Therapeutic and prophylactic mixtures. In what cases are medicinal infant formulas needed for infants: rules of use for digestive problems in children

Therapeutic nutrition is a powerful therapeutic factor, in which a properly formulated diet becomes a key mechanism that allows you to influence disrupted parts of metabolism and normalize functions. digestive system, activate the body’s defenses, which largely determines the course and outcome of the disease. For certain types of pathology, nutritional therapy is the only means of treatment.

For organization therapeutic nutrition a sick child in the first year of life is important right choice a product with a special specified composition that meets the characteristics of the disease and the nature of the metabolic processes disturbed.

Currently, in our country there is a wide range of specialized products for therapeutic and prophylactic purposes, produced domestically and abroad, for the nutritional correction of various diseases in infants.

Specialized mixtures for children with functional disorders of the gastrointestinal tract

IN last years Anti-reflux milk formulas are widely used in the nutrition of infants with regurgitation, vomiting, and constipation. Depending on the type of thickener, they are divided into two groups: mixtures containing carob gum (Nutrilak AR, Nutrilon AR, Frisovom, Humana AR) or starch (Samper Lemolak, Enfamil AR ", "Nutrilon Comfort") ( ).

The protein component of most of the listed antireflux products is dominated by whey proteins, which are easily digested and removed from the stomach relatively quickly. The only casein-predominant mixture is Nutrilon AR. Casein forms a denser clot in the stomach, which can prevent regurgitation and enhances the effect of the gum. In addition, this mixture has a moderately reduced fat content (3.1 g/100 ml), which promotes faster evacuation of food from the stomach.

Locust bean gum is a soluble, starch-free polysaccharide that swells in the baby's stomach, thereby preventing regurgitation. The carbohydrates that make up the gum are dietary fiber - indigestible polysaccharides that are not broken down in the upper gastrointestinal tract, but are fermented by colon microorganisms, promoting the selective growth of indigenous microflora.

The maximum permissible gum content in the product is 1 g per 100 ml. In antireflux mixtures, the gum content ranges from 0.34 to 0.5 g per 100 ml. Edible gum is divided into instant (instant) and natural (requiring dilution). hot water for swelling), obtained from the seeds of the Mediterranean acacia and containing 85% carbohydrates, 5% protein, 10% moisture.

Depending on the type of gum added to the product, the water temperature for diluting anti-reflux mixtures is different and is: for products containing instant gum, 40-50 ° C (“Humana AR”, “Nutrilak AR”, “Nutrilon AR”); for products with natural gum it is significantly higher than 70-80°C (“Frisov 1” and “Frisov 2”).

Anti-reflux products containing gum are introduced into the child’s diet gradually, at each feeding. It is possible to add them to a bottle with standard formula that the child receives, but it is more effective independent use at the beginning of feeding. The volume of the medicinal product is selected individually until regurgitation stops.

The second group of anti-reflux products consists of mixtures containing rice, corn or potato starch, rich in amylopectin, as a thickener (Samper Lemolak, Enfamil AR, Nutrilon Comfort 1 and Nutrilon Comfort 2). Amylopectin is a high-molecular compound - a branched polymer of glucose, the digestion of which is slow. Its breakdown occurs primarily in the small intestine under the action of glycoamylase. Amylopectin does not have prebiotic properties.

Antireflux formulas are primarily used for regurgitation (spitting up) in infants. Regurgitation is the return of food chyme after swallowing the food eaten. Regurgitation is often caused by inadequate feeding (rapid sucking, aerophagia, overfeeding, feeding irregularities, inadequate choice of formulas), as well as perinatal lesions of the central nervous system, pylorospasm, etc. Therefore, the prescription of antireflux mixtures should be preceded by identifying the causes of regurgitation.

Mixtures containing gum can also be used in the nutrition of children with functional constipation: chronic delay in bowel movement for more than 36 hours, increased intervals between bowel movements compared to the physiological norm, difficulty in defecation, and the passage of small amounts of high-density feces. It is known that gum has the properties of dietary fiber: it retains additional amounts of water and helps to gently stimulate intestinal motility, which leads to the elimination of constipation. The most effective of this group of products are mixtures with a predominance of whey fraction in the protein component, since caseins have a fixing effect. When treating constipation, milk mixtures with gum can not be introduced into every feeding, but independently as a separate feeding - 2-3 times a day.

In addition to mixtures that contain gum, the “Samper Bifidus” mixture containing lactulose has worked well in the nutrition of children with constipation ( ). Lactulose is a disaccharide consisting of galactose and fructose, obtained synthetically. It, like dietary fiber, is not digested by enzymes of the gastrointestinal tract; it reaches the colon unchanged, where it is fermented by lacto- and bifidobacteria and serves as a substrate for their growth. During the fermentation process, short-chain fatty acids are formed, the pH of the intestinal contents decreases and osmotic pressure increases, as a result of which fluid enters the intestinal lumen, peristalsis increases and constipation is eliminated.

Currently, “Agusha Baby Milk with Lactulose” is produced (OJSC “Children's Dairy Products Plant”, Russia), which is recommended for use in the nutrition of children with functional disorders of the gastrointestinal tract.

In addition to children's dairy products, lactulose is included in the composition of children's instant cereals "Nutrilak. Corn with lactulose", "Nutrilak. Oatmeal with lactulose" (Nutritek, Russia). These products are effective in feeding sick children with impaired intestinal motor function (constipation, unstable stool).

The formation of softer stools is also facilitated by dietary fiber - oligosaccharides, which are linear polymers of glucose and other monosaccharides (galactose, fructose). In human milk, galacto-oligosaccharides account for 12-14% of the total carbohydrates. They have a prebiotic effect, ensuring the growth of bifidobacteria in the child’s intestines. A prebiotic supplement containing 90% short-chain galactooligosaccharides and 10% long-chain fructooligosaccharides, which is part of the mixtures “Nutrilon Comfort 1” and “Nutrilon Comfort 2”, has similar properties.

Low-lactose and lactose-free mixtures

Low- and lactose-free infant formulas include products created on the basis of cow's milk proteins and intended for feeding children of the first year of life with lactase deficiency.

