 1 year, and all this time the child can and should receive breast milk. However, as he grows, breast milk alone can no longer meet the growing body's needs for nutrients and ingredients.

The timing of introducing food additives and complementary foods into a child’s diet is very individual and depends on:

1. The nature of feeding - on breastfeeding they are introduced later, on artificial feeding earlier
2. The nature of lactation and the rate of physical development of the child - if lactation is sufficient, the child grows and develops well, then supplements and complementary foods are introduced no earlier than 6 months (correction of nutrition through breast milk)
3. The time of year and climatic zone of residence - autumn and winter, in northern latitudes, a balanced diet for a nursing woman is not always possible and it is necessary to correct the child’s nutrition by introducing food additives and complementary foods earlier
4. State of health, diet and day of the nursing woman and state of health of the child
5. The child’s readiness to assimilate qualitatively new food: extinction of the reflex of “pushing out” food (with the tongue) with a well-coordinated swallowing reflex; the child’s readiness for chewing movements when a pacifier or other objects gets into the mouth, past or current teething
6. The presence of signs of relative malnutrition: a decrease in the subcutaneous fat layer, a slowdown in body weight gain.

Nutritional supplements include products that correct the deficiency of certain nutrients in the child’s diet; they are given in small quantities after breastfeeding or giving formula (sometimes in the intervals between feedings).

There are vitamin and protein supplements such as:

1. Fruit juices (puree) - apple, white cherry, white currant, apricot, peach, pear, plum (given in order of preference). Begin introducing it into the diet with drops, gradually increasing the amount to 40-60 ml. It is advisable that the baby’s first juices are natural and fresh (homemade)

2. Cottage cheese (calcined) is also desirable to make at home - 1-2 tablespoons of CaCl 2 are added to 200 ml of milk at the moment of boiling, then placed on cheesecloth, or a dairy kitchen, special baby food. Begin introducing grains into the diet and increase to 40 grams per day

3. Egg yolk hard boiled egg. From grains to 1/12 - 1/8 is added to milk or vegetable puree(introduce with caution into the diet of allergy sufferers)

Lure- this is a qualitatively new type of child nutrition, which completely replaces one of the feedings and is given before breastfeeding or giving formula.

More often in Vegetable puree is used as the first complementary food(potatoes, cabbage, zucchini, pumpkin, and last but not least carrots). Start with 1-2 teaspoons and gradually replace 1 feeding completely over 1-2 weeks (this is approximately 150 ml). Next 2-3 weeks without introducing anything new - adaptation period

After a month they introduce second complementary food - porridge(it is preferable to start with gluten-free cereals - rice, corn, buckwheat flour). Dry instant porridges are the most convenient: they are enriched with vitamins, calcium, iron, and have a guaranteed composition and safety. In children with a good weight, complementary foods begin with vegetables; in case of underweight children, porridge becomes the first complementary food. Usually 5 ml of vegetable oil is added to vegetable puree (it is advisable to alternate sunflower, olive, corn), and butter to porridge.

Boiled meat (veal, rabbit, turkey) is passed through a meat grinder twice and given to the child, starting with 1 teaspoon, gradually increasing the amount to 60-80 grams per day, usually at the third feeding

From the moment the first complementary foods are introduced, the child switches to 5 meals a day. Complementary foods must be separated by breastfeeding, usually the first, third and last feeding is breast milk or formula, the second is porridge, and the fourth is vegetables.

At 9 - 10 months they introduce 3 complementary foods: non-adapted dairy products: milk, kefir, yoghurts and only the first and last feeding remains completely breastfeeding.

Table of timing of introduction of complementary foods and food additives

Weaning rules:

1. Recommended age of child - over 1 year
2. With proper organization of nutrition, by the age of 1 year, breast milk already loses its importance as a source of nutrition, its amount in the child’s waste diet is no more than 200-300 ml and difficulties in weaning are associated only with psychological dependence child from the feeding process (protection, positive emotions, sleep)
3. Do not wean a child who is in a stressful state from the breast: during illness, during preventive vaccinations, if there is a long trip ahead (on a train, for example), a change in the situation and environment of the child, during the hot season (milk continues to be a source of fluid for the child), in the first weeks of the child’s stay in the preschool
4. If there is a significant amount of milk, a woman is advised to reduce the amount of fluid in her diet and tightly bandage the breast
5. It is undesirable to continue breastfeeding for a long time (in children over 3 years old), because this complicates the process of socialization of the child’s personality and development of independence

If the mother, despite the measures taken, does not improve lactation, the child must be switched to mixed or even artificial feeding.

