FEEDING THE CHILD THE FIRST YEAR OF LIFE

Depending on whether the child receives breast milk and in what quantities, are three
types of feeding: natural, artificial and mixed. '

Breastfeeding

Natural feeding - feeding infants breast milk mothers with subsequent introduction of
complementary foods with 4,5-5 months. The content of breast milk in the daily diet
of the child is at least 4 / 5.

This type of feeding, the most physiologic, as well as on quantitative and qualitative
composition of breast milk optimally cover all the needs of the child in proteins, fats,
carbohydrates, vitamins, mineral salts, etc. In the first 5 days after birth from breast
parturients allocated colostrum, which has a higher energy value than breast milk
secreted later. Colostrum in more protein, phosphorus, calcium, vitamins A and E,
less fat.

The most important benefits of breast milk

The breast milk is dominated by fine proteins (albumin), casein particle size is
several times less than in the cow, resulting in the curds in the stomach produce more
delicate, easily digestible flakes. The composition of breast milk to best meet the
needs of the child. The total amount of protein in breast milk is less than in
cow. Therefore, when artificial feeding occurs protein overload.

Breast milk (especially the colostrum) is rich in Ig. IgA plays an important role in
local immunity of the digestive tract of newborns. IgG, trapped in the body of the
child, provide passive immunity against many infectious diseases. In addition, breast
milk contains factors of specific and nonspecific resistance.

According antigenic properties of breast milk (unlike cows) is less alien to the child.

Breast milk contains an optimal set of enzymes, vitamins and other essential
components of a child.

The concentration of fat in breast and cow's milk is virtually the same, but the
qualitative composition is different: breast milk contains several times more
polyunsaturated fatty acids that serve as essential components of phospholipids and
constituent of cell membranes. Splitting of fat in the stomach in infants begins under
the influence of lipase of human milk.
Breast milk contains a large amount of carbohydrates (p-lactose) in the cow is a-
lactose. [J-lactose slowly absorbed in the intestines of the child, and therefore reaches
the colon, where together with oligo-aminosaharidami stimulates the growth of
normal flora (mainly bifidobacteria), which suppresses the reproduction of pathogenic
microorganisms and E. coli.

Breast milk is rich in various enzymes: amylase, trypsin, lipase (lipase in breast milk
than in cow's nearly 15 times, and amylase - to 100-fold). This compensates for the
temporary low activity of enzymes in the assimilation of the child and provides a
fairly large amount of food.

The concentration of calcium and phosphorus in human milk is lower than in cow, but
their relationship more physiological for the baby, are mastered they are much
better.Therefore, children in the breastfeeding, rickets develops less. The content of
elements such as sodium, magnesium, chlorine, iron, copper, zinc, cobalt, sulfur and
selenium in breast milk and optimally meet the needs of the child. For example, breast
milk contains 0.5 mg / l of iron, infant formula and -1.5 mg / l, but the extent of its
biological availability is 50% and 5% respectively. That is why children in the
breastfeeding is much less likely to suffer from anemia, and up to 6 months of age
there is no need to add to their diet of iron. With artificial feeding iron appoint an
additional 4 months in the form of fortified food products.

When breastfeeding is formed psychological relationship between mother and child,

develop parental feelings.

Thus, the abandonment of breastfeeding - a gross violation of prevailing in the

evolution of biological chain "pregnancy, childbirth, lactation." Breast milk - the gold
standard for infant nutrition.

Hypogalactia

The main reason for not breastfeeding - hypogalactia, ie secretory insufficiency of the
mammary glands. * Allocate primary and secondary hypogalactia.

Primary hypogalactia develops as a result of neuroendocrine disorders in women.

In most cases hypogalactia is a secondary that has developed because of the negative
impact on the mother complex biological, medical, social, psychological and
economic factors. The leading role belongs to social factors and causes of iatrogenic
nature.
According to WHO, only 1% of women can not breastfeed. In our country, more than
10% of mothers do not breast-feeding from birth. By 6 months of breastfeeding are
less than a third of children, with about 66% of mothers begin to introduce yourself
Fattened with 2 weeks of life. The main reasons hypogalactia following.

Lack of motivation to breast-feeding woman.

