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infancy period

(Anatomical physiological features child's body.

Age periods in children and their characteristics.)

The period of infancy conditionally begins on the 29th day of life and ends at 12 months. At this time, children grow intensively, add in body weight. Body length on average for the first year increases by 25 cm and reaches 75-80 cm, body weight triples, amounting to about 10.5 kg. Static functions develop, the child sits by 6 months, and walks by 1 year. From 5-6 months, milk teeth begin to erupt; by the year there are usually 8 teeth (front - 4 upper and 4 lower). A child is born with unconditioned congenital reflexes, which include sucking, swallowing, blinking, sneezing, the act of defecation, urination, etc. As the central nervous system differentiates, starting from 2 weeks of life, conditioned reflexes develop. At first they are quite simple, for example, a reflex to the position during feeding, to preparing for feeding, but already from the 3rd month the reflexes become much more complicated: the child steadily fixes his gaze, follows the movement of an object, turns his head to the sound source, responds with a smile, active movements of the arms and legs to talk with him. Starting from 6 months - pronounces separate syllables, laughs out loud. By the age of one, children usually know about ten words, and from that moment the development of speech begins. The total duration of sleep in children 2-3 months is 16-18 hours, of which 10-11 hours at night and 6-7 hours during the day in 3-4 doses. At the age of 3 to 6 months, the duration of sleep is 16 hours a day, from 6 to 10 months - 15-16 hours, of which about 5 hours during the day in 2-3 doses. After 10 months, children switch to a double daytime sleep with a total sleep duration of 14.5-15 hours per day.

Due to the intensity of metabolic processes, a large need for food is characteristic, which is compensated correctly organized feeding. With any errors in the diet, diseases of the gastrointestinal tract, rickets, anemia, respiratory diseases easily develop, the child's body weight can quickly decrease, malnutrition develops. It is necessary to pay attention to excessive sweating, nape baldness, violations muscle tone, an increase in the parietal and frontal tubercles, thickening of the epiphyses and ends of the ribs (“bracelets”, “rosary”), which indicates an actively ongoing rickets. A decrease in the thickness of the skin fold and a decrease in tissue turgor suggest malnutrition. The screening test for deficiency anemia is a blood test.

In infants with diseases, especially infectious ones, there is a tendency to diffuse, general reactions; so, with pneumonia, influenza, dysentery, convulsions, meningeal phenomena may appear, toxicosis, dehydration easily develop. In this period, the prevention of these diseases and their timely diagnosis are very important. Children of the first year of life are subject to monthly dispensary observation with the measurement of body parameters, a thorough examination, blood and urine tests. After that, the state of health and development of the child is assessed.

Normal physical and psychomotor development baby, the body's resistance to infections and other adverse environmental factors is possible only with proper nutrition, adequate regimen, care, hardening. In order to protect against infectious diseases, natural feeding and timely preventive vaccinations are especially important.

At full health three months old start combined prophylactic vaccinations according to the vaccinal calendar. It is necessary to strictly monitor compliance with the instructions and record any reactions to vaccination. Clinical examination of healthy children and vaccination is the duty of the paramedic working in the office healthy child and vaccination room.

