Kataeva A., Strebeleva E.A. Preschool oligophrenopedagogy: Proc. for stud. higher education, institutions. Features of the development of a child at an early age

Introduction. Healthy child

"... and when they asked to bring the most beautiful thing that exists in the whole wide world, the crow brought her child..."

The first fragmentary information about a healthy and sick child appeared in ancient times. Hippocrates, Galen, Soranus, Avicenna emphasized in their treatises the presence of features child's body, which distinguishes him from an adult and determines the atypical course of diseases, especially in early childhood. Even then, scientists paid much attention to the importance of breastfeeding, physical education And proper care for the harmonious growth and development of the child.

Russian scientists have made a huge contribution to the development of domestic pediatrics. N.F. Filatov - the founder of Russian pediatrics, N.P. Gundobin, the author of the classification of periods of childhood, and other scientists in their works singled out sections on a healthy child, feeding and upbringing.

IN modern world time it is necessary to pay great attention to the development and upbringing of children, tk. Children are the future of our planet.

1. Periods of childhood

The child's body is always in the process of growth and development, which occur continuously in a certain regular sequence. From the moment of birth to adulthood, the child goes through certain age periods.

child in different periods life is characterized by certain anatomical and physiological features, the totality of which leaves an imprint on the reactive properties and resistance of the organism. This explains both the peculiarity of the pathology and the peculiar course of certain diseases in children of different age groups.

But one should not think that the age characteristics of the child themselves doom him to illness. If the environmental conditions, temperature, nutrition, care, use of fresh air, etc. meet the requirements of the body of a newborn or baby, then this creates the prerequisites for its proper growth, development and protection from diseases. Conversely, adverse environmental conditions adversely affect the health of the child. Even small errors in care, nutrition, temperature can adversely affect the health of the child, especially the newborn and infant.

The most acceptable for practical purposes is the scheme of N. P. Gundobin, according to which the entire childhood age is divided into the following periods.

Gundobin Nikolai Petrovich, Russian pediatrician. In 1885 he graduated from the medical faculty of Moscow University. Since 1897, professor of the Department of Children's Diseases of the Military Medical Academy in St. Petersburg. The main works are devoted to the study of age-related features of the anatomy, physiology and pathology of the child's body. Gundobin N.P. was chairman of the school department of the Society for the Protection of National Health and one of the organizers (1904, together with N. A. Russkikh) of the Union for the Fight against Child Mortality.

Works: Education and treatment of a child up to the age of seven, 3rd ed., M., 1913; Features of childhood, St. Petersburg, 1906.

I. The period of intrauterine development: 1) the phase of embryonic development (embryo), 2) the phase of placental development (fetus).

II. Neonatal period.

III. The period of infancy (younger toddler age),

IV. The period of milk teeth: a - pre-preschool age (senior toddler age), b - preschool age (the period of attending kindergarten).

V. The period of adolescence (primary school age).

VI. Puberty (senior school age).

All the changes made by Soviet pediatricians are marked in brackets.

This division is conditional, and it is rather difficult to draw clear boundaries between periods. But it is convenient to use it when studying the physiological and pathological conditions of the child, as well as for practical therapeutic and prophylactic purposes.

2. Stages of intrauterine development

In the intrauterine development of a person, three periods are conventionally distinguished:

The implantation period lasts from the moment of fertilization to 2 weeks. This period is characterized by a rapid systematic crushing of a fertilized egg, its advancement along the fallopian tube to the uterine cavity; implantation (attachment of the embryo and introduction into the mucous membrane of the uterus) on the 6-7th day after fertilization and further formation of the fetal membranes, creating the necessary conditions for the development of the embryo. They provide nutrition (trophoblast), create a liquid habitat and mechanical protection (fluid of the amniotic sac).

The embryonic period lasts from the 3rd to the 10-12th week of pregnancy. During this period, the rudiments of all the most important organs and systems of the future baby are formed, the torso, head, and limbs are formed. The placenta is developing - the most important organ of pregnancy, separating two blood flows (mother and fetus) and providing metabolism between mother and fetus, protecting it from infectious and other harmful factors, from the mother's immune system. At the end of this period, the embryo becomes a fetus with a baby-like configuration.

The fetal period begins from the 3rd month of pregnancy and ends with the birth of a child. Nutrition and metabolism of the fetus is carried out through the placenta. There is a rapid growth of the fetus, the formation of tissues, the development of organs and systems from their rudiments, the formation and formation of new functional systems that ensure the life of the fetus in the womb and the child after birth.

After the 28th week of pregnancy, the fetus begins to form a supply of valuable substances needed in the first time after birth - calcium, iron, copper, vitamin B12, etc. There is a maturation of the surfactant, which ensures normal lung function. Prenatal development is influenced by various environmental factors. They have the most significant effect on the organs that develop most intensively at the time of exposure.

3. Breast period

The chest period - from 4 weeks to 1 year of life - is characterized by an intensive increase in body weight and height, intense physical, neuropsychic, intellectual development. By 4 months, body weight doubles, and by 1 year it triples.

For the first quarter of the year, the child grows by 3 cm every month, for the second quarter - by 2.5 cm, for the third quarter - by 1.5 cm and for the fourth quarter of the year the child adds 1 cm in height every month. big shifts in the psychomotor development of the child, during this period the foundation of health, physical and mental development is laid. It is evaluated every quarter of the year.

In the development of the visual analyzer, the following occurs: by the end of the 1st month, visual concentration is observed; by the 2nd - 3rd month - fixation of the gaze with simultaneous reactions of the muscles of the neck and head; by 3.5 months - discrimination of surrounding objects, prolonged concentration, tracking of objects; by 5 months, the ability to consider an object at close range is manifested; by 6 months, the child distinguishes colors well, expressing a certain attitude towards them.

The reactions of auditory perception are manifested, in addition to auditory concentration (end of the 2nd week), a clear orientation to sounds (1st month) and the search for its source from the end of the 2nd month. At 2-3 months, the child listens to sounds, and at 3-3.5 months, he unmistakably searches for the source of the sound. At 3-7 months there is a constant activity to a variety of sound stimuli, and from 10-11 months - a reaction to the sound in connection with the content and meaning of this sound.

Baby's motor development - holds head when held upright (at 5-6 weeks), lifts head or turns it to the side in prone position (at 5 weeks), rolls over to side from prone position back (4-4.5 months), sits independently (6-7 months), walks on all fours (at 8 months), gets up and stands, adhering to support (7-8 months), walks independently (at 11-12 -th month).

Development of grasping ability - stretches out a hand to an object (at the 3rd month), grasps an object (4.5 months), holds an object in each hand (6 months), brings the whole body into an active state when grasping (at the 7th month), the beginnings of specific manipulations (on the 11th month).

Teething from 5-7 months.

From 4-6 weeks, visual-auditory search and visual concentration on the face of an adult are observed, and from 3 months there is a pronounced need to communicate with adults. In an infant, the leading line of motor activity at 7-8 months is crawling, at the 12th month - the beginnings of manipulation games.

The development of I and II signaling systems of the central nervous system occurs, the goiter and thyroid glands function; adrenal function is weakened; beginning of pituitary function.

Rickets, malnutrition, food and respiratory allergies, respiratory diseases and acute gastrointestinal diseases may appear.

In each period, for the correct development of the child, the creation of certain environmental conditions, regimen, and upbringing is required.

Features of growth and development

Significant growth rates are characteristic - body length (height) increases by 50% of the length at birth, reaches 75-77 cm by the age of 1 year. Head circumference by the year is 46-47 cm, chest circumference - 48 cm. There is a rapid development of motor skills and motor skills. There are three peaks of physical activity: I - 3-4 months - a complex of revival, joy at the first communication with adults; II - 7-8 months - activation of crawling, formation of binocular vision (mastery of space); III peak - 11-12 months - the beginning of walking. Their sensory-motor connections are determined. Skeletal muscles and motor activity are factors that determine the processes of growth and development in the first year of a child's life. The growth rate is provided by a high metabolism.

Features of the central nervous system

There is an increase in the mass of the brain by one year by 2-2.5 times, the most intense differentiation of nerve cells in the first 5-6 months of life. Insufficient activity of -aminobutyric acid (inhibitory factor) and little myelin, which contributes to the rapid spread of any excitation.

The orienting reflex is preserved, reflecting the innate need for movement and activity of the sense organs. Nerve connections between the child and surrounding people are established through facial expressions, gestures, voice intonations. The development of fine hand movements contributes to the development of the brain and speech. Connections arise between words and response motor reactions of the child, then the child associates the visual and auditory perception of objects with words, the names of objects when they are shown, connections with individual actions (“give”, “show”) - this is the optimal course of development, necessary as basis for other periods of childhood. The need for contact with adults determines the mental development of the child.

Electroencephalogram at 2-3 months - stable rhythm; at 4-6 months - changes are unidirectional; at 8-10 months - progressive individualization.

Features of the endocrine system

In the chest period, there is an increase in the function of the pituitary and thyroid glands. They stimulate the growth and development of the child, metabolism, ensure the normal differentiation of the brain and intellectual development. The function of the adrenal glands is enhanced, there is a partial involution of the fetal adrenal cortex, an increase in the biological activity of corticosteroids.

Features of immunity

There is a slight decrease in the number of T- and B-cells in the blood compared with the neonatal period. Decrease of maternal IgG from 2-3 months is expressed, synthesis of own IgG increases from 2-3 months; its constant level is established after 8 months - 1 year. The IgM level by the end of the year is 50% of the adult level. The concentration of IgA slowly increases. IgE in a healthy child is contained in a small amount, its level depends on the manifestations of allergies (increases). The second critical period of immunity is observed at 4-6 months and is characterized by: low level specific antibodies - physiological hypogammaglobulinemia; synthesis of IgM antibodies that leave no immunological memory. Measles, whooping cough atypically flow - leaving no immunity! High sensitivity to respiratory syncytial infection, parainfluenza viruses and adenoviruses remains.

Nonspecific resistance factors

Typically high content of lysozyme and properdin. By the end of the first month of life, the complement level rises rapidly and reaches the adult level. From 2-6 months, the final phase of phagocytosis of leukocytes to pathogenic microorganisms is formed, with the exception of pneumococcus, staphylococcus, Klebsiella, Haemophilus influenzae.

The nature of the pathology

Respiratory diseases, acute gastrointestinal diseases, food allergies, rickets, dystrophy, and iron deficiency anemia often develop. Possible manifestation of hereditary diseases, tuberculosis, syphilis, HIV infection.

Assessment of physical development, motor skills, speech development, neuropsychic development, taking into account the leading line of development in the chest period, is carried out quarterly.

To assess the physical development of children under 1 year old, it is better to use the following indicators:

body weight;

Proportionality of development (head circumference; chest circumference, some anthropometric indices);

Static functions (motor skills of the child);

Timely eruption of milk teeth (in children under 2 years old).

The skull of a newborn has specific features. See fig.

The most stable indicator of physical development is the growth of the child. It determines the absolute length of the body and, accordingly, the increase in the size of the body, the development, maturation of its organs and systems, the formation of functions in a given period of time.

The greatest growth energy falls on the first quarter of the year (Table A). In full-term newborns, growth ranges from 46 to 60 cm. On average, 48-52 cm, but 50-52 cm are considered adaptive indicators of growth. This means that adaptation in the prenatal period occurred not only at the organismal level, but also at the organ level and enzymatic.

Table A. Increase in height and body weight in children of the first year of life

Age, months	Increase in height per month, see	Increase in growth over the past period, see	Monthly weight gain, gr.	Weight gain for the past period, gr.

During the first year, the child increases in height by an average of 25 cm, so that by the year his height is on average 75-76 cm. With the correct development of the child, the monthly increase in height can vary within ± 1 cm, however, by 6 months and by the year these fluctuations growth should not exceed 1 cm.

Growth reflects the features of plastic processes occurring in the human body. Hence the importance of quality nutrition, especially the content in it of a sufficient amount of a balanced high-grade protein component and B vitamins, as well as A, D, E. Of course, the "gold standard" of optimal nutrition for children under 1 year old is human milk. Deficiency of certain nutritional components selectively disrupts the growth processes in children. These include vitamin A, zinc, iodine. Stunting can be caused by various chronic diseases.

Measurements of the height of a child in the first year of life are made on a horizontal stadiometer. Measurements are made by 2 people. The measurer is right side child. The assistant holds the child's head in a horizontal position so that the upper edge of the tragus of the ear and the lower edge of the orbit are in the same plane perpendicular to the stadiometer board. The top of the head should touch the vertical fixed bar. The child's arms are extended along the body. Measuring with light pressure on the knees of the child with his left hand, he holds his legs in a straightened position, and with his right hand moves the movable bar of the height meter tightly to the plantar side of the feet, bent at a right angle.

In the second year of life, the child will grow by 12-13 cm, in the third - 7-8 cm.

Body mass.

Unlike height, body weight is a rather labile indicator that reacts relatively quickly and changes under the influence of a variety of reasons. Particularly intensive weight gain occurs in the first quarter of the year. The body weight of full-term newborns ranges from 2600g to 4000g and averages 3-3.5 kg. However, the adaptive body weight is 3250-3650 grams. Normally, in most children, by the 3rd-5th day of life, a “physiological” loss in weight of up to 5% is noted. This is due to the greater loss of water with insufficient milk supply. Recovery of physiological weight loss occurs by a maximum of 2 weeks.

The dynamics of body weight is characterized by a greater increase in the first 6 months of life and less by the end of the first year. The body weight of a child doubles by 4.5 months, triples by a year, despite the fact that this indicator can change and depends on nutrition, previous diseases, etc. The energy of increasing body weight gradually weakens with each month of life.

To determine body weight at the age of one year, it is better to use Table. 3.

Based on this table, the weight gain of the child for each subsequent month of life can be calculated by subtracting 50 grams from the increase of the previous month (but only after the 3rd month), or by the formula: X \u003d 800-50 x n, where 50 is the child adds 50 g less in body weight for each subsequent month of life, after the 3rd month; n is the number of months of a child's life minus three.

For example, in the tenth month of life, a child adds 800-(50x7) = 450g in weight.

There is another opinion that the average monthly increase in body weight in the first half of life is 800g, in the second half - 400g. However, it should be emphasized that the calculation according to the data given in Table. 3 is considered preferable (more physiological). Data on the assessment of body weight in relation to height (body length) for boys and girls in centile intervals are given in Table. 4 and 5.

On average, by one year, the body weight of a child is 10-10.5 kg. The increase in body weight in infants is not always characterized by such a pattern. It depends on the individual characteristics child and a number of external factors. Children with an initial low body weight give relatively large monthly weight gains and it doubles and triples earlier than in larger children. Formula-fed babies immediately after birth double their body weight about a month later than breast-fed babies. Body weight is a labile indicator, especially in a young child, and can change under the influence of various conditions sometimes during the day. Therefore, body weight is an indicator of the current state of the body, in contrast to height, which does not immediately change under the influence of various conditions and is a more constant and stable indicator. A deviation of body weight from the norm up to 10% is not considered a pathology, however, a pediatrician should analyze this loss.

proportionate development.

When assessing the physical development of a child, it is necessary to know the correct relationship between body weight and height. The weight-height indicator (MCI) is understood as the ratio of mass to height, i.e. what is the mass per 1 cm of body length. Normal in newborns (MCI) is 60-75 g.

In addition to height and body weight, correct body proportions are important for assessing physical development. It is known that the circumference of the chest in full-term babies is less than the circumference of the head at birth. Head circumference in full-term children varies within a fairly wide range - from 33.5 to 37.5 cm, on average it is 35 cm. When analyzing these digital indicators, one should take into account the height and weight of the child's body, as well as the ratio of the head circumference to the circumference of the chest . When comparing, it should be borne in mind that at birth the head should not exceed the chest circumference by more than 2 cm. In the future, it is necessary to focus on the growth rate of the head circumference. In the first 3-5 months, the monthly increase is 1.0-1.5 cm, and then 0.5-0.7 cm. By the year, the head circumference increases by 10-12 cm and reaches 46-47-48 cm (on average 47 cm).

In a child born with adaptive indicators of height and body weight, the head circumference is about 36 cm. During the first 3 months of life, the head circumference should “grow” by 4 cm (i.e., at 3 months - 40 cm). Over the next 3 months, the head circumference increases by another 3 cm and becomes 43 cm by 6 months, and 46-48 cm by the year. The size of a large fontanel at birth should not exceed 2.5x3 cm, 3x3 cm.

The circumference of the head is measured with the centimeter tape position at the back at the level of the occiput, and in front - above the eyebrows.

To characterize the physical development of a child, a correct assessment of the characteristics of his chest is of great importance, since vital activity internal organs largely depends on the shape and size of the latter. The increase in chest circumference occurs most intensively in the first year of life, especially in the first 6 months.

In a newborn, the circumference of the chest is 33-35 cm. The monthly increase in the first year of life averages 1.5-2 cm per month. By the year, the circumference of the chest increases by 15-20 cm, after which the energy of growth decreases and the circumference of the chest, on average, increases to preschool age by 3 cm, and in preschool - by 1-2 cm per year.

For an individual assessment of the physical development of the child, it is important to know the periods of intersection of the circumference of the head and chest. In healthy children, this decussation occurs at about 3-4 months, and in children who have at 5-7 months. the cross has not come, you need to take into account and analyze the dynamics of the development of the chest and head in them. An earlier crossover may indicate developing microcephaly, so it is necessary to monitor the timing of the closure of the large fontanel. A large fontanel should overgrow by the end of the first year in 80% of children, in other children - by 1.5 years. The anteroposterior size of the chest in most full-term newborns is less than or equal to the transverse diameter. Already during the first year of life, the transverse diameter begins to prevail over the anteroposterior and the shape of the chest flattens.

Statistical functions.

Static functions are evaluated taking into account the pace of motor development of the child. These are various motor skills of the child. It is necessary to take into account the ability of a child at a certain age to hold his head, make movements with his hands (feeling an object, grasping, holding a toy in one hand, performing various actions), the appearance of dynamic functions (turning from back to stomach and from stomach to back, pulling up, crawling, sitting down stand up, walk, run).

At 2 months, the child holds his head well,

at 3 months - turns well from back to stomach,

at 5.5 -6 months - turns well from stomach to back,

at 6 months - sits if he was planted,

at 7.5 months, (when the child learns to crawl well) - he will sit down by himself,

at 9 months - well worth it,

at 10 months - walks around the arena, holding on with his hand,

by 12 months - walks independently.

The development of static functions is facilitated by various sets of exercises for children: from 1 to 3 months; from 3 to 6 months; 6 to 9 months; from 9 to 12 months.

Timely eruption of milk teeth.

Teeth are laid around the 40th day of embryonic life. The child is born, as a rule, without teeth. Teething is a physiological act, the first teeth erupt at the age of 6 months. First, 2 lower middle incisors appear, by 8 months, 2 upper middle incisors appear, by 10 months, 2 upper lateral incisors appear. By the year, 2 lateral lower incisors erupt. Thus, in 1 year of life, a child should have 8 teeth - 4/4. By the age of 2, the eruption of the remaining 12 milk teeth ends. The skeletal system and the musculoskeletal apparatus in children, especially at an early age, are characterized by physiological weakness and require strict dosed physical activity.

Each of the indicators used, having an independent value, cannot serve as a criterion for the overall development of the child if it is considered in isolation, and not in connection with other signs. Sex differences and indicators of physical development in the first year of life are expressed insignificantly.

Thus, the physical development of a person is understood as a set of morphological and functional features in their relationship and interdependence on conditions. external environment and hereditary factors.

4. Signs of full-term newborn

The average body weight of a full-term newborn is 3400-3500 g for boys and 3200-3400 g for girls, while the fluctuations are very significant, but the lower limit of the body weight of a full-term baby is 2500 g.

Body length averages 50 cm, ranging from 48 to 52 cm. The weight and height of children are influenced by the age of the parents, the state of their health, the diet and regimen of the woman during pregnancy.

The head circumference (32-33 cm) of the newborn is 2-4 cm larger than the chest circumference, the length of the upper and lower limbs is the same, the chest circumference is 3-5 cm more than half-height, the hip circumference is 2-3 cm less than the shoulder circumference . The umbilical ring is located in the middle between the womb and the xiphoid process.

The facial part of the skull of a newborn is relatively small compared to the brain part. In most children, the hairline on the head is well defined. On the head of a child after birth, there may be a birth tumor, which is formed as a result of impregnation of soft tissues with serous fluid. Its resorption occurs in the next few hours after birth and rarely - on the 2nd-3rd day. In the first hours after birth, the face of the newborn is somewhat swollen, the eyes are closed or half-open, the eyelids are somewhat swollen, the skin is pink, and the subcutaneous fat is well developed.

The skin of a newborn is covered with the so-called original cheese-like lubricant, the amount of which varies considerably. On the shoulders and back, the skin is covered with a delicate fluff.

