Lure baby

Lure - any kind of food or liquid, other than women's milk or its substitutes, which feed children in the first year of life. Revision of some provisions on the adopted schemes of introduction of complementary foods can not be called extremely important, however, even here the positions of specialists are often very ambiguous. First of all, the degree of need for injected lactation is directly dependent on the degree of confidence in the quality of breast milk and breastfeeding in general. Optimal feeding with good nutrition of the pregnant and lactating can ensure a good development of the child without lures up to 1 - 1 1/2 years. Accordingly, such prolongation is exclusively breastfed, but optimal feeding can be associated with the greatest biological benefits for a child or a future adult. Lack of confidence in the optimality of feeding in the vast majority of lactating women can be the basis for recommendations and indications of mandatory introduction of thick complementary foods in the range of 4 to 6 months.

According to WHO recommendations, the child should only breast-feed with breastfeeding for about 6 months, followed by the introduction of lures. Other organizations advise to introduce lures between 4 and 6 months of life, continuing at this time breastfeeding or a mixture. Up to 4 months the child does not need a lure, and the reflex of pushing out, in which the tongue pushes everything that is put out of the mouth, makes it very difficult to feed the child.

First, you should offer lure after breastfeeding or with a mixture to provide sufficient nutrition for the child. Traditionally, as the first lure, rice porridge is enriched with iron, its advantages are that it is non-allergenic, easily digested, and serves as a source of iron for the child. Usually, it is advised to inject each new ingredient separately for a week, so you can recognize food allergy. There is no special order for the introduction of complementary foods, although they are usually introduced taking into account the reduction in the degree of mechanical processing, for example from rice porridge to mashed food, and then to grated on a large grater. Meat in the form of puree to prevent aspiration is a good source of iron and zinc, the intake of which with breast milk is limited, which makes meat a good additional food. Vegetarian children can also get enough iron with iron-enriched porridges, cereals, peas, dried beans, zinc from fermented whole grain bread and enriched baby porridges.

Homemade food is equivalent to commercially produced baby food, but the finished vegetable puree from carrots, beets, turnips, spinach is preferably under the age of one year, as they control the nitrate content that is present if vegetables are grown using water with fertilizer additives, which can cause methemoglobinemia in young children. Eggs, peanuts, cow's milk for the prevention of food sensitization should not be given to a child under 1 year. From honey it is necessary to refuse up to 1 year because of the risk of development of infant botulism. Food that can cause obstruction of the child's airways during aspiration should not be given (for example, nuts, pills, round candies) or should be given in the form of puree (meat) or cut into small pieces (grapefruit). Nuts are best given after 2-3 years, since they are not completely chewed and small pieces can get into the respiratory tract during aspiration with or without bronchial obstruction and cause pneumonia or other complications.

At the age of one year or later, one can begin to give the child whole cow's milk; skim milk is better not to give up to 2 years, when the child's diet will significantly approach the diet of the rest of the family. We should advise parents to limit the daily intake of milk to 16-20 ounces for younger children; more milk can reduce the amount of other important foods and lead to iron deficiency.

Juice contains few nutrients, leads to tooth decay and should be limited to 4-6 ounces a day or even excluded.

At about one year of age, the growth rate usually slows down. Children need less food, and they can refuse it during certain meals. Parents should be reassured and advised them to assess the amount of food eaten by the child for a week, not for one feed or a day. On malnutrition should be considered only if the child does not gain weight according to his age and physical development.

According to the results of calculations of American specialists on baby food, it was concluded that in 6-8 months a child fed only by breast milk, about 50% less iron, zinc, manganese, fluorine, vitamins D and B6, E, niacin, biotin, thiamin , magnesium, phosphorus.

Estimated values of energy and nutrients that must be obtained with complementary feeding to children who are naturally breastfed, according to EER, AL or RDA (WHO, 1998, Institute of Medicine, Food and Nutrition Board, American Academy of Pediatrics 2004-2006 rr.)

