Gastrointestinal immaturity at 6 months Functional disorders of the gastrointestinal tract in infants: the role of diet therapy. And how it all began

Any newborn baby is born with an immature digestive system. The main organ for the production of enzymes - the pancreas in the first months is not able to process vegetables, fruits, juices, cereals and even fermented milk products. Therefore, doctors do not recommend introducing these products (complementary foods) into the baby's diet until 4-5 months, when enzymes “ripe” in most children. And even such a product as breast milk or an adapted milk formula - a breast milk substitute, not all children can normally absorb. The reason is the same: the immaturity of the enzymes. Therefore, it is not uncommon for children to have lumps of curdled milk in the feces (which is a variant of normal stool at an early age), colic (normally almost every child has up to 3-3.5 months).

The most important role in ensuring the normal functioning of the intestines is played by beneficial bacteria of the intestinal flora - they neutralize toxins and allergens, stimulate the intestines and produce up to 80% of the lactase enzyme - the one that digests milk sugar lactose - one of the key components of breast milk and milk formulas. So, a child is born with a sterile intestine, that is, there are no bacteria there. Bacteria begin to colonize the intestines at the time of birth, the first 2 months the intestinal microflora changes several times a day, and then the process of stabilization of the intestinal microflora goes on until almost 1 year. All this time, the child is predisposed to the development of dysbacteriosis, against which allergies, stool disorders, and secondary lactase deficiency can develop.

By the way, secondary lactase deficiency, accompanied by pain in the abdomen, liquid foamy stools, bloating, is one of the most common gastroenterological problems faced by young parents. The causes are dysbacteriosis and enzymatic immaturity. Usually the problem is solved by 4 - 5 months, but there may be a more protracted course. With secondary lactase deficiency, it is not necessary to deprive the baby of breast milk and transfer to lactose-free mixtures - this will only slow down the development of its own enzymes.

The immune system is inextricably linked to the gut. You can even say that the intestine is the largest organ of the immune system. A newborn baby receives an immune memory from the mother in utero, which helps to cope with harmful microbes at first. Breast milk plays an important role in the further development of the immune system. The immune system has to learn, and it takes a long time for staphylococci and fungi to stop being an impossible task for it. But in the first months, while immunity has not yet been formed, children often have “thrush” (caused by fungi of the genus Candida) and pustular pimples, and green feces (both of which can cause staphylococci). Any dysbacteriosis occurs against the background of weakening or immaturity of local intestinal immunity.

The condition of the skin directly depends on the work of the intestines. No wonder there is a catchphrase: "the skin is a mirror of the intestines." Up to 90% of what appears on the baby's skin is of intestinal origin (diathesis is one of the manifestations of dysbacteriosis). At the same time, it must also be taken into account that the skin of babies is very delicate, sensitive, prone to inflammation.

The immaturity of the liver and biliary tract is manifested by the state of physiological jaundice in newborns. More precisely, the immaturity of the liver is one of the causes of such jaundice (there are other reasons not related to gastroenterology). Physiological jaundice is considered acceptable for the first 2 weeks after birth. If the jaundice lasts longer, it is chronic jaundice that needs to be treated.

Summing up, we can say that any modern child is born insufficiently adapted to the environment. There is an explanation for this. The fact is that a person, like any living being, can change, adapting to changing environmental conditions - this is the process of adaptation. For a long time, environmental changes and human changes went in parallel courses, so the person adapted without any problems. But over the past 50 - 100 years there have been such rapid and significant changes in the environment that human changes simply do not keep pace with these processes. Adaptation disorders are the most common modern problem. And children are much more likely than adults to suffer from adaptation diseases.

Pediatrician Yuri Kopanev

Colic in newborns is quite common, in about 30-50% of children, regardless of gender, race and place of residence. Young parents, due to the lack of proper experience in caring for children, have no idea why the baby developed intestinal colic and how to alleviate his condition. Naturally, the only correct solution in such a situation is to consult a pediatrician. Intestinal colic is diagnosed in newborns according to the following signs: the child cries for a long time and restlessly, screams, it is almost impossible to calm him down, he arches and twists his legs. Relief of the condition occurs after defecation or discharge of gas.

Most pediatricians were previously inclined to believe that colic in a newborn appears as a result of a violation of the baby's feeding regimen, errors in the mother's diet, etc. To date, the first place among the factors contributing to the development of intestinal colic in children is the immaturity of the gastrointestinal tract.

Why does colic occur in newborns? The crux of the problem is…

Perhaps we should start with the fact that colic in children of the first months of life is considered normal, and, as a rule, does not require treatment. However, not a single parent can calmly watch how a child screams and cries in pain. For some time, it is possible to alleviate the condition of the baby with the help of symptomatic therapy, but more on that later. In order for colic in a newborn to cease to be the main problem, it is necessary to know the nature of their occurrence.

