Feeding and nutrition of young infants. Principles and methods of feeding and feeding-related recommendations. What is complementary feeding

Food- a source of substances that provide replenishment of energy costs, basal metabolism and a sufficient amount of plastic material for the construction of organs and tissues of the child. Considering the main feature of the child’s body - constant growth and development - nutrition for him becomes of paramount importance. Actually rational feeding- one of the most important factors ensuring the health of a child in the future, since it is the key to harmonious (physical, mental, psychological) development, high body resistance to various infections and an adequate response to the influence of various environmental factors.

Organization of feeding consists of the efforts of the child’s parents, local pediatrician, local nurse, and also depends on the attitude of society to this issue.

The digestive system of children of the 1st year of life has a number of age-related characteristics:

Insufficient secretory capacity of the digestive glands;

Low enzyme activity in gastric and intestinal juice;

Anatomical incompleteness of the digestive tract;

Imperfection of protective mechanisms in all parts of the gastrointestinal tract and a number of others.

In this regard, the only correct, adequate and optimal for infant is natural feeding. This type of feeding corresponds to the basic principles of rational nutrition:

Getting enough food;

Satisfying the child’s needs (depending on age) for the main ingredients (proteins, fats, carbohydrates), as well as vitamins and microelements;

Compliance with a diet taking into account the age and individual needs of the child.

For successful organization of feeding breastfeeding, you must adhere to the following principles:

Early first breastfeeding in the first 30 minutes after birth;

In the 1st month of life - feeding “on demand” of the child, with the subsequent establishment of a diet;

Feeding only breast milk for the first 4-5 months;

Excluding water from the diet of breastfed children;

Weaning a child from the breast no earlier than 1 year - 1.5 years, provided that the child is healthy (optimally - in the autumn-winter period).

If the mother develops hypogalactia(decreased milk supply) or agalactia(complete lack of milk), the child is forced to transfer to mixed or artificial feeding. Science views such feeding as environmental disaster for the child.

Natural feeding is a type of feeding in which a child up to 5 months. receives only mother's milk, and from 5 months also complementary foods.

Distinguish three types human milk:

Colostrum- sticky thick liquid of yellow-gray color. Appears after the birth of a child and is secreted until the 4-5th day of his life.

Meaning colostrum and early breastfeeding:

Significantly reduces physiological loss of body weight;

Protects the newborn from infection;

Facilitates the course of adaptation processes;

Promotes early, closer physical and psycho-emotional contact between mother and child, which has a beneficial effect on their future relationships.

Transition milk produced from the 4-5th day of life to 2-3 weeks. It has an intermediate composition between colostrum and mature milk.

Mature milk- is produced from the 2-3rd week of a child’s life and has complete biological affinity with the child’s body.

Composition of breast milk and benefits of breastfeeding

Human milk contains the optimal amount of proteins, fats and carbohydrates in the best ratios: b:f:y = 1:3:6.

Squirrels- predominantly finely dispersed, identical to blood plasma proteins (lactalbumin, lactaferrin), which are immediately absorbed into the blood, as they do not require processing.

Nutrition correction

It is produced through the introduction of corrective additives and complementary foods.

Supplements- these are dosed products that are included in the diet as sources of vitamins, minerals, microelements and as additional sources of basic ingredients (proteins, fats, carbohydrates) necessary for a growing body

Complementary foods- these are dishes that completely replace breastfeeding, displacing mother's milk. The amount of complementary feeding depends on the one-time amount of food for a particular child.

IN 3 months- enter fruit juice (apple) in the amount of V cyT = Yuhp, where n is the number of months of the child up to 10. From 10 to 12 months. the amount of juice remains equal to 100 ml.

Administer starting with 2-3 drops and gradually, over the course of a week, increasing to 30 ml. Another week is allotted for adaptation.

At 3.5 months- enter fruit puree(apple), which is calculated in the same way as juice, the dose is increased to 35 g also per week.

At 5 months- / lure- introduce vegetable puree. First - from cabbage, zucchini, then - from carrots, potatoes. Add 3-5 ml of vegetable oil. Start with 1 teaspoon, increase the dose over the course of a week to the calculated dose, and then give another 1 week to adapt to the new type of food.

At 5.5 months- cottage cheese, home cooked. The maximum amount up to 1 year is 40 g (administered gradually, starting with 1/2 teaspoon).

At 6 months- II complementary foods- introduce milk porridge, first 5%, then 8% and after 2 weeks 10%. Start with rice, oatmeal, buckwheat: from 8 months. add semolina porridge, season the porridge with 5 g of butter.

Prepared with 1/2 milk and 1/2 vegetable broth, and from 7 months - with whole milk. Start with 1 teaspoon, increasing over the course of a week to the calculated dose, and then another 1 week is given for adaptation.

IN 6.5 months- egg yolk. Boil the egg hard for 10 minutes from the moment of boiling. Start with a few crumbs, mashed with breast milk, and bring to 1/2 yolk.

IN 7 months- meat puree to expand the menu and create lunch. Lean meat is used. Start with 1 teaspoon and increase to 50 g (by 11 - 12 months up to 70 g). At 9-10 months. - mashed potatoes are replaced with meatballs; at 11-12 months. - for steamed cutlets (after 10 months, replace meat with boiled fish 2-3 times a week).

At 8 months- III complementary feeding. Whole kefir is introduced according to the same principles as other dishes.

At 10 months- replace the fourth feeding with whole milk.

at 12 months- replace the last, fifth feeding with whole milk.

In the second half of the year, crackers and cookies are added.

Rules for introducing complementary foods and supplements

1. A new dish is given before breastfeeding from a spoon.

3. New dishes must be introduced gradually, starting with small doses, increasing the dose only after the child tolerates the previous one well.

4. The period for introducing a new dish is 1 week, and another week is needed for complete adaptation.

5. The interval between 2 new dishes should be 2 weeks.

6. Only one dish can be introduced at a time; move on to the next one only after the child has completely gotten used to the previous one.

7. Dishes should be homogeneous, without lumps, and easy to swallow (without choking).

Power calculation

Daily food volume calculated by the formula:

From 2 weeks to 2 months - 1/5 of body weight;

From 2 months up to 4 months - l/b of body weight;

From 4 months up to 6 months - 1/7 of body weight;

From 6 months up to 8 months - 1/8 of body weight;

From 9 months - 1000 ml;

From 12 months - 1200 ml.

One-time amount of food depends on the number of feedings:

V p = VjKK.

Number of feedings(QC):

Up to 1 month - 7 times in essence (every 3 hours with a night break of 6 hours);

From 2 to 5 months. - 6 times a day (every 3.5 hours with a night break of 6.5 hours);

From 5 to 12 months. - 5 times a day (every 4 hours with a night break of 8 hours).

There are other ways to calculate nutrition.

Mixed feeding

This is a type of feeding in which the child in the first half of life receives, along with breast milk, and supplementary feeding in the form of milk mixtures.

Efficiency mixed feeding depends on the proportion of breast milk in the baby’s daily diet:

If the amount of mother's milk is more than half of the daily ration (2/3, 3/4, etc.), then the effectiveness of mixed feeding approaches natural;

If the amount of mother's milk is less than half of the daily ration (1/3, 1/4, etc.), then the effectiveness of mixed feeding approaches artificial.

The reason for the introduction of supplementary feeding is hypogalactia in the mother, leading to malnutrition (starvation) of the child. Signs of fasting:

Flattening and then decreasing the weight curve.

Restlessness, disturbing intermittent sleep.

Reducing daily diuresis and frequency of urination.

Stool disorders (constipation, diarrhea).

If these signs are present, the mother and child are invited to a specially designated day for control feeding at the children's clinic.

Target control feeding - determination of the actual single volume of milk received by the baby.

Tactics after control feeding:

If there is enough milk, continue natural feeding.

If there is milk, but not enough:

Prescribe formula to the child in an amount equal to the deficit of a single volume of milk;

At the same time, treat the mother for hypogalactia.

Basics of proper mixed feeding.

1. Supplementary feeding is given after breastfeeding, from a spoon.

2. In order to maintain the existing level of lactation, the baby continues to be attached to the breast at least 3 times a day.

3. Calculation of the daily volume, number of feedings and timing of the introduction of new dishes are the same as with natural feeding.

4. Adapted milk formulas are used as supplementary feeding.

5. To avoid underfeeding and overfeeding (both quantitatively and qualitatively), periodic nutrition calculations are carried out.

Artificial feeding

This is a type of feeding when a child does not receive mother's milk in the first six months of life.

