Milk mixtures for artificial nutrition of infants. List of the best adapted and highly adapted infant formulas Highly adapted infant formulas list

1. Fresh: sterilized milk, fortified milk, etc.

2. Sour-milk: biokefir, bifidokefir, bifitate, biolact, acidolact, Evita, Narine, etc.

Scheme 7.Health food dietary products

1. Formulas for premature and low birth weight infants:

Bellakt-PRE, PreNAN, Nenatal, Pre-Nutrilak, Pre-Tutteli, Frisopre, Enfamil Premature, Humana 0, Pre-Nutrilon, etc.

2. Mixtures for children with functional disorders gastrointestinal tract (regurgitation syndrome, intestinal colic, constipation): "Bel-lact AR+"; "Grandmother's basket Antireflux BIO", "Nutrilak AR", "Nutrilon AR", "Frisov-1, 2", "Humana AR", "Samper Lemolak", "Sam-per Bifidus", "Enfamil AR", "Nan sour milk -1, 2" and others.

3. Formulas for children allergic to cow's milk proteins: A) based on soy protein isolate("Bellakt-Soy", "NAN Soy", "Humana SL", "Nutrilon-soy", "Frisosoy", "Enfamil-soy", "Nutrilak-Soy", "Similak-Izomil", "Heinz", " Soy Tutteli", "Gallia soy", "Soy Semp");

b) milk protein hydrolysates: casein ("Nutramigen" and "Pregestemil", "Alimentum"); whey ("Alfare", "Nutrilon-Pepti TSC", "Hipp", "Frisopep", "NAN GA-1, 2", "Peptidi Tutteli", "Humana GA-1, 2"); soy ("Gallia-soy"); mixed ("Aptamil", "Pregomin"). According to the degree of hydrolysis, there are: a) highly hydrolytic ("Alfare", "Pregestemil", "Nutramigen", "Alimentum", "Nutrilon-Pepti TSC", "Peptidi Tuttelii", "Hipp GA 1, 2"; b) partial hydrolysates ("Frisopep-1, 2", "NAN GA", "Humana GA-1, 2", etc.).

4.Mixes for children With anemia: enriched with iron "Similak", "Nan-Nan", etc.

5. Formulas for children with lactase deficiency: lactose-free mixtures("NAN Lactose Free", "Grandmother's basket without lactose", "Nutrilak lactose free", "Enfamil Laktofri"); low lactose(“Bellakt-NL”, “Nutrilak low-lactose”, “Nutrilon low-lactose”, “Humana-LP”, “Humana-LP + SCT”, etc.).

6. Formulas for children with phenylketonuria: "Aponti-40", "Lofenalak", "Phenildon", "Afenilak"; for older children - "Phenyl-free", "Aponti-80".

7. Mixtures, cereals for children with celiac disease: a) on based on protein hydrolysates: Alfare, as well as Nutramigen, Nutrilon Pepti TSC, Alimentum, Pregestimil; b) special cereals: rice "Nestlé", vegetable, banana "Danone", buckwheat, rice "Heinz", "Humana".

8. Formulas for children with cystic fibrosis: "Humana-LP + SCT", "Nutrilon Pepti TSC", "Pregestimil", "Hipp XA", "Alfare".

Adapted milk mixtures. Satisfactory development of children receiving artificial nutrition can only be achieved with the use of adapted mixtures. They are balanced in composition and are prepared from high-quality milk and non-dairy raw materials (vegetable oil, di- and polysaccharides, vitamins, minerals).

Highly adapted milk formulas as close as possible to the composition of human milk and adapted to the peculiarities of the digestion of children in the first 6 months of life.

In these mixtures, the total amount of protein and some salts is reduced. The composition of proteins has been changed due to enrichment with demineralized whey. Amino acid, vitamin and mineral composition is close to that of human milk. The amino acid taurine, the antioxidant P-carotene, a-lactalbumin, and nucleotides have been added to some mixtures.

Fats are represented by a mixture of vegetable oils (sunflower, corn, soy, coconut, etc.), which increase the content of essential polyunsaturated fatty acids. To improve the absorption of fat, natural emulsifiers (lecithin, etc.) are added to milk mixtures. Modern mixtures contain L-carnitine, long-chain polyunsaturated fatty acids (arachidonic, docosa-hexaenoic).

The amount of carbohydrates in mixtures has been increased due to their enrichment with lactose, dextrin-maltose (malt extract, glucose syrup, corn and other types of molasses). Some mixtures contain oligosaccharides, lactulose, which have prebiotic properties.

The composition of many milk mixtures includes growth factors, lysozyme, lactoferrin, selenium. There are mixtures that contain immunoglobulins, probiotics - bifidus and lactobacilli.

An important indicator of the compliance of the mixture with the physiological characteristics of children of the first year of life is its osmolarity (the sum of soluble components that determine its osmotic pressure should not exceed 290-320 mOsm / l). Excessive osmolarity creates an excessive load on the enterocytes of the small intestine mucosa and the immature kidneys of the child.

"Follow-Up" Blends serve for feeding children after 5-6 months. They contain a higher amount of protein and have a high energy value, which is fully consistent with the increased needs of the child in energy and nutrients. Mixtures are distinguished by a higher content of iron, calcium, zinc. The reserves of iron obtained in utero are depleted by 4-5 months, and its additional introduction into the mixture is required (1.1-1.4 mg of iron per 100 ml).

"Mixtures from 0 to 1 year" used in the nutrition of children throughout the first year of life. The protein component is dominated by both whey proteins and caseins.

"Mixtures from 1 year to 3 years" are used for children 1-3 years old. In the nutrition of children, not only up to 1 year old, but also older, it is not recommended to use whole cow's milk, as it contains a lot of protein and some mineral salts, it is low in iron, zinc, iodine, vitamins C, D, A, E, linoleum. howling fatty acid. In this regard, for children older than 1 year, mixtures of Bellakt-3 +, NAN-3, Friso-3 are shown.