Immaturity of the gastrointestinal tract (GIT).

Due to the fact that at birth the baby's gastrointestinal tract is absolutely sterile, in the first few days it is colonized by microorganisms, which subsequently form the intestinal microflora. Digestive problems and the appearance of colic in a newborn are often associated with a violation of the intestinal microflora, which makes it difficult to digest food. And if we add to everything else the immaturity of the enzymatic system, problems with peristalsis (dysmotility) and errors in the mother's diet - the appearance of intestinal colic in a newborn will become a completely natural phenomenon.

IMPORTANT! Violation of the intestinal microflora is most typical for children who are bottle-fed. This is due to the fact that breast milk contains bifidus factor, which contributes to the settlement of the intestines with bifidobacteria.

Why is the intestinal microflora disturbed in a newborn? The fact is that normally both “good” and conditionally pathogenic microorganisms live in the intestine. The "good" microbes include E. coli, lactobacilli and bifidobacteria, which are responsible not only for the quality of food digestion, but also participate in the formation of the body's immune defenses. If for some reason the content of beneficial bacteria decreases, conditionally pathogenic microorganisms begin to actively multiply and prevail in quantity. As a result, food is not digested well, and the child suffers from spasms, flatulence and constipation.

IMPORTANT! It cannot be said that it is the malnutrition of the mother that causes intestinal colic in the child, but this is his small merit. The use of foods that promote constipation (rice, blueberries) and increased gas formation (cabbage, legumes, flour, dairy products, raw vegetables and fruits) by a nursing mother aggravates the course of colic in a child.

What to do?

When intestinal colic occurs in a newborn, the development of dysbacteriosis should first of all be excluded - a condition in which the ratio of bifidobacteria and conditionally pathogenic microflora is disturbed towards the predominance of the latter, due to the use of antibiotics, prolonged illness, as well as other factors that reduce the body's immune properties. The reason for the development of dysbacteriosis in the first days of life is often the close contact of the child with the medical staff, as a result of which representatives of nosocomial infections (streptococcus, hemolytic staphylococcus, etc.) colonize his intestines.

For this purpose, feces are analyzed for dysbacteriosis, the main indication for which are stool disorders: constipation, liquid stools for three or more days, an admixture of mucus or undigested food, foamy stools, etc.

An analysis of feces for dysbacteriosis allows us to assess the ratio of the number of beneficial bifidobacteria (as well as lactobacilli and E. coli) to the number of conditionally pathogenic microorganisms (fungi, clostridia, enterobacteria). In addition, this analysis can identify bacteria that can cause serious illness, such as salmonellosis or shigellosis.

IMPORTANT! Most probiotics are sold over-the-counter in pharmacies, but the decision to prescribe drugs should be made only by the attending physician.

Incorrect attachment to the breast.

Often, colic in newborns develop as a result of swallowing large amounts of air during feeding. This happens in situations where the baby has not completely or incorrectly captured the breast - only the nipple without a halo. With this application, it is very difficult for a child to suck, he quickly gets tired and falls asleep, having time to swallow air, which “bursts” the intestines, causing pain.

What to do?

Make sure that the baby completely captures the nipple. The surest sign of proper attachment: the child rests his nose on his mother's chest. The appearance of cracks on the nipples indicates improper attachment of the child to the breast. In this case, it is recommended to consult with a lactation consultant.

lactase deficiency.

As mentioned above, the immaturity of the enzymatic system leads to poor digestion of food, which contributes to the development of fermentation processes in the intestines and, as a result, increased gas formation.

Lactose is an enzyme that breaks down the milk sugar, lactose. When colic appears in a newborn, lactase deficiency should be suspected, which is also manifested by stool instability, weight loss, and the development of dysbacteriosis. Lactase deficiency can be acquired (hypolactasia), against the background of infectious diseases of the intestine, an allergic reaction, etc. The cause of congenital lactase deficiency can be aggravated heredity (intolerance to cow's milk protein in close relatives), as well as prematurity.

What to do?

To exclude lactase deficiency, as one of the causes of colic in a newborn, it is necessary to analyze feces to determine carbohydrates and acidity levels. Normally, in the stool of a newborn, the amount of carbohydrates does not exceed 0.25%, while the Ph acidity of the feces should be more than 4. When a diagnosis of lactase deficiency is made, further treatment tactics will be known only after a complete examination. Thanks to the prescription of lactase preparations, in most cases it is possible to maintain breastfeeding and normalize the work of the baby's gastrointestinal tract.

