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. Content breast milk In the daily diet, the child 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 a breast child, they 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 - hygoglactium, 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 women.

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 at this age should be considered not as a supplier of nutrients, but as a stimulator of the 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.

Termination 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%.

The period of newborn is associated with an increase in blood flow in the vessels of the lungs and brain, a change in energy exchange and thermoregulation. From this period the enteral nutrition of the child begins. In the period of new it, adaptation mechanisms are easily violated. During this period, the hormonal crisis of a newborn, associated with a violation of the interaction of the endocrine apparatus of the mother and child and the generic stress. Conditions reflecting the adaptation of a child:

1) physiological skin of the skin;

2) physiological jaundice;

3) physiological weight loss;

4) Piece infarction.

During this period, anomalies of development, fetopathy, hereditary diseases, diseases caused by antigenic incompatibility are revealed, generic damage, intrauterine infection or infection in childbirth. Purulent-septic diseases, bacterial and virus lesions of the intestines and lungs may occur. In an early neonatal period, aseptic conditions must be created, optimal temperature Environment, close contact of the newborn with a mother. Late neonatal period covers the period from 8 to 28th day. During this period, a delay in the rise of body weight is revealed. The resistance of the child's body is low, complete adaptation has not yet happened.

During this period, diseases and conditions associated with the pathology of intrauterine, intranatal and early neonatal periods can also be revealed. An important criterion for the well-being of a child should be considered an assessment of the dynamics of body weight, neuropsychic development, sleep state.

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

Children on breastfeeding are 3 times less often in intestinal infections, 1.5 times with respiratory diseases.

1. In colostrum and in female milk contain antibodies to pathogens intestinal infections - to o-antigens Salmonella, Escherichi, Schigel, Enterovirus, respiratory infections (such as influenza, repurring infection, chlamydia, pneumococci), to the pathogens of viral diseases (polio virus, cytomegaloviruses, viruses of epidemic vapotitis, herpes, rubella), bacterial infections, caused staphylococci, streptococci, pneumococci, tetanus toxin).

2. In the colostrum contains immunoglobulins of all classes, especially YGA (90%). With lactation, its content decreases, but the daily consumption remains high (3-4 g). This immunoglobulin performs the role of first protection against the invasion, suppresses the adhesion of bacteria, neutralizes viruses, prevents allergyization.

During the day, the child gets 100 mg YGM. Placenta of ruminant animals for immunoglobulins impermeable. In the colostrum of hoofing animals is predominantly YGG, and YGA and YGM - in minor quantity.

3. In the first 4 weeks of lactation in female milk there is a lactoferrin (50-100 mg / l), which activates phagocytosis, communicating ionized iron in the intestine, blocks the neoplasm of the bacterial flora.

4. In the colostrum contains components of the Complement C3 (30 mg per day) and C4 (about 10 mg / day).

5. In the female milk, the Lizozyme content is 100-300 times higher than in a cow. Its action lies in damage to the shell of bacteria, stimulating the formation of amylase saliva, increasing the acidity of the stomach.

6. In women's milk, there is a bifidus factor, the activity of which is 100 times higher than in a cow. This carbohydrate contributes to the formation of bifidus flora, dairy and acetic acids, which prevents the growth of Staphylococcus, Salmonella, Schigell, Escherichi. With natural feeding, the ratio in the intestine of lactobacilli and other microorganisms is 1000: 1, with artificial - 10: 1.

7. In female milk, a large amount of viable cells are found - 0.5-1 million in 1 ml of milk, macrophages - 50-80%, lymphocytes - 10-15% of total cytosis. Milk macrophages are able to synthesize interferon, lactoferrin, lysozyme, complement components, they retain their value and in intestinal infections. Among lymphocytes in female milk are in-lymphocytes, synthesizing YGA, T-lymphocytes - helpers, suppressors, memory cells. They produce lymphokins. Neutrophils in colostrum - 5 x 105 per 1 ml, in the future there is some decline. They synthesize peroxidase, possess the ability to phagocytosis.

8. Allergy to the Mother's female Molok is unknown, while allergic to milk mixtures in children of 1st year is about 10%.

9. Female milk, especially colostrum, unlike cow, contains pituitary hormones, thyroid gland.

10. In female milk contains about 30 enzymes involved in hydrolysis, which provides a high level of assimilation of female milk.

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

12. Women's milk has a smaller ashism than cow's milk.

13. The ratio of the amount of the amount of serum lactoalbumin and lactoglobulins to Caseinogen is 3: 2. In the cow's milk, this ratio is 3: 2, so the adapted mixtures are enriched with serum proteins. Casein When serving milk in the stomach gives large flakes, and albumin is small, which increases the surface for contact with hydrolysis enzymes.

In women's milk contains proteolytic enzymes.

14. The main component of female milk is triglycerides. In children, due to the low activity of the pancreas lipase and low concentration of conjugated bile salts, the hydrolysis of fat is difficult. In breast milk, palmitic acid content is lower, which contributes to easier hydrolysis. The nutritional value of triglycerides of cow milk is lower than female, due to larger formation of free fatty acids, which are derived. The assimilation rate of female milk in the 1st week of life is 90%, cow - 60%, in the future it increases somewhat. The composition of fat female milk is also different from a cow. As part of fat female milk, unsaturated essential fatty acids prevail, which are not synthesized in the human body, especially in the first year of life. In cow's milk, they are contained in extremely small quantities. The high content of essential fatty acids is of great importance for brain development, the mesh eye shell, the formation of electric genesis. In female milk compared to a cow more phosphatide content, which ensure the closure of the gatekeeper when moving food into the duodenum, which leads to uniform evacuation from the stomach, contribute to the protein synthesis. The absorption factor of fat female milk is 90%, for cow's milk - less than 60%. It is explained by this presence of the enzyme lipase in female milk with its greater activity of 20-25 times. The splitting of milk fat lipase provides active acidity in the stomach, which contributes to the regulation of its evacuator function and more early allocation pancreatic juice. Another reason for the best digestibility of fat female milk is the stereochemical location of fatty acids in triglycerides.

15. The amount of milk sugar (lactose) in female milk is greater than in a cow, and in feminine it is B-lactose, which is slower digested in the small intestine and provides an increase in the gram-positive bacterial flora in the colon. The predominant lactose content among sugars of female milk has a large biological meaning. Thus, its monosaccharide galactose directly contributes to the synthesis of galacto-cerebronids of the brain. The predominant content in the female lactose milk (disaccharide), which has a greater energy value, but equal to monosaccharides osmolarity, provides osmotic equilibrium, optimal for the absorption of food substances.

16. The ratio of calcium and phosphorus in female milk is 2-2.5: 1, in a cow - 1: 1, which affects their suction and assimilation. The assimilation rate of female milk calcium is 60%, cow - only 20%. Optimal exchange rates are observed in the case of admission with female milk from 0.03 to 0.05 g of calcium and phosphorus per 1 kg of body weight, and magnesium is more than 0.006 g / (kg per day). Women's milk is richer with cow glands, copper, zinc, fat-soluble vitamins.

