GBOU VPO TVER STATE MEDICAL

ACADEMY OF THE MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT OF RUSSIA

DEPARTMENT OF PEDIATRICS

FACULTY OF MEDICINE AND DENTISTRY

Natural feeding. Hypogalactia.

Guidelines for students' independent work

4 Courses of the Faculty of Medicine

Compiled by:

Doctor of Medical Sciences, Professor A.F. Vinogradov

Candidate of Medical Sciences, Associate Professor A.V. Koptseva

Tver, 2012

Title of the training topic: Anatomical and physiological features of the digestive system in children. Feeding children in the first year of life. Natural feeding and its benefits. Measures to prevent hypogalactia. Methods for calculating the amount of food. Complementary feeding and technique of its introduction. The role of the local pediatrician in the fight for natural feeding. Mastering the skills of preparing a child for breastfeeding. Preparing a diet for breastfed children in the first year of life. Ethics and deontology skills.

The purpose of studying the educational topic: Study the anatomical and physiological features digestive system and modern aspects of natural feeding of children of the first year of life at the level of knowledge and skills to draw up a nutrition map for children of the first year of life who are breastfed, as well as solve situational problems on this topic. Show the benefits of natural feeding. Master the concepts of hypogalactia, measures to prevent and combat hypogalactia. Determine the role of the local pediatrician in the fight for natural feeding. To familiarize yourself with the basic principles of ethics in the aspect of the right to health and medical deontology.

Key terms:

1) Colostrum

2) Free feeding

3) Natural feeding

4) Volumetric method for determining the daily volume of food.

5) Complementary feeding

6) Hypogalactia

Topic study plan:

1. Definition of breastfeeding

   Nutrition Stages

   Composition of breast milk

   The benefits of human milk compared to cow's milk

   Frequency of feeding of children in the 1st year of life

   Calculation of daily food volume

   The concept of “complementary feeding”, timing and rules of introduction

   Hypogalactia: classification, etiology, prevention, treatment.

Presentation of educational material:

Breastfeeding - this is a controlled and corrected nutrition for children under 1 year old, differing in nature into 3 types: natural, mixed and artificial.

Natural feeding – is feeding a child with mother’s breast milk with timely physiologically justified introduction of complementary foods. Breastfeeding – feeding a child with breast milk before introducing complementary foods, including 5 positions (graded by priority):

Mother's breast.

Expressed breast milk.

Nurse's breast.

Expressed breast milk from a wet nurse.

Donor milk (milk bank from several other people's mothers).

It must immediately be emphasized that breast milk has no alternative in the problem of feeding and its replacement with any of the most adapted formulas is similar to an environmental disaster, because even the 5th gradation breast milk– donor milk from a breast milk bank is better than any adapted formula.

Anatomical and physiological features of the gastrointestinal tract of newborns:

Tender mucous membrane;

Good vascularization of the loose submucosal layer;

Little elastic and muscle tissue;

Weak secretory and enzyme-forming function.

Taking into account the above-mentioned features, the optimal product for feeding children in the first months of life is mother’s milk. From a modern point of view, breast milk is a protective factor, a chemical analyzer and fully provides the child with energy and biologically active substances, and colostrum is a powerful anti-stress factor.

Evolutionarily fixed 3 stage of children's nutrition:

Hemotrophic, when the embryo feeds at the expense of the mother, therefore it is strongly protected and... absolutely defenseless, because it “gets sick” along with the mother, which, due to its own immature defensive reaction, entails serious damage to organs and even the death of the embryo.

Amniotrophic - nutrition at the expense of the mother through the placenta and attempts at independent nutrition through the amniotic fluid (hemo-amniotrophic). This mechanism occurs between the 3rd and 5th months of pregnancy through ingestion amniotic fluid(up to 5 ml/kg/hour), which is by 6 months intrauterine life makes up up to 50% of the volume of amniotic fluid per day. The entry of proteins, fats and carbohydrates of amniotic fluid into the fetal gastrointestinal tract stimulates the development of such functions of the digestive tract as the breakdown and absorption of digestive substances and the formation of motility. Amniotic nutrition does not make a significant contribution to the provision of food ingredients to the fetus, but has a significant impact as a mechanism of adaptation to subsequent lactotrophic nutrition. It is thanks to the long-term and gradual increase in the volume of incoming amniotic fluid that the anatomical differentiation of the cells of the intestinal mucosa and the induction of the synthesis of digestive enzymes and gastrointestinal hormones occur. If hemotrophic nutrition provides the basic nutritional needs of the embryo, then amniotrophic nutrition facilitates subsequent adaptation.

Lactotrophic or enteral nutrition. The transition to extrauterine nutrition is a revolution, stress, similar to the transition to normal breathing, extrauterine circulation, etc.; this is a new qualitative leap in the ontogenesis of the individual. In the first stages of postnatal ontogenesis, the nature of feeding plays an important role.

Advantages of natural feeding over mixed and

artificial

(especially early artificial ones) is that it:

The evolutionarily fixed form of nutrition and its violation are like an environmental disaster that reduces the level of health;

Promotes the optimal development of the child in ontogenesis, because it is adjusted by evolution in terms of ingredients and micronutrients; presented in terms of proportion and quality in an optimal form for assimilation;

Reduces acute and chronic morbidity in children;

Increases life expectancy (including average life expectancy) by 10-15 years;

Prevents early sclerosis by stimulating enzyme systems that utilize cholesterol;

Significantly reduces the risk of leukemia;

Increases intelligence, creative activity and humanizes mentality;

Reduces sensitization;

Prevents dysbacteriosis;

It represents a feeding system with the following characteristics: closed, sterile, “products” heated to body temperature, tasty (taste analyzers are adapted to breast milk).

According to WHO/UNICEF recommendations (1989), healthy newborns should be placed at the mother's breast within the first 30 minutes after birth. Early breastfeeding helps stimulate lactation in the mother, increase the bactericidal properties of breast milk, improve immunity in children, and establish a normal intestinal biocenosis.

An important principle of feeding newborns is the principle of so-called “free feeding”, when the child is fed according to his request, and not according to a schedule. With the “free feeding” method, the child gradually develops his own individual rhythm - a “schedule” of food intake with constant, fairly long intervals between individual feedings.

When carrying out “free feeding”, the mother must learn to distinguish between the baby’s hungry cry and anxiety caused by other reasons. If the mother cannot adapt to “free feeding,” then in such cases she should switch to feeding the child at strictly defined hours.

Natural feeding is a type of feeding in which a child up to 6 months receives only breast milk.

There are 3 types of mother's milk.

