Feeding a child in the first year of life with human milk is called natural.

Feeding newborns during the first 7-10 days of life

Typically, a newborn baby begins to be put to the breast 6-10 hours after birth: a longer delay has an adverse effect on the newborn and his mother. When the baby is put to the breast later, there is a significant decrease in body weight in the first days of life and a later recovery.

In the first days after birth, the mother feeds the baby in bed from a side-lying position (Fig. 10). The baby is placed so that it is convenient for him to grasp the nipple with his mouth. The mother slightly lifts the breast with her hand, holding it between the thumb and the rest (the breast lies on the palm), and directs the nipple into the baby’s mouth, trying to ensure that the latter grasps well not only the nipple, but part of the adjacent skin (areola). In this case, with your thumb, the upper surface of the chest is slightly pressed downwards so that it does not cover the child’s nose and does not interfere with his breathing.

Subsequently, when the postpartum woman is allowed to sit or get out of bed (from the 3rd-4th day), she feeds the baby while sitting on a chair, placing her foot on a low bench (Fig. 11). Feeding from each breast must be alternated to ensure that both are completely emptied. The remaining milk must be expressed. Only when there is little milk, you have to feed from both breasts, but you should: 1) give the second breast only after the baby has sucked everything from the first, and 2) follow the order of attachment.

These rules are necessary, since the first portions of milk are sucked out by the baby more easily than subsequent ones, and more frequent feeding stimulates the function of the mammary gland. If you do not follow these rules from the very beginning, the child quickly gets used to it and does not suck, which causes stagnation of milk and a decrease in lactation.

Amount of milk necessary for a newborn child, fluctuates significantly. For practical purposes, the formula of G.I. Zaitseva is most suitable. Using this formula, you can roughly calculate how much milk a newborn baby needs (up to 7-8 days):

Daily amount of milk (in ml) = 2% of the child’s birth weight x n,

where n is the day of the child’s life. You can also use the modified Finkelstein formula:

n x 70 or 80,

where n is the day of the child’s life. To determine the amount of milk a child needs per day, the number of days of his life must be multiplied by 70 (with a weight below 3200 g) or by 80 (with a weight above 3200 g).

Sometimes another calculation is used: for a single feeding, a child should receive an amount of milk equal to 10 times the day of his life (for example, a 5-day-old child should receive 10 x 5 = 50 ml for one feeding).

The amount of food needed by a premature baby must be determined taking into account his individual needs and general condition. Usually on the 1st day 5-10 ml of milk is given for feeding, on the 2nd day - 10-15 ml, on the 3rd day - 15-20 ml. Subsequently, the daily volume of food is determined by the formula:

n x 10 for every 100 g of child’s weight,

where n is the number of days of life. After the 10th day of life, the amount of food is determined by body weight, as in full-term infants.

From the first days of life, a child must be taught order in feeding. A newborn baby does not have conditioned reflexes at birth. One of the very first conditioned reflexes is the feeding reflex. To do this, you need to feed the baby hourly.

I.P. Pavlov wrote, “that no other stimulus can compare, either qualitatively or quantitatively, with the passionate desire for food as a stimulant of gastric juice.” Only eating with appetite can be as beneficial as possible, while eating according to orders cannot have such a positive effect. Disorderly feeding reduces the baby's appetite, he sucks out little milk.

The frequency of feeding is of great importance. The works of Prof. N.I. Krasnogorsky established that in the activity of the central nervous system (CNS) there is a certain cyclical nature of the processes of excitation and inhibition. In children during the first 3 months of life, the process of excitation is replaced by a process of inhibition every 3 hours; in children 3-5 months old, this alternation is observed every 3.5 hours, in children older than 6 months - every 4 hours. The greatest appetite in children is observed when the excitation process predominates (when the inhibition process predominates in the central nervous system, inhibition of the food center also occurs). Therefore, the interval between feedings should be different, depending on the age of the child.

Children in the first 2-3 months of life must be fed every 3 hours with a night interval of 6 hours (the night interval is necessary for rest of the mother and child); the intervals between feedings in children from 3 to 5 months should be 3.5 hours (night interval 6 hours 30 minutes), and in children over 5 months every 4 hours (night interval 8 hours) 1 (Fig. 12).

If the child cannot calmly withstand such long night intervals and is not satisfied with 2-5 teaspoons of water, then one more feeding at night can be allowed.

The frequency of feeding is also determined by the length of time the food mass remains in the stomach, which depends on the type of food. Human milk is excreted from the stomach 2-2.5 hours after ingestion, artificial milk formulas made from cow's milk linger in the stomach for 3 hours, and porridge for 3-4 hours. Vegetables linger in the stomach for a particularly long time (4-5 hours). High fat and protein content increases the length of time food remains in the stomach.

1 V maternity hospitals Healthy newborn babies are fed somewhat less frequently (6 times), which is explained by the working conditions of medical personnel.

Techniques and rules of natural feeding

The success of breastfeeding largely depends on punctual compliance with a number of rules.

1. Before each feeding, the mother should gently wash her breasts with clean, washed hands. boiled water.
2. Express a few drops of milk, which removes random bacteria that easily enter the peripheral parts of the excretory ducts.
3. At the end of feeding, the breasts should be dried with a clean, soft linen cloth to avoid maceration of the nipples.

When breastfeeding, a physiological balance is established between mother and child, that is, the child sucks out as much milk as he needs. Physiological balance is determined by the composition of milk during feeding. It is very well developed in children from the 6th week of life.

However, the average duration of each breastfeeding should last no more than 15-20 minutes. Only newborn babies can be fed for a longer time (up to 20-30 minutes). It must be remembered that during the first 5 minutes of feeding, the baby sucks out about 50% of the milk he needs.

When feeding from a bottle through a nipple, it is necessary to dose the amount of food. If small child give milk formula in a bottle with a nipple, he will not stop sucking, despite the fact that the large volume of sucked milk will cause overdistension of the stomach.

Methods for calculating the required amount of milk for a baby

There are several ways to calculate the amount of food needed for children in the first six months of life.

