Principles of natural feeding. Its benefits. Nutrition for a healthy child. Natural feeding. Lure. Breastfeeding mistakes

Natural (breast) feeding

Relevance of the topic. Long-term observations and studies have proven that natural feeding in the 1st year of life is the basis for the full physical and mental development of the child, the formation of resistance to infectious and somatic diseases, and attempts to feed newborns and infants with milk of other biological species must be regarded as an ecological disaster. Therefore, the study of the benefits and principles of breastfeeding and activities aimed at its support is necessary to improve the health status of the child population.

The purpose of the lesson. To study the basic provisions on breastfeeding of children, its importance for the health of the child, to find out modern views to this problem, to learn the principles of this type of feeding.

As a result self-study the student must know:

1. Morphological and functional features of the digestive and metabolic organs in children in the age aspect.

2. Quantitative and qualitative composition of colostrum, transitional and mature human milk.

3. Features of women's milk, which determine its extraordinary biological value compared to other types of milk, and its impact on the development of the child.

4. Calculation of the volume of the daily diet of a child of the 1st year of life by different methods.

5. The need of the infant for the main food nutrients and calories.

6. The timing of the introduction of corrective additives (fruit and vegetable juices, fruit purees, egg yolk), bait into the child's diet.

7. Rules for the introduction of bait and corrective additives.

8. diet of a nursing mother.

9. An approximate scheme for compiling the diet of a child of the 1st year of life, is breastfed.

10. nutrition of premature babies.

11. Ten principles of successful breastfeeding WHO and UNICEF.

As a result of studying the topic, the student should be able to:

1. Make up a daily diet for healthy child 1st year of life, breastfed.

2. Evaluate the history data that testify to the quality of the child's nutrition, identify errors in the folded diet and correct them according to existing rules.

3. Make up the diet of a nursing mother.

4. Identify and evaluate clinical signs indicating a child's malnutrition, eliminate them.

Main literature

Chebotareva V.D., Maidannikov V.G. propaedeutic pediatrics. - M.: B. i., 1999. - S. 452-497.

additional literature

Mazurin AB, Vorontsov I.M. Propaedeutics of childhood diseases. - St. Petersburg: "Foliant Publishing House", 2001. - S. 827-922.

Pediatrics / Ed. N.P. Shabalov. - St. Petersburg: SpecLit, 2003. - S. 199-225.

Modern management of lactation and breastfeeding: Tutorial. With the assistance of the United Nations Children's Fund (UNICEF) in Ukraine. - M., 2002. - 152 p.

Auxiliary materials

1. Modern approaches to breastfeeding.

2. Daily requirement of children of the 1st year of life in the main nutrients and energy with natural feeding.

3. An approximate scheme of the timing of the introduction of bait with natural feeding.

4. Formulas for calculating the daily volume of breast milk for children.

5. Algorithm for compiling the child's daily menu.

Modern approaches to breastfeeding

To ensure the full feeding of the child, it is necessary to follow the rules that contribute to increased lactation in a woman. We present these rules.

1. The term of the first attachment of the child to the breast is essential for the development of lactation. It is best to do this in the first 30-40 minutes after the birth of the child. If there are no contraindications for the health of the mother and child, then after feeding, the child should be left with the mother for 1 hour. Then healthy newborns are left with the mother in the same room and applied to the breast when the child needs it.

2. Free feeding contributes to the formation of the relationship between mother and child. The rhythm of lactation is being established, but healthy child should not impose restrictions on feeding regimen. The number of feedings and their hours should be adjusted according to the needs of the child.

3. Studies of various aspects of natural feeding have shown that it is impossible to feed a newborn baby with breast milk substitutes, since their use leads to a change in the processes of colonization of the intestine by lactobacilli, disrupts the formation of the function of the digestive system, and contributes to the child's sensitization to proteins cow's milk, disorients the act of sucking due to the use of nipples in these cases.

4. Main indicator full feeding the child should be her physical and mental development. Control weighing data is an insufficient criterion for the usefulness of feeding. This is due to significant changes in the individual quality of milk. different women(the amount of proteins in mature women's milk varies widely: from 1 g to 2 g per 100 ml of milk), as well as with its changes during feeding (fat concentration can vary 4-5 times from the beginning to the end of the feeding process).

5. To stimulate lactation, prevent the development of lesions and cracks in the nipples, the best way is to feed the baby from both mammary glands subject to the complete emptying of one breast. It is necessary to feed with one breast for 5-15 minutes until it is completely empty, and if the child still requires food, continue feeding the second one, starting with the next feeding.

6. At present, it is considered inappropriate to give advice to the mother to express milk to the "last drop", because from the point of view of physiology this is impossible: the mammary gland constantly secretes milk and the more, the more intensively pumping is carried out.

7. Rational nutrition of the mother, frequent attachment of the child to the breast, including at night, friendly relations in the family, positive emotional orientation of the woman to breastfeeding are the main factors for improving her lactation and optimizing the feeding of the child in the 1st year of life.

The daily need of children of the 1st year of life in the main nutrients and energy with natural feeding (according to A.V. Mazurin, I.V. Vorontsov, 2000)

An approximate scheme for the timing of the introduction of bait with natural feeding

Since 1992, ten principles of successful breastfeeding developed by WHO and TsNICEF have been introduced into the Russian practice of breastfeeding.

1. Strictly adhere to the established rules for breastfeeding and regularly bring these rules to the attention of medical staff and women in labor.

2. Train medical staff in the necessary skills for professional breastfeeding counseling.

3. Inform all pregnant women about the benefits and techniques of breastfeeding.

4. Help mothers start breastfeeding within the first half hour after birth.

5. Show mothers how to breastfeed and how to maintain lactation when mothers are temporarily separated from their children.

6. Give newborns no food or drink other than breast milk, unless medically indicated.

7. Ensure that the mother and the newborn are in the same room around the clock.

8. Encourage breastfeeding on demand rather than on a schedule.

9. Do not give newborns who are breastfed, any sedatives and devices that mimic the mother's breast (nipples, pacifiers).

10. Encourage the establishment of breastfeeding support groups and refer mothers to these groups after discharge from the hospital.

The practice of early attachment of the baby to the breast is generally accepted. Having no significant nutritional value due to the low production of colostrum at this time, early breastfeeding ensures the formation of the immunological protection of the newborn, reducing its incidence. It also provides stimulation of lactogenesis in the mother, its success, the correct course of the postpartum period, induces psychological connections mother and child.

At the start of breastfeeding, it is critical for successful feeding has the position of the child at the breast and the completeness of the capture of the areola of the nipple. In the first days after childbirth, the mother feeds the child in the supine position on her side. The child is placed so that it is convenient for him to grab the nipple. At the same time, the mother helps him by slightly lifting the breast, holding it between the thumb and the rest of the fingers and directing it so that the child captures not only the nipple, but also part of the halo. Top part the chest is pressed down so that it does not cover the child's nose and does not interfere with his breathing.

As the condition improves, the mother can feed the baby while sitting, placing her foot on a low bench.

