Unit 21 - Feeding Children

8/13/2019 Unit 21 - Feeding Children

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UNIT 21 FEEDING CHILDREN

21.0 Objectives

21.1 Introduction

212 Complementary feeding

21.3 Foods for Complementary Feeding

21.3.1 Infant's First Food

21.3.2 Traditional Foods for Infants

21.3.3 Instant Infant Foods

2 1.3.4 Protective Foods

21.4 Age Specific Feeding Recommendations

2 1.4.1 Up to 6 Months of Age

21.4.2 6 Months upto 12 Months21.4.3 12 Months upto 2 Years21.4.4 2 Years and Older

21.5 Responsive Feeding

21.6 Keeping Foods Clean and Safe

21.7 Feeding During and After Illness

21.8 Feeding in ExceptionallyDifficultCircumstances21.8.1 Feeding During Emergencies

213 2 Malnourished Children21.8.3 Feedingin MaternalHIV

21.9 Let Us Sum Up21.10 Answers to Check Your Progress

21.0 OBJECTIVES

After going through this unit you should be able to:

define complementary feeding and outline its importance;

describe the complementary foods that can be fed to infants; and

describe feeding recommendations in children.

2 1 . INTRODUCTION

You have learnt in the previous unit that breast milk is the ideal fluidfood needed foraninfant during the first6 months of life. It is well recognized that the period om6 monthsupto2 years is the critical window period for promoting optimal growth and breast milkalone would not provide all the nutrients to achieve optimum growth. Therefore after 6

months, infants and children require other foods and fluids- known as complementary

foods, Complementdy foods should be nutritious, clean and safe, and fed in adequateamounts.

'The varied cultural beliefs in different parts of India with regards to the timing of

introduction of semi-solid foods, its consistency and amount are often hurdles in achievingadequate growth in the period 6-24 months. It is very important that families and mothers inparticular, are counseled and educated about the appropriate infant and child feeding

practices. These are equally important in special circumstances such as malnutrition and

emergencies. This unit will help you understand the correct infant and young child feedingpractices so that it will help you counseling families.


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21.2 COMPLEMENTARY FEEDING

Complementary feeding is defined as the process starting when breast milk alone is no

longer suj ficient to meet the nutritional requirements of infants and therefore other foodsand liquids are needed.The nutrient needs of term normal birth weight infants is usually met by breast milk during

the first 6 months of life provided the mother is well nourished. However, somemicronutrients,such as iron, may be limited before6 months and are dependent on thereserves rhese infants have at birth. Complementary foods are needed tofill the gapbetween the nutritional needs of the child and amounts providedby breast milk. The age forcomplementary feeding is generally between6- 24 months. However, infants must continue

to receive breast milk till12-24months even after introduction of complementary feeding.

21.3 FOODS FOR COMPLEMENTARY FEEDING

21.3.1 Infant's First Food

The f i rs t food for the infant mustbe made from the staple family cereal. The pomdgecan bemade fromsuji (semolina), atta (wheat flour), ground rice, ragi, millet, etc. by using a littlewater or milk. Roasted flour of any cereal can be mixed with boiled water,sugarljaggeryanda little oiVghee to make the fust complementary food soft, thick and creamy. Roasted flourdoes not thicken much and less water is needed to make porridge. Addition of sugarljaggeryand oil is important as increases the energy value of the food and oil also makes it soft

making it easy for the infant to feed.

In case a family cannot prepare porridge separately for the infant, you can advise the use of

pieces of half chapati that can be soaked in half a cup of milk or water and fed to the infant

after adding sugarljaggery and oil.213.2 .TraditionalFoods forInfantsAs soon as the infant starts eating the cereal pomdge well, mixed foods containing cooked

cereal, pulse and vegetables shouldbe given to the infant. Some of the traditional mixed

foods given to infants in different parts of India include khichidi, dalia, upma idli, sujikheer, dhokla, bhaat-bhaji, etc. These foods can be made more nutritious by addingcooked dal, vegetables, sugar or oil. It is always advisable to initiate foods from the familydiet so that the child easily adapts to the family food pattern.

21.3.3 Instant Infant Foods

Instant infant foods can be made from grains available in the home. One can takethree parts

of nycereal (ricelwheat)or millet (ragi, jowar, bajra), one part of any pulse(rnoong/chanrra/arhar) and half part of groundnut or white til. Each of these items should beroasted separately, ground, mixed and stored in airtight containers (can be storedupto amonth). For feeding the infant, take two tablespoon of the instant food mixture, add boiledwater or milk, sugadjaggeryand oillgheeand mix well. These instant foods can be usedwhen freshly cooked family food is not available. The nutritive value of this instant food can

be erhanced by adding cooked and mashed carrot or green leafy vegetables. The instantfood mix can also be made into halwa, dalia or upma and fed to the child.21.3.4 Protective FoodsThe child needs protective foods besides the modified family foods and instant mixes.