Method 1.- “volumetric” depending on body weight. The child should receive milk from 2 to 6 weeks 1/5 of his body weight from 6 weeks to 4 months 1/6 of his body weight from 4 to 6 months 1/7 of his body weight	For example. A child aged 3 months, weighing 5200 g, should receive milk at the rate of 1/6 of his body weight, i.e. 5200: 6 = 866 ml of milk.	Until recently, this method of calculating food volume was the most common. However, at present, due to acceleration, which is expressed in a very rapid increase in body weight during the first half of life and the birth of larger children, it may happen that the volume of food when calculated using this method may exceed 1 liter. In such cases, the volume of food should not exceed 1 liter, but then some nutritional correction is needed (see below).
Method 2. Calculation according to Shkarin. A 2-month-old (or 8-week-old baby) should receive 800 ml of milk per day, for every week short of 8, 50 ml less, and for every month longer than two, 50 ml more.	For children under 2 months of age, this can be expressed by the formula: 800-50 x (8-n), where n is the number of weeks of life. For example, a child aged 3 weeks according to this calculation method should receive: 800-50 X (8-3) = 550 ml. For children older than 2 months, you can use the formula: 800 + 50 x (n-2), where n is the number of months of the child. For example, a child aged 3 months should receive milk: 800+50 x (3-2) = 850 ml. Shkarin's calculation is hardly suitable for modern children due to the acceleration of their development. It is presented in our guide from a historical perspective.
Method 3. Calorie (energy) calculation: per 1 kg of body weight, the child should receive: in the first quarter of the year 120 kcal per day in the second quarter of the year 115 kcal per day in the third quarter of the year 110 kcal per day in the fourth quarter of the year 100 kcal per day	Having determined the child’s weight, it is easy to calculate how many kilocalories the child needs. Knowing that 1 liter of human milk contains on average 700 kcal, it is easy to calculate how much milk a child should receive per day.	For example, a 3-month-old child weighing 5 kg should receive 120 kcal per 1 kg of weight or 600 kcal per day (120 kcal x 5 = 600 kcal). By drawing up a proportion it is easy to convert the number of kilocalories into the volume of milk: 1000 ml of milk contains 700 kcal x ml - 600 kcal 600 x 1000 x = ----------- = 857 ml of milk. 700

Of the above methods of calculation, the most accurate is the calorie method. The calculation is based on the average normal weight of a child at a given age, but the daily volume of food should not exceed 1000 ml.

The formulas we have given for calculating milk are used for children in the first 6 months of life. Children from 6 months to 1 year of age should receive 1 liter of food. Knowing the total volume of food and the number of feedings during the day, it is easy to calculate how much milk a baby needs per feeding.

A textbook on nutrition for a healthy child. A. V. MAZURIN. M., "Medicine", 1980, 208 pp., ill.

Introduction Natural feeding Lactation Colostrum Biological and chemical properties of human milk Nutrition and regimen of a nursing mother Feeding newborns during the first 7-10 days of life Techniques and rules of natural feeding Methods for calculating the required amount of milk for a child

Natural, or breastfeeding, is feeding a child by putting his biological mother to the breast.

Breastfeeding is not limited to just providing the baby with nutrients of the required quality and quantity. I.M. Vorontsov (1998) writes that “breastfeeding today
is a phenomenon of general biological adaptation, programming and stimulation of development of children of the neonatal period and early age, where nutrition itself is only one of the components of the integral environment of the child’s development, forming the totality of influences and interactions that constitute the child’s early experience.”

The structure of the spectrum of effects of breastfeeding on the child’s body (according to I.M. Vorontsov, E.M. Fateeva, 1998):

Chemical composition and biological properties of human milk, the benefits of natural feeding
From the beginning of lactation and further, a change in the composition of milk and its calorie content occurs (Tables 1.48 and 1.49).
Table 1.48
Comparative composition of colostrum and milk in percentage (in g per 100 ml)
(according to A.F. Tour)

Table 1 49
Calorie content of colostrum and milk

Colostrum is a thick, sticky, yellow liquid. The composition and quantity of colostrum (it is small) correspond to the still weak digestive capabilities of the newborn. Compared to mature milk, colostrum contains more protein, and the albumin and globulin fractions of proteins prevail over casein (casein appears only from the 4th-5th day of lactation, and its amount gradually increases); 2-10 times more vitamin A and carotene, 2-3 times more ascorbic acid; contains more vitamins B]2 and E; 1.5 times more salts, zinc, copper, iron, leukocytes, among which lymphocytes dominate. There is especially a lot of class A (secretory) immunoglobulins in colostrum, which, along with other factors
promotes high efficiency of the intestinal immunological barrier immediately after birth. Therefore, colostrum is sometimes referred to as a factor providing the first vaccination, or, as they say, “warm” immunization of a child in contrast to “cold” (ampoule). On the contrary, the content of fat and milk sugar (lactose) in colostrum is lower than in mature milk. Many colostrum proteins (albumin, globulins, etc.) can be absorbed in the stomach and intestines unchanged, since they are identical to the proteins in the child’s blood serum. Colostrum is a very important intermediate form of nutrition between the periods of hemotrophic and amniotrophic nutrition and the period of enteral (lactotrophic) nutrition of the child.
Transition milk - this is milk at intermediate stages of biological maturity, released during individually different periods after birth. As its amount increases, the mammary glands fill, swell and become heavy. This moment is called the “arrival” or “flow” of milk. Transitional milk, compared to colostrum, contains less protein and minerals, and the amount of fat in it increases. At the same time, the amount of milk produced also increases, which corresponds to the child’s ability to absorb large volumes of food.
Mature milk - this is milk produced by the beginning of the 3rd week after birth (this happens in the vast majority of women; in 5-10% of women, mature milk may appear a week earlier). The composition of human milk (Table 1.50) largely depends on the individual characteristics of the nursing mother, the quality of her diet and some other factors.

