Infant feeding 4-6 months

Infant Feeding - 4-6 months

Calorie dense foods

Major weaning foods

INTRODUCTION

Different communities have different cultural beliefs regarding the introduction of foods in the child’s diet i.e.weaning process. In many families, introduction of semi-solid food is associated with a religious ceremony commonly known as “Anna Prashna”. Our elders knew that if a child were not introduced to non-sweet items soon enough, it would pose problems later, designating a ceremony for this ensures that this is started. We have to avail of this practice to propagate the introduction and continuation of additional food for young infants. In cases where such practices don’t exist parents and elders in the family need to be educated about the risk of delaying weaning and they can be persuaded to give other foods such as fruits, vegetables and pulses.

This is the task we are happily performing by telling you how to make food attractive, appealing and acceptable to your little darling. You are invited to send in your experiences about weaning foods and practices helping other mothers like you.

WHEN AND HOW TO START?

When and how do I start weaning my baby?

The first semi-solid foods are normally introduced at four to five months of age. It is important to make this transition to semi-solid foods an enjoyable one. The amount of food offered and swallowed in the beginning is a teaspoon or so.

Patience is needed when babies are first introduced to semi-solids. While they are learning to eat this way, they may often spit out the food – this does not mean that they dislike the food or are not hungry. It is normal for your baby to bring the food out, as the ability to swallow develops very slowly.

Infants enjoy this transition, if the food is not forced and the mother is relaxed at the time of feeding. Infants accept the food better, if not distracted by other activities while feeding. Try to have flexible feeding schedules. These are based on signs of hunger in your baby rather than on fixed hours of feeding. After the first few weeks, a healthy infant will develop a self-regulated feeding schedule. The number of total feeds a day will usually reduce to about six by the time the infant is six months of age.

QUALITIES OF WEANING FOODS

What are the desirable qualities of Additional (Weaning) Foods?

Breast milk is the only “standard” food for the infant. At the onset, with the infant still predominantly breast-fed, weaning foods are used as an additional source of energy as well as to satisfy the increasing requirements for all essential nutrients. Particular attention should be paid to proteins, iron, vitamin A and C, as these are frequently found to be deficient in the diet of young infants.

Keep in mind that you are feeding an infant with a small stomach capacity that has been used to liquid diet only.

Desirable Qualities of Weaning (Additional) Foods

Should have high energy content
Should be easy to digest
Should be semi-solid in consistency
Should not be too thick
Should be fresh and clean
Should not be expensive and should be easy to prepare

GUIDELINES DURING WEANING

Stomach capacity has never been given much importance while telling a mother how to feed her baby. This results in mothers either force feeding or getting unnecessarily worried about baby not taking enough.

The stomach capacity (4 – 6 months): 86 -130 ml (17 – 26 tsp.)

We offer few guidelines to help you wean your darling child better.

What points should be considered while introducing weaning foods?

Introduce only one food at a time to permit the infant to get used to it.
Allow the infant to become familiar with the food before trying to give another.
Give very small amounts of any new food at the beginning, 1-4 tsp.
Use a very thin consistency when starting solid foods. Gradually the consistency is made more solid as the infant learns how to propel the food back with the help of tongue.
If, after several trials, that baby has an acute dislike for a food, omit that item for a week or two and then try again. If the dislike persists it is better to forget about the food for a while and substitute another.
Food should be only slightly seasoned.
Child should be encouraged to try new flavors.
Infants may object to taking some foods by themselves but will take them willingly if when one mixed with another, e.g. egg may be mixed with formula, cereal or vegetable. Vegetables may sometimes be made accustomed to the new flavor.
Variety in choice of foods is important.
The mother or anyone feeding the infant must be careful to avoid showing in any way a dislike for a food that is being given.
A baby’s appetite varies a lot from meal to meal and day to day. During hot weather suffering from cold the child’s appetite may be less.
The quantity of each feed should be increased as the number decreases.

