Lecture number 3.

May be difficulty in natural feeding from mother and child. There are absolute and relative contraindications to natural feeding.

From the mother

1. Maudropathy of medium and severe
2. Operational delivery
3. Big blood loss in childbirth
4. Crotch
5. Purve and inflammatory diseases of the mother
6. Rezew conflict
7. Some Extgazenital Diseases of Mother (Hypertensive Disease2st., Sugar Diabetes, Heavy Anemia, Cardiovascular System and Kidney Diseases with Decompensation).

From the child:

1. Apprage score less than 7 points
2. Asphyxia
3. Birth injury
4. Hemolytic disease Newborn
5. Development defects
6. Prematurity with the lack of swallowing and sucking reflexes
7. Respiratory Distress Syndrome

Complications arising when feeding:

1. Development of lactostasis:

a) Primary inflammatory lactostasis - 2-4 days after delivery, in the diet of women should limit the use of liquid (especially warm), as much as possible to apply the child to the chest. If the tide of milk occurs at night, and the child does not wake up - stirring the breast milk. With pronounced lactostasis, it is recommended once - a sinestrol of 300,000 units, a means that reduces the viscosity of milk (25% solution of Magnesia sulfate 30 ml 2 times a day, a hypothiazide of 0.1 once a day), a means of increasing the evacuation capacity of a woman's milk ( Oxytocin 5 drops in the nose, prozero 1 tablet 10 minutes before feeding).

b) Secondary inflammatory lactostasis - breast pain + temperature rise to 38 and higher, chills - the treatment above is carried out 2-3 days with anti-inflammatory therapy.

Absolute contraindications from the child

1. birth injury
2. GBN in the first ten days
3. deep prematurity

Children in these cases are fed by writing milk, with GBN - donor milk.

Absolute contraindications from the mother:

1. Malignant tumors
2. acute mental illness
3. Heavy forms of blood and hematopoietic disease
4. pronounced form of the base disease
5. Pronounced forms of kidney disease
6. Pronounced forms of diseases of the CSS with decompensation

With pneumonia, influenza, angina, the question of breast feeding is solved depending on the state of the mother: in severe cases - temporarily stopped feeding, in the lungs - feed with boiled recreational milk. With the active form of tuberculosis, a child from the moment of birth is separated from the mother and is removed from the house for 1.5-2.0 months (in the department of the pathology of newborns), in order for immunity after vaccination.

Relative Contraindications from Mother:

1. Nipples of irregular shape (small, drawn). The child must adapt to the nipples. In pronounced cases, it is temporarily to feed through special glass nozzles.
2. Mastitis is a serious obstacle: the question of applying the child to the chest decides the pediatrician and an obstetrician-gynecologist. Given that on the one hand, a good suction of the mammary glands will lead to the reverse development of inflammatory changes, on the other, it is possible to make a newborn septic infection. Therefore, breastfeeding with purulent mastitis is contraindicated, renewed after a strictly individual solution.
3. Frequent cause - cracks and scales of nipples. To prevent cracks, oil linings with vitamin A, sea buckthorn oil, rosehip, calendula butter are used. Before feeding them wash them. During cracks, preparations are used:

a) Galascorbin - 2 teaspoons + 100 ml of distilled water with a napkin process 3-4 times a day.

b) 5% syntomicin ointment - 1-2 times a day on affected areas before feeding wash off

c) Eucalyptus leaves are poured cold, then boiled 15 minutes, insist for 2 hours, processed before feeding

d) chlorophilipet solution 2% - treated after feeding.

Relative obstacles from the child:

1. Clear lips and solid sky - can be adjusted to sucking. In severe cases - feed from a spoon or through a probe
2. Thrush - temporary difficulty requiring treatment
3. Short bridle language - does not complicate sucking
4. The intolerance to the female milk - rarely (enzymopathy) - the child is translated into therapeutic mixtures.

Hypolate is the reason for the transfer of children to mixed and artificial feeding in 80-90%.

1. Purpose - a condition in which, a sharp failure of milk in the mother is noted from the first days in 3-8% - is associated with diseases of the WHR and violation of the hormone levels in the body of a woman.

2. Secretary - more often the cause becomes mastitis, the cracks of the nipples, the sharp diseases of the mother. The leading place is a psychological factor - the lack of solid mood on the need for breastfeeding, mental illness and injury. Violation of the rhythm of feeding is a violation of the milk formation function - sucking activity decreases. Slug-sucking - a graduate irritation of the mammary glands - the decrease in lactation. The secondary hypolactation leads: complications of pregnancy, generic, postpartum period, inertial lifestyle, failure of nutrition, overwork, diseases of the SCC, respiratory organs, kidneys, etc., later applying a child to the chest, a long break between feedings.

The variability of the suction amount of milk may be greater, so it is necessary to care to diagnose hypolactation. Confirmed by the dioxide, the dynamics of the increase in body weight is carried out test feeding during several days.

4 Milk deficiency degrees:

To preserve the long-term lactation and hypolactation prevention, it is necessary:

1. Calm at home
2. Solid confidence in the need for breastfeeding
3. Additional sleep and rest
4. Proper, balanced nutrition with the use of special products (Femilak-2)
5. Frequent baby applying to chest (on demand)

To eliminate primary hypolactation, medical hormonal drugs are used, lactogen hormones (Lakin - 6 units * 3 times a day * 6 weeks, mammophysine - 0.5 ml * 3 times a day before feeding).

Reveal the causes of hypolactation and eliminate them.

In the treatment of secondary hypolactation besides establishing reasons

metabolic complexes (biogenic stimulants, vitamins, trace elements) are applied to 7 - 10 days and repeated as needed

Complex number 1.

Apilak in tablets 0.01 3 times a day under full resorption

Polyvitamins - Gendevit (up to 30 years), Undevit (over 30 to 1 dragey 2 times a day after meal. Additionally, vitamin E in dragee (with a mass of up to 60 kg. - 0.1, more than 60 kg. - 0.2 )

Glutamic acid is 1.0 3 times a day 20 minutes after eating, drinking, sweet tea.

Nicotinic acid of 50 mg. 4 times a day 20 minutes before feeding.

Complex number 2.

Beer yeast 60 gr. 3 times a day (dry 1 teaspoon)

Hepetine 1 tablet 4 times a day

Calcium Pantothenate 1 tablet 3 times a day

Lipoic acid 1.0 3 times a day

Asparks 1 tablet 3 times a day

Drinks: carrot juice, carrots, marching with milk, infusion of pepper, walnuts

Then - doctors (no later than 7 days). With hypolactation 3-4 degrees - treatment and at the same time doctors - mixed feeding

In case of insufficiency, breast milk is transferred to mixed or artificial feeding.

Mixed feeding - a child along with female milk receives discomfort in the form of milk animals or mixtures made from it and the number of detectors of more than 1/5 food

Artificial feeding - breast milk is completely absent or is less than 1/5 from the daily volume of food.

Artificial feeding in 1 year - metabolic stress. There is a relationship between artificial feeding and increased risk of development of obesity, diabetes, cardiovascular diseases, etc.

Breasts feed on breast milk More than 4 weeks, the rest receive mixed or artificial feeding.

Causes of reducing natural feeding:

1. hypologist
2. mother's employment
3. reluctance to breastfeed, due to increased opportunities to feed various mixtures

In the absence of maternal and donor milk, feed animal milk.

The composition of cow's milk:

3 times more proteins and salts, but less carbohydrates. Increased protein content is not a positive factor, because The protein is alien, coarse, difficult to digest.

Most disadvantages:

1. In its composition of a full protein 3 times mesh than in female milk
2. In cow's milk less albumin excess proteins turns into ballast protein as a result of the difficulty of assimilation that creates voltage in the process
3. Not identical to the content of proteins and carbohydrates in the cow's milk
4. Fats when splitting give lower fatty acids
5. Carbohydrates have a greater body to fermentation, because contain a-lactose
6. Vitamins in cow's milk are significantly less (from 5 times, and 9 times), the vitamins of group B are well represented, which in the process of cooking mixtures decrease sharply
7. Significantly less enzymes
8. Does not contain antibodies - no lactation immunity
9. Negative moment contamination. For artificial feeding, guaranteed milk (child) is necessary.

Requirements for warranty milk

Carbohydrates at least 4.5 g / l

Acidity no more than 20

Give at least 85 g / l dry residue

The total number of bacteria is not more than 50 thousand in 1 ml, there should be no pathogenic and grinding microorganisms

To avoid the reproduction of microbes, milk must be stored in the cold. Use after pasteurization or boiling. Under the influence high temperatures - Denaratus of milk, deemulgization of fats, coagulation of proteins, the destruction of vitamins, so we pasterate no more than 5 minutes.

In a 3 week-old child, ionic milk is used as a dexterity (one-piece milk is passed through a special hardware containing ion exchange resins), during this process, indispensable amino acids and carbohydrates are introduced.

The ionic milk proteins are in small flakes - the absorption increases, approximately 20% calcium is deposited - bufferiness decreases and the absorption is improved. After passing, vitamins of group V.

In children on artificial feeding - the difficulty of learning cow's milk and the high frequency of digestive disorders. To facilitate assimilation - a number of mixtures.

Groups of mixtures:

1. Non-adapted mixtures - prepared from cow milk by breeding, they differ significantly in quality from female milk
2. The adapted mixtures are in them the protein of cow milk undergoes pretreatment, vegetable fats are added with polyunsaturated fatty acids and taurine, carnitine, vitamins, mineral salts (iron, etc.). They are approximately close to female milk, but have biological differences. The Bav (hormones, enzymes) in women's milk (hormones) ensure the correct development and formation of a children's body, antibodies and immune complexes protect the child from diseases.

With the first drops of colostrum, the child gets natural immunization.

