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Health to you and your children!!!

Everything that is written in this article applies only to a child who is breastfed, organized in a natural way!

When to start complementary foods for a breastfed baby? Now there are many opinions on this issue. From some doctors, you can still hear the recommendation to start introducing apple juice, starting at three weeks. Many still continue to insist on the introduction of mashed vegetables, fruits and cereals from 3-4 months of age. There is also an opinion that a child should be fed after the appearance of the first teeth.

Lactation consultants recommend that you start introducing your baby to a new food only after the baby has shown interest in it. Such complementary foods are called pedagogical, because the main purpose of complementary foods is not to feed the child, but to introduce him to new food, teach him to chew, teach him to get food not only from his mother's breast.

At about six months of age, babies begin to show interest in the contents of their mother's plate, and try to try it, it is this behavior that is called active food interest and indicates the baby's readiness to get acquainted with new food. The nutritional interest of the baby is not associated with the feeling of hunger that arises in him, but with the desire to imitate his mother. He wants to do the same as she does, take some pieces from the plate and put them in his mouth.

What are the principles for the introduction of complementary foods during breastfeeding, if the mother wants to follow the biological line of behavior of the child? Here they are:

They begin the acquaintance of the baby with the introduction of microdoses (microprobes) of products, namely acquaintance, without the goal of feeding the child with some portion. A microdose for soft food is about as much as a mother can fit between the pads of her thumb and forefinger, if she squeezes them, or on the tip of a teaspoon. For liquid products - one sip, poured into a small cup on the bottom.

1 . The child can “at one sitting” try what the mother eats and what he is interested in in the amount of up to three microdoses.

2 . Only hard pieces are given to the baby’s hand, from which he himself will not eat much (hard apples, carrots, stalk, drying, etc.)

3 . Microprobes are given within 3-4 weeks. During this time, the baby can already get acquainted with many products used in his family and learn to drink from a cup.

4 . Complementary foods never replace breastfeeding! The baby can be introduced to new foods before, after and during breastfeeding. Often children wash down microprobes with mother's milk.

5 . Gradually increase the amount of food, allowing the child to eat more.

6 . Mom needs to keep the child's interest in food, to keep the desire to try. From six months to one and a half years, the child should get acquainted with all the products that are eaten in his family. To keep the desire to try, the mother should limit the child's food interest until 8-11 months: if the child has eaten 3-4 teaspoons of one product and asks for more, he should be given something else.

7 . From the outside, the introduction of complementary foods should look something like this: the baby begs for pieces, and his mother dresses him, sometimes. In such a situation, the child is always happy to get acquainted with new food and does not overeat.

8 . The child must learn to work with cutlery. Until 8-11 months, these are spoons (there should be a lot of them, because they fall all the time), the child has his own plate when he starts eating separately, usually after 8-11 months. Until this age, the baby can eat while sitting in his mother's arms and from her plate.

9 . If the child is tired of eating, has lost interest, it is necessary to take him away from the table.

The introduction of complementary foods to a child requires certain knowledge and experience. There will be no problems if the baby is healthy, is on properly organized breastfeeding, and his mother was shown how to introduce such complementary foods. This really needs to be shown, as does everything related to practice, such as breastfeeding and caring for a baby. If another experienced mother did not show the mother how to start feeding the baby correctly, she may make some mistakes without even knowing that she is making them. Some moms are successful. These are the lucky moms. How lucky, for example, mothers who have never seen how to breastfeed their baby correctly, but who managed to establish feeding. You can make mistakes that are not related to feeding itself, but to the behavior of the baby at the table. For example, a baby eats for a while, to put it mildly, not very carefully, prefers to take food with his hand, put it in a spoon, and then carry it into his mouth. Many mothers consider this behavior unacceptable, take away the spoon from the child and begin to feed him. The baby loses the desire to eat on its own. A child may really like some product and he may demand more and more for himself, and his mother gives in to him, getting the next day indigestion in the baby. With the correct introduction of complementary foods, the baby's well-being does not worsen, the tummy does not “get upset”, it continues to develop normally. If the mother knows the options for the normal behavior of the baby and adequately evaluates them and corrects them in time if necessary, a child will never grow out of the baby who does not know how to behave properly at the table, is sloppy or has poor appetite. Unfortunately, what all women were able to do 150 years ago, now almost no one remembers ...

Signs of improperly introduced complementary foods: the child eats very well for some time, and then refuses to try and eat anything. So, the child was overfed, he overate. Way out of the situation: for 5 days, take the child with you to the table, do not offer him anything, do not give, and eat with appetite in his presence.

Very often, mothers do not cope with the introduction of complementary foods just because they really want to feed the baby with other food. In the minds of modern mothers, there is a strong belief that breast milk is not a very reliable liquid in terms of its qualitative composition and must be supplemented with other foods. It completely ignores the fact that milk is a perfect product created by evolution specifically for feeding human babies, absolutely complete in its digestibility and nutritional value. Studies have shown that the early introduction of other foods impairs the absorption of nutrients from milk, and the child begins to fully absorb these substances from other foods only after a year. The feeding behavior of the baby is not artificially invented, but is due to the peculiarities of the development of his body, primarily the gastrointestinal tract. Mothers should remember that their task is not to feed the child with food, but to introduce him to it and keep the child interested in food. If you want your baby to have a good appetite in the future, never try to feed a child after he has lost interest in the process of eating. A mother who spends half a day making mashed potatoes or opening a ready-made jar is hard to watch as a child runs away after eating two spoons. I just want to catch him, distract him with a book, a toy or a TV, if only his mouth opens. Do not do this! A baby who has the opportunity to attach to his mother's breast will never suffer from hunger and thirst! If breastfeeding is organized correctly, then everything that the child needs, he will get from his mother's breast.

What to do with pieces of food, if the baby's food is not mashed, he can choke?

Food for the baby does not need to be crushed, but you need to start with small pieces-microdoses. If a child is given something from which he can potentially bite off a large piece, the child sits on his mother's lap and mother watches him, and as soon as a large piece is bitten off, the mother hooks her finger and takes it out of her mouth. The child actively learns and gradually learns to chew with his, as yet, toothless jaws, and then with toothy ones.

What if the baby spits out even very small pieces, or tries to burp them instead of swallowing?

Many children behave exactly like this: for a week or two they spit out all the pieces and periodically “choke”, then they begin to spit out the pieces “in one”, half they swallow, then, finally, they begin to swallow all the pieces. Mom needs to be patient and not insist. At the same time, the child must watch other people eat without spitting out the pieces.

When does complementary foods stop being just an introduction to new foods and begin to replace feedings?

Breastfeeding and switching to food from the common table are parallel processes. Substitution of feeding with complementary foods does not occur. The fact is that the main feedings from the breast in a child of 6 months and older are associated with dreams. Babies suck a lot when falling asleep for daytime and nighttime sleep, they are applied to the chest when waking up from daytime sleep and in the morning, they suckle at night, especially closer to morning. And acquaintance with complementary foods and food from the common table occur during mother's breakfasts, lunches and dinners. Relatively large portions of food the child eats already at the age of about a year and older. But even at this age, babies can often drink food with milk from the breast. The child continues to receive vitamins and other useful substances with breast milk in sufficient quantities and in optimal forms for assimilation, provided that his breastfeeding is properly organized, and the mother does not lack nutrients.

