Artificial feeding adapted and non-adapted mixtures. Modern adapted milk mixtures. How to give formula milk

For the newborn and infant is the mother's milk. But with a lack of breast milk, its absence or medical contraindications to breastfeeding, it becomes necessary to transfer the baby to mixed or artificial feeding.

The range of dry adapted formulas for feeding children of the first year of life on the Ukrainian market today includes more than 40 items. Mostly these are mixtures of imported production. The three factories for the production of baby food in Ukraine cannot yet provide the necessary variety and quantity of adapted baby formulas. The choice of a specific mixture for a child should be based, first of all, on an assessment of the condition of the baby and the characteristics of its development. Unfortunately, the material condition of parents plays an important role in the purchase of mixtures: highly adapted imported mixtures cost from 20 to 60 hryvnias per pack (approximately 10-20 days), and the domestic "Kid" - 5-7 hryvnias. And although many argue that it is impossible to save on children's nutrition, this factor should be taken into account when choosing a formula for a baby, since a long-term intake of exactly the mixture that suits the baby is necessary.

Rules for choosing a mixture:

consult with a pediatrician;

if the child received in the maternity hospital mixture and feels good, be sure to clarify what kind of mixture he received and continue feeding with this mixture;

consider age child;

choose highly adapted mixtures for children of the first half of life and less adapted - for children of the second half of the year;

evaluate individual tolerance formula for a baby - if there are signs of its intolerance (diathesis, abdominal pain, regurgitation, etc.), consult a pediatrician and change the mixture. But you can not "jump" from one mixture to another every 1-2 days. Adaptation to a new type of food occurs within 3-5 days.

should be carefully studied information on the label: composition of the mixture, the amount of all ingredients, calorie data;

the mixture should be taurine(free amino acid with sulfur content). Taurine is involved in the formation of brain tissue, retina, digestion and absorption of fats, the formation of protective functions of the body in the first months of a newborn's life;

Preferably in a mixture carnitine. Carnitine is an active biochemical vitamin-like compound that is involved in the metabolism of fats, proteins, vitamins and energy within the cell;

check to see if the mixture contains linoleic acid ( an essential fatty acid necessary for the proper formation of the child's brain and retina);

in a mixture based on cow's milk should be milk serum. It is administered instead of cow's milk casein, which provides a greater approximation of the amino acid composition of the mixture to the amino acid composition of human milk. Due to the presence of whey in the baby's stomach, a more tender and more easily digestible food clot is formed;

check best before date mixtures;

if the formula suits the baby, you must be sure that you can continue to easy to get this mixture or purchase several packages at once, taking into account the shelf life;

as the baby grows switch to a mixture of the same manufacturer for children in the second half of life.

The division of adapted mixtures according to the degree of approximation of their composition to breast milk:

Highly adapted. These mixtures contain whey and, similar to breast milk, a number of biologically active substances (taurine, choline, lecithin, inositol) that play an important role in the formation of the baby's body. They are used for children from the neonatal period. Number 0 and prefix pre- indicate that the mixtures are intended for feeding premature and newborn babies, and the number 1 - from birth to 4-5-6 months.

These include:

• "Nutrilon",
• Neonatal (Holland),
• "Nan", "Alfare" and "Alprem" (Switzerland),
• “Prehipp” and “Hipp-1” (Austria),
• "Puleva-1" (USA),
• Tutelli ("Valio"),
• Enfamil-1 (Holland/USA),
• "Pre-heinz" (USA),
• "CMA" (USA),
• Bona (Finland),
• "Pikomil" (Slovenia),
• "Samper Baby" ("Samper Foods and Co", Sweden),
• Heinz (England)
• "Humana" (Germany).

1. Less adapted blends. This subgroup includes mixtures (or as they are also called - formulas) with the presence of cow's milk protein - casein:

   • “Similak”, “Similak with iron” (USA),
   • "Impress" (Germany),
   • “Enfamil”, “Enfamil with iron”, “Enfamil-2” (Holland/USA),
   • "Nutrilon-2".

