Correct feeding of young children is not only the harmonious development and growth of the baby, but also laying the foundation for his health and resistance to infectious diseases and unfavorable environmental factors. Parents should pay the greatest attention to the nutrition of children in the first year of life. This is mainly due to the peculiarities of their body (lack of a supply of nutrients, unformed metabolic processes and an undeveloped defense mechanism), which complicates the process of assimilating nutrients from food. The conversation about the nutrition of children in the first year of life should start with considering the 3 main types of feeding: natural, artificial and mixed.

2.Natural feeding

Natural (breastfeeding) feeding is a form of nutrition for a newborn child, it is the only physiologically adequate nutrition for a newborn and an infant.

Breastfeeding is called natural. Human milk is a unique and most balanced food product for a baby in the first year of life; The composition of each mother's breast milk exactly corresponds to the needs of her baby in various substances: proteins, fats, carbohydrates, vitamins and minerals; Mother's milk contains special substances - enzymes that promote the digestion and assimilation of proteins, fats and carbohydrates; The mother's milk contains immunoglobulins and immune cells that protect the child from most infectious diseases: intestinal infections, infectious hepatitis, diphtheria, tetanus and others;

2.1. Benefits of human milk:

1. Human milk is completely devoid of antigenic properties, while cow's milk proteins have a pronounced antigenic activity, which contributes to the appearance and intensification of allergic reactions in infants.

2. The total amount of protein in breast milk much less than in cow, in structure it is close to the proteins of the child's cells. It is dominated by fine fractions, particles of coarse protein casein are several times finer than in cow's milk, which ensures that breast milk is curdled in the stomach with more delicate flakes and thereby more complete digestion.

3. Female milk contains such a unique substance as taurine - a sulfur-containing amino acid with neuro-active properties. With artificial feeding, protein overloads inevitably occur, since cow's milk contains three times more amino acids. These overloads are accompanied by intoxication, kidney damage due to metabolic disorders.

4. Human milk, especially colostrum, excreted in the first 3-4 days, is very rich in immunoglobulins, especially class A, with 90% of secretory IgA, which plays a fundamental role in the local immunity of the gastrointestinal tract of newborns. Leukocytes of breast milk synthesize interferon: it contains a large number of macrophages, lymphocytes. Lysozyme levels are 300 times higher than in cow's milk. It contains the antibiotic lactofelicin. Thereby breastfeeding ensures the formation of immuno-biological protection infant, in connection with which the morbidity and mortality of children who are breastfed are significantly lower than those with artificial feeding.

5. The amount of fat in human and cow's milk is practically the same, but there is a significant difference in its composition: breast milk contains several times more unsaturated fatty acids. The breakdown of fat in infants begins in the stomach under the influence of breast milk lipase; it stimulates the appearance of active acidity in the stomach, helps to regulate the evacuation function of the stomach and earlier release of pancreatic juice. All this facilitates the digestion and assimilation of fat, the individual components of which are part of the cells of all tissues and biologically active substances, are spent on myelination of nerve fibers, providing an increased need for fats in a 1-year-old child.

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

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

8. The mineral composition of food, the content of bioelements in it is of great importance for the growing organism. The concentration of calcium and phosphorus in breast milk is lower, but their absorption is two times better than from cow's milk. Therefore, with natural feeding, children are much easier and less likely to get sick with rickets. The content of bioelements (sodium, magnesium, chlorine, iron, copper, zinc, cobalt, sulfur, etc.) in breast milk is optimal and meets the needs of the child. Breast milk contains four times less sodium than cow's milk. Excessive sodium loads can cause vegetative-vascular dystonia with fluctuations in blood pressure during puberty, as well as more severe and more frequent crises in adult hypertension.

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

10. It has been shown that with natural feeding, sexual potency is better and fertility is higher.

11. With natural feeding, a life-long relationship to the mother is laid, her subsequent influence on the child's behavior, and also the future parenting behavior is formed.

The benefits and necessity of breastfeeding are now recognized as undeniable throughout the world.

Every pediatrician should 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 compelling arguments for mothers when talking with them.

Children's need for basic food ingredients

Since most often, when switching to artificial feeding, the child switches to feeding with formulas based on cow's milk, we will give a comparison of the composition of breast and cow's milk.

Table 1: Comparison of Breast Milk and Cow's Milk by Main Food Ingredient

Breast milk contains 1 - 1.2 g / 100 ml of protein, which is sufficient for the development of the baby. There is much more protein in cow's milk; excess protein can lead to earlier maturation of children - earlier death - tumors; kidney damage. Protein deficiency primarily affects the gastrointestinal tract: malabsorption syndrome, “mucosal baldness”.

Comparison of breast and cow's milk in terms of protein composition shows that fine proteins predominate in breast milk, for the breakdown of which a much smaller amount of enzymes is needed (the lack of which is characteristic of children in the first year of life), while casein predominates in cow's milk, which requires preliminary curdling and subsequent digestion of significant amounts of proteases; as a result, there is an increased risk of ingestion of undegraded protein components into the bloodstream and subsequent development of an allergy to cow's milk protein.

Immunological protection.

In breast milk, and especially in colostrum, there are a large number of factors that provide a child with passive immunity at first (see table).

Colostrum and mature milk of women contains a significant amount of cellular elements. These are mainly neutrophils, T- and B-lymphocytes, macrophages, epithelial cells; in colostrum, the content of cellular elements reaches 10 to the sixth power in 1 ml.