The term “mixed feeding” should be understood as this type of infant nutrition when the amount of supplementary feeding in the form of artificial mixtures is from 1/3 to 2/3 of the daily volume of food. When artificial feeding, breast milk is either completely absent from the child’s daily diet, or its share is less than 1/3 of the daily food volume.

Mixed feeding is much easier for a child to tolerate than complete deprivation of breast milk. Therefore, no matter how little milk the mother has, it must be given to the baby at every feeding. The enzymes contained in it will contribute to better digestion of “foreign” food, which is all, even the most advanced artificial mixtures.

To maximize the preservation of even small amounts of breast milk, it is necessary to put the baby to the breast at each feeding (first to one, then to the other), and only when both breasts are empty can you begin supplementary feeding. This tactic is absolutely necessary when feeding children in the first months of life, when every drop of mother's milk is valuable.

To prevent the baby from losing the ability to suck the breast, it is recommended to give the formula to him from a spoon.

Supplementary feeding is a breast milk substitute that is always given after breastfeeding.

When deciding on artificial feeding, a woman should understand that unjustified introduction can have a negative impact on breastfeeding, and that returning to breastfeeding under these conditions is very difficult.

Currently, unlike the late 80s - early 90s (when they took what they could get), there is no shortage of breast milk substitutes. But with a wide variety of artificial nutrition, it is difficult to make a choice: one package is more beautiful than another, which should you give preference to?

Choose mixtures not with your eyes, but with your mind, based on knowledge about the biological value of the individual components of baby food, their role for the child’s body, and also taking into account the child’s diseases.

When choosing what to feed your baby, first of all, you should consult with the pediatrician who is observing the child. You should also pay attention to what age the mixture is intended for. In this case, you need to focus on the products of companies that comply with the International Code on the Sale of Breast Milk Substitutes and the requirements of the World Health Organization on infant feeding.

Currently, the Russian market offers baby food from such well-known foreign companies as Nutricia - Holland, the Swiss corporation Nestlé, Hipp - Austria, Humana and Heinz - Germany, Danone - Finland.

Infant formulas - human milk substitutes - can be:

Unadapted (cow's milk or diluted kefir) - No. 2 - ½ milk, ½ cereal broth (buckwheat or rice) - half milk for feeding children up to 2 weeks; No. 3 - 2/3 milk, 1/3 cereal broth for feeding children from 2 weeks to 3 months

Adapted - similar in composition to human milk (enriched with carbohydrates, vitamins, amino acids, salts and microelements, fermented using high technology, which facilitates absorption)

Dry and liquid (ready to eat)

Fresh and sour. In practice, dry milk mixtures are most often used, which must be reconstituted by diluting them with water. For this, it is better to use environmentally friendly water.

Types of dry adapted mixtures:

Initial - most adapted to the digestive characteristics of children in the first four months of life (“Nutrilak 1” - Russia, “Nutrilon 1” - Holland, “Frisolak 1” - Holland, “Humana 1” - Germany, “Galia 1” - France, “Hipp” 1" - Austria, "Enfamil 1" - USA)

Starter formulas contain whey proteins, but the protein level is reduced (most of these formulas contain 1.4 - 1.6 g of protein per 100 ml of ready-to-use product, to approach the content of human milk). Initial mixtures are always enriched with taurine, a free amino acid necessary for the proper formation of the brain, visual analyzer, and facilitating the digestion and absorption of fats.

This amino acid is one of the essential amino acids for children in the first months of life, especially premature ones. Taurine is found in breast milk and is absent in cow's milk. The composition of the fat component of the “initial” mixtures is also as close as possible to the composition of human milk fats. To improve the absorption of fat, small amounts of natural emulsifiers (lecithin, mono- and diglycerides) are introduced into the milk mixture, which contribute to better fragmentation of fat globules and easier absorption of fat.

"Subsequent" adapted mixtures for feeding children over 3-4 months (“Nutrilak 2” - Russia, “Nutrilon 2” - Holland, “Humana 2” - Germany, “Galia 2” - France)

“Subsequent” semsi are prepared on the basis of cow’s milk with or without the addition of whey proteins and may contain lactose, sugar, and starch. The protein content in them is 1.8-2.2 g per 100 ml.

