How long does it take to get used to a new mixture? How to determine that formula is not suitable for a newborn and transfer the child from one diet to another? Difficulty feeding

Very often, for certain reasons, a young mother cannot feed her baby naturally, and then breast milk analogues and adapted milk formulas come to the rescue. But feeding with formula milk has several rules that must be followed.

Before purchasing formula for feeding your baby, you should consult your pediatrician. It is necessary to carefully read all the inscriptions on the label of the formula packaging, where all the data is indicated: the qualitative composition of the mixture, the child’s age recommended for this mixture, the method of preparation and the shelf life when opened and closed.

For more information about the composition of infant formula, as well as unacceptable and necessary additives, read

What you need to know about infant formula

Infant formulas are made from cow's milk, maximally adapted to the standard of balanced nutritional components and nutritional value - breast milk. For adaptation, innovative technologies are used to modify food components at specialized enterprises under strict control in compliance with all hygienic requirements that apply to products baby food.

Milk formulas are divided according to medical and age indications, but there are no fundamental differences between feeding formulas produced by different companies, and the principles of proper preparation and feeding of a child with formula do not differ from each other. So, what do young parents need to know to properly feed their baby formula?

First of all, you need to remember the following - you need to purchase nutritional formula only in pharmacies or specialized children's stores, having first carefully checked the packaging for damage to the surface and the expiration date.

For more information on how to choose a formula, as well as a review of the most popular infant formulas, read

Safety regulations

Formula is given to the baby from a special measuring bottle with a nipple. To prepare milk formula, you must also purchase special water, baby water, and boil it.

Baby dishes must be free of any defects, they must be carefully looked after, after each feeding the bottle must be rinsed under running warm water, washed feeding utensils must be placed at the bottom of a large pan on a towel for sterilization, bottles and nipples should be boiled for 10 minutes in a closed pan, then they should be removed from the water, placed on a clean towel and allowed to dry. Read more about how to properly wash and sterilize baby bottles

The hole in the nipple for feeding should be such that the baby does not choke on the freely flowing formula, but at the same time, so that the baby does not waste his last strength sucking the mixture. Today, manufacturers offer a wide range of nipples for feeding, but it is better to choose a special orthodontic nipple; such a nipple fits better into the baby’s mouth, and the movements of his tongue are as close as possible to the movements when sucking on the mother’s breast. Read about choosing the right nipple for a bottle

It is necessary to prepare the milk formula immediately before feeding the baby, and when preparing it, you should strictly follow the requirements on its packaging. There is no need to try to make the mixture thicker, as this can lead to a deterioration in the child’s well-being.

The required amount of boiled water cooled to 40-50 degrees is poured into a dry, clean bottle, then the required amount of dry mixture is poured from the packaging with a measuring spoon into the bottle, after which the bottle should be shaken well until completely dissolved.

Never heat formula in a microwave oven; the temperature difference between the surface of the bottle and its contents can be quite significant, and you will burn your baby. Before giving the mixture to your baby, you need to check its temperature by applying a few drops of the mixture to your wrist. Formula should be warm, not hot.

You should not re-feed your child uneaten formula, or prepare the formula for future use. If you had to prepare the mixture in advance for several feedings, then it should only be stored in the refrigerator and no more than a day. Infant formula is an excellent base for the proliferation of various types of pathogenic microorganisms, so the formula for feeding your baby should be prepared new each time.

Changing a child's diet based on advertising is not the best the best option, because the choice of baby food is now huge, and it’s very easy to make a mistake.

Therefore, if there is a need to change the formula, you should consult your pediatrician.

How to feed formula?

When preparing the mixture, do not fuss or rush, otherwise you may make various mistakes. If the bottle in which the baby food was prepared suddenly bursts, you should not pour the mixture into another bottle, it is better to prepare a new one.

The amount of formula that the baby eats during feeding may vary, but this should not alarm the young mother; this is completely normal, since the baby has different appetites at different times of the day.

Never force your child to finish the entire amount of formula in the bottle; the baby himself knows how much he needs to eat in order to be satisfied.

Read about how much and how often a child should eat formula.

Sometimes the question arises about how best to feed your baby - in a crib or in your arms. Some are inclined to believe that only in their arms, since this way he experiences greater unity with the person feeding him, and some young parents believe that feeding a child in a crib is intended to accustom him to independence. In fact, choose exactly the method that suits you and your baby equally. After feeding, be sure to hold the baby in an upright position in a “column” position so that he can burp the air that gets into his tummy during feeding.

Communication with the baby during feeding is one of the important points; try to make the baby feel your care and love for him, give him as much attention as possible.

It is necessary to feed the child taking into account his age and appetite. To each new mixture The child needs to get used to it, so the mixture is first administered in small doses. You cannot feed your baby formula milk based only on beautiful packaging, without taking into account the individual characteristics of his body.

Read about how to find out if the formula is right for your child and how to switch to another formula.

Breastfeeding newborns is a very valuable gift of nature. Experts say that every woman can breastfeed. But sometimes desire alone is not enough. Difficulties arise. If for some reason a woman cannot breastfeed, the choice of formula must be approached carefully. After all, the health and development of the baby depends on this. How to choose the right mixture? What mixtures are there? How to prepare the mixture correctly? Let's talk in the article.

What important points should be taken into account when switching to artificial feeding of newborns? First, consult your doctor. He can offer formulas that are as close to breast milk as possible. They must be of high quality and purchased in special stores or baby food departments.

Do not buy mixtures of different brands and several pieces. Buy one pack. After all, you don’t know whether it will suit the baby. Carefully study the composition and expiration date. When switching to a new formula, the baby may experience constipation or loose stools. Don't worry. Thus, the child’s body adapts to the new food.

You should not buy the mixture secondhand, even at a price significantly lower than the store price. Even if the packaging is intact and has a normal shelf life, there is no guarantee that it was stored under the required temperature conditions and acceptable humidity. This means it may be damaged.