Nutrients and energy	The amount to be obtained from complementary foods	The proportion of DRI that must be obtained from complementary foods	The amount to be obtained from complementary foods	The proportion of DRI that must be obtained from complementary foods
	Age 6-8 months		Age 9-11 months
Energy, kcal	25	372	49
Protein, g	2.47	25	4.19	42
Vitamin A, μg ME	146.00	29	228.00	46
Biotin, μg	3.17	53	3.82	64
Folate, μg	19.82	25	33.76	42
Niacin, mg	2.94	73	3.18	80
Pantothenic acid, mg	0.53	29	0.82	46
Riboflavin, mg	0,15	38	0.21	52
Thiamine, mg	0,15	50	0.19	62
Vitamin B6, μg	234.16	78	249.41	83
Vitamin B-12, μg	-0.19		-0.03
Vitamin C, mg	21.68	43	28.24	56
Vitamin O, μg	4.61	92	4.70	94
Vitamin E, mg	3.37	67	3.75	75
Vitamin K, μg	1.01	41	1.36	54
Calcium, mg	71.76	27th	117.68	44
Chromium, μg	-29.90		-21.70
Copper, mg	0.04	20	0.08	38
Fluoride, μg	488.67	98	491.30	98
Iodine, μg	52.12	40	70.16	54
Iron, mg	10.79	98	10.84	99
Magnesium, mg	50.22	67	55.96	75
Manganese, μg	595.75	99	596.74	99
Phosphorus, mg	175.88	64	198.84	72
Selenium, μg	5.84	29	9.12	46
Zinc, mg	2.15	72	2.35	78

Note. EEP - estimated energy needs; AL - sufficient intake; RDA - recommended daily intake; DRI - reference dietary norms.

The amount of nutrients that must be provided with complementary foods was calculated based on the difference between the DRI score and the estimated amount of nutrients supplied with human milk.

Recommendations vary relatively little. Of the new and well-grounded trends that have emerged in recent years, we should first of all point out the following:

1. tendency to later terms of introduction of lures;
2. transition from a formal age selection of terms to the formulations of individual indications and terms;
3. the allocation of preparatory, or "training", complementary foods;
4. trends in the replacement of traditional home-cooked lures for cereals, vegetables and factory-made meat purees, produced by the baby food industry; the advantage of the latter is enrichment with essential nutrients, which is essential for achieving a multicomponent balance of the diet;
5. the tendency to replace whole cow's milk or kefir (3rd step) with a new group of baby dairy products - a mixture of the second row, or "follow up"; this trend also arose from the need to ensure a multicomponent balance of the daily diet with a decreasing amount of breast milk in its composition; The second reason for limiting cow's milk is the desire to reduce the direct immunotoxic effect of cow milk casein on the intestinal epithelium.

The general trend is a somewhat later introduction of lactation in breastfeeding. Currently, the scheme for introducing lures is being developed, developed by the Institute of Nutrition of the Russian Academy of Medical Sciences.

The scheme of introduction of complementary feeding with natural feeding (methodical instructions M3 RF № 225 "Modern principles and methods of feeding children of the first year of life", Moscow, 1999)

Food and Dishes	Age, month
	0-3	3	4	5	6th	7th	8	9-12
Fruit juice, ml		5-30	40-50	50-60	60	70	80	90-100
Fruit puree, g *		5-30	40-50	50-60	60	70	80	90-100
Vegetable puree, g			10-100	150	150	170	180	200
Milk porridge, g				50-100	150	150	180	200
Cottage cheese, g				10-30	40	40	40	50
Yolk, pcs.						0.24	0.5	0.5
Meat puree, g						5-30	50	60-70
Fish puree, g							5-30	30-60
Kefir and sour-milk products, ml						200	200	400-500
Whole milk, ml			200 **	200 **	200 **	200 **	200 **	200
Rusks, biscuits, g					3-5	5	5	10-15
Bread, wheat						5	5	10
Vegetable oil, ml **			1-3	3	3	5	5	6th
Butter, g				1-4	4	4	5	6th

• * - Fruit puree is administered 2 weeks after the introduction of juice.
• ** - For preparation of complementary foods (vegetable purees, cereals).

However, the accumulated experience allows us to introduce some refinements and additions. First of all, it concerns the timing of the introduction of juices. Their introduction before the 4th month is inexpedient. Juices do not make any significant contribution to meeting the needs for vitamins and minerals, at the same time they can lead to the development of allergic reactions and digestive breakdowns.

