( By Edited by A.P. Dewan )

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Feeding and Nutrition

Good eating habits start young. Food provides the raw material for growth. Nutrients provide for a healthly immune system. There are a number of important ways in which a child's food requirements differ from those of an adult. Children grow at a tremendous rate and need much more energy in proportion to their body size. High fiber and low fat diet is not suitable for children under two. Toddler's small stomachs full up quickly and fiber rich foods may fill them without providing enough calories. For them more important are energy rich foods such as fats and dairy products. Janet Coleman of the British Dietetic Association believes "One of the most important are energy. Restricting fat reduces their caloric intake. After the age of two, if the child has a good diet and adequate caloric intake, you can reduce the amount of saturated fat they eat". Dairy products are a good source of protein and calcium and they provide calories. Encourage them to have milk, yogurt and cheese with meals and between meals.

Breast milk is the best for the child. He must be fed on that as much and as frequently as possible. The more the child draws on this source of food, the more milk will be produced by the mother's breasts. If and when the child reduces his draw on this source, the supply gets reduced in geometric progression. It is therefore, extremely desireable that the demand of the child on his mother's milk is not reduced. Utmost effort must be made not to bring in cow's milk goat's milk or some formula milk to supplement the mother's milk in the first four to six months of the child's life. Concentrate efforts on the various steps mentioned in the chapter on breast feeding to increase breast milk. If all efforts in that direction fail to give results then perforce milk will have to be fed from the bottle.

Bottle Feeding

Most popular form of milk for the bottle is the cow's milk delivered to your door step by your friendly and reliable milkman. It should be boiled, sterilised and diluted with water. It may be sweetened with very little sugar. Use a clean funnel to fill the bottles if necessary. Warm the feed to about 38 degree C (100 degree F) by placing the bottle in warm water for a few minutes. The bottle may not be heated otherwise. Bottle-feeding is simple but make sure that the baby can swallow properly and that he does not take in air with the milk. It is diffcult for the baby to swallow when he is lying flat. In that position he may even vomit. Do not try to force the baby to finish the bottle after he has stopped sucking. The baby knows when he has had enough. Hold the bottle at such an angle that the nipple is always full of milk. That will ensure that least amount of air is swallowed. It is better if the baby is in an upright or propped up position while being fed from a bottle. Babies feel happier when burped. Burping makes you relax, slow down, hold your baby gently, and stroke or pat him, and this is good for both of you. Do not give your baby a bottle full of milk in bed. His teeth will get discoloured and full of cavities. If he needs a bottle as a 'lovey' to go to bed with him, give him a bottle with water. Fortify the milk of the bottle with vitamins and iron.

Wash the bottle soon after use. Rinse every thing. Use brush for the inside of the bottle. Nipples should always be washed by hand. Needle or tooth pick should be twished in each nipple hole. Boil the nipples and caps for five minutes. In selecting the nipple ensure that it is the standard one which releases the milk at two drops a second when the bottle is held upside down.

Solid Foods

More children are being fed solid foods at an earlier age while nutritionists encourage a delay in introducing solid foods at least into the second half of the first year of life.

There is a temptation to feed solids as early as sixteen weeks. Such a premature attempt to introduce solids during the first four months invites enough to handle solids competently. His tongue protection and lip constriction patterns are so dominant that they interfere with normal swallowing mechanisms. Solids, if given early, upset the mother's milk balance also. It may result in marked reduction or over production of the mother's milk.

Not until 20 to 24 weeks is the baby likely to mature and interested enough to handle solids. At this period the mother is capable of maintaining an adequate milk supply over a full 12 hour interval without the stimulus of the infant's sucking. There is a special advantage if the child persists in demanding an early morning feed.

For giving the first solids begin with the mid-day meal. Start by feeding him from one breast. Then give him one or two teaspoons of food. After that give him to other breast. Then give him one or two teaspoons of food. After that give him the rest of the milk. As soon as the baby starts having any quantity of solid food, start with 20 millilitres of water at a time. You may feed him upto 100 millilitres of water during a whole day.

