Article on the topic: hygiene rules for schoolchildren article

Girls hygiene

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Silenko Oksana Nikolaevna

Pediatric gynecologist, candidate of medical sciences

20.01.2020

Dear parents! Today I will try to cover the topic “hygiene of girls aged 0 to 7 years” in my article. It would seem that what is so difficult about washing a child? However, there are certain rules, following which, you will not encounter problems in pediatric gynecology and you will not have to urgently look for a pediatric gynecologist!

Proper hygiene is that hygiene that does not harm the skin of a girl’s vulva and does not cause gynecological diseases. So what is it?

The first rule and the most important:

You need to wash the girl from front to back, and not vice versa! In no case should this be done 5-10 times a day, but rather 2 times a day under running water (morning and evening). Why? In order not to wash off the skin (lipid) lubricant, smegma and not to dry out the delicate, thin and often sensitive skin of the baby’s vulva with water.

Second rule:

Every time we wash, we do not use mother’s favorite soap or gel for the girl’s hygiene. For a girl under 3 years old, it doesn’t matter what product you use to wash her – expensive, cheap, cherry-flavored or strawberry-scented. The choice of child hygiene products falls entirely on the shoulders of the parents. And here it is important that the product has a neutral pH, without fragrances, flavorings and a mild surfactant. In order not to “rack your brains” over the choice of gel for washing, it is better to buy these products in a pharmacy or online with a pharmaceutical direction, especially if your mother, father or immediate family have or had a history of allergic dermatitis (no matter what kind of dermatitis - to pollen , dust, food, etc.). Hygienic gel is used to wash the vulva 1-2 times a week, not more often! If a girl has manifestations of atopic dermatitis, then once a week is enough. At the same time, we wash the folds of the vulva without fanaticism, we wash away those secretions that can accumulate over the course of a week and are easily washed off (I’ll write more about physiological secretions below).

This rule is used taking into account a clean bottom, in cases where the girl has “been a little” or the mother changes the diaper (and the mother should change the diaper every 2-3 hours!) Up to 3 months of the child’s life, frequent diaper changes and air baths half an hour to an hour are acceptable and recommended by pediatricians and pediatric gynecologists. But from 3 months of age to 1 year, the interval of air baths should increase, and the number of diapers should be reduced to 3-4 pieces per day! We use diapers for walks and choose some part of the night's sleep - the first or second half of the night, when the girl can be in diapers. From 1 year of birth to 2.5 years, diapers should only be used for walks.

Diapers are a “sore” topic for many mothers; not everyone agrees with the hygiene rules that I wrote about above and which our mothers, grandmothers, etc. adhered to for years. Here, parents always have their own choice - either the mother makes it comfortable for herself and uncomfortable for the child, or vice versa. So, in the case when the mother does not get enough sleep and puts the health of her child first, the girl has significantly fewer problems with the vulva, or there are none at all.

Third rule:

If the girl “has gone big”, it is necessary to rinse the anal folds well with hygiene gel and make sure that there are no fecal residues left in the vulva area. If there is even the slightest contamination, we wash the vulva with water and gel!

Fourth rule:

Wet wipes. We use napkins of any manufacture (Japanese, Russian, French, etc.) and even those purchased at a pharmacy with the inscription “for infants” or “for the smallest” in exceptional cases - when it is not possible to wash the child with running water. That is, napkins are an exception to good rules!