In human milk, immunoglobulins of various classes are found, which transmit passive humoral immunity from mother to child and provide the first line of defense of the gastrointestinal tract from pathogenic flora after birth.

Of particular importance among the factors of immune defense is secretory immunoglobulin A, which prevents the binding of pathogenic microbes to the receptors of epithelial cells of the intestinal mucosa, blocks the growth of bacterial colonies and promotes the formation of normal intestinal microflora. The S-IgA contains antibodies to pathogens of intestinal infections, RS virus, influenza viruses, poliomyelitis, rotavirus, staphylococcus, diphtheria and tetanus pathogens. There is an anti-lambliasis factor in breast milk.

Human milk also contains antibodies to antigens from food received by the mother. In particular, mothers who consume large amounts of cow's milk contain antibodies to its proteins in breast milk.

Protective function is also performed by the protein of human milk - lactoferrin, which has a pronounced antimicrobial effect: by binding iron ions, it inhibits the growth of microbes, which is associated with the capture of iron. Iron associated with lactoferrin is necessary for the synthesis of hemoglobin and tissue respiration factors (cytochromes) and, accordingly, for the proliferation and growth of all cells of a growing organism. Lactoferrin, by binding excess free iron ions, inhibits lipid peroxidation and protects tissues from damage.

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

The ratio of essential amino acids in breast milk (lysine, histidine, threonine, valine, methionine, isoleucine, leucine, phenylalanine) is much more consistent with the needs of the child than their content in cow milk. Breast milk contains an S-containing amino acid taurine,which is a growth modulator and has a stabilizing effect on cell membranes. In newborns, the need for this amino acid is increased, it is necessary for the construction of the retina, brain tissues, digestion and absorption of fats, conjugation of bilirubin. Human milk nucleotides. Breastmilk contains 13 acid-soluble nucleotides, of which the most important are AMP, HMF, UMF, CMP, and IMP; which in the body play the role of regulators of various processes of biosynthesis, especially in conditions of its rapid growth, they have a positive effect on the immune response and lipid metabolism, increase the degree of absorption of iron, promote the growth of bifidoflora in the intestine and stimulate the maturation of enterocytes.

Quantities fat, providing the construction of cell membranes, tissue growth, the formation of fat depots and covering the energy needs of the child, in human and cow's milk is approximately the same, but there are significant differences in fatty acid composition. Human milk contains 50% polyunsaturated fatty acids, which is 2 times higher than in cow's milk. The absorption efficiency of breast milk fat reaches 90%. Its absorption is influenced by the presence of active lipase in breast milk and the fact that the fat of human milk is in a state of fine emulsion and is more easily broken down. Cow's milk fats formed by saturated fatty acids easily bind with Ca and are excreted in the stool.

Higher polyunsaturated fatty acids - linoleic, linolenic, arachidonic, play a special physiological role in the growth and development of a child. Linoleic acid is referred to as essential, it is not synthesized in the body of children. From it, the child's body can actively synthesize arachidonic acid. Polyunsaturated fatty acids increase the antioxidant potential of tissues (primarily brain tissues) and serve as precursors in the synthesis of biologically active substances - prostaglandins, prostacyclins, leukotrienes, which have anti-inflammatory (leukotriene B) and histamine-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 milk (there are many of them in sunflower and corn oil, lard). The ratio of polyunsaturated omega 6 (linoleic, arachidonic) fatty acids to omega 3 (linolenic) in human milk is close to optimal (5/1). In many ways, the fatty acid composition depends on the mother's nutrition. Omega 3 fatty acids are found in large quantities in fish products and fish oils. Omega 3 fatty acids have a protective role in child's diseases.

Carbohydratesin human milk are represented mainly by lactose (90% - beta-lactose). Lactose in the intestine is broken down by the enzyme lactase into glucose and galactose, which are actively absorbed. Lactase "child type" is characterized by reduced activity, and therefore part of the lactose remains unhydrolyzed and in the large intestine is broken down by bifidobacteria with the formation of lactic acid, which lowers the pH of feces in infants. Secondary lactase deficiency very often develops in infants with intestinal infections and food allergies, and then diarrhea can be protracted and a transition to low-lactose nutrition is necessary. The alpha-lactose in cow's milk is more difficult to break down by the "baby-type" lactase.

After lactose, breast milk oligosaccharides are the second most important group of breast milk carbohydrates. Oligosaccharides such as fructose, galactose, fucose, beta-galactosyl-fructose and some amino sugars in human milk have the properties of a "bifidus factor", stimulating the multiplication of bifidobacteria and being, in essence, prebiotics. They are not digested in the small intestine, reach the large intestine, where they are fermented by the body's own bifidobacteria, which leads to an increase in the biomass of the latter. In addition, undigested oligosaccharides are soluble dietary fiber that promote soft stool in babies.

Oligosaccharides of human milk can displace microorganisms from the connection with membrane receptors in the intestine, which prevents adhesion and multiplication 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 the transmembrane potential of cells - is fully met by breastfeeding.

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

However, due to the immaturity of the system of neuroendocrine and renal regulation of water-salt metabolism in infants, dehydration, hyper- and hypoosmia, hyponatremia, hypokalemia often develop. With an excess of lactic acid, metabolic acidosis easily develops. When fed with undiluted cow's milk, the child experiences significant protein and, as can be seen from the table, electrolyte overload.

