Feeding and nutrition of young infants. Nutrition for infants and young children. Cottage cheese and dairy products

The timely introduction of the right complementary foods contributes to the health, nutritional status and physical development of infants and young children during a period of rapid growth and should therefore be the focus of health care systems. During the entire period of complementary feeding, mother's milk should remain the main type of milk consumed by an infant.

Complementary foods should be introduced at about 6 months of age. Some infants may need complementary foods earlier, but not before 4 months of age. Unmodified cow's milk should not be given before 9 months of age as a drink, but it can be used in small quantities in the preparation of complementary foods from 6–9 months of age. From 9-12 months, you can gradually introduce cow's milk into the diet of an infant and as a drink.

Complementary foods with low energy density can limit energy intake, so average energy density should generally be at least 4.2 kJ (1 kcal)/g. This energy density depends on the frequency of meals and may be lower if meals are taken more frequently. Low-fat milk should not be given until about two years of age.

Complementary feeding should be a process of introducing foods that are increasingly varied in texture, taste, aroma and appearance while continuing to breastfeed. Highly salty foods should not be given during the complementary feeding period, and salt should not be added to food during this period.

Complementary feeding is the feeding of foods and liquids to infants in addition to breast milk. Complementary foods can be divided into the following categories:

transitional foods are complementary foods specifically designed to meet the specific nutritional or physiological needs of an infant;
Family meals or homemade foods are complementary foods given to a young child that are, in general terms, the same foods as the foods consumed by the rest of the family.

During the transition from exclusive breastfeeding to cessation of breastfeeding, infants gradually learn to eat homemade food until it completely replaces breast milk (see Figure 1). Children are physically able to consume foods from the family table by the age of 1, after which these foods no longer need to be modified to meet the special needs of the infant.

The age at which transitional foods are introduced is a particularly vulnerable period in a child's development. The diet is undergoing its most fundamental change - from a single product (breast milk), where the main source of energy is fat, to an ever-increasing variety of products that are required to meet nutritional needs. This transition is associated not only with increasing and changing nutritional requirements, but also with the rapid growth, physiological maturation and development of the child.

Poor nutrition and incorrect feeding principles and practices during this critical period can increase the risk of malnutrition (wasting and stunting) and nutritional deficiencies, especially iron, and can have long-term negative health and mental development consequences. Therefore, among the most cost-effective interventions that health professionals can implement and support are nutritional interventions and improved feeding practices targeted at infants.

PHYSIOLOGICAL DEVELOPMENT AND MATURATION

The ability to consume “solid” foods requires the maturation of the neuromuscular, digestive, renal, and defense systems.

neuromuscular coordination

The timing of the introduction of "solid" foods and the ability of infants to consume them is affected by the maturation of neuromuscular coordination. Many food reflexes, which appear at different stages of development, either facilitate or hinder the introduction of different types of food. For example, at birth, breastfeeding is facilitated by both the latch-on reflex and the sucking-and-swallowing mechanism (1, 2), but the gag reflex may interfere with the introduction of solid foods.

Until 4 months of age, infants do not yet have the neuromuscular coordination to form a food bolus, transport it to the oropharynx and swallow. Head control and spinal support are not yet developed, and therefore it is difficult for infants to maintain a position for successful absorption and swallowing of semi-solid food. At about 5 months of age, children begin to bring objects to their mouths, and the development of the “chewing reflex” at this time allows the consumption of some solid foods regardless of the appearance of teeth. By about 8 months of age, most babies can sit up without support, have their first teeth, and have enough tongue flexibility to swallow harder food boluses. Soon after, infants develop manipulative skills for self-feeding, drinking from a cup, holding it with both hands, and they can eat food from the family table. It is very important to encourage children to develop eating habits, such as chewing and bringing objects to their mouths, at appropriate stages. If these skills are not acquired in time, behavioral and feeding problems may occur later.

Some of these reflexes and age-related skills are listed in Table 42, along with reflexes and skills, as possible types of foods that can be safely consumed thanks to these intraoral movements. The foods listed in Table 42 are examples and are not the only foods that can be introduced into the diet at the various stages of development described here. Moreover, there is no rigid relationship between the types of foods and the development of the nervous system; it's just that the child is physically more capable of handling the product at this stage of development.

Table 42. Infant and young child neurodevelopment and its implications for what types of foods can be consumed at different ages Age (months) Preset reflexes/skills Types of foods that can be consumed (a) Sample foods 0-6

chewing movements. The power of sucking is growing.

moving

gag reflex from middle to posterior third of tongue Puree food Vegetable (eg carrot) or fruit (eg banana) puree; mashed potatoes; gluten-free cereals (such as rice); well-cooked and mashed liver and meat 7-12

Spoon cleaning
lips. Biting and chewing. Lateral movements of the tongue and movement of food
to the teeth.

Pounded or chopped dishes and foods that you can eat with your hands Well-cooked liver and meat scrolled in a meat grinder; mashed boiled vegetables and fruits; chopped raw fruits and vegetables (e.g. banana, melon, tomato); cereals (eg wheat, oats) and bread 12-24 Rotational chewing movements.

jaw stability. Food from the family table

a Specifies the types of food that the child can successfully eat and swallow; it does not necessarily mean the timing of the introduction of this food.
Sources: Stevenson & Allaire (2); Milla (3).

Digestion and absorption

In infants, the secretion of gastric, intestinal and pancreatic digestive enzymes is not developed in the same way as in adults. However, the infant is able to fully and efficiently digest and absorb the nutrients found in breast milk, and breast milk contains enzymes that aid in the hydrolysis of fats, carbohydrates and proteins in the intestines. Similarly, in early infancy, bile salt secretion is only barely sufficient for micelle formation, and fat absorption efficiency is lower than in older children and adults. This insufficiency can be partly compensated by lipase, which is present in breast milk, but absent in commercial infant formulas, stimulated by bile salts. By about 4 months of age, stomach acid helps gastric pepsin to fully digest protein.

Although pancreatic amylase begins to fully contribute to starch digestion only at the end of the first year, most cooked starches are digested and absorbed almost completely (4). Even in the first month of life, the large intestine plays a vital role in the final digestion of those nutrients that are not completely absorbed in the small intestine. The microflora of the colon changes with age and depending on whether the child is breastfed or formula fed. The microflora ferments undigested carbohydrates and fermentable dietary fiber into short chain fatty acids that are absorbed in the colon, thereby maximizing energy utilization from carbohydrates. This process, known as "energy extraction from the colon", can provide up to 10% of the absorbed energy.

By the time an adapted food from the family table is introduced into the baby's diet around 6 months of age, the digestive system is mature enough to effectively digest the starches, proteins, and fats found in non-dairy foods. However, the capacity of the stomach in infants is small (about 30 ml/kg of body weight). Thus, if food is too bulky and low in energy density, infants are sometimes unable to consume enough of it to meet their energy and nutrient requirements. Therefore, complementary foods should have a high energy and micronutrient density and should be given in small amounts and frequently.

renal function

Renal solute load refers to the total amount of solutes that must be excreted by the kidneys. Basically, it includes food components that are not transformed during metabolism, mainly electrolytes sodium, chlorine, potassium and phosphorus, which have been absorbed in excess of the body's needs, and end products of metabolism, the most important of which are nitrogen compounds formed as a result of digestion and protein metabolism.

The potential solute burden on the kidney refers to solutes of dietary and endogenous origin that will need to be excreted in the urine unless they are used in new tissue synthesis or excreted by non-renal pathways. It is defined as the sum of four electrolytes (sodium, chloride, potassium, and phosphorus) plus solutes derived from protein metabolism, which typically account for over 50% of the potential solute load on the kidneys. Table 43 shows the significant differences in the potential solute burden on the kidneys of different types of milk and infant formula.

Table 43. Potential solute burden on the kidneys of different types of milk and infant formulaMilk and formula Potential solute burden on the kidneys (mosmol/litre)Mature human milk93Manufactured infant formula135Condensed milk formula260Whole cow milk308

Source: Fomon (5).

The newborn baby has too limited kidney capacity to handle the high solute load and conserve fluids at the same time. The osmolarity of mother's milk corresponds to the capabilities of the child's body, so the concern about the excessive load of dissolved substances on the kidneys primarily concerns children who are not breastfeeding, especially children who are fed unmodified cow's milk. This anxiety is especially justified during the period of illness. By about 4 months, kidney function is much more mature and infants are better able to conserve water and deal with higher solute concentrations. Thus, recommendations for the introduction of complementary foods usually do not need to be changed to match the developmental stage of the renal system.

Protective system

A vital defense mechanism is the development and maintenance of an effective mucosal barrier in the gut. In the newborn, the mucosal barrier is immature, as a result of which it is not protected from damage by enteropathogenic microorganisms and is sensitive to the action of some antigens contained in food. Breast milk contains a wide range of factors not found in commercial infant formulas that stimulate the development of active defense mechanisms and help prepare the gastrointestinal tract for the absorption of transitional foods. Non-immunological defense mechanisms that help protect the intestinal surface from microorganisms, toxins, and antigens include gastric acidity, mucosa, intestinal secretions, and peristalsis.

