Welcome to SRCC Children’s Hospital, managed by Narayana Health. Today we’ll talk to Dr. Mahesh Balsekar, who is a renowned paediatrician of the city. We will discuss when should complimentary feeding be started for babies. Everybody knows that mother’s milk is the best feed for a baby but that is sufficient only till a certain stage. So when should we start complementary feeding, let us ask Dr. Balsekar. What is the right age to start complementary feeding or outside milk for babies? WHO and Indian Academy of Paediatrics’ guidelines suggest for the first 6 months the baby should be fed only breast milk. If the baby remains hungry or if the growth is insufficient, then at the age of 5 months complementary feeding can be started. Otherwise, for 6 months the baby should be exclusively kept on breast milk. In our country, the climate here is very warm. So many mothers feel that the baby should also be given water during these 6 months. So when we say exclusive breast feeding, does it include water too? So long as the baby is on exclusive breast feed, it does not need water, as there is sufficient amount of water present in the breast milk irrespective of the temperature. When we start feeding the baby with solid foods after 6 months, at that time we have to start giving water too. it is necessary to start giving water too. What kind of solid foods should be introduced to the baby first after 6 months and how should weaning progress further? Please tell us something about it. With what type of food should we actually start with depends upon different cultures as they have a different approach towards it. For example, in Kerala solid foods start with bananas, in Tamil Nadu rice is introduced first. in Maharashtra, khimti that is,rice and split green gram paste is given. In some countries, they start with vegetable soup first. What food to start first with, is not so important. Some people believe that fruits should not be introduced first for the reason that if the baby is introduced to sweet taste first it will not accept other tastes later. Normally, when you introduce solids you begin with pulpy vegetable soups like carrots, pumpkin, bottle gourd, sweet potato. Initially, we can introduce it in the form of a thin soup followed by mashed vegetables to thicken the soup gradually. It is important during the first 6 to 9 months not to add salt or sugar to baby’s food. The feeding process should be easy, slow and in a very relaxed manner Initially start with 1 – 2 spoonful of food. If the baby accepts it happily, increase the quantity gradually over 7 to 10 days to a small bowl. Gradually increasing the intake of food is important because if any allergy, intolerance or indigestion happens it can be noticed immediately. So we have to build the process slowly. If we are starting with vegetable soup, increase the quantity gradually over a week. After a week or 10 days, you can shift the baby to rich and split green gram polenta (khichdi) without salt or sugar but with clarified butter or ghee. Again feed the khichdi in the form of thick soup like consistency starting with 2-3 spoonfuls and gradually increasing to a small bowl. During the first two weeks this remains the menu. In the third week, we can add fruits like stewed apple or banana milk and gradually increase its intake. It is important to start solid foods slow, relaxed and easy because for the baby these tastes are new. So the baby will not be able to accept them happily. So it takes 7 to 10 days for the baby to accept the new taste. So we should start with 2-3 spoonfuls and increase the quantity gradually. No force or coercion should be used. It should be done in a slow and relaxed manner. When complementary feeding is introduced, breast feeding continues. So how many times once, twice or thrice should the baby be fed in a day? This is a frequently and most commonly asked question by all mothers. When solid foods are introduced, begin with once a day. Gradually increase the quantity over in 7 to 10 days. After this give solid foods twice a day. When you start solids first, it should be fed around the lunch time that is in between 12 – 1 pm. When twice a day, first feed should be at around10:30 – 11:00 in the morning, second feed at 6:30 – 7:30 in the evening. After two weeks start the third feed. The timing should be
10:30 – 11:00 am, 1:00 – 1:30 pm and 6:00 – 7:00 pm. When introducing solids thrice a day, you will be serving the baby with all categories of food. Namely, vegetable soup in the morning, split green gram polenta (khichdi) in the afternoon and fruits in the evening. At the age of 8 months, start the fourth solid food. That means breakfast, lunch, afternoon snacks and dinner. All the categories of solids should be included in these four feeds. Namely, fruits, vegetables, cereals and proteins like dal or pulses, etc. So by the time the baby is 8 to 9 months old, it is getting all categories of foods four times a day. Should the baby be given bottle feed, if so when? This is another frequently asked question, please tell us. Introducing bottle feed is a matter of personal preference. If the baby enjoys breast milk and has accepted solids happily, there is no need to introduce bottle feed till the age of 1. Quite a few babies need more nutrition. Working mothers too need flexibility. In such a situation, bottle feed can be introduced after 9 months. Since in the initial stages of feeding solids, the baby consumes less quantity, it should be supplemented with breast feed or bottle feed. If start at 8 or 9 months, breast feeding can be continued up to 1 year or more. When can the baby be given non-vegetarian foods like eggs, meat, fish, etc. and how? Non-vegetarian foods are high in protein but have high chances of
causing allergy to the baby. So, it is not safe to start non-vegetarian
food before the baby is 9 months old. Normally, egg yolk is introduced during 9th month. Once the baby accepts it, egg white (albumen) is introduced after 1 year of age. Even if egg is introduced earlier,there is no problem. Other non-vegetarian foods should be introduced after the baby is 9 months old. Vegetarians should understand that high protein non-vegetarian food is not essential for the baby as vegetarian food has ample protein, energy and calories for the baby. What are the vitamins not present in ample quantity in our food? If so, what are those vitamins and when should they be introduced like iron, vitamin D as some doctors prescribe them and some others do not. What is your opinion? Every baby needs vitamin D. If the baby is exposed to early morning sun rays for 10 to 15 minutes daily, vitamin D drops are not required. But it is difficult to implement. So most paediatricians suggest vitamin D for all babies within first two weeks of birth. Since Indian diet especially does not encourage formula or iron 45 which is present in precooked cereals, iron drops should be introduced depending upon the situation after 5 months and continued up to 1 year. If the baby has a low birth weight or is premature, additional dose of calcium, vitamins and zinc is required. Otherwise, for normal babies vitamin D and iron are sufficient till the age of 1 and no additional supplements are required. Thank you, Dr. Balsekar. You ve helped us by giving us detailed information. Our mothers are often confused about when and what to introduce in the diet of their babies. Particularly because food is very important for a baby’s growth. Thank you for clearing all the misconceptions. Thank you on behalf of SRCC Hospital too. Thank you, Dr. Bela for inviting.