Reasons for transferring a child to artificial feeding:

Agalactia;

Absence of mother.

Basic rules of artificial feeding.

1. The nutrition and energy value of food is systematically calculated with subsequent correction (fats - butter, proteins - cottage cheese, carbohydrates - sugar syrup).

2. The daily amount of food is calculated in the same way as with breastfeeding.

3. The timing of introducing new dishes can be the same as with natural feeding, but it is more rational to shift their introduction 2-4 weeks earlier.

4. Since it takes more time to digest and absorb uncharacteristic food (mixtures), the intervals between feedings should be longer, and the number of feedings should be less than with natural feeding (up to 3 months - 6 times a day; from 3 to 12 months - 5 times a day).

5. Mixtures must be sterile and warmed to 40°C.

6. The hole in the nipple should be small so that food flows out in frequent drops.

7. The neck of the bottle should always be filled with mixture during feeding.

8. You can only feed an awake baby.

9. After feeding the baby, you need to hold him upright for 5-10 minutes and place him in the crib on his side.

10. The mixture must be changed periodically, but not too often.

Milk formulas

These are the products baby food, used instead of breast milk and close to it in composition. There are mixtures:

1. According to physical condition - dry And liquid.

2. For the main product - sweet(with milk) and fermented milk(on kefir).

3. In terms of composition - adapted And simple.

1. Dry- in powder form, which is diluted with hot water before use. They store better, are easier to prepare, and are basically adapted mixtures.

Liquid- V in the form of a solution in milk or kefir. They may retain important biological substances, but these are predominantly simple mixtures.

2. Sweet- based on boiled milk. Fermented milk- based on kefir or cottage cheese. Advantages of acidic mixtures:

Easier to digest because:

a) the protein in them is in an already curdled state;

b) lactic acid increases the secretory functions of the digestive tract;

c) evacuation of the mixture from the stomach is slower and more uniform;

They create an unfavorable (acidic) environment for pathogenic microbes, causing their death;

Flaws fermented milk mixtures:

Enhance the removal of salts;

In this regard, although acidic mixtures must be used, they are usually given once a day (rarely - 2 times).

Introduction of complementary foods
The timely introduction of appropriately selected complementary foods promotes health, nutritional status and physical development of infants and young children during the period of accelerated growth and should therefore be the focus of the public health system.
Throughout the entire period of introduction of complementary feeding, mother's milk should remain the main type of milk consumed by the infant.
Complementary feeding foods should be introduced at approximately 6 months of age. Some children breastfeeding complementary feeding products may be needed earlier, but not earlier than 4 months of age.
Unmodified cow's milk should not be given as a drink before 9 months of age, but can be used in small quantities in complementary feeding foods from 6 to 9 months of age. From 9-12 months, you can gradually introduce cow's milk into your baby's diet as a drink.
Complementary foods with low energy density may limit energy intake, so the average energy density should generally be at least 4.2 kJ (1 kcal)/g. This energy density is dependent on meal frequency and may be lower if meals are eaten more frequently. Low fat milk should not be given until approximately two years of age.
The introduction of complementary feeding should be a process of introducing baby food products that are increasingly varied in their consistency, taste, aroma and appearance, while continuing breastfeeding.
You should not give highly salty foods during the introduction of complementary foods, and you should not add salt to food during this period.

What is the introduction of complementary foods?
Complementary feeding is the feeding of foods and liquids to infants in addition to breast milk. Complementary feeding foods can be divided into the following categories:
- transitional foods are baby food products for complementary feeding, specifically designed to meet the specific nutritional or physiological needs of an infant;
- food from the family table, or homemade food, is baby food for complementary feeding that is given to a young child and which, in general terms, are the same products as the products consumed by the rest of the family.

During the transition from exclusive breastfeeding to weaning, infants gradually learn to eat home-cooked foods until they completely replace breast milk. Children are physically able to consume foods from the family table by the age of 1 year, after which these foods no longer need to be modified to meet the special needs of the infant.

The age at which transition foods are introduced represents a particularly vulnerable time in a child's development. Diet is undergoing its most fundamental change - the transition from a single product (breast milk), where the main source of energy is fat, to an ever-increasing variety of products that are required to meet nutritional needs. This transition is associated not only with increasing and changing nutritional needs, but also with the rapid growth, physiological maturation and development of the child.

Poor nutrition and poor feeding practices during this critical period can increase the risk of failure to thrive (wasting and stunting) and nutritional deficiencies, especially iron, and can have long-term negative effects on health and mental development. Therefore, some of the most cost-effective interventions that health professionals can implement and support include nutritional interventions and improved feeding practices targeting infants.

Physiological development and maturation
The ability to consume “solid” foods requires the maturation of the neuromuscular, digestive, renal and defense systems.

Neuromuscular coordination
The timing of the introduction of solid foods and the ability of infants to consume them is influenced by the maturation of neuromuscular coordination. Many food reflexes, manifested at different stages of development, either facilitate or complicate the introduction of different types of food. For example, at birth, breastfeeding is facilitated by both the latch reflex and the sucking and swallowing mechanism (1, 2), but the introduction of solid foods may be hindered by the gag reflex.

Up to 4 months, infants do not yet have the neuromuscular coordination to form a bolus of food, move it into the oropharynx and swallow. Control of head movements and spinal support have not yet developed, making it difficult for infants to maintain position for successful absorption and swallowing of semi-solid foods.

At about 5 months, babies begin to bring objects to their mouths, and the development of the “chewing reflex” at this time allows them to consume some solid foods regardless of the appearance of teeth. By about 8 months of age, most babies can sit up without support, their first teeth have emerged, and they have enough tongue flexibility to swallow harder clumps of food. Soon after, infants develop the manipulative skills to feed themselves, drink from a cup using both hands, and can eat food from the family table. It is important to encourage children to develop eating skills, such as chewing and putting objects to their mouths, at appropriate stages. If these skills are not acquired in time, behavioral and feeding problems may arise later.

Digestion and absorption
In infants, the secretion of gastric, intestinal and pancreatic digestive enzymes is not as developed as in adults. Nevertheless, infant is able to completely and effectively digest and absorb nutrients contained in breast milk, and breast milk contains enzymes that promote the hydrolysis of fats, carbohydrates and proteins in the intestines. Likewise, in early infancy, bile salt secretion is barely sufficient to form a micelle, and the efficiency of fat absorption is lower than in older children and adults.

This deficiency can be partially compensated for by lipase, which is present in breast milk but absent in industrially produced infant formulas and is stimulated by bile salts. At around 4 months of age, stomach acid helps stomach pepsin digest protein completely.

Although pancreatic amylase does not fully contribute to the digestion of starches until the end of the first year, most cooked starches are almost completely digested and absorbed (4). Even in the first month of life, the colon plays a vital role in the final digestion of those nutrients that are not completely absorbed in the small intestine. The microflora of the colon changes with age and depending on whether the child is breastfed or bottle-fed. Microflora ferments undigested carbohydrates and fermentable dietary fiber, converting them into short-chain fatty acids, which are absorbed in the colon, thereby ensuring maximum energy utilization from carbohydrates. This process, known as colonic energy extraction, can contribute up to 10% of absorbed energy.

By the time adapted family foods are introduced into a baby's diet around 6 months, the digestive system is mature enough to effectively digest the starch, protein and fat found in non-dairy foods. However, the gastric capacity of infants is small (about 30 ml/kg body weight). Thus, if food is too bulky and has low energy density, infants are sometimes unable to consume enough of it to meet their energy and nutrient needs. Therefore, complementary feeding products must have a high density of energy and micronutrients, and they must be given in small quantities and often.

Renal function
Renal solute load refers to the total amount of solutes that must be excreted by the kidneys. It mainly includes food components not transformed during metabolism, mainly electrolytes sodium, chlorine, potassium and phosphorus, which were absorbed in excess of the body's needs, and metabolic end products, the most important of which are nitrogen compounds formed as a result of digestion and protein metabolism.

Potential renal solute load refers to dietary and endogenous solutes that will need to be excreted in urine if they are not used in new tissue synthesis or excreted through nonrenal routes. It is defined as the sum of four electrolytes (sodium, chloride, potassium, and phosphorus) plus solutes derived from protein metabolism, which typically account for over 50% of the potential solute load on the kidneys.

