A healthy and balanced diet is one of the key factors of harmonious growth and development of the baby. It provides the maturation of organs and systems of the body, resistant to various adverse external factors Wednesday, as well as largely determines the quality and life expectancy of the child.

It's no secret that the ideal nutrition for infants is breast milk, which is the source of all necessary child easily assimilable nutrients, as well as a wide spectrum of biologically active compounds. However, with the growth and development of the child, there is a need for an increase in its diet and feeding him (the "lure" means any products except milk and substitutes (including juices and teas)).

This need is driven by the following main factors:

  • the need for a growing body of extra calories and some nutrients (iron, zinc, protein, etc.) with breast milk (or substitutes) at a certain stage of development (after 4-6 months) is no longer enough;
  • feasibility of expanding the range of nutrients, including diet, due to the different types of carbohydrates, vegetable protein, fatty acids, microelements, necessary for further growth and development of the child;
  • the need to include in the diet more dense than milk, food with a view to the development and training of the masticatory apparatus, digestive system, as well as peristalsis of the bowel;
  • need of socialization of the child (the transition to common table), learning his skills of independent eating, exploring the diversity of tastes.

Timely introduction of properly selected products foods will contribute to strengthening health, improve the nutritional status and physical development of children in the period of accelerated growth and maturation.

So when it comes "on time"? For a long time in our country there were legal provisions on the introduction of complementary foods with three weeks of age.

Such a system has been established in connection with the widespread use of artificial feeding is not adapted regarding milk products, which included unmodified cow's milk protein. As carbohydrate kid received mostly sucrose and glucose, as well as fats-a mixture of saturated and unsaturated fatty acids.

With this nutrition among children very often disrupt structures evolved enzyme system, goiter, allergic dermatitis, rickets and anaemia.

With the aim of improving the digestion as well as obtaining the necessary dietary fiber, fiber, vitamins and minerals expected very slow (starting with a few drops) but very early introduction of complementary foods.

Scheme introduction of complementary foods was roughly as follows: approximately 3 weeks child started giving juice (drops), hereinafter referred to as the vegetable broth, gradually adding one component to "teach" the child to these products. In 2 month introduced fruit puree, 3-kefir, 4-Kashi, 5-vegetable sauce and cheese, then egg, 7 months-meat and biscuits.

It is worth noting that this early introduction of foods in the ration existed only in the countries of the former USSR.

In 1999-2002 Gg. at the initiative of the World Health Organization (hereinafter who) epidemiological studies have been conducted as a result of which it has been established that one of the leading causes of development of Gastroenterology, allergy, immunological diseases among children and adults, is the early introduction of complementary foods.

Based on the results of these studies, installation, concerning the introduction of complementary foods, have undergone significant changes. The modern approach is based on the study of the physiology of organs and systems of the development of the child, his readiness to accept a new food. In particular, the ability to consume "solid" food requires neuromuscular maturation, digestive, renal and protective systems.

Neuro-muscular system. Many nutritional reflexes appear and disappear at different stages of development of neuromuscular coordination. Such reflexes can both facilitate and hinder the introduction of different kinds of food.

So, at birth, breastfeeding is facilitated by reflex grasping breast, as well as the mechanism of sucking and swallowing, but the introduction of "solid" food can interfere with the gag reflex.

In addition, up to 4 months infants still no neuromuscular coordination necessary to form a food lump, smuggle it in the oral part of the pharynx and swallow, so introduction even semi-solid foods before this time no physiological as. The baby is still difficult to control the movements of the head, the reliance of the spine is not developed, respectively, it is difficult to maintain the position for the successful absorption and ingestion of semi-solid foods.

Approximately 5 months, children are beginning to bring to mouth objects, gradually develops "reflex chewing" gag reflex moves from the middle to the back third of the tongue. This allows the baby, regardless of the presence of teeth consume food in the form of puree.

By the age of about 8 months most children already have first teeth, they can sit without support and have sufficient flexibility to swallow more solid lumps of food-pounded or serif dishes, as well as foods that you can eat with your hands.

Shortly thereafter, infants are developed skills of manipulation for self feeding, drinking from a Cup, holding it with two hands, as well as improving skills of mastication, and they may eat food with common backgrounds.

