Pediatrics feeding. Breast-feeding. General information. When to start breastfeeding

Lecture number 3

There may be difficulties in breastfeeding on the part of the mother and child. There are absolute and relative contraindications to breastfeeding.

From the mother's side

1. Moderate to severe nephropathy
2. Operative delivery
3. Large blood loss during childbirth
4. Perineal rupture grade 2
5. Purulent-inflammatory diseases of the mother
6. Rhesus conflict
7. Some extragenital diseases of the mother (hypertension, stage 2, diabetes mellitus, severe anemia, diseases of the cardiovascular system and kidney with decompensation).

From the side of the child:

1. Apgar score less than 7 points
2. Asphyxia
3. Birth injury
4. Hemolytic disease of the newborn
5. Developmental defects
6. Prematurity with no swallowing and sucking reflexes
7. Respiratory distress syndrome

Complications arising from feeding:

1. Development of lactostasis:

a) Primary inflammatory lactostasis - 2-4 days after childbirth, in the woman's diet, the use of liquid (especially warm) should be limited, the baby should be applied to the breast as often as possible. If the flow of milk occurs at night and the baby does not wake up, expressing breast milk. With pronounced lactostasis, it is recommended once - sinestrol 300,000 units, an agent that reduces the viscosity of milk (25% magnesium sulfate solution, 30 ml 2 times a day, hypothiazid, 0.1 once a day), an agent that increases the evacuation capacity of a woman's milk ( oxytocin 5 drops in the nose, proserin 1 tablet 10 minutes before feeding).

b) Secondary inflammatory lactostasis - chest pain + fever up to 38 and above, chills - the above treatment is carried out for 2-3 days with anti-inflammatory therapy.

Absolute contraindications on the part of the child

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

Children in these cases are fed with expressed milk, with HDN - donor milk.

Absolute contraindications on the part of the mother:

1. Malignant tumors
2. acute mental illness
3. Severe forms of blood and hematopoietic diseases
4. pronounced form of Graves' disease
5. Severe forms of kidney disease
6. Severe forms of CVD diseases with decompensation

With pneumonia, flu, sore throat, the issue of breastfeeding is decided depending on the condition of the mother: in severe cases, feeding is temporarily stopped, in the lungs, they are fed with boiled expressed milk. With an active form of tuberculosis, the child is separated from the mother from the moment of birth and removed from home for 1.5-2.0 months (to the neonatal pathology department) in order to develop immunity after vaccination.

Relative contraindications on the part of the mother:

1. Irregular nipples (small, inverted). The baby has to adjust to the nipples. In severe cases, you temporarily have to feed through special glass nozzles.
2. Mastitis is a serious obstacle: the pediatrician and obstetrician-gynecologist decides whether to attach the baby to the breast. It is taken into account that on the one hand, good suction from the mammary glands will lead to the reverse development of inflammatory changes, on the other hand, a septic infection can be introduced to the newborn. Therefore, breastfeeding with purulent mastitis is contraindicated, resumes after a strictly individual decision.
3. A common cause is cracks and abrasions in the nipples. To prevent cracks, oil pads with vitamin A, sea buckthorn oil, rose hips, and calendula oil are used. They are washed off before feeding. For cracks, drugs are used:

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

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

c) the eucalyptus leaves are poured cold, then boiled for 15 minutes, infused for 2 hours, the breast is treated before feeding

d) chlorophyllipt solution 2% - processed after feeding.

Relative obstacles on the part of the child:

1. Cleft lip and hard palate - you can adapt to sucking. In severe cases, spoon-fed or tube-fed
2. Thrush is a temporary problem that requires treatment
3. Short frenulum of the tongue - no difficulty in sucking
4. Human milk intolerance - rarely (enzymopathy) - the child is transferred to medicinal mixtures.

Hypolactia is the reason for transferring children to mixed and artificial feeding in 80-90%.

1.Primary - a condition in which a sharp lack of milk in the mother is noted from the first days in 3-8% - is associated with diseases of the VAS and a violation of the level of hormones in the woman's body.

2. Secondary - more often the cause is mastitis, cracked nipples, acute diseases of the mother. The leading place is the psychological factor - the lack of a firm attitude towards the need for breastfeeding, mental illness and trauma. Violation of the feeding rhythm - violation of the milk formation function - sucking activity decreases. Sluggish sucking - insufficient irritation of the mammary glands - decreased lactation. Secondary hypolactation is caused by: complications of pregnancy, childbirth, the postpartum period, irrational lifestyle, malnutrition, overwork, diseases of the CVS, respiratory organs, kidneys, etc., late attachment of the baby to the breast, a long break between feedings.

The variability in the amount of milk sucked out may be greater, therefore, it is necessary to carefully diagnose hypolactation. Confirmed by the observation of diuresis, the dynamics of the increase in body weight, control feedings are carried out for several days.

4 degrees of milk deficiency:

To save long lactation and prevention of hypolactation is necessary:

1. Tranquil home environment
2. Strong confidence in the need for breastfeeding
3. Extra sleep and rest
4. Correct, balanced nutrition with the use of special products (femilak-2)
5. Frequent latching of the baby to the breast (on demand)

To eliminate primary hypolactation, therapeutic hormonal drugs, lactogenic hormones are used (lactin - 6 U * 3 times a day * 6 weeks, mammofizin - 0.5 ml * 3 times a day before feeding).

Reveal the causes of hypolactation and eliminate them.

In the treatment of secondary hypolactation, in addition to establishing the causes

use metabolic complexes (biogenic stimulants, vitamins, microelements), they are prescribed for 7-10 days and repeated as needed

Complex number 1

Apilak tablets 0.01 3 times a day under the tongue until completely absorbed

Multivitamins - gendevit (up to 30 years old), undevit (over 30, 1 tablet 2 times a day after meals. Additionally, vitamin E in tablets (with a weight of up to 60 kg. - 0.1 each, more than 60 kg. - 0.2 each) )

Glutamic acid 1.0 3 times a day 20 minutes after meals, washed down with sweet tea.

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

Complex number 2

Brewer's yeast 60 gr. 3 times a day (dry 1 teaspoon)

Gefetin 1 tablet 4 times a day

Calcium pantothenate 1 tablet 3 times a day

Lipoic acid 1.0 3 times a day

Asparkam 1 tablet 3 times a day

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

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

In case of insufficient breast milk, they are transferred to mixed or artificial feeding.

MIXED FEEDING - the child, along with human milk, receives supplementary feed in the form of animal milk or mixtures made from it and the amount of supplementary feed is more than 1/5 of the food

ARTIFICIAL FEEDING - breast milk is completely absent or is less than 1/5 of the daily food intake.

Artificial feeding at 1 year - metabolic stress. There is a relationship between artificial feeding and an increased risk of obesity, diabetes, cardiovascular disease, etc.

Infants are fed breast milk more than 4 weeks, the rest receive mixed or artificial feeding.

Reasons for a decrease in breastfeeding:

1. hypolactation
2. mother's employment in production
3. unwillingness to breastfeed, due to the increased ability to feed with various formulas

In the absence of maternal and donor milk, animals are fed with milk.

Composition of cow's milk:

3 times more proteins and salts, but less carbohydrates. The increased protein content is not a positive factor, because foreign protein, coarsely dispersed, difficult to digest.

Main disadvantages:

1. It contains 3 times less high-grade Protein than human milk
2. In cow's milk, there are fewer albumin, excess protein is converted into ballast protein as a result of difficulty in assimilation, which creates stress in the nutrition process
3. Not identical in protein and carbohydrate content in cow's milk
4. Fats when broken down give lower fatty acids
5. Carbohydrates are more fermentable because contain a-lactose
6. There are significantly fewer vitamins in cow's milk (C 5 times, A 9 times), vitamins of group B are well represented, which sharply decrease during the preparation of mixtures
7. Significantly fewer enzymes
8. Does not contain antibodies - no lactation immunity
9. The negative point is pollution. For artificial feeding, you need guaranteed milk (baby).