The mammary glands during feeding must be alternated so that they are completely emptied. Remaining milk should be expressed. Only with an insufficient amount of milk in one mammary gland is fed from both. In this case, the second is applied only after the first is completely empty. In subsequent feeding, the child is first applied to the second and, only if necessary, to the first. The rules for sequential application must be observed, since the first portions of milk are sucked out more easily than subsequent ones. The child quickly gets used to undersucking, which causes stagnation of milk and a decrease in lactation.

The frequency of attachment of the child to the mammary gland at the beginning can be large, as this stimulates lactation. As milk production increases, the frequency of application of the child to the mammary gland is reduced and streamlined. Children of the first 3 months of life are fed every 3 hours with a 6-hour break. In the period from 3 to 5 months, the number of feedings is six times a day, that is, every 3.5 hours with a 6.5-hour break, and after 5 months - five times every 4 hours with an 8-hour night break . If the child does not withstand the night interval, it is recommended to feed him at night. Each child develops his own feeding schedule, in which certain deviations are possible, forcing either to increase or decrease the intervals between feedings, shift the night interval in one direction or another. But in general, the described recommendations should be followed, since the food regimen is the basis for the formation of a stable food reflex, stimulation of activity gastrointestinal tract. Chaotic feeding reduces the child's appetite, he sucks milk a little.

A healthy baby sucks from the breast in the first 5 minutes about 50% of the necessary milk. Therefore, each feeding is from 15 to 20 minutes, and for a newborn - up to 30 minutes.

The amount of milk a baby needs varies greatly. IN practical purposes using scoring methods. In some formulas, the individual characteristics of the child are more or less taken into account, in others they are not taken into account.

For newborns under the age of 7-8 days, the following formulas for calculating the daily amount of milk are more often used.

Zaitseva's formula:

V (in ml) \u003d 2% of the body weight of a newborn child * n, where n is the number of days the child lives;

Finkilstein formula:

V (ml / day) \u003d n * 70 (or 80),

where n is the number of days of a child's life; 70 - multiplier for newborn weight equal to or less than 3200 g; 80 - multiplier with a newborn weighing more than 3200 g.

Maternity hospitals often use a more simplified formula

V (volume of one feeding, ml) = 10n, where n is the number of days of a child's life.

To determine the amount of milk a child needs per day, the following calculation is used depending on his body weight:

at the age of 2 to 6 weeks, the amount of milk needed is 1/5 of body weight; from 6 weeks to 4 months - 1/6; from 4 to 6 months - 1/7.

The physiological energy requirement per 1 kg of body weight in children under 1 year old is, kcal per day:

in the first quarter of the year - 115; in the II quarter - 115; in the III quarter - 110; in the fourth quarter - 100.

Based on the physiological energy requirement, you can calculate the volume of milk (V), necessary for the child, according to the formula:

V \u003d (P * m * 1000) / 700,

where P is the need for kcal per 1 kg; m - body weight of the child, kg; 1000 - the volume of milk needed by a child after 6 months of life, ml; 700 - calorie content of 1 liter of women's milk, kcal.

Knowing the total daily volume of human milk and the number of feedings, it is possible to calculate the need for one feeding.

Contraindications to natural breastfeeding

There are absolute and relative contraindications to natural feeding of a child, both on the part of the mother and on the part of the child.

Absolute contraindications to the first attachment of a child to the breast are severe forms of perinatal CNS damage (violations cerebral circulation, hemorrhages), respiratory distress syndrome (distress syndrome). These children are fed with expressed milk. With hemolytic disease, newborns are fed with expressed donor milk. Deeply premature babies in the absence of swallowing and sucking reflexes are fed with expressed milk through a tube.

Absolute contraindications to feeding a child with milk are congenital diseases: galactosemia, phenylketonuria, maple syrup urine disease.

It is not recommended to breastfeed a child if the mother suffers from a disease in the stage of decompensation (diseases of the kidneys, heart, blood, Graves' disease, etc.), malignant neoplasms, acute mental disorder. In such cases, it is recommended to feed the children with donor milk.

Many maternal diseases are relative contraindications to breastfeeding, most often they are temporary.

At acute forms tuberculosis with bacillus excretion in the mother, with syphilis with infection of the mother at 6-7 months of pregnancy, with especially dangerous infections (smallpox, anthrax), the child is not fed with mother's milk. With measles and chickenpox in the mother of a child, you can breastfeed, provided that Y-globulin is administered to him.

With typhoid fever, chronic hepatitis, dysentery, salmonellosis, HIV infection, the child is fed with expressed sterilized mother's milk. With acute respiratory viral infections, tonsillitis, bronchitis, pneumonia, natural feeding of the child is interrupted only during the acute period of the mother's illness. In this case, the milk is expressed and given to the child. After the mother's condition improves, the child is again applied to the breast, with limited contact time and the use of a mask by the mother.

A contraindication to breastfeeding is the use by the mother medicines excreted with milk. The list of such drugs is very wide. The modern pharmaceutical industry necessarily indicates contraindications to the appointment of a particular drug to nursing mothers.

Difficulties with breastfeeding

The main difficulties in breastfeeding can be from both the mother and the child. The most common difficulty is the delayed appearance of milk. The term for the appearance of adequate lactopoiesis (3-5th day) may increase up to the 15th-20th day from birth. Such conditions are difficult to differentiate from primary hypogalactia and familial alaccia. In practice, all cases of insufficient milk production are attributed to delayed galactopoiesis and measures are taken to accelerate its formation. For this, frequent (up to 12 times) feeding of the child with supplementary feeding with donor milk is used. As milk output increases, supplementary feeding is reduced and the feeding regimen is normalized.

On the contrary, with a rapid increase in lactopoiesis, engorgement of the mammary glands, the development of lactostasis, and mastitis are possible. In these cases, before feeding, in order to relieve the tension of the mammary glands and better grasp the nipple, it is recommended to express a certain amount of milk and, after feeding, to express the remaining milk as completely as possible after feeding.

With an irregular shape of the nipples (small, infantile, flat, retracted), a pad is used at the beginning of feeding, and then the child himself adapts to suck on the breast.

Abrasions and cracks of the nipples appear in the first week of lactation, cause severe pain in the mother when feeding the baby; when they become infected, mastitis can occur. The reasons for the appearance of abrasions and cracks in the nipples are different: anomalies of the nipples, traumatizing them during feeding, non-compliance with hygiene standards. In these cases, the child is fed through a nozzle, disinfectants are used that promote epithelialization (ointments with vitamin A, Kalanchoe or plantain juice, solutions and ointments with furacilin, antibiotics, anabolic hormones). Prevention is hygiene care behind the mammary gland, the correct attachment of the child to the breast, non-violent weaning.

With excessive lactopoiesis, firstly, it is recommended to apply the child to both breasts in one feeding until completely saturated, and secondly, the remaining milk is decanted incompletely to preserve residual milk. The latter is a natural mechanism for reducing milk production.

Mastitis - inflammation of the mammary gland - usually develops against the background of engorgement of the mammary glands, for example, against the background of lactostasis, or due to infection of cracks and abrasions of the nipples. Mastitis can be aseptic and purulent. Prevention consists primarily in observing the rules of personal hygiene of a woman when applying a child to her breast, preventing lactostasis, abrasions and cracks in the nipples.

