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Methods: Four hundred and ninety-four mothers in early postnatal period admitted in Kempegowda Institute of Medical Sciences and Research Centre were enrolled in this study during the period from March to June All the mothers were questioned regarding about their knowledge of breast feeding, health education received during Antenatal visits, the problems during breast feeding and were also observed for any mistakes of mothers during breast feeding. Out of them most were house wives This study showed lacking antenatal education of mothers about breast feeding.

Among the problems encountered, majority of the mothers had no experience how to hold the baby in right position for breast feeding Affiliate of Elsevier; Picciano M. Nutrient composition of human milk. Pediatr Clin North Am. Mosby elsevevi; HMF contains protein or protein hydrolysate, fat, carbohydrate, sodium, calcium, phosphorus, copper, zinc, vitamins etc. The quality of EBM varies depending upon the time and mode of collection; e.

See Table 1. Non-nutritive Sucking It is important for orofacial development, for maturation of sucking reflex and for establishment of lactation. Hence, allow the baby to suck on the breast as early as possible and as long as possible even when no milk is secreted.

Lactobezoars These are milk residues that accumulate in the stomach. These may develop due to high calorie-dense preterm formula. These may be visible on X-ray after air insufflation of stomach. These are self-limited. When the mother is the primary caretaker, mother-infant bonding is established. Her bacteria will colonize on the baby.

These bacteria will not generally cause infection in the baby unlike the bacteria of the caretaker. This is due to the transplacental antibodies. Prolonged separation between the mother and baby will increase the gap further and it will also lead to suppression of lactation.

Hence, as far as possible mother should be included in the care of the preterm from the very beginning. In the 'Kangaroo mother care method', mother looks after the baby and gives warmth and breastfeeding to the baby.

Initially there is slight loss of weight and the birth weight is regained by 10 days. In preterm, the catch-up can be up to 10 times for the age or up to 5 times for the length. The preterm is expected to grow on par with the intrauterine growth or as per the corrected age. Warm Chain This refers to the maintenance of optimum temperature of LBW babies during transport and during procedures and while giving care. Those who are not thriving well may need milk formula or human milk fortifiers HMF.

These are to be pre scribed only when absolutely indicated and are to be given under supervision as collection of milk and mixing need extra care. Haphazard addition of low molecular weight substances will increase osmolality and renal solute load and there is chance for bacterial contamination.

Route of Feeding Babies above 34 weeks gestation and weight above 1. In infants less than 34 weeks gestation and less than g birth weight, start with gavage feeds and slowly switch over to oral feeding.

EBM is always pre ferred. Up to 0. Gravity assisted feeding in min is preferred to bolus feeding from a syringe with piston. Large preterms can be initiated on feeding within two hours of birth. An initial feeding schedule is given in Table 1. Abdominal distension and blood in stool should alert the possibility of NEC.

If feed volumes need to be reduced below the total fluid requirement, an IV infusion should be considered to make up the requirement. In very immature or sick babies, when enteral feeding is started using nasogastric tube, it is advisable to use a continuous infusion instead of bolus feeding. Regulatory norms of this country. Even though babies may thrive on breast milk alone during the first 6 months of life, they become biologi cally fit to accept semisolids after 4 months of age. It is essential to prevent growth faltering.

Weaning means 'to accustom to' or 'to free from a habit'. It is the process to accustom the baby to semisolids and solids in order to gradually free the baby from the habit of sucking at the breast.

Weaning is defined as 'the systematic process of introduction of suitable food at the right time in addition to mother's milk in order to provide needed nutrients to the baby' UNICEF, Weaning is the second step for self-existence.

The first step is cutting of the umbilical cord. The term 'complementary feeding' is now preferred because weaning im plies abrupt stoppage of breastfeeding, at least to some mothers. Time of Complementary Feeding or Weaning Birth weight doubles by 4 months of age and the nutritional demands gradually increase and the calcium and iron stores get depleted. But the breast milk supply increases till 6 months and then it plateaus off. By four months of age, the baby achieves head control and develops hand mouth coordination and starts enjoying mouthing.

Also that the extrusion reflex perishes, intestinal amylase matures and the gut becomes ready to accept cereals and pulses legumes. Gum hardens prior to tooth eruption and the baby enjoys gumming semisolids. Thus the baby is 'biologically ready' to accept semisolids by months of age.