Guaranteed milk requirements

Carbohydrates not less than 4.5 g / l

Acidity no more than 20

Give at least 85 g / l of dry residue

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

To avoid the growth of germs, milk must be kept cold. Consume after pasteurization or boiling. Under the influence high temperature- denaturation of milk, demulsification of fats, coagulation of proteins, destruction of vitamins, therefore pasteurized no more than 5 minutes.

In a 3-week-old baby, ion-exchange milk is used as a supplement (whole milk is passed through a special apparatus containing ion-exchange resins), during this process essential amino acids and carbohydrates are introduced.

Proteins of ion-exchange milk are curdled in small flakes - assimilation increases, approximately 20% of calcium is precipitated - buffering decreases and assimilation improves. After passing, the B vitamins are added.

In children on artificial feeding- Difficulty digesting cow's milk and a high incidence of digestive disorders. For ease of assimilation - a number of mixtures.

Mixture groups:

1. Non-adapted mixtures - prepared from cow's milk by dilution, they differ significantly in quality from human milk
2. Adapted mixtures - in them the cow's milk protein is pretreated, vegetable fats with polyunsaturated fatty acids and taurine, carnitine, vitamins, mineral salts (iron, etc.) are added. They are close in composition to human milk, but they have biological differences. BAS (hormones, enzymes) contained in human milk ensure the proper development and formation of the child's body, antibodies and immune complexes protect the child from diseases.

With the first drops of colostrum, the baby is naturally immunized.

Breastfeeding, carried out for a long time, reliably protects the child from early sensitization, reducing the risk of developing allergic diseases.

There are 2 groups:

Sweet mixes

Fermented milk mixtures

This has implications for metabolism and the state of local immunity in the intestine.

1.Unadapted mixtures - simple milk mixtures - dilution of cow's milk with 5% broth of various cereals (buckwheat, oatmeal, rice), in ratios

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

1: 1 - mixture No. 2 (B-mixture 54 kcal)

2: 1 - mix No. 3 (B-mix)

They are defective. Unsatisfactory mixture No. 1 (not used), mixture No. 2 - on a short time transitional mixture. Of all, the most acceptable mixture is number 3: in 100 ml of proteins 1.9, fats - 2.3, carbohydrates - 7.58, calories 59 kcal.

The industry produces mixtures:

They are not complete. have a lot of carbohydrates and calcium, little iron and vitamins, a low amount of fats (polyunsaturated fatty acids), a deficiency of amino acids - lys, lei, three, the shaft is unbalanced. The assimilation of simple mixtures occurs with a great strain of digestion.

Milk buffering is reduced by the acidification method: kefir - biological acidification - the action of lactic acid fermentation bacteria.

Kefir - stimulates the secretion of digestive juices, increases the secretion of bile, slowly and evenly leaves the stomach - are created favorable conditions for digestion. The lactic acid of kefir hydrolyzes fats and provides gentle curdling of proteins. Kefir inhibits the growth of pathogenic microflora in the intestine.

In the first 8 months of life, the breeding of kefir - B - and B-kefir (dilution of 5% with a decoction of cereals) is used. Sugar 5% is added, acidified with sourdoughs. B-kefir as a transitional mixture (1-3d). In kefir - in the absence of adapted mixtures and certain diseases up to 8 months. You can feed whole kefir from 8 months of age. When using kefir for up to 8 months, submucous diapedetic hemorrhages appear in the intestine, which play a role in the development of anemia.

3-day kefir is used for lactase deficiency because the lactase content is insignificant, it is used for mild forms of food allergies because protein fractions are less antigenic than cow's milk.

Fermented milk mixtures "Biolact" and "Biolact 2" use cow's milk, which is fermented with specially selected bacteria. "Biolact" has high proteolytic properties, contains a number of essential amino acids, vitamins (B12) and essential enzymes. Proteins are easily broken down and absorbed. When using "Biolact" hematopoiesis is activated. "Biolact 2" is enriched with microelements and vitamins. Used in children early age and newborns throughout the year.

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

Powdered formula, similar in composition to breast milk - adapted milk formula (breast milk substitutes). Although no processing line has been proven to be capable of producing a semblance of human milk, there is considerable similarity to dry mixes.

There are 4 types of breast milk substitutes:

1. Initial mixtures - used during the first two months of life. They are close in composition to breast milk and are adapted to the characteristics of the digestion and metabolism of children in the first year of life. They contain taurine, carnitine, which are not found in cow's milk, but are present in human milk.
2. Subsequent mixtures - intended for further feeding (after 2 months). Must be fortified with iron. by 3 months of life, iron stores are depleted - the risk of developing an iron deficiency state.
3. Partially adapted mixtures
4. Subsequent formulas - milk formulas for feeding from 5-6 months of age

(For mixtures see Appendix Table 1)

When transferring a child to mixed and artificial food

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

needs for basic ingredients. Adapted milk formulas should be preferred.

2. It is necessary to determine the amount of mother's milk and the amount of supplementation

3. Should be supplemented after each feeding

4. Begin feeding with small portions - increase the volume to the required amount.

With mixed feeding, the diet is free (on demand when controlling the amount of milk). If the amount of supplementary food is small, it is given from a spoon, because more easily, the easy entry through the nipple leads to the rejection of the breast. For large amounts of supplementation, use a bottle with a nipple with a fine hole.

The transfer of a baby to artificial feeding in the 1st month should not be quick, because its adaptation is intense due to physiological immaturity.

With artificial feeding of children of 1 months of life, 7 meals a day (after 3.5 hours) are recommended before the introduction of complementary foods - 5 meals a day.

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

The timing of the introduction of food additives: with mixed and artificial feeding:

Fruit juices - from 4 months.

Fruit puree - 4.5 months.

Cottage cheese - from 6 months

Yolk - from 7 months.

Meat dishes - from 7 months.

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

1st complementary food - from 5 months - vegetable puree... If it is not gaining weight well - 1m complementary food can be porridge.

2nd in 1 month after 1st (from 6 months)

3rd - from 8 months.

It is advisable not to use whole milk in children 1 year of age.

With mixed and formula feeding, the daily protein requirement depends on the type of dairy product.

When feeding with adapted formulas: (before the introduction of complementary foods)

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

When feeding with unadapted formulas: (before the introduction of complementary foods)

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

The need for fats and carbohydrates is the same

With a mixed diet, the calorie content increases by 5%, with an artificial one by 10%. With a large body weight of children, the amount of feeding is calculated based on the average amount of proteins and carbohydrates. The daily food volume may be below normal. At the age of 1.5-2.0 months, 1/6 of the body weight can be given, and if the dynamics correspond to age, then there is no need to increase the content of nutrients. With insufficient and excessive increase in body weight, nutritional correction is carried out.

Eating prematurely.

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

Children weighing 2000gr. And more, which are in a relatively satisfactory condition, maybe.

attached to the breast as full-term (after 20-30 minutes). The child's fatigue is monitored - cyanosis of the nasolabial triangle, shortness of breath. With these symptoms, the number of feedings is limited.

Children weighing 1500-2000 gr. In the absence of severe pathology, a trial bottle feeding is carried out.

Deeply premature babies weighing 1000-1500 g are fed through a tube (in the absence of swallowing and sucking reflexes).

If it is not possible to carry out enteral nutrition - parenteral nutrition. Complete parenteral nutrition - in case of a very serious condition of the child, ulcerative necrotizing enterocolitis, some abnormalities in the development of the gastrointestinal tract, in the pre and postoperative period. When carrying out parenteral nutrition, daily monitoring of CBS of blood, the level of basic elements, glucose, urea, measurement of urine output.