1. Colostrum is a sticky, thick yellow liquid,
appears after the birth of the child and is released until 4-5 days.

2. Transitional milk is produced from 4 - 5 days of life until 2 - 3
weeks has an intermediate composition between colostrum and
mature milk.

3. Mature milk is produced from 2 - 3 weeks of a child’s life and
has complete biological similarities with the child’s body.

Composition of breast milk (see 10 benefits of breast milk).

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 the 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. Less 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. On artificial feeding an increased need for food is established - the risk of obesity at an older age.

12. Physical (biological maturation and aging) and sexual development are faster in artificial babies, and 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, daytime sleep 1.5 - 2 hours, 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-breastfeeding 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 is fed), 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 a doctor

6. Do not abuse 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. In case of greedy sucking and (or) active flow of milk in a stream, periodically hold the baby vertically 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 his cheek, tickle his 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 vertically for 3-5 minutes to prevent regurgitation.

11. Wash the mammary gland

Currently, free feeding is recommended for a newborn baby and children in the first months of life - 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 amount of protein and fat in order to somehow satisfy the child’s needs. This milk is called colostrum. Then, lactation gradually 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 (the “final” milk contains up to 17% fat, so it is impossible to calculate). All nutritional corrections should come through breast milk (nutrition for a nursing woman)

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) - feeding from a spoon or through a tube

Mother's side

1. Flat, inverted nipple (special covers 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

4. Hypogalactia

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, and 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. Promotion of breastfeeding, 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 on the breast, latching on both breasts at one feeding

Quartz irradiation, UHF, massage, acupuncture

Mixed feeding.

Mixed feeding

Mixed feeding is a type of feeding in which the child receives breast milk and supplementary feeding in the form of formula milk.

The effectiveness of mixed feeding depends on breast milk in the child’s daily diet:

If the amount of mother's milk is half the daily amount
diet (2/3, 3/4), then the effectiveness of mixed feeding
approaches the natural;

If the amount of mother's milk is less than half
daily ration (1/3, 1/4), then the effectiveness of mixed
feeding approaches artificial feeding;

Supplements

Supplements are dosed meals that are included in the diet as sources of vitamins, minerals, microelements and as additional sources main ingredients (proteins, fats, carbohydrates).

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 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

The newborn period is associated with an increase in blood flow in the vessels of the lungs and brain, changes in energy metabolism and thermoregulation. From this period, enteral nutrition of the child begins. During the newborn period, adaptation mechanisms are easily disrupted. During this period, a hormonal crisis of the newborn develops, associated with a disruption in the interaction of the endocrine apparatus of mother and child and birth stress. Conditions reflecting the child’s adaptation:

1) physiological catarrh of the skin;

2) physiological jaundice;

3) physiological weight loss;

4) uric acid infarction.

During this period, developmental anomalies, fetopathy, hereditary diseases, diseases caused by antigenic incompatibility are revealed, birth injuries, intrauterine infection or infection during childbirth appear. Purulent-septic diseases, bacterial and viral lesions of the intestines and lungs may occur. In the early neonatal period, aseptic conditions must be created, optimal temperature environment, close contact of the newborn with the mother. The late neonatal period covers the period from 8 to 28 days. During this period, a delay in body weight gain is detected. The child’s body’s resistance is low; complete adaptation has not yet occurred.

During this period, diseases and conditions associated with the pathology of the prenatal, intranatal and early neonatal periods may also be identified. An important criterion for a child’s well-being should be an assessment of the dynamics of body weight, neuropsychic development, and sleep status.

The most important characteristics of this stage include the intensive development of analyzers, the beginning of the development of coordination movements, the formation of conditioned reflexes, and the emergence of emotional, visual and tactile contact with the mother.

2. Benefits of human milk

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

1. Colostrum and human milk contain antibodies to pathogens of intestinal infections - to the O-antigen of Salmonella, Escherichia, Shigel, enteroviruses, respiratory infections (such as influenza, reovirus infection, chlamydia, pneumococci), to pathogens of viral diseases (poliomyelitis virus, cytomegaloviruses, mumps viruses, herpes, rubella), bacterial infections caused by staphylococci, streptococci, pneumococci, tetanus toxin).

2. Colostrum contains immunoglobulins of all classes, especially YgA (90%). As lactation progresses, its content decreases, but daily consumption remains high (3–4 g). This immunoglobulin acts as the first defense against invasion, inhibits bacterial adhesion, neutralizes viruses, and prevents allergization.

The child receives 100 mg of YgM per day. The placenta of ruminants is impermeable to immunoglobulins. The colostrum of ungulates contains predominantly YgG, and YgA and YgM - in small quantities.

3. In the first 4 weeks of lactation, human milk contains lactoferrin (50-100 mg/l), which activates phagocytosis, binding ionized iron in the intestine, and blocks the new formation of bacterial flora.

4. Colostrum contains complement components C3 (30 mg per day) and C4 (about 10 mg/day).

5. The content of lysozyme in human milk is 100–300 times higher than in cow's milk. Its action is to damage the bacterial membrane, stimulate the formation of salivary amylase, and increase stomach acidity.

6. Human milk contains bifidus factor, the activity of which is 100 times higher than in cow's milk. This carbohydrate promotes the formation of bifidus flora, lactic and acetic acids, which prevents the growth of staphylococcus, salmonella, shigella, and escherichia. With natural feeding, the ratio of lactobacilli and other microorganisms in the intestines is 1000: 1, with artificial feeding - 10: 1.

7. A large number of viable cells are found in human milk - 0.5-1 million in 1 ml of milk, macrophages - 50-80%, lymphocytes - 10-15% of the total cytosis. Milk macrophages are capable of synthesizing interferon, lactoferrin, lysozyme, and complement components; they retain their importance during intestinal infections. Among the lymphocytes in human milk there are B-lymphocytes that synthesize YgA, T-lymphocytes - helpers, suppressors, and memory cells. They produce lymphokines. Neutrophils in colostrum - 5 x 105 per 1 ml, subsequently there is a slight decrease. They synthesize peroxidase and have the ability to phagocytose.

8. Allergy to human breast milk is unknown, while allergy to formula milk in 1-year-old children is about 10%.

9. Women's milk, especially colostrum, unlike cow's milk, contains pituitary and thyroid hormones.

10. Human milk contains about 30 enzymes involved in hydrolysis, which ensures a high level of digestion of human milk.

11. Human milk contains 2 times less protein, but more carbohydrates (lactose) than animal milk. The amount of fat is the same. The energy value due to protein in human milk is covered by protein by 8%, in cow's milk - by 20%. The share of the energy value of carbohydrates in human milk is 45%, in cow's milk - about 30%, fat in both cases covers about 50% of its energy value.