The relatively weak defense mechanisms of the infant's digestive tract at an early age, as well as reduced gastric acidity, increase the risk of mucosal damage by foreign food and microbiological proteins, which can cause direct toxic or immunologically mediated damage. Some foods contain proteins that are potential antigens, such as soy protein, gluten (found in some grain products), proteins in cow's milk, eggs, and fish, which have been associated with enteropathy. Therefore, it seems reasonable to avoid introducing these foods before 6 months of age, especially when there is a family history of food allergy.

WHAT IS COMPLETE FOOD FOR?

As the child grows and becomes more active, breast milk alone is not enough to fully meet his nutritional and physiological needs. To compensate for the difference between the amount of energy, iron and other essential nutrients provided by exclusive breastfeeding and the total nutritional needs of the infant, an adapted family food (transition food) is needed. With age, this difference increases and requires an increasing contribution of food other than breast milk to the supply of energy and nutrients, especially iron. Complementary foods also play an important role in the development of neuromuscular coordination.

Infants do not have the physiological maturity to move from exclusive breastfeeding directly to food from the family table. Therefore, to bridge this gap between needs and opportunities, specially adapted family foods (transitional foods) are needed, and the need for them lasts up to about 1 year, until the child is mature enough to consume ordinary homemade food. When transitional foods are introduced, the baby is also exposed to a variety of textures and textures, and this contributes to the development of vital motor skills such as chewing.

WHEN SHOULD I INTRODUCE COMPLETE FEEDINGS?

The optimal age of transition food introduction can be determined by comparing the advantages and disadvantages of different timings. It should be assessed to what extent breast milk can provide sufficient energy and nutrients to support growth and prevent deficiencies, as well as what is the risk of morbidity, especially infectious and allergic diseases, from the consumption of contaminated food and "foreign" dietary proteins. Other important considerations include physiological development and maturity, various developmental indicators that indicate an infant's readiness to feed, and factors related to the mother, such as nutritional status, the impact of reduced breastfeeding on a mother's fertility and ability to care for her baby, and existing principles and practices for caring for young children (Chapter 9).

Starting complementary foods too early has its dangers because:

breast milk can be displaced by complementary foods, and this will lead to a decrease in breast milk production, and therefore to the risk of insufficient intake of energy and nutrients by the child;
infants are exposed to pathogenic microbes present in foods and fluids that can be contaminated and thereby increase the risk of dyspepsia and therefore malnutrition;
the threat of dyspepsia and food allergies increases due to the immaturity of the intestine, and because of this, the risk of malnutrition increases;
fertility returns to mothers more quickly, as reduced breastfeeding reduces the period during which ovulation is suppressed.

Problems also arise when complementary foods are introduced too late because:

insufficient intake of energy and nutrients from breast milk alone can lead to growth retardation and malnutrition;
due to the inability of breast milk to meet the needs of the child, micronutrient deficiencies, especially iron and zinc, may develop;
Optimal development of motor skills, such as chewing, and the child's positive perception of the new taste and texture of food may not be ensured.

Therefore, it is necessary to introduce complementary foods at the right time, at the appropriate stages of development.

Much controversy remains over exactly when to start introducing complementary foods. And while everyone agrees that the optimal age is individual for each individual child, the question of whether to recommend the introduction of complementary foods at the age of "4 to 6 months" or "about 6 months" remains open. It should be clarified that “6 months” is defined as the end of the first six months of a child's life when they are 26 weeks old, and not the beginning of the sixth month, i.e. 21–22 weeks. Similarly, "4 months" refers to the end, not the beginning, of the fourth month of life. There is near universal agreement that complementary foods should not be started before 4 months of age and should not be delayed beyond 6 months of age. In the resolutions of the World Health Assembly in 1990 and 1992. “4-6 months” is recommended, while the 1994 resolution recommends “about 6 months”. Several more recent WHO and UNICEF publications use both formulations. A WHO review (Lutter, 6) concluded that the scientific basis for the recommendation of 4–6 months was not well documented. In a recent WHO/UNICEF report on complementary feeding in developing countries (7), the authors recommended that full-term infants be exclusively breastfed until about 6 months of age.

Many recommendations in industrialized countries use a period of 4–6 months. However, recent official guidelines published in the Netherlands (8) state that breastfed children who are of adequate growth should not, from a nutritional point of view, receive any complementary foods until about 6 months of age. If parents decide to start complementary foods earlier, this is quite acceptable, provided that the child is at least 4 months old. In addition, a statement from the American Academy of Pediatrics (9) recommends an age of “approximately 6 months”, and this has been adopted by various Member States of the WHO European Region when they adapted and implemented Integrated Management of Childhood Illness (IMCI) training programs for health professionals (see Appendix 3).

When deciding whether to recommend 4-6 months or approximately 6 months in the recommendations, it is necessary to evaluate how this is interpreted by parents or health professionals. Health care providers may misinterpret the advice and encourage the introduction of complementary foods by 4 months, just “just in case”. As a result, parents may think that their children should be eating complementary foods by 4 months of age and therefore start introducing “new flavors” of food before 4 months of age (7). Therefore, national authorities should evaluate how their recommendations are interpreted by parents and health professionals.

In countries in transition, there is evidence of an increased risk of infectious diseases when complementary foods are introduced before 6 months of age and that introducing complementary foods before this age does not improve the rate of weight and length gain in the child (10, 11). Moreover, exclusive breastfeeding for the first approximately 6 months offers health benefits. In adverse environmental conditions, even if there is a slight increase in energy intake with the introduction of complementary foods, the energy expenditure in response to increased morbidity associated with the introduction of foods and fluids other than breast milk (which is especially likely in unhygienic environments) results in no net benefit in terms of energy balance. In terms of nutrients, the potential benefits of introducing complementary foods are likely to be offset by losses from increased morbidity and reduced bioavailability of breast milk nutrients when complementary foods are given along with breast milk. In settings where nutritional deficiencies in infants under 6 months of age are a concern, improving maternal nutrition may be a more effective and less risky way to prevent maternal and infant nutritional deficiencies. Optimal maternal nutrition during pregnancy and breastfeeding not only guarantees high quality milk for the baby, but also maximizes the mother's ability to care for her baby.

For the WHO European Region, the recommendation is that infants should be exclusively breastfed from birth to about 6 months and for at least the first 4 months of life. Some babies may need complementary foods before 6 months of age, but should not be introduced before 4 months of age. The need for complementary foods before 6 months of age is indicated by the fact that the child, in the absence of obvious illness, is not gaining enough weight (as determined by two or three consecutive assessments) (see Chapter 10) or appears hungry after unrestricted breastfeeding. Care should be taken to use the correct growth target charts, bearing in mind that breastfed children do not grow at the same rate as those on which the US National Center for Health Statistics guidelines are based (12). However, when introducing complementary foods before 6 months of age, other factors need to be considered, such as body weight and fetal age at birth, the clinical condition and overall growth and nutritional status of the child. A study in Honduras (13) found that feeding breastfed infants with birth weights between 1500 and 2500 g free high-quality complementary foods from 4 months of age did not provide any benefits for physical development. These results support the recommendation to exclusively breastfeed for about 6 months, even for small babies.

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Kim Fleischer Michaelsen

Francesco Branca

Aileen Robertson

Feeding

è infant feeding

The World Health Organization was established in 1948 as a specialized agency of the United Nations responsible for directing and coordinating international health and public health problems. One of WHO's statutory functions is to provide objective and reliable information and advice on public health issues, a duty it fulfills in part through its publications. Through its publications, the Organization seeks to support the implementation of country health strategies and contribute to addressing the most pressing and pressing public health problems.

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Cover design: Sven Lund

World Health Organization Regional Office for Europe Copenhagen

Feeding and nutrition of infants and young children

Kim Fleischer Michaelsen, Lawrence Weaver,

Francesco Branca and Aileen Robertson

WHO Regional Publications, European Series, No. 87

ISBN 92 890 4340 7

The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate this publication, in part or in full. Applications and inquiries should be directed to the Publications Office of the WHO Regional Office for Europe, Scherfigsvej 8, DK-2100CopenhagenØ, Denmark. The Office will be happy to provide an update on any changes to the text, plans for new editions, and existing reprints and translations.