-- For the active promotion of breastfeeding should be close collaboration obstetric

and pediatric services. It should bring a positive motivation for breastfeeding among
pregnant women. Parents need to know about the benefits of breastfeeding for the
child and its beneficial impact on the health of women. We should not forget about the
contraceptive effect of breastfeeding, which is associated with the inhibitory effect of
prolactin on ovulation. In LAM and exclusively breastfed the risk of getting pregnant
in the first 6 months after childbirth is 2-5%. Contraceptive effect of breastfeeding
decreases when more rare the baby's chest.

-- In 60-70-ies. XX century in some countries have been organized group "to

promoting breast-feeding, where the consultants were mothers, suckled at least one
baby. The organization of such groups in a few years led to an increase in the
prevalence of breastfeeding.

Later than the first apposition to the chest. Contraindications to the early
(immediately after birth) apposition to the chest is very small. In foreign countries, the
vast majority of newborns are breastfed immediately after birth. In Russia, it occurs
only in 20% and 40% of a healthy child is applied to the chest one day after birth.

-- In some countries women are forbidden to give information on artificial feeding

during the first 3 months after birth; also prohibited advertising infant formula in
maternity wards and hospitals.

Rare the baby's chest, the regulation of breast-feeding, the technical approach to
monitoring the process of lactation.

-- Insufficient lactation is not seen as a contraindication to frequent apposition to the

chest. Conversely, recommend more frequent feeding (in 2-2,5 hours, without night
interval). Frequent and unrestricted breastfeeding in the first 2 weeks of life (9-10
times a day and more) significantly enhances lactation. Often to 2 months of age the
child himself, provides the regime - 7 times per day, ie every 3 h with 6-hour
nocturnal interruption. You should not attach too much importance to the number of
intake of milk, especially during a single feeding control, as well as children during
the day can drain different amounts of milk at different times. In addition, the
composition of breast milk is extremely variability (eg, protein content in milk of
various women ranged from 0,9 to 2,0 g per 100 ml).

-- Typically, the mother produced as much milk as a baby needs. To 1-2 months of
life during one feeding is better to give the child both breasts, as it stimulates lactation
and reduces the risk galaktostaza. If after feeding in the breast milk remains, it is
necessary to decant until it begins to stand out in drops (not streams). If the mother
has a lot of milk, it is better for one to give a breast-feeding, and the next feeding -
another child to receive a sufficient amount of fat (in the latter portion of human milk
fat in 1,5-5 times higher than in milk, emitted the beginning of feeding).

-- Often women experience "lakta1 | ion crises, usually their frequency - about 1.5
months, duration - 3-4 days (at least 6-8 days). At this time, to increase the number of
feedings. Unacceptable immediately finish feeding mixtures.

-- Sometimes, even when adequate filling of the mammary glands may be "hungry"
anxiety of the child due to a graded increase in its energy needs due to increased
motor activity. This is most typically in 3, 6 weeks, 3,7, 11 and 12 months. Typically,
in most cases, the increased activity of the child suck leads to an increase in lactation.

Violation of the regime of the day nursing women (excessive physical and mental
stress, lack of sleep) decreases lactation. Other reasons (violation of the diet, different
diseases, age, nursing women) play a minor role in the development of hyper-
pogalaktii.

-- Nursing mothers to eat a greater effect on the qualitative composition of milk than
its quantity.

-- Diseases of the mother suppress lactation. However, if a woman has during

pregnancy, was configured for lactation, lactation she often remains at a satisfactory
level.

-- In all the countries least likely breastfeed too young and elderly mother. In the
elderly is explained by biological reasons, the young, social and psychological (lack
of family planning, often accidental conception, the lack of attitude to breastfeeding
during pregnancy, etc.).

Correction hypogalactia. We should transfer the child to more frequent feeding. Are
important mode of nutrition and nursing women. In order to enhance lactation, use of
niacin, vitamin E, prescribe herbal medicine [decoction of leaves of nettles, hawthorn
extract, fresh parsley leaves, infusion of walnuts in the milk, laktovit (herbs) and
others]. The good effect is registered after the UV, ultrasound therapy, massage,
acupuncture, packs on the breasts. Please note that the drugs have less effect than the
methods of physiological stimulation of lactation.

Calculating the amount of food

The simplest way to calculate the daily amount of milk for a newborn in the first 9
days of life is this: his age (in days) multiplied by 70 (birth weight less than 3200 g) or
80 (birth weight over 3200 g). From 10 th to 14 th day of the required daily volume of
milk remains unchanged (as for the 9-day child).