What formulas exist for artificial feeding of newborns?

Baby food manufacturers offer a wide selection of different formulas. Sometimes parents are at a loss as to which one to choose. Each child is individual. In general, infant formula is made from high-quality cow's or goat's milk. The protein is processed.

1. Adapted. The composition is as close as possible to mother's milk. It is possible to feed a newborn with an artificial formula with maximum adaptation from the first days of life. The baby quickly gets used to the mixture, as it is nutritious and quickly absorbed by the body. It is based on demineralized whey, the correct balance of vitamins, fats and carbohydrates. Such mixtures include, for example, “Nan”, “Nutrilon”, “Humana 1”.

2. Partially adapted. Does not contain demineralized whey. Partially adapted mixture imitates the composition of breast milk. Just as nutritious and healthy. This is “Nestozhen”, “Malyutka”. They can be given from birth, but this food more often causes negative reactions in the child than the above. But the price is cheaper.

3. Unadapted. Includes casein, beneficial substances such as lactose, amino acids, vitamins and semi-saturated fatty acids (PUFAs). Made from unprocessed cow's milk. It is recommended to give to children over six months.

4. Fermented milk. Rich in bifidobacteria. If a bottle-fed newborn's stool is often hard, irregular, or has problems with the digestive tract, these formulas are the best choice. Doctors' opinions differ as to whether fermented milk formula can be a child's main diet. Some advise giving fermented milk mixture no more than once a day. Others say that you can feed children exclusively with it, because it is not kefir, but a mixture, albeit with the addition of bifidobacteria.

5. Medicinal. They have unique properties. They not only nourish the baby, but also have a healing function. Infants who have been diagnosed with anemia will benefit from formulas with high levels of iron; with disruption of the gastrointestinal tract - baby food based on soy milk; prone to allergies - hypoallergenic mixtures. Medical nutrition is prescribed to children born ahead of schedule. They contain a lot of vitamins, minerals, protein and proteins.

The mixtures are sold in the form of a dry powder and ready-made. The first option is more popular. It is economical and affordable for most families. Preparing the mixture is not difficult. Instructions are on the package.

Remember the main thing, the golden rule: you need to introduce a new mixture gradually. First 30 ml, the next day - 60 ml, etc. The mixture with a thickener is intended for children who regurgitate excessively. It is introduced a little at each feeding. The thick consistency of the food does not allow it to be easily pushed out of the stomach.

Why should you choose a quality mixture?

International standards have been developed based on biochemical research. They are responsible for the quality of breast milk substitutes. The emergence of such mixtures is the most important technological achievement of mankind. Previously, children were fed cow's milk, and almost all of them had problems with the kidneys, intestines, and allergic reactions. Nowadays, natural and artificial feeding are practically on the same level.

What are the features of the adapted mixture? What does it contain?

1. Reduced protein levels. An excess of aggressive cow protein leads to negative reactions in the child’s body. The digestive system cannot digest proteins due to a lack of enzymes. Abuse can lead to allergic reactions, metabolic disorders, digestive system problems and weight gain.

2. Proteins are very close in composition to mother’s milk. Such mixtures contain amino acids. They are necessary for building cells.

3. Presence of taurine. It is a sulfur-containing amino acid that is not found in proteins. Essential for children, especially in the first year of life. In older children, taurine is produced based on the synthesis of cysteine ​​and serine. Responsible for the proper functioning of the brain, cell building, absorption of fats and other components.

4. Semi-saturated fatty acids (PUFAs) are responsible for the development of the child’s brain. The body produces hormone-like substances based on PUFAs. Their main task is to regulate metabolic processes at the cellular level, providing anti-inflammatory effects and an immune response.

5. Carbohydrates. There are much more of them in breast milk than in cow's milk. The main one is lactose (85% of the carbohydrate composition). It consists of galactose and glucose and belongs to the group of disaccharides. The remaining 15% are oligosaccharides. They contain several molecules of simple sugars. Their main task is to maintain the intestinal microflora and protect against harmful bacteria. Oligosaccharides are replaced by a low molecular weight polymer of glucose in mixtures. It normalizes the intestinal microflora, is responsible for the absorption of fats and their entry into the blood. Thanks to this, the baby does not feel hungry.

How to prepare milk formula?

Not everyone knows how to prepare the mixture correctly. It would seem that this is as simple as shelling pears. But sometimes nuances arise that confuse parents.

Not a single, even the most expensive, adapted formula can replace breast milk. Transferring a child to formula should be done gradually if there are reasons for this.

First of all, carefully read the instructions on the package. Pay attention to such points.

1. What temperature should the water be.

2. What are the correct proportions for preparing the mixture.

3. Is there a measuring spoon in the package?

5. How long can the mixture be stored and under what conditions.

Sterility is the main condition for preparing the mixture. The main task of parents is to protect the child from germs by all means and to help adapt to environmental conditions. There is no need for extra microbes. Intestinal infections are very dangerous for a child of the first year of life. You need to prepare the milk formula before each feeding. For a newborn, be sure to boil the bottle and pacifier.

When everything is ready, let's start preparing the mixture. Determine the required ratio of water and measuring spoons of the mixture. Pour boiled water into the bottle and let it cool to the required temperature. Pour in the required amount of mixture (without a slide).

Do not use another spoon, only the one included. Cap the bottle and shake. Make sure there are no lumps. You should not shake the bottle too vigorously, so as not to saturate the milk drink with air bubbles.

Checking the temperature. Drop a little mixture onto your elbow. If the temperature is normal, you can give it to the baby.

It is important to maintain the correct ratio of water and mixture. Some mothers, in order to saturate the baby, add more measuring spoons to the water. There is no need to do this. For the first three months, the baby already suffers from colic.

Prepare only as much formula as your baby will eat. Do not store unfinished mixture or add a new portion to it. The longer the mixture is stored, the higher the risk of bacteria growing in it. If you are going on the road, take a thermos with boiled hot water with you. You will need it to prepare fresh mixture for the baby.