Breast-feedingExecuted for a long time, reliably protects the child from early sensitization, reducing the risk of developing allergic diseases.

Allocate 2 groups:

Sweet mixes

Equal milk mixtures

It matters regarding metabolism and the state of local immunity in the intestine.

1. ADAPED MIXES - Simple dairy mixes - breeding cow milk 5% decoction of various croup (buckwheat, oatmeal, rice), in relations

1: 2 - Mixture No. 1 (43 kcal)

1: 1 - mixture number 2 (b-mixture 54 kcal)

2: 1 - mix №3 (in-mix)

They are defective. The unsatisfactory mixture No. 1 (not applied), the mixture No. 2 - on a short time transition mixture. Of all the most acceptable mixture No. 3: in 100 ml of proteins of 1.9, fats - 2.3, carbohydrates - 7.58, calorie 59 kcal.

The industry produces mixtures:

They are not full. There are many carbohydrates and calcium, little iron and vitamins, a reduced amount of fat (polyunsaturated fatty acids), a shortage of amino acids - Liz, Lei, three, the shaft is unbalanced. The assimilation of simple mixes goes with a large digestion voltage.

Milk bufferiness reduces acidification method: kefir - acidification by biological means - the effect of bacteria of the milk-sour ferment.

Kefir - stimulates the secretion of digestive juices, enhances the selection of bile, slowly and evenly leaves the stomach - favorable conditions for digestion are created. Milk acid kefir hydrolyzes fats and provides gentle proteins. Kefir suppresses growth in the intestines of pathogenic microflora.

In the first 8 months of life, the breeding of kefir - b - and in-kefir (breeding 5% decoction of croup). Sugar is added 5%, acidify the sourdough. B-kefir as a transition mixture (1-3d). In kefir - in the absence of adapted mixtures and certain diseases up to 8 months. It is possible to feed a solid kefir from 8 months of age. When using a kefir up to 8 months in the intestines, submembricted diapelline hemorrhages appear, which play a certain role in the development of anemia.

3 Day kefir is used with lactase insufficiency. The content of lactase is minor, used with light forms of food allergies. Protein fractions have less antigenicity compared to cow's milk.

Equal milk mixtures "Bioolat" and "Bioolat 2" use cow's milk, which is fed by specially selected bacteria. Bioolat has high proteolytic properties, contains a number of major amino acids, vitamins (B12) and the necessary enzymes. Proteins are easily cleaved and digested. When using "bioolk", hemopoies is activated. "Bioolat 2" is enriched with trace elements and vitamins. Apply in children early age and newborns throughout the year.

Despite a number of positive properties of fermented milk mixtures, they differ from female milk and are not considered substitutes.

Dry mixes approximate in composition to breast milk - adapted milk mixtures (female milk substitutes). Although it has been proven that no technological line is capable of creating a similarity of female milk, there is a significant similarity of dry mixtures.

Distinguish 4 types of female milk substitutes:

1. Initial mixtures are used during the first two months of life. They are approaching the composition of breast milk and adapted to the peculiarities of digestive and metabolism of children of the first year of life. Contain taurine, carnitine, which are not part of the cow's milk, but are present in female milk.
2. Subsequent mixes are designed for further feeding (after 2 months). Must be enriched with iron because By 3 months of life, iron reserves are depleted - the risk of developing iron deficiency state.
3. Partially adapted mixtures
4. Subsequent formulas - milk mixtures for feeding from 5-6 month old age

(Look mixes in Appendix Table 1)

When transferring a child to mixed and artificial nutrition

1. The doctor must take into account the physiological features, the ability to adapt and

needs in the main ingredients. Adapted milk mixtures should be preferred.

2. It is necessary to determine the amounts of mother's milk and the volume of detectoration

3. Question it follows after each feeding

4. Start discomfort from small portions - increase the volume to the necessary one.

With mixed feeding, the power mode is free (on demand when monitoring the amount of milk). If the volume of the doctor is small - it is given from a spoon, because More easily influence through the pacifier leads to breast failure. With a large volume of detect, a bottle with a nipple with a fine hole is used.

The translation of the child on artificial feeding in the 1st months should not be fast, because His adaptation flows intensely because of physiological immaturity.

With artificial feeding of children of children, 1x months of life recommended 7- meals a day (after 3.5 hours) before the administration of adhesiveness - 5 per hour.

Taking into account individual characteristics, the number of feedings change: if the child does not eat the proposed volume - the frequent feeding is required by small portions.

Dates of the introduction of food additives: with mixed and artificial feeding:

Fruit juices - from 4 months.

Fruit puree - 4.5 months.

Cottage cheese - from 6 months

Yolk - from 7 months.

Meat dishes - from 7 months.

Fish - from 8-9 months, replaces I - 2 feedings.

1st lore - from 5 months - vegetable puree. If it does not pick up a mass - 1m feeding may be porridge.

2y after 1 month after 1go (from 6 months)

3rd - from 8 months.

Whole milk in children 1 year of life is desirable not to use.

With mixed and artificial feeding, the daily need for proteins depends on the type of dairy products.

When feeding adapted mixtures: (before the administration of adhesive)

Proteins - 3g / kg mixed; 3.5 g / kg artificial.

When feeding with non-adapted mixtures: (before the administration of ads

Proteins - 3.5G / kg mixed; 4.0 g / kg artificial

In fats and carbohydrates the need is the same

In mixed nutrition, caloric content increases by 5%, with an artificial by 10%. With a large body of children, feed volume is calculated based on the average number of proteins and carbohydrates. Daily food, maybe below the norm. At the age of 1.5-2.0 months, it is possible to give 1/6 mass of the body and if the dynamics corresponds to age, then the need to increase the content of food substances. In case of insufficient and excess increases, nutrition is carried out.

Power premature.

individually and depends on the degree of presence, body weight is the presence or absence of swallowing and sucking reflexes. Regardless of the selected method, the first feeding feeding starts after 2 - 3 hours after birth, but no later than 6 - 8 hours.

Children with weight 2000gr. And more, which are in a relatively satisfactory condition, M.B.

applied to the chest as a docking (after 20-30 minutes). They are followed by the appearance of the child's fatigue - cyanosis of the nasolanogogo triangle, shortness of breath. With these symptoms, the number of feedings are limited.

Children weighing 1500-2000 gr. In the absence of severe pathology, test feeding from the bottle.

Deep premature babies weighing 1000-1500 g. Feed through the probe (in the absence of swallowing and sucking reflexes).

In the absence of opportunity to conduct enteral nutrition - parenteral nutrition. Full parenteral nutrition - with a very serious condition of the child, ulcerative-necrotic enterocolitis, some anomalies for the development of the gastrointestinal tract, in up and postoperative period. When conducting parenteral nutrition, daily monitoring of the blood of blood, the level of the main elements, glucose, urea, diurea measurement.

At the first opportunity (when stabilizing the state), it is necessary to introduce a minimum volume of enteric power. As a result of the introduction of a small amount of milk (4-8 ml), the emission of intestinal hormones is stimulated, its motorboat is improved, the intestinal wall does not suffer, which contributes to the normal development and the full functioning of the gastrointestinal tract.

If an unripe child moves well to breastfeeding or sucks the rate of the bottle, 7-8 one-time power mode is installed for it after 2.5 - 3.0 hours with 4 hour night interruption

If necessary (weight of less than 1500 grams. And the pronounced symptoms of the oppression of the central nervous system) prematurely feed the portion through the nasogastric probe (7-10 times a day). Children with underdeveloped swallowing and sucking and sucking are fed through the probe, which is administered to a distance equal to the distance from the nose to the sword-shaped process for 2 days, removed, sterilize and administered through the other half of the nose. When the sucking reflex appears, feed from a bottle with a nipple.

With parenteral nutrition, the constant catheter in Vienna and fluid is introduced.

The composition of infusion solutions:

glucose, electrolytes, protein hydrolyzate, vitamins, fat emulsion.

Energy coefficient 720-800 kcal in 1 liquid liter. The solution is administered at the rate of 100-150 ml / kg of body weight / day - gradually go to feeding through the probe - from the bottle - to the chest.

Power volumes

1. the first 8 days of life according to the Rommel formula: the volume of milk \u003d 10 + n (day of life) is the amount of milk at 100 gr. Body masses
2. more than 10 days in a three-scale weight

? - 10-14 days 1/7

? - 2-3 weeks 1/6

By 1 month 1/5

1. Caloric method for premature

7 days - 70 kcal

10 days 100 kcal

20 days 120 kcal

Features of metabolism

1. High calorie need aged first 6 months. - 120 masses of the body from 7 to 12 months. - 115 kcal / kg body weight

2. Available need for vitamins, microelements

3. Positive azoty balance

4. Available need for water

1 year year of life - 150 - 120 ml / kg

From 1 to 3 years - 120 - 100 ml / kg

From 4 to 6 years - 100 - 80 ml / kg

From 7 to 12 years old - 80 - 60 ml / kg

From 13 to 15 years -50-40 ml / kg

Breast milk:

B - 50%-albumin All indispensable amino acids, JG, finely dispersed, easily absorbed f / PNGC 9-12% a lot of FLs Little fatty volatile sour (in-oxymalasal and dr.), More lipase activity, a significant amount in the emulsified state in - in -Lactose and oligaminosahara - bifidogenic factors, 28 microelements, 19 enzymes, vitamins, hormones, antibodies, lysozyme, coagulation factors; naturalness, sterility; bio, communication; Risk of SD, Atherosclerosis, Leukoza, XP. diseases of digestive organs, allergic diseases.