The chest of the newborn is convex, short, inactive. The limbs are short, the lower legs are slightly convex anteriorly and outwards, therefore they appear crooked. The muscles are poorly developed, especially the muscles of the limbs. Newborns are characterized by pronounced hypertension of the muscles, especially the flexors of the limbs. The movements of the upper and lower limbs are erratic. The voice is loud, the cry is insistent. The unconditioned reflexes (sucking, swallowing, sneezing, coughing, etc.) are quite well expressed. In boys, the testicles are lowered into the scrotum; in girls, the small lips and clitoris are covered by the large labia.

For a more accurate characterization of the state of the newborn, the Apgar scale is currently used, making an assessment within 1 minute after the birth of the child.

5. Apgar score

The test was proposed by anesthesiologist Virginia Apgar.

Virginia Ampgar (born Virginia Apgar; June 7, 1909 - August 7, 1974) was an American obstetric anesthesiologist. The author of the famous Apgar scale. She was born on June 7, 1909 in Westfield, New Jersey (USA) to Helen Clark and Charles Emory Apgar. She graduated from Mount Holyoke College in 1929 and Columbia University College of Physicians & Surgeons in 1933. In the same place, in 1937, she completed her residency in surgery. She then studied anesthesiology and returned to Columbia University in 1938 as head of the department of anesthesiology. In 1949, Apgar became the first female professor at Columbia P&S, at the same time she was involved in science and research work at the Sloane Hospital for Women. She received her Master of Public Health degree from Johns Hopkins University in 1959. In 1953, she proposed a test for assessing the health of newborns, the so-called. Apgar scale.

The result, recorded one minute after birth and recorded again 5 minutes later, reflects the general condition of the newborn and is based on observations in five rating categories. Children who score between 7 and 10 are considered good or excellent and usually require only routine care; those who score between 4 and 6 are in fair condition and may require only some resuscitation; and those whose result is less than 4 require immediate assistance to save their lives. At one time, it was believed that children whose scores remained low after 5 minutes after birth were doomed to have neurological problems in the future, but recent studies have shown that most of these children grow up normal and quite healthy.

The score is made up of the sum of the digital indicators of five features. With an indicator of 8-10, the condition of the newborn is assessed as good, with an indicator of 6-7 - satisfactory, and below 6 - severe. So, for example, in a newborn, the heart rate is 120 per minute (score 2), respiratory movements are irregular (1), the limbs are slightly bent (1), the reaction to the nasal catheter is a grimace (1), the skin color is the body is pink, bluish extremities (1); the overall Apgar score is 6.

Assessment of the condition of the newborn on the Apgar scale is practically quite acceptable, although it does not always reflect the variety of possible disorders, especially in preterm infants.

6. Premature baby

A premature baby is a baby born at a period of less than 37 completed weeks, that is, before the 260th day of pregnancy.

Degrees of prematurity:

grade 35-37 weeks weight approximately 2001--2500g

degree 32-34 weeks weight approximately 1501--2000g

degree 29-31 weeks weight approximately 1001--1500g

degree less than 29 weeks weight less than 1000 g.

What is the difference between premature babies and those born at term?

It was not in vain that nature came up with the idea that a person has a 9-month gestation period. At this time, the baby is formed and develops so that by the time of birth it is ready for extrauterine life. If for some reason the baby is born prematurely, then it will be more difficult for him to adapt to the unknown and difficult life outside the mother's tummy. Of course, much depends on how early the baby is not full-term. If the birth took place at 35-36 weeks, then the baby is already mature enough, and if at 28-30 weeks, then much more effort will be required to nurse him.

Premature babies usually have a disproportionate physique with short lower limbs and neck. The head looks larger in relation to the body. The skin of a premature baby is thinner and more delicate, covered with delicate fluffy hair. The ears are very soft. The subcutaneous fat layer in preterm infants is not sufficiently formed, and even fat lumps on the cheeks are weakly expressed. All these signs can have varying degrees of manifestations depending on the date of birth of the baby.

But not only external signs make it possible to distinguish a premature baby. The most important feature is the functional immaturity of all organs and systems of a premature newborn. So, premature babies retain heat worse, they are more lethargic and drowsy, they are characterized by a decrease in muscle tone and sluggish sucking. Of course, these functional features are the more pronounced, the smaller the child.

What is preterm care?

After birth, a premature baby requires special attention from doctors. Regardless of the degree of maturity and prematurity, the child must be given first aid - warm, suck amniotic fluid from the mouth, provide additional oxygen, and in more severe cases - conduct full complex resuscitation activities.

The severity of the condition of a premature baby can be associated with several reasons. First of all, pediatricians pay attention to the formation of respiratory function. In the lungs of a premature baby, not enough special substance is produced - a surfactant, which helps them to fully function: it prevents the alveoli from collapsing and ensures normal gas exchange. A lack of surfactant can cause a variety of respiratory problems, from a mild respiratory distress syndrome to a severe illness in which spontaneous breathing is impossible and mechanical ventilation is required.

Respiratory failure exacerbates the child's metabolic changes caused by birth stress and problems with the circulatory, digestive, and excretory systems.

To create a comfortable thermal regime for a premature baby, the baby is placed in an incubator. In parallel with this, correction of all existing violations is carried out. After a premature baby begins to retain heat better, is able to breathe on his own, and does not require intensive care, he can be transferred from the maternity hospital to the 2nd stage of nursing to a specialized department for premature babies. If premature births occurred in a specialized maternity hospital, then such a department is necessarily included in its composition. Such a department may be part of a maternity hospital, if the maternity hospital specializes in preterm birth, or at a children's hospital.

Nursing a premature baby at this stage is a logical continuation of the activities started in the departments of the maternity hospital. The period of adaptation to extrauterine life in a premature baby also has some differences compared to a full-term baby. Thus, weight loss in premature babies is usually greater than in babies born at term. Restoration of the initial body weight occurs over a longer period: full-term babies usually restore their birth weight by 7-10 days of life, and in premature babies, this period can stretch for 2-3 weeks.

Another condition that occurs in newborns is physiological jaundice. But in premature babies, jaundice is more pronounced and its duration is longer than in full-term babies, which in some cases requires treatment. It is connected with functional features and immaturity of liver enzymes. Feeding a premature baby can also cause some problems, as babies born prematurely do not absorb food well. Feed small newborns begin literally drop by drop, gradually increasing the volume. Breastfeeding is optimal for premature babies. As you know, the composition of the milk of a woman who gave birth prematurely differs from the milk of a mother whose birth occurred on time. It contains more protein, electrolytes, polyunsaturated fatty acids and less lactose, better meeting the needs of a small baby. In the event that breastfeeding is not possible, the child should receive a specialized mixture for premature babies.

When is a premature baby sent home?

This question worries many many parents whose babies were born prematurely. Of course, such decisions are made by doctors based on the condition of the child. Usually, if the weight of the child has reached 2000 g, the baby is actively sucking and gaining weight, he can be discharged under the condition of active monitoring at home by a pediatrician and patronage nurse. In addition, after discharge from the hospital, the baby may need to extra help ophthalmologist, neuropathologist, massage therapist and some other specialists.

In conclusion, it must be added that a baby born prematurely needs not only experienced and competent doctors and nurses, but also the love and care of mom and dad. Nursing a premature baby is a laborious and long process. But a premature baby has every chance to catch up with his peers over time, and in the future not to differ from them in mental and motor development.

A premature baby requires close attention, since a number of problems often arise in the process of nursing it. First of all, this applies to children born with a body weight of 1500 g or less "deeply preterm" and, especially, less than 1000 g "extremely premature." It should be remembered that the division into degrees of prematurity, taking into account weight parameters, does not always correspond to the true conceptual age of the child. This classification method is used to standardize treatment and observation, for the needs of statistics. In practice, in addition to this, it is necessary to take into account more wide range positions for assessing the actual age of the child.

The frequency of preterm birth is variable, but in most developed countries in recent decades it has been quite stable and amounts to 5-10% of the number of children born. The causes of prematurity can be divided into three large groups:

Socio-economic and demographic. Absence or insufficiency medical care, poor nutrition of a pregnant woman, occupational hazards (work on the assembly line, the presence of physical activity, standing position most working day), bad habits, unwanted pregnancy, etc.

Socio-biological. Premature births are more common in nulliparous women under the age of 18 and over 30 years old, the father's age is over 50 years old. The obstetric history matters: artificial termination of pregnancy (especially criminal or occurring with complications), pregnancy that occurred shortly after childbirth (less than 2-3 years).

Clinical. The presence of chronic somatic, gynecological, endocrinological diseases. Pathology of pregnancy: late preeclampsia, acute infectious diseases transferred during pregnancy, surgical interventions, physical injury especially the abdomen.

Pathology of the newborn: intrauterine infections, malformations, chromosomal abnormalities. Survival of premature babies is directly related to gestational age and birth weight. The group of children weighing less than 1500 g and below (less than 30-31 weeks of gestation) is less than 1% of live births, but 70% of newborn deaths. Premature babies during that shortened period of stay in the mother's womb did not have enough time to prepare for the conditions of extrauterine existence, they did not accumulate enough nutrient reserves.

The group of small children is especially dependent on the influence of external factors. They require ideal nursing conditions in order to achieve not only their survival, but also favorable further development.

One of the most important conditions for nursing premature babies is the optimal temperature regime immediately after the birth of the child, they are placed in an environment with an air temperature of 34 to 35.5 degrees (the smaller the weight of the child, the higher the temperature) by the end of the month, the temperature is gradually reduced to 32 degrees.

Another important condition for nursing is air humidity and in the first days it should be 70-80%.

These conditions are observed when placing a child in a couveuse (an incubator for nursing newborns), where children weighing up to 1500 g are usually placed. Also, the thermal regime can be maintained using special changing tables with a source of radiant heat.

Particularly worth mentioning is the feeding of premature babies. Children born before 33-34 weeks of gestation, as a rule, are fed through a tube inserted into the stomach every 3 hours.

7. Anatomical and physiological features of a premature baby

Premature babies have a peculiar physique - a relatively large head with a predominance of the brain skull, sometimes - open cranial sutures, small and lateral fontanelles, a low location of the umbilical ring; poor development of subcutaneous adipose tissue. Premature babies are characterized by abundant vellus hair (lanugo), with a significant degree of prematurity - underdevelopment of nails. The bones of the skull are malleable due to insufficient mineralization, auricles soft. In boys, the testicles are not descended into the scrotum (in extremely immature children, the scrotum is generally underdeveloped); in girls, the genital gap gapes due to underdevelopment of the labia and relative hypertrophy of the clitoris. Based on the external examination of the child, it is possible to draw a conclusion about the degree of prematurity (gestational age) based on a set of morphological criteria, for which evaluation tables of these signs in points have been developed.

The nervous system of premature babies is characterized by weakness and rapid extinction of physiological reflexes (in very premature babies, including sucking and swallowing); slow response to stimuli; imperfection of thermoregulation; muscle hypotension.

The morphology of the brain of a premature baby is characterized by smoothing of the furrows, poor differentiation of gray and white matter, incomplete myelination of nerve fibers and pathways.

The reactions of premature babies to various stimuli are characterized by generalization, weakness of active inhibition, and irradiation of the excitation process. The immaturity of the cortex determines the predominance of subcortical activity: movements are chaotic, shudders, hand tremors, and stop clonus may be noted.

Due to the immaturity of thermoregulatory mechanisms, premature babies are easily cooled (reduced heat production and increased heat transfer), they do not have an adequate increase in body temperature for an infectious process, and they easily overheat in incubators. Overheating contributes to the underdevelopment of sweat glands.

The respiratory system in a premature baby, like the nervous system, is characterized by immaturity (a predisposing background for pathology). The upper respiratory tract in preterm infants is narrow, the diaphragm is located relatively high, rib cage pliable, the ribs are located perpendicular to the sternum, in very premature babies, the sternum sinks. Breathing is shallow, weakened, the frequency is 40--54 per minute, the volume of breathing is reduced compared to full-term children. The rhythm of breathing is irregular, with occasional apneas.

The cardiovascular system of a premature baby, in comparison with other functional systems, is relatively mature, since it is laid on early stages ontogeny. Despite this, the pulse in premature babies is very labile, of weak filling, the frequency is 120-160 per minute. The most immature children are characterized by a rhythmic pulse pattern of the type of embryocardia. On auscultation, heart sounds may be relatively muffled; with the persistence of embryonic shunts (botallian duct, oval window), the presence of noise is possible. Blood pressure in premature babies is lower compared to full-term babies: systolic 50--80 mm Hg. Art., diastolic 20--30 mm Hg. Art. Average pressure 55--65 mm Hg, art.

Due to the increased load on the right side of the heart, the electrocardiogram of preterm infants is characterized by signs of a rightogram and a high P wave in combination with a relatively low voltage and smoothness of the interval S - T.

The gastrointestinal tract of premature infants is characterized by the immaturity of all departments, a small volume and a more vertical position of the stomach. Due to the relative underdevelopment of the muscles of the cardial part of it, premature babies are prone to regurgitation. mucous membrane alimentary canal in premature babies, it is tender, thin, easily vulnerable, richly vascularized. There is a low proteolytic activity of gastric juice, insufficient production of pancreatic and intestinal enzymes, as well as bile acids. All this complicates the processes of digestion and absorption, contributes to the development of flatulence and dysbacteriosis. In 2/3 of premature babies, even those who are breastfed, there is a deficiency of intestinal bifidoflora in combination with the carriage of opportunistic flora. The nature of the child's stool is determined by the characteristics of feeding; as a rule, preterm infants have a lot of neutral fat in the coprogram.

Features of the functioning of the endocrine system of a premature baby are determined by the degree of its maturity and the presence of endocrine disorders in the mother, which caused premature birth. As a rule, the coordination of the activity of the endocrine glands is disturbed, primarily along the axis of the pituitary gland - thyroid- adrenals. Process reverse development in the fetal zone of the adrenal cortex in newborns is inhibited, the formation of circadian rhythms of hormone release is delayed. Functional and morphological immaturity of the adrenal glands contributes to their rapid depletion.

In premature babies, the reserve capacity of the thyroid gland is relatively reduced, and therefore they may develop transient hypothyroidism. The gonads in premature babies are less active than in full-term babies, so they have a so-called sexual crisis much less often in the first days of life.

The processes of metabolic adaptation in premature babies are slowed down. At the age of 4-5 days, they often have metabolic acidosis in the blood plasma in combination with a compensatory shift towards alkalosis inside the cell; on the 2nd-3rd week of life, extracellular acidosis is compensated by intracellular normative reactions. Premature infants (even conditionally healthy ones) often have hypoglycemia, hypoxemia, and hyperbilirubinemia.

Renal regulation of acid-base balance and electrolyte composition in preterm infants is imperfect; water-salt metabolism is labile, which manifests itself as a tendency to edema and rapid dehydration in pathological conditions or inadequate care. The immaturity of the kidneys causes relatively high levels of residual nitrogen in the blood of preterm infants in the first 3 days of life (up to 34.4 mmol / l), in the following days this figure decreases; a premature baby has a relatively stable diuresis. Urine is weakly concentrated (due to the low concentration ability of the kidneys), the frequency of urination usually exceeds that of full-term babies (relatively high metabolic rate and water-nutrition load).

8. Anatomical and physiological features of full-term babies

Leather. Delicate, velvety to the touch, elastic, pink, there may be remnants of vellus hair on the back and shoulder girdle. Its richness in blood vessels and capillaries, the weak development of the sweat glands and the active activity of the sebaceous glands lead to a rapid overheating or hypothermia of the child. He has easily vulnerable skin, which is also important to consider, because. with improper care, diaper rash appears, an infection easily penetrates through the pores and pustules appear. On the back of my head upper eyelids, between the eyebrows there may be bluish or reddish spots caused by vasodilation (telangiectasia), or petechial hemorrhages. Sometimes there are yellowish-white nodules (milia) on the wings and bridge of the nose. All these phenomena disappear in the first months of life. In the area of the sacrum there may also be an accumulation of skin pigment, the so-called. "Mongolian spot". It remains noticeable for a long time, sometimes for a lifetime, but is not a sign of any disorders. The hair of a newborn is up to 2 cm long, the eyebrows and eyelashes are almost invisible, the nails reach the fingertips.

Subcutaneous fat. It is well developed, denser than it will become in the future - in terms of chemical composition, refractory fatty acids now predominate in it.

Bone system. It contains few salts, which give it strength, so the bones are easily bent if the child is not properly cared for.

Infant feature - the presence in the skull of non-ossified areas - the so-called. fontanelles. Large, in the form of a rhombus, located at the junction of the parietal and frontal bones, dimensions 1.8-2.6 x 2-3 cm. Small, in the form of a triangle, is located at the convergence of the parietal and occipital bones and in most children is closed at birth . Such a soft connection of the bones of the skull is of practical importance when the head passes through the narrow birth canal. Its natural deformation into an elongated "pear" is not terrible and should not cause "panic". The correct outlines are a matter of time. Parents should not be frightened by the conspicuous disproportion of the baby's body parts. Indeed, the head looks too large, because it is 1-2 cm larger than the circumference of the chest, the arms are much longer than the legs. The existing disproportion is also a matter of time, which will correct everything.

The chest is barrel-shaped: the ribs are located horizontally, and not obliquely, as in the future. They consist mainly of cartilage, as well as the spine, which does not yet have physiological curves. They will have to form later, when the child begins to sit and stand.

Muscular system. Their increased tone predominates - the arms are bent at the elbows, the legs are pressed to the stomach: the posture is uterine due to the preserved inertia. The neck does not hold the head - her muscles are not strong. The child “knocks” the arms and legs continuously, but purposeful movements and motor skills will come with the maturity of the nervous system.

Respiratory system. The mucous membranes of the respiratory tract are delicate, contain a greater number of blood vessels, therefore, with infections, more often viral, swelling develops quickly, a large amount of mucus is released, which greatly complicates breathing. It is also prevented by the anatomical narrowness of the nasal passages of the newborn, as well as his trachea (windpipe) and bronchi. The auditory, or Eustachian, tube is wider and shorter than in children older than age, which facilitates the penetration of infection and the development of otitis (inflammation of the middle ear). But on the other hand, there is never inflammation of the frontal sinus (frontitis) and maxillary, or maxillary, sinus (sinusitis), because they are not yet available. The lungs are underdeveloped, breathing is superficial and is mainly carried out by the diaphragm - a muscle located on the border of the chest and abdominal cavity. Therefore, breathing is easily disturbed by the accumulation of gases in the stomach and intestines, constipation, tight swaddling, pushing the diaphragm up. Hence the wish - to follow the regular emptying of the intestines, not to swaddle the child too tight. Since the baby does not receive enough oxygen during its shallow breathing, it breathes frequently. The norm is 40-60 breaths per minute, but this frequency increases even with a slight load. Therefore, it is necessary to pay attention first of all to shortness of breath, which is accompanied by a feeling of lack of air and can be a sign of a disease.

The cardiovascular system. With the birth of a newborn, changes occur in the circulatory system, at first the functional ones - the umbilical vessels and the vein cease their activity, and then the anatomical ones - the intrauterine blood flow channels are closed. With the first breath, the pulmonary circulation is activated, passing through which the blood is saturated with oxygen in the lung tissue. The pulse rate is 120-140 beats per minute, when feeding or crying, it increases to 160-200 beats. Blood pressure at the beginning of the first month 66/36 mm Hg. Art., and by the end of it - 80/45 mm Hg. Art.

Features of the development of young children

At this time, 3 periods of development are quite clearly traced in children.

The first period is from a year to a year and a half.

A child who has begun to walk becomes much more independent than before; at this age he is an explorer; he climbs everywhere. He fills himself with bumps, and he can not be kept. At the same age, the child begins to speak.

The second period is from one and a half to 2 years.

The kid improves in the skills acquired earlier, determines his place in the environment; you already clearly trace the manifestations of his character.

The third period is from 2 to 3 years.

This is the period of the most active mental development of the child.

Early age is the most important period in the development of a preschooler. It was at this time that the baby's transition to new relationships with adults, peers, and the outside world takes place. Early age is characterized by high intensity of physical and mental development. The activity of the child increases, its purposefulness increases; his movements become more varied and coordinated.

By the age of three, there are significant changes in the nature and content of the child's activities, in relations with others: adults and peers. The leading type of activity at this age is subject-effective cooperation. A three-year-old child is already able not only to take into account the properties of objects, but also to assimilate some generally accepted ideas about the varieties of these properties - sensory standards of shape, size, color, etc. They become samples, measures against which the features of perceived objects are compared.

Visual-figurative becomes the predominant form of thinking. The child is able not only to combine objects according to their external similarity (shape, color, size), but also to assimilate generally accepted ideas about groups of objects (clothes, dishes, furniture). Such representations are based not on the allocation of common and essential features of objects, but on the unification of those that are part of a common situation or have a common purpose. Children's curiosity is growing rapidly. At this age, there are significant changes in the development of speech: the vocabulary increases significantly, elementary types of judgments about the environment appear, which are expressed in fairly detailed statements.