12. Human milk has lower ash content than cow's milk.

13. The ratio of the sum of whey lactoalbumin and lactoglobulins to caseinogen is 3:2. In cow's milk this ratio is 3:2, so adapted mixtures enriched with whey proteins. Casein, when milk curds in the stomach, produces large flakes, and albumin produces small flakes, which increases the surface area for contact with hydrolysis enzymes.

Human milk also contains proteolytic enzymes.

14. The main component of human milk fat is triglycerides. In children, due to the low activity of pancreatic lipase and the low concentration of conjugated bile salts, fat hydrolysis is difficult. Breast milk contains lower levels of palmitic acid, which facilitates easier hydrolysis. The nutritional value of cow's milk triglycerides is lower than that of women's milk due to the greater formation of free fatty acids that are excreted. The coefficient of fat absorption in human milk in the 1st week of life is 90%, in cow's milk - 60%, and then increases slightly. The fat composition of human milk is also different from cow's milk. The composition of human milk fat is dominated by unsaturated essential fatty acids, which are not synthesized in the human body, especially in the first year of life. They are contained in extremely small quantities in cow's milk. The high content of essential fatty acids is of great importance for the development of the brain, retina of the eyes, and the formation of electrogenesis. Compared to cow's milk, human milk contains a higher content of phosphatides, which ensure closure of the pylorus during the passage of food into the duodenum, which leads to uniform evacuation from the stomach, and promote protein synthesis. The fat absorption coefficient of human milk is 90%, for cow's milk it is less than 60%. This is explained by the presence of the lipase enzyme in human milk with its activity being 20–25 times greater. The breakdown of milk fat by lipase provides active acidity in the stomach, which helps regulate its evacuation function and more. early discharge pancreatic juice. Another reason for the better digestibility of human milk fat is the stereochemical arrangement of fatty acids in triglycerides.

15. The amount of milk sugar (lactose) in human milk is greater than in cow's milk, and in female milk it is b-lactose, which is absorbed more slowly in the small intestine and ensures the growth of gram-positive bacterial flora in the large intestine. The predominant content of lactose among the sugars in human milk is of great biological significance. Thus, its monosaccharide galactose directly promotes the synthesis of galactocerebrosides in the brain. The predominant content of lactose (a disaccharide) in human milk, which has a higher energy value but an osmolarity equal to monosaccharides, ensures an osmotic balance that is optimal for the absorption of nutrients.

16. The ratio of calcium and phosphorus in human milk is 2–2.5: 1, in cow’s milk – 1: 1, which affects their absorption and assimilation. The calcium absorption rate of human milk is 60%, while that of cow's milk is only 20%. Optimal metabolic rates are observed in the case of intake of human milk from 0.03 to 0.05 g of calcium and phosphorus per 1 kg of body weight, and magnesium - more than 0.006 g/(kg per day). Human milk is richer than cow's milk in iron, copper, zinc, and fat-soluble vitamins.

3. The importance of colostrum in the nutrition of newborns in the first days of life. Characteristics of colostrum

Colostrum is a sticky, thick, yellow or gray-yellow color, which is released at the end of pregnancy and in the first 3 days after birth. When heated, it curdles easily. Colostrum contains more protein, vitamin A, carotene, ascorbic acid, vitamins B12, E, and salts than mature milk. Albumin and globulin fractions prevail over casein. Casein appears only from the 4th day of lactation, its amount gradually increases. Before the baby is put to the breast, the protein content in colostrum is highest. There is especially a lot of YgA in colostrum. There is less fat and milk sugar in colostrum than in mature milk.

Colostrum contains leukocytes in the stage of fatty degeneration, macrophages in significant quantities, and lymphocytes. Colostrum B lymphocytes synthesize secretory YgA, which, together with phagocytes, forms local intestinal immunity when intensive bacterial colonization of the newborn’s body occurs.

Colostrum proteins are absorbed unchanged due to their identity with the child’s serum proteins.

Colostrum is an intermediate form of nutrition between the periods of hemotrophic and amniotrophic nutrition and the beginning of lactotrophic (enteral) nutrition. The energy value of colostrum on the first day is 1500 kcal/l, on the 2nd day – 1100 kcal/l, on the 3rd day – 800 kcal/l.

4. Natural feeding and complementary feeding techniques

Natural feeding is feeding a child by attaching it to the breast of its biological mother. It represents the only form of adequate nutrition for a child after birth and during 1–1.5 years of life.

Newborn's first attachment maternity hospital carried out simultaneously with the first contact procedure. At the time of birth, a normal full-term baby has everything to successfully suckle at the breast according to the innate program of seeking nutrition within 120–150 minutes after birth: climbing to the mother’s breast, coordinated action of the arms and mouth in an active search for the nipple with a wide open mouth, tenacious suction to the chest and energetic satiation before falling asleep.

Breastfeeding should begin within the first hour after birth, when both the baby's reflexes (searching and sucking) and the sensitivity of the nipple area (areola) to tactile stimulation in the mother are highest. Skin contact after birth should be close - on the mother's stomach after an uncomplicated birth. When feeding, the baby should grasp the nipple and areola with an energetic “butting” movement with the head, lifting the breast, and then, as if placing it as the breast moves down, onto the wide-open mouth, with the tongue lowered but not sticking out under the breast. Grabbing only one nipple without an areola and then sucking on it is ineffective and immediately leads to the formation of a crack. The effectiveness of sucking is determined by the rhythmic massage of the areola with the baby's tongue. If sucking does not occur at the first skin contact, then holding the baby at the breast for more than 2 hours is inappropriate. Lifting the baby or creating skin-to-skin contact 2–3 hours after birth is also ineffective.

A good grasp of the mother's nipple by the baby's mouth provides him with sufficient ease of sucking and good reflex regulation of breathing associated with sucking the breast. Observation of feeding should be focused on achieving the act of swallowing milk, which can be judged by both the severity of swallowing movements and the sound accompanying swallowing.

Attachment of the baby to the breast should be carried out from the first day, according to any sign of hunger or discomfort on the part of the baby. Signs of hunger can be active sucking movements of the lips or rotational movements of the head with various sound signs even before the cry. The frequency of application can be 12–20 or more per day. The break between daytime feedings may not reach 2 hours, and between night feedings there may be no more than 3–4 hours.

The most natural deficiency states during breastfeeding.

1. Vitamin K deficiency in the first few days of life occurs due to its low content in human milk or due to low milk consumption during this period. A single parenteral administration of vitamin K to newborns is recommended.

2. Vitamin D deficiency occurs due to its low content in human milk and insufficient sun exposure. Recommendations: 200–400 IU of vitamin D per day during the period when there is no regular sun exposure.

3. Correction of iodine for mother and child is necessary in regions with suboptimal natural supply. Recommendations: single intramuscular injection of iodized oil.