In the first 7-8 days of life, the daily volume of milk for a child can be calculated according to the formula of Finkelstein, V \u003d 70 (80) * n where V is a daily, food volume, P - the number of days of life, 70 and 80 - empirical numbers; The figure 70 is taken if the mass of the child's body at birth is less than 3200 g, the number 80 is a body weight of 3200 g and more.

according to the formula G.I. Zaitseva V (2% of the body weight of the child) * n, where n is the number of days of life. To calculate the daily nutrition, a child over 8 days use:

Volume-weight method

from 9-10 days to 2 months. - 1/5 body weight;

from 2 to 4 months, - 1/6 body weight;

from 4 to 6 months, - 1/7 body weight;

from 6 to 9 months. - 1/8 body weight;

by the end of the first year - 1 / 8-1 / 9 mass body,

The amount of milk per feeding is calculated by dividing the daily volume by the number of feedings.

Colorian way

per 1 kg of body weight The child on natural feeding should receive up to 3 months - 120 kcal / day;

from 4 to 6 months. - 120 kcal / day;

from 7 to 12 months. - 115 kcal / day;

(Knowing the body weight and age of the child, it is easy to calculate the required amount of milk, based on the fact that in 100 ml of female milk contains 75 kcal) kcal + 5% with mixed (125-120 kcal), + 10% with artificial feeding (130- 125 kcal)

According to the needs of the child in food ingredients (the most accurate)

The need for protein is:

at the age of 3 months. - 2.2-2.5 g / kg

at the age of 4-6 months. - 3 g / kg

at the age of 7-12 months. - 3.5 g / kg

The need for fat:

at the age of 3 months. - 6.5 mg / kg,

at the age of 4-6 months. -6 g / kg;

at the age of 7-12 months. -5.5 g / kg.

The need for carbohydrates throughout the first year of life is 13 g / kg.

The need for proteins depends on the type of feeding, and in fats and carbohydrates remain the same with all types of feeding.

Mixed feeding: before the introduction of the attachment of 3.0 gr. Protein with adapted mixtures 3.5 gr. with non-adapted mixtures; After the introduction of the supplies of 3.5 gr.

Artificial feeding: before the introduction of the attachment of 3.5 gr. protein with adapted mixtures; 4.0 gr. Pries of non-adapted mixtures; After the administration of the attachment of 4.0 grams.

Feeding mode. First feeding in the first 20-30 minutes after birth. Feeding at the request3-4 week. 6 One-time after 3.5 hours - before the introduction of the feeding. 5 One-time feeding after 4 hours after the administration of the feeding.

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Nutritional supplements

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Breast milk is perfect nutrition for newborn children. All expert groups agreed that before six months old, the baby does not need any nutrition other than maternal milk and before a year old, it should be in the diet at mandatory.

Breast milk contributes not only to the development, but also adequate intestinal work and other organs and systems of a small organism.

Unfortunately, according to optimistic calculations, only 70% of mothers support breastfeeding within 3 months from birth, this figure is reduced to 30% to six months.

When to start breastfeeding

For the first time, the baby is applied to the chest several hours after delivery. Usually by this time the baby already demonstrates the desire to eat, but if this does not happen, it should be attached to the chest.

Young mothers are concerned that immediately after childbirth they have little milk, and this will not be enough newborne. It should be known that the first portions of milk are so-called. rich in nutrients, which is more than enough to a child in his first hours of life. Children are born with an excess of liquid and glucose in the body, and at first do not need large amounts of nutrition, and attaching a newborn to the chest is the best stimulator of milk production (lactation), and in two three days the amount of milk will increase significantly.

In some cases, according to medical reasons, mom and child can be divided, in this case, milk can be sent to feed the child when it takes.

Breastfeeding

There is no single (best) pose for breastfeeding. Two main conditions:

• Convenience for mom
• Convenience for kid

The basis of successful and comfortable feeding is the correct grip of the mother's nipple. The correct grip includes the capture of both the nipple and most of the halo, which creates a tightness, allows the baby to suck and swallow milk.

The correct grip allows you to avoid the appearance of cracks and soreness of the nipples.

Here are examples of some positions that allow the right seizure of the nipple

Frequency and breastfeeding

Feed children should be on demand. As noted above, after a few hours after birth, the child may require feeding. Signs of novice hunger are:

• Awakening
• Breast search
• Sucking hands (lips, language)

With a pronounced feeling of hunger, a child can cry, do not bring it to hunger.

On average, the newborn requires 8-12 feedings per day, but the variation is wide enough. Some babies require feeding every 30-60 minutes, others may not eat for hours. The unanimous opinion of experts - should not allow breaks in feeding for more than four hours, even if the child sleeps.

The duration of one feeding also varies the duration of one, someone is 5 minutes, and there are few for 20 minutes. You should not limit the feeding time, the child can suck the breast as much as it is comfortable.

It should be noted that children are individual in everything, and if today he asks the chest rarely and sucks little, then tomorrow everything can change, and he will suck often and much. No need to introduce artificial restrictions and invent power modes.

Power adequacy

One of the main sources of concern for young mothers: is a child eats enough enough.

Important: In the first few days after childbirth, children lose weight, even if it feeds enough. This occurs due to the loss of excess fluid, which occurs is born. It is absolutely normal and should not worry.

A child who is on breastfeeding, receives enough nutrients for adequate growth and development. Power failure can be defined simple enough:

• Counting the number of wet diapers or diapers. A few days after birth, the child should wet at least six diapers or diapers. If the number of diapers is smaller, urine color (or rather stains on the diapers from urine) orange (and not pale yellow as normal) then you can assume power failure, and a doctor should be informed about it.
• Weight control: The restoration of the weight lost after childbirth occurs within one or two weeks. If there is a significant lagging in weight, you should inform the doctor about it.

Nipples

Parents often use nipples. It is unacceptable to use nipples for peeling breastfeeding. Do not use nipples until the final child's teaching to the chest.

Baby breastfeeding - additives

Breast milk fully provides a child as nutrients, it fills its energy needs. However, in some cases it is required to enter the diet of vitamins, most often in the form of droplets:

• - Requires a child if a nursing mother is Vegan.
• - Additionally, all children are required
• - Requires children with iron deficiency anemia or multiple risk factors for the development of iron deficiency.

The rational nutrition of children is an important condition that ensures proper physical and mental development, adequate immunological reactivity. The guy of the first year of life is a special need for a full-fledged food diet due to intensive growth, violent psychomotor development and the formation of all organs and systems.

Fitting the first year of life

Depending on whether the child receives maternal milk and in what quantity, there are three types of feeding: natural, artificial and mixed.

Natural feeding

Natural feeding - nutrition of breastfeeds with breast milk, followed by the introduction of dust with 4.5-6 months. The content of breast milk in the daily diet is at least 4/5.

This kind of feeding is the most physiological, since in quantitative and high-quality composition, breast milk optimally covers all the needs of the child in proteins, fats, carbohydrates, vitamins, mineral salts, etc. In the first 5 days after labor from the breast, a prayer is highlighted with a higher energy value than breast milk secreted in the subsequent. In colosure, more proteins, phosphorus, calcium, vitamins A and E, less fats.

The most important advantages of breast milk

According to antigenic properties, breast milk (unlike cow) is less alien for a child. The structure of maternal milk, especially the colostrum, is close to the cells of the cells of the child.

In breast milk, fine proteins (albumin) are dominated, the sizes of casein particles are several times less than in a cow, due to which more delicate, easily digestible flakes are formed in the stomach. The composition of breast milk is most optimally consistent with the needs of the child. The total amount of protein in breast milk is less than in a cow. Therefore, with artificial feeding, protein overload occurs.

Breast milk (especially colostrum) rich Ig. IGA plays an important role in the local immunity of the newborn gastrointestinal. IgG, which fell into the body of the child, provide passive immunity from many infectious diseases. In addition, breast milk contains factors of specific and nonspecific resistance.

Breast milk contains optimal set Enzymes, vitamins and other components needed.

The concentration of fats in breast and cow's milk is almost the same, but high-quality composition is different: breast milk contains several times more polyunsaturated fatty acids serving the necessary components of phospholipids and included in cell membranes. The splitting of fat in the stomach in infants begins under the influence of breast milk lipase.

Breast milk contains a large amount of carbohydrates (β-lactose), the composition of cow's includes α-lactose. β-lactose is slower absorbed in the intestine of the child, so the colon reaches the colon, where, together with oligoaminosaharids, it stimulates the growth of normal flora (mainly bifidobacteria), overwhelming the reproduction of pathogenic microorganisms and intestinal sticks.

Breast milk is rich in various enzymes: amylase, trypsin, lipase (lipases in breast milk are greater than in a cow, almost 15 times, and amylases are 100 times). This compensates for the temporary low activity of the enzymes of the child and ensures the assimilation of a rather large amount of food.

The concentration of calcium and phosphorus in breast milk is lower than in a cow, but their ratio is most physiologically for big babyThey are absorbed much better. Therefore, children who are on natural feeding are rickets develop less frequently. The content of such elements like sodium, magnesium, chlorine, iron, copper, zinc, cobalt, sulfur and selenium, in breast milk optimally and meets the needs of the child.

With natural feeding, a psychological connection is formed between the mother and the child, parental feelings are developing. Thus, the rejection of natural feeding is rough

a violation of the biological circuit "Pregnant

birth-lactation ". Breast milk - Golden Standard Power Baby.

Hygogalactia

The main reason for the failure of natural feeding - hygogalactium, i.e. Secretor deficiency of dairy glasses. Select primary and secondary hypoglactic.

Primary hypogalactium develops due to neuroendocrine disorders, 5-8% of women are observed.

In the overwhelming majority of cases of hypogalactium, there is a secondary, developed due to the negative impact on the mother of the mother of a complex of biological, medical, social, psychological and economic factors. The leading role belongs to social factors and the reasons of a non-heroic nature.