At this age stage, children actively form the first elementary ideas about good and bad, behavioral skills, good feelings for adults and peers around them. This happens most successfully in conditions of favorable pedagogical influence of the kindergarten and the family. The third year of a child's life is transitional in development. This is still a small child, who has a lot in common with children of the previous stage and who requires especially careful and attentive attitude on the part of adults, but at the same time, he has qualitatively new opportunities in mastering skills, in forming ideas, in accumulating personal experience behavior and activities.

Children from two to three years old are characterized by an active focus on performing actions without the help of an adult, the manifestation of elementary types of verbal judgments about the environment, the formation of new forms of relationships, a gradual transition from single games and games side by side to the simplest forms of joint gaming activity. In the early age group, the teacher reinforces the ability to politely address adults and children with a request, provide small services to others, play with peers, give in toys, books, teaches the observance of elementary rules in didactic, outdoor games: listen calmly to the drivers, patiently wait for your turn ( if the wait is short). The guys are involved in preparing the table for breakfast, lunch, to carry out assignments for the care of plants and animals.

To implement these tasks, the teacher uses imitation as a specific feature of children two to four years old. An adult shows by his own example a positive attitude to work, to people around him, to children.

Young children are characterized by great emotional responsiveness, which allows them to successfully solve the problem of cultivating good feelings and relationships with people around them. At the same time, it is very important that the teacher maintains a positive emotional state in the kids: responsiveness to his proposal, request, a sense of empathy at the sight of another's grief. The children are brought up with love for their loved ones, the desire to do something good for them. This is achieved with the approval, praise by adults of the child's manifestations of good feelings towards others.

Early age - period intensive development child of different activities and personality development. In child psychology and pedagogy, the following main directions in the development of a child at this age stage are distinguished:

Development of subject activity;

Development of communication with adults;

Development of speech;

Game development;

Introduction to different types artistic and aesthetic activities;

Development of communication with peers, physical development and personality development

This division is rather arbitrary, since development is a single process in which the identified areas intersect, interact and complement each other.

In the third year of life, the child continues to master the surrounding objective world. The actions of the baby with objects become more diverse and dexterous. He already knows how to do a lot himself, knows the names and purposes of household items, strives to help adults: wash dishes, wipe the table, vacuum the floor, water the flowers. He increasingly consciously wants to act like an adult, he begins to be attracted not only by the process of performing an action, but also by its result. The child tries to get the same result as the adult. Thus, the child's attitude to his activity gradually changes: the result becomes its regulator. In independent studies, games, the baby begins to be guided by the plan, the desire to achieve success in activities.

Mastery of objective activity stimulates the development of such personal qualities of children as initiative, independence, purposefulness. The child becomes more and more persistent in achieving the goal.

In the third year of life, communication with peers begins to take an increasing place. This is due to the fact that by the age of three there is a special, specific content of children's communication with each other.

There is a noticeable change in communication: actions towards a peer as an inanimate object are on the wane, there is a desire to interest him in himself, sensitivity to the attitude of a peer. More and more kids are enjoying playing together. Their unpretentious and short-term actions are based on imitation of each other, but they speak of nascent communication. However, no matter how attractive the game with a peer is, an adult or a toy that appears in the field of view distracts the children from each other.

There may be arguments and aggression associated with ignorance of behavior, which in turn leads to tears in babies. In order to avoid conflicts, to show children how to behave, to evoke humanistic and kind feelings, a fairy tale helps the teacher in his work. Children are ready to perceive the meaning of the work through fairy-tale characters and project it into their lives.

Introduction. Healthy child

"... and when they asked to bring the most beautiful thing that exists in the whole wide world, the crow brought her child..."

The first fragmentary information about a healthy and sick child appeared in ancient times. Hippocrates, Galen, Soranus, Avicenna emphasized in their treatises the presence of features of the child's body that distinguishes it from an adult and determines the atypical course of diseases, especially in early childhood. Even then, scientists paid much attention to the importance of breastfeeding, physical education and proper care for the harmonious growth and development of the child.

In the modern world, it is necessary to pay great attention to the development and upbringing of children. Children are the future of our planet.

1. Periods of childhood

A child in different periods of life is characterized by certain anatomical and physiological features, the totality of which leaves an imprint on the reactive properties and resistance of the organism. This explains both the peculiarity of the pathology and the peculiar course of certain diseases in children of different age groups.

But one should not think that the age characteristics of the child themselves doom him to illness. If environmental conditions, temperature regime, nutrition, care, use of fresh air, etc., meet the requirements of the body of a newborn or infant, then this creates the prerequisites for its proper growth, development and protection from diseases. Conversely, adverse environmental conditions adversely affect the health of the child. Even small errors in care, nutrition, temperature can adversely affect the health of the child, especially the newborn and infant.

The most acceptable for practical purposes is the scheme of N. P. Gundobin, according to which the entire childhood age is divided into the following periods.

Works: Education and treatment of a child up to the age of seven, 3rd ed., M., 1913; Features of childhood, St. Petersburg, 1906.

I. The period of intrauterine development: 1) the phase of embryonic development (embryo), 2) the phase of placental development (fetus).

II. Neonatal period.

III. The period of infancy (younger toddler age),

IV. The period of milk teeth: a - pre-preschool age (senior toddler age), b - preschool age (the period of attending kindergarten).

V. The period of adolescence (primary school age).

VI. Puberty (senior school age).

All the changes made by Soviet pediatricians are marked in brackets.

2. Stages of intrauterine development

In the intrauterine development of a person, three periods are conventionally distinguished:

The implantation period lasts from the moment of fertilization to 2 weeks. This period is characterized by a rapid systematic crushing of a fertilized egg, its advancement along the fallopian tube to the uterine cavity; implantation (attachment of the embryo and introduction into the uterine mucosa) on the 6-7th day after fertilization and further formation of the fetal membranes, creating the necessary conditions for the development of the embryo. They provide nutrition (trophoblast), create a liquid habitat and mechanical protection (fluid of the amniotic sac).

After the 28th week of pregnancy, the fetus begins to form a supply of valuable substances that are necessary in the first time after birth - calcium, iron, copper, vitamin B12, etc. The surfactant matures, which ensures normal lung function. Prenatal development is influenced by various environmental factors. They have the most significant effect on the organs that develop most intensively at the time of exposure.

3. Breast period

For the first quarter of the year, the child grows by 3 cm every month, for the second quarter - by 2.5 cm, for the third quarter - by 1.5 cm, and for the fourth quarter of the year the child adds 1 cm in height every month. Large shifts are observed in the chest period in the psychomotor development of the child, during this period the foundation of health, physical and mental development is laid. It is evaluated every quarter of the year.

The reactions of auditory perception are manifested, in addition to auditory concentration (end of the 2nd week), a clear orientation to sounds (1st month) and the search for its source from the end of the 2nd month. At 2–3 months, the child listens to sounds, and at 3–3.5 months, he unmistakably searches for the source of the sound. At 3–7 months, constant activity to various sound stimuli is manifested, and from 10–11 months - a reaction to sound in connection with the content and meaning of this sound.

Baby's motor development - holds head when held upright (at 5-6 weeks), lifts head or turns it to the side in prone position (at 5 weeks), rolls over to side from supine position (4–4.5 months), sits independently (6–7 months), walks on all fours (at 8 months), gets up and stands, adhering to support (7–8 months), walks independently (at 11–12 months). m month).

Development of grasping ability - stretches out a hand to an object (at the 3rd month), grasps an object (4.5 months), holds an object in each hand (6 months), brings the whole body into an active state when grasping (at the 7th month ), the beginnings of specific manipulations (on the 11th month).

Teething from 5-7 months.

From 4–6 weeks, visual-auditory search and visual concentration on the face of an adult are observed, and from 3 months there is a pronounced need to communicate with adults. In an infant, the leading line of motor activity at 7-8 months is crawling, at the 12th month - the beginnings of manipulation games.

The development of I and II signaling systems of the central nervous system occurs, the goiter and thyroid glands function; adrenal function is weakened; beginning of pituitary function.

Rickets, malnutrition, food and respiratory allergies, respiratory diseases and acute gastrointestinal diseases may appear.

In each period, for the correct development of the child, the creation of certain environmental conditions, regimen, and upbringing is required.

Features of growth and development

Significant growth rates are characteristic - body length (height) increases by 50% of the length at birth, reaches 75-77 cm by the age of 1 year. Head circumference by the year is 46-47 cm, chest circumference - 48 cm. There is a rapid development of motor skills and motor skills . There are three peaks of physical activity: I - 3-4 months - a complex of revival, joy at the first communication with adults; II - 7-8 months - activation of crawling, formation of binocular vision (mastery of space); III peak - 11-12 months - the beginning of walking. Their sensory-motor connections are determined. Skeletal muscles and motor activity are factors that determine the processes of growth and development in the first year of a child's life. The growth rate is provided by a high metabolism.

Features of the central nervous system

The orienting reflex is preserved, reflecting the innate need for movement and activity of the sense organs. Nerve connections between the child and surrounding people are established through facial expressions, gestures, voice intonations. The development of fine hand movements contributes to the development of the brain and speech. Connections arise between words and response motor reactions of the child, then the child associates the visual and auditory perception of objects with words, the names of objects when they are shown, connections with individual actions (“give”, “show”) - this is the optimal course of development, necessary as a basis for other periods of childhood. The need for contact with adults determines the mental development of the child.

Electroencephalogram at 2-3 months - stable rhythm; at 4-6 months - changes are unidirectional; at 8-10 months - progressive individualization.

Features of the endocrine system

Features of immunity

There is a slight decrease in the number of T- and B-cells in the blood compared with the neonatal period. Decrease in maternal IgG from 2–3 months is expressed, synthesis of own IgG increases from 2–3 months; its constant level is established after 8 months - 1 year. The IgM level by the end of the year is 50% of the adult level. The concentration of IgA slowly increases. IgE in a healthy child is contained in a small amount, its level depends on the manifestations of allergies (increases). The second critical period of immunity is noted at 4–6 months and is characterized by: the lowest level of specific antibodies - physiological hypogammaglobulinemia; synthesis of IgM antibodies that leave no immunological memory. Measles and whooping cough atypically occur without leaving immunity! High sensitivity to respiratory syncytial infection, parainfluenza viruses and adenoviruses remains.

Nonspecific resistance factors

Typically high content of lysozyme and properdin. By the end of the first month of life, the complement level rises rapidly and reaches the adult level. From 2–6 months, the final phase of phagocytosis of leukocytes to pathogenic microorganisms is formed, with the exception of pneumococcus, staphylococcus, Klebsiella, Haemophilus influenzae.

The nature of the pathology

Assessment of physical development, motor skills, speech development, neuropsychic development, taking into account the leading line of development in the chest period, is carried out quarterly.

To assess the physical development of children under 1 year old, it is better to use the following indicators:

body weight;

Proportionality of development (head circumference; chest circumference, some anthropometric indices);

Static functions (motor skills of the child);

Timely eruption of milk teeth (in children under 2 years old).

The skull of a newborn has specific features. See fig.

Table A. Increase in height and body weight in children of the first year of life

Age, months	Increase in height per month, see	Increase in growth over the past period, see	Monthly weight gain, gr.	Weight gain for the past period, gr.
1	3	3	600	600
2	3	6	800	1400
3	2,5	8,5	800	2200
4	2,5	11	750	2950
5	2	13	700	3650
6	2	15	650	4300
7	2	17	600	4900
8	2	19	550	5450
9	1,5	20, 5	500	5950
10	1,5	22	450	6400
11	1,5	23, 5	400	6800
12	1,5	25	350	7150

Measurements of the height of a child in the first year of life are made on a horizontal stadiometer. Measurements are made by 2 people. The measurer is on the right side of the child. The assistant holds the child's head in a horizontal position so that the upper edge of the tragus of the ear and the lower edge of the orbit are in the same plane perpendicular to the stadiometer board. The top of the head should touch the vertical fixed bar. The child's arms are extended along the body. Measuring with light pressure on the knees of the child with his left hand, he holds his legs in a straightened position, and with his right hand moves the movable bar of the height meter tightly to the plantar side of the feet, bent at a right angle.

In the second year of life, the child will grow by 12-13 cm, in the third - 7-8 cm.

Body mass.

To determine body weight at the age of one year, it is better to use Table. 3.

For example, in the tenth month of life, a child adds 800-(50x7) = 450g in weight.

On average, by one year, the body weight of a child is 10-10.5 kg. The increase in body weight in infants is not always characterized by such a pattern. It depends on the individual characteristics of the child and a number of external factors. Children with an initial low body weight give relatively large monthly weight gains and it doubles and triples earlier than in larger children. Formula-fed babies immediately after birth double their body weight about a month later than breast-fed babies. Body weight is a labile indicator, especially in a young child, and can change under the influence of various conditions sometimes during the day. Therefore, body weight is an indicator of the current state of the body, in contrast to height, which does not immediately change under the influence of various conditions and is a more constant and stable indicator. A deviation of body weight from the norm up to 10% is not considered a pathology, however, a pediatrician should analyze this loss.

proportionate development.

In a child born with adaptive indicators of height and body weight, the head circumference is about 36 cm. During the first 3 months of life, the head circumference should “grow” by 4 cm (that is, at 3 months - 40 cm). Over the next 3 months, the head circumference increases by another 3 cm and becomes 43 cm by 6 months, and 46-48 cm by the year. The size of a large fontanel at birth should not exceed 2.5x3 cm, 3x3 cm.

The circumference of the head is measured with the centimeter tape position at the back at the level of the occiput, and in front - above the eyebrows.

To characterize the physical development of a child, a correct assessment of the characteristics of his chest is of great importance, since the vital activity of the internal organs largely depends on the shape and size of the latter. The increase in chest circumference occurs most intensively in the first year of life, especially in the first 6 months.

In a newborn, the circumference of the chest is 33-35 cm. The monthly increase in the first year of life averages 1.5-2 cm per month. By the year, the circumference of the chest increases by 15-20 cm, after which the growth energy decreases and the circumference of the chest increases on average by 3 cm by preschool age, and by 1-2 cm per year in preschool age.

Statistical functions.

At 2 months, the child holds his head well,

at 3 months - turns well from back to stomach,

at 5.5-6 months - turns well from stomach to back,

at 6 months - sits if he was planted,

at 7.5 months, (when the child learns to crawl well) - sits down by himself,

at 9 months - well worth it,

at 10 months - walks around the arena, holding on with his hand,

by 12 months - walks independently.

The development of static functions is facilitated by various sets of exercises for children: from 1 to 3 months; from 3 to 6 months; 6 to 9 months; from 9 to 12 months.

Timely eruption of milk teeth.

Thus, the physical development of a person is understood as a set of morphological and functional features in their relationship and interdependence on environmental conditions and hereditary factors.

4. Signs of full-term newborn

The head circumference (32-33 cm) of a newborn is 2-4 cm larger than the chest circumference, the length of the upper and lower limbs is the same, the chest circumference is 3-5 cm more than half-height, the hip circumference is 2-3 cm less than the circumference of the shoulders. The umbilical ring is located in the middle between the womb and the xiphoid process.

The facial part of the skull of a newborn is relatively small compared to the brain part. In most children, the hairline on the head is well defined. On the head of a child after birth, there may be a birth tumor, which is formed as a result of impregnation of soft tissues with serous fluid. Its resorption occurs in the next few hours after birth and rarely - on the 2-3rd day. In the first hours after birth, the face of the newborn is somewhat swollen, the eyes are closed or half-open, the eyelids are somewhat swollen, the skin is pink, and the subcutaneous fat is well developed.

The skin of a newborn is covered with the so-called original cheese-like lubricant, the amount of which varies considerably. On the shoulders and back, the skin is covered with a delicate fluff.

For a more accurate characterization of the state of the newborn, the Apgar scale is currently used, making an assessment within 1 minute after the birth of the child.

5. Apgar score

The test was proposed by anesthesiologist Virginia Apgar.

Virginia Apgar (Eng. Virginia Apgar; June 7, 1909 - August 7, 1974) was an American anesthesiologist in obstetrics. The author of the famous Apgar scale. She was born on June 7, 1909 in Westfield, New Jersey (USA) to Helen Clark and Charles Emory Apgar. She graduated from Mount Holyoke College in 1929 and Columbia University College of Physicians & Surgeons in 1933. In the same place, in 1937, she completed her residency in surgery. She then studied anesthesiology and returned to Columbia University in 1938 as head of the department of anesthesiology. In 1949, Apgar became the first female professor at Columbia P&S, while at the same time she did scientific and research work at the Sloane Hospital for Women. She received her Master of Public Health degree from Johns Hopkins University in 1959. In 1953, she proposed a test for assessing the health of newborns, the so-called. Apgar scale.

The score is made up of the sum of the digital indicators of five features. With an indicator of 8-10, the condition of the newborn is assessed as good, with an indicator of 6-7 - satisfactory, and below 6 - severe. So, for example, in a newborn, the heart rate is 120 per minute (score 2), respiratory movements are irregular (1), the limbs are slightly bent (1), the reaction to the nasal catheter is grimace (1), the skin color is pink, the limbs are cyanotic (1); the overall Apgar score is 6.

From the very first days of his birth, a person begins, like a sponge, to absorb a huge amount of information coming from the external environment: from people, from things, from events and life situations. And in addition to the fact that a person begins to develop physically, his psyche, his personality is also formed. And hardly anyone can give a 100% correct answer to the question of how this person will grow up. But if you start to understand what human development is, you will find that this complex process has its own patterns. And for this reason, one of the most important topics in psychology can be safely called developmental psychology, which is the subject of this lesson.

In the process of studying the presented material, we will get acquainted with the problem of development in psychology, as well as the subject and methods of developmental psychology and developmental psychology. Let us find out what specific questions developmental psychology studies and what tasks it sets for itself. Let's talk separately about such things as the development of the child, the development of abilities. We will find out what principles of development exist in psychology and how the formation and development of a person generally takes place. Let us briefly touch on various age-related deviations and abnormal development.

What is Developmental Psychology

And according to our traditional scheme, to begin with, we should understand what developmental psychology is in general, and how this phenomenon is understood in modern psychological science.

This is a field of psychology that studies the psychological changes of a person as he grows up. Therefore, developmental psychology is often referred to as developmental psychology, although developmental psychology can be safely called the methodological basis of developmental psychology, because. it contains a more extensive knowledge base. Age-related psychology may be part of developmental psychology, but in this lesson we will use these concepts as synonyms.

Developmental psychology includes several subsections:

Prenatal and Perinatal Psychology - studies the mental life of unborn and newborn children;
Child psychology - studies the mental development of the child;
Psychology of youth and adulthood - studies the mental characteristics of people in adolescence and adulthood;
Gerontopsychology - studies the psyche of the elderly.

Developmental psychology deals with the study of the human psyche and body in different age periods and at all stages. The appearance of developmental psychology dates back to 1882 and is associated with the publication of the book "The Soul of the Child" by the German psychologist Wilhelm Preuer. This work was devoted to child psychology. And already in the 20th century, developmental psychology became an independent science. And like any serious independent science, developmental psychology has its own subject, object, tasks and functions, which we will discuss below.

Subject, object, tasks and functions of developmental psychology

The object of developmental psychology. Based on the fact that psychology is the science of man and his mental characteristics, the object of developmental psychology is a person in the process of his development and maturation. Developmental psychology determines changes in the psyche of people associated with age, and tries to explain them, to understand the patterns by which people acquire knowledge and experience.

The subject of developmental psychology. The subject of study of developmental psychology is specific age periods, the causes of transitions from one period to the next and their mechanisms, trends, patterns, as well as the pace and direction of mental development in the process of overall human development. This also includes the individual and age characteristics of people, the development of mental processes and various types of activity, the formation of personality traits.

Tasks of developmental psychology. Developmental psychology sets itself the following tasks:

Reveal the general patterns of human development
Determine the reasons for the transition from one stage to another
Classify age periods
Create a psychological picture of each period
To study the leading factors of development

In connection with the tasks set, the following functions of developmental psychology can be distinguished:

Descriptive function- describes the features of human development in specific age periods in terms of external manifestations and internal experiences;
explanatory function- explains and helps to understand the causes, factors and conditions of changes in human behavior, as well as his experiences in different age periods;
predictive function- predicts certain changes in the behavior and experiences of a person at each age stage;
Corrective function- creates optimal conditions for managing human development.

Based on the foregoing, we can conclude that developmental psychology reveals the psychological content of each stage of development (growing up) and their dynamics. Moreover, any changes are considered in dynamics and taking into account the factors influencing the development of the human psyche. In the process of research, the patterns of development at different stages are compared, the mechanisms for acquiring and maintaining knowledge and skills are studied, they are compared and further identification of factors influencing personal and intellectual growth.

In order to make it possible to compile the most objective and holistic description of the development of the human psyche at all stages of his life, today a large number of different methods are used in research, which should be discussed in more detail.

Methods of developmental psychology

Developmental psychology uses general scientific and general psychological methods adapted specifically for it. And preference is given to the methods most suitable for studying age-related changes in the psyche and mental processes. All methods of developmental psychology can be divided into several categories: general scientific methods, psychogenetic, psychophysiological, historical and psychological. Let's consider each category separately.

General scientific methods

General scientific methods are a special modification of methods that are used in many other scientific disciplines. The main among them are observation, experiment and modeling.