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The period of infancy lasts up to one year. This is a period of further rapid growth and development of the child's body. For a year, the length of the child's body increases by an average of 25 cm, by the 4-5th month. its weight doubles, and by the year it triples and reaches an average of 10-11 kg. The change in the child's weight by months is shown in Fig. 6. The motor and mental spheres of the child develop very quickly: at first, he begins to sit, stand, recognize loved ones, and by the age of one he already walks, begins to speak the first words and from a small helpless creature turns into a little man, not yet completely perfect, but with his own feelings, experiences and worries. In this period, all the organs and systems of the child's body are developing more and more, but functionally they are rather imperfect and have their own characteristics. As with newborns, the skin is delicate, easily vulnerable and requires careful care. In the first 3-4 months 2 months Newborn 3 months 8700±750 M 8000±950 D 7800±800 M 7400±950 D 9500±1000 M 8500±1000 D 5 months 6 months 8900±10 00 M 8300±950 D 1070011200 M 101001 1200 L 990011200 M 9300 ±1000D 10400 ±1200 M 950011300 D 10500±1000 M 980011000 D 9 months Yu month 12 months 6. Scheme of changes in the body weight of an infant (in grams by month; M - boys, D - girls). phenomenon liquid stool. If these symptoms appear, you should contact. The muscular system is still not sufficiently developed, however, as the child begins to sit, get up, walk, it improves more and more, the muscles become stronger and more resilient. Muscle flexion ceases to be predominant by 3-4 months, in connection with this, the characteristic posture of a newborn with bent arms and legs gradually changes. The muscular system develops most correctly and harmoniously with the child's systematic physical education. Compared with newborns at this age, the respiratory muscles are more developed and the chest is actively involved in breathing. Increases lung capacity. Breathing becomes deeper, its frequency gradually slows down and by the year reaches 30-35 per 1 min. The lungs at this age carry a large load, the mucous membrane of the respiratory tract is delicate, therefore, with poor care for the child, respiratory diseases easily occur. The cardiovascular system is developing and improving more and more, the weight of the heart is increasing. Features of the structure of the heart and blood vessels facilitate blood circulation. The pulse rate gradually decreases, and blood pressure increases with age. In the first year of life, the digestive organs continue to develop. By 4-6 months. the amount of saliva increases, more digestive juices and bile are produced. From 3-4 months. the child begins to gradually introduce into the diet, in addition to milk, the products of plant and animal origin necessary for him strictly by age, that is, as the improvement went. - kish. tract. The number of bowel movements gradually decreases and by the year is 1-2 times a day. The digestive organs carry a greater load than in adults (for 1 kg of weight, a child needs food 2-27 g times more than an adult). At improper feeding at this age it is easy] to develop went. - kish. diseases and various disorders. The genitourinary system continues to develop as well. The volume is increasing Bladder, its walls become more elastic. The number of urination by the end of the year decreases to 15-16 times a day. Development nervous system baby in the first year of life happens very quickly. By the end of the first year, the weight of the brain increases by 272 times. The development of the sense organs takes place, the movements of the child become more and more complex, positive and negative emotions appear, speech begins to develop. Peripheral nerves (depart from the brain and spinal cord) by the end of the year are covered with a mielshyuvoy sheath, which serves as a kind of insulator - the child begins to react to various irritations not with chaotic movements, but with purposeful ones. All new conditioned reflexes appear and develop, to-rye are developed in the course of a child's life. So, the horizontal position of the child in his arms, the smell of milk make him turn his head, look for the breast. At the age of 1 month. the child begins to fix his gaze on the object, when a feeling of hunger appears - to cry, suck his fingers. With the proximity of the mother's breast, it revives - turns its head, opens its mouth, makes sucking and swallowing movements. For a few seconds he can hold his head in an upright position, and while lying on his stomach he tries to raise it. When touching the soles in the position of the child on the stomach, he pushes off with his feet and tries to crawl. If you support him under the armpits, he leans with his feet. When swaddling, he swings his arms and legs, turns his head, smiles. At this age, children sleep approx. 20 hours a day. At the age of 2 months. the child usually raises his head well and holds it in a vertical position for 1-1 * / 2 minutes, lying on his stomach raises his head and chest and keeps them in this position for a while. The child already follows moving objects well, reacts to the voice by turning his head, and when a bright object or a sufficiently loud sound appears, he stops sucking. The crawling reflex disappears when touching the soles. In response to an appeal to him, the child reacts more definitely and in a variety of ways - he smiles in response to a smile, when talking to him, he “gurgles” or makes vague sounds, actively responds to swaddling. Covers objects with the whole palm and holds them tightly. At the age of 3 months. the child freely holds his head in a vertical position for 5 minutes. He picks up the direction of the sound well, turns in his direction and actively follows the moving object. A clear visual reaction to feeding appears - when the mother's breast, a bottle of milk or a spoon is close, the child opens his mouth, reaches for the chest or towards the object. Lying on his stomach, he rises and rests on his forearms and elbows, turns over from his back to his side. Hand movements become more free and expedient - the child reaches for the toy, puts his fingers in his mouth, pulls the diaper. He loves if adults play with him, smiles, begins to recognize his mother and screams if they stop playing with him. At the age of 4 months. the child freely rolls over from his back to his stomach, lying on his stomach rises and follows a moving object. Can sit with support. Begins to react quite definitely to familiar and unfamiliar faces. He plays with toys hanging over the crib, picks up, feels, pulls in his mouth. When he rises, he rests only on his palms. He constantly hums, melodic sounds appear, during the game he not only smiles, but also laughs. At this age, the child already distinguishes some colors. At the age of 5 months. the child knows the mother well, does not go to the hands of strangers. He distinguishes well the tone of voice, with which he was addressed. His movements become more and more confident, he firmly takes toys and holds them in his hands for a long time. With support or support, he sits down, but still cannot keep his back straight. Supported under the armpits, stands straight on the legs. At the age of b months. self-sits and sits upright without support. Rolls from stomach to back, with support by the arms or by the chest, gets up and makes attempts to step over with his feet. Tries to crawl on all fours. Plays freely with toys - shifts them from one hand to another, swings them, picks up a fallen rattle. At the sight of food, he opens his mouth, he can eat from a spoon. Begins to pronounce the first syllables: "ma", "ba", etc. At the age of 7 months. the child crawls freely, rises on all fours, sits independently and confidently, kneels with support. Supported under the armpits, steps well with the feet. Reaching for his image in the mirror, from hand to hand. He repeats the syllables well: “mother”, “dad”, “woman”. At the age of 8 months. crawls freely, clinging to the crib, gets up and sits down himself. He tries to clap his hands, repeats the learned movements. He gets up and tries to walk with the support of his hands. Facial expressions become diverse - there is interest and surprise when new toy, an unfamiliar face. Looks for the object he needs with his eyes and shows a persistent desire to get it. He plays a lot with toys, examines them, taps one against the other, etc. At the age of 9 months. the child can perform quite complex movements - sorts through the cubes, collects small objects, fulfills simple requests: “give me a pen”, “wave your pen, goodbye”, etc. Looks for a fallen or hidden object, looks for objects that are in different places . Tries to stand without support, holding on to objects or hands, walks. Sits down from an upright position. At the age of 10 months. he rises and stands without support. Can walk holding only one hand, behind a chair or behind a stroller. He takes small objects with two fingers and does not give away the toy he likes. Very good imitates the movements of adults. Fulfills simple requirements, requests. Starts to pronounce | simple words surrounding objects and animals are called separate syllables. At the age of 11-12 months. the child is well oriented in space - gets up, sits down, bends down, walks with the support of the hand, at the end of the first year takes the first steps without support. The child knows the names of many objects and shows the named toy, parts of his body, etc. Understands the prohibitions and fulfills many requirements. Pronounces individual short words and knows them. The vocabulary of a child of this age is approx. 10 words. He sleeps 14-16 hours. per day. The scheme of development of static and motor functions in an infant is given in fig. 8. Infant care The basic principles of care are the same as for newborns, but have their own characteristics associated with age. The height of the walls of the crib should not be lower than the level of the baby's chest (approx. 