With 2 weeks of age required amount of milk is calculated taking into account the
daily energy requirements (in calories or joules) per kilogram of body weight or the
volumetric method, when the necessary amount of food is a percentage of body
weight of the child.

Energy (energy) calculation method: in 1 st quarter of the first year of life a child
should be 115-120 kcal / kg / day (502 kJ / kg / day), in 2-w - 115 kcal / kg / day (480
kJ / kg / day), in the 3rd - 110 kcal / kg / day (460 kJ / kg / day), 4 th - 100 kcal / kg /
day (440 kJ / kg / day). Knowing the age and weight of the child, calculate the amount
of milk needed child per day (X). For example, a child at the age of 1 month has a
weight of 4 kg and, therefore, needs to be 500 kcal / day. 1 liter of breast milk
contains about 700 calories, hence:

X = (500 x 1000) - 700 = 710 ml

- WHO experts believe that in today's recommendations, the energy requirement of an

infant in the energy, perhaps overstated by 15-30%, especially after 3 me
life.According to their data, at the age of 4.10 months consumption for 1 kg of body
weight should be 95-100 kcal.

The volume calculation method (Table 3-1) is more simple but less accurate. For
instance

measures, a child aged 1 month weighing 4 kg to 600 ml of breast milk per day (1 / 5
of 4 kg), ie no complete coincidence with the calculation of calories. All variants of
the calculation can only be estimated to determine the necessary amount of food. The
daily amount of food the children the first year of life should not exceed 1000-1100
ml (not

Table 3-1. The daily volume of food needed infant

Age The volume of food

2 -- -6 Weeks 1 / 5 of body weight
6 week-4 months 1 / 6 weight
4 -- -6 Months \ / 1 body weight
6 -- -9 Months 1 / 8 of body weight
9 -- -12 Months 1 / 9 of body weight

consider juices and fruit puree). It should be borne in mind that the need of the child
in the amount of milk is individual.

Qualitative composition of food

Relationship between the main food components (proteins, fats, carbohydrates) before
the introduction of complementary foods should be 1:3:6, after the introduction of
complementary foods - 1:2:4. To 4-6 months of protein requirements of 2-2,5 g / kg,
fats - 6,5 g / kg, carbohydrates - 13 g / kg, and after the introduction of
complementary foods - respectively 3-3,5, 6-6, 5 and 13 g / kg.

Power Mode

Power Mode set depending on the child's age, individual characteristics and the
quantity of milk from the mother. In the first 3-4 months of life of healthy term infants
fed 7 times a day, ie every 3 h with 6-hour nocturnal interruption. If a child can
withstand longer intervals between feedings, it is transferred to the 6 single and 5-one-
time feeding.With 4,5-5 months, most children are fed 5 times a day, after 9 months -
4 times a day. When disturbed at intervals between breast-feeding is water without
sugar or lightly sweetened, it is possible with a few drops of lemon juice. Some
children refuse to water, as their need for fluid is completely satisfied with the milk.

Baby food and nutrition quality correction

By 4-6 months of life feeding only breast milk can no longer meet the needs of the
child organism in nutrients, so this age are beginning to lures (Table 3-2).

Table 3-2. The timing of and types of foods

Age Type bait

4,5-5 months Vegetable puree: first monoovoschnoe (squash, pumpkin, cabbage),

then perhaps a combination of vegetables
5,5-6 months Kashi: first, rice, buckwheat, corn, and later - oatmeal,
Semolina
7,5-8 months Kefir, a children's yogurt
Baby food - the introduction of new foods, gradually and consistently replacing one
breastfeed. Currently, up to 4 months (in some countries, up to 6 months) is not
recommended to give the child something in addition to breast milk. If a child of the
first months of life revealed some deficiency, it is better not to make up his
appointment early in the juices and purees, and vitamins and other drugs, specifically
designed for infants.