The fifth rule concerns physiological secretions (smegma)

: Smegma is a white coating, up to 1 year of a child’s life - a dense coating; from 1 year and older - small, crumbly. This rule has small subtleties taking into account the anatomy and physiology of the girl. After birth, in the first month (up to a maximum of 3-4 months), white plaque is produced by the gonads every day and, accordingly, every day in a certain amount, parents can see it in the folds of the labia minora. The volume of discharge depends to a large extent on the estrogen background of both mother and girl. From 3 months of life (and for some, from 1-2 months), the estrogen level begins to fall and the discharge becomes less and less. Therefore, there is no clear age indicator, but there is individual care for each child. The mother should focus on the amount of discharge the girl has. In the first month of the child’s life, after washing with water, the discharge in the girl’s labia minora is removed daily with a cotton swab or a cotton swab dipped in Vaseline oil (it is more neutral and calm than peach or apricot oil). There is no need to try to thoroughly wash off the “plaque” with water; it is difficult to wash off due to the large amount of lipids in its composition. After 2-3 months from birth, when the discharge becomes less and less, this procedure can be performed every other day. In the future, closer to 1 year and up to 6 years, it is recommended to remove smegma once a week. There is no need to injure the girl’s skin every time with your actions, or make the vulva defenseless against external and internal environmental factors. Smegma is a protective physiological secretion and an indicator of a girl’s health! There is no smegma - therefore there is a risk of skin trauma, there is a risk of synechia of the labia minora, there is a risk of inflammation due to the activation of its opportunistic or pathogenic flora, which feels good where there is no protective smegma.

I will briefly summarize and duplicate the golden rules of hygiene for girls, developed by the head of the gynecological department of children and adolescents, Doctor of Medical Sciences, professor, Honored Scientist and Corresponding Member of the Russian Academy of Sciences, E.V. Uvarova (2010):

1. The skin of the perineum and external genitalia should always be clean. There should be no residues of feces, urine or other secretions on them;
2. You should take a shower 2 times a day and as needed;
3. You need to wash with warm water and clean hands. If desired and according to indications, you should use liquid soap for intimate hygiene, which is best purchased at a pharmacy;
4. The anal area and external genitalia should be washed with different hands, previously washed with soap;
5. To care for the genitals, it is better not to use washcloths, and the moisture after washing should be blotted rather than wiped, so as not to scratch the delicate mucous membrane of the genitals;
6. The towel must be clean, soft and strictly individual - this is a prevention of the provoking factor in relation to infection, including the genital tract.

The material was prepared by a pediatric and adolescent gynecologist, Ph.D. Silenko O.N.

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Child's personal hygiene (page 1)

PERSONAL HYGIENE OF A CHILD

Children must be kept clean and in a neat appearance. The staff is required to comb children's hair, cut their nails, and help them get dressed if necessary. Children of preschool age who are on a general regime must wash themselves, brush their teeth, and wash their ears every morning and evening. If necessary, you need to explain to your child how to use a toothbrush correctly. Nurses should help patients of early and preschool age: for example, girls comb their long hair with an individual comb, wash the external genitalia with warm boiled water every morning and evening in the direction from front to back, towards the anus. The condition of the nails is checked once a week, and a hygienic bath is organized every 7-10 days. On the same day, bed linen, underwear and clothes are changed. If necessary, clothes and underwear are changed more often.

Bed contents. The bed must be disinfected and wet cleaned. The use of wooden beds is allowed, but with the condition that their sizes correspond to the age of the children. The bed is placed in the room in such a way that it is convenient to approach it from any side, with the head end to the wall. The distance between adjacent beds should not be less than 1.5 m. The mesh on the bed should be well stretched, with a flat surface; a mattress should be placed on it and covered with a sheet, the edges of which are tucked under the mattress so that it does not curl or gather in folds. If the patient eats in bed, then the bed must be remade to remove crumbs and food debris from the sheets, and to straighten folds. Place clean pillowcases on pillows made of feather or cotton wool (bottom) and down (top). The blanket should be a flannelette since it is well ventilated and disinfected. In the summer, patients can use fabric blankets. Duvet covers are placed on fabric and flannel blankets. Children should not be allowed to sit on other people's beds, much less visitors should be allowed to do so. Parents must sit on chairs.

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For a certain category of patients, for example, with diseases of the spine, joints, or with pathological mobility of internal organs (vagus kidney), the mesh in the bed is replaced with a wooden shield, on top of which a mattress is placed.

