FEEDING of CHILDREN of early age. Food for the child is not only an energy source, necessary for heat generation and functioning of all bodies and fabrics; the substances entered with food are used and as the plastic material necessary for the growing children's organism, they exert impact on processes of metabolism, on specific and nonspecific resistance of an organism to influences of the environment.
A balanced diet of children — the major factor without which the correct development of the child is impossible. The food received by the child shall satisfy completely requirements of an organism and correspond its age fiziol, to opportunities (see table 1).
The amount of protein in food has special value for development and life activity of the child of early age. Decrease in protein in a diet quickly conducts to a growth inhibition and developments. The specified disturbances will be observed even at the sufficient caloric content of food at the expense of fats and carbohydrates since protein cannot be replaced with other substances. For food of children it is impossible to be limited to a minimum of protein, and it is necessary to enter optimum quantity it for creation of positive balance.
The quantitative need for protein depends not only on age of the child, but also on quality of the entered protein. At natural feeding children of 3 — 4 months well develop, receiving 2 — 2,5 g of protein on 1 kg of body weight. It is explained by special qualities of protein of women's milk. Not only the absolute amount of amino acids, but also their ratio matters. A certain value has also dominance in women's milk of finely divided albumine over casein. The relation of casein to albumine in women's milk 0,6: 1, and in cow — 5,6: 1.
Protein of cow's milk is digested slowly and does not contain sufficient amount of nek-ry amino acids in this connection at artificial feeding it is necessary to increase daily amount of protein on 1 kg, weight to 3,5 — 4,0 g, and sometimes more.
Not less contents in a diet of vitamins is important for the correct development of the child (see. Vitamins ).
Natural feeding of the baby is called feeding its breast milk. Natural feeding — the best way of food of children from the first days of their life. In the first days of a lactation the mammary gland separates colostrum (see), the players to-rogo every day are changed. Only on 2 — 3rd week it gets constant structure and becomes mature milk (see. Breast milk ). Feeding of the healthy newborn child should be begun in 6 — 12 hours after the birth depending on his specific features, features of mother, time of the birth.
After the first feeding of the child put to a breast every 3 — 3,5 hour with observance of a night break at 6 — 6,5 o'clock. Number of feedings — 6 — 7 in days, duration of each feeding at first — 20 min., further — 15 — 20 min., depending on activity of suction of the child, features of a maternal breast and a lactation. At each feeding of the child it is necessary to put only to one breast, paying attention to liberation it from milk. During the first three days children exhaust from 5 to 30 — 35 ml for feeding that makes apprx. 100 — 200 ml a day; every next day the amount of the milk exhausted by the child increases and to 8 — to the 9th day reaches 450 — 500 ml a day. The amount of milk necessary for the newborn daily during the first 7 — 8 days of life, it is possible to calculate by a formula approximately: 10XnX7, where n — number of days of life of the child.
Amount of milk at young people, especially primapara, women in the first days lactations (see) often happens insufficient; it can become the reason a nek-swarm of a delay of recovery of initial weight of the newborn child that, as a rule, does not affect negatively his further development. However if at the newborn child fiziol, weight reduction to 4 — to the 5th day of life exceeds 8% of initial weight and the tendency to recovery of weight is not found, and the child, without maintaining intervals between feedings, shows explicit concern, it is necessary to finish feeding it milk of other woman. It is necessary to milk a spoon or a pipette. The children who are prematurely accustomed to receive dokorm from a small bottle through a rubber pacifier almost always begin to suck inertly that strengthens a hypogalactia at mother. Such children should be transferred to the mixed feeding prematurely.