At the same time, it is often advisable to use not simply a chronological (according to the age scheme) assignment of lures, but to introduce them individually. In this case, you can get long terms of lactation in the mother and maximize the duration of exclusive breastfeeding. Such an individual delay should relate primarily to the energy-significant volume of lure or non-dairy food. Along with this, all children should receive very small amounts (1-2 teaspoons / day) of vegetable or fruit purees from the age of 4-6 months as a so-called pedagogical, or training, complementary food. "Learning" lure pursues its own goals - it allows the child to get acquainted with different sensations of taste and consistency of food, trains oral mechanisms of food processing and prepares the child for the period when he needs an energy supplement. The introduction of "training" complementary foods is not a departure from exclusive breastfeeding. Individualization of the term for the introduction of "training" complementary foods can be based only on the following signs of the maturity of the child:

1. the extinction of the "push" reflex (tongue) with a well-coordinated reflex of swallowing food;
2. the child's readiness for chewing movements when a nipple or other object enters the mouth.

As a "training" complementary foods, you can use 5-20 grams of grated apple or fruit puree without sugar. From the tip of a teaspoon some of the puree or apple is injected into the middle part of the child's tongue. It is advisable to do this after he has already sucked a little milk from his chest, still retained a sense of hunger, but already enjoyed the start of feeding. With good swallowing, good tolerability and no allergic reaction to lure, it can be given regularly and transferred to the beginning of feeding. If an allergic reaction occurs, you should give up this complementary product for a long time and, if possible, include the introduction of complementary foods as a whole. The age most suitable for "training", or testing, complementary, in most countries of Europe and the United States is chosen between the 16th and 24th weeks of life. The duration of this supplement is about 2-3 weeks. However, the "training" lure can be introduced for a long time, if the child is satisfied exclusively with the mother's breast milk, his weight increases well and he develops psychomotor well.

Indications for the introduction of the main or energetically significant complementary foods should be a clear manifestation of the child's dissatisfaction with the volume of milk obtained at such a state of his physiological maturity, when this dissatisfaction can already be compensated for by a thick lure. Dissatisfaction of the baby after breast feeding mother easily recognizes by the child's anxiety and the rapidity of screaming. This leads to a greater frequency of application, repeated night awakenings of the baby with a hungry cry, a decrease in the number of wet diapers and a reduction in stool. Some children may develop objective signs of malnutrition, even in the absence of anxiety and screaming. They become apathetic, their motor activity decreases. Often already Within a few days or 1 - 1 1/2 weeks, you can catch and slow the rate of increase in body weight with the crossing of the boundaries of the underlying centile zones. The statement of these signs should be a confirmation of the need for introducing complementary foods or complementary foods.

The latter is chosen under the following conditions:

• age more than 5-6 months;
• the existing adaptation to the promotion and swallowing of dense food by using "training" complementary foods;
• the current or actual eruption of a part of the teeth;
• confident sitting and head possession for expressing an emotional attitude to food or expression of satiety;
• the maturity of the functions of the gastrointestinal tract, sufficient to assimilate a small amount of dense food without digestion and allergic reaction to this product.

First introduce a test dose of complementary foods (1-2 teaspoons) and then (with good tolerance) rapidly increase the amount to 100-150 g of puree from fruits or vegetables or cereals prepared without salt and sugar and without the addition of butter. At the same time, gluten-free porridges are first introduced based on buckwheat or rice. The first porridges and vegetable homemade purees should be relatively sparse in half the milk.

We can distinguish the following stages (steps) of complementary feeding.

• Step 1 - the "training" lure (fruit or vegetables).
• Step 2 - one vegetable puree (potatoes, carrots, cabbage, spinach) or fruit puree (bananas, apples). It is highly desirable to use products specially produced by the baby food industry for lure.
• Step 3 - porridge gluten-free (rice, corn, buckwheat) preferably industrial production. If the porridge is homemade, then first on half milk and half-dense for 2 weeks. Then - a thick porridge or puree on whole milk for another 2 weeks. In a month, one puree and one cereal are combined in lure.
• Step 4 - add a vegetable puree with minced meat, fish or poultry meat. It is desirable from canned meat for baby food. Expansion of the circle of vegetables and fruits (excluding citrus fruits). The period of adaptation to this step is about 1-1 1/2 months.
• Step 5 - porridge on wheat flour (croup).
• Step 6 - substitutes for cow's milk for baby food ("follow up" mixes), unadapted dairy products (milk, yogurt, yoghurt, cottage cheese), citrus fruits and their juices, egg yolk hard-boiled.
• Step 7 - the beginning of the "piece" food for further stimulation of biting and chewing: cookies, slices of bread and bread, sliced fruit, steam cutlets, unsweetened vegetables, etc.

