Nutrition Section What you will find in this section

This section will help you better understand your child’s nutritional needs. The information in this section includes:

• Why nutrition is important for a baby.

• Why breastfeeding is important.

• Solutions to common breastfeeding problems.

• What things contribute to a healthy diet.

• Knowing when, what, and how much to feed baby depending on her age.

• Important information about feeding a sick child.

Why nutrition is important

Good nutrition is critical for infants and young children. Good nutrition helps babies get what they need to grow and develop. Did you know that the right foods can help with:

Energy

Protection from sickness (immunity)

Growth (healthy height and weight)

Strength (muscle development, bone health)

Learning (brain development)

Do you want your child to be energetic and healthy? Good nutrition can help! Do you want your child to have a strong mind and be able to learn? Good nutrition can help!

What we feed our children matters. It can make the difference between a sickly child and a healthy, energetic child who not only survives but thrives!

Breastfeeding

I decided to ONLY breastfeed my child for the first 6 months because I know it will help her grow up healthy and strong. I know breastfeeding is hard. It takes time and patience. But I also know it is the best for my baby.

During the first 6 months of life (180 days), your baby needs ONLY BREASTMILK to grow well and be healthy. Continue breastfeeding your baby for 2 years or more.

Benefits of exclusive breastfeeding

Good nutrition begins with breastfeeding. Breast milk is the perfect food for your baby aged 0–6 months because it:

• Has all the nutrients your baby needs for the first 6 months of life

• Has enough water to satisfy the thirst of your baby even in hot weather

• Has substances that protect your baby from common diseases such as diarrhea and chest infections

• Is clean, safe, easy to digest, and readily available

Breastfeeding

from the first hour of birth: Early initiation

Mothers should be supported to begin breastfeeding immediately after delivery. Early initiation has many benefits. It:

• Strengthens the bond between you and your baby

• Helps your baby develop the ability to suckle properly

• Increases your breast milk production

• Provides your baby with the first milk (colostrum) which acts like your baby’s first immunization and protects him/her from illnesses and infection

• Clears baby’s first dark stool and helps intestines to mature

• Prevents yellowing of the skin

Dangers of mixed feeding (starting complementary feeding too soon, sometimes called “early introduction”)

Babies should receive ONLY breast milk for the first 6 months. Introducing other foods earlier than 6 months of age, can lead to increased illness in the baby and decreased milk production in mothers.

Healthy eating for breastfeeding mothers

Mothers are amazing — their bodies create one of the most nutritious foods in the world. But it’s a lot of work and mothers need some help too. While you are breastfeeding be sure to:

• Drink plenty of clean water. At least 8 cups of clean drinking water a day will help your body make milk.

• Eat more food. Breastfeeding mothers are making their baby’s food so they need to eat more than if they were not breastfeeding. A breastfeeding mother should try to eat 2 more meals in addition to 3 larger meals and snacks throughout the day.

• Eat a healthy diet. Many times, mothers will eat last from the family pot. But while you are breastfeeding you need to make sure to eat enough to feed yourself and give you energy to care for your baby.

• Everyday try to eat:

• Protein like eggs, flesh foods (like chicken or fish), or legumes

• Whole grains like rice, bread, or chapati

• Fruits and vegetables (dark leafy greens, orange fruits, and vegetables)

• Foods that have good fats like fish, nuts, seeds, avocado, or plant oil

Proper positioning, attachment, and effective suckling

To make it easy for your baby to suckle the breast easily and get a good supply of milk, you need to:

Position your baby correctly to the breast:

• Sit comfortably in an upright position to breastfeed your baby

• Use a pillow or folded clothes to support and bring the baby closer to the breast.

• Support your baby’s whole body, not just head or neck.

• Ensure that your baby’s head and body is in a straight-line during breastfeeding.

• Ensure that your baby is close to you, facing you and can get to the breast without turning his or her neck.

• Make sure your nipple touches your baby’s nose so that the baby can open his or her mouth wide to attach to the breast.

Attach your baby to the breast correctly. Signs that your baby is attached well include:

• Your baby’s mouth should be wide open.

• You can see more of the dark surrounding the nipple above your baby’s mouth than you see below.

• Your baby’s lower lip should be turned outward and should not go in.

• Your breast should be touching your baby’s chin.

• Support your breast with your fingers forming a half moon or “C” shape.

Signs of effective suckling

• Your baby should take slow deep suckles with pauses in between.

• You should see or hear your baby swallowing after 1 to 2 suckles.

• When your baby is suckling well, you should not feel any pain on your breast.

• Always allow your baby to finish suckling from one breast before switching to the other to get all the nutrients from the early and later milk.