Start with home prepared cereals. It is best to start with rice as a cereal, well cooked and mushed. Wheat should come after a few months of the first rice feeding because wheat causes allergy more often than other cereals. Fruit is often the second solid added to the diet after cereals. Babies take to fruits enthusiatically. Banana should be very ripe. Mash it and add a little milk to it, if necessary. Stew the other fruits for the first few months of solids. You could add apples, pears and apricots etc. Postpone grapes till he is 2 years old. You could include fruits even twice a day.

Strained cooked vegetables should be the next to be added to his diet. Start with carrots and sweet potatoes. Squashed turnips and onions should be started late and spinach should be taken up even later. If a vegetable causes looseness or mucus, postpone taking that vegetable on board by a month or so.

Introduce solid foods gradually-one food at a time. Introduce a second food after a week and another one every week. This will provide a clue if he is allergic to some foods. Consistency of food is very important. The food should be in a thin and creamy form. Babies hate lumpy foods.

Learning to chew comes later. Foods should not be bulky. These foods should be energy rich with fats in the form of butter, cheese etc. You must ensure that he gets the fuel for growth. Dried fruits are also concentrated caloric source- could be wetted and mashed. Do not add any salt or sugar to any of these foods. Let the tastes formed be in favour of low salt and low sugar content, Egg yolks are out unit six months and egg whites until one year due to allergy risks. Do not start including refined foods. Start with complex carbohydrates. Serve fruits, not puddings. Put cooked vegetable through a blender or a sieve. Always prefers home prepared foods. Do no feed him on food from jars. Never forget that baby tastes are being formulated every day and that baby tastes are different from the adult tastes. Cater to the taste of your baby.

Finger foods may be introduced at age 7-8 months. A small portion of a carrot stick and crust of a whole-wheat bread are good. These provide good training.

Shift to chopped foods gradually. All babies choke a little as they get used to eating lumpy foods just as the babies fall while learning to walk. No problem. Add eggs to diet only after 9-10 months. Never give a raw egg. Egg can be given with any meal if the baby likes it. Egg could be given along with cereals. Do no give more than three or four eggs a week.

In fever do not feed solids to the baby. Must curb the quantity of sucrose and fizzy drinks that the child is likely to demand. For sweetening foods use honey, or dates, etc. If the babies do not begin to bite and chew food around 6 to 8 months age, they are likely to resist longer. Parents should aim to have a baby weaned off sloppy foods and start eating family meals by the end of 18 months. Learn to say No to junk food. If parents give in to the children into bad eating habits. Wean them from biscuits sweets and crispies and try them to get attached to cheese cubes, grated cheese, raisins, slices of apples and pears, bananas home-made pop corn without salt or sugar rice cakes carrot sticks and grapes etc.

Feeding Battles!

At about one year and with walking ability and with a negative attitude towards almost everything, starts the struggle between the child and the parents. Endangered relationship starts to go beyond food. It goes to dropping food and even smearing messy foods. When the child gets on the war path, you should try to get out of the struggle. You cannot win and you really should not win. Do not take the baby's resistance personally. You should allow the child necessary freedom to explode, to refuse and to test limits. After the very first bout remove the food. Soon he will begin to eat again.

Fix limits on how long feeding will continue and stick to those limits. Getting him to eat more is not important enough to justify the toddlers walking around while eating. Total development of the child is more important. The baby will survive nutritionally a few missed meals. Feeding should not develop into battle ground. Evolve a system and a routine. After a particular age, adopt regular feeding times if you want to avoid battles. Give up the idea of feeding on demand in the early months. Have no snacks in between. After a maximum feeding time of, say, 20 minutes, put the toddle down and put away the food. Give small amounts of food at a time. When the child finishes that, give more. As soon as he get attention by his food, end the meal. The child wants to get attention by his provocative behaviour. He is not after more food. You should deny him such an excitement. Instead of feeding battles, feeding should be a pleasant communicative area.

