Journal > feeding premature babies

Proper feeding of premature babies plays a crucial role in their development - not only physically, but also emotionally and intellectually. Good nutrition is the main condition for the normal operation of virtually all life-supporting organs and systems.

The main distinguishing feature of premature babies is low birth weight (in most cases, less than 2.5 kg). Babies who appeared ahead of time grow faster than full-term newborns, therefore they need a more intensive supply of energy and plastic material with food. But this process is complicated by the limited ability of their digestive system to digest food. Many premature babies have reduced sucking and swallowing reflexes, because the mechanisms of regulation from the side nervous system are not developed enough, and the sucking muscles are not fully formed.

Salivation, which is necessary for normal digestion, in premature babies begins with the first feedings, but it is still lower than in full-term newborns. In addition, their stomach capacity is relatively small, and they spit up more often than full-term babies. Decreased secretion of gastric juice and activity of intestinal enzymes. Based on this, preterm infants have such a low resistance to various pathogenic microbes, often accompanied by dysbacteriosis. The colonization of the intestines by various microbes largely depends on the nature of feeding - natural or unnatural.

The activity of the digestive system is possibly disturbed and under the influence of some pathologies suffered by the child before birth.

Based on this, nutrition for premature babies is prescribed personally, not forgetting that a child born with a weight of 1.5 kg differs from an infant who weighed more than two kilograms at birth.

At the time when venturing to feed

The time of the first feeding of a premature baby depends on his condition at the end of the birth. Overly delayed - it contributes to the loss of body weight. However, it is not required to insist on immediate attachment to the chest (according to the Nikitin method), this can lead to the formation of various diseases.

A premature infant that appears in a satisfactory condition can take the first feeding with colostrum in a couple of minutes. at the end of birth, after 4-6 hours or a couple later. In most cases, doctors try to ensure that the fasting period after birth does not exceed 24 hours. But from time to time a long delay in the appointment of nutrition is needed if the child has suffered hypoxia or there is a suspicion of intracranial hemorrhage.

If the baby has not eaten 12 hours after the end of birth, doctors give him a glucose nutrient solution - using a probe or intravenously.

How often to feed

It depends on a number of events, among which stand out:

* body weight at birth;

* the degree of maturity or, conversely, immaturity.

Most premature babies are able to tolerate 7-8 times feeding at intervals of 3 hours. Only with deep prematurity and some pathological conditions the frequency of feeding is increased to 10 daily.

Children with reduced sucking and swallowing reflexes begin to be fed using special probes inserted through the nose into the stomach, dosing food with a sterile syringe or a special device - an infusion pump. Later, when the reflexes are formed, they move on to feeding babies from a bottle.

At the time when applied to the chest

The issue of breastfeeding a premature baby is decided personally. The main conditions are the presence of a sucking reflex and a general satisfactory condition.

Sparing the strength of the baby, who appeared with a body weight of more than two kilograms, it is applied to the breast first for 1-2 feedings, and the rest are carried out from the nipple. When indicators of fatigue appear (blue around the mouth, lethargy of sucking, etc.), breastfeeding is stopped and supplemented with expressed milk from a bottle. When breastfeeding, doctors monitor the amount of sucked milk by weighing the baby before and after feeding.

In the first days of life, the amount of each feeding is from 5 ml (in the first days) to 15-20 ml (by the 3rd day of life). The amount of food along with this is determined by the pediatrician. To ensure that you are getting enough essential nutrients (proteins, fats, and carbohydrates) and energy on a regular basis, doctors use the calorie method. In accordance with it, by the end of the 1st month of life, the calorie content of the diet of a premature baby increases to 130-140 kilocalories (kcal) per kilogram of weight per day (115 kcal / kg is enough for a full-term baby at this age). The gap of 10-15 kcal is explained by how the child is fed - by breast, expressed or donor breast milk, standard or specialized mixtures.

Starting from the 2nd month of life for children born with a weight of more than 1.5 kg, the calorie content is reduced by 5 kcal / kg per day (compared with the high energy value at the 1st month of life). In children with a birth weight of 1-1.5 kg, the calorie content of the diet remains unchanged until 3 months of age. In the future, the caloric content of the diet (5-10 kcal/kg every month) is systematically reduced until it equals that of full-term babies. Along with the children's doctor takes note of the child's condition, food tolerance, weight gain over the past month, etc.