In addition, the causes of colic in a newborn may be:

• reflux of hydrochloric acid from the stomach into the esophagus (if the child is in a horizontal position most of the time after feeding);
• emotional lability of the mother;
• unfavorable home environment (loud noise, bright light, prolonged separation from mother), etc.

Colic in newborns. Means of first aid.

Until the cause of the development of intestinal colic in a baby is not exactly established, it is possible to alleviate his condition with the help of:

• carminatives (dill water, fennel tea, chamomile decoction);
• laying the baby on the tummy;
• light massage of the tummy clockwise, alternately bending the legs in the knee and hip joints;
• applying a warm diaper to the baby's tummy.

If the above methods of helping with colic in a child are ineffective, you can use a gas outlet tube, after lubricating the tip with petroleum jelly or baby cream.

Colic in newborns is a difficult period in the life of a young family, which you just need to survive. In the absence of serious health disorders, colic in a child goes away on its own by three to four months of life, so it is advisable to be patient and choose expectant tactics.

When an infant who is less than six months old falls ill, parents in many cases diagnose him with colic and do not pay much attention to the newborn's malaise, waiting for him to outgrow the age of colic. This is how serious diseases go unnoticed and without treatment, and the health and life of the child are endangered.

In order not to confuse colic in newborns with something dangerous, you need to know their symptoms and be able to distinguish colic from other conditions.

Colic or not?

Called a variety of figures for the occurrence of infantile colic: from 3% to 70% of children. This condition develops in infants from the 3rd week of life to 3 months. If the child was born prematurely, then colic may begin later and last up to 4-5 months of age.

It is easy enough for attentive parents to distinguish colic from other conditions. We are talking about infantile colic when a child cries loudly, inconsolably and seemingly for no reason for more than 3 hours a day, at least 3 days a week.

It all starts with incomprehensible crying for 15 minutes, which occurs several times a week. Gradually, the duration and frequency of attacks increases and reaches a maximum by the age of six weeks. In the most difficult period, the interval between attacks can be 3-5 hours, and its duration can also reach up to 3 hours. At about 3 months, the bright symptoms of colic disappear, but anxiety in a child may occur up to 6 months.

It is noticed that colic usually comes at the same time, usually in the evening. In this regard, some theories of the occurrence of infantile colic have arisen.

If you suspect that your baby has colic, go to the doctor. Let him confirm or refute your fears and rule out the disease.

Where do colic come from? Causes.

This big medical mystery remains unsolved. Among the alleged causes of colic, two are most seriously considered: the immaturity of the digestive and nervous systems of the infant.

Immaturity of the digestive system.

When the baby is just born, he eats little, and his body easily absorbs food. After 2 weeks, the amount of milk or formula increases. Protein processing requires a lot of enzymes and bacteria, but they may not be enough. Then undigested food ferments in the intestines, a lot of gas is released, which the baby still does not know how to get rid of because of weak abdominal muscles. Gas pressure in the intestines causes discomfort and even pain - hence the hysterical crying.

Immaturity of the nervous system.

Particularly sensitive, impressionable children throw evening "concerts" in order to free themselves from the impressions and emotions accumulated during the day. The surrounding world constantly transmits information to the child's brain - about sights, sounds, smells. By evening, the nervous system is overworked, which the child feels physically, and the only way to relieve this tension is crying. More often, nervous strain causes colic in children born hard or prematurely.

Sensitivity to products.

Breast migraine.

Some experts argue that colic occurs from headaches that appear due to atmospheric phenomena.

There is an opinion that colic suffers more often from formula-fed children. Studies have shown that the likelihood of colic does not depend on the method of feeding, and the mixture itself causes colic in very rare cases.

Intestinal obstruction is a violation of the movement of intestinal juices and digested food through it. The disease can cause many dangerous complications, especially in children. Intestinal obstruction in newborns in almost all cases requires urgent surgical intervention.

The disease in children is common and in most cases is associated with gastroenterological problems. The complexity of the course always depends on exactly where the blockage has formed in the intestine - the higher it is, the more acute the symptoms of the disease in the child and the more difficult the treatment.

The onset of the disease is characterized by swiftness: the symptoms appear within a short period of time and rapidly increase.

Intestinal obstruction can be not only acquired, but also congenital, which is associated with anomalies and pathologies in the development of the gastrointestinal tract even in the prenatal period.

Acquired obstruction has various causes, depending on which the disease is divided into two types: mechanical and dynamic.

Obstruction of the mechanical type occurs when tumors or hernias form in the abdominal cavity, blocking the intestines and preventing its normal functioning. The disorder can also appear after some operations with the formation of adhesions, the transfer of diseases, and even the intake of certain medications, as a side effect.