As soon as possible (with stabilization of the state), it is necessary to introduce the minimum volume of enteral nutrition. As a result of the introduction of a small volume of milk (4-8 ml), the release of intestinal hormones is stimulated, its motor is improved, the intestinal wall does not suffer, which contributes to the normal development and full functioning of the gastrointestinal tract in the future.

If an immature child tolerates breastfeeding well or sucks the norm out of the bottle, a 7-8 meal time is set for him every 2.5 - 3.0 hours with a 4 hour night break

If necessary (weight less than 1500 grams and severe symptoms of CNS depression), premature babies are fed portionwise through a nasogastric tube (7-10 times a day). Children with underdeveloped reflexes of swallowing and sucking are fed through a tube, which is inserted at a distance equal to the distance from the bridge of the nose to the xiphoid process for 2 days, removed, sterilized and injected through the other half of the nose. When the sucking reflex appears, feed from a bottle with a nipple.

With parenteral nutrition, an indwelling catheter is inserted into a vein and fluid is injected.

Composition of infusion solutions:

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

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

Volumes of food

1. the first 8 days of life according to Rommel's formula: milk volume = 10 + n (day of life) - this is the amount of milk per 100 g. body weight
2. more than 10 days by volume-weight method

? - 10-14 days 1/7

? - 2-3 weeks 1/6

By 1 month 1/5

1. Calorie method for premature babies

7 days - 70 kcal

10 days 100 kcal

20 days 120 kcal

Features of metabolism

1. High caloric requirement at the age of the first 6 months. - 120 body weight from 7 to 12 months. - 115 kcal / kg of body weight EB

2.Increased need for vitamins, microelements

3.Positive nitrogen balance

4.Increased need for water

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

1 to 3 years - 120 - 100 ml / kg

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

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

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

Breast milk:

B - 50% -albumins all essential amino acids, Jg, finely dispersed, easily absorbed; -lactose and oligoaminosugar - bifidogenic factors, 28 microelements, 19 enzymes, vitamins, hormones, antibodies, lysozyme, coagulation factors; naturalness, sterility; bio, communication; risk of diabetes, atherosclerosis, leukemia, chr. diseases of the digestive system, allergic diseases.

In the first 7-8 days of life, the daily volume of milk for a child can be calculated using the Finkelstein formula, V = 70 (80) * n where V is the daily amount of food, n is the number of days of life, 70 and 80 are empirical figures; the number 70 is taken if the child's body weight at birth is less than 3200 g, the number 80 is the body weight of 3200 g or more.

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

Volume weight method

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

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

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

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

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

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

Colory way

per 1 kg of body weight, a breastfed child should receive up to 3 months - 120 kcal / day;

from 4 to 6 months - 120 kcal / day;

from 7 to 12 months - 115 kcal / day;

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

According to the child's need for food ingredients (most accurate)

Protein requirements are:

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

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

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

Fat requirement:

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

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

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

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

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

Mixed feeding: before the introduction of complementary foods 3.0 gr. protein with adapted mixtures 3.5 gr. with unadapted mixtures; after the introduction of complementary foods 3.5 gr.

Artificial feeding: before the introduction of complementary foods 3.5 gr. protein with adapted mixtures; 4.0 g with unadapted mixtures; after the introduction of complementary foods 4.0 gr.

Feeding mode. First feeding in the first 20-30 minutes after birth. Feeding on demand 3-4 weeks. 6 times a day after 3.5 hours - before the introduction of complementary foods. 5 single feeding after 4 hours - after the introduction of complementary foods.

Complementary foods

Nutritional supplements

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. 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 Compared to Other Forms of Infant Feeding You Should Know medical workers and use in promoting breastfeeding?
Human milk is a unique biochemical substance, which contains ideal nutrients in ideal ratios for a baby. These ratios are rigidly determined as specific 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 quantities 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, not just the benefits of human milk over artificial formula made from cow's milk.

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In addition, an important advantage is the fact that breast milk is usually sterile, warmed 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 saves a lot family budget with a remarkable ratio of the "price-quality food" indicator.
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, which manifests itself, 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 fermentative 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 for the duration of 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, 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, which 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 alveoli 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 the 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.
V colostrum period the apocrine mechanism prevails, in high
lactation - merocrine, in stages of involution of the gland - holocrine.

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Distinguish the following periods of breastfeeding :
preparatory - the formation of a psychological attitude towards breastfeeding, starting from the school age of the expectant mother and until 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 the onset of significant milk secretion, or
"High 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 level of nutrients for the child as he grows up.
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 reactions 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 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 mcg
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 childbirth, 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 in the postpartum period;
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 the 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 recent years, there has been a revision of these recommendations, and at the present time it is necessary to recognize the significantly greater effectiveness of "free" feeding, or, otherwise, feeding at the "baby's request", which is understood as latching the baby to the breast as many times and at such times required by the child, including night hours. 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 newborn babies are not excluded: THE BABY SHOULD REFUSE NIGHT FEEDING
MYSELF... Free breastfeeding contributes to the development of optimal lactation and the establishment of close psycho-emotional contact between mother and child, which is very important for proper emotional and neuropsychic development baby.
Recent studies have shown that with free feeding, the volume of lactation in the first week after birth is 1.5 or more times 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 of basic nutrients with milk. 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, the health and physical development of the 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, you can feed the babies in one feeding with one breast. After the milk "arrives", the baby can be fed 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 upright position(prevention of air 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 occurs, 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 suck out colostrum or milk. Otherwise, there is no need to express colostrum or milk.
The decision on the need to express milk for a woman 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 the regimen of a nursing woman. 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 wide variety of fruits and vegetables. 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

Breast milk is the ideal food for newborn babies. All expert groups agreed that up to the age of six months, the baby does not need any nutrition other than breast milk and until one year old it should be in the diet without fail.

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

Unfortunately, according to the most optimistic estimates, only 70% of mothers support breastfeeding for 3 months from birth; by the age of six months, this figure drops to 30%.

When to start breastfeeding

For the first time, the baby is applied to the breast within a few hours after childbirth. Usually, by this time, the infant has already shown a desire to eat, but if this does not happen, it should be attached to the breast.

Young mothers are worried that immediately after giving birth, they have little milk, and this will not be enough for the newborn. You should know that the first portions of milk are so-called. , rich in nutrients, which are more than enough for a child in his first hours of life. Children are born with an excess of fluid and glucose in the body, and at first they do not need large amounts of food, and latching a newborn to the breast is the best stimulator of milk production (lactation), and after two or three days the amount of milk will increase significantly.

In some cases, for medical reasons, the mother and the baby can be separated, in which case the milk can be expressed to feed the baby when needed.

Breastfeeding position

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

• Convenience for mom
• Convenience for the baby

The basis for successful and comfortable feeding is the correct capture of the mother's nipple by the baby. Correct grip involves gripping both the nipple and most of the halo, which creates a tight seal, allowing the baby to suckle and swallow milk comfortably.

Correct grip avoids cracking and soreness of the nipples.

Here are some examples of positions that will allow you to properly grip the nipple.

Frequency and duration of breastfeeding

Children should be fed on demand. As noted above, within a few hours after birth, the baby may require feeding. Signs of an aspiring hunger are:

• Awakening
• Breast search
• Hand sucking (lips, tongue)

With a pronounced feeling of hunger, the child may cry, you should not bring him to hunger.

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

The duration of one feeding also varies widely, for someone 5 minutes is enough, and for someone 20 minutes is not enough. You should not limit the feeding time, the baby can suckle as much as he is comfortable.

It should be noted that children are individual in everything, and if today he rarely asks for breast and sucks a little, then tomorrow everything can change, and he will suck often and a lot. No need to introduce artificial restrictions and invent dietary regimes.

Adequacy of nutrition

One of the main concerns for new mothers is whether their baby is eating enough.

Important: In the first few days after giving birth, babies lose weight even if they eat enough. This is due to the loss of excess fluid with which it is born. This is completely normal and should not be worried.