Other methods of calculating nutrition, of which there are many, do not give the desired accuracy, only very approximate, often overestimated, results.

Full-term breastfed newborns will be able to do without additional drinking, because the liquid content in breast milk (about 87.5%) covers the need for it. Prematurely born babies need additional fluids. As a drink in the first days of life, lightly sweetened boiled water is more often used. Starting from the age of one month, only unsweetened boiled water is offered for drinking.

It is believed that premature babies who receive breast milk do not need additional vitamin supplements. But the vitamin composition of breast milk is highly dependent on the nutrition of the mother. Based on this, a nursing lady needs to pay special attention to her diet. In particular, vitamin D in breast milk is contained in a very small amount, completely insufficient for the prevention of rickets. Based on this, early (from the 10-14th day of life) appointment of this vitamin is recommended for premature babies. In addition, the use of modern adapted breast milk substitutes containing vitamin D in the diet of preterm infants does not cancel the specific prevention of rickets. The use of fish oil popular in the past for this purpose is completely unacceptable!

Iron is more responsible than gold

Iron stores in the body of premature babies are very scarce and can be depleted by the end of the 1st month. Based on this, the need for it is covered by fruit, berry and vegetable juices and purees. There is relatively little iron in breast milk, but it is well absorbed. Unfortunately, mother's iron, like iron in mixtures, does not fully cover the need for this element in premature babies, which often leads to the formation of iron deficiency anemia. In addition to the intake of iron with food, such children require the appointment of iron supplements in drops or syrups.

Most formulas intended for feeding premature babies contain relatively low levels of iron (less than 1 mg per 100 ml). Premature babies suffering from anemia, at the age of 3-4 months, it is advisable to give mixtures additionally enriched with iron (for example, the American product Enfamil with iron).

best to meet the needs premature baby- mother's milk. The protein composition of maternal colostrum and milk maximally corresponds to the nature of the protein metabolism of a premature baby. Fats in breast milk are easily digested, and lactose (milk sugar, its main carbohydrate) is well broken down and absorbed. Mother's milk contains many useful protective factors that provide protection to the intestinal mucosa and prevent the harmful effects of bacteria and viruses, and food allergens. All this, together with a balanced vitamin and mineral composition, explains the unique properties of breast milk, making its benefits obvious. In fact, breast milk It is both food and medicine.

In women who have given birth prematurely, breast milk is different from mature. In premature milk, the protein content is increased, and the percentage of fat is lower, which corresponds to the raisins of the assimilation of food by premature babies. Its calorie content is also higher.

But in many cases, breastfeeding a premature baby is unrealistic because of:

* insufficient amount of breast milk or its complete absence from the mother;

* the presence of antibodies in the milk in Rh-conflict;

* Disorders of reflexes of sucking and / or swallowing in a child;

* his serious condition (intracranial hemorrhage, etc.);

* intolerance to newborn breast milk proteins;

* lactase deficiency (lack of an enzyme that breaks down milk sugar), etc.

In these circumstances, donor breast milk or its substitutes are needed.

With unnatural feeding of premature babies, specialized adapted mixtures are used. Their composition best meets the needs of a premature baby. These mixtures are prescribed only by a doctor!

If it is not possible to provide the baby with these foods, it is possible to resort to feeding with standard breast milk substitutes. In dairy kitchens, free of charge - in the direction of the local pediatrician - the domestic acidophilic (sour-milk) mixture Malyutka is issued, which in Lately actively replaces Agu-1. From foreign acidophilic mixtures for feeding premature babies, Aci-Mailex, Pelargon and Laktofidus are suitable. It is completely unacceptable to use second mixtures when feeding (on the packaging of which the number 2 is at the end of the name). These products are not adapted to breast milk, but to cow's milk, the introduction of which into the diet of preterm infants should be carried out with extreme caution.

In the past, when feeding children who appeared ahead of time used kefir. But it is based on whole cow's milk, so its inclusion in the diet of premature babies in the first months of life is not recommended.