Mososy - adhesive thick liquid of yellow or gray-yellow color, which stands out at the end of pregnancy and in the first 3 days after delivery. When heated, it is easily achieved. In colostrum more protein, vitamin A, carotene, ascorbic acid, Vitamins B12, E, salts than in ripe milk. Albumin and globulin fractions prevail over Kazyin. Casein appears only from the 4th day of lactation, its number is gradually increasing. Before applying a child to a breast in a college, protein content is the highest. Especially much in the YGA college. Fat and milk sugar in colostrum is less than in ripe milk.

The colostrum contains leukocytes in the fat rebirth stage, macrophages are significantly quantities, lymphocytes. B-lymphocytes of colostrum synthesize secretory yg, which, together with phagocytes, forms a local immunity of the intestine, when an intense bacterial population of the organism of the newborn occurs.

Polars proteins are absorbed unchanged by the identity of the serum proteins of the child.

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

Natural feeding - Feeding the child by applying his biological mother to the breast. It represents the only form of adequate nutrition for the child after birth and within 1-1.5 years of life.

The first attachment of the newborn in the maternity hospital is carried out simultaneously with the procedure for the first contact. Normal Funny Child At the time of birth has everything to successfully suck the chest under the congenital food search program for 120-150 minutes after birth: Cramber to your mother's chest, coordinated action of the handles and mouth in the active search for a nipple with a wide open mouth, challenge To the chest and energetic saturation before falling asleep.

Breastfeeding should be started during the first hour after birth, when both of the child's reflex (search and sucking) and the sensitivity of the nipple area (AREOLAS) to the tactile stimulation of the mother are the highest. Skin contact after childbirth should be close - on the belly of the mother after uncomplicated labor. When feeding, the child must capture the nipples and the arole with an energetic "bated" movement of the head, lifting the chest, and then as if overlapping it when the chest moves down, on the wide open mouth, with a lining under the chest lowered, but not in the tongue. The capture of only one nipple without aseal and its subsequent sucking is ineffective and immediately lead to the formation of a crack. The effectiveness of sucking is determined by the rhythmic massage of the areal language of the child. If sucking at the first skin contact did not take place, then keep the child in the chest more than 2 hours inexpedient. Inefficiently and attaching a child or creating skin contact in 2-3 hours after childbirth.

A good capture of a child's mother's nipple provides him with sufficient ease of sucking, good respiratory regulation conjugate with chest sucking. Fermentation observation should be focused on achieving an act of swallowing milk, which can be judged by the severity of swallowing movements, and by sound accompanying swallowing.

The attachment of the child to the chest should be carried out from the first day, according to any sign of hunger or discomfort from the child. Signs of hunger can be active sucking movements of the lips or rotational head movements with various sound signs before screaming. The adhesive frequency can be 12-20 or more per day. The break between day feedings may not reach 2 hours, between the night to be no more than 3-4 hours.

The most natural scarce states in natural feeding.

1. The insufficiency of vitamin k in the first few days of life arises due to its low content in female milk or due to the small consumption of milk during this period. Recommended single parenteral administration of vitamin to newborns.

2. The insufficiency of vitamin D arises due to its low content in female milk and insolation. Recommendation: 200-400 MM Vitamin D per day at that time when there is no regular insolation.

3. Correction of the mother and child's iodine in the regions with non-optimal natural security is necessary. Recommendation: Optional intramuscular administration of iodized oil.

4. Iron deficiency. Of the 1 liter of maternal milk, the child receives about 0.25 mg of iron, from other food sources - about the same.

With natural feeding, the subsidy of iron should be carried out by drugs of iron or through the mixtures enriched with iron, if necessary, the introduction of doctors.

5. Fluorine deficiency requires the use of microdosis - 0.25 mg per day starting from 6 months and later.

The introduction of adhesiveness depends on the quality of female milk. Optimal feeding at good nutrition Pregnant and nursing can well provide the development of a child without adhesive up to 1-1.5 years.

The lack of confidence in optimal feeding requires the introduction of a thick dust in the interval of 4 to 6 months.

A 50-20 g of a grated apple or fruit puree can be used as a training attachment. With good swallowing, good tolerability and the absence of an allergic reaction, it can be given regularly for lures and move it to the beginning of feeding. Most suitable age - Between the 16-24th week of life, the duration of this attachment is 2-3 weeks (see Table 4).

The indication for the introduction of the main (or energetically significant dust) is the obvious manifestation of the child's dissatisfaction with the volume of milk with such a state of its physiological maturity, when this dissatisfaction can already be compensated for precisely. Some children can form objective signs of nutritional deficiency even in the absence of anxiety and screaming: children become apatic, the motor activity decreases, slowing down the tempo of the weight gain. Conditions for the introduction of feeding:

1) age more than 5-6 months;

2) the current adaptation to the promotion and swallowing of thick food when using the learning supplies;

3) consisting or current teething of the teeth;

4) confident seat and ownership of the head;

5) the maturity of the functions of the gastrointestinal tract.

First, the test dose of lure is introduced - 1-2 hours l. And then with good tolerability, fast extension takes up to 100-150 ml puree of fruits or vegetables or porridge without salt and sugar based on buckwheat cereals or rice.

Stages of dust expansion:

1) training tutorial;

2) One vegetable puree (from potatoes, carrots, cabbage) or fruit puree (from bananas, apples). It is better to use products issued by production;

3) porridges are glutenable (from rice, corn, buckwheat);

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

5) porridge on wheat flour;

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

7) The beginning of "piece" feeding: cookies, bread pieces, chopped fruits, steam cutlets.

The total daily amount of milk (breast or in the mixture) in no period of the first year of life should be less than 600-700 ml, it should be distributed evenly during the day.

By the end of the first year of life, instead of the mixtures of the "Follow Up" group for the dairy component of the diet, it is advisable to use substitutes for cow milk for children of 2-3 years of life "Entamil Junior" Foreign Minister Johnson.

With good tolerability of the dishes of the feed and appetite of the child, the volume of one serving of feeding can be the first year quarter of the first year to reach 200-400

The child's nutrition is the most important factor in his health, development, as well as one of the simplest and most secure methods of treatment.

When prescribing feeding a child of the first year of life, it is necessary to estimate its condition, age, actual and redefining weight (taking into account body weight at birth and subsequent weight gain by month). In addition, the presence of diseases such as impaired intestinal suction syndrome, atopic dermatitis, is taken into account. Taking into account the above, appointed adequate nutrition, which is recommended by the mother.

Under hypotrophy of 1 degree (body weight deficit from 10 to 20%) calculation of proteins, fats, carbohydrates are carried out on the basis of the body mass; With hypotrophy 2 degrees (body weight deficit from 20 to 30%) and hypotrophy of 3 degrees (body weight deficiency with above 30%) Calculation of proteins, fats, carbohydrates are carried out on the basis of the average between the actual and must have a body mass.

With the identified shortage of ingredients in the child's diet, their correction is carried out taking into account the content of proteins, fats and carbohydrates.

Types of breaming children up to the year

Russia adopted three types of feeding children up to year: natural (breast) child feeding with maternal milk, mixed-combination of breast milk and its artificial substitutes and artificial feeding - Use when feeding a child only substitutes for female milk.