According to WHO, only 1% of women are not able to feed their children with breasts. In our country, more than 10% of mothers do not feed the child with breasts from birth. By 6 months, less than a third of children remain on natural feed, and about 66% of mothers begin to independently enter the doctors from 2 weeks of the child. The main causes of hypoglactics are as follows.

Insufficient breastfeeding motivation in pregnant woman.

For active propaganda of natural feeding, there is a close cooperation of obstetric and pediatric services. It is necessary to bring up a positive motivation of breastfeeding among pregnant women. Parents need to be aware of the benefits of natural feeding for a child and a favorable effect of him on the health of a woman. You should not forget about the contraceptive effect of breastfeeding, which is associated with the inhibitory effect of prolactin on ovulation. With lactation amenorrhea and exclusively breastfeeding, the risk of becoming pregnant in the first 6 months after childbirth is 2-5%. The contraceptive effect of breastfeeding decreases with a rarerging of the baby's applying to the chest.

Often, women have "lactation crises", their usual frequency is about 1.5 months, duration - 3-4 days (less often 6-8 days). At this time, it is necessary to increase the number of feedings. It is unacceptable to return to the mixtures immediately.

Sometimes, even with sufficient filling of dairy glasses, there may be "hungry" anxiety of a child due to a steady increase in its energy demand due to growth

motor activity. It is most typically in 3, 6 weeks, 3, 7, 11 and 12 months. As a rule, in most cases, the increased sucking activity of the child leads to an increase in the volume of lactation.

Even in hot weather you do not need to steal a child with water - the breast milk consists of 80% of the water and therefore quenching his thirst. If he has a false sense of saturation, he arises, which oppresses a sucking reflex.

Violation of the course of a nursing woman (excessive physical and mental load, insufficient sleep) reduce lactation.

Other reasons (violation of the power mode, various diseases, the age of a nursing woman) play a minor role in the development of hypoglactics.

The nutrition of the nursing mother more affects the qualitative composition of milk than its quantity.

Mother's disease oppress lactation. However, if a woman even during pregnancy was configured to feeding the threshing, the lactation of it is often preserved at a satisfactory level.

In all countries, too young and old mother and older mother are becoming less likely. In the elderly, this is explained by biological reasons, in young - social and psychological (lack of family planning, often random conception, lack of attitude to breastfeeding during pregnancy, etc.).

Correction of hypoglactics. It is necessary to translate the child to more frequent feeding. To stimulate lactation, you can assign mothers specialized products, nicotine acid, vitamin E, UFO, UHF, ultrasound, acupuncture, compresses from a terry fabric, moistened with hot water to the dairy glands. Breast massage is effective before feeding (longitudinal movements from the base of the gland to the nipple). Also used phytotherapy. However, it should be borne in mind that the LANs have a smaller effect than the methods of physiological stimulation of lactation.

Calculation of the required food

Calculation is carried out, as a rule, only with artificial feeding and the introduction of feeding. The easiest way to calculate the daily amount of milk needed by the newborn in the first 9 days of life, the following: His age (in days) is multiplied by 70 (with a body weight of less than 3200 g) or 80 (with a body weight of more than 3200 g). From the 10th to the 14th day, the required daily volume of milk remains unchanged (as for a 9-day child).

From a 2-week age, the required amount of milk is calculated taking into account the daily need for energy (in calories) on a kilogram of body weight or a volumetric method, when the required amount of food is a certain proportion of the body mass of the child.

Caloric (energy) method of calculation: In the 1st and 2nd quarter of the first year of life, the child needs 115 kcal / kg / day, in the 3rd - 110 kcal / kg / day, in the 4th - 100 kcal / kg / SUT. Knowing the age and weight of the body of the child, calculate the amount of milk required by the child per day (x). For example, a child aged 1 months has a body weight of 4 kg and, therefore, needs 460 kcal / day; 1 l breast milk and most mixtures contain about 700 kcal, therefore:

X \u003d (460 x 1000) + 700 \u003d 660 ml

WHO experts believe that in modern recommendations, the energy need of an infant child in energy, possibly overestimated by 15-30%, especially after 3 months of life. According to their data, at the age of 4-10 months, energy consumption per 1 kg of body weight should be 95-100 kcal.

The volumetric method of calculation (Table 3-1) is simpler, but less accurate. For example, a child aged 1 month with a mass of body 4 kg, it is necessary 600 ml of breast milk per day (1/5 of 4 kg), i.e. There is no complete coincidence with the calculation of calorie. All calculation options can only approximately determine the required amount of nutrition. The daily volume of food children of the first year of life should not exceed 1000-1100 ml (no juices and fruit puree take into account).

Qualitative composition of food

The ratio between the main food ingredients (proteins, fats, carbohydrates) before the administration of the attachment should be 1: 3: 6, after the administration of the feed is 1: 2: 4. Up to 4-6 months, the need for proteins is 2-2.5 g / kg, fats - 6.5 g / kg, carbohydrates - 13 g / kg, and after administration of dust, respectively, 3-3.5 g / kg, 6- 6.5 g / kg and 13 g / kg.

Diet

The power mode is set depending on the age of the child, its individual characteristics and the number of milk in the mother. In the first 3-4 months of life of healthy docking children are fed 7 times a day, i.e. Every 3 hours with a 6-hour night break (this rule concerns predominantly children on artificial feeding). If a child withstands longer breaks between feeding, it is transferred to 6-time and 5-time feeding. With 4.5-5 months, most children are fed 5 times a day, post 9 months - 4-5 times a day.

Lure

By 4-6 months of life, feeding only breast milk can no longer satisfy the needs of the body of the child in nutrients, so from that age they begin to introduce lures (Table 3-2).

Table 3-2.Deadlines for administration and types of supplies

Dust - introduction of new food, more concentrated, gradually and consistently replacing one breastfeeding. Support is necessary:

To cover the emerging to this age due to the rapid growth of the deficit of energy, proteins, fats, micronutrients;

For the introduction of vegetable protein, fatty acids, vegetable oils, various carbohydrates, which are small in dairy products;

For receiving more dense food necessary for the further development of the child's gastrointestinal tract.

Differs include juices, fruit and vegetable mashed potatoes, porridge, cottage cheese, yolk, meat puree, masonous canned food, ke-, cow's milk.

The main rule is dust - use industrial manufacturing dishes. They guarantee quality and safety for an infant child in an unfavorable environmental situation. Their dignity is homogenization (preparation under pressure of 200 atm), which allows grinding food fibers and significantly

to increase the surface of the contact of the food particles with enzymes and thereby accelerate the digestion of foodstuffs, long shelf life, ensuring the needs of children in a wide range of various products throughout the year, regardless of the season, the speed of preparation, and, most importantly, they are enriched by all necessary for the rapidly growing Baby body micronutrients. As a rule, children with an allergic configuration transfer them better than homemade products.

In our country, they traditionally recommend starting adopting with apple juice after 3 months. The remaining juices are introduced later, not earlier than 4-6 months (the daily volume of juice is the age in the month multiplied by 10). Recommendations for the appointment of juices and fruit purees with sufficient lactation in the mother, its full nutrition (first of all we are talking about receiving the vitamin and mineral complex), the unstable chair of the child, its allergic mood should not be unnecessary categorical. Juices primarily in this age It should be considered not as a supplier of nutrients, but as a stimulator of activity of the gastrointestinal tract. It is quite acceptable to their later introduction. At the beginning of the introduction of dust breast milk remains the main source of not only energy, food substances, but also liquids. During this period, no other liquids are needed. In some countries, pediatricians recommend entering juices at a time when the child begins to receive meat (not earlier than 6 months). If the mother prepares juices alone, it is better to breed them with water in a 1: 1 ratio. But homemade juices cover only a few percent of the need for a child in vitamins.

Fruit puree is prescribed after 2-3 weeks after the introduction of juices (the same as for juices). Juices and fruit puree are given directly before or after feeding, sometimes in the intervals between them.

With 4.5-6 months, vegetable puree or porridge are introduced. Usually begin with a vegetable puree. To reduce the risk of allergyization, at the beginning of the child give mashed potatoes made from one type of vegetables (zucchini, pumpkin, colored cabbage, broccoli, carrots, later - potatoes, spinach, green beans, coarse, green peas), with a gradual transition to a mixture of vegetables. The daily volume is 100 g. With a tendency to constipate, overweight, it is possible to increase the daily dose of vegetable puree to 200 g (one or two receptions). Vegetable grinding puree, depending on the degree of grinding, there are 1st steps - homogenized (for children up to 5 months); 2nd steps - in the form of a puree (for children 6-

9 months); 3rd steps - large-nosed (for children 9-12 months). After 3-4 weeks, a milk porridge is prescribed - buckwheat, curl, rice based on dairy adapted mixtures. For breeding of the scenery caster, it is better to use breast milk or an adapted mixture, and not a solid cow's milk. The daily volume of porridge is approximately 200 g. Such porridges, such as oatmeal, barley, manna, are introduced later, because in these croups contains gluten, which is not always well tolerated by infants. If a child has an insufficient body weight, an unstable chair, a tendency to jerkling, it is better not to start with a vegetable puree, but with dairy pounds.

Cottage cheese is introduced to children from 6-7 months in the amount of 10-50 g. Initially, it is mixed with a small amount of breast milk. It is preferable to use fruit or fruit-vegetable purees with cottage cheese.

Oil (vegetable, creamy, fuel) is added to the dishes of homemade feeding from 5-6 months to 3-6 g per day. The oil is not added to the vegetable puree and industrial cuffs.

Meat is recommended to be administered from 7 months, first in the form of meat austic canned (meat content - approximately 10%); Later you can enter purely canned meat (mashed potatoes on a different basis - 100-200 g per day, pure meat puree - 60-70 g). Meat broths for nutrition of breasts are not used.

Canned fish (with vegetables, porridge) are introduced from 8-9 months 1-2 times a week instead of meat dust.