Sour-milk mixtures (KMS). Mixtures are prepared from cow's milk using cultures of lactic acid bacteria. Fermented milk adapted mixtures include Bifi-dobact, Bifitat, Nan sour milk, Biolact adapted, Bifilakt, Bifillin, Laktolin, etc. Such mixtures are recommended for children with unstable stools. In the process of preparing these products, enzymes and lactic acid accumulate in them, which contribute to gentle protein curdling, better absorption of fat, a decrease in sugar content, and the antigenicity of the protein component is somewhat reduced. Fermented milk mixtures normalize the intestinal microflora, suppress the processes of decay, restore peristalsis and the child's appetite.

Liquid mixtures are both fresh and sour-milk. Liquid mixtures have the following advantages: they are ready to use, incorrect dosing of the powder is excluded, the quality of the water used is guaranteed, they retain the properties of natural products.

Dry mixes are distinguished by increased storage stability, are easy to handle, and meet sanitary and hygienic requirements.

Simple non-adapted milk mixtures. Due to the inferior composition, such mixtures do not meet the age needs of children and cannot be recommended for long-term use. They can be used subject to the mandatory correction of the diet with the missing nutritional factors. In recent years, simple milk formulas of improved composition have been developed. These include fortified milk, Biolact-1, 2, Nairi, Narine, Matsoni, etc.

Choice of milk formula. When choosing a mixture, one should take into account: 1) the age of the child; 2) the degree of adaptation of the mixture; 3) its individual tolerance; 4) type of feeding.

In the first months of life, only adapted industrial products are used: in the first half of the year, the child is prescribed a highly adapted milk formula, in the second - a “following” formula. During the neonatal period, preference is given to fresh, highly adapted milk mixtures. Fermented milk mixtures can cause acidosis and regurgitation. At an older age (from 1 month), it is advisable to combine sour-milk and fresh adapted mixtures (1: 2).

You should feed the child the same mixture. With artificial feeding, the use of no more than two milk mixtures is allowed. The replacement of the mixture is recommended in cases of an allergic reaction and severe intestinal dysfunction to it, the child refuses this mixture, and the cessation of body weight gain within 1.5-2 weeks.

Unadapted fermented milk products can be introduced into the diet of healthy children after 8 months (if there is an indication on the package that the product is "baby food") in an amount not exceeding 200 ml / day. Duration of application - up to 3 months. Whole cow's milk is not recommended for use in the nutrition of children, not only up to 1 year old, but also older. They are prescribed mixtures for children over 1 year old.

The mixture for the child needs to be selected individually:

For newborns and children in the first months of life, it is better to use mixtures with a protein content in the range of 1.4-1.5 g per 100 ml of a liquid product and enriched with such biologically active additives as whey proteins, taurine, carnitine, etc .;

For weakened children, with reduced appetite, poor weight gain, mixtures with a higher protein content (1.6-1.8 g per 100 ml) are suitable, with anemia - with a high iron content (0.8-1.2 mg per 100 g);

In the event of an allergic reaction to a highly adapted milk formula, another formula of the same generation or therapeutic formula can be used;

For children with signs of rickets, mixtures enriched with vitamin D are intended;

For those who are often ill, with reduced body resistance - mixtures enriched with nucleotides;

In case of violations of the digestive processes, it is good to use fermented milk mixtures in addition to the main diet, especially those containing probiotics - live microorganisms or products containing them. When ingested in sufficient quantities in the gastrointestinal tract, they retain their activity and viability and have a positive effect on health. Probiotics include: bifidobacteria, lactobacilli, enterococci (streptococci - thermophilic, mesophilic), sticks - Bulgarian, acidophilic.

If the mixture is chosen correctly, then the child eats it with pleasure, he does not have dyspeptic disorders (regurgitation, vomiting, loose stools, constipation), manifestations of atopic dermatitis, deficient conditions (iron deficiency anemia, malnutrition, paratrophy, etc.).

Rules for the introduction of supplementary feeding: 1) choose the milk formula; 2) give supplementary feeding after breastfeeding; 3) it is more expedient to supplement the child after each feeding, since milk mixtures in the form of self-feeding help to reduce lactation; 4) Supplementary feeding is recommended to be given from a spoon or cup. Alternate feeding from the breast and nipple violates the sucking technique and contributes to the extinction of lactation; 5) when supplementing from a bottle, the suction of the mixture should be as difficult as when breastfeeding. To do this, there should be small holes in the short dense nipple so that the milk mixture flows out in drops; 6) prepare mixtures immediately before use. It is impossible to violate the recommendations for their preparation, including sanitary and hygienic requirements; 7) if necessary, the mixture is heated to 37-40 ° C in a water bath. To determine the degree of heating, pour a few drops on the back of the hand; 8) during feeding, it is recommended to hold the bottle at an angle of 45 ° so that the neck is filled with the mixture in order to avoid aerophagy; 9) Do not feed the baby if he is sleeping or crying. Do not leave children unattended during feeding; 10) feed the child at his request, without force feeding; 11) the remaining mixture is not used for the next feeding; 12) it is desirable to keep milk mixtures in the diet of a child up to one year and later.

Rules for partial breastfeeding and artificial feeding: 1) control the quantity and quality of food. The daily volume of food should not exceed 1100 ml; 2) it is recommended to switch to five meals a day with longer intervals between meals after the introduction of the 1st complementary food; 3) the timing of the introduction of complementary foods and corrective additives when feeding a child with adapted mixtures is the same as when breastfeeding, and are prescribed in the same sequence; 4) it is necessary to strictly observe the sanitary and hygienic requirements of food preparation, the mode of its heat treatment; 5) even with a small amount of breast milk, the mother should keep as long as possible breast-feeding. To maintain lactation, it is recommended to apply the baby to the breast at least 3-4 times a day.