According to WHO classification distinguishes: exclusively natural feeding, that is, when the child is fed only with breast milk and mostly natural feeding, when, along with breast milk, the baby gets a liquid.

Having prescribed food to the child of the first year of life, must remember the leading meaning of the natural feeding of children up to the year. Natural feeding contributes to a harmonious child. Women's milk prevents the emergence of a number of childhood diseases (Rahit, anemia, atopic dermatitis), as well as gastrointestinal and respiratory pathology. At the same time, mom, nursing baby breast milk, is protected from possible postpartum bleeding, unwanted pregnancy. Natural feeding reduces the risk of developing oncological pathology of the breast and ovaries.

Five phases of breast milk formation are isolated: absorption of the cell of the substances necessary for the formation of milk; intracellular synthesis of molecules; formation of granules or drops of secret; transport of the resulting substances in the apical cell; The output of the secret into the lumen Alveol.

Children's feed circuit

The first three months of life feeds mainly by maternal milk, which fully satisfies it in all nutrients. In 4 months of age, the child is beginning to introduce fruit juices, then fruit-berry puree. Not early 6-7 months. age with caution, you can enter citrus, tomato, raspberry, strawberry, juices from tropical fruits. It is not recommended to introduce grape juice. Timely introduction of food additives (fruit-berry juices, fruit-berry puree, yolk, cottage cheese) and supplies is an important stage in life. At the age of 5 months. The child is introduced first dust - vegetable puree, then at 6 months. Second - milk porridge. In 8 months. It is necessary to introduce a meat puree. Kefir and other fermented dairy products are allowed to give no earlier than 8 months.

If mom has completely absent breast milk or his share is less than 20% of the daily need, the child is transferred to artificial feeding. There are also a number of indications for translation to artificial feeding. It is impossible to feed breast milk if a child has a disease of the exchange or congenital metabolic disorders.

Artificial feeding of children up to a year has a number of adverse factors for a child and mother. When carrying out artificial feeding, there is no close communication with the mother. In this group of children, the likelihood of both food intolerance is high, the high risk of developing chronic diseases and sudden death syndrome is usually reduced mental Development. Also, the mother is not protected from the occurrence and breast.

With artificial feeding of children under the year, specialized food nutrition products of industrial release are used. There are milk mixtures for children up to 6 months and "subsequent" - for feeding children of the second half of life. For children of the first 6 months. Apply adapted breast milk substitutes (AZZHM), that is, the mixtures, as close as possible to female milk. Milk mixtures intended for feeding children after 6 months, a lesser degree of adaptation is distinguished. All substitutes of breast milk are divided into fresh (sweet) and fermented milk; Produced in a dry or liquid form.

For maximum approximation of the dairy mixture in composition to milk (adaptation), it is necessary to reduce the content of the general protein; increase the level of fats and carbohydrates; optimize the composition of carbohydrates and lipid fractions; reduce calcium, potassium, sodium; enrich the complex of vitamins, minerals and trace elements; Include in a mixture of taurine, carnitine, choline and protective factors.

Milk substitutes for breaming children up to year

The main groups of female milk substitutes for artificial feeding children up to the year, who should know every doctor of general medical practice:

Adapted substitutes for female milk containing whey protein:

• containing whey proteins enriched with taurine, carnitine (Agu1, Nutrilac 1, Nan, Hipp 1, Galia 1);
• containing serum protein enriched by Taurin (Taurin, Peltti, Bona, Nutrilon, Baby, Omneo, Pre-Nutrilon);
• containing serum proteins enriched with taurine, nucleotides (ENFAMIL 1, frisolac with nucleotides, seven colors Formula +1);
• containing serum protein and not enriched by taurine, carnitine, nucleotides (mom, my baby, eldorine).

Partially adapted milk mixtures: (apartamil, ducert, baby, Milazan, Milumil);

• some mixtures enriched with Taurin (Semi-Babi, Hunz 2, Semilac with iron, Nutrilon 2, Nutrilac 2, Human 2, Friessel);
• mixtures having taurine and nucleotides (SMA Gold, Enfamil 2, Friessel with nucleotides).

Equal milk mixtures are divided into dry and liquid. Such are dumped - nan, lactofidus, bifidus semi. The ratio of acidic and fresh mixes is 1: 1.1: 2.

According to the degree of adaptation, ferocular products are classified as follows:

• Adapted (Agu1, Agu2, Bifymil, Milk CM, Nan Acid Oil). These mixtures can be missed from the first months of life.
• Partially adapted products (acidophilic baby, bifilin, sprout, lactofidus, bifidus seed).
• Non-adaptured (kefir, bifi kefir, bifox, nyrine, yogurt, prostrochashi).

The advantage of fermented milk mixtures before native (sweet) non-adapted mixtures: protein is in a rapid state; evacuated from the stomach slowly and evenly; easier digested; used for feeding both healthy children and digestive disorders; Stimulate peristaltics, suppress the growth of pathogenic microorganisms, normalize the intestinal microflora. In addition, the content of Vitamins B1, B2, S. Inculiprates

With artificial feeding of children up to a year, lures can be introduced in more early deadlinesthan with natural.

The advantages and necessity of breastfeeding are currently considered indisputable worldwide.

Each pediatrician must thoroughly know the benefits of breastfeeding in order to have their own deep conviction in its necessity, on the one hand, and be able to find good arguments for mothers when congently with them.

The need of children in major food ingredients

Since most often, when moving to artificial feeding, the child goes to food with mixtures based on cow's milk, we present a comparison of the composition of the breast and cow's milk.

Table 1. Scaffolding and cow milk for basic food ingredients

Breast milk contains 1 - 1.2 g / 100ml protein, which is enough to develop a child. In the cow's milk protein significantly more; Excess protein can lead to earlier ripening of children - earlier death - tumors; Beak kidney. The deficiency of the protein primarily affects the gastrointestinal tract: Mal Absorption syndrome, "baldness of the mucous".

The comparison of the chest and cow milk in the protein composition shows that finely dispersed proteins are dominated in breast milk, for the splitting of which it is necessary to significantly less the quantities (the disadvantage of which is characteristic of children of the first year of life), whereas in cow's milk predominates casein, requiring preliminary and subsequent digesting a significant amount of proteases; As a result, the risk of increasing protein components in the blood and development in the subsequent allergies to the protein of cow's milk is increased.

Immunological protection.

In breast milk, and especially in colostrum contains a large number of factors providing the child at first passive immunity (see Table).

Mososy and mature women's milk contains a significant amount of cellular elements. These are mainly neutrophils, T- and B-lymphocytes, macrophages, epithelial cells; In the colostrum, the content of cell elements reaches 10 in six degrees in 1 ml.

In female milk, immunoglobulins of various classes were found, which transmit passive humoral immunity from mother to the child and provides the first line of protecting the tract with the pathogenic flora after birth.

Special importance among immune protection factors has secretory immunoglobulin A, which prevents the binding of pathogenic microbes with the epithelial cell receptors of the intestinal epithelial cells, blocks the growth of the colonies of bacteria and contributes to the formation of normal intestinal microflora. In the composition of S- IGA, antibodies were found to causative agents of intestinal infections, RS virus, influenza viruses, poliomyelitis, rotavirus, staphylococci, diphetherapos of diphtheria and tetanus. In breast milk there is an anti-beam factor.