Minerals - calcium, phosphorus, magnesium in human milk are in such proportions that promote their better absorption and bone mineralization. The Ca / P ratio in it is optimal and is 2: 1. With artificial feeding, the child receives much more Ca, but it is not absorbed, the excess of calcium in the diet inhibits the absorption of proteins and fats in the intestines and leads to constipation.

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

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

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

Iodine is essential for the synthesis of thyroid hormones. The content of iodine, copper, selenium in human milk strongly depends on the geochemical characteristics of the region of residence of the family.

Disadvantage vitamins in the nutrition of young children is a proven cause of the spread of serious diseases, primarily rickets and infectious diseases.

The complex action of vitamins A, E, C and beta-carotene determines powerful antioxidant protection and a full-fledged immune response of the body.

Vitamin D plays an active role in calcium metabolism and influences muscle function. Children of the first year of life are especially unprotected from vitamin D deficiency.

B vitamins are essential for all metabolic processes, growth and normal digestion.

Table 4. Vitamin content in human and cow's milk

Thus, the advantages of breast milk over cow's milk are obvious.

However, the pediatrician needs to explain in an accessible form to the parents and, first of all, to the mother the benefits of not only breast milk, but also breastfeeding.

Benefits of breastfeeding:

Breast milk meets the baby's needs for proteins, fats, carbohydrates, minerals and vitamins.

Children who are breastfed are less likely to get sick (see immunity factors).

Food allergies are less common in breastfed babies.

They have a lower risk of developing rickets and anemia.

They are less likely to have intestinal colic, constipation and intestinal dysbiosis.

Children who are breastfed have a lower incidence of otitis media

Less common malocclusion.

Children who are breastfed are ahead of artificially fed children in terms of neuropsychic and motor development.

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

10. In women who breastfeed their children:

the uterus contracts faster and postpartum bleeding stops

lower risk of mastopathy and breast cancer

lower risk of unwanted pregnancy

after the cessation of lactation, they better restore their original weight.

It is convenient to breastfeed (subject to hygiene, breast milk is sterile, warmed up to the desired temperature, when feeding at night, you do not need to get up and prepare the mixture, the baby calms down and falls asleep faster, when traveling and being outside the home, the baby is always provided with food).

Breastfeeding is beneficial because the cost of an adapted formula that is "suitable" for a child can be quite high.

Prevention of hypogalactia.

Before pregnancy:

Monitoring the normal sexual development of girls

Prevention and timely treatment of hormonal dysfunctions

Prevention of inflammatory diseases of the female genital area

Breast hygiene

During pregnancy:

Examination of the mammary gland, correction of the condition of the nipples

Breast hygiene

Psychological preparation for lactation

Rational nutrition of a pregnant woman

A varied diet of the mother during pregnancy and lactation ensures the child's tolerance to food in the future

In the maternity hospital:

Natural delivery

Early (0.5 hour after birth) latching on to the breast

prolactin release

colonization of the child's digestive tract with normal microflora

uterine contraction

Joint stay of mother and child

Frequent breastfeeding

Compliance with the rules of breastfeeding:

alternation of feedings, if necessary - two breasts

expressing in case of stagnant breast milk

hygiene

correct attachment to the breast

the inadmissibility of the weaning of the child from the breast before it is saturated.

Do not give your child other liquids (sweet teas, water).

Do not supplement with formula or donor milk, especially from a bottle.

It is necessary to provide the nursing mother with adequate nutrition and drinking regime (2.5 - 3 l / day).

After discharge from the hospital:

Pediatrician control over compliance with the rules of breastfeeding

Adequate nutrition and drinking regime for the mother

Introduction of vitamins into the diet

Adequate sleep and rest

Walks in the open air

Favorable psychological climate in the family

Inadmissibility of bottle supplementation during lactation crises

Control weighing for suspected hypogalactia.

If hypogalactia is suspected:

Revision of nutrition, drinking regime

If possible, eliminate the cause of hypogalactia

Using foods that increase lactation (mushroom soups, walnuts, milk tea)

Herbal medicine for hypogalactia (hawthorn fruits, decoction of hop cones, caraway seeds with sour cream, lemon balm, sweet clover, roots and leaves of wild strawberry, lactation teas)

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

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

Apilak 0.01 3 times a day 2 weeks

Nicotinic acid 0.05 - 0.1 3 times a day 0.5 hours before feeding 2 weeks

Powdered brewer's yeast 1 - 2 g 3 times a day 3 weeks

Breast massage before feeding

Table 5 WHO: Breastfeeding and Medicines

Nutrition of a nursing woman.

Adequate nutrition for a nursing mother has a significant impact on the composition of breast milk, which serves as a source of essential nutrients and vitamins for the infant.

In this regard, it is especially important for a nursing mother to receive a balanced diet. 5 meals a day are best, with small snacks in between meals. The diet should be based on plant foods (about 2/3), daily consumption of products from cereals is necessary: \u200b\u200bbread, rice, buckwheat, pastaas 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 include 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 requirements for easily digestible protein, contains little fat, its carbohydrates are represented only by milk sugar. It contains a high content of minerals (calcium, phosphorus, sodium, potassium, magnesium) and microelements - iron, zinc, copper, manganese, iodine, the intake of which is necessary to replenish the loss of these substances during pregnancy and childbirth and ensure their sufficient amount in the breast milk.

Milk "Bellakt" contains vitamins A, D, E, C, group B, beta-carotene. When consuming one glass of this drink per day, additional intake of vitamins is not required.

The Bellakt milk drink contains taurine, which is necessary for a child to build the retina of the eye, brain tissue, digest and absorb fats.