Therapeutic measures consist in more frequent attachment of the child to the breast and subsequent complete decantation of milk residues. Antibacterial therapy is prescribed for signs of infection. With signs of infection of the milk itself (appearance of pus, inoculation of microorganisms), the child is not applied to the breast, but fed with sterilized expressed milk.

Galactorrhea is the spontaneous secretion of milk from the breast during feeding by the other breast or the outflow of milk from both breasts between feedings.

In these cases, measures are taken to protect the skin from constant irritation with secreted milk (dressings made of absorbent material, their frequent change, lignin and ointments).

A frequent difficulty with natural feeding is hypogalactia - reduced secretory ability of the mammary glands. It must be distinguished from the delayed appearance of milk, feeding disorders (malnutrition of the mother, "lazy" suckers), temporary decreases in milk flow - lactation crises. There are objective signs of milk shortage. Chief among them is the dynamics of mass growth.

Distinguish between primary and secondary hypogalactia. Primary hypogalactia is caused by organic causes (immaturity of the mammary glands, neuroendocrine disorders, somatic diseases of the mother). In secondary hypogalactia, violations in the organization of natural feeding techniques (late first-time feeding, excessively cruel diet, "sluggish" or "lazy" suckers, mother's inexperience or lack of training, etc.), irrational regimen and mother's nutrition, psychological factors, diseases are important.

For the prevention of hypogalactia of any form, the elimination of the causes that caused it is of paramount importance. In the secondary form of hypogalactia, primary education of the mother in the rules of natural feeding, sanitary and educational work of medical personnel are important.

To establish sufficient milk production, it is recommended to apply the baby to the breast more frequently (up to 8-10 times a day), followed by pumping out the remaining milk. Only when all the means to restore lactation have been exhausted, is it recommended to supplement the child with donor milk or an artificial mixture, but not earlier than the 7th day from the start of all activities.

Difficulties in breastfeeding on the part of the child occur with such developmental anomalies as non-fusion upper lip and hard palate, prognathism. Typically, these babies adjust to breastfeeding or are spoon-fed or tube-fed. Temporary difficulty in breastfeeding may be associated with thrush, short bridle tongue, runny nose.

In some cases, temporary lactase deficiency may be observed, while a child receiving mother's milk has an increase in stools of a liquid consistency with a good increase in body weight. By 1-2 months, disaccharidase activity matures and dyspeptic symptoms disappear.

With congenital lactase deficiency, it is necessary to transfer children to lactose-free mixtures.

Difficulties in breastfeeding a child may be associated with weak sucking activity of children (“lazy” suckers). This happens primarily in premature, "immature" children who have suffered a birth injury. Some maternity hospitals continue to give newborns a 5% glucose solution to drink. In the future, this can lead to difficulties in breastfeeding.

In all these cases, it is important to prevent a decrease in lactopoiesis. The child is supplemented with expressed milk or is not allowed to fall asleep during feeding, the duration of feeding should not exceed 30 minutes; the child is applied to both breasts. After feeding, the remaining milk is expressed.

Correction of nutrition with natural feeding

With a normal pregnancy and rational nutrition of a nursing woman, the correction of a child's nutrition is very controversial.

With natural feeding, a lack of vitamins K, D, calcium, iron and fluorine is possible. Vitamin K deficiency in the first days of life occurs due to its low content in human milk or due to low milk intake. Therefore, breastfed newborns are given vitamin K parenterally once. In the autumn-winter period, when solar insolation is reduced, children are given vitamin B at a dose of 200-400 IU per day to prevent rickets. IN spring-summer period Vitamin E is not given.

Often in children of the 1st year of life, a negative calcium balance is found. With a daily calcium requirement of 0.4-0.6 g, the child absorbs only 0.2-0.25 g from human milk. Therefore, the missing amount is recommended to be administered in the form of calcium gluconate or glycerophosphate, starting from the 2nd month of life.

During the first year of life, a child should absorb about 200 mg of iron. In a liter of human milk it contains only 0.25 mg. Intrauterine deposited iron is utilized already by 4-5 months of extrauterine life. Therefore, from about the third month, breastfed newborns are recommended to administer iron supplements at the rate of 10 mg of reduced iron.

Recommendations for early correction of natural feeding with water-soluble vitamins and minerals or vegetable and fruit juices does not currently find wide support among nutritionists. Most of them recommend such a correction through nutrition or treatment of a nursing mother. However, even the latest nutritional guidelines recommend introducing juice, but not before the third month of life, and gradually. The total amount of juice is calculated in ml: 10*n, where n is the child's age in months. Vegetable juices are given before meals, fruit juices - after meals. They begin to give at first clarified juices, then juices with pulp, and from the fourth month - pureed fruits, both freshly prepared and canned for baby food. It is not recommended to mix different juices at the same time.

With properly organized natural feeding, children, as a rule, do not need protein correction.

Complementary foods with natural feeding

Women's milk provides proper development a child up to 5-6 months (until the doubling of body weight at birth). From 6 months to the 1st year, the child receives about 1000 ml of milk, which does not cover the high energy and plastic needs. Therefore, there is a need to additionally introduce the necessary food ingredients into the diet, to increase its energy value. These requirements are met by food thicker than milk.

In addition, the age of 5-6 months is characterized by a certain maturity of the enzymatic apparatus of the child's gastrointestinal tract. Some breastfed babies show signs of malnutrition in the form of fussiness, lethargy, slowing down, or flattening of the weight curve.

By this time, the child needs an additional introduction of minerals, vitamins, the sources of which are products of plant origin.

With complementary foods, ballast substances are also introduced in the form of fiber, peptins, which are necessary for the proper functioning of the gastrointestinal tract.

Complementary foods accustom the baby to new types of food and gradually prepare him for weaning.

Complementary foods are introduced gradually, starting with small amounts (3-5 teaspoons) before the main feeding with breast milk. Within a week, the amount of complementary foods is adjusted to the full volume of one feeding. The second week is allotted for adaptation to this type of food. The transition to a new type of complementary foods begins only after the child gets used to the previous one.

The consistency of complementary foods should initially be homogeneous, not causing difficulty in swallowing. Gradually, the food becomes thicker and they begin to give it from a spoon, accustoming the child to chewing.

The first meal of complementary foods can be vegetable puree or cereal, but all things being equal, it is better to start complementary foods with vegetable puree. Firstly, this is due to the fact that most children have a reduced appetite after eating a sweet dish; secondly, it is advisable to give vegetable puree to children with borderline conditions (prematurity, exudative diathesis, anemia, rickets, etc.), since it has allergenic properties to a lesser extent than cereals, contains a rich set of vitamins and minerals.

With the introduction of complementary foods, they monitor the child's stool, behavior, and the condition of the skin. At first, vegetable puree is given, mainly potato. Gradually, the proportion of potatoes in it decreases to 1/3 due to the introduction of other vegetables: carrots, cabbage, cauliflower, zucchini, pumpkin, greens (parsley, dill, spinach, etc.). Many vegetables and fruits containing carotene and carotenoids cause food allergies in some children in the form of rashes and diarrhea. Therefore, their assortment should be individual.