What about the salt, sugar, spices, and possibly harmful substances (such as nitrates) contained in the adult food that the baby will try? Baby food does not have all this, and therefore it can be more beneficial for the baby than food from the general table?

Food does contain salt, sugar, nitrates, and more. And baby food contains. Baby food is made in such a way that the child learns it without adapting to the products that make it up. There is no adaptation of the digestive system to taste, texture, or ingredients. The task of the mother is not to feed the child with other food, which can be done with baby food, but to continue the slow process of adapting the child's gastrointestinal tract to other food. This adaptation began when the child began to swallow amniotic fluid, the taste of which changed depending on the mother's nutrition, and continued with the onset of breast milk, the taste and composition of which changes not only during the day, but even during one feeding, and the mother eats not baby food. While the child eats small amounts of food, he adapts to its components: to salt, and to sugar, and to nitrates, as well as to its other components. And when he eats significant amounts of food, he will already be quite capable of coping with all this.

Does the baby need extra fluids in connection with the start of the introduction of complementary foods?

The baby continues to receive the main fluid from breast milk. The child usually begins to be interested in water and drinking after a year. Usually the baby is interested in the contents of his mother's cup and tries it, if you pour a little drink into the cup, on the bottom.

What about a child over a year old who has no food interest? Up to a year, all attempts to introduce complementary foods did not lead to anything. The child cried, turned away, up to vomiting. Now he eats very badly and not all, but only certain types of canned food. How to accustom a child to adult food and increase appetite?

So, usually, children behave who have not seen what and how other people eat. Often this happens if a separate process is arranged from feeding the child and they are fed with something special.

You need to stop breastfeeding your baby. It is necessary to put him at the table with everyone, or at least with his mother, do not try to feed him. It should become indifferent to everyone whether the child eats or not, at least it is necessary to “pretend” that this is so ... Let him watch for several days how other family members eat. If he starts asking you to try something, let's do it. Put on a plate the same as everyone else. In the presence of the baby, you need to eat with appetite. Don't try to distract yourself with TV, books, or toys. Do not scold or punish if the child spills or smears something, immediately remove it and demonstrate that everyone eats carefully.

If the baby is almost 5 months old, he is very interested in any food, looks everyone in the mouth and demands to try, is it possible now to introduce pedagogical complementary foods to him?

The kid is a developed and inquisitive child. He really wants to do with food the same as his mother. But we must remember that the gastrointestinal tract of a child, not yet full 5 months, is not yet very ready to get acquainted with other foods. Enzyme systems are just beginning to mature. The situation in the intestines is now stable, it is quite dangerous to interfere in it ahead of time. The task of the mother is to protect this stability from premature interventions. Food interest in a baby of this age should be limited, in other words, take him out of the kitchen and not eat in his presence. If you don’t really like such advice, you can do something, but only at your own peril and risk. We have already met with a situation where a mother, even knowing how to properly introduce complementary foods, is impatient and as a result of which the child received a breakdown in the digestive system, which had to be fought for a long time later. If the mother has the opportunity to introduce complementary foods under the full-time guidance of a lactation consultant (the best option), then it will be possible to do this from 5.5 months of age. If you can only act on your own, it is not recommended to introduce complementary foods before the baby is six months old.

Are there any peculiarities in the management of pedagogical complementary foods if the baby or his parents are allergic?

There are features, of course. For such a baby, products are introduced more slowly, starting with hypoallergenic ones, the amount of complementary foods is increased much more slowly than usual. The rate of product introduction can be described as “one step forward, two steps back”. Mom should follow a hypoallergenic diet, excluding foods that cause her allergies or any other inconvenience. A mother who is breastfeeding should not introduce new products to her baby against the background of an exacerbation of her own disease. All product samples must be completed by breastfeeding. It is necessary to introduce no more than one product per day and monitor the baby's reaction to it for at least 3 days.

Why can babies who eat baby food at 7-8 months eat 100-200g of mashed potatoes or cereals, but children who start with pedagogical complementary foods do not do this?

A child of the second half of life eats little because he does not want to eat yet. He only imitates his mother in her actions. He eats milk. Perhaps there is a genetic mechanism in the human cub that does not allow him to eat much at this age. A couple of thousand years ago, a child would probably have had big problems in the digestive system if he had been fed 100 g of game meat brought by his father from a hunt. Another thing is that then it would never have occurred to anyone to do this with a child. Even our great-grandmothers, 100 years ago, who cooked food for a family of 5-10 people on a stove or wood-burning stove, did not even think (and it was not possible), on the one hand, to feed the child with something specially prepared separately from everyone, but with on the other hand, and it was not in my mind to give the baby more common porridge or soup to eat ... Baby food is made so that the child can eat a lot of it. And any baby can be fed with them, but is it necessary? There are children who for the time being eat this “baby food” a lot and with pleasure, however, most of them have to be entertained during the feeding process so that their mouths open. Many people have to entertain in the process of eating for quite a long time, some - until adolescence. Often there is a situation when a child who ate with pleasure and a lot, up to a year or a little over a year, becoming older, begins to refuse food and turns into a small child, which is simply torture for parents to feed. These kids are not interested in food at all. There are, of course, children who relatively “safely” bypass the stage of baby food. "Safely" is put in quotation marks, because. now the long-term consequences of introducing large amounts of baby food to a child when he is biologically not quite ready for such a load are just beginning to be studied, the results will not be soon ...

The importance of breastfeeding a child will not be challenged by any person, even if he is the most notorious skeptic. Can anyone in their right mind deny the importance of this unique opportunity given to man and all mammals by nature? True, not all mothers have the level of lactation at the proper or at least average level, but this process can be easily stimulated through simple actions.

The importance of natural feeding of children in the first year of life

Natural feeding of children is the feeding of an infant with mother's milk with nutrition correction after 2 months of age and the introduction of complementary foods after 5 months. Breast milk for a baby is a natural food intended for him by nature itself. A factor that determines the amount of milk a mother has is a genetic predisposition. This indicator, which is necessary for breastfeeding newborns, is also influenced by the state of the nervous system of a nursing woman (negative emotions, insufficient sleep, fatigue), and nutritional value, existing diseases.

Lactation- a secretory process that occurs in the mammary gland. In the first days after childbirth, a secret of a peculiar composition is secreted, which is called colostrum. On the first day it is very small, just a few drops. In the following days, the increase in lactation can take place at different rates: sometimes by the 3rd day lactation reaches its full volume, in another case (more often in primiparas) in the first 3-4 days the amount of colostrum does not increase, but on the 4th day the mammary glands increase sharply, engorged, their secretion becomes abundant, there is " flow of milk."

Starting from the 2nd or 3rd day, the composition of colostrum changes, it “ripens” and by the end of the 2nd week (and sometimes a little later) passes into mature milk.

