The key nutrition care practices that have an impact on child nutrition include care of pregnant and lactating mothers, breast feeding and feeding young children, care of children during illness, psycho-social care of children, food preparation and storage, and hygiene.
The growth and nutritional outcomes of children are dependent on a complex relationship between the intrinsic characteristics of the child and the competence of the mother in providing childcare.
The baby’s developmental readiness determines:
- Which foods should be fed
- What texture the foods should be
- Which feeding styles to use
All babies develop at their own rate. Although age and size often correspond with developmental readiness, these should not be used as sole considerations for deciding what and how to feed babies. It is important to be aware of the baby’s rapidly developing mouth patterns and hand and body control, so that you know the appropriate food and texture, to serve them. You also need to know the appropriate feeding style to use at each stage of their development, the baby’s ability to eat foods of different textures, and how the food is fed.
Feeding the newborn
The ability of newborn babies to only suck and swallow liquids is due to their limited level of development and the way their mouths are designed.
As babies mature, they begin learning to eat infant cereals and strained solid foods from a spoon. Eventually, they are able to feed themselves small pieces of food by hand and later by spoon. There are different reflexes involved in feeding and eating.
Some of these reflexes are defined as follows:
- Rooting reflex: When a baby’s mouth, lips, cheek, or chin are touched by an object, the head and mouth turn towards the object and the baby opens its mouth. This reflex allows a baby to seek out and grasp a nipple.
- Suck/swallow reflex: After opening the mouth when baby’s lips and mouth area are touched, suckling or sucking movements begin. As liquid moves into the mouth, the tongue moves it to the back of the mouth for swallowing.
- Tongue thrust reflex: When the lips are touched, the baby’s tongue moves out of the mouth. This reflex allows for feeding from the breast or bottle but not from a spoon or cup.
- Gag reflex: When an object, such as a spoon or solid food, is placed way back in the mouth, the object is quickly moved back out of the mouth on the tongue. This reflex is one reason for waiting until a baby is four to six months old to feed solid foods. These reflexes maybe stronger or weaker, or last longer than normal, in babies who are delayed in their development.
Feeding guide for your child’s first four months
Do not give solid foods unless your baby’s physician advises you to do so. Solid foods should not be started before four months of age for the following reasons:
- Breast milk or formula provides your baby all the nutrients that are needed to grow.
- Your baby is not physically developed enough to eat solid food from a spoon.
- Starting your baby on solid food too early increases the chance that he/she may develop a food allergy.
- Feeding your baby solid food too early may lead to overfeeding and being overweight.
- As a general rule, solid foods do not help babies sleep through the night.
Feeding tips for your child
- When starting solid foods, give your baby one new food at a time and not mixtures (like cereal and fruit or meat dinners). Give the new food five to seven days before adding another new food. This way you can tell what foods your baby may be allergic to or cannot tolerate. Delaying introduction of eggs, wheat, and fish later than eight months of age has been shown to cause more allergies to these proteins.
- Begin with small amounts of new solid foods; a teaspoon at first and slowly increase to a tablespoon.
- The first solid foods are dry infant cereals, mixed as directed. Once your baby adjusts to these, you can add vegetables. Then add fruits and then meats.
- Do not use salt or sugar when making homemade baby foods. Also, avoid feeding homemade spinach, beets, green beans, squash, and carrots before six months of age because of the risk of methemoglobinemia (a blood disorder that can interfere with oxygen delivery in the blood) due to high concentration of nitrates. Canned foods may contain large amounts of salt and sugar and should not be used for baby food. Always wash and peel fruits and vegetables and remove seeds or pits. Take special care with fruits and vegetables that come into contact with the ground. They may contain botulism spores that cause food poisoning.
- Iron-fortified infant cereals should be fed until the baby is 18 months old.
- Cow’s milk should not be added to the diet until the baby is 12 months of age. Cow’s milk does not provide the right nutrients for your baby.
- Fruit juice without sugar can be started when the baby is able to drink from a cup (around six months or older).
- Feed all foods with a spoon. Your baby needs to learn to eat from a spoon. Do not use an infant feeder. Only formula and water should go into the bottle.
- Avoid honey in any form for the first year because it can cause a type of botulism.
- Do not put your baby in bed with a bottle propped in his/her mouth. Propping the bottle is linked to ear infections and choking. Once your baby’s teeth are present, propping the bottle can cause tooth decay.
- Your baby’s physician can advise you on how to wean a baby off the bottle.
- Avoid the ‘clean plate syndrome’. Forcing your child to eat all the food on his/her plate even when he/she is not hungry is not a good habit. It teaches your child to eat just because the food is there, not because he/she is hungry. Expect a smaller and pickier appetite as the baby’s growth rate slows around one year of age.
- Healthy babies usually require little or no extra water, except in very hot weather. When solid food is first fed to your baby, extra water is often needed.
- Do not limit your baby’s food choices to the ones you like. Offering a wide variety of foods early will pave the way for good eating habits later.
- Fat and cholesterol should not be restricted in the diets of babies and very young children, unless advised by your baby’s physician. Children need calories, fat, and cholesterol for the development of their brains and nervous systems and for general growth.