The first solid foods is prescribed in 4,5-5 months as a vegetable puree, with a better
start with monoovoschnogo puree. After 1-2 weeks to prepare mashed potatoes, you
can use a variety of vegetables (carrots, beets, turnips, peas, cabbage, later, from 6
months - potato). Only when a large variety of vegetables, the child receives needed
for a growing range of body trace elements and vitamins. Vegetables are boiled, then
rubbed through a sieve. The resulting mass of diluted to a consistency of thick cream
vegetable broth or milk mixture and give a child with a teaspoon. It is now widely
used vegetable purees, cooked industrially produced specifically for infants. These
advantages include the homogeneity of the puree , the greater their diversity, long
shelf life, ensuring the needs of children in a wide range of different products
throughout the year regardless of the season, the speed of cooking.

From 5-6 months introduce second complementary foods - porridge. Thus, for 7
months, two breast-feeding is replaced by two complementary feeding. Given that the
child had time to get used to the dense foods, getting vegetable pure, you can begin
immediately with 10% of porridge. First recommend buckwheat, rice, corn gruel, and
later - oatmeal, semolina. It is better to use ready-made porridge industrial production,
as their composition is not whole cow's milk, and adapted, that is as close in
composition to human milk, infant formula. In baby food should not add extra salt.

At 8 months the child replace another feeding of complementary foods (kefir, a

children's yogurt).

Baby food is always given to the baby's chest. Portion vegetable puree is typically
100-150 g, oatmeal, yogurt - about 200 g.

In addition to feeding the diet of the child is introduced, and other products needed for
the correction of its nutritional quality (Table 3-3).

Table 3-3. Timing the introduction of products for the correction of high-quality child nutrition

Age, months Products

4.6 Juices (apple, then plum, cherry, lemon);

fruit puree of apples, bananas, pears, etc.
4.6 Vegetable oil, butter, melted (3-5 grams per day)
6.7 Egg yolks
7,5-8 Curd (20-40 g per day)
7,5-8 Meat (ready-made mashed potatoes with pork, turkey, rabbit, horse,
beef, veal)
8.9 Fish (usually ready-made mashed potatoes with vegetables), given 1-2 times a week
instead of meat

Typically, at the age of 4 months the child give the clarified apple juice from 1 / 2
teaspoon and gradually bringing the volume of juice before the age norm (in order to
calculate the necessary amount of juice per ml, the child's age in months multiplied by
10). Later introduce other juices. Juices and fruit purees give directly before or after
feeding, sometimes in between. Recommendations for the appointment of juices and
fruit puree should not be too categorical. It is quite possible their introduction in 2-3
weeks later or earlier.

4-6 months is introduced, alternating, butter and vegetable oil. Vegetable oil is
necessary as a source of polyunsaturated fatty acids. Usually, oil is added to vegetable
purees.

From 6-7 months give a hard-boiled egg yolk: first by 1 / 2 egg yolks 2 times a
week, followed by 1 / 2 a day, by 1 year - 1 egg yolk a day.

Quark recommend designate 7-7,5 months, no more than 20-30 grams per day.

With 7,5-8 months the child receives the minced meat (first 20-30 grams a day later
- 50-60 g). It is added to vegetable purees. Even in the lean beef high in saturated fatty
acids. Currently, many dieticians recommend to refrain from the appointment of beef
broth in the first year of life and to prepare the vegetable soup broth. According to
testimony (at the use of mixtures of lactose, such as soy or prepared on the basis of the
protein hydrolyzate) designate specially prepared in an industrial setting meat sauce
with a 5 -- 6 months.

From 8-9 months a child can be given instead of meat fish 1-2 times a week.
Forcemeat to 10 months given in the form of meatballs in 12 months - in the form of
steam

cutlets. At the same time introducing bread and apple slices. In 12-16 months am
breastfeeding replaces adapted feeds from bifidobak-teriyami or yogurt with cookies
and crackers, whole cow's milk. Then just come with an evening feeding. Tea and
coffee should be avoided especially up to 2 years. By the end of the first year of life is
transferred to food from a common table, but mechanically and chemically
gentle. Meals should be balanced on the main ingredients and provide intensive
metabolism of the child.

Planned weaning gradually leads to the extinction of lactation. To avoid indigestion

impractical to stop breast-feeding in the hottest time of year, with an acute illness of a
child, at the time of immunization.

In conclusion, consider the exemplary menu of children of different ages.

At the age of 6,5 months: 6h - breast milk;

10 h - 10% porridge (150-180 ml), 1 / 2 egg yolks, fruit juice (50 ml) 14 h - breast
milk;

18 h - vegetable puree (150 ml), grated apple (30 g), 22 h - breast milk.