   Unlike the first type of mixtures used from birth to 4-5 months, the second group is recommended for children from 5-6 months of age. Number 2 in the name of the mixture suggests that they are intended for babies in the second half of life.

2. Partially adapted blends. These products no longer contain such biologically active additives as taurine, choline, and a number of fatty acids. This group of mixtures includes:

   • "Baby",
   • “Baby” (Ukraine, Russia),
   • Detolact, Solnyshko, Vitalakt-DM, Enriched Vitalact, Vitalakt-M (Ukraine),
   • "Milumil" (Germany),
   • "Milazan" (Germany).

1. Lactose free and low lactose mixtures for children with reduced activity of the lactase enzyme in the intestines, lactose intolerance, a tendency to diarrhea (diarrheal syndrome), acute intestinal infections:

   • Al 110
   • Nutrilon low lactose
   • Similac-isomil
   • Similac Aldolac

2. Adapted dairy-free mixes, containing soy protein and intended for children with intolerance to cow's milk protein, lactose, with galactosemia:

   • Alsoy
   • Bona Soya
   • Nutri-Soya
   • Peptidi Soya
   • Soy-Samp
   • Tutelli soy
   • Heinz soy blend
   • Humana LP (medical nutrition) SL
   • Humana-Soya
   • Enfamil Soya

3. Adapted blends for based on whey protein hydrolyzate for children with severe allergies to cow's milk protein and lactose, with deep prematurity, cystic fibrosis, intestinal absorption (malabsorption syndrome), in the pre- and postoperative period:

   • Alphare
   • Pepti Junior
   • Portagen (MilJohnson, USA)
   • Puleva 1 (USA)
   • Humana GA (hypoallergenic) 1 - from newborn
   • Humana GA 2 - from 5 months of age
   • Hipp GA (hypoallergenic) 1 - from birth
   • Hipp GA (hypoallergenic) 2 - from 4 months

4. adapted milk formulas, fortified with iron:

   • Detolact
   • Nestogen
   • Nutrilon 2
   • Similac with iron
   • SMA with iron
   • Samper Baby 1, Samper Baby 2 (Semper, Sweden)

5. Adapted formulas for feeding children born prematurely with low weight and insufficient weight gain:

   • Alprem
   • NAS pre
   • Neonatal
   • hipp pre
   • Humana pre
   • Enfalak (USA)

6. Adapted formulas for feeding children with regurgitation syndrome, vomiting:

   • Nutrilon-AR (antireflux)
   • Similac Izovok
   • Samper Lemolak (Semper, Sweden)
   • Frisovoy (Holland)

7. Adapted formulas for children with intestinal dysbiosis:

   • NAN fermented milk (Nestlé)
   • Bifidus (Semper, Sweden)
   • NAS from 6 months with bifidobacteria (Nestlé)

8. Gluten free formulas for babies with celiac disease:

   • Al-110 (Nestlé)
   • Soy-Samp
   • Hipp 1
   • Humana HN
   • Humana HN with MCT (medium chain triglyceride health food)

9. Phenylalanine Free Formulas for Children with phenylketonuria:

   • Milupa
   • Phenyl Free
   • Similac - Lophenolac

The well-being of the child, his correct physical and mental development will be the criterion that you have chosen the right mixture for your baby. When artificially feeding children with highly adapted mixtures, it should be borne in mind that they contain vitamins and minerals, including vitamin D. Therefore, rickets is not prevented for such children. All questions and problems on nutrition of children should be resolved with a pediatrician, a pediatric gastroenterologist and a pediatric nutritionist. It is necessary to purchase mixtures in specialized departments of supermarkets, in pharmacies or baby food stores.

It should be emphasized that non-adapted dairy products ( milk, kefir) do not match physiological needs of children of the first year of life and should not be included in their diets even in very difficult socio-economic conditions

In the most extreme case, when it is impossible to use modern adapted or partially adapted formulas in infant nutrition, it is better to return to the previous practice of using B-formulas, i.e. dilution of milk and kefir, which have an adverse effect on the child's body than whole dairy products. In this case, of course, additional inclusion of multivitamins in the diet and earlier introduction of complementary foods is necessary. These recommendations, of course, are of an "emergency" nature and can only be considered as an extreme and temporary option for organizing artificial feeding of children in the first year of life.