In female milk, there are also antibodies to the antigens of food received by the mother. In particular, mothers consuming a large amount of cow's milk, in breast milk contains antibodies to its proteins.

The protective function also performs a female milk protein - lactoferrin, which has a pronounced antimicrobial effect: tying iron ions, it suppresses the growth of microbes, which is associated with the seizure of iron. The iron associated with lactoferrine is necessary for the synthesis of hemoglobin and factor of tissue respiration (cytochromes) and, accordingly, for proliferation and growth of all cells of the growing organism. Laktorrin, binding excess free iron ions, suppresses the processes of lipid peroxidation and protects the tissues from damage.

The protective factors of breast milk also include C3 and C4 Complement fractions and lysozyme, the content of which, especially in colosure, is hundreds of times higher than in cow's milk.

The ratio of essential amino acids in breast milk (lysine, histinine, threonine, valine, methionine, isoleucine, leucine, phenylalanine) significantly more corresponds to the needs of the child than their content in the cow. In breast milk contains S-containing amino acid taurinewhich is a growth modulator and has a stabilizing effect on cell membranes. The newborn has a need for this amino acid, it is necessary for the construction of retinal, brain tissues, digestion and suction of fats, bilirubin conjugation. Nucleotides of female milk. Breast milk contains 13 acid-soluble nucleotides, of which the most important are AMP, GMF, UMF, CMF and IMF; Which in the body performs the role of regulators of various processes of biosynthesis, especially in its conditions of rapid growth, they have a positive impact on the immune response and lipid metabolism, increase the degree of iron absorption, contribute to the growth of bifioflores in the intestine and stimulate the ripening of enterocytes.

Number fatensuring the construction of cell membranes, tissue growth, the formation of fatty depot and covering the energy needs of the child, in women's and cow's milk are about the same, but there are significant differences in the fatty-acid composition. In female milk - 50% of polyunsaturated fatty acids, which is 2 times higher than in a cow. The effectiveness of the suction of fatty milk fat reaches 90%. It is affected by the presence of an active lipase in breast milk and the fact that fat milk fat is in a state of fine emulsion and is easier to split. The sizes of cow milk formed by saturated fatty acids are easily associated with Ca and stand out with a chair.

Special physiological role in the process of growth and development of the child is played by higher polyunsaturated fatty acids - linoleic, linolenic, arachidon. Linoleic acid belongs to essential, it is not synthesized in the body of children. From it, the child's body can actively synthesize arachidone acid. Polyunsaturated fatty acids increase the antioxidant potential of fabrics (primarily - brain tissues) and serve as predecessors in the synthesis of biologically active substances - prostaglandins, prostacyclines, leukotrienes with anti-inflammatory (leukotriene B) and histamic-like (leukotrienes C4, D4) action, are a powerful factor in the prevention of atherosclerosis. . The content of polyunsaturated fatty acids in cow's milk is 2 times lower than in female (there are many in sunflower and corn oil, swine fat). The ratio of polyunsaturated omega 6 (linoleic, arachidon) fatty acids to Omega 3 (Linolenova) in female milk close to the optimal (5/1). In many ways, the fatty-acid composition depends on the nutrition of the mother. Omega 3 fatty acids in large quantities are contained in fish products and fish oil. Omega 3 fatty acids have a protective value for child diseases.

Carbohydratesin female milk, presented mainly lactose (90% - beta-lactose). Lactose in the intestine is split by the enzyme lactase on glucose and galactose, which are actively absorbed. Lactaz "Children's type" is characterized by reduced activity, and in connection with which part of the lactose remains nonhydrolyzed and in the thick bowel is split by bifidobacteriums with the formation of lactic acid, which reduces the pH of the feast of breasts. The secondary lactase failure is very often developing in infants with intestinal infections and food allergies and then diarrhea can take a protracted nature and need to transition to low-beam power. Alpha lactose cow milk is harder to split the lactase "child-type".

After lactose oligosaccharide breast milk are the second large-breed milk carbohydrate group. Such oligosaccharides like fructose, galactose, fucose, beta-galactosyl fructose and some amino-mahara female milk have the properties of "bifidus factor", stimulating the reproduction of bifidobacterium and being in essence, prebiotics. They are not digested in the small intestine, reach thick, where they are subjected to fermentation with their own bifidobacteriums of the body, which leads to an increase in the biomass of the latter. In addition, undigested oligosaccharides are soluble food fibers that contribute to the formation of a soft stool in babies.

Oligosaccharides of female milk can exhibit microorganisms from the membrane intestinal receptors, which prevents adhesion and reproduction of microbes (Galacto-Mannose).

The child's need for electrolytes (see Table 2) - sodium, potassium, chlorine, which are necessary to maintain osmotic and ionic homeostasis and to create transmembrane cell potential - fully provided with natural feeding.

Table 2. The content of minerals and some trace elements in the female and cow's milk.

However, due to the immaturity of the neuroendocrine and renal regulation system of water and salt metabolism, dehydration, hyper-and hyposmia, hypongatremia, hypocalemia, hyperopalemia especially often develop in breast-old children. With an excess of lactic acid, metabolic acidosis is easily developed. When feeding an undiluted cow's milk, a child is experiencing a significant protein and, as can be seen from the table, electrolyte overload.

Mineral substances - calcium, phosphorus, magnesium in female milk are in such ratios that contribute to the better absorption and mineralization of bone tissue. The ratio of sa / r in it is optimally 2: 1. In case of artificial feeding, the child receives significantly greater than CA, but it is not absorbed, the excess of calcium in the diet is inhibits suction of proteins and fats in the intestine and leads to constipation.

In addition to iron, a zinc, which has an activating effect on the immune system and the necessary for the synthesis of DNA, the cell division, the synthesis of cells is of great importance from the microelements contained in breast milk.

Copper and selenium are necessary for the normal course of redox processes, immunity and ensuring antioxidant protection.

In breast milk there is a relatively stable composition (independent of meal) zinc, iron, calcium.

Iodine is necessary for the synthesis of thyroid hormones. The content of iodine, copper, selenium in female milk strongly depends on the geochemical features of the family living region.

Disadvantage vitamins In the nutrition of young children is a proven reason for the propagation of serious diseases, first of all, rickets and infectious diseases.

The integrated effect of vitamins A, E, C and beta-carotene determines the powerful antioxidant defense and a full-fledged immune response of the body.

Vitamin D plays an active role in the calcium exchange, affects muscle function. Children of the first year of life are particularly unprotected from vitamin D insufficiency.

Group vitamins are needed to implement all metabolic processes, growth process and normal digestion.

Table 4. The content of vitamins in the female and cow's milk

Thus, the advantages of breast milk before cow are obvious.

However, the pediatrician is necessary in an affordable form to explain to parents and, first of all, the benefits of not only breast milk, but also breastfeeding.

Benefits of breastfeeding:

Breast milk meets the needs of the child in proteins, fats, carbohydrates, minerals and vitamins.

Children on breastfeeding are less likely (see Immunity factors).

Children on breastfeeding are less likely there is a nutritional allergy.