4. Iron deficiency. From 1 liter of mother's milk, a child receives about 0.25 mg of iron, and about the same from other food sources.

When breastfeeding, iron supplementation should be carried out with iron medicinal preparations or through mixtures enriched with iron, if necessary, supplementary feeding.

5. Fluoride deficiency requires the use of microdoses - 0.25 mg per day from 6 months onwards.

The introduction of complementary foods depends on the quality of human milk. Optimal feeding with good nutrition for pregnant and lactating women can easily ensure the development of a child without complementary foods for up to 1–1.5 years.

Lack of confidence in optimal feeding requires the introduction of solid complementary foods between 4 and 6 months.

5. Complementary feeding dishes and timing of their administration during breastfeeding

As a training supplement, you can use 50–20 g of grated apple or fruit puree. If swallowing is good, well tolerated and there is no allergic reaction, it can be given regularly as complementary foods and transferred to the beginning of feeding. The most appropriate age is between 16-24 weeks of life, the duration of this complementary feeding is 2-3 weeks (see Table 4).

An indication for the introduction of main (or energetically significant complementary foods) is a clear manifestation of the child’s dissatisfaction with the volume of milk received in a state of his physiological maturity when this dissatisfaction can already be compensated by thick complementary foods. Some children may develop objective signs of malnutrition even in the absence of anxiety and crying: children become apathetic, decrease physical activity, the rate of weight gain slows down. Conditions for introducing complementary foods:

1) age more than 5–6 months;

2) established adaptation to moving and swallowing thick food when using educational complementary foods;

3) completed or current eruption of some teeth;

4) confident sitting and head control;

5) maturity of the functions of the gastrointestinal tract.

Table 4. Approximate scheme of natural feeding of children of the 1st year of life(Institute of Nutrition of the Russian Academy of Medical Sciences, 1997)

First, a test dose of complementary foods is introduced - 1-2 tsp. and then, with good tolerance, there is a rapid increase to 100-150 ml of fruit or vegetable puree or porridge without salt and sugar based on buckwheat or rice.

Stages of complementary feeding expansion:

1) educational complementary foods;

2) one vegetable puree(from potatoes, carrots, cabbage) or fruit puree (from bananas, apples). It is better to use manufactured products;

3) gluten-free porridge (from rice, corn, buckwheat);

4) supplementation of vegetable puree with minced meat, fish or poultry from canned meat for baby food, expansion of vegetables and fruits, except citrus fruits. Adaptation period – 1–1.5 months;

5) porridge with wheat flour;

6) cow's milk substitutes for baby food, non-adapted dairy products (milk, kefir, yogurt, cottage cheese), citrus fruits and their juices, egg yolk hard-boiled;

7) the beginning of “piece” feeding: cookies, pieces of bread, sliced ​​​​fruit, steamed cutlets.

The total daily amount of milk (breast or formula) in any period of the first year of life should not be less than 600–700 ml, it should be distributed evenly throughout the day.

By the end of the first year of life, instead of “follow up” formulas for the dairy component of the diet, it is advisable to use cow’s milk substitutes for children 2-3 years of age “Enfamil Junior” from Mead Johnson.

With good tolerance of complementary foods and the child’s appetite, the volume of one feeding portion can be 200–400 g by the 3rd–4th quarter of the first year.

(Feeding a healthy child in the first year of life)

Natural feeding is feeding infants with mother's milk with the introduction of complementary foods from the 5th month. In this case, the content of mother's milk in the daily diet should be at least 4/5. This type of feeding is the most physiological, its advantages are undoubted, since in its structure mother's milk is close to the composition of the child's tissues.

The most important benefits of human milk:

1. Women's milk is completely devoid of antigenic properties, while cow's milk proteins have pronounced antigenic activity, which contributes to the appearance and intensification of allergic reactions in infants. Refusal of breast milk if the child has allergic reactions is a grave mistake, although it is not uncommon to transfer the child from allergic reactions it seems to have a positive effect on artificial, usually fermented milk mixtures: the manifestations of exudative diathesis subside for some time. And everyone is happy - “the allergy was cured.” In fact, we excluded from the child’s diet the allergen that came to him through mother’s milk. In this situation, it was necessary to find and exclude from the mother’s diet the allergen to which the child reacts, and be sure to maintain natural feeding.

2. The total amount of protein in breast milk is significantly less than in cow's milk; its structure is similar to the proteins of the baby's cells. It is dominated by finely dispersed fractions, the particles of coarse casein protein are several times smaller than in cow's milk, which ensures that breast milk curdles in the stomach into more delicate flakes and thereby more completely digests it.

Human milk contains such a unique substance as taurine, a sulfur-containing amino acid with neuro-active properties. With artificial feeding, protein overloads inevitably occur, since cow's milk contains three times more amino acids. These overloads are accompanied by intoxication and kidney damage due to metabolic disorders. This leads to a delay in the development of the child’s central nervous system. It is known that higher intellectual capabilities occur in schoolchildren who were breastfed during the first 4-9 months.

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

4. Obesity in adults often has its roots in early childhood childhood. Artificial feeding contributes to obesity in infants. Many of them experience secondary obesity during puberty, which persists throughout their lives. This is also mainly due to protein overfeeding.

5. The amount of fat in human and cow's milk is almost the same, but there is a significant difference in its composition: breast milk contains several times more unsaturated fatty acids. The development of atherosclerosis in adults is based on dyslipidemia, the occurrence of which is greatly influenced by the lack of breast milk, especially in the first 5 months of a child’s life. The breakdown of fat in infants begins in the stomach under the influence of breast milk lipase; it stimulates the appearance of active acidity in the stomach, promotes the regulation of the evacuation function of the stomach and the earlier release of pancreatic juice. All this facilitates the digestion and assimilation of fat, the individual components of which are included in the cells of all tissues and biologically active substances, are spent on the myelination of nerve fibers, providing an increased need for fats in a child of the 1st year of life.

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

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

8. The mineral composition of food and the content of bioelements in it are important for a growing organism. The concentration of calcium and phosphorus in breast milk is lower, but their absorption is two times better than from cow's milk. Therefore, with natural feeding, children suffer from rickets much easier and less often. The content of bioelements (sodium, magnesium, chlorine, iron, copper, zinc, cobalt, sulfur, etc.) in breast milk is optimal and meets the baby’s needs. For example, iron in human milk is 0.5 mg/l, and in infant formula 1.5 mg/l; however, the degree of bioavailability is 50 and 5%, respectively. That is why breastfed children are much less likely to suffer from anemia, and there is no need to add iron to their diet until the age of 6 months. When artificial feeding, additional iron is prescribed from 4 months of age, usually in the form of food products enriched with this bioelement. Breast milk contains four times less sodium than cow's milk. Excessive sodium loads can cause vegetative-vascular dystonia with fluctuations in blood pressure during puberty, as well as more severe and more frequent crises during hypertension adult.