Observation

Observation- this is a purposeful and regularly repeated study of a person, based on the results of which an objective assessment is given. The observation method is a prerequisite for other methods such as journaling or autobiography. And the observation itself can be divided into several subspecies:

Indirect observation (the researcher does not register the process itself, but only its result; such observation can occur through authorized persons);
Direct observation (the researcher records data during direct observation of the process);
Field observation (the researcher records data in the natural environment);
Laboratory observation (artificial conditions are specially created for observation);
Open observation (the study is conducted openly and all its participants know about it);
Covert observation (the object of observation may not know about the study or know only part of the information);
Involved observation (the researcher himself participates in the process and can interact with the object);
Non-involved observation (the researcher can only observe without being included in the process itself);
Random observation (research is provided spontaneously, unplanned, due to circumstances);
Purposeful observation (the study is carried out specially, pre-planned);
Continuous observation (the researcher observes all objects, not singling out anyone);
Selective observation (the researcher observes a specific object);
Arbitrary observation (uncontrolled observation that does not have a clear plan);
Structured observation (the study is carried out according to a specific plan, using special documents, instruments, etc.);
Ascertaining observation (the study is carried out with the aim of fixing the data, without evaluating them);
Evaluative observation (a study is carried out in order to record data and evaluate them).

You can do your own observation. It is only important to understand why you will spend it. Set a goal. This is a top priority. For example, you would like to know how easy it is for your growing child to find a common language with peers. Use the method of purposeful non-participant field direct observation. Simply put, when you go for a walk with your child, go to the playground and let him play, watch him, look at how he converges with other children. Such an observation will give you an answer to a question that concerns you, you will get to know your child better, and you will also be able to somehow improve the model of your upbringing in order to eliminate the shortcomings that have begun to appear or, conversely, to strengthen some positive qualities you have noticed. Observation can become more scientific if you define a specific goal, carefully plan your research, try to simulate the situation and create the right conditions, and use some documentation or adhere to a certain system for analysis.

Experiment

Experiment is a method of purposefully changing one or more variables and observing the results of this change. It differs from observation in that it studies the reactions of a person, and not the spontaneous manifestations of his psyche. There are several types of experiment:

Laboratory experiment (the study is carried out in special conditions, and the subject is aware of his participation);
Natural experiment (the study is as close as possible to natural conditions, and the subject may not be aware of his participation);
Chamber experiment (research is carried out under less severe conditions than laboratory ones, but not in natural conditions: a room, a special room, etc.);
Formative experiment (during the study, the researcher actively influences the subject);
Individual experiment (the study is conducted with one person);
Group experiment (the study is conducted with a group of people).

The experiment is good in that it can be carried out repeatedly and created special conditions to study the mental process of interest. So, for example, it is very easy to check under what conditions your child best learns the material being studied. Conduct this experiment: find out your child's homework and, in the first case, give him the opportunity to do it on his own, without helping him and not being included in the process. In the second case, at run time homework stay close to your child and take part in homework from time to time (voice the task yourself or participate in the process of doing it). Such an experiment will allow you to find out what conditions are best for your child to effectively complete homework and master the material being studied, and this, in turn, means that you will be able to create precisely such conditions in the future, and your child's academic performance can significantly increase.

Modeling

Modeling- this is a recreation of a certain mental reality (state, situation, mood, etc.). The modeling method is used in psychology in order to obtain more accurate data about the psyche of the person being studied, the features of his behavior in certain situations and under certain conditions, as well as his reactions to them.

Using the modeling method, you can find out, for example, whether your child got rid of some bad habit after you took certain measures for this. Let's say you notice that your child constantly bites his nails when he has nothing to do with his hands for a long time. You told him that it was bad, tried in every possible way to show that it was not necessary to do this, that it was ugly and unhygienic, tried to distract him so that the habit faded into the background, used some other methods. Then you saw that for a week the child did not bite his nails. In order to verify the effectiveness or ineffectiveness of the methods you use to wean a child from a bad habit, you can specifically simulate the situation so that for a long time the child has nothing to do with his hands. Create conditions for internal impulses to manifest externally: stop distracting the child, turn on a cartoon for him or just leave him in the room, but so that there are no toys nearby, etc. of things. It is important that you can observe the child. Watch what he does, how his behavior has changed on the physical level. If your methods have been effective, then you will see that the child will not bite his nails. If your methods were ineffective, then the child will again pull his hands to his mouth, and this will be an occasion to try to wean the child from the bad habit in some other way. Perhaps even consult a specialist on such issues.

The above examples of the application of general scientific methods, of course, are far from the only and not exhaustive. In fact, there are a lot of ways to use them and they all differ in their characteristics. Our task is to understand the very idea and principle of operation of general scientific methods. And for this you need to more often project them onto the surrounding reality and put them into practice.

Next on the list, but less important, are psychophysiological methods.

Psychophysiological methods

Psychophysiological methods include methods for studying the higher nervous activity of children. The following are considered the most proven:

A technique for studying conditioned reflexes based on swallowing movements;
A technique for studying conditioned reflexes based on grasping movements;
A technique for studying conditioned reflexes based on indicative reinforcement (for example, the appearance of a picture);
A technique for studying conditioned reflexes based on verbal reinforcement;
Methodology for the study of sucking food reflexes;
Methodology for the study of defensive protective movements of the eye;
Replacing the direct stimulus with its verbal designation

Psychophysiological methods, as a rule, are used to study children in the first and second years of life and in specialized institutions. Therefore, if you are not a narrow specialist, these techniques are unlikely to give any results or practically valuable knowledge. The most convenient and recommended way to get acquainted with psychophysiological methods is to observe how specialists use them, as well as the ability to correctly interpret the data obtained.

Psychogenetic methods

Psychogenetic methods are aimed at isolating environmental and heredity factors in individual variations of psychological qualities. It can be said that “genotypic-environmental” is being studied, where the genotype is understood as a set of genes, and the environment is non-genetic factors that affect a person. The main psychogenetic methods are:

Twin method based on a comparison of two types of twins (monozygous, developed from one egg and dizygotic, developed from two or more eggs). There are also varieties of the twin method: classical, control twin method, separated twin method, family method, etc.;
Foster child method;
Pedigree analysis method (genealogical).

Psychogenetic methods, along with psychophysiological methods, can only be used by specialists and in specialized institutions, because appear to be the most complex and require a purely scientific approach.

historical methods

Historical methods, or, as they are also called, methods of document analysis, study the life path of a person, the features of heredity and environment, which created special prerequisites for his spiritual development. Basically, historical methods study those people whose activities had or have a certain cultural value, but can also be used to study the lives of ordinary people. This group of methods includes the following:

Diary
Autobiographical
Biographical
Pathographic (diseases of prominent people are described)

Historical methods seem very convenient for their application in practice, even ordinary people. If you have a person who arouses your admiration, and you would like to know more about him, his life, the conditions in which he developed, his inner world, then you can use the biographical or autobiographical method. To do this, you need to find and familiarize yourself with the sources that contain data about the life and personality of this person. And if you want to identify any patterns or important stages in the development of your child, you can use the diary method. Write down your observations about the subject of study in a diary. This diary should be a kind of protocol of observations, the analysis of which will help to identify what you need. By the way, the diary method is very popular and many psychologists have created their theories based on observations of their children.

And the last group of methods of developmental psychology are psychological methods.

Psychological methods

Psychological methods can be divided into two subgroups.

TO first subgroup include introspective methods. They are designed to directly collect information about the object of study. Here stand out:

Introspection- is used to identify certain features and mental phenomena in oneself by a person;
Self-esteem- is used to identify a person in himself not only features and phenomena, but also stable mental qualities.

Co. second subgroup include socio-psychological methods, carried out, in most cases, indirectly. Here stand out:

Conversation- obtaining information through communication, where the roles of participants are equal (a conversation between a teacher and a student, a conversation between a father and a son, etc.);
Interview- obtaining information through communication, where one person asks questions, is the leader, and the second answers, is the follower (oral exam, etc.);
Questionnaire- obtaining information through people's answers to prepared questions;
Sociometry- obtaining information through the study of the status of a person in society (a group of people);
Analysis of products of activity (creativity)- obtaining information through knowledge control (dictations, essays, etc.), restoration of activities from the opposite (from the result), graphics, drawings, etc.;
Testing- obtaining information through short structured tests (aptitude tests, perception tests, skill tests, projective tests, career guidance tests, intelligence tests, etc.).

Psychological methods can be safely ranked among the most commonly used in developmental psychology. One of the reasons for this is the convenience of their use and the ability to apply almost everywhere. You yourself can use any of the psychological methods in order to learn more about yourself or your loved ones. For yourself, for example, you can apply the method of self-observation, which will help you learn more about your character traits, habits, reactions, and so on. If you have a child, you can offer him some tests. It is up to you to decide what the test will be designed to determine. You can find a huge number of all kinds of tests on the Internet or in special collections that are sold in bookstores.

You can get more information about psychological methods from the second lesson of this training.

As we have noticed, there are quite a lot of research methods in developmental psychology. And for the most accurate definition and study of the origin, emergence and development of a person's mental manifestations at each stage of his development, these methods should be used, both individually and in combination. But what is no less important is to take into account the age of people whose mental characteristics are being studied, because there are certain age groups with their own special characteristics and features. Below are the age groups.

Age groups

Age- this is a kind of period of physical, psychological and behavioral development, which is characterized by its own characteristics. There are several types of ages:

biological age- the degree of development of the organism;
social age - degree of development social roles and functions;
Psychological age - features of psychology and behavior;
physical age - quantitative indicator of human development (days, weeks, months, years).

The division of a person's life path exists in order to make it possible to better understand the patterns of development and the specifics of different age stages. There have been many attempts at periodization throughout the history of developmental psychology. But the problem is objective age periodization remains relevant to this day, because. none of the previously proposed periodizations has been confirmed in the specific results of the study of developmental psychology. But, of course, despite this, the main age groups can still be distinguished. Physical periodization is best suited for this:

Infancy (from birth to 1 year)
Early childhood (from 1 year to 3 years)
Preschool age, play (from 3 to 6 years old)
School age(from 6 to 12 years old)
Youth (from 12 to 20 years old)
Youth (20 to 25 years old)
Adulthood (from 25 to 60 years old)
Old age (from 60 years old)

Each age group, among other things, is characterized by its own psychological characteristics. And the psychological periods do not coincide with the physical periods indicated above. So, if we consider the age groups on a psychological basis, the picture will look like this:

Up to 1 year

Everything is extremely simple here: the main thing that parents need to do in order for the child to develop is to support his life, feed, take care, etc. It is during this period that the child begins to learn about the world around him. Even at such a small age, the character of a person, especially behavior, perception, begins to appear. You need to be careful and pay attention to absolutely everything that concerns the child.

From 1 year to 3 years

During this period, the situation changes, the child begins to walk, show interest in his body and his genitals, and also expand his, so far small, vocabulary. The individuality of the child begins to appear and it is already possible to begin to notice its differences from other children. You can also see manifestations of predisposition. So, for example, you can give the baby a marker and see what he will do with it: he will start to nibble, throw or draw. Try to observe him more - this will help to identify any tendencies or, conversely, deviations.

3 years

This period is associated with the crisis of 3 years, because. from a calm baby, the child turns into a capricious fidget, starts arguing with parents, throwing up scandals, etc. This is exactly the period when you need to learn how to find common ground with your child, negotiate with him, develop your own tactics of behavior and manner of education. At this age, it is already possible to give the child to kindergarten. But before doing this, it is necessary to determine whether it will benefit him or not. To make it easier to do this, and indeed, to find an approach to the child, study more specialized literature, apply knowledge in practice. It might be worth attending a few seminars on parenting young children. And, of course, continue to observe the child and use different approaches in communication and education. Through experimentation, trial and error, you will find the best option.

4 years

The next stage of changes in the psychology of the child: he begins to be more actively interested in the world around him and more consciously perceive information. Therefore, it's time to think about what information your child receives, what he watches on TV, what books you read to him, what you talk to him about. It is best if you provide him with only useful and developing information, start teaching him to read and print letters. Read to him good stories and stories, try not to watch violence, pointless TV shows and goofy cartoons on TV. In general, bring to the child only the information that will contribute to his development.

5 years

This period in the development of the child is characterized by the fact that he begins to be interested in the causes of various phenomena, more and more often he wonders why certain things happen. Many children at this age have fears of various kinds, they are disturbed by some phenomena and events, nightmares can occur. At this stage, you should focus your attention on the manifestation of such moments. Be interested in what worries your child, what makes him worry and worry. Watch how he expresses his concerns. It can be drawings, strange inscriptions, unusual behavior. Pay attention to how you yourself behave in the process ordinary life communicating with him and other people. In this period, the transition of your child's perception from his previous perception of various phenomena to a more meaningful one is possible.

6 years

At this stage in the development of the child, you may notice that the prerequisites for the concept of what sexuality is. Many parents are shocked that their children begin to talk about indecent things, use obscene expressions in speech. It is important to determine whether this is the norm or a deviation. From the child, questions may be asked about how they appeared and where children come from. At this stage, you need to be able to adequately explain such things to your child so that he forms the right judgments and ideas about issues related to sensitive topics.

7-11 years old

At this age, the child goes to school, and this event has a huge impact on the development of a growing person. This age is often called the pinnacle of childhood. In the psychology of the child, many new guidelines appear, which are teachers, as well as assessments of their performance. Despite the fact that at this age it is common for a child to retain many childish qualities (naivety, frivolity, orientation towards adults), he begins to lose his childish immediacy in his behavior, new thought patterns appear. Studying is a meaningful activity, because new knowledge, skills, social status are acquired, interests and values, as well as the way of life are changing. At this stage, it is important for the parent to Special attention to your child, to talk more with him, to discuss his affairs, successes and failures, to be able to cheer up, guide him on the right path, set him up in a positive way. This plays a very important role in his subsequent development and perception of others and himself.

12-16 years old

This stage in the development of a teenager is characterized by intimate and personal communication with peers, a sense of adulthood, critical thinking, the need for self-affirmation, self-centeredness, and expansion of self-awareness. A teenager at this age is looking for himself, trying to show his individuality in appearance, behavior and speech. The desire for self-education and self-development, the need for communication, independence and independence from adults, emotional instability, the assertion of moral values, changeability of behavior, instability of views and actions are clearly expressed. It is very important to pay attention to what your child does in his spare time, what he is interested in, with whom he communicates, with whom he is friends, whether he has relationships with teenagers of the opposite sex. If you notice in your child aggressiveness towards you, frequent mood swings, decreased desire to learn, absenteeism, indifference to requests, antisocial behavior, etc., then special communication methods should be used. Namely: build communication on the basis of respect and goodwill, accept refusals and discuss the things necessary to complete the work, be able to justify your point of view, spend time together more often, take part in the personal life of a teenager and be interested in his hobbies, control educational process, conduct confidential conversations, give the opportunity to freely communicate with peers, give recommendations on internal and external self-expression. Such a strategy will allow you to set up a positive line in controlling the development of your child, find common ground with him and achieve success in mutual understanding.

16 years old - 22 years old

At this age, teenagers are increasingly striving to show and prove their readiness for adulthood, independence. The greatest difficulty here is that a teenager is already both an independent person and a person who still needs help and care. This is the time of youthful maximalism, as well as fatalism, in which there is a loss of hope for a brighter future, the futility of being, aspirations and life itself. During this period, you need to provide your child with even more support, although all circumstances indicate otherwise. You can not go on about a teenager and bend under his pressure. It is important to choose a specific demeanor so that the person does not feel disadvantaged or offended and, at the same time, you can make sure that he can adequately receive support and advice from you.

23 years old - 28 years old

This period of human development is characterized by the search for oneself, the awareness of one's individuality, the formation of oneself as an adult with his own rights, opportunities, duties, and obligations. A special place is occupied by thoughts about what place a person should take in life, what he aspires to, where to go, in what direction to develop. Here it is important and necessary to be a mentor, to guide, support, advise, conduct the right conversations, etc. If not properly influenced, then development can be influenced by factors that play an important role in the previous age group.

29 years old - 32 years old

This period can be characterized as a transition period. many ideas, attitudes and beliefs formed earlier often seem to be wrong, and life itself no longer seems as rosy and simple as it seemed before. At this stage, questions arise about the meaning of life, the correctness of the chosen path, the activities that a person is engaged in, his beliefs and worldview. Often people at this age destroy the foundations of their past, change their lifestyle, realize new truths, set new goals and strive for them. The most fruitful work during this period is the work of a person on himself, his self-consciousness, worldview, awareness of true values.

33 years old - 39 years old

At this stage of life, a person experiences pleasure from the activities he is engaged in, strives for career growth, achievement of success and all the benefits associated with this. The main thing here is that a person should be 100% sure that the direction he has chosen is correct and should not have any doubts about choosing his life path. Otherwise, a person can be overcome by depression and a psychological crisis, which can be eliminated either by careful and scrupulous work on oneself, or by the help of a qualified specialist.

40 years old - 42 years old

Time of the critical period. What a person has achieved seems insignificant and insufficient to him, often there is a feeling that life is wasted, nothing makes any sense, health and strength are declining, youth has passed, etc. As in the previous period, further psychological development depends on the person's sense of self, his picture of the world and the idea of his place in it.

43 years old - 49 years old

A new period of balance, which is characterized by the stability of the psyche, beliefs, worldview. A person with renewed vigor is ready to work, especially if it is some kind of new activity, creative people experience surges of inspiration. Everything contributes to living harmoniously and purposefully. It is very good if a person at this age feels the support of relatives and friends, feels his need, the participation of other people in his life.

After 50 years

After 50 years, people tend to come to a more harmonious life. They are in harmony with themselves, have rich life experience and can give an adequate assessment of their life path, past, present. The man already knows himself well. Often there is a desire to know things of a higher order, the meaning of being, the reasons for everything that happens. But this is done not from the position of a victim of a meaningless existence, but from the position of a mature personality, a mature person. A person who is over 50 may also experience a need to communicate with people. Old connections are often established and maintained and new ones appear. Better conditions for a normal life during this period, it is comfort, tranquility, a prosperous atmosphere, confidence in the future, the knowledge that there are loved ones nearby who can always help and support.

As you can see, each age group has its own characteristics and properties. Mental differences at each stage of human development affect his behavior, perception, activity, social activity and other important properties of his personality. Knowledge about age groups and their characteristics is of great practical importance, because they can be used to better understand your family and friends, just those around you and yourself. With the help of this knowledge, you can always find the best approach to a person of any age and make communication with him more productive, and life calm and harmonious.

In addition to the fact that there are different age groups that have their own properties, there is another important topic that is worth knowing about in order to be able to form an objective picture of the psychology of human development. These are development factors.

Factors affecting human development

The development of a person, his worldview, interests, needs, direction of his actions, the spiritual wealth of his personality and other features are directly dependent on the conditions under which he develops, and especially during childhood and adolescence. A person's personality is formed under the influence of a number of factors. The main ones among them are the following three: heredity, environment and upbringing. And they, in turn, can be divided into two large subgroups: biological (heredity) and social factors (environment, upbringing).

Heredity

Heredity This is information that is embedded in the human genes and transmitted from parents to children. And it consists of two parts:

Permanent part(Ensuring the birth of man by man)
variable part(what binds a person and his parents)

Once a person is born, he is not yet a person. His "I" is not yet manifested, he does not have a name, ideas, views, tastes, beliefs, morals, social status, etc. We can say that his life path is still unknown, and his fate is not predetermined. But in how a person will develop, heredity plays a big role. A person with better heredity will develop more successfully in society and interact with the outside world. An important condition is that a person born with certain characteristics will develop only within their framework. Thus, it turns out that a person is who he is, and his hereditary characteristics will affect him throughout his life. In fact, it looks like a person born with a poor physical heredity will not be able to achieve outstanding results in sports and physical activity, and one who was born mentally retarded will never become a scientist, philosopher, etc.

You can learn more about heredity.

Wednesday

Under environment one can understand natural, climatic, etc. conditions in which a person develops; state structure, the culture of the people, their traditions, customs, way of life. But also the environment is understood directly as the society in which a person develops: the family, the microclimate in the family, relationships between parents, the subtleties of education, friends, classmates and other people around.

The environment in which a person develops affects his socialization, the formation of knowledge, skills, behavior, social norms, attitudes towards culture, learning, work, and other people. In the environment, the psychological characteristics of a person, his needs, attitudes, interests, aspirations, personal, social, political, ideological and material values are formed. For example, a person who grew up in a dysfunctional family, was brought up by alcoholic parents, communicated with children from other similar families, will have values and aspirations that are different from the values and aspirations of a child who grew up in prosperity, brought up by cultural people (teachers, people of art, scientists). If you have a child and want to raise him as a worthy person, you must definitely keep track of the environment in which he grows and develops. It is in your hands to create the environment in which development will be the best. You can also conduct a small experiment on the influence of the environment on human development and feel the result by your own example. Try changing your social circle. Not forever, but temporarily - for the sake of the experiment. If your environment is dominated by people who are used to complaining about problems, complaining about their lives, blaming everyone for their failures, you can start communicating with people who are successful, self-confident, purposeful, tuned in to positive communication and used to independently manage their lives. Literally after a month of being in a new environment, you will see how your beliefs, attitudes, reactions, and aspirations have begun to change. Your old acquaintances will appear before you in a completely different light. This is one of the examples of the influence of the environment on a person.