Artificial milk formulas in clinical nutrition

Before healing, you need to feed. Nutrition is not only a way of delivering energy and plastic material to the body, substances necessary for its vital activity. A huge role is played by various products as therapeutic factors, determining in many respects the quality of a child's life, resistance to various diseases. The infancy of the child is most susceptible to pathological influences of the external environment. In these cases, for prophylactic purposes, and often for therapeutic purposes, special mixtures are used (Appendix 1).

"Special" formulas for premature and low birth weight infants

PreNAN Nestle, Switzerland

Detolak pre - "Lasunya", Ukraine, Balta

Nutrilak pre - Nutritek, Russia

PreNAN ( Nestle, Switzerland) is a powdered milk formula with long-chain polyunsaturated fatty acids (LCPUFA) for feeding premature and low birth weight babies, as well as children with malnutrition. The protein component is represented by 70% whey proteins. The protein level (2.3 g/100 ml premix) meets the higher needs of preterm and low birth weight infants. The fat component is represented by 30% medium chain triglycerides and provides optimal energy intake. Contains arachidonic and docosahexaenoic acids, which contribute to the formation of an adequate immune response, as well as affecting the development of the brain and retina. Provides complete prevention of deficient conditions. The energy value is above -80 kcal / 100 ml of the mixture.

Formulas for children with allergies

The "gold standard" for feeding young children with a tendency to food allergies is the use of mixtures based on cow's milk protein hydrolyzate.

Hydrolyzed mixtures are divided into 2 groups:

1 - casein hydrolysates, not available on the Ukrainian market;

2 - whey protein hydrolysates, have a number of advantages, as they are more in line with the standard of breast milk. They, in turn, are divided into highly hydrolyzed and partially hydrolyzed products.

Formulas based on protein hydrolysates are semi-elemental formulas for children with food intolerances, while they are complete breast milk substitutes. They are used as therapeutic mixtures for food allergies, with the development of malabsorption syndrome (impaired digestion and absorption of nutrients), which accompanies many diseases of childhood.

It should be noted that these mixtures have a specific bitter taste. However, given the urgent need for such nutrition for the child, the initial possible refusal of the baby should not be an obstacle to the use of the product. In such cases, a less concentrated mixture is given in the first 2-3 days.

TO highly hydrolyzed mixtures on the Ukrainian market include:

Alfare Nestle, Switzerland

Based mixtures partial hydrolysis:

- “NAS G.A. 1”, “NAS G.A. 2" - "Nestle", Switzerland

- "Humana GA 1", "Humana GA 2" - "Humana", Germany

- HiPP GA 1, HiPP GA 2 - HiPP, Austria

- "Nutrilon GA 1", "Nutrilon GA 2" - "Nutricia", Holland

- "Nutrilak GA" - "Nutritek", Russia

For example, “NAS G.A. 1”, “NAS G.A. 2" - hypoallergenic mixtures based on partially hydrolyzed 100% whey protein, are a clinically proven way to prevent allergies in the first year of life. They also contribute to the development of food tolerance and strengthen the immune system. NAS G.A. 2 intended for feeding children from 6 months, contains live bifidobacteria (B. Longum), which also help prevent the development of allergic conditions. This mixture is designed to correct the intestinal microflora, which may be necessary when introducing and expanding complementary foods in the second half of a child's life, when new foods in the diet induce the rapid development of opportunistic flora in the intestine.

NAN H.A. 1 and 2 have a unique combination of nutrients that strengthen immunity: the mixtures contain partially hydrolyzed protein OPTI PRO H.A., which significantly reduces the allergenicity of the mixture, promotes the formation of food tolerance, is easily digested, and reduces the frequency of functional disorders of the gastrointestinal tract. The composition of the mixtures includes LCPUFA for the prevention of allergies by modulating the immune response. Thanks to the addition, LCPUFA mixtures have anti-inflammatory and hypoallergenic effects, ensure the full development of the brain and retina.