When transferring premature babies to mixed and unnatural feeding in the first 2-3 days of introducing a new mixture, its amount forms approximately 10 ml per feeding (1-3 times a day) before breast milk. Then the amount of the mixture in the diet slowly - in 3-5 days - is increased to a complete replacement of 1-2 feedings. After 7 days, the introduced product can make up 50% of the diet. If necessary, within the next week, it is possible to completely transfer a premature baby to unnatural feeding with satisfactory tolerability of the product, the physiological nature of the stool, adequate sucking and the absence of regurgitation. The simultaneous appointment of drugs such as bifidumbacterin has a beneficial effect on the transition to unnatural feeding.

At the time when to introduce complementary foods

For premature babies, the timely introduction of complementary foods is no less, if not more, fundamentally important than for full-term babies.

Fruit or vegetable juices are introduced into the diet of babies aged 1 to 3 months, depending on which week of pregnancy the birth occurred, what was the weight of the baby at birth, and how well the baby tolerates non-dairy food. Juices are administered slowly, starting with a few drops to the desired amount, which is easy to find out by multiplying the month of life by 10. So, for example, a 4-month-old child should take 40 ml per day, or 8 teaspoons of juice. It is possible to give juices at the end of feeding or in the intervals between meals, both in pure and diluted form.

As the main juice, it is possible to advise apple, despite the fact that it is possible to use pear, cherry and blackcurrant. Carrot juice should be started no earlier than a child of 3-4 months of age and preferably mixed with apple juice (ratio 1: 1). It is better to abstain from tomato, grape and citrus juice during the first six months of life. And it is absolutely not necessary to give strawberry, strawberry and beetroot juices to premature babies during the first year of life - they can lead to allergies.

Fruit purees (apple, banana, etc.) begin to give by 2-3 months of life 2-3 weeks after the end of the introduction of juices, starting with half a teaspoon and bringing up the volume of juices in the daily diet of full-term babies.

Hard-boiled egg yolk administered from 3 - 3.5 months of age, after grinding and grinding in a small amount of breast milk or a mixture. The daily intake of the yolk is slowly increased to half a piece per day. In case of allergic reactions and indicators of intolerance, the yolk of a chicken egg can be replaced with a quail.

At the same age, cottage cheese is introduced, which is a couple of premature introductions of this product to healthy full-term babies. The amount of cottage cheese forms approximately 10 g during the first month after the end of the introduction, after a month it increases to 20 g, and after that it increases by 5 g every month until it reaches 50 g.

It is prescribed from 4-4.5 months of age. Unlike full-term babies, for whom the first food is vegetable puree, premature babies are given porridge (rice, oatmeal, buckwheat), which is cooked in vegetable broth or water, adding a small amount of breast milk or a mixture. be directed to carry out the stages of increasing the concentration of cereals introduced into the diet, starting with 5% (5 g or 1 teaspoon of flour per 100 ml of water). Then they give 7-8% cereals (1.5 teaspoons per 100 ml of water), and then 10% cereals (2 teaspoons per 100 ml of water). First, vegetable (sunflower or olive) is added to the porridge, and then butter in an amount of 3-4 g per serving. It is not necessary to add oil to instant cereals of factory production.

At 5 months, they begin to give a second complementary food in the form of vegetable puree with the addition of vegetable oil. Meat puree (beef, lean pork or liver) - for the prevention of anemia - can be administered from 5 months of age, but along with this, it is given no more than 10 g and no more than 2-3 times a week. Not later than 7 months of age, a premature baby should receive mashed meat every day, the amount of which increases from 10 g to 50 g per day. one year old. From 8 months, it is advisable to supplement the diet with bread or unsweetened biscuits. At the same age, vegetable soup is introduced, and then meat broth (from one teaspoon to 3-4 tablespoons).

Kefir and / or whole cow's milk - administered at the age of 8-9 months, replacing breast milk or formula. In most cases, one feeding with milk or kefir during the day is enough.

Is everything right

For the correct calculation and purpose of nutrition, and for indicators physical development a baby born prematurely needs regular monitoring. The main attention in assessing his physical development is paid to the weight gain for any month, and to the average daily gain. Along with this, we must not forget that the developmental processes of premature babies are more intense. By the age of 2, most prematurely born babies reach a level of physical development comparable to that of full-term peers. At 1-2 months of life, an increase in body weight is considered normal at the rate of 10-15 g / kg of birth weight.