You should not exceed the feeding norms for bottle-fed newborns, which were announced to you by your pediatrician. Usually they are written on the packaging of the mixture. If your child, after feeding the recommended dosage, feels the urge to suck on a bottle more, this is not a signal to offer more formula. Most likely, the signal of satiety from his stomach has not yet had time to reach his brain. Give your baby a pacifier if he sucks on one. And in the future, do not try to quickly feed the child. Let him suck slowly. To do this, purchase a slow flow bottle nipple. By the way, a small hole in the nipple will protect the baby from swallowing a large amount of air, and therefore from intestinal colic, belching and hiccups.

Give the child a mixture with a temperature of 36-38 degrees, the same as body temperature. This way it will be absorbed better.

Do I need to give water when bottle feeding?

Additional fluid is necessary for children receiving infant formula as their main diet. How much and how to properly supplement infants? First you need to decide what you will give to drink. There are several options for what kind of water to give to a newborn, and they can be combined with each other:

• special children's water;
• boiled water;
• pure spring water from an artesian well;
• fennel fruit infusion or other baby “tea” (usually recommended for colic);
• infusion or decoction of raisins, prunes, dried apricots (with their help, constipation in newborns with artificial feeding is also treated).

As for the quantity, focus on the following calculations: 30 grams of water multiplied by 1 kg of the child’s weight. That is, a child weighing 7 kg needs about 210 grams of fluid per day. But how much water to give a newborn during IV is very average recommendations. Children who have a high body temperature need more fluids. And a baby who is in a humid room with a comfortable air temperature will drink less. All this shouldn't bother you.

If supplementation during artificial feeding is not carried out enough, the child will most likely have problems with stool. Usually, literally trying to push liquid into the child, parents resort to tricks. For example, they begin to sweeten it. In principle, this is not harmful. If done in moderation. However, many children, after such desserts, have trouble drinking regular water in the future. In this case, it is more useful to try to feed the child with a syringe without a needle; if he does not drink water from a bottle, pour some water into his cheek. Or give it from a spoon.

First complementary food during artificial feeding

Previously, it was believed that formula-fed infants should begin receiving additional nutrition in the form of fruit juices as early as 4 months of age. Now that many adapted formulas are sold in stores at affordable prices, the introduction of such early complementary feeding is not at all necessary.

That is, it is recommended for bottle-fed babies to start complementary feeding at the same age as babies fed on mother’s milk, at 6 months. And not from fruit juices or fruit purees, but from vegetable purees or dairy-free cereals. This complementary food is given at 6-7 months. At 8 months it is time for meat. After - cottage cheese, fish and kefir.

Basic products that should be introduced into a child’s diet by the age of 1 year:

• vegetables;
• fruits;
• porridge;
• meat;
• fermented milk (kefir, cottage cheese - if the child does not have an allergic reaction to them).

Egg yolk and fish - if the child tolerates them well.

The introduction of complementary foods during artificial feeding can be carried out in accordance with the table on our website.

Table. Scheme for introducing complementary foods when artificially feeding children from 0 to one year old by month.

Adaptation (in Middle Ages, Latin adaptatio - adaptation) in biology is the adaptation of living organisms to changing conditions of existence, expressed in changes in morphological and physiological characteristics and behavior. Adaptation is also called the process of habituation.

Throughout early childhood, the child has to adapt to changing nutritional conditions: adaptation to milk nutrition; adaptation to mixtures; adaptation to the introduction of complementary foods; adaptation to the introduction of elements of a common table.

Immediately after the birth of the child, the supply of glucose through the hemotrophic pathways stops. The transition from hemotrophic to milk nutrition in the first days of life is a complex chain of interconnected processes. Lactotrophic nutrition in the early period of life is the basis for all metabolic processes. Moreover, lactotrophic nutrition, which is an analogue and continuation of hemotrophic nutrition, is a source of substances and stimuli that directly serve for the development and growth of all functional systems of the child’s body. That is why replacing breastfeeding with artificial or mixed feeding can be regarded as a gross interference in the metabolic processes of the newborn’s body, in fact, as a metabolic catastrophe.

The next phase in the development of a child’s autonomous nutrition is associated with the introduction of complementary foods. This phase is a complex and rather lengthy adaptation process. A child’s acquaintance with new food takes quite a long time, and normally only by the age of 1.5-2 years, mother’s milk is completely replaced by ordinary products.

The introduction of complementary foods when the degree of maturity of rapidly growing organs is insufficient for this is another metabolic catastrophe with possible adverse consequences. Thus, a child can experience 2 “metabolic catastrophes”: the first - when switching to mixed or artificial feeding, and the second - when introducing complementary foods early. The criteria for the readiness of children to introduce complementary foods and the sufficient duration of this process to ensure optimal metabolic adaptation are extremely important. There are certain physiological and biochemical justifications for the most optimal time for introducing complementary foods ().

As can be seen from the data given in the table, it is not advisable to introduce complementary foods before 3-4 months of life, since until this age the child is not physiologically prepared to assimilate food other than human milk or its substitutes. Therefore, according to most researchers, the first complementary foods should be introduced between 4 and 6 months of life. However, according to current practice in Russia, before the introduction of “basic” complementary foods, children begin to receive fruit juices.

In accordance with the feeding scheme approved by the USSR Ministry of Health in 1982 and currently officially in force in Russia, the introduction of fruit juices is recommended from 3-4 weeks of age.

At the same time, numerous data (including our own observations) show that in children who were introduced to juices up to 3-4 months, there were adaptation failures in the form of intestinal dysfunction (the appearance of “green”, mucus in the feces, disturbances in bowel movements, etc. ), skin rashes, and intestinal dysbiosis developed.

There is no need for early introduction of juices; they, like other types of complementary foods, should be included in the diet no earlier than 4 months.