Porridges, at first 5%, are cooked on a vegetable broth in half with milk, then they switch to 8-10% already on whole milk. They usually start with rice porridge, then include buckwheat and oatmeal. Semolina porridge is the least valuable, because, firstly, it contains a lot of gliadin, and secondly, children absorb wheat starch (from which semolina is made) worse than those listed above.

The introduction of the first complementary foods takes 3-4 weeks. Then a second complementary food is introduced (until it completely replaces breast milk). From 6-6.5 months, the child receives two feedings per day in the form of complementary foods and three times mother's milk. It is advisable to gradually form a second breakfast in the form of feeding porridge. Puree is usually given at lunch.

Starting from 5-5.5 months, add 3-5 g to complementary foods butter or up to 5 g per day vegetable. At the same time (not earlier), it is advisable to start introducing egg yolk into complementary foods, starting with small doses and bringing it to the whole by 6-6.5 months 2-3 times a week.

From 6.5-7 months, they begin to accustom the child to meat dish complementary foods, giving first meat broth (up to 50 ml), and by 7-7.5 months minced meat (up to 30 g). The second complementary food is obtained in the form of a dinner consisting of broth, vegetable puree with minced meat and fruit puree.

From 8 months, the child is replaced by another breastfeeding. Instead, they give mashed cottage cheese (30-50 g) with milk or kefir.

Thus, from 9 to 12 months, the child receives complementary foods three times a day and mother's milk twice (in the morning and in the evening).

From 9-10 months, in addition to meat complementary foods, fish complementary foods are introduced 1-2 times a week, first in the form of broth, and then minced meat.

Complementary foods are constantly diversified. Minced meat from 10 months is replaced with meatballs, and from 12 months - steam cutlet. From 8-10 months they begin to give white bread crackers, simple cookies, which are soaked in milk or broth. The main requirement for meat is that it should not be fatty, and the fish should not be bony. The combination of separate complementary foods should contribute to their better assimilation and bowel movement. Therefore, it is irrational to give two dense or two liquid main dishes in one feeding. Porridge is given no more than once a day as the most high-calorie dish.

Exists a large assortment canned baby food, which can also be successfully used with various types of complementary foods. Here you must first of all remember the age compliance of this product. The organoleptic properties of this product or dish should always be verified.

Subject to the rules for the introduction of complementary foods, weaning occurs gradually and painlessly. The global trend is currently setting the maximum duration of breastfeeding until the child himself refuses it. Domestic pediatricians recommend weaning children from the breast by one year.

Since most children refuse morning feeding by 10-11 months, it is replaced with whole cow's milk. Then the evening feeding is replaced with whole cow's milk with cookies. The gradual abolition of breastfeeding leads to inhibition of the endocrine and secretory activity of the mammary gland and spontaneous cessation of lactation. To reduce lactation, fluid intake is limited, the mammary glands are bandaged or a tightening bandage is worn.

The neonatal period is associated with an increase in blood flow in the vessels of the lungs and brain, a change energy metabolism and thermoregulation. From this period, enteral nutrition of the child begins. During the neonatal period, adaptive mechanisms are easily violated. During this period, a hormonal crisis of the newborn develops, associated with a violation of the interaction of the endocrine apparatus of the mother and child and birth stress. Conditions reflecting the adaptation of the child:

1) physiological catarrh of the skin;

2) physiological jaundice;

3) physiological weight loss;

4) uric acid infarction.

During this period, developmental anomalies, fetopathy, hereditary diseases, diseases caused by antigenic incompatibility are detected, birth injuries are manifested, intrauterine infection or infection during childbirth. Purulent-septic diseases, bacterial and viral lesions of the intestines and lungs may occur. In the early neonatal period, aseptic conditions, optimal ambient temperature, close contact of the newborn with the mother should be created. The late neonatal period covers the period from 8 to 28 days. During this period, a delay in the increase in body weight is detected. The resistance of the child's body is low, full adaptation has not yet occurred.

During this period, diseases and conditions associated with the pathology of the intrauterine, intranatal and early neonatal periods may also be revealed. An important criterion for the well-being of the child should be considered an assessment of the dynamics of body weight, neuropsychic development, sleep status.

IN the most important characteristic this stage includes the intensive development of analyzers, the beginning of the development of coordination movements, the formation of conditioned reflexes, the emergence of emotional, visual and tactile contact with Mother.

Breastfed children are 3 times less likely to suffer from intestinal infections, 1.5 times less likely to get respiratory diseases.

1. Colostrum and human milk contain antibodies to pathogens of intestinal infections - to the O-antigen of Salmonella, Escherichia, Shigel, enteroviruses, respiratory infections(such as influenza, reovirus infection, chlamydia, pneumococci), to pathogens of viral diseases (polio virus, cytomegalovirus, mumps, herpes, rubella), bacterial infections caused by staphylococci, streptococci, pneumococci, tetanus toxin).

2. Colostrum contains immunoglobulins of all classes, especially YgA (90%). With lactation, its content decreases, but the daily intake remains high (3–4 g). This immunoglobulin plays the role of the first defense against invasion, inhibits the adhesion of bacteria, neutralizes viruses, and prevents allergization.

The child receives 100 mg of YgM per day. The placenta of ruminants is impermeable to immunoglobulins. The colostrum of ungulates contains predominantly YgG, while YgA and YgM are present in small amounts.

3. In the first 4 weeks of lactation, lactoferrin (50-100 mg/l) is present in human milk, which activates phagocytosis by binding ionized iron in the intestine and blocks the formation of bacterial flora.

4. Colostrum contains complement components C3 (30 mg per day) and C4 (about 10 mg/day).

5. In women's milk, the content of lysozyme is 100-300 times higher than in cow's. Its action is to damage the shell of bacteria, stimulate the formation of salivary amylase, and increase the acidity of the stomach.

6. Women's milk contains bifidus factor, the activity of which is 100 times higher than in cow's milk. This carbohydrate contributes to the formation of bifidus flora, lactic and acetic acids, which prevents the growth of staphylococcus, salmonella, shigella, escherichia. With natural feeding, the ratio in the intestine of lactobacilli and other microorganisms is 1000: 1, with artificial feeding - 10: 1.

7. In women's milk, a large number of viable cells are found - 0.5-1 million in 1 ml of milk, macrophages - 50-80%, lymphocytes - 10-15% of the total cytosis. Milk macrophages are able to synthesize interferon, lactoferrin, lysozyme, complement components; they retain their significance in intestinal infections. Among the lymphocytes in human milk there are B-lymphocytes that synthesize YgA, T-lymphocytes - helpers, suppressors, memory cells. They produce lymphokines. Neutrophils in colostrum - 5 x 105 in 1 ml, then there is a slight decrease. They synthesize peroxidase, have the ability to phagocytosis.

8. Allergy to mother's human milk is unknown, while allergy to milk mixtures in children of the 1st year is about 10%.

9. Women's milk, especially colostrum, unlike cow's milk, contains pituitary and thyroid hormones.

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

11. Women's milk has 2 times less protein, but more carbohydrates (lactose) than animal milk. The amount of fat is the same. The energy value due to protein in women's milk is covered by protein by 8%, in cow's milk - by 20%. The share of the energy value of carbohydrates in women's milk is 45%, in cow's milk - about 30%, fat in both cases covers about 50% of its energy value.