Updated reissue, 2003

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Foreword ………………………………………………………………………………
Acknowledgment…………………………………………………

Introduction ……………………………………………………………………………………
What is this publication for and who needs it
intended? …………………………………………………………………..
Some determinants of health in Europe…

Terminology used …………………………………………………
Adaptation to local conditions and implementation


1. Health, nutritional status, principles and methods
feeding children ………………………………………………………………
Diseases of the gastrointestinal tract of children
early age …………………………………………………………………
Principles and methods of feeding and related

Literature ……………………………………………………………………………

substances …………………………………………………………………………….
Introduction …………………………………………………………………………….


nutrients ………………………………………………………….
Literature ……………………………………………………………………………
3. Energy and macronutrients …………………………………………………
Energy ……………………………………………………………………………….
Energy density ………………………………………………..
Protein …………………………………………………………………………………..

Fat ……………………………………………………………………………..


	Carbohydrates…………………………………………………………………………….
	Literature ……………………………………………………………………………
	Vitamins …………………………………………………………………………….
	Vitamin A …………………………………………………………………………..
	B vitamins ……………………………………………………………..
	Vitamin C …………………………………………………………………………..
	Vitamin D ……………………………………………………………………………..
	Literature ……………………………………………………………………………
	Application …………………………………………………………………….
	Minerals other than iron ……………………………………………..
	Iodine…………………………………………………………………………………….
	Zinc ………………………………………………………………………………….
	Calcium ……………………………………………………………………………….
	Sodium ………………………………………………………………………………

	Application ……………………………………………………………………..
	Fighting iron deficiency ……………………………..

	Physiology and pathophysiology of iron …………………………..
	Symptoms and consequences of iron deficiency……..
	Complementary foods and malnutrition management
	iron ……………………………………………………………………………..
	Other interventions to combat
	iron deficiency …………………………………………..
	Literature ………………………………………………………………………….
	Breastfeeding and its alternatives ………………..
	About the importance of breastfeeding …………………………….
	Benefits of breastfeeding in terms of
	supply …………………………………………………………………………….
	Benefits of breastfeeding, unrelated
	with food……………………………………………………………………..
	Importance of maternal nutrition ……………………………………………….
	Practical aspects of breastfeeding………….
	How to increase duration
	prevalence of breastfeeding …………..
	Contraindications to breastfeeding …………….
	Alternatives to breastfeeding ……………………..
	Literature ………………………………………………………………………….


8. Introduction of complementary foods ……………………………………………………………
What is complementary feeding? ……………………………………….
Physiological development and maturation ……………………….
Why is complementary food needed? …………………………………
When should complementary foods be introduced?……………………………………….
Composition of complementary foods ……………………………………..

complementary foods ………………………………………………………………………….
What is the best food for babies? ….

cooking …………………………………………………….
Literature ………………………………………………………………………….
9. Childcare practice ………………………………………………
Introduction …………………………………………………………………………..
UNICEF Child Care and Nutrition Initiative
child …………………………………………………………………………….
Factors affecting the ability of individuals
caring for the child, perform
correct feeding actions …………………………..
Care for girls and women and its consequences ………….
Feeding young children ………………………………..
Psychological help………………………………………………..
Resources needed for childcare …………………..
Literature ………………………………………………………………………….
10. Assessment of physical development ………………………………………..
Introduction …………………………………………………………………………..
How to measure physical development and use
maps of physical development …………………………………..
Basic population groups ………………………………………………
Interpretation of measurements of achievement
level of physical development ……………………………………..
Catching up the backlog in physical development…….
Literature ………………………………………………………………………….
11. Oral hygiene ……………………………………………………
Prevalence of dental caries ……………………………………
How caries occurs …………………………………………………………
Relationship between diet and caries
teeth………………………………………………………………………. 294
Prevention of dental caries………………………………………….
Literature ………………………………………………………………………….


12. Food safety ……………………………….
Introduction …………………………………………………………………………….
Microbiological contamination…………………………………….
Chemical pollution …………………………………………………
Literature ………………………………………………………………………….
Annex 1. International Code of Marketing
breast milk substitutes and subsequent
resolutions of the World Health Assembly,
related to this issue ……………………….
Annex 2 Prevention of virus transmission
human immunodeficiency from mother to child ………….

Appendix 3. Infant feeding in the Integrated Management of Childhood Illness … 363

As for me, this is one of the best articles about feeding a child from 6 months to 3 years from the brilliant neonatologist Anastasia Vitalievna. Residents of Volgograd - you are lucky! Here you will find if not all, then almost all the answers to your questions. Everyone must read!

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Child nutrition raises many questions for new parents.

If in the first months of a baby's life with nutrition everything is clear - breast milk is the ideal food for babies up to 6 months (full 26 weeks) - then what to do next?

It's time to feed!

But how to determine that this moment has come?

Grandmothers strive to give their grandson or granddaughter juice to drink almost from 3-4 weeks of age, feed semolina, because the child is hungry, since it is so often applied to the chest. Friends begin to introduce complementary foods using new methods. The Internet is full of conflicting information.

How can a young mother not be confused?

Let's figure it out!

What is complementary food?

The WHO defines complementary foods as: “any nutrient-containing food or liquid that supplements breast milk between 6 and 12 months”.

Please note that food only complements the food, but is not its basis. Breast milk continues to play a leading role in nutrition.

Breastfeeding with the introduction of complementary foods should remain the same. There is no need to reduce the number of attachments to the breast and reduce the daily volume of breast milk.

The introduction of complementary foods and breastfeeding are two parallel processes that perform different tasks and have different goals. A small child distinguishes this very well: for example, he still needs breasts to fall asleep, and not fruit puree, to calm down after the stress he has received, there is no better remedy than mother’s milk.

If the baby is bottle-fed, the adapted milk formula should also not be replaced by complementary foods too quickly.

Start feeding.

Timing introduction of complementary foods individual and are determined by the level of development of the organs and systems of the child, the degree of functioning of the central nervous system.

There are some signs that a child is ready to get acquainted with a new food:
extinction of the pushing reflex - if the baby gets something in his mouth, he does not immediately try to push it out with his tongue;
doubling birth weight (and for premature babies, it is proposed to talk about tripling);
the baby can consciously turn away from the spoon if the proposed product is not liked;
the child increases the frequency of breastfeeding or does not eat up with the usual portion of the mixture;
finally, the baby shows food interest: he is actively interested in what his parents eat there.

One or two signs from this list are still not enough to introduce complementary foods, most of them should appear, ideally all. In most cases, this happens just in time for the age of about six months, although sometimes a little earlier or later.

Sometimes unforeseen situations happen. Your baby appears to be ready for complementary foods, but there are the following points:
The kid is sick.
The stage of active teething has come, the baby is naughty, crying, in a word, not in the mood.
A family with a baby travels, often moves from place to place, recently changed their place of residence.
The kid gets used to changes in the life of the family: his mother went to work, a nanny appeared in the house.
The first samples of complementary foods gave a negative reaction (diarrhea, skin rashes, etc.).
Was vaccinated.

In such cases, it is appropriate to delay the start of complementary foods for 1-2 weeks.
Another important rule: immediately teach the child to eat on his own.

At first, help from your side is acceptable: the mother monitors the maintenance of cleanliness around the baby, prompts and directs the child’s movements, and controls behavior.

Remember, the child is quite capable of using a cup, spoon, napkin. The baby does not need any liquid porridge from the bottle as complementary foods. Encourage your child to be independent from the very beginning.

Where to begin?

Porridge or vegetables are recommended as the first complementary foods. If the child is not gaining weight well, he has a tendency to diarrhea, it is better to start with cereals. If the baby has good weight gain or strengthens it more often, then it is advisable to introduce vegetables first.

Starting with vegetables, and not as was previously done with fruit puree, is good because the child learns to perceive the neutral taste of vegetables, and gets used to it.

After the sweetness of fruits, namely, the sweet taste is more pleasant for the child, the kids reluctantly agree to eat more healthy vegetables and cereals.
When choosing vegetables, give preference to those that grow in your area.

The purpose of the initial period: to give the child the opportunity to try a completely different taste of food and teach him to eat from a spoon. At this time, the baby is offered a very small amount of complementary foods, only 1-2 teaspoons.

The food at this stage is mashed, one-ingredient foods that are soft in texture, with no added sugar, salt, or hot spices.
Heat complementary foods to a warm, comfortable temperature
The consistency of the dish should be puree (not liquid!). Ideally, this is the consistency of thick sour cream. This is the so-called thick puree, which retains its shape in a spoon.

Food that is thick enough not to spill out of a spoon gives the baby more energy.

A more liquid degree of puree close to the consistency of pancake dough is called liquid puree. If you immerse in it, and then remove the spoon, then the puree will slowly drain from the spoon.

When a baby starts eating solid foods, it takes time for the baby to get used to the new taste and texture of the food. Someone copes with this quickly and easily, but someone needs more time for this.

Be patient and remember: baby is learning to eat!
Your task is to support him in this.

All children are different, someone eats complementary foods before breastfeeding, and someone agrees to taste new food only after applying. Try different options!

Most importantly, no violence! Remember, food violence is violence against the body and personality. By forcing a child to eat, you harm him physically and mentally. If the child does not want to eat, then he does not need to eat at the moment. No coercion in food, no persuasion! No "feeding"!