60 cm) in order to prevent him from falling out of it, because in the second half of the year the children become quite active and mobile. Everything that is in the hands of the child (food, toys, pacifier, etc.) must be thoroughly washed or boiled. It is unacceptable to give a toy or pacifier that has fallen to the floor again to a child. In the first 6 months the child needs to be bathed daily, and later - 2-3 times a week (bathing time up to 8 minutes). From about a month old, he can already wear sliders, knitted shoes. As the child begins to stand, he needs clothes that do not restrict movement - panties, tights, stockings, etc. It must be remembered that all the skills that a child acquires in the first year of life largely depend on care for him, proper regimen, nutrition, education. An important role in the development of the child is played by classes with him by parents, properly selected toys. During the period of wakefulness, the child should receive enough visual, motor and auditory impressions, which, however, should not tire him. Physical education and hardening during infancy play a huge role in the proper formation and development of the child's body. Physically developed and hardened children adapt more easily to the environment, get sick less often and better tolerate various diseases. At the heart of the physical upbringing and hardening lies in the proper care of the child, rational clothing appropriate to the weather. Walking, begun in the neonatal period, in infancy is an important factor in hardening. An infant should be in the air every day, regardless of the time of year and weather, with the exception)! strong wind, rain, etc. In winter, they walk with a child 2-3 times a day: month old baby must be exposed to air for approx. 40 min. in a day. Then, gradually increasing walks by 5-10 minutes, bring their duration to approximately 3 months of age up to 4 hours. per day (in winter). In summer, the baby should walk all day if possible. During the walk, you need to make sure that the nose and hands of the child remain warm, and upon returning home, the baby is not sweaty. A slight runny nose in the absence of temperature is not a contraindication for a walk. Air baths in summer can be carried out in the air, and in winter - indoors, in any case, the ambient temperature should not be below 20-22 *. Begin air baths from 1-11/2 months, leaving the child naked for 1-2 minutes. 2-3 times a day. Then this time is gradually increased to 6 months. up to 8-10 minutes, and by the end of the year - up to 12-15 minutes. During the air bath, it is necessary to change the position of the child; at the same time you can do massage or gymnastics. In summer, air baths should be carried out in the shade, because in children under one year of age, direct sunlight can easily cause overheating (heat stroke or skin burns). Water procedures usually begin at the age of 3-4 months with wet rubdowns, gradually and carefully. Initially within 17g-2 weeks. 2 times a day, the child's skin is rubbed with a dry flannel or a piece of soft woolen cloth until it turns red. After dry rubdowns, wet ones begin. To do this, they usually use a mitten made of soft terry cloth. It is moistened in water, squeezed and evenly rubbed on the skin of the child on the trunk and limbs. Separate parts of the body are gradually rubbed, the rest at this time should be under the covers. In water for rubbing, it is recommended to add 1 teaspoon. l. table salt or 1 table. l. 40-70% ethyl alcohol per glass of water. The water temperature at first should be 35-36°, after a week it is reduced to 32-33°, then every month the temperature is reduced by 1°, but not lower than 30°. Rubbing is usually carried out after morning sleep within 4-6 minutes. Hardening should cause only positive emotions in the child. If a child falls ill, stops in weight, or is hyperexcitable, all procedures should be stopped and consult a doctor. After a break, hardening is resumed, after the permission of the doctor, from the initial stages. Massage and gymnastics are important factors in the correct physical. and mental development of the child, contribute to the development of all organs and systems of the body, the correct formation of the skeleton and muscles. A detailed set of exercises and massage techniques can be found in the clinic from the local doctor or nurse. Massage and gymnastics are usually carried out from IV2-2 months. The room where they are held should be well ventilated, the air temperature in it should not be below 20 °. In summer, all procedures can be carried out outdoors, in the shade, at a temperature not lower than 20-22 °. Massage and gymnastics are conveniently carried out on a table with a height of approx. 70 cm, covered with a blanket folded in several layers, oilcloth and diaper. Classes should be held at the same time, 30 minutes in advance. before meals or 1-1 * / g hours after it. Each exercise or massage is carried out 2 to 6 times with a total duration of not more than 10-12 minutes. Classes can be held 2 times a day. Under the influence of massage, blood circulation in the skin and muscles improves, they become more elastic and elastic. The main massage techniques for an infant at home are stroking and rubbing. They should be carried out with light, gentle and smooth movements from the periphery to the center (from the hand to the shoulder, from the foot to the inguinal fold, etc.). Wash your hands before starting the massage. During the massage of the arms and legs, they are given a position of slight semi-flexion (Fig. 9-11). Under the influence of physical Exercise improves the activity of all organs and systems of the body, motor skills develop better and faster, the child grows more quickly. The main attention in gymnastics in infancy should be given to the development of the correct movements of the child. Up to 3-4 months. you should not actively bend and unbend the limbs of the child, because in this period flexion of the limbs predominates and muscles and ligaments can be stretched. At the age of 1*/g-3 months. conduct exercises based on unconditioned reflexes - the so-called. passive (Fig. 12-20); running fingers along the spine causes its extension, when laying on the stomach, the child tries to raise his head, when he touches the feet, he pushes off with his feet, etc. It is useful to cause the child to actively move the legs, arms and whole body in response to stroking and addressing him. At the age of 3-6 months. introduce passive movements of the child's limbs - crossing the arms and legs, stretching the muscles - extensors of the back, etc. At the end of this period, active exercises are introduced that stimulate crawling, hand movements, which are best done with bright toys (Fig. 21-22). You can put the baby on the stomach several times a day. At the age of 6-10 months. the main attention should be paid to crawling, a cut strengthens many muscle groups of the trunk and limbs. At this age, during exercises, you need to talk with the baby as much as possible; on instructions, he can perform non-covered exercises, and in addition, this contributes to the development of the child's speech. The complex of exercises includes turns from the back to the stomach, circular motions hands, arching, sitting down, etc. (Fig. 23-26). It is necessary to use bright, different-shaped toys for classes. At 10-14 months. the child begins to stand up and walk, understand speech. Therefore, exercises such as raising the legs, squatting while holding hands, tilting and straightening the body, etc. are introduced. Classes greatly contribute to the child's understanding of speech, the acquisition of motor skills, and develop his activity and independence. Nutrition. The period of infancy is characterized by the rapid development of all organs and systems of the child's body. Therefore, the need for the body of children of this age in nutrients is very high. At the same time, the digestive organs of the infant are not yet sufficiently developed. Therefore, proper and rational feeding is of great importance for the harmonious growth and development of children, their state of health. If a child does not eat properly and receives an insufficient amount of the nutrients he needs, then this significantly affects his physical. and mental development, reduces resistance to various infections. It is also necessary to avoid overfeeding - overweight, obese children develop worse, often get sick. In addition to quantity, the qualitative composition of food is also important - a certain ratio of proteins, fats, carbohydrates and salts. The child needs a sufficient amount of vitamins, which are actively involved in the metabolism. Natural feeding. For children of the first year of life, especially in the first 6 months, the most physiological is the so-called. natural feeding, i.e. breastfeeding (see Breast milk). Mother's milk is adapted by nature itself to the peculiarities of digestion and metabolism of the child. It contains all the nutrients necessary for its proper growth and development - proteins, fats, carbohydrates, salts, water, vitamins. In addition, with breast milk, protective substances enter the child's body from the mother - the so-called. antibodies that protect the child in the first months of life from certain infectious diseases. Breast milk is digested better than any other food, has an optimal temperature, is almost completely absorbed by the baby's body, and does not contain microbes. It is necessary to prepare for breastfeeding even before the birth of the child, since already from the 2-3rd month. During pregnancy, the mammary glands begin to develop intensively and prepare for the production of milk. During pregnancy, a woman should eat properly and fully (see Nutrition, nutrition of a pregnant woman and a nursing mother), consume a sufficient amount of fluids, juices, take daily walks in the air, sleep normally, and do light work. It is strictly forbidden to smoke, drink alcohol. Flat or inverted nipples (Fig. 27) 27. Schematic representation of various forms of nipples: / - normal nipple; 2 - flat; 3 - retracted. you can try to timely pull out the breast pump. Having attached it to the nipple, several suctions are made, and then left for a certain time in an extended position. This procedure is repeated 2 times a day. It is necessary to harden the skin of the nipple and chest, for this 2-3 times a day they wash the chest with water or rub down soft cloth. It is useful to do breast massage - stroking from the base of the breast to the nipple. breastfeeding mother, in addition to proper nutrition and mode, it is necessary to drink a sufficient amount of liquid (at least 0.5 liters of milk per day). It is strictly forbidden to drink alcohol, beer, smoking. It is necessary to strictly observe the rules of personal hygiene, wash the chest 2-3 times a day, take a shower. The chest is wiped with a hard towel, trying not to damage the skin of the nipples. In addition, you should wash your breasts before each feeding. To prevent cracks in the sections, air baths of the mammary glands can be done for 10-15 minutes; in summer, this procedure can be carried out in the fresh air. Sunbathing during this period is contraindicated. For the period of feeding a child, it is necessary to abandon tiring entertainment and try to eliminate reasons for excitement, etc. The mammary glands do not begin to secrete milk immediately. In the first few days after birth, they secrete the so-called. colostrum is a thick, yellowish liquid that coagulates when boiled. Compared to mature milk, colostrum contains much more fat and salt. Colostrum is the most suitable food for children in the first days of life. From the end of the first week after childbirth, transitional milk rich in fats begins to be produced. Only