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

10. During artificial feeding, gastric secretion increases five times, i.e., the programmed course of the biological clock of maturation is disrupted. In the future, this contributes to the development of gastrointestinal dyskinesia, gastroduodenitis, cholecystitis, especially in the presence of a hereditary predisposition.

11. It has been shown that with natural feeding, sexual potency and fertility are higher in the future.

12. The composition of human milk changes in the presence of intrauterine diseases, which is considered as a compensatory reaction to the development of fetal pathology.

13. With natural feeding, a lifelong relationship with the mother is established, its subsequent influence on the child’s behavior, and the future is also formed parental behavior. Thus, bottle-fed animals have sharply distorted parental behavior when they become adults: they refuse to feed their offspring. Therefore, psychologists who deal with issues of breastfeeding attach great importance to natural feeding. family relations. Thus, refusal of natural feeding is a gross violation of the biological chain “pregnancy-childbirth-lactation” that has developed in evolution.

In conclusion, it must be added that mammary glands in a nursing mother, like the placenta in a pregnant woman, are a powerful barrier that rarely allows microorganisms, heavy metal salts and other products harmful to the child to pass through. Therefore, you need to be quite careful about recommendations such as giving up breastfeeding and switching your child to formula milk due to the unfavorable environmental situation in the area.

The main reason for refusing breastfeeding is hypogalactia, i.e. reduced secretory ability of the mammary glands. There are primary hypogalactia, which is a consequence of neuroendocrine disorders in a woman’s body. It may be associated with disorders of the hypothalamic-pituitary-ovarian regulation that arise in the prenatal period in a girl when her mother is prescribed estrogens, especially synthetic ones, during pregnancy. However, in the vast majority of cases, secondary hypogalactia develops due to the negative impact on the female body of an integral complex of biological, medical, social, psychological and economic factors. The leading role, of course, belongs to social factors and iatrogenic reasons. According to the World Health Organization, only 1% of women are unable to breastfeed their children. At the same time, in this country, more than 10% of mothers do not breastfeed from birth. By 6 months, less than 3 children remain breastfed, and mothers begin to independently introduce supplementary feeding from two weeks.

Causes of hypogalactia in modern conditions listed in order of importance.

1. Lack of attitude towards breastfeeding in a pregnant woman. If, when asked whether she will breastfeed her unborn child, a pregnant woman answers: “Yes, if I have milk,” this means that she has not been prepared for breastfeeding. To actively promote natural feeding, close cooperation between obstetric and pediatric services is necessary. Positive motivation should be cultivated breastfeeding in the microsocial environment of pregnant women. It has been statistically shown that the influence of family members, especially the father of the unborn child, the support of the medical staff of the antenatal clinic and maternity hospital turn out to be powerful stimulators of lactation. Future parents should know about the benefits of breastfeeding for a child and its beneficial effect on a woman’s health. Thus, in England, women who switched their children to artificial feeding early are considered to be at increased risk for the development of pre-tumor processes in the mammary glands. In many developing countries, the contraceptive effect of breastfeeding contributes more to spacing births than any other method of regulating fertility. Lactation has a pronounced contraceptive effect due to the fact that frequent irritation of the nipple leads to reflex inhibition of the hypothalamus. As a result, the secretion of hapophyseal gonadotropin decreases, which in turn inhibits ovulation and promotes amenorrhea. The contraceptive effect of breastfeeding decreases when the baby is put to the breast more rarely, for example, when feeding strictly according to the regimen. With lactational amenorrhea, the risk of becoming pregnant is 5-10%, i.e. the same as when using oral contraceptives. After ovulation resumes, lactation no longer has a contraceptive effect.

If there are other children in the family, it is necessary to at least periodically breastfeed the baby in the presence of older children.

In the 60-70s, when there was a noticeable decrease in the frequency of breastfeeding in developed countries, one of the main reasons for hypogalactia was considered to be insufficient support from health care workers. Groups “For expanding the practice of breastfeeding” were organized, where the consultants were mothers themselves who had breastfed at least one child. This led, after a few years, to a significant increase in natural feeding. Currently, an interesting trend has emerged - the highest percentage of natural feeding is observed in the most poor and most prosperous countries in the world, and in the latter women with higher education breastfeed 2.5-5 times more often than less educated people.

2. Late first breastfeeding. There are very few contraindications to early breastfeeding, immediately after birth. In Western European countries, the vast majority of newborns are immediately put to the breast. Even after a cesarean section, breastfeeding begins as soon as the mother comes to her senses after anesthesia. In our country, less than 20% of women begin breastfeeding immediately after birth. 40% of women in labor put their baby to the breast more than 24 hours later.

A video was shot in Sweden, which clearly shows that immediately after birth, when the baby lies on the mother’s stomach, he has a relaxation period for 5 minutes, then about 10-15 minutes - awakening, about 40 minutes - a period of activity, when the child is looking for the breast, and he must find it himself. Newborns should not be given the breast like a bottle: their mouth should be wide open and underlip as if turned inside out. Only such capture of the nipple along with the areola ensures sufficient supply of nerve impulses from their surface to the mother’s hypothalamus, which directly contributes to the onset of lactation. Under optimal conditions for keeping a child immediately after birth (certain temperature and humidity), the natural reserve of energy and water in the newborn is sufficient until lactation is established. Consequently, a healthy newborn does not need additional intake of water, 5% glucose, and especially infant formula. This will only interfere with the establishment of lactation.

In some countries, it is prohibited to provide information to a woman about artificial feeding during the first three months after birth; advertising of infant formula in hospitals is prohibited.

3. Rarely putting the baby to the breast in the future, regulation of breastfeeding, a purely technical approach to monitoring the lactation process. Insufficient lactation is not a contraindication to frequent breastfeeding. On the contrary, more frequent feeding is recommended, every 2-2.5 hours, without an overnight interval. Frequent and unlimited breastfeeding in the first two weeks of life, on average 9 times a day, significantly increases lactation. In the 80s In many developed countries, they began to abandon strict regulation of breastfeeding and a purely technical approach to monitoring the lactation process. You cannot attach too much importance to the amount of milk sucked, especially with a single control feeding, since children can suck out different volumes of milk at different hours during the day. In addition, the composition of human milk is extremely variable (for example, the protein content of milk different women ranges from 0.9 to 2.0 g per 100 ml). However, the composition of a child's tissues is individual, and his mother's milk is always suitable for him, but it may not be suitable for another child. Therefore, feeding children with donor milk is not absolutely identical to natural milk.