The kid ate 1/2 tsp. vegetable puree and turned away? Praise him for his success! The next day, offer 1 tsp. Liked? Great! Gradually increase volume to 140-150g by 7 months and to 180-200g by 8-12 months.

When the child begins to eat a large portion of food, add half a teaspoon of vegetable oil.

Some babies, due to their functional characteristics, cannot eat more than 100g in one feeding. food (this is normal!). Such children can be offered this type of complementary foods twice a day in small portions.

Porridge is our joy!

The second food after vegetables is porridge. We will introduce it a month after the start of the first complementary foods.

Previously, it was believed that in the first place it is necessary to start with gluten-free cereals (buckwheat, rice or corn).

But according to recent data, the timing of the introduction of gluten into the infant's diet does not affect the subsequent risk of developing celiac disease.
Therefore, which porridge (buckwheat, oatmeal, rice, corn) to give preference to, decide for yourself.

The only thing is that you should not start complementary foods with semolina. This cereal contains little fiber and is poor in vitamins and minerals.

Very often, mothers ask the question - Do you cook baby porridge yourself or buy ready-made cereals in boxes?
It all depends on your financial capabilities, availability of time and desire. The WHO recommendations emphasize that industrially produced cereals “…should be used in the nutrition of children if the mother has the means and opportunities to purchase them…”.
These porridges are convenient in their way of preparation, do not require cooking, are easily diluted with water, breast milk, and milk formula. They are enriched with vitamins and minerals in the amount necessary for the child. But they are expensive.
Therefore, there is nothing wrong if you cook porridge for your child yourself from ordinary cereals.

The principle of acquaintance with cereals is the same.
Start with one type of porridge. When you first meet, give preference to dairy-free porridge. On the first day, suggest 1/2 tsp, gradually adding 1-2 scoops per day.
Bring the volume of porridge to 150 ml. by 6 - 7 months and 160-200 ml. by 8-12 months. When introducing the full volume of porridge, add 5 g of butter to it.
Industrially produced cereals already contain all the necessary components, so oil is not added to such cereals.

Remember: all figures are indicative. We first of all look at our child. If he wants to eat an extra spoonful of complementary foods, we suggest, if his nose turns up, we remove the plate out of sight.

The main thing is not to form and consolidate a negative reaction at the sight of a plate of food. Eating disorders in children under one year old are not uncommon!

Meat time.

After your child got acquainted with vegetables and cereals, it's time for meat.
You can use beef, veal, turkey, rabbit, lean pork, chicken. Remember that red meat is preferable and healthier than white.

You can offer half a teaspoon of meat before the main complementary foods, or add 1/2 tsp. meat puree to already familiar vegetables. Gradually bring the volume up to 30 g, after a month 50 g, and by the year the child already receives 60-70 g of meat complementary foods.

You can cook the meat yourself or buy ready-made mashed potatoes in jars, preferably monocomponent, without salt, preservatives and other additives.

At 9-10 months, meat puree is replaced by steamed meatballs, and at 11-12 months - meat steam cutlets.
You can also use organ meats (liver, tongue).

Important: cereals, vegetables, meat are the three main complementary foods that are mandatory in a child's diet. All other foods are introduced for a variety of dishes, taste, smell and texture.

Fish and seafood.

From 9-10 months, a child without signs of allergy can be introduced to fish. Fish is introduced into the diet of children with caution, taking into account individual tolerance. If the baby is at risk for the development of allergies, it is better to postpone fish until 12 months, but if the child has already had a previous manifestation of food allergies, the introduction of fish is not indicated until 2-3 years.

It is better to use low-fat varieties of fish - hake, cod, pollock, pike perch, river perch. Usually fish is given 1-2 times a week instead of meat.
Seafood - seaweed, squid, octopus, mussels, scallops, crabs, shrimp, crayfish, fish roe, milk - should not be given to a child under 3 years old.

Fruit puree and dessert.

After your baby has learned to eat healthy vegetables, cereals and meat, it's time to enjoy sweet fruits and cookies. You can give them as a dessert at the end of the main meal, or use them as a healthy snack between meals.

Cottage cheese and dairy products.

It was the turn of the curd. Start with 1/2 teaspoon per day, gradually increasing to 40g-50g by 9-12 months.

Use low-fat cottage cheese (from 4 to 10%) without fruit additives and fillers.

Sour-milk baby food products (baby kefir, biokefir, yoghurts "Agusha", "Tyoma", etc.) can be introduced into the child's diet no earlier than 9-10 months of age in an amount of no more than 200 ml per day.

Whole cow's or goat's milk as a drink is not recommended for children under 12 months of age. But it can be used in small quantities when preparing food (for example, porridge) for complementary foods.

When can you give an egg to children?

Your baby is growing up, he is already 8-9 months old. He willingly eats vegetables, fruits, cereals and meat. Now it's time for the egg yolk.

The yolk of a hard-boiled chicken or quail egg is given to children from a small piece, pounded in a spoonful of breast milk. Gradually, portions are brought to a quarter of the yolk, and after another 8–10 days, to half. On average, half a yolk per day (4 eggs per week) is enough for a child up to almost a year. Quail egg yolks will need 8-10 per week.

Steep yolk mashed can be added to vegetable purees and soups. Mixing the yolk with porridge is not worth it; protein dishes are better combined with vegetables. A whole egg can be given to children from 1 year.

Children's herbal teas.

All types of tea, black, green, herbal (chamomile, mint, lemon balm, lingonberry) and coffee should be avoided before the age of 2 years, as these drinks interfere with the absorption of iron. In addition, there is insufficient scientific evidence to support the safety of various herbs and herbal teas for infants. After two years, drinking tea with meals should be avoided.

Separately, I want to say about tea with fennel.

Despite the fact that fennel tea is widely used for colic in newborns, its use should be avoided: fennel contains a toxic substance, estragole, which has been found in these teas in quantities sufficient to make their use undesirable, especially in newborns. Thus, pregnant and lactating women and children under 4 years of age should not consume fennel tea.

Where's the juice?

Juice is not a product of the first feeding. It is not suitable even for the second or third complementary foods. The child needs a lot of energy, and physically he is able to consume very little food. The products he receives must have a certain energy value, otherwise there is a risk of malnutrition.

Therefore, the early introduction of juices is unacceptable precisely because the juice does not carry any semantic load, but only “suppresses” the appetite.
Sometimes mothers complain that their baby eats a small amount of complementary foods. When you start to find out what the child eats and drinks during the day, it turns out that in the intervals between meals he is simply saturated with water and juices.

Among other things, due to the combination of high acidity and sugars, fruit juices, when actively used, often cause early childhood caries.

So with juices it is better to wait up to a year until the child learns to eat the main healthy and energy-rich food.

For more information on feeding, see

Is it worth it to drink a baby from a bottle?

Breast milk is a unique product, which for a child of the first 6 months of life is both food and drink. It contains up to 90% water, and it covers all the needs of the baby in the liquid.

Starting to suck milk from the mother's breast, the child first receives foremilk, which quenches thirst, and then hind milk, which satisfies hunger.

In the World Health Organization's Ten Principles for Successful Breastfeeding, principle #6 states: "Give newborns no food or drink other than breast milk, unless medically indicated."

But let's not forget that the process of becoming lactation takes 2-3 months, and for someone even longer.

We know that milk is produced in response to the suckling of a baby, i.e. how much the baby sucked milk from the chest - the same amount of milk will subsequently be produced.

If a child is given water instead of milk, especially before feeding, then the baby gets a false feeling of satiety, as a result, he sucks out less milk. The breast will remember this small volume and by the next feeding will produce less milk than the baby needs. If such a “substitution” is repeated regularly, milk production will gradually decrease to a critical level and mom will notice that she does not have enough milk.

Such a situation occurred in Soviet times, when there was a recommendation that all babies be given water to drink. The then mothers (now grandmothers) followed these recommendations, and by 3-4 months, most of them lost their milk.
In addition to reducing lactation, supplementing with water, especially from a bottle, is fraught with the baby's refusal to breastfeed. There is a so-called "nipple confusion" - the child chooses the easiest way and prefers the nipple, which is easier and more comfortable to suck than the mother's breast.

Therefore, it is not advisable to supplement babies up to 3 months of age, so as not to harm.

After the formation of lactation and as the single volume of feeding increases, the child can (if you really want to) offer water. It is best to do this using a teaspoon and a cup (to avoid the very “confusion”), especially for the street, you can purchase a drinker by age or a bottle.

It is advisable to use special bottled water for baby food to supplement the child. Boiled tap water is not the best option. in the process of boiling, salts of metals that are completely unnecessary for the body precipitate out (just look at the walls of the kettle).

Offer water between feedings. You should not insist too much and even more so forcefully water the baby. Your task is to offer, and the child will decide for himself whether he should drink at the moment and in what volume.

