Feeding children in the first year of life. Natural, artificial and mixed feeding. Modes and rules

GBOU VPO TVER STATE MEDICAL

ACADEMY OF THE MINISTRY OF HEALTH AND DEVELOPMENT OF RUSSIA

DEPARTMENT OF PEDIATRICS

MEDICAL AND DENTAL FACULTY

Natural feeding. Hypogalactia.

Guidelines for independent work of students

4 Courses of the Faculty of Medicine

Compiled by:

Doctor of Medical Sciences, Professor A.F. Vinogradov

Candidate of Medical Sciences, Associate Professor A.V. Koptseva

Tver, 2012

Name learning topic: Anatomical and physiological features of the digestive system in children. Feeding children in the first year of life. Breastfeeding and its benefits. Measures to prevent hypogalactia. Methods for calculating the amount of food. Complementary foods and the technique of its introduction. The role of the local pediatrician in the struggle for natural feeding. Learn how to prepare your baby for breastfeeding breastfeeding. Compilation of the diet for children of the first year of life on breastfeeding. Ethics and deontology skills.

The purpose of studying the educational topic: To study the anatomical and physiological features digestive system and modern aspects of natural feeding of children of the first year of life at the level of knowledge and skills to draw up a nutrition map for children of the first year of life who are breastfed, as well as to solve situational problems on this topic. Show the benefits of breastfeeding. To master the concepts of hypogalactia, measures for the prevention and control of hypogalactia. Determine the role of the local pediatrician in the struggle for natural feeding. To acquaint with the basic principles of ethics in the aspect of the right to health and medical deontology.

Basic terms:

1) Colostrum

2) Free feeding

3) Natural feeding

4) Volumetric method for determining the daily volume of food.

5) Lure

6) Hypogalactia

Topic study plan:

Definition of Breastfeeding
Nutrition stages
Composition of breast milk
Benefits of human milk versus cow milk
The frequency of feeding children in the 1st year of life
Calculation of the daily amount of food
The concept of "complementary foods", the timing and rules of introduction
Hypogalactia: classification, etiology, prevention, treatment.

Presentation of educational material:

feeding - this is a controlled and corrected nutrition for children under 1 year old, which differs in nature into 3 types: natural, mixed and artificial.

natural feeding - this is the feeding of a child with mother's breast milk with timely physiologically justified introduction of complementary foods. Breastfeeding - feeding a child with breast milk before the introduction of complementary foods, including 5 positions (gradations in order of priority):

Mother's breast.

Expressed mother's milk.

Nurse's breast.

Expressed breast milk of a nurse.

Donor milk (milk bank from several other mothers).

It must be emphasized right away that breast milk has no alternative in the problem of feeding and its replacement with any of the most adapted mixtures is like an environmental disaster, because even the 5th gradation of breast milk is donor milk from a breast milk bank better than any adapted mixture.

Anatomical and physiological features of the gastrointestinal tract of newborns:

Tender mucosa;

Good vascularization of the loose submucosal layer;

Little elastic and muscle tissue;

Weak secretory and enzyme-forming function.

Given the above features, the optimal product for feeding children in the first months of life is mother's milk. From the modern point of view, breast milk is a protective factor, a chemical analyzer and fully provides the child with energy and biologically active substances, and colostrum is a powerful anti-stress factor.

Evolutionarily fixed 3 stages of nutrition of children:

Hemotrophic when the embryo feeds at the expense of the mother, therefore it is strongly protected and ... absolutely defenseless, because it “sicks” along with the mother, which, with its own immature defensive reaction, entails serious damage to organs and even death of the embryo.

Amniotrophic - nutrition at the expense of the mother through the placenta and attempts to self-feed through the amniotic fluid (hemo-amniotrophic). This mechanism occurs between the 3rd and 5th months of pregnancy by swallowing amniotic fluid (up to 5 ml / kg / hour), which by 6 months intrauterine life makes up to 50% of the volume amniotic fluid per day. The intake of proteins, fats and carbohydrates of the amniotic fluid into the gastrointestinal tract of the fetus stimulates the development of such functions of the digestive tract as the breakdown and absorption of digestive substances, the formation of motor skills. Amniotic nutrition does not make a significant contribution to the provision of nutritional ingredients to the fetus, but has a significant impact as an adaptation mechanism for subsequent lactotrophic nutrition. It is due to the long and gradual increase in the volume of the incoming amniotic fluid that the anatomical differentiation of the cells of the intestinal mucosa, the induction of the synthesis of digestive enzymes and hormones of the gastrointestinal tract, also occurs. If hemotrophic nutrition provides the basic nutritional needs of the embryo, then amniotrophic nutrition facilitates subsequent adaptation.

Lactotrophic or enteral nutrition. The transition to extra uterine nutrition is a revolution, a stress similar to the transition to normal breathing, extra uterine circulation, etc.; this is a new qualitative leap in the ontogeny of the individual. At the first stages of postnatal ontogenesis, the nature of feeding plays an important role.

Advantages of breastfeeding over mixed and

artificial

(especially early artificial) is that it:

An evolutionarily fixed form of nutrition and its violation is like an ecological catastrophe that reduces the level of health;

Contributes to the optimal development of the child in ontogenesis, because it is corrected by evolution in terms of ingredients and micronutrients; presented in terms of ratio and quality in an optimal form for assimilation;

Reduces acute and chronic morbidity in children;

Increases life span (including average life expectancy) by 10-15 years;

Carries out the prevention of early sclerosis by stimulating enzyme systems that utilize cholesterol;

Reduces significantly the risk of leukemia;

Increases intelligence, creative activity and humanizes mentality;

Reduces sensitization;

Prevents dysbacteriosis;

Represents a feeding system with the following characteristics: closed, sterile, “products” heated to body temperature, tasty (taste analyzers are adapted to breast milk).

According to WHO/UNICEF (1989) recommendations, healthy newborns should be applied to the mother's breast within the first 30 minutes after birth. Early application helps to stimulate lactation in the mother, increase the bactericidal properties of breast milk, increase immunity in children, and establish normal intestinal biocenosis.

An important principle of feeding newborns is the principle of the so-called "free feeding", when the child is fed on demand, and not according to the schedule. With the method of "free feeding" the child gradually develops his own individual rhythm - the "schedule" of eating with constant fairly long intervals between individual feedings.

When conducting "free feeding", the mother must learn to distinguish between the baby's hungry cry and restlessness caused by other causes. If the mother cannot adapt to “free feeding”, then in such cases it is necessary to switch to feeding the child at strictly defined hours.

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

The optimal food product for a child in the first months of life is mother's milk, which corresponds to the characteristics of his digestive system and metabolism, providing adequate development child's body with rational nutrition of a nursing woman. All nutrients of human milk are easily absorbed, since their composition and ratio correspond to the functional capabilities of the gastrointestinal tract of an infant, and also due to the presence of enzymes in human milk (amylase, diastase, lipase, glucose-6-phosphate dehydrogenase, phosphatases, proteases, etc.) and transport proteins. Breast milk is a source of hormones and various growth factors (leptin, ghrelin, epidermal and insulin-like growth factors, etc.), which play an important role in the regulation of appetite, metabolism, growth and differentiation of tissues and organs of the child.

Due to the presence of antibodies, immune complexes, active leukocytes, lysozyme, macrophages, secretory immunoglobulin A, lactoferrin and other biologically active substances, breast milk helps to increase the protective functions of the child's body. Therefore, children who are breastfed are much less likely to get sick. infectious diseases develop more stable post-vaccination immunity.

Rice. Protective components of breast milk

IN last years bifido- and lactobacilli have been found in human milk, contributing to the optimal formation of intestinal microflora.

Breast milk, due to the presence of oligosaccharides, low levels of protein and phosphorus, promotes the growth of healthy intestinal microflora and thus has a positive effect on the development of the infant's immunity. The protective properties of human milk are not limited to anti-infective protection. Breastfeeding reduces the risk of developing diseases such as atherosclerosis, hypertension, diabetes, obesity, leukemia, etc. in subsequent years. Cases of sudden death are less frequently recorded in breastfed children.

Natural feeding has a beneficial effect on the development of the central nervous system of the child and his mental status. The bonding between mother and child during breastfeeding has a profound mutual emotional impact. It is noted that children who were fed with mother's milk are distinguished by good physical development, they are more calm, balanced, friendly and benevolent compared to children who were bottle-fed, and subsequently become attentive and caring parents themselves.

According to some data, children who are breastfed have a higher rate intellectual development which, perhaps, is partly due to the presence in breast milk of long-chain polyunsaturated fatty acids (DLPUFA), which are necessary for the optimal development of brain and retinal cells. In the blood cells of children who are breastfed, the amount of DPPUFA is significantly higher compared to children receiving artificial feeding.

Protein human milk consists mainly of whey proteins (70-80%), containing all the essential amino acids in the optimal ratio for the child, and casein (20-30%). Protein fractions of human milk are divided into metabolizable(food) and non-metabolizable proteins (immunoglobulins, lactoferrin, lysozyme, etc.), which make up 70-75% and 25-30%, respectively.

In women's milk, unlike cow's milk, there is a large amount of alpha-lactalbumin (25-35%), which is rich in essential and conditionally essential amino acids (tryptophan, cysteine). Alpha-lactalbumin promotes the growth of bifidobacteria, the absorption of calcium and zinc from the child's gastrointestinal tract.

There are in human milk nucleotides, which account for about 20% of all non-protein nitrogen. Nucleotides are the initial components for the construction of ribonucleic and deoxyribonucleic acids, they play an important role in maintaining the immune response, stimulating the growth and differentiation of enterocytes, through which the bioavailability of micronutrients, in particular iron, improves.

Main Components fat human milk are triglycerides, phospholipids, fatty acids, sterols. Its fatty acid composition is characterized by a relatively high content of essential polyunsaturated fatty acids (PUFAs), the concentration of which in women's milk is 12-15 times higher than in cow's milk. PUFAs are precursors of arachidonic, eicosapentaenoic and docosahexaenoic fatty acids, which are an important component of cell membranes, various classes of prostaglandins, leukotrienes and thromboxanes are formed from them, they are also necessary for the myelination of nerve fibers and the formation of the retina.