In lactose-free mixtures, the amount of lactose (milk sugar) is almost zero. The main carbohydrate component of such mixtures is dextrin-maltose. In low-lactose formulas, the amount of lactose is approximately 1 g per 100 ml (from 0.9 to 1.33 g), for comparison, human milk and standard milk formulas contain 6-7 g of lactose per 100 ml.

As a rule, in low- and lactose-free mixtures the ratio of whey proteins to casein is 60:40 or 50:50, and the fat component is represented by the composition vegetable oils, which is typical for adapted infant formulas and allows us to recommend them for use from the first days of a child’s life. Predominantly “casein” formulas include mixtures of “Humana-LP” with prebiotics: galacto-oligosaccharides, dietary fiber and “Humana-LP + MCT” (ratio of casein to whey fraction 80:20). The content of prebiotics (galacto-oligosaccharides, fiber) in combination with a low fat content gives rise to the use of these mixtures for the correction of diarrhea syndrome in lactase deficiency ( ) .

Hypolactasia or alactasia are diseases resulting from insufficient activity or complete absence of the parietal digestive enzyme, lactase, which breaks down milk sugar (lactose), which are manifested by osmotic (“fermentation”) diarrhea after taking lactose-containing dairy products.

Diet therapy is the main method of treating lactase deficiency. It is aimed at “bypassing” the metabolic block. The use of low- and lactose-free formulas in the nutrition of children with lactase deficiency allows us to provide a pathogenetic approach to the treatment of this pathology.

In case of primary (constitutional) lactase deficiency, a low-lactose (lactose-free) diet is prescribed for life. In case of secondary lactase deficiency, the main attention is paid to the treatment of the pathology that led to this condition, and limiting lactose in the diet is temporary, but a necessary measure.

At artificial feeding a mixture with the maximum amount of lactose that the patient can tolerate should be selected, without allowing the appearance of clinical symptoms and increased excretion of carbohydrates in feces. This is due to the fact that lactose is the only source of galactose, which is formed during its breakdown. Galactose is used for the synthesis of galactolipids, including cerebrosides, which are necessary for the formation of the central nervous system and myelination of nerve fibers. In addition, it is believed that daily consumption of small amounts of lactose is necessary for the intestinal microflora to adapt to it and maintain normal intestinal microbiocenosis. Lactose-free products are prescribed only for severe forms of lactase deficiency, when the use of low-lactose mixtures is ineffective.

In some cases, lactose-free products can be temporarily introduced and breastfeeding, when the administration of the lactase enzyme is ineffective and lactose restriction is necessary. Prescribing lactose-free formulas (as opposed to low-lactose products) allows us to maintain the use of mother's milk to the maximum possible extent.

Dietary correction for lactase deficiency consists of gradually replacing infant formula with a low-lactose or lactose-free product, which is introduced into each feeding. The required volume of the therapeutic mixture is determined by the clinical symptoms: if it is possible to eliminate diarrhea and colic by combining a low-lactose or lactose-free formula with a standard milk formula, the latter should not be completely canceled.

Fermented milk mixtures and products

Fermented milk products occupy an important place in the therapeutic nutrition of children in the first year of life, as they have a beneficial effect on the secretory activity of the digestive tract, intestinal motility, have an inhibitory effect on pathogenic microorganisms, stimulate the growth of indigenous microflora, help improve the absorption of calcium, phosphorus, magnesium and iron, have an immunomodulatory effect and increase the body's defenses.

Inhibition of the growth of pathogenic microorganisms when using fermented milk mixtures occurs due to the production of antimicrobial substances, competition for nutrients, obstacles to the adhesion of pathogenic flora to enterocyte receptors. The immunomodulatory effect of these products is to enhance phagocytosis, activate the proliferation of lymphocytes, prevent the degradation of secretory immunoglobulin A, stimulate the production of interferon, lysozyme, properdin, influence the cytokine system, and regulate the production of interleukins.

If fermented milk products contain live microorganisms (bifidobacteria and lactobacilli) - representatives of the normal microflora of the human intestine, then they are called probiotic products. They have a double functional effect due to the presence of probiotic strains of microorganisms and the lactic acid they produce.

When developing probiotic products, various types of microorganisms are used, mainly bifidobacteria and lactobacilli, which, as well as products created on their basis, are subject to strict requirements regarding safety, functional efficiency, and manufacturability.

Basic requirements for the safety of the product and its components are formulated in sanitary legislation documents Russian Federation, as well as in the international recommendations of FAO/WHO and consist in the use of strains of microorganisms isolated from humans; absence of pathogenicity, toxicity and adverse reactions, antibiotic resistance, high adhesive properties to the epithelium of the intestinal mucosa, stability of the genetic code.

Each strain of bifidobacteria has its own characteristics and range of action. So, Bifidobacterium (B.) bifidum and B. infantis prevail in the intestines of breastfed children, and B. adolescentis- with artificial feeding. Recently, strains have been widely used to obtain fermented milk mixtures with probiotic properties B.lactis(Bв 12), which have pronounced functional activity and good stability in the gastrointestinal tract of the child.

Lactobacilli are more often used in combined starter cultures when creating fermented milk products. It is known that lactobacilli Lactobacillus (L.) acidofilus, L. rhamnosus (LGG), L. casei have good preservation in the product, resistance to external influences, high probiotic effect ( ).

Fermented milk products can be liquid and dry; they are also divided into adapted and non-adapted ( ).

Liquid adapted fermented milk mixtures "Agusha 1" and "Agusha 2" (JSC "Children's Dairy Products Plant", Russia) are intended for use in the nutrition of children of the first year of life. The product "Bifilin" and the acidophilic mixture "Malyutka" are partially adapted fermented milk mixtures. The protein content in them is 1.7 g per 100 ml of liquid product, and the ratio of albumin and casein fractions is 20:80, as in cow's milk.

Unadapted liquid dairy products include “Tema. Fermented milk drink with Bv12" (JSC "UNIMILK", Russia), as well as "Narine", "Biolact", "Biokefir", "Bifidokefir", "Bifidok", which are produced in children's dairy kitchens or in baby food shops. They are used in the nutrition of children from 8 months.

The Russian consumer market also has liquid fermented milk probiotic products “Activia” and “Actimel” (Danone, France), intended for children over 3 years of age.

