· 7 മിനിറ്റ് വായന
Complementary feeding practices vary widely from place to place. Its impossible to lay down strict rules as its highly dependent on local beliefs and customs. WHO guidelines are the ones that give us a clear-cut idea regarding the same.
The ‘Ten Commandments of Infant Feeding’ are as follows:
Exclusive breast feeding till 6 months.
Start as early as possible.
Practice demand feeding.
Breast milk has sufficient nutrients and water content required for the baby.
Educate working mothers regarding expressed breast milk.
Family support is a major factor for its success.
Start complementary feeds after completion of six months even if the mother feels there is adequate milk.
On – demand breast feeding till at least 2 yrs of age.
No recommendation on upper limit.
Practise good hygiene and proper food handling.
Avoid bottle feeding.
Responsive feeding applying the principles of psychosocial care.
Feed infants directly and assist older children.
Feed slowly and patiently, and encourage children to eat, but do not force them.
If the child refuses any food item, experiment with different food combinations, preparations and textures.
Minimize distractions during meals (Ex. Mobile phone, TV).
Feeding times are periods of learning and love. Talk to children during feeding, with eye to eye contact. Don’t create a warzone.
Start with small amounts of food and increase the quantity as the child gets older.
Stop once they start showing signs of refusal.
Do not force feed.
Gradually increase food consistency and variety.
6 months: Pureed, mashed and semi-solid foods should be introduced. Gradually decrease the water content and increase the consistency.
8 months: Finger foods should be introduced.
10 months: Lumpy foods if delayed beyond this point, may increase the risk of feeding difficulties later on.
12 months: Family pot diet should be attained. Baby should be able to eat whatever other family members eat.
Avoid food items like groundnut that may cause choking until the child is bit more grown up.
Increase the number of times that the child is fed.
Start once a day after 6 months.
Increase to 2 – 3 meals per day by 7th to 8th month.
Increase to 3 – 4 meals per day by 9th to 10th month.
Add 1 – 2 snacks in addition to meals by 12th month.
Snacks are defined as foods eaten between meals-usually self-fed, convenient and easy to prepare.
Feed a variety of nutrient-rich foods to ensure that all nutrient needs are met.
A balanced diet should be rich in energy, protein and micronutrients (Fe, Zn, Ca, Vit A, Vit C & folate).
Diet should contain all the below mentioned components.
Local staple: cereals, roots and starchy fruits – Carbohydrates.
Pulses: Protein & some iron. Germinating pulses provide amylase.
Fruits and vegetables: Vit A & Vit C.
Meat & fish: Protein, iron and zinc.
Egg: Protein and vitamin A.
Dairy products: Calcium, protein, energy and B vitamins.
No controlled studies have shown that restrictive diets have an allergy-preventing effect. Therefore, age restriction for introduction is no longer recommended for any food types.
Start providing water along with complementary feeds.
Added sugar and salt are better avoided during initial days of complementary feeding as per western guidelines.
Non vegetarian items may be introduced once the child is comfortable in chewing.
No need to hurry in introduction of animal milk as long as breast feeding is adequate.
Fortified complementary foods or vitamin-mineral supplements may be given for infants in areas where deficiencies are prevalent. (Ex. Vit A, Vit D, Iron, Calcium)
Feeding during illness.
Do not force feed during illness.
Increase fluid intake during illness, including more frequent breastfeeding, and encourage the child to eat soft, favourite foods.
After illness, give food more often than usual and encourage the child to eat more.
Babies gain more than 6 kg in their first year and only around 2 kg in their second year. Due to the decreased rate of growth and increased interest in other activities, they tend to be less fascinated by food beyond one year of age. They tend to look leaner as well. Both these are normal phenomena and nothing to get worried about.
The first 1000 days of life (270 days in-utero and the first two years after birth) is the critical window period for nutritional interventions. As the maximal brain growth occurs, malnutrition in this critical period can lead to stunting and suboptimal developmental outcome. Infant & toddler period is the best time to promote acceptance of healthy foods. So we cannot afford to go wrong there.