Since second week of life the formula stated above is already inapplicable. The daily amount of milk necessary for feeding is calculated proceeding from the weight of the child: aged from 2 to 6 weeks — 1/5 — 1/6 body weight, of 6 weeks up to 4 months — 1/6, later — from 1/7 to 1/8 body weight. More exact is caloric calculation. In the first quarter of the first year the child shall receive in days on average 120 — 130 kcal on 1 kg of weight, in the second quarter — apprx. 110 — 120, in the third — apprx. 100 — 110 and, at last, by the end of the year — apprx. 90 — 100 kcal. The healthy child living in favorable conditions shall be up to 4,5 — 5 months on feeding by one maternal milk if it is enough at mother.
During the feeding of the child the difficulties connected with mother can arise a breast: 1) irregular shape of nipples that complicates their capture by the child; 2) the grazes and nipple cracks doing the act of suction of a breast to extremely painful; 3) mastitis; 4) galactorrhoea; 5) «a hard breast»; 6) hypogalactia; 7) a serious illness of mother — mental diseases, endocrine frustration, dekompensirovanny heart diseases, syphilis if infection occurred in the last month pregnancies (acute infectious diseases are not always a contraindication to feeding of the child a breast); 8) defective composition of milk. Difficulties are possible and from the child: 1) defects and diseases of an oral cavity and nose; 2) usual vomiting; 3) intolerance of women's milk; 4) serious illness of the child (intracranial birth trauma, pneumonia, sepsis, etc.). Great difficulties arise also during the feeding of inertly sucking children. Usually all listed difficulties can be eliminated; it is necessary to resort to feeding by the decanted milk of mother less often, and sometimes to transfer the child to the mixed feeding; only seldom or never (intolerance of women's milk) there is a need to transfer the child to artificial feeding by milk mixes and when the child does not transfer either some female, nor cow's milk (a galactosemia, hereditary intolerance of disaccharides, napr, lactoses), to it appoint nonmilk food.
At insufficient amount of milk at mother the dokarmlivaniye of the child by the decanted milk of other feeding woman — the donor is quite often applied. The donor milk subjected to heat treatment and kept after decantation within several hours loses many valuable biol, properties of women's milk. The children receiving only donor milk should be transferred to the mixed feeding, as a rule.
With 1,5 — 2-month age it is reasonable to give to the child vegetable, fruit or berry juice: begin with 0,5 chayn. l. 1 — 2 time a day, gradually to 5 — to the 6th month reach to 5 — 10 chayn. l. (25 — 50 g), and by the end of the year — to 80 — 100 g a day. Along with juice, but on account of the specified their quantity, since 2 — the 3rd month, the child can give grated crude apple or tinned fruit puree.
From 4,5 — 5 months the healthy child cannot be satisfied only with breast milk even if the quantity is quite enough of it and completely covers all caloric requirement of an organism of the child. From now on it is necessary to enter a feeding up into a diet.
The feeding up has a special purpose: introduction to food of substances, to-rykh in breast milk is not enough or they in it absolutely are absent — nek-ry types of proteins, carbohydrates and mineral salts. Besides, the feeding up accustoms the child to more dense food, taste of the new substances stimulating the digestive device i.e. prepares the child for transition to a table d'hote.
Main types of a feeding up are appointed approximately in the following terms: in 4,5 — 5 months — vegetable puree, 5 — 5,5 months — 5% porridge, kissel, 5,5 — 6 months — 10% porridge, 6 — 7 months — a beef-infusion broth, egg yolk, 7 — 8 months — a cracker, cookies, 7,5 — 8 months — mincemeat, 11,5 — 12 months — meat steam cutlets.
Porridge is recommended to be cooked from groat flour since it prepares from different types of grain and, therefore, contains various proteins and carbohydrates. Fruit or berry kissel (or puree) is given along with porridge in number of no more than 50 — 70 g; it is better to give fruit puree. The yolk is given abruptly welded for reduction of its allergenic action and for the purpose of elimination of possible infection with a psittacosis or toxoplasmosis; besides, the crude yolk is digested worse. Broth is recommended in number of no more than 50 — 100 ml: it has no nutritional value, but possesses the expressed sokogonny action therefore it is especially necessary for children with small appetite.
