1. Putting an older infant (>5-6 months) to sleep with a bottle in his mouth is discouraged because it may lead to dental caries, as well as the potential for future sleep problems, because the child associates sleep with having the bottle in his mouth. Most parents can wean the child from a bottle to a cup at the age of 9-12 months of age.
2. Routine supplementation of the food with “health tonics” and multivitamins is not recommended. The only exception is iron supplementation, which the child requires beginning at 4 months of age.
3. While the baby is being weaned and new foods introduced, it is but natural that the child has to develop a taste and liking for the texture and taste of the food. (It is also true in case of adults. If you are given a new thing to eat, say a dish of some foreign country, you will also take time and repeated eating of it to develop a taste for it). So, initially the volume of food consumed is less important than the experience of it. Because of this, it is recommended that parents give 1-2 spoons at a time of a new food daily and persist with the same food for 2 weeks before introducing another.
This is done to give time and opportunity to the child to “acclimatise” and “savour” the new food. In the initial stages, while taking the spoonful of food, the child is not experienced in co-ordinating the action of catching hold of the piece of food with his tongue and then pushing it back to be swallowed ultimately. So what you may find is that the child just clacks his tongue against the roof of the mouth, and most of the food gets squeezed out onto his chin. Some children initially have a strong tongue protrusion reflex and will push out the food offered with their tongue.
All this is normal and the parents should be aware about it, so that they anticipate it and don’t become discouraged. Children may even refuse the new food altogether initially, even on repeated offerings. In that case switch over to a new food item. However, foods previously refused can be periodically re-offered at a later time.
Parents should be mentally prepared and ready to accept (without getting irritated), some fun and mess while the child eats. They should allow the child freedom to explore food with his mouth and fingeis OT ‘with the spoon. It is but natural that the child will spill some food on his clothes, table and the floor. You can use your ingenuity and common sense to lessen the mess (like putting bib on his neck, which covers and hence protects his clothes; putting newspapers on the floor on which the child can sit while eating etc.).
But you should not prevent the child from having some fun. If you do that, the child may not find meal times pleasurable. Instead your constant worries about “messing” may adversely affect the child’s mood and he may start resenting meal times. You, also, will be tense with the “dreaded” anticipation of spillage and mess. So your major attention will be focussed on this; and you won’t be able to enjoy your child having fun experimenting with “novel ways” of eating.
5. Children need consistent mealtime rules and routines. Parents should strive for the following during meal times:
i. The mealtime should be in a pleasant, interactive atmosphere. The family should sit together and avoid distracting activities such as TV., magazine reading etc. during mealtimes. They should interact with each other and the child socially by conversation.
ii.The mealtime must not be a battleground between the child and the mother. Child’s wishes regarding eating should be respected and he should not be forced or pressurised to considering it as his “right to be fed.” Later on he becomes so habituated to “spoon feeding” by the mother that it becomes very difficult to take him off this habit and to make him self-feed.
iii.Efforts should be made to include the child in the table conversation instead of having long and detailed discussions between the adults only.
iv. The family mealtime is an excellent opportunity to find opportunities to praise and encourage the child for appropriate meal time behaviour.
v.Self-feeding should be most encouraged, even though it may be lengthy and messy. Often, the mother feeds the child (to avoid messiness, finish the meals quicker or out of “greed” that the child will eat more this way). This is not correct, as the child gradually becomes dependent on the mother for his feeding and starts
vi. Mealtimes should be of a finite duration (20-30 minutes). Leaving the table should not be contingent on “cleaning” the plate. Food not finished during the required time should beremoved, sometimes firmly.
vii. It is better to give small servings to the child, starting with small amounts, andoffering second servings rather than “piling” up the plate with lots of food.
viii. Excessive intake of liquids like milk, juices, beverages, cold drinks etc and continual “grazing” between meals should be avoided.
IX.Avoid pressure on the child related to either the type or the volume of intake.
X. Bribing the child to eat a particular food or to eat more is counter-productive and is best avoided. In fact, in the long run, it may increase the child’s aversion to food.
6. Don’t urge your child to take more than he wants as he is bound to resent it. He may try to escape from the “constant pressure” by rebelling or becoming balky. It is as though he gets the idea; “Eating is a struggle. The parents are constantly after me and so I have to fight to protect myself.” So don’t urge a child to take more than he wants. Let him enjoy his food, with you giving him the feeling that you are his friend, rather than his boss.
7. At the age of 1 year +, parents may find that the appetite of the child has decreased and that he has become choosy in his diet. This is in contrast to what the child was at 7-8 months, when he usually used to accept whatever was offered without much fuss. The big change that has come now is a normal phenomenon and is due to the issue of “autonomy and independence.” The child begins to realise that he is a separate person with a separate identity and mind of his own.
