Weaning

Weaning is the process of expanding the diet to gradually include foods & drinks other than breast milk to infant’s diet. It is considered as sweet but bitter period as it has both mixed feelings of joy and frustrations. Child may enjoy new flavours of food and at the same time may be frustrated by not receiving breast milk which is associated with feeling of closeness with mother. But weaning does not mean that this sweet bond of being fondled by mother ends. Weaning should be a gradual process so that new food should be welcomed without leaving child in frustrations.

Importance of weaning

From birth infant is totally dependent on breast milk for his nutritional needs as it is complete diet for the child. But slowly child has to move on to solid food to meet the growing demand of the body. So weaning is important for every child after a particular age for the following reasons -

• As the baby is growing, milk alone cannot provide complete nutritional needs and calories required for growth and development of child.
• Milk is poor source of iron therefore iron fortified food is required to be introduced to prevent iron deficiency anemia.
• Child needs certain minerals and essentials fatty acid for brain and visual development which are lacking in milk.

Though weaning is important but at the same time too early introducing solid food i.e before 4 months to child’s diet can be harmful for the following reasons -

• Gastrointestinal tract is too immature to digest and absorb solid food.
• There is absence of neuromuscular coordination which helps to move food from tip of tongue to the back of mouth.
• Kidneys are immature and cannot regulate the high solute load.
• Gastric, intestinal and pancreatic enzymes are not fully developed.

How to start weaning?

• Abrupt weaning should be avoided. It can be traumatic both for child and mother.
• Solid food should be introduced gradually and calmly. Don’t threaten or force food. Start with small amount of food and more frequently.
• Initially food should be prepared in breast milk or milk formula so it can be easily accepted by child.
• New food should be introduced mixed with familiar foods. Child should be given enough time for feeding without getting harsh on him/her.
• Weaning should be delayed if child is learning to adapt to the new environment such as - moving to new home / beginning of childcare / during starting of teething period.
• Reducing number of feedings over period few days to weeks makes child to adjust easily without making child irritated and fussy and at same time avoids problems of engorged painful breast. Mother can start up by reducing the time of feeding first and then by skipping or postponing feeding sittings.
• Avoid sitting in usual nursing area which remembers child about feeding.
• Child can be distracted by engaging in fun play activities during usual time of nursing.

Stages of weaning

• Stage 1: 4 to 6 month
• Stage 2: 6 to 9 month
• Stage 3: 9 to 12 month

Stage 1

Though weaning can be started at an early age of 4 months but still milk will constitute the major diet of infant and should be continued throughout the first year of life. Choice of the first weaning food depends on the local diet & food availability. Main concern at this age is to teach child to take food from spoon.

Don’t force food to the child. Be calm and gradual in introducing food. Child require time to remember the taste of food so same food should be tried for couple of days before child actually accepts it.

• Cereal used should be prepared with expressed breast milk or infant formula and is mixed to fluid consistency.
• Initially one to two teaspoonfuls of food is adequate, but this quantity is increased as the baby’s appetite increases.
• As the baby become accustomed to taking food from a spoon, the consistency of food is made thicker.
• If pureed fruits & vegetables are used, they should be prepared without addition of salt & sugar.
• Cereals such as baby rice or sago can be used as it is rich in starch.
• Mashed pureed starchy vegetables such as potato, sweet potato, cauliflower, lauki, and fruits such as apple, banana, pear, mango, chickoo can be given.
• At this stage all food must be sieved.
• It is important that iron rich cereals & green vegetables are introduced to prevent the development of iron deficiency anemia.

Stage 2

• As the child is growing he now needs food rich in iron and nutrients which milk alone cannot provide. Now it's time to introduce the child to cup.
• Child is now able to chew thus consequently minced and mashed food that includes small soft lumps can be given.
• At this stage babies must never be left alone while feeding because of the risk of choking.
• Gradually increase the amount of food.
• Introduce wheat based cereals such as khichdi, sooji halwa, dosa, pancakes.
• Enrich food by fermentation and germination.
• Raw soft fruits and vegetables can be given. e.g banana, apple.
• Cooked carrot, green beans and spinach are good choice.
• Eggs, meat and fish should not be given before 9 months.

