Pediatric Oncall- FEEDING YOUR CHILD FROM 1

FEEDING YOUR CHILD FROM 1 - 3 YEARS

Nutritional considerations: All parents wish their children to be healthy and there's a great deal you can do to give your child the best start in life as well as good health in later years. The first few years are of vital importance, for this is the crucial time when the foundations for future good health are laid. Food and nutrients are the building blocks in a good diet, which help them to form strong teeth and bones, muscles and healthy tissues. A good diet can also help to protect against illness.

A child's diet needs special care and planning- the requirements for energy and nutrients are high, but appetite is small and eating habits are likely to be finicky.

The diet therefore needs to be:

Made up of small frequent meals,
Diet to be "Nutrients Dense"-providing plenty of nutrients in small volume of food.

Particularly important nutrient include:
Iron: Iron deficiency is common in this age group as iron requirements are high but dietary intake is often low, especially if little or no meat is eaten. Foods rich in Vitamin C such as orange or tomato with evening meal eaten at the same time help maximise iron absorption. Good sources of iron are listed in Table 1.

Calcium: This is vital for the growth of bones and teeth. Requirements will be met as long as the child consumes enough milk and dairy products. Good sources of dietary calcium are listed in Table 1.

Vitamin A, C, D:
Vitamin A is needed for healthy skin and cell development and can be often be lacking in diets of this age group.
Vitamin C is important for the immune system and growth. It also helps in the absorption of iron, especially iron from non-meat sources (non heme iron). Vitamin intakes are often low in children who eat little.
Vitamin D is essential for calcium metabolism (breakdown of calcium) and can be synthesised through the action of sunlight on the skin. In winter, and if your child is always covered, make sure that you include dietary sources of vitamin D, along with vitamin D in tablet or liquid form.

Key nutrients and dietary sources (Table 1):

Nutrient	Important for	Dietary sources
Iron	Needed to make red blood cells and carry oxygen to the body as part of hemoglobin the blood.	Meat based (heme) sources- eggs, lamb, meat, liver, and kidney. Plant (non heme) sources - fortified cereals like cornflakes, bread, dried fruits, beans and pulses and green leafy vegetables (cabbage, spring onions, palak, methi, green beans)
Calcium	Essential for strong bones and teeth, blood clotting and nerve cells.	Non-Dairy based - Fish with soft edible bones, dark leafy vegetables, sesame seeds (Til).Dairy based products-milk, yoghurt (dahi) cheese, paneer,
Vitamin A	Formation and maintenance of skin, hair and membranes, needed for bone and teeth growth and help us see in the dark	Yellow and orange fruits and vegetables (peppers, tomatoes mango and apricots), dark leafy vegetables and dairy products
Vitamin C	Essential for structure of bones, cartilages and muscles.	Helps the immune system and the absorption of iron Citrus fruits, berries and vegetables (make sure you don't cook too soft) potatoes and fruit juice.
Vitamin D	Aids in bone and tooth formation and helps the heart and nervous system	Fishes like mackerel, Bombay duck and dairy products.

Now that we know which are the key nutrients for this age group, how does this translate to real food? Suitable foods are divided into Four Major Groups and a fifth Minor - or 'occasional' group. If you base your child's intake on these groups you'll be certain that all the important nutrients are provided.

Four Major Food Groups:

MILK AND DAIRY FOODS: Aim for 500-600ml of milk each day. It will provide energy for growth and calcium for strong bones and teeth.
Some ideas to try

MILK	Ragi porridge or cornflakes with milk Vermicelli cooked in milk Rice pudding, custard Rawa or Sago kheer Bread pudding
CHEESE	Cheese on Bread Cubes of Cheese Cheese on Vegetables Soup with grated Cheese Paneer in curries
YOGHURT (DAHI)	Add fresh fruit to Yoghurt Yoghurt with Sugar or Honey Yoghurt made into Lassi drink or Fruit Lassi To serve as "Kadhi"