It is possible to appoint this or that feeding up sometimes slightly earlier or a little later than the specified terms depending on specific features of the child and environmental factors. To the child, it is excessive well-fad or having rickets, anemia, at first it is better to appoint vegetable puree, to children of subnutrition, with an unstable chair — porridge. Depending on age and specific features of the child porridge can be cooked on half or whole milk, on vegetable broth or a beef-infusion broth.
To children of the last quarter of the first year of life a part of butter in a daily diet, napr, in porridge or vegetable puree, it is possible to replace with the best refined grades of vegetable oil, but the quantity it shall not exceed 10 — 15% of total quantity of the entered fat. It is necessary to reckon to a nek-swarm of degree and with individual taste of the child.
At natural feeding the child shall receive (on 1 kg of weight): proteins 2,0 — 2,5 g before introduction of a feeding up, after introduction of a feeding up — 3,0 — 4,0 g; fats of 7,5 g in the first quarter of the first year of life, 7.0 g — in the second, 6,5 g — in the third, 5,5 g — in the fourth quarter of the first year of life; carbohydrates of 13,0 — 14.0 g.
The ratio between proteins, fats, carbohydrates at natural feeding shall be to a feeding up — 1: 3: 6, with a feeding up — 1:2:4.
With age the number of meals is reduced; if the newborn received 7 feedings, it is reasonable since the end of the first — the beginnings of the second month of life to transfer it to 6 feedings, from 4 months — to 5 feedings. Many children by 12 months spill out night feeding, and the number of meals is reduced to 4. With purpose of a feeding up the number of feedings by a breast is reduced, and by 10 — 12 months of the child it is possible to wean.
The mixed feeding (dokarmlivaniye)
The mixed feeding (dokarmlivaniye) — a way of feeding of children of the first 4 — 5 months of life, at Krom they receive not only women's milk, but also artificial milk mixes. Need of such dokarmlivaniye arises if needs of the child for food ingredients and calories owing to these or those reasons cannot be satisfied completely only with one women's milk, and time for a feeding up did not come yet. In these cases appoint artificial dokorm, usually milk mixes. Indications to the mixed feeding can be various: 1) insufficient amount or defective composition of maternal milk; 2) the specific features of the child demanding or restrictions of amount of maternal milk (heavy displays of exudative diathesis), or introductions of the increased amount of protein or fat (premature children, children with frustration of food).
The quantity and character of the added mix are defined by age of the child, the reason of a dokarmlivaniye and amount of missing maternal milk. For prolonged use as a dokorm to healthy children appoint: the milk divorced broths, whole milk from 5% of sugar, kefir and its cultivations, ionite milk, the mix «Kid» and other dry milk blends. To children of the first days of life, if it is not possible to add missing colostrum of mother with colostrum or milk of other woman, appoint Speransky's mix, the mix «Baby» or mix No. 2 (see. Milk mixes ). These mixes, especially mix No. 2, cannot be considered rather full, and already from 1,5 — 2 weeks it is necessary to replace them with mix No. 3 of milk and kefir. At the mixed feeding especially attentively it is necessary to consider amount of proteins, fats, carbohydrates and calories on 1 kg of weight of the child; it is necessary to increase amount of protein a little in comparison with what the child receives at natural feeding since the foreign protein is worse acquired by an organism of the child. The amount of fat shall remain approximately apprx. 7 — 7,5 g on 1 kg of weight, as well as during the feeding milk of mother. Mixes No. 2 and No. 3 are poor in fat, and the quantity it should be increased addition of cream to them; it is possible to use the mix «Kid». At the mixed feeding the caloric coefficient shall be slightly higher, than at natural feeding. Total number of feedings within a day same, as well as at natural feeding. It is possible to appoint a feeding up to about 2 weeks earlier, than during the feeding of the child only a breast of mother. At the mixed feeding it is especially necessary to enter fruit juice timely.