Thus, the secret of the mammary gland in the first 2-3 days is called colostrum, after the 4-5th day - transitional milk, after the 3rd week the milk, which acquires a constant composition, is mature.

The calorie content of colostrum decreases from 1500 calories per 1 liter to 600 calories on the 7th day.

Microscopically, colostrum differs from mature milk, which is excreted in the form of milky globules. Colostrum contains colostrum bodies - large cells filled with fat droplets.

The photo of breastfeeding newborns shows how visually colostrum differs from mature milk:

The importance of breastfeeding a child is difficult to overestimate. Mother's milk best meets the needs of the child. In addition to communication and a sense of closeness that accompany the process of feeding, antibodies enter the child's body with mother's milk, which are necessary to protect the baby's body from diseases and prevent allergies. A breastfed newborn child receives essential amino acids, polyunsaturated fatty acids, milk sugar, vitamins in the most digestible form, iron, enough water, lactose, hormones, biologically active substances (growth factors, substances that provide metabolic processes in the body).

The importance of breastfeeding for a newborn baby is also that mother's milk protects the baby from infections. And not only due to the presence of immunoglobulins - lysozyme and breast milk interferons are highly active against many microbes.

Breastfeeding a Newborn: Feeding Technique

The technique of breastfeeding a newborn is simple, but it will not be superfluous for primiparous women to familiarize themselves with the basic rules.

For proper breastfeeding of a newborn, before feeding, the mother should wash her hands, express 1-2 drops of milk. The classic position for feeding is sitting or lying down. When feeding while sitting, there should be support for the back and legs.

According to the breastfeeding technique, the child is turned to face the mother (his head should be in line with the body), pressed to himself, supporting behind his back, applied to the chest (but not the chest to the baby!) So that the lower lip is under the nipple.

The breast is supported during feeding. To do this, you need to put your hand under your chest, lifting it from below with your thumb. Then they touch the baby's lips with the nipple, wait until he opens his mouth, when the baby touches the palate with the nipple, the baby begins to make sucking movements, the mouth cavity is filled with milk, and the baby swallows it.

Observing the feeding technique, when breastfeeding, it is necessary to pay attention to the fact that when sucking, the child takes into his mouth not only the nipple, but also the areola, so that the head is not strongly thrown back and nasal breathing is not hindered by pressing against the mother's breast.

At the end of natural feeding of children of the first year of life, it is recommended to leave the breast open for 5-10 minutes. Milk remains on the nipples, its fat protects the skin from damage.

Each feeding is carried out from one breast. The duration of feeding with proper breastfeeding of a newborn is 15-30 minutes.

Difficulties in natural feeding of young children from the mother

Maternal difficulties in breastfeeding include:

• difficulty in excretion of milk;
• decreased secretory activity of the mammary glands - hypogalactia;
• outflow of milk;
• flat, inverted nipples;
• cracks, inflammation of the nipples;
• blockage of the milk duct;
• illness of the mother or taking medications that are contraindicated for the child and excreted in breast milk.

If there is a violation of the outflow of milk, an increase in temperature, an increase and soreness of the mammary glands, it is necessary to express milk.

When the milk duct is blocked, a painful seal is formed, which often leads to the development of inflammation of the mammary gland - lactational mastitis.

To prevent this complication, when breastfeeding young children, the duct is released by frequent feeding, changing the position during feeding, applying dry heat.

With hypogalactia, first of all, it is required to streamline the sleep pattern of a nursing woman. She should rest at least 8 hours a day, but since this is often unrealistic, daytime sleep for 1.5-2 hours, walks in the fresh air, timely high-calorie nutrition, consumption of actogenic drinks, intake of vitamin and mineral complexes containing vitamins A, E, P, glutamic acid, dry brewer's yeast hydrolysates, carrot juice. To prevent hypogalactia, the diet of nursing mothers is also enriched with milk, sour-milk drinks, honey, cottage cheese, sour cream, cheese, walnuts. The amount of free fluid is increased to 2.5 liters per day. Increased intake of fresh juices, fruits, berries without sugar. Contribute to the production of milk rosehip broth, coffee and cocoa with milk, strong green tea.

The excess energy value of the diet does not affect the amount of women's milk, but worsens its fatty acid composition. There is an increase in the content of saturated fatty acids, which can lead to obesity in the child.

For the prevention of hypogalactia, Femilak-2 can be recommended to lactating women. It is produced from skimmed milk, corn oil, milk sugar (lactose). This milk formula is enriched with essential vitamins and minerals. "Femilak" is recommended to take from 40 to 80 g per day. One glass of this milk formula provides nearly 30% of breastfeeding mothers' extra energy needs, more than 20% extra protein and 50% extra calcium.

Breastfeeding Difficulties: Difficulties on the part of the baby

Breastfeeding difficulties for a baby include:

• underdeveloped sucking reflex;
• "fear" of the chest;
• congenital defects of the mouth and nose, short frenulum of the tongue.

The sucking reflex is weakly expressed in preterm infants and infants born debilitated. They have to be fed through a tube or with the help of special devices.

If the baby is "fearful" of the breast, you need to find out if the mother is receiving bitter medicines or foods that give the milk some tastes that are unpleasant for the baby.

In the case of congenital clefts, the lips or palate are adapted to feeding by closing the cleft with the breast. Before surgical correction of the defect, it is recommended to feed, holding the child upright.

If sucking is difficult due to a short frenulum of the tongue, it is cut (the operation is performed on an outpatient basis by a surgeon in a polyclinic).

Breastfeeding stimulation: how to increase lactation

Given the importance of breastfeeding, mothers need to take care to increase their milk supply.

To stimulate breastfeeding, you need to breastfeed your baby as often as possible, including at night. To increase the lactation of milk during breastfeeding during one feeding, you need to apply the baby to both breasts alternately.

How else to increase lactation while breastfeeding so that the baby gets the required amount of milk? To do this, you need to introduce nuts, fish into the diet. It is also recommended to take a warm drink 20-30 minutes before feeding.

Artificial feeding of children at the age of the first months of life is 80% due to hypogalactia.

The expiration of milk after or between feedings (galactorrhea) is a neurosis. Treatment is often ineffective. Usually, a woman is prescribed restorative treatment, massage. To prevent protection of the skin in the area of ​​the mammary glands, absorbent wipes are applied to the nipple.

Irregular shape and size of the nipples can also cause difficulty in breastfeeding. Already during pregnancy, it is recommended to delay nipples that have an irregular shape (flat, inverted, etc.). In some cases, stretching the nipples before each application to the breast helps. There are a number of attachments in the form of pads that change with each feeding.

A very firm breast with abundant secretion of milk can prevent nipple latching. In these cases, it is recommended to express part of the milk before applying to the breast.

The most common causes of breastfeeding difficulties are cracked, abraded nipples and mastitis.

With cracks, it is required to minimize irritation by feeding through a protective pad, sometimes the baby is not applied to the breast for several days. He is fed with expressed milk obtained through breast milk collection pads.

In mastitis, milk is sucked out by a breast pump immediately after breastfeeding.