Mechanical obstruction in a child also includes such conditions as intestinal volvulus and intussusception, when one of the sections of the intestine penetrates into the underlying zone and forms a blockage.

In most cases, obstruction of the mechanical type is observed in the small intestine, but sometimes blockage of the large intestine can also occur. Causes can be diseases such as colon cancer, volvulus, diverticulitis, narrowing of the lumen caused by scarring or inflammation, severe stool hardening.

Dynamic obstruction is divided into:

• spastic, caused by prolonged tension of the intestinal walls;
• paralytic or functional, caused by complete relaxation of the intestine.

Functional obstruction may have general symptoms and signs, but does not form a mechanical blockage. The intestines cannot function normally due to nervous or muscular disorders that cause a decrease in the number of natural contractions or their complete cessation, which greatly complicates the promotion and removal of contents.


The causes of paralytic ileus in any intestinal section can be:

• operations performed on the organs of the theses and abdominal cavity;
• some medicines;
• intestinal infections;
• Parkinson's disease and other disorders of the nervous or muscular nature.

Symptoms of bowel obstruction in newborns

The cause of obstruction in newborns is pathology of intestinal development, narrowing of the lumen or lengthening of some areas, as well as individual structural features and location of intestinal loops.

Violation symptoms:

• severe bloating without passing gases;
• delayed meconium stool, its complete absence or meager amount;
• vomiting, often with an admixture of bile;
• severe polyhydramnios in the prenatal period.

The causes of disorders can also be the presence of diabetes in the mother, as well as atresia of the small intestine and Hirschsprung's disease.

If the small intestine or duodenum of a newborn is severely narrowed or there is no lumen, one can observe the release of mucous lumps from the rectum. They do not contain admixture of skin cells of the surface layers, which are always present in the amniotic fluid and are swallowed by the baby developing inside. Such cells are always present in the meconium of an infant during normal bowel movements.

Symptoms in children under one year old

At this age in children, the violation has its own specifics. The most common cause of obstruction in infants is intussusception, when part of the intestine, twisted, enters the lower section and leads to the formation of a blockage. Most often, this condition occurs in boys aged 5 to 10 months. In older children, this disorder is rare.


The cause is usually the immaturity of the intestine and the instability in its mechanisms, which, as a rule, disappears as the child grows. Other factors can also disrupt the natural functioning of the intestines, for example, the introduction of a new product into the diet of crumbs, a change in nutrition (a sharp forced transition from breastfeeding to artificial), infections.

Signs of intussusception:

• vomit;
• frequent bouts of pain in the abdomen;
• the presence of bloody discharge with mucus instead of stool;
• bloating;
• seals in the abdominal cavity, clearly palpable on palpation;
• attacks of pain with a sudden sharp appearance and the same ending, after a short time they are repeated, from which the babies cry, scream and are very worried.

In the presence of acute low obstruction caused by the presence of an obstruction in the lower part of the small intestine or in the large intestine, the child has no stools at all, the abdomen is strongly swollen due to accumulated gases, and vomiting appears that has the smell of feces.

Symptoms of children after a year

In children older than a year, the disease manifests itself sharply, so parents can usually name not only the day the problem occurred, but also almost the exact time. The child develops severe pain in the abdomen, vomiting, while there is no stool and gases do not pass, the accumulation of which causes visible swelling. Toddlers cannot sit still, are constantly looking for a comfortable position and may periodically scream in pain.

The type of obstruction can be determined by a set of signs, for example, the closer to the stomach the resulting blockage is, the stronger the vomiting will be and the sooner it will occur. If the problem is in the large intestine, vomiting is usually absent, but children have an excruciating urge to defecate, accompanied by severe bloating, which makes the babies cry loudly and angrily.

In the presence of intussusception from the rectum, spotting may be observed, which indicates tissue damage and the presence of severe irritation of the intestinal walls.


If you do not provide the baby with timely assistance, necrosis of the intestinal tissues may begin, as evidenced by a decrease in pain against the background of a sharp deterioration in the general condition.

An important sign of a disorder in children older than a year is the presence of Val's symptom, when there is a stable, often asymmetric swelling of the abdomen, visible to the eye and clearly palpable on palpation, while the resulting tumor does not move.

Diagnostics

The symptoms of the disorder are pronounced, which allows parents to detect the problem in time and consult a doctor, in this case, a surgeon, since only he can accurately diagnose and help the child. If it is not possible to contact a surgeon, you need to show the child to a pediatrician, but in no case should you self-medicate.

Diagnostic measures include:

1. Inspection of the baby, assessment of his condition, identification of symptoms.
2. Collection of anamnesis.
3. General blood analysis.
4. X-ray of the abdomen.
5. Ultrasound can also be performed, but such a procedure for obstruction does not have much information content.