12. Women's milk has a lower ash content than cow's milk.

13. The ratio of the sum of the amount of whey lactalbumins and lactoglobulins to caseinogen is 3: 2. In cow's milk, this ratio is 3: 2, so the adapted mixtures are enriched with whey proteins. When curdling milk in the stomach, casein gives large flakes, and albumins - small ones, which increases the surface for contact with hydrolysis enzymes.

Human milk also contains proteolytic enzymes.

14. The main component of human milk fat is triglycerides. In children, due to the low activity of pancreatic lipase and the low concentration of conjugated bile salts, fat hydrolysis is difficult. In breast milk, the content of palmitic acid is lower, which contributes to easier hydrolysis. The nutritional value of triglycerides in cow's milk is lower than in human milk, due to the greater formation of free fatty acids that are excreted. The coefficient of absorption of fat from women's milk in the 1st week of life is 90%, cow's - 60%, then slightly increases. The composition of human milk fat is also different from cow's milk. The composition of human milk fat is dominated by unsaturated essential fatty acids that are not synthesized in the human body, especially in the first year of life. They are found in very small amounts in cow's milk. The high content of essential fatty acids has great importance for the development of the brain, the retina of the eyes, the formation of electrogenesis. In women's milk, compared to cow's milk, there is a higher content of phosphatides, which ensure the closure of the pylorus when food passes into the duodenum, which leads to uniform evacuation from the stomach, and promote protein synthesis. The fat absorption coefficient of human milk is 90%, for cow's milk - less than 60%. This is explained by the presence of the lipase enzyme in human milk with its 20–25 times greater activity. The breakdown of milk fat by lipase provides active acidity in the stomach, which contributes to the regulation of its evacuation function and the earlier release of pancreatic juice. Another reason for better digestibility of human milk fat is the stereochemical arrangement of fatty acids in triglycerides.

15. The amount of milk sugar (lactose) in women's milk is greater than in cow's milk, and in women it is b-lactose, which is absorbed more slowly in the small intestine and ensures the growth of gram-positive bacterial flora in the large intestine. The predominant content of lactose among the sugars of human milk is of great biological importance. So, its monosaccharide galactose directly contributes to the synthesis of galacto-cerebrosides in the brain. The predominant content of lactose (disaccharide) in human milk, which has a higher energy value, but has an osmolarity equal to monosaccharides, provides an osmotic balance that is optimal for the absorption of nutrients.

16. The ratio of calcium and phosphorus in women's milk is 2–2.5: 1, in cow's milk - 1: 1, which affects their absorption and assimilation. The coefficient of absorption of calcium in women's milk is 60%, cow's - only 20%. Optimal metabolic rates are observed in the case of intake with human milk from 0.03 to 0.05 g of calcium and phosphorus per 1 kg of body weight, and magnesium - more than 0.006 g / (kg per day). Women's milk is richer than cow's iron, copper, zinc, and fat-soluble vitamins.

Colostrum is a sticky, thick liquid of yellow or grey-yellow, which is released at the end of pregnancy and in the first 3 days after childbirth. Curls easily when heated. Colostrum contains more protein, vitamin A, carotene, ascorbic acid, vitamins B12, E, salts than in mature milk. Albumin and globulin fractions prevail over casein. Casein appears only from the 4th day of lactation, its amount gradually increases. Before the baby is breastfed, colostrum is at its highest protein content. YgA is especially abundant in colostrum. There is less fat and milk sugar in colostrum than in mature milk.

Colostrum contains leukocytes in the stage of fatty degeneration, macrophages in a significant amount, lymphocytes. B-lymphocytes of colostrum synthesize secretory YgA, which, together with phagocytes, forms local intestinal immunity when there is an intensive bacterial colonization of the newborn's body.

Colostrum proteins are absorbed unchanged due to the identity of the child's serum proteins.

Colostrum is an intermediate form of nutrition between the periods of hemotrophic and amniotrophic nutrition and the beginning of lactotrophic (enteral) nutrition. The energy value of colostrum on the first day is 1500 kcal/l, on the 2nd day - 1100 kcal/l, on the 3rd day - 800 kcal/l.

Breastfeeding is the feeding of a child by applying to the breast of his biological mother. It represents the only form of adequate nutrition for the child after birth and during 1–1.5 years of life.

The first attachment of a newborn in the maternity hospital is carried out simultaneously with the first contact procedure. By the time of birth, a normal full-term baby has everything to successfully suckle the breast according to the innate nutrition search program for 120–150 minutes after birth: climbing to the mother’s breast, coordinated action of the arms and mouth in an active search for a nipple with a wide open mouth, tenacious suction to the chest and vigorous saturation before falling asleep.

Breastfeeding should begin within the first hour after birth, when both the baby's reflexes (search and suck) and the sensitivity of the nipple area (areola) to tactile stimulation in the mother are highest. Skin contact after childbirth should be close - on the mother's abdomen after uncomplicated childbirth. When feeding, the child should grab the nipple and areola with an energetic “butting” movement of the head, raising the chest, and then, as it were, laying it down when the chest moves down, on a wide-open mouth, with tongue lowered but not protruding under the chest. Capturing only one nipple without an areola and then sucking it is ineffective and immediately leads to the formation of a crack. The effectiveness of sucking is determined by the rhythmic massage of the areola with the tongue of the child. If sucking at the first skin contact did not take place, then keeping the baby at the breast for more than 2 hours is not advisable. It is also ineffective to attach the baby or create skin contact 2-3 hours after birth.

A good grip of the mother's nipple in the baby's mouth provides him with sufficient ease of sucking, good reflex regulation of breathing associated with breast sucking. Feeding observation should be focused on achieving the act of swallowing milk, which can be judged both by the severity of swallowing movements and by the sound that accompanies swallowing.

Breastfeeding should be done from day one, for any sign of hunger or discomfort on the part of the baby. Signs of hunger can be active sucking movements of the lips or rotational movements of the head with various sound signs even before the cry. The frequency of application can be 12-20 or more per day. The break between day feedings may not reach 2 hours, between night feedings it can be no more than 3-4 hours.

The most natural deficient states with breastfeeding.

1. Vitamin K deficiency in the first few days of life occurs due to its low content in human milk or due to low milk consumption during this period. A single parenteral administration of vitamin K to newborns is recommended.

2. Vitamin D deficiency occurs due to its low content in human milk and insufficient insolation. Recommendations: 200-400 IU of vitamin D per day during a period when there is no regular sun exposure.

3. Correction of iodine for mother and child is necessary in regions with suboptimal natural resources. Recommendations: single intramuscular injection of iodized oil.

4. Iron deficiency. From 1 liter of mother's milk, a child receives about 0.25 mg of iron, from other food sources - about the same.

When breastfeeding, iron supplementation should be provided with iron medicinal products or through iron-fortified formulas, if necessary, the introduction of supplementary foods.