Arachidonic and docosahexaenoic fatty acids are found in human milk in small amounts (0.1-0.8% and 0.2-0.9% of the total fatty acids, respectively).

Breast milk fats are easier to digest than cow's milk fats, as they are more emulsified and breast milk contains the enzyme lipase, which is involved in the digestion of the fat component of milk, starting from the oral cavity.

The content of cholesterol in women's milk is relatively high and ranges from 9 to 41 mg%, stabilizing by the 15th day of lactation at the level of 16-20 mg%. Breastfed babies have more high level cholesterol than with infant formula. It is necessary for the formation of cell membranes, tissues of the nervous system and a number of biologically active substances, including vitamin D.

Carbohydrates human milk is represented mainly by the disaccharide b-lactose (80-90%), oligosaccharides (15%) and a small amount of glucose and galactose. Unlike the a-lactose of cow's milk, the b-lactose of human milk is slowly broken down in the small intestine of the child, partially reaching the large intestine, where it is metabolized to lactic acid, promoting the growth of bifidus and lactobacilli. Lactose promotes better absorption of minerals (calcium, zinc, magnesium, etc.).

Oligosaccharides - carbohydrates, including from 3 to 10 monosaccharide residues, which are not cleaved by digestive tract enzymes, are not absorbed in the small intestine and reach the lumen of the large intestine unchanged, where they are fermented, being a substrate for the growth of bifidobacteria. In this case, competitive inhibition of the development of conditionally pathogenic flora occurs. In addition, human milk oligosaccharides are receptors for bacteria, viruses (rotaviruses), toxins and antibodies, thereby blocking their binding to the enterocyte membrane. The considered functions of oligosaccharides, as well as lactose, underlie the prebiotic effects of human milk, largely determining its protective effect against intestinal infections in infants.

Mineral the composition of women's milk is significantly different from cow's milk, which contains 3 times more salts, mainly due to macronutrients. The relatively low mineral content of human milk ensures its low osmolarity and reduces the burden on the immature excretory system. Macronutrients include calcium, phosphorus, potassium, sodium, chloride and magnesium. The remaining minerals are microelements and are present in the tissues of the human body in small quantities. Ten of them are currently classified as essential: iron, zinc, iodine, fluorine, copper, selenium, chromium, molybdenum, cobalt and manganese.

Minerals enter the body with food and water, and are excreted with urine, feces, sweat, desquamated epithelium and hair.

It is assumed that iron, calcium, magnesium, zinc are absorbed much better from women's milk than from cow's. This is primarily due to their optimal ratio with other minerals (in particular, calcium with phosphorus, iron with copper, etc.). The high bioavailability of trace elements is also provided by the transport proteins of human milk, in particular, lactoferrin - the carrier of iron, ceruloplasmin - copper. The low level of iron in human milk is compensated by its high bioavailability (up to 50%).

Deficiency of trace elements that are regulators metabolic processes, is accompanied by a decrease in the adaptive capabilities and immunological protection of the child, and their pronounced deficiency leads to the development pathological conditions: violation of the processes of building the bone skeleton and hematopoiesis, changes in the osmotic properties of cells and blood plasma, a decrease in the activity of a number of enzymes.

Human milk contains all water- and fat-soluble vitamins. The concentration of vitamins in milk is largely determined by the nutrition of the nursing mother and the intake of multivitamin preparations. It should be emphasized, however, that the level of vitamin D in women's milk is extremely low, which requires its additional administration to children who are breastfed.

Vitamin deficiency leads to violations of enzymatic activity, hormonal dysfunctions, and a decrease in the antioxidant capacity of the child's body. In children, polyhypovitaminosis is more common, and an isolated deficiency of one micronutrient is less common.

The composition of human milk changes during lactation, especially during the first days and months of breastfeeding, which allows you to most fully meet the needs of an infant. A small amount of milk (colostrum) in the first days of lactation is compensated by a relatively high content of protein and protective factors; in the following weeks, the protein concentration in human milk decreases and then remains practically unchanged. The most labile component of human milk is fat, the level of which depends on its content in the diet of a nursing mother and changes both during each feeding, increasing towards its end, and during the day. Carbohydrates are a more stable component of human milk, but their levels also change during feeding, being maximum in the first portions of milk.

In the maternity hospital in order to become sufficient in terms of volume and duration of lactation healthy newborn the baby should lay on the mother's breast in the first 30 minutes after uncomplicated childbirth for a period of at least 30 minutes.

The reasoning for this method includes the following points:

Early attachment of the child to the mother's breast ensures the rapid activation of the mechanisms of milk secretion and more stable subsequent lactation;

Sucking a baby promotes an energetic release of oxytocin and thereby reduces the risk of blood loss in the mother, contributes to an earlier contraction of the uterus;

The contact of mother and child has a calming effect on the mother, the stressful hormonal background disappears;

Through the mechanisms of imprinting, it helps to enhance the feeling of motherhood, increase the duration of breastfeeding;

The newborn is easier to adapt to extrauterine life;

Close contact between mother and child ensures that newborns receive maternal microflora

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

It contains more immunoglobulins, leukocytes and other protective factors than mature milk, which largely protects the child from intense bacterial contamination, reduces the risk of purulent-septic diseases;

It has a mild laxative effect, thanks to which the child's intestines are cleared of meconium, and with it bilirubin, which reduces the development of jaundice.

Contributes to the formation of optimal intestinal microflora, the duration of the phase of physiological dysbacteriosis decreases;

Contains growth factors that affect the maturation of the functions of the intestines of the child.

In order for the child to receive colostrum in the maximum possible amount, the frequency of breastfeeding should not be regulated. In order to implement free feeding on demand, a healthy child should be in the same room with the mother. It is shown that with free feeding, the volume of lactation is higher than with feeding by the hour. The "free feeding" mode is a key factor in ensuring full lactation and helps to establish close psycho-emotional contact between mother and child.

To maintain lactation, night feedings are especially significant, since prolactin levels are higher at night. Duration of breastfeeding healthy child in the early days should not be limited, even when he practically sucks nothing, but dozes at the chest. The need for contact and sucking may be independent, relatively independent of eating behavior. However, in the future, excessively frequent attachment of the child to the mother's breast at the slightest disturbance can lead to overfeeding. In this regard, one of important tasks pediatricians, especially district pediatricians, is teaching the mother to differentiate the "hungry" cry of the child from the cry due to other causes: infantile colic, discomfort, change of scenery, overheating or cooling of the child, neurological pathology, etc.

Assessment of the adequacy of lactation and the amount of secreted female milk sufficient for the baby requires a thorough analysis of the child's behavior, the nature of the stool, and the frequency of urination. Likely signs insufficient lactation are:

Anxiety and crying of the child during or immediately after feeding;

The need for frequent breastfeeding;

The child sucks the breast for a long time, makes a lot of sucking movements, in the absence of swallowing;

Feeling by the mother of complete emptying of the mammary glands with the active sucking of the child, there is no milk when decanting after feeding;

Restless sleep, frequent crying, "hungry" cry;

Scanty rare stool

However, the most reliable signs of malnutrition are low weight gain and infrequent urination (less than 6 times per day) with the release of a small amount of concentrated urine. The final conclusion about insufficient lactation can be made on the basis of the results of weighing the child after each feeding during the day.

In some cases, even with a sufficient amount of milk, the mother stops breastfeeding the baby due to the baby's refusal to breastfeed, while:

The baby latch but does not suckle, does not swallow, or suckles very little;

When the mother tries to breastfeed, the child screams and resists;

After a short sucking breaks away from the chest, choking with crying;

The baby takes one breast but refuses the other.

The reasons can be different, among which the most common are:

Violations of the organization and technique of feeding (wrong position of the child at the breast);

An excess of milk in the mother, in which it flows too quickly;

Teething,

Diseases of the child (perinatal damage to the nervous system, partial lactase deficiency, gastrointestinal form of food allergy, acute respiratory viral infection, otitis media, thrush, stomatitis, etc.).

Finding out the cause and carrying out if necessary timely treatment help to maintain full breastfeeding.

Hypogalactia true (or primary) is rare, no more than 5% of women. In other cases, the decrease in milk production is caused by various reasons, the main of which are: the woman’s lack of dominant lactation (psychological mood), emotional stress, early and unreasonable introduction of supplementary feeding with infant formula, the need to go to work, the child’s illness, the mother’s illness, etc. .

In some cases, hypogalactia is transient in nature, manifesting itself in the form of so-called lactation crises, which is understood as a temporary decrease in the amount of milk that occurs for no apparent reason. They are based on the features of hormonal regulation of lactation. Lactation crises usually occur at 3-6 weeks, 3, 4, 7, 8 months of lactation. Their duration is on average 3-4 days, and they do not pose a risk to the health of the child. In such cases, more frequent attachment of the baby to the breast in combination with feeding from both breasts is sufficient. Complete peace and rest of the mother. Diverse, nutritious, high quality food. Warm drinking of drinks, especially with the use of lactogenic herbs or preparations 15-20 minutes before feeding, as well as special products of lactogenic action.

If the mother is not prepared in advance for such a situation, then at the first signs of a decrease in lactation, she tries to supplement the child with mixtures. Therefore, one of the important tasks of the local doctor and nurse of the children's clinic is to explain the safety of short-term lactation crises.

Measures used in secondary hypogalactia (lactation crises):

More frequent applications to the chest;

Settlement of the regimen and nutrition of the mother (including optimal drinking regimen due to the additional use of at least 1 liter of liquid in the form of tea, compotes, juices);

Impact on the psychological mood of the mother;

Orientation of all family members (father, grandparents) to support breastfeeding;

Contrast shower on the area of the mammary glands, soft rubbing of the chest with a terry towel;

The use of special drinks with a lactogenic effect;

Do not introduce infant formula into the child's diet without the advice of a doctor.