The newborn baby has too limited renal capacity to handle the high solute load and simultaneously conserve fluids. The osmolarity of mother's milk is consistent with the baby's body capacity, so concerns about excessive solute load on the kidneys primarily concern infants who are not breastfeeding, especially infants fed unmodified cow's milk. This concern is especially justified during illness. By about 4 months, renal function has become significantly more mature and infants are better able to conserve water and cope with higher solutes. Therefore, recommendations for the introduction of complementary feeding do not usually require changes to suit the stage of renal development.

Defense system
A vital defense mechanism is the development and maintenance of an effective mucosal barrier in the intestine. In a newborn, the mucosal barrier is immature, as a result of which it is not protected from damage by enteropathogenic microorganisms and is sensitive to the action of certain antigens contained in food. Breast milk contains a large set of factors that are not found in commercial infant formulas and which stimulate the development of active protective mechanisms and help prepare the gastrointestinal tract for the absorption of transitional foods. Non-immunological defense mechanisms that help protect the intestinal surface from microorganisms, toxins and antigens include gastric acidity, mucosal lining, intestinal secretions and peristalsis.

The relatively weak protective mechanisms of the digestive tract of the infant at an early age, as well as low gastric acidity, increase the risk of damage to the mucous membrane by foreign food and microbiological proteins, which can cause direct toxic or immunologically mediated damage. Some foods contain proteins that are potential antigens: soy protein, gluten (found in some grain products), proteins in cow's milk, eggs and fish that are associated with enteropathy. Therefore, it seems prudent to avoid introducing these foods before 6 months of age, especially when there is a family history of food allergy.

What is complementary food needed for?
As a baby grows and becomes more active, breast milk alone is not enough to fully meet its nutritional and physiological needs. Adapted family foods (transition foods) are needed to compensate for the difference between the amount of energy, iron and other essential nutrients provided by exclusive breastfeeding and the total nutritional needs of the infant. With age, this difference increases and requires an increasing contribution of foods other than breast milk to provide energy and nutrients, especially iron. Complementary foods also play an important role in the development of neuromuscular coordination.

Infants do not have the physiological maturity to make the transition from exclusive breastfeeding directly to family food. Therefore, to bridge this gap between needs and capabilities, specially adapted family foods (transitional foods) are needed, and the need for them continues until approximately 1 year, until the child is mature enough to consume regular home-cooked food. Introducing transition foods also exposes the baby to a variety of textures and textures, which helps develop vital motor skills such as chewing.

When should complementary foods be introduced?
The optimal age for introducing transition foods can be determined by comparing the advantages and disadvantages of different dates.
The extent to which breast milk can provide sufficient energy and nutrients to support growth and prevent deficiencies should be assessed, as well as the risk of morbidity, especially infectious and allergic diseases, from consumption of contaminated foods and “foreign” food proteins. Other important considerations include physiological development and maturity, various developmental indicators that indicate the infant's readiness to feed, and maternal factors such as nutritional status, the effect of decreased breastfeeding on the mother's fertility and her ability to care for the infant, and existing principles and practices in early childhood care (Chapter 9).

Starting complementary feeding too early has its dangers because:
- breast milk can be replaced by complementary foods, and this will lead to a decrease in breast milk production, and therefore to the risk of insufficient energy and nutritional intake by the child;
- Infants are exposed to pathogens present in food and liquids that may be contaminated, thereby increasing the risk of diarrheal diseases and therefore malnutrition;
- the threat of dyspeptic diseases and food allergies increases due to intestinal immaturity, and because of this the risk of malnutrition increases;
- fertility returns to mothers more quickly, since decreased breastfeeding reduces the period during which ovulation is suppressed.

Problems also arise when complementary foods are introduced too late because:
- insufficient energy and nutritional intake from breast milk alone can lead to growth retardation and malnutrition;
- due to the inability of breast milk to meet the baby's needs, micronutrient deficiencies, especially iron and zinc, may develop;
- the optimal development of motor skills, such as chewing, and the child's positive perception of the new taste and texture of food may not be ensured.
Therefore, complementary feeding should be introduced at the right time, at the appropriate stages of development.

There remains much disagreement about exactly when to start introducing complementary foods. And although everyone agrees that the optimal age is individual for each individual child, the question of whether to recommend introducing complementary foods at the age of “4 to 6 months” or “about 6 months” remains open. It should be clarified that "6 months" is defined as the end of the first six months of a baby's life when he or she reaches 26 weeks, not the beginning of the sixth month, i.e. 21-22 weeks. Likewise, "4 months" refers to the end, not the beginning, of the fourth month of life.

There is almost universal agreement that complementary feeding should not be introduced before 4 months of age and should be delayed until after 6 months of age. In the resolutions of the World Health Assembly in 1990 and 1992. "4-6 months" is recommended, whereas the 1994 resolution's recommendation is "approximately 6 months." Several more recent publications by WHO and UNICEF use both formulations. A WHO review (Lutter, 6) concluded that the scientific basis for recommending a period of 4–6 months is not well documented. In a recent WHO/UNICEF report on the introduction of complementary feeding in developing countries (7), the authors recommended that full-term infants be exclusively breastfed until approximately 6 months of age.

Many recommendations in industrialized countries use a period of 4-6 months. However, recent official guidelines published in the Netherlands state that breastfed infants who are growing well should not be given any complementary feeding from a nutritional point of view until around 6 months of age. If parents decide to start complementary feeding earlier, this is quite acceptable provided that the child is at least 4 months old. In addition, the American Academy of Pediatrics statement recommends an age of “approximately 6 months,” and the same has been adopted by various Member States of the WHO European Region when adapting and implementing Comprehensive Management of Childhood Illness training programs for health care providers.

For the WHO European Region, the recommendation is that infants should be exclusively breastfed from birth to approximately 6 months and for at least the first 4 months of life. Some babies may need complementary foods before 6 months, but they should not be introduced before 4 months.

Composition of complementary feeding products
Chapter 3 provided estimates of the average energy required from complementary feeding products in at different ages. The effect of different levels of breast milk intake and different energy densities of complementary foods on the frequency of food intake required to meet energy requirements was examined, taking into account food volume limitations dictated by gastric capacity. The next section takes up these issues again and examines them in more detail. The physical properties of starch are analyzed from the point of view of the thickness of the main food given as complementary foods. Based on this, possible changes in the preparation of basic foods are suggested to help produce foods that are neither too thick for an infant to consume nor so thin that they have reduced energy and nutrient density. The following discusses ways to improve the nutrient density of a staple meal by adding other complementary foods, as well as other factors that influence the amount of food consumed (such as taste and aroma) and the amount of each nutrient actually absorbed (bioavailability and nutritional density ).

Energy density and viscosity
The main factors that influence the extent to which an infant can meet his energy and nutrient needs are the consistency and energy density (amount of energy per unit volume) of complementary foods and the frequency of feeding. The main source of energy is often starch, but when heated with water, starch grains gelatinize and form a voluminous, thick (viscous) porridge. Because of these physical properties It is difficult for infants to swallow and digest such porridge. In addition, the low calorie and nutritional density means that large volumes of food must be consumed to meet the infant's needs. This is usually not possible due to the limited capacity of the infant's stomach and the limited number of meals per day. Thinning a thick cereal to make it easier to swallow further reduces its energy density. Traditionally, complementary foods are low in energy density and low in protein, and although their liquid consistency makes them easy to consume, the volumes required to meet an infant's energy and nutrient needs often exceed the maximum volume that an infant can ingest. Adding a little vegetable oil can make food softer and easier to eat, even when cold. However, adding large amounts of sugar or lard will increase the energy density, but will increase the viscosity (thickness) and therefore make the food too heavy to consume in large quantities.

Therefore, complementary feeding foods should be rich in energy, protein and micronutrients and have a consistency that makes them easy to consume. Some countries in the developing world solve this problem by adding amylase-rich flour to thick porridges, which reduces the viscosity of the porridge without reducing its energy and nutrient content. Amylase-rich flour is made by sprouting cereal grains, which activates amylase enzymes, which then break down starch into sugars (maltose, maltodextrins and glucose).

When starch is broken down, it loses its ability to absorb water and swell, and so porridge made from amylase-rich sprouted flour has a high energy density, maintaining a semi-liquid consistency but increased osmolarity. These types of flours take time and tedious work to prepare, but they can be prepared in large quantities and added a little at a time to thin the porridge as needed. They can also be produced on an industrial scale at low cost.