What is new in pediatric dietetics is the creation of dry adapted fermented milk mixtures ( ).

When using fermented milk products in children of the first year of life, there is a decrease in the severity of functional disorders of digestive processes, such as colic, a tendency to constipation, dyspeptic symptoms, decreased appetite, as well as an improvement in the composition of the intestinal microflora. These products are used in infants at risk of developing nutrition-related diseases, as well as those suffering from rickets, anemia, and malnutrition. At the same time, a higher digestibility of iron and an increase in the level of hemoglobin in children with anemia, an improvement in the processes of osteogenesis in children with rickets and a more pronounced increase in body weight in children with malnutrition were noted, which is due to the high digestibility of protein, calcium and iron.

Hypoallergenic products based on milk protein hydrolysates

The emergence of mixtures created on the basis of milk protein hydrolysates marks the beginning of a new era in the prevention and treatment of food allergies, as well as a number of serious diseases accompanied by impaired intestinal absorption syndrome and a decrease in the nutritional status of the child.

Depending on the degree of breakdown of milk protein, mixtures are isolated based on its complete (high) or partial (moderate) hydrolysis. Both casein and whey fractions of milk proteins can undergo hydrolysis.

Casein mixtures based on milk protein hydrolysates (depending on the initial milk raw materials) include Nutramigen, Pregestimil, Frisopep AS. Whey products include “Damil Pepti”, “Nutrilak GA”, “Nutrilak Peptidi SCT”, “Nutrilon Pepti TSC”, “Nutrilon GA 1” and “Nutrilon GA 2”, “Alfare”, “NAN GA 1” and “NAN GA” 2", "Frisopep", "HiPP GA 1" and "HiPP GA 2", "Humana GA 1" and "Humana GA 2".

It has been established that the higher the molecular weight of the hydrolyzate peptides, the greater the risk of developing allergic reactions. Compared to cow's milk protein, the allergenicity of the protein component of products created on the basis of highly hydrolyzed protein is reduced by 10,000-100,000 times, and partially hydrolyzed by 300-1000 times. Molecular mass peptides, at which the allergenicity of the hydrolyzate becomes minimal, is 1.5 kDa; peptides with a molecular weight of 3-3.5 kDa can in some cases cause allergic reactions.

All mixtures of this class are enriched with a complex of vitamins and minerals in accordance with the physiological needs of children of the first year of life and comply with WHO requirements for ingredient composition, biological and nutritional value, influence on the physical and psychomotor development of children in the first year of life.

In accordance with the clinical purpose, mixtures based on milk protein hydrolysates are divided into therapeutic, treatment-and-prophylactic and prophylactic ( ).

Medicinal mixtures include only mixtures obtained as a result of deep hydrolysis of milk protein, which, as a rule, are semi-elemental, since in addition to the modified protein component they contain medium-chain fatty acids, monosaccharides, glucose polymers and are completely devoid of lactose. These products are intended for children with severe manifestations of food allergies caused by hypersensitivity to cow's milk proteins and other food proteins, as well as patients with maldigestion and malabsorption syndrome due to celiac disease, pancreatic insufficiency, dystrophy of the intestinal mucosa, after resection of sections of the small intestine, etc.

Knowledge of the characteristics of the lipid and carbohydrate composition of various medicinal mixtures created on the basis of highly hydrolyzed milk protein allows you to select the optimal product depending on the clinical manifestations in each specific case. The lipid component of the mixtures “Alfare”, “Nutrilak Peptidi MCT”, “Nutrilon Pepti TSC”, “Pregestimil” contains medium chain triglycerides (up to 50% of the total amount of lipids), which are easily broken down, do not require emulsification by bile and the participation of pancreatic lipase, and are absorbed into the portal vein system, bypassing the lymphatic vessels. These products are indicated for patients with severe gastrointestinal manifestations of food allergies and malabsorption syndrome.

When using medicinal protein hydrolysates, it is possible to achieve a significant improvement in skin and gastrointestinal manifestations within 2-3 weeks from the start of their use, and clinical remission after another 2-3 months. At the same time, in children with underweight, the nutritional status is normalized. The duration of use of these products is individual, on average it is 3-4 months or more.

When choosing a specialized product based on protein hydrolyzate, it is also necessary to take into account the presence or absence of lactose in its carbohydrate component, since secondary lactase deficiency often accompanies food hypersensitivity, in such cases it is advisable to use medicinal mixtures that do not contain lactose (Nutramigen, Frisopep AS ").

Hypoallergenic mixtures with partially (moderately) hydrolyzed milk protein (“NAN GA 1” and “NAN GA 2”, “Nutrilon GA 1” and “Nutrilon GA 2”) are intended only for the prevention of allergic diseases in children at high risk for the development of atopy transferred to mixed or artificial feeding.

The peptide profile and low residual allergenicity of such mixtures as "Damil Pepti", "Nutrilak GA", "HiPP GA 1" and "HiPP GA 2", "Humana GA 1" and "Humana GA 2" allow their use not only in for preventive purposes, but also for the treatment of mild forms of allergy to cow's milk proteins that occur without the participation of immunoglobulin E-mediated mechanisms.

All products created on the basis of milk protein hydrolysates have a bitter taste and a specific odor; when prescribed during the adaptation period, slightly liquefied and frequent stools, greenish or Brown, which should not be a reason to cancel the product.

Soy protein isolate based mixtures

Modern soy formulas are developed on the basis of soy protein isolate, in which the protein content is more than 90%, and undesirable components (indigestible carbohydrates, trypsin inhibitor, lectins and saponins) are removed during the technological production process. No genetically modified soy is used in the production of soy formulas for baby food.

The biological value of soy protein isolate is increased due to the additional introduction of L-methionine and other amino acids and is comparable to milk casein. The fat composition of soy mixtures is represented by a mixture of vegetable fats, and carbohydrates consist of dextrin-maltose, corn starch ( ). Thus, all soy formulas are dairy-free and lactose-free.

Mixtures based on soy protein isolate are enriched with a vitamin-mineral complex, and the use modern technologies allows you to increase the absorption of calcium, phosphorus and iron.