Treatment

Any type of intestinal obstruction in babies requires mandatory hospitalization, since children can only be helped in stationary conditions.

To stabilize the state:

1. A dropper is installed with a solution to restore the water-salt balance in the body.
2. When the abdomen is bloated, a special probe is also installed for the baby, inserted through the nose, the purpose of which is to remove accumulated gases and liquids.
3. A catheter is placed in the bladder to drain urine and conduct tests.

Conservative therapy can be carried out only in cases where the baby does not have serious complications with intestinal obstruction. A set of measures will be aimed at eliminating the stagnation in the intestines and eliminating the consequences of poisoning the body.


Conservative measures include:

• Lavage of the stomach and esophagus through a special probe. The procedure allows you to stop the vomiting process.
• Carrying out enemas with hypertonic solutions.
• Carrying out siphon enemas using sodium chloride.
• The introduction of intravenous water-salt solutions.
• The introduction of air into the rectum of the baby during intussusception. The purpose of the procedure is to straighten the formed intestinal fold.
• Appointment of medications, antispasmodic, antiemetic, painkillers.
• At the end of all procedures, with the successful elimination of the problem, the baby is pierced subcutaneously with prozerin, which helps to stimulate the proper functioning of the intestines.

Paralytic forms of obstruction are treated with drugs that cause contractions of the intestinal muscles, which contributes to the rapid movement of the contents to the exit, as well as laxatives.

Surgical treatment (operations)

Surgical intervention is resorted to in cases of direct indications for surgery or when conservative methods of treatment have not yielded the necessary results. The operation is aimed at eliminating the problem, that is, at removing the area of ​​the affected intestine, eliminating the resulting mechanical blockage and taking measures to prevent the recurrence of the disorder.

In particularly complex and severe cases, several operations may be required to remove the obstruction and prevent the problem from occurring in the future.

Lifestyle and nutrition during treatment

During the period of conservative therapy, as well as surgical treatment, the child needs rest and hunger. It is important to ensure that the baby strictly follows the instructions of the doctors and does not take any food without their permission. The same applies to the intake of liquids.

After the obstruction is eliminated by conservative methods, a small patient is prescribed a special sparing diet that restores the normal functioning of the intestines and its microflora. In the case of an operation, the bowels are stimulated with medications, gradually allowing the baby to take light food in small portions.

In the future, hard-to-digest foods, vegetables and fruits that have a fastening effect and cause constipation should be excluded from the diet of a small patient. The child’s menu should include fermented milk products, cereals, kissels, light meat broths and soups based on them, boiled and steamed lean meat, fruit jellies, rosehip broth, green tea.

constipation problem in children

Well, in general, at the request of the masses, so to speak ... =)

IN modern recommendations of the Ministry of Health of the Russian Federation on the nutrition of children of the first year of life says: "The optimal timing of the introduction of various products is determined by the physiological and biochemical characteristics of the development of infants. Thus, by 3 months of life, the increased permeability of the intestinal mucosa decreases, a number of digestive enzymes mature, at 3-4 months a sufficient level of local intestinal immunity is formed and the mechanisms for swallowing semi-liquid and solid food (extinction of the "spoon ejection reflex")".

World Health Organization formulates recommendations on the timing of the introduction of complementary foods in the following way: "Complementary foods should be introduced at about 6 months of age. Some breastfed babies may need complementary foods earlier, but not before 4 months of age.".

Let's see what is the readiness for complementary foods, at what age does it occur and how physiological are such terms and the complementary feeding scheme from the point of view of the work of the emerging digestive system.

Biologically speaking, a human baby is ready to be introduced to adult food when:
1) the mechanisms for its assimilation mature (physiological readiness);
2) he is able to chew and swallow food in pieces (physiological readiness);
3) able to hold a piece in his hand and bring it to his mouth (physical readiness);
4) he got a so-called. "food interest" - social behavior, which is expressed in the desire to imitate adults and eat the same as they (psychological readiness).

Let's consider these points in more detail.

1) Physiological readiness for complementary foods. Maturation of the gastrointestinal tract and enzymatic system.

How does the digestive system of an infant not receiving any other food and liquid other than breast milk work?

The activity of enzymes in a child who receives only breast milk remains low throughout the first six months of life. By the way, it is the immaturity of the enzymatic system of a normal healthy breastfed child that explains the white coating on his tongue, which pediatricians very often mistake for thrush - a fungal disease of the oral cavity.

On exclusive breastfeeding, the stomach and pancreas do not work "at full capacity", most of the assimilation processes occur in the intestines. This becomes possible due to the special properties of breast milk, which contains enzymes in its composition. That is, with breast milk, the child simultaneously receives substances that help his digestion.