from 2-3 weeks. milk acquires a constant composition, mature milk appears. In a healthy lactating woman, up to 1-1.5 liters of milk is excreted per day, sometimes more. Before each feeding, wash your hands thoroughly, wipe the nipple and areola area with a piece of cotton moistened with boiled water or solution of boric acid (1 teaspoon per glass of water - Fig. 28). The first few drops of milk are expressed and drained. From the end of the first week after childbirth, breastfeeding is done while sitting. Sit comfortably; under a leg, respectively a breast, a cut feed, substitute a small bench (fig. 29). With one hand they support the head and back of the child, and with the other they put the nipple in the mouth. Grasping the chest with the middle and index fingers, they pull it slightly backwards so that the child can breathe freely (Fig. 30). It is necessary to ensure that during sucking the child covers not only the nipple, but also the areola with his lips - this prevents the swallowing of air and subsequent regurgitation. At each feeding, the baby is fed only one breast. The child sucks out the required amount of milk on average in 10-15 minutes. In any case, the duration of feeding should not exceed 20-30 minutes. If the baby suckles sluggishly or the mother has tight breasts, better after 20 minutes. wean him from the breast and feed him with expressed milk. It is necessary to weigh the baby before and after feeding to determine the amount of milk sucked by him. Sometimes there are so-called. lazy suckers, when the child, at first quite actively sucking the breast, after 5-7 minutes. falls asleep. In such cases, the nipple is slightly pulled out of his mouth or gently touched on the ears or nose to wake the child. At the end of feeding, the child is placed in the crib; the nipple is washed with boric acid solution, dried with a thin soft cloth, lubricated with vaseline or sunflower (sterilized) oil and covered with a piece of gauze. After feeding, the milk remaining in the breast, even if it is very small, is expressed to the “last drop”. This helps to increase the amount of milk and is an additional massage. Between feedings, the child should be given boiled water, slightly refilled. 28. Treatment of the nipple before feeding: the nipple and the area around the nipple are wiped with a piece of cotton wool moistened with boiled water or a solution of boric acid. The frequency of breastfeeding varies with age. Feeding the child should be carried out at strictly defined hours. First 3 months the child is fed 6-7 times a day (every 3-3*/2 hours with a 6-hour night break), then 5 times a day (every 4 hours with an 8-hour night break). Weakened children in the first 3 months. you can feed 7 times a day (every 3 hours with a 6-hour night break), from 3 to 6 months. 6 times a day, and then 5 times a day. If the feeding hours come, and the child is sleeping, then you should not wake him up, it is better to skip feeding. If the baby is healthy, sucks well and often wakes up one of the feedings, it can be transferred to 5 meals a day before the age of 3 months. At night, the child should not be fed, but if necessary, you can drink. Only in extreme cases, when no persuasion works, the child is fed at night. The amount of milk needed by a child by age per day is calculated using the following formulas. For children of the first 7-8 days of life, the Finkelyntein formula (slightly modified) is used: and X 70 (when the child weighs less than 3200 g) or n X 80 (when the child weighs more than 3200 g), where n is the day of the child's life. The volume of each feeding is calculated by dividing the resulting figure jia the number of feedings. By the 8-10th day of life, the child sucks out an average of 500 ml per day. An approximate calculation of the amount of milk per day for each month of the first year of life is calculated using three formulas (you can use one of them or take the average result). 1. In the Shkarin formula, it is assumed that a child aged 2 months. (8 weeks) should receive 800 ml of milk per day. If the child is younger, then he should receive 50 ml less milk for each week of life missing up to 8 weeks; eg a 5 week old baby should receive 800 - (50 X 3) = 650 ml. If the child is older than 2 months, then he should receive 50 ml more for each month after 2 months of age; e.g. a 3 month old baby. should receive 800 + (50 X 1) = 850 ml. 2. Volumetric method takes into account not only the age, but also the weight of the child; the child should receive the following amount of milk: from 2 to 6 weeks - 7s of weight, from 6 weeks. up to 4 months - Ve weight, from 4 to 6 months - h weight, from 6 to 9 months - */8 weight. 3. The most accurate is the caloric method. It is assumed that the child in the 1st quarter of the year should receive approx. 130-120 kcal 1 kg, in the 2nd - approx. 120-110 kcalkg, in the 3rd - approx. 110-100 kcal / kg, in the 4th - approx. 100-90 kcal/kg. Knowing that 1 liter of human milk contains approx. 700 kcal, you can easily calculate the required amount of milk per day. The total amount of milk received by a child per day should not exceed 1 liter. An indicator of the health of the child and the correct feeding is a good weight gain, uniform and sufficient development of the subcutaneous fat layer. Sometimes a child gains weight unevenly over the months, but in the future, the weight, as a rule, evens out. On average, a child by 4-5 months. doubles, and by the year - triples its weight. All the above calculations can be fully attributed only to a healthy full-term baby. In case of diseases, prematurity (see Premature baby), the quantity and quality of food, the rate of weight gain is set by the doctor individually for each child. When breastfeeding, various difficulties can arise. Tight breasts make it difficult to express milk and suck. The child is malnourished, becomes restless, although the mother has enough milk. In such cases, a small part of the milk should be expressed before feeding, which improves its outflow and reduces breast tension. With an irregular shape of the nipples, if they have not been pulled out, the child can be fed through the patch (Fig. 31, left); after feeding, you need to express milk with a breast pump (Fig. 31, right) or by hand (Fig. 32). When there are cracks and abrasions on the nipples, feeding becomes very painful for the mother, but they are necessary. 31. Pad on a flat or elongated nipple (left) and breast pump (right). continue at least through the overlay and be sure to consult a doctor. Breast care during this time should be especially careful. If the mother has signs of mastitis (breasts), an urgent need to consult a doctor. Before the arrival of the doctor, the child is fed with healthy breasts, milk is expressed from the sick one and given to the child only sterilized (the bottle of milk is kept in boiling water for 30-40 minutes). From the mother's diet, it is necessary to exclude spicy dishes and seasonings, onions, garlic, etc., because they give the milk a specific taste and smell and can cause the baby to refuse the breast. If the mother has little milk, she needs to create the most favorable conditions for nutrition, sleep and rest, increase the amount of fluid she drinks, but not more than 2 liters per day (while trying to consume more dairy products). Drinking beer for this purpose is contraindicated. After each feeding, carefully and systematically express the milk remaining in the breast “to the last drop”. Pumping is done with smooth squeezing movements of the hand from the base of the breast to the nipple. The skin of the breast and the nipple area must be lubricated with vaseline oil. With any amount of milk from the mother, they begin to breastfeed the child and only the missing amount of milk is replaced with a donor, milk mixture or specially prepared kefir. Failure to comply with this rule can lead to the complete disappearance of milk from the mother. Mixed feeding - Fig. 33. Scales for weighing infants. venation - compensation for the missing amount of breast milk from the mother by supplementing the child with donor milk, milk mixtures or specially prepared kefir. Supplementary feeding is at least 4/3 of the daily diet of a child; ka. When switching to mixed feeding, it is very important to accurately determine the amount of milk missing for the baby. For this, the child is weighed before and after feeding and the amount of sucked milk is determined - the so-called. control weighing, a cut is made on scales (fig. 33), having previously put a warm diaper on them. If there is no scale at home, control weighing is carried out in the clinic. Supplementary feeding for children older than 3-4 months. it is better, if possible, to give from a spoon, and not from a nipple, to which they quickly get used (it is easier to suck through a nipple), and may refuse to suck on the breast. The hole in the nipple should be small; it is better to do it with a calcined needle (Fig. 34). The feeding position of the bottle must be correct (Fig. 35). Gradually, when the child gets used to supplementary feeding, its amount can be increased and completely replaced with several feedings. But the breast must be given at least 3 times a day (otherwise, the amount of milk from the mother quickly decreases). The type of supplementary food depends on the age of the baby. Children up to 3 months. it is better to give donor milk, and only Fig. 34. Piercing the nipple with a calcined needle. in its absence, milk mixtures are used - products obtained from the dairy kitchen as prescribed by a doctor. Children up to 2 months. it is better to prescribe B-kefir. The mixture "Baby" can be given only at separate feedings, in a limited amount, because. because it is much sweeter than milk and children may refuse to breastfeed. If a child does not eat kefir well, he can be given mixtures of cow's milk - B-buckwheat, B-rice, B-oats. With the introduction of supplementary feeding after 2 months. during the first week, the child is given B-kefir, B-buckwheat, etc., and then they switch to whole kefir and mixtures of cow's milk. The food should be warmed up to 36-37 (for this it is convenient to use an electric heater baby food). Artificial feeding is necessary if the mother's milk provides less than * / s of the daily diet of the child. In the first 2-3 months it is necessary to try to provide such a child with donor milk. Milk mixtures are used the same as for supplementary feeding, in compliance with the above rules. Artificial feeding is much more difficult to carry out than mixed feeding, therefore it is necessary to strictly follow all the doctor's recommendations. It is better to use fermented milk mixtures, because they suppress the growth of pathogenic microbes in the intestines, reduce fermentation, and are well absorbed. At increased amount sugar in mixtures, fermentation intensifies, digestion worsens, metabolism is disturbed; children gain too much weight, which