At the age of 8,5 months: 6h - breast milk;

10 h - porridge (150 ml), 1 / 2 egg yolks, fruit puree (50 g) or fruit juice (50 ml);

14 h - minced meat (20 grams), vegetable puree (150 g), juice (30 ml) 18 h - yogurt
(160 ml), curd (20 g), 22 h - breast milk.

Errors breastfeeding

When breastfeeding The most common errors.

1. Later than the first apposition to the chest.

2. Excessive regulation of breast-feeding.

3. Needless categorical recommendations on the appointment of juice, fruit puree,

vegetables, cereals, cheese, meat.

4. Weaning th 3 - 3a accept her medicines.

5. When an unstable chair, caused by a relative lactase deficiency or transient

laktazts 0 th failure, this chair mistakenly regard as a manifestation of staphylococcal
enterocolitis.

6. When mzstnte & gshzyvzh>? Xia Horsham -97% even with milk from healthy
breast. On the first four errors mentioned above. Let us dwell in more detail in the last
two.
 Often, the mother complains that the child's first 2 months of life there are fragile
and sometimes a rapid chair, occasionally mixed with green slime, almost constant
flatulence, intestinal colic, although the child remained calm, sucking good, body
weight increases. Often in this situation, after a preliminary seeding feces and breast
milk and baby mother is diagnosed with staphylococcal enterocolitis, although the
possibility of getting MRSA if pumping milk, and its detection in the feces may be a
sign of transient dysbacteriosis. Unsustainable chair by the children during the first 2
months of life, usually associated with lactase deficiency. It can be primary
(hereditary), but in most cases is transient and occurs in premature babies, children
with intrauterine hypotrophy, pr, and various inflammatory diseases, antibacterial
therapy , dysbacteriosis. Chance and relative lactase deficiency, associated with a high
concentration of lactose in breast milk or the immaturity of the digestive tract (even in
healthy children). In such cases, helps to translate mother at 3-4 weeks of dairy-food,
which often even improves lactation. A good effect is the appointment of probiotics
(bifidum-bakterina, lineksa, primadofulyusa, etc.) short course.

* Question of the possibility of breast feeding in mastitis remains controversial. In 60-

70-ies. XX century there was a strict ban on the second and even a healthy breast-
feeding in other disease, n 0, in recent years some pediatricians admit the possibility of
feeding in the early stages of mastitis is not only healthy, but the patient
chest.However, the appearance of pus in the milk of breast-feeding expressly
prohibited.

Artificial feeding

Artificial feeding is known in infants breast-milk substitutes - special blends, prepared

mostly from cow's milk.

Mixtures are divided into simple and adapted, that is as close in composition to human
milk. In addition, the mixture is divided into acidic and fresh, native and dry. At
present, the acid mixture is considered as therapeutic option.

Simple (non-adapted) mixture

By the simple (not adapted) sweet native mixtures include in-RIS-buckwheat, oats, B-
containing 2 / 3 milk and 1 / 3 groats broth with added sugar. In-kefir (2 / 3 yogurt and
1 / 3 conjee ) - a simple mixture of acid. In-appointed with a mixture of 3 weeks to 3
months of life. Then they are replaced in whole kefir supplemented with 5% sugar. A
similar composition and nutritional value are dry mixes such as "burly", "Health" with
the decoction of cereals or flour.

Adapted mixture
For the artificial feeding of infants are currently using only adapted infant formula.
They have almost completely replaced the simple mixture, since the high content of
protein and minerals in the diet when feeding formula not adapted adversely affects
the health of the child. Pre-treatment of cow's milk is aimed at reducing the protein
content in it, salts of calcium, sodium, enriched with vitamins, trace elements,
lysozyme, etc. Nutritional value of mixtures of adapted approaches to breast milk, so
the rules of feeding them close to those observed in breast-feeding (the same
calculation for the energy value, the same number of feedings per day, the same time
the introduction of complementary foods). Excrete dry fresh and fresh native breast
milk substitutes. Method of preparation, shelf life of the mixture and the age of the
child, for which the mixture are shown on the package.