The most common mistakes in partial breastfeeding and artificial feeding: 1) frequent unreasonable replacement of milk formula. Indications for transferring a child to another mixture are a delay in weight gain for 1.5-2 weeks, allergic reactions, severe bowel dysfunction, refusal of the child from the mixture; 2) untimely introduction of additional food products; 3) the appointment of fermented milk mixtures in large quantities (more than 50% of the daily diet), especially in the first weeks of a child's life; 4) overestimation or underestimation of the concentration of milk mixtures during their preparation: the use of milk or cream instead of water, the discrepancy between the number of measuring spoons of the instructions for preparation; 5) excessive heat treatment of milk and mixtures, leading to the loss of biological properties (decrease in the content of vitamins, inactivation of enzymes and protective factors, partial protein denaturation).

Diet. It is set depending on the age of the child, his state of health and individual characteristics. It is recommended to feed newborns at the request of the child, including at night. Up to 5 months, the approximate number of feedings is 6 times a day after 3.5 hours; from 4.5-6 months (after the introduction of the 1st complementary foods), the child is fed 5 times a day after 4 hours. From 1 year, and more often from 1.5 years, children are transferred to four meals a day.

Partial free feeding involves certain hours of feeding with possible deviations from them up to 30 minutes and feeding the child on demand without exceeding the daily amount of food.

Calculation of the amount of food. IN the first 7-8 days of life, the daily amount of milk can be calculated:

1) according to Zaitseva's formula:

Daily amount of milk (ml) = 2% of body weight at birth x P,

Where P - day of the child's life;

2) according to another formula:

Daily milk volume (ml) = 70 P at birth weight below 3200 g or 80 P with a mass above 3200 g,

Where P - day of a child's life.

Later, the daily amount of milk is calculated volumetric method: from 2 weeks to 2 months it is 1/5 of the proper body weight, from 2 to 4 months - 1/6, from 4 to 6 months - 1/7. After 6 months, the daily volume is no more than 1 liter (single - 200 ml). For determining single food requirement The daily amount of food is divided by the number of feedings.

Proper body weight can be determined by the formula

M should \u003d Mo + Monthly increases,

where Mo is the mass at birth.

Monthly increases are 600 g for the first month, 800 g for the second, 800 g for the third, and each subsequent month is 50 g less than the previous one.

You can calculate the amount of food using calorie method, based on the child's need for calories. In the first quarter of the year, the child should receive 120 kcal / kg of body weight, in the second - 115 kcal / kg, in the third - 110 kcal / kg, in the fourth - 105 kcal / kg (1 liter of human milk contains 700 kcal).

For example, a child at the age of 1 month has a body weight of 4 kg and, therefore, needs 480 kcal / day. The daily volume of food is 480 kcal and 1000 ml: 700 kcal = 685 ml.

Algorithm for compiling an approximate menu for infants. It is necessary: ​​1) to determine the approximate hours of feeding; 2) highlight the main foodstuffs; 3) determine the set of products allowed by age; 4) determine the daily and one-time need for food; 5) rationally distribute the set of allowed products; 6) if necessary, carry out nutrition correction, following the appropriate doctor's prescriptions.

Control questions and tasks

1. Define partial breastfeeding (artificial) feeding. 2. What are the reasons for transferring a child to breastfeeding formulas. 3. What are the consequences of formula feeding? 4. How to determine the amount of milk sucked by the baby? 5. What should be the tactics in case of detection of hypogalactia? 6. What is a supplement? 7. List the types of milk mixtures. Name the representatives of each group. Describe their advantages and disadvantages. 8. What are the rules for the introduction of supplementary feeding? 9. What are the rules and mistakes of partial breastfeeding and artificial feeding. 10. Calculate the daily and one-time need for food in a child for 5 days, 1.5 months, 5 months. Make a menu for a child of 6, 8, 10 months who is breastfed (partially breastfed, bottle-fed).

According to the logic of things, the child should receive a product that, in terms of its properties, will be as close as possible to women's milk. Such products are produced in sufficient quantities (thousands of items and variants) and go on sale under the general name "adapted milk formulas". You should know that the creators of any milk formula are trying, more or less successfully, to solve the main problem: to bring its (mixture) composition as close as possible to breast milk.

Depending on how successfully this task is solved, all manufactured mixtures are divided into three main categories: highly adapted, less adapted and partially adapted.

It would be completely wrong to conclude that a highly adapted mixture is always better than a partially or less adapted one. We have already mentioned that the composition of breast milk changes over time, ideally matching the needs of a child at a certain age. By changing the adaptability of mixtures, manufacturers try to follow Nature as much as they can, changing the composition of food products in a certain way. Thus, highly adapted formulas are ideal for feeding children from birth to six months, while less adapted formulas are intended, as a rule, for children in the second half of life.

You should also be aware that there are special mixtures for special situations. Special situations are violations in the state of health of the child, requiring the mixture to be given certain properties. Such mixtures are prescribed only by doctors - for example, for feeding premature babies or children with low birth weight, for children with allergies, for children with a tendency to spit up, for feeding children with certain congenital metabolic disorders, etc.

The tactics and principles for choosing a milk formula are as follows:

• The child, as we have repeatedly emphasized, has a simply amazing ability to adapt to everything. In this sense, nutrition is no exception, and the main troubles - abdominal pain, diarrhea, allergic reactions, etc. - usually occur when switching from one type of food to another or when a new product is included in food. Based on this, both you and I and the child are not at all interested in changing mixtures often.

That's why There are two optimal options:

1) an adapted milk formula, on the packaging of which it is written: "Designed to feed babies from birth to 12 months";

2) the option is even more preferable when one mixture is a logical extension of the other and both mixtures have similar production conditions. For example, specific firms produce highly adapted mixtures of Nutrilon, Hipp, Nan and the same companies produce less adapted mixtures, they are also called "subsequent formulas" - "Nutrilon-2", "Hipp-2", "Nan-2". It is obvious that the composition of mixtures with the number 2 in terms of the number of main components (proteins, fats, carbohydrates, acids, mineral salts, vitamins) corresponds exactly to the needs of the child from the age of five to six months.