Mixtures based on soy protein isolate can be used quite effectively in the treatment of food allergies induced by cow's milk proteins. However, clinical observations show that in 20-25% of children in the first year of life they can cause the onset or exacerbation of atopic dermatitis or gastrointestinal manifestations of allergies. Our studies indicate that most often allergic reactions develop with the rapid (within 1-2 days) introduction of soy mixtures, their early administration (to children in the first months of life), and a burdened allergic history.

To prevent the development of an undesirable effect when using soy mixtures in children, certain conditions must be met: immediate relatives must not be allergic to soy and legumes, the child’s age must be at least 5-6 months (especially with cutaneous-gastrointestinal or gastrointestinal forms of food allergy), gradual (within 5-7 days) introduction of the product into the child’s diet. You should also take into account the individual tolerance of the mixture; it should be used for at least 3 months.

In addition, these soy mixtures can be used for therapeutic nutrition in children with galactosemia (with this pathology they are the first choice products), lactase deficiency, celiac disease as an alternative to dairy products and formulas. While recognizing the overall nutritional adequacy of industrial soy formulas, they should not be recommended for premature infants.

Thus, the use in pediatric practice of specialized infant formulas obtained using the most modern technologies allows, in the shortest possible time, to organize pathogenetically based therapeutic nutrition, meet the needs of a sick child in macro- and micronutrients, facilitate the course of the pathological process, improve nutritional status and accelerate the achievement of clinical remission of the disease or recovery.

Literature

T. E. Borovik,
V. A. Skvortsova, Doctor of Medical Sciences
K. S. Ladodo, Doctor of Medical Sciences, Professor
E. A. Roslavtseva, Candidate of Medical Sciences
N. N. Semenova, Candidate of Medical Sciences
T. N. Stepanova, Candidate of Medical Sciences
SCCD RAMS, Moscow

If the baby has allergies, it is important to preserve them for as long as possible, while the mother must follow a hypoallergenic diet.

If natural feeding is impossible, or the mother has little milk, the doctor may prescribe a special formula for the child.

In infants, one of the first allergens that causes the development of food allergies is cow's milk. In babies with atopic dermatitis, an allergy to cow's milk proteins is detected in 70-85% of cases. Therefore, for children with allergies, the doctor usually prescribes a dairy-free formula.

All dairy-free formulas are divided into preventive, therapeutic and prophylactic and therapeutic. The doctor chooses this or that mixture, taking into account many factors: the age of the baby, the presence or absence of a confirmed diagnosis of allergies, the nature of the allergic reaction (skin, gastrointestinal or other manifestations), the severity of the disease, etc.

It is important to remember that a mother cannot “prescribe” any medicinal mixture to her child. Therapeutic nutrition is recommended by a doctor who will subsequently monitor the baby’s condition.

Soy mixtures

Nutrilak Soya, Nutritek, Russia
Nutrilon Soy, Nutricia, Holland
Frisosoy, Friesland Foods, Holland
Humana SL, Humana, Germany
Enfamil Soy, Mead Johnson, USA

Because these formulas contain protein and potential allergens, their use in children with food allergies is limited. They are not used in children under 5-6 months, during the period of exacerbation of an allergic disease, in the presence of gastrointestinal manifestations, and also if the baby is allergic to soy.

Hypoallergenic mixtures based on partially hydrolyzed milk protein

NAS GA 1, Nestlé, Switzerland
NAN GA 2, Nestlé, Switzerland
Nutrilak GA, Nutritek Russia
Nutrilon GA 1, Nutricia, Holland
Nutrilon GA 2, Nutricia, Holland
GA Topic 1, Unimilk, Russia
Topic GA 2, Unimilk, Russia
Frisolak GA 1, Friesland Foods, Holland
Frisolak GA 2 Friesland Foods, Holland
Humana GA 1, Humana, Germany
Humana GA 2, Humana, Germany
Humana GA 3, Humana, Germany
HiPP GA 1, HiPP, Austria
HiPP GA 2, HiPP, Austria

These mixtures are usually prescribed when there is a high risk of atopy (susceptibility to allergies). The use of partial hydrolysates, in contrast to highly hydrolyzed mixtures, ensures the formation of tolerance (immunity) to dairy products in the future. In addition, partially hydrolyzed mixtures are more physiological compared to products created on the basis of highly hydrolyzed protein, since they contain lactose, which stimulates the growth of bifidobacteria and promotes the absorption of a number of minerals (calcium, magnesium, manganese).

Medicinal mixtures based on highly hydrolyzed milk proteins

Nutramigen, Mead Johnson, USA
Pregestimil, Mead Johnson, USA
Nutrilak Peptidi SCT, Nutritek, Russia
Nutrilon Pepti TSC, Nutricia, Holland
Friesopep, Friesland Foods, Holland

These mixtures are prescribed to children in the acute period of the disease, with severe manifestations of allergies (atopic dermatitis, gastrointestinal disorders).

Compared to cow's milk proteins, the allergenicity of the protein component of mixtures created on the basis of highly hydrolyzed protein is reduced by 10,000-100,000 times. However, if there is a proven allergy to cow's milk, it is advisable to prescribe milk that does not contain protein at all.

Based on materials from the National Program for Optimizing Feeding of Children in the First Year of Life in the Russian Federation, Moscow, 2010

The question of selecting a mixture for healthy child very important, but it becomes more complicated when we're talking about about a baby with any diseases or disabilities. In this case, such children are prescribed medicinal formulas for children as the main type of nutrition.

Medicinal mixtures can be a powerful therapeutic factor that will have a beneficial effect on the course of the disease, normalize the functioning of the gastrointestinal tract, restore metabolism and the body's defenses. For some types of childhood diseases, especially in infants, medicinal mixtures are the only medicine.

Today in Russia there is a huge choice special types therapeutic and preventive nutrition (mixtures) of both domestic and foreign production. All of them are designed to help correct and cure various diseases of children aged from birth to 1-2 years. It is very important to choose a medicinal formula with your pediatrician or healthcare provider. More precisely, only a doctor should prescribe such a mixture. After all, the course and outcome of the disease depend on how correctly the composition of the mixture is selected, how well it corresponds to the nature of the disorder and the characteristics of the disease, as well as on the correct dosage.