Early weaning is often due to ignorance and leads to contamination and infection due to unhygienic preparation. Dilute weaning foods also lead to malnutrition. Late weaning leads to growth faltering and malnutrition. Continuation of Breastfeeding Breast milk should continue to be the main food of the baby even when weaning is started.

To minimize interference with normal breastfeeding, it should be given between breastfeeds. Breastfeeding should continue for as long as feasible, pref erably till two years of age. This is important as the first two years is a period of rapid brain growth and breast milk contains factors essential for brain growth and development.

Complementary Foods Complementary foods can be home made or instant foods. In any case, it is better to start from mono cereals, followed by multi cereals and cereals-pulse combina tion. Cereal like rice is the best choice to start weaning as it is gluten free and easily digestible. The first cereal could be rice, which is gluten free and easily digestible. After that mother can make different combination with wheat, pulse, vegetables. They should be locally available, economical and acceptable.

Cerealpulse combination is better due to fortification of amino acids as cereals generally lack lysine and pulses lack methionine.

Tubers, fruits, biscuits and banana pow der are also popular weaning foods. Each type of complementary foods home made or instant should be analyzed for the advantages and disadvantages.

The advantage of homemade weaning cereals is that they are economical, easily avail able, culturally accepted, and closer to family food and versatile.

However, it is quite difficult to keep the nutritional value of home food as per the high require ments of faster growing baby. Addition of jaggery for calories and minerals, milk for protein and oil for calories can make homemade food more nutrient denser. However the digestibility, presence of micronutrients and vitamins and bioavailability is a big concern due to processing and cooking time.

The instant complementary food offers balanced nutrient content as per the recommenda tions for the older infants. The reasonable combination of homemade and instant foods may get the best result in prevention of micronutrient deficiencies and development of healthy family food habits.

Family Pot Feeding The acceptance of food from the family food should be a part of the mixed feeding regime. It is essential to switch over gradually to the usual family food. It can be given in a thickened and mashed form from the family pot without adding hot spices. Provide little extra oil or ghee, green leafy vegetables and seasonal fruits to the baby.

The infant should grow up, accustomed to the traditional foods. Idli, dosai, soups, payasam etc. A new food should be introduced in the morning session and only one item should be introduced at a time. Around 6 months of age: After 4 months of age, cereal-based porridge ragi, suji, rice etc. Fruit juice also can be started.

Mashed rice with pulses, mashed tubers and vegetables, soups, mashed fruits, biscuits, egg yolk fol. Cereal-pulse combinations, roots and tubers, vegetables, especially green leafy vegetables and others, seasonal fruits, milk products, egg, fish, meat etc.

Predigested instant foods are nutrient dense. Frequent feeding is desirable as it aids in good acceptance by the infant. Soaking and malting of grains will increase digestibility and vitamin content. Sprouting or germination will enhance vitamin content and make it amylase rich food ARF and will decrease the bulk on cooking. Fermentation enhances vita min C and digestibility; e.

It also increases shelf-life. The once a day introduction of instant food could be a way of balancing the nutrient gap and one-step solution to prevent malnutrition. Quality instant foods offer balanced nutrients including macro and micronutrients, with good bioavailability. Developing Readiness for Family Foods through Varied Tex tures and Tastes It is very essential to introduce varied textures throughout complementary feed ing period.

Under normal scenario, the mother tends to give a soft, completely mashed food for a longer period. This might not satisfy the baby's urge to chew with the development of teeth and preparation for textured family diet could be difficult. It is essential to advice the mother to differentiate the texture through the preparation and cooking methods.

A soft to coarser to bigger bite texture will be a positive approach towards developing the baby for acceptance of family foods. Introducing new tastes with addition of vegetables, fruits will expose the baby to healthy eating practices. It is essential to practice the child towards good nutrition, and healthy eating, right from the complementary feeding period.

Preparation and Storage of Weaning Foods Careful hygienic preparation and storage of weaning food is important. Hand washing with soap and water should be practiced before cooking and feeding. The food stuffs should be freshly prepared. Precooked ready-to-mix cereal-.