Specialists working in the field of pediatrics and baby nutrition face 3 main tasks:

• pay maximum attention to supporting breastfeeding and ensuring full lactation in mothers;
• achieve maximum efficiency of artificial feeding (supplementary feeding and complementary feeding), ensuring adequate growth, development and resistance of children to the effects of adverse external factors;
• introduce new products in such a way as not to cause adaptation failure, a “metabolic catastrophe”, and, as a consequence, the development of atopic dermatitis.

Preservation and stimulation of lactation

Natural feeding is a physiological phenomenon for mother and child, and therefore cases of true lack of milk (hypogalactia) are rare. The most crucial moment is the formation of lactation in the mother in the first 3-4 months after birth. We can recommend the following rules that must be followed for successful feeding:

• early attachment of the baby to the breast (in the delivery room);
• a free feeding regime is desirable (at the child’s request);
• when introducing complementary feeding or supplementary feeding to prevent the extinction of lactation, it is recommended to put the baby to the breast at the end of each feeding;
• If there is not enough milk, you need to put the baby to the breast more often. We must remember that every drop of mother’s milk is priceless for an infant. At the same time, frequent breastfeeding can increase milk production in the mammary gland;
• A nursing woman should be provided with a nutritious, balanced diet. The exclusion of many products (fermented milk, meat, fish, vegetables and fruits, protein foods) is not justified;
• it is necessary to maintain an adequate drinking regime: a nursing woman should drink 150-200 ml of liquid 30 minutes before feeding and 20-30 minutes after feeding. You can drink compotes, fruit drinks, juices, tea, milk tea, still mineral water. It is undesirable to consume sweet carbonated water and whole cow's milk. From alcoholic drinks you can: low-alcohol or non-alcoholic beer (up to 500.0 ml per day), a glass of dry wine or champagne (without gases);
• the nursing woman should be provided with mental comfort, the absence of psycho-emotional stress and iatrogenic effects (rash statements from medical workers can significantly reduce lactation);
• prevention of inflammatory diseases of the mammary gland, for which it is advisable to periodically (once every 2-3 months) check milk “for sterility” - microbiological purity, i.e. carry out bacteriological examination of breast milk and therapeutic measures as necessary;
• prevention of congestion, for which it is recommended to completely express milk when there is excess milk. Expressed milk can also be used for subsequent feedings;
• correct interpretation of lactation crises, which can occur in any period of lactation and are accompanied by a short-term decrease in lactation and the appearance of anxiety in the child and a decrease in stool. With adequate measures, lactation is restored within 5-7 days, i.e., a return to the normal lactation regime occurs, but premature introduction of supplementary feeding can cause suppression of lactation;
• if breast milk is infected, do not stop breastfeeding, but carry out treatment, if possible, without the use of antibiotics;
• If a nursing woman is prescribed antibacterial therapy for any reason, she should, firstly, select an antibiotic from a special “approved” list (ampicillin, penicillin, oxacillin, etc.), and secondly, prescribe the child a preventive course of probiotics to reduce the risk of developing he has intestinal dysbiosis. As our experience shows, in this case, dysbiosis from the use of antibiotics poses almost no threat to the child;
• it is necessary to individually decide on the advisability of using any medication by a nursing woman; if possible, their use should be avoided.

If there is a tendency to decrease lactation, it is possible to use such remedies as mlekoin, apilak, apilaktin, femilak, and covering the breast with a warm cabbage leaf before feeding.

Maximum efficiency of artificial feeding

In our opinion, there are three interrelated criteria for the adequacy of natural feeding.

• The child's weight gain is at least 600 g on average per month (based on birth weight).
• The interval between feedings is at least 2.5 hours.
• The amount of mother's milk eaten by the child corresponds to the need: 1/5 of the actual weight - up to 1 month; 1/6-1/7 of actual weight - up to 5-6 months. The amount of food a child eats can be determined by carrying out control weighing, not just once, but throughout the day (or better yet, several days in a row).

If all of the listed criteria correspond to the above, then the child’s nutrition should be considered adequate, and until 4-5 months such a child does not need to change his diet (introduce supplementary feeding and complementary feeding). If there are deviations, you need to find out whether they are associated with any diseases or dysfunctions (including intestinal dysbiosis) or whether the reason is a deficiency of breast milk.

If mother's milk is not enough to ensure adequate feeding of the child, the question of introducing supplementary feeding arises. The concept of “supplementary feeding” includes formulas - breast milk substitutes.

Human milk substitutes are divided primarily according to the degree of their approximation to the composition of human milk into two large groups: adapted and partially adapted. Adapted substitutes are most similar to human milk in all respects: they have a reduced total protein content compared to cow's milk (up to 1.4-1.6 g/100 ml), and the protein component is represented by a mixture of casein (the main protein cow's milk) and whey proteins (dominant in human milk) in a ratio of 40:60 or 50:50. This is close to their ratio in mature human milk (45:55). Whey proteins form in the stomach under the influence of hydrochloric acid a much more delicate and finely dispersed clot than casein, which provides a larger area of ​​​​contact with digestive enzymes and, as a result, a higher degree of digestion and absorption.

The main carbohydrate in most human milk substitutes is lactose, which has a number of properties that are of important physiological importance for infants. It promotes the absorption of calcium, has a bifidogenic effect (i.e., the ability to support the growth of bifidobacteria), and reduces the pH in the large intestine. The last two of its properties are due to the fact that most of the lactose (up to 80%) is not absorbed in the small intestine and enters the large intestine, where it serves as a substrate for B. bifidum and lactobacilli, under the influence of which it is fermented to form lactic acid.