Starchy foods can also be improved by mixing with other foods, but it is critical to know the effect of such additions not only on the viscosity of the food, but also on the protein and micronutrient density of the food. For example, although the addition of animal fats, vegetable oils, or margarine increases energy density, it negatively affects protein and micronutrient density. Therefore, starchy foods need to be fortified with foods that increase their energy, protein and micronutrient content. This can be achieved by adding milk (breast milk, commercial formula, or small amounts of cow's milk or cultured milk), which improves the quality of the proteins and increases the density of essential nutrients.

Variety, taste and aroma
To ensure that growing children's energy and nutritional needs are met, they need to be offered a wide range of foods with high nutritional value. In addition, it is possible that when children are offered a more varied diet, it improves their appetite. Although the pattern of food intake changes with each meal, children regulate their energy intake at subsequent meals so that their total daily energy intake usually remains relatively constant. However, the amount of energy consumption on different days may also vary slightly. Despite the fact that children have their own preferences, children, when given different foods, usually choose some set that includes their favorite foods, and as a result receive a nutritionally complete diet.

A child's intake of transition foods can be influenced by a range of sensory properties, such as taste, aroma, appearance and texture. The taste buds of the tongue perceive four primary taste qualities: sweet, bitter, salty and sour. Sensitivity to taste helps protect against eating harmful substances and can also help regulate the amount of food a child eats.

Although children do not need to learn to like sweet or salty foods, there is good evidence that children's preferences for most other foods are strongly influenced by cognition and experience. The only innate preference humans have is for sweet tastes, and even newborn babies greedily eat sweet substances. This can be a problem as children develop a preference for the frequency of exposure to a particular taste. Avoiding all foods other than sweets will limit the variety of foods and nutrients your child consumes.

Compared to eating a monotonous diet, children eat more when they are exposed to a variety of foods. It is important that children who are initially unfamiliar with all foods have repeated access to new foods during the introduction of complementary feeding so that they develop a healthy system of positive food perceptions. It has been suggested that food should be sampled at least 8-10 times, with a clear increase in positive food perceptions occurring after 12-15 times. Thus, parents need to be reassured and told that refusal to eat is normal. Products need to be offered many times, since those products that the child initially refuses are often later accepted. If the child's initial refusal is interpreted as permanent, the product will likely no longer be offered to the child and the opportunity to have access to new foods and taste experiences will be lost.

The process of introducing complementary foods depends on whether the child has learned to enjoy the new food. Breastfed babies may develop a positive response to solid foods more quickly than formula-fed babies because they are accustomed to the different tastes and smells of breast milk.

What is the best food to prepare for infants?
The choice of products used for complementary feeding varies significantly among different categories of the population due to different traditions and varying degrees of availability. The next section examines the use of different foods for complementary feeding. A new WHO report offers a useful way to calculate how different foods contribute to filling the energy and nutrient gaps that occur when breast milk no longer meets an infant's growing needs.

Products of plant origin
In addition to nutrients, foods contain combinations of other substances, most of which are found in abundance in plants. No single product can provide the body with all nutrients (with the exception of breast milk for infants in the first months of life). For example, potatoes provide vitamin C but not iron, while bread and dry beans provide iron but not vitamin C. Therefore, a healthy diet must contain a variety of foods to prevent disease and promote growth.

Plant foods contain biologically active components, or metabolites, that have been used for centuries in traditional potions and herbal medicines. Isolation, identification and quantification of these plant metabolites is associated with their potential protective role, and interest in their identification has arisen due to epidemiological evidence that some of them protect against the development of cancer and cardiovascular disease in adults.

It is also possible that such components have a beneficial effect on young children, although scientific evidence for this is insufficient. Many metabolites found in plants are not nutrients in the traditional sense and are sometimes called "non-nutrients." These include substances such as dietary fiber and related substances, phytosterols, lignans, flavonoids, glucosinolates, phenols, terpenes and compounds from plants in the onion family.

To ensure that you consume all of these protective substances, it is important to eat as diverse a plant-based diet as possible. There is no need to take vitamin supplements or herbal extracts as a replacement or addition to the consumption of good quality healthy foods, and for medical reasons it is generally not recommended.

Cereal products
Grain products constitute the main food of almost all categories of the population. Wheat, buckwheat, barley, rye, oats and rice make a significant contribution to diets in the WHO European Region. In general, 65-75% of the total weight of grain products is carbohydrates, 6-12% proteins and 1-5% fats. Most carbohydrates are in the form of starch, but grain products are also an important source of dietary fiber and contain some simple sugars. Most grains contain slow-digesting starch in their raw state, which is converted to quickly digestible starch when cooked. Partially ground grains and seeds contain starch that is resistant to digestion.

Grain products are also a source of micronutrients. Micronutrients are concentrated in the outer layers of cereal bran, which also contain phytates, which can have a negative effect on the absorption of several micronutrients. Thus, high-yield flour types, such as wallpaper flour, which contain more of the outer layers of the grain, are richer in micronutrients, but also contain a higher percentage of phytates. Conversely, finer-milled white flours that contain less grain in its original form contain less phytates but also fewer micronutrients.

Potato
Potatoes are a root vegetable and are one of the most important components of the diet in many European countries. Potatoes are rich in starch, and due to the fact that they can be stored under simple conditions for quite a long time, they, together with grain products, represent the main source of food energy throughout the year. Potatoes contain relatively little protein, although the biological value of potato proteins is very high.
Potatoes contain significant amounts of vitamin C and are also a good source of thiamine. The vitamin C content of potatoes varies depending on the length of storage: after three months, approximately two-thirds of ascorbic acid remains, and after 6-7 months, about one-third remains.
Freshly cooked potatoes are quickly and easily digested. However, if it cools after cooking, the starch it contains can undergo retrogradation and form what is called “resistant starch,” which is not digested in the small intestine, although it can be fermented in the colon.

Vegetables and fruits
Vegetables and fruits provide vitamins, minerals, starch and dietary fiber, as well as other non-nutritive substances such as antioxidants and phytosterols (see above). They have an important protective function, helping to prevent micronutrient deficiencies, and are usually low in fat.
Vegetables and fruits make the largest contribution to vitamin C intake. Consuming vegetables and fruits that contain vitamin C (such as cabbage, broccoli, citrus fruits and their juices) along with iron-rich foods such as beans, lentils, whole grain products, improves the absorption of non-heme iron from plant foods (see Chapter 6). Other micronutrients found in fruits and vegetables include B vitamins, including vitamin B6. Dark green leafy and orange fruits and vegetables are rich in carotenoids, which are converted into vitamin A; In addition, dark green leafy vegetables are rich in folate and contain significant amounts of potassium and magnesium.
Vegetables and fruits contain a variety of vitamins, minerals, non-nutritive substances (such as antioxidants) and dietary fiber, and therefore it is advisable to choose a range of vegetables and fruits to meet daily nutrient intake recommendations. The health benefits of vegetables and fruits may, to some extent, be determined by non-nutritive substances. This is one of the reasons why vitamins and minerals are best obtained from vegetables and fruits, rather than from pills and supplements, thereby ensuring the consumption of other essential (perhaps as yet undiscovered) nutritional components.
The availability of fresh vegetables and fruits varies depending on the time of year and region, although fresh frozen, dried and canned vegetables and fruits can be eaten year-round. Whenever possible, you should choose locally produced products. If vegetables and fruits are canned or processed foods are consumed, they should contain the minimum amount of added fat, vegetable oil, sugar and salt.
Many green leafy vegetables are cooked before consumption. Cooking in water can lead to leaching and thermal loss of vitamin C, especially when vegetables are not consumed immediately. Vitamin loss is reduced if you use only a minimal amount of water or boil vegetables for a very short time.

Legumes
Legumes, and in particular seed legumes (soybeans, peas, beans and lentils), have great nutritional value, especially when animal products are scarce. When ripe, they contain little water, store well and are an important source of nutrients in many diets when eaten with grain products. Seed legumes are rich in complex carbohydrates, both starch and dietary fiber, and are also a source of significant amounts of vitamins and minerals.
However, some legumes contain a number of toxic components, including lectins, which act as hemagglutinins and trypsin inhibitors. When ripe, a number of seeds (such as kidney beans) contain toxic concentrations of these components, and it is therefore important to properly prepare these foods by thoroughly soaking and boiling them to avoid any toxic effects.

