UNIT 21 FEEDING CHILDREN

21.0 21.1 212 21.3 Objectives Introduction Complementary feeding 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 Age Specific Feeding Recommendations 2 1.4.1 Up to 6 Months of Age 21.4.2 6 Months upto 12 Months 21.4.3 12 Months upto 2 Years 21.4.4 2 Years and Older Responsive Feeding Keeping Foods Clean and Safe Feeding During and After Illness Feeding in Exceptionally Difficult Circumstances 21.8.1 Feeding During Emergencies 21 3 . 2 Malnourished Children 21.8.3 Feeding in Maternal HIV Let Us Sum Up

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21.5 21.6 21.7 21.8

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21.10 Answers to Check Your Progress

21.0

OBJECTIVES
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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.

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INTRODUCTION

You have learnt in the previous unit that breast milk is the ideal fluidfood needed for an infant during the first 6 months of life. It is well recognized that the period &om6 months upto 2 years is the critical window period for promoting optimal growth and breast milk alone 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 adequate amounts. '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 achieving adequate growth in the period 6-24 months. It is very important that families and mothers in particular, 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 feeding practices so that it will help you counseling families.

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 foods and 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, some micronutrients, such as iron, may be limited before 6 months and are dependent on the reserves rhese infants have at birth. Complementary foods are needed to fill the gap between the nutritional needs of the child and amounts provided by breast milk. The age for complementary feeding is generally between 6- 24 months. However, infants must continue to receive breast milk till 12-24 months even after introduction of complementary feeding.

Complications in Early Pregnancy

21.3 FOODS FOR COMPLEMENTARY FEEDING

21.3.1 Infant's First Food
The first food for the infant must be made from the staple family cereal. The pomdge can be made from suji (semolina), atta (wheat flour), ground rice, ragi, millet, etc. by using a little water or milk. Roasted flour of any cereal can be mixed with boiled water, sugarljaggeryand a little oiVghee to make the fust complementary food soft, thick and creamy. Roasted flour does not thicken much and less water is needed to make porridge. Addition of sugarljaggery and 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, . Traditional Foods for Infants

As soon as the infant starts eating the cereal pomdge well, mixed foods containing cooked cereal, pulse and vegetables should be given to the infant. Some of the traditional mixed foods given to infants in different parts of India include khichidi, dalia, upma, idli, suji kheer, dhokla, bhaat-bhaji, etc. These foods can be made more nutritious by adding cooked dal, vegetables, sugar or oil. It is always advisable to initiate foods from the family diet 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 take three parts of any cereal (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 be roasted separately, ground, mixed and stored in airtight containers (can be stored upto a month). For feeding the infant, take two tablespoon of the instant food mixture, add boiled water or milk, sugadjaggery and oillghee and mix well. These instant foods can be used when 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 instant food mix can also be made into halwa, dalia or upma and fed to the child.

21.3.4 Protective Foods

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The child needs protective foods besides the modified family foods and instant mixes. These include foods like milk, curd, egg, fruits and vegetables. They contain vitamins and minerals, which help the body to run smoothly and protect against illness. Dark green leafy vegc:tables are rich sources of vitamin A, folate and iron.

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

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The infant should be exclusively breast fed The infant should be breast fed as often as it wants, both at day and night, at least 8 times in 24 hours. You should counsel mothers against giving water, other fluids or foods during when on exclusive breast feeds.

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21.4.2 6 months Up to 12 months

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The child must continue to be breast fed and must also be started on complimentary foods that we have discussed in the preceding sections. The child must receive at least 1 cup per serving of foods made from the staple family foods (see 1.3.1 and 1.3.2). If the infant is also being breast fed, then it should receive at least 3 serving per day. If the infant is not being breast fed, then it should receive at least 5 serving per da)? In these infants, animal milk must be fed undiluted by a cup and never with a feeding bottle.