Feeding a premature baby is the most significant event. Based on this, a pediatrician should invariably give advice on its implementation and monitor their effectiveness.

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Babies born prematurely need constant attention and special treatment. Caring for them is very different from caring for normal newborns. Most often, premature babies from the hospital are transferred to the neonatal intensive care unit. There, the mother has the opportunity to get the first skills in caring for a child. But after discharge, when a young mother finds herself at home alone with her baby, she may become confused. Let's look at the main nuances that mom will have to adhere to until the baby gets stronger.

Feeding
Feeding is one of the most important moments in caring for a premature baby, so the doctor gives recommendations regarding feeding the baby, based on his individual characteristics. And it is important for a young mother to follow them clearly.
And now let's move on to the general, but rather important points.

According to doctors, in our time, parents practice feeding their children not on time, but on demand. This system cannot be applied to premature babies, because they are still too weak to show that they are hungry.

Usually the child is advised to feed every three hours, without taking a break for the night. However, if he is too weak and does not eat well, the doctor may recommend reducing the intervals between feedings.

Be sure to make sure that the child eats the portion assigned to him. If the baby falls asleep during feeding, you need to wake him up quietly and try to feed him. It can be difficult to wake up such a baby, but this is normal, do not be afraid that something is wrong with him. Doctors advise gently twitching the baby's ear and nose. This is what most irritates the newborn, and he wakes up.

There is also another important point which many parents miss. From the first days of life, a child should be given water to drink in addition to milk. He should drink 100 g of water per 1 kg of weight per day. That is, if a child weighs 2 kg, he should drink 200 g of water per day.

dressing up
Dressing a premature baby - too important nuance. It must be remembered that in children whose weight is less than 3 kg, heat transfer has not yet developed. They need constant heat, otherwise hypothermia can set in very quickly.

The temperature in the room where the child is located should be 25-27 0 С, and the air humidity should be 50-70%. To monitor this, you can hang a thermometer and a hygrometer at a level of 1.5 m from the floor near the crib.

To maintain the necessary humidity in the room, it is often necessary to do wet cleaning, and you can also use a special humidifier. In addition, do not forget about ventilation. It is advisable to ventilate the room every 3-4 hours for 15-20 minutes. At this time, the baby should be taken out to another (warm) room.

So that the baby does not freeze and does not experience unnecessary stress, try to change his clothes one by one: first a vest, then a diaper and panties. Open areas of the body can be covered with a diaper, so the baby will be calmer.

Every time you need to dress a newborn in clean and ironed linen on both sides. Do not neglect this nuance, because the baby still has practically no immunity, and he can easily get sick.

Bathing
For the first time after the birth of premature babies do not bathe. A child born with a weight of more than 1.5 kg, the first bath is allowed after 7-10 days. If the baby was born with a lower weight, then you should start bathing him after 2-3 weeks. Before the first bath, it is better to consult a doctor if you decided to do it too early.

A newborn should be bathed in a separate baby bath, and in the first three months only in boiled water. The water temperature should be 38 0 C, and the room - not less than 25 0 C.

The first bath should not last long - 4-5 minutes. After the child should be wrapped in a warm towel, allowed to dry, warm, and only then change.

At the first baths, the child may cry. This is unusual and scary for him. Over time, bathing will become one of his favorite activities.

Dream
Premature babies sleep a lot. Sometimes even 20 hours a day. This is due to the fact that the child has not yet matured, and in a dream it develops more quickly. A few months will pass and the baby will begin to be more awake and show interest in the world around him.

Preterm birth rates in the US range from 11% to 13% of all pregnancies. Almost 60% of cases multiple pregnancy end in preterm birth. A birth is considered "premature" if the baby is born before the end of 37 completed weeks of pregnancy. Preterm births can be late - premature (34-36 weeks), moderately premature (32-36 weeks) and very premature (less than 32 weeks).

It should be noted that even late premature birth carried out only when indicated, and these children are at greater risk than full-term ones: everything necessary must be done to maintain the pregnancy.