Your baby is getting enough milk when she is gaining weight – at least ½ kg per month, passing light coloured urine at least six times a day and is active

To encourage your breasts to make more milk let the baby empty the breast of milk before switching to the other breast. When your breast is empty, it will feel soft. An empty breast sends signals to the brain and breast to make more milk.

Remember...

Breast milk has everything your baby needs until 6 months, IF you feed your baby whenever he or she is hungry.

Breastfeeding on demand

Breastfeed on demand day and night, as often as the baby wants. Some families think that breast milk alone is not enough, but as long as you breastfeed your baby on demand, breast milk is all your baby needs. Breastfeeding on demand also produces more milk. So, the more you breastfeed, the more you can breastfeed.

Look for signs of hunger: fussing, sucking/moving lips, opening mouth, sticking out the tongue, putting hands in his mouth, and making rapid eye movement before his/her eyes are open. Do not wait for your child to cry before feeding your baby. Watch your baby’s hands. A hungry baby will fist his hands, but a satisfied baby’s hands will be relaxed.

Continue to breastfeed on demand (whenever your baby wants it) for two years or beyond. Continue to breastfeed even as you add different foods to your baby’s diet.

Expressing breast milk

Expressing breast milk while you are away from your baby will help you to continue breastfeeding your baby, maintain milk flow, and prevent unpleasant breast conditions such as breast engorgement and mastitis (a painful infection of the breast).

You should express breast milk as often as your baby would breastfeed (every 2–3 hours). Expressed breast milk can be stored in a covered container for about 8 hours at room temperature.

For instructions on how to express breast milk, talk to your health provider.

Breast conditions

Many breast conditions, such as flat nipple, inverted nipple, full or engorged breasts, mastitis, and candidiasis can interfere with breastfeeding if not managed properly.

If you have cracked nipples: If your baby does not have a good latch on your breast it can cause cracked nipples that can be painful and may lead to an infection in your breast. You can prevent this by helping your baby get a good latch. You can moisturize your nipples with your own breast milk or cooking oil. You can also apply a clean cloth with clean, warm water.

If you have a warm, painful lump in your breast: You may have an infection in your breast. This can happen if you don’t nurse often enough or if your nipples are cracked. Visit the clinic or hospital to be treated for the infection.

While it may be painful, the best thing to do for both you and your baby is to continue to breastfeed. You can also apply a clean cloth with clean, warm water to your breast to relieve the pain.

Things to know if you are HIV+

If you are HIV+ and on antiretroviral therapy (ART), you can safely breastfeed your baby so he can get all the benefits of breast milk. As long as you don’t miss any ART doses your baby has very little chance of getting HIV, but can get a lot of benefits to from your breast milk.

Continue to breastfeed your baby for 2 years and beyond, and keep taking your ART.

Family Support

Breastfeeding mothers need support from their families and communities. Spouses, family members, and friends can help by:

• Allowing time and a comfortable space for mothers to breastfeed

• Helping with household chores, caring for older children, assisting the mother in feeding the baby with expressed breast milk and offering to take babies to their workplace for breastfeeding if necessary

• Ensuring mothers eat healthy foods so they can produce the nutrients they and their babies need to stay healthy

My wife always wants to feed me first, the kids second, and she eats what’s left over.

But when she is pregnant or breast feeding I know she needs more food to help my children grow healthy and strong so I encourage her to eat enough food.

Remember...

Only breast milk for the first 6 months Continue breastfeeding for 23 months

Complementary Feeding Giving other foods to your baby 6-23 months old baby

Breastfeeding should continue for 2 years and beyond. At 6 months, you will begin complementary feeding as you introduce new foods into your baby’s diet in addition to breast milk. But how can you make sure that your child is getting all the nutrition they need from their food?

Remember: “FATVAH.” FATVAH stands for:

1. Frequency (when to feed baby)

2. Amount (how much to feed baby)

3. Texture (the recommended thickness and consistency of baby’s food)

4. Variety (what to feed baby)

5. Active Feeding (how to feed baby)

6. Hygiene (cleanliness)

Let’s look at FATVAH in detail.

Frequency, Amount, and Texture

• Frequency: When or how often to feed your baby.

• Amount: How much a baby will eat changes as they grow. What size meals you should feed your baby depends on their age. It is important to make sure you are feeding your baby enough food for their age.

• Texture: The texture of your baby’s food is important as she is learning to eat solid foods and it will change over time. As your baby grows, he or she learns how to swallow and chew. To avoid choking it is important to feed the right food texture at the right age.