Numerous observations show that a sufficient production of breast milk mainly depends on the "mood of the mother" to breastfeed her child, her conviction that this is important and necessary and that she is able to breastfeed her child. A more successful development of lactation and its continuation take place in conditions where, in addition to the desire and confidence of the mother, she is actively supported by all family members, as well as professional advice and practical assistance from medical workers. It is advisable that a woman's education on breastfeeding takes place during pregnancy in the "School of Pregnant Women"

The most important role in the promotion of breastfeeding is assigned to doctors and nurses, who should actively encourage family and social support for breastfeeding, provide parents with full information about its comprehensive positive influence on the child's body and the advantages over infant formula. To carry out activities for the successful establishment and maintenance of the practice of breastfeeding, All health professionals involved in obstetric care and medical supervision of infants should be able to provide practical assistance to mothers in breastfeeding.

In accordance with international program WHO/UNICEF "Protection, promotion and support of breastfeeding", which outlines the main provisions in the form of ten principles of successful breastfeeding, the Ministry of Health of the Russian Federation developed a breastfeeding support program and approved a number of regulatory and methodological documents (1994, 1996, 1998, 1999, 2000). According to these documents, it is recommended to carry out the following work to support natural feeding in medical and preventive institutions for obstetrics and childhood:

Have accessible printed information regarding breastfeeding practices, which should be shared regularly with all health care personnel;

Inform all pregnant women about the benefits of breastfeeding and the need for early attachment of the newborn to the mother's breast (within the first 30 minutes after birth);

Provide 24/7 co-existence of mother and child in the mother and child ward of the maternity hospital and encourage breastfeeding at the request of the child;

Teach mothers how to breastfeed and maintain lactation;

Strive for exclusive breastfeeding during the first 4-6 months of life, that is, not to give healthy newborns any food other than breast milk, except in cases due to medical indications;

Ensure continuity in the work of the antenatal clinic, obstetric hospital, children's clinic and children's hospital.

These activities must be carried out taking into account the health status of both the mother and the child.

Possible contraindications to breastfeeding by the mother are: eclampsia, severe bleeding during childbirth and in postpartum period, an open form of tuberculosis, a state of severe decompensation in chronic diseases of the heart, lungs, kidneys, liver, as well as hyperthyroidism, acute mental illness, especially dangerous infections (typhoid, cholera, etc.), herpetic eruptions on the nipple of the breast (before their aftercare) , HIV infection.

It has now been established that an HIV-infected woman has a 15% chance of infecting a child through breast milk. In this regard, in the Russian Federation, children born from HIV-infected mothers are recommended to be fed with adapted mixtures.

With such diseases of a nursing mother as rubella, chickenpox, measles, mumps, cytomegalovirus infection, herpes simplex, acute intestinal and acute respiratory viral infections, if they occur without severe intoxication, breastfeeding, subject to the rules general hygiene not contraindicated. The presence of hepatitis B and C in women is currently not a contraindication to breastfeeding, however, feeding is carried out through special silicone pads. In acute hepatitis A in the mother, breastfeeding is prohibited.

With mastitis, breastfeeding should continue. However, it temporarily stops when Staphylococcus aureus or Gram-negative flora is detected in breast milk in an amount of more than 1000 colony-forming bacteria per 1 ml. A breast abscess is a possible complication of mastitis and is most likely when breastfeeding is interrupted abruptly. Feeding from a healthy gland should continue, and milk from an infected breast should be carefully expressed and discarded.

Stop breastfeeding in cases where the mother is taking therapeutic doses of cytostatics, immunosuppressive drugs, anticoagulants such as phenindione, radioisotope contrast agents for treatment or examination, lithium preparations, most antiviral drugs(except for acyclovir, zidovudine, zanamivir, limovudine, oseltamivir - with caution), anthelmintic drugs, as well as antibiotics: macrolides (clarithromycin, midecamycin, roxithromycin, spiramycin), tetracyclines, quinolones and fluoroquinolones, glycopeptides, nitroimidazoles, chloramphecol, co-trimoxazole. However, there are alternative drugs to the above listed antibiotics that are not contraindicated for breastfeeding.

Usually safe, used in medium doses short courses: paracetamol, acetylsalicylic acid, ibuprofen; most cough medicines; antibiotics - ampicillin and other penicillins, erythromycin; anti-tuberculosis drugs (except for rifabutin and PASK are prohibited); antifungal agents (except for fluconazole, griseofulvin, ketoconazole, itraconazole are prohibited); antiprotozoal drugs (except for metronidazole, tinidazole, dihydroemetine, primaquine are prohibited); bronchodilators (salbutamol); corticosteroids; antihistamines; antacids; antidiabetic agents; most hypertensive drugs, digoxin, and single doses of morphine and other narcotics. At the same time, while taking medications by the mother, careful monitoring of the child is necessary in order to detect their side effects in a timely manner.

It is possible to suppress lactation when a woman takes estrogens, including estrogen-containing contraceptives, thiazode diuretics, ergometrine.

The transfer of an infant, especially a newborn, to artificial feeding due to drug treatment mothers medicines in a therapeutic dosage in normal cases carries a certain threat to his health and quality of life.

Given the negative impact of tobacco smoke, tar and nicotine on the child's body and on lactation, women who smoke during lactation are advised to stop smoking. Nicotine can reduce the amount of milk produced and inhibit its release, as well as cause irritability in the child, intestinal colic and low rates of weight gain in infancy. Women who smoke have lower levels of prolactin, which can shorten lactation, and lower levels of vitamin C in breast milk than non-smokers. Smoking women should be motivated to quit smoking or at least significantly reduce the number of cigarettes smoked. However, breastfeeding remains the best option, even if the woman smokes. The content of harmful substances in breast milk will be less if a woman smokes a cigarette after breastfeeding, and not before.

Mothers suffering from alcohol and drug (heroin, morphine, methadone or their derivatives) addiction should not breastfeed their child.

Breastfeeding during the onset of a new pregnancy can continue.

Contraindications to early breastfeeding on the part of the child- assessment of the state of the newborn on the Apgar scale below 7 points in case of severe asphyxia of the newborn, birth trauma, convulsions, respiratory distress syndrome, as well as deep prematurity, severe malformations (gastrointestinal tract, maxillofacial apparatus, heart, etc.).

Among the contraindications to the early attachment of the child to the mother's breast, until very recently, delivery by caesarean section was also included. However, if this operation is performed under epidural anesthesia, breastfeeding in the delivery room is possible. If the delivery was carried out under anesthesia, then after the end of the operation, the puerperal is transferred to the intensive care unit of the maternity hospital, and the baby is transferred to the children's ward of the postpartum department. A few hours (no more than 4) after the end of the anesthesia, the nurse brings the newborn to the mother and helps her to attach it to the breast. During the first day, this is done several times. On the second day, with a satisfactory condition of the mother and baby, they are reunited in the postpartum department of the joint stay of the mother and child.

With a number of severe congenital malformations (heart defects with decompensation, cleft palate, cleft lip etc.), when breastfeeding is not possible, the baby should receive expressed breast milk.

Absolute contraindications to breastfeeding by a child at subsequent stages of lactation are very limited - hereditary enzymopathies (galactosemia, maple syrup disease). With phenylketonuria, the volume of breast milk in combination with medicinal products is set individually.

It is necessary to dwell on the issues of supplementation of children who are exclusively breastfed. The practice of domestic pediatricians shows that newborns and older children who are exclusively breastfed sometimes need fluids. This condition may be due to low humidity in the apartment, elevated temperature environment, plentiful fatty foods, eaten by the mother the day before, etc. In these situations, you can offer the child water from a spoon, if he began to drink willingly, then he needed it. In addition, supplementation is necessary for sick children, especially in diseases accompanied by high fever, diarrhea, vomiting, severe hyperbilirubinemia.

Currently, there are more than 50 diseases that in children in the neonatal period can be manifested by icteric coloration of the skin. Therefore, long-term preservation of jaundice in a newborn requires a mandatory examination.

Even with severe physiological jaundice in children in the first days of life, breastfeeding should not be abandoned. Early attachment of the baby to the breast and frequent feedings are an important factor prevention of jaundice, since colostrum, having a laxative effect, leads to a faster discharge of meconium. With insufficient nutrition of a newborn baby, jaundice may be more intense and prolonged due to the thickening of bile. Supplementation with water or glucose does not contribute to the prevention of jaundice, but reduces its severity. It is important that the baby receives an adequate amount of milk, because malnutrition develops bile thickening syndrome.

Breastfeeding-associated jaundice - breast milk jaundice or Arias jaundice develops in 1-4% of children after the first week of life, is characterized by an increase in the level of unconjugated bilirubin and does not affect the child's condition. The pathogenesis has not been studied enough, a connection with various components of breast milk is assumed to be breast milk factors. You can get confirmation of the diagnosis by stopping the attachment of the baby to the breast and using pasteurized mother's milk for feeding for 1-2 days. During this time, the intensity of jaundice decreases significantly and breastfeeding can be continued.

It is advisable to breastfeed a child with hyperbilirubinemia due to AB0 incompatibility from birth, since the antibodies contained in milk are destroyed by hydrochloric acid and enzymes of the digestive system. In case of a Rh conflict, if the child has not undergone a replacement blood transfusion, then during the first 10-14 days he is fed with maternal pasteurized (antibodies are destroyed during pasteurization) or donor milk. In cases of replacement blood transfusion, 3-5 hours after the operation, the child can be attached to the breast.

It is advisable to continue breastfeeding up to 1-1.5 years, and the frequency of breastfeeding after a year is reduced to 1-3 times a day.

Materials for this chapter were provided by: prof. Fateeva E. M. (Moscow), prof. Mandrov S.I. (Ivanovo), prof. Bombardirova E. P. (Moscow). prof. Rusovoy T.V., (Ivanovo), MD Odinaeva N. D., Ph.D. Kapranova E. I. (Moscow), Ph.D. Gmoshinsky M. V. (Ivanovo), Ph.D. Proshchina I. M. (Ivanovo), Ph.D. Batanova E. V. (Ivanovo), Ph.D. Lukoyanova O. L. (Moscow), Ukraintsev S. E. (Moscow).