If you often put the baby to the breast on demand, then most likely you will notice that the baby is perfectly saturated and gets drunk on your milk and refuses water. And he does it right!

There are many studies that have determined that babies who are exclusively breastfed on demand do not need extra water. These studies were carried out in places with different climates (both wet and dry) with a temperature difference of 22-41°C and a relative humidity of 9-96%.

The American Academy of Pediatrics recommends: “Do not give supplements (water, glucose water, formula, or other fluids) to breastfed newborns unless there is medical evidence to do so… In the first 6 months of life, even in hot climates, it is not necessary to give newborns water or juice, as this may cause infection or allergies.”

From the moment you introduce complementary foods, you can safely begin to offer your baby water to drink after and between feedings. But do not expect that the baby will make a choice in favor of water, and not in favor of tasty and familiar from birth mother's milk.

As for formula-fed babies, they usually do not need additional water.

There are outdated opinions that it is necessary to supplement the artificial ones, because the mixture is a heavy and satisfying product. This applies to old unadapted mixtures that were not of high quality. Modern infant formulas are adapted and improved in composition.

At the same time, in hot weather, an artificial baby can be offered to drink water if you feel that the child is thirsty, not hungry.

In addition, if a bottle-fed baby is constipated, then he needs additional fluids. Supplementation in this case will contribute to better emptying of the intestines.

I want to draw your attention to the fact that we are talking about supplementing healthy babies.
A child with fever, diarrhea, signs of dehydration, especially those who are bottle-fed, undoubtedly needs additional fluids.

Infants with mild SARS or intestinal infections, as a rule, are often applied to the chest and thereby compensate for the loss of fluid.

However, in some cases, despite frequent attachment to the breast, signs of dehydration and / or intoxication persist and increase. In such situations, it is necessary to introduce solutions for oral rehydration (Humana Electrolyte, Hydrovit).

Nutrition for children aged 1 to 3 years.

The long-awaited 1 year has come!
Now your child can eat food from your home table, of course, provided that the principles of healthy eating are followed by the whole family.

The World Health Organization has formulated the following nutritional recommendations for children over 1 year of age:

Continue breastfeeding in the second year of a child's life.

It is very important that the transition from breastfeeding to regular food from the family table is gradual. Therefore, it will be beneficial for the child if breastfeeding is continued after a year. In addition, in the second year of life, 500 ml of breast milk provides about:
30% of a child's daily energy requirement
40% - in proteins
95% - in vitamin C.
In addition, breast milk provides additional immunological protection and reduces the risk of digestive disorders.

In the child's diet, a variety of foods should be present daily, largely vegetables and fruits, preferably fresh.

Gradually expand the range of fruits, berries and vegetables in your child's diet. It is an excellent source of vitamins, minerals, non-nutritional substances (such as antioxidants) and dietary fiber.

Therefore, instead of using various vitamins and dietary supplements, include more vegetables and fruits in your diet. (in summer it is fresh vegetables and fruits, in winter canned, frozen, dried). Where possible, locally produced products should be selected.

Vegetables and fruits make the largest contribution to the intake of vitamin C. Eating vegetables and fruits containing vitamin C, along with foods rich in iron, improves absorption of the latter and prevents the development of iron deficiency.

In addition, early introduction of unmodified cow's milk and other dairy products can cause blood loss from the intestinal tract and thus have a negative effect on iron levels in the body. Therefore, it is not recommended to give cow's milk as a drink until 9 months, ideally up to 12 months. After this age, if the baby is no longer breastfed, cow's milk can be introduced gradually. If the baby is not breastfeeding, he should be fed iron-fortified infant formula.

Various factors affect the absorption of iron from food. For example, in the presence of vitamin C, iron is absorbed better. If the child receives fruit juices, which are made from the pulp of fruits, they have a high content of vitamin C. This has a positive effect on the absorption of iron.
But tea reduces the absorption of iron from food by 62%! Therefore, drinking tea after a meal is undesirable.

A child after a year should receive 60-70 g of red meat every day (veal, beef, rabbit, turkey).

Do not offer fatty pork, lamb, duck and goose meat to children under 3 years of age. Let me remind you that store-bought sausages, smoked meats, sausages and sausages in the diet of a child under 3 years old are also not appropriate.

Several times a day, the child should receive bread, cereals, pasta and potatoes.

These foods form the basis of nutrition. Potatoes and grain products are the main source of energy throughout the year. They are rich in carbohydrates and trace elements, and although they contain relatively few fats and proteins, their value is very high.

Until the age of 2, milk and dairy products in the child's diet should be of normal fat content (3.2% or 3.5%). After this age, low-fat milk and dairy products are recommended.

Most dairy products contain many different nutrients, especially protein and calcium. The latter is necessary for the development of healthy teeth and bones and plays an important role in cell metabolism.

Sufficient calcium can be obtained while maintaining a low level of fat intake.
You can read more about the norms of calcium intake.

It is not recommended to introduce low-fat milk to a child under 2 years of age, as its energy density decreases, and also because a much higher percentage of the energy contained in it falls on protein, and foreign protein is a strong allergen.

To prevent iodine deficiency when cooking, choose iodized salt. Don't add salt to your food, choose foods that are low in salt.

It is advisable to adhere to this principle from the moment of introduction of complementary foods. Since iodine is an indispensable mineral in the synthesis of thyroid hormones, which are necessary for the normal growth and development of the child.

The only rich natural source of iodine is sea fish.

About the prevention of iodine deficiency diseases in children written
You can read about iodine deficiency and iodized salt

Limit the frequency and amount of consumption of sugary drinks, sweets, refined sugar.

Sugar should only be added in very limited amounts.
Sugar is not a necessary part of the diet of young children and is not recommended for consumption. However, if sugar is given to a child, then the total amount should not exceed 25 g per day, including all sugar in sweets, jams, rolls, drinks, juices, as well as sugar that is added, for example, to sour fruits to improve their palatability.
Sweet foods can develop a preference for sweet foods later in life, which negatively impacts dental health.

The daily amount of food for children aged from 1 to 1.5 years should be 1000-1200 ml, from 1.5 to 3 liters - 1200-1400 ml.

The interval before feeding is 3.5-4 hours. It is during this time that the food eaten is evacuated from the baby's stomach, and he will be ready for the next meal.

The most high-calorie should be breakfast and lunch. It is at lunchtime that it is most correct to offer meat complementary foods. Dinner is always lighter and consists mainly of vegetable and cereal dishes.

Food must be prepared in a safe and hygienic way.

Food must be carefully cooked. This is necessary for the prevention of foodborne diseases.

Careful heat treatment kills many microorganisms. For this purpose, all parts of the product must be warmed up so that steam rises from them.

Preferably, food prepared for infants and young children should not be stored at all. If this is not possible, food should only be stored until the next meal in the refrigerator (below 10⁰C) or hot (about 60⁰C or above). After storage, the dish must be thoroughly reheated.

Wash vegetables and fruits before eating. It will not be superfluous to remove the peel

Use water that is safe to drink. Ideally, this is bottled water intended for baby food.
Wash your hands thoroughly before preparing food, when serving food, and after every interruption, especially if you have changed your child's clothes, visited the toilet, or come into contact with animals.

Avoid bottle feeding babies. Rinsing bottles and nipples completely clean is quite difficult. Therefore, give preference to a mug, a plate and a spoon. If you still have to use bottles and nipples, they must be thoroughly washed and boiled after each use, or use sterilizers specially designed for this.

Protect food from insects, rodents and other animals.

Drinking mode.

Teach your child to quench their thirst with ordinary water, and not with sweet compote or store-bought juice. Get your baby a beautiful bright mug or drinker. Many children like to drink through a straw, perhaps so he will be interested and agree to take a sip of water.
Gently offer a drink, remind about it. Are you thirsty? Offer the child for the company.

It is not necessary for the child to drink a large amount of liquid at once. Better often and little by little.

Do not forget that many vegetables and fruits, soups, breast milk already contain water. Therefore, if your child, after eating a light soup or kissing his chest, refused to drink, this is normal.

Whether the baby is drinking enough can be judged by the color of the urine and the amount of urination. Normal urine is clear, colorless or with a slight yellowish tint.

Until the age of three, do not give your child a drink containing caffeine (various teas, coffee, soda).

Little bad guys.

The poor appetite of the crumbs and the selectivity in food often cause anxiety for many mothers. Instability in food is typical for most children.

One day, the baby may have a good appetite, and he eats everything that you offer him. The next day, he can eat almost nothing, but only suck on the breast. Today he leans on vegetables, and tomorrow he refuses them. Should I be worried?

Children's food intake comes into balance over a period of time. And if you follow how the child ate during the week, you will see that his diet is quite balanced.