What happens if a breastfeeding baby starts receiving formula or other foods as supplements or complementary foods before their digestive tract is ready? The mechanisms of assimilation of other food already described above will still start, because the ability of the human body to adapt is very high. But these processes will be forced to start and earlier than provided for by the genetic program of this particular child. Such a child, earlier than his peers, begins to assimilate certain types of adult food and extract from it the substances necessary for growth and development. But is this an achievement and does it promote health?

There is enough evidence to doubt this. That's what writes about it pediatrician, candidate of medical sciences, employee of the Scientific Center for Children's Health of the Russian Academy of Medical Sciences: “Quite often, the early introduction of complementary foods (at 3-4 months) causes adverse reactions from the physiologically unprepared body of the child. The most common are dysfunctions of the gastrointestinal tract in the form of abdominal pain, intestinal colic, regurgitation, vomiting and stool disorders.<...>... there are situations when early complementary foods (especially if the rules for its introduction are not followed) provoke a serious disruption of the digestive system<..>. Allergies are another common complication of early introduction of complementary foods. Its development is facilitated by the high permeability of the intestinal wall for large molecules, the immaturity of digestive enzymes and the immune system.<...>sometimes the early introduction of a new product provokes the development of long-term and difficult-to-treat allergic diseases, for example, atopic dermatitis - a chronic inflammation of the skin of an allergic nature, bronchial asthma, etc.<...>There are long-term consequences of early introduction of complementary foods. Early feeding creates an increased burden on the child's immature organs, especially the gastrointestinal tract, liver and kidneys. And in the future, when the baby is already older, these organs are weaker and more vulnerable to adverse effects. For example, weakness of the gastrointestinal tract can manifest itself at preschool age with abdominal pain, vomiting and stool disorders, and at school age, the development of inflammatory processes in the stomach and intestines (gastroduodenitis, colitis) is already possible. Thus, the first complementary foods should be introduced at a favorable time for this..

By WHO data, the minimum age at which a child can receive complementary foods without obvious harm to health is "about 4 months". By this age, some children develop sufficient neuromuscular coordination to "form a food bolus, transport it to the mouth of the pharynx and swallow." Before 4 months, "Infants do not yet have the neuromuscular coordination to do so. Head control and spinal support are not yet developed, and therefore it is difficult for infants to maintain position for successful absorption and swallowing of semi-solid foods." Also, "by about 4 months, stomach acid helps gastric pepsin to fully digest protein" and "renal function becomes much more mature and infants are better able to conserve water and cope with higher concentrations of solutes."

Thus, we can say that the body of a healthy breastfed baby begins to gradually mature to receive food other than breast milk, from about 4 months. However, firstly, the exact age of readiness of the gastrointestinal tract for each individual child cannot be established. Secondly, in addition to the readiness of the digestive system, there are other factors that need to be considered. They will be discussed below.

2) Physiological readiness for feeding. Withering away of the ejection reflex of solid food and teething.

Until 5-6 months, babies retain the so-called reflex of pushing out solid food of solid food - a natural mechanism that has been formed precisely so that nothing but breast milk enters the child's body. However, man figured out how to deceive nature - he learned to grind or grind food into a homogenized mass and "pour" early complementary foods into the child, either in this way or in the form of juices. And not only pour in, but also bring a theoretical basis for it. IN already mentioned recommendations of the Ministry of Health it is claimed that "at 3-4 months<…>the mechanisms of swallowing semi-liquid and solid food mature (fading of the "spoon ejection reflex")". Pretty bold statement, which is not confirmed by practice. Most children of this age are indeed physiologically able to eat semi-liquid or thoroughly pureed food from a spoon, but this does not at all equal the extinction of the solid food push reflex. In practice, children of mothers who start complementary foods earlier than 5-6 months choke when they find the slightest lump in porridge or mashed potatoes. In addition, they may have difficulty swallowing pieces even after 6 months.

However, even if we assume that in some children the solid food ejection reflex dies off already at 3-4 months, it is incorrect to talk about the child's readiness for complementary foods on the basis of this sign alone.

An additional physical sign is teething. However, like the death of the adult food reflex, the mere fact of teething before 6 months does not indicate that the child is ready for complementary foods. It is necessary to consider whether a particular child is ready to get acquainted with solid food individually, taking into account the totality of signs. The child is able to successfully chew food even before the appearance of the first teeth.

3) Maturation of motor skills and the emergence of food interest. Physical and mental readiness for complementary foods.