A breastfed baby gets enough nutrients for adequate growth and development. Malnutrition can be defined quite simply:

• Counting the number of wet diapers or diapers... A few days after birth, the baby should wet at least six diapers or diapers. If the number of diapers is less, the color of the urine (or rather the spots on the diapers from the urine) is orange (and not pale yellow as normal), then it can be assumed that there is a malnutrition, and the doctor should be informed about this.
• Weight control: weight loss after childbirth is restored within one to two weeks. If there is a significant lag in weight, you should inform your doctor about it.

Nipples

Parents often use pacifiers. It is unacceptable to use nipples to delay breastfeeding. Nipples should not be used until the baby is fully trained to breastfeed.

Breastfeeding Baby - Supplements

Breast milk fully provides the baby with both nutrients and replenishes his energy needs. However, in some cases, vitamins are required to be introduced into the diet, most often in the form of drops:

• - required by the child if the nursing mother is vegan.
• - additionally required for all children
• - required for children with iron deficiency anemia or multiple risk factors for the development of iron deficiency.

A child's nutrition is the most important factor in his health, development, and also one of the simplest and safest methods of treatment.

When prescribing feeding to a child of the first year of life, it is necessary to assess his condition, age, actual and due weight (taking into account body weight at birth and subsequent weight gain by months). In addition, the presence of such diseases as the syndrome of impaired intestinal absorption, atopic dermatitis, is taken into account. In view of the above, adequate nutrition is prescribed, which is recommended to the mother.

In case of hypotrophy of 1 degree (body weight deficit from 10 to 20%), the calculation of proteins, fats, carbohydrates is carried out based on the required body weight; with hypotrophy of the 2nd degree (deficit of body weight from 20 to 30%) and hypotrophy of the 3rd degree (deficit of body weight with more than 30%), the calculation of proteins, fats, carbohydrates is carried out based on the average between the actual and the expected value of the body weight.

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

Types of feeding children under one year old

In Russia, there are three types of feeding of children under one year old: natural (breast) feeding of the child with mother's milk, mixed-combination of breast milk and its artificial substitutes and artificial feeding - using only breast milk substitutes when feeding a child.

According to the WHO classification, they are distinguished: exclusively natural feeding, that is, when the child is fed only with breast milk and mainly natural feeding, when, along with breast milk, the baby receives liquid.

When appointing food to a child of the first year of life, one must remember the leading importance of natural feeding of children under one year old. Natural feeding promotes a harmonious baby. Human milk prevents the occurrence of a number of childhood diseases (rickets, anemia, atopic dermatitis), as well as gastrointestinal and respiratory pathologies. At the same time, a mother who feeds a baby with breast milk is protected from possible postpartum hemorrhage and unwanted pregnancy. Natural feeding reduces the risk of developing oncological pathology of the breast and ovaries.

There are five phases of breast milk formation: absorption by the cell of substances necessary for the formation of milk; intracellular synthesis of molecules; the formation of granules or drops of secretion; transport of the resulting substances into the apical cell; secretion exit into the lumen of the alveoli.

Feeding scheme for children under one year old

The child for the first three months of life feeds mainly on mother's milk, which fully satisfies him in all nutrients. At the age of 4 months, the child begins to enter fruit juices, then fruit and berry purees. Not earlier than 6-7 months. age with caution, you can enter citrus, tomato, raspberry, strawberry, tropical juices. It is not recommended to introduce grape juice. Timely introduction of food additives (fruit and berry juices, fruit and berry purees, yolk, cottage cheese) and complementary foods is an important stage in life. At the age of 5 months. the child is introduced to the first complementary food - vegetable puree, then at 6 months. the second is milk porridge. At 8 months. it is necessary to introduce meat puree. Kefir and other fermented milk products are allowed to be given no earlier than 8 months.

If the mother does not have breast milk completely or its share is less than 20% of the daily requirement, the child is transferred to artificial feeding. There are also a number of indications for transferring to artificial feeding. You can not feed with breast milk if the child has metabolic diseases or congenital metabolic disorders.

Artificial feeding of children under one year old has a number of unfavorable factors for baby and mother. When carrying out artificial feeding, there is no close communication with the mother. In this group of children, there is a high likelihood of food intolerance, a high risk of developing chronic diseases and sudden death syndrome, as a rule, the level of mental development... Also, the mother is not protected from the occurrence of the mammary gland.

When artificially feeding children under one year old, specialized industrial baby food products are used. Distinguish milk formulas for children under 6 months and "subsequent" - for feeding children in the second half of life. For children of the first 6 months. use adapted breast milk substitutes (AFM), that is, mixtures as close as possible to human milk. Milk formulas intended for feeding children after 6 months are less adaptable. All breast milk substitutes are divided into fresh (sweet) and fermented milk; available in dry or liquid form.

To maximize the approximation of the milk mixture in composition to milk (adaptation), it is necessary to reduce the total protein content; increase the level of fats and carbohydrates; optimize the composition of carbohydrates and lipid fractions; reduce the amount of calcium, potassium, sodium; enrich with a complex of vitamins, minerals and trace elements; include taurine, carnitine, choline and protective factors in the mixture.

Milk substitutes for feeding babies up to one year

The main groups of breast milk substitutes for artificial feeding of children under one year old, which every general practitioner should know:

Adapted human milk substitutes containing whey protein:

• containing whey protein, enriched with taurine, carnitine (AGU1, Nutrilak 1, Nan, Hipp 1, Galia 1);
• containing whey protein, enriched with taurine (Tutteli, Pilty, Bona, Nutrilon, Baby, Omneo, Pre-Nutrilon);
• containing whey protein, enriched with taurine, nucleotides (Enfamil 1, Frisolac with nucleotides, Semilak formula +1);
• containing whey protein and not enriched with taurine, carnitine, nucleotides (Mom, My baby, Eldorin).

Partially adapted milk formulas: (Aptamil, Datolact, Malysh, Milazan, Milumil);

• some mixtures enriched with taurine (Semper Baby, Hants 2, Semilak with iron, Nutrilon 2, Nutrilak 2, Humana 2, Frisomel);
• mixtures containing taurine and nucleotides (CMA gold, Enfamil 2, Frisomel with nucleotides).

Fermented milk mixtures are divided into dry and liquid. Dry include - Nan, Lactofidus, Semper Bifidus. The ratio of sour and fresh mixtures is 1: 1.1: 2.

By the degree of adaptation, fermented milk products are classified as follows:

• Adapted (Agu1, Agu2, Bifimil, KM Milk, Nan fermented milk). These mixtures can be introduced into feeding from the first months of life.
• Partially adapted products (Acidophilus Baby, Bifilin, Rostock, Lactofidus, Semper Bifidus).
• Unadapted (kefir, Beefi Kefir, Bifidok, Narine, yoghurts, curdled milk).

The advantage of fermented milk mixtures over native (sweet) unadapted mixtures: the protein is in a dissolved state; evacuated from the stomach slowly and evenly; easier to digest; are used for feeding both healthy children and for digestive disorders; stimulate peristalsis, inhibit the growth of pathogenic microorganisms, normalize the intestinal microflora. In addition, the content of vitamins B1, B2, C is increased in fermented milk mixtures.

With artificial feeding of children under one year old, complementary foods can be introduced earlier than with natural feeding.

The purpose of the lesson:

To form students' knowledge about the types of feeding and the benefits of breastfeeding a child in the first year of life; terms and rules for the introduction of the main types of baby food into the diet; the principles of compiling the menu; types of milk mixtures and rules for feeding a child.

Material presentation plan:

1. Types of feeding of children of the first year of life, the advantages of natural feeding.

2. Early attachment to the breast of the newborn.

4. Rules for breastfeeding, calculation of the daily and one-time nutritional needs of the child, the diet of the child in the first year of life.