The mixed feeding of the child during the first 6 — 8 weeks of life considerably concedes to chest and shall be appointed only in the presence of unconditional indications to it and impossibility to add missing maternal milk donor. After 2 — 21! 2 months of difficulty at correctly carried out mixed feeding meet usually not more often than at natural. The mixed feeding demands from the doctor bigger, than during the breastfeeding, understanding and the account age fiziol, and specific features of the child.
Correctly carried out mixed feeding when maternal milk remains to the main in a diet of the child, and dokorm only supplements it, as a rule, provides quite normal development of the child. Dokorm it is possible to give as one or several independent feedings, alternating them to feedings only a breast or as addition to one or several feedings by a breast. However if the mixed feeding is caused by a hypogalactia in mother, applying of the child to a breast at all feedings is obligatory. Dokorm it is necessary to give after feeding by a breast when in a breast there is no milk left any more. It is desirable that at the mixed feeding mother in whole or in part nursed the child not less than three times since at more rare applyings to a breast the lactation at mother quickly dies away, and the child begins to take reluctantly a breast, preferring receiving milk, easier for it, from a small bottle.
Concentrated (protein-rich, fats and carbohydrates) and medical mixes (vegetable milk, etc.) shall be appointed for a dokorm only according to special indications.
Artificial feeding — a way of feeding of babies without women's milk, only one artificial milk mixes or milk of nek-ry animals. Artificial feeding cannot be considered as quite physiologic. Milk of animals has no valuable biological properties of milk of mother; it demands from an organism of the child of bigger energy consumption and bigger tension of processes went. - kish. digestion and interstitial exchange. Healthy full-term children aged after 3 — 4 months easily adapt to artificial feeding and quite well develop if it is carried out correctly. Children of the first 6 — 8 weeks of life, children weak from the birth, premature, with various diathesis, dystrophy and other diseases not always well develop on artificial feeding.
It is undesirable to appoint artificial feeding to newborn children from the first days of their life.
For artificial feeding the mixes prepared from cow's milk are usually used: milk mixes, whole milk, kefir and cultivations of kefir, a yogurt, ionite milk, Speransky's mix (for newborns), the mix «Baby» (up to 1 — 2 month) and the mix «Kid» (since 1 — 2 month). At the nek-ry people for food of children use milk, structure to-rogo even more, than cow, differs from women's (see table 2). Goat milk before cow has no advantages.
Medical mixes (a pakhtanye, proteinaceous milk, Moro's mixes, etc.) appoint only according to special indications. At artificial nutrition the child shall receive protein in a little bigger quantity, but not exceeding 4 — 4,5 g on 1 kg of weight; at the expense of protein shall become covered apprx. 12% of the calories received by the child. The amount of fat on 1 kg of weight remains approximately same, as at the natural and mixed feeding. A ratio between proteins, fats and carbohydrates about 1: 1,5 (2): 3,5 (4). The number of calories are 5 — 10% higher, than at natural feeding. Number of feedings — from 7 to 5, depending on age of the child; it is desirable to transfer children to 5 feedings since artificial mixes are late in a stomach of the child longer earlier.
The easiest to prepare mixes of milk with water, mucous or flour broths with addition of sugar (5%). Cultivation of milk 1: 1 (mix No. 2) is appointed only by the newborn. From 2 weeks age and to 3 months to children appoint mix No. 3 (2: 1), sometimes with addition of cream, and then gradually transfer to whole milk with addition 5% of sugar. From 5 months also 5% porridge are entered. Further expansion of a feeding up is carried out approximately as well as at the natural and mixed feeding.
With success it is possible to apply kefir and cultivations to long artificial feeding by its mucous broths concerning 2: 1 (mix No. 3, V). Kefir as the acid fermented mix has nek-ry advantages before whole milk or its cultivations (see. Lactic products , in food of children), but it is more difficult to prepare it, and nek-ry children drink it reluctantly. Artificial mixes are rather poor in vitamins.