The mixtures that are maximally adapted to human milk in all their components include: “Nutrilon” (“Nutricia”, the Netherlands), NAS (“Nestlé”, Switzerland), “Humana-1” (“Humana”, Germany), “ HiPP-1 (HiPP, Austria), SMA (White Nutrition International, USA), Galia-1 (Danone, France), Samper Baby-1 (Samper, Sweden) , “Frisolak” (“Friesland”, the Netherlands), etc. The mixtures “Bona” and “Piltti” (Nestlé, Finland) and “Tutteli” (Valio, Finland) are very close to them in composition, not containing, however, taurine and carnitine. A special feature of the mixtures “Similak” (Abbott Laboratories, USA) and “Nestozhen” (Nestlé, the Netherlands) is their protein component: unlike all those mentioned adapted mixtures, in Where whey proteins predominate, casein dominates in these mixtures, accounting for 80% of the total protein in the product. In this case, casein is subjected to special processing, which increases its digestibility. The composition of the necessary components of casein formulas is also as close as possible to the composition of human milk. This circumstance, as well as well-known literary data on the high efficiency of casein formulas in the nutrition of children of the first year of life and at the same time the similarity of blood aminograms of children receiving both types of mixtures, allow casein formulas to be classified among the adapted mixtures that can be used in the nutrition of children with first days of life.

The high content of mineral salts in cow's milk, kefir and other non-adapted whole milk products leads to a significant load on the renal tubular apparatus, disturbances in the water-electrolyte balance, increased excretion of fats in the form of calcium salts, etc. This is one of the reasons why non-adapted dairy products It is not recommended in our country for children in the first 6-8 months of life, and in the USA - even throughout the first year. Unadapted dairy products (milk, kefir, etc.) do not correspond to the physiological characteristics of children in the first year of life and should not be included in their diet until 6-8 months of life, even in very difficult socio-economic conditions.

It should be emphasized that the ingredient and chemical compositions of all modern human milk substitutes that meet international standards are quite close to each other. At the same time, in practice there are often cases when a child gives pronounced allergic (pseudo-allergic) reactions to one of the modern most adapted mixtures, but tolerates another mixture of the same generation well. This indicates the need for maximum individualization of children’s nutrition and the abandonment of any ready-made templates and standards when prescribing infant formula. The criterion here can only be the results of careful observation of the child over time and an assessment of his tolerability of a particular product, naturally, provided that the doctor has a clear idea of ​​​​its composition.

Expanding the child’s nutrition and supplementing mother’s milk (or its substitutes) with other products (complementary foods) are determined by the following main factors:

• the need to additionally introduce energy and a number of nutrients into the body of a growing child, the supply of which only with human milk (or its substitutes), starting from a certain stage of infant development (usually from 4-6 months), becomes insufficient;
• the feasibility of training and developing the digestive system of children;
• the need to train and develop the masticatory apparatus;
• the feasibility of stimulating intestinal motor activity.

A balanced diet for a child from 6 months to 1 year should include:
3/4 of the total daily volume - protein foods (breast milk, formula - breast milk substitutes, cereals, fermented milk products);
1/4 of the total daily volume is fiber (vegetables, fruits in the form of puree or in another form);
+ 10 ml x age (month) per day - juice;
+ 50.0 per day - cottage cheese;
+ 1/2 yolk 2-3 times a week;
+ 50.0 per day for meat or fish.

Prevention of the development of atopic dermatitis when introducing new products

The child’s adaptation to the introduction of new foods is largely due to the normal composition and functioning of the intestinal flora. Considering that the main carbohydrate in breast milk, lactose, is broken down with the active participation of bifidobacteria and lactobacilli, their presence in sufficient quantities is necessary for adaptation to both breast milk and lactose-containing artificial formulas. The presence of lactose in baby food is the basis of all metabolic processes, so replacing milk formulas with lactose-free ones is not physiological.

Thus, dysbiosis can be the cause of so-called adaptation diseases, which include a skin reaction to the introduction of new products that occurs in children in the first year of life. This reaction is officially designated as atopic dermatitis; parents often use the term “diathesis.” The basis for the appearance of atopic dermatitis upon the introduction of supplementary feeding or complementary feeding is a failure of adaptation. In turn, failure of adaptation caused by dysbiosis or improper introduction of a new diet leads to worsening dysbiosis, and a vicious circle arises. The result can be persistent intestinal dysbiosis, the development of a deep imbalance and the formation of a chronic disease that can last for many years to come.

Atopic dermatitis is a chronic recurrent inflammatory skin disease manifested by intense itching, sympathetic skin reaction, papular rashes and severe lichenification in combination with other signs of atopy.

Among the etiological factors leading to the development of atopic dermatitis, sensitization to food allergens is indicated, especially in childhood. This is due to congenital and acquired disorders of the digestive tract, improper feeding, early introduction of highly allergenic foods into the diet, intestinal dysbiosis, the presence of a high titer of UPF, disruption of the cytoprotective barrier, etc., which contributes to the penetration of antigens from food gruel through the mucous membrane into the internal environment of the body and the formation of sensitization to food products.

Food allergies are of greatest importance in the development of atopic dermatitis in young children, and the causative allergens are cow's milk proteins, eggs, and fish. Accordingly, one of the main postulates of treatment was the exclusion of a huge number of foods from the child’s diet, which often led to gross disturbances of metabolic processes. This issue was actively discussed at the 1st International Symposium of Herg Reich (Davos, Switzerland, 1998), where some scientists noted the absence of IgE antibodies in almost half of children with atopic dermatitis. According to our data, the level of IgE during food reactions in children of the first year of life increases quite rarely. Most likely, the central point in the development of atopic dermatitis is not just an increase in IgE, but impaired regulation of this immunoglobulin. A decrease in the synthesis of γ-interferon, which blocks the production of IgE, can trigger the development of atopic dermatitis. It was found that the concentration in the blood of γ-interferon is lower in children at risk who developed atopic dermatitis in the first year of life than in children without atopy, although IgE levels in these children did not differ significantly.