should not be allowed, because “loose” children often get sick. At artificial feeding the child should be transferred to 5 meals a day earlier than usual, because milk and kefir mixtures are retained in the stomach and digested in the intestines longer than breast milk. , Regardless of the nature of feeding, children of the first year of life need, in addition to breast milk, additional administration of vitamins, animal and vegetable products, and mineral salts. At the age of 1-IV2 months. the child is given juices - fruit, berry or vegetable, with which he receives the necessary amount of vitamins and salts. Juices are given after the main feeding, preferably apple, carrot, tomato, blackcurrant, lemon, cherry, raspberry, apricot. A few drops of juice can be added to drinking water. In case of intolerance to one or another juice (appearance of a rash on the skin, disorder of the stool), it must be canceled and consult a doctor. More often, intolerance and allergic reactions occur to juices such as orange, tangerine, strawberry. Grape juice enhances fermentation processes, so it is not given for up to a year. To prevent the occurrence of allergic reactions, juices are introduced gradually, very carefully. They start with 3-5 drops and, adding about the same amount every day, gradually bring their number per day to 5 months. up to 50 ml. You should not give the same juice every day, it is better to alternate several juices. With the introduction of new juice, its amount is increased gradually. The daily amount of juice is divided into 2-3 doses. It is better to prepare all juices at home; in winter, you can use store-bought ones prepared especially for children. At the age of V / 2-2 months. You can add applesauce to your meals. Start with 7g teaspoons. l. and gradually increase, bringing up to 50 g per day. It contains vitamins, mineral salts, as well as fiber, which improves digestion and prevents constipation. You can also give puree from other fruits. You can make your own puree or use store-bought, specially prepared ones. 35. Bottle feeding. but for baby food (see Baby food mixtures). At the age of 3 7g months. cottage cheese is added to the child's nutrition (start gradually with 7 g teaspoon and bring its amount to 30-40 g), cream (start with 3-5 drops, bring their amount to 5-10 ml). Cottage cheese and cream can be given no more than 2-3 times a week. At the age of 4-47g months. you can add egg yolk to the diet; start with 1/4 of the yolk and gradually increase to 7g. The egg is boiled hard, the yolk is rubbed through a sieve and diluted with breast or cow's milk to a gruel. Lure. As the child grows and develops, his body needs everything large quantity proteins, fats, carbohydrates, mineral salts and vitamins. Breastfeeding (mother's milk) can no longer fully provide the required amount of nutrients. Therefore, it is necessary to additionally introduce a variety of products of animal and vegetable origin into the child’s diet for any type of feeding. following rules: 1) any new complementary food is introduced very carefully, gradually, in small portions; 2) it is necessary to constantly monitor the child's stool and skin (his disorder or the appearance of a rash on the skin, "diathesis" - on the cheeks are indicators of intolerance to the child's body of the administered product); 3) for the nutrition of the child, you can use only the freshest good-quality products, carefully processed and prepared in an easily digestible form (juice, puree, porridge-"mud", etc.); 4) you can not start complementary foods or introduce a new dish on hot days, as well as during the illness of the child. At the age of 47g-5 months. introduce the first dish of complementary foods - vegetable puree. It is better to cook it at home, but you can also use purchased ones, especially those made from a mixture of different vegetables. You need to start with the most easily digestible vegetables - potatoes, carrots, turnips, and then give others or mix them into the above. Vegetables are steamed or stewed in a small amount of water, rubbed through a sieve and, when churned, a small amount of salt, boiled cow's or breast milk is added in the amount of 7z-7j of the volume of vegetables. In puree, you can add a small amount of vegetable oil, cottage cheese, and later meat. Begin to give mashed potatoes with 1-2 teaspoons. l. and within 2 weeks. bring its amount to 150-160 g. Vegetable puree, like any other complementary food, should be given in the middle of the day, in one of the breastfeedings, reducing the amount of breast milk accordingly. You should not start complementary foods with semolina porridge and jelly, because they contain a lot of carbohydrates (sugar), which worsen digestion, predispose to exudative diathesis, make the child full and loose. From the moment of the introduction of complementary foods, they begin to feed the child with a spoon. By 5 months the child should receive 4 times harder milk, once vegetable puree, juices, cottage cheese, cream. Only after consulting a doctor and according to indications can you give fish oil. At the age of 5-6 months. introduce a second complementary food in the form of various cereals. It is better to feed the child with buckwheat, rice, oatmeal. They are cooked on cow's or breast milk in the form of porridge - "smear". In porridge, you can add 2-3 g of butter, cottage cheese, cream. They begin to give them, like mashed potatoes, gradually bringing them up to an amount that can be replaced by one feeding. You can cook porridge from a mixture various cereals, as well as use special chopped cereals for baby food. At the age of 6-7 months. the child is fed with meat broth; start with 1-2 teaspoons. l. and gradually adjusted to 50 ml. Broth with crackers is fed during the daytime, vegetable puree is given for the second, juice for the third; thus, it turns out a full meal. By 8 months the child should be breastfed 3 times, 1 time - porridge, 1 time - broth and vegetable puree. All other complementary foods are added to this. At the age of 7*/g-8 months. you can begin to introduce meat into the child’s diet, first in the form of minced meat twice turned through a meat grinder (gradually increase to 1 tablespoon per day). By 10 months he can eat meatballs, by the end of the year - steam cutlets. Instead of meat, you can give low-fat varieties of fish, also in the form of minced meat or meatballs. From 8 months instead of one of three breastfeedings, the child is fed with whole milk or kefir. The diet at this age can be built as follows: at 6 o'clock - breast milk, at 10 o'clock - porridge, cottage cheese or yolk + fruit puree; at 2 pm - meat broth with breadcrumbs + vegetable puree with minced meat + fruit juice; at 6 pm -¦ kefir or cottage cheese + fruit puree; at 22 o'clock - breast milk. Gradually, by the end of the year, food should be made thicker, rubbed less and less diluted with liquid. By the age of one, the child receives a fairly complete and varied diet and can be weaned. First, morning breastfeeding is replaced with kefir, cottage cheese or whole milk. A week later, the same is done with evening feeding. It is impossible to wean a child from the breast in the hot season or during illness. To reduce and stop the production of milk in the mother, she needs to drink less for several days, tightly bandage her breasts or wear a tightening bra. Milk stops being produced after about 3-4 days. The upbringing of a child should start from the very beginning. early age, without violence, to persistent®. This takes a lot of work and patience. In the process of education, they gradually move from simple to more complex, constantly repeating and consolidating what they have learned. At the age of up to 1 year, education should be directed mainly to organizing the correct daily routine of the child, developing his motor skills, visual and auditory perception, and speech. First of all, it is necessary to establish a strict daily regimen - a certain time of sleep and wakefulness, feeding, walking, etc. This not only facilitates caring for a child, but also gradually accustoms him to order and neatness with age. Children quickly get used to the established regimen and daily routine. If the regimen is not observed, the child does not sleep well, is naughty; indiscriminate feeding reduces appetite, the child eats poorly and loses weight. At proper care for the child, the implementation of all the gig. rules, he develops the habit of clean clothes and diapers, frequent change of linen. Children get used to daily washings, baths and take them with pleasure. After 6 months you should bathe the child with toys, allow him to play in the water. Gig. Skills instilled in a child from childhood are an important part of upbringing and hardening. It is necessary to accustom the child to the potty after he begins to sit confidently. Before going to bed and after sleeping, it must be planted on a pot, which must be in a certain place. You can not put children on the potty at night, interrupting sleep. You should not keep the child on the pot for a long time, it is better to repeat this procedure after a certain time. Too often planted in a pot is also not recommended. It is necessary to develop the motor activity of the child. Massage and gymnastics are the main factor in the development of motor skills. However, it is impossible to engage with a child in a forced manner, to force him to do what he still cannot do due to his age. In no case should children be pulled into pillows, put on their feet before the due age, as the child grows and develops, he will begin to do this himself. Only from now on can these skills be developed. Otherwise, curvature of the spine and legs may occur. The game and toys help the development of the child, to-rye improve not only his movements, but also develop independence, the ability to concentrate. It is necessary to choose the right time for classes with the child; they will give him pleasure only if he is full and slept. From 3 months the child begins to actively monitor the environment, shows interest in various objects, reaches out to them. From this time on, children need bright toys of various shapes and colors (Fig. 36). It is necessary to speak with the child clearly and clearly, in short phrases. When communicating with a child, it is necessary to pronounce the names of the surrounding objects. From 7 months children understand certain words, turn towards the named object. At this time, you can begin to teach the child to fulfill simple requests, look for the named toy, learn words with him, while it is important that 36. The position of the child in relation to the hanging toys would be visible to him the movements of the lips. When talking with a child, you can not distort words. When playing and studying with a child, one should be careful: choose a place for games farther from hot objects; picking it up, hold it freely, but with both hands, without tossing it up.