For seriously ill patients, special functional beds are needed that allow them to provide the required position (for example, semi-sitting, etc.). The functional bed consists of a frame with panels, two backrests, two side bars, an overbed table and a basket. The bed panel is made up of three movable sections: head, hip and foot.

The side bars of a functional bed are removable and can be used to ensure the safety of young children or as auxiliary devices with which bandages can be used to secure the patient’s arms and legs during long-term intravenous infusions, etc. The over-bed table consists of a tray and two legs and is installed directly above the bed in front of the patient’s face, if the latter is in a semi-sitting position. There is a basket for the potty.

Near each bed there is a bedside table where the child’s personal hygiene items, his linen, toys, and books are located. A nurse monitors the condition of the bedside tables.

Bed and underwear are changed in the department every 7-10 days after a hygienic bath, but if necessary, linen is changed more often. Older children who are in satisfactory condition change clothes on their own, and younger patients are helped by nurses or auxiliary nurses.

When changing the underwear of a seriously ill patient who is on strict bed rest, the nurse grabs the edges of the shirt, removes it over the head and then frees his hands. Clean underwear is put on in reverse order. If the patient's arm is injured, first remove the sleeve from the healthy arm, and then from the sick one. Put the shirt first on the sore arm and then on the healthy arm.

Usually, at the same time as changing underwear, bed linen is changed. If the patient can sit, then the nurse transfers him from the bed to a chair and remakes the bed. Changing linen for bedridden patients is done in two ways: 1) the dirty sheet is rolled up with a roller from the side of the head and legs, and then removed. A clean sheet, rolled up on both sides like a bandage, is placed under the patient’s sacrum and straightened along the length of the bed; 2) the sick child is moved to the edge of the bed, then the dirty sheet is rolled up lengthwise, a clean sheet is straightened out in the free space, onto which the patient is transferred, and on the other side the dirty sheet is removed and the clean one is straightened.

Dirty linen - separately bedding and underwear - is collected in plastic bins with lids or in oilcloth bags and taken out of the ward to a special room. The hostess sister, putting on a spare robe and an oilcloth apron, sorts the linen and transfers it to the central linen room of the hospital, from where it is sent to the laundry. After changing linen, the floor and surrounding objects in the room are wiped with a rag soaked in a 1% solution of calcium hypochlorite.

The department contains a supply of linen for a day. Do not dry laundry on central heating radiators or reuse them.

Untimely and improper change of linen, mainly bed linen, contributes to the development of bedsores.

Prevention of bedsores. Skin care is especially important for children who are on strict bed rest for a long time and do not have the opportunity to take hygienic baths. The skin is wiped with a towel or clean soft cloth (gauze) moistened with one of the disinfectants (semi-alcohol solution, cologne, table vinegar, camphor alcohol, etc.). One end of the towel is moistened, lightly wrung out and wiped behind the ears, neck, back, buttock area, front of the chest, armpit and groin folds, folds on the arms and legs. Then use the dry end of the towel to wipe the skin dry in the same order.

A bedsore is necrosis of soft tissue (skin and subcutaneous tissue). More often, bedsores occur in weakened children in the area of ​​the sacrum, shoulder blades, greater trochanter, elbows, heels, where soft tissues are compressed between the surface of the bed and the underlying bony protrusion.

The formation of bedsores is promoted by poor skin care, an uncomfortable bed, and infrequent remaking of the bed, which leads to impaired blood circulation in the skin and underlying tissues. First, paleness of the skin appears, which is subsequently replaced by redness, swelling and peeling of the epidermis. The occurrence of blisters and skin necrosis indicates more pronounced local disorders and a clear underestimation by medical personnel of the initial symptoms of bedsores. In severe cases, not only soft tissues, but even the periosteum and superficial layers of bone tissue undergo necrosis. Rapid infection leads to sepsis.