Some may be surprised by the term "dosage" in conjunction with infant formula. But this is exactly how medicinal infant formulas are prescribed and taken - in doses and at a strictly defined time. This is another condition for the baby’s rapid recovery.

The therapeutic mixture should not only provide the child with nutrients, but also provide real help for various diseases. For example, children with digestive problems (diarrhea, constipation) should be fed mixtures with probiotics. Each medicinal mixture is specially designed for a certain type of child’s disease. These can be mixtures for children with allergies, for babies suffering from constipation, diarrhea, regurgitation, poor weight gain, and premature babies. There are also mixtures for children with hereditary diseases: celiac disease, cystic fibrosis, phenylketonuria, galactosemia, etc.

These mixtures have one thing in common - they must have a composition of components that is most acceptable and useful for a particular disease. In one case, less protein may be needed; in another, carbohydrate intake should be reduced.

Therapeutic milk formulas also differ from simple milk formulas in that they must be adapted to human milk in their other components. To do this, whey proteins, triglycerides and some other components are added to the medicinal mixtures to increase the absorption of the mixture. Medicinal mixtures can be used in parallel with breastfeeding, but only if the type of the baby’s disease allows.

Infants with digestive system disorders should be fed anti-reflux medicinal milk formulas. Depending on the type of thickener they are:

• mixtures with carob gum (Nutrilak AR, Frisovom, Nutrilon AR, Humana AR);
• mixtures with starch (Samper Lemolak, Nutrilon Comfort, Enfamil AR)

Children prone to food allergies should eat special therapeutic hypoallergenic formulas (NAS 1, NAS 2, Humana 1, Humana 2, etc.). They have hydrolyzed proteins from cow's milk.

Therapeutic formulas for baby food are usually very expensive. In addition, they are often unable to provide the child with 100% nutrients. Therefore, it is worth making every effort to ensure that the baby recovers faster and transfer him to a healthy, nutritious diet.

It is quite simple to choose a milk formula for a healthy baby, but some children have allergies, digestive disorders, and cannot tolerate certain foods. Medicinal formulas for feeding have been created especially for such children. They greatly simplify the life of parents and are absolutely safe for the baby.

How to choose a medicinal mixture

First, you should consult a pediatrician who will correctly determine the presence of the disease. After passing tests and a competent examination, the doctor will easily recommend a specific mixture.

If your baby has obvious digestive problems, then you should opt for a mixture with a probiotic. It helps great with tummy troubles or diarrhea. Probiotics contained in food help strengthen the baby’s immunity and heal the body. With regular intake of a mixture with a probiotic, digestion is normalized and disorders disappear. Pediatricians often recommend a probiotic for children with allergic reactions. The mixture is perfectly absorbed by the body and does not irritate it. At the pharmacy you can easily purchase a mixture of “Nan” with a probiotic made in Switzerland. It is the most popular among medicinal mixtures.

Some children have congenital lactose intolerance. This often becomes a problem for mothers because they do not understand what to feed their babies. Fortunately, pharmacies have long had mixtures that do not contain lactose. An example is “Nutrilak low-lactose”, a mixture produced in Russia. The “Nan” mixture has proven itself to be excellent and is often the choice of pediatricians and parents.

How to properly use medicinal milk formulas

First of all, the mixtures must be appropriate for the baby’s age. Moms can easily navigate by the markings on the food box.

Medicinal mixtures can be used in mixed feeding, that is, in combination with breast milk. But they are also perfect for artificial feeding. The main thing is to follow the dosage instructions. After the positive effect of the therapeutic mixture, you can gradually transfer the child to a well-adapted one.

When choosing a treatment, trust the opinion of a specialist. No need to choose more budget options, they definitely won’t bring any benefit. If the baby responds well to the chosen mixture, then there is no need to experiment and change it.

This information is intended for healthcare and pharmaceutical professionals. Patients should not use this information as medical advice or recommendations.

Medicinal mixtures in the nutrition of infants

T. E. Borovik, Doctor of Medical Sciences, Professor
V. A. Skvortsova, Doctor of Medical Sciences
K. S. Ladodo, Doctor of Medical Sciences, Professor
E. A. Roslavtseva, Candidate of Medical Sciences
N. N. Semenova, Candidate of Medical Sciences
T. N. Stepanova, Candidate of Medical Sciences
SCCD RAMS, Moscow

Therapeutic nutrition is a powerful therapeutic factor, in which a properly formulated diet becomes a key mechanism that allows you to influence disrupted parts of metabolism, normalize the functions of the digestive system, and activate the body’s defenses, which largely determines the course and outcome of the disease. For certain types of pathology, nutritional therapy is the only means of treatment.

To organize therapeutic nutrition for a sick child in the first year of life, the correct choice of a product with a special specified composition that meets the characteristics of the disease and the nature of the metabolic processes disturbed is important.

Currently, in our country there is a wide range of specialized products for therapeutic and prophylactic purposes, produced domestically and abroad, for the nutritional correction of various diseases in infants.

Specialized mixtures for children with functional disorders of the gastrointestinal tract

In recent years, anti-reflux milk formulas have been widely used in the nutrition of infants with regurgitation, vomiting, and constipation. Depending on the type of thickener, they are divided into two groups: mixtures containing carob gum (Nutrilak AR, Nutrilon AR, Frisovom, Humana AR) or starch (Samper Lemolak, Enfamil AR ", "Nutrilon Comfort").

Chemical composition And energy value specialized infant formula for children with gastrointestinal dysfunction (in 100 ml of finished product)

The protein component of most of the listed antireflux products is dominated by whey proteins, which are easily digested and removed from the stomach relatively quickly. The only casein-predominant mixture is Nutrilon AR. Casein forms a denser clot in the stomach, which can prevent regurgitation and enhances the effect of the gum. In addition, this mixture has a moderately reduced fat content (3.1 g/100 ml), which promotes faster evacuation of food from the stomach.

Locust bean gum is a soluble, starch-free polysaccharide that swells in the baby's stomach, thereby preventing regurgitation. The carbohydrates that make up the gum are dietary fiber - indigestible polysaccharides that are not broken down in the upper gastrointestinal tract, but are fermented by colon microorganisms, promoting the selective growth of indigenous microflora.

