Dr. Dushyant V. Punvani, M.D. (Paediatrics)

Adequate food is most important for the growth of infants and young children.   It is more crucial during the first 5 years of life when rapid growth occurs and the child is entirely dependent on the mother for food.  Insufficient food leads to inadequate weight gain and hinders growth.

BREAST FEEDING

The advantages of breast-feeding and advice on how to successfully breast feed should be communicated to the pregnant lady in the antenatal period itself.  The mother needs to ensure that her nipples are not retracted [by gentle pulling them out] and regular cleaning is necessary because drying of the normal secretions can lead to cracked nipples.

Breast-feeding is the simplest way to feed.

• Breast milk is warm, bacteria-free and always available.

• There are no problems with quantity if the child is gaining weight adequately.

• It is easily digestible and has a low osmotic load- this is of special importance in premature babies who have immature digestive and excretory systems.

• It confers passive immunity via the colostrum, which is rich in antibodies and enzymes.

• The mother feels satisfied and this leads to better mother-child bonding.

• This in turn leads to better lactation.

PHYSIOLOGICAL CONSIDERATIONS

A relaxed mother feeds better- sudden worry or anxiety adversely affects lactation.  Production and secretion of milk are both stimulated by sucking.  No particular foods are known to conclusively increase the quantity of breast milk - it is important for the mother to have an adequate balanced diet.

The baby should be put to the breast immediately after birth – this leads to better lactation and encourages bonding.  The yellowish early milk secreted is colostrum – this is rich in proteins and protective antibodies and should always be fed to the newborn.  Substitutes such as water with sugar/ jaggery or "janam ghutti" should be discouraged, because they have no nutritive value and also cause no stimulation of the breast, leading to delayed milk production.

There is also a greater chance of aspiration of fluids given by spoon, especially in a child who is sleeping or crying.  They also carry a risk of causing infection.  For the sake of cultural satisfaction, a few drops may be allowed if cleanliness and sterility can be ensured.  Mature milk starts by day 3 and gradually increases in quantity.

The child can be fed 5-6 times in the day and night as required – 10 minutes at each breast with burping between breasts and after the feed - within a few weeks the baby learns to sleep for longer hours and soon sleeps through the night.   With adequate milk secretion the baby often sets up a self – demand schedule, feeding every 3-4 hours.  A mouthful of milk is sometimes brought up along with wind – this is not of any significance.  Habitual posetters go on bringing up milk – this is no cause for worry if weight gain is good and this stops when semi-solids are introduced.

A baby is being satisfactorily breast fed when he sleeps a good deal, gains weight adequately and passes normal stools.

BOWEL PATTERNS

The dark brown-black early stools [meconium] are soon replaced by yellowish sticky semi-solid stools, curd like or occasionally greenish. These soon become golden-yellow.

The child may pass a soft stool after each breast feed or one soft stool in 2-5 days – both patterns are completely normal and do not call for any treatment.

WEANING

After 3-4 months most mothers do not have sufficient milk for it to be the only source of the child’s nutrition.

While introducing foods other than breast milk, one has to:

• Offer the semi-solids before the milk feed when the child is hungry

• Give small amounts so that the child can get used to the taste and consistency –

• There is no hurry and if the child initially spits out the new food it is because he is still learning to swallow and does not mean that the new food is not liked

• The food should be thoroughly mashed, at the correct temperature and have no chillies or spices.

• The preferences of the child should be respected.

• There should be frequent changes to prevent boredom.

• At 3-4 months, start gradually with diluted juices to be fed with a spoon.

• Mashed fruit – ripe banana, apple or any seasonal fruit can follow this.

Later one can introduce cereals in the form of suji/ atta/ ragi/ rice porridge.   All this should be gradually increased from 1-2 spoons to as much as the child can comfortably eat.  A 5-6 months one can introduce soft-boiled vegetables.  Clear soups by themselves have little nutritive value.

By the age of 7-9 months the healthy child should be on all the items of the family diet, suitably mashed and given in small quantities.

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