Breast age(from 4 weeks to 1 year) is characterized by: intensive metabolism, higher than in subsequent years, the pace of physical and neuropsychic development. In the first 3-4 months of life, the child retains passive immunity received from the mother, so his body is resistant to infectious diseases such as measles, scarlet fever, chicken pox, rubella.

At the same time, children of the 1st year of life are predisposed to the development of anemia, rickets, malnutrition, and digestive disorders due to: easily occurring metabolic disorders, relative immaturity of the functions of the gastrointestinal tract, and high sensitivity to pathogenic microorganisms. For the correct development of the child in this age period, rational feeding and a clear organization of the daily routine are of particular importance.

The nervous system is intensively developing, characterized by the active formation of new conditioned reflexes (based on the existing unconditioned ones) and their consolidation. However, under the influence of any pathological influences (illness, stress, etc.), skills can easily be lost. During the period of infancy, the child makes a huge leap in neuropsychic development.

Neuropsychic development of children of the 1st year of life 1. Main criteria (lines) of development. Az - visual analyzer. Ac - auditory analyzer. E - emotions. Before - movements are common. Dr - hand movements. Ra - active speech. N - skills. Rp - speech understanding. Wed - sensory. And - the game and actions with the subject. D - movement. NPD - neuropsychic development.

2. Formulas of NPR for children of the 1st year of life. 1 month Az As Do E Ra. 2 months As Az Do E Ra. 3 months Az Do E Dr. 4 months Az As E Do Dr Ra N. 5 months Az As Dr Ra N E Do. 6 months As Dr Do Ra N. 7 months Dr Do Rp Ra N. 8 months E Dr Do R Rp Ra N. 9 months E As Dr Do Rp Ra N. 10 months E Dr Do Rp Ra N. . 11 months E Dr Do Rp Ra N. 12 months In Az Dr Do Rp Ra N.

Physical development. Indicators characterizing the physical development of children undergo significant dynamics in the course of a child's life. Average length the body of a full-term newborn is 50 cm. In the future, the increase in body length is subject to individual fluctuations and is not uniform in different periods of life. Body length up to 2 years is measured with a horizontal stadiometer.

Increase in body length in the first year of life: 1 3 months - 3.0 cm (9.0 cm); 4 6 months 2.5 cm (7.5 cm); 7 9 months 2.0 cm (6.0 cm); 10 12 months 1.0 cm (3.0 cm) each. During the first year, the child grows by 25 cm and his height per year is 75 cm. To assess growth rates after a year, centile tables are used.

Birth weight varies widely. Average indicators are 3200 3400 g. In the first year of life, weight gain occurs as follows: 1 month. 600 g; 2 months 800 g; 3 months 800 g; 4 months 750 g and further in each subsequent month 50 g less than in the previous one. The average monthly weight gain in the 1st half of the year is 700 g, in the second half of the year 500 g. It is believed that by 4 5 months. body weight doubles in life, and triples by the age of one year. The approximate weight of a child at 1 year old is 10 kilograms. Assessment of body weight indicators after a year is carried out using centile tables.

Circle chest The circumference of the chest in a full-term baby at birth is 32-34 cm. In the first year of life, the circumference of the chest increases monthly by an average of 1.2 cm. The circumference of the chest per year is on average 48 cm. The head circumference of a full-term newborn is 34-36 cm , an increase in circumference in the first year of 1 cm monthly.

Head circumference The chest circumference of a full-term baby at birth is 32-34 cm. At the age of 2-3 months. there is an alignment of these sizes, at the age of 1 year, the circumference of the head is 2 cm less than the circumference of the chest. The circumference of the head per year is on average 46 cm. An increase in the volume of the head can be observed with hydrocephalus. A decrease in the volume of the head may be associated with the early closure of the fontanel, as a manifestation of rickets or a congenital malformation.

Factors affecting the growth and development of a child of infancy and his state of health Heredity - hereditary diseases or a tendency to any disease inherited from parents or close relatives (including features of the immune system). Organization of care - the presence of a certain regimen of the day, sufficient exposure to the air, hygiene measures, organization of wakefulness. Feeding. Environmental safety. Organization of physical education and hardening.

Physical education and organization of hardening in the 1st year of life This is one of the most important factors influencing the development of the child and his health, and at the same time it is a way to meet the needs: "move"; "to be healthy; "communicate" .

Physical education Physical education is a set of measures aimed at strengthening the health of the child, preventing diseases and harmonious physical and mental development. Physical education solves 2 interrelated and interdependent tasks: health protection and promotion; full development of the individual. The solution of these problems is carried out with the help of the following measures: observance of the daily routine; compliance with hygiene standards and rules; carrying out general and special hardening procedures; performing massage and age-appropriate gymnastics complexes.

Day regimen The basis of any daily regimen is: activity; dream; nutrition; being outdoors. A properly organized daily routine provides the body with the necessary pauses that provide periods of less activity, i.e. rest in the physical and psycho-emotional senses. This allows you to provide a cheerful mood during the day and the harmonious development of the individual.

The daily routine is built taking into account: the state of health; age; individual characteristics of the child. When building a day regimen, they proceed from the following provisions: Provide the child with a deep, sufficient sleep. Ensure regular meals. Timely alternate vigorous activity with sufficient rest and maximum stay in the fresh air.

Sleep is essential for rest and recuperation of the child. Sleep duration: . a) in children under 1 year old is 22 - 1/2 m, where m is the number of months; b) in children older than a year is 16 - 1/2 p, where p is the number of years (according to I. N. Usov, 1969, 1992). Multiplicity of daytime sleep: from 1 month to 5 m 4, from 5 m to 9 m 3, from 9 m to 1.5 years 2, from 1.5 years 1 time; from 1 year to 3 years - 1 time; from 3 years - at the request of the child; from the age of 10 - for medical reasons.

Food intake should correspond to the age and individual needs of the child: up to 1 year: from 1 month to 3 x 7 times a day (night break at 6 o'clock) from 3 to 5 months. - 6 times a day; from 5 to 12 months - 5 times a day (night break 8 hours); from 1 year to 3 years - 4 times a day; from 3 years and older - 3-4 times a day.

Activities must be organized taking into account the age and individual characteristics of the child. The duration of wakefulness is: up to 1 month. - 1 hour; from 1 to 3 months - 1.5 hours; from 4 to 12 months - 3 hours; older than a year - 5, 5-6 hours. It is necessary to follow the sequence of components of the regimen: up to 1 year: awakening, feeding, wakefulness, sleep; older than 1 year: awakening, wakefulness, feeding, sleep.

Compliance with hygiene standards and rules. The temperature in the room is also necessary for hardening skin receptors, proper breathing and sound sleep: in the 1st half of the year - 20-22 ° C; in the 2nd half of the year - 19-20°С. Decreasing the temperature in the room is carried out by: ventilation (through); air conditioning. Purposes of ventilation: reduce air temperature; increase the concentration of oxygen; reduce the concentration of microbes.

Multiplicity and duration, ventilation: in winter: 4-5 times a day for 10-15 minutes. ; in summer: around the clock (non-through, and if through - then every hour). Personal hygiene: daily hygienic bath, under washing, and at the 2nd year of life, the use of soap, a toothbrush, a towel. Timely change of underwear and bed linen.

Walks: in the summer 2 3 times a day for 2 2, 5 hours; in winter, 2 times a day for 1-1.5 hours (if there is no wind up to - 10 ° C, if it is windy - up to 5 ° C). Clothing: should be comfortable, not restrict movement, appropriate for the season and should be made from natural fabrics. Shoes: must be leather, with a hard heel, with fixation of the ankle joint and with a heel up to 1 cm.

Organizing a safe environment Organizing a safe environment is of great importance for a child's health. As motor skills develop, the baby enjoys more and more freedom. But the child has no previous experience and therefore does not know what is dangerous and what is not. This combination of factors creates conditions for increased traumatism in children, especially from 6 to 12 months. Food can only be prevented by constant b monitoring of the baby (you can’t “take your eyes off it”) and the implementation of a number of safety rules.

Remove carpets from the child's room, because of which he may fall. Remove napkins from secretaries, cabinets, bedside tables and heavy objects standing on them (vases, figurines, etc.). Close all sockets with special plastic plugs, and remove electrical appliances out of the reach of the child. Exclude small items (balls, studs, bolts, etc.) from the child's games and constant use.

Hide on a turnkey basis all sharp, cutting and piercing objects (needles, scissors, knitting needles, knives, etc.). Place all medicines in one place under lock and key (for example, in a box). Hide Items household chemicals locked up (detergents, deodorants, insecticides, etc.). Enclose the exits to the stairs (if the house has more than one floor).

The windows in the child's room must be closed, and if they are opened during ventilation, the child is taken out to another room for this time. Make it impossible for a child to access the kitchen to the sanitary rooms. Place all alcoholic drinks, packages of cigarettes and matches in a bar that can be locked with a key. Remember! 90% of injuries in children under 3 years old are due to the negligence and carelessness of adults! These rules will help meet the child's need to "avoid danger."

hardening. I Hardening is the training of the body in order to increase its resistance to various influences. external environment. It is necessary for the prevention of diseases in a child. For the purpose of hardening, natural factors are used: I - water; II - the sun; III - air.