The health benefits of breastfeeding for infants and mothers

Infant

• The frequency and duration of dyspeptic diseases is reduced
• Provides protection against respiratory infection
• The incidence of otitis media and relapses of otitis media is reduced
• Possible protection against necrotizing enterocolitis of newborns, bacteremia, meningitis, botulism and urinary tract infections
• May reduce the risk of autoimmune diseases such as diabetes Type I and inflammatory diseases of the digestive tract
• Reduces the risk of developing an allergy to cow's milk
• Possible reduction in risk of obesity in older childhood
• Visual acuity and psychomotor development improve, which may be due to the presence of polyunsaturated fatty acids in milk, in particular doco-sahexaenoic acid
• IQ scores increase, which may be due to factors present in milk or increased stimulation
• Malocclusions are reduced due to improved jaw shape and development

Mother

• Early initiation of breastfeeding after the birth of the child helps to restore the mother's strength after childbirth, accelerates the involution of the uterus and reduces the risk of bleeding, thereby reducing maternal mortality, and also preserves the mother's hemoglobin reserves due to reduced blood loss, which leads to better status gland
• The period of postpartum infertility increases, which leads to an increase in the interval between pregnancies if contraceptives are not used
• It is possible to accelerate weight loss and return to pre-pregnancy weight
• Reduced risk of breast cancer during premenopause
• Possibly reducing the risk of ovarian cancer
• It is possible to improve bone mineralization and thereby reduce the risk of hip fractures in postmenopausal age

Breastfeeding technique and regimen

First breastfeeding Healthy full-term babies are produced as quickly as possible, optimally - within the first 30 minutes after the baby is born. After the first cry, the appearance of breathing and the initial processing of the umbilical cord, as well as wiping, it is laid out on the mother’s stomach, in its upper part. For skin contact, it is better not to wash the newborn with water; it is also advisable to postpone the instillation of eye drops until the end of the first application. The child, lying on his stomach, is held by the mother with her hand, and he is covered from above either only with a sterile sheet, or with a sheet and a blanket (together with the mother). The child's searching behavior is expressed in sucking movements, turning the head and crawling movements of the limbs. Most newborns are able to independently find and grasp the areola of the mother's breast. It has been noted that early contact with the mother contributes to the rapid establishment of lactation, the production of breast milk in larger volumes and for a longer period, better and faster adaptation of newborns to the conditions of extrauterine life, in particular, to an earlier colonization of the intestines and skin with bifidum flora and a decrease in the duration of the phase transient intestinal dysbiosis. Skin to skin contact It allows not only the baby to feel the mother’s warmth, the beating of her heart, but also stimulates the development of the child’s psyche and the establishment of mental contact with the mother. It also helps to enhance a woman’s sense of motherhood, calm the woman and eliminate her stressful hormonal levels, better involution of the uterus, etc. Ideally, mother and child should be left in close skin contact after an uncomplicated birth for 1-2 hours. If sucking does not take place at the first skin contact, then keeping the baby on the breast for more than two hours is inappropriate.

In the event that putting the baby to the breast immediately after birth is difficult ( C-section, illness of the mother or child), this must be done as soon as possible, and before that the milk must be regularly expressed and given to the child.

Main indications for later breastfeeding:

• on the part of the child: children born in a state of asphyxia, with suspected intracranial injury, with cephalohematoma, as well as newborns whose general condition is unsatisfactory, very premature, children with developmental defects, from mothers with Rh-negative blood;
• on the maternal side: surgical interventions during childbirth, childbirth with preeclampsia, heavy bleeding during childbirth, the presence of any infectious processes.

Currently, it is recommended that mother and baby be placed in the same room immediately after birth. When staying together in the postpartum ward, the mother has unlimited access to the baby at any time of the day, she can feed him on demand, that is, adhere to a free feeding regime. Signs of hunger can be rotational movements of the head in search of the mother's breast, active sucking movements of the lips, smacking lips, loud, persistent crying. However, in some cases, if the mother does not understand the reasons for the child’s anxiety and attempts to eliminate it by frequent breastfeeding, overfeeding can be observed, which is a risk factor for the development of gastrointestinal dysfunction, excessive weight gain, and accelerated growth. A child may cry not only because he is hungry, but also for other reasons. Obviously, in these cases, feeding the child cannot eliminate the cause of the cry and, moreover, can intensify it (for example, with intestinal colic). The frequency of breastfeeding can be 12-20 or more times a day and is determined solely by the child’s needs. During feeding, at first you can put the baby on both mammary glands. Such frequent feeding contributes to better development of lactation. It is important not to relieve the child’s anxiety caused by fasting, supplementation between feedings, especially glucose or tea with sugar, especially milk formula. Breast milk, with a sufficient level of lactation, fully meets the need for fluid even in hot climates. The break between daytime feedings may not reach even two hours, and between night feedings there may be no more than 3-4 hours. Moreover, to ensure long-term stable lactation in the first days after birth, night feedings are especially important.

Subsequently, as the child grows, and also as the volume of lactation increases, the frequency of feedings is reduced and stabilized in the range from 10-15 in the first days and weeks to 5-7 in subsequent periods. The transition from an uncertain feeding regimen to a relatively regular one takes from 10-15 days to 1 month. When forming a diet, it is important to show some flexibility. The number of feedings can vary widely depending on the state of lactation on a given day, the degree motor activity and the child’s energy consumption, his well-being, etc. This also applies to night feedings. On the one hand, night feedings are considered among the factors promoting lactation. On the other hand, it cannot be considered that feeding a child at night after the neonatal period, in the case of established satisfactory lactation, is strictly obligatory for all children. A good night's sleep and adequate rest are important for a nursing mother and also contribute to maintaining good lactation. If the child does not need night feedings, he will refuse them himself and should not be prevented from doing so. “Free” feeding or “on demand” feeding contributes to the establishment of not only optimal lactation, but also close psycho-emotional contact between mother and child, proper neuropsychic and physical development of the child.

An important advantage of sharing a newborn with the mother is to minimize the risk of infection in the baby. In the case when a child is cared for by a mother from birth, his body is populated by the same microbes that are in the mother’s body. Moreover, breast milk contains specific antibodies to them. In the case when a child is placed in a children's room, where he is cared for by the staff of the maternity hospital, the baby is surrounded by microorganisms inherent in “strangers”. Safe for them, such bacteria can turn out to be pathogenic for the child, and there are no specific antibodies against them in mother’s milk. This often contributes to the sudden development of epidemics of skin diseases, respiratory and gastrointestinal infections among newborns.

Factors such as limiting the time of feeding, feeding on a schedule, uncomfortable or incorrect position of the mother when feeding, using nipples, and the child receiving other liquids, such as water, sugar solutions, vegetable or animal-dairy products, reduce the duration and effectiveness of the baby's breastfeeding.

The duration of stay at the breast is determined by each child himself. Some babies suckle very actively, quickly release the nipple and turn away from the breast. But there are also so-called “lazy suckers” who suck slowly and sluggishly, often fall asleep at the breast, but when trying to remove the nipple they wake up and suck again. This long feeding can lead to damage to the skin of the nipple and the formation of cracks on it. Therefore, it is advisable that the duration of one feeding does not exceed 20-30 minutes. For this purpose, the “lazy sucker” should be stimulated - by patting him on the cheek, making an attempt to remove the nipple, etc.