NAN H.A.- a specially designed mixture, with the help of which the problem of allergy prevention is solved in a complex way. This is a modern and scientifically based tool for preventing allergic pathology in children and strengthening immunity with a clinically proven long-term effect.

Soy Blends at present, taking into account the availability of modern hydrolyzed mixtures and due to the low biological value of soy protein, the presence of cross-allergic reactions to it and a number of other factors, they are rarely used.

"Detolak soya" - "Lasunya", Ukraine, Balta

"Nutrilak soya" - "Nutritek", Russia

Artificial is called feeding of infants with breast milk substitutes - special mixtures prepared most often from cow's milk.

Mixtures are divided into simple and adapted, i.e., as close as possible in composition to breast milk. In addition, the mixtures are divided into sour and fresh, native and dry. Currently, acid mixtures are considered as a therapeutic option.

Simple (non-adapted) mixtures
Simple (non-adapted) sweet native mixtures include B-rice, B-buckwheat, B-oats, containing 2/3 of milk and 1/3 of cereal broth with added sugar. B-kefir (2/3 kefir and 1/3 rice water) is an acidic simple mixture. B-mixtures are prescribed from 3 weeks to 3 months of life. Then they are replaced with whole kefir with the addition of 5% sugar. Similar composition and nutritional value have dry mixes such as "Krepysh", "Health" with cereal broths or flour.

Adapted Blends
For artificial feeding of infants, only adapted milk formulas are currently used. They almost completely replaced simple mixtures, since the increased content of protein and minerals in the diet when fed with unadapted mixtures adversely affects the health of the child. Pre-treatment of cow's milk is aimed at reducing the content of protein, calcium, sodium salts, enrichment with vitamins, microelements, lysozyme, etc.

The nutritional value of adapted mixtures is close to breast milk, so the rules for feeding them are close to those observed when breastfeeding (the same calculation for energy value, the same number of feedings per day, the same timing of the introduction of complementary foods). Allocate dry fresh and native fresh breast milk substitutes. The method of preparation, the shelf life of the mixture and the age of the child for whom the mixture is intended are indicated on the packaging.

Whole milk
At present, it is strongly discouraged to use whole cow's milk for feeding children under one year old, as this leads to the development of a deficiency of various trace elements, such as zinc, copper and iron. Often, parents have a question about the possibility of prescribing goat's milk. Goat's milk is largely similar to cow's milk, but it has even less folic acid and vitamin B12. Goat milk fat is better absorbed than cow milk fat. The proteins of both milks are immunologically different, so children with intolerance to cow's milk can absorb goat's.

In addition, goat milk proteins are easier to digest and absorb. Both milks can be used to make adapted milk formulas. Currently, there is an adapted mixture of goat milk "NANNY". The conducted studies indicate the prospects of using this mixture in the diet therapy of food allergies in infants.

In recent years, mixtures for therapeutic nutrition have appeared. Their basis can be different - milk, soy, protein hydrolysates ..

Milk mixtures.
1. Mixtures used for prematurity or low birth weight of the child for the treatment of malnutrition of I and II degrees (for example, Alprem, Pre-Nutrilon, etc.).
2. Free and low lactose(for example, "Nutrilon", "Humana", Ypres.).
3. "Lactofidus" - dry fermented milk mixture with lactase activity(lactose content not reduced).
4. Sour-milk, fully or partially adapted(containing pre-probiotics) mixtures (for example, "NAN-sour milk", acidophilic "Malyutka"; non-adapted - different types of kefir).
5. Adapted Blend based on goat's milk ("NANNY").

Soy Protein Blends(for example, Alsoy, Nutrilon-soy, Ypres.).

Mixtures based on protein hydrolysates.
1. With a low degree of protein hydrolysis; used for moderate forms of indigestion, malnutrition II degree (for example, Hipp-GA-1, Frizopep-1, etc.).
2. With a high degree of protein hydrolysis; used in severe forms of indigestion, malnutrition III degree (for example, "Alfare", "Nutrilon-Pepti" Ypres.).