5. Difficulty breastfeeding (the concept of hypogalactia).

6. Criteria for determining the optimal time for introducing food additives and complementary foods into the child's diet.

7. The main types of baby food: terms and rules of introduction, cooking technology.

8. Rules of weaning.

9. The concept of mixed and artificial feeding.

10. Types of infant formula, criteria for choosing the optimal infant formula for a child.

11. Rules for preparing milk formula and feeding a baby from a bottle.

After studying the topic, the student must:

Represent and understand:

1. Benefits of early breastfeeding.

2. The concept of hypogalactia.

3. The role of the nurse in preserving the natural feeding of the child.

4. Criteria for the timing of the introduction of complementary foods and food additives into the child's diet.

5. Rules for weaning a baby.

6. Criteria for choosing the optimal type of milk formula.

Know:

1. Terms and rules for the first attachment to the breast.

2. Benefits of breastfeeding.

3. Rules for breastfeeding.

4. Nutritional regimes of a child in the first year of life, depending on age, calculation of his daily and one-time nutritional requirements.

5. Rules of nutrition and regimen of a nursing mother.

6. Rules for drawing up a menu for a child of the first year of life.

7. Rules for mixed and artificial feeding (the concept of "supplementary feeding").

8. Types of milk mixtures.

9. Rules for feeding a baby from a bottle.

10. Terms of maintaining the main types of baby food for a child who is on natural and artificial feeding; introduction rules and preparation technology.

The natural feeding of a newborn and an infant is breastfeeding. It is breast milk that is the ideal food product created by nature itself for feeding a baby. Lack of breastfeeding is an environmental disaster.

Benefits of breastfeeding:

1. Breast milk contains all the necessary ingredients in optimal ratios of B: W: Y = 1: 3: 6
2. There is more protein in cow's milk, but it is coarsely dispersed (casein), therefore it is difficult to break down and assimilated, and the protein of breast milk is finely dispersed, practically does not require enzymes for splitting and, accordingly, is very well absorbed, therefore, allergic reactions develop much less often in infants
3. Human milk proteins contain all essential amino acids
4. Human milk contains protective antibodies against various infections
5. Contains significantly more unsaturated fatty acids to increase resistance to infections
6. More milk sugar (lactose), which contributes to brain development, normalization of intestinal microflora
7. Less mineral salts compared to the composition of cow's milk (salts overload the kidneys, contribute to the further development of hypertension)
8. The optimal amount of vitamins, minerals, enzymes
9. Breast milk is sterile (lower risk of intestinal infections)
10. Contains Lecithin, which promotes the multiplication of brain cells
11. On artificial feeding, an increased need for food is fixed - the risk of obesity at an older age.
12. Physical (biological maturation and aging) and sexual development are faster in artificial people, and mental development is vice versa (intelligence, talent - for their implementation, breastfeeding is necessary for at least 6 months)
13. The child accumulates (deposits) in the subcutaneous fat better components of breast milk and then uses them for several years (for the brain)
14. Sucking contributes to correct articulation, correct formation of the maxillofacial skull. In infants, speech disorders are less common.

Until now, a huge amount of nutrients in breast milk has not been deciphered (for example, taurine is needed for brain development, the formation of the retina, it is not in cow's milk because calves do not need to go to school).

It is impossible to create a full-fledged breast milk substitute also because, depending on the age of the child, the composition of human milk changes, reflecting the changing needs of a growing body, and feeding with donor milk will still not be natural, but pseudo-natural.

Benefits of early latching within the first 30 minutes after birth:

For the mother:

1. Promotes rapid uterine contraction, reducing the risk of bleeding, and quick recovery forces;

2. Stimulates long-term lactation;

3. Reduces the risk of developing mastitis

4. Early contact stimulates a sense of motherhood.

For a child:

1. Promotes the formation of normal intestinal microflora

2. A reliable immunological protection is formed (on the second day of the child's life, the number of antibodies in the mother's milk decreases by 2 times)

3. Stimulation of the sucking reflex

4. Close psychological and emotional contact with the mother in the first hours after the stress endured - birth

Rules for the first attachment to the chest.

The first time the child is laid out on the mother's belly naked and covered with a sterile sheet even before the end of the umbilical cord pulsation (if the state of health of the child and the mother allows)

It is ineffective to apply to the breast or create skin contact after 2 to 3 hours.

1. The correct daily routine: sleep at least 8 hours a day, daytime sleep 1.5 - 2 hours, walking in the fresh air, moderate physical activity, positive emotional attitude, avoidance of stressful situations
2. The amount of fluid in the diet increases by about 1 liter
3. The calorie content of the daily diet should be increased by 50% compared to the diet of a non-lactating woman of this age. Meat and (or) fish, dairy products (cottage cheese, cheese), vitamins are needed every day. Meals 4-5 times a day (as many times as the child feeds), in small portions, to stimulate milk production, 10-15 minutes before feeding, drink a glass of tea with milk and cheese.
4. Refrain from eating foods that change the smell and taste of milk (fresh onions, garlic)
5. No medication before consulting a doctor
6. Do not abuse gas-forming (cucumbers, grapes), laxative (plums, beets) and fixing (nuts, pear), allergenic (strawberries, pineapple, red fish, eggs, honey) and tonic (strong tea, coffee, chocolate) products
7. The duration and usefulness of lactation significantly depend on the breastfeeding history of the woman herself.

Breastfeeding rules:

1. Wash your chest under running water, remove long hair
2. Take a comfortable position - sitting, lying on your side
3. Make sure that the baby is in a comfortable environment, and nothing distracts him from the feeding process (clean, dry, warmly dressed)
4. Make sure that the baby's nasal breathing is free (remove crusts from the nose if necessary)
5. Make sure that when sucking, the baby captures not only the nipple, but also the areola and that he does not rest his nose against the mammary gland
6. With greedy sucking and (or) active milk flowing out in a stream, periodically hold the baby upright for several minutes, and then reapply it to the breast
7. With sluggish sucking, falling asleep, the baby during feeding, wake him up (stroking the cheek, tickling the heels)
8. The duration of the first feedings is usually 30-40 minutes (this is the period of lactation formation), then on average it takes 20 minutes (in the first 5 minutes of feeding, the baby sucks out 50% of the milk volume)
9. If the amount of milk in one mammary gland is not enough to meet the needs of the baby, then it is applied to the other, and in the next feeding the sequence is changed
10. After feeding the baby, it is necessary to hold for 3-5 minutes vertically to prevent regurgitation.
11. Wash the mammary gland

Currently, free feeding is recommended for a newborn baby and children in the first months of life - the baby is applied to the breast at the first sign or demand (up to 12-16 times a day). This is done because in the first weeks after birth, there is a process of adaptation of the nursing mother's body to the needs of the child and frequent attachment solves the problem of the child's hunger and stimulates lactation in the mother. Up to 3-4 days of a child's life, the mammary glands secrete very little milk, but it contains a large number of protein and fat in order to somehow meet the needs of the child.

This milk is called colostrum. Then lactation gradually increases and the composition of milk (transitional) approaches the composition of the mature one: protein - about 2.5 g, fat - on average 3 g, carbohydrates - 7 g. The composition of milk of a nursing woman is very individual and variable, it also depends on the quality and frequency her nutrition, emotional state, hereditary characteristics of lactation. Nobody knows the milk rate. For each pair of "mother - child" it is individual (in the "final" milk fat is up to 17%, so it is impossible to calculate). All nutritional adjustments should go through breast milk (nutrition of a lactating woman)

Calculation of the daily amount of milk:

1. In the first 2 weeks of a child's life:

The amount of milk per day is 70 x n, if the birth weight is less than 3200 grams and 80 x n, with a body weight of more than 3200 grams, where n is the day of life

1. From 2 weeks to 2 months - 1/5 of body weight:

2 months - 4 months - 1/6 body weight

4 months - 6 months - 1/7 body weight

From 5 months The daily volume is approximately equal to 1 liter, and one-time 200 ml.

