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Mama, Give Me the Right Food…….
“My child does not eat at all. Could you prescribe a tonic?” This is a concern expressed by most parents during their visit to the paediatrician for a routine checkup. Yet, rarely do these children appear malnourished. They do not have sunken cheeks nor are the ribs plainly visible. They seem healthy and their weight is appropriate. The complaints arise probably because the amount of food they eat falls short of the parents’ expectations.
The weight of a child in the first year is determined by the birth weight. For example, a child who is 3kg at birth should be 9kg on his or her first birthday (three times the birth weight). After the first year, the growth rate slows down. The weight after the age of two can be calculated using the formula: (age +3) x 5 = weight in pounds. Divide it by 2.2 to get the value in kilograms. The BMI is calculated as weight in kilograms divided by height in metre cubed. For children up to 10 years, this should be 23.
If a child is underweight, or the weight curve has plateaued or is dropping, investigations have to be done. The problem may be treatable and correctable. Children often get worm infestation. This may cause weight loss and a perverted desire to eat chalk, toothpaste, uncooked rice or lick paint. Usually a single dose of albendazole is all that is required. It can be prescribed by the paediatrician. But if the physical examination and tests are normal, the problem may lie with faulty feeding practices.
Correct food habits have to be started at birth and continued through life. Breast milk is best for a newborn baby even if it is pre-term. The World Health Organisation has recommended that it should be the only food (exclusive) the baby receives for the first 120 days. Breast milk has a high concentration of antibodies and immunoglobulins which protect against viral and bacterial diarrhoea, cold, cough, measles, chicken pox, mumps and a variety of other infections between six and nine months. Despite extensive research and claims of superiority, baby food manufacturers have not managed to duplicate breast milk.
Weaning foods can be introduced after 120 days. Breast milk tastes bland, so unless the initial weaning food tastes similar, the baby may reject it. Natural foods like rice, wheat or ragi are best. Precooked, ready-to-eat packaged cereals have no advantage. They may (despite claims to the contrary) contain preservatives or high concentrations of electrolytes which the baby’s immature organs cannot handle.
New foods should be introduced only every two weeks. Mashed banana, stewed apple and freshly prepared juices are easily digested. Homemade string hoppers or idlies can be served with milk and sugar. A mixture of rice, pulses, potato, carrot and other vegetables can be cooked with salt, mashed properly and given to the baby.
After the age of 10 months, undiluted cow milk may be given. The total quantity a day should not exceed 400ml. But if it is given first thing in the morning, it suppresses the appetite. Milk should be served after breakfast. It contains only 60 calories per 100ml. This means that consuming large volumes will fill the stomach but not provide as much energy as the same volume of calorie-dense food. Additives and “health drinks” do not really provide nutrition. They contribute very little to the health or weight of a child unless taken in large unrealistic portions.
A sedentary child who sits in front of the television will not have a good appetite. Physical activity is essential. This has to be provided and supervised by parents as most schools today concentrate on academics. At least one hour of activity — such as running, jumping and cycling — is essential for a good appetite and good health.
Milk biscuits, cream biscuits, packaged snacks and aerated, carbonated cool drinks provide empty calories. A child who is not particular about meals but prefers to eat snacks and watch television all day will be unhealthy, develop a paunch and have a poor appetite. This may also lead to obesity. An occasional snack is a reward, not a substitute for proper meals.
Many “health tonics”, often touted as natural, are available in the market. Non- allopathic (homeopathic or aryuvedic) products may have tongue-twisting names and contain many ingredients. Their side effects are not known, nor whether they have reactions with any allopathic medication that a child is taking. Tonics containing cyproheptadine do increase the appetite. This drug is actually a potent antihistamine with many dangerous side effects, one of which is an increased appetite.
It must also be kept in mind that the apple does not fall far from the tree. If both parents are thin, it is likely that the child will also be so. This may be genetic or the result of food and exercise habits inculcated over several generations.
Source: The Telegraph (Kolkata, India)