Therapeutic mixtures prescribed for regurgitation, vomiting, colic, constipation; antireflux mixtures (for example, Nutrilon, Enfamil, etc.).
Medicinal mixtures are widely used for the prevention and treatment of intestinal disorders, dysbacteriosis, and allergic reactions. It should, however, be remembered that these mixtures are prescribed for medicinal purposes. Each of these mixtures has its drawbacks.

Sour-milk mixtures are recommended to replace no more than 50% of the daily amount of food. The physiological effect of these mixtures is high: they normalize intestinal motility, increase the absorption of proteins, and are more easily tolerated in latent lactase deficiency. However, dairy products irritate the gastrointestinal mucosa. In adapted fermented milk mixtures, the acidity is 2 times less than in non-adapted ones, therefore the latter (kefir, yoghurts) are administered no earlier than 8 months of life.

Children with intolerance to cow's milk protein are sometimes prescribed soy mixtures, where animal protein is replaced with vegetable protein. However, in the diet of an infant, the proportion of proteins of animal origin should be at least 90%, which is necessary for his rapidly developing organism. Soy mixtures are also lactose-free.

In more severe cases, for the treatment of children with intolerance to whole milk, mixtures prepared on the basis of hydrolyzed proteins containing free amino acids and oligopeptides are used. But you need to remember that they are prescribed only for indications, in the absence of an effect from others, such as sour-milk mixtures, for a limited period of time. So, mixtures containing protein hydrolyzate are used for 2-4 weeks, gradually turning into full-fledged mixtures.

Errors in artificial feeding

• Too frequent changes in food (replacing one mixture with another).
• Limiting the diet and transferring the child to another mixture at the slightest deterioration in the stool.
• The appointment of fermented milk mixtures in large quantities.
• Translation of medicinal mixtures (soy, based on protein hydrolyzate) with minor manifestations of allergies.

The adapted milk formula in terms of components is as similar as possible to the composition of breast milk. This diet contains whey proteins, which are easily absorbed in the body of newborns. In addition, phosphorus and calcium are presented in the optimal ratio necessary for the full development of a small child.

Composition and properties

Infant formula powder is prepared on the basis of cow's milk and contains lactose. Therefore, this diet is not suitable for newborns with cow protein allergy and lactose intolerance. But for other babies, lactose is an essential carbohydrate found in breast milk.

In addition to lactose, the composition of adapted nutrition includes the following components:

• Iodine ensures the normal functioning of the thyroid gland, the functioning and development of material metabolism. In the first year of life, the baby should receive at least 100 micrograms of iodine per day;
• Nucleotides are involved in the structure of DNA and RNA. They stimulate the child, improve the intestinal microflora, form and strengthen the immune system;
• Taurine is an amino acid that is needed for the formation of the nervous system, the functioning of the brain and the development of vision in newborns. It is very important in the first days of life, since the body begins to synthesize this element on its own only after 1.5 months. The daily norm of taurine for infants is 40-50 mg;
• Polyunsaturated fatty acids provide the formation and development of the brain, nerve cells and visual function. Read about how vision develops in newborns.

In addition, the formula for newborns may include various vitamins and minerals, dietary fiber and lutein, prebiotics and probiotics. Avoid formulations containing glucose, starch, coconut or palm oil. Such mixtures are difficult to digest, often cause colic and increased gas formation.

Non-adapted mixtures are made from fresh or powdered milk without special treatment. They are not suitable for newborns and can only be used for children over one year old!

Kinds

Goat milk mixes

For newborns with an allergy to cow protein, goat milk mixtures are often prescribed. At the first manifestations of a food allergy, contact your pediatrician immediately. With this disease, infants may experience a rash, redness and peeling on the skin, impaired stool and frequent profuse regurgitation, vomiting and swelling. Respiratory symptoms include runny nose and nasal congestion, sneezing, coughing and sore throat, and in severe form - asthma.

Goat milk mixtures have appeared recently and are characterized by high cost. But for newborns with moderate to severe allergies, they are a real salvation. The proteins in goat's milk are digested and absorbed much more easily than in cow's milk. By the way, many pediatricians do not recommend drinking cow's milk to nursing mothers until 4-5 months after the birth of the baby and using this drink for the first feeding.