BREAD, OTHER CEREALS AND POTATOES: Starchy staples form an important part of anyone's diet. They are also called as fillers. They provide energy, various nutrients and fibre. One can choose from variety of breads, cornflakes, maize, jowar, bajra, potatoes, yam (suran), rice, chapatti and rotlas.
Some ideas to try:

TASTY SNACKS	Cornflakes Popcorn Toast, Bun, Potato pattice Upma, Poha Pancakes, (Made from rice flour and Gram flour (Chana Atta) Palak Puri, Thepla.
MORE SUBSTANTIAL MEALS	Chapatti or Stuffed Paratha with Paneer or Dal or Potato Pulav or Khichri with Yoghurt Noodles or rice mixed with shredded omelette and vegetables Chapattis or Rotlas with vegetables or dal.· Omelette with bread or sandwiches. Omelette with bread or sandwiches.

FRUITS AND VEGETABLE GROUP: They contain lot of vitamins, minerals and fibre and also add variety to meals by adding colouring textures and flavours. Try and introduce lots of different types from early age.
Some ideas to try:

Stuffed parathas with vegetables
Spinach cutlets or Vegetable cutlets.
Theplas (Wheat flour mixed with Methi or Spinach)
Give Carrot sticks, Apple slices, Banana slices, Cucumber Slices, Tomato Slices, or Pineapple Slices as snacks.
Mix chopped or mashed vegetables with rice or Dal.
Use fruits in puddings

MEAT, FISH AND VEG. ALTERNATIVES: Protein is needed by young children to grow and develop. Meat, Fish, Eggs, Nut, Pulses, Beans, Lentils, Peas and Soya Granules (Nutrella) are good sources of proteins. If you are vegetarian, give at least 2 portions of vegetable servings to ensure enough proteins and iron in the diet.
Some meals to try:

MEAT AND FISH
· Boiled Egg, omelette
· Sandwich made with shredded chicken
· Egg on toast
· Lentil soup
· Sprouts boiled and made into chat.
· Dal or lentil curry with chapatti or rice.
· Fish curry with rice
· Mince meat cutlets.
· Or meat soup VEG. ALTERNATIVES
· Dal khichri
· Lentil soup

FIFTH GROUP - THE OCCASIONAL FOODS GROUP: It consists of -

Sugar: A small amount of sugar as mild sweetening is fine with foods in MILK Group.
Fatty and sugary foods: This group includes butter, ghee, oil sugar, biscuits, cakes, wafers, sweets, chocolates, ice cream, soft drinks and other sugary drinks.
- These foods should not be given too often, and when they are, only in small amounts. Too much will impair the intake of more nutritious foods from the other food groups and compromise the quality of diet. Children between this age group require around 25gms of fat per day.
- When teeth are in constant contact with sugary foods and drinks, they will decay. Therefore avoid using foods like cakes, biscuits, chocolate and such foods as reward.

Some Common problems:

Problems	Possible Solutions
Food refusal	Structured meal pattern3 meals and 2-3 small nutritious snacks Offer variety of foods with some favourites Offer small portions and praise your child for eating even a little Do not force feed Family mealtimes Happy, relaxed environment Do not offer sweets or favourite foods as reward instead reward them with a trip to park, zoo or taking out to museum.
Refuses to drink milk	Offer in small fun cup or through a coloured straw Add milk or cream (malai) to foods Include milk-containing foods like kheer, porridge, custard, homemade ice cream and lassi. Try flavoured milk or milkshakes.
Refuses to eat fruit and vegetables	Try mixing vegetables in other foods Include small amount of fruits or vegetables at each mealtime to allow opportunity to try Children learn by example- if parents and other family members eat fruits and vegetable then they are more likely to do so. Blend fruit drinks or milk shakes added fruit To prepare kheer or porridge with added fruits
Excessive milk drinking	Limit milk intake to 500-600ml per day Give milk after meals or at snacks time Use cup not bottle. Offer milk in small cups

Last updated on 25-03-2003

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