|Oral Rehydration Therapy and the Control of Diarrheal Diseases (Peace Corps, 1985, 566 pages)|
|Module Three: Nutrition and diarrhea|
|Session 7 - Nutrition during and after diarrhea|
Weanlings are particularly vulnerable to infection. Michael Gurney considers how this important time can be made safer and more beneficial for the baby.
Weaning does not refer only to the stopping of breastfeeding. It is the gradual process by which a baby becomes accustomed to semi-liquid and solid foods which increasingly complement breastfeeding. It is complete when the child is eating the regular family diet and breastfeeding has completely or nearly stopped. Phrases such as "the baby should be weaned at six months" can be very misleading.
Weaning is one of many changes that all take place together. The weanling child is becoming accustomed not only to new foods but to a new environment and to new physical and mental skills. He is very vulnerable to illness at this time.
When should weaning start?
The best way to wean varies according to the circumstances of each family. If a mother has to go out to work she may have to start giving extra foods earlier than is best for the baby, while continuing to breastfeed whenever she is at home. Where sanitation and cooking facilities are poor, she may be wise to start weaning foods later than is ideal.
In general, breastmilk is perfectly adequate until the baby is at least four to six months old, or weighs about seven kilograms. Other foods need to be introduced about this time to complement breast milk. They are unnecessary, and can be dangerous, if given earlier.
What makes a good weaning diet?
Texture: At first, the baby needs liquid foods. These become thicker until, by his first birthday, he is able to chew pieces of food. A good practice is to start with a porridge or pap containing the food ingredients mixed together into a creamy consistency.
Quantity: Babies have very small stomachs and are growing very fast. They need small amounts of foods which are rich in dietary energy. Little and often is the rule. At first weaning food is extra to breastfeeding; as time goes on it becomes the main food, and breastfeeding becomes less important. The frequency of feeding should increase rapidly until the baby is soon taking at least five meals a day plus breastmilk. Feeding should continue at this rate well into the baby's second year. Snacks, such as fruit, between meals are useful - as long as they are always clean.
Quality: Most weaning diets around the world are based on starchy staple foods such as rice, potatoes and cassava. This is fine as long as certain precautions are taken. Such staples are not nutritious enough in themselves. A porridge using the staple mixed with something extra is excellent. The best additions are peas and beans mashed with the skins removed; milk; meat (finely chopped) or other animal foods; plus dark green leafy vegetables or yellow-orange fruits such as papaya and mango. Suitable recipes and methods of preparing weaning mixes can be found and developed in most cultures.
Energy supplement: Many weaning porridges do not contain enough energy for the baby's needs. During cooking, the starch used in the porridge takes up water and becomes very bulky. Extra oil added to the porridge has two benefits: it adds energy (oil is very rich in calories); and the oil changes the consistency of the porridge, making it easier for the smallest babies to swallow. Oil should be incorporated in all weaning foods except where obesity is a problem.
Two other ways of reducing the bulkiness of weaning foods and making them better and easier for the infant are fermenting or roasting the staple grains. This is done in some parts of the world and can be of great benefit.
Economy: if people spend extra money to buy special weaning foods they are likely to give too little in order to make it last. Weaning foods made at home can be just as good as those bought from shops. In fact, some products sold for babies are very poor in nutritional quality. It is usually best to rely on foods available from the family pot.
Hygiene: Contaminated food is one of the most critical problems during the weaning period. In poor, unsanitary environments it is very difficult to avoid diarrhoea in young children. Breastfeeding provides a major protection against diarrhoea. Good hygiene is essential in preparing weaning foods and keeping them until the next feed. But it is difficult to feed a baby five or more uncontaminated meals a day, when the mother can only afford to light the kitchen fire once. Local technologies need to be used to resolve the problem.
Utensils: Bottles and rubber teats are difficult to keep clean. Moreover, in order for a weaning porridge to pass through the teat it has to be very dilute; therefore the baby risks not getting enough food. It is best to keep suckling from the breast, not the bottle. When food is mashed for a baby, avoid using sieves which are difficult to clean. A cup and spoon are suitable for giving weaning foods; this allows the mother to change the food from liquid to semisolid as the baby grows.
Breastfeeding: Breast milk is very nutritious and protects against infections. It also provides the close, loving contact that encourages secure development. As far as possible, breastfeeding should continue throughout the difficult process of weaning.
Dr Michael Gurney, Nutrition Unit, WHO, CH-1211 Geneva 27, Switzerland.
(From: Diarrhoea Dialogue: Issue 15, November 1983, p.6)