They are below the risk of developing Rahita and anemia.

They are less likely there are intestinal colic, constipation and dysbacteriosis of the intestine.

In children on breastfeeding below the otite frequency

Less often bite anomalies.

Children on breastfeeding are ahead of children on artificial feeding in terms of neuropsychic and motor development.

Thanks to the close bodily contact with the mother, they are more obedient, calm, they love more and better understand it.

10. In women who fed their children with breasts:

the uterus is faster and postpartum bleeding stops

below the risk of mastopathy and breast cancer

below the risk of unwanted pregnancy

after stopping lactation, they better restore their initial weight.

It is convenient to feed the breasts (if the hygiene is observed, breast milk sterile, heated to the desired temperature, when feeding at night you do not need to get up and cook the mixture, the child calms down faster and falls asleep, when traveling and finding outside the house, the child is always provided with food).

Breastfeed is profitable, because The cost of the adapted mixture, which "suit" to the child can be quite high.

Prevention of hypoglactics.

Before pregnancy:

Monitoring the normal sexual development of girls

Prevention and timely treatment of hormonal dysfunction

Prevention of inflammatory diseases of the female genital sphere

Breast hygiene

During pregnancy:

Material inspection, nipple state correction

Breast hygiene

Psychological preparation for lactation

Rational food pregnant

The diverse nutrition of the mother during pregnancy and lactation provides the child's tolerance to food in the subsequent

In the hospital:

Rhodeworce natural way

Early (0.5 hours after childbirth) attaching a child to the chest

prolactin release

settlement of child's garter with normal microflora

reduced uterus

Mother and Child Joint Stay

Frequent applying to the chest

Compliance with breastfeeding rules:

alternation of feedings, if necessary - two chest

stirring in case of staggerness of breast milk

compliance with hygiene

proper applying to the chest

invalidity of the child from the chest before its saturation.

You can not give the child other liquids (sweet teas, water).

You can not register with mixtures or donor milk, especially from the bottle.

It is necessary to provide a nursing mother enough nutrition and drinking mode (2.5 - 3 l / day).

After discharge from the hospital:

Pediatrician monitoring compliance with breast feeding rules

Sufficient food and drinking Mother's Mode

Introduction of vitamins in the food diet

Sufficient dream and rest

Walks in the open air

Favorable psychological climate in the family

Invalidity of the bottle of reconstruction during lactation crises

Control weighing with suspected hypoglactic.

With suspected hypoglactic:

Power revision, drinking mode

If possible, eliminating the causes of hypoglactics

Use of products that increase lactation (mushroom soups, walnuts, tea with milk)

Hygoglactic phytotherapy (hawthorn fruits, hop, hop cones, cumin with sour cream, melissa, donel, roots and strawberry leaves forest, lactation teas)

Vitamin A 8.6% oil. Solution - 4 drops 2 times a day 20 days

Vitamin E 50 - 100 mg / day 10 - 14 days

Apilak 0.01 3 times a day 2 weeks

Nicotine Acid 0.05 - 0.1 3 times a day 0.5 hours before feeding 2 weeks

Dry beer yeast 1 - 2 g 3 times a day 3 weeks

Breast Massage Before Feeding

Table 5 WHO: breastfeeding and medicines

Nutrition nursing woman.

The full nutrition of the nursing mother has a significant effect on the composition of breast milk, which serves as a source of essential nutrients and vitamins for an infant child.

In this regard, the nursing mother is especially important to receive balanced nutrition. It is best suited for 5 meals a day with small noons between the main meals. The basis of the diet should be vegetable food (about 2/3), it is necessary to use the daily use of cereals from cereals: bread, rice, buckwheat, pasta products, as well as potatoes, fresh vegetables and fruits. (Proteins - 120 - 130 g, fats - 120 - 130 g, carbohydrates - 450 - 500 g.; 3700 - 4000 kcal.)

In addition, the daily diet must be protein food - meat, fish, cottage cheese, cheese, and most importantly - milk as a source of valuable protein and calcium (no more than 500 ml). Milk for pregnant women and lactating mothers "Bellakt" meets their increased needs in an easily dismantled protein, contains little fat, its carbohydrates are represented by milk sugar. It has a high content of minerals (calcium, phosphorus, sodium, potassium, magnesium) and microelements - iron, zinc, copper, manganese, iodine, the receipt of which is necessary to replenish the losses of these substances during pregnancy and childbirth and ensure their sufficient quantity in breast milk.

Milk "Bellakt" contains vitamins A, D, E, C, group B, beta-carotene. When using one glass of this drink, no additional reception of vitamins is required.

In the milk drink "Bellakt" contains a taurine, the necessary child to build the retina of the eye, brain tissues, digesting and suction of fats.

If there are intestinal dysfunctions from a mother or baby, cell milk, enriched with bifidobacteriums, can be used.

The nursing mother also needs in full-fledged drink, for example, in the form of fruit juices, tea, hobs, compotes, as breastfeeding significantly increases the need for vitamins and minerals. Useful use of teas to enhance lactation (HIPP, for example).

The advantages and necessity of breastfeeding are currently considered indisputable worldwide. According to the 5th session of WHO (2004) for the nutrition of children of the first year of life, the duration of only breastfeeding is established up to 6 months, and breastfeeding is recommended up to 2 years or more.

However, there is a reservation - but taking into account the national conditions and features of nutrition of nursing mothers. It is established, for example, that, starting from 3 to 4 months of age, the child is depleted with iron depot, and the need for it increases, and breast milk can no longer cover it - this can lead to a deficiency of iron. From 5 to 6 months of age, the needs and other food ingredients - proteins, fats, carbohydrates change, which leads to the need to introduce into the diet. baby Correcting additives to food and adhesive.

Natural

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

Composition of female milk

The optimal food for the child of the first months of life is maternal milk, appropriate to the features of its digestive system and metabolism, ensuring adequate development of the children's body with a rational nutrition of a nursing woman. All female milk nutrients are easily absorbed, since their composition and the ratio correspond to the functional capabilities of the gastrointestinal tract of the infant child, as well as due to the presence of enzymes in the women's milk (amylases, lipases, phosphatases, proteases, etc.) and transport proteins. Breast milk is a source of hormones and various growth factors (epidermal, insulin-like, etc.), which play a crucial role in regulation of appetite, metabolism, growth and differentiation of tissues and child organs.

Due to the presence, immune complexes, active leukocytes, lysozyme, macrophages, secretory immunoglobulin A, lactoferrin and other biologically active substances, breast milk increases the protective functions of the children's body. Oligosaccharides, as well as low levels of protein and phosphorus in female milk contribute to the growth of healthy intestinal microflora. In recent years, bifido and lactobacillia, determining the formation of immunity, are detected directly in female milk (Fig. 2).

Therefore, children on natural feeding are much less frequently ill with infectious diseases, develop more resistant post accmineous.

Protective properties of female milk are not limited to anti-infectious protection. Breast reduces the risk of development in subsequent years of diseases such as atherosclerosis, hypertension, sickness, diabetes, obesity, leukemia, etc. In children on breastfeeding, cases of sudden death are registered less often.

