Chapter-4 Diet for Pregnancy and Lactating Period
Pregnancy is a period when the baby develops in the mothers womb. It is a period of
about 9 months. Life begins from a tiny fertilized cell. This cell grows and develops into a
fully formed baby weighing about 2.5-3.5 kg. At birth. During this period several changes
occur in the mothers body. The placenta develops. Through the placenta oxygen and
nourishment reaches the foetus. The uterus increases in size, the breasts enlarge and
get ready to produce milk, the blood volume increases and so does the basal metabolic
rate. During pregnancy how much weight should a woman gain? A woman should gain
10-12 kg. During pregnancy. The unborn baby and the changes in the mother’s
body/tissues account for the weight gain.
Adequate weight gain during pregnancy ensures healthy infant at birth
Diagram
Foods to emphasize during pregnancy
Diagram
Which nutrients are of importance during pregnancy? Almost all the nutrients are
essential during pregnancy. However, some nutrients need more emphasis. These
include energy, protein, calcium, iron and iodine
Physiological Changes During Pregnancy:
Increase Basal Metabolic Rate Due to the foetal growth and development there is an
increase in basal metabolic rate which rises by about 5% in the 1st trimester reaching to
a high as 12% during later stages of pregnancy, when the rate of foetal growth is very
high.
Gastrointestinal Changes There is altered gastrointestinal function during pregnancy.
Nausea, vomiting and constipation occur which indicate reduced gastric tone, motility
and secretion. Women even have cravings for some abnormal substances such as clay,
starch etc. And this habit is known as ‘PICA’.
Hormonal Changes Progesterone and estrogen are two hormones that have major
effects on maternal physiology during pregnancy. The chief action of progesterone is to
cause a relaxation of the smooth muscles of the uterus, so that it can expand as the
foetus grows. Relaxation of the muscles of GIT reduces motility in the gut, allowing more
time for nutrients to be absorbed. However, slower movement can lead to constipation
commonly experienced by pregnant women. Progesterone also induces maternal fat
deposition and increases renal sodium excretion. The secretion of estrogen is lower
than that of progesterone during early months of pregnancy but it increases appreciably
after the 100th day of gestation. Estrogen and progesterone stimulate the growth of
mammary glands and also inhibits lactogenic function of the pituitary gland until birth
of the infant.
Changes In Body Fluids There is an increase in blood volume by nearly 40 percent to
enable the circulation of a larger amount of blood, the capacity of the heart to pump
blood is increased by about 33%. The increased amount of blood is required to carry
nutrients to the fetus and metabolic wastes away from foetus. The hemoglobin level of
12 to 13 g for healthy non- pregnant woman drops to about 11g despite an increase in
total haemoglobin content, i.ie., haemodilution occurs. During pregnancy normal Hb
levels are 11g/100ml and id it below 11g/100ml considered anemic.
Alter Renal Functions Due to foetal and maternal metabolism during pregnancy, there
is an increased production of various metabolites like creatinine, urea and other waste
products. The rate of blood flow through the kidney is increased with a subsequent
increase in the rate of glomerular filtration in the nephrons.
Blood Composition: The plasma volume increases on an average by about 50 percent
and the red cell mass by about 20 per cent. The concentration of hemoglobin and the
packed cell volume usually fall despite the absolute increase in total hemoglobin.
Water Balance: The Total body water may increase by as much as seven liters and in
the late pregnancy, the kidney may have some difficulty in disposing of the surplus
water ingested.
Weight Gain: The weight gain in pregnancy, its nature and significance should be
considered. The gain in weight for the healthy woman who enters pregnancy should
average 9-10 Kg. Gain in weight varies widely, being somewhat greater in young women,
than those who are older, and greater in those who are having their first babies. The
weight of a woman who has gained 8-10 Kg. During the first trimester should not be held
to the restricted 9-10 Kg. Such a restriction could seriously interfere with the supply of
nutrients to the foetus. On the other hand, a woman who has gained little during most of
her pregnancy cannot expect to make up entirely for this deficiency by considerable
increase in weight during the last trimester. For obese women, restriction of calorie
intake to maintain weight or even to lose weight, is no longer advocated.
Nutritional Requirements During Pregnancy
Diagram
Energy
(Thiamine, Riboflavin & Niacin)
Protein
Iron
Calcium
Folic Acid
Vitamin B12
Zinc
Iodine
Energy. A calorie requirement during pregnancy is increased for maintaining the growth
of the foetus placenta and maternal tissues and for the increased basal metabolic rate.