On the first day after birth, the mother feeds the baby in bed, and in the following days she chooses the most comfortable position for herself and the baby - lying down, sitting with her feet resting on a bench 20-30 cm high, or standing (if there were perineal tears, perineotomy, episiotomy).

Before feeding, the mother should thoroughly wash her hands with soap, wash her breasts with boiled water and dry with a soft towel, without rubbing the area of ​​the nipple and areola. It is better to express the first drops of milk before feeding. The hand supporting the child must have support. While supporting the baby by the back and shoulders, the mother should not put pressure on the baby's head, otherwise he will reflexively throw his head back. During feeding, the mother holds the baby facing her, “belly to belly,” so that he does not have to turn his head. When using any posture and body position during feeding, the nursing woman and the child should clearly see each other’s faces, using feeding time to carefully study each other’s faces, facial expressions, and eye expressions. The breast is taken with the second and third fingers of the opposite hand by the edges of the areola above and below the nipple and the nipple is inserted into the child’s mouth. During sucking, the child should cover with his mouth not only the nipple, but also the entire areola, as well as the part of the breast below the areola. Underlip The baby should be turned outward, the baby's chin, cheeks and nose should fit snugly to the chest. The baby draws in the nipple and areola of the breast, and then
pressing on them with the tongue, squeezes out the milk. From the breast that the child sucked, you need to express the remaining milk(but, of course, not to the “last drop”), then wash the breast with boiled water and hold it open for a while, allowing the nipple to air dry. With sufficient lactation, the baby receives milk from only one breast during feeding, and from the other at the next feeding. However, if the baby has completely emptied one breast and there is not enough milk, the other should be offered. Each time you should start feeding on the other side. It is also very important not to stop feeding too early. Infants do not suck continuously; the baby may pause during feeding. The baby must decide not to take the breast when it is offered again after a few minutes. The chemical composition of "fore" and "hind" milk is different Foremilk is the milk produced at the beginning of a feeding. Hindmilk is the milk produced at the end of a feeding. The first portions of breast milk contain more lactose, less fat, and slightly less protein. The last (“back”) portions of milk are richer in fat, the amount
which can reach up to 7-8%, which ensures a fairly high calorie content of this milk.

After finishing feeding, the baby is placed in a vertical position for 1-2 minutes to burp the air swallowed during feeding. Sometimes the baby spits up a little milk, but this should not cause concern.

Expressed breast milk has to be given to the child in cases where for some reason it is impossible to apply it directly to the mother’s breast (mother’s illness, birth injury, extreme prematurity of the child, etc.). There are situations when a mother cannot feed her child due to everyday reasons (day work, study, etc.). If milk is given from a bottle, it is necessary that the hole in the nipple is small so that the milk flows out in separate drops. Otherwise, the child, having become accustomed to easily receiving food through the nipple, will quickly refuse to suckle. However, a nipple that is too tight and a small hole in it can contribute to the swallowing of air during feeding and, as a result, regurgitation and intestinal colic.

Store expressed milk must be refrigerated at a temperature not exceeding +4 °C. Within 3-6 hours after expressing and if stored correctly, it can be used after heating to +36-37 °C. When stored for 6-12 hours, milk can only be used after pasteurization, and after 24 hours of storage it must be sterilized. To do this, place a bottle of milk in a saucepan, pour warm water slightly above the level of the milk in the bottle; during pasteurization, the water is heated to +65-75 °C and the bottle of milk is kept in it for 30 minutes; during sterilization, the water is brought to a boil and boiled for 3-5 minutes.

Some possible reasons for a child's anxiety.

• Before the age of 3-4 months, children often become restless during feeding. In this case, the child, starting to suck the breast, suddenly drops the nipple, cries loudly, pulls his knees to his stomach, then sucks again and cries again. The attack can last from 10 minutes to 2 hours. Such a reaction in practically healthy children can be caused by intestinal colic, when when the first portions of milk enter the gastrointestinal tract, intestinal motility increases. Increased gas formation and air swallowing during rapid and greedy breast sucking are also important. In this case, you should interrupt feeding, pick up the baby in your arms, holding him in an upright position, or lightly massage the abdomen with a warm hand in a clockwise direction. It is important to speak kindly to your child. If this does not help, you can install a gas outlet tube. Sometimes gases and feces pass on their own. When the baby calms down, feeding can be continued. If colic occurs frequently, the child can be given activated carbon, smecta, or chamomile decoction.
• The occurrence of colic in a child is sometimes associated with the consumption of certain foods by the nursing mother (excess milk, coarse vegetables, coffee, etc.). In this case, they should be excluded from the diet or the amount reduced. Anxiety may be related to maternal smoking or medication use.
• A baby may cry while feeding if thrush has developed in the mouth. In this case, sometimes you have to feed the baby expressed milk from a spoon and actively treat thrush.
• A child with a runny nose cannot breathe freely during feeding. Then, before feeding, you need to thoroughly clean the baby’s nasal passages with cotton swabs and drip some vasoconstrictor drops. If necessary, cleansing the nasal passages is repeated during feeding.
• Excitement and crying of a child during feeding often occurs in cases where the mother has so-called “tight breasts.” At the same time, milk is produced in sufficient quantities, but it is difficult to separate, and it can be difficult for the baby to suck it in the right amount. In this case, the mother should express a certain amount of milk immediately before feeding, and perhaps give a massage mammary gland, then the breast will become softer and it will be easier for the baby to suck.
• Certain difficulties with feeding a child may arise if the nipples are of irregular shape. The nipples may be flat and inverted, and the baby may not be able to latch on properly. Such phenomena can be prevented if special preparation of the nipples (massage, stretching) is carried out before birth. If this was not done and the child was unable to adapt to sucking such a breast, he has to be fed through a special pad, and sometimes with expressed milk. However, many children overcome these difficulties over time.
• The reason for a child's crying may be an increase in the child's appetite (hungry crying) due to an uneven increase in energy expenditure, if, for example, he began to grow faster than before. This is a common cause of fuss at around 2 and 6 weeks of age and around 3 months. If the baby begins to suckle more often over the course of several days, lactation will increase.