The maximum permissible gum content in the product is 1 g per 100 ml. In antireflux mixtures, the gum content ranges from 0.34 to 0.5 g per 100 ml. Edible gum is divided into instant (instant) and natural (requiring dilution with hot water for swelling), obtained from the seeds of the Mediterranean acacia and containing 85% carbohydrates, 5% protein, 10% moisture.

Depending on the type of gum added to the product, the water temperature for diluting anti-reflux mixtures is different and is: for products containing instant gum, 40–50 ° C (“Humana AR”, “Nutrilak AR”, “Nutrilon AR”); for products with natural gum, significantly higher than 70–80°C (“Frisov 1” and “Frisov 2”).

Anti-reflux products containing gum are introduced into the child’s diet gradually, at each feeding. It is possible to add them to a bottle with standard formula that the child receives, but it is more effective to use them independently at the beginning of feeding. The volume of the medicinal product is selected individually until regurgitation stops.

The second group of anti-reflux products consists of mixtures containing rice, corn or potato starch, rich in amylopectin, as a thickener (Samper Lemolak, Enfamil AR, Nutrilon Comfort 1 and Nutrilon Comfort 2). Amylopectin is a high-molecular compound - a branched polymer of glucose, the digestion of which is slow. Its breakdown occurs primarily in the small intestine under the action of glycoamylase. Amylopectin does not have prebiotic properties.

Antireflux formulas are primarily used for regurgitation (spitting up) in infants. Regurgitation is the return of food chyme after swallowing the food eaten. Regurgitation is often caused by inadequate feeding (rapid sucking, aerophagia, overfeeding, feeding irregularities, inadequate choice of formulas), as well as perinatal lesions of the central nervous system, pylorospasm, etc. Therefore, the prescription of antireflux mixtures should be preceded by identifying the causes of regurgitation.

Mixtures containing gum can also be used in the nutrition of children with functional constipation: chronic delay in bowel movement for more than 36 hours, increased intervals between bowel movements compared to the physiological norm, difficulty in defecation, and the passage of small amounts of high-density feces. It is known that gum has the properties of dietary fiber: it retains additional amounts of water and helps to gently stimulate intestinal motility, which leads to the elimination of constipation. The most effective of this group of products are mixtures with a predominance of whey fraction in the protein component, since caseins have a fixing effect. When treating constipation, milk mixtures with gum can not be introduced into every feeding, but independently as a separate feeding - 2-3 times a day.

In addition to mixtures that contain gum, the “Samper Bifidus” mixture containing lactulose has proven itself well in the nutrition of children with constipation. Lactulose is a disaccharide consisting of galactose and fructose, obtained synthetically. It, like dietary fiber, is not digested by enzymes of the gastrointestinal tract; it reaches the colon unchanged, where it is fermented by lacto- and bifidobacteria and serves as a substrate for their growth. During the fermentation process, short-chain fatty acids are formed, the pH of the intestinal contents decreases and osmotic pressure increases, as a result of which fluid enters the intestinal lumen, peristalsis increases and constipation is eliminated.

Chemical composition and energy value of specialized infant formula for children with constipation (in 100 ml of finished product)

Currently, “Agusha Baby Milk with Lactulose” is produced (OJSC “Children's Dairy Products Plant”, Russia), which is recommended for use in the nutrition of children with functional disorders of the gastrointestinal tract.

In addition to children's dairy products, lactulose is included in the composition of children's instant cereals "Nutrilak. Corn with lactulose", "Nutrilak. Oatmeal with lactulose" (Nutritek, Russia). These products are effective in feeding sick children with impaired intestinal motor function (constipation, unstable stool).

The formation of softer stools is also facilitated by dietary fiber - oligosaccharides, which are linear polymers of glucose and other monosaccharides (galactose, fructose). In human milk, galactooligosaccharides account for 12–14% of the total carbohydrates. They have a prebiotic effect, ensuring the growth of bifidobacteria in the child’s intestines. A prebiotic supplement containing 90% short-chain galactooligosaccharides and 10% long-chain fructooligosaccharides, which is part of the mixtures “Nutrilon Comfort 1” and “Nutrilon Comfort 2”, has similar properties.

Low-lactose and lactose-free mixtures

Low- and lactose-free infant formulas include products created on the basis of cow's milk proteins and intended for feeding children of the first year of life with lactase deficiency.

In lactose-free mixtures, the amount of lactose (milk sugar) is almost zero. The main carbohydrate component of such mixtures is dextrin-maltose. Low-lactose formulas contain approximately 1 g of lactose per 100 ml (0.9 to 1.33 g), compared with 6–7 g of lactose per 100 ml in human milk and standard formulas.

As a rule, in low- and lactose-free formulas the ratio of whey proteins to casein is 60:40 or 50:50, and the fat component is represented by a composition of vegetable oils, which is typical for adapted infant formulas and allows them to be recommended for use from the first days of a child’s life. Predominantly “casein” formulas include mixtures of “Humana-LP” with prebiotics: galacto-oligosaccharides, dietary fiber and “Humana-LP + MCT” (ratio of casein to whey fraction 80:20). The content of prebiotics (galacto-oligosaccharides, fiber) in combination with a low fat content gives rise to the use of these mixtures for the correction of diarrhea syndrome in lactase deficiency.

Chemical composition and energy value of low-lactose and lactose-free milk formulas (per 100 ml of finished product)

Hypolactasia or alactasia are diseases resulting from insufficient activity or complete absence of the parietal digestive enzyme - lactase, which breaks down milk sugar (lactose), which are manifested by osmotic (“fermentation”) diarrhea after taking lactose-containing dairy products.

Diet therapy is the main method of treating lactase deficiency. It is aimed at “bypassing” the metabolic block. The use of low- and lactose-free formulas in the nutrition of children with lactase deficiency allows us to provide a pathogenetic approach to the treatment of this pathology.

In case of primary (constitutional) lactase deficiency, a low-lactose (lactose-free) diet is prescribed for life. In case of secondary lactase deficiency, the main attention is paid to the treatment of the pathology that led to this condition, and limiting lactose in the diet is temporary, but a necessary measure.