Frequency, amount, and texture change a lot as your baby grows so we are going to talk about them by each age group:

• 6 months

• 7–8 months

• 9–11 months

• 12–23 months

Understanding the icons

In the next couple of pages we introduce a series of icons to help understand when, what, and how often to feed your baby.

When

What

First foods Foods like porridge

How often

Snacks Meals

For example, if you see the image to the right it is telling you to one meal of first foods like porridge in the morning and breastfeed your baby on demand.

6 Months

At this age, your child should be able to sit without support. You should plan to feed them two things:

• Breast milk: Your baby will still be getting most of his nutrition from breastfeeding. Plan to breastfeed your baby about on demand but at least eight times during the day.

• First foods: As your baby starts to eat, begin with cereals like porridge, mashed potatoes, or mashed banana, etc. Do not feed your baby animal milk until they are 1 year old.

Frequency

• Continue to breastfeed your baby on demand but at least 8 times during the day and night.

• Feed baby aged 6 months 2 “first foods” a day — in the morning and the evening.

Amount Texture

2 to 3 tablespoons of porridge or pureed food in each meal

Start with thick porridge or well mashed/pureed foods.

A tablespoon is equal to the size of your thumb.

Porridge should not drip off spoon

When you are introducing new foods, remember:

• Do not force the baby to eat. This can cause them to choke.

• Be patient and actively encourage the baby to eat.

• Have relaxed and happy mealtimes. Encourage the baby to eat by clapping hands, making funny faces, saying encouraging words.

7–8 months

At this age, your child should be crawling. As he gets older, increase the amount of food gradually. Do not feed your baby animal milk until they are 1 year old.

Frequency

• Continue to breastfeed your baby on demand but at least 8 times during the day and night.

• Feed baby aged 7–8 months 3 “snack: sized meals a day.

Amount Texture

½ cup of food at each meal.

Mashed or pureed family foods.

A ½ cup is equal to half of a fist.

It’s best to make only what you will serve for one meal. Since babies this age eat so little it can be hard to make such a small amount if you do not have other children in the house. If you do have to serve the food later in the day, make sure it is covered to keep flies away and do not store the food for more than 4 hours. Reheat the food to the boiling point before serving it again so you kill any germs. Never store food overnight to give the baby the next day.

9–11 months

At this age, your child should be able to stand with objects. Between 9 and 11 months, a lot of new foods can be introduced. Do not feed your baby animal milk until they are 1 year old.

Frequency

• Continue to breastfeed your baby on demand but at least 6 times during the day and night.

• Feed baby aged 9–11 months 3 meals a day and 1 snack.

Amount Texture

¾ cup of food at each meal. A ¾ cup is equal to ¾ of a fist.

Give your baby one snack (ripe banana, mango, boiled potato, arrow root, or avocado) either between morning and afternoon or afternoon and evening meal.

Finely chopped food

Pieces should be no bigger than the nail on your little finger.

12–23 months

At this age, your child should be walking without support. During your baby’s 2nd year of life (from 12–23 months) you should be getting them used to eating from the family pot. Just be sure that the food is cut into small pieces they can chew and is not too spicy. You can begin to introduce animal milk at this age.

Frequency

• Breastfeed your baby every time he or she wants (day and night)

• Feed baby aged 12–23 months 3 meals a day, plus two snacks.

Amount

1 cup of food at each meal

Texture

Give your baby 2 snacks (ripe banana, mango, boiled potato, arrow root, or avocado) between morning and afternoon then afternoon and evening meals

Give your baby food from the family pot cut into small pieces to make it easy for him or her to eat.

Variety—A Diverse and Healthy Diet

It’s important for every member of the family to eat a healthy diet, but it is particularly important for breastfeeding mothers and young children. The best way to ensure your child has a healthy diet is to make sure they eat lots of different types of foods.

The food wheel divides foods into 7 color-coded food groups:

1. Flesh Foods

2. Grains, Grain Products, and Other Starchy Foods

3. Eggs

4. Pulses, Legumes, Seeds, and Nuts

5. All Other Fruits and Vegetables

6. Vitamin A Rich Fruits and Vegetables

7. Dairy and Dairy Products

Using the wheel will help you give your child the food they need to grow up strong, smart, and healthy. Each food group contributes to these important benefits for your child:

Your child should have foods from at least 4 different food groups every day. Make sure your child has foods from all 7 food groups each week. It is also important to eat a variety of foods within the food group as well. For example, try to eat a variety of different types of pulses, not just one type. All the recipes in this book will show you the food groups it includes to help you plan a healthy diet for your child.

There are also special foods that are full of nutrients and are affordable. These special foods will have a yellow star next to them.

