How to feed your child in the first year of life; for all mothers, especially first time mothers

I am a nutritionist in a children’s hospital. Hence, part of my job description entails giving sound advice on infant and young child feeding to mothers, especially first time mothers. While most mothers  know what to feed the child and what not to, for a few, this business is a groping in the dark-a trial here and there while hoping that everything works out fine. I have never really appreciated the sacrifices mothers make until I started interacting with them as a nutritionist. I have come across mothers whose children were born prematurely; some have cerebral palsy; others with very low birth weights; iron deficiency anaemia; chronic constipation and a myriad of other conditions. Yet in all these situations, the mothers’ love for their child was not quenched. On the contrary, it seemed to ignite that tender loving that only a mother can give. Many have taken time off their work to take care of their children. And in cases of say, cerebral palsy, others have quit their careers altogether. It is because of this that any help extended to mothers is very much welcome and might offer some consolation for their enduring sacrifices. This is my help to them.

Birth-6 months

Mother’s milk is best for the baby. It is essentially for this reason why as nutritionists we advocate for exclusive breastfeeding for the first six months and continued breastfeeding up to two years. Exclusive breastfeeding means giving only breast milk, and no other foods or fluids, not even water. (Medicines and vitamins not diluted with water may be given, if medically indicated.). Breast milk provides all the nutrients and fluid requirements that the child needs for the first six months. Furthermore, it offers protection against common childhood diseases particularly diarrhoea, chest and ear Infections. This is especially so when taken during the first hour of life. Breast milk is much superior to formula milk in many ways. To begin with, it does not require rigorous hygiene measurements as providing formula milk. Risk of infection with poor handling of feeding bottles is very high in formula milk provision. Secondly, it is more easily digested than formula milk. In addition, breastfed children have been found to have better life outcomes than non-breastfed children. This is because breast milk contains docosahexaenoic acid (DHA), a long-chain fatty acid that is essential for infant brain and eye development.

Quite often, I have heard mothers complain they do not have enough milk. This is not the actual case. Milk flow is dependent on the baby suckling. The longer the child suckles, the more the milk will be produced and let down. If the baby suckles less, for example because other fluids or foods are given, the mother will produce less milk.

It is not advisable to introduce cow’s milk until the child is one year old. This is because cow’s milk has higher protein content and the child’s kidneys have not developed enough to deal with the excretion of waste that comes from protein digestion of cow’s milk. Furthermore, the child is prone to early offsets of allergic reactions and gastrointestinal blood loss.

The table below shows why breast milk is superior to formula milk and cow’s milk owing to its optimum balance of nutrients that the child requires during the first six months of life.

Nutrient Comparison of Breast Milk, Formula, and Cow’s Milk
Products per 100 ml Energy

(kcal)

Protein

(g)

Calcium

(mg)

Phosphorus (mg) Iron

(mg)

Breast milk 70 1.0 32 14 0.3
Milk-based formula

(20 kcal/oz)

67 1.5 42-51 28-39 1.2
Soy-based formula

(20 kcal/oz)

67 1.8-2.1 60-71 42-51 1.2
Whole cow’s milk (homogenized) 64 4.9 120 95 Trace
Breast milk 70 1.0 32 14 0.3

 

6-12 months

At six months, breast milk alone cannot provide nutrients such as iron in the required amounts. Hence, complementary feeding becomes necessary. Hereby, an iron fortified cereal/porridge is introduced. This is done gradually say 2-3 tablespoons on the first day while still breastfeeding and ½ cup increasing to ¾ cup at say 6.5 months. If the child has not been gaining weight optimally, the porridge/cereal can be enriched with cooking oil. It is important to avoid mixed flours/composite flours. This is because different flours have different cooking temperatures. Hence, this might expose the child to gastrointestinal distress.

When introducing mashed foods or pureed foods, it is important to give a balanced diet. Each meal should contain carbohydrates, proteins and vitamins and minerals. The following pointers might be helpful.

  • Vegetables might be accepted more readily if introduced before fruits, since fruits taste sweeter.
  • Allow at least 3 days between introduction of each new food.
  • Begin with small amounts of foods, offering seconds as necessary.
  • Give the child water after every meal to avoid dehydration.

Plant proteins are usually introduced between 6-8 months and animal proteins at 8 months. Animal proteins are introduced later because some children are prone to allergies especially if there is a history of the same in the family. Hence, when introducing animal protein, it important to do so one at a time. Hence, if the child develops an allergy, the culprit food can be easily recalled and an alternative given. Common allergens are found in egg white, cow’s milk, citrus, wheat, chocolate, fish, shellfish, tree nuts, and nut butters.

It is crucial to reduce or abstain altogether from blending food as the child approaches 8 months. This is because it will take longer for a child used to blended food to learn how to chew food.  Furthermore, it has been shown that children who learn how to chew food early on also learn how to speak early on. So if you want your child to say ‘Baba’ or ‘Mama’ earlier, desist blending his or her food after 8 months.

Now, there is more to be said about maternal nutrition, allergens, vitamin and mineral requirements etc. However, a brother also has to pay his bills. Hence, should you feel the need for more information, just book an appointment with a nutritionist at any of the Gertrude’s Children’s Hospital Clinic nearby you (Gertrude’s Children’s Hospital). I assure you, it will be worth your while.

 

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