Complementary Feeding - How to successfully wean your baby

 

               

Hot chocolate, ovaltine and cocoa drinks, fenugreek and dill seeds, moringa and other herbs are some of the elements that constitute many mothers’ diets in the first six months after the birth of their babies. This is not to mention the jugs of porridge and bone soup, black beans and traditional vegetables that they have to take religiously all in a bid to increase their breast milk and ensure their little ones have enough to drink. So when the babies hit the 6 months mark it’s a period of celebration for most mothers not just because they have exclusively breastfed for 6 months but also because they no longer have to worry about the quantity of breast milk they have since the baby is now allowed to take a little more than just breast milk. The mother no longer has to be overly concerned about what they eat and of course, the extra weight that comes from eating all manner of food, can now be shed.

It is indeed a major milestone that however, brings in new challenges because the breast milk is no longer adequate for the baby and the mother has to start complementary feeding. While on breast milk the mother would never have to worry about preparation or whether the nutrient value of the milk was adequate, because the breast milk comes ready to drink meaning no preparation is required except warming and it is nutritionally whole with the full complement of nutrients that the baby requires for growth and development.

The transition to family food by complementary feeding is critical because if it is not done in the right way, the growth of a baby who was flourishing on breast milk could be slowed and in some circumstances the baby growth can be stunted. Poor food handling during this time can result in infections like diarrhoea that further affect the growth. Hence, a lot of caution has to be exercised during this period to ensure that the gains made during the period of exclusive breastfeeding are sustained.

What is complementary feeding?

Complementary feeding is the introduction of food to a baby’s diet in addition to the breast milk. It is recommended that complementary feeding begins from six months of age up to 24 months so as to ensure that the baby receives adequate nutrients to continue growing strong and healthy.

Before six months of age, the mother’s milk in combination with the babies nutrient reserves stored in the infants body when he was growing in the uterus, are usually adequate to meet the nutritional requirements for optimal growth. However, by six months of age, the baby has used most of the nutrients that had been stored and needs extra.

The other reasons why complementary feeding should commence at six months of age is that the babies’ growth and development is very rapid at this age, hence, they require additional nutrients to sustain adequate growth and development during this period. Also their digestive system has matured adequately to be able to digest other foods apart from breast milk.

The quality and quantity of food

It is critical that complementary feeding be practiced in a manner that ensures that the quality and quantity of food the baby receives is adequate to sustain optimal growth and development. The nutritional value in the food being given to the baby has to be adequate. In this regard, the baby should receive food from all the classes i.e proteins, carbohydrates and vitamins.

The frequency of feeding should be optimum i.e., the food should be introduced gradually beginning with around two feeds a day and gradually increasing to whole meals and snacks like the rest of the family.

The consistency of the food should be carefully changed as the child grows i.e., the food should not be too thick or too thin. Large sized shaped pieces of food should be initially avoided as they can easily choke a child. The variety of food provided during this period should be adequate to cover the child’s nutritional needs. Avoid giving the child only one type of food.

As a way of maintaining optimum quality, parents should ensure that the risk of food contamination is minimized. In order to reduce the risk of infection to the child, the caregiver should prepare and give the food in a clean environment and observe simple measures like proper hand washing before handling the baby’s food and thoroughly cleaning utensils used by the baby.

How do you encourage the baby to feed?

The transition from breastfeeding to eating may be challenging to most babies and effort needs to be put into making the process easier. It is important to make the process as smooth as possible so that the baby can easily adapt.

The caregiver should be sensitive to the child’s cues for hunger and respond appropriately. Do not let the child cry for food before they’re fed. Feeding the child when they’re too tired or sleepy limits the amount of food they can take. The food should be at the correct temperature, a baby may find it difficult to eat food that is either too hot or too cold.

The baby should not be forced to feed and neither should they be punished even if they’re reluctant or fussy feeders. The caregiver should be patient and encourage the baby to feed. The baby should be allowed to take all the time they need without being rushed. It’s okay for a baby to play in between feeds as long as they continue to eat.