Whole milk

At present, strongly recommend the use of whole cow's milk for nutrition of children
up to a year, as it leads to shortages of various trace elements such as zinc, copper and
iron. Often parents question about the possibility of the appointment of goat's
milk. Goat's milk is largely similar to mad cow, but it is even less of folic acid and
vitamin B, 2.Fat goat's milk is absorbed better than cow. Proteins of both milk
immunologically different, so children with intolerance to cow's milk can digest goat's
milk. In addition, proteins of goat's milk easier to digest and assimilate. And, both the
milk can be used for the preparation of adapted milk mixtures. There are currently
adapted mixture of goat's milk NANNY. Our studies show promising application of
this mixture in the diet therapy of food allergy in infants.

Treatment of the mixture

In recent years, mixes for therapeutic feeding. Basis of them can be different - milk,
soy protein hydrolysates.

I. Mixtures based on milk.

Mixtures used in preterm or low weight baby for treatment of malnutrition I and II
degrees (for example, "" Alprem "," Pre-Nut-rilon "etc.).

No-and nizkolaktoznye (for example, "Nutrilon", "Humala" etc.).

"Laktofidus" - a dry sour mix, having lactase activity (lactose is not reduced).

Sour milk, completely or partially adapted (containing pre-and probiotics) mixture

(for example, "NAS-fermented, oxyphilic" Baby "; non-adapted - different types of
yogurt).
 Adapted mixture based on goat's milk ( NANNY).

II. Mixtures based on soy protein (eg, "Alsoy", "Nutrilon-soy" and so on). Sh mixtures
based on protein hydrolysates.

With a low degree of hydrolysis of the protein, when used moderately forms of
digestive disorders, malnutrition II degree (for example, "Hipp-HA-1", "Frizopep-1",
etc.).

With a high degree of hydrolysis of protein, used in severe forms of digestive

disorders, malnutrition III degree (for example, "Alfaro", "Nut-rilon-peptidyl" and so
on).

IV. Treatment of the mixture assigned at regurgitation, vomiting, colic, constipation;

antireflux mixture (for example, "Nutrilon", "Enfamil" etc.).

Treatment of the mixture is widely used for prophylaxis and treatment of intestinal
disorders, dysbacteriosis, allergic reactions. However, it should be remembered that
these mixtures prescribed for therapeutic purposes. Each of these mixtures has its
drawbacks.

Mixtures of fermented milk is recommended to replace not more than 50% of the
daily volume of food. The physiological effect of these mixtures is high: they will
normalize intestinal motility, increase the absorption of proteins, it is easier be
transferred to the latent lactase deficiency. However, dairy products irritate the
mucous membrane of the digestive tract. In the adapted-milk mixtures acidity in 2
times less than in the not adapted, so latter (kefir, yogurt) imposed no earlier than 8
months of life.

'Children with cow's milk protein intolerance is sometimes prescribed soy mixture,
where animal protein is replaced by vegetation. However, in the diet of an infant share
of animal protein should be at least 90%, which is necessary for its rapidly developing
organism. In soya blend and no lactose.

In more severe cases for treatment of children with lactose, whole milk is used a
mixture prepared on the basis of hydrolyzed proteins containing free amino acids and
oligopeptides. But we must remember that they were appointed only on the testimony,
with no effect on others, such as lactic acid, mixtures of limited time. Thus, mixtures
containing protein hydrolysates, are used for 2-4 weeks, gradually moving to full
mixture.
Errors in artificial feeding

Too frequent changes in the diet (replacement of one mixture to another).

Restricting the diet and the transfer of the child to a different mix with the slightest
deterioration in his chair.

Appointment of sour mix in large quantities.

Translation therapeutic mixture (soy, based on the hydrolyzate of protein) with

minor manifestations of allergy.

Mixed feeding

If insufficient milk from mothers injected Fattened the same milk formula as that of
artificial feeding. First, give the child the breast, and only after full discharge finish
feeding mixture. In order to maintain lactation, children are breastfed often. The
alternation of breastfeeding and formula is undesirable because it leads to a decrease
in lactation and impairing the digestion of components of cow's milk. Introducing
Fattened recommend a pacifier with a small hole, as with the free flow of lactation aid
from the bottle baby may refuse the breast. As with artificial feeding, the child's needs
in terms of calories, proteins, fats, carbohydrates, timing the introduction of
complementary foods depends on the type of infant formula used in the lactation aid.