5. Fluorine deficiency requires the use of microdoses - 0.25 mg per day from 6 months onwards.

The introduction of complementary foods depends on the quality of women's milk. Optimal feeding with good nutrition of a pregnant and lactating woman may well ensure the development of a child without complementary foods up to 1–1.5 years.

The lack of confidence in optimal feeding requires the introduction of solid complementary foods at intervals of 4 to 6 months.

As a training food, you can use 50-20 g of grated apple or fruit puree. With good swallowing, good tolerability and no allergic reaction, it can be given regularly for complementary foods and transferred to the start of feeding. The most suitable age is between 16-24 weeks of age, the duration of this complementary food is 2-3 weeks (see Table 4).

An indication for the introduction of the main (or energetically significant complementary foods) is a clear manifestation of the child's dissatisfaction with the volume of milk received in such a state of his physiological maturity, when this dissatisfaction can already be compensated for precisely by dense complementary foods. Some children may develop objective signs of malnutrition even in the absence of anxiety and crying: children become lethargic, decreases physical activity, there is a slowdown in the rate of weight gain. Conditions for the introduction of complementary foods:

1) age over 5–6 months;

2) the current adaptation to the promotion and swallowing of solid food when using educational complementary foods;

3) the ongoing or ongoing eruption of a part of the teeth;

4) confident sitting and possession of the head;

5) the maturity of the functions of the gastrointestinal tract.

First, a trial dose of complementary foods is introduced - 1-2 tsp. and then, with good tolerance, there is a rapid increase to 100–150 ml of fruit or vegetable puree or porridge without salt and sugar based on buckwheat or rice.

Steps to expand complementary foods:

1) educational complementary foods;

2) one vegetable puree (from potatoes, carrots, cabbage) or fruit puree (from bananas, apples). It is better to use products released by the production;

3) gluten-free cereals (from rice, corn, buckwheat);

4) addition of vegetable puree with minced meat, fish or poultry meat from canned meat for baby food, expansion of vegetables and fruits, except for citrus fruits. Adaptation period - 1–1.5 months;

5) cereals on wheat flour;

6) cow's milk substitutes for baby food, non-adapted dairy products (milk, kefir, yogurt, cottage cheese), citrus fruits and their juices, egg yolk hard boiled;

7) the beginning of "piece" feeding: biscuits, pieces of bread, sliced ​​fruit, steam cutlets.

The total daily amount of milk (breast or formula) in any period of the first year of life should not be less than 600-700 ml, it should be distributed evenly throughout the day.

By the end of the first year of life, instead of mixtures of the "follow up" group for the milk component of the diet, it is advisable to use cow's milk substitutes for children of the 2nd-3rd year of life "Enfamil Junior" by Mead Johnson.

With good tolerability of complementary foods and the child's appetite, the volume of one portion of feeding can be 200–400 g by the III–IV quarter of the first year.

We recommend reading: A selection of useful tips on baby food, recommendations, answers to frequently asked questions about baby nutrition.
FAQ: Baby food. Problems and solutions.
Cooking for the child: Recipes for delicious and healthy meals for children.
Discussion on baby food:

A healthy, breastfed baby can be unmistakably identified by the special sparkle of the eyes, velvety skin and muscle elasticity, cheerful disposition and calm behavior. Biologically active substances, hormones, enzymes contained in breast milk ensure the proper development of all systems and organs of the child. The antibodies and immune complexes present in it protect the child from pathogens and viruses.

Science has proven that breast-fed babies are much less likely to get viral and infectious diseases than artificial children. They also have a much lower risk of developing allergic diseases. Breastfeeding has the most beneficial effect on development nervous system child and his psyche. It is noted that in people who are breastfed, the intellect is more often at a higher high level. There are observations that antisocial behavior, cruelty towards animals and others, difficulties in communication, including with persons of the opposite sex, a decrease in parental feelings are more common in people who did not receive mother's milk in infancy. It has been confirmed that atherosclerosis, diabetes mellitus, leukemia, chronic diseases of the digestive system are much less common in those who early childhood was breastfed.

Breastfeeding is also beneficial for the health of the woman herself. She has a much better chance of avoiding cancer of the breast and female genital organs, the uterus returns to normal after childbirth faster, and the fat folds formed during pregnancy in the waist, abdomen and hips dissolve. Breastfeeding has a beneficial effect on the psyche of a woman, making her more balanced, kind and peaceful. It is also important that breast milk is always “at hand”, always sterile, fresh, of optimal temperature and consistency. Natural feeding is also preferable from an economic point of view.

In the first month of life, the child needs 5 cans of a substitute of 500 g each, in the second - 6.5 cans, in the third - 8 cans. For the first six months, 43-45 cans of artificial mixtures are consumed. Given their high cost, a significant amount is spent on feeding a baby. With natural feeding, if the baby develops normally, up to 4-6 months, the family almost does not spend money on baby food, since it is up to this age that a healthy child for normal development is quite enough nutrients coming with mother's milk.

How to properly prepare for breastfeeding

Since pregnancy future mom should give myself a statement: “I will breastfeed my baby. I can do it. I will have enough milk for my baby.” This should be repeated from time to time as a spell, because for normal lactation, the psychological attitude is of great importance. Objectively, almost every woman is capable of sufficient milk production. Complete inability to breastfeed is extremely rare.

Except psychological mood need to take care of good nutrition. The food of a pregnant woman should be rich in proteins, minerals and vitamins. Equally important are normal sleep, regular walks, a complete rejection of alcohol and smoking, you should try to avoid overwork and unnecessary worries. Regular visits during pregnancy women's consultation and discuss in detail with your obstetrician-gynecologist issues related to the upcoming breastfeeding. Based on the examination of the mammary glands, he will be able to give specific recommendations for preparing for lactation.

About the influence of the shape and size of the breast on feeding

The size of the mammary glands does not affect the process of lactation. Practice shows that women with small breasts, even more often than those with large breasts, become excellent nurses. The problem usually occurs with flat or inverted nipples, regardless of whether your breasts are large or small. In these cases, starting from the 6th month of pregnancy, you need to massage and stretch the nipples. Can be worn special pads for their correction. If this is done regularly, a positive result occurs in most cases. It has a good effect on the lactation process cold and hot shower in the morning and a light stroking massage of the mammary glands before and after feeding.

Benefits of early breastfeeding

A healthy newborn has a well-developed sucking reflex, so it is best to breastfeed immediately after birth. A naked baby is placed on the mother's stomach and allowed to suck on the breast. Such close contact between them should last at least half an hour. During this time, the mother and child get out of the state of birth stress, their relationships are strengthened, all the senses of the newborn are actively included in the work. This tactic contributes to a more rapid development of the mechanisms of secretion of breast milk and subsequent sustainable lactation, since the suckling movements of the child give a signal for the formation of the hormone oxytocin in the mother's body, which stimulates milk production. This hormone also increases uterine contractions and accelerates the separation of the placenta, thereby preventing the mother from postpartum hemorrhage.

Contraindications for early breastfeeding

They exist, but they are few. This - serious illness kidneys, caesarean section, large blood loss during childbirth, negative Rh factor, diabetes mellitus. On the part of the child - an Apgar score at birth less than 7 points, asphyxia, birth trauma, hemolytic disease, severe malformations and profound prematurity. But even in these cases, the time between birth and first breastfeeding should be kept to a minimum. The shorter this time, the easier it is to establish normal lactation in the future. The necessary decision in each case must be made by the attending physician.