It is very important to encourage children to undertake skills at appropriate stages of the meal, such as chewing and Christmas gift items to your mouth. If these skills are not on time purchased and later behavior problems may arise and feeding.

Digestion and absorption. The newborn is able to fully and effectively Digest only breast milk, which already contains the enzymes necessary for the hydrolysis of fats, proteins and carbohydrates (simply put, breast milk digests itself).

Approximately 4 months of gastric pepsinu gastric acid helps Digest protein entirely. Most past cooked starches have already digested and absorbed almost entirely thanks to the work of the pancreatic amylase (although its full part in the digestion of starches it will start only at the end of the first year of life a baby). 

Microflora of large intestine also varies with age and depending on whether the child are breast or artificially. She fermentiruet undigested carbohydrates and capable of sbrazhivaniju fibers, turning them into short-chain fatty acids that are absorbed in the large intestine, thus ensuring maximum utilization of energy from carbohydrates.

Thus, the introduction of complementary foods be useful only after the baby's digestive system is dozreet to the required level to effectively Digest starch, proteins and fats found in food nemolochnoj.  This happens at different times, but not before the 4-6 months.

Renal function. Loading of solutes on the kidneys is the total amount of solutes, which must be inferred by the kidneys. It mainly includes netransformiruemye during the metabolism of dietary components (mainly sodium, chlorine, potassium, phosphorus), which were absorbed over the needs of the organism, as well as metabolic end products, including nitrogen compounds.

The potential load on the kidneys of solutes dissolved substances includes food and endogenous origin, used in the synthesis of new tissue, as well as not nepochechnymi output paths, respectively, subject to the excretion of urine. The potential loading of solutes is defined as the sum of four electrolytes (sodium, chlorine, potassium, phosphorus) and dissolved substances derived from protein metabolism, which usually accounts for over 50% of the potential load on the kidneys.

A newborn baby has too limited bandwidth of the kidneys, to cope with high loading of solutes and simultaneously retain fluid. The lowest potential stress on the kidneys have breast milk — 93 mosmol/l, infant formula is 135 mosmol/l. With the introduction of complementary foods load is increased by a factor of two or more times.

Approximately 4 months of kidney function is much more mature, and kids can cope with higher concentrations of solutes, while keeping water out. However, children who have suffered chronic intrauterine or post-neonatal hypoxia maturation may occur at a later date (approximately 6 months).

Thus, based on the level of maturation of renal system, introduction of complementary foods also appears to be safe at the age of 4-6 months.

Protective system. Immature intestinal mucosa infants not protected from damage caused by pathogenic micro-organisms and are sensitive to the effects of some antigens contained in food.

A great contribution to the development of active defense mechanisms making breast milk. Under the influence of lymphocytes and partially hydrolysed milk immunoglobulin G matures lymphoid system bowel (GALT Gut-associated lymphoid tissue), which is a key factor not only protection but also reduces the permeability of the intestinal wall. Thus, breast milk helps prepare the gastrointestinal tract to absorb food transition. Unfortunately, even in the most adapted mixture no many substances that are present in breast milk, therefore the maturation of lymphoid system intestines in infants on artificial feeding can take longer.

Among the neimmunologicheskih protective mechanisms to help protect the surface of the intestine of pathogens and toxins, the antigens include gastric acidity, secrets of the digestive tract, motility and mucosaHowever, the infant and these protective mechanisms are poorly developed, so the early introduction of complementary foods increases the risk of damage to the mucous membranes of the foreign food and microbiological proteins that can cause direct toxic or immunologically mediated damage, facilitate the development of allergic reactions (for which I presented a very dubious recommendations some doctors of the early introduction of complementary foods to children with atopic dermatitis, supposedly in order to accelerate the maturation of the DIGESTIVE TRACT).

Thus, the introduction of complementary foods should not begin earlier 4-6 months, since before this time the body of the kid still isn't able to adequately perceive the food other than breast milk or substitutes.

At the same time, the introduction of the first semi-solid foods later 6-7 months also could have some negative consequences in connection with the following:

  • insufficient intake of energy and nutrients from one breast milk (or substitutes) can lead to stunted growth, malnutrition, delayed maturation of the structure and function of the gastrointestinal tract, to the development of constipation;
  • due to the inability of breast milk (or substitutes) to meet the increased demand in the developing organism, the child may develop a deficiency of iron, zinc, copper and other trace elements;
  • You may experience difficulty in adjusting to a more solid than milk, food (in particular, the delay of chewing and swallowing skills, as well as the negative perceptions of new taste and structure of food).

