One of the joys of parenthood is to see your child grow. The sure way of enjoying this is to ensure proper nutrition for the child. However, in developing countries like India, the infancy period has been recognized to be a hazardous one. Malnutrition, repeated episodes of diarrhoeal and respiratory infections, poor personal and environmental hygiene, low income levels, illiteracy and, distant, slow and non-affordable access to preventive and curative health services, all contribute to this grim picture. The National Family Health Survey-2 has found the prevalence of under nutrition to be very high in India. Of all the children under 3 years of age 47% were underweight and 18% were severely underweight.

The first two years of life are the most vital in a child’s growth. The nutrition provided in this phase of life, lays the foundation of health and healthy feeding habits. Widespread ignorance and misapprehension largely result in high incidence of malnutrition and illness in this age. It is very important that babies are exclusively breastfed for the first six months. Neither top milk nor any other liquid or semisolid feeds should be given during this period. After 6 months of age complementary appropriate semisolid foods are gradually added while breastfeeding is continued. Improper feeding practices are fraught with dangers of:

This vital growth period can, therefore, be made a safer one by ensuring hygienic preparation and handling of complementary foods, increasing the nutritional quality (especially energy density and the micronutrients) of complementary foods and ensuring adequacy of feeding.

Cereals: Rice, Wheat, Jawar and Millets. Cereals contain 7 to 12% protein 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 can be used. The porridge should be thick (too thick for not to be given through a bottle) and concentrated but soft. Some oil or fat (or sugar) is added to help 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.

Legumes: Lentils, bengal gram, red gram, horse gram, moong dal, arhar, rajma, and lobia, etc. Their protein content is 20-25%. The immature legumes do not have much protein in contrast to the dry legumes that are a much richer source. They are also a good source of vitamins and minerals. When eaten with cereal staples, they are just as nutritious as animal foods (meat, fish, milk) but are much cheaper. Recently, Soya been has become quite popular in urban areas and it contains 40% protein.

Foods from animals like eggs, meat, and fish are all nutritious. They are rich sources of energy and provide high quality protein, vitamin B12 and iron and are easily digestible. Eggs should be initiated in a half boiled or full boiled and mashed form. Meat of all origins needs to be properly cooked, chopped very finely, pounded or mashed before it can be given to a child. However, socio-culture beliefs of vegetarianism and high cost limit their use.

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 that of human or cow’s milk. Milk is rich source of riboflavin and calcium, and has some amount of vitamin A and C. However, it is poor source of iron and goat’s milk does not have vitamin B 12. Milk can be used to cook the porridge or added to other complementary foods to enhance their energy content and soften them. Several milk product like curd, cottage cheese (panir), khoya, etc. are available and can be used in addition to or in place of milk.

Oil or fat helps to increase the energy density of the food and helps in absorption and metabolism of Vitamin A. It can be used during initial cooking of the food or after it is ready, and helps in swallowing and digestion.

Sugar or jaggery (gur) is added to improve taste and to provide additional energy and minerals.

Vegetables & Fruits. Vegetables help to increase the vitamin (especially A, B and C) and minerals (especially iron) contents of the complementary foods. The dark green or yellow vegetables are particularly good sources of vitamin A. Tubers and starchy roots like potato, sweet potato and colocasia (arbi) are rich in carbohydrates. These should be well cooked and properly mashed and are best given along with the cereals.

Fruits add to variety and taste. They can be given after mashing either alone or with cereals. The fruits like banana, mango, papaya, pear, plum, peaches are good sources of vitamin A and citrus fruits provide vitamin C besides minerals. But fruits contain no proteins and are not a good source of energy. A lot of money should not be spent on expensive fruits.

Feeding amount and frequency is an important factor that affects a child’s nutritional status. Given the small stomach sizes, young children need to be fed frequently during the day to ensure adequate food consumption. Start with 1 to 2 teaspoonfuls and gradually increase the amount of food. Over 3 to 4 weeks increase to 50 to 60 g or half a cup (or one banana). Feed 2 to 3 times a day till about 9 months age, after which the feeds can be increased from 3 to 6 times a day. The fewer the feedings, the higher the caloric needs per feeding. Continue breastfeeding and preferably give semisolids after breastfeeding.

Gradually add tubers and starchy roots to improve variety and taste. Fruits can be added after mashing alone or with cereals, they are not a good source of energy but provide vitamin A and C. All foods from animals are nutritious, but the high cost limit their use.

Feeding from the family pot. Family foods, that is, the foods that the rest of the family normally eats can provide all the nutrition for the baby without any additional expenditure. Giving the family food in a mashed form, without or before adding hot spice or extra salt, and adding something extra like oil and green leafy vegetable is best. Foods such as rice, dals and vegetables can be easily modified in this manner. Traditional Indian foods also provide a good opportunity to mix cereals and legumes to improve nutritive value. Foods like idli, dosa, dal-chawal, misi roti, upma, powha, etc. are very good examples of such foods. They can be mashed, oil (if more is required) and salt or sugar is added to taste and kept aside in covered containers to be given to the infant when required.

Practice active feeding: The mother, father or other caregiver should actively encourage and help the child to eat himself/herself, while ensuring that the baby gets enough food. This helps in developing coordination and motor development. Hand feeding should not be looked down upon. This is a traditional method of feeding throughout the country. What should be stressed is that the hands should be clean and the nails short and scrubbed.

Mealtime should be a pleasant time for both the caregivers and the children. It is not only what to feed but how to feed the child and is equally important for growth and development of the child. Caregivers should enjoy actively feeding the child to make feeding an opportunity for interaction and psychosocial stimulation. Interaction between the two should assure the child that s/he is loved and cared for.

Dr. J.S. Bhasin, Dr. Jagdish C. Sobti and Dr. Rita Gupta