NATURAL FEEDING.

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 breast milk of each mother 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;

¨ Breast milk contains substances that regulate the growth, development of the child and ensure the correct formation of his brain and intelligence (hormones, growth factors, taurine, zinc, iodine, etc.);

¨ In the process of breastfeeding, a special very close relationship develops between the mother and the child, the warmth of which remains throughout the rest of life;

¨ Breastfeeding is 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.

Breastfeeding is a physiological phenomenon for mothers and babies, and therefore cases of true milk shortages are rare. The period of recovery of lactation in the mother is most responsibly observed - the first 3-4 months after childbirth. The following guidelines can be recommended for successful breastfeeding:

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

¨ in the first weeks, it is advisable to provide the child with a free feeding regimen (at the request of the child) and only later transfer the child to food by the hour, which he himself chose;

¨ 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;

¨ If there is not enough milk, it is necessary to breastfeed the baby frequently. It must be remembered that every drop of mother's milk is priceless for a nursing baby. However, frequent breastfeeding can increase milk production in the breast.

NUTRITION OF A NURSING MOTHER.

A nursing mother must necessarily receive a full-fledged balanced diet, since a woman spends additional energy and nutrients for the formation of milk, and, therefore, it is necessary to replenish these costs.

The calorie content of the mother's diet during lactation should be increased by an average of 30-40% and be 2500-3000 kcal / day. The amount of protein should be about 100 g (60-70% of animal origin), fats - 85-90 g (15-20 g - vegetable fat), carbohydrates - 300-400 g. This amount of nutrients corresponds to the developed by the Institute of Nutrition RAMS an approximate daily set of products, which includes: 200 g of meat or poultry, 70 g of fish, up to 600 ml. milk in any form (preferably the use of fermented milk products, 50 g of cottage cheese, 20 g of cheese, 400 g of various vegetables, 200 g of potatoes and 200-300 g of fruits and berries.

Vegetables are best consumed in their natural form or in the form of salads and vinaigrettes. Of the cereals, it is most advisable to use oatmeal and buckwheat. We recommend coarse bread with the addition of bran. Avoid hot spices, excess spices, large amounts of onions and garlic, which give the milk a specific taste and smell. During breastfeeding, it is necessary to limit the use of foods with increased allergenic properties: chocolate, cocoa, natural coffee, citrus fruits, honey, nuts. Alcoholic drinks, including beer, are strictly prohibited for a nursing mother.

The amount of liquid (including soups, vegetables, etc.) should be an average of 2 liters.

During breastfeeding, mothers should take any multivitamin preparation containing vitamin D (for example, Gendevit - 2 tablets per day).

LURE. VIEWS. RULES OF INTRODUCTION.

Complementary feeding is an independent type of nutrition that replaces one, and then several feedings with breast milk or mixtures. Talk to your pediatrician about prescribing complementary foods. The introduction of complementary foods is due to:

¨ an increase in the growing baby's need for energy and basic food ingredients (P.Zh.U.);

¨ an increase in the child's body needs for minerals (iron, calcium, magnesium) and vitamins;

¨ the need to train the chewing apparatus;

¨ the need to stimulate the digestive glands and their gradual adaptation to the digestion of adult food;

¨ the need to introduce plant fibers, which play an important role in the proper functioning of the child's gastrointestinal tract;

¨ the need to educate the child's skills to consume new types of food, including a thicker consistency, which prepares him for weaning.

BASIC RULES FOR INTRODUCING BAITS.

¨ Start introducing complementary foods only to a healthy child or, in extreme cases, during the recovery period, with normal stool;

¨ complementary foods are introduced warm before breastfeeding or formula;

¨ complementary foods are given from a spoon, vegetable puree can first be added to a bottle of milk, so that the child can more easily get used to the new taste;

¨ each meal of complementary foods is introduced gradually, with small amounts (1-2 teaspoons) and within two weeks is brought to the age dose;

¨ they switch to a new type of complementary foods 1.5-2 weeks after the introduction of the previous one;

¨ the density of complementary foods should gradually increase;

¨ the second complementary food - cereals - you need to start with gluten-free cereals (rice, corn, buckwheat) and cook them in the same milk or milk mixture that the child receives;

¨ Baby food in jars contains the optimal amount of salt and sugar and therefore should not be added.