Children's crackers, galley, cookies enriched with micronutrients, in the menu of the child are introduced from 8 months.

Currently, it is not recommended to use a whole cow / goat milk for nutrition of breasts. Instead, it is advisable to use special baby milk enriched with micronutrients, or partially adapted milk mixtures ("transitional" mixtures), in which the amount of protein is reduced and the composition of fatty acids is optimized.

Natural feeding errors

With natural feeding, the most common errors are most common.

Later first applying to the chest.

Excessive breastfeeding regulation.

Termination of breastfeeding with transient lactase deficiency.

Cessation of breastfeeding due to reception by the mother of any medicines.

Refusal of feeding from a healthy breast when mastitis.

Artificial feeding

Artificially called breastfeeding breastfeeding substitutes for breast milk - special mixtures prepared most often from cow's milk.

Currently, with artificial and mixed feeding, it is recommended to use adapted milk mixtures, as close as possible in composition to breast milk. Pre-treatment of cow's milk for the production of adapted mixtures is aimed primarily to reduce the content of protein in it. In the mixtures compared to untreated cow milk, the number of essential fatty acids, vitamins, trace elements increased. The nutritional value of the adapted mixtures is approaching the female milk, so the rules of feeding them are close to those when breastfeeding (the same calculation on energy value, the same amount of feeding per day, the same deadlines for the administration of luch).

Milk mixtures are divided into "initial" or "starting", intended for feeding children of the first 4-6 months of life and "subsequent" - for children of the 2nd half of the life. There are also mixtures that can be used throughout the 1st year of the child's life.

Medical mixes

IN last years There are mixtures for therapeutic nutrition. Their base can be different - milk, soybean, protein hydrolyzates. They can be divided into preventive, therapeutic and preventive and therapeutic.

Preventive mixtures are used for lightweight forms of food allergies. These include mixtures on goat milk, which

It is similar to a cow, but differs in antigenic structure. In the absence of the effect on goat milk mixtures, adapted fermented milk mixtures, which are recommended to replace no more than 50% of the daily food volume are used. Equal milk mixtures have a smaller allergizing effect (compared to fresh mixtures), in addition, they have an anti-infective effect, normalize intestinal motorcy and a child's chair. Nevertheless, fermented milk gusts are irritated, so in the first days of life, especially in premature, they can cause esophagitis and enhance jerking. If a child with food allergies of 50% of the daily food is replaced with adapted fermented milk mixtures, then the remaining 50% is better to give in the form of physiological freshly milk mixtures. With an insufficient effect of such a type of feeding, a child can be translated temporarily only for fermented milk products. When using fermented milk mixtures, a partial removal of a protein of cow's milk from the diet of the child occurs. However, with a more pronounced food allergy, this is not enough. In these situations, therapeutic and prophylactic mixtures are used. These include silent mixtures based on soy protein (soy mixtures), as well as special products based on the hydrolyzate of milk protein with a low (partial) degree of hydrolysis. Despite the fact that soy mixes are used for more than 60 years and are not registered any adverse effects, it should be borne in mind that soy protein is vegetable. Meanwhile, the share of animal proteins in children of the first year of life should have at least 90% of their total. Currently, soy mixes are prescribed no earlier than 5-6 months. Apparently, with food allergies and the absence of the effect of fermented milk mixtures, it is better to immediately move to mixtures based on protein hydrolyzate with a weak degree of hydrolysis. With the admission of these mixtures, the positive dynamics in the average-haul forms of food allergies occurs in 90% of children after 2-3 weeks from the beginning of their application. Often, it is often recommended to use these mixtures for a long time, at least 3-6, sometimes up to 9 months, nevertheless, taking low content in them a solid animal protein, it is advisable gradually, but as early as possible to switch to fermented, and further and fresh physiological mixtures. Mixtures with partial protein hydrolysis can also be used to prevent food allergies when transferring to mixed or artificial feeding of children from the group high risk With a burdened allergic history.

In severe forms of food allergies and the absence of the effect of the use of the above mixtures, mixtures based on a high degree of hydrolysis (i.e. full splitting) of a protein should be used. The effect of them comes, as a rule, very quickly, as they are practically devoid of allergenic properties. At the same time, there are practically no whole protein in these mixtures, the long absence of which the breast child can lead to the retardation of the development of the nervous system. They have a bitter taste, and some children refuse their reception. In addition, the absence of allergens in mixtures based on a high degree of protein hydrolysis prevents the formation of food tolerance by the child, which does not contribute to the reduction of sensitization and in the future. Finally, they are very expensive. Therefore, after the disappearance of the symptoms of the disease, it is necessary to gradually translate the child to therapeutic and prophylactic, then prophylactic and, finally, physiological mixtures.

Errors in artificial feeding

Too frequent changes in food (replacement of one mixture to another).

Translation of a child to another mixture at the slightest stool.

Appointment of fermented milk mixtures in large quantities, especially prematurely in the first days of life.

Translation into therapeutic (soy, based on protein hydrolyzate) mixtures with minor manifestations of allergies.

Mixed feeding

In case of malfunction of milk, the mother introduces the same milk mixtures as with artificial feeding. At first, the child gives the breast and only after the complete emptying it is quicted with a mixture. In order to preserve the lactation, the child is applied to the chest more often. The alternation of breastfeeding and mixtures is undesirable, as it leads to a decrease in lactation and the difficulty of digesting the products of cow's milk. Improve the discounts are recommended through a nipple with a small hole, since with a free receipt of a doctor from a bottle of a child can refuse the chest. As with artificial feeding, the need of a child in calories, proteins, fats, carbohydrates, the deadlines for the administration of feeding depend on the type of milk mixtures used in the proceed.

Food of children older than a year

In children, after 1 year, the capacity of the stomach increases, all salivary glands are actively functioning, the chewing machine develops.

For 2 years, indigenous teeth appear, which makes it possible to enter the child to the diet food that requires facing. The chewing process is complicated, and not all children immediately get used to solid food with pieces and good chew, especially those who have long received a very liquid food in the first year. In order to accustom a child to the chewing process, it is necessary to gradually and consistently include increasingly thick dishes in its diet. The differentiation of liver and pancreas tissues at an early age is not yet completed, which requires proper selection of products and their appropriate culinary processing. At the age of 1 to 1.5 years, food is prepared in the dirty form, then gradually include dishes with a more thick consistency. Industrial manufacturing dishes are preferable.

The need for proteins changes with age. The number of proteins for children aged 1 to 3 years should be 3.5-4 g / kg / day, from 12 to 15 years - 2-2.5 g / kg / day. Deviations in one or another side are adversely reflected in the state of the child. The lack of proteins in food leads to a delay in physical and mental Development, decrease in immunity, violation of erythropoese. The excess receipt of proteins with food leads to the stress operation of the digestive tract, increases the intensity of the exchange processes, increases the burden on the kidneys.

Children need not only in optimal quantities, but also in the quality utility of proteins, therefore, in balanced foods, it is necessary to use various and vegetable proteins of animal and vegetable origin in the amino acid composition. The number of animal proteins in food in children from 1 to 3 years should be 75%, from 7 years and older - 50%. Meat and meat products that contain full-fledged proteins and fats are basically the same varieties as in infants (pork, poultry meat, rabbit, horse). In the absence of allergic reactions - veal, beef. Children under 3 years old recommend low-fat varieties of fish - Cod, Heck, Sudak, Marine Okun.

Fats cover about 40-50% of the total energy needs, of which at least 10-15% should have to share vegetable fats, since the fats formed in the body of carbohydrates and proteins, as well as an animal fat coming down with food, consist mainly from Saturated fatty acids. Polyunsaturated fatty acids are necessary for the maturation and operation of the central nervous system, enhance immunity.

Carbohydrates perform mainly energy, to a lesser extent plastic functions. They provide about 55% of energy costs.

For baby food, milk and dairy products are indispensable. In the second year of life, instead of whole cow milk, it is advisable to use partly adapted milk mixtures or special baby milk enriched with vitamins and microelements. The required daily amount of dairy products for children is 1-3 years old - 600 ml, at an older age - 500 ml. Milk products with high protein content include cottage cheese and cheese. Children up to 1.5-2 years old cheese is better to give in the progress.

In a set of baby food, it is necessary to include a wide range of cereals (buckwheat, rice, corn, oatmeal, manna). It is advisable to combine buckwheat (nucleus) with milk, since the amino acid composition is optimal.

Adding sugar to many types of food improves its taste. Sugar is a source of carbohydrates. However, excess sugar is harmful to children. Of the sweets, it is better to recommend jam, marmalade, cookies, honey.

Vegetables, fruits, greens are of particular importance in the nutrition of children. Most fruits and vegetables contain little protein and indispensable amino acids, but when they use, other products proteins are much better absorbed. For example, the digestibility of the meat protein, bread, croup without vegetables is 70%, and when using the latter -

85%.

The need for a child in minerals and vitamins is usually satisfied with food, if their range is quite diverse. Vegetarianism, especially strictly, i.e. With the exception of dairy products, the composition of trace elements will noticeably impairs.

Food Mode of Children

Up to 1.5 years, the child eats 4-5 times a day, and after that - 4 times a day. To preserve appetite and better assimilation, it is necessary to observe certain hours of food reception. In the intervals between them, the child should not be picked up, especially sweets. If it cannot wait for the set feeding time, you can give unstellious varieties of fresh fruits and vegetables. Children with reduced appetite for 10-15 minutes before meals you can drink 1/4-1 / 2 cup of simple water room temperature. It has a pronounced sluggone effect.

It is important to correctly distribute the food diet for the energy value, given, on the one hand, the required saturation duration, on the other, the permissible load on the gastrointestinal tract. In each feed

we must include energy-valuable products (egg, cottage cheese, cheese or meat), as well as containing ballast substances from cereals and vegetables (Table 3-3).