Animal products
Animal products are a rich source of protein, vitamin A and easily absorbed iron and folate. Meat and fish are the best sources of zinc, while dairy products are rich in calcium. Meat, fish, and seafood promote the absorption of non-heme iron, and in addition, meat (especially liver and other organ meats) is a source of highly absorbable heme iron (Chapter 6). Epidemiological studies have shown that meat consumption is associated with a lower prevalence of iron deficiency. However, animal products are often expensive, and the consumption of excess protein is uneconomical and ineffective, since excess protein is broken down into energy and stored as fat if this energy is not immediately needed. If it is energy that is needed immediately, it is much more effective to obtain it from high energy-dense foods rich in micronutrients rather than from proteins.

Meat

Nutrients are present in fatty and lean tissues of meat in different concentrations, with higher concentrations in lean tissue. Therefore, the energy value and concentration of almost all nutrients is determined by the ratio of fatty and lean tissues. In Western European countries, the general population is now being advised to reduce their intake of saturated fat, and leaner carcass meats are now in demand. In contrast, in the central and eastern parts of the Region, the fat content of most meats and meat products remains very high. However, liver is naturally low in fat and has the added benefit of being easy to cook and mash without becoming fibrous, making it easier for infants and young children to eat. Moreover, liver deserves special mention as one of the best transition foods because it is an excellent source of protein and most essential micronutrients.
Lean meat contains significant amounts of proteins of high biological value and is also an important source of highly bioavailable minerals such as iron and zinc. Young children may find it difficult to eat meat because it is fibrous, so complementary meat (preferably lean) should be minced, minced or pureed.
Some meats are expensive, but some (such as liver) are inexpensive, and very small amounts of meat may have nutritional benefits for infants and young children. A little meat added to an otherwise vegetarian diet has a positive effect on increasing body length, either due to the higher biological value of proteins or because it is a source of minerals.

Fish and seafood

Fish is an important source of complete proteins, providing the same amounts as lean meat per unit weight of product. Moreover, all fish, both freshwater and sea, as well as shellfish are rich sources of essential amino acids. This type of protein is accompanied by very small amounts of fat in white fish and shellfish, while the fat in other types of fish (such as salmon, tuna, sardines, herring and mackerel) contains a large percentage of long-chain polyunsaturated fatty acids of the n-3 type, which important for the development of the nervous system. Fish is a valuable source of iron and zinc, which are present in slightly lower concentrations than in meat, with the exception of shellfish, which tend to accumulate trace elements. For example, oysters are one of the richest sources of zinc. Marine fish are also one of the main sources of iodine, which accumulates in them from the marine environment. However, caution must be exercised when doing this, as there is a risk of eating fish caught in polluted waters.

Egg
Eggs from a range of poultry, including chicken, duck and goose, play an important role in diets throughout the European Region. The egg is a universal food with high biological value. Egg whites contain amino acids essential for physical and mental development, and the lipids contained in eggs are rich in phospholipids with a high ratio of polyunsaturated to saturated fatty acids. Eggs can be produced with high efficiency at relatively low cost and are a valuable means of improving animal protein intake. Egg whites are associated with allergic reactions and should therefore not be introduced before 6 months of age. Eggs are a potential cause of salmonella poisoning. therefore, it must be subjected to careful heat treatment.
Eggs are often considered a good source of iron, so they are introduced early into complementary foods. But although the iron content of eggs is relatively high, this iron is chemically bound to phosphoproteins and albumin, as a result of which its bioavailability is not very high.

Milk and other dairy products
Due to its nutritional composition, fresh cow's milk is a source of many nutrients for a growing baby, however it should not be introduced before the baby is 9 months old because:
- it can displace the consumption of breast milk;
- it has low iron content;
- it may cause gastrointestinal bleeding, especially before 6 months of age
- it has a high content of proteins and sodium - 3-4 times higher than in breast milk.

In order to ensure the microbiological safety of animal milk, it is important to either pasteurize it or boil it before use. Cow's milk from which the fat has been partially removed (semi-skimmed milk, usually 1.5-2% fat) or completely (skim milk, usually less than 0.5% fat) has significantly less energy and fat-soluble vitamins than whole milk. cow's milk. Likewise, milk powder made from dehydrated skim milk has low energy content. In addition, like commercially produced infant formulas, milk powder can become contaminated if it is diluted with dirty water. It is therefore extremely important to prepare the milk under hygienic conditions by strictly following the instructions so that the reconstituted milk powder is neither too concentrated nor too diluted.

Lactose intolerance (due to the cessation of intestinal lactase excretion in children in some non-rural populations) is rare in the European Region and does not constitute a contraindication to the use of cow's milk or the milk of other mammals during the introduction of complementary feeding.

Age at which cow's milk can be introduced
Some mothers may not be able to provide enough breast milk in late infancy to meet their baby's needs. This can happen for a variety of reasons, including the need or desire to return to work. Some countries recommend eliminating cow's milk from an infant's diet before 12 months of age. Until 12 months of age, it is recommended to give your baby only breast milk or commercial formula, mainly for the reasons listed above. Other countries recommend introducing cow's milk gradually, starting at 9 or 10 months. There is no harm in feeding babies breast milk or formula until they reach 12 months of age if sufficient amounts are given and if the iron content of complementary feeding foods is sufficient.
However, in many countries in the Region, commercially produced infant formula is much more expensive than cow's milk, so providing infant formula before 12 months of age may not be feasible for economic reasons. Based on these arguments, it seems reasonable to make the following recommendations regarding the optimal timing of introducing cow's milk.
Unmodified cow's milk should not be used as a drink and dairy products should not be given in large quantities before 9 months. They can, however, be used in small quantities to prepare complementary foods from 6 months onwards. From 9 to 12 months, cow's milk and other dairy products can be gradually introduced into the infant's diet as a drink, preferably in addition to breast milk if breast milk intake is insufficient or if the family wishes to stop using infant formula.

Cow's milk quantity
It is recommended to continue breastfeeding throughout the first year of life, and if possible, into the second year. If your breast milk supply is still high (more than 500 ml per day), there is no reason to introduce other types of milk. However, many women in the Region stop breastfeeding before the child reaches 1 year of age, and if they continue to breastfeed between 9 and 12 months, average milk consumption is low. If total milk intake is very low or zero, several nutritional deficiencies are at risk, and protein quality may be a problem if other sources of animal protein are not available. In late infancy (from about 9 months), excessive consumption of cow's milk can limit dietary diversity, which is important in introducing the baby to new tastes and food textures that support the development of eating skills.
In addition, since cow's milk is low in iron content and bioavailability, consumption of large amounts predisposes the child to iron deficiency.
For example, if a 12-month-old baby consumes one liter of cow's milk or the equivalent amount in dairy products, this will provide two-thirds of his energy needs, leaving very little room for a varied, healthy diet.

Reduced fat milk
In many countries, reduced-fat milk is recommended as part of a healthy adult diet. It is, however, not recommended before the age of 1 year, and in some countries up to 2-3 years. For example, in the United Kingdom, semi-skimmed milk is generally not recommended before age 2 years, and fully skimmed milk is not recommended for children under 5 years of age (17). It is advisable not to rush into introducing reduced-fat milk not only because it has a low energy density, but also because a much higher percentage of its energy content comes from protein. For example, protein accounts for 35% of the energy in skim milk, and 20% in whole milk, while only 5% in breast milk. If a significant percentage of energy intake comes from reduced-fat milk, this will increase protein intake to levels that may be harmful. On the other hand, reduced-fat milk will not be harmful if given in small to moderate quantities and with additional fat added to the diet.
Thus, it seems prudent not to introduce reduced-fat milk until approximately 2 years of age. The same general principles should be followed when introducing other types of milk, such as goat, sheep, camel and mare's milk, into the diet of an infant. Allowance should be made for the varying solute loads and varying vitamin and mineral contents of different milks, and in all cases it is essential to ensure their microbiological safety.