Formulas used throughout the entire first year of a child’s life from 0 to 12 months (“Nan” - Switzerland, “Tuteli” - Finland, “Heinz” - USA)

These mixtures may or may not contain whey proteins and taurine. The fat component of these mixtures consists of vegetable fats or a mixture vegetable oils and milk fat. Lactose, dextrin-maltose are used as carbohydrate components, and sometimes sucrose and starch are used.

All dry adapted mixtures are enriched with vitamins, macro- and microelements.

When choosing a formula for a healthy child and analyzing its composition, you need to pay attention to the following indicators:

The only source of carbohydrates in all types of milk is milk sugar - lactose. This carbohydrate is found only in milk and is not found anywhere else. The hydrolytic breakdown of lactose in the intestine proceeds slowly, and therefore the intake of lactose does not cause intense fermentation. The entry of lactose into the intestines normalizes the composition of beneficial intestinal microflora. Therefore, in a high-quality product for feeding healthy children, the sugar substitute should not be sucrose, fructose or glucose, but lactose, which is the most important component of breast milk, and possibly dextrine maltose.

The amount of whey proteins and casein should be in a ratio of 3:2 or 60% and 40%

Since at the breastfeeding stage the ratio of whey proteins and casein in breast milk is on average 60% to 40%, then ideally they should have the same ratio in human milk substitutes. With this ratio of whey proteins and casein, there will be no indigestion of the latter, as with cow's milk.

Taurine enrichment at a level of at least 4.5/100 ml

If the food of an adult must contain eight essential amino acids, which are the main components and structural components of protein molecules, then in childhood Histidine and arginine are also added to the essential amino acids, since they are not synthesized in the child’s body in quantities capable of satisfying its needs. The free amino acid taurine is added to the formula of many breast milk substitutes to improve their biological value. In addition, it is involved in the synthesis of bile acids.

The presence of linoleic and linolenic polyunsaturated fatty acids and their ratio (not lower than 8.8)

For the proper growth and development of a child, two important polyunsaturated fatty acids (PUFAs) - linoleic and @-linolenic acids - must be present in baby food products. Linoleic acid is necessary for the synthesis of protein in brain cell membranes. In human milk its content is 15%, and at least 10% is recommended in milk replacers. The ratio of linoleic and linolenic acids is also important.

Carnitine enrichment at a level of at least 0.8 mg/100 ml

Carnitine is not an enzyme, as it is sometimes called, but a compound that normalizes fat metabolism; if it is deficient, free fatty acids cannot penetrate mitochondria and oxidize. Lack of carnitine in an adult is rare, since adults get it from food - beef, chicken meat, etc. More often, a lack of carnitine occurs in premature infants, it is caused either by a violation of its biosynthesis, or by “leakage” in the kidneys.

For normal height and development infant Baby food products must contain a complex of mineral elements (macro- and micro) and vitamins.

The ratio of calcium to phosphorus, which should be close to 1.7 for children under three months of age and 2.2 for children from four months to one year (in full-fledged human milk this ratio is 2.2)

Calcium and phosphorus are necessary for the child to form bone tissue. However, if there is an excess content of these minerals in the mixture, they are excreted from the baby’s body, putting a huge burden on the child’s still undeveloped kidneys. Undigested calcium forms insoluble salts in the intestinal lumen, which impairs fat absorption. With an optimal ratio of calcium and phosphorus in the mixture, the absorption of calcium from the intestine and the mineralization of bone tissue improves, and the risk of developing hypocalcemia (as a result of hyperphosphatemia) is reduced. In addition, the optimal ratio of these minerals helps reduce stool density and prevents the development of constipation.

Enrichment of the mixture with iron to a level not lower than 0.11 mg/100 ml (its content in human milk is 0.15 mg/100 ml)

Of the 15 microelements, nine are of greatest importance for the growth and development of a growing organism: iron, iodine, zinc, copper, selenium, cobalt, chromium, molybdenum and manganese. At the same time, there are microelements, the innate reserves of which are sufficient for the first 4-6 months of life (copper) and microelements, the content of which in the body of newborns is extremely small and must be constantly replenished. Taking these data into account, modern mixtures should contain sufficient amounts of iron, zinc, iodine and selenium. Iron is involved in the synthesis of blood hemoglobin, ensures the normal functioning of the immune system and the adequacy of behavioral characteristics.