In early pregnancy it is minimal but rises sharply towards the end of the first trimester
and then remains more or less constant for the second and third trimesters. The extra
energy requirement for pregnant woman is additional 300 kcal per day during 2nd & 3rd
trimester of pregnancy
Increased energy needs increase their needs Thiamine 0.2mg Riboflavin 0.2 mg Niacin
2.0 mg Include sprouts & fermented foods in the diet.
Protein: There is an increased demand for protein during pregnancy particularly in the
second half of pregnancy. The normal protein requirement of adult women is 1gm/kg
body weight. During pregnancy the Indian Council of Medical Research recommend an
additional 15 gm/day.
Fat Dietary: fat intake during pregnancy and lactation (as a proportion of energy intake)
should be the same as that recommended for the general population. The omega-3
long-chain polyunsaturated fatty acid (n-3 LCPUFA), docosahexaenoic acid (DHA), must
be deposited in adequate amounts in brain and other tissues during fetal and early
postnatal life.
Iron: More iron is required for fetal demands & mother’s blood volume increased 50%.
During pregnancy additional 8 mg (30+8)=38 mg. Without enough iron the fetus will
draw its supply from the mother, often leaving her anemic. Include iron rich foods-Green
Leafy Vegetables, Bajra, Riceflakes, soybean, egg yolk, liver etc. Iron absorption can be
improved by taking vitamin C rich food such as amla, citrus fruits or juices. Iron is
needed in larger doses, especially in the later stages of pregnancy, and cannot be met
by diet alone, an iron supplement can alleviate this condition.
Calcium: Calcium is essential for the calcification of foetal bones and teeth and also
for storage to meet the high demands during lactation. Additional 600 mg
(400+600)=1000mg Use of vitamin D and calcium reduces muscular cramps of
pregnancy. Dairy products, fish, green leafy vegetables give the calcium in your diet.
Phosphorous: The RDA for phosphorous is the same for pregnant women as for non
pregnant women.
Fluoride: The adequate Intake (Al) for fluoride in pregnancy is 3mg/day
Magnesium: The new RD A of 360-400mg of magnesium in pregnancy includes an
increase of 40-90 mg to meet the needs of fetal and maternal tissue growth.
Sodium Metabolism is altered during pregnancy under the stimulus of a modified
hormonal milieu Glomerular filtration of the increased murternal blood volume typically
leads to the filtration of am additional sodium load of 5000 to 10,000 mg/day
consumption of sodium should not be less than 2 to 3 mg/day.
Zinc & iodine: Zinc is required for growth & protein synthesis. The RDA for zinc is 15
mg/day during pregnancy iodine is required for normal physical & mental growth of the
foetus. An additional increment of 25 mg/ day of iodine over the RDA of 175 mg/day has
been proposed as adequate to cover the extra demands of the fetus for iodine
Folic Acid & Vitamin B12 :Pregnancy increases a woman’s need for folic acid & Vit B12
to 400 ug & 15 ug The need for folic acid & Vit B12 is essential to the formation &
development of red blood cells.
RICH SOURCES OF IMPORTANT NUTRIENTS
Iron Green leafy vegetables, whole grains, cereals, dry fruits, nuts, meat, jaggary
Calcium Milk, milk products, sesame seeds, almonds, soya milk, turnip, egg
Vitamins Orange and dark green vegetables, citrus fruits, appile, tomato, amla,
vegetables, meat, fish, eggs, sunlight, milk and milk products, soya products
Proteins Paneer, milk and other milk products, combined grains, seeds, nuts, egg,
meat, poultry, soya beans
Fats Butter, ghee, oils, nuts.
Caffeine
Risk for miscarriages, premature deliveries and Small for Date infants Avoid caffeinated
foods, beverages like Coffee, tea, cocoa, cola & medications
Smoking
Placental abnormalities Foetal damage Foetal & neonatal mortality Malformations
Alcohol
Low birth Weight Malformed structures (eyes, nose) Imapaired CNS performance
including mental retardation. Defect in body system.
Special Consideration in Planning Diet for Woman with Problems Related to
Pregnancy
During pregnancy certain digestive problems commonly occur, which lead to nausea,
vomiting, heartburns, feeling of heaviness and fullness, constipation etc. Let us
consider how to overcome these problems? Overcoming Morning Sickness (Nausea,
Vomiting)
Provide carbohydrate-rich food/food preparations like biscuits, bread, rusk etc, to the
pregnant woman early in the morning (preferably with bed tea).