How to properly stop lactating breast milk

No less relevant is the question of how to properly stop lactation of breast milk if the mother decided, for objective reasons, to stop natural feeding of the child.

• pressure bandage on the chest;
• restriction of fluid intake for 2-3 days;
• exclusion from the diet of products that increase lactation: nuts, dill, tea with milk, etc.

Before stopping lactation of breast milk, remember that it is not recommended to refuse breastfeeding to a child during his illness, during and after vaccinations, changes in climatic conditions and other situations that are not familiar to him.

During the treatment of inflammation and injuries of the nipples, the following rules must be followed:

• wash the chest no more than 1 time per day;
• after the end of feeding, leave the breast open;
• Use only hygroscopic pads.

When the mother is ill, the approach to breastfeeding is different and depends on the woman's pathology.

In case of a viral infection, a woman puts on a mask, and after feeding, she is isolated in another room from the child.

It is not recommended to take herbal laxatives while breastfeeding; neuroleptic and psychotropic drugs, alkaloids that depress the respiratory center, and other drugs, including alcohol and nicotine.

Rules and stages of breastfeeding a newborn baby

The rules for breastfeeding a newborn baby, developed by WHO (UNICEF), are as follows:

• strictly adhere to the established rules of breastfeeding;
• inform pregnant women about the benefits and techniques of breastfeeding;
• help mothers start breastfeeding within the first half hour after birth;
• show mothers how to breastfeed and how to keep lactating even if they are temporarily separated from their babies;
• another rule of breastfeeding a child is not to give newborns any food or drink other than breast milk, except in cases due to medical indications;
• practice round-the-clock finding of the mother and the newborn side by side in the same room;
• encourage breastfeeding on demand rather than on a schedule.

The child, as he grows and develops, gradually switches to eating regular food. Conventionally, this period is divided into:

• stage of breastfeeding only;
• transitional power stage;
• weaning stage.

The first stage lasts up to 5-6 months, and then complementary foods are introduced. Complementary foods in the diet are necessary to expand the range of foods; for the development of motility of the digestive system; to train the chewing apparatus to receive hard food; for the additional introduction of protein, trace elements, vitamins necessary for the growth of the child.

It has been established that the protein content in breast milk in the early lactation period is 16-18 g/l. Then its decrease begins, and by the 3-4th month the amount of protein drops to 8-10 g / l, and by 6 months it decreases even more. The child needs it every month more and more.

Contraindications to natural feeding of young children

Contraindications to natural feeding of children are divided into temporary and permanent.

Temporary contraindications include birth trauma of a child with impaired cerebral circulation or other serious illnesses of the infant, accompanied by respiratory and heart failure. Permanent contraindication - intolerance to mother's milk. In this case, the child is transferred to a special diet.

Permanent contraindications on the part of the mother are: infectious diseases (tuberculosis, syphilis and others with bacillus excretion), severe kidney damage, uncompensated heart disease, taking cytostatics.

With influenza, tonsillitis, pneumonia, the issue is resolved individually. In the acute period, milk is expressed, in other cases, the mother feeds the child in a mask.

Proper breastfeeding of premature babies

Breastfeeding of premature babies born in the most satisfactory condition begins to feed 6-8 hours after birth. Children who are in serious condition are fed for the first time 24 hours after birth. During the first days of life, such children are given a 5% glucose solution in sufficient quantities.

Children born with a body weight of less than 1.5 kg are fed through a tube or through a catheter intravenously with special liquids. For breastfeeding premature babies weighing over 1.5 kg, expressed breast milk from special devices (horn, bottle) is used, and children weighing more than 2 kg are breastfed. However, if the child does not suck actively enough and gets tired quickly during sucking, then supplementary feeding should be immediately carried out with expressed mother's milk from a horn or from a bottle.

The feeding regimen of premature babies is 8-9 times a day (per day).

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

Composition of human milk

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

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

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

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

Natural feeding has a beneficial effect on the development of the central nervous system of the child and his mental status. The bonding between mother and child during breastfeeding has a profound mutual emotional impact. It is noted that children who were fed with mother's milk are distinguished by harmonious physical development, they are more calm, balanced, friendly and benevolent compared to children who were bottle-fed, and subsequently become attentive and caring parents themselves.

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

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

Rice. 2. Protective factors in breast milk

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

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

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

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

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

Fats in mother's milk are easier to digest than cow's, as they are more emulsified, in addition, breast milk contains the enzyme lipase, which is involved in the digestion of the fat component of milk, starting from the oral cavity.

The content of cholesterol in women's milk is relatively high and ranges from 9 to 41 mg%, stabilizing by the 15th day of lactation at the level of 16-20 mg%. Breast-fed babies have higher cholesterol levels than formula-fed babies. Cholesterol is necessary for the formation of cell membranes, tissues of the nervous system and a number of biologically active substances, including vitamin D.

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

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

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

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

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

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

Human milk contains all water- and fat-soluble vitamins. The concentration of vitamins in milk is largely determined by the nutrition of a nursing mother and the intake of multivitamin preparations. It should be emphasized, however, that the level of vitamin D in women's milk is extremely low, which requires its additional administration to children who are breastfed.

Vitamin deficiency leads to violations of enzymatic activity, hormonal dysfunctions, and a decrease in the antioxidant capacity of the child's body. In children, polyhypovitaminosis is more common, and an isolated deficiency of one micronutrient is less common.

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

Organization of breastfeeding

In the maternity hospital, in order to become sufficient in terms of volume and duration of lactation, a healthy newborn child should be laid out on the mother's chest in the first 30 minutes after an uncomplicated birth for a period of at least 30 minutes.

THE ARGUMENTATION OF THIS METHOD INCLUDES THE FOLLOWING PROVISIONS:

1. Early attachment of the child to the mother's breast ensures the rapid activation of the mechanisms of milk secretion and more stable subsequent lactation;

2. Sucking a baby promotes an energetic release of oxytocin and thereby reduces the risk of blood loss in the mother, contributes to an earlier contraction of the uterus;

3. Contact of mother and child:

It has a calming effect on the mother, the stress hormonal background disappears;

Promotes, through the mechanisms of imprinting, an increase in the feeling of motherhood, an increase in the duration of breastfeeding;

Provides newborns with maternal microflora.

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

It contains more immunoglobulins, leukocytes and other protective factors than mature milk, which largely protects the child from intense bacterial contamination, reduces the risk of purulent-septic diseases;

It has a mild laxative effect, thanks to which the intestines of the child are cleared of meconium, and with it bilirubin, which prevents the development of jaundice;

Contributes to the formation of optimal intestinal microflora, reduces the duration of the phase of physiological dysbacteriosis;

Contains growth factors that affect the maturation of the functions of the intestines of the child.

In order for the child to receive colostrum in the maximum possible amount, the frequency of breastfeeding should not be regulated. In order to implement free feeding on demand, a healthy child should be in the same room with the mother. It is shown that with free feeding, the volume of lactation is higher than with feeding by the hour. Early attachment to the breast and "free feeding" are key factors in ensuring full lactation and contribute to the establishment of close psycho-emotional contact between mother and child.