Natural feeding has a favorable effect on the development of the central nervous system of the child and his mental status. The unity of the mother and the child in the process of breastfeeding has a deep mutual emotional impact. It is noted that children who were fed to maternal milk are characterized by harmonious physical developmentThey are more relaxed, balanced, friendly and good are desirable compared to children who were on artificial feeding, and later the hundreds themselves are attentive and careless parents.

According to some data, in children who obtained breastfeeding, above the intellectual coefficient, which may be partly due to the presence of long-chain polyunsaturated fatty acids in breast milk (DPNCH) necessary for the development of brain and retinal cells. In the blood of children on breastfeeding, the number of DPHKK is significantly higher, compared with children who receive artificial feeding

The protein of female milk consists mainly of racking proteins (70-80%) containing indispensable

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

In female milk, in contrast to the cow milk, there is a large number of alpha lactalbium on (25-35%), which is rich in essential and conditionally essential amino acids (tryptophan, cysteine). Alpha Lactalbumin contributes to the growth of bifidobactivity, the absorption of calcium and zinc from the gastrointestinal tract of the child.

In the composition of the female milk there are nucleotides, which account for about 20% of all non-leisure nitrogen. Nucleotides are the initial components for constructing ribonucleic and deoxyribonucleic acids, it belongs to them in support of the immune response, stimulation of growth and differentiation of enterocytes.

The main components of the fat female milk are triglycerides, phospholipids, fatty acids you, sterols. Its fatty acid composition is characterized by a relatively high content of essential polyunsaturated fatty acids (PNGC), whose conversion in women's milk is 12-15 times greater than in a cow. PNCH - precursors of arachidon, eikapentanenenoy and subcosanese fatty acids, which are an important component of cell membranes, of which various classes of prostaglandins, leukotrienes and thromboxanes are formed, they are also necessary for the myelination of nerve fibers and forming the retina.

Long-chain polyunsaturated fatty acids - arachidonovaya and approxogeneous are contained in female milk in small quantities (0.1-0.8% and 0.2-0.9% of the total content of fatty acids, horizontally), but significantly higher than In Coro, we have a milk.

Fats The maternal milk is digested easier than cow, as they are more emulsified, in addition, in breast milk, linden enzyme is contained in digesting the fat component of milk, starting with the oral cavity.

The cholesterol content in female milk relatively high ranges from 9 to 41 mg%, stabilizing to 15 days of lactation at the level of 16-20 mg%. Children on natural feeding there is a higher level of cholesterol than when using baby milk mixtures. Cholesterol is necessary for formingcell membranes, tissues of the nervous system and a number of biologically active substances, including vitamin D.

Carbohydrates of female milk are presented mainly by Disacharida-lactose (80-90%), oligosaccharides (15%) and a small amount of glucose and galactose. In the face of a-lactose of cow's milk, B-lactose female milk slowly splits in the small intestine of the child, partially reaching the colon, where it is metabolized to lactic acid, contributing to the growth of bifido- and lactobacilli. Lactose contributes to the best absorption of minerals (calcium, zinc, magnesium, etc.).

Oligosaccharides are carbohydrates, including from 3 to 10 residues of monosaccharides, which are not exposed to chopping the enzymes of the digestive tract, are not absorbed in the small intestine and in unchanged form reach the lumen of the colon, where they are fermented, being a substrate for the growth of bifidobacteria. At the same time, competitive inhibition of development of conditionally pathogenic flora occurs. In addition, the oligosaccharides of female milk have receptors for bacteria, viruses (rotable), toxins and, thereby blocking their binding from the enterocyte membrane. The considered functions of oligosaccharides, as well as lactose, underlie the prebi-ootic effects of female milk, to a large extent determining its protective effect on intestinal infections in breast-age children.

The mineral composition of female milk is a significant way, but differs from the cow, which contains 3 times more salts, mainly due to macroelements. The relatively low content of mineral substances in female milk provides its low osmolarity and reduces the load on the immature excretory system. Macroelements include calcium, phosphorus, potassium, sodium, chlorine and magnesium. The remaining minerals are microelements and are present in the tissues of the human body in small quantities. Ten of them are currently attributed to the class of essential: iron, zinc, iodine, fluorine, copper, selenium, chrome, molybdenum, cobalt and manganese.

Minerals enter the body with food and water, and stand out - with urine, feces, then, with a sorted epithelium and hair.

It is assumed that iron, calcium, magnesium, zinc are absorbed significantly better from female milk than from cow. This is primarily due to their optimal relationship with other mineral substances (in particular calcium with phosphorus, iron with copper, etc.). The high bioavailability of trace elements is also provided by transport proteins of female milk, in hour, lactoferrine - iron carrier, ceruloplase-min - copper. The low level of iron in female milk is compensated by its high bioavailability (up to 50%).

The insufficiency of trace elements, which are regulated by the exchange processes, is accompanied by a reduction in adaptive capabilities and immunological protection of the child, and their pronounced deficit leads to the development of pathological conditions: a violation of the concession of the congestion of the bone skeleton and blood formation, a change in the osmotic properties of cells and blood plasma, a decrease in the activity of a number of a number of Enzymes.

In female milk, all the water and zhiros creative vitamins are present. The concentration of vitamins in milk is largely determined by the nutrition of a nursing mother and with the plain polyvitamin preparations. It should be emphasized, however, that the level of vitamin D in female milk is extremely low, which requires its additional appointment to children on natural feeding.

The deficit of vitamins leads to the violations of the far mentative activity, hormonal dysfunctions,

reducing the antioxidant capabilities of the child's body. Children are more often observed by polyhypovitaminosis, it is less commonly an isolated deficiency of one micronutrient.

The composition of the female milk changes in the process of lacquer, especially during the first days and months of breastfeeding, which allows the most fully to make the needs of the infant. A small amount of milk (colostrum) in the first days of lactation compensates for the relatively high content of protein and protective factors, in the following weeks the protein concentration in female milk decreases and in the future it remains almost unchanged. The most labile component of female milk - fat, the level of which depends on its content in the diet of a nursing mother and changes both during each feeding, increasing to its windows and throughout the day. Carbohydrates are more stable by the component of female milk, but their level also changes during feeding, being maximum in the first portions of milk.

Organization of natural feeding

In the maternity hospital in order to establish suica in terms of volume and lactation duration healthy newborn The child should be laid out on the mother's breast in the first 30 minutes after not complicated delivery for a period of at least 30 minutes.

The argumentation of this method includes the following provisions:

1. The early attachment of the child to the breast of the mother provides the rapid inclusion of milk secretion mechanisms and more stable subsequent lactation;
2. The sucking of the child contributes to the energetic chosen of the oxytocin and thereby reduces the danger of blood loss in the mother, contributes to an earlier reduction in the uterus;
3. Contact Mother and Child: - It has a soothing effect on the mother, disappears

stressful hormonal background; - contributes through the mechanisms of imprinting a strengthening of the sense of motherhood, an increase in the continued breastfeeding; - ensures newborn mother

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

• contains more leukocytes and other protection factors than mature milk, which largely protects the child from the intensive bacterial disgrace, reduces the risk of purulent-septic diseases;
• It has a soft laxative effect, thanks to this, the intestines of the child is cleaned of megonia, and with it from bilirubin, which prevents the jaundice once with the
• contributes to the establishment of the optimal intestinal microflora, reduces the duration of the phase of physiological dysbacteriosis;
• It contains growth factors that affect the ripening of the child's intestinal functions. To obtain a browse child in the maximum possible volume, the frequency of applying to the chest should not be regulated. In order to implement free feeding on demand healthy

the child must be in the same ward with his mother. It is shown that with free feeding the volume of lactation is higher than when feeding on the clock. Early applying to the chest and the "free veneer" are key factors for ensuring a full lactation and contribute to the establishment of close psycho-emotional contact between the mother and the child.