Avoid foods which have a strong odour or flavour. Overcoming Heartburns, Feeling of
Heaviness/Fullness
Restrict fatty/fried foods. Puries, pakoras, parathas and other such fried food should be
served judiciously
Avoid eating too much at one time. Space the meals
Increase the meal frequency. Take small but frequent meals. A 5-6 meal pattern would
be acceptable. Preventing Constipation in Pregnancy
Include plenty of fibre-rich foods in the diet. Green leafy vegetables, other vegetables in
form of salads, whole pulses (bengal gram, black horse gram). These foods have
sufficient amount of fibre.
Include adequate amount of water/fluids in the diet. Water (atleast four to six
glasses/day) other drinks/beverages such as milk, butter-milk, coconut water, lime
juice, fruit juice etc. Should be taken in between meals.
Preventing Nutritional Anaemia
Consuming iron-rich foods (green leafy vegetables, black gram, bengal gram, jaggery,
rice flake, liver, egg etc. Alone will not help meet the increased iron need during
pregnancy. All pregnant women must take iron and folic and tablets, starting from the
second trimester onwards. The iron-folic acid tablet providing 60 mg iron and 500 mg
folic acid daily is recommended. Also the use of iodized salt is beneficial
Give iron/folic acid tablets during pregnancy
Diet During Pregnancy
You need to eat one extra meal a day during pregnancy.
Take milk and dairy products like curd, buttermilk, paneer-these are rich in calcium,
proteins and vitamins.
Eat fresh/seasonal fruits and vegetables as these provide vitamins and iron. Cereals,
whole grains and pulses are good sources of proteins.
Green leafy vegetables are a rich source of iron and folic acid.
A handful (45 grams) of nuts and at least two cups of daal provide daily requirement of
proteins in vegetarians.
For non-vegetarians, meat, egg, chicken or fish are good sources of proteins, vitamins
and iron.
For Overweight Pregnant Woman During Pregnancy
Reduce Sugar, Refined Cereal and Od Moderate Consumption of Nuts and Oilseeds
Undernourished Pregnant Woman Should Gain Minimum 13 kg During Pregnancy.
Increase Pulses Oil and Nuts
Diet Chart for Normal Pregnant Woman and Malnourished
(Undernourished/Overweight) Pregnant Woman – South India
Table
Food Options
Breakfast: Khara Bhaath, Kesari Bhaath, Ragi Dosa, Besibele Bhaath, Vangi Bhaath,
Khara Pongal, Sweet Pongal, Akki Roti (Rice), Ragi Roti, Dosa, Sambar, Coconut
Chutney, Idli Sambar Chutney, Puttu (Steam Cake) Appam, Upma, Uthappam,
Idiyappam, Puri and Curry, Chapati and Curry, Pongal, Egg Curry, “Fish Curry, etc.
Snacks: Idli, Upma, Bonda, Murukku, Bhajji (Chilli, Capsicum, Banana), etc. Lunch &
Dinner: Rice, Sambar, Aviyal, Koottucurry (Boiled Vegetables With Coconut Gravy), Mix
Veg Curry, Chapati, Kootu, Jowar Roti, Stued Brinjal, Mushroom Curry, Gogurapachadi,
Bottle Gourd Corry, Ragi Mudda, Fish Curry “Chicken Curry, “Fish Fry, etc. Sweets
Payasam, Peanut Chikki, Mysore Pak, Til Seeds Laddu, Rava Kesan, Ragi Sweet Adal,
etc.
Green Vegetables: Palak, Fenugreek, Amaranth, Moringa Leaves, Gongura Leaves,
Coriander, Mint, etc.
Fruits: Banana, Jack Fruit, Orange, Guava, Apple, Grapes, Mango, etc. Other
Vegetables: Carrot, Beans, Pumpkin, Cabbage, Drumsticks, Bitter Gourd, Beetroot,
Potato, Brinjal, Parwal, etc.
Pulses: Moong Dal (Split and Skinned Green Gram), Chawli Dal (Black Eyed Beans),
Masoor Dal (Split Red Lentils), Sabut Masoor (Indian Brown Lentils), Toor Dal (Yellow
Pigeon Peas), Hari Matar (Green Peas), White Peas, Bengal Gram, Urad, Soyabean, Moth
Beans, etc.