Dairy products
Liquid milk has a short shelf life. Fermentation allows you to extend the shelf life of milk and thereby ensure the possibility of storing and transporting milk and dairy products. Most fermented milk products are products of fermentation by lactic acid bacteria, which leads to the production of lactic acid and short-chain fatty acids from lactose, and therefore a drop in pH, which inhibits the growth of many pathogens. Fermented milk products are nutritionally similar to unfermented milk, except that some of the lactose is broken down into glucose, galactose, and the products described above. These lactic acid products are an excellent source of nutrients such as calcium, protein, phosphorus and riboflavin.
Traditionally, fermented milk products have been attributed a number of health benefits, and they are used to prevent a wide range of diseases, such as atherosclerosis, allergies, gastrointestinal diseases, and cancer. Although the empirical results have yet to be supported by controlled studies, initial results examining the antibacterial, immunological, antitumor, and cholesterol-lowering effects of lactic acid consumption indicate potential benefits. There is increasing evidence that in young children, certain strains of lactic acid bacteria have a beneficial effect against the onset and continuation of acute diarrhea. The potential health benefits, also called probiotic effects, are attributed to either the large number of live bacteria present in the product or the short-chain fatty acids or other substances that are formed during fermentation.
Fermented milk products are thought to speed up the absorption of non-heme iron due to their lower pH. The two most common and available fermented milk products containing probiotics in the Region are yogurt and kefir.
Yogurt is produced by fermentation of milk (usually cow's milk) under the influence of Lactobacillus bulgaricus and Streptococcus thermophilus at a given time and temperature.
Kefir is a sour milk with a characteristic effervescent sour taste that first appeared in the Caucasus. It currently accounts for 70% of the total amount of fermented milk products consumed in the countries of the former Soviet Union (24). Kefir is made by adding kefir grains (small clusters of microorganisms that are held together in a polysaccharide matrix) or mother cultures made from grains to milk, which ferment the milk.
Cheese is also a fermented milk product that converts an unstable liquid into a concentrated food product that can be stored. Hard cheeses are approximately one-third protein, one-third fat and one-third water and are also a rich source of calcium, sodium and vitamin A, and to a lesser extent B vitamins. Soft cheeses, such as cottage cheese, contain more water than solids and therefore have lower nutrient and energy densities. At about 6-9 months, food for<прикорма>Cheese, cut into cubes or slices, can be introduced in small quantities, but the consumption of soft cheese and cheese spreads spread on bread should be limited for up to 9 months.

Fruit juices
In this publication, fruit juice refers to juice prepared by squeezing fruit. Sometimes the term "fruit juice" or "fruit drink" is used to refer to a drink made by mixing jam or compote with water. Such drinks usually contain only water and sugar and very little vitamin C, and therefore do not have any useful properties"real" fruit juice or fruits from which juice can be made.
Nutritionally, fruit juices squeezed from fruits contain all the nutritional substances present in fruits, with the exception of dietary fiber. The most important sources are citrus fruits such as orange, lemon and grapefruit.
It is also common to drink apple and grape juice, and in Europe fruit nectars are also popular, such as nectars from apricots, pears and peaches. Fruit juices are a good source of vitamin C, and if given with meals, they improve the bioavailability of non-heme iron present in plant foods. However, it is important to limit the amount of juice you consume so as not to interfere with breast milk intake or dietary variety. In addition, fruit juices contain glucose, fructose, sucrose and other sugars, which, due to their acidity, can cause caries and tooth erosion.
In some sections of the population, there is an opinion that fruit juice should not be given to infants because it is too acidic, and tea is given instead. It is true that some fruit juices have a very low pH, but there is no logical reason to avoid them in infants' diets or to recommend tea instead. The pH of the stomach is close to one (very high acidity), and therefore fruit juices with their acidity do not have any negative effect.
However, overconsumption of so-called fruit juices, which contain artificial sweeteners and simple carbohydrates other than glucose, sucrose and fructose, is alarming. Drinks containing sugar alcohols, such as mannitol and sorbitol, may cause diarrhea in some children (25, 26).

Honey
Honey may contain Clostridium botulinum spores, the substance that causes botulism. Since in gastrointestinal tract Infants do not contain enough acid to kill these spores; infants should not be given honey, otherwise they may develop this disease.

Tea
Tea is a popular drink throughout the European Region but is not recommended for infants and young children. Tea contains tannins and other compounds that bind iron and other minerals, thereby reducing their bioavailability. In addition, sugar is often added to tea, which increases the risk of dental caries. Sugar consumed in tea can also suppress your appetite and prevent you from consuming more nutritious foods.

Herbal teas
In many Western European countries there is a growing trend towards the use of “natural” substances and alternative medicines, and this has led to the spread of herbal infusions for children. However, due to their small body size and rapid rate of physical development, infants are potentially less protected than adults from the pharmacological effects of some chemicals present in herbal teas. Herbal teas, such as chamomile tea, may have the same negative effect on non-heme iron absorption as other teas, including green tea(27). Additionally, there is a lack of scientific evidence to support the safety of various herbs and herbal teas for infants.

Vegetarian food
Vegetarian diets exclude animal products to varying degrees. The main concern with vegetarian diets is the small but significant risk of nutritional deficiencies. These include deficiencies in iron, zinc, riboflavin, vitamin B12, vitamin D and calcium (especially in vegans) and insufficient energy intake. These deficits are most pronounced in those who have increased energy needs - infants, older children and pregnant and lactating women. Although including animal products does not guarantee an adequate diet, it is easier to achieve a balanced diet with animal products than without them. Meat and fish are important sources of protein, easily absorbed heme iron, zinc, thiamine, riboflavin, niacin and vitamins A and B12. In a vegetarian diet, these nutrients must come from other sources.

Eggs, cheese and milk are sources of complete proteins, as well as B vitamins and calcium. If complementary feeding diets do not contain animal products (and therefore milk), problems may arise, especially in the final period of infancy and early childhood, when there may be little breast milk. These diets rely solely on plant proteins, and the only plant protein that approaches the quality of animal protein comes from soy. If soy is not prepared correctly, feeding it during infancy may have negative effects due to its high content of phytoestrogens and antinutrients such as phytate. It can also cause antigenic reactions and cause enteropathy similar to celiac disease and cow's milk protein intolerance. Proteins in a strictly vegetarian diet should be a complete mixture of plant proteins, such as legumes eaten with wheat, or rice and lentils. For adults, proteins from two or more plant food groups consumed daily will probably be sufficient. But for children, and especially for children aged 6 to 24 months, each meal should include two additional sources of plant protein if possible.

Strictly vegetarian diets (i.e., without any sources of animal protein and especially without milk) can have a particularly serious negative impact on the development of the infant and should therefore be avoided. Examples are severely restricted macrobiotic diets (a strict vegetarian diet combined with a commitment to natural organic foods, especially cereals), which carry a risk of nutritional deficiencies and are associated with protein-calorie malnutrition, rickets, and delayed physical and psychomotor development in infants. children and young children (28, 29). During the introduction of complementary feeding, such diets are not recommended (30).

Some practical tips for cooking
Food from the family table
Home-cooked foods usually provide a healthy basis for introducing complementary foods, so their consumption is strongly encouraged. A good start to introducing complementary foods is to use a family meal mix that is based on a staple food (such as bread, potatoes, rice or buckwheat). A variety of homemade products can be used. Most of them need to be softened by heat treatment and then mashed, pureed or chopped. When preparing purees, it may be necessary to add a small amount of breast milk or cooled boiled water, but so that the food does not become too diluted and does not lose its nutritional density. Transition foods should be relatively mild in taste and not heavily seasoned with salt or sugar. Only a minimal amount of sugar should be added to sour fruits to improve their taste. Adding unnecessary amounts of sugar to an infant's food and drink may develop a preference for sweet foods later in life, which can negatively impact dental and overall health.

Ideally, infants should eat the same food as the whole family. The food they receive should be prepared as far as possible without adding sugar or salt. Very salty foods such as pickled vegetables and salty meat products should be avoided. Set aside some family food for the infant and then add flavorings (such as salt or spices) for the rest of the family.
As mentioned above, some complementary foods have low energy and nutritional density or may be bulky and viscous

The presented methodological recommendation “Feeding and nutrition of infants and young children” examines the features of breastfeeding, the introduction of complementary foods, and alternatives to breastfeeding. Characteristics for children of different ages are presented. You can download the methodological recommendation “Feeding and nutrition of infants and young children” for review, or read the methodological recommendation online.

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Name: Rational feeding of young children
Legonkova T.I., Stepina T.G., Voitenkova O.V., Sarmanova L.V.
The year of publishing: 2011
Language: Russian
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Description: The methodological recommendation “Rational feeding of young children,” edited by Legonkova T.I., et al., examines the basic principles of natural feeding. Presented physiologically... Download the manual

Name: A modern view of the conditions for caring for newborns
Baibarina E.N., Ryumina I.I., Antonov A.G., Moore J., Lenyushkina A.A.
The year of publishing: 2010
Language: Russian
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Description: Methodological recommendation "Modern view on the conditions of nursing newborns" edited by E.N. Baibarin, et al., considers the principles of hypothermia prevention, optimization of tactile sensations,... Download the manual

Name: Rickets
Chernaya N.L., Nikolaeva T.N., Spivak E.M.
The year of publishing: 2003
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Name: Course of lectures on pediatrics
Lyalikov S.A., Baygot S.I., Rovbut T.I., Sorokopyt Z.V., Tikhon N.M.
The year of publishing: 2009
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A mother's most important baby care activity is to breastfeed sustainably for 24 months or longer. Any form of infant feeding other than exclusive breastfeeding requires someone to spend time preparing the food, maintaining good hygiene during food preparation and storage, and feeding the food to the baby.

