Not a day passes in the clinic without a mother complaining “my child just doesn’t eat, doc. Please do something!”, and the grandparents standing behind nodding sagely. In fact, feeding related queries are the commonest that I get, and the most difficult ones to answer satisfactorily. A young mother tends to get totally confused by conflicting advice from various sources including family members, friends, the internet, social media, peers etc., and is also influenced by deeply rooted traditional practices, myths and misconceptions about feeding. Spending more than an hour per meal trying to make a child eat seems to be the norm rather than the exception, and a cause of worry for many parents. This is my attempt to make life a little easier for them. (Dr. Naveen Kini)
Healthy feeding practices should always be started in infancy, and the best way to begin is to exclusively breast feed the child till the completion of 6 months of age. Cow’s milk is best left for the calf, and the feeding bottle on the departmental store shelf! Exclusive breast feeding provides the child nutrition tailor-made to his/her needs, enhancing brain development and improving immunity (and therefore lesser instances of ear and respiratory infections, and diarrhoea).
Weaning at 6 months provides a wonderful opportunity for parents to really get to know their child. Harness the natural curiosity and eagerness of the child to experience new tastes and textures in food, so that eating remains an activity that gives the child immense pleasure. Most feeding problems start at this stage, and if not approached rightly, making eating a stressful experience for the child. Preconceived notions, inaccurate advice and personal anxiety are some of the factors that have to be set aside, to enjoy this phase of your child’s development. These are some tips:
•Respect the child’s wishes, and do not force something upon him/her that is not liked.
•Do not distract the child to make him/her eat. Feeding should always be at a designated place such as the ‘high chair’ or dining table, and not in front of the TV, or outside the house in the garden or on the road.
•Stop just before the child is full, and do not try and finish the whole bowl.
•Don’t feed the child the same meals over and over again. Even 8 month olds can get bored very soon.
•Try different flavours and textures. A child can be fed most of the things that you regularly eat, by the age of 1 year. Common weaning food suitable for infants include mashed fruits and vegetables, ragi gruel, khitchdi, pongal, rice with dal, etc. and also the readily available commercial cereals.
•Encourage the child to slowly eat with his own hands, either using his fingers or a spoon. This acquired skill called ‘hand-mouth co-ordination’ is very important for future skilled work with the hand, especially hand-writing and drawing.
How many meals should my child have?
Having 3 or 4 small meals a day, particularly breakfast, lunch, evening snack and dinner, is always better than skipping a meal, and having one large meal a day. Breakfast is particularly important, as you are ‘breaking’ a long overnight ‘fast’. Having a small meal in the morning will go a long way in preventing binge eating later in the day. That said, it is a common fact that some children, especially the ones facing some stressful situations in school, do not tolerate breakfast well. They end up having stomach pain and even vomiting if forced to eat, and are best left alone till they get used to the school environment. Make sure you send a healthy snack, which the child can eat later if desired.
What should my child be eating?
Most parents ponder over this deeply, and this is a topic hotly discussed the world over. Various myths, cultural beliefs, misconceptions and sometimes illogical conclusions lead to tremendous confusion and anxiety.
The recommendations of the USDA (United states Department of Agriculture) have been the most widely followed for many decades, and most of us are familiar with the ‘Food Pyramid’ concept published in the year 1992.
This was basically is a pyramid-shaped diagram representing the optimal number of servings to be eaten each day from each of the basic food groups.
The drawbacks of the pyramid were:
•With an overstuffed breadbasket as its base, the Food Pyramid failed to show that whole wheat, brown rice, and other whole grains are healthier than refined grains.
•With fat relegated to the “use sparingly” tip, it ignored the health benefits of plant oils—and instead pointed to the type of low-fat diet that can worsen blood cholesterol profiles and make it harder to keep weight in check.
•It grouped healthy proteins (fish, poultry, beans, and nuts) into the same category as unhealthy proteins (red meat and processed meat).
•It overemphasized the importance of dairy products.
MyPlate is the current nutrition guide published by the USDA, a food circle (i.e. a pie chart) depicting a place setting with a plate and glass divided into five food groups. It replaced the USDA’s MyPyramid guide in June 2011.
MyPlate illustrates the five food groups that are the building blocks for a healthy diet using a familiar image — a place setting for a meal, namely Fruits, Vegetables, Protein, Grains and Dairy products.
The basic messages that the MyPlate guide tries to convey are:
•Make half your plate fruits and vegetables.
•Make at least half your grains whole grains.
•Go lean with protein.
•Reduce sodium (salt) in foods like soup, bread, and frozen meals.
•Switch to fat-free or low-fat (1%) milk.
•Drink water instead of sugary drinks.
•Find a balance between food and physical activity.
•Enjoy your food, but eat less. Avoid oversized portions.
To put it more simply:
•See that at every meal that you child eats, half the plate should contain fruits of all colour, and a variety of vegetables. (Potatoes and French fries don’t count!)
•See that grains (rice, chapathi, roti etc) fill only a quarter of your plate. Substitute polished grains with whole grains. For example, eat more of red rice than white rice. Use whole wheat atta for chapathis. Eat whole grain pasta, and wheat bread instead of the regular bread, which is made of maida. Popcorn, with very little butter and salt added, can be a healthy whole grain snack.
•The other quarter should be a source of protein, such as dal, sambar, pulses, nuts, seeds, egg or meat. Choose lean meat like fish and poultry, over red meat and processed meat.
•Get your daily dose of calcium from dairy products like milk, curds (yogurt), cheese, milk shakes, paneer etc. Not-so-lean children above the age of 2 years can be offered low fat or skimmed milk, and limit the quantity to 1 to 2 glasses a day. In children who cannot tolerate milk for whatever reason, use non dairy sources of calcium like tofu, fish (sardines,salmon), spinach, peas, okra, beans, sesame seeds, almonds, figs, oranges etc.
•Keep fats and oil to a minimum. Use vegetable oils, which are rich in the healthy MUFA (Mono Unsaturated Fatty Acids) and PUFA (Poly Unsaturated Fatty Acids), like sunflower, olive or rice bran oil, for cooking. Avoid solid fats which like butter, ghee or animal fat, which contain unhealthy Saturated Fatty acids. Shallow fry instead of deep frying.
The Barker Hypothesis
Children who are born small, or born prematurely, are particularly vulnerable to faulty feeding practices, born out of the natural desire of the parents to see them tall and chubby. In fact, these are the babies that require careful follow up and growth monitoring to ensure that their weight remains within the normal limits. More and more evidence is now coming in showing that these babies are very prone to obesity, heart disease, diabetes, blood pressure and stroke.
Healthy eating habits usually continue on to adulthood, and it is therefore very important to start young. Remember, as parents you are the role models for your child, and setting a good example with your diet is the best way to begin.