Nuts: Groundnuts, Dried Coconut, Til, Water Melon Seeds, etc
Points to keep in mind for diet of pregnant woman
Type of recipes, time of consumption and frequency may vary according to the region
and cultural preferences and convenience but amounts provided in the diet chart need
to be followed to meet adequate dietary requirements
Use up to 30g oil (20g of vegetable oil and 10g butter or ghee) per day for Normal
Pregnant Woman, 35g oil (25g of vegetable oil and 10g butter or ghee) for
Undernourished Pregnant Woman and 20g oil (15g of vegetable oil and 5g butter or
ghee) for Overweight Pregnant Woman
Use double fortified salt (Iron iodine) during preparation of the meal. Restrict salt usage
to <5g per day
Cereals may be replaced twice or thrice per week with millets (Nutri-cereals), use
whole wheat and less polished rice and avoid refined wheat our and highly polished
rice.
Lactation
Lactation is the period after child birth. During this period the mother nourishes a fully
developed and a rapidly growing baby with breast milk. An Indian woman produces
approximately 700-800 ml milk/day. All the nutrients required by the baby are provided
by breast milk which is primarily derived from mother’s blood. Lactation therefore is a
period of great importance for the woman and the quantity of milk produced is largely
dependant on mother’s diet. A good nutritious diet is therefore very important during the
period of lactation. Which nutrients are of importance during Lactation Energy, protein,
calcium, vitamin A and vitamin C are here to be emphasized, look at recommended
dietary intake during lactation which gives the recommended dietary intake during
lactation.
Infant depends to all his nutritional needs on mother’s milk
Exclusive breast feeding for 4-6 months of infant’s life
A well nourished mother on an average secretes about 850 od of milk/day
Severely malnourished mother, the level may go down to as low as 400ml/day
Factors of affecting Lactation
Physiology of lactation
Changes during pregnancy
Increased breast issue
Maturation of structure
Hormonal controls
Prolactin: stimulates milk production
Oxytocin stimulates milk release
“let-down” reflex
Nutritional factors
Poor nutrition of the mother reduces quantity of milk production
Quality and composition of milk may be maintained to some extent.
Mother’s own body stores are used.
Quantity of milk being less, the total amount of nutrients available toa child from a
poorly nourished mother is low.
Psychological factors
Mother’s willingness to nurse
Neuroendocrine stimulation & let down reflex
Cry or the thought of the baby lead to milk ejection.
emotions like fear, anxiety, worry, grief or anger may retard milk secretion.
Mother should regard lactation as a pleasant experience
Social
Lactation has declined
Increasing urbanization and industrialization
Women working outside home
Attitudes
Modern social values.
Inculcation of sound values which help to promote and encourage breast feeding
Facts About Breastfeeding
Most critical in first few weeks
Colostrum:
Immunological factors
Antibodies to diseases to which mother has been exposed
Benefits of Breastfeeding for the Infant
Provides favorable balance of nutrients with high bioavailability
• provides hormones that promote physiological development
• Improves cognitive development
• Protects against a variety of infections
• Reduces risk of SIDS
• Protects against some diseases such as diabetes
• Decreases risk for allergies
Benefits of Breastfeeding for the Mother
• Contracts the uterus
• Mother returns to pre-pregnancy weight faster
• conserves iron stores (by prolonging amenorrhea)
• Reduces risk of breast cancer
• Protects bone density.
• Saves money and offers convenience!
Energy
• Production of 100 ml of milk (67 Kcal) requires 85 Kcal expenditure.
• A well nourished mother on an average secretes about 850 ml of milk/day.
• The additional intake of energy recommended during the first 6 months
• Of lactation is 550 Kcal/day and 400 Kcal/day from 6 months – 1 year.
Protein
100 ml of milk has 1.1 g protein 70% of dietary protein is converted to milk protein an
additional intake of 25 g during the first six months 18 g during 6-12 months of lactation
is recommended.
Fat and EFA
If severe energy restriction leads to maternal fat depot being used. Breast milk
produced has similar fatty acid composition, to maternal fat. ICMR suggests daily intake
of 45g of visible fat. The requirements of linoleic acid during lactation is higher l.e. 6
energy%.
Calcium
Total calcium secreted through milk is about 300mg/day, ICMR has recommended a
daily intake of Ig calcium.