• THE MAIN CONCLUSION: THEY DO NOT LOOK FOR GOOD FROM GOOD. The child is healthy, develops normally, gains weight. Well, you don’t need to change anything just because a neighbor buys something different for her every week and one box is more beautiful than the other.

How to give formula milk?

First of all, strictly follow the instructions regarding storage and breeding.

With mixed feeding, two options are possible:

First, breast and only then supplement with a mixture;

Completely replace one of the feedings with the mixture.

It is necessary to choose the option in which the mixture is consumed in a smaller amount (mother's milk, respectively, in a larger amount).

The optimum temperature of the mixture should be equal to the temperature of the child's body.

The essence of the word “adapted” is adapted, corresponding to the needs of the child.

In order to avoid unnecessary maternal tantrums, I inform you that cow's milk intolerance is not a tragedy, but a nuisance. Formulas that do not contain cow's milk proteins (soy, almond milk) have been developed.

A typical example. Mixtures "Malyutka" and "Baby" can be produced by: MKK Khorol, Ukraine; MCC Istra, Russia, MCC Vyakovyssk, Belarus.

However, there is a possibility that the reader of this book is living in isolation from civilization, having a cow, but not having a store that sells adapted milk formula. With this in mind, cow's milk can be used as follows: 120 ml of milk (boiled!) + 80 ml of boiled water + 1.5 teaspoons of sugar. Within a month, a child can be fed with diluted cow's milk without any fear for his health. But it is highly desirable to try to make contact with civilization during this month and still buy an adapted milk formula. I emphasize once again: any dry mixture is better than cow's milk - cleaner, stable in composition, contains vitamins.

There is no better food for newborn babies than mother's milk. It is also much easier for a mother to live when there is no need to go shopping, the child does not need to cook or warm up anything, or wash the dishes after feeding. Unfortunately, not all nursing mothers have enough milk to feed their baby for up to a year. It also sometimes happens that the mother falls ill with an incompatible breastfeeding disease, and feeding has to be stopped, or she is forced to take potent drugs that penetrate into the milk. In such situations, the question of wholly or partially artificial nutrition arises, and the best alternative to mother's milk for infants is an adapted formula from dairy products.

What is the composition of infant formula?

Infant formulas are called adapted, as their composition is very similar to the composition of human breast milk. They contain the optimal content of whey proteins, which are easily processed by the digestive organs of the baby. Formulated specifically for the baby's digestive system, infant formulas are rich in phosphorus, potassium and calcium in the right proportion. They are essential for the body baby for normal growth and development of the skeleton and teeth.

In cow's milk, the content of carbohydrates and vitamins is lower, and minerals and proteins are higher than in human milk. Manufacturers of all adapted milk formulas try to create a food product with a composition that is as similar as possible to human breast milk.

Special substances - nucleotides, which are included in many modern adapted mixtures, are necessary for newborn babies from the first days of life. With their help, the immune system of the crumbs fully develops. All of its developing organs and tissues are in dire need of them: blood cells, skin, intestinal mucosa.

Nucleotides are the building blocks of DNA. Thanks to them, the natural microflora of the stomach and intestines of the newborn is formed. In the milk of a woman, there are much more nucleotides than in the milk of a cow or goat.

Adapted milk formulas for babies of the first 5-6 months of life also contain the amino acid taurine. It is especially important to receive it for premature babies, since the acid is extremely important for the proper formation of the visual analyzer and nervous system of newborns, and it also takes part in the production of bile acids.

Milk mixtures contain 45-50 g/l of taurine. The body of a newborn child up to 1 month old is not able to synthesize this substance on its own, so it needs to be obtained from food. All adapted milk formulas are divided into highly adapted, less adapted and partially adapted.

Highly adapted infant formulas

An adapted milk formula of this type is closest in composition to human milk. It is designed for the smallest - from birth to six months. Although these "starter formula" products are intended for very young children, they can be fed to babies up to almost a year old. The main disadvantage of this type of food is its rather high cost.

Below is a list of the most commonly used dry products of this type for artificial nutrition:

• "Baby-1" - Nutricia, Russia (more in the article:);
• "Nan-1" (Nan-1) - Nestle, Switzerland (we recommend reading:);
• "Hipp PRE" (Hipp PRE) - Hipp, Austria;
• "Humana PRE" (Humana PRE) and "Humana-1" (Humana-1) - Humana, Germany;
• "Friso PRE" (Friso PRE) - Friesland Campina, Holland;
• "Hipp 1" (Hipp 1) - Hipp, Austria;
• Frisolac-1 Gold (Frisolak-1 Gold) and Frisolac-1 (Frisolak-1) - Friesland Campina, Holland;
• "Nutrilon-1" (Nutrilon-1) - Nutricia, Holland (we recommend reading:);
• "Semper Baby-1" (Semper Baby-1) - Semper, Sweden;
• "Lasana PRE" (Lazana PRE) and "Lasana-1" (Lazana-1) - Humana, Germany.

Less adapted blends

Baby food of this type is already somewhat different in composition from mother's milk. Less adapted milk mixtures contain all the vitamins, minerals and microelements necessary for the baby of the second half of the year of life.

“Follow-Formula” products, in contrast to highly adapted ones, contain more iron. This is due to the fact that the body of a child in the first months of life contains a sufficient amount of iron, which was still inherited from the mother during intrauterine life. After the child reaches the age of 5-6 months, iron stores already need to be replenished.

