Breast milk remains the ideal, most nutritious food for infants starting from birth till 2 years of age. Till the age of six months, breast milk alone meets the infant’s energy requirements, thus making it crucial that infants are ‘exclusively’ breastfed till the age of 6 months. Breast milk is highly beneficial for an infant as it is the first immunization it receives from his/her mother; it reduces the risk of infectious diseases such as gastroenteritis, respiratory and ear infections and food allergies. The National Breast Feeding Committee and WHO recommend that all infants be exclusively breastfed for 6 months.

After the age of six months breast milk alone cannot meet an infant’s energy requirements, therefore it is important to introduce solid foods in the infant’s diet. It is important to remember that children are at the greatest risk of nutritional deficiency and growth retardation between the ages of 6 to 24 months, therefore around six months of age, introduction of complementary foods along with sustained breast feeding is essential. Appropriate and timely introduction of solid foods in an infant’s diet helps promote growth and development, preventing stunting and increasing a child’s chances for leading a healthy and productive life as an adult.

Lack of breast feeding and a poor nutritional intake, inappropriate introduction of solid foods during the first year of life and incorrect weaning practices are some of the risk factors contributing to high infant and child morbidity and mortality rate in Pakistan and around the world. The indicators that reflect the health status of children under five in Pakistan show malnutrition to be a result of relative or absolute deficiency of one or more essential nutrients. The major nutritional problems comprise low birth weight due to poor maternal nutrition of proteins and various micro-nutrients such as of iron, zinc and iodine. The life long impacts of these poor nutritional practices include impaired intellectual, physical and social development, poor performance in school and reduced productivity in later life.

Weaning is the introduction of other foods to baby’s diet. It is important in the context of being a developmental, emotional, physiological and behavioral event.

However the addition of semi-solid food before the baby is 6 months old can adversely affect the intake of breast milk because the baby will be less hungry and would reduce suckling the breast which would lead to a decline in the quantity of breast milk. Early introduction of semi-solid foods can also lead to infections and other problems related to gastrointestinal immaturity at that age.

As a result of poor knowledge on the part of the mother regarding the nutritional requirements of her baby, many babies do not get adequate food between 6 months to 2 years of age. Case studies from India report that almost half of the cases of malnutrition in children are from households where there isn’t any shortage of food. The reason why food is not given to the child is that the mother does not know how much food the child needs or she does not recognize that her child is not growing appropriately as a consequence of malnourishment. Most mothers do not understand the importance of giving a semi-solid diet, expecting the child to go directly from a pure milk based diet to a solid diet consisting of roti and other food items.

Thus there are three important issues that emerge at this point. Firstly, it is important to decide what food should be given appropriate to the age of the child. Secondly, not just the kind of food is important but the quantity essential. Lastly, the frequency with which the food is given is another significant area to be addressed.

Appropriate Foods to Start Weaning at 6 Months:
It is best to start with boiled rice, potatos, or bananas. These may be mashed and mother’s milk added to make it semi solid. It is best not to give wheat based products till at least 10-12 months. In addition other seasonal fruits such as mango, papaya, chickoo can be also be given. Fruits which are not soft and cannot be mashed easily such as apples or pears may be cooked for a few minutes and then mashed. In addition to being breastfed on demand (at least 5 to 6 times per day) the infant should be given weaning foods 2 to 3 times per day. The amount given initially is small, about 1 to 2 teaspoons, the aim being to accustom the infant to taking food from a spoon and to swallow semi-solids.

Appropriate Foods at 6-9 Months:
Once weaning has been initiated and the infant is eating semi-solid food for example khitchri (mixture of boiled mashed rice and pulses), mashed vegetables can also be given from the food normally cooked at home. Green, leafy vegetables such as spinach and mustard leaves (sarson) are rich in vitamin A and iron and should be included in the diet 2 to 3 times per week. Green vegetables can be given separately, added to the daal (mixture of boiled mashed pulses) or to the khitchri. The amount given should be gradually increased so that by 9 months the infant is taking about ½ cup of khitchri, rice, or cereal and about 1 slice of bread or small roti with cooked vegetables or daal.

Breast feeding 5 to 6 times a day should be continued. Weaning foods should be given to the child 3 to 4 times a day before the infant is breastfed. Most infant foods are bulky and the child’s stomach is small (gastric capacity of a 6 month child is about 228 gm or one cup) therefore the infants often cannot eat enough to meet their energy requirement. Some oil in the food is good for the baby as it increases the energy density of the food.

Appropriate Foods at 9-12 Months:
The food at this age does not need to be mashed. Finger foods can be introduced during this stage. Besides, a large variety of foods can be given at this age, such as all wheat products, egg, meat and fish in addition to what the baby is already eating. Liver made into a puree can be given 1 to 2 times per week as it will provide the baby a good source of iron and vitamin A. The quantity of food a baby is willing to eat varies, but the infant should at least be breastfed 3 times per day or offered ½ cup of other milk if available. In addition to this, they should be fed 4 to 5 times per day with other foods besides milk. Infants should be offered appropriate amounts of food but should not be force fed. Different infants can consume different amounts of food at one time. If the child does not eat much s/he will need to be fed more often in the day. The child’s growth is a good indicator of whether the child is eating enough or not. Thus the child should be weighed every month and the weight should be recorded on a growth chart which is readily available from a local doctor.