Article by Natalia Kryazhevsky, yoga teacher, breastfeeding consultant, sling consultant, specially for the book Conscious Pregnancy and Natural Parenthood.

It is impossible to establish a natural process by acting unnaturally.

Breastfeeding (LF) is a natural physiological process that follows childbirth. The body of a woman who has given birth is ideally prepared for breastfeeding. According to statistics, only about 2% of women have objective reasons that do not allow them to practice it. Then why do mothers often complain that there are such difficulties with breastfeeding, such as lack of milk, insufficient weight gain of the child or breast problems? Why does this process, honed over millennia, produce such failures? Has anything changed in it lately?

The natural process has not changed. Our way of life has changed. And this was most evident in the 20th century. The process of industrialization needed a labor force, so women who were not dependent on children were in demand; strollers, separate cribs and early foods came into fashion. The consequence of urbanization is small, isolated families in which expectant mothers had no experience in caring for babies, communicating with them, and often never saw BF live.

By the end of the last century, aggressive advertising of artificial nutrition also joined. Formula manufacturers hail breastfeeding as the ideal, and formula-feeding is the norm and concludes that "breastfeeding is more complete and optimal." This is essentially true, but there is a catch. Indeed, in our case, the biological norm, a sample for comparison, is the natural physiological process of breastfeeding. Compared with it, it turns out that the mixture is inferior and suboptimal and less suitable for the child's body. And artificially fed children are inferior to infants in terms of immunity, intellectual development and many other parameters. Of course, this presentation of the product is disadvantageous for mixture manufacturers. However, in order to make informed decisions, it is important for us to understand such information substitutions.

It is impossible to completely recreate breast milk. Each pair of mother-child it is individual. According to scientists, the number of its components ranges from 400 to 4000 (20-30 in mixtures). The composition of milk (proteins, fats, carbohydrates, immune factors, vitamins, hormones, etc.) is constantly being studied not only by individual laboratories, but also by entire institutes. Those substances that can be discovered are often patented - they are so unique. In addition to food and drink, breastfeeding meets the other basic needs of the infant, who is born completely immature and dependent. This is, firstly, physical contact with the mother - the child is not aware of himself as a separate being and feels his body only through external touches on the skin that is very sensitive during this period. Secondly, the need for warmth and security from strong physical influences. Thirdly, the satisfaction of the sucking reflex and saturation. In addition, it is easier for a nursing mother to notice that the baby is wet and also satisfy the need for comfort.

The benefits of breastfeeding for a child are obvious and priceless. But for the health of the mother, this process is very important and is the key to a positive psychological attitude, optimal hormonal background, the rapid recovery of the pre-pregnancy state, and in the future - less likelihood of osteoporosis, breast cancer, uterus and other serious diseases.

It is necessary that the expectant mother has full information about breastfeeding before childbirth, after which a large number of questions about lactation immediately arise. The “Rules for Successful Breastfeeding”, which WHO formulated back in the late 80s, can be a significant help in this. last century.

It's important to know that early attachment of the baby to the breast(during the first hours after childbirth) is invaluable for the development of lactation and the formation of the attitude of the mother and child to breastfeeding.

It is necessary to exclude pre-breast feeding, i.e. do not bottle feed a newborn before the mother puts it on her breast. The child must have the correct imprinting - recognition and memorization of the process of breastfeeding. In addition, the stomach of a newborn is the size of a cherry, so the few milliliters of colostrum that are secreted from the mother's breast are enough for him to feed in the first 1–3 days.

Breastfeeding has a very positive effect on the processes of establishing closer contact between mother and child and mutual learning. cohabitation of mother and child after childbirth.

The correct position of the child at the chest essential for effective suckling and maternal comfort. Signs of proper attachment (the way the baby grabs and sucks the breast) are: a wide-open mouth with lips turned outward, while the nipple and almost the entire areola are in the mouth, the chin touches the mother's breast, the nose breathes freely, when sucking, the cheeks are rounded and swallowing is noticeable. There are three main feeding positions that help to effectively empty all lobes of the mammary gland: “cradle”, “from under the arm” and “lying”. It is recommended to do all three at least once a day for each breast during the first 1-2 months. It is very important that in any position for feeding, the position of the mother is comfortable and relaxed.

For a successful GV, it is necessary to establish feeding on demand when the breast is offered even at the slightest hint from the child: search movement of the head, lips, mouth opening, etc. At the same time, breastfeeding even up to 4 times per hour is considered normal. Unfortunately, in some maternity hospitals, feeding according to the regimen is still practiced. At the same time, it has been proven that large artificial intervals between feedings lead to a gradual extinction of lactation and the need to introduce supplementary feeding.

It is important for moms to follow a rule that will support optimal weight gain and lactation - the duration of feeding is regulated by the child. Feeding ends when the baby moves away from the breast. In a child’s life, there may be periods of long “hanging” on the chest, which are easy to come to terms with, realizing that breastfeeding is a sedative, communication with mom and “ordering food for the future”, since the sucking process itself stimulates milk production.

Breastfeeding at night is very important, because they are the most complete (all participants are relaxed and in no hurry). In addition, it has been proven that at night and in the early morning, in response to suckling, a large amount of prolactin, the hormone responsible for milk production, is produced.

Since milk contains 88-90% water, a breastfed baby does not need to be supplemented. In hot weather, it is recommended to simply apply more often to the chest. The imaginary feeling of satiety when supplementing can reduce appetite, and therefore affect weight gain and breast stimulation.

Nipples, bottles and pacifiers are breast substitutes. They “take away” part of the sucking reflex for themselves, which will affect weight and maintain lactation. In addition, the sucking processes of the nipple and the breast are different, which can cause nipple injuries, restless behavior of the baby under the breast, and other consequences. For supplementary feeding, it is better to use non-sucking objects (syringe, spoons, drinkers, etc.).

Complete feeding last 20 minutes or longer, so that the child receives a sufficient amount of fat, which is the key to good weight gain.

Breast hygiene can be done during a shared shower 1-2 times a day. At frequent washing the secret produced by the glands of Montgomery and having bactericidal and softening properties is washed off. This can cause damage to the nipple when suckling.

Frequent weighing of the child do not provide objective information. Indicative are weighing no more than 1 time per week. Based on two signs: a weekly increase and the number of urination, a reliable conclusion can be made about the sufficiency of nutrition for breastfeeding. For a child under 6 months, the number of urination should be more than 10-12 times a day.

Additional pumping is not needed. When feeding on demand, milk is produced as much as the child needs, otherwise hyperlactation is possible.

Proved that up to 6 months The gastrointestinal tract of the child is not ready for other food, therefore, until this moment, it is recommended only breastfeeding.

Breastfeed your baby recommended up to a minimum of 2 years. During this period, there is a maximum assimilation of nutrients from mother's milk. Positively continue breastfeeding and beyond. This provides a strong immune system for the child, as well as psychological and emotional comfort.

Very important support for breastfeeding mothers especially moral. Communication with women who nursed their children up to 2–4 years of age can help with this.

Note that all these rules bring us closer to natural breastfeeding behavior. Really, modern science it just rediscovers the natural wisdom that is instilled in us from birth and blurred by superficial stereotypes of "adult" life. This is also why it is so important to follow a child who is naturally pure and wise, and not only in matters of breastfeeding.

It is important to remember that problems that arise are normal and natural. We all have the ability to solve them. Remember: a woman who gives birth to a child will always be an ideal mother for him. No one will understand him better than her.

Comments by Kristina Khlystova, certified nutritionist, online trainer and author of the Live Food Cleansing and Live Food Cleansing for Breastfeeding Mom and Baby courses:

Why is breastfeeding the most natural process in motherhood?
Because it is a natural physiological continuation of pregnancy and childbirth. It is designed by nature itself. If we abstract from society and civilization, then in nature the survival of an infant depends on whether the mother can breastfeed him. Mixtures do not exist, clean water too, nipples and bottles - even more so. Mom carries the baby in her arms, in slings, breastfeeds him on demand and regularly drops him off, because a loud scream or smell can attract unwanted attention.

Where, then, does the myth of the “non-dairy mother” come from?

We owe this to the peculiarities of history in the last 150 years. In merchant and peasant families of pre-revolutionary Russia, women breastfed at least "three long posts" (about 2 years). In high society, breastfeeding was considered bad form, so the child was given to the nurse, and the breast was pulled. Due to such trauma to the chest, there was a high mortality rate from the so-called "chest fever", that is, purulent mastitis.

After the revolution and the civil war, when there were not enough men, women were forced to work hard in production and agriculture. This is how the hourly feeding regimen arises, because due to the need to work, the mother could not be with the baby all the time. After the Second World War, the situation of women became even more difficult. It was necessary to raise the country and work literally everywhere. During this period, a strict feeding regime is fixed by the hour. The babies remain in the crèche under the supervision of staff who are forced to formula feed and not on demand. A ban on night feedings and co-sleeping(after all, a woman needed to sleep after a hard day's work). Naturally, without active breast stimulation (sucking on demand) and night feedings (the release of prolactin, which is responsible for the amount of milk, especially in the early morning hours!) Lactation fades. Moms at work. The chest swells, a huge number of mastitis. Therefore, mixtures become just a salvation! They are introduced everywhere. However, their composition is imperfect, and children develop beriberi. As a result, early complementary foods are introduced when the child is not yet ready. Artificial rather than natural breastfeeding is becoming the norm.

In addition, feeding according to the regimen often provokes breast problems (cracks and soreness from improper attachment, lactostasis and mastitis). Hence the myth of the pain, complexity and even indecency of breastfeeding. And so, several generations of such "non-dairy mothers" give rise to the idea that this is the norm. Girls in families do not have a positive experience of natural feeding, their brothers and sisters are bottle fed. Even dolls today are sold with bottles and nipples, making such feeding a matter of course!

What is the Breast Milk Substitute Marketing Code?