You can learn more about what the environment is and its influence at this link.

Upbringing

Upbringing- this is a purposeful formation of the personality, preparing it for life in society. This factor is somewhat different, in contrast to the previous two, in nature - purposefulness and awareness. Another feature of education is that it always takes place in accordance with the socio-cultural values of the society in which it is carried out.

Education almost always means positive impacts, moreover, systematic, because single actions do not bring results. As a rule, the parents of the child are the main ones in the upbringing process, educators, teachers, teachers, etc. play secondary roles. Parents pass on knowledge, life experience to their children, teach some things, explain, show, tell, control. From what kind of upbringing was given to the child, to a tangible extent depends on how he will grow up, how he will communicate with other people and behave in society, what moral and ethical standards, beliefs and so on he will have. To make a real person out of a growing child, you need to make great efforts to proper education. This applies to everything, from small to large: from the fact that it is uncultured and unhygienic to bite your nails to that you need to take off your hat indoors; from the fact that you don’t need to swear and to the fact that you should have a goal in life and strive for something. Many examples can be cited. But what is more important is to understand the mechanisms of influence on the child. Now a lot of literature has been written on the upbringing of children, some trainings and seminars on this topic are constantly held, there are many sites on the Internet that specialize in parenting consultations. Use different sources, apply knowledge in practice and be attentive to your children. But remember that the main thing in upbringing is your own example, because a child will probably someday want to smoke a cigarette, even if his parents say that this is bad, but they themselves smoke.

You can get acquainted with no less interesting information about education at this link.

The factors under the influence of which a personality is formed exert their influence not singly, but in a complex way, i.e. together. For this reason, when studying the psychology of human development, it is necessary to take into account any details, nuances, events and phenomena that a person encounters on his life path. Only such an approach will make it possible to understand why a person (in any plan) was formed in this way and not otherwise.

Everything that we have considered in this lesson is an integral part of the development of a person and his life. Every personality is a unique creation, formed under the influence of many factors, and this process obeys its own laws. Developmental psychology, or to be more precise, knowledge about it, is the key to a successful understanding of your children, parents, relatives, friends, yourself and a person in general. Using the acquired knowledge in our everyday life, we can make our life better, more successful, more harmonious and happier, and always achieve mutual understanding with people who are nearby!

Literature

If you want to get acquainted with the topic of developmental psychology in more detail and find out even more interesting and useful information, you can use the list of references that we have presented below.

Abramova G.S. Developmental psychology: Proc. allowance for university students. - M.: Academy, 1997
Abramova G.S. Psychology of human life: Research of gerontopsychology: Proc. allowance for students of psychology. fak. universities. - M.: Ed. center "Academy", 2002
Bern E. Games that people play. Psychology of human relationships Publisher: Eksmo, 2008
Vasilyeva T.V. You understand me? (Tests for children 5-7 years old with the recommendations of a psychologist). - S.-Pb, 1994
Wilson G., Grylls D. Find out the IQ of your child M., 1998
Vygotsky L.S. Questions of child psychology. - S.-Pb. - 1999
Gamezo M.V., Domashenko I.A. Atlas of psychology. - M., 2003.
Craig Grace. Psychology of development. - St. Petersburg, 2000
Kulagina I.Yu. Developmental psychology: child development from birth to 17 years. - M., 1998
Kulagina I.Yu., Kolyutsky VN Developmental psychology: Human development from birth to late maturity: (Full life cycle of human development): Proc. allowance for students of higher special. educational institutions. - M., 2001
Craig Grace. Psychology of development. - St. Petersburg, 2000
Mill J. About freedom / Per. from English. A. Friedman. Science and life. -1993.№11
Mukhina V.S. Developmental psychology: phenomenology of development, childhood, adolescence. - M., 1999
Orlov Yu. M. Ascent to individuality: Book. for the teacher. — M.: Enlightenment, 1991
Obukhova L.F. Age-related psychology. - M., 2000
social philosophy. Textbook. - Edited by I.A. Gobozov. - M.: Publisher Savin S.A., 2003
Sorokin P. A Man. Civilization. Society / General ed., comp. and foreword. A. Yu. Sogomonov: Per. from English. — M.: Politizdat, 1992
Uruntaeva G. A. preschool psychology: Proc. allowance for students of secondary ped. educational institutions. - M.: Ed. center "Academy", 1999.

Test your knowledge

If you want to test your knowledge on the topic of this lesson, you can take a short test consisting of several questions. Only 1 option can be correct for each question. After you select one of the options, the system automatically moves on to the next question. The points you receive are affected by the correctness of your answers and the time spent on passing. Please note that the questions are different each time, and the options are shuffled.

Introduction. Healthy child

"... and when they asked to bring the most beautiful thing that exists in the whole wide world, the crow brought her child..."

The first fragmentary information about a healthy and sick child appeared in ancient times. Hippocrates, Galen, Soranus, Avicenna emphasized in their treatises the presence of features of the child's body that distinguishes it from an adult and determines the atypical course of diseases, especially in early childhood. Even then, scientists paid much attention to the importance of breastfeeding, physical education and proper care for the harmonious growth and development of the child.

In the modern world, it is necessary to pay great attention to the development and upbringing of children. Children are the future of our planet.

1. Periods of childhood

The most acceptable for practical purposes is the scheme of N. P. Gundobin, according to which the entire childhood age is divided into the following periods.

Works: Education and treatment of a child up to the age of seven, 3rd ed., M., 1913; Features of childhood, St. Petersburg, 1906.

I. The period of intrauterine development: 1) the phase of embryonic development (embryo), 2) the phase of placental development (fetus).

II. Neonatal period.

III. The period of infancy (younger toddler age),

IV. The period of milk teeth: a - pre-preschool age (senior toddler age), b - preschool age (the period of attending kindergarten).

V. The period of adolescence (primary school age).

VI. Puberty (senior school age).

All the changes made by Soviet pediatricians are marked in brackets.

2. Stages of intrauterine development

In the intrauterine development of a person, three periods are conventionally distinguished:

The implantation period lasts from the moment of fertilization to 2 weeks. This period is characterized by a rapid systematic crushing of a fertilized egg, its advancement along the fallopian tube to the uterine cavity; implantation (attachment of the embryo and introduction into the uterine mucosa) on the 6-7th day after fertilization and further formation of the fetal membranes, creating the necessary conditions for the development of the embryo. They provide nutrition (trophoblast), create a liquid habitat and mechanical protection (fluid of the amniotic sac).

3. Breast period

The reactions of auditory perception are manifested, in addition to auditory concentration (end of the 2nd week), a clear orientation to sounds (1st month) and the search for its source from the end of the 2nd month. At 2–3 months, the child listens to sounds, and at 3–3.5 months, he unmistakably searches for the source of the sound. At 3–7 months, constant activity to various sound stimuli is manifested, and from 10–11 months - a reaction to sound in connection with the content and meaning of this sound.

Development of grasping ability - stretches out a hand to an object (at the 3rd month), grasps an object (4.5 months), holds an object in each hand (6 months), brings the whole body into an active state when grasping (at the 7th month ), the beginnings of specific manipulations (on the 11th month).

Teething from 5-7 months.

The development of I and II signaling systems of the central nervous system occurs, the goiter and thyroid glands function; adrenal function is weakened; beginning of pituitary function.

Rickets, malnutrition, food and respiratory allergies, respiratory diseases and acute gastrointestinal diseases may appear.

In each period, for the correct development of the child, the creation of certain environmental conditions, regimen, and upbringing is required.

Features of growth and development

Significant growth rates are characteristic - body length (height) increases by 50% of the length at birth, reaches 75-77 cm by the age of 1 year. Head circumference by the year is 46-47 cm, chest circumference - 48 cm. There is a rapid development of motor skills and motor skills . There are three peaks of physical activity: I - 3-4 months - a complex of revival, joy at the first communication with adults; II - 7-8 months - activation of crawling, formation of binocular vision (mastery of space); III peak - 11-12 months - the beginning of walking. Their sensory-motor connections are determined. Skeletal muscles and motor activity are factors that determine the processes of growth and development in the first year of a child's life. The growth rate is provided by a high metabolism.

Features of the central nervous system

The orienting reflex is preserved, reflecting the innate need for movement and activity of the sense organs. Nerve connections between the child and surrounding people are established through facial expressions, gestures, voice intonations. The development of fine hand movements contributes to the development of the brain and speech. Connections arise between words and response motor reactions of the child, then the child associates the visual and auditory perception of objects with words, the names of objects when they are shown, connections with individual actions (“give”, “show”) - this is the optimal course of development, necessary as a basis for other periods of childhood. The need for contact with adults determines the mental development of the child.

Electroencephalogram at 2-3 months - stable rhythm; at 4-6 months - changes are unidirectional; at 8-10 months - progressive individualization.

Features of the endocrine system

Features of immunity

Nonspecific resistance factors

The nature of the pathology

Assessment of physical development, motor skills, speech development, neuropsychic development, taking into account the leading line of development in the chest period, is carried out quarterly.

To assess the physical development of children under 1 year old, it is better to use the following indicators:

body weight;

Proportionality of development (head circumference; chest circumference, some anthropometric indices);

Static functions (motor skills of the child);

Timely eruption of milk teeth (in children under 2 years old).

The skull of a newborn has specific features. See fig.

Table A. Increase in height and body weight in children of the first year of life

Age, months	Increase in height per month, see	Increase in growth over the past period, see	Monthly weight gain, gr.	Weight gain for the past period, gr.
1	3	3	600	600
2	3	6	800	1400
3	2,5	8,5	800	2200
4	2,5	11	750	2950
5	2	13	700	3650
6	2	15	650	4300
7	2	17	600	4900
8	2	19	550	5450
9	1,5	20, 5	500	5950
10	1,5	22	450	6400
11	1,5	23, 5	400	6800
12	1,5	25	350	7150

In the second year of life, the child will grow by 12-13 cm, in the third - 7-8 cm.

Body mass.

To determine body weight at the age of one year, it is better to use Table. 3.

For example, in the tenth month of life, a child adds 800-(50x7) = 450g in weight.

On average, by one year, the body weight of a child is 10-10.5 kg. The increase in body weight in infants is not always characterized by such a pattern. It depends on the individual characteristics of the child and a number of external factors. Children with an initial low body weight give relatively large monthly weight gains and it doubles and triples earlier than in larger children. Formula-fed babies immediately after birth double their body weight about a month later than breast-fed babies. Body weight is a labile indicator, especially in a young child, and can change under the influence of various conditions sometimes during the day. Therefore, body weight is an indicator of the current state of the body, in contrast to height, which does not immediately change under the influence of various conditions and is a more constant and stable indicator. A deviation of body weight from the norm up to 10% is not considered a pathology, however, a pediatrician should analyze this loss.

proportionate development.

In a child born with adaptive indicators of height and body weight, the head circumference is about 36 cm. During the first 3 months of life, the head circumference should “grow” by 4 cm (that is, at 3 months - 40 cm). Over the next 3 months, the head circumference increases by another 3 cm and becomes 43 cm by 6 months, and 46-48 cm by the year. The size of a large fontanel at birth should not exceed 2.5x3 cm, 3x3 cm.

The circumference of the head is measured with the centimeter tape position at the back at the level of the occiput, and in front - above the eyebrows.

In a newborn, the circumference of the chest is 33-35 cm. The monthly increase in the first year of life averages 1.5-2 cm per month. By the year, the circumference of the chest increases by 15-20 cm, after which the growth energy decreases and the circumference of the chest increases on average by 3 cm by preschool age, and by 1-2 cm per year in preschool age.

Statistical functions.

At 2 months, the child holds his head well,

at 3 months - turns well from back to stomach,

at 5.5-6 months - turns well from stomach to back,

at 6 months - sits if he was planted,

at 7.5 months, (when the child learns to crawl well) - sits down by himself,

at 9 months - well worth it,

at 10 months - walks around the arena, holding on with his hand,

by 12 months - walks independently.

The development of static functions is facilitated by various sets of exercises for children: from 1 to 3 months; from 3 to 6 months; 6 to 9 months; from 9 to 12 months.

Timely eruption of milk teeth.

4. Signs of full-term newborn

The facial part of the skull of a newborn is relatively small compared to the brain part. In most children, the hairline on the head is well defined. On the head of a child after birth, there may be a birth tumor, which is formed as a result of impregnation of soft tissues with serous fluid. Its resorption occurs in the next few hours after birth and rarely - on the 2-3rd day. In the first hours after birth, the face of the newborn is somewhat swollen, the eyes are closed or half-open, the eyelids are somewhat swollen, the skin is pink, and the subcutaneous fat is well developed.

The skin of a newborn is covered with the so-called original cheese-like lubricant, the amount of which varies considerably. On the shoulders and back, the skin is covered with a delicate fluff.

For a more accurate characterization of the state of the newborn, the Apgar scale is currently used, making an assessment within 1 minute after the birth of the child.

5. Apgar score

The test was proposed by anesthesiologist Virginia Apgar.

signs	0 points	1 point	2 points
Pulse	Absent	Less than 100 bpm	More than 100 bpm
Breath	Absent	slow, irregular	Good, shout
Muscle tone	Weak	Flexes arms and legs	Actively moving
Reflexes (reaction to the catheter in the nose)	Absent	grimaces	Sneezes, coughs, pushes away
Color of the skin	Blue, pale	Normal, but bluish arms and legs	Normal throughout the body

The score is made up of the sum of the digital indicators of five features. With an indicator of 8-10, the condition of the newborn is assessed as good, with an indicator of 6-7 - satisfactory, and below 6 - severe. So, for example, in a newborn, the heart rate is 120 per minute (score 2), respiratory movements are irregular (1), the limbs are slightly bent (1), the reaction to the nasal catheter is grimace (1), the skin color is pink, the limbs are cyanotic (1); the overall Apgar score is 6.

Assessment of the condition of the newborn on the Apgar scale is practically quite acceptable, although it does not always reflect the variety of possible disorders, especially in preterm infants.

6. Premature baby

A premature baby is a baby born at a period of less than 37 completed weeks, that is, before the 260th day of pregnancy.

Degrees of prematurity:

grade 35-37 weeks weight approx. 2001-2500 g

grade 32-34 weeks weight approx. 1501-2000 g

grade 29-31 weeks weight approx. 1001-1500 g

degree less than 29 weeks weight less than 1000 g.

What is the difference between premature babies and those born at term?

It was not in vain that nature came up with the idea that a person has a 9-month gestation period. At this time, the baby is formed and develops so that by the time of birth it is ready for extrauterine life. If for some reason the baby is born prematurely, then it will be more difficult for him to adapt to an unknown and difficult life outside his mother's tummy. Of course, much depends on how early the baby is not full-term. If the birth took place at 35–36 weeks, then the baby is already mature enough, and if at 28–30 weeks, then much more effort will be required to nurse him.

What is preterm care?

After birth, a premature baby requires special attention from doctors. Regardless of the degree of maturity and prematurity, the child needs to be given first aid - warm, suck amniotic fluid from the mouth, provide additional oxygen, and in more severe cases - carry out a full range of resuscitation measures.

The severity of the condition of a premature baby can be associated with several reasons. First of all, pediatricians pay attention to the formation of respiratory function. In the lungs of a premature baby, not enough special substance is produced - a surfactant, which helps them to fully function: it prevents the alveoli from collapsing and ensures normal gas exchange. Lack of surfactant can cause a variety of respiratory problems - from a mild respiratory distress syndrome to a serious illness in which spontaneous breathing is impossible and mechanical ventilation is required.

Respiratory failure exacerbates the child's metabolic changes caused by birth stress and problems with the circulatory, digestive, and excretory systems.

Nursing a premature baby at this stage is a logical continuation of the activities started in the departments of the maternity hospital. The period of adaptation to extrauterine life in a premature baby also has some differences compared to a full-term baby. Thus, weight loss in premature babies is usually greater than in babies born at term. The recovery of the initial body weight occurs over a longer period: full-term babies usually regain their birth weight by 7-10 days of life, and in premature babies, this period can stretch for 2-3 weeks.

Another condition that occurs in newborns is physiological jaundice. But in premature babies, jaundice is more pronounced and its duration is longer than in full-term babies, which in some cases requires treatment. This is due to the functional characteristics and immaturity of liver enzymes. Feeding a premature baby can also cause some problems, as babies born prematurely do not absorb food well. Feed small newborns begin literally drop by drop, gradually increasing the volume. Breastfeeding is optimal for premature babies. As you know, the composition of the milk of a woman who gave birth prematurely differs from the milk of a mother whose birth occurred on time. It contains more protein, electrolytes, polyunsaturated fatty acids and less lactose, better meeting the needs of a small baby. In the event that breastfeeding is not possible, the child should receive a specialized mixture for premature babies.

When is a premature baby sent home?

This question worries many many parents whose babies were born prematurely. Of course, such decisions are made by doctors based on the condition of the child. Usually, if the weight of the child has reached 2000 g, the baby is actively sucking and gaining weight, he can be discharged under the condition of active monitoring at home by a pediatrician and a patronage nurse. In addition, after discharge from the hospital, the baby may need additional help from an ophthalmologist, neurologist, massage therapist and some other specialists.

A premature baby requires close attention, since a number of problems often arise in the process of nursing it. First of all, this applies to children born with a body weight of 1500 g or less "deeply preterm" and, especially, less than 1000 g "extremely premature." It should be remembered that the division into degrees of prematurity, taking into account weight parameters, does not always correspond to the true conceptual age of the child. This classification method is used to standardize treatment and observation, for the needs of statistics. In practice, in addition, it is necessary to take into account a wider range of positions to assess the actual age of the child.

Socio-economic and demographic. Lack or insufficiency of medical care, poor nutrition of a pregnant woman, occupational hazards (work on the assembly line, physical exertion, standing most of the working day), bad habits, unwanted pregnancy, etc.

Clinical. The presence of a pregnant woman with chronic somatic, gynecological, endocrinological diseases. Pathology of pregnancy: late preeclampsia, acute infectious diseases suffered during pregnancy, surgical interventions, physical injuries, especially of the abdomen.

Another important condition for nursing is air humidity and in the first days it should be 70-80%.

Particularly worth mentioning is the feeding of premature babies. Children born before 33-34 weeks of gestation, as a rule, are fed through a tube inserted into the stomach every 3 hours.

7. Anatomical and physiological features of a premature baby

Premature babies have a peculiar physique - a relatively large head with a predominance of the brain skull, sometimes - open cranial sutures, small and lateral fontanelles, a low location of the umbilical ring; poor development of subcutaneous adipose tissue. Premature babies are characterized by abundant vellus hair (lanugo), with a significant degree of prematurity - underdevelopment of nails. The bones of the skull are malleable due to insufficient mineralization, the auricles are soft. In boys, the testicles are not descended into the scrotum (in extremely immature children, the scrotum is generally underdeveloped); in girls, the genital gap gapes due to underdevelopment of the labia and relative hypertrophy of the clitoris. Based on the external examination of the child, it is possible to draw a conclusion about the degree of prematurity (gestational age) based on a set of morphological criteria, for which evaluation tables of these signs in points have been developed.

The morphology of the brain of a premature baby is characterized by smoothing of the furrows, poor differentiation of gray and white matter, incomplete myelination of nerve fibers and pathways.

The respiratory system in a premature baby, like the nervous system, is characterized by immaturity (a predisposing background for pathology). The upper respiratory tract in preterm infants is narrow, the diaphragm is located relatively high, the chest is pliable, the ribs are located perpendicular to the sternum, in very preterm infants the sternum sinks. Breathing is shallow, weakened, the frequency is 40-54 per minute, the volume of breathing is reduced compared to full-term children. The rhythm of breathing is irregular, with occasional apneas.

The cardiovascular system of a premature baby, compared with other functional systems, is relatively mature, as it is formed at the early stages of ontogenesis. Despite this, the pulse in premature babies is very labile, of weak filling, the frequency is 120-160 per minute. The most immature children are characterized by a rhythmic pulse pattern of the type of embryocardia. On auscultation, heart sounds may be relatively muffled; with the persistence of embryonic shunts (botallian duct, oval window), the presence of noise is possible. Blood pressure in premature babies is lower compared to full-term babies: systolic 50-80 mm Hg. Art., diastolic 20-30 mm Hg. Art. Average pressure 55-65 mm Hg, art.

Due to the increased load on the right side of the heart, the electrocardiogram of preterm infants is characterized by signs of a rightogram and a high P wave, combined with a relatively low voltage and smoothness of the S-T interval.