Preventive measures aimed at preventing bedsores include turning a sick child on his side (if his condition allows), shaking off crumbs repeatedly every day, eliminating wrinkles in underwear and bedding, and wiping the skin with disinfectant solutions. Seriously ill people who have been in bed for a long time should be placed under a rubber (inflatable) circle wrapped in a diaper. It is placed in such a way that the sacrum is in the lumen of the circle. If skin hyperemia appears, the area is carefully wiped with a dry towel to improve local blood circulation. Ultraviolet irradiation is used. The skin in areas of maceration is washed with cold water and baby soap and wiped with alcohol, and then powdered with talcum powder or simple powder.

The blisters are treated with a solution of brilliant green, then a dry bandage is applied. When necrosis is limited, the doctor removes dead tissue and closes the wound with a sterile cloth moistened with a 1% solution of potassium permanganate. Subsequently, the nurse changes the bandage 2-3 times a day and informs the doctor about the condition of the wound. As the wound surface is cleansed, ointment dressings (Vishnevsky ointment, syntomycin emulsion, etc.) begin to be used.

The appearance of bedsores in children is evidence of extremely poor care, low medical culture of the department staff, and an irresponsible attitude towards their direct responsibilities.

Oral care. In the morning and evening, a sick child should brush his teeth using children's toothpaste. It is advisable that children rinse their mouths with warm water after each meal, preferably lightly salted (a quarter teaspoon of table salt per glass of water) or soda water (3-5 g of sodium bicarbonate per glass of water).

Eye care. No special eye care is required. The child washes his eyes during the morning and evening toilet. However, if there is discharge that sticks the eyelashes together, the eyes are washed with a sterile gauze swab moistened with warm, strong tea.

For eye diseases, as prescribed by a doctor, drops are instilled or ointments are rubbed in. Before the procedure, the nurse thoroughly washes her hands with soap and a brush, and wipes them with alcohol. The pipette for instilling drops and the spatula for putting in the ointment are boiled before use.

To instill drops into the eyes, the medicine is drawn into a pipette. Using your index finger, slightly pull back the lower eyelid, and with the other hand, slowly release one drop from the pipette (closer to the nose). The big one should look in the opposite direction. After some time, a second drop is instilled and the child is asked to close his eyes. After use, the eye dropper is washed with warm water and placed in a special case.

The eye ointment is applied using a glass spatula. To do this, the lower eyelid is pulled back and ointment is placed on the conjunctiva, the eyes are asked to be closed, and the ointment is rubbed over the eyelid with careful movements of the fingers.

Ear care. During the daily morning toilet, when the child washes himself, he should also wash his ears. If a wax plug is detected in the external auditory canal, it is removed. To do this, drop a few drops of a 3% solution of hydrogen peroxide or sterile petroleum jelly into the ear, and remove the plug using a cotton swab using a rotational motion. When instilling drops into the left ear, the patient's head is tilted towards the right shoulder. With your left hand, pull back your earlobe, and with your right hand, instill a few drops into the ear canal. After this, a small cotton swab is placed in the ear for a few minutes or a scarf is tied around the head.

Nasal cavity care. If the child cannot clear his nose on his own, then a nurse will help him and remove the crusts that have formed. To do this, a cotton swab moistened with petroleum jelly (preferably sterile), glycerin or another oil solution is alternately inserted into the nasal passages. In this case, the child’s head is tilted back and after 2-3 minutes, the crusts are removed with rotational movements. Caring for your nose requires some skill and patience.

Nails are trimmed with small scissors with rounded jaws so as not to injure the skin. After finishing cutting, the scissors must be wiped with cotton wool moistened with alcohol or a 0.5% chloramine solution.

Hair care. It consists of washing your hair, combing your hair, braiding your hair, etc. Only individual combs are used to comb your hair. Combing short hair for boys is usually easy. Girls' long hair should be divided into separate strands, combed each separately, and if necessary, braided hair or secured with hairpins. If there is excessive dandruff or dirty hair, use a thick comb dipped in a solution of table vinegar. Wash your hair with baby soap or shampoo.

Help with natural needs.