The ratio of vitamin E to linoleic polyunsaturated fatty acid should be 1.7

All vitamins are very important for the normal growth and development of the baby. But it is especially important to pay attention to the content of vitamins D, E, and folic acid in human milk substitutes. Vitamin D promotes the absorption of phosphorus and calcium and is necessary for the normal formation of bones and teeth. Vitamin E acts as an antioxidant that protects cellular structures from damage, supports immune system. Moreover, its content should be in a certain ratio with the level of linoleic acid. Folic acid is a major participant in the formation of hemoglobin in red blood cells and is necessary for protein synthesis.

Absence of any food additives (indicated on labels and packaging by the index E)

Osmolarity of the mixture, which should be in the range of 300-320 mOsm/l

Lysozyme is usually added to infant formulas.

I would like to draw special attention to the need to strictly follow the instructions for preparing milk formula. It is prohibited to prepare either an overly concentrated or a more dilute mixture. Both are equally harmful! When using a more concentrated mixture, the child receives an excess amount of all nutrients, and therefore, he may develop digestive disorders - regurgitation, vomiting, unstable stools, and sometimes allergic reactions. If you give your child more diluted nutrition than he should, the baby will receive an insufficient amount of “plastic” material and will lag behind in physical development.

Rules for feeding a baby from a bottle:

1. The bottle and nipple must be sterile (at home they are boiled for 20 and 10 minutes, respectively, and then stored in a clean container with a lid)
2. The milk mixture is prepared according to the instructions and poured into the bottle.
3. Before feeding, it is necessary to check the temperature of the mixture and the speed of its flow - to do this, allow a few drops to flow onto the back of the forearm, the mixture should not be hot and should flow out in rare drops (the child may choke on the milk stream and aspirate the milk)
4. It is necessary to check that the child has free nasal breathing (clear the nose of crusts) and feels comfortable (clean, dry, warm)
5. It is advisable to feed the baby in your arms
6. As the mixture flows out, you need to change the angle of the bottle so that its neck is completely filled with milk (prevention of aerophagia)
7. After feeding, you need to hold the baby upright
8. Soak the bottle and nipple and sterilize it

It should be noted that most children of the first year benefit from adapted fermented milk formulas, which have a number of advantages over unleavened ones. They contain pure cultures of acidophilus bacillus, bifidobacteria or other lactic acid bacteria, which improve the digestion of food and have the ability to remove harmful microorganisms from the intestines. This prevents the development of many intestinal diseases. Fermented milk mixtures are especially recommended for weakened children suffering from unstable stools and decreased appetite. Mixtures are best used in the hot season, when the likelihood of acute gastrointestinal disorders increases.

In a child’s diet, it is advisable to use fresh and fermented milk adapted formulas in a 1:1 ratio, since the use of only fermented milk formulas (especially with high acidity) can cause regurgitation and some shifts in the acid-base balance of the body.

Currently, to feed children with health problems, there are specialized milk formulas - breast milk substitutes.

If a child cannot tolerate cow's milk (allergy to cow's milk protein, lactase deficiency, galactosemia), then substitutes made from soy or casein hydrolyzate and devoid of lactose will be healthier for him.

Such mixtures include “Bebelak soya”, “Vinnie-soy”, “Nutrilon low-lactose”, “Nutri-soy”, “Alfare”, “Alsoy”, “Al 110”, “Frisosoy” and others. These mixtures do not contain any components of cow's milk, sucrose, lactose and gluten, and are enriched with taurine and methionine, which provides an optimal ratio of amino acids; vitamin D and carnitine, which prevents the development of rickets and improves the absorption of fats and fat-soluble vitamins, contains linoleic and linolenic fatty acids, and a slightly increased amount of iron. It should be noted that soy-based medicinal mixtures can be used only strictly according to indications; they are lower in calories and do not contain animal protein. Mixtures based on protein hydrolysates have poor taste.

Some medicated formulas are intended for feeding premature babies, low birth weight babies, or poorly developing children. Premature babies have higher needs for both energy and protein compared to normal babies and should receive 22% more ingredients. Therefore, such mixtures contain at least 2 g of protein per 100 ml with a higher calorie content - 75 - 85 kcal/100 ml. In addition, they should contain more linoleic and linolenic fatty acids, since the synthesis of the latter in the body of premature babies is difficult. Formulas intended for children with low birth weight include domestic “Novolakt 1”, imported “Alprem”, “Prepiltti”, “Enfalak”, “Nenatal”, “Frisopre”.