Hygiene rules are often neglected to save time.

Artificial feeding has many negative consequences, especially in terms of hygiene. To save time for the caregiver, the bottle can be placed on the pillow next to the baby. This deprives the child of physical and eye contact and psychological support. Unfortunately, families are often unaware of these dangers and are poorly informed by health care providers.

Often complementary foods are introduced too early because people think that this will stop the baby from crying so much and the mother will thus be able to go about her business. Other time-saving efforts include feeding thin cereals to older infants, either from self-feeding cups or bottles (which have nipples cut off to allow passage of thicker liquids). Pacifiers are used for the same reasons. Neither of these methods is recommended. Any replacement of breast milk in the first 6 months can lead to a decrease in the mother's milk production, when milk production needs to be increased. Also, crying can often be a signal that a child needs care and comfort, and not just a signal of hunger.

Active methods of introducing complementary foods

How the caregiver facilitates feeding and encourages eating plays an important role in infant and young child nutrition. There are four aspects to proper feeding:

Adapting the feeding method to the child’s psychomotor abilities (ability to hold a spoon, ability to chew);

Responsiveness of the caregiver's response, including encouraging food and offering supplements;

Interactions with the caregiver, including relationships of tenderness and affection;

Feeding situation, including the organization, frequency and regularity of feeding, supervision and protection of the child during feeding and by whom this is carried out.

Adapting to a child's changing motor skills requires a great deal of attention from the caregiver because these skills change rapidly in the first two years of life. As the child ages, it takes less and less time to eat some solid and sticky foods, but this does not apply to more liquid purees. A child's ability to hold a spoon, handle a cup, or grasp a piece of solid food also improves with age. Those caring for children need to be confident that children are able to feed themselves as expected. In addition, children strive to be independent and may eat more if they are given the opportunity to use their newly acquired finger manipulation skills to pick up food.

It is especially important for young children to be sensitive when feeding.

Children can be encouraged, coaxed, offered refills, talked to while they eat, and monitored how much they eat. The amount of food a child eats may depend more on active encouragement from the caregiver than on the portions offered. Recommendations that mothers encourage their children at mealtimes can be as effective as recommendations about what they should feed their children.

Children are encouraged to develop good eating habits by caregivers who model healthy eating themselves. Good eating habits are also facilitated by a relaxed and comfortable atmosphere without arguments. Evidence suggests that when fed with affectionate encouragement and sensitivity, babies often eat more than when left to their own devices.

The caregiver's ability to recognize and respond appropriately to the baby's hunger cues may be critical to developing good feeding practices. For example, if a baby's mouth movements are interpreted as a refusal to accept a new food, feeding may be stopped and the baby will receive less food.

Caregivers may not know how much their child eats. One study found that when mothers paid more attention to the amount of food their child was eating, they were surprised by how little the child was eating and were willing to increase the amount of food offered to the child. Having a separate plate for each child can help determine quantities to eat and will act as an incentive for those children who eat slowly. Children often refuse to eat unless their preferred babysitter is nearby. Patience and understanding, and recognizing that the baby needs to get used to and get to know the caregiver, increases the chances of success with infant feeding.

There is some cultural spectrum of control around food. One extreme is when everything is controlled by the child's caregiver, and the other extreme is when all control is given entirely to the child. Both extremes are not good for the child. Too much control in the hands of an adult can lead to the fact that the child will be forced to eat, pressure will be constantly put on him, leading to the imposition of food (7-8). Instead of providing an opportunity for interaction and the development of cognitive abilities and social skills, feeding can turn into minutes and hours of conflict, leading to the child refusing to eat. A sensitive and attentive adult caring for a child can often ensure that the child eats better if he can adapt to the child's refusals and counter them with affectionate encouragement.

At the other extreme of the spectrum, caregivers are passive and relinquish the initiative for eating to the child. At a certain age, children need and want independence with food, but before that, too much independence will result in them not eating as much as they need. Passive feeding may be due to lack of time and energy or

the belief that children should not be forced to eat. This belief may be justified, but if the child has anorexia or poor appetite, additional encouragement may be needed. It has been noted that caregivers begin to encourage children to eat only after they see that the child refuses to eat, and this can simply lead to fruitless fights.

The environment in which children are fed can also influence how children eat. Children can be fed regularly every day, sitting them in a certain place where food is easy to reach, or at a time that is most convenient for an adult. If the main meal is prepared late in the evening, children may fall asleep before it is ready. Children can be easily distracted, especially if they have difficulty eating certain foods (for example, eating soup with a spoon that the child cannot use) or the food does not taste very good. If there is not enough supervision of feeding, older siblings or even animals may take advantage of the baby's insecurity and take food away from him, or food may be spilled on the floor. The best feeding environment for a baby is a familiar place, away from distractions and intrusion from strangers.

Adaptation to food from the family table

The transition from breastfeeding and transitional food to regular family food and cessation of breastfeeding should be gradual, and the child should be allowed to return to the breast from time to time. By the second year of life, as the child eats more and more food, unadapted food from the family table becomes a necessary addition to breastfeeding (Chapter 8). Caregivers can expect children to feed themselves during this transition. But if you expect too much from your child, he may not get enough food. Adults should still be aware of how much a child eats and be aware of the possibility of anorexia.

Many scientific works have documented the importance of the relationship between the child and the person caring for him, and the organization of the feeding situation, in conditions of insufficient physical development of the child. Feeding situations in which a child lags behind in physical development differ in a number of characteristics from situations in which the child grows normally. Factors associated with stunting include: an authoritarian, pedantic approach, which may suppress the child's internal regulation of hunger; low degree of mother’s response and sensitivity to various manifestations in the child; an atmosphere in the family in which there is no sense of support and unity, and, possibly, the presence of individuals with difficult characters (9). Using behavior modification strategies to change these relationships leads to positive changes in feeding habits and practices (10). More research is needed to examine how feeding principles and practices should be modified, especially in situations where feeding is not responsive to the child's wishes, including situations of extreme adult passivity or force feeding.

The caregiver's response to the child's appetite may cause the child to request less food. When food is scarce, adults may discourage children from asking for food, leading to lower food intake when more food becomes available. Sometimes caregivers believe that a child should learn not to ask for food, or that immediately responding to a child's request for food is “pampering” the child or unduly indulging his whims. In such cases, the child's chances of getting enough food are reduced, since demand plays an important role in determining the amount of food consumed. Snacks between meals are sometimes an important source of additional energy.

On the other hand, overfeeding and overweight in children are becoming an important public health problem in the European Region (see Chapter 10). Often diets are overly energy dense (from added fats and sugars) and low in micronutrients, resulting in higher energy intake than needed. And here the principles and methods of feeding, as well as attitudes towards feeding, play a significant role in the generation and prevention of overfeeding.

Article from detailed description types of complementary foods, tables, timing and examples was created to help young parents transfer their baby to a balanced diet and develop healthy habits at a very early age.

Children from birth and up to 6 months don't need complementary feeding. Nature's ideal food for babies- This mother's breast milk, with which he receives the necessary nutrients, vitamins, minerals and antibodies. If the mother does not have or does not have enough milk, then to kid it is necessary to introduce complementary foods in the form artificial mixtures. But now this is no longer a problem, since manufacturers of most artificial formulas have brought the product to the proper level, which can fully replace breast milk. In this article we will not touch on the psychological and tactile connection between the child and the various pros and cons between breastfeeding and artificial formula, since this topic is quite sensitive, capacious and requires independent disclosure in another article. And regardless of what type of feeding the child chooses - breastfeeding or artificial formula, baby's main complementary foods must begin no earlier than 6 months according to WHO recommendations(World Health Organization) and UNICEF(UN Children's Fund), unless otherwise provided by medical recommendations for the condition health baby. Early complementary feeding(before 6 months) is administered on the recommendation of a pediatrician according to medical indications, which is why it is also called pediatric.