To maintain lactation, night feedings are especially significant, since the level of prolactin is higher. The duration of applying to the chest of a healthy child in the first days should not be limited, even when it is practically nothing sucks, and the chest is sleeping. The need for contact and sucking may be independent, relatively independent of food behavior. However, in the future, an excessively frequent attachment of the child to the mother's chest during its slightest concern can lead to the overlap. In this regard, one of the important tasks of pediatricians, in precision precinct, is the training of the mother's differentiation of the "hungry" scream of the child from the cry, due to other reasons: infant colic, discomfort, variation of the situation, overheating or cooling the child, pain, etc.

Assessment of lactation adequacy requires a thorough analysis of the child's behavior, the nature of the chair, the frequency of urination. By probable signs of lactation lactation are:

• anxiety and cry of a child during or immediately after feeding;
• the need for frequent applying to the chest;
• long feeding, in which the child makes a lot of sucking movements, in the absence of swallowing;
• The feeling of the mother of fast complete emptying of the thoracic glands with the active sucking of the child, when plugging after feeding milk there is no milk;
• Restless sleep, frequent crying, "hungry" cry;
• A meager rare chair However, the most reliable signs of short-term power supply are low body weight and rare urination (less than 6 times a day) with a small amount of concentrated urine. The final conclusion about insufficient lactation can be made on the basis of the results of the child's weighing at home after each feed during the day ("control" weighing).

In some cases, even with a sufficient amount of milk, Mother cannot feed the baby with breasts:

• The child takes the chest, but does not suck, does not swallow or sucks very little;
• When trying to give the chest, the child screams and resists;
• After a short sucking, it breaks away from the chest, falling from crying;
• The child takes one breast, but refuses another. The reasons may be different, among which the most common are:
• violations of the organization and technique of feeding (incorrect position of the child in the chest);
• an excess of milk in the mother at which it flows too fast;
• teething,
• Child diseases (perinatal damage to the nervous system, partial lactase insufficiency, gastrointestinal shape Food allers GIA, acute respiratory and viral infection, otitis, thrush, stomatitis, etc.). Clarification of the cause and conduct if necessary

Hygogalactium True (or) is rare, no more than 5% of women. In other cases, the decrease in milk generation caused by various reasons by us, the main of which are the lack of lactation dominants (psychological attitude) due to poor preparation during pregnancy, as well as emotional stress, early and unreasonable introduction of discomfort by children's mixtures, the need access to work, child disease, mother's disease, etc.

In some cases of hygoglactium, there is transient character, manifested in the form of so-called lactation crises, under which the temporary decrease of the amount of milk arising without a visible cause. The lack of information about them and not knowledge of correction methods - the most frequent factors for breastfeeding.

The basis of lactation crises are the features of the hormonal regulation of lactation. They usually naughte for 3-6 weeks, 3, 4, 7, 8 months of lactation. The duration of lactation crises on average is 3-4 days, and they do not pose a danger to the health of the child. In such cases, it turns out to be sufficiently more frequent attachment of the child to the chest in conjunction with feeding from both breasts. We need peace and rest mother; diverse, full, with high flavors nutrition; Warm drinking beverages especially with the use of lactogon herbs or pre parats for 15-20 minutes before feeding, as well as special lactagon action products.

If the mother is not prepared in advance to such a situation, then at the first signs of the decline in lactation, she is trying to pectinate the child to the mixtures. Therefore, one of the important tasks of the district doctor and nurses of children's polyclinic ki is to clarify the safety of short-term lactation crises.

Events used in secondary hypoga lactation (lactation crises):

• more frequent applying to the chest;
• Settlement of the mother's mode and nutrition (including optimal drinking mode due to additional use of at least 1 liter of fluid in the form of tea, compotes, water, juice);
• Impact on the psychological attitude of the mother;
• Orientation of all family members (father, grandmothers, grandfather's poverty) to support breastfeeding;
• Contrast shower on the area of \u200b\u200bdairy gloys, soft rubbing of the breast with a terry towel;
• the use of special drinks with a lactogon effect; At the same time, children's milk mixtures in the nutrition of the child without recommendations of the doctor are not entered.

Numerous observations show that the accurate breast milk developing mainly depends on the "Movement of Mother" to feeding his baby with breasts, her conviction is that it is important and necessary and that it is capable of implementing .. A more successful becoming lactation and its continuation Pass under conditions, when, besides the desire and confidence of the mother, it is actively supported by all family members, as well as professional advice and practical help of medical workers. It is advisable to teach women to breastfeeding issues during pregnancy in the "School of Pregnant".

The most important role in propaganda of breastfeeding is given to doctors and medical sisters, which should actively encourage family and social support for breastfeeding, provide parents

complete information about its comprehensive positive impact on the child's body and benefits to children's mixtures. To carry out activities on the successful formation and maintenance of practices, natural feeding, all health workers related to the objective and medical person who observes childhood children must have the ability to provide practical assistance to breastfeeding.

In accordance with the International Program of WHO / UNICEF "Protection, promotion and support of breastfeeding practices", where the main provisions in the form of ten principles of successful breastfeeding, the Ministry of Health of the Russian Federation developed a program for chest feeding and approved a number of normal Methodological documents (1994, 1996, 1998, 1999, 2000). According to these documents, in therapeutic and proflic institutions of the objects and childhood, the ropes will be held the following work on the support of natural feeding:

• have accessible printed information relating to the practice of breastfeeding practices that follows regularly to the attention of all medical personnel;
• inform all pregnant women on the advantages of breastfeeding and the need for early applying a newborn baby to the mother's chest (for the first 30 minutes after delivery);
• Provide a round-the-clock joint stay of the mother and a child in the Chamber "Mother and Child" of the maternity hospital and encourage breastfeeding for the child's request;
• teach mothers technology feeding baby breasts and preservation of lactation;
• To strive for the first 4-6 months of the life of the life of solely breastfeeding, that is, not to give healthy newborn children any food, except for breast milk, to exclude cases due to medical testimony;
• To ensure the continuity of the work of the female concentration, an obstetric hospital, a children's poly clinic and children's hospital. These activities need to be carried out with regard to the state of health, both mother and the child.

Possible contraindications to breast range Watching from the mother are: eclampsia, strong bleeding during childbirth and in the postpartum Perud, an open form, a state of pronounced decompensation in chronic diseases of the heart, lungs, kidneys, liver, and hyperthyroidism, sharp psyche diseases , especially dangerous infections (typhus, etc.), herpetic rashes on the nipple of the milk gland (until their fogging), HIV infection.