In 1960, 100% of Mexican children were breastfed for up to six months, and in 1970 children who received breast milk at six months remained 9%. What has happened in these ten years? Yes, it's just that manufacturers of mixtures came to Mexico with aggressive advertising.

In 1981, the International Code of Marketing of Breast-milk Substitutes was created. In Russia, alas, few people know about the very fact of the Code's existence. And even more so, no one is in a hurry to comply with it. The Code does not prohibit the sale and use of mixtures. The purpose of the code is to protect mothers from aggressive advertising, which from all sides says that formula is as healthy as mother's milk! There is a strict prohibition in the provisions of the code: no advertising of any breast-milk substitutes; no advertising of feeding bottles and nipples; no free samples and samples, especially in medical institutions. And what do we see in pharmacies? Women's consultations? Maternity hospitals? Fact: Mothers who received formula trials were 39% more likely to stop breastfeeding than those who did not. This is such a sad statistic...

And even sadder is that 10 years ago, according to a survey in Russia, 48% of mothers did not see the difference between breast milk and formula at all! Just think about it!

Ecological breastfeeding excludes the use of bottles or nipples, separation of mother and child, parental feeding regimen, or restriction of nighttime feedings. Please note: this is not the “best”, and even more so not the “ideal”, as manufacturers of artificial nutrition try to convince in their advertising, namely the norm. This is the standard that every child needs for normal growth and development.

What are the uniqueness and benefits of breast milk?

Lactation begins with the release of colostrum in the first days after childbirth. This is a yellow liquid that contains all the components to ensure the immunity of the newborn. It contains 8-14% protein, immunoglobulin A, a large number of leukocytes, more than 130 types of prebiotics, big number vitamins (and some more than in mature milk, for example, A, E and others). It has a laxative effect for faster removal of meconium from the intestines of the child. Not a single mixture can provide such protection to the baby's body. More than 150 patents for breast milk components for the production of medicines have been received in the world.

Next comes "transitional milk". It has hundreds of different components, the ratio of which is constantly changing depending on the needs of a particular child during the day, week. Transitional Milk contains lactoferrin, a unique constituent of human milk. It's milk protein main function which is the binding and transport of iron in the body, and the “side” effects are the active fight against any infection, the regulation of natural immunity, and even the slowdown in the growth of tumors and metastases. 1 gram of lactoferrin from cow's milk costs more than $1,000, and from human milk it costs more than $3,000. At the same time, the content of lactoferrin in cow's milk- about 0.1 g per liter, and in the female - 2 g per liter. That's how high the cost of natural nutrition, which every mother can give her baby! If you consider that the baby eats about a liter, such food costs more than $ 6,000! That's the price! Who here said that the mixture and milk are equivalent?!

Interestingly, the content of lactoferrin is maximum in the first 5 days of a baby's life. Then it decreases significantly and again begins to increase already in the second year of feeding. A very important factor in protecting long-term feeding! Feed babies over 1.5–2 years old! This is no longer food, but pure immunity for them!

Mature breast milk also contains vitamins and minerals essential for growth and development. human body. The composition of mother's milk changes not only within a month or a day, but also during one feeding, depending on the individual needs of the child!

Breast milk is easily digested and absorbed by the baby, contributing to the development and maintenance of healthy intestinal microflora. Most milk components cannot be recreated in laboratories. In the most adapted mixtures, there are only about 60 of them. And in milk there are more than 300 of them, and this number continues to grow. Breast milk contains the best ratio of proteins, fats, vitamins and minerals that your baby can easily digest. It is not possible to achieve such a ratio industrially. Medical studies have shown that the incidence of infants is 70% lower than that of "artificial" ones.

What are the benefits of breastfeeding for children?

Artificial nutrition is a standardized artificial food, not designed for your one and only baby. She makes his vital systems work in emergency mode. Breast milk substitutes are based on cow's milk, which is completely different from human milk. In addition to the fact that mother's milk is always at hand, it is also absolutely sterile. The industrial production of mixtures carries big risk for the health of the child. There are many cases when arsenic, plastic, broken glass, lead, etc. And how many confused labels, which is fraught with lost health for "allergic" children! A lot of terrible things are happening in this area.

What are the benefits of breastfeeding for mothers?

Breastfeeding is a completely natural part of a woman's reproductive cycle, a mandatory continuation of pregnancy and childbirth. Oxytocin helps to restore strength after childbirth, the rapid contraction of the uterus and stop postpartum bleeding. Due to the long absence of menstruation, a nursing mother is better protected from iron deficiency anemia. Breastfeeding seriously protects a woman from cancer breasts and ovaries (20% less with each birth if the baby has been breastfed for at least two months).

Psychological benefits: Breastfeeding has a very strong effect on the mother's character, making her softer, calmer and more sensitive, especially with the baby. An invisible thread of mutual attachment, an intuitive connection, is born and becomes stronger and stronger.

Do all mothers have the opportunity to breastfeed?

According to WHO statistics, about 3% of women cannot breastfeed. Moreover, these 3% fall on the situations of some serious illnesses mother or child, while a certain number of women, if desired, can establish mixed feeding. That is, roughly speaking, only 1-2% of women really cannot feed! In our country, almost every second person refuses GW for one reason or another.

However, in the vast majority of situations, breastfeeding is not only possible, but also contributes to the restoration of health. For example, with general infectious mild diseases of the mother, chicken pox, cytomegalovirus - in all these cases, the child, on the contrary, when feeding, even without having time to get sick himself, already receives protection in the form of antibodies with milk. The chance of transmitting hepatitis A and B through breast milk is negligible compared to the risk intrauterine infection. Therefore, if the infection of the child did not occur during childbirth, there are no contraindications for breastfeeding. Maternal staphylococcus and streptococcus, endometritis, urinary tract infections may well be cured with continued breastfeeding. There is no prohibition to feed with mastitis (moreover, breastfeeding contributes to its faster cure). But this is a double-edged sword: the mother gets rid of mastitis, and the child eats up pus from the mother's inflamed chest ...

Finally, it is worth saying a few words about situations where the mother is convinced that even if she can feed, she will not have enough milk. For example, in the case of multiple births. In fact, active feeding helps to increase milk production. If desired, if the mother has good support, she can feed successfully and for a long time!

Why does a breastfed baby not need to be supplemented with water until 6-8 months?

The water content in breast milk is about 90%. If we start to supplement the baby before the introduction of complementary foods, we run the risk of facing several dangers. The first danger is malnutrition due to the imaginary feeling of satiety due to water. How much water the child drank, the same amount of milk he did not finish. A child grows from milk, but not from water. Accordingly, the second danger is a decrease in breast stimulation and a decrease in milk production. The result is breast rejection. In addition, mother's milk is sterile, but water is not. This is a big risk to disrupt the microflora of the baby, which will bring a lot of trouble with the “problem tummy”.

What do supporters of feeding according to the regimen not know about?

First, frequent sucking is physiological norm for the baby, because mother's milk is absorbed much faster than the mixture (when feeding which, in fact, certain intervals are maintained so that the tummy rests and everything is assimilated).

Secondly, sucking mother's breast is not only nutrition, but also communication with mother, ensuring psychological comfort and good development of the baby.

Why is it not recommended to use pacifiers and pacifiers?

The muscles of the baby's mouth get tired of the pacifier, and the baby sucks less at the breast. Accordingly, the mother's milk production decreases.

The baby develops "nipple confusion" and may begin to suckle incorrectly at the breast.

Any nipple is a source of infection.

Nipples are the cause of improper jaw growth, crooked and diseased teeth, and malocclusion.

The pacifier closes the child on itself. After all, they do not pay the attention he needs. Significantly weakens the connection with the mother.

Pacifiers have been linked to cases of childhood autism.

What are the benefits of long feeding?

It is no coincidence that WHO recommends breastfeeding a baby for at least (!) 2 years. After a year, breast milk changes its composition. It is no longer the main food for the baby, and come to the fore immune functions. The older the child becomes, the greater the concentration of immunoglobulins in milk. In the second year of feeding, the usual daily dose milk that a breastfed baby receives (on average 448 ml) provides 43% of the protein requirement, 36% of the calcium requirement, 75% of vitamin A, 94% of vitamin B12 and 60% of vitamin C. The benefits of long-term feeding are especially noted by literate dentists and orthodontists for the correct formation of the maxillofacial skeleton, eruption of milk and permanent teeth.

No less important are psychological aspects long feeding. Unfortunately, for many people, “other food can be fed” automatically becomes “other food should be fed”. However, premature forceful weaning can cause a delay emotional development and increase dependence on parents. One of the foreign studies showed that the longer a child breastfeeds, the better social adaptation goes later, at the age of six to eight. To kids older than a year emotional instability is characteristic (either teeth erupt, then it catches a cold, then the regime has gone astray, then something is beyond one’s strength, the child begins to get upset because of the inconsistency of his desires with the possibilities, etc.), and while maintaining the GV, the whole family will much easier pass through a difficult time of age-related psychological and physical crises.

“Now my son is 2 years and 9 months old and I still breastfeed him. Heard a lot of opinions about it, mostly unflattering. Someone says that milk after a year is useless, and it doesn’t exist at all. But it is. The other day I felt a rush to my chest, which has not been for a year. Of course, now there are few feedings, one or two at night, and I even wonder how nature itself made it so that these feedings eventually come to naught. This is the bond between mother and child, necessary for further full development child."

Varvara Kuznetsova, production and sale of clothes, Dobrynya's mother

“Nature has laid down an ingenious mechanism for feeding a child with mother’s milk, through which he receives not only nutrients, but also information about your Family. It was a great pleasure for me to feed the baby with my milk. I couldn't even imagine that it could be otherwise. This is the very intimate contact when no words are needed to understand the depth of love for each other. Child for a long time cannot speak, and this bodily contact with the mother, much deeper than touch, allows him to learn about the emotions and feelings that the mother experiences. Now the child is almost 3 years old, he eats the same as me (vegetarianism). I still have some milk that the baby is happy to enjoy after the main meal or according to his mood. I do not set any time frame for the end of breastfeeding, since this should be a mutual decision. When the child receives all the warmth that I can give him through feeding, the process will be completed..