The gastrointestinal tract of premature infants is characterized by the immaturity of all departments, a small volume and a more vertical position of the stomach. Due to the relative underdevelopment of the muscles of the cardial part of it, premature babies are prone to regurgitation. The mucous membrane of the alimentary canal in preterm infants is tender, thin, easily vulnerable, and richly vascularized. There is a low proteolytic activity of gastric juice, insufficient production of pancreatic and intestinal enzymes, as well as bile acids. All this complicates the processes of digestion and absorption, contributes to the development of flatulence and dysbacteriosis. In 2/3 of premature babies, even those who are breastfed, there is a deficiency of intestinal bifidoflora in combination with the carriage of opportunistic flora. The nature of the child's stool is determined by the characteristics of feeding; as a rule, preterm infants have a lot of neutral fat in the coprogram.

Features of the functioning of the endocrine system of a premature baby are determined by the degree of its maturity and the presence of endocrine disorders in the mother, which caused premature birth. As a rule, the coordination of the activity of the endocrine glands is impaired, primarily along the axis of the pituitary gland - thyroid gland - adrenal glands. The process of reverse development of the fetal zone of the adrenal cortex in newborns is inhibited, the formation of circadian rhythms of hormone release is delayed. Functional and morphological immaturity of the adrenal glands contributes to their rapid depletion.

The processes of metabolic adaptation in premature babies are slowed down. At the age of 4-5 days, they often have metabolic acidosis in the blood plasma in combination with a compensatory shift towards intracellular alkalosis; on the 2nd-3rd week of life, extracellular acidosis is compensated by intracellular normative reactions. Premature infants (even conditionally healthy ones) often have hypoglycemia, hypoxemia, and hyperbilirubinemia.

8. Anatomical and physiological features of full-term babies

Leather. Delicate, velvety to the touch, elastic, pink, there may be remnants of vellus hair on the back and shoulder girdle. Its richness in blood vessels and capillaries, the weak development of the sweat glands and the active activity of the sebaceous glands lead to a rapid overheating or hypothermia of the child. He has easily vulnerable skin, which is also important to consider, because. with improper care, diaper rash appears, an infection easily penetrates through the pores and pustules appear. On the back of the head, upper eyelids, between the eyebrows, there may be bluish or reddish spots caused by vasodilation (telangiectasia), or petechial hemorrhages. Sometimes there are yellowish-white nodules (milia) on the wings and bridge of the nose. All these phenomena disappear in the first months of life. In the area of the sacrum there may also be an accumulation of skin pigment, the so-called. "Mongolian spot". It remains noticeable for a long time, sometimes for a lifetime, but is not a sign of any disorders. The hair of a newborn is up to 2 cm long, the eyebrows and eyelashes are almost invisible, the nails reach the fingertips.

Subcutaneous fat. It is well developed, denser than it will become in the future - in terms of chemical composition, refractory fatty acids now predominate in it.

Bone system. It contains few salts, which give it strength, so the bones are easily bent if the child is not properly cared for.

Respiratory system. The mucous membranes of the respiratory tract are delicate, contain a greater number of blood vessels, therefore, with infections, more often viral, swelling develops quickly, a large amount of mucus is released, which greatly complicates breathing. It is also prevented by the anatomical narrowness of the nasal passages of the newborn, as well as his trachea (windpipe) and bronchi. The auditory, or Eustachian, tube is wider and shorter than in older children, which makes it easier for infection to enter and develop otitis media (inflammation of the middle ear). But on the other hand, there is never inflammation of the frontal sinus (frontitis) and maxillary, or maxillary, sinus (sinusitis), because they are not yet available. The lungs are underdeveloped, breathing is superficial and is mainly carried out by the diaphragm - a muscle located on the border of the chest and abdominal cavities. Therefore, breathing is easily disturbed by the accumulation of gases in the stomach and intestines, constipation, tight swaddling, pushing the diaphragm up. Hence the wish - to follow the regular emptying of the intestines, not to swaddle the child too tight. Since the baby does not receive enough oxygen during its shallow breathing, it breathes frequently. The norm is 40-60 breaths per minute, but this frequency increases even with a slight load. Therefore, it is necessary to pay attention first of all to shortness of breath, which is accompanied by a feeling of lack of air and can be a sign of a disease.

Digestive system: functionally immature, and since newborns have an increased metabolism, it carries a large load - minor errors in the diet of a breastfeeding mother and the child's diet can cause indigestion (dyspepsia).

The mucous membrane of the mouth is rich in blood vessels, thin, delicate, easily vulnerable.

The language is big. On the mucous membrane of the lips there are so-called. "pads" - small whitish elevations, separated by stripes, perpendicular to the length of the lip (pillows of Pfaundler-Lyushka); the mucous membrane forms a fold along the gums (Robin-Majito fold); elasticity of the cheeks is given by the so-called. Bish's lumps are accumulations of adipose tissue located in the thickness of the cheeks. They are present both in healthy people and in those born with malnutrition - an eating disorder accompanied by a decrease in body weight. With the transition of malnutrition to a severe form, the body loses almost all adipose tissue, except for Bish's lumps.

The digestive glands, including the salivary glands, have not yet developed: very little saliva is secreted in the early days.

The muscles that block the entrance from the esophagus to the stomach are also underdeveloped - this leads to frequent mild regurgitation. To prevent it after feeding, you need to hold the baby for 20 minutes in your arms, vertically, leaning against your chest. Initially, the stomach holds about 10 ml of liquid, by the end of the first month its capacity increases to 90-100 ml.

The muscles of the intestine are still little trained and the movement of food through it is slowed down. Therefore, newborns are so tormented by accumulations of gases formed during the digestion of milk and bloating - flatulence. Frequent constipation. The bowel movements in the first 1-3 days of life (called "meconium") have a characteristic viscous texture of a dark green color, there is practically no smell. Meconium is formed from amniotic fluid, mucus, bile, which enter the stomach and intestines of the fetus. By the presence of these secretions in the first hours after birth, the absence of malformations in the development of the esophagus, stomach, intestines, and anus is judged by the child. Organ obstruction requires immediate surgical intervention.

During the first 10-20 hours of life, the intestines of the child are almost sterile, then it begins to be populated with the bacterial flora necessary for the digestion of food. The type of feces also changes - feces appear - a mass of yellow color, consisting of 1/3 of saliva, gastric, intestinal juices and 1/3 of food debris. In this, the work of the digestive glands is also noticeable. The largest of them, which is also a protective barrier of the body against toxic compounds - the liver - is relatively large in infants. But in healthy people, the edge of the liver can protrude from under the lowest rib (on the border of the chest and abdomen) by no more than 2 cm.

Urogenital system. By the time of birth, the kidneys, ureters, and bladder are well formed. However, the severe stress experienced by the child during childbirth disrupts the metabolism for a short time. In areas where urine is formed, uric acid crystals are deposited and kidney function is somewhat reduced for the first few days. The child urinates only 5-6 times a day. From the 2nd week, the metabolism gradually stabilizes, the number of urination increases up to 20-25 times per knock. This frequency is normal for the first months, given the relatively small volume and insufficient extensibility of the walls. Bladder. The external genitalia are formed. In boys, the testicles are most often lowered into the scrotum, but if they are in the lower abdomen, they can descend on their own in the first 3 years. In girls, the large labia cover the small ones.

Metabolism. The need for carbohydrates is increased, the absorption of fats and their deposition in tissues is increased. The water-salt balance is easily disturbed: the daily requirement for liquid is 150-165 ml/kg.

Hematopoiesis. In newborns, the main focus of hematopoiesis is red Bone marrow all bones, additional - liver, spleen, lymph nodes. The spleen is approximately equal in size to the palm of the child himself, its lower edge is in the projection of the left costal arch (the lowest protruding rib on the border of the chest and abdomen). Lymph nodes, as a rule, cannot be identified during examination, their protective function is reduced.

Endocrine system. During childbirth, the adrenal glands carry the greatest load of all glands and some of their cells die, which determines the course of some borderline conditions (see section Transitional States). The thymus gland, which plays a protective role, is relatively large at birth, subsequently decreasing in size. The thyroid, parathyroid, and pituitary glands continue to develop after birth. The pancreas, which is involved in digestion and takes part in the metabolism of carbohydrates (produces the hormone insulin), functions well by the time of birth.

Nervous system. Immature. The convolutions of the brain are barely outlined. Stronger developed in those departments where there are vital centers responsible for breathing, heart function, digestion, etc. In infancy, they sleep most of the day, waking up only from hunger and discomfort. Congenital reflexes, such as sucking, swallowing, grasping, blinking, etc., are well expressed, and by the 7th-10th day of life, the so-called. conditioned reflexes, a reaction to the taste of food, a certain posture, usually associated with feeding, by his hour the child will soon begin to wake up on his own.

Sense organs. In the first weeks, the olfactory organs almost do not smell, only an extremely loud sound can wake up, disturb only too much. bright light. The thoughtless look of the child does not linger on anything, many have physiological strabismus due to weakness of the eye muscles, involuntary movements eyeballs- nystagmus. Up to 2 months he cries without tears - lacrimal glands do not produce fluid. So far, only taste sensations, touch and temperature sensitivity help him to know the world. But you can’t say about a two-month-old that he is “blind and deaf.” A sure sign - stubbornly looks at the sonorous bright rattle.

Immunity. Some factors that play a protective role in the body are produced in utero. Part of the immune substances the child receives from the mother with colostrum, in which their concentration is very high, and with breast milk, where their content is much lower, but in sufficient quantities. But in general, the immune system is imperfect, the child is vulnerable in terms of infection.

9. Postterm baby

A truly post-term pregnancy lasts more than 41-42 weeks, i.e. more than 10-14 days after the expected date of delivery. A post-term baby is born with signs of overmaturity. The most common of these are:

"bath" feet and hands (maceration of the skin, i.e. its softening under prolonged exposure to liquid);

a decrease in the amount of cheese-like lubricant (a waxy secretion of the sebaceous glands of the fetus, softening the effect of amniotic fluid on its skin);

reduction of subcutaneous fat and the formation of skin folds;

decrease in skin elasticity;

long fingernails;

poorly expressed head configuration;

dense bones of the skull, narrow sutures and fontanelles;

with prolonged overuse, a greenish color of the umbilical cord and skin of the child may be observed (due to their staining with meconium).

Usually in these cases there are also changes on the part of the placenta - petrificates (i.e., deposition of calcium salts), fatty degenerations are found in it. In addition, a decrease in the amount of amniotic fluid is considered a sign of impaired function of the placenta and biological pregnancy.

Prolonged pregnancy, although it lasts more than 41 weeks, ends with the birth of a full-term, functionally mature child, whose life is out of danger. In other words, not any pregnancy that lasted longer than the expected period is truly post-term, but only one that ended with the birth of an overripe child.

The difference between a truly post-term pregnancy and an allegedly post-term one is not in the number of “extra” days that have passed since the expected date of birth, but in the fact that in the first case, the “mother-placenta-fetus” system is no longer able to function normally, and in the second, its work is not violated.

Why is the pregnancy "protracted?"

The causes of pregnancy loss are many and varied. They can be associated with disorders in any part of the mother-placenta-fetus system.

Among maternal risk factors, chronic diseases of the genital area, hormonal disorders, hereditary factors, and a history of post-term pregnancies should be noted. An important role is played by those complications during pregnancy, as a result of which the function of the placenta is impaired. The fact is that certain biologically active substances are necessary for the development of labor, for example, chorionic gonadotropin and estrogens, which are produced precisely by the placenta. Practice shows that the so-called macrosomia (fetal weight more than 4000 g) may also be the cause of overdose. From this enumeration, it becomes clear that a whole “bouquet” of reasons can lead to overgestation, which is often difficult to figure out, and besides, these reasons often provoke one another and overlap each other (for example, fetal disorders exacerbate placental hormonal insufficiency , since some of the hormones synthesized by it finally "ripen" precisely in the body of the fetus, etc.). Therefore, it is necessary to take very seriously the fear that the doctor or you have that the pregnancy is overdone.

What is the danger of true overwearing?

For a child. With a post-term pregnancy, the fetus's need for oxygen increases - after all, it continues to develop, and the "aging" placenta cannot provide its increased nutritional needs. One of the consequences of developing intrauterine suffering (lack of oxygen) is the reflex excretion by the fetus of the original feces - meconium. Due to the lack of oxygen, the fetus can take its first breath while still in the uterine cavity and inhale amniotic fluid with meconium. And then later (in the first hours of life) the newborn develops severe complication- meconium aspiration syndrome, requiring prolonged mechanical ventilation and powerful antibiotic therapy. Due to overmaturity, the bones of the fetal skull become dense and lose their ability to change during childbirth (they are no longer able to overlap each other). The period of attempts is lengthened, and the child may develop a birth injury.

For mother. A post-term pregnancy means a delayed onset of labor. Childbirth often proceeds with complications: weakness of labor activity, bleeding. Increasing frequency caesarean section- both due to complications of labor, and due to acute fetal hypoxia.

Caring for a post-term baby

For baby skin

The mother of a post-term baby should know that her baby has drier skin, so she should be treated with oil more often. Which oil to choose, the neonatologist will tell the mother when she is discharged from the hospital or the pediatrician when she comes to visit the newborn.

When changing baby diapers and diapers, you need to thoroughly wash it every time (gently rinse all the folds and see if there are any diaper rash) and dry (get wet) with a diaper. Be sure to use baby skin care products: cream, oil. Before you put on a fresh diaper and wrap the baby in a clean diaper, you need to leave him naked for a while so that the skin "breathes" and the legs move freely. This "ventilation" will help you avoid diaper rash.

spring

Postterm infants may have denser skull bones at birth, and the large fontanel may close more quickly than in term infants. You should not be afraid of this, the child should not have any pathology. And it is impossible to cancel the course of vitamin D without consulting a pediatrician in any case. But, just in case, at a month and at three months, it is recommended to show the baby to a neurologist and, as prescribed by the doctor, to do neurosonography.

Another problem that parents of babies who are born after the term often faces is intrauterine malnutrition. If the aged placenta supplies insufficient oxygen and nutrients, it is possible that the growth of the newborn will correspond to his age, and he will weigh less.

This is not a very serious problem for children born after their due date. The baby must be properly fed, fed with mother's milk, more often applied to the breast. If you follow these simple recommendations, then, as a rule, postterm babies begin to gain weight even faster than those born at term.

Otherwise, care for a post-term baby should be the same as for a full-term baby.

10. Borderline conditions of newborns

The neonatal period is the period of adaptation of the child to the conditions of extrauterine life, the duration of which is 28 days from the moment of birth.

After the birth of the child, the living conditions of the child change radically, he immediately enters a different environment, where the temperature is significantly lower (compared to the intrauterine one), visual, sound and other stimuli appear. The child needs to adapt to a new type of breathing and a way of obtaining nutrients, which is accompanied by changes in almost all body systems.

Conditions, reactions that reflect the process of adaptation to childbirth, new living conditions, are called transitional (borderline, transient or physiological) states of the newborn. They are characterized by the appearance in childbirth or after birth, then pass. These conditions are called borderline not only because they occur at the border of two periods of life (extrauterine and intrauterine), but also because they are usually physiological for newborns, under certain conditions (uncomfortable environmental conditions after birth, care defects) can acquire pathological traits. For example, children with low birth weight are more sensitive to changes in environmental temperature, which can lead to large loss of body weight and the development of pathological conditions.

The borderline conditions of newborns include:

1. The "just born baby" syndrome is associated with the release of a large amount of hormones during childbirth in the child's body and an abundance of external and internal stimuli. Immediately after birth, the baby takes a deep breath, screams loudly and assumes a characteristic flexion posture. Within 5-10 minutes after birth, he is active, looking for a nipple and sucks vigorously if he attaches it to the breast. After a while, the baby calms down and falls asleep.

2. Changes skin observed in almost all newborns in the 1st week of life:

Simple erythema - redness of the skin that appears after the removal of the original lubricant, the brightest on the 2nd day after birth, completely disappears by the end of the 1st week of life.

Peeling of the skin - occurs on the 3-5th day of life, more often on the stomach, chest. Especially abundant peeling is observed in post-term children. This condition does not require treatment, however, it is better to lubricate the peeling areas after bathing with a moisturizing baby cream or cosmetic milk.

Toxic erythema is a spotted rash with grayish-yellow seals in the center, which is most often located on the extensor surfaces of the limbs around the joints, on the chest. The well-being of the babies is not disturbed, the body temperature is normal. Within 1-3 days, new rashes may appear, after 2-3 days the rash disappears. Treatment is usually not required, but with abundant toxic erythema, additional drinking is recommended, sometimes the doctor prescribes antihistamines (antiallergic drugs).

3. Loss of initial body weight at birth occurs due to starvation due to milk deficiency in the first days of lactation. The maximum loss of body weight is usually observed on the 3rd-4th day of life and in healthy newborns is from 3 to 10% of birth weight. In premature babies, the initial weight loss depends on the corresponding indicator at birth and is restored only by 2–3 weeks of life, and the timing of body weight recovery is directly dependent on the maturity of the child. Recovery of body weight in full-term newborns usually occurs by the 6th–7th day of life in 60–70% of children, by the 10th in 75–85%, and by the 2nd week of life in all healthy term infants. The key to a good weight gain in a newborn baby is early attachment to the breast, a free feeding regimen. Loss of more than 10% of body weight at birth can lead to a worsening of the child's condition. In this case, on an individual basis, the doctor decides on the additional feeding of the child or supplementary feeding with the mixture.

4. Physiological jaundice of the skin is determined by an increase in the level of bilirubin in the blood and is observed in 60–70% of children. Bilirubin is contained in a small amount in the blood of every adult and child, however, in the neonatal period, the level of this substance may increase, and this is due to the characteristics of the newborn child:

Increased production of bilirubin occurs during the breakdown of erythrocytes - red blood cells, which contain the main oxygen carrier in the body - hemoglobin. In utero, the erythrocytes of a child contain the so-called fetal hemoglobin, which differs in its structure from the hemoglobin of an adult. After birth, an active process of breakdown of erythrocytes with fetal hemoglobin and synthesis of erythrocytes with adult hemoglobin begins.

The immature liver enzymes of the newborn cannot cope with the large amount of bilirubin.

Transient jaundice of the skin appears on the 2-3rd day of the child's life, reaches a maximum on the 3-4th day, disappears by the end of the first week. However, the appearance of jaundice on the first day of life or intense yellow coloration of the skin is an alarming sign and requires additional examination.

5. Violations of the thermal balance occur in newborns due to the imperfection of the processes of regulation and instability of the ambient temperature. Newborns easily overheat and cool down under uncomfortable external conditions for them. The main features of the process of thermoregulation in infants are:

The ability of children to easily lose heat under uncomfortable conditions (decrease in ambient temperature, wet diapers);

Reduced ability to give off heat when the ambient temperature rises (for example, when a child is wrapped up, the crib is located in close proximity to a radiator or in direct sunlight).

All this leads to the fact that in the first 30 minutes after birth, the child begins the process of reducing body temperature. To prevent hypothermia, immediately after emerging from the birth canal, the baby is wrapped in a sterile diaper, gently wiped and placed on a heated changing table. Given the above features of newborns, it is necessary to maintain a comfortable ambient temperature (for a full-term baby, this is 20–22 °). In this case, possible overheating must be avoided. Since it is very rare, in 1% of newborns, temporary hyperthermia may develop on days 3–5 - an increase in body temperature to 38–39 °.

6. The hormonal crisis of newborns is mainly associated with the effect of mother's hormones on the child and occurs in full-term newborns. In premature babies, these conditions are quite rare. The sexual crisis includes several conditions:

Breast engorgement, which begins at 3-4 days of life, reaches a maximum at 7-8 days and then gradually decreases. Sometimes milky white discharge is noted from the mammary gland, which in composition approaches the mother's colostrum. Breast enlargement occurs in most girls and half of the boys. This condition does not require treatment, however, in some cases - with severe engorgement - the pediatrician recommends the use of special compresses. In addition, parents can be advised to apply a special soft bandage to the child's chest, which will prevent possible additional injury to the skin of the breast by clothing. In no case should you squeeze out the secret of the mammary glands from the child because of the danger of suppuration.

Desquamative vulvovaginitis - profuse grayish-white mucous discharge from the genital slit, appearing in 60-70% of girls in the first three days of life. Allocations occur for 1-3 days and then gradually disappear. The nature of the vaginal discharge can also be bloody - this is not a cause for concern. This condition does not require therapy.

Milia - whitish-yellow nodules 1-2 mm in size, rising above the level of the skin, localized more often on the wings of the nose and bridge of the nose, in the forehead, chin. These are sebaceous glands with abundant secretion and clogged ducts. They occur in 40% of newborns and do not require treatment.

Dropsy of the testicles (hydrocele) - occurs in 5-10% of boys, resolves without treatment during the neonatal period.

7. Transient stool changes - stool disorders observed in all newborns in the first week of life. In the first 1-2 days, all newborns pass the original stool (meconium) - a thick, viscous mass of dark green color. The absence of meconium may be a sign of a serious illness, such as intestinal obstruction, which requires additional examination and treatment. On the 3-4th day of life, a transitional stool appears - inhomogeneous in consistency and color (lumps, mucus, dark green areas alternate with greenish and yellow). By the end of the first week of life, the stool in most newborns is established in the form of a yellow slurry.