A premature newborn outwardly differs significantly from babies born at term. While the average weight of a term baby at birth is 3.17 kg, a premature newborn can weigh 2.26 kg or less. Thanks to the development of modern medicine, children born after the 27th week of pregnancy, weighing 1 kg, have almost every chance of survival; Eight out of ten babies born after 30 weeks have few health and developmental problems, while premature babies born before 28 weeks have more complications and require intensive treatment and care in the neonatal intensive care unit.

The earlier the baby is born, the thinner the subcutaneous fat layer is, so the skin appears transparent and the blood vessels underneath are visible. The proportions of the body are different than in full-term children: the head is larger in relation to the rest of the body. On the back and shoulders may persist Thin hair- lanugo. There is no original lubrication, because she was supposed to appear at the end of pregnancy, before birth. Facial features are sharper than those of full-term babies. Over time, the baby will look exactly like a normal newborn. Due to the lack of subcutaneous fat, a premature baby can easily get cold and get sick even at room temperature. That is why premature babies are placed immediately after birth in incubators (incubators), under a source of radiant heat, where the temperature can be regulated and maintained. After a quick examination in the delivery room, the baby is usually transferred to the neonatal intensive care unit.

You may notice that a premature baby cries very quietly or inaudibly. Due to the immaturity of the respiratory system, he may have breathing problems. If a baby is born more than two months premature, breathing difficulties can cause serious health problems because other organs, which are also immature, will not be supplied with enough oxygen. To make sure this doesn't happen, doctors will monitor breathing and heart rate with special equipment and ventilate the lungs with constant positive pressure. These procedures are necessary for the survival of the child. Transferring a child to the intensive care unit can be difficult for you: you will not be able to take the baby in your arms or touch him when you want, you will not be able to take him to the ward with you.

Concerned about the health of the baby, do not forget about breastfeeding.

To manage stress, ask to see the baby as soon as possible after the birth and try to be as active in the baby's care as possible. If you are allowed to be near the child - be there. If you can not take the child in your arms until his condition stabilizes, touch him more often. Many intensive care units allow parents to implement the Kangaroo Method, which maximizes skin-to-skin physical contact between the baby and mother, but only after the support of the child's major organ systems is not needed.

As soon as the doctor allows, you can feed the baby. The health staff will tell you about breastfeeding or artificial feeding, depending on your abilities and what is best for the child. Some premature babies are first fed intravenously or through a tube that is passed through the mouth or nose into the stomach. But the best nutrition is breast milk, which contains antibodies and other substances that enhance the immune response and help the baby resist infections. In some cases, if there are difficulties with breastfeeding, it is necessary to express breast milk for feeding through a tube or from a bottle. Once you begin a full breastfeeding, breastfeed your baby as often as possible to increase milk supply. However, mothers of premature babies sometimes use a breast pump in addition to frequent breastfeeding to help produce enough milk.

Your desire to return home as soon as possible is understandable, but the newborn may not yet be ready for this. Remember that your child is in good hands and you can visit it as often as you can. While your baby is in the hospital, rest, prepare your home and family for their arrival, and read the information for parents on caring for premature babies. If you master the basic principles of caring for a baby while still in the hospital, you will feel more confident when you return home. As soon as the doctor allows, touch the baby, stroke him, sing lullabies to him.

You will be discharged and you can take your baby home as soon as he breathes on his own, maintains body temperature, is breast-fed or formula-fed, and is gaining weight steadily. The local pediatrician will be informed about the discharge of your child from the hospital, you can contact him with all questions and for advice.

Dr. Komarovsky - the most popular pediatrician in Russia and Ukraine, the author of 13 books on childcare - has released the third book of the trilogy "Handbook of Sane Parents" - "Medicines". With the presentation of the book, everyone's favorite pediatrician visited Moscow and St. Petersburg. I took advantage of the situation and, over a leisurely dinner at John Jolie, asked Dr. Komarovsky all the most important questions.