Feeding a child in the first days of his life

In the first day or two after childbirth, the mammary glands do not produce milk, but colostrum. It contains a high percentage of protein and minerals, therefore, even in small quantities, it satisfies the nutritional needs of the child in the first days of life. In addition, getting into the gastrointestinal tract of a newborn, colostrum ensures the maturation of the intestinal mucosa, which prepares it for normal digestion of food in the future. A faster “arrival” of milk in the mother in the first days after childbirth is facilitated by the frequent sucking of the breast by the baby, since its sucking movements provoke the release of hormones responsible for the formation of milk into the mother’s blood. That is why they are so important cohabitation from the first hours after birth. At the same time, the mother has the opportunity to feed the child on demand, and the child can choose for himself a more suitable mode of feeding, sleep and wakefulness. All this provides psychological comfort for both of them. In such conditions, the mother, as a rule, very soon begins to produce a sufficient amount of milk.

During the period of lactation, it is better not to give the child anything as a drink or supplement, except in cases due to medical indications, so how are u healthy newborn the supply of fluid and nutrients is sufficient to maintain its vital activity for several days after birth. To give a child a drink with a solution of glucose, boiled water, or, even worse, to feed him during this period with artificial milk mixtures is not only unnecessary from the point of view of the physiological needs of the newborn, but also harmful, since this reduces or perverts his sucking ability. As a result, the baby will suck badly at the breast or refuse it completely, and this, in turn, will make it difficult for the mother to become normal lactation.

How to know if your baby is getting enough breast milk

The vast majority of women (90-95%) can produce enough milk for their baby if they want to and if they feed the baby correctly and on demand. Free feeding (feeding at the request of the child) finds more and more supporters. It is more comfortable for babies both physiologically and physically. psychological point vision, and helps mothers to easily establish optimal lactation. When the child is hungry, he will definitely let you know about it, it is only important for the mother to carefully observe him and learn to distinguish “hungry” crying from any other. A hungry baby readily "takes" the breast and begins to suckle greedily. Satisfied, he himself lets her go and seems very pleased. To suck required amount milk, the baby usually needs 15-20 minutes.

To be sure that the baby receives enough milk, it is necessary from time to time to carry out control weighings of the baby before and after feeding and regularly monitor the parameters of his physical and emotional development. Once a month, you need to visit your pediatrician, who, when examining a child, can conclude whether he is receiving good nutrition.

A healthy child in the first half of the year, on average, gains weight from 500 g to 1 kg per month (at least 125 g per week). In addition, there is a very simple wet diaper test. If the baby is exclusively breastfed and at the same time urinates at least 6 times a day, then he has enough milk. The urine should be colorless or pale yellow. Sometimes it may seem to the mother that the child demonstrates a feeling of hunger more often than usual. As a rule, this occurs at the age of 2 - 6 weeks and 3 months, when children begin a period of more rapid growth. If during this period the baby is allowed to breastfeed more often, then the mother's milk production will increase, and the baby will soon return to the previous regimen.

What to do when there is not enough milk

First of all, do not panic and do not rush to start supplementing your baby with formula. If you feel that the child is malnourished, give him the breast more often than usual, in most cases, over time, milk begins to be produced in sufficient quantities for the child. You need to pay close attention to your diet, it should have enough protein foods and foods rich in vitamins and minerals. Do not forget about multivitamin complexes specially designed for pregnant and lactating women. The psychological and emotional attitude is important. Stop being nervous, try to calm down and focus on the thought that you have enough milk. In addition, there are a number of biologically active substances of plant origin that promote lactation. Drinks can be recommended carrot juice and radish juice, infusions of oregano, nettle, fennel, dill, cumin, anise, lettuce seeds. Pharmacies sell herbal preparations that enhance lactation. If this does not help, you can resort to special stimulants. These are nicotinic and glutamic acid, vitamin E (tocopherol acetate), dry brewer's yeast, royal jelly, apilac and other products. With persistent hypogalactia (lack of breast milk), the doctor may prescribe hormone therapy. If a woman is generally healthy and has a clear internal setting for breastfeeding, after using these drugs, sufficient lactation is restored in almost 100% of cases. Qualified advice on breastfeeding can be obtained at the round-the-clock consultation center at the maternity hospital No. 6 in Moscow by phone: 250-8456, 250-2908. If you still had to supplement the baby with formula, do it either from a spoon or from a special mug, it is better to refuse a bottle with a nipple. Otherwise, the baby will suck badly at the breast or may completely refuse it. In this case, lactation will decrease, and you will be forced to switch to artificial feeding.

Aids for normal lactation

There is currently a wide range of aids helping the mother to support breastfeeding. They can be used when there are difficulties associated with both the condition of the mother and the baby. For example, when sufficient milk is not produced even in response to the sucking reflex, normal lactation can be restored by frequent emptying of the breast with a breast pump, which is used every one to two hours. And when the child is not able to completely empty the breast, it can also be freed from milk residues by using a breast pump, which, in turn, is a kind of prevention of mastitis. They resort to his help even when the child is not able to suckle for any reason. However, the use of breast pumps is recommended only in cases where natural ways turn out to be ineffective. After childbirth, every woman should be trained the right way manual pumping, and first of all it is necessary to use them and only secondly - breast pumps. With flat and inverted nipples, special linings are used. During breastfeeding, nipples often crack. To speed up the healing process without interrupting breastfeeding, apply special cream based on 100% lanolin, vitamin A in oil solution, sterile sea ​​buckthorn oil and other means.

Natural feeding is the feeding of infants with mother's milk with the introduction of complementary foods from the 5th month. At the same time, the content of mother's milk in the daily diet should be at least 4/5. This type of feeding is the most physiological, its advantages are undoubted, since in its structure, mother's milk approaches the composition of tissues.

The most important benefits of human milk are as follows:

Ø Women's milk is completely devoid of antigenic properties, while cow's milk proteins have a pronounced antigenic activity, which contributes to the appearance and intensification of allergic reactions in infants. Refusal of breast milk if the child has allergic reactions is a gross mistake, although it is not uncommon for a child to be transferred from allergic reactions to artificial ones, usually fermented milk mixtures as if it gives a positive effect: the manifestations of exudative diathesis subside for a while. And everyone is happy - "allergy cured." In fact, at the same time, the allergen that came to him through mother's milk is excluded from the child's nutrition. In this situation, it was necessary to find and exclude from the mother's diet the allergen that causes a reaction in the child, and be sure to maintain natural feeding.

Ø The total amount of protein in breast milk is much less than in cow's milk, in structure it is close to the proteins of the child's cells. It is dominated by fine fractions, the particles of coarse casein protein are several times smaller than in cow's milk, which ensures curdling of breast milk in the stomach with more delicate flakes and thus easier digestion.

Ø Women's milk contains a unique substance taurine. It is a sulfur-containing amino acid with neuroactive properties.

