Dr Tejo Pratap Oleti, Consultant Neonatologist at Fernandez Hospitals highlights the importance of getting infant nutrition right. He addresses the myths and misconceptions around it and advises on simple ways to ensure that little babies and toddlers get the right nutrition.
Why is nutrition in Infancy (ages 0-3 years) important?
During first 3 years of life, brain attains almost 90-95% of adult size. First 1000 days i.e from conception to 2 years of age is very important period in child’s life. During this period, significant growth of brain, immune and other systems happen. So, the nutrition during this period is very important to get maximum benefit.
हिंदी में पढ़ें: शिशु पोषण- हर माता-पिता के लिए आवश्यक जानकारी
What are the dietary needs of an infant?
Infant requires around 100 kcal/kg/day. The energy requirement goes high during sickness. Proteins should account for 15-20% of total energy intake. Lipids or fats can constitute up to 30-50% of total energy. Apart from these, child also requires higher amount of calcium, phosphate, other trace elements, vitamins and iron compared to other age groups.
Most parents are unsure about how much to give, can you shed some light on it?
Till 6 months of age, we advise exclusive breast feeding as much as the infant can take. After 6 completed months of age, we can start complementary feedings.
Start with 1-2 feeds per day and increase up to 4-5 times a day. Two to three major meals with 1-2 small feeds as snacks can be given. Start with 1/4th of the cup (measuring 200 ml) or 2-3 table spoons and gradually increase. Usually, an infant will be able to take up to 3/4th to full cup of feed by 10-12 months of age. Start with puree consistency and later make it granular and mashed food. By one year of age, usually an infant can take normal home food. Later, the child usually takes half of the amount of adult intake.
Usually, we can start with cereal and pulses-based food along with carbohydrate rich vegetables like potato and sweet potato etc. and fruits like banana and steam cooked apple. We can add a little ghee or oil for top-up calories. Keep adding new vegetables and fruits to the menu as the child tolerates it.
Common cereal food started is rice based. Home made mixture containing cereal to pulses ratio of 2-3:1 is a good one to start. The mixture can be prepared by mixing cereals and pulses as mentioned and soak them for 1 hour. Later, it can be roasted and powdered and kept in air-tight container. As and when required, it can be cooked by mixing it with water.
After breastmilk, what milk should an infant be graduated to?
We recommend to exclusively breast feed till 6 months of age and thereafter to start complementary feeds. Mother can continue to breast feed as long as feasible, preferably till 2 years of age. If wanting to start alternate milk, any animal milk toned or whole milk can be started at 1 year of age, but definitely not before. Skimmed milk and low-fat milks (1-2%) are not recommended during first 2 years of life because of their high protein and electrolyte content and low caloric density.
What are the common infancy nutritional issues in India?
Protein energy malnutrition, Calcium and vitamin D deficiencies, Iron deficiency, Iodine deficiency and vitamin A deficiency are few common nutritional issues in India.
What are the causes of poor nutrition?
- Early weaning – often due to ignorance and leads to contamination and infection due to unhygienic preparation.
- Dilute weaning foods also lead to malnutrition.
- Late weaning.
- Less quantity.
- Poor quality.
What is the difference between malnutrition and undernutrition?
Malnutrition refers to deficiencies, excesses or imbalance of intake energy, protein and/or other nutrients.
Undernutrition is the result of food intake that is continuously insufficient to meet dietary energy requirements, poor absorption and/or poor biological use of nutrients consumed. This usually results in loss of body weight.
What are the long term consequences of poor nutrition on Non-Communicable Diseases?
Undernutrition, and its effects on growth, development and maturation, has numerous detrimental outcomes, including the potential to increase risk of developing a Non Communicable Disease later in life, most common being cardiovascular disease, diabetes and cancer. So the first 1000 days from conception to the age of two are critical for the current health of the child and also for later risk of disease in the adulthood.
What are the benefits of homemade meals?
- Variety is unlimited; any food available for home cooking can be prepared for the baby (provided it suits the developmental stage of the infant).
- They are fresh and unprocessed.
- Can be ground, pureed or sieved for proper and varied consistency.
- Culturally acceptable and available.
- Shift to family pot feeding is comfortable.
- More economical.
Are fortified packaged foods more nutritious than fresh foods?
Parents who can afford will tend to lean towards giving packaged foods. Some fortified foods have extra nutrients above the normal quantities in natural foods. However, by providing variety of food with adequate quantity we can meet the needs of the children without fortification. Packaged food might be containing few preservatives for increasing shelf life. Parents need to look at composition before purchasing. Packaged foods should be restricted to limited needy situations like travel.
What are the myths surrounding infant nutrition and formula feeding?
Myth 1 Formula feeding neonates will gain weight better
Ans: Weight gain pattern in healthy infants is same whether infant is on breast feeds or formula feeds. The composition of breast milk varies according to the age of the infant. This will help infant in having healthy weight gain.
Myth 2 Formula feeds are more fortified, contains vitamins and other molecules at higher quantities which are good for mental and physical development.
Ans: Breast milk contains many natural elements like probiotic bacteria, immunity providing antibodies/cells and stem cells. These natural elements will help in better immunity and growth of all organs. Composition of breast milk is so unique that it will meet majority of the needs of the infant. Studies also proven that breastfed infants will have higher IQ points and reduced chance of malnutrition.
Myth 3 Formula feeding is easy to give
Ans: Wrong. Breast feeding is easy to give and to maintain. Mother-infant dyad needs to be supported in correcting position and latching techniques. It doesn’t need any extra efforts to prepare the feeds whereas formula feeding preparation must be taught in a right way following aseptic precautions and correct diluting technique. Any lacunae in the process will cause more harm. We also need to be remembered that breast milk is natural and customized for humans.
Myth 4 Few formula feedings must be given at least in the night and to provide rest for mother
Fact: Prolactin is a hormone which is mainly produced during night. Suckling from the infant will help to produce more prolactin. Mother-infant dyad will become happier and feel solaced after successful breastfeeding . Night breast feeds are very important for growth of the infant and to sustain good breast milk output.
Myth 5 Infants can’t digest solid food. So complimentary feeds should be in liquid form.
Ans: After 6 months of age, infants have ability to tolerate semi-solid foods. Neck muscles and gastro-intestinal system will be mature enough to help the child swallow and digest solids. Graded textured food introduction will also help in maturation of different oro-motor skills. Liquid diet (dal water/ juices etc) will have lesser calories and induce early satiety to infant.
Myth 6 During summer months we need to give more water to infants
Ans: Till first 6 months, breast milk is sufficient for exclusively breastfed infants. No need to give extra supplementary water. Mother will increase her production as per the demand of infant.
After each complimentary feed, we usually advise few sips of water. Milk consumed by the infant has good amount of water component which is sufficient. Giving more liquids will decrease appetite and cause early satiety. While infant is sick, we need to give more liquid diet.
Myth 7 Child needs to be fed with force if he/she is not taking in sufficient amounts
Ans: Child should be fed according to his needs. Parents should not decide about the quantity. Child should enjoy eating with pleasure or else will lead to eating disorders (fussy eating and others). Try different variety of foods with different taste and textures. Make the child sit along with you while family is eating.
Myth 8 Infant can’t digest non-vegetarian foods
Ans: We can introduce non-vegetarian diet as early as 9 months of age. Well-cooked and mashed food is preferred.
Dr. Tejo Pratap Oleti