- The golden rule of a sane parent?
- The main thing is the happiness and health of the family. The family should live not in the interests of the child, but in the interests of the family. If the child is well, and the father is bad, it is disgusting. And the child should feel it. I can't imagine that my child was given a chocolate bar, and he did not divide it into three parts. Mom is also a person, she also loves chocolate, you can’t humiliate her dignity. What a child becomes depends on the parents.

- List five myths about child health.
- It's hard to choose five, there are dozens of times more. The first two: vitamins and immunostimulants affect the incidence rate. There are extremely dangerous myths, for example, about the benefits of rubbing children with alcohol or vodka at high temperatures. Fourth: Necessity is the first, second and third. Well, the fifth myth: you need to go to the sea in order not to get sick - at the sea they are more often poisoned than healed.

- Perinatal matrices: myth or reality?
- It's beyond my understanding. Most of all I like the specialty "perinatal psychologist". These are people who know what the fetus is thinking. They know what kind of agony a child experiences when he was put alone in a crib, when at the age of one and a half he was deprived of his breast ...

- Attention Deficit Disorder: Myth or Reality?
- Reality, definitely. Formerly a child left unattended to itself. And it is less dangerous than when it is provided to TV or the Internet. It is a tragedy of society when a mother ties a child to the TV, because she is calmer when he is near, in the next room, than when she runs down the street. 20 years ago, all the most interesting was in the yard. Now everything is interesting at home. This is where hypodynamia, the obesity epidemic, comes from.

- How much does growing up on artificial nutrition affect the health of the baby?
- Naturally, modern milk formula allows you to minimize the risks if the mother knows how to deal with it. At the same time, a lower risk of getting sick (for example, diabetes) has been proven if the baby is breastfed. Better mom there can be nothing.

Bloggers ask: is a pneumococcal vaccine required for a child who, in principle, gets sick infrequently, there was no pneumonia?
- As a rule, no. The vaccine is expensive, not everyone can afford it. Now, if the state provides it to all of us at its own expense, then why not.

- Should children be treated with antibiotics?
- When they have antibiotic-susceptible bacterial infections, it's worth it. What is not worth it is to treat children for viral infections with antibiotics prophylactically. Antibiotics have saved millions of lives, but they must be used for their intended purpose.
The main rule for the use of drugs: take not just like that, but about it. This “about” is described in any instruction in the “Instructions for Use” section. Any drug, if not indicated, is contraindicated. If you don’t find the word “flu” in the instructions for ampicillin with the flu, then it’s time to doubt the doctor who prescribed it.

- Is it better to get chickenpox or get it?
- Definitely, instill. Chickenpox is usually a mild illness, but often not a mild one.
I worked for many years in pediatric intensive care, saw both chickenpox encephalitis and death from chickenpox. The head doctor says in the morning: "Chickenpox in hematology." To an ordinary person, this phrase does not mean anything. But we understand: there are children with leukemia, without immunity; one windmill means half of them will die. And these children were brought to us to die. In nephrology, chickenpox - half of those on hemodialysis will die.
A random girl suffered a severe chickenpox - her whole face is covered in scars.
It's good to have a mild form of chickenpox at the ideal age and when you're healthy. Vaccination against chickenpox - like the flu - is not a matter of expediency, but of material possibility.
The statistics of complications of chickenpox could be significantly improved if children were vaccinated. And here's the question: will you be able to gather Swamp Square people with the slogans "Protect our children from the disease against which protection has been developed", "A country with a multi-billion dollar budget can afford to vaccinate every baby"? Attitude towards children - to children's medicine, to kindergartens, to schools - is the criterion of a nation's maturity. If a hundred thousand people come out in defense of some political force, but do not come out in defense of their own children, sorry, for such a nation this is a catastrophic situation.

- Does Russian medicine have a future in this case?
I have already raised my children. I will not send my grandchildren to the healthcare system. If, God forbid, something happens to them, I will take them to the country where I believe in medicine - to Germany, to Israel ... - where I can control the quality of drugs, where I can influence something.
Here I do not believe in the quality of medicines, I do not believe in those people who should control the quality of medicines, I see advertisements for medicines on TV, and I am ashamed of the country. I am afraid that when civilized insurance medicine finally comes to us, they will pay not for civilized medicines, but for those that are produced by a relative of the director of an insurance company.