Brevity of feeding (when feeding according to the regimen)

Newborn - 6-7 times a day (every 3 hours with a night break of 6 hours)

From 1 month up to 5 months - 6 times / day

From 5 months up to 1 year - 5 times / day (interval between feedings 4 hours)

Difficulty breastfeeding:

From the side of the child:

1. Rhinitis with impaired nasal breathing (suction of secretions, removal of crusts from the nose, use of vasoconstrictor drops before feeding)
2. Thrush (candidal stomatitis) - treatment of the oral mucosa with a 2% solution of baking soda after each feeding
3. Lack of sucking reflex (premature baby) - spoon or tube feeding

From the mother's side

1. Flat, inverted nipple (special pads are used to make it easier for the baby to grip)
2. Nipple scuffs and cracks ( correct attachment to the breast so that the child presses on the areola, and does not pull the nipple, special ointments - bipanten)
3. Stagnant milk - correct feeding and expressing milk, using a breast pump

Hypogalactia is a decrease in lactation, a very common problem in lactating women today.

Possible signs of hypogalactia development:

1. The child has become restless, does not sleep well, does not maintain the interval between feedings
2. Decreased daily urine output (less likely to urinate)
3. Low weight gain, flat weight curve
4. Subjective sensation of an "empty" breast in a woman

Diagnosis of hypogalactia - control feeding, when the baby is weighed before and after attachment to the breast, the difference in weight is compared with the nutritional norm obtained for this child according to the formula

Prevention and treatment of hypogalactia:

1. Breastfeeding promotion, psychotherapy
2. Prevention of cracks and mastitis
3. Compliance with diet and daily regimen, support of other family members
4. A decoction of nettle (20 grams of dry leaves per liter of boiling water, leave for 45 minutes and drink 1 tablespoon 3 times a day), fruits of anise, dill, oregano, lactogonic herbal preparations
5. Medicines: vitamins "E", "A", "PP", "C", gendevit, aevit, prenatale, materna, dry brewer's yeast, apilak, microdoses of iodine
6. More frequent breastfeeding, one breastfeeding on both breasts
7. Quartz irradiation, UHF, massage, acupuncture

We have already spoken in sufficient detail about breastfeeding, natural feeding of a newborn. But infancy the age of the child is considered to be up to 1 year, and all this time the child can and should receive breast milk. However, as it grows, breast milk alone can no longer meet the growing body's needs for nutrients and ingredients.

The timing of the introduction of food additives and complementary foods into the child's diet is very individual and depends on:

1. The nature of feeding - breastfeeding they are introduced later, artificially earlier
2. The nature of lactation and rates physical development child - if lactation is sufficient, the child grows and develops well, then supplements and complementary foods are introduced no earlier than 6 months (correction of nutrition through breast milk)
3. The time of year and the climatic zone of residence - in autumn and winter, in the northern latitudes, balanced nutrition of a nursing woman is not always possible and it is necessary to correct the child's nutrition by introducing food additives and complementary foods earlier
4. The health status, diet and day of the breastfeeding woman and the health status of the baby
5. The child's readiness to assimilate a qualitatively new food: the extinction of the reflex of "pushing" food (with the tongue) with a well-coordinated reflex of swallowing; the child's readiness for chewing movements when nipples or other objects enter the mouth, completed or ongoing teething
6. Signs of relative malnutrition: a decrease in the subcutaneous fat layer, a slowdown in body weight gain.

Food additives include those products that correct the deficiency of certain nutrients in the child's diet, given in small quantities, after being applied to the breast or giving formula milk (sometimes in between feedings).

There are vitamin and protein supplements such as:

1. Fruit juices (puree) - apple, white cherry, white currant, apricot, peach, pear, plum juices (given in order of preference). They begin to introduce into the diet with drops, gradually increasing the amount to 40-60 ml. It is desirable that the baby's first juices are natural and fresh (homemade)

2. Cottage cheese (calcined) is also desirable for home-made - for 200 ml of milk at the time of boiling, add 1-2 tablespoons of CaCl 2, then lean back on cheesecloth, or dairy cuisine, special baby food. They begin to introduce into the diet with grains and bring up to 40 grams per day

3. Egg yolk is a hard-boiled egg. From grains to 1/12 - 1/8 are added to milk or vegetable puree (with caution, introduce allergy sufferers into the diet)

Lure- it's high quality the new kind nutrition of the child, which completely replaces one of the feedings and is given before latching to the breast or giving milk formula.

More often in vegetable puree is used as the first complementary food(potatoes, cabbage, squash, pumpkin, and last but not least, carrots). They start with 1 - 2 teaspoons and gradually replace 1 feeding completely over 1 - 2 weeks (this is about 150 ml). Then 2-3 weeks without introducing anything new - adaptation period

A month later, enter the second complementary food is porridge(it is preferable to start with gluten-free cereals - rice, corn, buckwheat flour). The most convenient dry instant cereals: they are enriched with vitamins, calcium, iron, have a guaranteed composition and safety. In children with a good weight, complementary foods begin with vegetables, with a lack of weight, porridge becomes the first complementary foods. 5 ml of vegetable oil is usually introduced into vegetable puree (it is advisable to alternate between sunflower, olive, corn), and creamy into the porridge.

Boiled meat (veal, rabbit, turkey) is passed through a meat grinder twice and given to the child, starting with 1 teaspoon, gradually increasing the amount to 60-80 grams per day, usually in the third feeding

From the moment of the introduction of the first complementary foods, the child switches to 5 meals a day. Complementary foods must be separated by breastfeeds, usually the first, third and last feeds are breast milk or formula, the second is porridge, and the fourth is vegetables.

At 9 - 10 months, enter 3 complementary foods: unadapted dairy products: milk, kefir, yoghurts and fully breastfeeding, only the first and last feeding remains.

Table of the timing of the introduction of complementary foods, food additives

Weaning rules:

1. Recommended child age - over 1 year old
2. With proper nutrition, by the age of 1 year, breast milk already loses its importance as a source of nutrition, its amount in the child's waste diet is no more than 200-300 ml and the difficulties of weaning are associated only with the child's psychological dependence on the feeding process (protection, positive emotions, dream)
3. Do not wean a stressed child from the breast: during an illness, taking preventive vaccinations, if you have a long trip (on a train, for example), a change in the environment and environment of the child, in the hot season (milk continues to be a source of fluid for the child), in the first weeks of a child's stay in a preschool
4. With a significant amount of milk, a woman is advised to reduce the amount of liquid in the diet, tight bandaging of the mammary gland
5. Long-term preservation of breastfeeding is undesirable (in children over 3 years old), because this complicates the process of socialization of the child's personality, the development of independence

If the mother, despite the measures taken, does not improve lactation, the child has to be transferred to mixed and even artificial feeding.

The term "mixed feeding" should be understood as such a type of nutrition for an infant, when the volume of supplementary feeding in the form of artificial mixtures is from 1/3 to 2/3 of the daily volume of food. With artificial feeding, breast milk in the child's daily diet is either completely absent, or its share is less than 1/3 of the daily food volume.

Mixed feeding is much easier for the baby than complete withdrawal of breast milk. Therefore, no matter how little the mother has milk, it must be given to the child at every feeding. The enzymes contained in it will contribute to better digestion of "foreign" food, which are all, even the most perfect artificial mixtures.

To maximize the preservation of at least small amounts of breast milk, it is necessary to apply the baby to the breast at each feeding (first to one, then to the other), and only when both breasts are emptied, you can start feeding. This tactic is absolutely necessary when feeding babies in the first months of life, when every drop of mother's milk is valuable.

So that the child does not lose the skill of sucking at the breast, it is recommended to give the mixture from a spoon.