The state of the gastrointestinal tract plays a significant role in the pathogenesis of reactions to nutrition and atopic dermatitis. A connection between non-atopic eczema and infectious agents has been proven, in particular with staphylococcal, streptococcal infections, fungi of the genus Candida, hemolytic E. coli and other representatives of the UPF. A study that included 100 outpatients confirmed the prevalence of different types of staphylococci at 88%. Other studies have provided evidence that the breakdown products of staphylococcal enterotoxin and other microorganisms are highly homologous to the IgE receptor. Their significance for skin inflammation may be associated with the attachment of microbial enterotoxins to B lymphocytes, which stimulates the synthesis of IgE, causing secondary hypersensitization. In addition, waste products of microorganisms - toxins - can accumulate in the child’s body. They are neutralized by normal flora bacteria, as well as by the pancreas and liver, causing their reactive inflammation and dysbacteriosis, which, in turn, reduces the quality of digestion and affects the breakdown and absorption of vital nutrients.

Very often, inflammatory skin rashes are caused by impaired intestinal motility (spastic colitis), which leads to severe constipation and is often a consequence of intestinal dysbiosis. Staying in the intestines sometimes for several days, feces, breaking down, form ammonia and ammonia acids, which also causes endotoxemia syndrome.

Diet plays a particularly important role in the development and exacerbation of allergic dermatoses. Very often, when single rashes appear on the skin, doctors exclude valuable nutritional components from the child’s diet, without replacing them with anything, which leads to a pronounced disruption of all types of metabolism and the functional state of many body systems, the functioning of which requires a sufficient amount of proteins, fats and carbohydrates. In this case, the exacerbation of the disease is often caused not by the product itself, but by a violation of its breakdown and absorption. The normal intestinal flora is, again, responsible for the complete breakdown and absorption of food.

The persistence of microbiological disorders in the intestine, along with factors such as hereditary predisposition, disorders of higher nervous activity, the autonomic nervous system, disorders of the internal organs, metabolic, neurohumoral, neurovascular disorders, poor nutrition, various intoxications, the influence of adverse environmental factors, becomes the cause chronic relapsing course of atopic dermatitis.

In connection with the above, the importance of preventing allergic problems in early childhood, when the child is especially vulnerable, becomes obvious. The basis of such prevention is the correct introduction of new products, which allows you to avoid disruption of adaptation and maintain the balance of intestinal normal flora.

The main timing of conducting a planned microbiological examination of feces to identify and correct abnormalities in children of the first year of life should be taken into account:

• by 1.5-2 months - by this time the first stage of the formation of the biocenosis ends;
• by 4-5 months - before the start of complementary feeding;
• after 6 months (at 7-8 months) - when many complementary foods are introduced, teeth begin to erupt;
• after 1 year - control.

In addition, it is possible to study the biocenosis after changing the diet, taking antibiotics, or performing microbiological correction (no earlier than 2-3 weeks).

Rules for introducing supplementary feeding and complementary feeding

The basic principle of introducing any new product is gradualism; you need to start with very small doses of new food.

Another important principle of feeding is the stability of basic nutrition. This applies to adapted formulas - breast milk substitutes. If a child receives an adapted formula as supplementary feeding, it is not advisable to change it to a similar one, so as not to overload the child’s adaptive capabilities. Supplementary feeding is introduced gradually, and if there is no significant deterioration in the child’s condition within 7-10 days, the formula does not need to be changed. In some cases, when the child is not able to normally digest adapted formulas, therapeutic nutrition can be temporarily introduced (“Frisov” - for constipation and regurgitation; “Al-110” - for lactase deficiency; hypoallergenic mixtures (“Humana-GA”) - for severe dermatitis, etc.), which also needs to be introduced as gradually as possible. We consider soy nutrition and hydrolysates to be non-physiological products that lead to metabolic dysfunction, therefore we do not recommend using such food as a supplement, but, if possible, we advise replacing it with medicinal or adapted mixtures. Typically, adaptation disorders are associated with intestinal dysbiosis, and after its correction, it is possible and necessary to gradually move from medical nutrition to an adapted milk formula.

There is reason to believe that human biological evolution in recent decades has lagged behind the evolution of the environment. Therefore, most children are born with adaptation disorders or significant prerequisites for such disorders (dysbacteriosis, which appears in early age in most children). Therefore, it is necessary to introduce new foods to children of the first year much more carefully than was done previously for previous generations. A more careful introduction of supplementary feeding or complementary feeding will not harm the child at all; no shortage of nutrients and vitamins will arise. At the same time, careful inclusion of a new product in the diet will minimize the risk of developing atopic dermatitis and other adaptation disorders in the child.

Even if a child is significantly lacking breast milk, gradual introduction of supplementary feeding is justified, and the risk of malnutrition is potentially less dangerous than the risk of failure to adapt. Our experience shows that children to whom complementary feeding or complementary feeding was introduced immediately in large quantities, in most cases had more pronounced disturbances of the intestinal biocenosis, accompanied by functional decompensation, including manifestations of atopic dermatitis, compared to children to whom new food was introduced gradually.

The lower the initial dose of a new product, the slower it is increased, the less likely it is for atopic dermatitis to occur.

This rule can be illustrated with a “physical education” example. In order not to “tear” the muscles, but to effectively “pump up”, you need to gradually increase the load. This also applies to the functioning of the pancreas, immune system and other adaptation mechanisms. We must not forget that in a child’s first months of life these mechanisms are underdeveloped and the load must be adequate. Thus, than younger child, the more caution he should be given any new product.

It is advisable to introduce a new product at the end of feeding, if possible, mixing it with the usual diet.

New products are introduced into those feedings when they are planned to be used in the future. Supplementary feeding (adapted formula - breast milk substitute) can be administered several times a day, and any type of complementary feeding is administered only once a day. In this case, a “physical training” analogy can also be useful: during physical training, the muscles are first “warmed up” and only then are they given a load. Enzymatic systems and the intestines also need to “warm up” and begin to work actively, digesting familiar food. The introduction of a new product at the end of feeding will not take the baby’s body by surprise, in addition, it will be easier for him to get used to the new taste sensations. When the amount of a new product reaches 30.0-50.0 (with proper administration - by the 7-10th day), and the child adapts to this product, you can start giving this product at the beginning of feeding.