Feeding low birth weight and premature babies has its own characteristics. Of course, breast milk is the optimal food for them too. However, human milk alone cannot always satisfy all the needs of these children for macro- and micronutrients and ensure high rates of physical development. In this regard, it is proposed to add to the diet of such children (along with breast milk) fortifying formulas, for example Enfamil HMF (Mead Johnson), Similac Natural Care (Ross), Care Neonatal BMF (Nutricia), which correct the composition of human milk and make it the composition is more optimal for low birth weight children. This allows you to preserve the main advantages and protective properties of natural feeding of a low birth weight baby and give him the opportunity to develop intensively.

Ways to determine the amount of milk a breastfeeding baby needs

One of the main indicators of whether a child is getting enough breast milk is his behavior. If after the next feeding the baby calmly lets go of the breast, looks contented, and has enough sleep until the next feeding, then he has enough milk. Objective signs of adequate milk volume are uniform, in accordance with age norms, weight gain, an increase in other anthropometric indicators (body length, head circumference), good skin condition, elastic soft tissue, normal frequency of urination and stool. If there is a suspicion of insufficient lactation, It is necessary to carry out control feedings. The child (clothed) is weighed before and after
breastfeeding at every feeding during the day. During individual feedings, the amount of milk sucked varies so much that it is difficult to determine the amount of milk sucked per day from one or two weighings. The data obtained during control weighing is compared with the calculated values.

In the first 10 days of life the required amount of milk for a full-term baby can be determined using the formulas:

• Finkylyitein's formula modified by A.F. Tur:

amount of milk per day (ml) = n x 70 or 80,
where: n - day of life; 70 - with birth weight below 3200 g; 80 - with a weight at birth above 3200 g.

• Formula of N.P. Shabalov:

amount of milk per 1 feeding (ml) = 3 ml x day of life x body weight (kg);

• Formula of N. F. Filatov as modified by G. I. Zaitseva:

amount of milk per day (ml) = 2% body weight x day of life.

Starting from the 10th day of life The daily amount of milk is calculated in two ways:

• “Volume” method according to Geibner-Cherny . The amount of food is prescribed depending on age and body weight. In this case, body weight should correspond to average age norms.

The daily amount of food is:
at the age of 10 days to 1.5 months - 1/5 of the actual body weight;
at the age of 1.5-4 months - 1/6;
at the age of 4-6 months - 1/7;
over the age of 6 months - 1/8 of body weight.

• Calorie method by M. S. Maslov.

The energy value of food per 1 kg of child’s body weight should be:
in the 1st quarter of the year - 120 kcal/kg/day;

in the 2nd quarter of the year - 115 kcal/kg/day;

in the 3rd quarter of the year - PO kcal/kg/day; in the 4th quarter of the year - 105 kcal/kg/day.
One liter of human milk has a calorie content of approximately 700 kcal.

To determine the volume of one feeding, it is necessary to divide the daily volume of food by the total number of feedings. For example, a child aged 1 month should receive 800 ml of milk per day. With 7 feedings, the volume of each feeding will be equal to 1 ml of milk, and with 6 feedings - 130 ml. A child in the first year of life should not receive more than 1000-1100 ml of food per day.

Introduction of complementary foods

Currently there is a tendency towards more late dates introduction of complementary foods - no earlier than the 5-6th month of life. Early introduction of complementary foods may reduce the frequency and intensity of suckling and, as a result, reduce breast milk production. It is advisable to use not a simple chronological (according to age scheme) prescription of complementary foods, but to introduce them individually. This can help maintain mother's lactation and maximize the duration of exclusive breastfeeding. Such an individual deferral should apply primarily to the energetically significant volume of complementary foods and non-dairy foods. In addition, all children should from the age of 5-6 months, receive fruit juices and fruit purees as the so-called “pedagogical” or “enriching” complementary foods. Educational complementary feeding has its own goals - it allows the child to become familiar with the different sensations of taste and texture of food, trains the oral mechanisms of food processing and prepares the child for the period when he will need an energy supplement. The introduction of educational complementary feeding is not a departure from exclusive breastfeeding. Individualization of the period for introducing educational complementary foods can be based on the following signs of the child’s maturity:

• extinction of the pushing reflex (with the tongue) with a well-coordinated reflex of swallowing food;
• the child’s readiness for chewing movements when a pacifier and other objects enter the mouth.

Initially (not earlier than the 5th month of life), breastfed children are given juice. The introduction of juice into a child’s diet should begin with 1/2 teaspoon, gradually increasing its amount to 5-20 ml. It is advisable to start the introduction with apple juice without sugar, which is characterized by low acidity and low potential allergenicity. The nutritional value of juices is determined primarily by the presence of natural sugars (glucose, fructose, sucrose, etc.), which are easily absorbed and oxidized in the body, being a source of energy. To others an important component Juices contain organic acids (malic, citric, etc.), which promote the digestion process. Juices also contain significant amounts of potassium and iron.

2-3 weeks after the appointment of juices, fruit puree is introduced into the diet (apple puree is also better). Subsequently, the range of fruits is expanded - in addition to apple juices and purees, plum, apricot, peach, cherry, raspberry, and blackcurrant are offered. In this case, sour and tart juices should be diluted with water. Orange, tangerine, and strawberry juices, which are among the products with a high potential allergenicity, should not be given to children under 6-7 months of age. This also applies to juices from tropical and exotic fruits (mango, guava, papaya, etc.). It is not recommended to give grape juice to children due to its high sugar content.

The introduction of juices and fruit purees should begin with juices and purees from one type of fruit, and only after getting used to it can juices and purees from mixed fruits be introduced into the diet. It is better to give “educational” complementary foods to the child during the second feeding, after he has sucked some milk from the breast, still retains the feeling of hunger, but has enjoyed the feeding. A small amount of fruit puree from the tip of a teaspoon is introduced onto the middle part of the child's tongue. It is more advisable to use canned juices and fruit purees for industrially produced baby food, since in conditions of unfavorable environmental conditions and an insufficient level of sanitary and hygienic knowledge of the population, it is industrially produced products that provide the guarantee of quality and safety necessary for children of the 1st year of life. In addition, as a rule, canned foods for infants are enriched with vitamins, iron and other nutrients necessary for children.

Actually, “complementary feeding” should be introduced into the diet of a healthy full-term baby no earlier than 5-6 months. At the same time, it is recommended to approach the timing of introducing complementary foods based not on a formal age principle, but taking into account the individual characteristics of the body. An indication for the introduction of dense, energetically significant complementary foods may be the child’s behavior - manifestation of the child’s dissatisfaction in the form of anxiety, increased crying, the need to put the baby to the breast more often, repeated awakenings at night with a hungry cry, animated movements of the arms and legs at the sight of food, a decrease in the number of wet diapers and reduction of stool. Some children, on the contrary, become lethargic and apathetic. An important objective sign of malnutrition is a slowdown in the rate of weight gain (Table 1.53).