If the mother or baby has intestinal dysfunctions, you can use Bellakt milk, enriched with bifidobacteria.

A nursing mother also needs a full drink, for example, in the form of fruit juices, tea, fruit drinks, compotes, since breastfeeding significantly increases the need for vitamins and minerals. It is useful to use teas to increase lactation (HIPP, for example).

The benefits and necessity of breastfeeding are now recognized as undeniable throughout the world. According to the data of the 5th session of the WHO (2004) on nutrition of infants in the first year of life, the duration of breastfeeding alone is set up to 6 months, and breastfeeding is recommended for up to 2 years or more.

However, there is a reservation - but taking into account the national conditions and the characteristics of the diet of nursing mothers. It has been established, for example, that, starting from 3-4 months of age, the child's iron depot is depleted, and the need for it increases, and breast milk can no longer cover it - this can lead to iron deficiency. From 5 to 6 months of age, the needs for other food ingredients also change - proteins, fats, carbohydrates, which leads to the need to introduce corrective food additives and complementary foods into the infant's diet.

. "Bottle feeding" - defines only the technique of feeding from a bottle through a nipple with expressed human milk or formula.
"Artificial feeding" - feeding from a bottle with formulas - breast milk substitutes even in the presence of a single attachment to the breast or the total volume of breast milk up to 50
100 ml regardless of the presence or absence of complementary foods.

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Natural feeding.
Every doctor should strive to organize the infant
feeding.
We must urge all doctors, regardless of their specialization, to be active advocates and fighters for natural feeding, focusing primarily on improving the health of women - expectant mothers and creating clear targets for breastfeeding in them.
What are the benefits of breastfeeding over other forms of infant feeding that healthcare professionals should know and use to promote breastfeeding?
Human milk is a unique biochemical substance, which contains ideal nutrients in ideal ratios for a baby. These ratios are rigidly determined as species biological characteristics of a person, dynamically changing in the process of adaptation of a newborn to extrauterine existence.
So, the first portions of milk produced by a woman after childbirth are called colostrum. Colostrum - a highly concentrated substrate that satisfies with its small amounts the high energy and plastic material requirements of a newborn who has just undergone birth stress.
Colostrum, transitional milk and mature milk contain unique
biological components:
- species specific antibodies;
- active leukocytes and macrophages;
- adaptive hormones;
- enzymes involved in digestion and facilitating the utilization of milk;
- antimicrobial factors - lysozyme, lactoferrin;
- levorotatory isomer of milk sugar - beta-lactose and oligosaccharide - lactulose (or bifidus factor), causing priority colonization of the child's intestines with lactic acid flora;
- and many other factors not yet studied.
All of these substances are destroyed by boiling and even by sterilization. This is why we are talking about the benefits of breastfeeding, and not just about the benefits of human milk over artificial formula made with cow's milk.

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In addition, an important advantage is the fact that breast milk is usually sterile, warmed up to the optimal temperature, which creates elements of convenience for both mother and baby.
The indispensable positive qualities of breastfeeding include the formation of close maternal ties, which are important in the formation of a family, the formation of a child as a social being.
Breast milk allows you to save a significant part of the family budget with an excellent price-quality ratio.
Breastfeeding affects the health of the mother and is an effective means of reducing the risk of cancer in women.
Thus, breast milk is the ideal food for babies in the first months of life. Currently, pediatricians around the world are recognized, and this is enshrined in the documents of the World Health Organization (WHO) and the Union for the Protection of Children (UNICEF) (Geneva, 1979) that breastfeeding was, is, and probably
for a long time will still remain the most complete
nutrition of infants.
Exceptions to this rule so rare that you can hardly take them into account. This refers to the extremely rare congenital autosomal recessive diseases:
galactosemia, manifested, as a rule, immediately after birth, jaundice and hypoglycemic convulsions due to the non-assimilation of galactose from breast milk by the child. Galactosemia occurs with a frequency of 1 newborn per 100,000 births;
congenital
lactase
failure,
intolerance to milk sugar - lactose disaccharide, manifested by fermentation diarrhea from the moment of birth;
phenylketonuria -intolerance to the amino acid phenylalanine, which is found in milk, and which accumulates in the body and turns into a poison for the nervous system.
In many other cases, contraindications to breastfeeding are relative and temporary.Indeed, at the risk of transmitting infectious or immune pathogens with milk, it is possible to feed the child with pasteurized or boiled breast milk, it is possible to postpone the start of feeding during treatment, etc.