Flesh Foods

These are flesh foods that help your child grow, be strong, and learn.

Foods included in the Flesh Food Group

Chicken

Cow Meat

Goat Meat

Organ Meats (like chicken livers or beef kidney)

Helpful hints for Flesh Foods

Fish

Omena (dried smoked fish)

Insects (like termites and grasshoppers)

• Focus on including foods (omena, insects, and organ meats) in your child’s diet. These foods are more affordable than flesh meats.

• Add ground omena or insects to your child’s food.

• Liver is a very nutritious. Your child only needs a small amount to get the benefits. Consider mixing it with leafy greens or other foods.

• Meat soup is not as nutritious as meat flesh. Modify the meat (mash, mince, grate, or cut the meat into small pieces) so it is easy for the child to eat.

• Keep poultry and small animals on your shamba.

I used to think cow meat was too expensive to feed my child. But he only needs a small amount. That makes it affordable to buy.

Grains, Grain Products, and Other Starches

These are grains, grain products, and other starchy foods. These are good basic foods that help with energy.

Foods included in the Grains, Grain Products, and Other Starches Food Group

Bread and Chapati Rice

Helpful hints for Grains, Grain Products, and Other Starches

• Flours included in food group can be a good source of iron. Iron is an important mineral that strengthens you baby’s muscles and brain.

You can increase the amount of iron your baby gets from flours by fermenting the flours. Fermented flours are also easier to digest and have vitamins that protect against disease. Fermentation also enhances flavor and color. The recipe section includes instructions on how to ferment flour.

• You can also germinate grains. Germinated food has more vitamins and is easier to digest.

• Do not mix many different flours together when preparing porridges for babies and young children.

Eggs

Eggs are extremely nutritious and help build strong muscles and smart brains.

Egg Food Group

All types of eggs including chicken eggs, duck eggs, and guinea fowl eggs.

Helpful hints for the Egg Food Group

• Eggs are a special food which means they are nutritious and affordable.

• Some communities resist feeding children eggs because they think eggs make a child unable to talk. Actually, eggs help children with language because they help build smart brains.

• For your child to get the important benefits from eggs, try to feed your child at least 2 eggs every week.

• Do not sell all your eggs, save some for your baby.

• Keep poultry on your shamba.

Pulses, Legumes, Seeds, & Nuts Food Group

These foods help your child grow and be strong.

Food in the Pulses, Legumes, Seeds, and Nuts Food Group

Helpful hints for the Pulses, Legumes, Seeds, and Nuts Food Group

• Many foods in this Food Group are special foods which means they are affordable and full of important nutrients. These include lentils, pulses and beans.

• You can germinate or “sprout” legumes (beans, green grams, lentils). Germinated food has more vitamins and is easier to digest. The recipe section includes instructions on how to germinate certain foods.

Vitamin A Rich Fruits and Vegetables

Vitamin A rich fruits and vegetables are important for brain power and a good source of vitamins. Dark green leafy vegetables are also rich in iron.

Foods in the Vitamin A Rich Fruits and Vegetables Food Group

Dark green leafy vegetables (spinach, kale, rocket, etc.)

Helpful hints for the Vitamin A Rich Fruits and Vegetables Food Group

• Dark green leafy vegetables (spinach, kale, amaranth leaves, jute marrow leaves, pumpkin leaves, etc.) are very nutrition and important to your child’s diet. There is a variety of dark green leafy vegetables including traditional vegetables.

• Try to feed these foods at least once a day.

• Orange fruits and vegetables are also very important. Consider growing orange fleshed sweet potatoes, carrots and pumpkin so they are always available to you. If you do not have a fruit trees, make sure to save some money to buy fruits at the market.

• Grow your own dark green leafy vegetables.

Di d yo u kn ow tha t yo ur favori te foo ds a s an a du lt a re ba se d on w ha t yo u ar e fed as a ch il d? S et you r ch il d up for a lifetime of he al th y ea ting b y in trod uc in g a di vers e an d he al th y di et e arly !

All Other Fruits and Vegetables

All fruits and vegetables provide lots of vitamins that help protect your child from sickness.

Food in the Other Fruits and Vegetables Food Group

Helpful hints for the Other Fruits and Vegetables Food Group

• Try to feed these foods every day.

• Do not buy “fruit” juice at the market. Bottled or canned juice usually has very little real juice and a lot of sugar. It is always better for your child to have the actual fruit rather than the juice, but if you do want to give your child fruit juice as a rare treat, squeeze it yourself from whole fruit.

• Do not overcook vegetables or you will cook out all the important nutrients. Vegetables that are cooked well but not over cooked still have their bright color and are able to be pierced by a fork but are not mushy.