Supplementary feeding should be started at 4 months:

Shallow spoon should be used to allow the baby to suck.
Food should not be forced on the baby
The aim is to expose the baby to a large variety of foods/ tastes.
By 6 months of age, your baby will generally accept foods 2 – 3 times/day.
The foods should be of a thin enough consistency (smooth puree) to allow baby to suck.
Salt should not be added or added sparingly to weaning food as the child may get used to salty foods.
Sugar should be used sparingly as :

– May get used to sweet foods and refuse other foods later.

– May lead to excessive weight gain, (therefore unsweetened cereals/curds should be encouraged.)

Familiarity of foods earlier on will prevent rejection later.
Homemade foods are encouraged as:

-Familiarity with common foods

-Early integration with family diet

-Prevents over dependence

CARE DURING PREPARATION

Should any special care be taken during preparation?

The nutritive value of many weaning foods can be improved by taking due care during preparation. The porridge or for that matter any other weaning food should not be excessively watered down or thinned in the belief that it will be easier to ingest and digest. A classic example of this is the thin ‘dal’ water. Even small babies can easily tolerate semi-solid foods and over dilution results in loss of valuable calories.

Unnecessary loss of nutrients should be avoided. For instance, it is better to wash vegetables whole before cutting them into small pieces. The smaller the piece, the greater is the loss of nutrients. Use the minimum amount of water for cooking and mash the food with the water used for cooking. Adding excess water and draining it off later results in loss of water-soluble nutrients and should be avoided.

Husks, bean skin and vegetable fibers can cause indigestion, so everything must be thoroughly mashed in the beginning.

SUMMARY

Frequent breast-feeding should continue but simultaneously start with additional semi-solid foods in the form of mashed fruit like banana, or cereals like suji. If suji is not available, porridge can be made with wheat flour (atta), ground rice, ragi, millet, etc. Mix a little oil or ghee in the porridge. 1/2 to 1 teaspoonful is enough to begin with. The number of feeds should gradually increase over 3-4 weeks, so that when it reaches 50 to 60 gm of porridge (half a cup) or one whole banana, it could replace one milk feed. Other fruits in season like papaya, chikoo and mango can be given in a similar manner. On the hills, apple, apricot and pear can be given after cooking them for a few minutes.

Cow’s milk should be given in the form of curd, custard.

Cooked ground and strained fish and meat may be given at the same time as egg yolk at five to six months of age. The fish or meat serving may be alternated with egg yolk and dal.

Semi-solid feed should preferably be given after breast-feeding so that there is minimal interference with the suckling and breast milk production. However, some babies do not accept semi-solids once their hunger is partly satisfied by breast milk. In them, semi-solids can be offered prior to breast-feeding.

Food note

Keep breast feeding the child till 1 years of age at least, and even during illness.
Drinks during weaning –boiled and cooled water according to thirst.
During illness feed the child as normal, even if the child resists.
During diarrhea – give lot of fluids to the child, in fact replace each bout of stools with a glass (250 ml) of clean boiled water

CALORIE DENSE FOODS

Malting

To meet the increased demands of calorie and protein, well cooked mashed cereals mixed with milk and sugar can be given. Calorie dense cereals can be prepared by malting; also, sprouted pulses and beans can be used. Cereals like wheat, bajra, ragi, jowar, and pulses like moong (whole) can be malted.

How is the food malted?

Soak overnight.
Remove the water and tie in the moist cloth and keep in warm place (Sprouting).
After 48 hours when sprouts come out dry in sun or roast it.
Make into flour.

Advantages

During the process of malting, starch is converted to maltose due to increased production of enzyme amylase. Thus, this is also called Amylase Rich Food. Due to the conversion of starch into amylose, thinner gruels are made. With this either the infant can consume more gruel or more flour can be added to make thick gruel. This way calorie consumption can be increased.
Also, 1/2 to 1 teaspoon of malted cereal, added to porridge, khichri and other weaning foods, will reduce its viscosity and child will be able to eat a larger quantity of it. This is a very good way of increasing energy density of weaning foods.
The malting process increases the riboflavin, niacin content. Sprouting various pulses and beans increase the content of vitamin B group and vitamin C.
A major advantage of preparation of these energy dense foods is that they are pre-cooked. Thus, these cereals in powdered form can be stored in airtight bottles. They can be mixed with boiled water, cooked for a few minutes and fed to the baby.

