(PRACTICAL NOTEBOOK )

PREPARATION OF INDIGENOUS
COMPLEMENTARY FOODS
Breast feeding alone is adequate to maintain growth and development up to 6 months. And
complementary feeding should be given to maintain their growth and development according
to age. So it is necessary to introduce more concentrated energy riches nutritional
supplements by this age. Infant also need iron containing food supplements to prevent iron
deficiency anemia. Complementary feeding or weaning is the process of giving an infant
other foods and liquids along with breast milk after the age of 6 months as breast milk alone
is no longer sufficient to meet the nutritional requirements of growing baby. It is the process
.by which the infant gradually becomes accustomed to adult diet

WHY START AT SIX MONTHS

Infant's intestinal tract develops immunologically with defense mechanisms to protect the
.infant from foreign proteins
The infant’s ability to digest and absorb proteins fats, and Carbohydrates, other than tios
breast milk increases rapidly
The infant's kidneys develop the ability to excrete the waste products. The infant develops the
neuromuscular mechanisms needed for recognizing and accepting variation in the taste and
.color of foods

WHAT ARE THE SIGNS That BABY IS READY FORCOMPLEMENTARY FEEDING

.Hold his/her head straight when sitting down

.Opens his/her mouth when others eat is interested in foods when others eat
.Receives frequent breast feed but appear hungry soon after
.Is not gaining weight adequately

GUIDE FOR COMPLEMENTARY

FEEDING

.Feed infant slowly and patiently and encourage them to eat but do not force them
.Practice good hygiene and proper food handling to reduce the risk of diarrhea
.Start with small amounts of food and increase the quantity as child gets older
.Gradually increase food consistency and variety as the child grows older
.Increase the number of times the child is fed complementary food, as the child gets older
.Feed a variety of nutrient rich foods to ensure that all needs are met
Give micronutrient rich complementary foods or vitamin and mineral supplements to the
.infant as needed
It is advisable to start one or two teaspoons of new food at first which should be given when
.baby is hungry, just before regular feeding, during the day time

PREPARATION FOR WEANING FOOD

.Wash hands
.Keep food in clean utensils
.Separate raw and cooked food
.Cook food thoroughly
.Keep food at safe temperatures
.Use safe water and raw material
.Give freshly prepared food
Keep the cooked food covered

QUALITIES OF complementary FOODS

Weaning food should be liquid at first, then semi solid and solid food to be introduced
.gradually
.Clean, fresh and hygienic, so that no infection can occurs
.Easy to prepare at home with the available food items and not costly
.Easily digestible, easily acceptable and palatable for infants
High in energy density and low in bulk viscosity and contains all nutrients necessary for the
.baby
.Based on cultural practice and traditional beliefs
Well-balanced, nourishing and suitable for the infant

-COMPLEMENTARY FEEDING AT DIFFERENT AGE

to 6 months 4

.Weaning to be initiated with fruit juice

Within one to two weeks new food to be introduced with soji, biscuit socked with milk,
vegetable soup, mashed banana, mashed vegetable. Each food should be given with one or
.two teaspoon at first for 3 to 6 times per day

to 9 months 6

Food item to be given at this period include soft mixture of rice and dal, khichri, pulses,
mashed and boiled potato, bread or roti soaked with milk or dal, mashed fruits, egg yolk,
.curd
.Amount of food should increase gradually

-to 12 months 9
More variety of household food can be added. Fish, meat, chicken can be introduced. Food
.need not to be mashed but should be soft and well cooked

- to 18 months 12

The child can take all kind of cooked food. The amount and frequency should increase
.gradually
- PROBLEM DURING WEANING

If on starting weaning, breast feeding is stopped suddenly, it can have adverse psychological
effect on the child. Weaning food, if prepared unhygienic or not digested properly can cause
diarrhea. If weaning food are not nutrient rich, the child can develop malnutrition. Children
may develop indigestion, abdominal pain, diarrhea or rashes if they are allergic to certain
.foods

:ADVANTAGES

.It prevents malnutrition

.It prevents deficiency diseases, e.g. anemia
.Promotes growth

-:DISADVANTAGES

.It may lead to diarrhea, if the food is preparing an unhygienic way

Negligence in choosing nutritious weaning food can lead to either calorie, protein, vitamin or
.mineral deficiencies

ANTHROPOMETRY

Introduction

AnthropoS "man" and Metron "measurement Single most portable, universally applicable, *
inexpensive
Non-invasive technique. Reflect the current nutritional status