These include foods likemilk, curd, egg, fruits and vegetables. They contain vitamins andminerals which help the body to run smoothly and protect against illness. Dark green leafyvegc:tablesare rich sources of vitamin A, folate and iron.

Complications in

Early Pregnancy


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Abnormal Pregnancy

21.4 AGE SPECIFIC FEEDING RECOMMENDATIONS

You should aware that the quantity and type of foods that are given to children vary with

their age.

21.4.1 Up to 6 months of Age

1) The infant should be exclusively breast fed

2) The infant should be breast fed as often as it wants, both at day and night, at least 8times in 24 hours.

3) You should counsel mothers against giving water, other fluids or foods during when

on exclusive breast feeds.

21.4.2 6 months Up to 12 months

1) The child must continue to be breast fed and must also be started on complimentary

foods that we have discussed in the preceding sections.

2) The child must receive at least1 cupper serving of foods made from the staple family

foods (see 1.3.1 and 1.3.2).

3) If the infant is also being breast fed, then it should receiveat least 3 servingper day.

4) If the infant is not being breast fed, then it should receiveat least 5serving per da ?Inthese infants, animalmilk must be fed undiluted by a cup and never with a feeding bottle.

Feedingrecommendations6-12months--

6 Monthsupto 12Months

Breastfeed as often as the child wants.Give at least one katori serving* at a time of :-

Mashed roti/ rice ~breadhiscu i tmixed insweetened undiluted milk OR

- Mashed rot iricehread mixed in thick dal withadded gheeloilor khichri with added oivghee.Add cooked vegetables also in the servingsORSeviWdalia/halwa/kheerprepared in milk orany cereal porridge cooked in milk ORMashed boiledAriedpotatoesOffer bananabiscuit1cheek01 mango/papayaas snacks in between the servings3 times per day ifbreastfed;5 times per day if not breastfed.Remember:

-

-

-

Keep the child in your lap and feed with your ownhandsWash your own and child's hands with soap andwater everv time before feedina


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21.4.2 12 Months Up to 2 Years1 ~ r e a s tfeeding can be continued even at this age if the child wants to2) The child must be fed fiom the traditional family foods (see 1.3.2, 1.3.3 and 1.3.4)3) The child must receive at least I upperserving.4) The child must receive at least 5servingsper day.

5) The child's serving must be kept and fed fiom a separate bowllplate for the child.Feeding recommendations12-24months

12Monthsup to2 Years

Breastfeed a s oftenas the childwants.Offer food from the family potGive at least 1112 katori s e ~ n gat a time of :-Mashed rotilricehread mixed in thick dal withadded gheeloll or khiihri with added oillghee. Addcooked vegetables also in the servings OR

-Mashed rotilrice lbreadhiscuit mixed insweetened undiluted milk OR

- Sevianldalia/hatwa/kheerprepared in milk or anycereal porridge cooked in milk OR- Mashed boiledfiried potatoesOffer bananalbiscuitl cheek01 mango1 papaya

as snacks in between the servings5 times per day.

Remember:it by the side of child and help him to finish the

servingWash your child's hands with soap and watereverv time before feedina

21.4.3 2Years and Older1) After 2 years the c k l d must receive family foods, at least 3 times a day.2) In addition to the 3 main meals, the child should receive 2 snacks /day of nutritiousfimds between family meals. These snacks can be foods such as

- Ripe banana, papaya, mango or other k i t s- Curd, pudding

-

Bread, chapatti with butterhoney- Biscuits

- . Boiled potatoes

Avoid i oodssuch as fizzy drinks, sweets/candiesor cltucolatesas they are of poor nutritivevalue.

21.5 RESPONSIVE FEEDING

It is important to remember that feeding a child is not a mechanical event. We need torespond to the needs of a child (applying principles of psycho-social care) when feeding

children and this is known as responsive feeding. Outlined below are some practiceguidelines we need to counsel parents and care givers to follow when feedihg children.I ) Infants should be directly fed hy caregivers and older children should be assisted tofec:d by themselves.

Complications inEarly Pregna ncy


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Abnormal Pregnancy Encourage children to hold their own spoon by twelve months of age. This can

be messy, and they will need help, but it makes their mealtimes more interesting.

Give children their own plate or bowl.

2) Feed slowly and patiently; encourage children eat but do not force $em3) If children refuse many foods, experiment with different food combinations, tastes,

textures and methods of encouragement

4) Minimize distractions during meals, if the child looses interest easily

5) Remember that feeding time are periods offun and learning- talk to children duringfeeding with eye to eye contact

UsingMealTimesto mproveChildDevelopmentUse mealtimes to improve children's development. Some examples are:

Children can leam new words and concepts, foods and colours. Talk about how thefood tastes, name the utensils, foods and colours.

Let children touch and pick up food themselves. This helps to develop their co-

ordination.

Help children feel good about themselves by giving them praise and smiling at them.