After the child has eaten the usual food, the new product should be dropped into the mouth from a pipette, or given on the tip of a teaspoon, or mixed with the “last spoon” of the usual food. Day after day, the portion of the product increases.

No more than one new product should be introduced in 7-10 days.

It takes time to adapt to a new product: at least one week. This process goes better when you have to adapt to one influence. If, at the peak of adaptation, another effect is added to one effect, which also requires adaptation, this can lead to a breakdown. This applies not only to nutrition: it is undesirable to introduce new foods 3 days before or 3 days after vaccinations, in the first week of teething, during acute respiratory infections and other acute diseases, as well as in the first 10-14 days of corrective measures for dysbiosis intestines. In addition to facilitating adaptation, compliance with this condition provides information about the individual tolerance of the new product being introduced.

The course of adaptation and individual tolerance of a new product should be assessed by changes in the child’s stool, skin, behavior and well-being.

The initial state should be assessed against these criteria before introducing a new product. When introducing a new microdose product, you should monitor the changes. If deterioration from the initial condition is noted (the appearance or intensification of skin rashes; changes in stool: disturbances in bowel movements, liquefaction, the appearance of mucus or “green”; restlessness or regurgitation) and these disturbances are moderate in nature, the administered product does not need to be discontinued immediately: for some time (2 -4 days) you can continue to give it without increasing the dose. In this way, the digestive systems can adapt, which will be manifested by a return to the original state, in which case the gradual introduction of a new product can be continued. If the manifestations of adaptation failure are pronounced or after deterioration there is no return to the original state, the new product is canceled. After discontinuation of the product that caused adaptation failure, it is advisable not to introduce new products for some time (up to 1 week), and then the introduction of complementary foods should be continued. You can return to a product that is not suitable for your child after 3-4 weeks, including it gradually in the diet.

It is very important to follow these rules when first trying to introduce new products. In the future, the child’s adaptive capabilities improve, and new foods can be introduced at a faster pace, but still with caution.

These rules may seem overly strict, however, in our opinion, caution and even reinsurance when introducing new products to a child under 1 year old will not hurt. There will be no great harm if the introduction of complementary foods is delayed; the child will still receive all the food components he needs for development. And the risk of failure of adaptation with the subsequent development of intestinal dysbiosis and atopic dermatitis with careless introduction of new products in children of the first year of life increases many times.

When introducing complementary foods, it is advisable to give preference to ready-made baby food products, adapted or partially adapted. Getting used to such products occurs more smoothly than to home-made products. In turn, if adaptation to “canned” nutrition has already occurred, it will be easier for the child to adapt to other products. Baby food does not contain preservatives or harmful additives, is enriched with vitamins and is balanced in composition, but it can only be purchased in specialized stores or baby food departments.

In some cases, recommendations for timing of administration indicated on the packaging of baby food (especially for juices and purees) do not correspond to the physiological capabilities of the child (). Regardless of the recommendations of the company that produces baby food, you need to remember that the introduction of any complementary foods is undesirable until 4-5 months, and such products as cottage cheese, meat, fish - until 6-7 months.

It should be borne in mind that in addition to individual intolerance to certain foods, the child may simply not like the taste of the new food. In this case, he will spit out new food or refuse it. We believe that forcing a child to eat is wrong. You can try to make the child like the food (for example, add fructose) or refuse this product (perhaps temporarily, until the child begins to feel differently about the product).

If you are intolerant to a particular product, you can find a replacement for it among similar ones. But if adaptation disorders accompany the introduction of almost any complementary food product or a whole group of products is not digested (for example, dairy products, including lactose-containing mixtures), then most likely the issue is not in nutrition, but in internal problems leading to disadaptation syndrome. Most often, according to our observations, this problem is dysbiosis. Correction of microecological disorders leads to the restoration of the child’s normal adaptation to nutrition.

A. L. Sokolov
Yu. A. Kopanev, Candidate of Medical Sciences
MNIIEM im. G. N. Gabrichevsky, Moscow

Lyudmila Sergeevna Sokolova

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Article last updated: 05/01/2019

An adapted formula, that is, very close in composition to breast milk, was created taking into account all the needs of bottle-fed babies. The task of parents is to approach the choice of complementary foods for their child with all responsibility, study all the possible options that manufacturers offer and, of course, listen to the advice of the pediatrician.

Despite the fact that all infant formulas are similar in composition to each other, the newborn’s reaction to them can be completely different. It is not always possible to choose the right nutrition for a newly born baby the first time, and a young mother faces a number of problems that arise from eating food that is inappropriate for him. How to determine whether a given food is suitable for a child, or whether it is necessary to think about replacing it?

Criteria for selecting formula:

1. If the newborn started receiving formula milk in the maternity hospital, then changing it, at least for the first time, is not recommended.
2. It must correspond to the age of the baby. Packages with baby food from birth to 6 months are marked with the number 1, from six months to a year, with the number 2, and over one year - 3
3. Check the expiration date on the packaging
4. The product must contain all the vitamins and microelements necessary for the full development of the baby: taurine, carnitine, linoleic acid, lactulose, probiotics, nucleotides, polyunsaturated fatty acids, iodine, iron
5. The amount of protein should range from 12 to 14 grams per 1 liter of prepared product
6. The composition must be free of starch and sucrose.
7. Instructions for preparing food should be informative and understandable
8. Try to choose an affordable product, one that you can easily purchase in the future.

If you try to follow these simple rules, then most likely you will succeed; the food you choose will be healthy and will bring you and your baby many pleasant moments. But there are exceptions to every rule, and every newborn organism is individual, so even the best and most expensive formula may be unsuitable for your baby. It is necessary to introduce complementary foods with a new product gradually, observing the reaction over several days.

How to introduce new food into your baby's daily menu?

You need to start feeding your child new food as carefully as possible, with small amounts, increasing portions every day, and monitor how he reacts to the innovation.