Currently it has been established that HIV is an info woman with a probability of 15% infect a child through breast milk. In this regard, in the Russian Federation, children born from HIV infiled mothers are recommended to feed adaptico-bathments.

With such diseases of the nursing mother as Red Ha, ,, epidemic, cytome-gallovirus infection, simple herpes, sharp intestinal and sharp respiratory and viral infections, if they proceed without pronounced, breastfeeding under the observance of common hygiene rules are not contraindicated. The presence of hepatitis B and with women is currently not contraindicated to the chest

fed feeding, however, feeding is carried out through special silicone lining. With acute hepatitis, the mother has breastfeeding.

In mastitis, breastfeeding continues. However, it is temporarily terminated when a massive growth in breast milk of golden coke stafilo in the amount of 250 more than 1 ml and single colonies of representatives of the Enterobacteriacae family or the species of Pseudomonas Aeruginosa (Methodical recommendations for bacteriological control of breast milk ka, Moscow, 1984). Breast is a possible complication of mastitis and is most likely with a sharp breaking of breastfeeding. Feeding from a healthy gland must continue, and the milk of infected breast should be gently constrained and pour.

Cessing breastfeeding in cases where the mother takes cytostatic in therapeutic doses, immunosuppressive drugs, anticoagulants of the Phoenindion type, radioisotope contrast agents for treatment or examination, drugs of lithium, most of your antiviral drugs (except acyclovir, Zidovudine, Zanamivir, Limovoudin, Ozheltamivir - with caution), anthelmintic drugs, attack some: (, midekamycin, roxitromycin, spiracecine), tetracycles, quinolones and fluoroquinolones, glycopeptides, nitrumidazoles, chlorine MEF nor count ,. However, the alternative drugs listed antibiotic cats are not contraindicated for breastfeeding.

Usually safe paracetamol, acetylsalicylic acid, ibuprofen, used in medium doses; most antitussive drugs; - and other penicilos,; (except rifabutin and); antifungal medium of TVA (except for fluconazole, griseofullvin, ketoconase, intractrazole); Antiprotozoic preparations (except metronidazole, tinidazole, dihydroeomethine, primahi); Bronnutators (); ; Antihistamines; antacids; antidiamatic agents; Most of the hypotensive varieties, as well as one-time doses of morphine and other narcotic drugs. At the same time, during the reception of drug drugs, the mother, it is necessary to observe the child with the goal of the detection of their side effects.

It is possible to invent lactation when taking a woman of estrogen, including estrogen-containing contraceptive you, thiazodic diuretics, ergometrine.

The translation of the child of his chest, especially newly born, on artificial feeding due to drug treatment of the mother drugs in the therapeutic dosage carries a dedicated threat to the state of his health and quality of life.

Considering the negative impact of tobacco smoke, resin and nicotine on the child's body and lactation, smoking women during lactation, it is recommended to refuse smoking. Nicotine can reduce the volume of milk generated and inhibit its release, as well as cause irritability from the child, intestinal colic and lead to a low rate of body weight at heart age. In smoking women below the level of prolactin, which can reduce the lactation period, and the concentration of vitamin C in breast milk is reduced compared to non-smoking. It is necessary to form in smoking women to motivate on the refusal of smoking or at least a significant decrease in the number

shipped cigarettes. The content of harmful substances in breast milk will be less if the woman smokes a cigarette after breastfeeding, and not before it.

Do not feed the child with breasts of mothers, suffering alcohol and narcotic (heroin, morphine, methadone or their derivatives) addiction.

Breastfeeding during the onset of the new bank can continue.

Contraindications for early applying to the child's chest from the child - assessment of the state of the newly born on the scale below 7 points with severe newborn, generic injury, cramps, respiratory disorder syndrome, as well as deep prematurity, heavy defective defects (gastrointestinal tract, maxillofacial apparatus, hearts, etc.).

To the number of contraindications to the early attachment of the child to the mother's chest until the very last time also related to the root separation by the CES operation of the Revo section. However, if this operation is carried out under peridural anesthesia, the attachment of the child to the chest in the generic hall is possible. If the delivery was carried out under anesthesia, then after the end of the operation, their parental is translated into the ward of intensive therapy of the maternity hospital, and the baby is in the children's chamber of the postpartum separation. After a few hours (no more than 4), after the end of the actions of the anesthesia, a children's sister brings a newborn to the mother and helps her attach it to his chest. During the first day, this is repeated several times. On the second day, with a satisfactory condition of the mother and baby, they are reunited in the postpartum separation of the co-stay of the mother and the child.

With a number of heavy congenital (heart defects with decompensation, wolf fall, hunger lip, etc.), when applying to the chest is impossible, the child must receive a recreational maternal milk. Absolute contraindications to breast range Watching from the child at the subsequent lactation stages are very limited - hereditary enzyme commits (etc.). With phenylketonuria, the volume of breast milk in combination with therapeutic products is established individually.

It should be discharged on issues of disappointing children on exclusively breastfeeding. Practice of domestic pediatricians shows that the newly born and older children who are breastfeeding sometimes need a bone. Such a state may be associated with low humidity in the apartment, increased temperature The environment, abundant fatty food eaten by the mother on the eve, etc. In these situations, it is possible to put water from a spoon with a child, and if he began to be eager to drink, then he also needed her. In addition, dopping is necessary for sick children, especially with diseases accompanied by high fever, diarries, vomiting, hyperbilirubineia.

Currently, there are more than 50 diseases that in children in the period of newborn can prohibit jaundice skin staining. Therefore, the last conservation of jaundice in the newborn requires a compulsory survey.

Even with a pronounced physiological jaundice in children in the first days of life, it is impossible to refuse breastfeeding. Early attachment of the child to the chest and frequent feedings are an important factor in the prevention of jaundice, since colostrum, possessing the laxative effect, leads to a more rapid disorder of the meconium. In case of insufficient nutrition, the newly born baby may be more intensive and long-term due to bile concentration. Doping with water or glucose solutions does not contribute to the presence of jaundice, but reduces the degree of its severity. It is important that the child get an adequate amount of milk, since in case of insufficient nutrition, it is developing bile thickening syndrome.

Breastfeeding - from the maternal milk or jaundice of Arias is once every 1-4% of children after the first week of life, characterizes the level of unrelated bilirubin and does not affect the condition of the child. Pathogenesis has been studied in no enough, it is assumed with the various components of breast milk. You can get confirmation of the diagnosis by stopping the attachment of the child to the chest and using pasteurized maternal milk for feeding for 1-2 days. During this time, the intensity of jaundice significantly decreases and can be continued to breastfeeding.

A child with hyperbilirubinemia, due to the incompatibility of AVO, it is advisable to feed the Gro Due from birth, since contained in milk are destroyed by hydrochloric acid and the enzymes of the digestive system. With a rhesus conflict, if the child has not been replaced by blood transfusion, it is fed with pasteurized during the first 10-14 days (during the pasteurization of the antibodies) mate with rhine or donor milk. In cases of replaced blood transfusion, 3-5 hours after the operation of the child can be attached to the chest.

Breastfeeding is advisable to continue to 1-1.5 years, and the frequency of the child's attachment to the chest after a year decreases to 1-3 times a day.