Fluids
Increased intake of fluids for adequate milk production, since milk is a fluid tissue. If
inadequate fluid intake, then suboptimal quantity of milk production. Water and
beverages such as juices, tea, coffee and milk all add to the fluid necessary to produce
milk.
Galactagogues
They are those foods that help to produce more milk. For example-ajwain, methi seeds,
saunth, till seeds
In addition, they may also supply protein, iron, calcium and B-group vitamins.
Foods to include in the Indian diet plan for lactating mothers:
When a mother is breastfeeding, she needs to include galactagogues in her diet.
Galactagogues are those foods that facilitate milk production and increase it. You must
eat foods that give strength and speed up the process of healing in earlier times, the
mother was made to eat khichdi more often but nowadays doctors recommend eating a
normal diet after 2-3 days of delivery. Here are some foods that should be included in
the Indian diet plan for lactating mothers:
Proteins:
The baby is in the growing stage and needs lots of proteins. Mothers must eat lots of
proteins for 2 reasons one to meet the growing baby’s requirement and for self-healing
Protein Foods to include in lactating mothers diet:
• Soybean, chicken, grilled fish, and egg whites can be included in less spicy and
grilled form after 15 days of delivery.
• Mothers can also get proteins by drinking a glass of milk along with a spoon of
protein powder recommended by the gynecologist. Take Milk 2 times a day.
• Soaked Almonds (15 pieces per day).
• Vegetarian moms can include a lot of orange masoor dal as it helps in increasing
the milk supply. You can also include Mung dal, Paneer and cheese in your diet
• Avoid Curd intake in the first 2 months after delivery. You can start eating curd
from 3rd month onward.
• Consume Chickpeas and lentils in lesser quantity, Introduce these foods in the
mother’s diets after 20-25 days of delivery.
• If you feel that lentils are hard on your digestion or your baby’s digestion, Skip it
till your baby turns 3 months old, then reintroduce these foods. Lentils are gascausing foods and a little harsh on the digestion of the newborn
Liquids:
A lactating mother should drink ample liquids since it helps in milk production. Less
intake can lead to dehydration and decreased supply of milk
Liquid foods to include in a Lactating mother’s diet:
• Water and coconut water.
• Vegetable-based soups made out of spinach, bottle gourd, beetroot, and carrots
are super beneficial.
• Ragi kanji, buttermilk lafter 1 month of delivery) and milk, etc are good options.
• Drinking a liquid half an hour prior to feeding is most beneficial.
Whole grains:
Diagram of whole grains
Eat lots of whole grains and whole-grain foods since these are highly nutritious and
easily digestible.
Whole-grain foods to include in lactating mothers’ diet:
Whole wheat flour
Oats and broken wheat daliya.
Brown rice, quinoa, ragi, Museli, etc.
Vitamins:
Consume Green leafy vegetables and fruits periodically in order to get lots of vitamins
and minerals. They help in better milk production and a good let down effect. Vitamins
are essential for the proper growth of the baby and to get the systems to function
normally in a mother after delivery.
Vegetables and Green leafy foods to include in lactating mother’s diet:
Spinach, dill, and fenugreek.
You can include Pumpkins, bottle gourds, ridge gourds, Parval (pointed gourds) and
tinda
Carrots and beetroots are especially very good for the lactating mom and the growing
baby.
Beans can be included in your diet in little quantity after 20-25 days of delivery.
Fruits like Apple, pomegranate, pear, and papaya are good to have
Herbal teas or Herbal Infusions:
One can drink herbal teas prepared with ingredients that are safe to take while
breastfeeding. The biggest advantage of drinking herbal tea is that it doesn’t contain
caffeine, you can buy a ready herbal mix or make your own at home.
Ingredients to use for Homemade Herbal Infusions:
Ajwain or Gondh katira – Ajwain infused water is beneficial in correcting the digestion
issues and getting the entire digestive system to work right after the baby’s birth. It helps
the mother shed some fat and clear the blood clots with easy.
Mint leaves and some Cloves or sount / fennel seeds This drink increases the milk
secretions and thus facilitates lactation.
Lemongrass and Ginger-Ginger helps a lot in healing and as a pain reliever in women
after delivery.
Iron and Calcium:
A lot of women stop taking their Iron and calcium medicines after delivery. If you do so,
Eat foods that are rich in iron and calcium. The mother loses lots of blood during
delivery and needs to renew her iron stores. Calcium is needed for the healthy bones
and teeth of the baby. It is also needed to replenish the lost calcium from his mother’s
body.