Anna Solovey, music director kindergarten mother of Hope

“Thanks to the courses at the Jewel parent school and the correct information, we succeeded with GV, feeding was on demand, without a regimen. We are feeding now, the child will soon be 3 years old. On the chest, the child calms down, is comforted in case of some kind of anxiety or pain. A deep connection is established between mother and child on a spiritual level, a very close relationship. During attachment to the breast (especially in the first months), a wave of incredible tenderness and love for the baby is overwhelmed. Truly, the devil's idea is to separate mother and child, breaking the bond between them established through breastfeeding. Breastfeeding can be very tiring, it requires a lot of patience, endurance, the child can “hang” on the chest for a long time (especially if the pregnancy was nervous and stressful, and the birth was difficult), and this is a real ascesis not to tear him away from himself, endure and give what he needs".

Natalya Khodyreva, programmer, Anna's mother

You can learn the technique of proper attachment to the breast and get help in establishing lactation with the help of breastfeeding consultants.

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

Composition of human milk

The optimal food product for a child in the first months of life is mother's milk, which corresponds to the characteristics of its digestive system and metabolism, ensuring adequate development of the child's body with a rational diet for a nursing woman. All nutrients in human milk are easily digestible, since their composition and ratio correspond to the functional capabilities of the gastrointestinal tract of an infant, and also due to the presence of enzymes (amylases, lipases, phosphatases, proteases, etc.) and transport proteins in human milk. Breast milk is a source of hormones and various growth factors (epidermal, insulin-like, etc.), which play an important role in the regulation of appetite, metabolism, growth and differentiation of tissues and organs of the child.

Due to the presence of antibodies, immune complexes, active leukocytes, lysozyme, macrophages, secretory immunoglobulin A, lactoferrin and other biologically active substances, breast milk increases the protective functions of the child's body. Oligosaccharides, as well as low levels of protein and phosphorus in human milk, promote the growth of healthy intestinal microflora. In recent years, bifidobacteria and lactobacilli, which determine the development of immunity, have been found directly in human milk (Fig. 2).

Therefore, breastfed children are much less likely to suffer from infectious diseases and develop more stable post-vaccination immunity.

The protective properties of human milk are not limited to anti-infective protection. Breastfeeding reduces the risk of developing diseases such as atherosclerosis, hypertension, diabetes, obesity, leukemia, etc. in subsequent years. Cases of sudden death are less frequently recorded in breastfed children.

Natural feeding has a beneficial effect on the development of the central nervous system of the child and his mental status. The bonding between mother and child during breastfeeding has a profound mutual emotional impact. It is noted that children who were fed with mother's milk are distinguished by harmonious physical development, they are more calm, balanced, friendly and benevolent compared to children who were bottle-fed, and later they themselves become attentive and caring parents.

According to some data, children who received breastfeeding have a higher IQ, which may be partly due to the presence of long-chain polyunsaturated fatty acids (DLPUFA) in breast milk, which are necessary for the development of brain and retinal cells. In the blood of breastfed children, the amount of DPPUFA is significantly higher compared to children receiving artificial feeding.

Human milk protein consists mainly of whey proteins (70-80%) containing essential

Rice. 2. Protective factors in breast milk

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

Human milk contains nucleotides, which account for about 20% of all non-protein nitrogen. Nucleotides are the initial components for the construction of ribonucleic and deoxyribonucleic acids, they play an important role in maintaining the immune response, stimulating the growth and differentiation of enterocytes.

The main components of human milk fat are triglycerides, phospholipids, fatty acids, and sterols. Its fatty acid composition is characterized by a relatively high content of essential polyunsaturated fatty acids (PUFAs), the concentration of which in women's milk is 12-15 times higher than in cow's milk. PUFAs are precursors of arachidonic, eicosapentaenoic and docosahexaenoic fatty acids, which are an important component of cell membranes, they form various classes of prostaglandins, leukotrienes and thromboxanes, they are also necessary for the myelination of nerve fibers and the formation of the retina.

Long-chain polyunsaturated fatty acids - arachidonic and docosahexaenoic are found in human milk in a small amount (0.1-0.8% and 0.2-0.9% of the total fatty acids, respectively), but significantly higher than in cow's milk. milk.

Fats in mother's milk are easier to digest than cow's, as they are more emulsified, in addition, breast milk contains the enzyme lipase, which is involved in the digestion of the fat component of milk, starting from the oral cavity.

The content of cholesterol in women's milk is relatively high and ranges from 9 to 41 mg%, stabilizing by the 15th day of lactation at the level of 16-20 mg%. Breast-fed babies have higher cholesterol levels than formula-fed babies. Cholesterol is necessary for the formation of cell membranes, tissues of the nervous system and a number of biologically active substances, including vitamin D.

Human milk carbohydrates are represented mainly by the disaccharide b-lactose (80-90%), oligosaccharides (15%) and a small amount of glucose and galactose. Unlike the a-lactose of cow's milk, the b-lactose of human milk is slowly broken down in the small intestine of the child, partially reaching the large intestine, where it is metabolized to lactic acid, promoting the growth of bifidus and lactobacilli. Lactose promotes better absorption of minerals (calcium, zinc, magnesium, etc.).

Oligosaccharides - carbohydrates, including from 3 to 10 monosaccharide residues, which are not cleaved by digestive tract enzymes, are not absorbed in the small intestine and reach the lumen of the large intestine unchanged, where they are fermented, being a substrate for the growth of bifidobacteria. In this case, competitive inhibition of the development of conditionally pathogenic flora occurs. In addition, human milk oligosaccharides have receptors for bacteria, viruses (rotaviruses), toxins and antibodies, thereby blocking their binding to the enterocyte membrane. The considered functions of oligosaccharides, as well as lactose, underlie the prebiotic effects of human milk, largely determining its protective effect against intestinal infections in infants.

The mineral composition of women's milk is significantly different from cow's milk, which contains 3 times more salts, mainly due to macronutrients. The relatively low mineral content of human milk ensures its low osmolarity and reduces the burden on the immature excretory system. Macronutrients include calcium, phosphorus, potassium, sodium, chloride and magnesium. The remaining minerals are microelements and are present in the tissues of the human body in small quantities. Ten of them are currently classified as essential: iron, zinc, iodine, fluorine, copper, selenium, chromium, molybdenum, cobalt and manganese.

Minerals enter the body with food and water, and are excreted with urine, feces, sweat, desquamated epithelium and hair.

The insufficiency of microelements, which are regulators of metabolic processes, is accompanied by a decrease in the adaptive capacity and immunological protection of the child, and their pronounced deficiency leads to the development of pathological conditions: disruption of the processes of building the bone skeleton and hematopoiesis, changes in the osmotic properties of cells and blood plasma, and a decrease in the activity of a number of enzymes.

Human milk contains all water- and fat-soluble vitamins. The concentration of vitamins in milk is largely determined by the nutrition of a nursing mother and the intake of multivitamin preparations. It should be emphasized, however, that the level of vitamin D in women's milk is extremely low, which requires its additional administration to children who are breastfed.

Organization of breastfeeding

In the maternity hospital, in order to become sufficient in terms of volume and duration of lactation, a healthy newborn child should be laid out on the mother's chest in the first 30 minutes after an uncomplicated birth for a period of at least 30 minutes.

THE ARGUMENTATION OF THIS METHOD INCLUDES THE FOLLOWING PROVISIONS:

1. Early attachment of the child to the mother's breast ensures the rapid activation of the mechanisms of milk secretion and more stable subsequent lactation;

2. Sucking a baby promotes an energetic release of oxytocin and thereby reduces the risk of blood loss in the mother, contributes to an earlier contraction of the uterus;

3. Contact of mother and child:

It has a calming effect on the mother, the stress hormonal background disappears;

Promotes, through the mechanisms of imprinting, an increase in the feeling of motherhood, an increase in the duration of breastfeeding;

Provides newborns with maternal microflora.

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

It has a mild laxative effect, thanks to which the intestines of the child are cleared of meconium, and with it bilirubin, which prevents the development of jaundice;

Contributes to the formation of optimal intestinal microflora, reduces the duration of the phase of physiological dysbacteriosis;

Contains growth factors that affect the maturation of the functions of the intestines of the child.

In order for the child to receive colostrum in the maximum possible amount, the frequency of breastfeeding should not be regulated. In order to implement free feeding on demand, a healthy child should be in the same room with the mother. It is shown that with free feeding, the volume of lactation is higher than with feeding by the hour. Early attachment to the breast and "free feeding" are key factors in ensuring full lactation and contribute to the establishment of close psycho-emotional contact between mother and child.

To maintain lactation, night feedings are especially significant, since prolactin levels are higher at night. The duration of breastfeeding of a healthy child in the first days should not be limited, even when he practically does not suck out anything, but is dozing at the breast. The need for contact and sucking may be independent, relatively independent of eating behavior. However, in the future, excessively frequent attachment of the child to the mother's breast at the slightest disturbance can lead to overfeeding. In this regard, one of the important tasks of pediatricians, especially district pediatricians, is to teach the mother to differentiate the "hungry" cry of the child from the cry due to other reasons: infantile colic, discomfort, change of scenery, overheating or cooling of the child, pain, etc.