Egg white may be allergenic in some. After 9 months, introduce soft food that can be chewed, avoiding hot spices. Chappathi and other hard items can be made soft by adding little milk. A variety of food from family pot can be given times a day gradually increasing the quantity. By one year of age, the baby should be taking everything cooked at home. This is called 'family pot feeding'. A oneyear-old child should eat half of what the mother eats.

In case of using instant baby foods, detailed reading of preparation instruction on the pack should be done. Careful Feeding Practices The feed should be carefully fed. There should be a careful selection of weaning foods and advice should be given to the mother by the health care professional. In thick consistency, the mother should not be adding more water to the feed as it might lead to dilution of the nutrients which would lead again to malnutrition.

The caretaker should be informed and trained on the right feeding practices. The weaning or Complementary Bridge and the Safety Net to Prevent Malnutrition Most of the children fall into the pit of malnutrition during the weaning and postweaning phase.

Some even succumb to it. Jelliffe has suggested a 'three plank protein bridge' to prevent PEM. Mothers are expected to make the 'weaning bridge' or the bridge of complementary feeding to carry the children across the pit of malnutrition during liquid to solid transition.

The three planks include 1 Continued breastfeeding, 2 Introducing vegetable protein and 3 Animal pro tein. Some mothers do not make a bridge at all and some others make a bridge that may collapse into the pit. So a 'safety net' is needed beneath the bridge Fig. Those who do not avail this facility should arrange extra feeding either in the play school in the form of group eating or at home using the 'Akshayapatra'.

It a special container for the child into which small pieces of food can be added in order to make the child eat during play. Toddlers years of age A toddler needs more than half the food that the mother eats. This should be given in frequent servings. As toddlers are more interested in play and as they have a physiological anorexia and reduced growth rate than infants, they must be coaxed to eat. Eating while playing, group eating and eating from a special vessel 'Akshayapatra', into which pieces of food stuff can be added on, may be adopted.

They often enjoy eating from their own special vessel. Preschool Children years A preschool child should eat half the quantity of food that the father eats.

They are interested in group play and in exploring and mastering the environment. They should be coaxed to eat. Group eating and supplementary feeding from the. ICDS anganwadis should be made available to them in addition to family pot feeding. Vegetables and fruits should be given to them to ensure a good supply of vitamins and minerals. They enjoy variety in food items.

School-going Children They should eat three-fourth of food that the father eats. They should take a balanced diet and should not miss meals especially breakfast which is the brain's food. Feeding During and After Illness Breastfeeding and feeding of easily digestible soft food items should be contin ued during illness. Starvation should be avoided unless medically advised. The child should be coaxed to eat small quantities every hours.

After the illness, give an extra meal for weeks to regain the lost weight. Growth and Development Monitoring Frequent weighing and recording on the growth chart are desirable.

A flat curve or a downward curve should be of concern and appropriate intervention should be initiated. Medical check-up, investigations, prompt diagnosis and treatment of intercurrent infections and extra feeding are the interventions.

Developmental milestones should also be of concern and early intervention should be under taken if there is developmental delay. Be 'baby friendly' and initiate breastfeeding soon after birth, preferably within minutes after delivery. Practice exclusive demand feeding during the first months of age. Continue breastfeeding as long as possible, preferably till two years of age, the period of rapid brain growth and myelination.

Start building the weaning or complementary bridge at the age of months by introducing semisolids that 'the child can eat and not drink'. Slowly switch over to family pot feeding and empower the baby to take everything cooked at home by one year of age.

Make a safety net for the young child in the form of supplementary feeding, group eating or small frequent feeds using the 'Akshayapatra concept' to prevent malnutrition.

Ensure a balanced diet that includes all the various food items and nutrients. Ensure extra nutrition during special physiological needs like adolescence, pregnancy, lactation and old age. Don't starve the child during illness and offer easily digestible food items including breast milk and give an extra meal for weeks after an illness to regain the lost weight.

Ensure micronutrients and antioxidants by including green leafy vegetables GLV , green yellow orange GYO vegetables and fruits etc. Ensure quality of survival and overall development by non-nutritional inter ventions like socioeconomic advancement, standards of sanitation, immuni zation, periodic deworming, and protected water supply, control of alcohol ism, family harmony, tender loving care TLC and developmental stimula tion.

Re-lactation It is the resumption of breastfeeding following cessation or significant decrease in breast milk. This is possible through motivation support, frequent suckling and drop and drip method. Supplementary suckling technique SST can be tried. There is no other food for infants as good as breast milk and breastfeeding the best way to ensure mutual health of both the.