The baby should be engaged by talking to them and complimenting them as they feed. Positive reinforcement will motivate them to eat more. Distractions should be minimized. If the caregiver becomes harsh, the baby might resent feeding and this will ultimately affect their food intake and growth.

Ultimately the caregiver should ensure that the feeding experience is interesting and happy otherwise the baby may develop a negative attitude towards feeding altogether hence compromising their growth and development.

FREQUENCY OF FEEDING

It is recommended that the feeding is commenced gradually and slowly increased as the baby grows:

• Between 6 and 8 months: the baby should be fed 2 to 3 times a day.
• Between 9 and 11 months: the baby is fed 3 to 4 times daily.
• Between 12 and 24 months: the baby is fed 3 to four times with additional nutritious snacks in between meals.

HOW TO PREPARE THE BABY’S FOOD

Food preparation to a big extent determines the ease with which a baby will take food hence, caregivers should be careful to ensure that the food is appropriate for age and time.

High standards of hygiene should be observed when preparing the baby’s food. Care should be taken to ensure that hands are always washed with soap and water before handling the food and before actually feeding the baby. Fruits and vegetables should always be washed before preparation and the baby’s utensils should be thoroughly cleaned.

It is recommended that parents start their children on food that is easily available and affordable in their local setting since this will ensure that the baby’s food is always fresh. Cooked food should be preferably used in a day because storing for future use risks the food being stale.

While it is important to ensure that food is tasty, it is recommended that the use of salt and sugar is minimal. Spices and herbs should be initially avoided until the baby is ready to take family food.

How to introduce food

One food should be introduced at a time to allow the child to get used to it and also for observation of allergies and tolerance .i.e, do not introduce two different types of food at the same time.

The texture of food should gradually change from semi-solid food to solid. By eight months babies can eat finger food and by one year most babies can comfortably eat the same type of food as the rest of the family.

The variety of food should also gradually change and increase as the child grows i.e, alternate different proteins, carbohydrates and fruits at different meals to get a good range of nutrients.

If the locally available foods are not adequate in meeting the nutritional needs of the child, then fortified foods should be considered to avoid the risk of malnutrition.

COMMON CHALLENGES DURING COMPLEMENTARY FEEDING

There are common challenges while introducing complementary feeding such as lack of knowledge on the appropriate food to feed the child - many parents do not have access to professional advice on complementary feeding hence they rely on information provided by relatives and friends which may not be adequate. As a result the quality of food is compromised:

• Foods provided may be lacking or have insufficient quantities of essential nutrients including minerals and vitamins.

• The variety of food provided is too little and the baby gets bored and refuses to eat.
• The consistency of the food is inappropriate for their age hence difficult for the child to feed on.

A lot of working parents are unable to stay at home with their babies during this time because of work commitments hence, the children are left with caregivers who may not adhere to recommended practices like hygienic food preparation and proper cleaning of utensils.

Competing economic priorities may be another challenge. A very small portion of the family budget is allocated to food for the child because of other pressing needs.

POINTS TO REMEMBER

Breastfeeding should not be stopped during this period. Breast milk is still important in

ensuring the babies get adequate nutrition hence should be continued as food is gradually introduced.

The period between 6 months and 24 months is very critical for babies because there is rapid growth and development and if the nutritional needs are not adequately met this time, the baby can become malnourished and affected for the rest of their life.

Malnutrition experienced in the first two years of life is majorly due to poor complementary feeding practices and can have long term irreversible consequences because the brain and body development being affected.

The long term consequences of malnutrition at this age include reduced future learning abilities, reduced ability of the body to fight infection and reduced economic output. Children are most vulnerable to illness during this period because of the risk of infection during the introduction of food and handling of food hence, a lot of caution should be exercised during this period.