As a rule, the mother produces as much milk in her mammary glands as the baby needs; It is better to feed from both mammary glands, especially if there is not enough milk, as this stimulates lactation and also reduces the risk of lactostasis. If milk remains in the mammary glands after feeding, it is necessary to express it while it flows in a trickle (not drops).

The breasts are not processed as breast milk is the best cream. In addition, each breast has a specific smell that the baby recognizes.

4. Violation of the daily routine of a nursing woman. Excessive physical activity and especially insufficient sleep reduce lactation. Therefore, a nursing woman must sleep during the day.

5. Other reasons - poor diet, illness, age of the nursing woman - play a minor role in the development of hypogalactia.

The nutrition of a nursing mother has a greater influence on the quality composition of milk, although it must be remembered that the mammary gland, being a powerful barrier, usually allows as many macro- and microelements as the baby needs. Therefore, the mother should not be overly enthusiastic about vitamins, microelements, and minerals. The volume of milk depends even less on the mother's nutrition. For example, in African countries, where people are dying of hunger, many women breastfeed for up to 2-3 years in order to save the child.

Of course, various maternal diseases inhibit lactation. However, if a woman was determined to breastfeed even during pregnancy, and this often happens in women with chronic diseases, since this is their last chance have a child, then, as a rule, their lactation is quite satisfactory.

Across all countries, young and older mothers are least likely to breastfeed. But if in the elderly this is explained by biological reasons, then in the young only by social ones - lack of family planning, often accidental conception, lack of intention to breastfeed during pregnancy, etc.

Based on the above, in order to stimulate lactation it is necessary:

1) transfer the child to more frequent feeding;

2) adjust the daily and nutritional regimen of a nursing woman.

Can be assigned to mother nicotinic acid, vitamin E, ultraviolet radiation, UHF, ultrasound, vibration massage, acupuncture, compresses from terry cloth soaked hot water, on the mammary glands. Use herbal medicine:

1) decoction of nettle leaves, 1 tablespoon 3 times a day (4-5 tablespoons of nettle are brewed per 1 liter of water);

2) hawthorn extract 20-30 drops 3-4 times a day before meals for 10-14 days.

They use infusions of dandelion roots, oregano, dill fruits, and anise. However, it must be remembered that, firstly, the use of medications gives a much smaller effect than methods of physiological stimulation of lactation, and secondly, the above measures will only help if the woman understands the importance of natural feeding and is committed to breastfeeding. We can say that “a woman’s milk comes through her head.”

The calculation of the required amount of food occurs when there is insufficient increase in body weight or the child is restless in the period between feedings. It is also necessary to determine the dose of nutrition when feeding with expressed milk and its substitutes.

The simplest way to calculate the amount of milk a newborn needs in the first 9 days of life is as follows: a single feeding requires 10 ml of milk, multiplied by a day of life (with 6-7 feedings). From the 10th to the 14th day, the daily volume of milk remains unchanged.

From two weeks of age, the required amount of milk is determined taking into account the daily calorie requirement per kilogram of body weight.

Daily requirement for kilocalories per 1 kg of body weight:

I quarter of the year – 120-125;

III – 115-110;

Knowing age and body weight, you can calculate the amount of milk a child needs per day (x). For example, a child aged 1 month has a body weight of 4 kg and, therefore, needs 500 kcal per day; 1 liter of breast milk contains 700 kcal. Hence:

x = 500 x 100/700 = 710 ml.

You can also use a less accurate, but simpler method of calculating volume based on body weight. In accordance with this, a child aged from 2 to 6 weeks should receive 1/5 milk, from 6 weeks to 4 months - 1/6, from 4 to 6 months - 1/7 of body weight.

For example, a child aged 1 month with a body weight of 4 kg requires l/s from 4 kg, which is 800 ml per day, i.e. there is no complete coincidence with the calculation of calorie content.

The daily volume of food for children of the first year of life should not exceed 1000-1100 ml.

All calculation options allow only approximately determining the required amount of food. You should keep in mind the baby's individual need for the amount of milk.

The feeding regimen is established depending on the age of the child and the amount of milk in the mother, taking into account the individual needs of the child and other points. In the first 3-4 months of life, healthy full-term babies are fed 7 times, i.e. every 3 hours with a 6-hour night break. If the child withstands a longer period of time between feedings, he is transferred to 6 feedings a day. From 4.5-5 months, most children are fed 5 times a day. After 9 months, many children prefer 4 meals a day.

If there is anxiety between feedings, the child is given sugar-free or slightly sweetened water, perhaps with a few drops of lemon juice. Some children refuse water because they completely satisfy their need for it with milk.

Lure. Breast milk can fully meet the needs of a child’s body only up to a certain age. In the last 10-15 years, many developed countries have returned to the recommendations of the 40-50s: do not prescribe anything additional to the child until 4, and in some countries even until 6 months of age. In our country, taking into account the socio-economic conditions, the previous recommendations still remain. From the 2nd month of life, fruit and vegetable juices are included in the diet. At first, the child is given a few drops, gradually increasing the volume. In the future, the amount of juice is calculated according to the following scheme: the child’s age in months is multiplied by 10. As a rule, they start with apple juice. After 3 months, you can introduce other juices (carrots, pomegranates, cabbage, black currants, etc.). Lemon juice It can also be given from the second month of life, but in a smaller volume - about 5 ml in the first half of the year, 10 ml per day in the second. Among citrus fruits, grapefruit juice can be prescribed even to children with allergies.

From 2-3 months, in addition to juices, homogenized fruit purees can be prescribed, since food homogenization significantly increases the surface of contact of food particles with enzymes and thereby accelerates the digestion and assimilation of food substances. In the absence of ready-made homogenized fruit purees, from 3 months, use baked or fresh grated apple. Juices and fruit juice are given immediately before or after feeding, sometimes in the interval between feedings.

However, in most cases, even if a deficiency of micronutrients develops, it is better to fill it not with the early administration of juices and fruit purees, but with vitamins complexed with microelements and minerals, specially designed for infants.