According to domestic and foreign scientists, 20 - 30% of children under the age of 6 months periodically experience regurgitation. Children suffering from regurgitation, constipation or abdominal colic should be fed with breast milk substitutes such as Nutrilon Antireflux, Frisovo, Nenny, Lactofidus. All of them are characterized by their low fat content, which helps avoid retention of the mixture in the stomach and improves its emptying, the predominance of casein and the use of carob beans as a thickener. Under the influence of gastric juice, casein forms flakes, the mixture quickly thickens, and carob beans are not digested in the stomach and maintain the consistency of its contents. All this reduces the incidence of reflux.

Deserves special attention adapted breast milk substitute "Nanny", produced on the basis of goat milk. Studies of the Nanny mixture conducted by the Institute of Nutrition of the Academy of Medical Sciences of the Russian Federation made it possible to recommend its use in the following cases:

1. As a dietary alternative for feeding healthy children in cases of impossibility, undesirability or insufficiency of breastfeeding
2. For feeding premature babies
3. In case of intolerance and (or) allergy to cow's milk or soy proteins
4. For the prevention of various food allergies, diathesis, eczema
5. For the prevention of iron deficiency anemia
6. For digestive disorders: dysbacteriosis, intestinal colic, regurgitation, diarrhea
7. For the prevention and treatment of asthmatic phenomena

So, choosing an acceptable and healthy diet for a child if breastfeeding is not possible is not at all easy.

Due to the lower biological value of formula for a child compared to breast milk, the timing of introducing food additives and complementary foods to a formula-fed child is usually lower than to his peer who is breastfed. Although the question of the timing of introducing basic baby food products into the diet is decided individually.

Possible problems for the child and his relatives:

Sleep disturbance due to fasting, flatulence

Regurgitation, rashes on the body due to a violation of the diet of a nursing mother

Lack of knowledge among the child’s relatives about the rules of breastfeeding, the diet of a newborn, and the diet of a nursing mother

Violation of the child’s need for food due to fraying or cracked nipples; hypogalactia, mother's refusal to breastfeed

Lack of knowledge among the child’s relatives about the timing, rules of introduction and technology for preparing basic types of baby food

Regurgitation, flatulence, bowel dysfunction in a child due to improper introduction of foods into his diet

Delay in physical development due to late introduction of food additives and complementary foods into the child’s diet:

Abdominal pain, increased bowel movements due to non-compliance with hygienic requirements when preparing baby food

Lack of knowledge about the criteria for choosing formula for a child, the rules for preparing formula and bottle feeding

Regurgitation, flatulence, bowel dysfunction, pain from burns of the oral mucosa due to non-compliance with the rules for preparing milk formula and the rules for feeding a baby from a bottle

Regurgitation, flatulence, restlessness due to abdominal pain, itchy skin due to frequent changes in the type of formula

Sleep disturbance, anxiety due to fasting due to non-compliance with the child’s diet

Nursing interventions:

Provide early breastfeeding for newborns

Convince the child's mother of the need for natural feeding

Teach mother the rules of breastfeeding

Inform the mother of the child about the types of feeding the child: free and on a schedule

If signs of hypogalactia are detected, invite the mother and child to the clinic for a control weighing and intensify measures to stimulate lactation

Carry out regular (monthly) monitoring of the rate of physical development of the child (weight gain)

Together with the doctor, determine the optimal timing for introducing food additives and complementary foods into the child’s diet.

Create a sample menu for your child

Inform the child’s mother about the types of baby food, the technology of their preparation, the timing and rules of introduction into the child’s diet

Teach the mother the rules for creating a child’s menu

If it is necessary to transfer the child to mixed feeding, inform the mother about the rules for introducing supplementary feeding into the child’s diet.

Together with your doctor, choose the optimal type of formula for your child.

Teach the mother the technique of preparing formula and the rules of feeding the baby from a bottle.

NATURAL

The rationality of infants is the key to their adequate growth and development, as well as High Quality life, both in early childhood and in subsequent years.

Composition of human milk

The optimal food product for a child in the first months of life is mother’s milk, which corresponds to the characteristics of his digestive system and metabolism, ensuring adequate development child's body with rational nutrition of a nursing woman. All nutrients in human milk are easily digestible, since their composition and ratio correspond to the functional capabilities of the gastrointestinal tract of an infant, and also 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 a critical role in regulating appetite, metabolism, growth and differentiation of the child’s tissues and organs.