An excellent source of iron, as well as zinc, calcium and copper, are the following mixtures:

• "Ialutka-2" - Nutricia, Russia;
• "Detolakt" - Ukraine;
• "Semper Baby-2" (Semper Baby-2) - Semper, Sweden;
• "Nan-2" (Nan-2) - Nestle, Switzerland;
• "Humana-2" (Humana-2) and "Humana-3" (Humana-3) - Humana, Germany (we recommend reading:);
• "Hipp-2" (Hipp-2) and "Hipp-3" (Hipp-3) - Hipp, Austria;
• Frisolac-2 Gold (Frisolak-2 Gold) and Frisolac-2 (Frisolak-2) - Friesland Campina, Holland;
• "Nutrilon-2" (Nutrilon-2) - Nutricia, Holland.

Partially adapted infant formulas

These are adapted infant formulas of the so-called "casein formula", which have a thicker consistency. They are recommended for children from 5-6 months, especially those who have difficulty holding food and often spit up immediately after eating. Partially adapted milk formula of this type is the most affordable. In addition to lactose, this carbohydrate product contains sucrose and starch.

The most common of these types of mixtures are:

• "Nestogen" (not empty) - Nestle, Switzerland (we recommend reading:);
• "Solnyshko" - Nutritek, Russia;
• "Similac" (similac) - Abbott Laboratories, USA (we recommend reading:);
• "Malyutka-1 plus" - Nutricia, Russia;
• "Baby" and "Baby" - Ukraine.

Liquid adapted mixtures "Agusha"

Many parents believe that completely ready-to-use liquid mixtures are better absorbed by the crumbs than dry ones that still need to be diluted. Russian-made liquid adapted infant formula of the Agusha brand, created for feeding babies up to a year, has won great popularity among mothers. Produced "Agusha-1" and "Agusha-2". The number 1 in the name means that the mixture is recommended for children from birth to six months, and the number 2 - from six months and older. Mixtures "Agusha" for each age differ in the color of the package. In turn, each of them is of two types: sterilized and fermented milk.

Mothers speak of these species in different ways. Some children prefer sterilized "Agusha", others prefer sour milk. There is no particular difference in their composition. The only difference is that sterilized products should be consumed immediately after opening the package, while sour-milk Agusha in an open pack can be stored for up to 12 hours.

Non-adapted milk formulas

These products are made from whole milk of animals and are not subjected to specific processing. They categorically cannot be fed to babies in the first six months of life, because they very little resemble breast milk.

If it is absolutely not possible to purchase an expensive adapted milk formula for the baby, then it is better to order him food in the children's dairy kitchen in the direction of the pediatrician. Children's yogurt or milk prepared in a dairy kitchen using a special technology will bring more benefits than unadapted mixtures. In this situation, you need to introduce complementary foods to the child a little earlier than it should be for age.

How to choose a formula for feeding a child?

Nutrition is selected based on the age, health status of the baby, his tendency to allergies, as well as the degree of adaptation of the product and the financial capabilities of the family. It can be very difficult to choose the first mixture for your baby, because most milk mixtures are very similar in composition. Even a highly adapted mixture can cause an allergy, but a partially adapted child can tolerate it perfectly, and vice versa.

New food for the crumbs should be given to him to try a little bit, and increase the portion gradually, as in the beginning of complementary foods. At the same time, carefully monitor the condition of the skin - have red spots appeared, behind the child's stool - is there constipation or diarrhea, is the tummy swollen? At the slightest sign of intolerance, the mixture should be replaced with another one. If the baby feels well, is cheerful, active, grows and develops normally, then you have made the right choice and nutrition is completely suitable for him.

Adapted milk formulas

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

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

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

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

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

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

There are also herbal medicines

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

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

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

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

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

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

GBOU VPO TVER STATE MEDICAL

ACADEMY OF THE MINISTRY OF HEALTH AND DEVELOPMENT OF RUSSIA

DEPARTMENT OF PEDIATRICS

MEDICAL AND DENTAL FACULTY

Mixed and artificial feeding

Guidelines for independent work of students

4 Courses of the Faculty of Medicine

Compiled by:

Doctor of Medical Sciences, Professor A.F. Vinogradov

Candidate of Medical Sciences, Associate Professor A.V. Koptseva

Tver, 2012

Name of the topic: Feeding mixed and artificial. Nutrient mixtures used for mixed and artificial feeding. Canned, adapted products. Peculiarities of feeding premature babies. Principles of nutrition for children older than a year. The role of the local pediatrician in the organization of rational nutrition of children.

Examination of children who are on various types of feeding. Development of the survey methodology. Drawing up a diet and menu layout for children of the first year of life on mixed and artificial feeding on the instructions of the teacher.

The purpose of studying the educational topic: To study modern aspects of mixed and artificial feeding of children of the first year of life at the level of knowledge and skills to draw up a nutrition map for children of the first year of life who are on mixed and artificial feeding, as well as to solve situational problems on this topic. To master the concepts of supplementary feeding, canned and adapted products. To acquaint students with the basic principles of feeding premature babies and children older than a year. To determine the role of the district pediatrician in organizing the rational nutrition of children.

1. Basic terms:

1) Mixed feeding

2) The concept of "supplementary feeding"

3) Artificial feeding

4) Adapted milk formula

1. Topic study plan:

Definition and principles of mixed feeding

Definition and principles of artificial feeding

Classification of adapted milk formulas

AMS selection criteria

Sour-milk mixtures

Consequences of artificial feeding

Features of nutrition of premature babies

Principles of nutrition for children older than a year

1. Presentation of educational material:

Under mixed feeding understand breastfeeding with forced (non-physiological) supplementation in the form of cow's milk (milk of animals and plants) or its dilutions (mixtures) in the amount from 1/5 to 4/5 of the daily requirement.

Mixed feeding is a type of feeding when, along with women's milk, milk mixtures are given to children, because due to the age of the child, he cannot yet be given complementary foods. Supplementation with artificial milk formulas is called supplementary feeding.

Indications for mixed feeding is a lack of milk in the mother (hypogalactia) or some diseases of the mother. The clinical symptoms of a fasting child are flattening or falling of the weight curve, restlessness, infrequent urination, and stool changes. The stool is usually at first reduced or, conversely, speeded up.