When artificial feeding, a mixture with the maximum amount of lactose that the patient can tolerate should be selected, without allowing the appearance of clinical symptoms and increased excretion of carbohydrates in feces. This is due to the fact that lactose is the only source of galactose, which is formed during its breakdown. Galactose is used for the synthesis of galactolipids, including cerebrosides, which are necessary for the formation of the central nervous system and myelination of nerve fibers. In addition, it is believed that daily consumption of small amounts of lactose is necessary for the intestinal microflora to adapt to it and maintain normal intestinal microbiocenosis. Lactose-free products are prescribed only for severe forms of lactase deficiency, when the use of low-lactose mixtures is ineffective.

In some cases, lactose-free products can be temporarily introduced during breastfeeding, when the administration of the lactase enzyme is ineffective and lactose restriction is necessary. Prescribing lactose-free formulas (as opposed to low-lactose products) allows us to maintain the use of mother's milk to the maximum possible extent.

Dietary correction for lactase deficiency consists of gradually replacing infant formula with a low-lactose or lactose-free product, which is introduced into each feeding. The required volume of the therapeutic mixture is determined by the clinical symptoms: if it is possible to eliminate diarrhea and colic by combining a low-lactose or lactose-free formula with a standard milk formula, the latter should not be completely canceled.

Fermented milk mixtures and products

Fermented milk products occupy an important place in the therapeutic nutrition of children in the first year of life, as they have a beneficial effect on the secretory activity of the digestive tract, intestinal motility, have an inhibitory effect on pathogenic microorganisms, stimulate the growth of indigenous microflora, help improve the absorption of calcium, phosphorus, magnesium and iron, have an immunomodulatory effect and increase the body's defenses.

Inhibition of the growth of pathogenic microorganisms when using fermented milk mixtures occurs due to the production of antimicrobial substances, competition for nutrients, and obstacles to the adhesion of pathogenic flora to enterocyte receptors. The immunomodulatory effect of these products is to enhance phagocytosis, activate the proliferation of lymphocytes, prevent the degradation of secretory immunoglobulin A, stimulate the production of interferon, lysozyme, properdin, influence the cytokine system, and regulate the production of interleukins.

If fermented milk products contain live microorganisms (bifidobacteria and lactobacilli) - representatives of the normal microflora of the human intestine, then they are called probiotic products. They have a double functional effect due to the presence of probiotic strains of microorganisms and the lactic acid they produce.

When developing probiotic products, various types of microorganisms are used, mainly bifidobacteria and lactobacilli, which, as well as products created on their basis, are subject to strict requirements regarding safety, functional efficiency, and manufacturability.

The basic requirements for the safety of the product and its components are formulated in the sanitary legislation of the Russian Federation, as well as in the international recommendations of the FAO/WHO and consist in the use of strains of microorganisms isolated from humans; absence of pathogenicity, toxicity and adverse reactions, antibiotic resistance, high adhesive properties to the epithelium of the intestinal mucosa, stability of the genetic code.

Each strain of bifidobacteria has its own characteristics and range of action. So, Bifidobacterium (B.) bifidum and B. infantis prevail in the intestines of breastfed children, and B. adolescentis- with artificial feeding. Recently, strains have been widely used to obtain fermented milk mixtures with probiotic properties B.lactis(Bв 12), which have pronounced functional activity and good stability in the gastrointestinal tract of the child.

Lactobacilli are more often used in combined starter cultures when creating fermented milk products. It is known that lactobacilli Lactobacillus (L.) acidofilus, L. rhamnosus (LGG), L. casei have good preservation in the product, resistance to external influences, and a high probiotic effect.

Microorganisms used for the preparation of fermented milk products for baby food

Fermented milk products can be liquid or dry; they are also divided into adapted and non-adapted.

Liquid fermented milk products

Liquid adapted fermented milk mixtures "Agusha 1" and "Agusha 2" (JSC "Children's Dairy Products Plant", Russia) are intended for use in the nutrition of children of the first year of life. The product "Bifilin" and the acidophilic mixture "Malyutka" are partially adapted fermented milk mixtures. The protein content in them is 1.7 g per 100 ml of liquid product, and the ratio of albumin and casein fractions is 20:80, as in cow's milk.

Unadapted liquid dairy products include “Tema. Fermented milk drink with Bv12" (JSC "UNIMILK", Russia), as well as "Narine", "Biolact", "Biokefir", "Bifidokefir", "Bifidok", which are produced in children's dairy kitchens or in baby food shops. They are used in the nutrition of children from 8 months.

The Russian consumer market also has liquid fermented milk probiotic products “Activia” and “Actimel” (Danone, France), intended for children over 3 years of age.

What is new in children's dietetics is the creation of dry adapted fermented milk mixtures.

Chemical composition and energy value of dry adapted fermented milk mixtures (per 100 ml of finished product)

When using fermented milk products in children of the first year of life, there is a decrease in the severity of functional disorders of digestive processes, such as colic, a tendency to constipation, dyspeptic symptoms, decreased appetite, as well as an improvement in the composition of the intestinal microflora. These products are used in infants at risk of developing nutrition-related diseases, as well as those suffering from rickets, anemia, and malnutrition. At the same time, a higher digestibility of iron and an increase in the level of hemoglobin in children with anemia, an improvement in the processes of osteogenesis in children with rickets and a more pronounced increase in body weight in children with malnutrition were noted, which is due to the high digestibility of protein, calcium and iron.

Hypoallergenic products based on milk protein hydrolysates

The emergence of mixtures created on the basis of milk protein hydrolysates marks the beginning of a new era in the prevention and treatment of food allergies, as well as a number of serious diseases accompanied by impaired intestinal absorption syndrome and a decrease in the nutritional status of the child.

Depending on the degree of breakdown of milk protein, mixtures are isolated based on its complete (high) or partial (moderate) hydrolysis. Both casein and whey fractions of milk proteins can undergo hydrolysis.

Casein mixtures based on milk protein hydrolysates (depending on the initial milk raw materials) include Nutramigen, Pregestimil, Frisopep AS. Whey products include “Damil Pepti”, “Nutrilak GA”, “Nutrilak Peptidi SCT”, “Nutrilon Pepti TSC”, “Nutrilon GA 1” and “Nutrilon GA 2”, “Alfare”, “NAN GA 1” and “NAN GA” 2", "Frisopep", "HiPP GA 1" and "HiPP GA 2", "Humana GA 1" and "Humana GA 2".