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 The protein and phosphorus in human milk promote the growth of healthy intestinal microflora. In recent years, bifidobacteria and lactobacilli, which determine the development of immunity, have been found directly in human milk (Fig. 2).

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

The protective properties of human milk are not limited to anti-infective protection. Breastfeeding reduces the risk of developing diseases such 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 unity of mother and child during breastfeeding has a deep mutual emotional impact. It was noted that children who were fed mother's milk are distinguished by harmonious physical development, they are calmer, balanced, friendly and kind compared to children who were bottle-fed, and subsequently they themselves become attentive and caring parents.

According to some data, breastfed children have a higher IQ, which may be partly due to the presence of long-chain polyunsaturated fatty acids (LCPUFAs) in breast milk, which are necessary for the development of brain and retinal cells. In the blood of breastfed children, the amount of DPFA is significantly higher than in children receiving artificial feeding.

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

amino acids in the optimal ratio for the child, and casein (20-30%). The protein fractions of human milk are divided into metabolizable (food) and non-metabolizable proteins (lactoferrin, lysozyme, etc.), which account for 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 and 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 (PUFAs), the concentration of which in human milk is 12-15 times higher than in cow's milk. PUFAs are precursors of arachidonic, eicosapentaenoic and docosahexaenoic fatty acids, which are an important component cell membranes, from which they form various classes prostaglandins, leukotrienes and thromboxanes; they are also necessary for the myelination of nerve fibers and the formation of the retina.

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

The fats of mother's milk are easier to digest than cow's milk, since they are more emulsified, in addition, breast milk contains the lipid enzyme, 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 and ranges from 9 to 41 mg%, stabilizing by the 15th day of lactation at the level of 16-20 mg%. Breastfed babies have higher cholesterol levels than formula-fed babies. Cholesterol is necessary for the formationstudies of cell membranes, tissues of the nervous system and a number of biologically active substances, including vitamin D.

Carbohydrates in human milk are represented mainly by the disaccharide L-lactose (80-90%), oligosaccharides (15%) and small amounts of glucose and galactose. Unlike a-lactose in cow's milk, b-lactose in human milk is slowly broken down in the small intestine of the child, partially reaching the colon, 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, including from 3 to 10 monosaccharide residues, which are not broken down by enzymes of the digestive tract, are not absorbed in the small intestine and, unchanged, reach the lumen of the colon, where they are fermented, serving as a substrate for the growth of bifidobacteria. In this case, competitive inhibition of the development of conditionally pathogenic flora occurs. 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 differs significantly from cow's milk, which contains 3 times more salts, mainly due to macroelements. The relatively low mineral content of human milk ensures its low osmolarity and reduces the load on the immature excretory system. Macronutrients include calcium, phosphorus, potassium, sodium, chlorine and magnesium. The remaining 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.

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

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

Human milk contains all water- and fat-soluble vitamins. The concentration of vitamins in milk is largely determined by the diet 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 its additional administration to breastfed children.

Vitamin deficiency leads to disturbances in enzymatic activity, hormonal dysfunctions,

reducing the antioxidant capacity of the child’s body. In children, polyhypovitaminosis is more often observed; 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 most fully meet the needs of the infant. The small volume of milk (colostrum) in the first days of lactation is compensated by a relatively high content of protein and protective factors; in subsequent weeks, the protein concentration in human milk decreases and subsequently remains virtually unchanged. The most labile component of human milk is fat, the level of which depends on its content in the diet of the nursing mother and changes both during each feeding, increasing towards its end, and during the day. Carbohydrates are a more stable component of human milk, but their level also changes during feeding, being maximum in the first portions of milk.

Organization of natural feeding

IN maternity hospital In order to achieve sufficient volume and duration of lactation, a healthy newborn baby should be placed on the mother’s chest in the first 30 minutes after an uncomplicated birth for a period of at least 30 minutes.

THE ARGUMENTATION FOR THIS METHOD INCLUDES THE FOLLOWING PROVISIONS:

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

stress hormonal background; — through imprinting mechanisms, contributes to strengthening the feeling of motherhood and increasing the duration of breastfeeding; - ensures that newborns receive maternal

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

• contains more leukocytes and other protective factors than mature milk, which significantly protects the child from intense bacterial contamination and reduces the risk of purulent-septic diseases;
• has a mild laxative effect, thanks to which the child’s intestines are cleared of meconium, and with it 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 influence the maturation of the child’s intestinal functions. In order for the child to receive colostrum in the maximum possible volume, the frequency of breastfeeding should not be regulated. In order to carry out free feeding on demand, a 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 hourly feeding. Early breastfeeding and “free feeding” are key factors in ensuring full lactation and contribute to the establishment of close psycho-emotional contact between mother and child.