DIFFERENT FEEDING PERIODS FOR A CHILD.

The processes of assimilation of food in the human body are quite complex, and in children of the first year of life, given their intensive growth, insufficient maturation of the formations of all organs and systems, they proceed with a particularly heavy load.

We can conditionally distinguish several periods of nutrition for children:

1. from 0 to 3-6 months when the baby only gets milk;

2. from 3-6 months to 1 year- transitions during which complementary foods are gradually introduced into the child's diet;

3. from 1 to 3 years- early childhood, when the child gradually and carefully gets used to traditional family meals;

4.5. preschool ( from 3 to 6 years old) and school ( from 7 to 14 years old), characterized by a wide range of foods and dishes used in nutrition, basically not different from those that adults receive.

1 period. If the baby is breastfed, then up to 3 months it is inappropriate and even harmful to include other products in the diet in addition to milk. It may be necessary to include vitamin D. In the absence of human milk, commercial substitutes should be the staple food.

2 period. Breast milk or breast milk substitutes continues to be the staple of a baby's nutrition. The recommended daily dose, depending on the age of the child, ranges from 400 to 800 ml. milk.

A number of foods that are primarily included in the diet of children as a supplement to breast milk or its substitutes are fruit juices. This is primarily due to the fact that they have the same liquid consistency familiar to a baby as milk. At the same time, the introduction of juice allows you to provide the child with a number of new nutrients for him, which he needs; sugars new to the baby (glucose, fructose), organic acids (citric, malic); promotes the assimilation of milk nutrients, as well as additional amounts of vitamin C, potassium, iron. Taking into account the unfavorable environmental situation, it is most advisable to introduce natural juices of industrial production into the diet of babies. Juices should be introduced into the diet gradually, starting from two teaspoons, and increased within 2-3 weeks to 30-40 ml, and then by 8-10 months to 80-100 ml. in a day.

With natural feeding, juices should be introduced into the child's diet no earlier than 3 months of life.

It is advisable to introduce ordinary juice into the child's diet first, which is characterized by low acidity and low potential allergenicity, then pear, plum, apricot, peach, raspberry, cherry, blackcurrant, orange, tangerine, strawberry juices, which are among the products with potentially high allergenicity, can be recommended which should not be given earlier 6-7 months... This also applies to tropical juices and juices from other exotic fruits (papaya, mango). The introduction of juices should be made from one type of fruit (to exclude its possible allergenic effect) and only after getting used to it, you can introduce mixed fruit juices into the diet of babies.

3 period, 4 period, 5 period. From one year on, the baby usually no longer receives breast milk and can eat the same foods as an adult. However, one should avoid giving dried fruits, which can only be administered after 18 months... Butter fruits (peanuts, almonds and others) are practically prohibited up to 5 years... Sausages can be given in very small quantities. Chocolates and chocolates are best for children. after 5 years, but before this age, crush the child with marshmallows, marmalade, marshmallow, honey, jam, jam. In order to instill good habits in a future adult, you do not need to add too much sugar and salt to food, you should limit the consumption of fatty foods and sauces. Eggs are best used no more than twice a week, boiled or fried.

Rational nutrition of children- an important condition that ensures correct physical and mental development, adequate immunological reactivity. A child of the first year of life has a special need for a full-fledged diet due to intensive growth, rapid psychomotor development and the formation of all organs and systems.

Feeding a baby in the first year of life

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

Natural feeding

Natural feeding - feeding of infants with mother's breast milk, followed by the introduction of complementary foods from 4.5-5 months. The content of breast milk in a child's daily diet is at least 4/5.

This type of feeding is the most physiological, since in terms of the quantitative and qualitative composition, breast milk optimally covers all the baby's needs for proteins, fats, carbohydrates, vitamins, mineral salts, etc. In the first 5 days after childbirth, colostrum is excreted from the breast of the puerpera, which has a higher energy value than breast milk, which is subsequently secreted. Colostrum contains more proteins, phosphorus, calcium, vitamins A and E, and less fat.

The Most Important Benefits of Breast Milk

Fine proteins (albumin) predominate in breast milk, the size of casein particles is several times smaller than in cow milk, due to which, when curdled, more delicate, easily digestible flakes are formed in the stomach. The composition of breast milk best suits the needs of the baby. The total amount of protein in breast milk is less than in cow's milk. Therefore, with artificial feeding, protein overload occurs.