He no longer wants the mother to control him; instead he wants to be autonomous. The parents should be aware of this and realise that this is a part of growing up. They should respect this feeling of “autonomy” (often perceived as rebellion by the parents). Otherwise at meal times, the mother may want the child to feed something, which he may reject to assert his control. The dining table may get converted into a battlefield, with the mother and the child “battling” for control, trying to show who the boss is. But if the mother is aware of this phenomenon, she will let the child choose and eat himself without imposing her own wishes. Also she won’t be having the unpleasant feeling that the child is rebelling and “going out of control.”
Another notion mothers have is that their child should consume a lot of milk (whatever the age) and more often than not, one finds that the child balks at it and doesn’t want to drink milk. If at all he consumes milk, it is due to the “pressure” of the parents. I think the “over-stress” of the mothers on milk is due to the fact that they consider milk as a very nutritious and wholesome food. There is no doubt that milk is a wholesome and nutritious diet.
But one should also realise that at the age of 1.5 – 2 years, when the child has started eating almost like an adult (i.e. he eats all the routine things prepared in the household), his milk consumption will naturally decrease. How much milk an adult takes? Some, practically nil; yet do they suffer from any malnutrition? The same applies to the child also. Even if he consumes less milk, he won’t have any problems with his health as he is consuming other food items. Therefore the mother should not force the child to consume milk in the fear that without it, the child’s health will suffer.
9. A golden dictum is that a child will never self-starve. You have just to keep within his reach different food items. Once you realise this fundamental fact, you will not “coerce” or “bribe” him to eat more. A sure way to lessen the appetite of the child and convert him into a “problem feeder” is the “pressure” being applied on the child by you to eat more; but what it actually does is just the opposite. Because the child doesn’t consider this “pressure” as being pleasant, he loses the enjoyment of eating. On the other hand, if you leave the child free of pressures, knowing that the child will not starve himself; the child will relish eating as he now enjoys it. In this way, his wish to be autonomous is also maintained and he will not become balky.
Supplementation of the child’s diet with tonics or vitamins (e.g. B-complex syrups, vitamins A, C etc.) for otherwise healthy children is not recommended. Similarly, “appetisers”, calcium and vitamin D (to make the bones strong), protein supplements (to make the muscles strong), liver tonics (to make the liver strong so that he is able to “better digest” the food), tonics to increase the height of the child etc. are not required.
They do nothing else but burn a hole in the pockets of the parents without any objective benefit to the child. Unfortunately, selling medicines (e.g. children tonics) has become a big business where drug companies make a huge profit (at the expense of the parent’s hard-earned money). Obviously, these “tonics” won’t sell if the parents don’t clamour for them. Unfortunately, the parents think that without tonics, their child’s growth will not be optimal and so they unwittingly promote this “tonic selling business.”
I, in my day to day practice, hardly ever encounter a parent, who is not in “love” with the tonics. If the doctor prescribes a tonic, the parents are very pleased and eager to give their child that tonic. In fact, parents come to the doctor, bringing a perfectly healthy, active and smiling baby with no other complaints except that they want some tonic for their child. Imagine yourself in the doctor’s shoes. The patient has paid the consultation fees to get a very good tonic prescribed. Can the doctor refuse this request? Practically, it is very hard. So the doctor writes some tonic, though in his heart, he knows that it may not be really beneficial and required.
A healthy child won’t become deficient in calcium or vitamins or proteins. His liver and digestive capabilities cannot be improved by liver tonics. The height of a child is genetically determined and “tonics” do not increase it. Regarding the complaint that my child is malnourished (thin), in the majority of cases, it is only the subjective perception of the parents. Objectively it is not correct (as can be judged by the fact that the child is active and alert, has no anaemia or other signs of nutritional deficiencies, and his weight lies within the normal range).
But still parents are not convinced. In fact I hardly meet a parent who is satisfied with the eating and appetite of his child. They always feel that the child is not eating properly But this is not true, because to find a case of malnutrition in an educated middle or upper class family is very rare. Further the objective evidence (e.g. weight) proves beyond doubt that the child is not undernourished and thus it is only a parental anxiety. Agreed some children may appear thinner than others, but if you look at these “thin” children without a biased view, you will find that actually their growth is perfectly normal.
There is always a range of normalcy rather than any fixed “set point”. For e.g. a 1-year child’s normal range of weight falls from 8-12 kg. So if you see an 8 kilo baby and if you see a 12 kg baby (i.e. having 50% more weight), you may perceive a substantial difference in their built; but actually both of them are growing normally and certainly neither of them can be termed as malnourished. Parents should also remember that the constitution and built of a child is to a large extent determined genetically (i.e. like father, like boy).
The appetisers and tonics toted to stimulate the appetite and weight gain of the child can at the most, do so temporarily i.e. the weight gained will be lost once the medicine is stopped (much like the anti-obesity drugs). Drugs (e.g. anabolic steroids etc.) have a temporary effect, cannot be continued for a prolonged period of time (due to undesirable side effects) and once they are stopped; the weight reduces back to the original.
Bottom line: Do not be obsessed with the appetite and weight of the child. Whatever he eats is enough for him to be fit and healthy.