The advantages of complementary foods for industrial production are based on a higher degree of product homogeneity, a relative guarantee of control on the ecological purity of raw materials and a wide enrichment with various micronutrients, which largely relieves the risk of their insufficiency during the weaning period or the reduction in the volume of the formula for artificial feeding. We give examples.

Milk porridge "Milupa"

Composition	100 g of granulate	Portion (40 g per 150 ml of water)
Protein, g	11.9-15.6	5.2-7.4
Fats, g	14.1-17.4	5.9-7.9
Carbohydrates, g	58.1-67.7	26.4-31.7
Vitamin A, μg	295-333	118-153
Vitamin E, mg	2.0-2.2	0.8-1.0
Vitamin C, mg	41-46	18-21
Vitamin K, μg	5.2-5.6	2.5-2.6
Vitamin Bh, mg	0.49-1.4	0.24-0.6
Vitamin B2, mg	0.48-0.53	0.2-0.26
Niacin, mg	3.8-6.9	1.5-2.8
Vitamin B6, mg	0.25-0.47	0.1-0.22
Folacin, μg	20	8
Vitamin B12, μg	0.4-0.7	0.2-0.3
Biotin, μg	7-8	3-4
Folic acid, μg	60-67	Thirty
Pantothenic acid, mg	1.7-1.9	0.7-0.9
Calcium, mg	400-500	200
Iron, mg	4.0-4.4	1.7-2.0
Iodine, μg	48-55	19-26
Energy value, kJ	1823	758-923

A fairly wide range of complementary foods is also produced by the domestic food industry.

With any scheme for introducing complementary foods, the expansion of their range and quantity is due to the "squeezing out" of breast milk. Therefore, the period of introduction of lures simultaneously becomes the beginning of the period of weaning from the breast. It is very useful to maximize the lactation of the mother and putting the baby to the breast. There is evidence of a positive impact on the development of children, even a single application to the breast of a child of the second year of life.

The total daily amount of milk (breast and mixtures) should not be less than 600-700 ml in any period of the first year of life. This amount is desirable to distribute evenly throughout the day on the amount of feeding that is added in the individual feeding regimen of the child (from 3 to 5 by the end of the year).

By the end of the first year of life, instead of the "follow up" group mixtures for the dairy component of the diet, it is advisable to use cow's milk substitutes for children of the 2nd and 3rd years of life.

With the good tolerability of the complementary foods and the child's appetite, the volume of one serving of feeding may exceed 200-240 g by the 3-4th quarter of the first year of life. In these cases, the number of feedings can be reduced up to 4 times a day, not counting possible night feedings. Immediately after the year, you can try and go to 3 basic and one lightweight feeding (milk mixture, juice or fruit at breakfast or afternoon snack.)

As the number of applications to the breast decreases, the amount of milk produced by the mother decreases. Excommunication of the baby from the breast at any age should occur gently and gradually, in no case accompanied by conflicts between the mother and the child, only in an atmosphere of joyful cooperation in the development of new products and meals. If circumstances force the mother to a more rapid completion of lactation, she can resort to a tanned bandaging of the breast, applying pieces of ice in the bladder, some decrease in the volume of the liquid being drunk. Taking small doses of estrogen can also contribute to the rapid cessation of lactation.

The entire period of introduction of lures is critical in relation to the education of taste sensations and preferences, conscious behavior "at the table," the teaching of family communication at meal times, creating stereotypes of eating behavior. Reducing the proportion of dairy products in the diet - the risk of a sustained loss of appetite, with consequent consequences for development and health. Adequate choice of dishes and portions, the attractiveness of taste and appearance of food, the rigidity of the requirements for "eating out" of what is put on the plate, respectful attitude to the emotional state and appetite of the child, a reasonable combination of exactingness with the system of encouragement and praise should become general rules for all family members and the surrounding child.