Since the early s, research attention has been focused on the potential long-term benefits of breastfeeding in childhood and beyond. Breast milk is the best nutrition for infants and is used as the 'gold' stan dard for good infant nutrition at birth. It provides the right nutrients protein, fat, carbohydrate, vitamins, minerals, and water in the right quantities to sustain normal growth and development for the first months of life.

In addition to its nutrient content, breast milk contains a host of additional components that ben efit infants. Breast milk can also provide the basis for good nutrition even after 6 months of age, until a child is fully weaned. Infants grow most rapidly during the first 6 months of life, making this period a critical time for nutrition. Although breast milk is the ideal way to feed a baby, there are situations. Keeping this in mind, it is extremely important that a medical practitioner is completely aware of the commercial preparations available.

However, this should be done only with the objective of establishing the right "Baby friendliness", and sustenance of life and good nutrition. Some of these conditions are the following: The main cause of malnutrition and micronutrient deficiency diseases is primarily due to wrong choice of food, improper feeding practices, and incorrect techniques.

So it becomes essential to understand the significance of feeding suitable breast-milk substitutes and safe alternative for infants who are not breastfed. Cow's milk can be adapted for formula feeding Fig. The key steps involved are: Types of Starter Formulas Starter formulas may be whey-adapted, hypoallergenic, or therapeutic specialty. These formulas generally have mineral concentrations similar to those of breast milk with the use of demineralised whey.

This is the most commonly used starter formula Table 1.

Nutrition and Child Development

Casein-Predominant Formula. Skimmed cow's milk is the main source of protein in casein-predominant formula. Casein predominance means that it takes longer for this formula to pass through the infant's stomach. Due to the slower gastric passage, they are said satisfy the baby for a longer period of time and are often appreciated for their satiating effects. Fe Vit E: Acidified formulas have been biologically acidified by a microorganism or they can also be directly acidified by using lactic acid.

The type of lactic acid produced is important. For example, only the L-form of lactic acid is metabolized and therefore acceptable in infant feeding. The D-form of lactic acid is not metabolized and can cause metabolic acidosis. An acidified formula provides the benefits of a finer, more digestible curd and a reduced risk of formula contamination. Therefore, these for mulas are indicated for infants who present with poor digestion and in situations where hygiene may be poor and the risk of formula contamination is high.

Hypoallergenic HA Formula. Hypoallergenic formulas are cow's milk based formulas that have been specially treated to break down the protein chains into shorter chains of amino acids. The proteins in hypoallergenic formulas have been moderately hydrolyzed and pro cessed by a protease to reduce their allergenicity.

The benefit of such formulas is a reduction in the incidence of symptoms of potentially allergic origin, such as eczema, rhinitis, urticaria, etc. This benefit is more pronounced in infants with allergy or family history of allergy. However, in absolute numbers, more babies who do not have a family history of allergy also benefit from these formulas. Therapeutic or Specialty Formulas. These formulas comprise a broad group of formulas with specific properties that are useful when feeding infants with special dietary needs.

They include: Formulas designed to meet the special needs of low birth-weight LBW infants. Lactose-free formulas.

Nutrition and Child Development

Although the protein source differs between whey-adapted and caseinpredominant formulas, the growth effects of these two types of formulas are quite similar.

However, the following observations can be made: Serum concentrations of the essential amino acid threonine and branchedchain amino acids are greater when infants are fed a whey-adapted formula, but the implications of these findings are unknown.

Serum concentrations of the amino acids methionine, tyrosine, and phenyla lanine are greater when infants are fed casein-predominant formulas. High levels of these amino acids have been associated with pathological condi tions, but at concentrations far higher than those observed in routine infant feeding. For preterm infants, the greater cysteine content of whey-adapted formulas may be an advantage.

Furthermore, lactobezoars may be more common when casein-predominant formulas are used in preterm infants. Formulas designed to provide nutritional support to infants with diarrhoea.

Formulas hypoallergenic containing extensively hydrolyzed protein for in fants who are allergic to cow's milk. Thickened infant formulas to reduce regurgitation; these are referred to as anti-regurgitation AR formulas. Formulas designed for infants who have metabolic problems, such as phe nylketonuria.