If the child is on strict bed rest, then a bedpan (enamel or rubber) is placed on him or a urine bag (enamel or glass) is given. A patient who is allowed to get up must use a potty, which is placed under the bed. The potty is numbered, its number corresponds to the bed number. Labeling is necessary to ensure that the child only uses his own potty. The vessel, urinal or potty is washed daily with hot water and laundry soap and then treated with a 1% chloramine solution or a 0.5% bleach solution. To eliminate the smell of urine, containers for sending items are treated with a weak solution of potassium permanganate.

The nurse notes the amount of food eaten by the child in the medical history.

Washing dishes, storing food. Strict compliance with sanitary and hygienic requirements for storage conditions of food products and prepared meals plays a decisive role in the prevention of food poisoning. In the buffet you can store bread in special bags (no more than a day), sugar, tea.

Due to the special technological requirements for the preparation of medical food (grinding, pureing), dietary dishes are a particularly favorable environment for the development of pathogenic microorganisms. In this regard, attention should be paid to the timing of the sale of ready-made dishes. It is strictly forbidden to store leftover food in the buffet, as well as mix food leftovers with fresh dishes; using food left over from a previous meal to feed children.

Tableware is stored in the buffet. After each feeding of children, it is disinfected. Dishwashing is carried out taking into account the purpose and degree of contamination. First, wash the mugs and teaspoons, and then the plates. Dry and disinfect the dishes in a dry-heat oven at a temperature of 130 °C for 30 minutes. Instructions for washing and disinfecting dishes are posted in a visible place in the buffet room.

At the end of washing, washcloths (rags) for washing dishes are soaked in a 1% solution of chloramine or in a 0.5% clarified solution of bleach for 60 minutes or boiled for 15 minutes, then dried and stored in specially designated places.

Clean dishes are kept in a specially designated cabinet. Medical personnel should not be allowed to use utensils intended for sick children.

Food waste is collected in special labeled bins with a lid. They must be removed from the department on the same day.

FEATURES OF INFANT CARE

Children in the first year of life especially need careful care and observation. The basis of care is adherence to the strictest cleanliness, and for a newborn child, sterility (asepsis). Care for infants is carried out by nursing staff with mandatory supervision and participation of a doctor. Persons with infectious diseases and purulent processes, malaise or elevated body temperature are not allowed to work with children. Medical personnel in the infant department are not allowed to wear woolen items, jewelry, rings, or use perfume, lipstick, cosmetics, etc.

The medical staff of the department where infants are located must wear white, carefully ironed gowns (they are replaced with others when leaving the department), caps, 4-layer marked masks and removable shoes. Strict personal hygiene is mandatory.

Care of skin and mucous membranes. Care is carried out taking into account the child's condition. It shouldn't cause any discomfort.

The morning toilet of a newborn consists of washing the face with warm boiled water and rinsing the eyes with a sterile cotton swab moistened with boiled water. Each eye is washed with a separate swab in the direction from the outer corner to the bridge of the nose. During the day, the eyes are washed as needed.

The baby's nasal passages have to be cleaned quite often. Cotton buds made from sterile cotton wool are used. The flagellum is lubricated with sterile petroleum jelly and carefully moved deep into the nasal passages by 1.0-1.5 cm with rotational movements; the right and left nasal passages are cleaned with separate flagella. This manipulation should not take too long. It is strictly forbidden to use dense objects, such as sticks (matches) with cotton wool, etc.

The external auditory canals are rarely cleaned; they are wiped with dry cotton wool.

The oral cavity of healthy children is not wiped, as the mucous membranes are easily injured.

Newborns and infants need to have their nails trimmed. It is more convenient to use scissors with rounded jaws or nail clippers.

At the end of the newborn period (3-4 weeks), the baby is washed in the morning and evening, and also as needed. The child’s face, neck, ears (but not the ear canal), and hands are washed with warm boiled water or wiped with cotton wool moistened with water, then wiped dry. At the age of 1-2 months, this procedure is carried out at least twice a day. From 4-5 months you can wash your baby with tap water at room temperature.