Breast milk (especially colostrum) is rich in Ig. IgA plays an important role in the local immunity of the gastrointestinal tract of newborns. IgG ingested in a child's body provides passive immunity against many infectious diseases. In addition, breast milk contains factors of specific and non-specific resistance.

In terms of antigenic properties, breast milk (as opposed to cow's milk) is less alien to the baby.

Breast milk contains an optimal set of enzymes, vitamins and other components necessary for the baby.

The concentration of fats in breast and cow's milk is practically the same, but the qualitative composition is different: breast milk contains several times more polyunsaturated fatty acids, which are essential components of phospholipids and are part of cell membranes. The breakdown of fat in the stomach in infants begins under the influence of breast milk lipase.

Breast milk is high in carbohydrates (ß-lactose); bovine contains a-lactose. ß-lactose is absorbed more slowly in the intestines of the child, therefore it reaches the large intestine, where, together with oligo-aminosaccharides, it stimulates the growth of normal flora (mainly bifidobacteria), which suppresses the reproduction of pathogenic microorganisms and Escherichia coli.

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

The concentration of calcium and phosphorus in breast milk is lower than in cow's milk, but their ratio is the most physiological for an infant, they are absorbed much better. Therefore, in children who are breastfed, rickets develops less often. The content of elements such as sodium, magnesium, chlorine, iron, copper, zinc, cobalt, sulfur and selenium in breast milk is optimal and meets the needs of the child. For example, breast milk contains 0.5 mg / L of iron, and formula milk - 1.5 mg / L, but the degree of its bioavailability is 50% and 5%, respectively. That is why breastfed babies are much less likely to suffer from anemia, and up to 6 months of age there is no need to add iron to their diet. With artificial feeding, iron is prescribed additionally from 4 months in the form of foods enriched with it.

With natural feeding, a psychological connection is formed between the mother and the child, parental feelings are developed.

Thus, refusal from natural feeding is a gross violation of the biological chain "pregnancy-childbirth-lactation" that has developed in evolution. Breast milk is the gold standard for infant nutrition.

Calculation of the required amount of food

The simplest way to calculate the daily amount of milk required by a newborn in the first 9 days of life is as follows: his age (in days) is multiplied by 70 (with a body weight of less than 3200 g) or by 80 (with a body weight of more than 3200 g). From the 10th to the 14th day, the required daily milk volume remains unchanged (as for a 9-day-old baby).

From 2 weeks of age, the required amount of milk is calculated taking into account the daily energy requirement (in calories or Joules) per kilogram of body weight or by the volumetric method, when the required amount of food is a certain proportion of the child's body weight.

Caloric (energy) method of calculation : in the 1st quarter of the first year of life, the child needs 115-120 kcal / kg / day (502 kJ / kg / day), in the 2nd - 115 kcal / kg / day (480 kJ / kg / day), in 3 -th - 110 kcal / kg / day (460 kJ / kg / day), in the 4th - 100 kcal / kg / day (440 kJ / kg / day). Knowing the age and body weight of the child, calculate the amount of milk required by the child per day (X).
For example, a child at the age of 1 month has a body weight of 4 kg and, therefore, needs 500 kcal / day. 1 liter of breast milk contains about 700 kcal, therefore:

X = (500 × 1000) - 700 = 710 ml

WHO experts believe that in current recommendations, the energy requirement of an infant for energy may be overestimated by 15-30%, especially after 3 months of life. According to them, at the age of 4-10 months, energy consumption per 1 kg of body weight should be 95-100 kcal.

The daily amount of food needed by an infant.

Age	Food volume
	1/5 body weight
6 weeks - 4 months	1/6 body weight
	1/7 body weight
	1/8 body weight
	1/9 body weight

Volumetric method of calculation simpler, but less accurate. For example, a child aged 1 month with a body weight of 4 kg needs 600 ml of breast milk per day (1/5 of 4 kg), i.e. there is no complete coincidence with the calorie calculation. All calculation options allow you to only approximately determine the required amount of food. The daily food volume of children of the first year of life should not exceed 1000-1100 ml (juices and fruit puree are not taken into account). It should be borne in mind that a child's need for milk volume is individual.