To maintain lactation, night feedings are especially significant, since prolactin levels are higher at night. The duration of breastfeeding of a healthy child in the first days should not be limited, even when he practically does not suck out anything, but is dozing at the breast. The need for contact and sucking may be independent, relatively independent of eating behavior. However, in the future, excessively frequent attachment of the child to the mother's breast at the slightest disturbance can lead to overfeeding. In this regard, one of the important tasks of pediatricians, especially district pediatricians, is to teach the mother to differentiate the "hungry" cry of the child from the cry due to other reasons: infantile colic, discomfort, change of scenery, overheating or cooling of the child, pain, etc.

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

Anxiety and crying of the child during or immediately after feeding;

The need for frequent breastfeeding;

Prolonged feeding, in which the child makes a lot of sucking movements, in the absence of swallowing;

Feeling by the mother of the rapid complete emptying of the mammary glands with the active sucking of the child, there is no milk when decanting after feeding;

Restless sleep, frequent crying, "hungry" cry;

Scanty rare stool

However, the most reliable signs of malnutrition are low weight gain and infrequent urination (less than 6 times per day) with the release of a small amount of concentrated urine. The final conclusion about insufficient lactation can be made on the basis of the results of weighing the child at home after each feeding during the day (“control” weighing).

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

The baby latch but does not suckle, does not swallow, or suckles very little;

When the mother tries to breastfeed, the child screams and resists;

After a short sucking breaks away from the chest, choking with crying;

The baby takes one breast but refuses the other. The reasons can be different, among which the most common are:

Violations of the organization and technique of feeding (wrong position of the child at the breast);

An excess of milk in the mother, in which it flows too quickly;

Teething,

Diseases of the child (perinatal damage to the nervous system, partial lactase deficiency, gastrointestinal form of food allergy, acute respiratory viral infection, otitis media, thrush, stomatitis, etc.).

Finding out the cause and carrying out if necessary

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

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

Lactation crises are based on the peculiarities of hormonal regulation of lactation. They usually occur at 3-6 weeks, 3, 4, 7, 8 months of lactation. The duration of lactation crises is on average 3-4 days, and they do not pose a danger to the health of the child. In such cases, more frequent attachment of the baby to the breast in combination with feeding from both breasts is sufficient. The mother needs rest and rest; varied, full-value, high-tasting food; warm drinking of drinks, especially with the use of lactogenic herbs or preparations 15-20 minutes before feeding, as well as special products of lactogenic action.

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

Measures used in secondary hypogalactia (lactation crises):

More frequent breastfeeding;

Settlement of the regimen and nutrition of the mother (including the optimal drinking regime due to the additional use of at least 1 liter of liquid in the form of tea, compotes, water, juices);

Impact on the psychological mood of the mother;

Orientation of all family members (father, grandparents) to support breastfeeding;

Contrast shower on the area of ​​the mammary glands, soft rubbing of the chest with a terry towel;

The use of special drinks with a lactogenic effect;

At the same time, children's milk formulas are not introduced into the child's diet without the recommendations of a doctor.

Numerous observations show that sufficient production of breast milk mainly depends on the “mood of the mother” for breastfeeding her child, her conviction that this is important and necessary and that she is able to do this. conditions when, in addition to the desire and confidence of the mother, she is actively supported by all family members, as well as professional advice and practical assistance from medical workers. It is advisable for women to be taught about breastfeeding during pregnancy in the "School of Pregnant Women".

The most important role in the promotion of breastfeeding is given to doctors and nurses, who should actively encourage family and social support for breastfeeding, provide parents with full information about its comprehensive positive effect on the child's body and advantages over infant formula. To carry out activities to successfully establish and maintain the practice of breastfeeding, all health workers involved in obstetric care and medical supervision of infants must have the ability to provide practical assistance to mothers in breastfeeding.

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

Have accessible printed information regarding breastfeeding practices, which should be shared regularly with all health care personnel;

Inform all pregnant women about the benefits of breastfeeding and the need

early attachment of a newborn baby to the mother's breast (within the first 30 minutes after birth);

Provide 24/7 co-existence of mother and child in the mother and child ward of the maternity hospital and encourage breastfeeding at the request of the child;

Teach mothers how to breastfeed and maintain lactation;

Strive for exclusive breastfeeding for the first 4-6 months of life, i.e. not to give healthy newborns any food other than breast milk, unless medically indicated;

Ensure continuity in the work of the antenatal clinic, obstetric hospital, children's clinic and children's hospital.

These activities must be carried out taking into account the health status of both the mother and the child.

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

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

With such diseases of a nursing mother as rubella, chickenpox, measles, mumps, cytomegalovirus infection, herpes simplex, acute intestinal and acute respiratory viral infections, if they occur without severe intoxication, breastfeeding, subject to the rules of general hygiene, is not contraindicated. The presence of hepatitis B and C in women is currently not a contraindication to breastfeeding, however, feeding is carried out through special silicone pads. In acute hepatitis A in the mother, breastfeeding is prohibited.

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

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

Usually safe, used in medium doses, are short courses of paracetamol, acetylsalicylic acid, ibuprofen; most cough medicines; antibiotics - ampicillin and other penicillins, erythromycin; anti-tuberculosis drugs (except rifabutin and PASK); antifungal agents (except fluconazole, griseofulvin, ketoconazole, itraconazole); antiprotozoal drugs (except metronidazole, tinidazole, dihydroemetine, primaquine); bronchodilators (salbutamol); corticosteroids; antihistamines; antacids; antidiabetic agents; most antihypertensive drugs, digoxin, as well as single doses of morphine and other narcotic drugs. At the same time, while taking medications by the mother, careful monitoring of the child is necessary in order to detect their side effects in a timely manner.

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

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

Given the negative impact of tobacco smoke, tar and nicotine on the child's body and on lactation, women who smoke during lactation are advised to stop smoking. Nicotine can reduce milk production and inhibit its secretion, as well as cause irritability in the child, intestinal colic and lead to low rates of weight gain in infancy. Women who smoke have lower levels of prolactin, which can shorten lactation, and lower levels of vitamin C in breast milk compared to non-smokers. Smoking women should be motivated to quit smoking or at least significantly reduce the number of cigarettes smoked. The content of harmful substances in breast milk will be less if a woman smokes a cigarette after breastfeeding, and not before.

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

Breastfeeding during the onset of a new pregnancy can continue.

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

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

With a number of severe congenital malformations (heart defects with decompensation, cleft palate, cleft lip, etc.), when breastfeeding is not possible, the child should receive expressed breast milk.

Absolute contraindications to breastfeeding by a child at subsequent stages of lactation are very limited - hereditary enzymopathies (galactosemia, etc.). With phenylketonuria, the volume of breast milk in combination with medicinal products is set individually.

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

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

Even with severe physiological jaundice in children in the first days of life, breastfeeding should not be abandoned. Early attachment of the baby to the breast and frequent feedings are an important factor in the prevention of jaundice, since colostrum, having a laxative effect, leads to a faster discharge of meconium. With insufficient nutrition of a newborn baby, jaundice may be more intense and prolonged due to the thickening of bile. Supplementation with water or glucose solutions does not contribute to the prevention of jaundice, but reduces its severity. It is important that the baby receives an adequate amount of milk, because malnutrition develops bile thickening syndrome.