• Grow your own fruits and vegetables.

• Edible wild fruits are also nutritious and can be included in your child’s daily meals.

Dairy and Dairy Products

These foods are milk and dairy products that help build strong muscles and bones.

Foods in the Dairy and Dairy Products

Milk (cow, goat, buffalo, and camel) Yogurt Cheese

Wait until your child is 1 year old before you feed them any animal milk including fermented milk.

Helpful hints for the Dairy Products Food Group

• Do not feed your family “raw” milk. It is best to boil milk and let it cool before serving it to kill any germs.

• Fermented milk is a great food with many health benefits. Consider making fermented milk at least once a week for your entire family. It can be made from cow, goat, or buffalo, or camel milk.

Active Feeding

Babies need to learn how to eat. Feed them with a lot of love and patience. Gradually introduce new foods and remember:

• Respond to your child with smiles, eye contact and speak or sing to your child during feeding time.

• Do not feed a child when he/she is tired and sleepy.

• Serve your child in his/her own bowl.

• Allow the child to finish chewing the food in his or her mouth before offering another spoon of food.

• Give babies 8 months and older food that he or she can hold with his or her fingers and eat by him or herself.

• Stay with the child throughout the meal and be attentive.

Helpful hints to eat healthy with less money

1. You only need a small amount of nutrient-dense foods to get the benefits; so you can purchase small amounts.

2. Eggs are very healthy, so do not sell all your eggs. Save 2 eggs a week for your child.

3. Consider affordable but healthy substitutions. For example, if your budget doesn’t allow you to buy meat today, consider buying offal.

I cover my food once I’m done cooking to prevent flies and bugs from contaminating the food with germs that cause diarrhea. Covering food can also help slow how quickly food will go bad.

Hygiene

Creating a healthy kitchen

A healthy diet helps your child grow up strong, but a healthy diet is not just about what you feed your child. It is also about how you prepare your food. Diarrhea is the second most common reason for death in children under 5. The good news is that safe food preparation can prevent many reasons for diarrhea and other food born illnesses. Here are some helpful hints to create a healthy kitchen and protect your children from illness.

Make sure your water is safe to drink. Treat water by either boiling it or using water treatment tablets or sachets to kill all the germs that can cause diarrhea and other disease.

Wash and dry utensils every time you use them. Some people only wash their utensils once a day, but this lets flies and animals contaminate them with germs that can make your family sick. Instead, wash utensils every time you use them.

Wash vegetables before cutting and peeling them. Cook them for a short time to prevent overcooking and eat immediately to preserve its nutritional value.

Cook meat, fish, and eggs thoroughly.

Store food while it is still hot. When you leave your food uncovered, flies can land on it leaving behind germs that can make your child sick. To prevent this, store all your food as soon as you are done cooking in a clean container with a lid.

Use clean containers to store foods and keep food covered.

Wash your hands with soap and clean running water before you prepare food. Wash your hands before you prepare any food. This includes after cleaning, feeding animals, or getting food from the garden.

Wash your hands and your baby’s hands and face with soap and clean running water before you feed your baby. The hands of babies must be washed with clean running water and soap before eating even if they are unable to feed themselves.

Keep food away from animals and children. Make sure any animals are kept away from your food and the food preparation area, so they do not contaminate food. You should also keep young children away, so they do not burn themselves on hot items while you are cooking.

Reheat your food until it is hot. Many people reheat food only until it is warm, not hot. Food must be very hot to kill any germs that got on the food while it was stored.

I used to wash my utensils once at the end of the day. But I found out that germs can live on them and make my baby sick. So now I wash them every time I use them.

Do not store cooked food for more than 4 hours. Only cook enough for the day and do not store cooked food for more than 4 hours. That means that if you cook in the morning, you need to use the food by the afternoon. If you cook in the afternoon, you need to use the food by evening. Do not store cooked food overnight.

I didn’t know that a child’s hands should be washed the same way as an adult’s hands. But now, I wash my child’s hands and face with soap AND clean water before she eats and after she goes to the toilet.

Keep your cooking fire outside. Smoke from a cooking fire is can be dangerous for your child’s lungs and can cause permanent damage. Make sure your fire is outside and your child is not near it.

Things to know about cooking fires

The smoke from cooking fires can be dangerous to your baby, young children, and pregnant women.

Smoke can damage a child’s lungs and brains. It happens so slowly that you may not notice it so the safest thing is to keep babies and children away from fires.

Smoke can also cause early birth and miscarriages; so if you are pregnant consider wearing a cloth over your mouth and nose while cooking over a fire.