However, these foods should not form the major feeds throughout the day, but given 1-2 times in the whole day. This is because the child should become familiar with various common foods and develop a taste for all foods and not reject them later.

As the shelf life is short, malting has to be done every three or four weeks.

Various food preparations from these malted foods

Foods:

Cereals like wheat, bajra, jowar, can be malted. Ragi malt is a common weaning food in the southern parts of India where ragi is commonly eaten.
Other cereals like rice, rice flakes, corn flakes, can also be roasted and powdered and given in the form of porridge.
Pulses like moong (whole) can be malted, as it is easy to digest. Roasted and powdered moong dal can be used in porridge.
Vegetables: boiled and mashed soft vegetables can be added to the porridges. For e.g. tomato, gourds, spinach and other green leafy vegetables.

Egg: Hard cooked egg yolk can be added to the various porridges.

Little sugar and oil / butter (1tsp.) can be added to the porridge to increase the calorie content.

How is the food malted?

Soak overnight.
Remove the water and tie in the moist cloth and keep in warm place (Sprouting).
After 48 hours when sprouts come out dry in sun or roast it.
Make into flour.

Advantages

During the process of malting, starch is converted to maltose due to increased production of enzyme amylase. Thus, this is also called Amylase Rich Food. Due to the conversion of starch into amylose, thinner gruels are made. With this either the infant can consume more gruel or more flour can be added to make thick gruel. This way calorie consumption can be increased.
Also, 1/2 to 1 teaspoon of malted cereal, added to porridge, khichri and other weaning foods, will reduce its viscosity and child will be able to eat a larger quantity of it. This is a very good way of increasing energy density of weaning foods.
The malting process increases the riboflavin, niacin content. Sprouting various pulses and beans increase the content of vitamin B group and vitamin C.
A major advantage of preparation of these energy dense foods is that they are pre-cooked. Thus, these cereals in powdered form can be stored in airtight bottles. They can be mixed with boiled water, cooked for a few minutes and fed to the baby.

As the shelf life is short, malting has to be done every three or four weeks.

Suggested recipes from energy dense foods:

Add all ingredients and cook for a few minutes by adding water or milk to a thin / semisolid consistency

Plain porridge
Bajra 1 tbsp.
Chana dal 1 tbsp.
Riceflakes porridge
Rice flakes 1 tbsp.
Fruit porridge
Rawa 1 tbsp.
Add a banana/fruit after boiling
Apple porridge
Rice 1 tbsp.
Apple boiled ï¿½ no.
Veg porridge
Bajra 1 tbsp.
Moong 1 tsp.
Carrot/Veg.1 tbsp.
Tomato porridge
Bajra 1 tbsp.
Rice powder 1 tsp.
Moong 1tsp
Tomato (boiled, seedless) 1 tbsp

MAJOR WEANING FOODS

What are the main categories of Indian Foods that can be used for weaning?

Cereals

Cereals contain 7 to 12 % proteins and about 75% carbohydrate. They form an important source of energy, iron and protein in the Indian diet and also supply a certain amount of fat, which is referred to as invisible fat.

A thick creamy porridge made from cereals in water/ milk/ milk-water mixture is a good weaning food for babies. Cereals are cheaper than most other foods and are usually consumed by the family. When given alone, especially after being cooked in water, most cereals are too low in energy. The porridge should be thick (too thick to be given in a bottle) and concentrated but soft. Some oil or fat (or sugar) should be added to the porridge to make it richer in calories and easier to swallow and digest. Care should be taken to ensure that the porridge is not watered down or made unduly thin which will further compromise the energy content.

