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Lecture notes, cheat sheets
Childhood diseases. Feeding children. Prevention of hypogalactia. Characteristics of infant formula (lecture notes)
Directory / Lecture notes, cheat sheets Table of contents (expand) LECTURE No. 2. Feeding children. Prevention of hypogalactia. Characteristics of milk mixtures Feeding a child in the first year of life with human milk is called natural. In the process of sucking, the jaw apparatus, muscles of the mouth and tongue develop, and the correct bite is formed. Breastfeeding of the child by the mother has a beneficial effect on the development of the central nervous system of the child and his mental activity. Quantitative differences between women's milk and animal milk: the total amount of protein is approximately 2 times less than in cow's milk, and the amount of carbohydrates is 2 times more. It is generally accepted that on average 100 ml of human milk contains 1,2 g of protein, 3,5 g of fat, 7,5 g of carbohydrates. The energy value of 100 ml of human milk is 70 kcal. Qualitative differences between women's milk and animal milk: in women's milk, the content of lactoalbumin, lactoglobulin, immunoglobulins is much higher than casein. The content of amino acids in women's milk is less than in cow's milk, but their ratio is more consistent with the needs of a child in the first year of life. Hydrolytic enzymes contained in human milk and involved in the breakdown of protein are of great importance. Triglycerides are the main component of fat in human milk. The amount of milk sugar - lactose - in women's milk is greater. Qualitative differences lie in the different isomeric structure of milk sugar: human milk contains β-lactose, and cow's milk contains L-lactose. α-lactose is absorbed more slowly in the small intestine than β-lactose, and has time to reach the large intestine and stimulates the growth of gram-positive bacterial flora. β-lactose stimulates the synthesis of B vitamins and affects the composition of lipids, reducing the content of neutral fats and increasing the content of lecithin. Human milk contains oligoamino sugars, which stimulate the growth of bifidobacteria. The total amount of mineral salts in women's milk is less than in cow's milk, which makes it possible to avoid the retention of osmotically active ions in the body of a child in the first months of life, which has a low excretory function of the kidneys. In human milk the ratio between phosphorus and calcium is 1:2, and in cow's milk it is 1:1. The amount of vitamins in human milk depends on the time of year and on the vitamin value of the nursing mother’s food. On average, human milk contains significantly more fat-soluble vitamins (A, D, E) than cow's milk. The first breastfeeding should take place in the delivery room 20-30 minutes after birth. During the first application, skin-to-skin contact is very important. The duration of the first contact should be at least an hour. Early breastfeeding also contributes to good uterine contractions in the postpartum period. Preparing women for successful breastfeeding: in the first half of pregnancy, nutrition does not require special correction, it is only important to provide sufficient vitamins and minerals, rich sources of which are vegetables and fruits. In the second half of pregnancy, when the weight of the fetus begins to increase rapidly, the woman’s need for basic nutrients (protein, minerals) increases. It is advisable that the diet include about 500-600 ml of milk or fermented milk products, 100-150 g of cottage cheese, 100-200 g of meat or fish, 500-600 g of vegetables, 200-300 g of fruits or berries. By the end of pregnancy, in order to avoid too much weight gain, it is advisable to somewhat limit the amount of carbohydrates in the diet by reducing the consumption of bread, confectionery, and sugar. For sufficient provision of the body with vitamins during pregnancy, it is recommended to take B vitamins and ascorbic acid. Contraindications for early attachment of the child to the mother's breast: on the part of the mother, these include moderate and severe nephropathy, operative delivery, large blood loss during childbirth, perineal ruptures of I-II degree, purulent-inflammatory diseases of the mother, Rh-negative blood, as well as severe extragenital diseases; on the part of the child, these include an Apgar score below 7 points, asphyxia, birth trauma, hemolytic disease of the newborn, malformations, prematurity, respiratory distress syndrome. Contraindications to feeding with mother's milk: metabolic disease (galactosemia, phenylketonuria), mother taking cytostatics, radioactive drugs. Despite a sufficient amount of milk from the mother, the baby needs to be introduced to complementary foods at 5-6 months. Lure - This is an additional type of food of animal or plant origin. Rules for introducing complementary foods: complementary foods are introduced only to a healthy child, after doubling body weight; Complementary foods should be given before breastfeeding, starting with 5-10 g, gradually increasing to 150 g. In the second half of the child’s life, the volume of complementary foods should not exceed 180 g. A new type of complementary food is introduced after complete adaptation to the previous one. Complementary feeding dishes should be homogeneous in consistency and should not cause difficulty in swallowing. As you age, you need to move on to thicker and then denser foods. Complementary foods are given warm with a spoon in a sitting position. When introducing complementary foods, you should monitor the baby's skin and stool: if it remains normal, then the next day the amount of complementary foods should be increased. You cannot combine the introduction of complementary foods with preventive vaccinations. The first nutritional supplement is administered in the form of fruit juice at 3-3,5 months, starting with 1-2 tsp, increasing the amount to 20-30 ml. Fruit puree is administered 3-4 weeks after juice (from 3,5-4 months), starting with 3-5 g, increasing to 10-12 ml by 80-100 months. At 5 months, the first complementary meal is introduced, replacing one feeding - vegetable puree from zucchini, carrots, potatoes. You can not add onions, garlic, spices. At 6 months, porridge from rice, buckwheat, corn is introduced, starting with 50 g, increasing to 150 g (you cannot start complementary feeding with semolina porridge!), cottage cheese in the amount of 3-5 g/kg, and cookies. From 7 months, ripe fruits, minced meat, and yolk (1/4-1/2 part) are introduced. From 8 months they introduce kefir, bread. From 9 months, the child is given fish instead of meat 1-2 times a week. By the year steam cutlets. Artificial feeding - this is feeding, in which the child in the first half of life receives not breast milk, but milk mixtures as the main food. Currently, numerous dry formulas used for artificial feeding of healthy children can be divided into four groups. Group I - adapted mixtures (cow's milk is used for production, and adaptation is reduced to a decrease in the content of protein and calcium salts in it). These include "Nan", "Nutrilon", "Heinz", "Enfamil". Group II - partially adapted mixtures (they are partially close to the composition of human milk). These include "Baby", "Baby", "Milumil". Group III - subsequent formulas, i.e. milk mixtures intended for nutrition at a subsequent age stage. These include "Hipp-2", "Enfamil-2". Group IV - non-adapted mixes "Krepysh", "Health". Mixed feeding - this is feeding, in which the child in the first half of life receives mother's breast milk and supplementary feeding, i.e., milk formula, since complementary foods cannot be prescribed to the child by age. The reasons for transferring children to mixed feeding are hypogalactia in the mother and social factors (for example, when the mother goes to work). Hypogalactia is a decrease in the secretory ability of the mammary glands. There are early hypogalactia, developing in the first 10-14 days; late - at a later date; primary of neuroendocrine origin and secondary, caused by poor nutrition, violation of the daily routine, somatic and infectious diseases of the mother. Lactation crises are a decrease in the amount of milk without external reasons. They are observed in the first 3 months of lactation, sometimes after 6-8 months, the duration of transient hypogalactia is 3-4 days, rarely - 6-8 days. Prevention. Put the baby to the breast as often as possible, avoid nervous stress and mental stress, take medications that enhance lactation, ensure good nutrition by drinking carrot juice, infusion of dill, anise and infusion of walnuts (1/2 cup of walnuts, brew 1/2 liter boiling milk in a thermos and infuse for 3-4 hours, take the infusion 1/3 cup 20 minutes before breastfeeding). Author: Gavrilova N.V. << Back: History of domestic pediatrics, organization of maternity protection. Childhood periods >> Forward: Constitutional anomalies in children. Diathesis options (Allergic diathesis. Exudative-catarrhal diathesis. Lymphatic diathesis. Neuro-arthritic diathesis)
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