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

It is advisable to breastfeed a child with hyperbilirubinemia due to AB0 incompatibility from birth, since the antibodies contained in milk are destroyed by hydrochloric acid and enzymes of the digestive system. In case of Rh conflict, if the child has not had an exchange transfusion, then during the first 10-14 days he is fed pasteurized (antibodies are destroyed during pasteurization) mother's or donor's milk. In cases of replacement blood transfusion, 3-5 hours after the operation, the child can be attached to the breast.

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

Materials for this chapter were provided by: prof. Fateeva E.M. (Moscow), prof. Mandrov S.I. (Ivanovo), prof. Bombardirova E.P. (Moscow), prof. Geppe N.A. (Moscow), Ph.D. Kapranova E.I., candidate of medical sciences, associate professor Kutafin Yu.F. (Moscow), prof. Rusovoy T.V. (Ivanovo), MD Odinaeva N.D. (Moscow), prof. Mangrov F.K. (Novokuznetsk), Ph.D. Proshchina I.M. (Ivanovo), Ph.D. Batanova E.V. (Ivanovo), Ph.D. Lukoyanova O.L. (Moscow), Ukraintsev S. E. (Moscow), Yakovlev Ya.Ya. (Novokuznetsk).

Feeding a child in the first year of life with women's milk is called natural.

Feeding newborns for the first 7-10 days of life

Usually, a newborn baby begins to be breastfed 6-10 hours after birth: a longer delay adversely affects the newborn and his mother. With a later attachment of the child to the breast, there is a significant decrease in body weight in the first days of life and its later recovery.

In the first days after childbirth, the mother feeds the child in bed from a lying position on her side (Fig. 10). The child is placed so that it is convenient for him to grab the nipple with his mouth. The mother slightly raises her breast with her hand, holding it between her thumb and the rest (the breast lies in the palm of her hand), and directs the nipple into the child's mouth, trying to ensure that the latter well captures not only the nipple, but part of the adjacent skin (areola). At the same time, with the thumb, the upper surface of the chest is slightly pressed down so that it does not cover the child's nose and does not interfere with his breathing.

In the future, when the puerperal is allowed to sit or get out of bed (from the 3-4th day), she feeds the child in a sitting position on a chair, placing her foot on a low bench (Fig. 11). Feeding with each breast must be alternated so that both are completely emptied. The rest of the 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 out of the first, and 2) follow the order of application.

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

The amount of milk a newborn baby needs varies greatly. 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 baby's weight at birth 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 needed by a child during the day, it is necessary to multiply the number of days of his life by 70 (when weighing less than 3200) or by 80 (when weighing more than 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 per feeding).

The amount of food needed by a premature baby should 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. In the future, the daily amount of food is determined by the formula:

n x 10 for every 100 g of the 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.

A child from the first days of life must be taught to order in feeding. A newborn child 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 child by the hour.

IP Pavlov wrote, "that no other stimulus can be compared either in qualitative or quantitative terms with the craving for food as a stimulant of gastric juice." Only food with an appetite can be as healthy as possible, while food on command cannot have such a positive effect. Chaotic feeding reduces the child's appetite, he sucks milk a little.

Of great importance is the frequency of feeding. The works of prof. N. I. Krasnogorsky found that in the activity of the central nervous system (CNS) there is a certain cyclicity of the processes of excitation and inhibition. In children of the first 3 months of life, the process of excitation is replaced by the process of inhibition every 3 hours; in children aged 3-5 months, such an alternation is observed every 3.5 hours, in children older than 6 months - every 4 hours. The greatest appetite in children is observed with the predominance of the excitation process (with the predominance of the process of inhibition in the central nervous system, the food center is also inhibited). Therefore, the interval between feedings should be different, depending on the age of the child.

Children of the first 2-3 months of life should be fed every 3 hours with a night interval lasting 6 hours (the night interval is necessary for the mother and child to rest); 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 older than 5 months every 4 hours (night interval 8 hours) 1 (Fig. 12).

If the child does not calmly endure such long nightly 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 duration of the food mass in the stomach, which depends on the type of food. Women's milk is excreted from the stomach 2-2.5 hours after ingestion, artificial milk mixtures from cow's milk linger in the stomach for 3 hours, and cereals for 3-4 hours. Vegetables linger in the stomach for a particularly long time (4-5 hours). A high content of fat and protein increases the duration of food in the stomach.

1 In maternity hospitals, healthy newborns are fed somewhat less frequently (6 times), which is explained by the working conditions of medical personnel.

Technique and rules of natural feeding

The success of breastfeeding largely depends on the punctual observance of a number of rules.

1. Before each feeding, the mother should carefully wash her breasts with boiled water with cleanly washed hands.
2. Express a few drops of milk, which removes random bacteria that easily enter the peripheral sections of the excretory ducts.
3. At the end of feeding, the breast must be dried with a clean soft linen cloth so that there is no maceration of the nipples.

When breastfeeding, a physiological balance is established between the mother and the 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 duration of each breastfeeding on average should last no more than 15-20 minutes. Only newborns 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 a small child is given milk formula in a bottle with a nipple, he will not stop sucking, despite the fact that a large amount of sucked milk will cause overdistension of the stomach.

Methods for calculating the required amount of milk for a child

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 at the age of 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 instance. A child aged 3 months, weighing 5200 g, should receive milk at the rate of 1/6 of body weight, i.e. 5200: 6 = 866 ml of milk.	Until recently, this method of calculating the volume of food was the most common. However, at present, due to the acceleration, which was expressed in a very rapid increase in body weight during the first six months of life and the birth of larger children, it may happen that the volume of food calculated in this way can exceed 1 liter. In such cases, the volume of food should not exceed 1 liter, but then some correction of nutrition 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 each week missing up to 8, 50 ml less, and for each month more than two, 50 ml more.	For children younger than 2 months, 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 method of calculation 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 for the child. For example, a child aged 3 months should receive milk: 800 + 50 x (3-2) = 850 ml. Shkarin's calculation in modern children is hardly suitable due to the acceleration of their development. It is given in our guide in a historical aspect.
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 weight of the child, it is easy to calculate how many kilocalories the child needs. Knowing that 1 liter of women's milk contains an average of 700 kcal, it is easy to calculate how much milk a child should receive per day.	For example, a child aged 3 months, weighing 5 kg, should receive 120 kcal per 1 kg of weight, or 600 kcal per day (120 kcal x 5 \u003d 600 kcal). By drawing up a proportion, it is easy to translate 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 caloric one. The calculation is based on the average normal weight of the child at a given age, but the daily amount of food should not exceed 1000 ml.

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

Educational guide to healthy child nutrition. A. V. MAZURIN. M., "Medicine", 1980, 208 p., ill.

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

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

Natural feeding is the feeding of infants with mother's milk with the introduction of complementary foods from the 5th month. At the same time, 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 approaches the composition of the tissues of the child.