Complementary feeding is the introduction of new food, more concentrated and high-calorie, gradually and consistently replacing breastfeeding. By 4.5-5 months, children double their body weight; breast milk can no longer provide the child’s body with the main ingredients. By 5 months, a significant amount of saliva is also released, and the secretion of gastric juice and pancreatic juice increases. Previously complementary feeding in the form of 5% semolina porridge was introduced at 5-5.5 months. Since the 60s, everywhere the first complementary foods are prescribed at 4-5 months in the form of vegetable puree in order to primarily cover the deficiency of bioelements. To prepare puree, you need to use a variety of vegetables (carrots, beets, turnips, green peas, cabbage, and later, from 6 months, potatoes). Only with a wide range of vegetables does a child receive the set of microelements, mineral salts and vitamins necessary for a growing body. It is better to cook vegetables in a pressure cooker, as it saves time and reduces the loss of nutrients. Then the boiled vegetables are rubbed through a sieve and divided in half. Place one half in a glass jar, close it tightly with a plastic lid and put it in the refrigerator until the next day. The second is diluted to the consistency of thick sour cream with vegetable broth or milk and given to the child from a teaspoon, which is necessary for the proper functioning of the gastrointestinal tract. Currently, industrial vegetable purees of domestic or foreign production are widely used, especially for infants. Their advantage is homogenization, greater variety, long shelf life, providing children with a wide range of different products throughout the year, regardless of the season, and speed of preparation.

Often, children with allergies tolerate them better than homemade vegetable puree, which, unlike industrial puree, contains too much sodium.

These recommendations for prescribing juices, fruit and vegetable purees if the mother has sufficient lactation, her nutrition is adequate, the child’s stool is unstable, or if the child is allergic should not be too categorical. It is quite acceptable to introduce juices and purees 2-3 weeks later. This is especially true for excitable children, who have high levels of acidity and pepsin activity in the first phase of secretion, since juices and purees stimulate the secretion of gastric juice.

From 5-6 months, a second complementary feeding is introduced in the form of 7%, and later 10% semolina porridge, initially with vegetable broth or 50% milk. After 2 weeks, you can cook the porridge with whole milk. Considering that the child has managed to get used to thick food, receiving vegetable puree, you can start right away with 10% of porridge. Semolina porridge is alternated with buckwheat, oatmeal, and rice. First, rice, buckwheat, and Hercules are crushed in a coffee grinder. You can use ready-made rice and buckwheat flour, oatmeal. It is useful to give assorted porridge made from oatmeal, rice, and buckwheat.

It is preferable to use cereals enriched with various additives (iron, calcium, phosphorus, B vitamins).

In some countries, porridge is prescribed as the first complementary food, and vegetables are given later; in other countries, it is believed that the sequence in which foods are included in the diet does not play a significant role. At the same time, 3-6 g of butter or vegetable oil are introduced, alternating. Vegetable oil necessary, especially for children with allergies, as a source of polyunsaturated fatty acids. From 4-5 months, add hard-boiled egg yolk, first once a week, then every other day.

There is no need to add salt to your child's food. Excess salt is harmful to the kidneys of infants.

In developed countries, modern children often suffer from protein overfeeding. Therefore, it is recommended to prescribe cottage cheese as a complementary food only from 6-7 months, as a rule, no more than 20-30 g per day. Cottage cheese also causes a long-term increase in the acidity and proteolytic activity of gastric juice, which contributes to the tension of the secretory process of the gastric glands. Its earlier administration is used to correct nutrition in case of protein deficiency. In such cases, it can be used from 2-3 weeks.

Thus, by 7 months, two breastfeedings are replaced with complementary foods. Sample menu for a 6.5 month old child: 6 hours – breast milk; 10 hours – 10% porridge (150 ml), 1/2 yolk, juice 50 ml; 14 hours – breast milk; 18 h – vegetable puree (150 ml), cottage cheese 20 g, grated apple 30 g; 22 hours – breast milk.

From 7.5-8 months, the child receives minced meat from boiled beef, no more than 20-30 g per day. It is added to vegetable puree. Other authors prefer pork, poultry, especially white meat, to beef, as less allergenic products. Even lean meat contains a lot of unsaturated fatty acids, so some authors believe that fish is preferable for children. Sometimes low-fat broth, no more than 50 ml, is prescribed 2-3 times a week. But at present, many nutritionists recommend refraining from prescribing meat broth in the first year of life, especially in children with constitutional abnormalities.

At 8 months, the baby is replaced with another feeding with complementary foods. This is kefir or milk with cottage cheese.

Sample menu for a child 8.5 months old: 6 hours – breast milk; 10 hours – porridge (150 ml), yolk, grated fruit or juice (50 g); 14 hours – minced meat (20 g), vegetable puree (150 g), juice (30 ml); 18 hours – kefir (160 ml), cottage cheese (20 g); 22 hours – breast milk. Minced meat is replaced with meatballs from 10 months, and steamed cutlets from 12 months. At the same time, bread and apples are given in pieces. Usually a child is weaned at the age of 1 year. At 12-16 months, morning feeding is replaced with whole cow's milk or kefir with cookies or crackers. Then do the same with evening feeding.

Thus, by the end of the first year of life, the child is transferred to food from the common table, but mechanically and chemically gentle. It must be balanced in terms of the main ingredients and must ensure an intensive metabolism of the child. Systematic weaning gradually leads to the extinction of lactation, but sometimes a pressure bandage on the chest is required. It is recommended to stop breastfeeding in the hot season, if the child is acutely ill, or during preventive vaccinations in order to avoid digestive disorders.

One serious mistake in breastfeeding is extremely common these days. Often the mother complains that the child in the first two months of life has unstable, sometimes rapid stools, periodically with an admixture of greens, mucus, almost constant flatulence, intestinal colic, although the child remains calm, sucks well, and gains weight. In such a situation, often after preliminary culture of the baby’s feces and mother’s milk, a diagnosis of staphylococcal enterocolitis is made, although it is possible that it gets into the milk during expression, especially since, as a rule, epidermal staphylococcus is sown from milk. The presence of staphylococcus in a child’s stool is also not always explained by enterocolitis. Unstable stool in children in the first 2 months of life is usually associated with lactase deficiency, which can be primary (hereditary), but in the vast majority of cases it is transient in nature and occurs in premature infants, with intrauterine malnutrition, with various inflammatory diseases, with perinatal damage to the central nervous system, antibacterial therapy, dysbacteriosis. There may also be a relative lactase deficiency associated with a high concentration of lactose in breast milk or varying degrees maturity of the gastrointestinal tract even in healthy children. In such cases, it helps to switch the mother to a dairy-free diet for 3-4 weeks, which often improves lactation. Bifidum-bacterin 2-2.5 doses x 3 times a day 30 minutes before meals for 10-20 days, pancreatic enzymes 0.15 x 3-4 times a day, cholestyramine 0.15 have a good effect -0.2 g/kg body weight per day in 4-5 doses with food for 7-30 days. However, if the child is feeling well, it is better to refrain from drug treatment, since by 4 months the secretory function of the digestive glands and the extrasecretory function of the liver usually increase and transient lactase deficiency disappears. There is a lot of controversy regarding the issue of breastfeeding in the presence of mastitis. In the 60-70s. there was a strict ban on feeding even healthy breasts in this situation. However, in recent years, more and more authors have admitted the possibility of feeding in the initial stages of mastitis not only from a healthy, but also from a diseased breast. Breastfeeding is definitely prohibited if pus appears in the milk.