From 8 months, you can give a fermented milk drink (baby kefir, bifi kefir and other fermented milk products specifically intended for feeding children in the first year of life) as an independent complementary feeding dish. Fermented milk products are characterized by high nutritional value and significant physiological, including probiotic, activity. Unmodified (fresh) cow's milk for drinking should not be given to children under 9 months of age, but it can be used in the preparation of complementary foods from 6 to 9 months of age.

Currently, there is a tendency to introduce into the diet of children in the second half of life, instead of kefir and whole milk, new baby food products - mixtures of the "follow ir" group ("following formulas") - mixtures "Pikomil-2", "Enfamil-2", " Bebelak-2”, “Nutrilon-2”, “Nan 6-12 months with bifidobacteria”, etc. This trend is due to the need to ensure a multicomponent balanced daily diet with a decreasing amount of breast milk in its composition, the desire
decrease direct immunotoxic effect of cow's milk casein on the intestinal epithelium.

By the end of the first year of life, instead of “follow up” mixtures for the dairy component of the diet, it is advisable to use cow’s milk substitutes for children of the 2nd and 3rd year of life (for example, the “Enfamil Junior” mixture).

At the end of the first year (usually from 11 months), to further stimulate biting and chewing, in addition to crackers and cookies, pieces of bread and rolls, sliced ​​fruits, etc. are given.

With any scheme for introducing complementary foods, the expansion of their range and quantity occurs due to the “displacement” of breast milk. As the number of breastfeeding decreases, the amount of milk produced by the mother will also decrease. However, there are reasons to consider it advisable to maintain at least one feeding per day with breast milk for up to 1.5-2 years and even longer, as recommended by WHO and UNICEF. It is very important to continue breastfeeding during the hot summer months if the baby becomes ill.

MIXED AND ARTIFICIAL FEEDING

Contraindications to breastfeeding from mother's side:

• open form of tuberculosis with bacilli excretion;
• HIV infection;
• especially dangerous infections (smallpox, anthrax), tetanus;
• state of decompensation with chronic diseases heart, kidneys, liver;
• acute mental illness;
• malignant neoplasms.

If the mother has infections such as measles and chickenpox, breastfeeding can be provided if the baby is given immunoglobulin. In case of typhus, chronic hepatitis, dysentery, salmonellosis, the mother can express milk and feed the child with this milk after sterilization. For acute respiratory viral infections, sore throat, bronchitis and pneumonia, feeding can be done by applying to the breast after the body temperature has decreased and the woman’s general condition has improved. In this case, it is necessary to use masks and limit contact between mother and child between feedings. A serious contraindication for feeding a child, including expressed milk, is the use of medications in treatment. These include: antibiotics (chloramphenicol, tetracycline), isoniazid, nalidixic acid (negram or nevigramon), sulfonamides, estrogens, cytostatics, cyclosporine, antithyroid drugs, diazepam, lithium salts, meprotan, phenyline, reserpine, atropine, ergotamine, iodine preparations, hexamidine.

Contraindications to breastfeeding on the part of the child : hereditary metabolic diseases - galactosemia, phenylketonuria, “urine with the smell of maple syrup” disease.

For preparing simple mixtures milk is diluted with water or cereal decoctions (rice, buckwheat) in a 1:1 ratio - mixture No. 2 (in the first 2 weeks of life); 2-1- mixture No. 3 (aged from 2 weeks to 3 months). By diluting milk, one achieves, first of all, a reduction in the amount of protein per unit volume. The missing amount of carbohydrates is replenished by adding sugar, and fat by adding cream. After 3 months, children are given whole cow's milk with the addition of 5% sugar (mixture No. 5). However, according to modern recommendations, non-adapted mixtures (both sweet and kefir) can be given no earlier than 8-9 months. At the same time, fermented milk products (including adapted ones) should make up no more than 50% of the total daily volume of human milk substitutes and (or) “subsequent” formulas, received by the child, since a large amount of them can cause shifts in the acid-base balance in infants. Introduction of non-adapted mixtures into the diet in more younger age may have an adverse effect on nitrogen metabolism and immature kidney function.

To prevent a baby from refusing to breastfeed during mixed feeding A small amount of supplementary feeding is given from a spoon. If the amount of supplementary feeding is greater, then the mixture is given from a horn through an elastic nipple. It should have one or more very small holes, which are burned with the tip of a hot needle. When the bottle is tipped over, the mixture should flow out in drops, not a trickle. If mixed feeding is carried out due to hypogalactia, it is advisable to use mother’s milk as much as possible at each feeding. Therefore, the baby is first put to the breast and only after it has been emptied is it fed additionally. The rest of the mother's milk is expressed and given either at the same feeding or at the next

In children who are on artificial feeding, Complementary feeding can be introduced earlier, than in breastfed children. This is due to the fact that children already receive a significant amount of “foreign” food products in human milk substitutes: cow’s milk, sweet syrups, vegetable oils, containing a fairly large amount of new nutrients - proteins, oligosaccharides, lipids, different in structure from these ingredients of human milk. Thus, children are to a certain extent adapted to “foreign” nutrition. The first complementary food (vegetable puree) during artificial feeding is introduced into the diet from 4.5-5 months, the second complementary food (cereal-based) - from 5.5-6 months. However, taking into account individual developmental characteristics, just as with natural feeding, porridge can also be used as the first complementary food, preferably enriched with iron, vitamins, and microelements. Fruit juices and purees should be prescribed from 3 and 3.5 months, respectively. It is also acceptable to introduce juices earlier (from 1.5 months), taking into account their individual tolerance. It is advisable to use the yolk from the age of 6 months, meat - from 7 months. Kefir, other fermented milk products and whole cow's milk as complementary foods can be introduced into the diet from 8 months, however, even in these children it is preferable to use “follow-up” formulas.

Feeding a baby with breast milk is called natural.