In preschool children, breakfast should contain 25% of daily energy value and consist of porridge cooked on milk, eggs or cheese, bread with oil, tea or coffee with milk. Such breakfast provides the necessary duration of saturation, relatively light assimilation and appetite for the time of the next eating. For lunch accounts for 35% of the daily energy needs. Recommend soups, meat or fish with a garnish. For dinner and afternoon school (40% of energy needs) include vegetable dishes, cottage cheese, milk, baked products.

Table 3-3.Approximate menu for children from 1 year to 3 years

For kids school age The power mode is changed, taking into account the increased energy costs in the first half of the day. It is these children that the disorders of the food status are most noticeable - the deficiency of animal proteins, polyunsaturated fatty acids, most trace elements against the background of excessive intake of animal fats. Schoolchildren eating little fresh vegetables, fruits, dairy products (less than 50% of the norm). At the same time, children and adolescents in the period

accelerated growth and puberty increases the body's need for basic food ingredients. The lack of proteins and trace elements leads to a decrease in immunity, a shortage of body weight, low-speed, lag in study. Children should receive an extra hot breakfast at school. The energy value of their food diet during the day is distributed as follows: the first breakfast - 25%, the second - 20%, lunch - 35%, dinner - 20%.

Natural, or thoracic, feeding the child's feeding by applying his biological mother to the breast.

Breastfeeding is not limited to only the child with nutrients of the required quality and in required quantity. I. M. Vorontsov (1998) writes that "breastfeeding today
- This is a phenomenon of general biological adaptation, programming and stimulation of children's development of newborn and early age, where the actual food is only one of the components of the integral environment of the child's development, which forms the combination of influences and interactions, which is the early child's experience. "

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

Chemical composition and biological properties of female milk, the benefits of natural feeding
Since the beginning of lactation and in the future there is a change in the composition of milk and its calorie content (Table 1.48 and 1.49).
Table 1.48.
Comparative composition of colosis and milk in percent (in 100 ml)
(according to A. F. Tour)

Table 1 49.
Calorie of colostrum and milk

Colostrum represents thick, sticky, yellow color liquid. The composition and amount of colostrum (it is small) correspond to the still weak digestive possibilities of the newborn. Compared to mature milk in the colostrum, more protein is contained, and the albumin and globular-new protein fractions are prevalent over the casein (casein appears only from the 4-5th day of lactation, and its number gradually increases); 2-10 times more vitamin A and carotene, 2-3 times - ascorbic acid; more contained vitamins B] 2 and E; 1.5 times more salts, zinc, copper, iron, leukocytes, among which the lymphocytes dominate. Especially much in the brewing of immunoglobulins of class A (secretory), which, along with other factors
It also contributes immediately after the birth of the high efficiency of the intestinal immunological barrier. Therefore, colosure sometimes refer to the factor providing the first vaccination, or, as they say, the "warm" immunization of the child, in contrast to the "cold" (ampulon). The content of fat and dairy sugar (lactose), on the contrary, in colostrum is lower than in ripe milk. Many splashing proteins (albumin, globulins, etc.) can be absorbed in the stomach and intestines unchanged, as they are identical to the serum proteins of the child. The colostrum is a very important intermediate form of nutrition between the periods of hemotrophic and amniotrophic nutrition and a period of enteral (lactotrophic) nutrition of a child.
Transient milk - This is milk at intermediate stages of biological maturity, stands out for individually different timing after delivery. When increasing its number, breast glands are filled, swell and become heavy. This moment is called the "arrival" or "tide" of milk. Transient milk compared with the colostrum contains fewer protein and mineral substances, and the amount of fat in it increases. At the same time, the amount of milk produced is growing, which meets the possibility of a child to absorb large volumes of food.
Mature milk - This is milk generated by the beginning of the 3rd week after childbirth (this happens at the overwhelming majority of women; 5-10% of women mature milk may appear a week before). The composition of the female milk (Table 1.50) largely depends on the individual characteristics of the nursing mother, the quality of its nutrition and some other factors.

Benefits of breastfeeding for infants and mothers health

Breast child

• The frequency and creativity of dyspeptic disease is reduced
• Protection against respiratory infection
• The frequency of otitis and recurrence of otitis is reduced
• Protection of necrotic enterocolitis of newborns, bacteria-mi, meningitis, botulism and urinary tract infections
• It is possible to reduce the risk of autoimmune diseases, such as type I diabetes and inflammatory diseases of the digestive tract
• The risk of developing allergies to cow's milk is reduced.
• It is possible to reduce the risk of obesity in older childhood.
• The acuity of sight is improved and psychomotor development, which may be due to the presence of polyunsaturated fatty acids in milk in milk, in particular, docking acid
• Raised indicators mental Development On the IQ scale, which may be due to the factors or increased stimulation present in milk
• Ski anomalies decrease due to improving the shape and development of jaws

Mother

• The early start of breastfeeding after the birth of the child contributes to the restoration of the mother's forces after delivery, speeds up the involution of the uterus and reduces the risk of bleeding, thereby reducing maternal mortality, and also retains the reserves of hemoglobin from the mother thanks to the reduction of blood loss, which leads to better status gland
• The period of postpartum infertility increases, which leads to an increase in the inter-shaft between pregnancies, if no contraceptives are used
• It is possible to accelerate the loss of body weight and return to the mass of the body, which was before pregnancy
• The risk of breast cancer decreases in the pre-deposacterial period
• It is possible to reduce the risk of ovarian cancer
• It is possible to improve bone mineralization and due to this reduction in the risk of thigh fractures in post-blocks

Technique and breastfeeding mode

Breast first applying healthy docking children produce as quickly as possible, optimally - for the first 30 minutes after the birth of a baby. After the first cry, the appearance of breathing and primary treatment of umbilical umbilicals, as well as wipes, it is laid out on the belly of the mother, in its upper part. For the skin contact of the newborn, it is better not to wash with water, it is also advisable to postpone until the end of the first applying and instilcing eye drops. The child lying on his stomach holds his hand, and on top of it cover or only a sterile sheets, or a sheet and a blanket (along with his mother). The search behavior of the child is expressed in the sucking movements, turns of the head and the climbing movements of the limbs. Most newborns are able to find independently and capture the Maternal breasts. It is noted that early contact with the mother contributes to the rapid formation of lactation, the production of breast milk in larger volume and more than a long, better and faster adaptation of newborns to the conditions of allutrobal life, in particular, to an earlier intestinal population and skin of bifidum-flora and a decrease in the duration of the phase of the transient intestinal dysbiosis. Contact "Leather to the skin"allows not only the baby to feel the maternal heat, the beating of her heart, stimulates the development of the child's psyche and the establishment of mental contact with the mother. It also contributes to strengthening the sense of motherhood in a woman, calm the woman and the disappearance of its stressful hormonal background, the best involution of the uterus, etc. Ideally, the mother and child should be left in close skin after uncomplicated birth for 1-2 hours. If sucking during the first skin contact did not take place, then it is impractical to keep a child on the chest.

In the event that the attachment of the baby to the chest immediately after the birth is difficult ( cesarean section, Mother's disease or child), do this should be done immediately as soon as it becomes possible, and before that, milk must be regularly aligned and give it to the child.

Main readings for later applying to the chest:

• from the child: children born in the state of asphyxia, with suspicion of intracranial injury, with cheefalohematoma, as well as newborns, the general condition of which is unsatisfactory, deeply premature, children with defects, from mothers with rezes-negative blood supplies;
• from the mother: operational interventions in childbirth, childbirth in preopect lamps, abundant bleeding during childbirth, the presence of any infectious processes.

Currently, they recommend immediately after childbirth to place a mother and a child in the same Chamber. With a joint stay in the postpartum chamber, a mother has unlimited access to the baby at any time of the day, it can feed it on the first demand, that is, adhere to the free feed mode. Signs of hunger can be the rotational movements of the head in search of the mother's chest, active lip relatives, smacking lips, loud, persistent crying. However, in some cases, in case of misunderstanding the causes of the child's concern and attempt to eliminate it by frequent applying to the chest, it is possible to observe a repaint, which is a risk of developing the dysfunction of the gastrointestinal tract, excessive increases in body weight, accelerated growth. The child can cry not only because it is hungry, but also for other reasons. Obviously, in these cases, feeding a child cannot eliminate the cause of the scream and, moreover, can increase it (for example, with intestinal colic). The frequency of applying to the chest can be 12-20 or more than a day and is determined by the need of a child. During feeding at first, a child can be applied to both milk glands. Such frequent feeding contributes to the best formation of lactation. It is important not to remove the child's concern due to starvation, doping between feedings, especially glucose or tea with sugar, even more than the milk mixture. Breast milk with a sufficient level of lactation fully provides the need for liquid even in a hot climate.A break between day feedings may not reach two hours, and between the night to be no more than 3-4 hours. Moreover, to ensure a long-term sustainable lactation in the first days after birth, night feedings are of particular importance.

Subsequently, as the child grows, as well as as lactation increases, the multiplicity of feedings are reduced and stabilized in the range from 10-15 in the first days and weeks to 5-7 in subsequent periods. The transition from an indefinite feeding regimation to relatively regular takes from 10-15 days to 1 month. When the power mode is generated, it is important to show well-known flexibility. The number of feedings can vary widely depending on the status of lactation in this particular day, degree motor activity And the energy consumption of the child, his well-being, etc. This concerns and night feedings. On the one hand, night feedings refer to the number of factors contributing to lactation. On the other hand, it is impossible to assume that the feeding of a child at night after a period of newborn, in the event of a steady satisfactory lactation, is strictly mandatory for all children. Night sleep and sufficient holiday are important for a nursing mother, they also contribute to maintaining good lactation. In the event that the child does not have the need for night feedings, he himself will refuse them and prevent him from it. "Free" feeding or feeding "on demand" contributes to the establishment of not only optimal lactation, but also close psycho-emotional contact between mother and child, the right neuropsychiatric and physical development of the child.