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Physiological bases of lactation.
Lactation - the process of milk secretion by the mammary gland controlled by a complex secretion regulation system. In the development of the mammary gland and the formation of lactation, the following successive phases are distinguished:
mammogenesis (the development of the mammary gland in the first 2-3 months of pregnancy), lactogenesis(milk secretion at the end of pregnancy and after childbirth), galactopoiesis (accumulation of secreted milk) and automatism
breast secretion ... Lactation processes are under the control of a complex regulatory system, including, first of all, hormonal control, the nervous system and the action of mediators. The increase and proliferation of the acini of the mammary gland provides the action of progesterone, and estrogen promotes the development of the milk ducts. In the regulation of mammogenesis and lactogenesis, prolactin, STH, ACTH, TSH, insulin, and chorionic gonadotropin play a role.
Under milk secretion understand intracellular biosynthesis and the release of formed substances outside the cell that have a strictly specific meaning. Secretory cycle flowing in the epithelial cell of the mammary gland, consists of 5 phases:
1.absorption by a cell from blood and tissue fluid of substances necessary for the formation of milk;
2. intracellular synthesis of complex molecules;
3. the formation of a drop or granule of secretion;
4. transport it to the apical end of the cell;
5. exit (extrusion) of the secretion from the cell into the lumen of the alveoli.
Extrusion of substances formed in the secretory cells of the mammary gland is carried out according to the following mechanisms:
- apocrine. The distal end of the cell turns into a drop of secretion, is pulled into the lumen of the alveolus and detaches from the cell along with a portion of the cytoplasm and dilated microvilli.
The reduced cell gradually grows to its original size and begins a new cycle of secretion;
- holocrine.
As a result of the accumulation of secretion, the cell is reborn and completely secreted into the lumen of the alveoli. Replenishment of cells lost in this way occurs due to intensive mitosis of the secretory epithelium;
- merocrine. The secret leaves the cell through pores in the cell membrane.
A variation of the merocrine mechanism is
lemmocrine , in which the apical plasmolemma flows around the formed drop of secretion from all sides and detaches from the cell without damaging the cytoplasm.
IN colostrum period the apocrine mechanism prevails, in high
lactation - merocrine, in stages of gland involution - holocrine.

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There are the following periods of breastfeeding :
preparatory - the formation of a psychological attitude towards breastfeeding, from the school age of the expectant mother to the end of pregnancy. Active preparation for lactation occurs during pregnancy;
mutual induction period - from the first application immediately after childbirth with skin contact until significant milk secretion occurs, or
"Tide" on the 3-5th days after childbirth;
adaptation period - from an irregular regime to the formation of a stable rhythm of hunger and satiety. Growth intensity increasing to a maximum (10-12 g / kg / day). The emergence of the phenomenon of "cry of a child - milk flow".
main period - successful feeding with gradually increasing or constant intervals between feedings, good emotional contact between mother and baby, good nutritional status of the baby.
The accumulation of his subcutaneous fat layer.
Composition of human milk
Characterizing the composition of human milk, it is necessary to highlight the following features:
1. Optimal and balanced levels of nutrients for the child as they grow older.
2. High digestibility of nutritional substances of human milk by the child's body.
3. Low osmolality.
Thanks to these features, human milk is fully consistent with the characteristics of the child's metabolism and in the early stages has a positive effect on growth, development, immunological resistance, intellectual potential, behavioral and mental responses and learning ability of children.
The chemical composition of human milk is shown in Table 2.

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Table 2.
Average chemical composition of human milk (per 1 liter).
TYPE OF MILK
FOOD
SUBSTANCES
UNITS
CHANGE
Colostrum
o (1-5days)
Transiently
e (6-10 days)
Matured
e (from 15 days)
Protein g 22 17.5 10
Fat g 25 44 45
Carbohydrates g 57 64 73
Energy value kcal
545 725 740
MINERALS
Calcium mg 255 260 255
Phosphorus mg 124 158 130
Sodium mg 410 325 180
Potassium mg 810 650 455
Magnesium mg 36 32 30
Iron mg 0.85 0.59 0.40
Copper mg 0.65 1.04 0.30
Manganese mcg
8,5
Traces 3,5
Zinc mg 8 3.8 1.4
Iodine mcg
45-450 -
20-100
Chlorine mg 890 650 390
Fluorine mcg
- 130 5-100
Selenium mcg
42 -
15
VITAMINS
Retinol (A) μg
1600 880 550
Carotenoids μg
1370 380 200
Calciferol
(D) μg
- -
1,3-
76,0
Tocopherol (E) mg 14.8 8.9 4.3
Vitamin K μg
- - 0,6-9,3
Thiamine (B1) mg 0.02 0.06 0.2
Riboflavin
(B2) mg 0.3 0.37 0.6
Pyridoxine
(B6) mg -
-
0,18
Niacin (PP) mg 0.75 1.75 2
Cyanocobalam n (B12) mcg
0,45 0,35 0,50

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Folic acid (Sun) μg
5 5,7 14
Pantothenic acid (Bz) mg 1.8 2.9 4.5
Ascorbic acid (C) mg 72 70 62
Biotin mcg
- - 4,8
Choline mg -
-
50-140
Natural feeding technology.
Time plays an important role in the development of lactation in a woman who has given birth.
first attachment the baby to the breast, which is currently recommended to be carried out immediately after birth, directly in the delivery room within 30-60 minutes after birth, taking into account the condition of the newborn and the woman in labor. Early attachment to the breast has a positive effect on the condition of both the mother and the child, accelerates the onset of milk production, and increases its production. It is important to emphasize that the first portions of breast milk (colostrum) contain significant amounts of immunoglobulins and other protective factors, and therefore their intake into the child's body increases the infant's resistance to infections and other unfavorable external factors that he encounters immediately after birth.
Contraindications to early breastfeeding by the mother:
surgical intervention during childbirth;
severe bleeding during childbirth and postpartum;
open form of tuberculosis;
the state of decompensation in chronic diseases of the heart, kidneys, liver;
acute mental illness;
malignant neoplasms.