• Human milk is a unique and most balanced food product for a child of the first year of life;
• The composition of each mother's breast milk exactly corresponds to the needs of her baby for various substances: proteins, fats, carbohydrates, vitamins and minerals;
• Mother's milk contains special substances - enzymes that promote the digestion and absorption of proteins, fats and carbohydrates;
• Mother's milk contains immunoglobulins and immune cells that protect the child from most infectious diseases: intestinal infections, infectious hepatitis, diphtheria, tetanus and others;
• Breast milk contains substances that regulate the growth and development of the child and ensure the correct formation of his brain and intellect (hormones, growth factors, taurine, zinc, iodine, etc.);
• In the process of breastfeeding, a special, very close relationship arises between mother and child, the warmth of which remains throughout the rest of life;
• Breastfeeding is good for the mother's health because... it promotes contraction of the uterus after childbirth, helps restore the figure and is the best prevention of mastopathy and breast cancer.

Natural feeding- a physiological phenomenon for mother and child and therefore cases of true lack of milk are rare. The most responsible period for restoring lactation in the mother is the first 3-4 months after birth. We can recommend the following rules necessary for successful feeding:

• early attachment of the baby to the breast (in the delivery room);
• in the first weeks, it is advisable to provide the child with a free feeding regime (at the child’s request) and only later transfer the child to feeding according to the hour, which he himself has chosen;
• when introducing complementary foods, to prevent the extinction of lactation, it is recommended to put the baby to the breast at the end of each feeding;
• If there is not enough milk, it is necessary to put the baby to the breast often. We must remember that for infant Every drop of mother's milk is priceless. At the same time, frequent breastfeeding can increase milk production in the mammary gland.

NUTRITION FOR A NURSING MOTHER. A nursing mother must receive a complete, balanced diet, since a woman spends additional energy and nutrients to produce milk, and, therefore, it is necessary to replenish these costs.

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

Vegetables are best consumed in in kind or in the form of salads and vinaigrettes. The most appropriate cereals to use are oatmeal and buckwheat. Wholemeal bread with added bran is recommended. Avoid spicy seasonings, excess spices, large quantity onions and garlic, which give milk a specific taste and smell. During breastfeeding, it is necessary to limit the consumption of foods with increased allergenic properties: chocolate, cocoa, natural coffee, citrus fruits, honey, nuts. Nursing mothers are strictly prohibited alcoholic drinks, including beer.
A woman is recommended to eat 5 times a day within 30-40 minutes. Before breastfeeding.
The amount of liquid (including soups, vegetables, etc.) should average 2 liters.
During breastfeeding, mothers should take some kind of multivitamin preparation containing vitamin D (for example, Gendevit - 2 tablets per day).

LURE. KINDS. INTRODUCTION RULES. Complementary feeding is an independent species nutrition, replacing one and then several feedings with breast milk or formula. Talk to your pediatrician about prescribing complementary foods. The introduction of complementary foods is due to:

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

BASIC RULES FOR INTRODUCTION OF COMPLETE FEEDINGS.

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

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

We can roughly distinguish several periods of feeding children:
1. from 0 to 3-6 months, when the child receives only milk;
2. from 3-6 months to 1 year - transitions, during which complementary foods are gradually introduced into the child’s diet;
3. from 1 year to 3 years - early childhood when the child gradually and carefully gets accustomed to traditional family dishes;
4.5. preschool (from 3 to 6 years old) and school (from 7 to 14 years old), characterized by a wide range of foods and dishes used in nutrition, basically no different from those received by adults.

1st period.
If a child is naturally fed with mother's milk, then up to 3 months it is inappropriate and even harmful to include other products in the diet in addition to milk. It may be necessary to include vitamin D. In the absence of human milk, commercially produced substitutes should serve as the main food product.

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

3rd period, 4th period, 5th period.
Starting from the age of one year, the child, as a rule, no longer receives breast milk and can consume the same foods as an adult. However, one should avoid giving dried fruits, which can only be introduced after 18 months. Pancake week fruits (peanuts, almonds and others) are practically prohibited for up to 5 years. Sausages can be given in very small quantities. It is better to give chocolate and chocolate candies to children after 5 years of age, but before this age, give the child marshmallows, marmalade, marshmallows, honey, jam, jam. To instill healthy habits in a future adult, you should not add too much sugar and salt to your food, and you should limit your consumption of fatty foods and sauces. It is better to use eggs no more than twice a week, boiled or fried.

Fruit puree should be recommended to breastfed children 2-3 weeks after the appointment of juices, that is, at 3.5-4 months, using approximately the same assortment of fruits as in the case of juices. And in this case, we recommend industrially produced baby puree, which guarantees the required composition and safety.

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

It is better to start introducing cereal complementary foods (milk porridge) 3-4 weeks after the introduction of vegetable puree. However, in cases where the child is not gaining weight well or has unstable stools, you can start introducing complementary foods with milk porridge, and only then introduce vegetable puree. The first to be given are porridges that do not contain gluten (a special type of protein, grain), which can cause intestinal disease in the child - clumping - rice, corn, buckwheat. Porridge should be included in the diet gradually. In the beginning, you should add one teaspoon to the evening feeding, 2-3 teaspoons to increase the calorie content of the food.

Then, within two weeks, cereal porridges are introduced into the morning feeding in the form of a thick milk mixture, which is given to the child from a spoon. After the introduction of the first type of cereal porridge, after a two-week adaptation period, the child is accustomed to another type of porridge.

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

Yolk during natural feeding should be prescribed from the 6th month of life. Its earlier administration quite often leads to allergic reactions in children.

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

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

TEN GOLDEN RULES OF BABY FOOD.

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

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 liquid. yellow color,
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 it is much less common for infants to develop allergic reactions

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. Artificial feeding increases the 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, 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 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 (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.

Efficiency 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

NATURAL FEEDING.

Feeding a baby with breast milk is called natural.

¨ Human milk is a unique and most balanced food product for a child of the first year of life;

¨ The composition of each mother’s breast milk exactly corresponds to the needs of her baby for various substances: proteins, fats, carbohydrates, vitamins and minerals;

¨ Mother's milk contains special substances - enzymes that promote the digestion and absorption of proteins, fats and carbohydrates;

¨ Mother’s milk contains immunoglobulins and immune cells that protect the child from most infectious diseases: intestinal infections, infectious hepatitis, diphtheria, tetanus and others;

¨ Breast milk contains substances that regulate the growth and development of the child and ensure the correct formation of his brain and intellect (hormones, growth factors, taurine, zinc, iodine, etc.);

¨ In the process of breastfeeding, a special, very close relationship arises between mother and child, the warmth of which remains throughout the rest of life;

¨ Breastfeeding is good for the mother's health because... it promotes contraction of the uterus after childbirth, helps restore the figure and is the best prevention of mastopathy and breast cancer.