Supplementation is a breastmilk substitute that is always given after breastfeeding.

When deciding on artificial feeding, a woman should understand that unreasonable introduction of it can adversely affect breastfeeding, and that it is very difficult to return to breastfeeding in these conditions.

Nowadays, in contrast to the late 80s - early 90s (when they took what they could get), there is no shortage of breast milk substitutes. But with a wide variety of artificial nutrition, it is difficult to make a choice: one package is more beautiful than the other, which one to give preference to?

Choose mixtures not with your eyes, but with your mind, based on knowledge of the biological value of individual components of baby food, their role for the child's body, and also taking into account the child's diseases.

When choosing what to feed your baby, first of all, you should consult with the pediatrician who is observing the baby. Attention should also be paid to what age the mixture is intended for. In this case, you need to focus on the products of companies that comply with the International Code on the sale of breast milk substitutes and the requirements of the World Health Organization for baby feeding.

Currently on Russian market presented baby food from such well-known foreign companies as Nutricia - Holland, Swiss corporation Nestlé, Hipp - Austria, Humana and Heinz - Germany, Danone - Finland.

Milk formulas - breast milk substitutes - can be:

Unadapted (cow's milk or kefir diluted) - No. 2 - ½ milk, ½ cereal broth (buckwheat or rice) - half milk for feeding children up to 2 weeks; No. 3 - 2/3 milk, 1/3 cereal broth for feeding children from 2 weeks to 3 months

Adapted - close in composition to human milk (enriched with carbohydrates, vitamins, amino acids, salts and microelements, using high technologies fermented, which facilitates assimilation)

Dry and liquid (ready to eat)

Unleavened and sour. In practice, dry milk mixtures are most often used, which must be reconstituted by diluting with water. For this, it is better to use environmentally friendly water.

Types of dry adapted mixtures:

Initial - maximally adapted to the digestive characteristics of children in the first four months of life (Nutrilak 1 - Russia, Nutrilon 1 - Holland, Frisolak 1 - Holland, Humana 1 - Germany, Galia 1 - France, Hipp 1 "- Austria," Enfamil 1 "- USA)

Starter mixes contain whey proteins with reduced protein levels (most of these mixes contain 1.4 to 1.6 grams of protein per 100 ml of ready-to-eat product to approximate that of human milk). The starter mixes are always enriched with taurine, a free amino acid necessary for the proper formation of the brain, visual analyzer, and aids in the digestion and absorption of fats.

This amino acid for babies in the first months of life, especially premature babies, is one of the irreplaceable ones. Taurine is found in breast milk and absent in cow's milk. The composition of the fatty component of the "initial" mixtures is also as close as possible to the composition of fats in human milk. To improve the assimilation of fat, small amounts of natural emulsifiers (lecithin, mono- and diglycerides) are introduced into the milk mixture, which contribute to better fragmentation of fat globules and easier absorption of fat.

"Follow-up" adapted formulas for feeding children older than 3-4 months ("Nutrilak 2" - Russia, "Nutrilon 2" - Holland "Humana 2" - Germany, "Galia 2" - France)

"Subsequent" semsi are prepared on the basis of cow's milk with or without added whey proteins, may contain lactose, sugar, starch. The protein content in them is 1.8-2.2 g per 100 ml.

Formulas used throughout the first year of a child's life from 0 to 12 months (Nan - Switzerland, Tutteli - Finland, Heinz - USA)

These blends may or may not contain whey proteins and taurine. The fat component of these mixtures consists of vegetable fats or a mixture of vegetable oils and milk fat. Lactose, dextrin-maltose are used as a carbohydrate component, sometimes sucrose and starch are also used.

All dry adapted mixtures are enriched with vitamins, macro- and microelements.

When choosing a mixture for a healthy child and analyzing its composition, it is necessary to pay attention to the following indicators:

The only source of carbohydrates in all types of milk is milk sugar - lactose. This carbohydrate is found only in milk and is not found anywhere else. The hydrolytic breakdown of lactose in the intestine is slow, and therefore the intake of lactose does not cause intense fermentation. The intake of lactose into the intestines normalizes the composition of the beneficial intestinal microflora. Therefore, in quality product For feeding healthy babies, the sugar substitute should not be sucrose, fructose or glucose, but lactose, which is an essential component of breast milk, and possibly dextrinmaltose.

Whey and casein should be proportioned as 3: 2 or 60% and 40%

Since at the stage of breastfeeding, the ratio of whey proteins to casein in breast milk is on average 60% to 40%, ideally they should correlate in the same way in breast milk substitutes. With such a ratio of whey proteins and casein, indigestion of the latter, as from cow's milk, will not

Taurine enrichment at a level of at least 4.5 / 100 ml

If the food of an adult must necessarily contain eight essential amino acids, which are the main constituents and structural components of protein molecules, then in childhood histidine and arginine are also added to essential amino acids, since they are not synthesized in the child's body in quantities that can satisfy its needs. Free Amino Acid - Taurine is added to the formula of many breast milk substitutes to improve their biological value. In addition, it is involved in the synthesis of bile acids.

The presence of linoleic and linolenic polyunsaturated fatty acids and their ratio (not less than 8.8)

For the proper growth and development of a child, the two most important polyunsaturated fatty acids (PUFA) - linoleic and @ -linolenic must be present in baby food. Linoleic acid is essential for the synthesis of protein in the membranes of brain cells. In human milk, its content is 15%, and in milk replacers, at least 10% is recommended. The ratio of linoleic and linolenic acids is also important.

Enrichment with carnitine at a level of at least 0.8 mg / 100 ml

Carnitine is not an enzyme, as it is sometimes called, but a compound that normalizes fat metabolism; with a lack of it, free fatty acids cannot penetrate into mitochondria and be oxidized. Lack of carnitine in an adult is rare, since adults get it from food - beef, chicken meat, etc. More often, a lack of carnitine occurs in premature babies, it is caused either by a violation of its biosynthesis, or "leakage" in the kidneys.

For normal growth and development infant baby food products should contain a complex of mineral elements (macro- and micro) and vitamins.

The ratio of calcium and phosphorus, which should be close to 1.7 for children under the age of three months and to 2.2 for children from four months to one year (in full-fledged human milk, this ratio is 2.2)

Calcium and phosphorus are necessary for the child to form bone tissue. However, with an excess of these minerals in the mixture, they are excreted from the baby's body, giving a huge load on the child's still undeveloped kidneys. Undigested calcium forms insoluble salts in the intestinal lumen, which impairs fat absorption. With an optimal ratio of calcium and phosphorus in the mixture, the absorption of calcium from the intestine and bone mineralization are improved, the risk of hypocalcemia (as a result of hyperphosphatemia) decreases. In addition, the optimal ratio of these minerals can help reduce stool density and prevent the development of constipation.

Fortification of the mixture with iron to a level not lower than 0.11 mg / 100 ml (its content in human milk is 0.15 mg / 100 ml)

Of 15 micronutrients for the growth and development of a growing organism highest value have nine: iron, iodine, zinc, copper, selenium, cobalt, chromium, molybdenum, and manganese. At the same time, there are trace elements, the innate reserves of which are enough for the first 4-6 months of life (copper) and trace elements, the content of which in the body of newborns is extremely insignificant and must be constantly replenished. Taking into account these data, modern mixtures should contain a sufficient amount of iron, zinc, iodine and selenium. Iron is involved in the synthesis of blood hemoglobin, ensures the normal functioning of the immune system and the adequacy of behavioral characteristics.

The ratio of vitamin E to linoleic polyunsaturated fatty acid should be 1.7

All vitamins are very important for the normal growth and development of the baby. But it is especially important to pay attention to the content of vitamins D, E, folic acid in breast milk substitutes. Vitamin D contributes to the absorption of phosphorus and calcium, it is necessary for the normal formation of bones and teeth. Vitamin E acts as an antioxidant that protects cellular structures from damage and supports the immune system. Moreover, its content should be in a certain ratio with the level of linoleic acid. Folic acid is the main participant in the formation of hemoglobin in red blood cells and is necessary for the synthesis of proteins.