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If you have a positive serological test for HIV infection, milk can be expressed and given to the baby after sterilization.
Contraindications to early breastfeeding by a child:
assessment of the condition of the newborn on the Apgar scale below 7 points;
severe asphyxia of the newborn, impaired cerebral circulation,
deep prematurity, severe malformations
(maxillofacial apparatus, heart, gastrointestinal tract, etc.).
Another key factor in ensuring complete lactation is free feeding regimen a newborn, in which the children themselves set the intervals between feedings, which can be achieved when the mother and child are together in the same ward.
For many years in our country, the main approach to feeding children was feeding strictly by the hour, with observance at the beginning
3-hour and then 3.5-hour break between feedings. However, in last years a revision of these recommendations took place, and at present it should be recognized that the "free" feeding or, otherwise, feeding on the "baby's demand", which means latching the baby to the breast as many times and at such a time as the baby requires, should be recognized, including at night clock. Feeding frequency depends on the newborn's reflex activity and birth weight.
A newborn baby may "require" from 8-10 to 12 or more breastfeeding per day. Feeding time can be 20 minutes or more. By the end of the first month of life, the frequency of feeding usually decreases (up to 7-8 times), and the duration of feeding decreases. Night feedings with free feeding of newborns are not excluded: THE BABY SHOULD REFUSE NIGHT FEEDING
CAM... Free breastfeeding contributes to the establishment of optimal lactation and the establishment of close psycho-emotional contact between the mother and the child, which is very important for the correct emotional and neuropsychic development of the infant.
Recent studies have shown that with free feeding, the volume of lactation in the first week after birth is 1.5 times or more higher than with hourly feeding. At the same time, the "specific" content (ie, the content per 1 liter of milk) of proteins, fats, vitamins and the activity of a number of milk enzymes is not lower, and in some cases even higher than with

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feeding by the hour. The consequence is a large total (daily) secretion with milk of basic nutrients. The tendency for a greater volume of lactation and greater secretion of nutrients with milk with free feeding than with feeding "by the hour" persists in subsequent periods of lactation.
Free feeding undoubtedly has a positive effect on the mother's lactation function, health and physical development child. Only in some cases, when the mother does not understand the reasons for the child's anxiety and attempts to eliminate it by frequent attachment to the breast, can there be overfeeding phenomena associated with an increase in the growth rate and the development of overweight. In this regard, one of the important tasks of district pediatricians is to teach the mother to differentiate the "hungry" cry of the child from the cry associated with the fact that he has intestinal colic or is uncomfortable, scared, bored, sad, cold, or, conversely, hot.
Is of great importance correct technique breastfeeding... In the first days after birth, babies can be fed in one single breastfeeding. After the milk "arrives", you can feed the baby each feed from both breasts, so that the feed ends from the breast from which the feed began.
Feed should be done in a comfortable position for the mother, in a relaxed environment.
The most comfortable position is sitting and so that the child is in an upright position (preventing air from entering the child's stomach). At night and if it is impossible to feed while sitting, you can feed while lying on your side. It is desirable that during feeding, the child has the opportunity to contact the mother as closely as possible (skin-to-skin, eye-to-eye contact). With such close contact, not only the formation of the child's attachment to the mother takes place, but also additional hormonal stimulation of lactation, which is especially important both during its formation in the first days and weeks after childbirth, and with a temporary decrease in lactation in connection with the so-called lactation crises.
Pumping breast milk may be advisable only in the early period of establishing lactation in the absence of the possibility of "free" feeding of the child or the inability of the child, for one reason or another, to effectively suction colostrum or milk. Otherwise, there is no need to express colostrum or milk.
The decision on whether a woman needs to express milk should be made only after consulting a qualified health worker - a midwife or obstetrician. In this case, manual expression is preferable, the technique of which should be taught to the woman by the postpartum nursing staff. If manual expression is ineffective, you can use a breast pump, preferably a piston pump.

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An important factor in the formation and maintenance of lactation in a woman is adherence to a nursing woman's regimen. What should be
mode pregnant and lactating women in terms of preventing milk deficiency?
In the second half of pregnancy the total caloric content of food must be increased to 3000-3500 kcal / day, and the need for protein - up to 2 g / kg of a woman's body weight per day. The daily diet of a pregnant woman at this time should be 100-120 g of protein, of which 60% is an animal, 80 -
100 g of fat (of which 20% vegetable oil), 300-350 g of carbohydrates (they need to be somewhat limited by sugar, confectionery, wheat bread). A pregnant woman's diet should contain a varied range of vegetables and fruits. Limit salt intake to 5-6 grams to prevent edema. The needs of pregnant women for vitamins significantly exceed the physiological needs of an adult, therefore, it is advisable to prescribe vitamin preparations containing physiological doses of vitamins, including vitamin D for pregnant women.
Nutrition nursing mother should be about the same as in the second half of pregnancy, its calorie content is 3200-
3500 kcal per day.
An approximate daily set of products is 200 g of meat, poultry or fish, 1 liter of milk in any form, 100-150 g of cottage cheese, 20-30 g of cheese, 1 egg, 600 g of vegetables (of which no more than 200 g of potatoes), 200- 300 g of fruit.
Pregnant and lactating women

Natural feeding is feeding a baby with human milk by latching the baby to the breast. When a mother has a question why she should breastfeed her baby, she should first of all know the benefits of breastfeeding the baby and how radically it differs from cow's milk.