The most important benefits of human milk:

1. Women's milk is completely devoid of antigenic properties, while cow's milk proteins have a pronounced antigenic activity, which contributes to the appearance and intensification of allergic reactions in infants. Refusal of breast milk if the child has allergic reactions is a gross mistake, although often the transfer of a child with allergic reactions to artificial, usually fermented milk mixtures seems to have a positive effect: the manifestations of exudative diathesis subside for a while. And everyone is happy - “allergy 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 much less than in cow's milk; in terms of structure, it is close to the proteins of a child's cells. It is dominated by finely dispersed fractions, the particles of coarsely dispersed casein protein are several times smaller than in cow's milk, which ensures curdling of breast milk in the stomach with more delicate flakes and, thereby, its more complete digestion.

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, kidney damage due to metabolic disorders. This leads to a delay in the development of the central nervous system of the child. It is known that higher intellectual abilities occur in schoolchildren who were breastfed for the first 4-9 months.

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

4. Often, adult obesity is rooted in early childhood. Artificial feeding contributes to obesity in infants. Many of them during puberty observed secondary obesity, which persists throughout life. This is also due, mainly, to protein overfeeding.

5. The amount of fat in women's 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 absence of breast milk is of great importance in the occurrence of which, 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, contributes to the regulation of the evacuation function of the stomach and the earlier release of pancreatic juice. All this facilitates the digestion and absorption of fat, the individual components of which are part of 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 relatively high. They largely determine the microbial flora of the intestine. They include B-lactose (up to 90%), which, together with oligoaminosaccharides, stimulates the growth of normal flora with a predominance of bifidobacteria, thereby suppressing the proliferation of pathogenic microorganisms and E. coli. In addition, B-lactose is involved in the synthesis of B vitamins.

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

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

9. Breast milk differs from cow milk in a higher content and higher activity of vitamins, in particular vitamin D, which also contributes to the prevention of rickets.

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

11. It is shown that with natural feeding, sexual potency is better in the future, fertility is higher.

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 breastfeeding, a life-long fixed relationship with the mother is laid, its subsequent influence on the behavior of the child, and future parental behavior is also formed. Thus, in bottle-fed animals, parental behavior is sharply perverted when they become adults: they refuse to feed their offspring. Therefore, psychologists dealing with family relations attach great importance to natural feeding. Thus, the refusal of natural feeding is a gross violation of the biological chain “pregnancy-delivery-lactation” that has developed in evolution.

In conclusion, it must be added that the mammary glands in a nursing mother, like the placenta in a pregnant woman, are a powerful barrier that rarely passes microorganisms, salts of heavy metals and other products harmful to the child. Therefore, it is necessary to be quite careful about such, for example, recommendations as refusing breastfeeding and transferring the child to formula milk due to the unfavorable environmental situation in the area.

The main reason for not breastfeeding is hypogalactia, i.e. decreased secretion 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 occur even in the prenatal period in a girl when her mother is prescribed estrogens during pregnancy, especially synthetic ones. However, in the overwhelming majority of cases, secondary hypogalactia develops due to the negative impact on the female body of a holistic complex of biological, medical, social, psychological and economic factors. The leading role, of course, belongs to social factors and iatrogenic causes. According to the World Health Organization, only 1% of women are unable to breastfeed their children. At the same time, more than 10% of mothers in our country have not breastfed since birth. By the age of 6 months, less than 3 children remain breastfed, and mothers begin to independently introduce supplementary feeding from two weeks.

The causes of hypogalactia in modern conditions are listed in order of their importance.

1. Lack of inclination for breastfeeding in a pregnant woman. If, when asked whether she will breastfeed her unborn child, the pregnant woman replies: “Yes, if I have milk,” this means that she was not set up for breastfeeding. Active promotion of natural feeding requires close cooperation between obstetric and pediatric services. Positive motivation for breastfeeding should be nurtured in the microsocial environment of pregnant women. It is 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, the maternity hospital are powerful stimulants of lactation. Future parents should be aware of the benefits of breastfeeding for a child, its beneficial effect on a woman's health. So, in England, women who early transferred children to artificial feeding are classified as high-risk groups for the development of pre-tumor processes in the mammary glands. In many developing countries, the contraceptive effect of breastfeeding is more likely to prolong birth intervals than any other method of fertility regulation. 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 the pituitary gonadotropin decreases, which in turn inhibits ovulation and contributes to amenorrhea. The contraceptive effect of breastfeeding decreases with less frequent attachment of the baby to the breast, 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 with the use of oral contraceptives. After the resumption of ovulation, lactation no longer has a contraceptive effect.

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

In the 1960s and 1970s, when there was a marked decrease in the frequency of breastfeeding in developed countries, one of the main causes of hypogalactia was considered insufficient support from health workers. Groups “For the expansion of breastfeeding” were organized, where mothers themselves who breastfed at least one child were consultants. This led after a few years to a significant increase in natural feeding. An interesting trend has now emerged - the highest percentage of natural feeding is observed in the most poorest 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 women.

2. Late first breastfeeding. There are very few contraindications to early, immediately after birth, breastfeeding. In Western European countries, the vast majority of newborns are immediately applied to the breast. Even after a caesarean section, they begin to breastfeed as soon as the mother recovers from anesthesia. In our country, less than 20% of women begin to feed immediately after birth. 40% of women in labor put the baby to the breast more than a day later.

In Sweden, a video was filmed, which clearly shows that immediately after childbirth, when the child lies on the mother’s stomach, for 5 minutes he has a period of relaxation, then about 10-15 minutes - awakening, about 40 minutes - a period of activity, when a child is looking for a breast, and he must find it himself. It is impossible to give a newborn a breast like a bottle: his mouth should be wide open and the lower lip, as it were, turned inside out. Only such a capture of the nipple together with the areola ensures sufficient supply of nerve impulses from their surface to the hypothalamus of the mother, 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 a newborn is sufficient until lactation is established. Consequently, a healthy newborn does not need additional intake of water, 5% glucose, and even more so milk formulas. This will only interfere with the establishment of lactation.

In some countries, it is forbidden to give information to a woman about artificial feeding during the first three months after childbirth; advertising of milk mixtures in hospitals is prohibited.

3. Rare attachment of the child 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, after 2-2.5 hours, without a night 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 the strict regulation of breastfeeding and a purely technical approach to the control of the lactation process. It is impossible to attach too much importance to the amount of sucked milk, especially with a single control feeding, since children during the day can suck out different amounts of milk at different hours. In addition, the composition of women's milk is extremely variable (for example, the protein content in the milk of different women ranges from 0.9 to 2.0 g per 100 ml). However, the composition of the tissues of the child 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.

As a rule, the mother produces as much milk in the mammary glands as the child 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 after feeding milk remains in the mammary glands, it is necessary to express it while it flows in a stream (and not drops).

The breast is 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 definitely sleep during the day.

5. Other reasons - a violation of the diet, diseases, the age of a nursing woman - play an insignificant role in the development of hypogalactia.