You should not fix, weigh portions of the child's dishes, trying to determine how much food he ate. It's redundant. Take a closer look at your child - is he/she in a good mood, is he/she active, running, playing, frolicking, gaining weight and growing? This means that the child has enough energy.

If a son or daughter refuses to eat the food that you have prepared with love, do not take the refusal as a personal insult. Respect the taste preferences of the child!

If your "picky" has a dish or product that is not your favorite, you should not give it along with the dish that the baby eats willingly. Most likely, the child will not eat either product. It is better to go the other way - to offer the baby the same product, but in a different form. Call on your imagination to help. And you will see that the useful can always be combined with the pleasant.

When the baby plays around at the table, testing your patience, he carefully monitors your reaction. Therefore, the most correct way to interrupt the theatrical performance of a little artist is to calmly take him out of the chair and send him to play. When hungry, the naughty will ask for food.

Remember, food is not a means to achieve obedience (if you behave well, I will buy ice cream, cake ...). No food rewards. Food is not a means of enjoyment. Food is a way to live!

Do not rush your child while eating. Food is not fire fighting. The pace of eating is individual.

Teach your child to chew food well without swallowing pieces. It is with poor chewing of food that the frequent complaint of mothers about undigested pieces of food in the stool is associated. Many children are too lazy to chew and swallow pieces whole. There is no need to be afraid of this, run to do an ultrasound scan and take a coprogram, you do not need to treat this condition with enzymes. All you really need is to teach your child to chew!

We often hear complaints from mothers that the child is choking on pieces of food, or that he has a gag reflex for such food. Most likely, the baby was initially used to a very liquid consistency of food and now it is difficult for him to cope with the pieces. There's nothing wrong with that! Everything comes with experience and the process of chewing and swallowing too. Therefore, calmly and patiently offer your child soft pieces of food (for example, boiled carrots, banana), gradually moving on to denser pieces (potato, apple, meatballs).

If the child chokes, the food makes him uncomfortable, causes vomiting - do not insist, remove the product in this feeding, and next time offer it again.

It is not worth it to be overly persistent.

Despite the fact that after 1 year a child can eat food from an adult table, there are foods that are not desirable and even dangerous for children.
What not to feed young children read

What is a "norm"?

Dear parents, I would like to draw your attention to the fact that all the norms and figures indicated in the article are very indicative.

After all, what is a "norm"? This is some average value. A boring scientific concept that has nothing to do with this particular child, does not take into account a huge number of real factors.

Appetite and the ability to absorb a certain amount of food are affected by:
mood
physical activity (is your child enough in the fresh air, does he have enough time to run, jump?)
the atmosphere in the family (if mom and dad just had a fight, the child is unlikely to eat with appetite)
feature of metabolism
current state of health
weather conditions (in hot weather, you don’t really feel like eating, in the cool season, after a walk, vice versa), etc.

Be honest, do you weigh your portion unless you want to intentionally lose or gain weight? Do you look at the clock to drink or eat?

In the desire to eat, we all start from our feelings of hunger. If a person is hungry, then he wants to eat and will eat exactly as much as his stomach can hold. Someone due to their physiology eats in small portions, but quite often. Someone has a larger portion, but the frequency of eating less often. Both of them live comfortably.

I well understand the desire of young mothers to learn children's nutritional norms, because for the first time you need to build on something.

However, the amount of food should be exactly as much as the child needs at the moment for good health and mood.

If a child, in your opinion, eats poorly and little, but at the same time grows, gains weight well, is active, inquisitive, develops according to age, then he receives exactly as much food as his body needs for the normal functioning of all organs and systems.

But what if the baby eats a little more than the norm? For example, many children love cottage cheese and are ready to eat much more than the abstract norm. Isn't it harmful?

Let's figure it out. If, in addition to cottage cheese (this may be another product that your baby loves), the child receives portions of vegetables, meat and cereals sufficient for him, then there is nothing wrong. But if a child manipulates, wanting to get his favorite cottage cheese instead of the main complementary foods, then this cannot be indulged.

It's time for dinner, and your child refuses to eat vegetables with meat, demanding dessert? It's okay, most likely, the child has not worked up an appetite. Let him frolic, get some air. She will get hungry, eat everything that her mother offers, and then enjoy dessert if she wants.

It happens that children do not eat fish, eggs, dairy products. Again, be calm. Lots of interchangeable products. If you have imagination, you can mask the "unloved" ingredients. There are many different recipes and their design for children on the network, go for it!

When writing the article, information from the AKEV website, WHO guidelines "Feeding and nutrition of infants and young children" were actively used.

The introduction of complementary foods

WHAT IS FEEDING INTRODUCTION?

Complementary feeding is the feeding of foods and liquids to infants in addition to breast milk. Complementary foods can be divided into the following categories:

transitional foods are complementary foods specifically designed to meet the specific nutritional or physiological needs of an infant;
Family meals or homemade foods are complementary foods given to a young child that are, in general terms, the same foods as the foods consumed by the rest of the family.

PHYSIOLOGICAL DEVELOPMENT AND MATURATION

The ability to consume “solid” foods requires the maturation of the neuromuscular, digestive, renal, and defense systems.

neuromuscular coordination

Some of these reflexes and age-related intraoral movement skills are listed in Table 42, along with possible types of foods that can be safely consumed due to these reflexes and skills. The foods listed in Table 42 are examples and are not the only foods that can be introduced into the diet at the various stages of development described here. Moreover, there is no rigid relationship between the types of foods and the development of the nervous system; it's just that the child is physically more capable of handling the product at this stage of development.

Table 42. Nervous development in infants and young children and its implications for what types of foods can be consumed at different ages
Age (months)	Established reflexes/skills	Types of foods that can be consumed (a)	Product examples
0-6	Breast sucking/sucking and swallowing	Liquids	Breast milk
4-7	The appearance of the first chewing movements. The power of sucking is growing. moving gag reflex from the middle to the back third of the tongue	Puree food	Vegetable (eg, carrot) or fruit (eg, banana) puree; mashed potatoes; gluten-free cereals (such as rice); well-cooked and mashed liver and meat
7–12	Spoon cleaning lips. Biting and chewing. Lateral movements of the tongue and movement of food to the teeth.	Pounded or chopped dishes and foods that can be eaten with your hands	Well-boiled liver and meat scrolled in a meat grinder; mashed boiled vegetables and fruits; chopped raw fruits and vegetables (e.g. banana, melon, tomato); cereals (e.g. wheat, oats) and bread
12-24	Rotational chewing movements. jaw stability.		Food from the family table

a Specifies the types of food that the child can successfully eat and swallow; it does not necessarily mean the timing of the introduction of this food.
Sources: Stevenson & Allaire (2); Milla (3).

Digestion and absorption

renal function

Source: Fomon (5).

Protective system

WHAT IS COMPLETE FOOD FOR?

WHEN SHOULD I INTRODUCE COMPLETE FEEDINGS?

Starting complementary foods too early has its dangers because:

breast milk can be displaced by complementary foods, and this will lead to a decrease in breast milk production, and therefore to the risk of insufficient intake of energy and nutrients by the child;
infants are exposed to pathogenic microbes present in foods and fluids that can be contaminated and thereby increase the risk of dyspepsia and therefore malnutrition;
the threat of dyspepsia and food allergies increases due to the immaturity of the intestine, and because of this, the risk of malnutrition increases;
fertility returns to mothers more quickly, as reduced breastfeeding reduces the period during which ovulation is suppressed.

Problems also arise when complementary foods are introduced too late because:

insufficient intake of energy and nutrients from breast milk alone can lead to growth retardation and malnutrition;
due to the inability of breast milk to meet the needs of the child, micronutrient deficiencies, especially iron and zinc, may develop;
Optimal development of motor skills, such as chewing, and the child's positive perception of the new taste and texture of food may not be ensured.

Therefore, it is necessary to introduce complementary foods at the right time, at the appropriate stages of development.

to be continued................

In accordance with the Convention on the Rights of the Child, every child of infants and other age groups has the right to adequate nutrition.
Malnutrition is associated with 45% of deaths among children.
Globally, in 2017, an estimated 155 million children under the age of five were stunted (too short for their age), 52 million children had a low weight-for-height ratio, while 41 million children were overweight or obese.
About 40% of children under 6 months of age are exclusively breastfed.
Few children receive adequate and safe complementary foods; in many countries, less than a quarter of children aged 6 to 23 months meet the criteria for dietary diversity and frequency appropriate to their age.
More than 820,000 children under 5 years of age could be saved each year through optimal breastfeeding of all children from birth to 23 months. Breastfeeding increases IQ, improves school attendance and is associated with higher income in adulthood (1).
Improving child development and reducing health care costs through breastfeeding results in economic benefits for both individual families and at the national level.