An important advantage of the joint placement of the newborn with the mother is to minimize the risk of developing an infection in the kid. In the case when a mother is caught behind the child from birth, his body is settled by those microbes that are in the mother's body. And in maternal milk there are specific antibodies to them. In the event that the child is placed in a children's room, where the staff of the maternity hospital is caressing behind him, the baby is surrounded by microorganisms inherent in "other people's people". Safe for them, such bacteria may be pathogenic for a child, and there are no specific antibodies in the mother's milk against them. This often contributes to sudden development among newborn skin disease epidemics, respiratory and gastrointestinal infections.

Reduce the duration and efficiency of sucking breasts by a child such factors as a restriction of feeding time, feeding on a schedule, an uncomfortable or improper position of the mother when feeding, the use of the nipple, the resulting child of other liquids, such as water, sugar solutions, vegetable or animal-dairy products.

The duration of staying in the chest every child determines himself. Some children suck the chest very actively, quickly release the nipples and turn away from the chest. But there are also the so-called "lazy sausages", which are sucking slowly and sluggish, often fall asleep in the chest, but when trying to remove the nipples wake up and suck again. Such long-term feeding can lead to damage to the skin of the nipple and the formation of cracks on it. Therefore, it is desirable that the duration of one feeding does not exceed 20-30 minutes. To this end, the "lazy sausage" should be stimulated - to sweat on the cheek, make an attempt to remove the nipple, etc.

On the first day after childbirth, Mother feeds a child in bed, in the following days, chooses for himself and the child the most convenient position - lying, sitting with a stop of 20-30 cm, or standing on the bench (if there were crotch breaks, perineotomy, episodemation).

Before feeding, the mother should thoroughly wash his hands with soap, wash the chest boiled water And dry the soft towel, not rubbing the area of \u200b\u200bthe nipple and the arolam. The first droplets of milk before the start of feeding is better to start. A hand that supports the child should have a support. Supporting the baby behind his back and shoulders, the mother should not press the child's head, otherwise he will reflexively throw off his head. Mother during feeding holds a child face to himself, "belly to the stomach" so that he should not turn his head. When using any poses and position of the body during feeding, a nursing woman and a child should see each other's faces, using feeding time to carefully study each other, facial expressions, eye expressions. Breasts take the II and III fingers of the opposite hand over the edges of the arole from above and from the bottom from the nipple and the nipples are injected into the mouth of the child. During sucking, the child should cover the mouth not only the nipple, but also the entire near-block circle (ARAOLU), as well as part of the chest below the Area. The lower lip of the child should be turned outward, chin, cheeks and the nose of the child - to fit the chest tightly. The child pulls the nipple and the sore of the chest, and then,
Pressing the tongue on them, squeezes the milk. From the chest that a child sustain you need to write the residues of milk(But, of course, not until the "last drop"), then wash the chest with boiled water and hold the open one for a while, give a nipple to dry in the air. With sufficient lactation, the child during feeding receives milk only from one chest, and in the next feeding - from the other. However, if the child is completely emptied one chest, and the milk is missing, one should offer another. Each time you begin feeding on the other side. It is also very important not to stop feeding too early. Breast children do not suck continuously, during feeding the child can take pauses. The child must decide himself not to take the chest when it is offered to him again in a few minutes. The chemical composition of the "front" and "rear" milk is different Front milk is milk produced at the beginning of feeding. The rear milk is milk produced at the end of feeding. In the first portions of breast milk, more lactose is contained, less fat, slightly less protein. The latter ("rear") of milk portions are more rich in fat, the number
which can reach up to 7-8%, which ensures sufficiently high calorie content of this milk.

After the end of feeding, the child give a vertical position for 1-2 minutes to join the sword during air feeding. Sometimes the child joins a little milk, but it should not cause fears.

Enclosed breast milk it is necessary to give a child in cases where for some reason it is impossible to apply it directly to the breast of the mother (mother's disease, generic injury, deep presence of a child, etc.). There are situations where the mother cannot feed the child due to the causes of domestic nature (day work, study, etc.). If milk is given from the bottle, it is necessary that the hole in the nipple is small, and the milk flowed into separate drops. Otherwise, the child, happily getting used to light food through the nipple, will quickly refuse to suck the chest. However, too tight nipple and a small hole in it can contribute to the swallowing of the air when feeding and as a result - jerking, intestinal colic.

Store enclosed milkit is necessary in the refrigerator at a temperature not higher than +4 ° C. For 3-6 hours after plugging and in the case of its proper storage, it can be used after heating to + 36-37 ° C. When stored for 6-12 hours, milk can only be used after pasteurization, and after 24 hours of storage it must be sterilized. For this, a bottle with milk is put in a saucepan, pouring warm water somewhat higher than the level of milk in a bottle; In case of pasteurization, water is heated to + 65-75 ° C and a bottle with milk is kept in it for 30 minutes, during sterilization the water is adjusted to a boil and boiled for 3-5 minutes.

Some possible reasons Anxiety of a child.

• At the age of 3-4 months, children often show concern during feeding. At the same time, the child, starting to suck the chest, suddenly throws her nipple, crying loudly, pulls his knees to the stomach, then sucks again and cry again. The attack can last from 10 minutes to 2 hours. Such a reaction in practically healthy children can be caused by intestinal colic, when the intestinal peristalsis is enhanced by the first portions of milk in the gastrointestinal tract. There is also a value of increased gas formation, air swallowing with fast and greedy sucking chest. In this case, feeding should be interrupted, take the kid on the hands, holding it in a vertical position, or make a light skin massage with a warm hand clockwise. It is affordable to talk gently with a child. If it does not help, you can put gauge tube. Sometimes gases and feces are separated by themselves. When a child calms down, feeding can be continued. With a frequent occurrence of colic, the child can give activated carbon, smect, decoction of chamomile.
• The emergence of colic in a child sometimes bind with a nursing mother of any products (excessive milk, coarse vegetables, coffee, etc.). At the same time, they should be excluded from the diet or reduce the amount. Anxiety can be associated with the smoking of the mother or drug intake.
• The child can cry during feeding if thrush developed in his mouth. In this case, sometimes you have to feed the baby with a spoonful milk from the spoon and actively treat the thrush.
• It can not freely breathe during feeding a child if there is a cold. Then before feeding, it is necessary to carefully clean the nasal strokes of the baby with cotton swabs, drip out any vesseloring drops. If necessary, purification of nasal moves repeat during feeding.
• The excitement and crying of a child when feeding is often in cases where the mother has the so-called "tight chest". Milk is produced in sufficient quantity, but it is difficult to get hard, and the child is difficult to suck it in the right amount. In this case, mom should be directly before feeding a certain amount of milk, it is possible to make a massage of the chest, then the chest will become softer and the child will become easier to suck.
• Certain difficulties with the feeding of a child may occur with the wrong form of nipples. Nipples can be flat and drawn, and the child can not capture the chest correctly. You can prevent similar phenomena, if before giving birth to special preparation of nipples (massage, pulling). If this was not done and the child failed to adapt to sucking such a chest, it is necessary to feed it through a special lining, and sometimes with recreational milk. However, many children eventually cope with these difficulties.
• The reason for crying a child may be an increase in the child's appetite (hungry cry) due to an uneven increase in energy consumption, if, for example, he began to grow faster than before. it frequent cause Anxiety aged about 2 and 6 weeks and about 3 months. If a child becomes sucking more often for several days, lactation will increase.

Feeding of low and premature babies it has its own features. Of course, both breast milk is optimal food. However, one of the female milk can not always satisfy all the needs of these children in macro and micronutrients, ensure high rates physical development. In this regard, it is proposed to be powered by such children (simultaneously with breast milk) mixtures-folds, such as Enfamil HMF (MEAD Johnson), Similac Natural Care (Ross), Care Neonatal BMF (NUTRIAA), which corrected the composition of female milk, make it The composition is more optimal for attic children. This allows you to preserve the main advantages and protective properties of the natural feeding of a small child and give it the opportunity to develop intensively.

Ways to determine the amount of milk needed to the breast child

One of the main indicators of the adity of the child of breast milk is his behavior. If, after another feeding, the baby calmly releases the chest, has a satisfied appearance, it has enough sleep until the next feeding, it means that milk is enough. The objective signs of the adequate volume of milk are uniform, in accordance with the age standards, increase in body weight, an increase in other anthropometric indicators (body length, head circumference), good skin condition, elastic tour-mountains of soft tissues, normal scope of urination and stool. In case there is a suspicion of lactation deficiency, it is necessary to conduct control feedings. Child (in clothing) weighed before and after
Applying to the chest each time feeding during the day. In case of individual feedings, the amount of suction milk varies so much that one or two weighing is difficult to determine the amount of milk sucking per day. Obtained by control weighing The data is compared with the calculated values.

In the first 10 days of life the required amount of milk for a duddy child can be determined by formulas:

• Finkylitein formula in the modification of A. F. Tura:

the amount of milk per day (ml) \u003d n x 70 or 80,
Where: n - day of life; 70 - when mass at the moment of birth is below 3200 g; 80 - when mass at the moment of birth higher 3200 g.

• Formula N. P. Shabalova:

the amount of milk per 1 feeding (ml) \u003d 3 ml x day of life X body weight (kg);

• Formula N. F. Filatova in Modifications G. I. Zaitseva:

the amount of milk per day (ml) \u003d 2% body weight x day of life.

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

• "Volume" way to Gaber-Cherni . Food volume is prescribed depending on the age and body weight. At the same time, the mass of the body must correspond to the average age standards.