Basic principles of complementary feeding for children according to UNICEF:

1. From birth to 6 months, breastfeed, and starting at 6 months of age, introduce complementary foods while continuing breastfeeding.
2. Continue frequent breastfeeding on demand until age 2 or longer.
3. Feed your baby based on his needs and in accordance with the principles of psychosocial care.
4. Maintain proper hygiene and adhere to proper food storage and handling practices.
5. From 6 months, start giving your baby small amounts of complementary foods, and as the baby gets older, increase the portions, while continuing frequent breastfeeding.
6. As your child gets older, gradually increase the consistency and variety of food based on his needs and capabilities.
7. As your child gets older, increase the daily number of meals during which he or she consumes complementary foods.
8. Give your child a variety of nutritious foods.
9. If necessary, give your child complementary foods fortified with vitamins and minerals.
10. When sick, give your baby plenty of fluids, including more breast milk, and encourage him to eat light foods that he likes. After illness, feed your child more often than usual and encourage him to eat more.

Starting from 6 months of age, the child’s body’s need for nutrients is no longer satisfied only by mother’s milk and must be gradually introduced lure. At this age, babies begin to show interest in adult food. Complementary feeding should be introduced with small amounts of foods new to the child and gradually increased as the child gets older.

The child is introduced to new food gradually, starting with very small portions (see table below). A new type of baby nutrition includes nutritional supplements And lure.

Nutritional supplements:

• fruit and berry juices;
• fruit and berry purees;
• chicken or quail egg yolk;
• cottage cheese

Nutritional supplements should be introduced gradually and after the main feeding or between feedings. But this rule does not apply to egg yolk; it is recommended to give it at the beginning of feeding.

Lure It is a qualitatively new type of nutrition that satisfies the needs of a growing child’s body in all food ingredients and accustoms him to thick food. This includes:

• vegetable purees;
• porridge;
• dairy products (kefir, yogurt, biolact...)

Rules for introducing complementary foods:

1. Complementary foods should be given before breastfeeding
2. Each type of complementary feeding should be introduced gradually, starting with a small amount (10-15 g) and increasing it to the required volume over 7-10 days, completely replacing one breastfeeding.
3. You cannot introduce two or more new dishes at the same time. You can switch to a new type of food only when the child gets used to the previous one.
4. The consistency of complementary foods should be homogeneous and not cause difficulty in swallowing.
5. Complementary foods should only be given from a spoon.
6. The number of feedings with the introduction of complementary foods is reduced to 5 times, then to 3 main and 2 snacks at the request of the child.
7. The temperature of the dish should be equal to the temperature of the mother's milk received (approximately 37 C).

Against the background of the introduction of food additives and complementary foods, strict monitoring of the child’s health is necessary.

Scheme for introducing food additives

Fruit and berry juice(introduced from 7-8 months)

The juice should be started with drops. Within 7-10 days, bring to the required daily volume, calculated by the formula n x 10, where n is the number of months, but not more than 100 ml in the second half of the year. Example: child 7 months x 10 = 70 ml. Give after feeding or between feedings. It is advisable to use freshly prepared juices (must be diluted with water in a 1:1 ratio), but packaged juices specifically designed for baby food are also suitable. The sequence of introducing juices from berries, fruits and vegetables: apple, plum, apricot, peach, cherry, blackcurrant, pomegranate, cranberry, lemon, carrot, beetroot, cabbage. Citrus fruits, tomato, raspberry, strawberry juices, juices from tropical fruits (mango, papaya, guava...) - these juices should be given no earlier than 11-12 months. It is not recommended to include grape juice in a child's diet at such an early age, as it can cause bloating.

Fruit and berry puree(introduced from 7 months)

Puree should be started with 0.5 teaspoon. Within 7-10 days, bring to the required daily volume, calculated by the formula n x 10, where n is the number of months, but not more than 100 ml in the second half of the year. The calculation is carried out in the same way as for juices (see above). Give after feeding or between feedings. Both freshly prepared purees and in the form of canned fruits and berries for baby food are used.

Yolk(introduced at 8-9 months)

You need to start with 1/4 yolk. You can give 1/2 yolk every day until the end of the year at the beginning of feeding, after grinding it with milk or with a complementary feeding dish.

Cottage cheese(introduced at 9-10 months)

Start with 5 grams (1 teaspoon). Gradually, over the course of a month, increase to 20 grams. By the end of the first year - 50-70 g. Cottage cheese should be given at the end of feeding.

Scheme for introducing complementary foods

I complementary foods - Vegetable puree (or porridge). Start at 6 months.

It is administered as a 5% concentration.

1 Week- increasing the volume to 130-150 ml with the simultaneous exclusion of one breastfeeding;

2 week- concentration thickening up to 8-10%;

3 week- getting used to one type of vegetables;

4 week- variety (introduction of new vegetables).

4 breastfeedings left (approximately!)

II complementary foods -Porridge (or vegetable puree). Start a week after the first feeding.

Immediately administered as a 10% concentration in 2-3 days. We start with gluten-free, dairy-free, unsweetened cereals (buckwheat, rice, corn). With the introduction of complementary foods, another breastfeeding is replaced. 3 breastfeedings left (approximately!)

Expansion II complementary foods - meat puree. Start a week after the second feeding. Added to vegetable puree, starts with 5 g, by 7 months it is increased to 30 g, then to 50 g, by the end of the year - to 60-80 g. 3 breastfeedings remain (approximately!)

III complementary foods - kefir (fermented milk products). Start at 8 months. The third breastfeeding is displaced. 2 breastfeedings left (approximately!)

Instead of breast milk for formula-fed or mixed-fed children, human milk substitutes (formulas) are used.

Note:

1. To maintain lactation after complementary feeding, it is advisable to offer the baby the breast.
2. Subject to good health, optimal indicators of physical and neuropsychic development, stable and sufficient lactation in the mother, and high-quality nutrition, the first complementary foods can be introduced no earlier than 6 months.
3. When preparing complementary foods (dairy-free cereals, purees), the optimal liquid for diluting them is breast milk or an adapted milk formula.

Note: Instead of vegetable puree, the first complementary food can be porridge (rice, buckwheat, corn, gluten-free).

When feeding your baby, you must adhere to the principles sensitive feeding, respond to signs of hunger and satiety. These signs must be taken into account to determine the amount of food a child will eat at one time, as well as the need for snacks.

Feeding based on the baby's needs (sensitive feeding):

• Feed infants and help older children feed on their own. Feed slowly and patiently, stimulate your baby's interest in food, but do not force him.
• If your child refuses most foods, try different combinations of foods, flavors, textures, and feeding methods.
• If your baby quickly loses interest in food during feeding, keep distractions to a minimum.
• remember, that feeding time This is a time to teach and show love: talk and maintain eye contact with your baby while feeding.

• Food must be clean.
• Raw and prepared food should be kept separate.
• Food must be prepared carefully.
• Food must be stored at a safe temperature.
• To prepare food, you need to use clean water and food.

Additional Information:

The amount of food indicated in the table is recommended in cases where energy density of this food ranges from 0.8 to 1.0 kcal/g. If the energy density of food is about 0.6 kcal/g, it is necessary to increase the number of calories in food (adding certain foods) or increase the amount of food that the child eats at one meal. For example:

• for children 6-8 months: gradually increase the amount of food to 2/3 cup;
• for children 9-11 months: give baby 3/4 cup;
• For children 12-23 months: Give your baby a full cup.

If your baby is not breastfed, give him an extra 1-2 cups of milk per day and 1-2 extra meals per day.

The energy density of food products given to children as complementary foods should be higher than that of breast milk - that is, at least 0.8 kcal per gram. The food quantity indicators given in the table assume that complementary foods contain 0.8-1.0 kcal per gram. If the energy density is higher, then less food is needed to meet energy needs. If the energy density of the food is lower than that of breast milk, the total number of calories the baby receives may be lower than when he was exclusively breastfed. This is one of the common reasons malnutrition.

Small child's appetite often serves as a good indicator of the amount of food needed. However, illness and malnutrition reduce appetite, so a sick child may eat less than he actually needs. When a child is recovering from illness or malnutrition, he may need extra help with feeding to make sure he is getting enough food. If during this recovery the child's appetite improves, he needs to be given more food.

Optimal food consistency for a child depends on his age and level of neuromuscular development. Starting at 6 months, the baby can eat pureed, mashed and semi-solid foods. At 12 months, most children can eat the same foods as other family members. But they need foods rich in nutrients, and foods that can cause choking (for example, whole peanuts) must be avoided. Weaning food should be thick enough so that it stays on the spoon and does not drip off it. In general, thick or firmer foods are more nutritious and energy dense than thin, watery or soft foods.

Crisis of the first year of life- look