Review

It is estimated that malnutrition causes 2.7 million child deaths each year, or 45% of all child deaths. Infant and young child feeding is an important area for improving child survival and promoting healthy growth and development. The first two years of a child's life are especially important, as optimal nutrition during this period contributes to reduced morbidity and mortality, reduced risk of chronic disease, and overall better development. Optimal breastfeeding is critical—it could save more than 820,000 children under 5 years of age each year.

early initiation of breastfeeding within an hour after the birth of the child;
exclusive breastfeeding during the first six months of life; And
introduction of adequate, nutritious and safe complementary foods at six months of age, along with continued breastfeeding until the child is two years of age or older.

However, many infants and other age groups do not receive optimal nutrition; for example, on average, only 36% of children under 6 months of age are exclusively breastfed.

Recommendations have been finalized to meet the needs of infants born to HIV-infected mothers. Now, thanks to antiretroviral drugs, these children can be exclusively breastfed for up to six months and continue to be breastfed for at least 12 months, with a significant reduction in the risk of HIV transmission.

Breast-feeding

Exclusive breastfeeding for six months has many benefits for infants and their mothers. The main ones are the protection against gastrointestinal infections observed not only in developing but also in industrialized countries. Early initiation of breastfeeding—within an hour of birth—protects the newborn from infection and reduces neonatal mortality. The risk of death from diarrhea and other infections may be higher among children who were previously partially breastfed or never breastfed.

Breast milk is also an important source of energy and nutrients for children aged 6-23 months. It can provide half or more of the energy needs of a child aged 6-12 months and one third of the energy needs of a child aged 12-24 months. Breast milk is also an important source of energy and nutrients during illness and contributes to a reduction in mortality among malnourished children.

Breastfed children and adolescents are less likely to be overweight or obese. They also score higher on IQ tests and better school attendance. Breastfeeding is associated with higher income in adulthood. Improving child development and reducing health care costs through breastfeeding results in economic benefits for both individual families and at the national level (1).

Extended breastfeeding also improves maternal health and well-being; it reduces the risk of ovarian and breast cancer and allows for interruptions between pregnancies—exclusive breastfeeding of infants under six months of age has a hormonal effect that often causes a lack of menstruation. This is a natural (though unreliable) method of preventing pregnancy, known as the lactational amenorrhea method.
Mothers and families need to be supported to ensure optimal breastfeeding for their children. Actions to protect, strengthen and support breastfeeding include:

the adoption of policies such as the International Labor Organization's Maternity Protection Convention No. 183 and Recommendation No. 191 supplementing Convention No. 183 by offering longer leave and greater benefits;
International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolutions;
Implementing the Ten Keys to Successful Breastfeeding as outlined in the Breastfeeding Friendly Hospitals Initiative, including:

ensuring skin-to-skin contact between mother and child immediately after birth and initiating breastfeeding within the first hour of the child's life;
breastfeeding on demand (that is, as often as the child wants, day and night);
room sharing (allowing mothers and babies to be together 24 hours a day);
children should not be given extra food or drink, not even water.

supportive health services providing counseling on infant and young child feeding in all interactions with caregivers and young children: during prenatal and postnatal care, home visits for healthy and sick children and immunizations; And
community support, including mother support groups and community-based health promotion and health education activities.

Supplementary interventions greatly contribute to the spread of breastfeeding, and rates of exclusive and continued breastfeeding may improve within a few years.

Lure

Around the age of six months, a baby's energy and nutrient needs begin to exceed the level at which they can be met by breast milk, and complementary foods become necessary. At this age, the child is ready to eat other foods and in his development. Failure to introduce complementary foods by the age of six months or inappropriate introduction of complementary foods can affect the growth of the child. The guidelines for proper complementary foods are as follows:

continue frequent, on-demand breastfeeding until the child is two years of age or older;
be sensitive when feeding the baby (eg, directly feed infants and help older children. Feed slowly and patiently, encourage but do not force, talk to the baby and maintain eye contact with him);
practice good hygiene and proper food handling;
start at six months of age with small amounts of food and gradually increase as the child gets older;
gradually increase the consistency of food and make it more diverse;
increase the number of baby feedings - 2-3 times a day for children aged 6-8 months and 3-4 times a day for children aged 9-23 months with 1-2 additional snacks at the request of the child;
use fortified foods or vitamin and mineral supplements as needed; And
increase fluid intake, including through breastfeeding, and offer soft, favorite foods.

Feeding in exceptionally difficult conditions

Families and children in difficult circumstances require special attention and practical support. Wherever possible, mothers and infants should stay together and receive the support they need to provide the most appropriate feeding under the circumstances. Breastfeeding remains the preferred feeding option for children in almost all difficult situations, such as:

children with low body weight or prematurely born children;
HIV-infected mothers;
adolescent mothers;
malnourished infants and young children;
families suffering from the consequences of complex emergencies.

HIV and infant feeding

Breastfeeding, especially early and exclusive breastfeeding, is one of the most effective ways to improve infant survival rates. While HIV can be transmitted from mother to child during pregnancy, childbirth, and through breast milk, evidence on HIV and infant feeding suggests that antiretroviral drugs (ARVs) given to an HIV-infected mother can significantly reduce the risk of HIV transmission during breastfeeding, as well as improve her health.

Mothers living in areas with high rates of morbidity and mortality due to diarrhea, pneumonia and malnutrition, where breastfeeding is supported by national health authorities, should exclusively breastfeed their babies for 6 months and then introduce appropriate complementary foods and continue breastfeeding for at least the first year of the baby's life.

WHO activities

WHO is committed to supporting countries in implementing and monitoring the Comprehensive Implementation Plan for Maternal, Infant and Young Child Nutrition, endorsed by Member States in May 2012. The plan contains six goals, one of which is to increase exclusive breastfeeding rates for the first six months by at least 50% by 2025. Activities that will contribute to this goal are outlined in the Global Strategy for Infant and Young Child Feeding, which aims to protect, promote and support appropriate infant and young child feeding.

UNICEF and WHO established the Global Breastfeeding Community to provide political, legal, financial and public support for breastfeeding. The community brings together performers and donors representing governments, philanthropic institutions, international organizations and civil society. The overall vision of the Community is to provide a world in which all mothers receive the technical, financial, emotional and social support they need to breastfeed.

WHO has established a Global Monitoring and Support Network for the implementation of the International Code of Marketing of Breast-milk Substitutes and subsequent relevant WHA resolutions called NetCode. Its aim is to protect and promote breastfeeding by preventing the inappropriate trade in breast-milk substitutes. In particular, NetCode builds the capacity of Member States and civil society to strengthen national legislation on the Code of Practice, continuously monitor compliance with it, and take action on any violations.

Principles and methods of feeding and feeding-related recommendations

Many countries in the WHO European Region do not have their own guidelines for infant and young child feeding. However, they do exist in some countries, such as Denmark, Ireland, the Netherlands, Sweden and the United Kingdom. In the former Soviet Union, the need for such guidelines has long been recognized (they were last updated in 1982) (25). Scientific reasoning and young children is still a relatively new area of research, in which new steps are being taken all the time. Therefore, it is essential that these methodological recommendations keep pace with the progress of the science on which they are based.

It can be seen that the recommendations regarding infant feeding differ considerably between Western and Eastern European countries. In many Eastern European countries, recommendations on child feeding have been influenced by recommendations from the former Soviet Union (25). The review identified a number of Soviet-era recommendations that differ from international standards (26). The low iron status and possibly high levels of stunting among infants and young children in the European Region and especially in the countries of the former Soviet Union are partly due to inadequate complementary feeding practices.

Regarding breastfeeding, the literature of the former Soviet Union recommended:

late start of breastfeeding (6-12 hours after birth), especially for sick women, including women suffering;

feeding with a 5% glucose solution before the production of breast milk is established;

exclusive breastfeeding only during the first month (although this was not universally practiced);

As the main food during the first 4-4.5 months;

complete cessation of breastfeeding by the age of 10-11 months;

breastfeeding strictly according to the schedule.

The importance of a night break between feedings was often emphasized. In accordance with the regimen of feeding 6 times a day, a break of 6 and a half hours at night was recommended; with a 5-time feeding regime, this break increased to 8 hours. A review of Soviet literature (J. Vingraite, personal communication, 1998) showed that some authorities allowed feedings to deviate from this schedule by 10-15 minutes.

Unadapted infant formula in the Soviet Union included diluted fresh or sour cow's milk with added sugar, vitamins and minerals. At 2-3 months, it was recommended to introduce cow's milk diluted with a decoction of cereals (for example, 50 ml of pure cow's milk or kefir, 45 ml of a decoction of cereals and 5 ml of one hundred percent sugar syrup).

Previous Soviet recommendations for the introduction of weaning foods included: supplemental fluids, primarily tea and water with sugar for breastfed babies; the introduction of vegetable and “fruit” juices (jam with water) at 1 month; introduction of unmodified cow's milk at 4 months and pure kefir at 3 months; introduction of fruit at 2 months, hard-boiled egg yolk at 3 months and cottage cheese at 4 months; adding sugar and saline solutions to baby food; the introduction of cereals with the addition of sugar, syrup, salt and butter at 4 months.