<.>children's sanatorium Sosnovaya Roshcha, Kislovodsk /<.>how to get a referral to the Institute of Balneology in Pyatigorsk /<.>Essentuki Central Military Sanatorium /<.>Zheleznovodsk Ministry of Internal Affairs / Zheleznovodsk San Kirov

RECREATION AND TREATMENT IN SANATORIUMS - DISEASE PREVENTION

NEWS

Natural (breast) feeding

Relevance of the topic. Long-term observations and studies have proven that natural feeding in the 1st year of life is the basis for the full physical and mental development of a child, the formation of resistance to infectious and somatic diseases, and attempts to feed newborns and infants with the milk of other biological species must be regarded as an environmental disaster. Therefore, studying the benefits and principles of natural feeding and activities aimed at supporting it is necessary to improve the health of the child population.

Purpose of the lesson. Study the basic provisions about breastfeeding children, its importance for the child’s health, find out modern views to this problem, learn the principles of this type of feeding.

As a result of self-study, the student should know:

1. Morphofunctional characteristics of the digestive and metabolic organs in children in the age aspect.

2. Quantitative and qualitative composition of colostrum, transitional and mature human milk.

3. Features of human milk that determine its extraordinary biological value compared to milk of other types, and its effect on the development of the child.

4. Calculation of the daily diet of a child of the 1st year of life using different methods.

5. The infant's need for major food nutrients and calories.

6. Timing of introducing corrective additives into the child’s diet (fruit and vegetable juices, fruit purees, egg yolk), bait.

7. Rules for introducing bait and corrective additives.

8. Diet of a nursing mother.

9. An approximate scheme for compiling the diet of a child of the 1st year of life, who is breastfed.

10. nutrition of premature babies.

11. Ten principles for successful breastfeeding by WHO and UNICEF.

As a result of studying the topic, the student should be able to:

1. Compile a daily diet for a healthy child of the 1st year of life, who is breastfed.

2. Assess medical history data indicating the quality of the child’s nutrition, identify errors in the combined diet and carry out their correction according to existing rules.

3. Create a diet for a nursing mother.

4. Identify and evaluate clinical signs indicating child malnutrition and eliminate them.

Main literature

Chebotareva V.D., Maydannikov V.G. Propaedeutic pediatrics. - M.: B. i., 1999. - P. 452-497.

additional literature

Mazurin A.B., Vorontsov I.M. Propaedeutics of childhood diseases. - St. Petersburg: "Foliant Publishing House", 2001. - P. 827-922.

Pediatrics / Ed. N.P. Shabalova. - St. Petersburg: SpetsLit, 2003. - P. 199-225.

Modern management of lactation and breastfeeding: Tutorial. With the assistance of the United Nations Children's Fund (UNICEF) in Ukraine. - M., 2002. - 152 p.

Auxiliary materials

1. Modern approaches to breastfeeding.

2. The daily requirement of children of the 1st year of life for the main nutrients and energy during breastfeeding.

3. An approximate diagram of the timing of the introduction of bait during natural feeding.

4. Formulas for calculating the daily volume of breast milk for children.

5. Algorithm for compiling a child’s daily menu.

Modern approaches to breastfeeding

To ensure adequate feeding of the child, it is necessary to follow the rules that help increase lactation in a woman. Here are these rules.

1. The timing of the baby’s first attachment to the breast is essential for the development of lactation. It is best to do this in the first 30-40 minutes after the birth of the baby. If there are no contraindications due to the health of the mother and child, then after feeding the child should be left with the mother for 1 hour. Then healthy newborns are left with the mother in the same room and are put to the breast as the child needs.

2. Free feeding contributes to the development of the relationship between mother and child. The rhythm of lactation is improving, but healthy child There should be no restrictions on the feeding regimen. The number of feedings and their hours should be adjusted according to the child’s needs.

3. Studies of various aspects of natural feeding have proven that it is impossible to feed a newborn baby with breast milk substitutes, since their use leads to changes in the processes of intestinal colonization with lactobacilli, disrupts the formation of the function of the digestive system, promotes sensitization of the child to cow's milk proteins, and disorients the act of sucking due to use of the nipple in these cases.

4. The main indicator of adequate feeding of a child should be its physical and mental development. Control weighing data is an insufficient criterion for the completeness of feeding. This is due to significant changes in the individual quality of milk from different women (the amount of proteins in mature women’s milk varies widely: from 1 g to 2 g per 100 ml of milk), as well as with its changes during feeding (fat concentration can vary by 4 - 5 times from the beginning to the end of the feeding process).

5. To stimulate lactation and prevent the development of lesions and cracks in the nipples, the optimal way is to feed the baby from both breasts, provided that one breast is completely emptied. You need to feed one breast for 5-15 minutes until it is completely empty, and if the baby still requires food, continue feeding the second, starting with the next feeding.

6. Currently, it is considered inappropriate to advise a mother to express milk until the “last drop”, because from a physiological point of view this is impossible: the mammary gland constantly secretes milk, and the more intense the pumping, the more milk is released.

7. Rational nutrition of the mother, frequent latching of the baby to the breast, including at night, friendly relationships in the family, a woman’s positive emotional orientation towards natural feeding are the main factors in improving her lactation and optimizing the feeding of the child in the 1st year of life.

Daily requirement of children of the 1st year of life for the main nutrients and energy during natural feeding (according to A.V. Mazurin, I.V. Vorontsov, 2000)

An approximate diagram of the timing of the introduction of bait during natural feeding

Names of products and dishes	Age, months							Note
	5th		6th	7th	8th	9th	10-12th
Fruit juice, ml	40 50		60	70	80	90	90 100	March 5th - one month of age
Fruit puree, ml	40 50		60	70	80	90	90 100	3 5.5 months of age
Cheese, g	-		10-30	40	40	40	50	3 June-months of age
Yolk	-		1/4	1/2	1/2	1/2	1/2	3 June-months of age
Vegetable puree, g	10-100		150	150	170	180	200	3 5-5.5 months of age
Milk porridge, g	50 150		150	150	170	170	200	3 6-6.5 months of age
Meat puree, g	-		-	5- 30	50	50	60 70	3 7-7.5 months of age
Kefir, ml		-	-	-	200	200	200	August 3 - one month of age
Bread (premium grade), g		-	-	-	-	-	5-10	March 11th month of age
Vegetable oil, ml		1-3	3	3	5	5	6	March 5th - one month of age
Cow butter, g		-	1-4	4	4	5	6	3 June-months of age