At artificial feeding mix is given warmed up to 40 — 45 °; in a rubber pacifier do not too big opening, boil it after each feeding.
In the USSR the adapted dry milk blends «Baby» and «Kid» gain ground. Their correct preparation (recovery) gives the chance to cover the need for protein with its smaller quantity, than at the use of usual mixes, without causing tension of adaptable mechanisms, in particular the strengthened removal of nitrogen kidneys that was observed in attempt to give not the optimum, but maximum quantity of protein. Their structure concerning lipids is of special value that allows to apply the mix «Baby» in the period of a neonatality when functions of digestion are in the period of formation.
At artificial feeding of babies if dynamics of increase of their weight and amount of the main feedstuffs received by them and calories systematically is not considered, conditions quantitatively and qualitatively insufficient or excess food are easily created. The overfeeding arises at excess food porridges and mealy dishes more often. Excess increase of weight is quite often mistakenly estimated as a sign of good development of the child; however corpulent children, as a rule, are ill more often and heavier have diseases. The overfeeding has especially an adverse effect on children with the so-called limfatiko-hypoplastic constitution. These children demand for the correct development of rather smaller number of calories on 1 kg of weight due to reduction of carbohydrates. Defective feeding is one of the reasons hron, frustration of food (see. Gipostatura , Hypotrophy , Dystrophy ).
At the end of the first year of life of the child it is necessary to accustom to chewing of food that is reached by a variety and complication of the menu, gradual replacement of liquid and semi-fluid food of more dense. At this time most of children can be transferred to four times food, and only children with small appetite should be fed 5 times a day. Aged from 1 year up to 3 years children shall receive on 1 kg of body weight about 4,0 g of proteins, 4,0 — 5,0 g of fats and 14,0 — 16,0 g of carbohydrates. Vegetable oil shall not exceed 10 — 15% of total quantity of fats in a diet of the child. Amount of milk (kefir, curdled milk, milk for cooking etc.) aged from 1 up to 1,5 years — 600 — 700 ml for days, from 1,5 to 3 years — 500 — 600 ml; eggs — No more than 1 in day; meat — 50 — * 60 g. Reasonablly 1 — 2 time a week to arrange vegetarian days. Other foodstuff — bread, vegetables etc. — a strict dosage does not demand. It is necessary to pay attention to tastes of food, to its external design and to table layout. Children should be accustomed gradually to independence at meal, hygiene and culture of meal, to the correct use of a spoon, a fork, napkin etc.
At food of children from 1 year to 3 years when the amount of the received food is not considered yes sir as about one year, it is necessary not to allow systematic underfeeding of children with small appetite and overfeedings of children with good appetite. Control is exercised by weighing of children from 1 time a week to 1 time a month depending on age. See also Food (children).
Bibliography: Bozhkova K. and Village of Vitkovska. Food of sick children, the lane with polsk., Warsaw, 1967; Vlasov V. A.imazurin of A. V. Pitaniye of the healthy child, M., 1970; Kislyakovskaya V. G. Practical guidance on food of children of early age, M., 1967; Korobkina G. S. Products of baby food, M., 1970, bibliogr.; Philosophy of food of children and teenagers, under the editorship of E. M. Fateeva and T. S. Nevska, M., 1974; Food of the healthy and sick child, under the editorship of M. I. Olev-sky and Yu. K. Polteva, M., 1965, bibliogr.; Round A. T. Reference book on a dietetics of children of early age, L., 1971, bibliogr.; H 1 z e of of H., GrunwaldK.u. Weilbezahl H. Gesunde Ernah-rung der Vorschulkinder, B., 1968; Klein-1) u m H. Diatetik im Kleinkindesal-ter, Lpz., 1971, Bibliogr.
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