The human cub is born immature and completely dependent on its mother. At the age of up to 6 months, the baby gradually, in accordance with the genetic program laid down in him, learns to hold objects in his hands, bring them to his mouth, sit and, finally, move independently (crawl and walk). At the same age, by observing adults, he begins to form the first skills of social adaptation. The degree of development of the psyche and motor functions is directly related to the readiness for complementary foods. The child is ready to get acquainted with adult food when he has opportunity and desire try this food.

Complementary foods started "at the initiative of the mother", that is, until the moment the child has shown interest in other food and can physically get it (for example, being in the arms of the mother, grab a piece from the table and put it in his mouth), there will always be for this child "early", and therefore fraught with health risks.

Based on the foregoing, for each child, the age of the start of complementary foods will be individual, based on the totality of all the signs of maturation of his organism. But on average, in most children who are fully breastfed, all signs of readiness for complementary foods appear no earlier than 5.5 months.

Now let's figure out which children, according to WHO "complementary foods may be needed earlier (6 months), but not before 4 months of age".

Early complementary foods for medical reasons: yes or no.

As stated in the same modern recommendations of the Ministry of Health of the Russian Federation, "the need to expand the nutrition of the child and supplement mother's milk with other foods is due<...>the need for additional introduction into the body of a growing child of energy and a number of nutrients, the intake of which only with women's milk, at a certain stage of infant development (from 4-6 months), becomes insufficient ".

Based on this statement, it is concluded that children who are exclusively breastfed up to 6 months of age are more at risk of developing iron deficiency anemia, food allergies and malnutrition (underweight).

However, this statement contradicts modern scientific data.

Studies have proven that proteins, and fats, and carbohydrates, as well as vitamins and minerals, are found in breast milk in the most bioavailable form. This means that throughout the entire period of feeding (and even in an adult) these substances from breast milk are absorbed better than from other products.

In addition, studies have long confirmed another fact - the energy value of breast milk with the age of the child not only does not decrease, but, on the contrary, increases. Such data, in particular, were obtained in the course of laboratory monitoring of the composition of breast milk, conducted by a group of specialists from the Ural State Medical Institute.

about the same WHO also writes : "The data in Table 11 show that infants in industrialized countries who consume average amounts of breast milk do not require any complementary foods to meet their energy requirements until the age of 6-8 months".

Thus, if a child is really anemic or underweight EVEN with full breastfeeding, this means that the functioning of his digestive system is already impaired. And if so, he will not absorb nutrients and microelements from other products. Moreover, increasing the volume of complementary foods by reducing the number of daily breastfeeding can lead to a decrease in weight gain, constipation and other disorders of the gastrointestinal tract, as well as the occurrence of anemia and allergies (because they create an unreasonable burden on the immature digestive tract and enzymatic system).

In other words, early feeding not only does not solve the health problems of the child, but can lead to a deterioration in his condition. A strategy to help a child in case of established problems with the absorption of nutrients and microelements from mother's milk should not be based on the introduction of complementary foods, but on the search for and elimination of the cause of the disease and its drug or other therapy, with the obligatory preservation of full breastfeeding. If there is a need to stimulate the enzymatic system, up to 5.5 months it is better to introduce the child not with adult food, but with a small amount of an adapted mixture. The risk of formula supplementation at 3-5 months of age is significantly lower than that of adult formula supplementation.

A few words about food allergies. This condition is ALWAYS associated with pathologies of the gastrointestinal tract. Allergy occurs due to the high permeability of the intestinal walls, unable to resist the penetration of antigens. Factors in the development of allergies in infants associated with the organization of nutrition - the lack of colostrum feeding, supplementary feeding with a mixture in the first days of life, mixed feeding. The introduction of early complementary foods to children with allergies cannot be justified by medical necessity, because early feeding necessarily means an increase in the load on the already weak and permeable gastrointestinal tract of the child. Children with allergies should only be introduced to complementary foods when they show signs of being ready for it, and very gradually. Breast milk has the mildest effect on the child's digestive system, and the enzymes contained in it help digest food, which is even more important for an allergic child than for a healthy child.

Hyperdiagnosis of anemia and malnutrition in children on exclusive breastfeeding.

If a child is found underweight first of all, it is necessary to clarify what growth rates the pediatrician uses and how much weight gain deviates from the WHO schedules for breastfed children. Perhaps the child adds absolutely normally, just does it differently than the child on the IW.

In addition, it is important to remember that the diagnosis of "hypotrophy" is made only on the basis of a combination of signs, including the state of the child's muscle tone, his skin, assessment of physical and mental development, and not on the basis of absolute weight indicators.