Natural feeding is a physiological phenomenon for mother and child and therefore cases of true lack of milk are rare. The most responsible period for restoring lactation in the mother is the first 3-4 months after birth. We can recommend the following rules necessary for successful feeding:

¨ early attachment of the baby to the breast (in the delivery room);

¨ in the first weeks, it is advisable to provide the child with a free feeding regime (at the child’s request) and only later transfer the child to feeding according to the hour, which he himself chose;

¨ when introducing complementary foods, to prevent the extinction of lactation, it is recommended to put the baby to the breast at the end of each feeding;

¨ if there is not enough milk, it is necessary to put the baby to the breast often. We must remember that every drop of mother’s milk is priceless for an infant. At the same time, frequent breastfeeding can increase milk production in the mammary gland.

NUTRITION FOR A NURSING MOTHER.

A nursing mother must receive a complete, balanced diet, since a woman spends additional energy and nutrients to produce milk, and, therefore, it is necessary to replenish these costs.

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

Vegetables are best consumed in their natural form or in the form of salads and vinaigrettes. The most appropriate cereals to use are oatmeal and buckwheat. Wholemeal bread with added bran is recommended. You should avoid spicy seasonings, excess spices, large amounts of onions and garlic, which give milk a specific taste and smell. During breastfeeding, it is necessary to limit the consumption of foods with increased allergenic properties: chocolate, cocoa, natural coffee, citrus fruits, honey, nuts. Alcoholic drinks, including beer, are strictly prohibited for a nursing mother.

The amount of liquid (including soups, vegetables, etc.) should average 2 liters.

During breastfeeding, mothers should take some kind of multivitamin preparation containing vitamin D (for example, Gendevit - 2 tablets per day).

LURE. KINDS. INTRODUCTION RULES.

Complementary feeding is an independent type of nutrition, replacing one and then several feedings with breast milk or formula. Talk to your pediatrician about prescribing complementary foods. The introduction of complementary foods is due to:

¨ increasing the growing baby’s need for energy and basic food ingredients (P.ZH.U.);

¨ increasing the child’s body’s need for minerals (iron, calcium, magnesium) and vitamins;

¨ the need to train the masticatory apparatus;

¨ the need to stimulate the digestive glands and their gradual adaptation to the digestion of adult food;

¨ the need to introduce plant fibers, which play an important role in the proper functioning of the child’s gastrointestinal tract;

¨ the need to educate the child in the skills of consuming new types of food, including thicker consistency, which prepares him for weaning.

BASIC RULES FOR INTRODUCTION OF COMPLETE FEEDINGS.

¨ Start introducing complementary foods only to a healthy child or, as a last resort, during the recovery period, with normal stool;

¨ complementary foods are introduced warm before breastfeeding or formula feeding;

¨ complementary foods are given from a spoon, vegetable puree can be first added to a bottle of milk so that the child gets used to the new taste more easily;

¨ each complementary food is introduced gradually, from small quantities (1-2 teaspoons) and is brought up to the age dose within two weeks;

¨ a new type of complementary feeding is switched to 1.5-2 weeks after the introduction of the previous one;

¨ the density of complementary foods should gradually increase;

¨ second complementary food - cereal porridges - you need to start introducing them with gluten-free porridges (rice, corn, buckwheat) and cook them with the milk or formula that the child receives;

¨ Baby food in jars contains the optimal amount of salt and sugar and therefore should not be added.

DIFFERENT PERIODS OF CHILD NUTRITION.

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

We can roughly distinguish several periods of feeding children:

1. from 0 to 3-6 months when the child receives only milk;

2. from 3-6 months to 1 year– transitions, during which complementary foods are gradually introduced into the child’s diet;

3. from 1 year to 3 years– early childhood, when the child gradually and carefully becomes accustomed to traditional family dishes;

4.5. preschool ( from 3 to 6 years) and school ( from 7 to 14 years), characterized by a wide range of foods and dishes used in nutrition, basically no different from those that adults receive.

1st period. If the child is breastfed naturally, then up to 3 months It is inappropriate and even harmful to include other products in the diet in addition to milk. It may be necessary to include vitamin D. In the absence of human milk, commercially produced substitutes should serve as the main food product.

2nd period. Breast milk or breast milk substitutes continue to be the mainstay of a child's diet. The recommended daily dose, depending on the age of the child, is from 400 to 800 ml. milk.

The number of products that are primarily included in the diet of children as a supplement to breast milk or its substitutes are fruit juices. This is primarily due to the fact that they have the same liquid consistency familiar to a baby as milk. At the same time, the introduction of juice allows you to provide the child with a number of new nutrients that he needs; sugars new to the baby (glucose, fructose), organic acids (citric, malic); promotes the absorption of milk nutrients, as well as additional amounts of vitamin C, potassium, and iron. Taking into account the unfavorable environmental situation, it is most advisable to introduce natural industrial juices into the diet of children. Juices should be introduced into the diet gradually, starting with two teaspoons, and increased over 2-3 weeks to 30-40 ml, and then by 8-10 months to 80-100 ml. in a day.

When breastfeeding, juices should be introduced into the child’s diet no earlier than 3 months of age.

It is advisable to introduce regular juice first into the child’s diet, which is characterized by low acidity and low potential allergenicity, then pear, plum, apricot, peach, raspberry, cherry, blackcurrant, orange, tangerine, strawberry juices, which are among the products with potentially high allergenicity, can be recommended. that should not be given earlier 6-7 months. This also applies to tropical juices and juices from other exotic fruits (papaya, mango). The introduction of juices should be made from one type of fruit (to exclude its possible allergenic effect) and only after getting used to it, mixed fruit juices can be introduced into the baby’s diet.

3rd period, 4th period, 5th period. Starting from the age of one year, the child, as a rule, no longer receives breast milk and can consume the same foods as an adult. However, one should avoid giving dried fruits, which can only be administered after 18 months. Pancake week fruits (peanuts, almonds and others) are practically prohibited up to 5 years. Sausages can be given in very small quantities. Chocolate and chocolate candies are best given to children after 5 years, but before this age, give the child marshmallows, marmalade, marshmallows, honey, jam, jam. To instill healthy habits in a future adult, you should not add too much sugar and salt to your food, and you should limit your consumption of fatty foods and sauces. It is better to use eggs no more than twice a week, boiled or fried.