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Feeding recommendations6-12 months

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6 Months up to 12 Months
Breastfeed as often as the child wants. Give at least one katori serving* at a time of : - Mashed roti/ rice ~breadhiscuitmixed in sweetened undiluted milk OR - Mashed rot'iricehread mixed in thick dal with added gheeloil or khichri with added oivghee. Add cooked vegetables also in the servings OR - SeviWdalia/halwa/kheer prepared in milk or any cereal porridge cooked in milk OR - Mashed boiledAriedpotatoes Offer bananabiscuit1cheek01 mango/ papaya as snacks in between the servings

'3 times per day if breastfed; 5 times per day if not breastfed. Remember: -Keep the child in your lap and feed with your own hands Wash your own and child's hands with soap and water everv time before feedina

21.4.2 12 Months Up to 2 Years

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Complications in Early Pregna ncy

~ r e a sfeeding t can be continued even at this age if the child wants to The child must be fed fiom the traditional family foods (see 1.3.2, 1.3.3 and 1.3.4) The child must receive at least I % cupper serving. The child must receive at least 5 servingsper day. The child's serving must be kept and fed fiom a separate bowllplate for the child.

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Feeding recommendations 12-24 months

12 Months up to 2 Years

Breastfeed a s often as the child wants. Offer food from the family pot Give at least 1112 katori s e ~ n g at ' a time of : -Mashed rotilricehread mixed in thick dal with added gheeloll or khiihri with added oillghee. Add cooked vegetables also in the servings OR - Mashed rotil rice lbreadhiscuit mixed in sweetened undiluted milk OR - Sevianldalia/hatwa/kheer prepared in milk or any cereal porridge cooked in milk OR - Mashed boiledfiried potatoes Offer bananalbiscuitl cheek01 mango1 papaya as snacks in between the servings
5 times per day. Remember: S i t by the side of child and help him to finish the serving Wash your child's hands with soap and water everv time before feedina

21.4.3 2 Years and Older

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After 2 years the ckld must receive family foods, at least 3 times a day. In addition to the 3 main meals, the child should receive 2 snacks /day of nutritious fimds between family meals. These snacks can be foods such as
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Ripe banana, papaya, mango or other k i t s Curd, pudding Bread, chapatti with butterhoney Biscuits

- . Boiled potatoes

21.5

- RESPONSIVE FEEDING

Avoid i'oods such as fizzy drinks, sweets/candiesor cltucolates as they are of poor nutritive I value.

It is important to remember that feeding a child is not a mechanical event. We need to respond 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 practice guidelines we need to counsel parents and care givers to follow when feedihg children.
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Infants should be directly fed hy caregivers and older children should be assisted to fec:d by themselves.

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.
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Feed slowly and patiently; encourage children eat but do not force $em If children refuse many foods, experiment with different food combinations, tastes, textures and methods of encouragement Minimize distractions during meals, if the child looses interest easily Remember that feeding time are periods offun and learning - talk to children during feeding with eye to eye contact

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Using Meal Times to ImproveChild Development Use mealtimes to improve children's development. Some examples are: Children can leam new words and concepts, foods and colours. Talk about how the food tastes, name the utensils, foods and colours. Let children touch and pick up food themselves. This helps to develop their coordination. 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.

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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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Utensils should be cleaned well, dried and kept covered. Foods prepared for infants should be cooked properly. After cooking, foods should be kept in a covered container. Cooked food should not be kept for more than 2 hours in hot climate unless there is facility for refrigeration. Stored drinking water must be covered and protected from animals. Do not keep chemical such as pesticides and insecticides close to food containers.

Complications in Early Pregnancy

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2 1 . 7 FEEDING DURING AND AFTER ILLNESS

When children become ill, remember, they loose their appetite and eat less. They may also not &t because they may be vomiting or have ulce~;s in their mouth. Often even if the child wants to eat, parents may offer less food or-diluted foods to children because they "fear" , indigestion during illness.
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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 parentslcaregivers are: 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 fevet or diarrhea Feed 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 DIFFICULT - CIRCUMSTANCES

21.13.1 Feeding During Emergencies
Whc:n disaster strikes, remember, whole communities are thrown in disarray. Malnutrition is threat to infants and children during emergencies. The conditions during a se~ious emergencies 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 till 6 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. The distribution of b;east milk substitutes must be controlled in emergency sites. If required, those responsible for feeding it must be capable of preparing it safely and feed it with a cup. Bottle feeds mudbe strongly discouraged.

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Abnormal Pregnancy

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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. Blended foods provided as food aids which are fortified with essential nutrients can be used to feed older infants and children. Households with only one adult pose a threat to child feeding. Such households must be given practical help to facilitate child feeding. Children who are severely malnourished should receive medical and therapeutic help to rehabilitate them.

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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 Maternal HIV

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 mother chooses 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.

21.110 ANSWERS TO CHECK YOUR PROGRESS

Complications in Early Pregnancy