Of particular concern is that in cases of anemia diagnosis (and) it was recommended to introduce cereals and other solid foods earlier than 4 months.

breastfeeding: initiation, duration and practice of exclusive breastfeeding

Due to the lack of comprehensive and comparable data and harmonized international definitions, it is difficult to make any general statements about the prevalence of breastfeeding in the WHO European Region. Data on the percentage of children who are breastfed, shown in fig. 8 are taken from various sources (27). These data need to be approached with caution: survey methods were different, and in some cases no description was given of how the surveys were carried out.

Rice. 8. Prevalence of breastfeeding in different countries of the European Region

Rice. 9. Prevalence of exclusive breastfeeding in selected countries of the European Region, 1989-1998

But even after these warnings, it can be seen that breastfeeding practices vary dramatically across European countries. In the United Kingdom, about 25% of babies are breastfed at 3 months of age, and in Uzbekistan, over 90%. However, the prevalence of breastfeeding in a given country can change significantly over a few years. For example, in Norway the prevalence of breastfeeding at 3 months of age increased from a mere 25–30% in 1969 to about 80% in 1965 (28).

Unfortunately, the data presented in Fig. 8 do not reflect the percentage of “exclusively” breastfeeding. Only a few studies have defined "exclusive" breastfeeding, but data from studies that provide this definition are presented in Fig. 9, which shows relatively high rates of exclusive breastfeeding in Sweden at both 3 and 6 months of age. In contrast to Sweden, the percentage of exclusive breastfeeding in the Central Asian republics at 3 months is much lower (about 10% or less), with the exception of Kyrgyzstan and Georgia, where the figure is about 30%. Poland is making excellent progress, with exclusive breastfeeding soaring from almost zero in 1988 to almost 40% in 1997.

In the Russian Federation in 1996, about 95% of children born in maternity hospitals started breastfeeding (O. Netrebenko, personal communication, 1997). The average duration ranged from 3 to 4 months depending on when breastfeeding was started and on the educational level of the mother. The most educated women breastfed their children for significantly longer than women with lower levels of education. The prevalence of partial breastfeeding was about 50% at 3 months and about 30% at 6 months. Most breastfed children also received cow's milk. The prevalence of exclusive breastfeeding at 4 months of age ranged from 22% to 28% in most oblasts. In St. Petersburg, however, the percentage of exclusive breastfeeding was very high (42%), which was likely the result of higher levels of education and willingness of local authorities to support the implementation of international breastfeeding recommendations (see Chapter 7).

Studies conducted in the Central Asian republics show that, despite the high prevalence of breastfeeding, a small percentage of children are exclusively breastfed (Fig. 9); in more than 50% of cases, breastfeeding has not yet begun after the first 24 hours. The lack of exclusive breastfeeding, coupled with deteriorating socioeconomic conditions, water pollution and low vaccination coverage, poses a threat to the health of infants. In Kazakhstan, despite a high percentage of breastfeeding, with an average duration of about 12 months, the period of exclusive breastfeeding is very short (8). In the former Yugoslav Republic of Macedonia, only 8% of children are exclusively breastfed at 4 months. In contrast, in the Nordic countries, where huge efforts have been made to increase the percentage of exclusive breastfeeding, this rate is very high (Figures 8 and 9).

It can be seen that the percentage of breastfeeding in the Region is increasing, and the rates are especially good in the Nordic countries, where the percentage is very high compared to what it was 20 years ago. Efforts are needed to maintain these high rates, and more efforts need to be made in all countries to increase the percentage of exclusive breastfeeding during the first few months of a child's life (see Chapter 7). This is especially important for vulnerable categories, such as national minorities and low-income families living in high-risk areas with poor hygiene, sanitation and water supply.

use of infant formula, cow's milk and other fluids

Table 5. Age of introduction of liquids other than breast milk into the infant's diet

Distributed throughout the European Region. In Uzbekistan, 35% of children under 3 months of age who were covered by the 1996 Demographic and Health Survey were bottle-fed with a nipple, with 12% receiving infant formula and 23% condensed milk (9). The use of cow's milk is more common in rural areas.

Earlier introduction of cow's milk is associated with blood loss in the gastrointestinal tract. Because cow's milk is also low in iron content and bioavailability, early introduction of cow's milk can lead to iron deficiency (see Chapter 6). In the Russian Federation, 12-month-olds who received cow's milk during the first three months of life had significantly lower hemoglobin levels than those who received cow's milk from the age of 7 months (O. Netrebenko, personal communication, 1997). Similarly, in the United Kingdom, Asian children are more likely to receive cow's milk than white children, and therefore Asian children are more likely to develop iron deficiency anemia (29). In addition, Asian children typically consume more cow's milk than white children (30). A study conducted in Italy showed that between 1983 and 1992 a decrease in the percentage of infants who were given cow's milk, while an increase in the percentage of breastfeeding, was accompanied by a decrease in the prevalence of both anemia and iron deficiency among infants and young children (31).

Table 5 shows the early introduction of cow's milk and other fluids into infant diets in some countries. In Lithuania, cow's milk is diluted with water or mixed with a decoction of cereals - rice, oats or buckwheat. In Azerbaijan, wheat flour is used in combination with diluted cow's milk and an egg.

In the Russian Federation, the types of fluids other than breastmilk given to children differ between large cities and towns and rural areas. In Moscow, about 50% of infants at the age of 2 months begin to receive infant formula in addition to breast milk. In addition to infant formula, about 10% of infants in cities received unadapted milk (cow's milk, kefir, goat's milk) as supplements during the first four months. 22% of children in settlements and rural areas received cow's milk or kefir at least three times a day during the first 4 months instead of breast milk. The timing of the introduction of non-adapted milk depends on the level of education of the mother and on the income of the family: in low-income families, children receive cow's milk much earlier than children in more affluent families (O. Netrebenko, personal correspondence, 1997).

Other fluids commonly given to babies in the first or second month of life include plain or sweetened water and tea. In Uzbekistan, 40% of babies received tea in the first month after birth, rising to 72% by 3 months of age (21). The same picture is typical for other Central Asian republics. For example, in Kazakhstan, Kyrgyzstan and Uzbekistan, 21%, 34% and 49% of infants, respectively, received tea in the first few months of life (19). In Armenia, water and herbal tea are introduced in the first two months and regular tea in the third month. In most cases, water is boiled and given without added sugar, but sugar is added to herbal teas (67%) and regular teas (95%). In rural areas, the introduction of tea and sugar occurs even earlier (6).

The practice of drinking tea (both ordinary and herbal) to babies also persists in Western Europe, especially among national minorities, as well as in Central Europe. This practice is not recommended, not only because it interferes with breastfeeding, but also because the polyphenols present in tea interfere with iron absorption.

introduction of semi-solid and solid foods

Table 6 shows complementary foods in some countries. In the Russian Federation, the proportion of infants receiving complementary foods before 4 months of age ranges from 17% in St. Petersburg to 32% in the Urals (O. Netrebenko, personal communication, 1997). Similarly, in Armenia, children at the age of 4-5 months are given semi-solid food (fruit and vegetable purees, cereals and potatoes) and biscuits, and at 6 months they are given an egg. At about 8-9 months, they begin to give bread and pasta, minced meat, fruits and vegetables. In the last turn - at about 1 year - other meat dishes and fish are introduced. Compared to the Russian Federation, in Armenia one can see fewer differences in the timing of the introduction of different products between urban and rural areas, or between indigenous people and refugees (6).

Table 6. Timing of the introduction of complementary foods in infant nutrition

In the United Kingdom in 1996, white mothers typically started solid foods for their children earlier than Asian mothers. At 8 weeks of age, 2% of Bangladeshi, 3% of Pakistani and 5% of Indian children received some form of solid food, and 18% of white children. In all groups, most mothers introduced food between 8 weeks and 3 months. By age 3 months, 70% to 73% of Asian mothers and 83% of white mothers gave their babies some form of solid food (29).

In the Central Asian republics, the diets of infants are often monotonous and consist mainly of porridge, which is poor in nutrients. The results of the 1996 Demographic and Health Survey in Uzbekistan (9) show that in the 24 hours prior to the interview, 19% of children aged 4 to 7 months received meat, poultry, fish or eggs, and 35% received fruits or vegetables.

In the Balkan region, children in Albania are fed mainly cereals (35), while diets in the former Yugoslav Republic of Macedonia are high in grains, beans and vegetables.
The impact of the socioeconomic situation on nutritional status is manifested in the fact that the ability to buy meat and dairy products is reduced due to high prices (36). Thus, the introduction of fruits and vegetables, as well as meat and liver, may be delayed or reduced in quantitative terms by economic and/or seasonal factors. On the contrary, in Italy meat is introduced at 5-6 months, and in Spain after 6 months.