If the fact of insufficient weight gain is established, the next step is to assess the organization of breastfeeding and eliminate risk factors for underweight, if any. At the age of 3-6 months, such factors are:

1) the absence of prolonged feedings during the day, in particular, for falling asleep, during sleep and waking up; an awake baby of this age may be weaning, suckling little, and getting less milk than necessary. For example, a lack of weight happens if a child spends all his dreams on the street or on a balcony, or falls asleep not with a breast, but with a dummy.
2) professional massage;
3) any change in the usual daily routine and living conditions of the child (guests, trips, moving, accustoming to sleep in his own bed, etc.);
4) swimming and diving in a large bath or in a pool (especially if these procedures began to be practiced after 3 months);
5) vaccination.

Iron-deficiency anemia- a diagnosis that is made on the basis of a combination of clinical signs and always means a violation of metabolism and the functioning of the gastrointestinal tract. Based on hemoglobin tests alone, such a diagnosis is incorrect. Besides:
- norms of hemoglobin in children differ from norms of adults;
- at about 3 months in children observed physiological decrease in hemoglobin levels that does not require treatment;
- what level of hemoglobin is normal for a child on breastfeeding and whether these indicators differ from those of children on artificial feeding, has not been studied. However, according to WHO, 30% of breastfed children at the age of 1 year have lower hemoglobin than their non-breastfed peers. Such a number of "deviations from the norm" may not indicate the prevalence of pathology, but that for children on breastfeeding, lower hemoglobin values ​​at the age of 1 year are the physiological norm. In the past, WHO has already adjusted the norms of weight gain for children by breastfeeding (in the direction of decrease), it is possible that other parameters for assessing children's health need to be revised, depending on the presence or absence of breastfeeding.

In any case, when making a diagnosis of iron deficiency anemia, it is necessary to take into account not only the numbers in the tests, but the general condition of the child, the presence or absence of clinical signs of the disease.

Volumes of complementary foods at the age of 6-12 months and older. The nutritional value of breast milk at this age.

Receiving the first complementary foods stimulates the activity of the enzymatic system of the infant. The stomach and pancreas are involved in the process of digesting food. However, this does not happen instantly, the body needs time to "learn" to fully absorb nutrients and vitamins from other foods. And until this happens, the child gets everything he needs from breast milk.

In the first months after the start of complementary feeding, his main task is not to feed the child and not to make up for the lack of nutrients and vitamins that has arisen in his breastfeeding (since it is still impossible to do this instantly at the expense of adult food). Complementary foods at this age are needed in order to:
- introduce the child to adult food;
- stimulate the work of the enzymatic system;
- teach chewing and swallowing;
- support the food interest of the child;
- form a normal eating behavior.

The solution of all these problems contributes to the so-called pedagogical complementary foods, that is, feeding the child with small pieces (microdoses) of products included in the family's diet.

According to current WHO recommendations, in the diet of a child at the age of 1 year, breast milk (or its substitutes) should be at least 70-75%. There are other data that indicate that breast milk is quite capable of meeting all the needs of a child of 6-12 months. So, the St. Petersburg pediatrician professor I. M. Vorontsov, on the basis of his research, claims that if the mother is healthy and eats normally, the child can be on breastfeeding without complementary foods for up to 9-12 months without any harm to himself.

There is a theory (it is put forward by ethologists) that at the dawn of evolution, when a person ate mainly coarse vegetable fiber, breast milk was the main food of a child for at least 3-4 years (only by this age a child can fully absorb such fiber), otherwise case, without mother's milk or nurse's milk, the child did not survive.

This theory is supported by the state of affairs in modern Africa, where, in conditions of a lack of protein food, the duration of breastfeeding can indeed become a matter of survival of the child. scientists described the disease "kwashiorkor"- a severe form of malnutrition due to protein deficiency, often accompanied by a lack of vitamins and the addition of an infection that usually develops after weaning the baby. The disease usually occurs in children 1-4 years old.<...>When a baby is weaned, in the case when products that replace mother's milk contain a lot of starches and sugars and few proteins<..>, the child may develop kwashiorkor. This name comes from one of the languages ​​of the coast of Ghana, its literal meaning is "first-second", which means "rejected", reflecting that the condition begins in the eldest child after weaning, often due to the fact that the family was born another child."

In practice, based on the experience of mothers living in modern civilized countries, breast milk is enough for a child to meet the nutritional needs for at least 1.5 years. When the body ceases to have enough calories or some trace elements from breast milk, a child of this age himself increases the amount of adult food or some specific foods in his diet - the main thing is not to spoil his eating behavior by force-feeding and give him access to family "resources", then eat to take with you to the table and offer a variety of food.

The digestive system of a child is mainly formed by the age of 2 years. Until this age, breast milk supports the work of the child's digestive system, helps the absorption of essential nutrients, reduces the risks of diseases of the digestive system, and contributes to a milder transfer of infectious and inflammatory diseases of the gastrointestinal tract.