The absence of any food additives (indicated on labels and packages with the E index)

The osmolarity of the mixture, which should be in the range of 300-320 mOsm / l

Lysozyme is usually added to infant formulas

I would like to draw special attention to the need to strictly follow the instructions for preparing the milk formula. It is impossible to allow the preparation of both too concentrated and more diluted mixture. Both are equally harmful! When using a more concentrated mixture, the child receives an excess amount of all nutrients, and therefore, he may develop digestive disorders - regurgitation, vomiting, unstable stool, and sometimes allergic reactions may occur. If you give your child more diluted food than it should be, then the baby will receive an insufficient amount of "plastic" material and will lag behind in physical development.

Bottle feeding rules:

1. The bottle and nipple must be sterile (at home they are boiled for 20 and 10 minutes, respectively, and then stored in a clean container under a lid)
2. The milk mixture is prepared according to the instructions and poured into a bottle
3. Before feeding, it is necessary to check the temperature of the mixture and its flow rate - for this, a few drops are allowed to flow out onto the back of the forearm, the mixture should not be hot and should flow out in rare drops (the child may choke on the milk stream and aspirate milk)
4. It is necessary to check that the child has free nasal breathing (clear the nose from crusts) and he feels comfortable (clean, dry, warm)
5. It is advisable to feed the baby in your arms
6. As the mixture flows out, the angle of inclination of the bottle must be changed so that its neck is completely filled with milk (prevention of aerophagia)
7. Hold the baby upright after feeding
8. Soak and sterilize the bottle and nipple

It should be noted that for most children of the first year, fermented milk adapted formulas, which have a number of advantages over fresh ones, are especially useful. They contain pure cultures of acidophilus bacillus, bifidus or other lactic acid bacteria that improve the digestion of food and have the ability to remove harmful microorganisms from the intestines. This prevents the development of many intestinal diseases. Fermented milk mixtures are especially recommended for children with weakened, unstable stools and decreased appetite. The mixture is best used in the hot season, when the likelihood of acute gastrointestinal disorders increases.

In the child's diet, it is advisable to use fresh and fermented milk adapted mixtures in a 1: 1 ratio, since the use of only fermented milk mixtures (especially with high acidity) can cause regurgitation, some shifts in the acid-base balance of the body.

Currently, for the nutrition of children with health problems, there are specialized milk formulas - breast milk substitutes.

If a child does not tolerate cow's milk (allergy to cow's milk protein, lactase deficiency, galactosemia), then his substitutes prepared on the basis of soy or casein hydrolyzate and devoid of lactose will be more useful for him.

Such mixtures include "Bebelak soya", "Vinnie-soya", "Nutrilon low-lactose", "Nutri-soya", "Alfare", "Alsoy", "Al 110", "Frisosoy" others. These mixtures do not contain any components of cow's milk, sucrose, lactose and gluten, enriched with taurine and methionine, which provides an optimal amino acid ratio; vitamin D and carnitine, which prevents the development of rickets and improves the absorption of fats and fat-soluble vitamins, contains linoleic and linolenic fatty acids, a slightly increased amount of iron. It should be noted that soy-based medicinal mixtures can only be used strictly according to indications, they are less high in calories, and do not contain animal protein. Mixtures based on protein hydrolysates have low palatability.

Some formulas are intended for feeding premature babies, low birth weight babies, or poorly developing babies. Premature babies have higher requirements for both energy and protein than normal and should receive 22% more ingredients. Therefore, such mixtures contain at least 2 g of protein per 100 ml with a higher calorie content - 75 - 85 kcal / 100 ml. In addition, they should contain more linoleic and linolenic fatty acids, since the synthesis of the latter in the body of premature babies is difficult. The mixtures intended for children with low birth weight include domestic "Novolakt 1", imported "Alprem", "Prepiltti", "Enfalak", "Nenatal", "Frisopre".

According to domestic and foreign scientists, 20-30% of children under 6 months of age periodically regurgitate. Children suffering from regurgitation, constipation or colic in the abdomen should be fed with such breast milk substitutes as Nutrilon Antireflux, Frisovoy, Nenni, Lactofidus. All of them are low in fat, which helps to avoid retention of the mixture in the stomach and improves its emptying, the predominance of casein and the use of carob beans as a thickener. Under the action of gastric juice, casein forms flakes, the mixture thickens quickly, and the carob beans are not digested in the stomach and maintain the consistency of its contents. All of this reduces the incidence of reflux.

Special attention should be paid to the adapted Nanny breast milk substitute, produced on the basis of goat's milk. Research of the Nenny mixture conducted by the Institute of Nutrition of the Academy of Medical Sciences of the Russian Federation made it possible to recommend its use in the following cases:

1. As a dietary alternative for nutrition of healthy children in case of impossibility, undesirability or insufficiency of breastfeeding
2. For feeding premature babies
3. If you are intolerant and / or allergic to cow's milk or soy proteins
4. For the prevention of various food allergies, diathesis, eczema
5. For the prevention of iron deficiency anemia
6. For digestive disorders: dysbiosis, intestinal colic, regurgitation, diarrhea
7. For the prevention and treatment of asthmatic phenomena

So, choosing an acceptable and healthy food for a child when breastfeeding is impossible is not at all easy.

Due to the lower biological value for a child of infant formula compared to breast milk, the timing of the introduction of food additives and complementary foods to an artificial child is usually lower than to his peer who is breastfed. Although the question of the timing of the introduction of basic baby food into the diet is decided individually.

Possible problems of the child and his relatives:

Sleep disturbance due to starvation, flatulence

Regurgitation, rashes on the body due to a violation of the diet of a nursing mother

Lack of knowledge among the relatives of the child about the rules of breastfeeding, the diet of the newborn, the diet of the nursing mother

Violation of the child's need for food due to abrasion, cracked nipple; hypogalactia, mother's refusal to breastfeed

Lack of knowledge among the relatives of the child about the timing, rules of introduction and the technology of preparation of the main types of baby food

Regurgitation, flatulence, stool disturbance in a child due to improper introduction of food into his diet

Lagging in physical development due to the late introduction of food additives and complementary foods into the child's diet:

Abdominal pain, increased stool frequency due to non-compliance with hygiene requirements when preparing baby food

Lack of knowledge about the criteria for choosing infant formula, formula preparation and bottle feeding

Regurgitation, flatulence, stool disturbance, pain from a burn of the oral mucosa due to non-compliance with the rules for preparing milk formula and the rules for feeding a baby from a bottle

Regurgitation, flatulence, anxiety due to abdominal pain, itchy skin due to frequent changes in formula

Sleep disturbance, anxiety due to fasting due to non-compliance with the child's diet

Nursing interventions:

Perform early attachment to the breast of a newborn

Convincing the mother of the baby to breastfeed

Teach mom how to breastfeed

Inform the mother of the child about the types of feeding the child: free and according to the regimen

If signs of hypogalactia are detected, invite the mother and child to the clinic for check weighing and intensify activities to stimulate lactation

Carry out regular (monthly) control over the pace of physical development of the child (weight gain)

Together with the doctor, determine the optimal timing for introducing food additives and complementary foods into the child's diet

Create a sample menu for a child

Inform the mother of the child about the types of baby food, the technology of their preparation, the timing and rules for introducing into the child's diet

Teach mom the rules for making a child's menu

If it is necessary to transfer the child to mixed feeding, inform the mother about the rules for introducing supplementary feeding into the child's diet

Together with the doctor, choose the optimal type of milk formula for the child

To teach the mother the technique of preparing milk formula and the rules for feeding the baby from a bottle.