In order to find out if the mother has enough milk, it is necessary to weigh the baby in the early hours before and after feeding, i.e. conduct control weighing child. By the difference in weight, you can judge how much milk the baby sucked. Having calculated the required amount of milk according to the formulas, and knowing the amount of milk received by the child from the mother, it is possible to calculate the required amount of supplementary feeding.

When mixed. feeding before feeding is prescribed depending on the amount of milk in the mother, that is, after each feeding, or some of them, or by alternating full feedings with breast milk and formula. As a supplement in modern dietetics, adapted milk mixtures are used, which are used for artificial feeding, and are described in the corresponding section.

Principles of mixed feeding:

The introduction of supplementary feeding not earlier than 4-7 days of the fight against hypogalactia.

The choice of supplementary feeding, taking into account age, appetite.

Supplementary feeding is prescribed after breastfeeding.

The number of feedings remains the same as with natural feeding, but if the milk deficit is more than 50%, then the number of feedings is reduced by 1.

Supplementary feeding can not be introduced into all feedings if the milk deficit is 50% or less.

Do not change supplement.

Carry out weekly control feedings (2-3 times a day 2-3 days a week at different hours of the day).

Change in the need for food ingredients when using non-adapted mixtures up to 3.5-4.0 g/kg per day of protein.

Supplementation is introduced in a spoon or through a small hole in the nipple.

Taking into account modern views (National program for optimizing the feeding of children in the first year of life, 2010), the timing of the introduction of complementary foods with mixed and artificial feeding does not change.

Artificial feeding - this is the feeding of a child in the first months of life with animal or plant milk (soybean, almond) with a deficiency of breast milk, which is 4/5 or more of the daily diet.

Principles of artificial feeding:

The frequency of feeding when prescribing adapted mixtures can be the same as when prescribing non-adapted formulas - the number of feedings is reduced by 1 and you can switch to 5 meals a day from 3-4 months.

The volumes of nutrition during artificial feeding are calculated in the same way as with natural feeding (the volumes do not depend on the type of feeding, but on the capabilities of the gastrointestinal tract).

Complementary foods are introduced at the same time as with natural feeding.

The need for protein increases when feeding with non-adapted mixtures up to 4-4.5 g / kg, when receiving adapted mixtures, the amount of protein is the same as in natural.

Calorie increases by 10% when using non-adapted mixtures.

Any attempt to switch to mixed and natural feeding is encouraged.

The transfer of a child to artificial feeding is a "metabolic stress" and in this regard, doctors should pay great attention to the correct choice of "substitutes" for women's milk, taking into account individual characteristics of health, physical development and even appetite.

The basis of most "replacement" or mixtures is cow's milk, which differs significantly from human milk in its composition and properties. In cow's milk, the content of protein, calcium, potassium, sodium and other mineral salts is significantly higher than in women's milk. At the same time, the level of carbohydrates, a number of fatty acids and vitamins, on the contrary, is lower than in human milk. In order to bring the composition of cow's milk closer to that of women's milk (or otherwise "adapt" its composition to the characteristics of the immature body of the child, hence the name "adapted milk formulas"), it is necessary to reduce the content in cow's milk. protein and salts, but to increase the level of carbohydrates (lactose), some vitamins and fatty acids. Currently, various substitutes for women's milk, both domestic and imported, are widely represented on the Russian market. "Substitutes" for women's milk can be dry or liquid (ready-to-drink), unleavened or sour.

Milk mixtures are divided into 2 large groups - adapted and non-adapted, in turn, mixtures in each of these groups - into sweet and sour-milk.

Adapted milk formula(AMS) - a food product in liquid or powder form, made on the basis of cow's milk, milk of other farm animals, intended for use as a substitute for women's milk and as close as possible to it in chemical composition in order to meet the physiological needs of children of the first year of life in nutrients and energy. The content of protein, fats, carbohydrates, minerals and vitamins in mixtures must comply with domestic and international standards for adapted milk formulas. There is a modern classification of children's adapted milk formulas (Fig. 1). This mainly concerns the division of mixtures, depending on the age of the children, into “initial” (from 0 to 6 months), “subsequent” (from 6 to 12 months) and for children from 0 to 12 months.

Particular attention is paid to the "initial" mixtures, the composition of which is maximally adapted to the physiological needs and characteristics of the metabolism of children in the first six months of life. Recently, there has been a tendency to reduce the level of protein in modern dairy products in order to bring it closer to human milk quantitatively. So, in most "initial" mixtures, the amount of protein is 1.4-1.6 g / 100 ml, and the minimum level is 1.2 g / 100 ml, the ratio of whey proteins and casein is 60:40, 50:50, in separate mixtures 70:30. almost all modern mixtures contain taurine, α-lactalbumin, and some contain nucleotides.

To adapt the fat component of the "initial" mixtures, vegetable oils (sunflower, corn, soybean, rapeseed, coconut, palm), rich in polyunsaturated fatty acids (PUFAs), are introduced into their composition. To improve the emulsification of fats, a small amount of natural emulsifiers lecithin, mono- and diglycerides are introduced into the mixtures. Almost all mixtures contain L-carnitine, which promotes the assimilation of fatty acids at the cellular level. The current trend is the enrichment of mixtures of DSHIFA (arachidonic and docosahexaenoic), which are precursors of prostaglandins, thromboxanes and leukotrienes,

As a carbohydrate component, mainly lactose and maltodextrin are used. A number of mixtures contain galacto- and fructooligosaccharides, which have a prebiotic effect and promote the selective growth of bifidobacteria. Some formulas contain lactulose, which is also a prebiotic.

All mixtures include the necessary set of vitamins and minerals in accordance with the physiological needs of children in the first months of life. This is primarily iron, copper, zinc, iodine. selenium, which has antioxidant properties, was introduced into a number of mixtures. The ratio of calcium and phosphorus is in the range of 1.5:1 - 2.0:1.