New Components in Infant Formulas New components that have been added to infant formulas in recent years include long-chain polyunsaturated fatty acids, probiotics, prebiotics, nucleotides, and antioxidants. Breast milk is a rich source of LC-PUFAs, which have been proven to have clinical benefits in the diet of preterm babies.

Two such fatty acidsarachidonic acid AA and Docosahexaenoic acid DHA are found in cell membranes and are important for the development of a baby's brain, eyes, and nervous system.

The sources could be algae oil or fish oil. Probiotics and Prebiotics. Probiotics are live bacteria that live in harmony with and confer health benefits to their host.

In the body, they act mainly in the large intestine where they can provide a barrier that prevents the adherence of pathogenic bacteria e. They also work in harmony with the immune system to support and enhance its effectiveness. In other words, they are components that can act as food for probiotics, thus encouraging the growth and colonization of a normal and healthy intestinal flora.

Prebiotics are found naturally in breast milk, as well as in certain fruits and vegetables. Immediately before birth, the intestine of a newborn is sterile. The coloni zation of bacteria in the gut begins with the process of birth, the infant's exposure to the environment, and milk feeds. The type of bacteria that colonize the gut relates to the type of feed a baby receives, which means breastfed babies have a different microflora than formula-fed babies.

Not only are Bifidobacteria and lac tobacilli naturally found in breast milk, but breast milk also has such a composi tion that it favours the growth of specific beneficial bacteria. In general, the predominant flora of a breastfed infant is composed of Bifidobacteria, while formula-fed infants have a much more diverse flora like coliforms. Nucleotides are the building blocks of deoxyribonucleic acid DNA , which com prises the set of instructions or the code for the auto-reproducing component of every cell in the body.

Nucleotides, when present in formula, are important for growth and development, and also serve as important cofactors in cellular signal ing and metabolism. Infant formulas also contain antioxidants such as beta-carotene. Certain other vitamins and minerals that are essential for healthy growth and develop ment also play the role of antioxidant. The recommendations are introducing weaning foods around six months of age, and giving follow-on formula in a quantity of not less than ml daily along with complementary foods.

Avoiding foods that may contain high amounts of nitrates e. Delaying the introduction of highly allergenic foods, such as egg white and sea fish. Probiotics can be added to infant formula and also to infant cerealsthe most common strain being Bifidobacteria lactis, which has been shown to in crease the amount of Bifidobacteria in the large intestine. Scientific research has shown that probiotic-supplemented formulas can reduce the incidence of diar rhoea.

A reduction in antibiotic-associated diarrhoea has also been shown. There are a number of important considerations when adding probiotics to infant formulas and cereals, including: The probiotics must be safe and effective for infants and must comply with legislative requirements.

The benefits of probiotics discussed above are in term infants; their role in preterm infants is investigational. Spores of any form are not probiotics by definition and are not considered safe. HMP is recommended as it is cheaper and variety can be achieved.

For a complementary feeding diet, cow's milk contains too much protein, sodium, and saturated fats and not enough essential fatty acids, vitamin D, and iron. As a result, the incidence of iron-deficiency anemia at 12 months of age is substantially higher in infants who are fed cow's milk.

To ensure adequate nutrients during complementary feeding, along with a variety of home-made preparations, one feed of commercial feed with all enriched nutrients can be given in affordable situations.

Commercial Weaning Preparations Mostly nutrient dense and prepared as per the standards Standardized for high quality Easy to use Energy density is specified Often include added vitamins e. Variety is unlimited; any food available for home cooking can be prepared for the baby provided it suits the developmental stage of the infant Can be fresh and unprocessed Can be ground, pureed, or sieved for proper consistency Can be culturally acceptable and available Shift to family pot is comfortable Are more economical.

Pulpy Weaning Foods. These are high-quality pulp of selected single or combination of fruit and veg etable pulps packed in suitable containers.

They do not have added colours or preservatives. These are not available in India. Starter infant formulas are not optimal because they contain too much fat and not enough calcium. In some circumstances, they may even be too low in protein or iron e. Also called follow-up formula, as "a food intended for use as a liquid part of the weaning diet for the infant from the 6th month onwards till two years of age. The protein content will be sufficient to support growth. The protein used is from good-quality sources in the form of milk, eggs, and fish.