Attribution: Avallain Ltd 

Infatile Colic – A mothers nightmare

                                      

Mary had gone through a successful delivery and enjoyed all the attention she received after the arrival of her bundle of joy. The nurses were always at hand to help with the baby as she entertained her visitors who streamed in to congratulate her. They would take the baby to the nursery when she cried and only brought her back when she was calm, changed and well fed. When she went home it was all bliss until one night 2 weeks down the line when they were all startled by the baby’s sharp crying. She had been fine the whole day and had been put to bed as usual. Mary panicked and called her neighbour. They tried to soothe the baby but nothing worked. After about 30 minutes of non-stop crying, Mary and her husband drove to the hospital. All the while the baby was crying. When they got there, two hours later, the baby just passed a bowel motion then went quiet and slept.

The baby was examined at the hospital and was found to be fine. This was a big relief for Mary and her husband. The doctor reassured them and discharged them home indicating that the baby might have colic. For the few weeks that followed, Mary had to deal with this situation until her baby was 4 months old.

What is colic?

Colic is a term that describes a situation where a baby cries inconsolably for a particular duration of time, usually around three hours. The baby would normally cry around the same time every day and for more than 3 days in a week. In addition to this, colic is associated with the following situations:

• The baby is otherwise healthy, well fed and adding weight appropriately.
• The crying is usually sudden with no obvious association.
• The baby usually cries louder than they normally would and all strategies to sooth and calm the baby down, don’t usually succeed.  
• The infant may actually sound like they are in pain and remain irritable and fussy.
• The baby with colic commonly calms down after passing a bowel movement or gas and goes back to sleep peacefully leaving an exhausted mother.

What causes colic?

Myths

There are several myths that try to explain the causes of colic, treatment and management. In most Kenyan communities children are named after their grandparents or other deceased relatives and it was commonly believed that if the ancestors were not happy with the name a baby was given the baby would cry inconsolably until the name was changed.  

It is also commonly believed that babies cry to manipulate their parents. Some babies are believed to be spoiled and want to be carried all the time hence the crying. It is also commonly believed that baby boys cannot get satisfied on breast milk alone hence require substitution very early.

It is not clear what the exact cause of colic is however it is believed that colic is associated with the inability of the baby to expel the air trapped in their gut during feeding. It is also believed that the premature guts get irritated by certain components in mother’s milk and elimination of the same may improve things for the colicky baby.

Management of colic.

It is recommended that different strategies be used in combination to manage colic with the main aim being reducing the infants crying and helping the family to cope during this period. Here are some of the things you can do to help manage colic:

• Burp the baby immediately after feeding. If the baby is bottle fed and drinks a lot of milk you could burp him half way through the feed.
• Alter your diet to minimize foods associated with excessive gas production, these include cabbage, beans, broccoli or peas.
• Cut on dairy products, nuts and eggs. These foods are associated with allergy and some babies with colic appear to improve when they are eliminated from the diet.
• Some studies suggest that formula-fed babies with colic improve when their formula is changed to a hypoallergenic formula or soy-based formula. The results of these studies are inconclusive and you need to consult your healthcare provider before changing.
• Parents often get distressed when their babies get colic and therefore need support. Parents should get help with the baby during this time to minimize the fatigue and anxiety experienced when the baby is crying.

It is advisable that parents visit a hospital to have all other possible causes of excessive crying ruled out.

Medication like simethicone and herbal remedies like chamomile and fenugreek are sometimes recommended but there isn’t adequate scientific evidence to prove that they work.

During the crying episode

• Be calm and patient, this will help in coping with the situation.
• Make sure that the baby is dry, try to breastfeed in case the baby is hungry, keep the baby warm and put them in a comfortable position. These are common causes of baby’s crying just for the sake of it.
• Other strategies that appear to soothe babies include walking around the house, gently rocking the baby, playing some music or changing the environment. Different children respond differently to all this so a mother should find what works best for their child.

What to avoid

• Do not give your baby any medicine to make them sleep as it may be harmful.
• During the crying episode do not violently shake the child as this may injure the child.