The level of vitamins in AMS exceeds that in women's milk by 15-20% on average. their digestibility is lower than from human milk. At the same time, much attention is paid to vitamin D. Its content in 100 ml of the finished mixture should be 40-50 MB according to the standards. Vitamins of group B, vitamin A, β-carotene are added to all mixtures.

"Subsequent" mixtures, unlike the initial one, contain a higher amount of protein (up to 2.1 g/100 ml). The predominance of whey proteins over casein is no longer mandatory. Products for children of this age group are distinguished by a higher content of iron, calcium, zinc.

"0 to 12 months" formulas can be used in the nutrition of children throughout the first year of life. However, this group of products is not numerous and is used to a limited extent under modern conditions, due to the wide range of initial and subsequent formulas.

In a number of dry fresh mixtures, probiotics were introduced: bifidobacteria and lactobacilli. Modern technologies make it possible to ensure the safety of microorganisms in the product throughout the entire shelf life.

Criteria for the selection of adapted milk formulas (AMC):

the age of the child;

socio-economic conditions of the family;

allergic history;

individual intolerance to the product.

The criterion for the correct choice of the mixture is the good tolerance of the child to this product.

As a result of all these changes, a fairly good breast milk substitute is obtained, but it is necessary to strive to minimize the risk of sensitization to a foreign protein by using protein hydrolysates and providing the child with non-specific protection against intestinal infections by adding substances such as lactoferrin, lactoperoxidase, lysozyme, etc.

Among the adapted women's milk substitutes are domestic liquid ones - "Agu-1" (Lianozovsky baby food plant, Russia), "Baby Milk" (Lianozovsky dairy plant, Russia) and dry mixes - "Mikamilk" (Kofranleit / Rosdetspecprodukt, France / Russia ), as well as imported ones - Nan (Nestlé, Switzerland), Nutrilon (Nutricia, Holland), Efamil-G (Bristol Mayer Squibb's Mead Johnson Branch), Pre-HiPP and HiPP (KhiPP, Austria ), Humana-1 - a taurine-containing formula for children from the first days of life up to 3-6 months, the ratio of whey protein / casein 60:40, does not contain glucose, sucrose and gluten, Humana-2 - from 3-4 months to 1 year, Humana-Baby-fit - from 6 to 12 months, gluten-free, enriched with iron, protein component 80:20, good content of vegetable oils, banana pectins in combination with starch increase the viscosity of the mixture and have an anti-dyspeptic effect, Frisolak - from 0 to 12 months , has a good ratio of linoleic and linolenic acids, a protein component of 60:40, fermented milk mixtures - "Gallia" and "Lactofidus" (Danone, France).

Somewhat less adapted mixtures are the so-called "casein formulas". Their name is due to the fact that they are made on the basis of powdered cow's milk, the main protein in which is casein, without the addition of demineralized whey. As a result, such mixtures are less close to the protein composition of human milk. At the same time, for all other components (carbohydrate, fat, vitamin, mineral, etc.), these mixtures, as well as the adapted ones described above, are as close as possible to the composition of human milk. Casein formulas include such well-known blends as Similak (Abbott Laboratories, USA), Nestogen (Nestlé, Switzerland) and others.

Finally, partially adapted blends. Their composition is only partially close to the composition of human milk - they lack demineralized whey, the fatty acid composition is not fully balanced, not only lactose, but also sucrose and starch are used as a carbohydrate component. These mixtures include "Aptamil", "Milumil" (Milupa, Germany). These substitutes can be used in the nutrition of children of the first year of life, starting from 2-3 months.

All modern women's milk substitutes and "follow-up" mixtures are among the instant (instant) products. For their use in children's nutrition, it is only necessary to mix a strictly defined amount of dry powder with pre-boiled warm (50-60 ° C) water and mix thoroughly, avoiding the presence of lumps.

Benefits of fermented milk formulas:

improve digestion processes;

have a partially cleaved protein that loses its allergic properties;

vitamins produced by bacteria;

they partially destroy lactose, which some children do not tolerate well;

displace pathogenic flora;

there is no more ethyl alcohol in them than in bread, juice, breast milk; it is necessary for the metabolic processes taking place in the body.

Disadvantages of fermented milk mixtures:

have a high calcium content;

the ratio of whey protein to casein 20:80;

when they are used, the acid-base balance shifts to the acid side.

Thus, milk formulas are considered good if:

Protein 1.2 - 1.5 g/dl;

The ratio of whey protein to casein is 60:40;

The composition contains taurine;

Vegetable fat - 1%;

Carbohydrates - dextrinmaltose;

Vitamins A, D, E;

Osmolarity = 280 mOsm/l.

Currently, in the diet of patients with food allergies, dairy-free mixtures prepared on the basis of soy protein isolates of foreign production are widely used: Humana SL (Germany), Nutrisoy and Frisosoy (Holland), Prosobi (USA), Alsoy (Sweden), as well as domestic product - Nutrilak-soy. The protein component of these products is represented by soy protein isolate; fatty - formed due to vegetable oils; carbohydrate - represented by dextrinmaltose, which has a positive effect on intestinal microbiocenosis. The products are enriched with a complex of vitamins and minerals in accordance with the requirements of young children. The mixtures do not contain milk protein, lactose and gluten.

Formula-fed children, like their peers, need complementary foods. Given that modern adapted milk formulas contain the necessary set of vitamins and minerals, there is no need to correct for these substances with complementary foods in more early dates than when breastfeeding.

Consequences of artificial feeding

Shortening of average life expectancy by 10 years (min);

Sensitization of 75% of children;

Dysbacteriosis 100% of children;

Chronic diseases of the gastrointestinal tract - 45-55%;

The development of early sclerosis (there is no activator of cholesterol utilization enzymes);

Early hypertension;

Early coronary artery disease, strokes, etc.;

Children are at risk for oncology and hemoencology (leukemia);

The ratio of diseases of children on natural: mixed: artificial feeding as 1:3:6. 2-3 times more group of FBI;

Children "artists" are prone to mechanical, uncreative labor, nihilism and aggression.