Quality food composition

The ratio between the main food components (proteins, fats, carbohydrates) before the introduction of complementary foods should be 1: 3: 6, after the introduction of complementary foods - 1: 2: 4. Up to 4-6 months, the need for proteins is 2-2.5 g / kg, fats - 6.5 g / kg, carbohydrates - 13 g / kg, and after the introduction of complementary foods - 3-3.5, 6-6, respectively, 5 and 13 g / kg.

Diet

The diet is set depending on the age of the child, his individual characteristics and the amount of milk in the mother. In the first 3-4 months of life, healthy full-term babies are fed 7 times a day, i.e. every 3 hours with a 6-hour night break. If the child can withstand longer breaks between feedings, he is transferred to 6 and 5 meals a day. From 4.5-5 months, most children are fed 5 times a day, after 9 months - 4 times a day. In case of anxiety, between feedings, the child is given water without sugar or slightly sweetened, possibly with a few drops of lemon juice. Some children give up water because their need for fluids is fully met by the milk they receive.

Complementary feeding and high-quality nutritional correction

By the age of 4-6 months of life, feeding only with breast milk can no longer satisfy the needs of the child's body for nutrients, therefore, from this age, they begin to introduce complementary foods.

Natural feeding is feeding a baby with human milk by latching on 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 matches 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 close relationship develops between the mother and the child, the warmth of which remains throughout the rest of life;
7. Breastfeeding is 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 casein protein 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. Thanks to this, the 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 the fat. Unsaturated fats predominate in breast milk. Formula feeding has been shown to often lead 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 assimilation 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 two times better, 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 of breastfeeding and regularly bring these rules to the attention of medical personnel and women in childbirth.
2. Train health care personnel in the necessary skills to practice breastfeeding.
3. Inform all pregnant women about the benefits and techniques of breastfeeding.
4. Help mothers 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 newborn babies 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 scheduled.
9. Do not give breastfed infants any sedatives or devices that mimic the mother's breast (nipples, pacifiers).
10. Encourage the organization of breastfeeding support groups and refer mothers to these groups after discharge from 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 regimen (at the request of the child) and only later transfer the child to food by the hour, which 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 frequently latch on the baby to the breast. It must be remembered that every drop of mother's milk is priceless for a nursing baby. 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 further 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 may 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 caesarean section (under general 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 the 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, optimal ambient temperature, and close contact of the newborn with the mother should be created. 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 the state of 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.

2. Benefits of human milk

Children who are breastfed are 3 times less likely to have intestinal infections, and 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 pathogens 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 plays the role of 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 is 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, thyroid gland.

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

11. Human milk contains 2 times less protein, but more carbohydrates (lactose) than animal milk. The amount of fat is the same. The energy value due to protein in human milk is covered by protein by 8%, in cow's milk - by 20%. The share of the 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 milk is curdled in the stomach, casein gives 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 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 milk. 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, in comparison with 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 absorption coefficient of fat in human milk is 90%, for cow's milk - less than 60%. This is explained by the presence of the lipase enzyme in human milk with its 20-25 times greater activity. Lipase breakdown of milk fat provides active acidity in the stomach, which contributes to the regulation of its evacuation 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 greater 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 an osmolarity equal to monosaccharides, provides an osmotic balance that is optimal for the assimilation 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.

3. The importance of colostrum in the nutrition of newborns in the first days of life. Characteristics of colostrum

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 birth. Curd easily when heated. Colostrum contains more protein, vitamin A, carotene, ascorbic acid, vitamins B12, E, salts than 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. Especially there is a lot of YgA in colostrum. 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 there is an intensive bacterial colonization of the newborn's body.

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.

4. Natural feeding and complementary feeding technique

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 latching on 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 reflexes of the baby (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 uncomplicated childbirth. 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 as the breast moves downward, on a wide-open mouth, with the tongue being lowered but not protruding under the breast. Grasping only one nipple without the areola and then sucking it is ineffective and immediately leads to the formation of a crack. Sucking efficiency is determined by rhythmic massage of the areola with the baby's tongue. If sucking at the first skin contact did not take place, then it is impractical 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 by the baby's mouth provides him with sufficient ease of sucking, good reflex regulation of breathing associated with sucking at the breast. Monitoring feeding should be focused on achieving the act of swallowing milk, which can be judged both by the severity of swallowing movements and by the sound accompanying 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 of iodine for mothers and children is necessary in regions with suboptimal natural abundance. 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 with good nutrition of a pregnant and lactating woman 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.