The nutrition of a nursing mother has a greater effect on the qualitative composition of milk, although it must be remembered that the mammary gland, being a powerful barrier, usually lets through as many macro- and microelements as the child needs. Therefore, the mother is not shown an excessive passion for vitamins, microelements, minerals. The volume of milk is even less dependent on the nutrition of the mother. For example, in African countries, where people are dying of hunger, many women breastfeed up to 2-3 years to save the child.

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

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

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

1) transfer the child to more frequent feeding;

2) adjust the daily routine and nutrition of a nursing woman.

You can assign the mother nicotinic acid, vitamin E, UVI, UHF, ultrasound, vibration massage, acupuncture, compresses of terry cloth moistened with hot water on the mammary glands. Phytotherapy is used:

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

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

Use infusions of dandelion roots, oregano, dill, anise. However, it must be remembered that, firstly, the use of medications gives a much lesser effect than the methods of physiological stimulation of lactation, and secondly, the above measures will help only if the woman is aware of the importance of natural feeding, is set to breastfeeding. We can say that "a woman's milk goes through her head."

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

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

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

Daily need for kilocalories per 1 kg of body weight:

I quarter of the year - 120-125;

III - 115-110;

Knowing the age and body weight, you can calculate the amount of milk that the 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 \u003d 500 x 1000 / 700 \u003d 710 ml.

You can also use a less accurate, but simpler method of calculating by volume from body weight. In accordance with this, a child aged 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 needs l / s of 4 kg, which is 800 ml per day, i.e. there is no complete coincidence with the calorie calculation.

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. It should be borne in mind the individual need of the child for the amount of milk.

The feeding regimen is set depending on the age of the child and the amount of milk the mother has, while 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, that is, every 3 hours with a 6-hour night break. If the child can withstand a longer period of time between feedings, he is transferred to 6 meals 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.

In case of anxiety between feedings, the child is given water without sugar or slightly sweetened, with a few drops of lemon juice. Some children refuse water, as they completely satisfy the need for it with milk.

Lure. Breast milk can fully meet the needs of the baby'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 up to 6 months of age. In our country, given the socio-economic conditions, the previous recommendations are still being maintained. 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 enter other juices (carrot, pomegranate, cabbage, blackcurrant, etc.). Lemon juice can also be given from the second month of life, but in a smaller volume - in the first half of the year about 5 ml, in the second 10 ml per day. From citrus fruits, grapefruit juice can be prescribed even to children with an allergic mood.

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

However, in most cases, even if a deficiency of micronutrients is formed, it is better to fill it not with the early prescription of juices and fruit purees, but with vitamins S in combination with trace elements and minerals specially designed for infants.

Complementary foods - the introduction of new foods, 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, secretion of gastric juice and pancreatic juice increases. Previously, complementary foods in the form of 5% semolina were introduced at 5-5.5 months. Starting from the 60s, everywhere the first complementary foods are prescribed at 4-5 months in the form of vegetable puree in order to cover, first of all, the deficiency of bioelements. To prepare mashed potatoes, you need to use a variety of vegetables (carrots, beets, turnips, green peas, cabbage, later, from 6 months, potatoes). Only with a wide range of vegetables does a child receive a set of microelements, mineral salts and vitamins necessary for a growing organism. It is better to cook vegetables in a pressure cooker, as it saves time and reduces nutrient loss. Then boiled vegetables are rubbed through a sieve, divided in half. One half is placed in a glass jar, closed tightly with a plastic lid and put 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, vegetable purees of industrial production of domestic or foreign production, especially for infants, are widely used. Their advantage is homogenization, greater variety, long shelf life, ensuring the needs of children in a wide range of different products throughout the year, regardless of the season, speed of preparation.

Often, allergic children tolerate them better than home-made vegetable puree, which, unlike industrial ones, has too much sodium.

These recommendations for the appointment of juices, fruit and vegetable purees with sufficient lactation in the mother, her good nutrition, unstable stool of the child, with an allergic mood should not be overly 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 food is introduced in the form of 7%, and later 10% semolina, first on vegetable broth or 50% milk. After 2 weeks, you can cook porridge with whole milk. Given that the child managed to get used to thick food, getting vegetable puree, you can start right away with 10% porridge. Semolina is alternated with buckwheat, oatmeal, rice. Previously, rice, buckwheat, “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, buckwheat.

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

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

You don't need to add salt to your baby'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 dish 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 acidity and proteolytic activity of gastric juice, which contributes to the tension of the secretory process of the gastric glands. Its earlier appointment 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 by complementary foods. Approximate menu for a child 6.5 months: 6 hours - breast milk; 10 hours - 10% porridge (150 ml), yolk 1/2, juice 50 ml; 2 p.m. - breast milk; 18 hours - 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 is high in unsaturated fatty acids, which is why some authors believe that fish is preferable for children. Sometimes low-fat broth is prescribed 2-3 times a week, no more than 50 ml. But at present, many nutritionists recommend refraining from prescribing meat broth in the first year of life, especially in children with constitutional anomalies.

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

Approximate menu for a child of 8.5 months: 6 hours - breast milk; 10 hours - porridge (150 ml), yolk?, grated fruit or juice (50 g); 2 pm - 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 from 10 months is replaced with meatballs, from 12 months - steam cutlets. At the same time, they give bread and apple slices. The baby is usually 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 the evening feeding.

Thus, by the end of the first year of life, the child is transferred to food from the general table, but mechanically and chemically sparing. It should be balanced in terms of the main ingredients, should provide an intensive metabolism of the child. Systematic weaning gradually leads to the extinction of lactation, but sometimes a pressure bandage is required on the chest. It is not recommended to stop breastfeeding in the hot season, in case of an acute illness of the child, during preventive vaccinations in order to avoid indigestion.

Currently, one serious mistake in breastfeeding is extremely common. Often the mother complains that the child of the first two months of life has an unstable, sometimes rapid stool, periodically mixed with greenery, mucus, almost constant flatulence, intestinal colic, although the child remains calm, sucks well, and gains weight. In such a situation, often after preliminary sowing of the child's feces and mother's milk, a diagnosis of staphylococcal enterocolitis is made, although it is possible that it enters the milk during decantation, especially since, as a rule, epidermal staphylococcus is sown from milk. The presence of staphylococcus in the feces of a child is also far from always explained by enterocolitis. Unstable stool in children of the first 2 months of life is usually associated with lactase deficiency, which may be primary (hereditary), but in the vast majority of cases it is transient in nature and occurs in premature babies, with intrauterine malnutrition, with various inflammatory diseases, with perinatal lesions of the central nervous system, antibiotic therapy, dysbacteriosis. There may also be a relative lactase deficiency associated with a high concentration of lactose in breast milk or varying degrees of maturity of the gastrointestinal tract, even in healthy children. In such cases, it helps to transfer the mother to a dairy-free diet for 3-4 weeks, which often improves lactation. A good effect is exerted by 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 -0.2 g / kg of body weight per day in 4-5 doses with food for 7-30 days. However, if the child feels 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 in 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 admit the possibility of feeding in the initial stage of mastitis not only from healthy, but also from diseased breasts. Breastfeeding is definitely prohibited when pus appears in the milk.

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