After urination and defecation, the child is washed, following certain rules. Girls are washed from front to back to avoid contamination and infection of the genitourinary tract. Washing is done with your hand, onto which a stream of warm water (37-38 °C) is directed. For severe contamination, use neutral soap (“Children’s”, “Velvety”, etc.). It is unacceptable to wash children with standing water, for example in a basin.

After washing, the baby is placed on the changing table and the skin is blotted with a clean diaper. Then the folds of the skin are lubricated with a sterile cotton swab moistened with sterile vegetable (sunflower, peach) or vaseline oil. For this purpose, you can also use baby cream or special mash.

Bathing. The first hygienic bath is given to a newborn after the umbilical cord falls off and epithelization of the umbilical wound (7-10th day of life). During the first 6 months they bathe daily, in the second half of the year - every other day. For bathing you need a bath (preferably enameled), baby soap, a soft sponge, a water thermometer, a jug of warm water for rinsing the baby, a diaper, a sheet.

The bath is pre-washed with hot water, soap and a brush, then treated with a 0.5% chloramine solution (if bathing is carried out in a childcare facility) and rinsed with hot water.

For children of the first half of the year, the water temperature in the bath should be 36.5-37 °C, for children of the second half of the year 36-36.5 °C. The duration of the bath in the first year of life is no more than 5-10 minutes. With one hand they carefully support the child’s head and back, with the other they lather the neck, torso and buttocks; Wash especially thoroughly the folds in the neck, elbow, groin areas, behind the ears, under the knees, between the buttocks. Then the child is turned back up and doused with clean water. The baby is quickly wrapped in a warm diaper and dried with blotting movements, after which, after treating the skin folds with sterile vaseline oil, he is dressed and placed in a crib.

When bathing, use soap no more than 2 times a week, preferably “Children’s”. For some children, daily bathing can cause skin irritation, especially if the water is hard. In these cases, a bath with the addition of starch is recommended: 100-150 g of starch is diluted with warm water and the resulting suspension is poured into the bath.

Children of the first half of the year are bathed in a lying position, while children of the second half of the year are bathed while sitting.

Sometimes after frequent washing with soap, hair becomes dry. In such cases, after bathing, they are lubricated with boiled vegetable oil or a mixture of 1/3 castor oil and 2/3 vaseline (or boiled sunflower) oil. After treatment, wipe the hair with a dry cotton swab.

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Rules for swaddling and clothing for children of the first year of life. It is better to swaddle a full-term newborn with arms for the first 2-3 weeks, and then, at the appropriate air temperature in the room, the arms are laid out on top of the blanket. Considering that tight swaddling restricts movement, the newborn is dressed in special clothes: first they put on two long-sleeved blouses (one light, the other flannel), then they wrap them in a diaper. In this form, the child is placed in an envelope made of cotton fabric. Usually a soft flannelette blanket is placed in the envelope, and if necessary, a second flannelette blanket is placed on top of the envelope.

Swaddling is done before each feeding.

After swaddling each child, the changing table and oilcloth mattress are thoroughly wiped with a 0.5-1% chloramine solution. Children are swaddled on the changing table without purulent manifestations; if it is necessary to isolate the child, all manipulations (including swaddling) are performed in bed.

Provided that children's clothes are washed daily, a certain set of clothes is provided for children in the first months of life (Table 8).

A thin vest is wrapped on the back, and a warm one is wrapped on the child’s chest. The sleeves of a warm vest are longer than the arms; they should not be sewn up. The bottom edge of the vest should cover the navel.

When swaddling, the baby is placed in such a way that the top edge of the diaper reaches the armpits. The diaper is placed on the perineum, after which the baby is wrapped in a thin diaper. Place a polyethylene diaper (oilcloth) measuring 30 X 30 cm (top edge at lumbar level, bottom edge to knee level). The baby is then wrapped in a warm diaper. If necessary, the child is covered with a blanket on top.