Pulses

The Indian diet consists of several kinds of legumes – lentils, Bengal gram, red gram, black gram, horse gram, rajma etc. Red gram is mostly eaten in the southern, western and central parts of India. A wider variety of pulses are eaten in the northern parts. Their protein content is 20-25%. Dry legumes that are a much richer source than the immature legumes, are also a good source of vitamins and minerals.

The legumes need to be cooked thoroughly and mashed to make them easily digestible for babies. It should be thick (too thick to be given in a bottle) and concentrated but soft. Some oil or fat (or little sugar) should be added to make it richer in calories and easier to swallow and digest.

When given with cereal staples, they are just as nutritious as animal foods (meat, fish, and milk).

Fruits

Commonly consumed fruits are banana, guava, melon, mango and citrus fruits. Pear, apple, plum, peach are abundantly available in the hilly regions. Banana is rich in carbohydrates and supplies about 80 calories per 100 gram. It is easily digestible and is very good as the first semi-solid food for the baby. Guava and citrus fruits are rich in Vitamin C while mango and papaya are good sources of vitamin A. Before giving any fruit to your baby, be sure that it is washed in clean water, peeled carefully, deseeded and then mashed.

Juice of fresh fruits:

Oranges, tomatoes, sweet lime, grapes serve to supplement the protective nutrients not present in sufficient amounts in breast milk as well as in animal milk. It is advantageous to start feeding small quantities of fresh fruit juice by the 4th month of life.

In the early stages, the fruit juice is strained and diluted with an equal amount of boiled water and only a couple of teaspoonfuls are fed. The amount of fruit juice fed is gradually increased and at the same time the dilution with water is cut down.

Soup from Green leafy vegetables:

In case fresh fruits are not available, green leafy vegetables may be used as an alternative. Strained soups should be given.

Fish Liver Oil:

Fish liver oils are good sources of vitamin A and D. Infants can be given a few drops to ï¿½ tsp. per day mixed in small quantity of milk.

Oils and Fats

Oils and fats should preferably be added to the weaning foods since they increase energy value, make the food softer and easier to swallow and help in absorption of vitamin A. Many kinds of oils are used in different parts of India – mustard oil in Bengal, Assam and Kashmir, and groundnut, sunflower, palm and til (sesame) oil in other parts.

Sugar and Jaggery

This can be used as an alternative to oils to increase the energy value of the weaning foods. However, care should be taken that excess of sugar is not added as it may result in dental decay and osmotic diarrhea.

Foods of animal Origin

Nearly all foods of animal origin are nutritious since they provide high quality protein, vitamin B12 and iron and are easily digestible.

Cooked, ground and strained fish and meat may be given at five to six months of age. Egg yolk can be given to the infant between the age of four to six months of age. The yolk contains protein, iron and vitamins, which are valuable additions to the baby’s diet. Hard cooked egg yolk seems to agree well with the babies.

Soft custard is also a suitable way in which to introduce egg yolk. Egg white, because of the frequency of allergic manifestations, is not given until the infant is 8 to 10 months old and then it is given very cautiously

Milk and Milk Products

All types of milk provide high quality protein, mostly in the form of casein, in contrast to human milk, which has mainly lactalbumin. The fat content of buffalo’s milk is almost double than that of human or cow’s milk. Milk is a rich source of B₆ and calcium, and has some amounts of vitamins A and C, however it is a poor source of iron. Goat’s milk does not have vitamin B₁₂. Instead of just being used alone, milk can be used to cook porridge or added to other weaning foods to enhance their energy content and soften them. Several milk products like curd, cottage cheese (Paneer), khoya, etc. are available and can be used. All of them have good nutritive value.

Bottle feeding

At around the fourth- fifth month of life, frequency of breastfeeding is reduced to 3-4 times per day and animal milk is substituted. Since the proportion of nutrients in animal milk differs from that of human milk, the cow’s milk should be diluted with boiled and cooled water in the proportion of 2:1 for the first few deeds. The amount of water is gradually reduced so that in course of a few weeks the baby receives undiluted animal milk. Two feeds, with 225 ml per feed is an ideal replacement. Sugar can be added for taste and to increase calories.