Benefits of breastfeeding your baby:

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

The difference between breast milk and cow milk:

1. Protein content. There is less protein in breast milk than in cow's milk, fine fractions prevail in it, particles of coarse protein casein are several times smaller, which ensures that breast milk is curdled in the stomach with more delicate flakes, which facilitates the digestion process.
2. Breast milk proteins are similar to plasma proteins, and cow's milk proteins have a pronounced AH activity, which contributes to the appearance of allergic reactions.
3. The amino acid content in breast milk is less, which is more optimal for the baby. There are three times more amino acids in cow's milk, this leads to protein overload, which can lead to metabolic disorders.
4. Human milk, especially colostrum secreted in the first three days, is very rich in immunoglobulins, especially A, which plays an important role in the creation of local immunity in the gastrointestinal tract of newborns. The level of lysozyme is 300 times higher than in cow. It contains the antibiotic lactofelicin. Thereby infant has good immuno-biological protection.
5. The amount of fat is the same, but there is an important distinguishing feature, it is the composition of fat. Unsaturated fats predominate in breast milk. Proven that artificial feeding often leads to obesity.
6. Carbohydrates in breast milk are abundant.
7. Breast milk is rich in enzymes: amylase, trypsin, lipase. In cow's milk, enzymes are hundreds of times less. This compensates for the temporary low enzymatic activity of the child and ensures the absorption of a fairly large amount of food.
8. The mineral composition of breast milk: the amount of calcium and phosphorus is less than in cow's milk, but absorption is twice as good, so breastfed babies are much less likely to get rickets. The content of bioelements (sodium, magnesium, iron, zinc, etc.) in breast milk is optimal and meets the needs of the child. Breast milk contains a large amount of vitamin D, which helps prevent rickets.

Basic principles of successful breastfeeding:

1. Strictly adhere to the established rules for breastfeeding and regularly bring these rules to the attention of medical personnel and women in childbirth.
2. Train health-care personnel in the skills necessary to carry out the breastfeeding practice.
3. Inform all pregnant women about the benefits and techniques of breastfeeding.
4. Help mothers to start breastfeeding within the first half hour after giving birth.
5. Show mothers how to breastfeed and how to maintain lactation even if they are temporarily separated from their babies.
6. Give infants no food or drink other than breast milk unless medically indicated.
7. To practice around the clock finding the mother and the newborn side by side in the same ward.
8. Encourage breastfeeding as requested by the infant rather than on a schedule.
9. Do not give breastfed infants any sedatives or devices that imitate the mother's breast (nipples, pacifiers).
10. Encourage the organization of a breastfeeding support group and refer mothers to these groups after leaving the maternity hospital.

Rules for successful feeding:

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

2) in the first weeks, it is advisable to provide the child with a free feeding regime (at the request of the child) and only later transfer the child to the hourly food that he himself chose;

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

4) if there is not enough milk, it is necessary to often latch the baby to the breast. It must be remembered that for nursing baby every drop of mother's milk is priceless. However, frequent breastfeeding can increase milk production in the breast.

Possible contraindications for breastfeeding on the part of the mother:

Eclampsia;

Heavy bleeding during or after childbirth;

Open form of tuberculosis;

Decompensation or chronic diseases of the heart, lungs, kidneys,

baking, as well as hyperthyroidism;

Acute mental illness;

Especially dangerous infections;

Herpetic eruptions on the nipple of the mammary gland (before their follow-up treatment);

HIV infection;

Mastitis in a woman:upon detection of massive growth of St. aureus ≥ 250 CFU in 1 ml and / or a single growth of Enterobacteriacae and Pseudomonas aeruginosa (Guidelines for bacteriological control of breast milk, Moscow, 1984);

Taking cytostatics, immunosuppressive drugs, anticoagulants, some antibacterial drugs;

Alcohol and nicotine addiction.

Breastfeeding during a new pregnancy can continue.

Contraindications to early attachment to the mother's breast with the child's side:

Apgar score below 7 points;

Birth injury;

Seizures;

Deep prematurity;

Severe malformations (gastrointestinal tract, maxillofacial apparatus, heart, etc.);

Delivery by surgery cesarean section (under anesthesia).

Absolute contraindications for breastfeeding on the part of the child in the subsequent stages of lactation:

Hereditary enzymopathies (galactosemia);

Phenylketonuria (with an individual selection of medical nutrition).

In the first days after childbirth, it is important for the development of lactation:

early breastfeeding,

feeding the baby on demand,

joint stay of mother and child,

prevention of lactocrisis.

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

1) physiological catarrh of the skin;

2) physiological jaundice;

3) physiological weight loss;

4) uric acid infarction.

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

During this period, diseases and conditions associated with the pathology of the intrauterine, intrapartum 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, and sleep.

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

Children who are breastfed are 3 times less likely to get intestinal infections, 1.5 times less likely to have respiratory diseases.

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

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

The child receives 100 mg of YgM per day. The placenta of ruminants is impermeable to immunoglobulins. Colostrum of ungulates contains mainly YgG, and YgA and YgM - in insignificant amounts.

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

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

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

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

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

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

9. Human milk, especially colostrum, unlike cow's milk, contains hormones of the pituitary gland and thyroid gland.

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

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

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

13. The ratio of the sum of the amount of whey lactoalbumins and lactoglobulins to caseinogen is 3: 2. In cow's milk this ratio is 3: 2, therefore the adapted mixtures are enriched with whey proteins. When curdling milk in the stomach, casein produces large flakes, and albumin - small, which increases the surface for contact with hydrolysis enzymes.

Human milk also contains proteolytic enzymes.