Faulty management may be the cause in some cases. Parents should not be disturbed by periods of stationary weight. The subtlety of body chemistry and child behaviour are one. The poor eater may manifest himself as early as 12-16 weeks. He may be a vomiter. He insists on being fed the same food, the same way, at the same place by the same person. He is a poor eater. It is this very person who generally likes to enter the feeding battles. By about 4 or 5 years of age, such a child also outgrows much of his indifference and propensity to fight.

After two years the energy needs of the children reduce dramatically and they start asking for funny foods. They would much rather play than eat. On this new battle front your strategy has also to change. If the child refuses food, do not press. One missed meal will not hurt. Make food look attractive. Offer small portions at a time. Do not rush the child. Put a small amount of every thing on the plate, even if some food items have been rejected before. Say no to food that are a waste of stomach space. Offer raw vegetables and attractive salads before the regular meal. This could be the start of eating healthy foods - no fried stuff, no white refined wheat products, no sucrose rich or salty foods. Give children under two, full cream milk of cow or goat. From age two introduce low fat milk.

Nutrition Tips

Fruits and vegetable are most nutritious when fresh. Peel tough skinned fruits and vegetables. Cook soft skinned fruits and vegetables in their skins so as to retain their vitamins and fiber. Cook fruit and vegetables in steam or in a tightly covered pan with as little water as possible. This helps to retain the vitamins which are otherwise lost in cooking. If you want to give meal to the baby, cook and puree it and thin the puree with vegetable water or soup. Use poly - or uni-unsaturated fats. Limit the use of butter and saturated fats after 2 years of age. Enrich mashed vegetables with little fat.

Do not buy burised or wrinkled fruit and vegetables. Do not soak them in water. Just wash them. Do not overcook foods. Cook food just before eating. Let the food go directly from the fire to the table. As it is usually not possible to cook fresh food for a child five or six times a day, cook three times a day. Fill the remaining three slots with breast feeding, dried foods, fruits, bread, nuts and other clean home-made snacks which can be stored for long periods.

The child needs energy for basic metabolism of the body at rest, for baby activities, for processes of digestion and excretion and for growth. The figures given below are meant to indicate to you the requirements of an average metabolism and average activity. These figures do not limit you because your child may have a metabolism wherein he burns more calories or may be hyper-active and thus need more energy:-

AgeCalories requirements per day
Upto 6 months120 calories per kg body weight
7-12 months100 calories per kg body weight
1-3 years1200
4-6 years1500

Over nutrition could be as harmful as under nutrition. Just to give you an Idea, one gram of fat yields 9 calories, one gram of protein 4 calories and one gram of carbohydrates 4 calories.

When consulting tables of representative values of foods for nutrients, do not forget that those values are based on averages and in fact would depend on the amount of nutrients in the soil on which those foods were grown. Another variable factor is the physical capacity of the child as to how much energy, fat, protein etc he can extract or draw from the food he eats. Those tables are just for you general guidance.

Prefer foods on which no insecticides have been sprayed and which have ripened on the trees and not ripened by use of chemicals.

Shakespeare, in Hamlet, provides a tip in this behalf when he says, "Fruit unripe, sticks on the tree; But fall, unshaken, when they mellow be".

In childhood, adequate intake of vitamins A, B and C is necessary Natural sources of these vitamins are: vitamin A-yellow and green fruits and vegetables, milk and milk products, egg yolk and liver. Carrots are very rick in vitamin A; Vitamin B (generally B2, B6 and B12)-whole grains, milk, legumes, liver, brain, banana, peanuts, raisins, eggs, fresh fish, meat and yellow and green vegetable. Vitamin C - citrus, papaya, mango, tomatoes, potatoes and other fruits and vegetables.

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