Stage 3

• Breast milk or milk formula up to 500-600 ml daily should be continued.
• By the end of this stage baby should be eating similar foods to the rest of the family as three main meals with either drinks of milk or snacks between them.
• Food no longer needs to be mashed.
• The early morning milk feed is replaced by a drink of water or diluted fruit juice.
• Lightly cooked or raw food should be encouraged such as apple, pear, chickoo, banana.
• Boiled eggs, mixed seasonal vegetable soup, khichri, rice kheer, rice mashed in yoghurt can be included in diet providing good nutrition.

What is the right time to start complementary food?

American Academy of Pediatrics and World Health Organization recommends that weaning should start at six months of age. Child should be exclusively breastfed for first six months and breastfeeding should be continued at least for a year or longer if mother wants to or if child demands. With the introduction of solid food stuffs child may lose interest in being breastfed thereby making weaning easy.

First food

The solid food stuff with which weaning should be started is known as first food. The child should be introduced to the first food with the objective of including solid food in their diet and not to give them as full meals which can lead to constipation. The first food should be once which can be easily digested by the child. They can be mixed with breastmilk or formula milk which will be helpful in easy weaning without lending child in much of frustrations.

• First vegetables – mashed potato, pumpkin, butternut squash, sweet potato.
• First fruits – apple puree, pear, over ripe banana, papaya, avocado.
• Fruit juices – apple juice prepared at home by boiling and mashing it and then straining to extract clear apple juice.

Introduce child first to vegetables because fruits having sweet flavors are always welcome and can be introduced next. Fresh food should be preferred then frozen food.

How often and how much food should be given as beginner?

• For the first week one or two spoonful of mashed food mixed with milk is enough until child demands it more.
• To start up food can be given once a day for first week and then slowly increase the frequency.
• Same food should be given for at least three days so that child can remember the taste and starts accepting it more easily.
• Feed solid food to the child when he is not much hungry or after regular feed, as on empty stomach child will demand milk feed only without which he may land up in frustrations.

What Food stuff should be avoided?

There are certain foods which can be harmful and should not be given to baby before 12 months of age. These includes -

• Salt - Amount of sodium required by infant is very less and is supplied by milk itself. Further child don’t know the taste of salt and child’s kidneys which are immature at such a young age should not be burdened with extra salt excretion. It may lead to development of certain disease later in adulthood such as hypertension.
• Sugar - As the child’s taste buds does not know the taste of sweet so adding extra sugar means adding empty calories that should be avoided as it can only lead to development of lifelong taste for sweets which increases weight and chances of obesity later. To sweeten food, natural fruit extracts can be used such as soak dates in water overnight and then use date water as sweetener.
• Spices - It can be used but with precautions. Hot spices should be avoided as it can lead digestive system upset.
• Shellfish - As it can be cause severe allergic reactions. Further avoid fish containing mercury.
• Smoked food - These food are difficult to digest for young babies and should be avoided in too young child.
• Soft/ blue cheese
• Nuts and seeds - They can lead to choking if child accidentally inhales them. Some nuts may develop allergy e.g specially peanuts.
• Honey - Honey should be avoided below 1 year as it contains bacterium [clostridium botulinum] causing infant botulism - a serious condition.
• Citrus, berries and kiwi - They can cause severe reactions as child’s main diet is milk. Can be introduced after 6 months in control quantity.
• Cow milk - Below one year cow milk should not be served to child as it is rich in protein and fat which is difficult to digest. Further it contains high level of sodium and potassium which burden kidneys and on contrary lack vitamin E, iron and essential fatty acids thus leading to iron deficiency anemia.

Different food preferred for weaning

Child’s diet should be one which includes right amount of all nutrients such as protein, vitamin, minerals and carbohydrates but no single food can provide complete nutrition. So maximum variety of food should be given. At the same time food mixes should be encouraged.

Food for weaning can be grouped under different groups -

• Starchy food - These foods provides energy needed for growth and development .e.g bread products, cereals, rice, oats and potatoes.
• Fruits and vegetables - Fresh, frozen or tinned fruits and vegetable contain a wide range of vitamin and minerals which are helpful for development. E.g broccoli, peas, sweet corns, carrot, apricots, plums, peaches, cherries.
• Milk, cheese and yogurt - They are rich in protein, calcium and some vitamins and minerals. Milk fortified with vitamin D can be further beneficial.
• Meat fish and alternatives - Meat, fish, eggs, nuts and pulses such as lentils, kidney beans, chick peas and dhal are good source of protein iron and omega three fat.
• Food high in fat and sugar - e.g oils, butter and cakes. They are good source of energy but lack minerals and vitamins so these may be included in baby’s diet but in controlled quantity.