14. The main component of human milk fat is triglycerides. In children, due to the low activity of pancreatic lipase and low concentration of conjugated bile salts, hydrolysis of fat is difficult. In breast milk, the palmitic acid content is lower, which facilitates easier hydrolysis. The nutritional value of triglycerides of cow's milk is lower than that of human milk, due to the greater formation of free fatty acids, which are excreted. The coefficient of assimilation of fat in human milk in the 1st week of life is 90%, in cow's milk - 60%, further increases slightly. The fat composition of human milk is also different from that of cow's. The fat in human milk is dominated by unsaturated essential fatty acids, 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 the development of the brain, the retina of the eyes, and the formation of electrogenesis. In human milk, compared to cow's milk, there is a higher content of phosphatides, which ensure the closure of the pylorus during the passage of food into the duodenum, which leads to a uniform evacuation from the stomach, and promote protein synthesis. The fat absorption coefficient of human milk is 90%, for cow's milk it is less than 60%. This is explained by the presence of the lipase enzyme in human milk with its higher activity 20–25 times. Lipase breakdown of milk fat provides active acidity in the stomach, which contributes to the regulation of its evacuatory function and earlier release of pancreatic juice. Another reason for the better digestibility of human milk fat is the stereochemical arrangement of fatty acids in triglycerides.

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

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

Colostrum is a sticky, thick yellow or gray-yellow liquid that is secreted at the end of pregnancy and in the first 3 days after delivery. Curd easily when heated. Colostrum contains more protein, vitamin A, carotene, ascorbic acid, vitamins B12, E, salts than in mature milk. Albumin and globulin fractions prevail over casein. Casein appears only from the 4th day of lactation, its amount gradually increases. Before latching the baby to the breast, the colostrum has the highest protein content. Colostrum is especially rich in YgA. There is less fat and milk sugar in colostrum than in mature milk.

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

Colostrum proteins are absorbed unchanged due to the identity of the proteins of the child's serum.

Colostrum is an intermediate form of nutrition between the periods of hemotrophic and amniotrophic nutrition and the onset of lactotrophic (enteral) nutrition. The energy value of colostrum on the first day is 1500 kcal / l, on the second - 1100 kcal / l, on the third - 800 kcal / l.

Natural feeding - feeding a baby by latching on to the breast of his biological mother. It represents the only form of adequate nutrition for a child after birth and for 1–1.5 years of life.

The first attachment of the newborn in the maternity hospital is carried out simultaneously with the first contact procedure. A normal full-term baby by the time of birth has everything in order to successfully suckle according to the innate feeding program within 120–150 minutes after birth: climbing to the mother's breast, coordinated action of hands and mouth in an active search for a nipple with a wide open mouth, tenacious suction to the breast and vigorous saturation before falling asleep.

Breastfeeding should be started within the first hour after birth, when both the baby's reflexes (searching and sucking) and the sensitivity of the nipple area (areola) to tactile stimulation in the mother are highest. Skin contact after childbirth should be close - on the mother's abdomen after an uncomplicated birth. When feeding, the child should grasp the nipple and areola with a vigorous "vigorous" movement with the head lifting the breast, and then, as it were, applying it when the breast moves down, on a wide-open mouth, with the tongue laid down under the breast, but not protruding out. Grasping only one nipple without the areola and then sucking it is ineffective and immediately leads to the formation of a crack. Sucking effectiveness is determined by rhythmic massage of the areola with the child's tongue. If sucking at the first skin contact did not take place, then it is inappropriate to keep the baby at the breast for more than 2 hours. It is also ineffective to attach the baby or create skin contact 2-3 hours after delivery.

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

The attachment of the child to the breast should be carried out from the first day, at any sign of hunger or discomfort on the part of the child. Hunger signs can be active sucking movements of the lips or rotational movements of the head with various sound signs even before screaming. The frequency of application can be 12–20 or more per day. The break between daily feedings may not reach 2 hours, between night feedings there may be no more than 3-4 hours.

The most natural deficiency states during breastfeeding.

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

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

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

4. Iron deficiency. From 1 liter of breast milk, the baby receives about 0.25 mg of iron, from other food sources - about the same.

With natural feeding, iron supplementation should be carried out with iron medications or through iron-fortified mixtures, if necessary, the introduction of supplements.

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

The introduction of complementary foods depends on the quality of breast milk. Optimal feeding when good nutrition pregnant and lactating women may well ensure the development of a child without complementary foods up to 1–1.5 years.

Lack of confidence in optimal feeding requires the introduction of thick complementary foods in the interval from 4 to 6 months.

You can use 50–20 g of grated apple or fruit puree as a training food. With good swallowing, good tolerance and the absence of an allergic reaction, it can be given regularly for complementary foods and transferred to the beginning of feeding. Most suitable age - between the 16-24th week of life, the duration of this complementary feeding is 2-3 weeks (see table. 4).

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

1) more than 5-6 months old;

2) the established adaptation to the promotion and swallowing of thick food when using training complementary foods;

3) completed or current eruption of a part of the teeth;

4) confident sitting and head control;

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

First, a trial dose of complementary foods is introduced - 1–2 tsp. and then, with good tolerance, there is a rapid build-up to 100-150 ml of puree from fruits or vegetables or porridge without salt and sugar based on buckwheat or rice.

Stages of complementary feeding expansion:

1) training complementary foods;

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

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

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

5) porridge with wheat flour;

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

7) the beginning of "piece" feeding: biscuits, slices of bread, sliced \u200b\u200bfruit, steam cutlets.

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

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

With good tolerance of complementary foods and the child's appetite, the volume of one serving of feeding can be 200-400 g by the III-IV quarter of the first year.