Here is an approximate scheme for introducing a new product into the diet of a newborn:

• 1st day. 10 grams of an unfamiliar mixture, once a day.
• 2nd day. 20 grams, twice a day.
• 3rd day. 30 grams, three times.
• 4th day. 40 grams, four times a day. And so on until the volume of the mixture reaches 70 grams, and the number of feedings reaches seven.

This scheme is suitable for newly born babies; if you start introducing a new formula at a later date, then its amount increases in direct proportion to the age of the child. For example: at 3 months, start complementary feeding with 20 grams, and at 5 months with 30 grams, adding the same amount daily.

Switching a child to a new product in one day is strictly not recommended, as it can lead to negative consequences, such as bloating, indigestion and allergic reactions. Under no circumstances should you change baby formula without good reason; such a change is a very big burden on a fragile body.

How to determine if the mixture is suitable?

1. The baby's stool is regular, normal in color and consistency
2. There are no rashes on the body, the skin has a normal appearance
3. The baby eats with pleasure
4. Gains weight normally, is active and develops well

If all the signs of good health, mood and timely development of the newborn described above are present, then you have made the right choice and the new food is suitable for your baby. You can safely continue to feed your baby with it, moving to the next level when he reaches the appropriate age.

In what cases does the mixture need to be replaced?

If, after introducing a new product into the diet, you notice at least one of the following symptoms, this is a consequence of the fact that the chosen food is not suitable for the baby and you need to think about replacing it.

1. Frequent stools with white lumps of undigested food and mucus
2. Increased gas formation, colic and constipation
3. Constant regurgitation, even between feedings
4. Skin rashes, redness
5. Poor weight gain
6. The baby is lethargic, often capricious, cries and irritated
7. Sleeps restlessly at night, wakes up repeatedly
8. The child does not eat enough and cannot maintain feeding intervals

Observe the baby's behavior while eating; if he doesn't like it, he will refuse to eat. In this case, you should not force him to eat, but you need to figure it out and understand the reason for the refusal.

Of course, you need to gradually transfer your child to a new diet; the child’s body needs adaptation, otherwise he will be tormented by colic and regurgitation. If after 2-3 weeks the unpleasant symptoms do not disappear, the selection of a suitable mixture should be continued.

Allergy to formula milk

An allergic reaction to infant formula is the first sign that it is not suitable for him. Allergies can manifest as constipation, colic, diarrhea, regurgitation and rashes and are quite common. Typically, this reaction of the body occurs in the second month of life, but can appear at any age. What to do in such cases and how to fight so as not to provoke more severe forms of it?

First of all, you should try to dilute a smaller amount of dry powder in the same volume of water as before, that is, make a less concentrated mixture. This will reduce the load on the gastrointestinal tract and eliminate fermentation in the intestines. If this option does not help, you should think about changing the product or introducing additional nutrition into the diet, in the form of medicinal mixtures.

If the allergy is caused by dysbiosis, you can try adding a fermented milk mixture to your baby’s regular daily menu, which helps restore the intestinal microflora. Typically, such mixtures contain probiotics, which increase the number of beneficial microorganisms in the child’s intestines, normalizing his function and stool.

Normally, in a healthy baby, the number of regurgitations after feeding is one to two; if an allergy occurs, their number increases several times and often turns into prolonged hiccups. In this case, it would be appropriate to add an anti-reflux mixture to the baby’s diet and drink it in a course. It has a thicker consistency due to the locust bean gum, casein or starch present in the composition. The effect of such a mixture is as follows: when it enters the stomach, it swells and forms a dense, thick lump, which the child is not able to regurgitate.

An excellent alternative to a mixture with cow protein can be a product based on goat milk. Such mixtures are excellent for infants, contain the required amount of animal proteins and are superior to regular ones in nutritional value.

Any prescription, be it replacing a newborn’s diet or introducing medicinal mixtures into the diet, must come from a pediatrician. Self-indulgence in this matter should be completely excluded.

Causes

Replacing the mixture is necessary if:

• The child had a reaction in the form of allergies, constipation, regurgitation, and diarrhea.
• When the child has reached a certain age (for children over six months old it is changed).
• If you have to use a special mixture for medical reasons.

If the baby’s body reacts well to the mixture, it should not be changed. This can be understood by the fact that the baby feels well, there are no skin rashes and no problems with stool.

The decision to change can be made solely by the pediatrician. Many mothers change it several times a month just because “it seemed to them that the other one is more modern,” and they introduce it once. Thus, they harm the baby’s body. Remember that the new mixture should be given in small quantities and the volume should be increased gradually. This is the only way adaptation occurs without stress for the child’s body.

If the child feels well, you should not change the formula on a whim.

• Do not mix old and new mixture. They need to be given in different bottles.
• Prepare both new and old formula before feeding.
• Monitor the condition of the baby and analyze the symptoms described above for an unsuitable mixture.
• It is advisable to introduce the new mixture in the first half of the day.
• It should be diluted exclusively with boiled water in accordance with the instructions on the package. Ideally, this should be done immediately before feeding.
• If you need to stock up on formula, be sure to refrigerate it and store it for no more than 24 hours.

Schedule

When it is necessary to change the formula that is fed to the baby, the introduction of the new product should be gradual:

1. On the first day it is given only once in an amount of 10 ml.
2. On the second day it is given three times, 10 ml each.
3. On the third day the product is given three times. Give 20 ml per feeding.
4. On the fourth day it is given to the baby 5 times. For one feeding, 50 ml of the new product is given.
5. On the fifth day, the total amount is increased to 400 ml, divided into 4 feedings (100 ml at a time).
6. On the sixth day, 150 ml of a new product is given for each feeding. The total volume of the introduced mixture is 600 ml or more.
7. On the seventh day, the new mixture can already replace the child’s entire diet, since the body has fully adapted by this time.

Before introducing the medicinal mixture, you should consult with your pediatrician, since in some cases a one-time complete transition is necessary.