To maintain lactation, night feedings are especially important, since prolactin levels are higher at night. The duration of breastfeeding of a healthy baby in the first days should not be limited, even when he practically does not suck anything, but dozes at the breast. The need for contact and sucking can be independent in nature, relatively independent of eating behavior. However, in the future, excessively frequent attachment of the baby to the mother's breast at the slightest concern 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. .

Assessing the adequacy of lactation requires a thorough analysis of the child’s behavior, stool patterns, and frequency of urination. Possible signs of insufficient lactation are:

• restlessness and crying of the child during or immediately after feeding;
• the need for frequent breastfeeding;
• long feeding, in which the child makes a lot of sucking movements, in the absence of swallowing;
• mother's sensation of rapid, complete evacuation mammary glands when the baby is actively sucking, when pumping after feedings, there is no milk;
• restless sleep, frequent crying, “hungry” cry;
• scant, infrequent stools. However, the most reliable signs of malnutrition are low body weight gain and rare urination (less than 6 times per day) with the release of a small amount of concentrated urine. The final conclusion about insufficient lactation can be made based on 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 her baby:

• the baby takes the breast, but does not suck, does not swallow, or sucks very little;
• when the mother tries to breastfeed, the child screams and resists;
• after a short sucking, he breaks away from the breast, choking from crying;
• the baby takes one breast but refuses the other. The reasons may 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 in the mother, in which it flows too quickly;
• teething,
• diseases of the child (perinatal damage to the nervous system, partial lactase deficiency, gastrointestinal form of food allergy, acute respiratory viral infection, otitis media, thrush, stomatitis, etc.). Finding out the cause and carrying out if necessary

True hypogalactia (or) is rare, occurring 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 woman’s lack of lactation dominant (psychological attitude) due to poor preparation during pregnancy, as well as emotional stress, early and unjustified introduction of supplementary feeding with infant formula, the need going back to work, illness of a child, illness of a mother, etc.

In some cases, hypogalactia is transient in 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 correction methods are the most common factors for stopping breastfeeding.

Lactation crises are based on the peculiarities of hormonal regulation of lactation. They usually occur 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 child’s health. In such cases, more frequent latching of the baby to the breast in combination with feeding from both breasts is sufficient. The mother needs peace and rest; varied, nutritious, high-tasting food; warm drinks, especially those containing lactogenic herbs or preparations, 15-20 minutes before feeding, as well as special lactogenic products.

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

Measures used for secondary hypogalactia (lactation crises):

• more frequent breastfeeding;
• regulation of the mother's diet and nutrition (including optimal drinking regimen through the additional use of at least 1 liter of liquid in the form of tea, compotes, water, juices);
• impact on psychological attitude mothers;
• orientation of all family members (father, grandmothers, grandfathers) to support breastfeeding;
• contrast shower on the mammary gland area, gentle rubbing of the breasts terry towel;
• the use of special drinks that have a lactogenic effect; At the same time, infant formula is 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 establishment of lactation and its continuation take place in conditions where, in addition to the desire and confidence of the mother, she is actively supported by all family members, as well as professional advice and practical assistance from medical workers. It is advisable that women be taught about breastfeeding during pregnancy at the “School for Pregnant Women”.

The most important role in promoting breastfeeding is given to doctors and nurses, who should actively encourage family and social support for breastfeeding and provide for parents

complete information about its comprehensive positive effect on the child’s body and its advantages over infant formula. To carry out activities to successfully establish and maintain the practice of natural feeding, all health workers involved in obstetrics and medical supervision of infants must have the ability to provide practical assistance to mothers with breastfeeding.

In accordance with the WHO/UNICEF international program “Protection, promotion and support of breastfeeding practice”, which sets out the main provisions in the form of ten principles of successful breastfeeding, the Ministry of Health Russian Federation A program to support breastfeeding was developed and a number of normative and methodological documents were approved (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 preventive institutions for obstetrics and childhood:

• have readily available printed information regarding breastfeeding practices that should be regularly communicated to all health care personnel;
• inform all pregnant women about the benefits of breastfeeding and the need for early attachment of a newborn baby to the mother’s breast (within the first 30 minutes after birth);
• ensure round-the-clock coexistence of mother and child in the “mother and child” ward of the maternity hospital and encourage breastfeeding at the request of the child;
• teach mothers techniques for breastfeeding and maintaining lactation;
• strive to exclusively breastfeed for the first 4-6 months of life, that is, not give healthy newborns any food other than breast milk, except for medical reasons;
• ensure continuity in the work of the antenatal clinic, obstetric hospital, children's polyclinic and children's hospital. These activities must be carried out taking into account the health status of both mother and child.