From 2-3 months, during daytime “waking”, diapers are replaced with onesies, and at 3-4 months, when drooling is especially profuse, a bib is put on over the vest.

A scarf or cap made of cotton fabric is put on the head only after a bath and while walking.

At 9-10 months, baby undershirts are replaced with a shirt, and rompers are replaced with tights (in winter with socks or booties).

Feeding children in the first year of life. There are three types of feeding: natural (breast), mixed and artificial.

Natural (breastfeeding) is the feeding of a child with a woman's milk.

When breastfeeding a baby, certain rules must be followed.

1. Before feeding, the mother should carefully wash her breasts with boiled water with clean, washed hands.

2. Express a few drops of milk, which removes bacteria from the final sections of the excretory glandular ducts.

3. Take a comfortable position for feeding: sitting, placing your left leg on a stool if feeding from the left breast, and vice versa.

4. It is necessary that when sucking, the child captures with his mouth not only the nipple, but also the isola. The baby's nose must be free to breathe properly. If nasal breathing is difficult, before feeding, the nasal passages are cleaned with a cotton swab moistened with petroleum jelly or using an electric suction.

5. The duration of feeding should not exceed 20 minutes. During this time, the child should not be allowed to fall asleep.

6. If after feeding the mother has milk left, then the remaining milk is expressed into a sterile container (in a bottle with a funnel or in a glass). The most effective way is to suction the milk using a vacuum device. If it is not available, use a rubber pad or a breast pump with a rubber cartridge. Breast pumps must be sterilized before breastfeeding begins.

In the absence of a breast pump, milk is expressed by hand. First, the mother washes her hands with soap and wipes them dry. The thumb and index fingers are placed on the outer border of the isola, and the fingers are squeezed tightly and rhythmically. The nipple should not be touched.

7. In order to prevent the formation of cracks and maceration of the nipples, the breasts at the end of feeding must be dried with a clean, thin linen diaper.

When breastfeeding, the child himself regulates the amount of food he needs. However, in order to know the exact amount of milk he received, it is necessary to systematically carry out so-called control feeding. For this, the baby is swaddled before feeding as usual, then weighed (in swaddles), fed, re-weighed in the same clothes without changing diapers. The difference in mass is used to judge the amount of milk sucked. Control feeding is mandatory if the child’s weight gain is insufficient due to illness.

If the baby has not sucked enough milk, as well as if he is sick or the mother is sick, he is fed or supplemented with expressed breast milk. Store expressed milk in the refrigerator at a temperature not exceeding + 4 °C. Within 3-6 hours after expressing and if stored correctly, it can be used after heating to 36-37 °C. When stored for 6-12 hours, milk can be used only after pasteurization, and after 24 hours of storage it must be sterilized. To do this, place a bottle of milk in a saucepan, pour warm water slightly above the level of the milk in the bottle; Then, during pasteurization, the water is heated to 65-75 ° C and the bottle of milk is kept in it for 30 minutes; during sterilization, the water is brought to a boil and boiled for 3-5 minutes.

Bottles of expressed milk are stored in the refrigerator at the nurse's station along with formula. Each bottle should have a label that says what it contains (breast milk, kefir, etc.), the date of preparation, and on the bottle of expressed milk the hour of pumping and the mother’s name.

Mixed feeding is feeding in which the child, along with breast milk, additionally receives artificial milk formula.

Artificial feeding is feeding a child in the first year of life with artificial milk formula.

Feeding a baby with formula milk during mixed and artificial feeding is mainly done through a nipple from a bottle. Use graduated bottles with a capacity of 200-250 ml (graduation value is 10 ml). A nipple with a hole is put on the bottle. A hole is pierced in the nipple with a needle heated over a flame. The hole in the nipple should be small so that when you turn the bottle over, the milk flows out in drops and does not flow in a stream. Formula or milk should be given to the child heated to a temperature of 37-40 ° C. To do this, before feeding, place the bottle in a water bath for 5-7 minutes. The water bath (pan) must be labeled “For heating milk.” Each time you need to check whether the mixture is warm enough or not too hot.