11. Benefits of Breastfeeding

Benefits of breastfeeding for baby. Why is it so important to breastfeed?

It is no secret that nutrition is very important for the growth and development of a child. From the very birth of a baby, one of the main concerns of parents is feeding. How to feed a little man who is not yet able to cope with this on his own?

Modern medicine has developed certain rules that must be observed in order for the child's body to develop well. These rules relate to the quantity and quality of food, the content of vitamins, water, mineral salts, the number of calories that he must receive in order to grow normally and be healthy.

In recent decades, disputes have not subsided about the advantages and disadvantages of artificial feeding, about the possible choice for a mother to breastfeed or formula feed. But even today, in the era of new technologies, despite the fact that baby food (mixture) is prepared very carefully and is as close as possible to breast milk in composition, breastfeeding, of course, has only advantages!

Breast milk is the ideal food for a baby in its first year of life. After all, it is a natural product created by nature itself.

It is optimal in its composition. Better than any other product based on cow's or goat's milk, it is suitable for feeding a baby.

Proteins, fats, minerals and vitamins are absorbed best when breastfed.

The basis of breast milk is made up of special whey proteins. They have a high biological value, are easily digested and absorbed. They contain all the essential amino acids, in particular, cystine and taurine, necessary for the full development of the baby. It is especially important that breast milk's own proteins do not cause allergic reactions and manifestations in the child, which we often see when using artificial mixtures based on cow's milk.

Breast milk fats contain a large amount of special beneficial fatty acids that are easily broken down and absorbed by immature intestinal enzymes. Milk itself contains the enzyme lipase, an enzyme that ensures the digestion of fats. It is lipase that provides soft stools, protection against constipation and colic.

Carbohydrates in breast milk are predominantly lactose (milk sugar). It is she who provides the optimal acidic environment for babies in the intestines and prevents the growth of pathogenic microorganisms in it.

The energy value (calorie content) of breast milk fully meets the needs of the newborn for energy. Breastfeeding allows the baby to eat according to his appetite, allows you to adapt to his needs in such a way that bottle feeding seems never to be possible.

Breast milk contains enzymes, hormones and other biologically active substances that are extremely important for the growth and development of the baby.

The uniqueness of breast milk lies in the fact that it “adapts” to the intestines of your baby, facilitating the adaptation of the entire gastrointestinal tract, ensuring its proper colonization with beneficial microorganisms. Thanks to this, we can sometimes correct violations of the intestinal microbiocenosis without the use of drugs.

Breast milk contains a unique composition of immune factors (secretory immunoglobulin A, lactoferrin, lysozyme). Thanks to them, human milk has a powerful anti-infective property.

And immune defense milk is individual for each baby. With mother's milk, most of the protective antibodies against many pathogenic bacteria and viruses are transmitted to the child. These special antibodies protect the mother's body and the baby's body from infection.

These substances are absent in mixtures and in animal milk. That is why breastfeeding is so important for a child in the first year of life. After all, during this period, the children's immune system is still not sufficiently developed, does not function at full strength, and the kids are so exposed to infection. Breast milk protects the baby in the summer at increased risk intestinal infections, and in winter - with a high threat of viral diseases.

The correct physiological colonization of the intestines with beneficial bacteria, which we talked about above, also plays a big role in the protective forces of the child's body.

Breast-feeding forms the correct bite when covering the nipple, reduces the frequency of dental problems in early childhood, reduces the frequency of caries.

It is important that breastfeeding provides close emotional and psychological contact between the baby and the mother. Breastfeeding creates an amazing sense of security, closeness and trust that lasts for years to come. Nothing compares to those happy moments of feeding, when the baby gives his mother the first smiles.

And finally, breast milk does not need to be cooked and is sterile and at the right temperature.

There are benefits to breastfeeding for the mother as well. Among them - the ability of postpartum recovery of the uterus through hormones, reducing the risk of ovarian cancer and breast cancer.

The benefits of breastfeeding for a child in the first year of life are obvious. But in modern environmental and social conditions, parents and pediatricians are increasingly forced to use substitutes for women's milk.

Health Benefits for Moms

Successful recovery after childbirth. The hormone oxytocin, produced when a baby suckles, causes the uterus to contract. This is especially true in the first half hour after the birth of the baby for the safe separation of the placenta and the prevention of postpartum hemorrhage. The first attachment to the breast and the first long-term feeding should be carried out immediately after childbirth - this is called for by foreign doctors and WHO in their document "Ten steps leading to successful breastfeeding". Feeding the baby in the first 2 months will help the uterus restore its pre-pregnancy shape, and the neighboring abdominal organs will safely take their usual "places".

"Rest" of the reproductive system. Breastfeeding produces the hormone prolactin in the mother's body, which is responsible for the amount of milk. This hormone suppresses the production of estrogen and progesterone, hormones necessary for ovulation and changes in the walls of the uterus for a new pregnancy. Thus, breastfeeding reliably protects you from conception. However, it should be noted here that the necessary protective level of prolactin is maintained only when the child is fed in a natural way:

the breast is given to the child as often and for as long as he wants - during the day and, most importantly, at night (at least 3 times per night);

mother does not offer the baby to suck on foreign oral objects (pacifiers, bottles);

complementary foods are introduced to the baby after 6 months, the volume of adult food increases very gradually;

at night, the baby sleeps next to the mother and is breastfed at the first sign of sleep disturbance.

Studies have shown that about 95% of mothers who organize natural feeding remain incapable of a new conception for an average of 13-16 months. And in a third of mothers, ovulation does not resume during the entire period of breastfeeding!

Prevention of breast cancer. Estrogen hormones promote the growth of cancer cells in the reproductive system and are closely associated with cancers. As mentioned above, prolactin - the main "milk" hormone - suppresses the production of estrogen and slows down cell growth in general. Feeding one child for at least 3 months reduces the risk of breast cancer and ovarian epithelial cancer by 50% and 25%, respectively. Also, against the background of breastfeeding, mastopathy improves. There is even such a way of natural treatment of this disease: breastfeed the baby up to 3 years.

Decreases the need for insulin in diabetic patients.

Calcium is absorbed better during pregnancy, lactation and another six months after the cessation of lactation! Foreign scientists came to such sensational conclusions in the course of a number of studies. Why, then, in some women during these periods of life there are suspicions of a lack of calcium for their body? Most likely, the matter is in the improperly organized nutrition of a nursing mother. It is important, after all, not just to absorb foods containing this element in sufficient quantities. It is important to "help" calcium fully absorb from food.

Also possible reasons calcium deficiency can be a small (less than 3 years) interval between pregnancies and errors in the organization of breastfeeding. Why? The fact is that the birth of a child causes a whole series of hormonal changes: pregnancy - childbirth - the formation of lactation (up to 3 months after childbirth) - mature lactation - involution of lactation (between 1.5 and 2.5 years of the baby) - cessation of breastfeeding - return body to the pre-pregnancy state (within six months). It is the work of hormones during these periods that contribute to a more complete absorption of calcium. If this reproductive chain was interrupted (for example, the mother stopped feeding the baby before the onset of lactation involution, or a miscarriage occurred, or the mother hurried with a new pregnancy), if at any of the stages there was a gross intervention from the outside and the natural hormonal balance was disturbed (for example, artificial stimulation of labor, or lactation was interrupted by medication, or a woman uses hormonal contraceptives), if breastfeeding was not organized in a natural way - the hormonal system of a nursing mother does not work properly, and calcium can really be absorbed in insufficient quantities. Therefore, before blaming breastfeeding for tooth decay, consider whether you are doing everything in accordance with nature and common sense.

For the same reason of better absorption of calcium, the risk of osteoporosis in old age (osteoporosis - a disease caused by the leaching of calcium salts from the bones) also decreases by 25% with each breast-fed baby. Perhaps, for many women, this item will not seem very important. However, if you look around - senile fractures are not so rare. And if you consider that they are difficult to compensate for, then you should think about prevention in advance!

Restoration of normal weight. One of the most important questions of a woman who has given birth: "When will I again become as slender as before the pregnancy?" Answer: in about a year - if you feed your baby naturally! The fact is that during the period of bearing a baby, the mother’s body “makes reserves” for its subsequent feeding: what if there is a crop failure? or a natural disaster? or drought? Mom should have a lot of "reserve" calories prepared for milk production in the first, most important year of a baby's life. Therefore, there is absolutely no need to follow diets for weight loss - they, as a rule, will not help restore pre-pregnancy weight. Nature has provided only one way to return the former attractiveness - long-term breastfeeding.

Prevention of depression. In the absence of breastfeeding after childbirth, if there are problems with feeding, as well as when it is abruptly interrupted, the mother experiences a sharp drop in the level of female sex hormones. The so-called endogenous depressions begin, to overcome which the professional help of a psychotherapist is often needed. In turn, in the presence of successful feeding in a nursing woman, neuropeptide hormones are present in large quantities, including the well-known hormone endorphin. Its action causes a state similar to the joyful elated state of two lovers: "we are knee-deep in the sea, the main thing is that I have you, and that we are together!" Such a mother endures difficulties with courage, takes care of the baby with joy, radiates emotional satisfaction and, despite frequent fatigue, seems to fly on the wings of love.

Stronger immunity. This is caused by increased metabolism in the body of a nursing mother. Intensive metabolic processes accelerate the elimination of toxins, increase the rate of renewal of bones and tissues, and also make the mucous membrane of the nasopharynx less susceptible to infectious agents.

Increased stress tolerance. This effect is achieved due to the work of two hormones:

Prolactin is a powerful tranquilizer. He seems to be sending a signal to a nursing mother: "Calm down, don't be nervous, everything will be fine..."

oxytocin - helps a woman focus mainly on the needs of a small child, leaving experiences on various everyday occasions as if on the periphery of consciousness.

Thus, during the period of breastfeeding, a woman builds a clear system of life values, more consciously structured inner space, the reaction to the events of the external world is streamlined and additional mental resources appear to solve various problems.

In addition to the above, I would like to add that breastfeeding also has indirect health benefits for mothers:

It is extremely economical! Instead of spending on artificial formulas, bottles, pacifiers, nipples, sterilizers, food warmers, medicines for a baby who will get sick much more often than a baby on breast milk, mom has the opportunity to buy something else. For a health trip to the sea, for example, or for a visit to the pool, for massages and beautician services.

The emotional connection between mother and child that occurs in the process of breastfeeding will also play a positive role in maintaining mother's health. How, you ask? As you know, all diseases are from the nerves. And a child with whom there is no deep and trusting contact can be great to spoil the nerves of parents!

12. The process of formation of breast milk

Lactation is the activity of the body that causes the formation of breast milk, its accumulation in the mammary gland and periodic excretion from it during sucking or pumping.

In the period from birth to full maturity of a woman, the ductal apparatus of the mammary gland grows, outgrowths of the primary ducts form. At their ends or sides, kidneys can be laid - the beginnings of future alveoli.

Each menstrual cycle is accompanied by a temporary activation of the mammary glands. IN mammary glands women mainly in the second half of the menstrual cycle occur structural changes- proliferation of ducts and epithelium, expansion of the lumen, loosening, and sometimes swelling of the surrounding stroma. Thus, hormonal stimulation associated with the sexual cycle causes a kind of "gymnastics" of the mammary gland even before pregnancy.

The mammary gland reaches its full development and preparation for lactation during pregnancy. From the moment of conception, milk ducts develop strongly in the lobules of the gland, at the ends of which alveoli are formed. Later, secretory sections are formed, the volume of fat lobules and interalveolar fat is significantly reduced, and blood vessels and nerves.

For the process of lactation, it is not necessary that the pregnancy ends at a normal time.

If it is interrupted ahead of schedule (but not too early), lactation can begin and develop quite intensively. An example of how wisely everything is arranged by nature is a different chemical composition of the breast milk of a mother of a premature baby, in comparison with the composition of the milk of a woman whose baby was born on time - in the first case, breast milk contains more antibodies that provide anti-infective immunity, and iron, which is necessary for better blood oxygenation.

Hormones during lactation: prolactin, oxytocin

Two maternal reflexes are involved in lactation: milk production and milk removal. Both involve hormones (prolactin and oxytocin) and both depend on the main driver of lactation, milk suction. Stimulation of the nipple-areola complex by the child sends neuroreflex impulses to the hypothalamus of the maternal brain, causing the secretion of prolactin in the anterior pituitary and oxytocin in the posterior.

Prolactin is the dominant, key hormone in the process of lactation: it is he who stimulates the production of breast milk in the alveoli.

Oxytocin - working in "pair" with prolactin, causes a contraction of the corresponding muscle cells of the alveoli, pushing milk into the excretory ducts, and also potentiates uterine contraction, which contributes to the rapid and complete recovery of a woman after childbirth.

It should be noted that not only the physical, but also the mental state of the mother, her ability to control herself and make adequate decisions in difficult situations depends on the work of these two hormones - oxytocin, and especially prolactin. If a mother has no doubts that she is able to breastfeed her own child with her breast milk, she will do it safely even under conditions of stress.

Any lactating woman should be aware that lactation is best promoted by frequent (approximately every two hours) attachment of the baby to the breast: due to this, there is a constant emptying of the mammary gland, as well as milk production.

It must be emphasized that prolactin ("milk-forming" hormone) is secreted by the pituitary gland precisely when the child suckles. Thanks to this, a new supply of breast milk is prepared already during feeding, and 2 hours after it, about 70-75% of the milk sucked by the baby is restored for the next feeding. Therefore, the more often the baby suckles, the more milk is produced.

Since lactation is an energy-intensive process, evolution provided for the existence of appropriate mechanisms, a kind of "guardians" that do not allow the overproduction of such an invaluable product as breast milk (along with stimulating mechanisms that allow satisfying the ever-increasing needs of the child).

The volume of milk produced by each gland is strictly regulated by the efficiency of its suction and/or pumping.

13. Breast milk. Composition and properties

The immaturity of the gastrointestinal tract of infants leads to the need for processing and the consumption of nutrients in an easily digestible form. The best and most physiological food for a child of 1 year of life is only mother's milk. Breastfeeding contributes to the normal growth and development of the child, increases its resistance to infections and much more. other.

The uniqueness of breast milk lies in the fact that it contains special substances that protect the baby's body from various diseases. The baby receives mother's milk sterile and warm, which means that the risk of diseases is underestimated and the digestion process proceeds in more favorable conditions.

The composition, properties of breast milk, its quantity changes throughout the entire period of lactation, depending on the state of health of the mother, her nutrition, regimen, season of the year, and the needs of her child. And, of course, every mother's milk adapts to her child. Everything that he needs for growth and development, he will find in breast milk.

At the end of pregnancy and in the first 3-4 days after childbirth, colostrum (colostrum) is released - a thick, sticky yellow liquid, from 4-5 days - transitional milk, from 2-3 weeks - mature milk.

Breast milk contains about 100 nutritional and biologically active components that are characteristic of the human body. The most important are proteins, fats and carbohydrates. In breast milk, they are in an ideal ratio for assimilation by the child's body - 1: 3: 6, while in cow's - 1: 1: 1.

Among them, proteins and protein-containing components (hormones, enzymes, specific and nonspecific protection factors) have the greatest biological specificity.

Colostrum, unlike mature milk, is richer in proteins, salts and vitamins (for example, A, C, E, K, carotene), leukocytes and special colostrum bodies. But it contains less lactose, fat and water-soluble vitamins. Colostrum bodies are special cells, irregular in shape with numerous small fatty inclusions. Proteins consist mainly of whey proteins - globulins and albumins, casein appears in transitional milk, from 4-5 days of lactation and makes up only 1/5 of all proteins. There is less fat in colostrum than in transitional and mature milk. But in terms of calories, it is higher (see tab. No. 1), which is very important in the first day of a child's life.

Colostrum has a high level of immunoglobulins and many other protective factors, which allows it to be considered not only a food product, but also a medicine - a modulator of a child's development.

Transitional milk is excreted from 4 to 5 days after birth. It is rich in fat, but in composition it is already approaching mature milk.

Mature milk appears by the end of 2 weeks. But in the process of lactation, its composition also changes. It can be different during the day and even during one feeding. So, at the beginning of feeding, the milk is more liquid, towards the end it is fatter and thicker.

In the baby's stomach, human milk coagulates into smaller flakes than mammalian milk. It is also important that it comes from mother to child at body temperature, almost sterile, containing bactericidal substances, in particular immunoglobulins, lysozyme, lactoferrin, alpha-2-macroglobulin, etc. All the main ingredients of human milk are absolutely non-antigenic in relation to the child.

Breastfeeding contributes to the formation of contact between the child and the mother, which is very important for the development of his psyche.

Mature human milk has the lowest protein content compared to the milk of all other mammals. The average protein content of breast milk is 1.10g/100ml. The nutritional protein content can be even less than 0.8 g per 100 ml if corrected for such proteins that are almost not broken down in gastrointestinal tract and cannot be absorbed - this is lysozyme, lactoferrin, secretory immunoglobulin A. But even this amount is quite enough for the normal growth of the child.

Protein is necessary for a child as the main plastic material, as an important element for the synthesis of hormones, enzymes, the production of antibodies and the formation of immunity. The child's body is especially sensitive to a lack of protein and a change in its qualitative composition.

Composition and some physical and chemical characteristics of human milk and colostrum.

MAIN COMPONENTS	COLOSTRUM	TRANSITION MILK	MATURE MILK
Protein, g %	16,2- 4,2	3,2- 1,9	0,9- 1,8
Casein	2,7	1,59	1,1
Lactalbumin	1,2	0,51	0,4
Lactoglobulin	1,5	0,8	0,6
Fats, g %	2,8-4,1	2,9- 4,4	2,7- 4,5
Carbohydrates, g%	4,0- 7,6	5,7- 7,6	7,3-7,5
Water, g%	87	88	88
Ash, g%	0,5- 0,4	0,4- 0,3	0,3- 0,25
Energy value, kcal	106,8- 83,6	61,7- 77,6	57,1- 77,7

Human milk protein consists mainly of delicate albumins and globulins, which are easily digested and absorbed by the child's body. But rough casein in breast milk is ten times less than in cow's milk. The particles of human milk casein are so small that they form tender flakes in the baby's stomach and are easily processed. Cow's milk also contains beta-globulin - the main culprit of allergic reactions, which is not found in breast milk (see Table No. 2)

Characteristics of the proteins of women's and cow's milk., g / 100ml

Protein is made up of amino acids. Amino acids are essential nutrients for the body. Of the 24 known amino acids, 8 are essential - threonine, valine, leucine, isoleucine, lysine, tryptophan, phenylalanine, methionine. And for children of the first year of life, histidine is also an indispensable amino acid. Women's milk, for example, has more taurine and cystine, less methionine, compared to cow's milk.

Cystine is essential for the development of the fetus and premature babies. Taurine serves as a neuromodulator for the development of the central nervous system, for the formation of bile salts, for the absorption of fats. Children are not able to synthesize taurine, so it acts as an essential amino acid.

Fats are one of the sources of energy for the body. Fats and their metabolic products are involved in the formation of cell membranes, are carriers of fat-soluble vitamins A, D, E, K, participate in the formation of the nervous system, etc.

Women's milk fats contain a large amount of polyunsaturated fatty acids, which are an indispensable plastic and energy material for the development of a child's body. Women's milk is stable in terms of fatty acid composition and consists of 57% unsaturated and 42% saturated fatty acids, rich in cholesterol, phospholipids. Human milk fats are much better absorbed in the baby's body compared to formula milk fats.

With a lack of fat in the child's diet, growth slows down, immunity decreases, and pathological conditions skin. Excess of it inhibits the secretion of the digestive glands, reduces the level of digestion and absorption of protein, disrupts phosphorus-calcium metabolism.

The digestibility of breast milk fat is very high - about 90%, due to which about 50% of the child's daily energy needs are covered.

Carbohydrates

The main carbohydrates in breast milk are lactose, which provides up to 40% of the energy needs of a growing baby's body, and small amounts of galactose, fructose, oligosugar, for example, bifidus factor. Lactose is a specific food for infants, since the lactose enzyme is found only in young mammals.

Lactose promotes the absorption of calcium and iron, the synthesis of intestinal microbes of B vitamins, vitamin K, stimulates the formation of intestinal lactobacilli, and inhibits the growth of Escherichia coli. Lactose in cow's milk, on the contrary, stimulates the growth of E. coli.

Breast milk is an easily digestible energy source that creates a slightly acidic environment in the large intestine, which is detrimental to putrefactive bacteria and beneficial to beneficial flora in the presence of the bifidus factor.

The composition of minerals, macro- and microelements in women's milk is relatively better than in cow's milk. It contains more substances important for hematopoiesis: iron, copper, manganese, cobalt, etc., it is richer in enzymes and vitamins of groups B, A, C, etc.

Breast milk contains lactogenic hormones, hormone-like substances, factors of growth and differentiation of cells and tissues, factors of specific and non-specific protection against infections that are involved in the formation of the child's immunity (see Table No. 3).