The amount of iron in follow-on formulas is higher than that in starter formulas, due to increased demands and less supply from milk. Healthy eating is important for toddlers in order to: Provide the energy and nutrients they need for growth and development. Encourage development of skills through touch, smell, and taste. Establish eating behaviours and practices that can form the basis for life long, health-promoting eating habits.

These are some of the important physical and psychomotor developments that occur at this stage in life: Reaching, grasping, and releasing are nearly fully mature at this age.

Better coordination and more complicated gestures e. This is the "learning" agethe age for all kinds of experiments in the area of feeding, such as holding spoons, self-feeding, and drinking from a straw. As growth rate declines, children's appetite declines physiological anor exia and they may eat less.

With the acquisition of language and motor skills, young children may seem distracted at mealtime. This is part of normal develop ment.

Nutritional Requirements They should have small, regular, nutritious and energy-dense meals that include a variety of foods. The addition of snacks is important and should contribute significantly to their daily intake of nutrients Table 1.

Commercially-Prepared Junior Foods Junior foods are the natural follow-up to infant cereals, jarred baby foods, and. Therefore, the fat content of a follow-on formula should be higher than 3. Toddlers need proteins for growth, muscle formation, and synthesis of antibodies to resist infection. However, too much protein can overload their kidney functions. Fat is an energy-dense nutrient; a lack of fat in a toddler's diet will induce abnormal fatigue and is associated with slow weight gain.

Essential fatty acids They play in metabolic processes. It is important to protect the heart by avoiding saturated fatty acids and giving more mono- and poly unsaturated fats.

Calcium Iron It is needed for strong bones and teeth. Iron deficiency is relatively common and is responsible for excessive fatigue, loss of concentration, and apathetic behaviour. It is also associated with a reduced capacity to learn and an increased sensitivity to infections.

Nutrition and Child Development

Zinc is necessary for growth and healthy immune function. Deficiency is associated with impaired ability to learn, skin problems, and recurrent infections.

Others are iodine, FA, vitamin A, D etc. They also provide a natural link to general family foods. A wide variety of junior foods mainly in the area of breakfast cereals, snacks, finger foods, cookies and biscuits, and even complete meals is now available specifi cally for toddlers. However, commercially-prepared foods for one-to-three-year olds must provide the right balance and range of nutrients that toddlers require. Studies show that the diet of many toddlers is nutritionally inadequate.

Foods for toddlers should not contain excess salt. The most common prob lem areas are lack of essential fatty acids, iron, and vitamin E, marginal intakes of calcium, too much protein, too much rapidly-absorbed carbohydrates. The foods that serve toddlers best are those that contain prime-quality, well-balanced nutri.

Milk Products for Toddlers Similar to follow-on formulas, growing-up milks GUMs have been designed as a substitute for regular cow's milk in the toddler's diet to provide a more balanced source of nutrition. They supply the valuable nutrients contained in cow's milk calcium, vitamin B2, vitamin B6 and those missing in cow's milk and in the toddler's diet essential fatty acids, iron, vitamins A and D, trace minerals. Conclusion Breastfeeding is the best way to feed infants during their first months of life.

However, when it is not possible to feed breast milk, alternatives to provide the best of the nutrients possible should be advised. Nonetheless these alternatives can never replace the goodness of breast milk and natural foods available.

Feeding and eating experiences early in life also shape the quality of nutrition and dietary preferences throughout childhood. The most common queries in paediatric clinics is in the area of feeding.

And the entire family of the child poses feeding related issues as the major reason for weight loss. The remarkable role of a paediatrician in eliminating the doubts about feed ing related problems cannot be undermined.

Among infants, the usual feeding problems are underfeeding, overfeed ing, aerophobia, gas colics etc. Burping after each feeding is essential to prevent aerophobia. Posseting is regurgitation of small amounts of food. This is often due to overfeeding or lack of burping. Rumination merycism is a psychological disorder in which the child brings out small quantities of food back into the mouth and again chews it and swallows it.

This is similar to 'chewing the cud' by certain animals. This needs psychological evaluation and counseling. Constipation and loose stools also may occur. High solute formula and cow's milk may lead to consti pation.