CAUTION

Be sure to seek immediate medical help if:

• You suspect that the crying could be a result of injury.
• The baby appears lethargic, has reduced consciousness and/or becomes very irritable.
• The child refuses to feed for hours and there is reduction in the amount of urine they pass.
• The baby has a fever of above 38.0 degrees.

Outcome of colicky babies

• Colic spontaneously resolves when the baby is around 4 months of age and the child does not suffer any deficits associated with the condition later in life.
  
  
  
  
  
  
  
  
  See http://iafya.org/mumchild_content/child/newborn_problems/ for more information of newborn related problems.
  
  
  Attribution: Avallain Ltd

In The Nick Of Time - A story about cervical cancer in Kenya

IN THE NICK OF TIME
Image Source: http://en.wikipedia.org/wiki/File:Gray1167.svg


Last week, I had an epiphany; one of those moments when reality assumes certain clarity and smacks you right in the face, leaving your wits ruffled. This was a surprise to me because I have never been one of those people with a profound outlook on life,  those people who are always scratching the surface looking for a deeper meaning of things or for a third dimension to life. I am contented with a surface view of most things and of life in general.  For a long time, this is the attitude I have carried to work every morning; an aloofness and emotional detachment towards my patients, until last week when I attended Karen’s wedding.
 
To go back a little, my meeting Karen was by chance, one of those occurrences that fate throws at you on a random Thursday afternoon and whose significance is never apparent until later. I had just completed a particularly tedious shift and was sitting at the hospital cafeteria, immersed in my own thoughts and absent-mindedly thumbing the remainder of what had been a rather untasty doughnut as I waited for the traffic to fizzle out before heading home.
 
She walked into the restaurant and took a seat not far from mine and ordered a diet coke. She took it with one of those vegetable salads and a hotdog.  In the course of her meal, the draught from one of the overhead fans picked up one of her paper napkins and it landed onto my feet.  I picked it up and pushed it back on her table. She offered a smile and said polite thanks and I nodded in acknowledgement.  I was done with my meal and I figured traffic must have lightened up so I stood up and left.
 
A couple of weeks later, I was walking along the hospital corridor when I bumped into her.  She recognized me first,  I stopped and we exchanged pleasantries.  She asked me what I was doing there, I told her I was one of the hospital psychiatrists, at which she was amused and told me she always pictured all psychiatrists were old, bearded and had a schizophrenic look. I laughed and told her jokingly that nowadays we had newer models that were young, hip and had swag, like me. I asked her what had brought her to hospital and she told me that she was coming for a routine visit at the Specialist clinic. She was diabetic, and had been since she was ten; she was on medication and checked her blood glucose every week. The doctor had recently added some new medication to her treatment - to protect her kidneys, as she had explained to me, and the medication was making her cough. She had come back today to get the medication changed.
We stood for a while on the corridor and talked and I found her quite charming. I learnt that she had just turned thirty-two and had worked as a banker.  At the moment, she was between jobs but was pursuing a couple of leads which she hoped would be successful. Her last job had been at an Israeli telecommunications company which had closed shop and relocated to Zambia.

After this encounter, we met several times afterwards; she made it a habit to pass by my cramped-up office on her way from her routine visits. She even made friends with one of my manic patients. It was during one such pop-in visit that she mentioned to me that she was experiencing some slight discomfort when having intercourse and had noticed some spotting on her pants thereafter. She was vaguely curious if this was anything serious and wanted my opinion on it, much as I was quite ignorant on the matter. I suggested that she sees a gynecologist. I also remember casually throwing in the idea of a pap smear although I didn’t expect much from it since she was a bit young and chances of cervical cancer were remote.
 
I didn’t see her for a while after that visit, until she called me on one Friday morning a couple of weeks later and asked if she could pass by. I agreed and she did. She had decided to go for the Pap smear out of curiosity and the results had not been good; a highly suspicious cervical abnormality. A follow up biopsy done had confirmed her fears - early stage cancer localized to the cervix.  She had received her results earlier in the day and had called me almost immediately. Our conversation was somber and devoid of the usual good humor, she was scared out of her wits at the prospects of dying young and was in need of assurance.
 