Assessment of the adequacy of lactation requires a thorough analysis of the child's behavior, the nature of the stool, the frequency of urination. Possible signs of insufficient lactation are:

Anxiety and crying of the child during or immediately after feeding;

The need for frequent breastfeeding;

Prolonged feeding, in which the child makes a lot of sucking movements, in the absence of swallowing;

Feeling by the mother of the rapid complete emptying of the mammary glands with the active sucking of the child, there is no milk when decanting after feeding;

Restless sleep, frequent crying, "hungry" cry;

Scanty rare stool

In some cases, even with a sufficient amount of milk, the mother cannot breastfeed the baby:

The baby latch but does not suckle, does not swallow, or suckles very little;

When the mother tries to breastfeed, the child screams and resists;

After a short sucking breaks away from the chest, choking with crying;

The baby takes one breast but refuses the other. The reasons can be different, among which the most common are:

Violations of the organization and technique of feeding (wrong position of the child at the breast);

An excess of milk in the mother, in which it flows too quickly;

Teething,

Finding out the cause and carrying out if necessary

Hypogalactia true (or primary) is rare, no more than 5% of women. In other cases, a decrease in milk production is caused by various reasons, the main of which are: the woman’s lack of dominant lactation (psychological mood) due to poor preparation during pregnancy, as well as emotional stress, early and unreasonable introduction of supplementary feeding with infant formula, the need to go to work , illness of the child, illness of the mother, etc.

In some cases, hypogalactia is transient in nature, manifesting itself in the form of so-called lactation crises, which is understood as a temporary decrease in the amount of milk that occurs without apparent reason. Lack of information about them and lack of knowledge of correction methods are the most common factors for stopping breastfeeding.

Lactation crises are based on the peculiarities of hormonal regulation of lactation. They usually occur at 3-6 weeks, 3, 4, 7, 8 months of lactation. The duration of lactation crises is on average 3-4 days, and they do not pose a danger to the health of the child. In such cases, more frequent attachment of the baby to the breast in combination with feeding from both breasts is sufficient. The mother needs rest and rest; varied, full-value, high-tasting food; warm drinking of drinks, especially with the use of lactogenic herbs or preparations 15-20 minutes before feeding, as well as special products of lactogenic action.

Measures used in secondary hypogalactia (lactation crises):

More frequent breastfeeding;

Settlement of the regimen and nutrition of the mother (including the optimal drinking regime due to the additional use of at least 1 liter of liquid in the form of tea, compotes, water, juices);

Impact on the psychological mood of the mother;

Orientation of all family members (father, grandparents) to support breastfeeding;

Contrast shower on the area of the mammary glands, soft rubbing of the chest with a terry towel;

The use of special drinks with a lactogenic effect;

At the same time, children's milk formulas are not introduced into the child's diet without the recommendations of a doctor.

Numerous observations show that sufficient production of breast milk mainly depends on the “mood of the mother” for breastfeeding her child, her conviction that this is important and necessary and that she is able to do this.. More successful development of lactation and its continuation take place in conditions when, in addition to the desire and confidence of the mother, she is actively supported by all family members, as well as professional advice and practical assistance from medical workers. It is advisable for women to be taught about breastfeeding during pregnancy in the "School of Pregnant Women".

The most important role in the promotion of breastfeeding is assigned to doctors and nurses, who should actively encourage family and social support for breastfeeding, provide parents with full information about its comprehensive positive effect on the child's body and advantages over infant formula. To carry out activities to successfully establish and maintain the practice of breastfeeding, all health workers involved in obstetric care and medical supervision of infants must have the ability to provide practical assistance to mothers in breastfeeding.

In accordance with the WHO/UNICEF international program "Protection, promotion and support of breastfeeding", which outlines the main provisions in the form of ten principles for successful breastfeeding, the Ministry of Health of the Russian Federation developed a breastfeeding support program and approved a number of regulatory and methodological documents (1994 , 1996, 1998, 1999, 2000). According to these documents, it is recommended to carry out the following work to support natural feeding in medical and preventive institutions for obstetrics and childhood:

Have accessible printed information regarding breastfeeding practices, which should be shared regularly with all health care personnel;

Inform all pregnant women about the benefits of breastfeeding and the need

early attachment of a newborn baby to the mother's breast (within the first 30 minutes after birth);

Provide 24/7 co-existence of mother and child in the mother and child ward of the maternity hospital and encourage breastfeeding at the request of the child;

Teach mothers how to breastfeed and maintain lactation;

Strive for exclusive breastfeeding during the first 4-6 months of life, that is, not to give healthy newborns any food other than breast milk, except in cases due to medical indications;

Ensure continuity in the work of the antenatal clinic, obstetric hospital, children's clinic and children's hospital.

These activities must be carried out taking into account the health status of both the mother and the child.

Possible contraindications to breastfeeding on the part of the mother are: eclampsia, severe bleeding during childbirth and in the postpartum period, an open form of tuberculosis, a state of severe decompensation in chronic diseases of the heart, lungs, kidneys, liver, as well as hyperthyroidism, acute mental illness, especially dangerous infections (typhus, cholera, etc.), herpetic eruptions on the nipple of the mammary gland (before their aftercare), HIV infection.

With such diseases of a nursing mother as rubella, chickenpox, measles, mumps, cytomegalovirus infection, herpes simplex, acute intestinal and acute respiratory viral infections, if they occur without severe intoxication, breastfeeding, subject to the rules of general hygiene, is not contraindicated. The presence of hepatitis B and C in women is currently not a contraindication to breastfeeding, however, feeding is carried out through special silicone pads. In acute hepatitis A in the mother, breastfeeding is prohibited.

With mastitis, breastfeeding continues. However, it temporarily stops when a massive growth of Staphylococcus aureus in the amount of 250 CFU or more per 1 ml and single colonies of representatives of the Enterobacteriacae family or Pseudomonas aeruginosa species is detected in breast milk (Methodological recommendations for the bacteriological control of breast milk, Moscow, 1984). A breast abscess is possible complication mastitis and is most likely with abrupt interruption of breastfeeding. Feeding from a healthy gland should continue, and milk from an infected breast should be carefully expressed and discarded.

Stop breastfeeding in cases where the mother is taking therapeutic doses of cytostatics, immunosuppressive drugs, anticoagulants such as phenindione, radioisotope contrast agents for treatment or examination, lithium preparations, most antiviral drugs (except acyclovir, zidovudine, zanamivir, limovudine, oseltamivir - with caution ), anthelmintic drugs, as well as some antibiotics: macrolides (clarithromycin, midecamycin, roxithromycin, spiramycin), tetracyclines, quinolones and fluoroquinolones, glycopeptides, nitroimidazoles, chloramphenicol, co-trimoxazole. However, alternative drugs to the listed antibiotics are not contraindicated for breastfeeding.

Usually safe, used in medium doses, are short courses of paracetamol, acetylsalicylic acid, ibuprofen; most cough medicines; antibiotics - ampicillin and other penicillins, erythromycin; anti-tuberculosis drugs (except rifabutin and PASK); antifungal agents (except fluconazole, griseofulvin, ketoconazole, itraconazole); antiprotozoal drugs (except metronidazole, tinidazole, dihydroemetine, primaquine); bronchodilators (salbutamol); corticosteroids; antihistamines; antacids; antidiabetic agents; most antihypertensive drugs, digoxin, as well as single doses of morphine and other narcotic drugs. At the same time, while taking medications by the mother, careful monitoring of the child is necessary in order to detect their side effects in a timely manner.

It is possible to suppress lactation when a woman takes estrogens, including estrogen-containing contraceptives, thiazode diuretics, ergometrine.

The transfer of an infant, especially a newborn, to artificial feeding due to drug treatment of the mother with drugs in a therapeutic dosage carries a certain threat to his health and quality of life.

Given the negative impact of tobacco smoke, tar and nicotine on the child's body and on lactation, women who smoke during lactation are advised to stop smoking. Nicotine can reduce milk production and inhibit its secretion, as well as cause irritability in the child, intestinal colic and lead to a low rate of weight gain in infancy. Women who smoke have lower levels of prolactin, which can shorten lactation, and lower levels of vitamin C in breast milk than non-smokers. Smoking women should be motivated to quit smoking or at least significantly reduce the number of cigarettes smoked. The content of harmful substances in breast milk will be less if a woman smokes a cigarette after breastfeeding, and not before.

Mothers suffering from alcohol and drug (heroin, morphine, methadone or their derivatives) addiction should not breastfeed their child.

Breastfeeding during the onset of a new pregnancy can continue.

Contraindications to early attachment to the mother's breast on the part of the child - an assessment of the condition of the newborn on the Apgar scale below 7 points in case of severe asphyxia of the newborn, birth trauma, convulsions, respiratory distress syndrome, as well as deep prematurity, severe malformations (gastrointestinal tract, maxillofacial apparatus , hearts, etc.).

Among the contraindications to the early attachment of the child to the mother's breast, until very recently, delivery by caesarean section was also included. However, if this operation is performed under epidural anesthesia, breastfeeding in the delivery room is possible. If the delivery was carried out under anesthesia, then after the end of the operation, the puerperal is transferred to the intensive care unit of the maternity hospital, and the baby is transferred to the children's ward of the postpartum department. A few hours (no more than 4) after the end of the anesthesia, the nurse brings the newborn to the mother and helps her to attach it to the breast. During the first day, this is repeated several times. On the second day, with a satisfactory condition of the mother and baby, they are reunited in the postpartum department of the joint stay of the mother and child.

With a number of severe congenital malformations (heart defects with decompensation, cleft palate, cleft lip, etc.), when breastfeeding is not possible, the child should receive expressed breast milk.

Absolute contraindications to breastfeeding by a child at subsequent stages of lactation are very limited - hereditary enzymopathies (galactosemia, etc.). With phenylketonuria, the volume of breast milk in combination with medicinal products is set individually.

It is necessary to dwell on the issues of supplementation of children who are exclusively breastfed. The practice of domestic pediatricians shows that newborns and older children who are breastfed sometimes need fluids. Such a condition may be associated with low humidity in the apartment, elevated ambient temperature, abundant fatty foods eaten by the mother the day before, etc. In these situations, you can offer the child water from a spoon, and if he began to drink willingly, then he needed it. In addition, supplementation is necessary for sick children, especially in diseases accompanied by high fever, diarrhea, vomiting, hyperbilirubinemia.

Even with severe physiological jaundice in children in the first days of life, breastfeeding should not be abandoned. Early attachment of the baby to the breast and frequent feedings are an important factor in the prevention of jaundice, since colostrum, having a laxative effect, leads to a faster discharge of meconium. With insufficient nutrition of a newborn baby, jaundice may be more intense and prolonged due to the thickening of bile. Supplementation with water or glucose solutions does not contribute to the prevention of jaundice, but reduces its severity. It is important that the baby receives an adequate amount of milk, because malnutrition develops bile thickening syndrome.