It is important for you to remember that feeding contaminated foods to infants and children

can make them sick. Therefore personal hygiene and cleanliness are crucial while preparing

foods for children. It is important that you counsel caregivers and families about safe

methods of preparing and storing foods for infants and children. Some of the important

guidelines are outlined below.

1) Hands should be washed with soap and water before handling food and before feeding

the child. Both the child's and the caregiver hands must be washed.


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2) Utensils should be cleaned well, dried and kept covered.

3) Foods prepared for infants shouldbe cooked properly.

4) After cooking, foods should be kept in a covered container.

5) Cooked food should not be kept for more than 2 hours in hot climate unless there is

facility for refrigeration.

6) Stored drinking water must be covered and protected from animals.

7) Do not keep chemical such as pesticides and insecticides close to food containers.

21.7 FEEDING DURING AND AFTER ILLNESS

Whenchildren becomeill, remember, they loose their appetite and eat less. They may alsonot t because they may be vomiting or haveulce~;sin their mouth. Often even if the childwants to eat, parents may offer less food or-diluted foods to children because they"fear"

,

indigestion during illness.

But, on the contrary, sick children need more fluids and foods. Foods help them fight illness

and also prevent malnutrition that may be caused by illness.

Parents must be counseled to feed children during their illness. Some of the advice that need

to given to parentslcaregiversare:Sick infants need to be given more breast feeds if they are being breast fed.

Children should be coaxed and encouraged to have small frequent meals

The foods offered to sick children must be soft, varied, appetizing and their favorite

foods

Give extra fluid if the child has fevetor diarrheaFeed the child when alert and not when sleepy

When recovering from illness, children should be given complimentary foods more

often and encourage the child to eat as much as possible at each meal. Extra food

should be fed till the child regains weight.

21.8 FEEDING IN EXCEPTIONALLY DIFFICULTCIRCUMSTANCES

21 13 1Feeding During EmergenciesWhc:n disaster strikes, remember, whole communities are thrown in disarray. Malnutrition is

a se~iousthreat to infants and children during emergencies. The conditions duringemergencies can undermine breast feeding practices and the support to these women. The

shortage of food resources and often the unsuitability of supplementary foods, become

serious risks for malnutrition amongst children. The following section outlines the principles

of managing the feeding of children in emergencies.1) Infants in emergencies should be breastfed till6 months and efforts must be made to

reinforce this message to women and lactating mothers. In case biological mothers are

not available (due to death and illness) alternative methods of breast feeding such as

wet nursing must be considered for these infants.

Complications in

Early Pregnancy

2) The distribution of b;east milk substitutes must be controlled in emergency sites. Ifrequired, those responsible for feeding it must be capable of preparing it safely and

feed it with a cup. Bottle feeds mud e strongly discouraged.


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Abnormal Pregnancy 3) The food aids for children must be nutritionally adequate and culturally acceptable. It

must be easy to cook and use minimal fuel. Food aids must be available regularly and

on time. The distribution system must ensure that all those eligible receive their

entitlement.

4) Blended foods provided as food aids which are fortified with essential nutrients can be

used to feed older infants and children.

5) Households with only one adult pose a threat to child feeding. Such households must

be given practical help to facilitate child feeding.

6 Children who are severely malnourished should receive medical and therapeutic helpto rehabilitate them.

21.8.2 Malnourished Children

Nutritionally adequate and safe complimentary foods may be difficult to obtain for

malnourished children. Mothers of such children may be invited to a camp and provided 2

weeks ration of roasted cereal-pulse mixes and given instruction for their use. These children

must be followed every 2 weeks for growth monitoring, health check up and supply of

instant food rations for a period of 3 months. These children need extra attention during

both the early rehabilitation phase and over the long term.

21.8.3 Feeding in MaternalHIV

All HIV infected mothers should receive counseling about the feeding options and their

risks. The advantages of breast feeding and risks of transmission must be explained to the

mother. The dangers of mixed feeding should be explained to HIV positive mothers. All HIV

positive who choose to breast feed must be supported to ensure exclusive breast feeding till

6 months so that they do not succumb to social pressures of artificial feeding. If a motherchooses not to breast feed, she should be supported to provide safe artificial feeding.

21.9 LET US SUM UP

In this unit we have learnt that complimentary feeding is a process of giving foods and fluids

to infants when breast milk alone is no longer sufficient to meet their nutritional

requirements. The first food can come from staple family cereals. Traditional foods can be

used to feed infants and children along with protective feeds.

Infants should be exclusively breast fed till 6 months. Complimentary food should be served

thrice a day between 6-12 months. During the second year of life children should be given 5

feeds a day with each serving being about 1% cups. During illness feeding of children must

continue.

During emergencies efforts must be made to ensure that children get safe, adequately

nutritious feeds and caregivers must be given practical support to facilitate the same.

Malnourished children must be given extra foods and monitored frequently to ensure

adequate growth.


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21.110 ANSWERS TO CHECK YOUR PROGRESSComplications in

Early Pregnancy

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Unit 21 - Feeding Children