However, disagreement as to exactly when to start feeding on maintenance now remain. It is undeniable that the optimal age is individual for each child, but the question about what age to recommend, remains open. 

There is almost universal agreement that the introduction of complementary foods should not begin until the age of 4 months (assuming that it is a full 4 months of life, i.e. at least 17 weeks) and detain him until the age of 6 months or older (i.e., 26 weeks of the child's life).

In the resolutions of the World Health Assembly in 1990 and 1992 Gg. recommended age 4-6 months, whereas in resolution, 1994. the recommendation States that "about 6 months". In the methodical recommendations for the who European region, with special emphasis on the republics of the former Soviet Union "feeding and nutrition of infants and young children" from 2001 year recommended products for feeding around the age of 6 months, however, indicated that some infants may need to lure before, but not before 4 months of age.

The necessity of introduction of complementary foods until the child reaches 6 months of age indicates that the child in the absence of overt disease is not enough putting on weight or looks hungry after unrestricted breastfeeding. And the lack of weight gain should be set as a result of 2-3 consecutive evaluations using normative indicators of physical development, who installed specially for children at natural feeding. In addition, other factors should be taken into account: body mass and age of gestation at birth, the child's nutritional status, clinical condition and general physical development.

As a result of a study conducted in Honduras, it was found that feeding children breastfed, with birthweight from 1500 Gr. up to 2500 grams. free high quality products for babies starting from 4 months of age did not give any advantages for physical development. In addition, in countries with economies in transition, there is evidence of increased risk of infectious diseases with the introduction of complementary foods for up to six months and that the introduction of complementary foods up to that age does not improve the growth of the mass and length of the child's body. This is due to the fact that the immature organism to assimilate "solid" food is much heavier than breast milk (or substitutes), spent virtually all of the energy obtained from complementary foods. In addition, increased energy consumption in response to increased morbidity related to the introduction of products and liquids in addition to breast milk (or substitutes). Given that lure partially replaces breast milk (or substitutes), which is much easier to digest, as a rule, the potential benefits of the introduction of complementary foods are being eroded.

Thus, the who recommendations are that right is feeding children exclusively breastfed for about 6 months even for LBW infants. At the same time, to improve the situation with a set of baby weight, we recommend that you review the diet of the mother for its usefulness (Pro diet lactating mothers can be read here).

The main provisions of the theory and practice of introduction of complementary foods in the Russian Federation established the "national program for optimization of breastfeeding babies in the first year of life in the Russian Federation" adopted at the 16TH Congress of Pediatricians of Russia (February 2009).

In accordance with the program in terms optimal introduction of complementary foods is age 4.5 months -5.5. If you select period, preference should be given to not calendar age and degree of physical and motor development of the child. If exclusively breastfed healthy full-term infants with normal weight and growth rates at birth, with optimal health and nutrition feeding mother perhaps a later introduction of complementary foods-with 6 months.

It is worth noting that the timing of introduction of complementary foods, depending on the type of feeding (if bottle-fed used modern adapted baby milk formula) do not differ, however, can vary the sequence of introduction of certain types of products.

In view of the foregoing, I believe that considering the timing of introduction of complementary foods as a kind of dogma. When deciding on the introduction of complementary foods (preferably in conjunction with the child's physician in charge) should take into account the individual characteristics of the child: the speed of its growth indicators, mass and body length, appetite, etc.

Particular care should be approached to the determination of the timing of introduction of complementary foods when you have an allergic predisposition, manifestations of atopic dermatitis in the child, long an unstable chair, later start enzymes etc. In these cases, you should not be in a hurry, because the later will introduced solid foods, the higher the likelihood that the digestive system and enzymes "marketed", respectively, the new products will be processed normally.

Since the main criterion of preparedness for the introduction of complementary foods is a certain degree of maturity of the body of the child, the early introduction of complementary foods to children bottle-fed also unnecessarily because they are "mature" no earlier than breastfed babies (and sometimes even later).

 

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