Breastfeeding-associated jaundice - breast milk jaundice or Arias jaundice develops in 1-4% of children after the first week of life, is characterized by an increase in the level of unbound bilirubin and does not affect the child's condition. The pathogenesis has not been studied enough, a connection with various components of breast milk is assumed. You can get confirmation of the diagnosis by stopping the attachment of the baby to the breast and using pasteurized mother's milk for feeding for 1-2 days. During this time, the intensity of jaundice decreases significantly and breastfeeding can be continued.

It is advisable to breastfeed a child with hyperbilirubinemia due to AB0 incompatibility from birth, since the antibodies contained in milk are destroyed by hydrochloric acid and enzymes of the digestive system. In case of a Rh conflict, if the child has not undergone an exchange transfusion, then during the first 10-14 days he is fed pasteurized (antibodies are destroyed during pasteurization) mother's or donor's milk. In cases of replacement blood transfusion, 3-5 hours after the operation, the child can be attached to the breast.

It is advisable to continue breastfeeding up to 1-1.5 years, and the frequency of breastfeeding after a year is reduced to 1-3 times a day.

Materials for this chapter were provided by: prof. Fateeva E.M. (Moscow), prof. Mandrov S.I. (Ivanovo), prof. Bombardirova E.P. (Moscow), prof. Geppe N.A. (Moscow), Ph.D. Kapranova E.I., candidate of medical sciences, associate professor Kutafin Yu.F. (Moscow), prof. Rusovoy T.V. (Ivanovo), MD Odinaeva N.D. (Moscow), prof. Mangrov F.K. (Novokuznetsk), Ph.D. Proshchina I.M. (Ivanovo), Ph.D. Batanova E.V. (Ivanovo), Ph.D. Lukoyanova O.L. (Moscow), Ukraintsev S. E. (Moscow), Yakovlev Ya.Ya. (Novokuznetsk).

Natural feeding is a type of feeding in which a child up to 6 months receives only mother's milk.

There are 3 types of mother's milk.

1. Colostrum is a sticky, thick liquid. yellow color,
appears after the birth of the child and is released up to 4-5 days.

2. Transitional milk is produced from 4 - 5 days of life and up to 2 - 3
weeks has an intermediate composition between colostrum and
mature milk.

3. Mature milk is produced from 2 - 3 weeks of a child's life and
has a complete biological similarity with the body of the child.

Composition of breast milk (see 10 benefits of breast milk).

Benefits of breastfeeding:

1. Breast milk contains all the necessary ingredients in optimal ratios B:W:U=1:3:6

2. There is more protein in cow's milk, but it is coarsely dispersed (casein), so it is difficult to break down and digest, and breast milk protein is finely dispersed, practically does not require enzymes for splitting and, accordingly, is very well absorbed, therefore, babies develop much less often allergic reactions

3. Human milk proteins contain all the essential amino acids

4. Human milk contains protective antibodies against various infections

5. Contains significantly more unsaturated fatty acids that increase resistance to infections

6. More milk sugar (lactose), which contributes to the development of the brain, the normalization of intestinal microflora

7. Less mineral salts compared to the composition of cow's milk (salts overload the kidneys, contribute to the further development of hypertension)

8. The optimal amount of vitamins, trace elements, enzymes

9. Breast milk is sterile (lower risk of intestinal infections)

10. Contains lecithin, which promotes the reproduction of brain cells

11. An increased need for food is fixed on artificial feeding - the risk of obesity at an older age.

12. Physical (biological maturation and aging) and sexual development are faster in artificers, while mental development is the opposite (intelligence, talent - breastfeeding for at least 6 months is necessary for their implementation)

13. The child accumulates (deposits) in the subcutaneous fat the best components of breast milk and then uses them for several years (for brain function)

14. Sucking contributes to the correct articulation, the correct formation of the maxillofacial skull. Infants are less likely to have speech disorders.

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

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

Benefits of early, within the first 30 minutes after birth, breastfeeding:

For mother:

1. Promotes rapid contraction of the uterus, reducing the risk of bleeding, and rapid recovery;

2. Stimulates prolonged lactation;

3.Reduces the risk of developing mastitis

4.Early contact stimulates the feeling of motherhood.

For a child:

1. Contributes to the formation of normal intestinal microflora

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

3. Stimulation of the sucking reflex

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

Rules for the first application to the breast.

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

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

1. The correct mode of the day: sleep at least 8 hours a day, daytime sleep 1.5 - 2 hours, walks on fresh air, moderate physical exercise, positive emotional mood avoidance of stressful situations

2. The amount of liquid in the diet increases by about 1 liter

3. The calorie content of the daily diet should be increased by 50% compared to the diet of a non-nursing woman of this age. Meat and (or) fish, dairy products (cottage cheese, cheese), vitamins are needed daily. Nutrition 4-5 times a day (as many times as the child feeds), in small portions, to stimulate milk production, drink a glass of tea with milk and cheese 10-15 minutes before feeding.

4. Refrain from taking products that change the smell and taste of milk (fresh onion, garlic)

5. No medication before consulting a doctor

6. Do not abuse gas-forming (cucumbers, grapes), laxative (plums, beets) and fixing (nuts, pears), allergenic (strawberries, pineapple, red fish, eggs, honey) and tonic (strong tea, coffee, chocolate) products

7. The duration, usefulness of lactation significantly depend on the anamnesis of feeding the woman herself.

Breastfeeding Rules:

1. Wash the chest under running water, remove long hair

2. Take a comfortable position - sitting, lying on your side

3. Make sure that the child is in comfortable conditions, and nothing distracts him from the feeding process (clean, dry, warmly dressed)

4. Make sure that the child's nasal breathing is free (if necessary, remove crusts from the nose)

5. Make sure that when sucking, the child captures not only the nipple, but also the areola and that he does not rest his nose on the mammary gland

6. With greedy sucking and (or) active flow of milk in a jet, periodically hold the baby upright for several minutes, and then apply it to the breast again

7. With sluggish sucking, falling asleep the child during feeding, wake him up (stroke the cheek, tickle the heels)

8. The duration of the first feedings is usually 30-40 minutes (this is the lactation formation period), then it takes an average of 20 minutes (in the first 5 minutes of feeding, the baby sucks out 50% of the milk volume)

9. If the amount of milk in one mammary gland is not enough to meet the needs of the child, then it is applied to the other, and in next feeding change sequence

10. After feeding the baby, it is necessary to hold it vertically for 3-5 minutes to prevent regurgitation

11. Wash the mammary gland

Currently, free feeding is recommended for a newborn baby and children of the first months of life - the baby is applied to the breast at the first sign or demand (up to 12-16 times a day). This is done because in the first weeks after birth, the process of adapting the body of the nursing mother to the needs of the child takes place and frequent application solves the problem of the child's hunger and stimulates lactation in the mother. Up to 3-4 days of a child's life, the mammary glands secrete very little milk, but it contains a large amount of protein and fat in order to somehow satisfy the needs of the child. This milk is called colostrum. Then lactation gradually increases and the composition of milk (transitional) approaches the composition of mature milk: protein - about 2.5 g, fat - an average of 3 g, carbohydrates - 7 g. her food, emotional state, hereditary features of lactation. Nobody knows the norms of milk. For each “mother-child” pair, it is individual (in the “final” milk, fat is up to 17%, so it is impossible to calculate). All nutrition correction should go through mother's milk (nutrition of a nursing woman)

Difficulties with breastfeeding:

From the side of the child:

1. Rhinitis with impaired nasal breathing (suction of secretion, removal of crusts from the nose, use of vasoconstrictor drops before feeding)

2. Thrush (candidiasis stomatitis) - treatment of the oral mucosa with a 2% solution of baking soda after each feeding

3. Absence of a sucking reflex (premature baby) - feeding from a spoon or through a tube

From the mother's side

1. Flat, inverted nipple (used special pads to make it easier for the child to grasp)

2. Scuffs and cracks of the nipple (correct attachment to the breast so that the child presses on the areola, and does not pull the nipple, special ointments - bipanten)

3. Milk stasis - proper feeding and expression of milk, use of a breast pump

4. Hypogalactia

Hypogalactia - a decrease in lactation, is currently a very common problem for lactating women.

Possible signs of the development of hypogalactia:

1. The child has become restless, does not sleep well, does not withstand the interval between feedings

2. Decreased daily diuresis (became less likely to urinate)

3. Low weight gain, flat weight curve

4. Subjective feeling"empty" breast in a woman

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

Prevention and treatment of hypogalactia:

1. Breastfeeding promotion, psychotherapy

2. Prevention of cracks and mastitis

3. Compliance with diet and daily routine, support for other family members

4. Decoction of nettle (20 grams of dry leaves per liter of boiling water, leave for 45 minutes and drink 1 tablespoon 3 times a day), anise fruits, dill, oregano, lactogenic herbs

5. Medications: vitamins "E", "A", "PP", "C", gendevit, aevit, prenatale, materna, dry brewer's yeast, apilak, microdoses of iodine

6. More frequent breastfeeding, breastfeeding on both breasts in one feeding

Quartz irradiation, UHF, massage, acupuncture

Mixed feeding.

mixed feeding

Mixed feeding is a type of feeding in which the child receives breast milk and supplementary feeding in the form of milk mixtures.

The effectiveness of mixed feeding depends on breast milk in the daily diet of the child:

If the amount of mother's milk is half the daily
diet(2/3, 3/4) , then the effectiveness of mixed feeding
approaches natural;

If the amount of mother's milk is less than half
daily ration (1/3, 1/4), then the effectiveness of the mixed
feeding approaches artificial;

Additives.

Supplements are dosed meals that include in the diet as sources of vitamins, minerals, trace elements and as additional sources main ingredients (proteins, fats, carbohydrates).

A distinction is made between vitamin and protein supplements, such as:

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

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