A few weeks later, and barely three weeks to her wedding, Karen underwent a total hysterectomy, a surgical procedure for removing the uterus and cervix.  I was impressed by how fast she had recovered as she walked down the aisle on her wedding day; they had decided to carry on with the nuptials in spite of her surgery. As I watched her that day, I felt happy for her,  despite the fact that I knew she would not be able to conceive. I was happy that her cancer had been diagnosed at an early stage when it was still amenable to surgery with a good chance of success. The odds are always high that most cancers in African women are discovered late and she had beaten the odds.
Cervical cancer is the second most common cancer in women and accounts for over 200,000 deaths worldwide every year, over eighty percent of which occur in developing countries. It is common among older women with a high number of births although a number of cases have been reported among younger women.  Early stage cervical cancer can be diagnosed by a pap smear, a fifteen-minute outpatient procedure and can be easily treated using a variety of surgical procedures. Advanced cancer of the cervix is difficult to treat and carries a high mortality rate.
 
Despite this increased risk of acquiring cervical cancer among African women, it is shocking to find out that as much ninety percent of women in Kenya have never had a pap smear or screening for any sexually transmitted infection. Compare this to western Europe where as much as eighty percent of the women have had at least one pelvic examination every year. In general, it is recommended that all women should have a pap smear done at least once in their lifetimes.  If the results of this first smear are normal, a follow up smear is recommended after another year after which they should be done every three years.  HIV infected women are advised to have a pap smear every year since they have a higher chance of developing cervical cancer.



See http://www.iafya.org/tip/03349 for more information

Contribution by Dr. Griffin Manguro - http://www.ustadhgriffin.wordpress.com

Dr. Griffin Manguro
Research Project Physician
Mombasa HIV/STI Research Clinic
Tel. 0721908504
email: mangurogriffin@yahoo.com

Water-borne diseases: Kenya’s curse of the rains

©2006 Walter Siegmund

After the dry spell of January - March we now have the long rains season. Despite the excitement that come with rain, such seasons also presents us with health challenges. Some of the medical conditions that you are more likely to suffer from in during this period are called water-borne diseases, and include cholera, typhoid fever, gastroenteritis, jaundice and other forms of diarrhoea.

Transmission
Water-borne diseases usually result when some microorganisms, which are usually present in human and animal feces, find their way into your body system. This may happen when you drink water from a contaminated source, or more often, from contaminated hands, clothes, food, utensils etc. Such diseases can easily be spread and can sometimes be dangerous. To prevent such, high standards of cleanliness need to be maintained.

Effects of the diseases
If you are infected with any of these diseases, you may develop a severe illness, sometimes leading to death. Such infections may also lower your body’s ability to fight off other infections. Your intestines may also be affected such that your body may not be able to absorb nutrients well, sometimes resulting in malnutrition. When you are sick, you are likely to be less productive, including children missing classes due to illness. Such preventable causes of illnesses lead to increased health expenditures at the individual, household, societal and national level.

As a simple guide, the following is a list of things that you should do or not do during this season to avoid these diseases

What you should do:
i) Wash hands thoroughly with soap before preparing or consuming food, and after visiting the toilet.
ii) Boil drinking water if suspected to be from a source that is likely to be contaminated; or use chlorine (marketed locally as ‘waterguard’ to disinfect all drinking water)
iii) Use toilets for both short and long calls
iv) Avoid living in flooded or flood prone areas during the rainy season
v) All victims who start passing loose stool should take lots of fluid to correct the fluid loss. If the condition worsens they should be taken to a health center for proper diagnosis and management.


What you should avoid:
i) Consuming foodstuffs from roadside vendors
ii) Exposing food to flies
iii) Half cooked meals
iv) Avoid self medicating or buying over-the-counter medications. Always take medicine after advice from a qualified healthcare professional.

Author: Dr. Allan M. Makenzi


More information: www.iafya.org