5. Complementary foods and the timing of their appointment with natural feeding

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. The most appropriate age is between 16-24 weeks 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 lethargic, physical activity decreases, and the rate of weight gain slows down. 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.

Table 4. Approximate scheme of natural feeding of children of the 1st year of life(Institute of Nutrition, Russian Academy of Medical Sciences, 1997)

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 expansion of complementary foods:

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 ​​fruit, steamed cutlets.

The total daily amount of milk (breast milk or in mixture) in any period of the first year of life should not 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 formulas of the “follow up” group for the dairy component of the diet, it is advisable to use cow's milk substitutes for children 2–3 years of age, Enfamil Junior, from Mead Johnson.

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.

Feeding a baby in the first year of life with human milk is called natural.

Feeding newborn babies in the first 7-10 days of life

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

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

Later, when the puerpera is allowed to sit or get out of bed (from the 3rd or 4th day), she feeds the baby in a sitting position on a chair, placing her foot on a low bench (Fig. 11). Each breast must be alternated to ensure that both are completely emptied. Any remaining milk must be expressed. Only when there is little milk, you have to feed from both breasts, but at the same time you should: 1) give the second breast only after the baby has sucked everything out of the first, and 2) follow the order of attachment.

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

The amount of milk required for a newborn baby varies considerably. For practical purposes, the formula of G.I. Zaitseva is most suitable. Using this formula, you can roughly calculate how much milk a newborn baby needs (up to 7-8 days):

Daily amount of milk (in ml) = 2% of the baby's weight at birth x n,

where n is the day of the child's life. You can also use the modified Finkelstein formula:

n x 70 or 80,

where n is the day of the child's life. To determine the amount of milk a child needs during the day, the number of days of his life must be multiplied by 70 (with a mass below 3200) or by 80 (with a mass above 3200 g).

Sometimes they use another calculation: for a single feeding, the child should receive an amount of milk equal to 10, multiplied by the day of his life (for example, a 5-day-old child should receive 10 x 5 = 50 ml for one feeding).

The amount of food required for a premature baby should be determined taking into account his individual needs and general condition. Usually, on the 1st day, 5-10 ml of milk is given for feeding, on the 2nd day - 10-15 ml, on the 3rd day - 15-20 ml. In the future, the daily volume of food is determined by the formula:

n x 10 for every 100 g of the child's weight,

where n is the number of days of life. After the 10th day of life, the amount of food is determined by body weight, as in full-term.

From the first days of life, a child must be taught to order in feeding. A newborn baby has no conditioned reflexes at birth. One of the very first conditioned reflexes is the reflex to the feeding time. To do this, you need to feed the baby by the hour.

IP Pavlov wrote, "that no other stimulus can be compared either qualitatively or quantitatively with a passionate desire for food as a causative agent of gastric juice." Only food with an appetite can be as healthy as possible, while food on order cannot have such a positive effect. Indiscriminate feeding reduces the baby's appetite, he sucks out little milk.

The frequency of feeding is of great importance. The works of prof. NI Krasnogorskiy found that in the activity of the central nervous system (CNS) there is a certain cyclical nature of the processes of excitation and inhibition. In children of the first 3 months of life, the process of excitation is replaced by the process of inhibition every 3 hours; in children of 3-5 months, this alternation is observed every 3.5 hours, in children older than 6 months - every 4 hours. Therefore, the interval between feedings should be different, depending on the age of the baby.

Children of the first 2-3 months of life must be fed every 3 hours with a 6-hour night interval (the night interval is necessary for the mother and child to rest); the intervals between feedings in children from 3 to 5 months should be 3.5 hours (night interval 6 hours 30 minutes), and in children older than 5 months, every 4 hours (night interval 8 hours) 1 (Fig. 12).

If the child does not calmly withstand such long night intervals and is not satisfied with 2-5 teaspoons of water, then one more feeding at night can be allowed.