Features of nutrition of premature babies

A premature baby should be admitted to the pediatric site with a well-formed sucking reflex and diet. Usually this is 7 feedings with a 6 hour night break. For 6 meals a day, it is transferred upon reaching a body weight of 3,000 gr.

The most optimal type of feeding a premature baby is breastfeeding. The amount of milk absorbed by the child should be strictly monitored. Therefore, a premature baby should be provided with scales, which the clinic should provide him. In cases of insufficient absorption of breast milk, additional feeding with a spoon is required. This should be told to the mother and taught to her. In this case, special dry adapted mixtures for premature babies are used. A feature of these mixtures is a higher content of protein and carbohydrates, and, accordingly, calorie content, compared to conventional adapted mixtures. Special adapted formulas for preterm infants should be used until they reach 4 kg, and then switch to regular adapted formulas.

Types of feeding premature babies

Women's milk after premature birth has a special composition that is more consistent with the nutritional needs of premature babies and is consistent with their ability to digest and assimilate. Compared to the milk of women who gave birth at term, it contains more protein (1.2-1.6 g per 100 ml), especially in the first month of lactation, slightly more fat and sodium and less lactose, with the same total level of carbohydrates. The milk of women after premature birth is also characterized by a higher content of a number of protective factors, in particular, lysozyme. Human milk is easily digestible and well tolerated by premature babies.

Despite the special composition, the milk of women who gave birth prematurely can satisfy the nutritional needs of only premature babies with a relatively large body weight - more than 1800-2000 g, while premature babies with a lower body weight after the end of the early neonatal period gradually begin to experience a deficiency in protein, a number of minerals (calcium, phosphorus, magnesium, sodium, copper, zinc, etc.) and vitamins (B 2, B 6, C, D, E, K, folic acid, etc.).

It becomes possible to preserve the main advantages of natural feeding and, at the same time, to meet the high nutritional needs of a premature baby when fortifying human milk with “amplifiers” or fortifiers (for example, “Pre-Semp”, Samper, Sweden, “Breast milk fortifier, Friesland Foods, Holland, etc.). They are specialized protein-mineral or protein-vitamin-mineral supplements, the addition of which to freshly expressed or pasteurized human milk eliminates nutritional deficiencies.

Indications for the appointment of artificial feeding for premature babies are only the complete absence of mother's or donor milk, as well as intolerance to women's milk. In the nutrition of children born prematurely, only specialized mixtures intended for feeding premature babies, the nutritional value of which is increased compared to standard adapted products (Pre-NAN, Pre-Nutrilak, Pre-Nutrilon with prebiotics, Humana-O-G A, Friso-pre, Enfamil premature).

Complementary foods are prescribed to premature babies starting from 4-5 months of age. The introduction of complementary foods up to 4 months is unacceptable due to the immaturity of both the digestive system and metabolic processes. Later (from 6 months) the appointment of complementary foods is also unacceptable, since the supply of nutrients (minerals and individual vitamins) in children born prematurely is sharply limited.

The introduction of complementary foods is carried out slowly and gradually. Until children reach 7-8 months of age, each feeding should end with the baby being attached to the breast or using milk formulas.

Organization of rational nutrition and the role of the district pediatrician

The organization of breastfeeding in primary health care is of paramount importance, because:

the preservation of natural feeding is the protection of the child's right to health; it is the official policy of the WHO and the government of the Russian Federation and, finally, it is the main positive factor determining health;

the leading organizer in this process is the KZR (healthy child's office);

in a children's polyclinic, one of the leading criteria for the qualification of a doctor and the effectiveness of his work is the proportion of breastfeeding.

Local pediatrician:

maintains a permanent preventive work to maintain a high proportion of natural feeding (at least 75% of all nursing mothers of children under 1 year of age) at all stages: before pregnancy, before childbirth, intranatal and postnatal.

identifies risk groups for hypogalactia;

uses all components of the diagnosis of hypogalactia: anamnestic, clinical, control feeding;

in case of a threat of hypogalactia, it immediately takes measures (algorithm for combating hypogalactia);

informs the head of the pediatric department in advance about the reasons for the possible transfer of each child to mixed and artificial feeding for a collegiate decision;

plans centralized or decentralized provision of breast milk for mothers with hypogalactia (breast milk bank, lactating mothers' circle for mutual assistance);

organizes the improvement of medical literacy (medical "education") of parents through various forms of education: "health universities", "school for young parents" (there is also a "school for a young father"), where they teach, among other things, the basics of feeding.

The doctor should convey to the mother's mind the importance of following the regimen:

daily routine;

work and rest;

sleep and wakefulness;

loads (from general sports to strict bed);

nutrition (especially in terms of the frequency of feeding, the amount of food, the timing of the introduction of complementary foods and the duration of breastfeeding).

Nutrition for children older than a year:

Each period of childhood is characterized by its own characteristics of growth and development, the degree of morphological and functional maturity of individual organs and systems, and the specifics of physiological and metabolic processes.

Principles of nutrition for children older than a year:

Adequate energy value of daily food rations, corresponding to the energy consumption of children.

A balanced diet for all interchangeable and indispensable nutritional factors, including amino acid proteins, dietary fats and fatty acids, vitamins, mineral salts and trace elements, as well as minor food components (flavonoids, nucleotides, etc.).

The maximum variety of the diet, which is the main condition for ensuring its balance.

Rational diet.

Optimal technological and culinary processing of products and dishes, ensuring their high taste and preservation of the original nutritional value.

Accounting for the individual characteristics of children (including their intolerance to certain foods and dishes).

Ensuring the sanitary and hygienic safety of food, including compliance with sanitary requirements for the state of the catering unit, the food supplied, their transportation, storage, preparation and distribution of dishes.