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CHAPTER the physical and mental health development

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CHAPTER 2

LITERATURE REVIEW

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Introducing the solid foods to
the babies aged between 4-6 months is referred as “weaning”, which has a
nutritional importance in the physical and mental health development of the
children (Maslin, et al., 2015). Weaning is the transition from milk-based diet
to the diet containing foods from almost all food groups. The World Health
Organization (WHO) suggests the use of breast milk for feeding up till 6 months
of age and then recommends the initiation of solid and semi-solid foods into
diet so that infant’s lingual muscles can strengthen (WHO, 2002). As the child
grows their nutritional needs increase, particularly of iron, which is why
weaning is recommended. Good and adequate nutrition supports your baby’s rapid
growth and development. Introducing the variety of foods from the earlier
stages of weaning is the best way to encourage healthy eating habits that can
last a lifetime (Collin et al., 2002).

2.1: Weaning as a first
bite at 6 months of age

 

Learning to eat foods, from bites
of baby cereal to regular table foods is a long process for any child. Before a
baby is offered a first bite from a spoon, they get all their nourishment
through the breast milk. The correct term for weaning is “the introduction of
complementary foods” (Akobeng, 2006). As an infant grows it requires a variety
in diet to meet his/her growing needs. Solid foods are added to complement
breast or formula milk complementary feeding. As the various systems of the
infant mature, the introduction of complementary serves to meet the increased
demand for energy and nutrients imposed by rapid growth and development. This
gradually reduces the reliance on milk as the primary energy and nutrient
source, encourages the development of neuromuscular coordination and introduces
the infant to an increased variety of tastes and textures (Carlsson et al.,
2006).

2.1.1 Importance of Weaning:

 

The weaning period is therefore a
vulnerable time when the child should be attentively cared for and observed so
as to maintain health (Dewery, 2001).Once the infant is used to the new taste,
small amounts of other soft foods can be introduced gradually in sequence,
allowing the baby to get used to one food before introducing another (Elegbe et
al., 1984). Studies have revealed that foods other than breast milk should not
be started before 6 months (Rapley, 2006). Suitable foods after six months age
are porridge made with maize, millets, sorghum flours and mashed soft boiled
rice. As the infant grows breastmilk becomes insufficient in providing the
child with other essential nutrients due to which infants usually become
deficient in iron, zinc, copper and potassium, which can be prevented by
providing complementary foods rich in these nutrients (Dewey, Finley, &
Lorrendal, 1984; Simmer, Ahmed, Carlson, Thompson, 1990).

 

The late introduction of
complementary foods is also harmful, because the infant growth seizes or slows
down increasing the risk for malnutrition and micronutrient deficiency
(Onofiok, 2005). 91.6 percent of the mothers introduced complementary foods
from zero to five months of age, which is too early for weaning as the infants
gastro intestinal system is not ready for high carbohydrate foods commonly used
for weaning in developing countries (Yamashiro, 2003).

81.6 percent of infants had
3meals/day, while 18.2 percent of children eating more than 3 meals/day for
reasons of hunger and satiety, stomach capacity and adequate growth (WHO,
2006).

 

WHO currently recommends  two to three meals a day with complementary
foods for breastfed infants between 6 and 8 months of life and three to four
meals a day for those between 9 and 24 months, with additional nutritious
snacks (pieces of fruit or bread, homemade cake, cassava) once or twice a day
at 12 months (WHO, 2003). Feeding complementary foods from a cup or bowl with a
spoon also familiarizes the infant with the textures, flavors and smells,
whereas diluting these foods with prepared formula or other liquids, as is
necessary to feed them by bottle, deprives the infant of these sensory
experiences.

 

Feeding from a cup is also though
to enhance the development of chewing and swallowing mechanisms. To decrease
the risk of infection with introduction of complementary foods, it is often
recommended that prepared formula and complementary foods to bed fed with a cup
and spoon which is thought to be safe microbiologically than feeding with a
bottle and hand (Collin et al., 2002).

 

Infant at the age of 6 to 9 month
becomes used to swallowing solid food, a thicker consistency may be offered.
Hard foods should not be given. Fruits, vegetables, meats, pulses and cereals
should be offered. Yogurt can also be given. In this age the infant’s
acceptance to new foods is more than after 12 months (Bingley et al., 2004).
Babies not being breast fedd should be given a formula feed up to the age of 12
months (Willson et al., 1990). Nutritional requirements of infants are high.
This is a period of growth and development. In the first year of life infants
triple their birth weight and double their length.

2.1.2 Age for
Weaning:

 

The word “Wean” is a transition
or movement from one relationship to another (Bonyata, Flora, & Yount,
2012). Before weaning as WHO recommends to breastfeed the child up till age of
6 months and then introduce solid foods to diet along the breast milk. It is
thought that breastmilk becomes useless after a certain age for the infant
which is not true. Breastmilk contains antibodies which works as a protecting
shield for the baby (Bonyata et al., 2012).

 

Some doctors recommend to
continue nursing for 2 years with the intake of complementary foods. Age of the
weaning is highly individualized (Bonyata et al., 2012). Some infants are not
ready to leave the breastmilk up till one year while others can welcome the
solid foods by an early age of 3 months. Many studies are conducted predict the
age of weaning fro which it was concluded that minimum age for introduction of
complementary foods is 2.5 years and a maximum age of 7 years (Dettwyler,
1997). This was than corrected by WHO  to
six months of age which is considered as an ideal age for the introduction  of solid foods to promote the growth and
development of the infants.

 

2.2 Infant growth and
development at the 6-9 months of age

 

There may be a wide physiological
variation in the needs of individual infants and the recommendations for breast
fed babies differ to those for formula fed infants. Breastfeeding provides all
the nutrients an infant needs for the first six months of life (Kramer &
Kumna, 2001). The currents recommendations is 4-6 months for the introduction
of complementary foods in formula fed babies (Barker, 1992). For all infants,
the introduction of solid foods becomes necessary at some point, usually not
before 4-6 months. Solids should not be introduced before 17-18 weeks. While
the ability to suck and swallow is already developed in utero, during the first
few months an infant is unable to chew.

 

Before the infants are three or
four months old, babies automatically push out their tongues when anything
enters their mouth such as extrusion reflex (Gupta et al., 1991). This
indicates that the child can only swallow fluids and no solid foods.
Post-Nataly the extrusion reflex is strong to prevent an infant from choking on
chunks of food but this reflex weakens during the first half of infancy. By the
age of six months, neuromuscular coordination has matured, allowing an infant
to maintain an upright head position and begin to take food from a spoon. Foods
should be prepared adequately containing the required nutrients as well as
appropriately with a suitable texture and temperature (WHO, 2004). Without the
knowledge of proper weaning practices as well as a perception of the child’s
hunger needs, malnutrition and illness may ensue.

 

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