Today, four brands of mixtures based on goat's milk are produced. Let's look at the advantages and disadvantages of each.

How to choose the right mixture

The choice of mixture should be treated very responsibly. Be sure to consult with a pediatrician, he will help you choose the best suitable diet. Remember, the younger the baby, the more adapted it should be. Therefore, highly adapted mixtures should be chosen for newborns. for stomach problems and severe colic, increased flatulence, a sour-milk mixture is suitable, and for allergies to cow protein, goat milk.

Choose food that is appropriate for the child's age. Numbers are on the package. Marking “0” or “Pre” (“Pre”) select for premature babies or children with insufficient of the year.

Before buying, check the composition and expiration date of the product, the integrity of the packaging. For the first time, give your baby a small portion of milk powder. If the baby has an allergy or there are violations in the work of digestion, the mixture must be changed. Nutrition is not suitable if the baby eats poorly, cries during, before and / or after feeding. When you find the right mix, don't change your diet again!

Adapted milk formulas

All adapted milk formulas, according to the degree of approximation of their composition to breast milk, are divided into three categories:

highly adapted ("NAS", "Pre - NAS", "Nutrilon", "Hipp-1", "CMA", "Bona", Piltti, etc. .,

less adapted ("Similak", "Impressa", "Hipp-2", "Enfamil", etc.)

and partially adapted ("Malyuta-ka", "Baby", "Detolact", "Sunshine", "Milazan", "Vitalakt", "Ladunka" and others..).

In addition, mixtures are divided into simple sweet ("B-rice", "B-buckwheat", "B-oats") and lactic acid ("B-kefir", B-acidophilic mixture, kefir, acidophilic milk, etc.). • non-adapted milk formulas based on whole or diluted cow's milk do not provide adequate nutrition for children. has a high content of proteins (3 times more) and minerals (2.8 times more) than in human milk, has a high osmolarity. Therefore, there is a large load on immature kidneys, causing metabolic stress, promoting growth and excessive accumulation of fat.

Unadapted mixtures cause significant deviations in the body of children: decrease in the energy potential of cells and the level of protein synthesis, lipid spectrum disorders, anemia and impaired immunity. Lactic acid mixtures provide the growth of bifidoflora (Nan fermented milk, "AGU-1", "AGU-2" fermented milk).

There are also herbal medicines

Therapeutic mixtures for premature babies: Pre NAN, Prenutrilon, Frisopre, Enfalak, Neonatal, Enfalak Premature, etc. Lactose-free mixtures include Nutri-soy, Al-110 , "Tutteli-soy", "Bona-soy", "isomil-semilak", "about myself", "Alsoy" and others.

Low-lactose mixtures: low-lactose Nutrilon, low-lactose Humana and Portagen.

For the treatment of children with cystic fibrosis and diarrhea, mixtures of "Robolakt", "Alpha re", "Pepti Junior", "Pregestemil" and others are used.

With symptoms of regurgitation, an anti-reflux mixture is used "Enfamil", "Nutrilon Omneo", "Frisov". For children of the 2-3rd year of life, a mixture of "En-surnames Junior" is intended.

The average protein requirement of a child with natural feeding before the introduction of complementary foods is 2-2.5 g per kg of body weight per day, after the introduction of complementary foods it rises to 3-3.5 g. With mixed and artificial feeding, the need for proteins is 2.5 - 3.5 g per kg of body weight when using a highly adapted mixture and 3.5-4.5 g per kg of body weight when using non-adapted mixtures. The amount of fat in the first quarter of the year is 6.5 g per kg of body weight, in the second - 6.0 g, in the third - 5.5 g, in the fourth - 5.0 g per kg of body weight. The need for carbohydrates in children of the first year of life is 12-14 g per kg of body weight.

The required amount of energy per kg of body weight depends on the quarter of the year: in the first quarter, the child needs 120 kcal, in the second - 115, in the third - 110, in the fourth - 100. Feeding a child with unadapted mixtures requires an increase in the energy value of food by 5-10%.