- What is the stumbling block of Russian healthcare?
- Soloukhin in one of the stories described the transition that each of us faces - from this life to that one. It's scary, it's easy. You can beg for an ampoule of morphine in agony for three years, or you can calmly leave. And it depends on the healthcare system in the country. And the problem is this: at the age when we can change this system, we are interested in completely different things.
A case in point was in Ukraine. Closed the Ukrainian torrent. This is the protest movement! A bunch of men organized hacker attacks, collapsed the websites of the Ministry of Internal Affairs and the president. It got to the point that the president's son stood up for them, and the site was opened. That is, when the peasants were deprived of the right to watch free stolen movies, they were ready to tear anyone up.
But before that, there was no vaccine in Ukraine for almost two years. In a European country in the 21st century, children were not vaccinated for two years. Do you think one of these men lifted a finger for the sake of their children? I wrote a post about this in my blog:.

- The load of the modern student - is it not excessive?
- Ideally, you need to resolve the issue of extracurricular time. If, in addition to school, the child does three more hours homework, and the rest of the time stupidly watching TV, there is nothing good in this. Our problem is the lack of free public school sports. It is impossible to imagine a school in Canada where there is no ice rink or school pool. We only dream about it. But it's not expensive to make volleyball courts: pull a rope between two poles - and let the children play.
It is necessary that one and a half hours a day the child has intense physical activity. If we have organized these one and a half hours, then no load at school will be excessive. Then we will keep him healthy.

- How is the benefit of an hour and a half load explained?
- This is human physiology: the heart should not beat smoothly, but respond to loads, which ensures normal work vessels, muscles. It is necessary to motivate children to run faster, jump higher, walk without acne, etc. Then they won’t even start smoking in the 8th grade. It is necessary to develop a cult of a healthy attitude towards oneself. Because a person who systematically kills himself is a person who has little brains. Being stupid is shameful. A person who smokes is stupid, because he goes against instinct, he deliberately kills his health. There are no living beings that deliberately kill themselves.

- Does your child have enough school holidays, or maybe they need more? Perhaps they need to be broken down into periods differently?
- It is not the fact of the holidays that is important, it is important how the child spent them. How many children can afford to go swimming in the sea during the autumn holidays, and go skiing in the winter?

- Computer: for or against, from the point of view of medicine?
- For, of course! How without it! You just need to know how to use it. It is quite obvious that it must be dosed. If a child jumps for an hour and a half a day, then let him sit quietly and stare at the computer.

- Vegetarian nutrition for children: is it possible?
- By and large, it is unnatural for a person. What mom and dad believe in, the child usually believes in. If parents want to pass on their beliefs to their child, I have a technique that allows you to maintain health with a complete vegetarian diet. I myself believe that the child has the right to eat what he wants. But if I, as a doctor, do not see an opportunity to convince my mother, then I am forced not to relax, but to offer a methodology: what is, what vitamin complex drink so that you can do without prohibited products.
There are shops for vegetarians all over the world, but how many of them are there in Russia? In Moscow, one or two.

- How harmful or useful are seasonal vitamin pills? They are said to cause cancer.
- It is not true. Only a manufacturer of vitamins not in tablets can say so. The question needs to be structured differently. Vitamins are therapeutic and prophylactic drugs that are taken according to strict indications. If a person can afford a harmonious varied diet, he does not need any vitamins. With the exception of certain situations, and even more often we are talking about trace elements: an increased need for iodine in pregnant and lactating women, folic acid in preparation for pregnancy, vitamin D - if you live in the Arctic Circle.

- Are there crisis years from 7 to 18 years old - or is it one continuous crisis?
- It seems to me that the named range is stretched. The riot of sex hormones, without a doubt, changes life priorities. Peers, usually of the opposite sex, become authorities for the child; the opinion of a neighbor on the desk becomes more important than the opinion of mom or dad. It is important to have time to become an authority for a girl before she is 10, and for a boy before he is 12 (all this is approximate, of course). If you failed to do this, then, alas, you are too late - you will not be able to influence the situation.