Hardening rules according to G. N. Speransky. 1. Hardening can be started and then carried out only with the full health of the child. 2. It is necessary to gradually increase the intensity of hardening procedures. 3. Hardening must be carried out systematically. 4. Hardening must be carried out taking into account the individual characteristics and age of the child. 5. You can start hardening procedures at any time of the year, but it is better - in the warm. 6. Hardening should be carried out only with positive emotional reactions of the child. 7. If hardening is interrupted due to illness, then it must be started again from the initial levels of intensity, but the rate of building up of hardening procedures should be greater than before the break.

Before starting hardening, it is necessary to clarify the child's health group. For group I - the mode includes all types of hardening and physical education. For group II - only sparing procedures are used: the temperature of water and air is 2 C higher than for group 1; its decrease should be slower: t- with local influences - by 1 ° C every 3-4 days; t - under general influences - by 1°C every 5-6 days. Physical activity is limited.

For group III - special procedures are assigned (local water and air impacts of a moderate level). The final temperature of air and water is 4 -C higher than for children of group I; the time of action of the hardening factor decreases, and its temperature decreases very slowly.

I. Hardening with air begins from the first days of a child's life during swaddling and walking. II. Hardening with water also begins to be carried out from an early age. Distinguish: 1) local water procedures: - washing; - local rubdown; pouring feet; 2) general water procedures: complete wiping; full pouring; bath; Shower; swimming in open water.

There are 3 phases of the action of cold water on the body: Phase I - a sharp spasm of the skin vessels (chills, general tension, pale and cold skin); Phase II - expansion of skin vessels or adaptation stage (decrease in tension, respiratory rate and pulse, reddening of the skin, feeling of warmth); Phase III - vascular paresis with blood stasis (pale skin with cyanosis, chills): NB! When correct; carrying out hardening phase III is absent.

A gradual increase in the strength of the impact of water is achieved due to: a) a uniform decrease in its temperature; b) increasing the area of wetted skin, replacing local procedures with general ones in (increasing order of intensity); c) increasing the duration of exposure. Any water procedure ends with wiping dry with a gentle massage or rubbing until redness. Hardening with water is carried out after sleep and before meals.

Washing - is carried out daily, with a decrease in temperature by 1 ° C every 2-3 days to 15-16 ° C. They wash not only the face, but also the neck, upper chest, and armpits. 2. Rubbing (local and general) begins at 6 months with t = 32-33 C. By the end of the year, they are reduced to t = 28 ° C, by 3 years - 25 ° C; preschoolers - 22 ° C; schoolchildren 18-20°C). - Technique: wipe hands with a moistened and slightly wrung out mitten (from fingers to shoulder, after 3 days - chest, then back, stomach, legs and whole body). Duration 6-8 min.

3) Local dousing (legs - feet and shins) is carried out after 1 year. Initial t \u003d 28 ° C, with a decrease to 20-22 ° C (by 1 ° C every 2-3 days). The duration is - 20-30 s. From 1.5 years - contrasting douches with t°C: in group I 38°C decrease to 18 C; in group II 38°C to 18°C - 38 C. Duration: cold water- 3-4 min. ; warm - 6-8 min.

General douche and shower - from 1.5-2 years; temperature 1°C higher than for wiping. c Duration is 20-40 s (do not water the child's head!). Bathing in a bath is recommended from 14-15 days of life with t = 37°C with a gradual slight decrease. Bathing in open water - start from 3-4 years old, t water should be 20 ° C and above, and t air + 24-26 ° C. The duration of bathing is 1-2 minutes. with an increase up to 5 min. In the water, the child must move and swim.

III. Hardening by sunlight - recommended after the 1st year of life, very carefully, after the previous air bath for 10-20 minutes. Time sunbathing 9 11 o'clock in the morning 1-1.5 hours after a light breakfast. Duration: starting from 1 min. and increasing to 10 min. on each side (back, stomach). After a sunbath, douche or shower with t = 36°G is recommended, with a decrease to 28°C. All hardening procedures are carried out under the supervision of a doctor!

Massage - is prescribed for children from 1-1.5 months to 1-1.5 years in parallel with gymnastics. In the future, games are used, and then morning exercises and sports (from 7 to 8 years old). The result of the massage: skin capillaries expand, blood circulation, tissue trophism and metabolism improve, muscle strength increases, elasticity and mobility of the ligamentous apparatus improves. Massage has a tonic effect on the nervous system.

Massage is carried out at an indoor air temperature of 0-21°C, not earlier than 40-45 minutes 2 after feeding; with positive emotional reactions of the child; clean, dry, warm hands. Basic massage techniques: stroking; "rubbing; kneading; vibration; tapping.

Massage sequence: I. Front surface: legs; hands; stomach; breast. II. Back surface: back; buttocks; hands; legs.

The result of gymnastics: increased blood flow, improved metabolism, increased immunological activity of blood and tissues, increased emotional tone of the child. Gymnastic complexes become more complicated with approximately every quarter.

For balance, it is necessary to periodically reduce the degree of physical activity when the child gets tired of it. To do this, you can use the following techniques: laying on the stomach; giving the child a vertical position; giving a baby a pacifier; loose swaddling at night (and, if necessary, before daytime sleep).

There are five groups of children's health. Depending on belonging to a particular health group, children and adolescents need a differentiated approach in the development of a complex of therapeutic and preventive measures.

Comprehensive health assessment. For a comprehensive assessment of the child's health, 6 criteria are used: Group 1 (criteria that determine health) features of ontogeny, determined according to genealogical, biological, social anamnesis. 2nd group (criteria characterizing health) level physical development and its harmony level of neuropsychic development level of resistance of the body level of the functional state of the body the presence or absence of chronic diseases or congenital malformations

The first group of health The first group - healthy children, with normal development and a normal level of functions: children without chronic diseases; not sick or rarely sick during the observation period; having normal, age-appropriate, physical and neuropsychic development (healthy children, without deviations).

The second group of health (risk group) The second group - healthy children, but having functional and some morphological abnormalities, as well as reduced resistance to acute and chronic diseases: children who do not suffer from chronic diseases; having some functional and morphological deviations; often (4 times a year or more) or long-term (more than 25 days for one disease) ill (healthy, with morphological abnormalities and reduced resistance). Children and adolescents in the second health group (the so-called risk group) require more attention from doctors.

The third group of health The third group - children with chronic diseases in a state of compensation, with preserved functional capabilities of the body The fourth group - children with chronic diseases in a state of subcompensation, with reduced functionality The fifth group - children with chronic diseases in a state of decompensation, with significantly reduced functionality of the body

The fourth group of health is a person with chronic diseases, congenital malformations in a state of subcompensation, with violations of the general condition and well-being after an exacerbation, with a protracted period of convalescence after acute diseases (patients in a state of subcompensation).

The fifth health group is children with severe chronic diseases in the stage of decompensation, with a significant decrease in functionality (patients in a state of decompensation). As a rule, children of this group do not attend children's institutions and are not covered by mass medical examinations.

Comprehensive assessment of the health status of an infant. Comprehensive assessment of the health status of an infant includes the following steps: Anthropometry. Assessment of physical development by formulas. Assessment of physical development according to centile tables. Collecting information visually and from the words of the mother about the neuropsychic development (NPD) of the child. Compilation of the NPR formula. Evaluation of NPR, determination of the group and degree of development. Assessment of the state of health of the child for the past period. Definition of health group. Drawing up an action plan in accordance with the health group.

Control questions. List the anatomical and physiological features of the organs and systems of an infant. Name the patterns of physical development of children of the 1st year of LIFE, methods of its assessment. G Give a description of the neuro-psychological development of a child of infancy by months and the rules for its assessment. List the basic needs of infants and how they can be met by age. Give a description of the methods of physical education and hardening in the 1st year of life.

