Things to keep in mind about infant and child feeding

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Infant and child feeding is not rocket science and many mothers and grandmothers have the knowledge on what foods the child needs. Often, the barriers to providing these foods are cultural, social and economic rather than lack of knowledge. Very often, removing these barriers can itself go a long way in ensuring better quality and quantity of food for children.

Some of the main points to keep in mind with regard to feeding children under 5 years of age.

1. Breast feeding should be exclusive up to the age of 6 months. Complementary foods are given in addition to breastfeeding up to 1-2 years.

1. Complementary foods have to be prepared using ingredients that are normally consumed by the family rather than tinned or ready to use foods. Care has to be taken during preparation and storage to ensure that the food itself doesn’t become a source of infection eg. diarrheal diseases.

1. Given that young children and infants have a small stomach capacity, it is important to understand that each meal should contain nutrient dense foods to meet their nutritional needs. Diluted, watery feeds fill the stomach but will not meet requirements.

1. For the energy needs of the child, locally consumed cereals and millets can be provided. Some of these are more nutritious if soaked, sprouted/germinated and fermented to reduce the anti-nutritional factors found in them. Starchy roots and fruits such as banana, potato etc. can be introduced. However, it is important to remember that these foods alone cannot provided all the nutrients that a child needs and they have to be eaten with other foods.
   

2. At least 40-50% of energy needs of the infant and 30% of the child’s needs should come from fats. Fats and oils are concentrated sources of energy, are important for proper growth and development and help absorption of fat soluble Vitamins (A,D,E,K). At least ½ a teaspoon should be added into each meal either during or after cooking. Too much of fats/oils can make the child full very quick and not able to eat the full meal. Fish, ghee, butter, full fat milk, other animal source foods are good sources of essential fatty acids. Sugar, jaggery and honey contribute to energy but do not contain many other nutrients. Sugary drinks, biscuits, sweets etc. have very little nutritional value and can also get the child too used to sugar, even addicted. Avoid giving tea and coffee to infants.
   

3. Animal source foods such as meat, organ/offal, fish, whole fat milk, yoghurt, cheese, eggs etc. are rich sources of many nutrients. These can be introduce based on what is eaten by the family and available locally. These foods can be given every day as preparations that are easy for the child to eat, initially completely mashed into the food and later chopped into bite size pieces. Dry fish can be powdered and sieved to remove small bones. The presence of meat and organ meat in the meal also helps absorb nutrients such as iron from other non-haem foods such as legumes, pulses, vegetables and green leafy vegetables. By age one, the child should be eating all the foods consumed by the family.

1. Vegetables and green leafy vegetables can initially be cooked well and mashed, later cut up into small pieces. By one year, the child should be able to chew and be comfortable with different tastes and textures. Introduce a variety of vegetables but these should be done one at a time to make sure that the child has adjusted well to it.

1. Legumes and pulses in the ratio of 1:3 with cereals (khichdi) can also be introduced, preferably after soaking/sprouting and being well cooked. They offer proteins, vitamins and minerals. Roasted and powdered groundnuts can also be included into the porridge or mashed foods or as Chikki cooked with jaggery.

1. Vitamin C rich foods are important as part of the meal (as it improves absorption of iron) or between meals. This includes orange, lemon, tomato, guava, mango, pineapple, papaya etc and should be given in an age-appropriate manner.

1. Breast milk supplies a good amount of Vitamin A that the infant needs. Complementary and supplementary feeds that includes animal source foods, dark green leaves (spinach etc.) and yellow/orange fruits and vegetables (pumpkin, carrots, yellow sweet potato, papaya, mango etc.) are good sources of Vitamin A.

1. Breast fed babies are usually adequately hydrated unless they have in illness. The management of ill babies is not covered here. Later, infants and children can be offered clean, potable water on demand when they are thirsty.

1. It is important to give frequent meals (5-6 feeds) as the child consumes small quantities and also needs energy for daily activities as well as good quality proteins, vitamins, minerals and fats for growth and development. This table gives an overview of important points to keep in mind in the context of infant/child feeding as discussed earlier and whether millets can meet those requirements. Refer to the note of millets for further explanations and references.

	Nutritional requirements	Points to consider regarding millets
1.	Children need energy dense foods but only these are inadequate	Millets can provide energy but are not nutrient dense
2.	Foods for children should be digestible	Most millets are difficult to digest because they contain both soluble and insoluble fibres
3.	Nutrients from foods should have good bioavailability	Because of the presence of phytates, tannins, protease inhibitors, lectins, oxalic acid etc., the proteins, vitamins and minerals, specially iron and calcium from millets are precipitated and have low bioavailability.
4.	Since infants and children have small stomach capacity, nutrient dense foods should be given	Millets are not nutrient dense. Because they have high fibre content, they cause satiety (feeling of fullness) quickly so infant/child feels full without receiving adequate nutrition
5.	Children need frequent meals to meet their increased needs for growth and development	Because millets are difficult to digest and contain fibre, children feel full for longer periods of time and therefore consume fewer meals. This means that they have lesser frequency of nutrient poor foods which can lead to deficiencies of protein, vitamin, mineral, fatty acids etc. over a period of time especially when consumed alone.
6.	Complimentary foods have to be prepared using foods regularly consumed by the family	In the context of millets, it is not required to force the child to consume those that he or she are not used to.
7.	Children need 9 essential amino acids from the diet	No single millet can provide all the 9 essential amino acids, so these have to be give as combination or with other foods.
8.	Vitamin B12 is essential for infants/children	Millets do not contain Vitamin B12. This can only be ensured through animal source foods which are the only known sources of the Vitamin

References

Infant and young child feeding: Training module for ANMs. (2016).

Mamidi, R. S., Kulkarni, B., Radhakrishna, K. V., & Shatrugna, V. (2010). Hospital based nutrition rehabilitation of severely undernourished children using energy dense local foods. Indian Pediatrics, 47(8).

World Health Organization. (2021). Infant and young child feeding counselling: an integrated course. Trainer’s guide.