The frequency of feeding is also determined by the duration of the stay of the food mass in the stomach, which depends on the type of food. Human milk is excreted from the stomach 2-2.5 hours after ingestion, artificial milk mixtures from cow's milk linger in the stomach for 3 hours, and porridge for 3-4 hours. Vegetables are especially long in the stomach (4-5 hours). The high content of fat and protein increases the duration of the stay of food in the stomach.

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

Technique and rules of natural feeding

The success of breastfeeding depends to a large extent on the punctual adherence to a number of rules.

1. Before each feeding, the mother should carefully wash her breasts with boiled water with clean hands.
2. Squeeze out a few drops of milk, with which you remove stray bacteria that easily get into the peripheral parts of the excretory ducts.
3. At the end of feeding, the breast must be dried with a clean, soft linen cloth so that there is no maceration of the nipples.

When breastfeeding, a physiological balance is established between the mother and the baby, that is, the baby sucks out as much milk as it needs. Physiological balance is determined by the composition of the milk during feeding. It is very well developed in children from the 6th week of life.

However, the duration of each breastfeeding should, on average, last no more than 15-20 minutes. Only newborn babies can be fed for a longer time (up to 20-30 minutes). It should be remembered that the baby during the first 5 minutes of feeding sucks out about 50% of the milk he needs.

When feeding from a bottle through a nipple, it is necessary to dose the amount of food. If a young child is given formula in a bottle with a nipple, he will not stop sucking, despite the fact that a large amount of sucked milk will cause hyperextension of the stomach.

Methods for calculating the required amount of milk for a baby

There are several ways to calculate the amount of food required for children in the first half of their life.

Method 1.- "volumetric" depending on body weight. The child should receive milk at the age of 2 to 6 weeks 1/5 of his body weight from 6 weeks to 4 months 1/6 of his body weight from 4 to 6 months 1/7 of his body weight	For example. A child aged 3 months, weighing 5200 g, should receive milk at the rate of 1/6 of the body weight, i.e. 5200: 6 = 866 ml of milk.	Until recently, this method of calculating the amount of food was the most common. However, at present, in connection with the acceleration, which was expressed in a very rapid increase in body weight during the first half of the year of life and the birth of larger children, it may happen that the amount of food calculated in this way can exceed 1 liter. In such cases, the volume of food should not exceed 1 liter, but then some nutritional correction is needed (see below).
Method 2. Calculation according to Shkarin. A 2-month-old (or 8-week-old baby) should receive 800 ml of milk per day, which is 50 ml less for every week, and 50 ml more for every month more than two.	For children under 2 months old, this can be expressed by the formula: 800-50 x (8-n), where n is the number of weeks of life. For example, a child aged 3 weeks according to this calculation method should receive: 800-50 X (8-3) = 550 ml. For children over 2 months old, you can use the formula: 800 + 50 x (n-2), where n is the number of months for the child. For example, a child at the age of 3 months should receive milk: 800 + 50 x (3-2) = 850 ml. Shkarin's calculation in modern children is hardly suitable due to the acceleration of their development. It is presented in our manual from a historical perspective.
Method 3. Caloric (energy) calculation: per 1 kg of body weight, the child should receive: in the first quarter of the year 120 kcal per day in the second quarter of the year 115 kcal per day in the third quarter of the year 110 kcal per day in the fourth quarter of the year 100 kcal per day	Having determined the weight of the child, it is easy to calculate how many kilocalories the child needs. Knowing that 1 liter of human milk contains on average 700 kcal, it is easy to calculate how much milk a child should receive per day.	For example, a child aged 3 months, weighing 5 kg, should receive 120 kcal per 1 kg of body weight or 600 kcal per day (120 kcal x 5 = 600 kcal). By composing the proportion, it is easy to convert the number of kilocalories into the volume of milk: 1000 ml of milk contains 700 kcal x ml - 600 kcal 600 x 1000 x = ----------- = 857 ml of milk. 700

Of the above calculation methods, the most accurate is the calorie one. The calculation is based on the average normal weight of a child at a given age, but the daily volume of food should not exceed 1000 ml.

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

A textbook on nutrition for a healthy child. A. V. MAZURIN. M., "Medicine", 1980, 208 p., Ill.

Introduction Natural feeding Lactation Colostrum Biological and chemical properties of breast milk Nutrition and regimen of a nursing mother Feeding newborn babies in the first 7-10 days of life Technique and rules of natural feeding Methods for calculating the required amount of milk for a child