.Used to evaluate both under & over nutrition

Parameters of anthropometry

:Age dependent factors

a) Weight
b) Height
c) Head circumference
d) Chest circumference

:Age independent factors

a) Mid-arm circumference (1-5 years)
b) Weight for height
C) Mid upper arm/height ratio

Weight

:The weight can be recorded using a

Beam type weighing balance
Electronic weighing scales for infants and children
Bathroom type of mechanical scale (very unreliable)
Salter spring machine (in field conditions)
aby Weighing Scale
Length or Height/Stature
Measurement Technique
Length- child less than 2 years of age
Measured using infantometer
If child > 2 years of age, we measure height using Stadiometer affixed on the wall which
provides a direct read out of height with an accuracy of 0.1 percent
Height is <length - the ligaments are opposed in standing position
Technique of length measurement
.The infant is placed supine on the infantometer
Assistant or mother is asked to keep the vertex or top of the head snugly touching the fixed
.vertically plank

The leg are fully extended by pressing over the knee, and feet are kept vertical at 90° , the
movable pedal plank of infantometer is snuggly apposed against sol and length is read from
.scale

Technique for height measurement

.Children( stand staight ) - stadiometer

Child should stand with bare feet on flat floor

Child against a wall -feet parallel, heels
.buttocks, shoulders and occiput touching wall
.Head should be kept in Frankfurt plane

Wooden spatula or plastic ruler, the topmost point

of the vertex is identified on the wal

Growth chart

Also called "road to health" chart

graphical display of a child's physical growth and
development
.WHO chart is recognized internationally

WHO chart has two reference curves whereas chart

used in India as per ICDS scheme has five reference

.Curves

.chart is different for girls and boys

The term Macrocephaly refers to OFC (Occipitofrontal head

circumference) of more than 2SD above the mean while
Microcephaly refers to OFC more than 3SD below the mean for
.age, sex , height and weight

CHEST CIRCUMFERENCE

,It is usually measured at the level of nipples

.preferably in mid inspiration

Xiphisternum

In children.

5years down position=

years standing position 5>

Relationship betvween head size

:with Chest Circumference

At birth: head circumference > chest

.Circumference by upto 3 cms

At around 9 months to 1 year of age: head

,circumference = chest circumference

but thereafter chest grows more rapidly

.compared to the brain

:BMI WEIGHT FOR AGE PERCENTILES

:The weight status categories and percentile ranges for children are

BMI = Mass in kg /height in m2

OBESE
OVERVEIGHT: 85th to below the 95th percentile

greater than or equal to the 95th percentile

:NORMAL

5th to below the 85th percentile

UNDERWEIGHT: Below the 5th percentile

COUNSELING SKILLS, BREASTFEEDING FOR WORKING WOMEN, REFUSAL OF
BREASTFEED, NOT ENOUGH MILK

Maryam Ahmed

;Counseling Skills-Listening and Learning

Building Confidence and Giving Support and Checking Understanding
Counseling is a way of working with people in which you understand how they feel, and help
.them to decide what to do

Six skills for listening and learning

Skill 1. Use helpful non-verbal communication

Keep your head level

Keep appropriate distance
Pay attention
Remove barriers
Take time
Touch appropriately

Skill 2. Ask open questions

"?How? What? When? Where? Why"

Example: 'Closed' Questions
?Do you breastfeed your baby
Open' Questions'
?How are you feeding your baby
Closed' Questions'
?Does your baby sleep with you .1
?Are you often away from your baby .2

Skill 3. Use responses and gestures which show interest

Skill 4. Reflect back what the mother says

.My mother says that I don't have enough milk
?a) Do you think you have enough
?b) Why does she think that
?c) She says that you have a low milk supply

Skill 5. Empathize show that you understand how she feels

Skill 6. Avoid words which sound judging

?Does he suckle well
?Are his stools normal
?Is he gaining enough weight

Skills for building confidence and giving support

Skill 1. Accept what a mother thinks and feels

Accepting means responding in a neutral way, and not agreeing or disagreeing

Reflecting back' and 'responses and gestures which show interest are both useful ways to
show acceptance

Skill 2. Recognize and praise what a mother and baby are doing right

Skill 3. Give practical help

?Which response is more appropriate

".You should let the baby suckle now, to help your breastmilk to come in"
".Let me try to make you more comfortable, and then I’ll bring you a drink"