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

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

For diseases of a nursing mother such as rubella, epidemic, cytomegalovirus infection, herpes simplex, acute intestinal and acute respiratory viral infections, if they occur without significant symptoms, breastfeeding is not contraindicated while observing the rules of general hygiene. The presence of hepatitis B and C in women is currently not a contraindication to breast

nomu 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 massive growth of Staphylococcus aureus in breast milk is detected in an amount of 250 CFU or more per 1 ml and single colonies of representatives of the Enterobacteriacae family or the species Pseudomonas aeruginosa (Methodological recommendations for the bacteriological control of breast milk, Moscow, 1984). mammary gland is possible complication mastitis and is most likely when breastfeeding is abruptly interrupted. Feeding from the healthy breast should continue, but milk from the infected breast should be carefully expressed and discarded.

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

Short courses of paracetamol, acetylsalicylic acid, ibuprofen, used in medium doses, are usually safe; most cough medicines; - and other penicillins; (except rifabutin and); antifungal agents (except fluconazole, griseofulvin, ketoconazole, intraconazole); antiprotozoal drugs (except metronidazole, tinidazole, dihydroemetine, primaquine); bronchodilators (); ; antihistamines; antacids; antidiabetic agents; most antihypertensive drugs, as well as single doses of morphine and other narcotic drugs. However, during the reception medications mother, careful monitoring of the child is necessary in order to timely detect their side effects.

Lactation may be suppressed when a woman takes estrogens, including estrogen-containing contraceptives, thiazode diuretics, and ergometrine.

Transferring an infant, especially a newborn, to artificial feeding due to the mother's drug treatment with drugs in a therapeutic dosage carries a certain threat to his health and quality of life.

Considering the negative impact of tobacco smoke, tar and nicotine on the child’s body and on lactation, women who smoke during lactation are advised to stop smoking. Nicotine can reduce the volume of milk produced and inhibit its secretion, as well as cause irritability in the child, intestinal colic and lead to low rates of weight gain in infancy. Women who smoke have lower prolactin levels, which can shorten lactation periods, and also have lower concentrations 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. Content harmful substances There will be less in breast milk if a woman smokes a cigarette after breastfeeding rather than before.

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

Breastfeeding can continue during a new pregnancy.

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

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

In a number of severe congenital conditions (heart defects with decompensation, cleft palate, cleft lip, etc.), when breastfeeding is impossible, the child should receive expressed breast milk. Absolute contraindications to breastfeeding on the part of the child at subsequent stages of lactation are very limited - hereditary enzyme pathies (etc.). For phenylketonuria, the volume of breast milk in combination with medicinal products is determined 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 fluids. This condition may be associated with low humidity in the apartment, increased ambient temperature, abundant fatty foods ate by the mother the day before, etc. In these situations, you can offer the child water from a spoon, and if he begins to drink willingly, it means he needs it. In addition, supplementation is necessary for sick children, especially with diseases accompanied by high fever, diarrhea, vomiting, and hyperbilirubinemia.

Currently, there are more than 50 diseases that in children in the neonatal period can manifest as icteric discoloration of the skin. Therefore, long-term persistence 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 breastfeeding and frequent feedings are important factor prevention of jaundice, since colostrum, having a laxative effect, leads to faster passage of meconium. If the newborn child is undernourished, it may be more intense and prolonged due to thickening of bile. Supplementing with water or glucose solutions does not help prevent jaundice, but reduces its severity. It is important that the child receives an adequate amount of milk, since with insufficient nutrition, bile thickening syndrome develops.

Related to breastfeeding- from breast milk or Arias jaundice develops in 1-4% of children after the first week of life, is characterized by an increase in the level of unconjugated bilirubin and does not affect the child’s condition. The pathogenesis has not been sufficiently studied; a connection with various components of breast milk is assumed. You can confirm the diagnosis by stopping breastfeeding and using pasteurized breast milk for feeding for 1-2 days. During this time, the intensity of jaundice decreases significantly and breastfeeding can be continued.

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

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