Food intolerance and bacterial contamination can lead to loose stools. Anorexia and decreased food intake are usual problems among toddlers. They want to select the food and to self-feed and the mothers tend to disagree with this. Another peculiarity of this period is that the growth rate reduces and they are more interested in play and in exploring the environ ment. So the mother will have to coax the child to eat during play.

In general, we have to respect the child and set good eating habits. Escalating obesity rates among young children across the globe has prompted interest in investigating the role of children's eating styles in the main tenance of healthy weights and dietary adequacy.

These feeding and growth-related problems can place excessive stress on the family, and can negatively impact the physical, intellectual, social and academic development of the child.

There is increasing recognition that prob lematic eating behaviours in childhood may be precursors to eating behaviours later in life.

Eating behaviours can vary on a continuum from picky eating to disinhibit overeating or binge eating. Eating disorders are an important diagnosis in children as they have sig nificant medical and psychiatric morbidity and mortality. The incidence of these eating and weight related disorders are occurring in increasingly younger aged children, and evidence shows that this "dysfunctional" eating leads to an in creased risk for eating disorders.

Children's food acceptance patterns develop and change dramatically during the first few years of life, presenting parents with the difficult challenge of providing nutritionally complete diets for their young children. Dietary intake of infants begins with a liquid diet, a transition to comple mentary foods occurs in the latter six months, and, by 24 months, most children are on adult food pattern in the form of family pot feeding.

Nutrition and Child Development

Children with feeding disorders are characterized by an inability or refusal to eat or drink sufficient quantities or types of food to sustain weight and to meet nutritional requirements for growth. Eating behaviours in childhood may vary on a continuum ranging from picky eating, irregular eating, overeating, to uninhib ited or binge eating. The childhood eating behaviours may be influenced also by factors like mother's exposure to and acceptance of a new food, family character istics, number of exposures to a new food, perceived opportunities to taste a new food, verbal praise given in a social context and early feeding patterns.

Definitions There are various eating disorders in children like picky eating, infantile anorexia and anorexia nervosa. Picky eating is at one extreme of the continuum. It is also known as 'neophobic', 'fussy eater', 'choosy', and 'problem eaters' across studies.

Picky eating is a common problem for many children. Picky eating may cause concern for parents about adequacy of the child's diet and they are also more likely to pressure a child to eat if they perceive the child to be underweight. Research based on picky eating in children has shown that these children tend to: They have accep tance of a limited number of foods, unwillingness to try new type of foods, limited intake of vegetables and other foods, and exhibit strong food preferences.

Children with infantile anorexia develop their illness because of difficulty with the transition to self-feeding. Criteria for diagnosis include: Infantile anorexia, unlike so-called "picky eating," is a subtype of infantile feeding disor der and is characterized by failure to gain weight or weight loss over at least 1 month, rare interest in food or expression of hunger, age of onset before the child is 3 years old, and the exclusion of trauma to the oropharyngeal area or other medical conditions.

This is defined as a feeding disorder of separation and is characterized by food refusal by the infant with intense conflict in the motherinfant relationship over issues of autonomy, dependency, and control. Environmental factors affecting development may include both diet and.

Oct 17, PDF Nutrition plays an important role in the development of a child,. Motor development score. Elizabeth L Prado.. The links between early childhood nutrition and childhood mortality are well documented. Elizabeth KE..

According to the National Health and Nutrition. About the author Dr KE Elizabeth is a talented clinician, academician and. Since the evaluation of child growth trajectories and the interventions. Age in months. Trace Elements. KE Elizabeth. IAP stress that for proper growth and development, infants.. Oct 30, PDF Objective: An important aspect of malnutrition is deficiency of different.

We systematically reviewed the role of nutrition in child growth weight or. A review by Guo.She should also take plenty of green leafy vegetables, seasonal fruits and fluids. If enough milk is not removed, engorgement of breast may result. Arachidonic acid is the precursor of prostaglandin playing a crucial role in immunity and inflammatory modulation. Start Now. This study showed lacking antenatal education of mothers about breast feeding.

Escalating obesity rates among young children across the globe has prompted interest in investigating the role of children's eating styles in the main tenance of healthy weights and dietary adequacy. Milk of magnesia, liquid paraffin and glycerine suppositories are safe. Leptin has been shown to affect appetite, metabolism.

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Review my other posts. I have only one hobby: tug-o-war. I relish healthily .