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

• Caloric method M. S. Maslova.

The energy value of food per 1 kg of body weight of the child must be:
In the 1st-fourth of the year - 120 kcal / kg / day;

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

in the 3rd quarter of the year - on kcal / kg / day; In the 4th quarter of the year - 105 kcal / kg / day.
One liter of female milk has a calorie content of about 700 kcal.

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

Introduction Prikamov

Currently there is a tendency to more late time Introduction Dust - no earlier than 5-6 months of life. Early administration of feeding can reduce the frequency and intensity of sucking and, as a result, reduce the production of breast milk. It is advisable to use not a simple chronological (in the age scheme) appointment of supplies, but to introduce them individually. This may contribute to the preservation of lactation in the mother and the maximum extension of the timing of exclusively breastfeeding. Such an individual delay should relate primarily to the energy-significant volume of adhesive and non-cellular nutrition. Along with this, all children should from the age of 5-6 months to receive fruit juices and fruit purees as the so-called "pedagogygenic", or "managing", dust. Educational supplies pursues his own goals - it allows the child to get acquainted with the different feelings of taste and consistency of food, training oral food treatment mechanisms and prepares the child to the period when it becomes necessary for an energy supplement. The introduction of training dust is not a departure from exclusively breastfeeding. Individualization of the term for the introduction of a training tutorial can rely on the following signs of the child's maturity:

• extrusion reflex dflex (tongue) with a well-coordinated reflex of sorting food;
• the readiness of the child to the chewing movements in the mouth of the nipples and other items.

At first (not earlier than the 5th month of life), children on breastfeeding give juice. The introduction of juice into the nutrition of the child should be started with a 1/2 teaspoon, gradually increasing its amount to 5-20 ml. It is advisable to start an administration of apple juice without sugar, which is characterized by low acidity and low potential allergenity. The nutritional value of the juices is determined primarily by the presence of natural sugars (glucose, fructose, sucrose, etc.), which are easily absorbed and oxidized in the body, while the source of energy. Another important component of the juice is organic acids (malic, lemon, etc.), which contribute to the process of digestion. Juices also contain significant amounts of potassium and iron.

2-3 weeks after the appointment of juices, fruit puree is introduced into the diet (also better apple). Subsequently, the range of fruit is expanding - in addition to apple juice and mashed potatoes, plum, apricot, peach, cherry, crimson, black-hearth environments are given. At the same time, acidic and tart juices should be brewed with water. Orange, mandarine, strawberry juices belonging to the number of products with high potential allergenity should not be given to children under 6-7 months. This also applies to the juices of tropical and exotic fruits (mango, guava, papaya, etc.). Do not recommend to give children grape juice due to the increased content of sugar in it.

The introduction of juices and fruit purees should be started from juices and mashed potatoes from one type of fruit and only after addiction to it can be administered to the rations of juices and puree from mixed fruits. "Training" lore better give the child to the second feeding, after he sucked a little milk from his chest, still retained a feeling of hunger, but he enjoyed feeding. A small amount of fruit puree from the tip of a teaspoon is introduced into the middle part of the child's tongue. It is more advisable to use canned juices and fruit purees for baby food industrial production, since in the conditions of an unfavorable environmental situation and an insufficient level of sanitary-hygienic knowledge of the population, it is the products of industrial output to children of the 1st year of life a guarantee of quality and security. In addition, usually canned products for nutrition of breasts are enriched with vitamins, iron and other nutrients necessary for children.

Actually, the "Prikorm" should be introduced into the diet of a healthy donating child not earlier than 5-6 months. At the same time, it is recommended to approach the deadline for the administration of the attachment on the basis of not the formal age principle, but taking into account the individual characteristics of the body. Indication to the introduction of a thick energetically significant feeding may be the behavior of a child - the manifestation of the child's dissatisfaction in the form of anxiety, curricens, the need for a more frequent attachment of the baby to the chest, repeated awakening at night with a hungry cry, lively movements with hands and legs at the sight of food, reducing the number of wet diapers And the gentle of the chair. Some children, on the contrary, become sluggish and apatic. An important objective sign of insufficient nutrition is the slowdown in the tempo weight gain, (Table 1.53).

From 8 months, as an independent dish, the supplies can be given a sour-live drink (Kefir Children, Bifti-kefir and other designed specifically for the nutrition of children of the first year of life fermented dairy products). Efficiency products are characterized by high nutritional value and significant physiological, including probiotic activity. Unmodified (fresh) Cow's milk for drinking should not be given to children until 9 months of age, but it can be used when cooking for feeding from 6-9 months.

Currently, there is a tendency to introduce into the diet of children of the second half of life instead of kefir and whole milk of new food nutrition products - mixtures of the group "Follow IR" ("follow-up formulas") - "PKKOMYL-2", ENFAMIL-2 mixtures, " Bebelk-2 "," Nutrilon-2 "," NAN 6- 12 months with bifidobacteriums ", etc. This trend is due to the need to ensure the multiccomponent balance of the daily diet with a decreasing amount of breast milk in its composition, aspiration
reduce direct immunotoxic action casein cow's milk on intestinal epithelium.

By the end of the first year of life, instead of the mixtures "Follow Up" for the dairy component of the diet, it is advisable to use substitutes of cow milk for children of the 2nd and 3rd year of life (for example, a mixture of "Enfamil Junior").

At the end of the first year (usually from 11 months) for further stimulation of biting and chewing, besides a sugar market and cookies give pieces of bread and bread, sliced \u200b\u200bfruits, etc.

With any diagram of the administration of adhesive, the expansion of their range and quantity occurs due to the "displacement" of breast milk. As the number of attachments to the breast decreases, the amount of milk produced by the mother will decrease. However, there are reason to consider it appropriate to preserve at least one feeding per day with breast milk up to 1.5-2 years and even longer, as recommended by WHO and UNICEF. It is very important to preserve breastfeeding in the hot summer months, in the event of a child's disease.

Mixed and artificial feeding

Contraindications for breastfeeding from the mother:

• open shape of tuberculosis with bacillomodulation;
• HIV infection;
• particularly dangerous infections (smallpox, Siberian ulcer), tetanus;
• state of decompensation in chronic diseases of the heart, kidneys, liver;
• acute mental illness;
• malignant neoplasms.

With such infections, the mother, like measles and chickenpox, can be breastfeed, subject to the introduction of immunoglobulin to the child. With typhus, chronic hepatitis, dysentery, salmonellosis Mother can grind milk and feed the child with this milk after sterilization. With ORVI, angina, bronchitis and pneumonia, feeding can be applied to the chest after a decrease in body temperature and improving the overall state of the woman. It is necessary to use masks and limit the contact of the mother and the child in the break between feeding. A serious contraindication for feeding a child, including and encoded milk, is to use medicines. These include: Antibiotics (Levomycetin, Tetracycline), Isoniazide, Nalidix Acid (Negro or Nevgramone), Sulfanimides, Estrogens, Cytostatics, Cyclosporin, Anti-Retreats, Diazepams, Salt Lithium, Mesprotan, Phenylin, Resern, Atropin, Ergotamine, Iodine Prepare, Hexamidine.

Contraindications for breastfeeding from the child : Hereditary metabolic diseases - Galaktozhemia, phenylketonuria, urine disease with the smell of maple syrup.

To prepare simple mixesmilk is divorced by water or cereal beams (rice, buckwheat) in a 1: 1 ratio - a mixture number 2 (in the first 2 weeks of life); 2-1-mixture number 3 (aged 2 weeks to 3 months). Milk breeding is primarily reduced by the amount of protein per unit volume. The missing amount of carbohydrates is fused by adding sugar, and fat - cream. After 3 months, the children give whole cow milk with the addition of 5% sugar (Mix No. 5). However, according to modern recommendations, non-adapted mixtures (and sweet, and kefirs) can be given no earlier than 8-9 months. At the same time, fermented milk products (including adapted) should be no more than 50% of the total daily volume of substitutes for female milk and (or) "subsequent" mixturesThe resulting child, since their large number can cause shifts in acid-alkaline equilibrium. The introduction of non-adapted mixtures in a diet in a more junior age can have an adverse effect on nitrogenous metabolism, the functions of immature kidneys.

To prevent the child's refusal from the chest, with mixed feedinga small volume of the doctorate is given from the spoon. If the number of detectors is greater, then the mixture is given from the horn through an elastic nipple. It must have one or more very small holes, which burn the tip of the hot needle. When tipping the bottle, the mixture should flow by drops, not a trickle. If mixed feeding is carried out due to the hypoglac, it is desirable to use maternal milk with each feeding. Therefore, at first, the child is applied to the chest and only after its empties they do. The remains of the maternal milk constantly and give it or in the same feeding, or the next

In children on artificial feeding, lure can be introduced in earlier deadlines,than in children on natural feeding. This is due to the fact that children are already obtained as part of female milk substitutes a significant number of "alien" foods: cow's milk, sweet syrups, vegetable oils containing a sufficiently large number of new food substances - proteins, oligosacha rides, lipids, distinguished by the structure from These ingredients of female milk. Thus, children are adapted to a certain extent adapted to "alien" nutrition. The first lure (vegetable puree) in artificial feeding is introduced into the diet from 4.5-5 months, the second lure (on a cerebral basis) - from 5.5-6 months. However, taking into account the individual features of development, as well as in natural feeding, cereal, better - enriched with iron, vitamins, microelements can be used as the first dust. Fruit juices and mashed puree should be prescribed from 3 and 3.5 months, respectively. Permissible and earlier (from 1.5 months) the introduction of juices, taking into account their individual tolerance. Yolk is advisable to use from age for 6 months, meat - from 7 months. Kefir, other fermented milk products and a whole cow's milk as a dish that feeds can be administered to meals from 8 months, however, these children have previously used "subsequent" formulas.