The baby's infancy is the period from the 29th day of his life (the first four weeks the child is considered a newborn) until the end of the first year of life. One can only wonder what significant changes occur in such a short period. Here the baby still does not know how to control his body and can tell his mother about his desires only through a cry, and by the year his skills and requirements are already practically conscious. What happens during these 12 months?

First year of life

If compared with other age periods, then in the first 12 months the baby's body grows intensively, all systems and organs develop very quickly, and an intensive metabolism occurs. For example, the mass of the baby with which he was born doubles by 4-5 months, and when the child reaches a year, it triples, amounting to approximately 10-11 kg.

The growth of the child during this period increases by a quarter of a meter, amounting to about 75 cm per year. The morphological structure and functions of the child's nervous system are improving. Only in the first 6 months of life, the mass of his small brain increases by 200%.

Due to the fact that the functions of the central nervous system are rapidly developing, there is an early development of conditioned reflexes of all analyzers. Quite quickly goes neuropsychic development. It is in the first year of life that the beginnings of speech appear in babies. When a baby is only 2 months old, all his senses are so developed that the child picks up and distinguishes different signals sent from outside.

How are movements developing?

Perhaps all mothers know that babies are born with the necessary minimum unconditioned reflexes: sucking, grasping, stepping reflex. For the period from 1 to 3 months, babies begin to hold their heads. By 4, they can already roll over from the back to the side, a little later, and on the tummy. Toddlers reach for rattles, take them in their hands. Now they are very inquisitive.

By 5 months, babies begin to crawl, pulling their legs up to their tummy, they arch their backs in a very funny way. True, this does not work for everyone.

By the age of six months, children begin to sit down, kneel in the crib, bravely holding on to the crossbars. If they are driving down the street in a stroller, they carefully study everything that surrounds them. Kids are interested in everything - cars, flying pigeons, running dogs, cats and much more.

By 7-8 months, babies boldly get up in their beds, walk along the railing, holding onto the handles.

There is very little time left before the babies start walking. This usually happens when the kids reach 10-12 months of age.

The infancy of a child is quite interesting both for him and for his parents. Every day for the baby is marked by a new skill and discovery. Eyes loving mother can notice even the smallest changes in the behavior of the baby. But do not forget that all kids are different: for example, someone starts to sit already at 5 months, and someone only at 7. This is completely natural, so you should not rush things, but you just need to enjoy every moment.

Oh those teeth!

It is impossible to imagine the infancy of a baby without the appearance of teeth. It doesn't go smoothly for everyone. In children, the temperature may rise, tearfulness and strong salivation may be observed, and appetite may decrease.

At about six months, the baby's first teeth appear - the two lower incisors, and after a couple of months - the two upper ones.

By 10 months, the two upper lateral incisors erupt in children, and by the year, the two lower lateral incisors erupt.

By the year, usually the little ones already have eight milk teeth. If a child does not have so many teeth, parents should not worry: everything happens strictly individually. In some babies, the first teeth appear only at the age of one.

How does speech develop?

In infancy, the development of the baby's speech also occurs.

For the first six months, the crumbs laugh a lot, walk, pronounce simple sounds: “agh”, “gee”, “aaa”.

After six months (up to about 9 months), the baby begins to pronounce sounds such as “ma”, “ama”, “ba”. By 10-12 months, the little one repeats the sounds of adults. He can already say “ma-ma”, “ba-ba”, “give”. In his first year of life, the child begins to utter his first meaningful words.

It should be clarified that the speech addressed to him by mom, dad, grandparents, the little one perceives from birth. But during this period, he recognizes intonation more than speech itself. The baby can be calmed by kindly spoken words, and a raised or irritated voice can be frightening.

At six months, the baby already responds to his name and smiles meaningfully. After a month or two, he already begins to understand when they say to him: “come to me,” in response, he holds out his hands. At the same age, the child understands the word "no". Hearing the word addressed to him, he breaks away from unnecessary occupation.

At one year old, a baby can wave a hand to adults at their farewell gestures and the words “bye-bye”.

In order for the baby to develop speech faster, it is necessary to read fairy tales to him, sing songs, and talk with the baby more often.

About feeding

The baby comes into this world unadapted to independent existence, so feeding an infant is an integral part of his life support. Parents are obliged to take care of him to ensure all his physiological needs. Different types feeding, depending on the existing capabilities and needs of the child, involve the use of breast milk, artificial mixtures and different types of complementary foods. Experts are sure that it is breastfeeding that is optimal for babies.

Feeding in infancy should combine the nutrients, fluid, vitamins that are necessary for the body of a newborn baby. All of these components are present in mother's breast milk.

Necessary basis

Mother's milk contains the right balance of nutrients, which changes as the baby grows, as well as antibodies that protect the baby from various diseases during the most sensitive period of infancy. Based on this, the process of natural breastfeeding can be regarded not only as a form of nutrition, but also as a basis for the proper formation of the body's immunity.

The natural mechanism that provides the baby with the necessary period for feeding (until the main part of the milk teeth grows) lasts 1-1.5 years. It is during these months that the child needs their child so much, each mother decides on her own. In most cases, this lasts approximately 1.5-2 years.

The period of infancy includes children from 1 month to 1 year (12 months).

The main feature of the period of infancy is the high rate of physical and neuropsychic development based on accelerated metabolic processes. .

In many ways, the structure and functions of the main body systems retain the same features that were characteristic of the neonatal period:

abundant blood supply;

reduced protective functions;

imperfection of the regulatory functions of the nervous and endocrine systems.

However, in eleven months there are significant changes in the body of the child. Let's consider the most significant of them.

The nervous system is developing intensively, the active formation of new conditioned reflexes (on the basis of existing unconditioned ones) and their consolidation are characteristic. However, under the influence of any pathological influences (illness, stress, etc.), skills can be easily lost.

The mass of the brain doubles by 9 months, the spinal cord - by 10 months (by 3 years, the mass of the brain triples).

The weight of the brain by the year is 1/11-1/12 of the body weight.

In connection with the development of motor functions, coordination of movements improves, which means that the cerebellum develops.

The main part of the reflexes of newborns fades by 3 months (only a few of them - by 4-6 months).

Infants remain prone to rapid generalization of any infection and to toxic brain damage.

During the period of infancy, the child makes a huge leap in neuropsychic development.

The skin and its appendages also develop and improve. From the l-th month, perspiration and lacrimation appear. By 4-8 weeks (i.e., by 1-2 months), vellus hair is replaced by stiffer ones, skin functions improve.

By the end of 1 month, the umbilical wound is completely epithelialized. In connection with the preservation of the relative instability of thermoregulation, the child (like a newborn) easily overheats and overcools. Consequently, the same rules of personal hygiene and requirements for clothing and linen remain as for a newborn child.

From 6 months, a hygienic bath can be carried out every other day (except for the summer period).

Due to the active growth of the skeleton, vitamin D, which is formed in the skin of a child, becomes insufficient for bone growth. Therefore, all breastfed children from 4 weeks in the autumn-winter period are prescribed a prophylactic dose of vitamin D - 500 IU per day.

The musculoskeletal system is developing intensively. The accumulation of motor skills develops muscle strength and agility, and muscle mass increases. However, the predominant development of large muscles differs. chest, back, neck, shoulders, pelvis, hips. fine motor skills(hands, feet) develops much more slowly.

By 3 months, muscle hypertonicity disappears.

The large fontanel persists almost throughout the l-th year of life and closes by 12-16 months:

Curves of the spine are formed:

- by 2 months, when the child begins to hold his head on his own, cervical lordosis appears (anterior bend in the sagittal plane);
- by 6 months, when the child begins to sit independently, thoracic kyphosis appears (posterior bend in the sagittal plane);
- by 12 months, when the child begins to walk independently, lumbar lordosis appears.

Milk teeth erupt in the following order (Fig. 24): - medial incisors - at 6-9 months;