It has been established that the higher the molecular weight of the hydrolyzate peptides, the greater the risk of developing allergic reactions. Compared to cow's milk protein, the allergenicity of the protein component of products created on the basis of highly hydrolyzed protein is reduced by 10,000–100,000 times, and partially hydrolyzed by 300–1000 times. The molecular weight of peptides at which the allergenicity of the hydrolyzate becomes minimal is 1.5 kDa; peptides with a molecular weight of 3–3.5 kDa can in some cases cause allergic reactions.

All mixtures of this class are enriched with a complex of vitamins and minerals in accordance with the physiological needs of children in the first year of life and comply with WHO requirements for ingredient composition, biological and nutritional value, and influence on the physical and psychomotor development of children in the first year of life.

In accordance with the clinical purpose, mixtures based on milk protein hydrolysates are divided into therapeutic, treatment-and-prophylactic and prophylactic.

Chemical composition and energy value of mixtures based on hydrolysates, depending on their clinical purpose (in 100 ml of the finished product)

Medicinal mixtures include only mixtures obtained as a result of deep hydrolysis of milk protein, which, as a rule, are semi-elemental, since in addition to the modified protein component they contain medium-chain fatty acids, monosaccharides, glucose polymers and are completely devoid of lactose. These products are intended for children with severe manifestations of food allergies caused by hypersensitivity to cow's milk proteins and other food proteins, as well as patients with maldigestion and malabsorption syndrome due to celiac disease, pancreatic insufficiency, dystrophy of the intestinal mucosa, after resection of sections of the small intestine, etc.

Knowledge of the characteristics of the lipid and carbohydrate composition of various medicinal mixtures created on the basis of highly hydrolyzed milk protein allows you to select the optimal product depending on the clinical manifestations in each specific case. The lipid component of the mixtures “Alfare”, “Nutrilak Peptidi MCT”, “Nutrilon Pepti TSC”, “Pregestimil” contains medium chain triglycerides (up to 50% of the total amount of lipids), which are easily broken down, do not require emulsification by bile and the participation of pancreatic lipase, and are absorbed into the portal vein system, bypassing the lymphatic vessels. These products are indicated for patients with severe gastrointestinal manifestations of food allergies and malabsorption syndrome.

When using medicinal protein hydrolysates, it is possible to achieve a significant improvement in skin and gastrointestinal manifestations within 2–3 weeks from the start of their use, and clinical remission after another 2–3 months. At the same time, in children with underweight, the nutritional status is normalized. The duration of use of these products is individual, on average it is 3–4 months or more.

When choosing a specialized product based on protein hydrolyzate, it is also necessary to take into account the presence or absence of lactose in its carbohydrate component, since secondary lactase deficiency often accompanies food hypersensitivity, in such cases it is advisable to use medicinal mixtures that do not contain lactose (Nutramigen, Frisopep AS ").

Hypoallergenic mixtures with partially (moderately) hydrolyzed milk protein (“NAN GA 1” and “NAN GA 2”, “Nutrilon GA 1” and “Nutrilon GA 2”) are intended only for the prevention of allergic diseases in children at high risk for the development of atopy transferred to mixed or artificial feeding.

The peptide profile and low residual allergenicity of such mixtures as "Damil Pepti", "Nutrilak GA", "HiPP GA 1" and "HiPP GA 2", "Humana GA 1" and "Humana GA 2" allow their use not only in for preventive purposes, but also for the treatment of mild forms of allergy to cow's milk proteins that occur without the participation of immunoglobulin E-mediated mechanisms.

All products created on the basis of milk protein hydrolysates have a bitter taste and a specific odor; when prescribed during the adaptation period, slightly thin and frequent stools, greenish or brown in color, are possible, which should not serve as a reason for discontinuing the product.

Soy protein isolate based mixtures

Modern soy formulas are developed on the basis of soy protein isolate, in which the protein content is more than 90%, and undesirable components (indigestible carbohydrates, trypsin inhibitor, lectins and saponins) are removed during the technological production process. No genetically modified soy is used in the production of soy formulas for baby food.

The biological value of soy protein isolate is increased due to the additional introduction of L-methionine and other amino acids and is comparable to milk casein. The fat composition of soy mixtures is represented by a mixture of vegetable fats, and carbohydrates consist of dextrin-maltose and corn starch. Thus, all soy formulas are dairy-free and lactose-free.

Chemical composition and energy value of specialized mixtures based on soy protein isolate (per 100 ml of the finished mixture)

Mixtures based on soy protein isolate are enriched with a vitamin and mineral complex, and the use of modern technologies allows for increased absorption of calcium, phosphorus and iron.

Mixtures based on soy protein isolate can be used quite effectively in the treatment of food allergies induced by cow's milk proteins. However, clinical observations show that in 20–25% of children in the first year of life they can cause the onset or exacerbation of atopic dermatitis or gastrointestinal manifestations of allergies. Our research indicates that most often allergic reactions develop with the rapid (within 1–2 days) introduction of soy mixtures, their early administration (to children in the first months of life), and a burdened allergic history.

To prevent the development of an undesirable effect when using soy mixtures in children, certain conditions must be met: immediate relatives must not be allergic to soy and legumes, the child’s age must be at least 5–6 months (especially with cutaneous-gastrointestinal or gastrointestinal forms of food allergy), gradual (within 5–7 days) introduction of the product into the child’s diet. You should also take into account the individual tolerance of the mixture; it should be used for at least 3 months.

In addition, these soy mixtures can be used for therapeutic nutrition in children with galactosemia (with this pathology they are the first choice products), lactase deficiency, celiac disease as an alternative to dairy products and formulas. While recognizing the overall nutritional adequacy of industrial soy formulas, they should not be recommended for premature infants.

Thus, the use in pediatric practice of specialized infant formulas obtained using the most modern technologies allows, in the shortest possible time, to organize pathogenetically based therapeutic nutrition, meet the needs of a sick child in macro- and micronutrients, facilitate the course of the pathological process, improve nutritional status and accelerate the achievement of clinical remission of the disease or recovery.

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