Some factors of anti-infective protection of breast milk

All these data speak of great benefit breast milk for the growth and development of the child in the first years of life. And before you refuse to breastfeed your child for aesthetic and psychological reasons, evaluate the positive aspects of such feeding and weigh the pros and cons…..

14. Colostrum

Some experts compare it with medicine. It is considered the first vaccination, the first vaccine of the baby, toning up his name system. Because it contains much more antibodies and protective substances than mature milk.

It is known that in the first application of crumbs to the breast, the baby sucks out about 2 ml. colostrum. However, this is enough to start immunizing the body of a newborn baby.

It is important that the first application takes place in the first hour after birth, just during this period the baby begins to show search behavior - to look for his mother's breast. He rested from childbirth and is ready to move on to enjoy his mother's milk. The movements of the baby are very touching, he tries to raise his head, crawl towards his mother's chest, opens his mouth, sticks out his tongue. Most babies are able to independently reach the treasured areola of the mother's breast and grab onto it with a small mouth. If this moment is missed, then the baby will fall asleep and then it will no longer be possible to attach him to his mother's breast by any persuasion - he will rest.

On the first day after childbirth, the breasts are soft to the touch and as if empty. The secretion of colostrum is insignificant, it is yellowish in color and cloudy. By the end of the second day, the breast begins to fill up - the colostrum becomes larger, the color of the colostrum changes to rich yellow, sometimes orange.

The amount of colostrum secreted is different for different women, from about 10 to 100 ml per day, but, despite this, it is enough for a newly born little man. Because, despite the small amount of this product, it is very nutritious.

Colostrum is thick, there is not much liquid in it - this is good, because the baby is not yet able to process large volumes of liquid, his kidneys are not yet adapted to them. That is why extra water is contraindicated for the baby! It is known that a child is born with a supply of water that protects his body from dehydration until mature milk rich in water arrives. In addition to all of the above, colostrum in its composition has laxative properties, which helps the baby's body to get rid of the original feces.

15. Causes of hypolactia

Hypolactia occurs in 10-15% of lactating women. There are primary and secondary hypolactia. With primary hypo-lactia, from the very beginning after childbirth, there is an insufficient amount of milk. With secondary hypolactia, milk secretion in the postpartum period gradually decreases or completely stops. The causes of hypolactia can be functional insufficiency of the mammary glands, maternal diseases associated with pregnancy, targeted care for the mammary glands, nipple cracks, mastitis. Overwork, sleep disturbance, mental trauma also matter.

Good nutrition must be combined with the right regimen. A nursing mother should be in a calm environment, have enough rest, do moderate physical work, walk in the fresh air and sleep at least 8-9 hours a day. Smoking and consumption of alcoholic beverages is absolutely unacceptable. If possible, a nursing mother should not take medicines, as some of them can be transmitted with milk and adversely affect the baby's body. Proper nutrition and observance of the regimen by a nursing woman largely prevent hypogalactia. However, it often develops in women who adhere to the regimen and rational nutrition. Women, especially nulliparous women, often suffer from the assumption that they have little colostrum or milk, due to increased sensitivity of the nipples or a feeling of fullness in the mammary glands on the 4th or 5th day after childbirth. Sensitivity of the nipples is one of the problems of the first period of breastfeeding. The main cause of soreness and cracks in the nipples is improper sucking, due to the inept attachment of the child to the breast. When feeding, it is necessary to change the position of the child in order to change the force of pressure on different areas pacifier. Another reason is malnutrition, as a result of which a hungry baby suckles more actively and possibly incorrectly. In this case, you do not need to limit the duration of feeding. It is better to feed the baby more often, thereby preventing both excessive sucking and milk stasis in the breast. To avoid the appearance of cracks and sore nipples, a nursing mother should properly care for the mammary gland:

Avoid excessive washing of the glands, especially with soap;

Do not use creams and aerosols;

After feeding, leave a few drops of milk on the nipples so that they dry in the air;

Keep nipples outdoors as much as possible, at least at night;

Make sure that the nipples are always dry.

If the baby suckles normally and in the correct position, and the nipples remain sensitive, other causes should be looked for. Perhaps the child has thrush, then the mother's nipples may become infected and their soreness will appear. In this case, it is necessary to treat both the mother and the child. Psychosomatic soreness of the nipples may occur, especially in nulliparous women, if the mother experiences feelings of anxiety and insecurity about her ability to breastfeed. A mother may feel uncomfortable if she has to feed her baby in an open room or in the presence of other people. The anxious mood of a woman may also be due to the fact that she is worried about what is happening in her absence at home, about the future care of the baby.

17. Mixed artificial feeding

Any mother, even with enough milk and good physical performance, does not hurt to know about such a useful thing as mixed feeding of a child. Such mixed feeding is a diet in which artificial feeding with mixtures alternates with natural - breastfeeding. At the same time, the baby receives mother's milk in an amount of not less than 150-200 g per day.

Mixed feeding of infants is usually called supplementary feeding in the first 4-5 months of life. This is the time when the baby needs a decent amount of natural nutrition.

Of course, there is nothing better than breastfeeding, especially in the first six months of life. However, due to some malfunctions in the woman's body, mostly true hypogalactia, there may be a need for artificial substitutes, although the time for complementary foods is still far away. True hypogalactia can occur as a result of underdevelopment of the nipples, stress during pregnancy, or diseases that are not uncommon in modern women in labor. In these cases, mixed breastfeeding can come in handy. Well, if the mother is quite healthy and also managed to go to work in a couple of months, then breastfeeding also recedes into the background: pumping must be replenished with supplementary feeding from adapted milk mixtures.

Of the mixtures for mixed feeding of a child, as well as for a completely artificial one, "Baby", "Agu-1" and "Agu-2", which are hypoallergenic, are perfect. A mixture of Speransky and "Baby" is prescribed in the first days of life with a lack of natural colostrum. The norms of artificial feeding with mixtures are determined by how much mother's milk the child lacks and what substances he lacks.

If a child is transferred to mixed feeding from birth, then with the age of up to a year, his nutrition is supplemented with mixtures for the second half of the year, milk diluted in decoctions, whole milk with 5% sugar, diluted kefir and ion-exchange milk. Don't be surprised by this: mixed feeding babies require more calories than natural feeding. There is also an increased need for protein, fruit juices and supplementary feedings. And the time for complementary foods comes earlier by about two weeks.

Some mothers fundamentally refuse mixed feeding of babies, resorting to donor milk. But this is not always possible, and Lately mothers very rarely resort to this method of feeding their baby. In this matter, you should not be afraid of mixed feeding: problems with mother's milk can be resolved over time and it is possible to switch back to breastfeeding. After all, as we have already said, mixed feeding is the lot of babies who are not yet a year old, which means that mother's milk is still of great value. The main thing is to maintain the ability to feed, that is, to restore lactation and not to wean the child from breastfeeding during the period of mixed feeding. Working mothers are advised to take the crumbs to their place at night, and during the day to calmly express and add artificial feeding with a mixture.

To do this, you must strictly follow the regimen and rules of feeding. If a mother puts her baby to the breast more than twice a day, then the flow of milk will not disappear. Even if you have already fed, washed and put your miracle to bed, you can also give a sleepy breast - they smack their lips in a dream, receiving additional tiny portions of milk, and at the same time stimulating a milk rush.

It is also important that the child does not get used to the nipple with its wide opening, or rather, does not know it at all. This is the main feature of mixed feeding of a child - to help breastfeeding rather than replace it. Instead of a pacifier, it is better to use a special cup or spoon for feeding. It is necessary to feed mixtures only after "lunch by breastfeeding". Firstly, again, the "mixed period" will pass without loss of mother's milk, and secondly, it has been proven that any artificial formula feeding is absorbed better in combination with breast milk. As a result, even with 30% of the mother's feeding, the child develops quite normally, even if the other 70% consist of a store-bought diet. So breastfeed as long as you can!

To determine the need for supplementary feeding, it is advisable to carry out control weighings before and after feeding. This makes it easier to figure out how much formula your baby needs. Baby diapers will help here, or rather, their number. In medicine, there is a test called the dry diaper symptom.

A newborn with a normal diet should write 3-6 times a day, or even more. On the tenth day, the baby should reproduce around twelve. If already in the first week of life there are less than three wet diapers (although this is extremely rare), then mixed feeding of the child immediately begins.

The same diapers will help determine the end of the “mixed diet course”: as soon as the diaper record reaches 14 pieces per day, supplementary feeding is reduced, though gradually and under the supervision of a pediatrician. The most difficult thing is to wean children who receive more than 200 grams of artificial mixtures per day from supplementary feeding.

Finally, the following must be said: before introducing the mixture, they should try to solve the problem by taking care not of the baby, but of themselves. Monitor your diet, think about what may be missing in your body for the required amount of milk. Good help (literally in a couple of days) lactation teas, fortified supplements. Difficulties with feeding a child can be the consequences of a psychological state: when feeding a baby, the mood plays the biggest role. As you know, just the sight of your crumbs already contributes to the flow of milk. Do not forget that mothers are also prone to lactation crises in the first months of feeding. This is a very temporary phenomenon, and mixtures will have nothing to do with it.

And only in the case of a deep examination, you can start mixed feeding of the child to help breastfeeding, and not replace it.

18. Correction of nutrition and rules for the introduction of complementary foods

How well a child will eat in the first year of life depends on his health and attitude to food in the future. So bring up a real connoisseur of healthy food!

The most delicious and healthy food for a child during the first six months of life is considered to be mother's milk. If, for some reason, the mother cannot breastfeed the child, then he should receive a high-quality adapted formula. But there comes a time when a growing body needs other food.

You will recognize that it is time to introduce complementary foods according to several basic criteria: interest in adult food, the ability to sit confidently, the appearance of the first teeth. So, it's time to think about how to introduce complementary foods to the child.

First food

Previously, doctors advised mothers to include drops of juice in the children's menu literally from the age of two weeks. Now, nutritionists are increasingly talking about the dangers of early introduction of complementary foods to a child, moreover, they support their words with irrefutable evidence.

If we are talking about babies who are breastfed, the World Health Organization recommends starting their acquaintance with new products no earlier than six months.

And an artificial child must be fed from five and a half months. However, this does not mean that you should seat the little one at the table on a well-defined day. Wait for the moment when he asks you for what you eat.

Most likely, the baby will do this out of pure curiosity. But the result of the research will pleasantly surprise him! Give your baby a slice of a peeled apple or pear. You can also offer from your plate half a teaspoon of boiled potatoes, buckwheat porridge on the water.

Pediatricians call this method pedagogical complementary foods. It differs from the usual one in that its task is not so much to feed the baby as to introduce him to adult food and the rules of behavior at the table.

Everything has its time

Do not rush to transfer the child to a common table. While not everything that adults eat suits him. Despite the fact that the baby's digestive system is already quite developed, he still cannot eat fried, salty, smoked, fatty foods. Semi-finished products, sausages, sausages, some raw vegetables, sweets, cakes are also prohibited.

Important rule

Let your child decide when to finish the meal. Do not force him to finish eating, do not force feed - and then you will not have problems with food.

We introduce complementary foods

To start, offer your little gourmet half a teaspoon of the new dish before the main meal. It is advisable to do this in the morning. Then immediately supplement your baby with breast milk or formula. The next day, you can give a whole spoonful. The main thing is to monitor the general condition of the child.

Redness, skin rashes, and abdominal pain are warning signs. Eliminate this product from the diet immediately and refuse to introduce anything new for at least three days. Did the meet and greet go well? Gradually increase the portion. And a week later, feel free to introduce another product.

From the moment you completely replace one meal with complementary foods, start giving your baby water or tea. Offer a drink after meals and between meals. As for the artificial baby, he has long been familiar with water. In this case, be guided by his desires.

Literally immediately after the introduction of a new product, you will notice changes in the child's stool, he will have bad breath. Don't worry: everything is fine. It's just one of the stages of physiological development.

Behavior rules

Do not expect your child to obediently sit at the table and carefully wield a spoon. Even if you put a bib on him, he will still get dirty. And, no doubt, he will touch the food with his hands, smear it on the table or on his knees. Experiments are also ahead with a spoon: the baby will probably want to clamp it in his teeth, knock on the plate.

Naturally, the child will not immediately begin to use the spoon on his own. But the sooner you give it to your baby, the sooner he will learn it. At the same time, feed him with another spoon. The most convenient and safe plastic cutlery. You - with a flat handle, the baby - with a curved one.

A little later, offer the child a fork. Believe me, it's never too early to start mastering it. But provided that the devices are used correctly by adults themselves.

Rules for feeding a child

When collecting information about complementary foods for a child, you probably noticed that there are no unambiguous opinions and recommendations. Pediatricians and nutritionists advise starting to introduce complementary foods at four months, then at six. The indicated ages on jars of baby food generally confuse mothers.

However, all this should not confuse you. Firstly, in some countries where mashed potatoes and cereals are produced, there are other norms for the introduction of products. Secondly, they are designed for artificial children, who are supposed to be introduced to new foods earlier than babies. To date, most experts adhere to the following complementary feeding scheme.

Complementary feeding scheme

Complementary foods for 6 months It is better to start with porridge or vegetable puree. Grind corn, rice or buckwheat in a coffee grinder and boil it in water (let the consistency be liquid) or use similar commercially produced cereals.

As for vegetables, boiled zucchini, cauliflower or potatoes are suitable for the first time. Grind them with a blender and offer the baby. A serving of 100-150g will be optimal.

Complementary foods for a 7-month-old baby You can cook a little gourmet mashed potatoes from several vegetables already familiar to him, cook soup by adding vegetable oil and egg yolk (¼ teaspoon no more than twice a week).

Complementary foods for an 8 month old baby it's time to find out what dessert is. Fruit puree from apple, pear, peach are ideal for the baby. mix them with porridge or offer them as an independent dish. But keep in mind: if before that the baby ate 70 g of vegetables, then let's give no more than 50 g of fruit.

In addition, it's time to try kefir (full serving - 100 ml) and cottage cheese (50 g per day). Cook them yourself using sourdough - you will do well. But special meals are also suitable. Just do not forget that beneficial bacteria live from 5 to 14 days. If the packaging says that the product can be stored longer, then there are no probiotic cultures.

Complementary foods for a 9-month-old baby Start eating meat. Beef, rabbit, turkey - it's healthy and tasty! Boil the meat, and then chop it in a meat grinder or with a blender. Baby food is fine too. For the first time, give half a teaspoon of meat along with vegetables. Gradually increase the amount to 3-4 teaspoons per day.

Just do not cook soups with meat broth for your baby - a small stomach cannot digest this complex dish.

Complementary foods for a 10-month-old baby Meat should be constantly on the baby's menu now. At the same time, nutritionists advise to arrange one “fasting” day, replacing meat with fish. Choose low-fat varieties (hake, cod, sea bass). At the same time, do not forget that the first portion of the new product is half a teaspoon, the full one is 50g.

At this age, you can already offer the baby borscht. Just first check his reaction to bright vegetables - beets and carrots. Try also pumpkin, berry puree, yogurt, baby biscuits.

Complementary foods for an 11-month-old baby Soups are perfectly complemented by fresh herbs (it is better if you start growing dill and parsley on the window, so as not to doubt their environmental friendliness). Borsch will taste better with sour cream. Bread with butter will also appeal to the little gourmet. Feel free to cook semolina, barley, barley, oatmeal and millet porridge for him - they will certainly please him.

Complementary foods for a 12-month-old baby The baby's menu has already expanded quite a bit by this time. He probably has a favorite food too. For example, an apple with celery or steam meatballs. Now it would be good to introduce juice (cook it yourself and at first dilute it with water 1: 1) and milk (designed specifically for children).

cooking lessons

Of course, you care about the health of the baby, strive to feed him only healthy and freshly prepared foods. However, the concept of "proper nutrition" in relation to the child has a number of features. For children's dishes there are laws.

Boiled or steamed Vegetables from a double boiler or cooked in a small amount of water have a rich taste, and their texture is more tender. In addition, with this processing, vitamins are better preserved. In no case do not fry anything, even dressing for soup or borscht.

Without salt and sugar All products contain some of these natural ingredients, so teach your baby to the natural taste. But what you can safely add to soup or mashed potatoes is a little bit of vegetable oil. And only closer to the year, start slightly salting the dishes using iodized salt.

As for drinks, sweeten sour compotes and jelly with natural grape sugar or honey - provided that the little one is not allergic to it.

Wiped Usually, at the time of the introduction of complementary foods, only one or two teeth erupt in a child, that is, he cannot chew on his own. Therefore, food must be mashed to a state of puree (homogenized). A little later, at 8-9 months, it will be enough to knead it with a fork. And by the year - cut the food into small pieces.

The freshest Try to prepare food for the baby for one meal only. Never offer your child something that he did not finish last time. And even more so, do not cook from the evening to tomorrow.

To drink or not?

Nutritionists advise not to drink during meals - only after it, preferably after 10-15 minutes. So do not put on the table everything that you want to offer your baby. It's better to do it one by one. Purchase convenient dishes for tea, compote and water. You should not pour the drink into a bottle with a nipple, immediately teach your baby to drink from a cup. Choose a model with a convenient spout and a blocker: if the baby knocks over the cup, the liquid will not spill. For older children, models with a straw are suitable.

food allergens

Nutritionists note: cases of allergic reactions in young children have become more frequent. There are several causes of the disease, including incorrect or untimely introduction of complementary foods and intolerance to any food by the child.

Gluten Wheat, oats and rye contain gluten protein, which is poorly absorbed by the child's body up to 5-6 months. First of all, introduce gluten-free cereals: corn, buckwheat, rice. Wait a little with other cereals, as, however, with bread and cookies. Offer them to your baby only after 8-9 months.

Cow's milk Until the age of one, the enzymatic systems of the child are not ready to digest this product. If you want to pamper your baby with milk porridge, dilute it with breast milk or formula.

Eggs Allergy to protein is quite common. Therefore, up to a year, give the child only the yolk (in a small amount).

In addition to these products, fish, honey, beans, lamb, vegetables, berries and fruits of red and orange colors can cause rashes on the cheeks. Be careful with them, never offer your baby several new foods at the same time and keep a food diary, especially if the allergy still manifests itself. Write down the dish, how it was prepared, and the baby's reaction. This information will help you easily determine the culprit for the appearance of red spots on the skin of a child.

19. Calculation of the daily amount of food for full-term children of the first year of life.

There are several ways to calculate nutrition.

First 10 days of life

Formula Zaitseva G.I.

daily milk volume = 2% of birth weight? age in days

For example, the age of the child is 7 days,

birth weight - 3200g

daily milk volume = 64 * 7 = 448 ml

The volume of milk per feeding with free feeding (the number of feedings is at least 10) is approximately 45 ml, with feeding by the hour (7 times a day) - 64 ml.

Finkelstein formula

If the birth weight of the child is less than 3200g:

Daily milk volume = age in days x70

If the weight of the child at birth is more than 3200g:

Daily milk volume = age in days x80

After the 10th day of life

Bulk method:

The daily amount of food is:

aged 10 days to 2 months. 1/5 of the child's body weight

from 2 months up to 4 months 1/6 of the child's body weight

from 4 months up to 6 months 1/7 of the child's body weight

from 6 months up to 8 months 1/8 of the child's body weight

older than 8-9 months and until the end of the year 1000-1200 ml per day

Conclusion

In recent years, the characteristics of a healthy person, his environment, disease prevention have emerged as a separate discipline studied in medical sciences. educational institutions. For a nurse, knowledge about a healthy child is important, because. they allow nursing process taking into account the individual characteristics characteristic of young patients.

1. D.A. Kryukova, L.A. Lysak, O.V. Furs “A healthy person and his environment”.

2. N.Yu. Rylov "Newborn baby"

3. http://www.razumniki.ru/vnutriutrobnoe_razvitie.html

4. Evgeny Komarovsky. "The health of the child and the common sense of his relatives"

5. http://www.missfit.ru/mammy/prikorm/

6. http://www.ratnatg.ru/korrekcia.htm

7. http://www.net-boleznyam.ru/periody-detskogo-vozrasta/

Kataeva A., Strebeleva E.A. Preschool oligophrenopedagogy: Proc. for stud. higher education, institutions. Features of the development of a child at an early age

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Kataeva A., Strebeleva E.A. Preschool oligophrenopedagogy: Proc. for stud. higher education, institutions. Features of the development of a child at an early age

How much does it cost to write your paper?

Thank you, an email has been sent to you. Check your mail.

What is Developmental Psychology

Subject, object, tasks and functions of developmental psychology

Methods of developmental psychology

General scientific methods

Observation

Experiment

Modeling

Psychophysiological methods

Psychogenetic methods

historical methods

Psychological methods

Age groups

Up to 1 year

From 1 year to 3 years

3 years

4 years

5 years

6 years

7-11 years old

12-16 years old

16 years old - 22 years old

23 years old - 28 years old

29 years old - 32 years old

33 years old - 39 years old

40 years old - 42 years old

43 years old - 49 years old

After 50 years

Factors affecting human development

Heredity

Wednesday

Upbringing

Literature

Test your knowledge

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