- New standards for nursing premature babiesconsidered bornvery small ones - from 500 g. Are there any prospects for such children? Do they need to be dealt with?
- This topic causes me great skepticism and pain. Give the society an analysis: for the last five years in our country in s there were one hundred children weighing from 600 g to a kilogram. Give the society statistics on what happened to them in the first five years, what it cost their parents, how many families broke up, how happy, healthy, full-fledged these children are now, as they are with their eyesight. Give society the answers to these questions.
I was in Frankfurt in the department for such children and heard such pain in the words of those who nurse them - and this is with their level! 90% of these children are blind, they have problems with the skin, with the intellect.
If we decide that we are nursing premature babies because this is the European standard, let's start from another place: from European vaccination standards, European school standards ... If we bring children into this world, let's start from another.

- What self-help measures should a child know?
- I wrote a book about it. It's practically finished script 50-episode film about emergency care. It needs to be filmed and shown in all schools: what a child should do at a high temperature, when a friend was shocked, when someone was pulled out of the water ... Our posters demonstrating help for drowned people - when the poor fellow is pressed through the knee, as if the lungs are a washcloth, from which you can squeeze the water - a national disgrace. I am ashamed of the country when they begin to discuss the benefits of a tourniquet. A correctly applied tourniquet is tantamount to the loss of a limb, it is needed if, for example, an arm has been torn off. At the same time, there is a tourniquet in every first-aid kit.
But what is epipen *, almost no one here knows. Do you remember in the movie Social network» The police break into the house where the guys are using cocaine? The policeman takes out a syringe from one of them and asks what is in it. The guy says: "Epipen", - and they lag behind him. Every dog ​​knows what epinephrine is and why it is needed. If instead of a tourniquet we put epipen in the car first-aid kit, we would save several thousand lives in a year.

- What do you consider a priority in the work of a pediatrician?
- Mutual understanding with mom and dad. Explaining to them their role is that they are more important than the doctor. With us, it usually happens the other way around: the doctor tries to prove his worth. As well as a nurse, a midwife, teachers in schools, an auto mechanic, a plumber, an electrician: "You can't get anywhere without us." Moreover, the plumber will begin his story by saying that all the previous plumbers who have been in your apartment are absolute idiots.
The possibilities of parents are an order of magnitude greater than the possibilities of the state. It is impossible to raise children independently of society, and societies are different everywhere. Therefore, my main task is to give such a method of care, education and assistance in case of illness that can be implemented in the country where you live, taking into account your mentality, your grandmothers and your healthcare system. A technique that will allow you to raise a child and save a family.

- Eugene, how can I find you on the Internet?
- The real Komarovsky lives on. Today only here.

About Dr. Komarovsky's new book
Previously, specialists could not afford to write about medicines, this topic was always a taboo for both doctors and parents: if you tell the truth about some medicines, they will change them to others, about others you will say, they will stop buying ... And this is a matter of personal interest.
"Handbook of sane parents: Medicines" Yevgeny Komarovsky wrote two years, the preparation took, according to the author, 35 years. Textbooks about medicines are written not by doctors, but by pharmacologists. But the paradox is that it is with doctors that parents talk about medicines. Therefore, one of the primary goals of Dr. Komarovsky's new book is to become a Russian-pharmacological phrasebook. When the instructions, which are theoretically intended for the layman, say that “this drug inhibits the C-450 enzyme,” it hardly becomes clearer why this medicine is needed.
The book consists of three parts: 1. Pharmacological ABC, where the basics of pharmacology are given: what is the difference between a medicine and a drug, and a pill from a lozenge. 2. Stories about drugs - about the main groups of drugs, with an emphasis on childhood. 3. Specific situations: drugs and pregnancy, drugs and breastfeeding, drugs and allergies, what is 20mg in 5ml, etc.
Many pharmaceutical companies would give a lot to keep this impressive book (one Index took 40 pages) from being published. “One of my acquaintances, a chemist,” comments Komarovsky, “having looked at the contents, bought three copies at once with the words: it will quickly become a bibliographic rarity, such a book will not be allowed to be published twice.” For the same reason, the publishing house released a circulation six times larger than usual.

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* EpiPen(Epinephrine Auto-Injector) - a syringe pen with adrenaline, which you can use yourself in an emergency. As a rule, with anaphylactic shock - due to asthma, allergies or insect bites.