Ø When artificial feeding, when feeding, protein overloads inevitably occur, since cow's milk contains 3 times more amino acids. These overloads are accompanied by intoxication, leading to a delay in the development of the child's central nervous system, as well as kidney damage due to metabolic disorders. It is known that schoolchildren who were breastfed during the first 4-9 months of life have higher intellectual capabilities compared to other children.

Ø Women's milk, especially colostrum, secreted in the first 3-4 days after childbirth, is very rich in immunoglobulins, mainly class A, with 90% secretory IgA, which plays a fundamental role in local immunity gastrointestinal tract of newborns. Breast milk leukocytes synthesize interferon; milk contains a large number of macrophages, lymphocytes, and the level of lysozyme is 300 times higher than in cow's milk. The composition of human milk also includes the antibiotic lactofelicin. Due to this, natural feeding ensures the formation of immunobiological protection of the infant, and therefore, the incidence and mortality among children receiving mother's milk are significantly lower than among children who are formula-fed.

Often, adult obesity is rooted in the early childhood. Artificial feeding contributes to obesity in infants. Many of them experience secondary obesity during puberty, which persists throughout their lives, mainly this is also associated with protein overfeeding.

Ø The amount of fat in women's and cow's milk is almost the same, but there is a significant difference in its composition: breast milk contains several times more unsaturated fatty acids. The development of atherosclerosis in adults is based on dyslipidemia, a large role in the occurrence of which is played by the absence of breast milk in the child's diet, especially in the first 5 months of life. The breakdown of fat in infants begins in the stomach under the influence of breast milk lipase; it stimulates the appearance of active acidity in the stomach, contributes to the regulation of its evacuation function and the earlier release of pancreatic juice. All this facilitates the digestion and absorption of fat, the individual components of which are part of the cells of all tissues and biologically active substances, are spent on the myelination of nerve fibers, providing an increased need for fats in a child of the first year of life.

Ø Carbohydrates in breast milk are relatively in large numbers. They largely determine the microbial flora of the intestine. They include β-lactose (up to 90%), which, together with oligoaminosaccharides, stimulates the growth of normal flora with a predominance of bifidobacteria, thereby suppressing the proliferation of pathogenic microorganisms and E. coli. In addition, β-lactose is involved in the synthesis of B vitamins.

Ø Women's milk is exceptionally rich in various enzymes: amylase, trypsin, lipase (lipases in breast milk are almost 15 times more than in cow's milk, and amylase - 100 times). This compensates for the temporary low enzymatic activity of the child's gastrointestinal tract and ensures the absorption of a fairly large amount of food.

Ø Importance for a growing organism, it has the mineral composition of food, the content of microelements in it. The concentration of calcium and phosphorus in breast milk is lower, but they are absorbed 2 times better than the same trace elements from cow's milk. Therefore, with natural feeding, children are much easier and less likely to get rickets. The content of trace elements (sodium, magnesium, chlorine, iron, copper, zinc, cobalt, sulfur, etc.) in breast milk meets the needs of the child. For example, women's milk contains 0.5 mg / l of iron, and 1.5 mg / l in milk mixtures, however, the degree of bioavailability is 50 and 5, respectively. That is why children who are breastfed are much less likely to suffer from anemia, therefore there is no need to supplement their diet with iron until 6 months of age. With artificial feeding, additional iron is prescribed from 4 months of age, usually in the form food products enriched with this trace element. Breast milk contains 4 times less sodium than cow's milk. Excess sodium loads can be the causes of vegetovascular dystonia with fluctuations blood pressure during puberty, as well as more severe and more frequent crises in adult hypertension.

Ø Breast milk differs from cow's milk in a higher content and higher activity of vitamins, in particular vitamin B metabolites, which also contributes to the prevention of rickets.

With artificial feeding, gastric secretion increases by 5 times, i.e., the programmed course of the biological clock of maturation is disturbed. In the future, this contributes to the development of gastrointestinal dyskinesia, gastroduodenitis, cholecystitis, especially in the presence of a hereditary predisposition.

It was found that adults who were in infancy breastfed, better sexual potency, higher fertility. The composition of human milk changes in the presence of intrauterine diseases, which is considered as a compensatory reaction to the development of fetal pathology.

With breastfeeding, a life-long relationship with the mother and its subsequent influence on the child are laid, and the future parental behavior of the child himself is formed. As observations have shown, in animals fed from a bottle, parental behavior is sharply perverted: when they become adults, they refuse to feed their offspring. Therefore, psychologists dealing with family relations attach great importance to natural feeding. Thus, the rejection of natural feeding is a gross violation of the biological chain "pregnancy - childbirth - lactation" that has developed in evolution.

In conclusion, it must be added that the mammary glands in a nursing mother, like the placenta in a pregnant woman, are a powerful barrier that rarely passes microorganisms, salts of heavy metals and other substances harmful to the child. Therefore, it is necessary to be quite careful about such, for example, recommendations as refusing breastfeeding and transferring the child to formula milk due to the unfavorable environmental situation in the area.

Rare attachment of the child to the breast in the future, regulation of breastfeeding, a purely technical approach to controlling the process of lactation. Insufficient lactation is not a contraindication to frequent application to the chest. On the contrary, it is recommended frequent feeding, after 2-2.5 hours without a night interval. Frequent and unrestricted breastfeeding in the first 2 weeks. life (an average of 9 times a day) significantly increases lactation. In the 1980s, many developed countries began to abandon the strict regulation of breastfeeding. It is impossible to attach too much importance to the amount of sucked milk, especially with a single control feeding, since the appetite of children during the day may be different. In addition, the composition of women's milk, and, consequently, the need for it, are extremely variable: for example, the protein content in the milk of different women ranges from 0.9 to 2 grams. in 100 ml. The composition of the tissues of the child is individual, and his mother's milk is always suitable for him, but may not be suitable for another child. Therefore, feeding children with donor milk is not absolutely identical to natural.

As a rule, the mother's mammary glands produce as much milk as the child needs. It is better to feed from both glands, especially if there is not enough milk, as this stimulates lactation and also reduces the risk of lactostasis. If after feeding milk remains in the mammary glands, it is necessary to express it until it flows in a trickle (and not drips).

Treatment of hypogalactia: nicotinic acid, vitamin E, UV, UHF, ultrasound, vibration massage, acupuncture, terry cloth compresses moistened hot water, on the mammary glands. Phytotherapy is used: a decoction of nettle leaves, 1 tablespoon 3 times a day (4-5 tablespoons of nettle are brewed in 1 liter of water); hawthorn extract 20-30 drops 3-4 times a day before meals for 10-14 days. Use infusions of dandelion roots, oregano, dill, anise.

The calculation of the required amount of food occurs when the child's body weight does not increase enough or he is restless between feedings.

It is also required to determine the dose of nutrition when feeding with expressed milk and its substitutes.

Most in a simple way counting the amount of milk necessary for a newborn in the first 9 days of life, is as follows: 10 ml is required for a single feeding. milk multiplied by a day of life (with 6-7 meals a day). From the 10th to the 14th day, the daily volume of milk remains unchanged. From 2 weeks of age, the required amount of milk is determined taking into account the daily calorie requirement for each kilogram of body weight.

Daily need for kilocalories per 1 kg. body weight is :