When feeding children with adapted milk formulas such as “Detolakt”, “Malyutka”, “Bona”, the sequence of preparatory operations is somewhat different. Boiled water is poured into a sterilized bottle, dry milk mixture is added with a measuring spoon and the bottle is shaken. Then a clean nipple is placed on the bottle. After feeding, wash the bottle using a brush.

When feeding, the bottle must be held so that its neck is always filled with milk, otherwise the baby will swallow air, which often leads to regurgitation and vomiting.

The baby is held in his arms in the same position as when breastfeeding, or in a position on his side with a small pillow placed under his head.

During feeding, you should not leave the baby; you need to support the bottle and monitor how the baby sucks. You cannot feed a sleeping baby. After feeding, you need to thoroughly dry the skin around the baby’s mouth, carefully lift it and place it in a vertical position, which helps remove air swallowed during feeding.

In order for food to be better absorbed, it is necessary to follow the established feeding hours. If the general condition is not disturbed and the appetite is preserved, then the diet of patients can be the same as that of healthy children of the same age (children up to 2 months are fed 7 times, up to 5 months - 6 times, from 5 months to 1-1.5 year - 5 times). If the child is in serious condition or has poor appetite, feed more frequently (every 2-3 hours) and in smaller portions.

Sick children are sometimes very difficult to feed, not only because they have a poor appetite, but also because of habits acquired at home. Great patience is required, since even a short-term refusal to eat in weak and malnourished children can adversely affect the course of the disease. In hospitals, all formulas for children of the first year of life are received at the catering department. Dry formulas in the buffet are converted into ready-to-use formulas immediately before feeding the baby. The type of formula, its volume and frequency of feeding for each child is determined by the doctor.

To replace breast milk, adapted milk formulas are currently used: “Malyutka”, “Malysh”, “Detolakt”, “Pelty”, etc.

When artificial feeding, the volume of milk formula sucked is determined using the graduated scale of the bottle. The amount of milk sucked from the mother's breast or formula from a bottle is noted after each feeding on an individual nursing sheet filled out for each infant.

Already in the first year of life, starting from the 4th-5th month, the child is gradually accustomed to new types of food (complementary feeding). When introducing complementary foods, certain rules must be followed. Complementary foods are given before breastfeeding or formula feeding, and spoon-fed. Complementary feeding dishes include porridge, vegetable puree, meat puree (minced meat, meatballs), yolk, broth, cottage cheese, etc. Since the child begins to sit at 6 months, he should be fed at a special table or sitting on the lap of an adult. When feeding the baby, an oilcloth apron or just a diaper is tied to the chest.

In the first year of life, especially in infant wards, sterile feeding utensils should be used for feeding.

Rules for sterilizing nipples and bottles. Dirty nipples are thoroughly washed first in running water, and then with warm water and soda (0.5 teaspoon of baking soda per glass of water), and they are turned inside out. Then the nipples are boiled for 10-15 minutes. Nipple sterilization is carried out once a day, usually at night. It is carried out by the ward nurse. Clean rubber pacifiers are kept dry in a closed (glass or enamel) container labeled “Clean pacifiers.” Clean nipples are taken out with sterile tweezers, and then put on the bottle with clean, washed hands. Used pacifiers are collected in a container marked “Dirty pacifiers.”

Bottles are sterilized in the pantry. First, the bottles are degreased in hot water with mustard (50 g of dry mustard per 10 liters of water), then washed with a brush, rinsed with running water outside and inside (use a device in the form of fountains for rinsing bottles) and rinsed. Clean bottles, neck down, are placed in metal nets, and when the remaining water has drained, the bottles in the nets are placed in a dry-heat oven for 50-60 minutes (temperature in the oven is 120-150 °C).

Bottles can be sterilized by boiling. To do this, they are placed in a special container (tank, pan), filled with warm water and boiled for 10 minutes.