Sources of Iron food in lactating Mothers diet:
Non-vegetarian mom can include liver and organ meat of chicken and duck.
Meats like pork, lamb, and beef,
Seafood like oysters, sardines, mussels, and shellfish
Vegetarian moms can include dry beans, black eyed peas, and green peas.
Cabbage, broccoll, kale, and turnip greens.
Foods soaked in iron vessels with tomatoes will also provide some iron
Pressed rice (Poha) and Puffed rice are good sources too.
Replacing Sugar with Jaggery can help too
Sources of Calcium food in lactating Mothers diet:
Milk and milk products like curd, cheese, and paneer.
Fishes with soft bones like salmon, anchovies, and sardine
Leafy vegetables like kale, mustard greens, and turnip tops.
Ragi, sesame and Rajgeera.
Galactagogues:
Galactagogues are an essential part of a lactating mother’s meals. They help to
increase the milk supply and meet the growing needs of the baby. These can be easily
incorporated in our day to recipes and given to the mother. We have incorporated these
Galactogogues in our Indian diet plan for lactating mothers
Galactagogues foods that can be included in a lactating mother’s diet:
Shatavari, fenugreek and fennel seeds
Milk,
Almonds,
Orange Masoor dal,
Spinach,
Garlic,
Sesame and poppy seeds, and
Ragi kanji also help in increasing milk secretions
Foods to avoid in Indian diet plan for lactating mothers:A lactating mother needs to
eat carefully. She cannot eat certain types of foods yet since some foods are difficult to
digest and some foods are not good for the baby. Here are some foods that are better
avoided Indian diet plan for lactating mothers
Spicy foods:
Your child does get a taste of everything you eat so it is better to avoid spicy and strongly
flavored foods.If your child drinks spicy milk, he/she might not like to take a feed again.
Oily foods:
Avoid having too many fried and oily foods. Oily foods are heavy and hard to digest.
Ghee and oil should be used in moderation while cooking food for a breastfeeding
mother since she doesn’t have much activity and this can lead to weight gain.
Cruciferous vegetables:
Vegetables such as cauliflower, broccoli, cabbage and asparagus are cruciferous. Avoid
them. These are difficult to digest and can cause infant colic and gas. Legumes like
rajma, chana and soya beans should also be avoided for the first 2-3 months after.
No aerated drinks:
Try not to rely on aerated drinks to quench your thirst as they only contain artificial sugar
and calories. Packaged juices are fattening too. Hence it is better to have homemade
fresh juices instead of buying packaged juices.
Caffeinated drinks:
Caffeine is best avoided as it is a diuretic and will only make you rush to the washroom
more often. They also cause heartburn and nausea. If you really want to have tea, try
herbal tea.
Cigarettes
Cigarette smoking can affect the growth of the baby. Hence it should be avoided.
Alcohol:
Alcohol contains nicotine and toxins which can prove to be harmful to the baby, thus it
is better to avoid drinking while you’re breastfeeding. It can pass on from the blood into
your breast milk and thus it can affect the baby adversely.
It is very important to not give up. There will be instances where you will feel or others in
the family will make you feel that your milk is not sufficient for your baby. The baby will
become cranky or demand more often for feeds. But these are all phases. According to
the baby sciences, every baby gets cranky and more demanding once in a month or 45
days on account of the sudden growth spurt. Deal with it. Be patient and don’t give up
on breastfeeding. These are the times when you get desperate and seek help and
support. Our Indian diet plan for lactating mothers is planned in such a way that it will
pacify you through such situations with ease.
Important Tips for an Indian diet plan for lactating mothers:
It is true that a lactating mather needs to eat for two people as long as she’s going to be
feeding the baby.
The mother must get sufficient nutrition else the baby will derive nutrients from the
mother’s body and she may suffer from nutritional deficiencies and many other
problems.
Lactating mothers feel hungry more often and they should eat whenever they feel so.
When a baby doesn’t get nutritious milk, She will become unhealthy and also demand
frequent feeds.
The stress should be on getting extra nutrition and not extra calories. This is important
both for the mother and the baby.
Extra calories are only going to add on the weight and will not help with the growth of the
baby nor will they give strength to the mother. Our Indian diet plan for lactating mothers
will give you an insight into the right food choices you need to make.
The fear of becoming Obese in Lactating Mothers:
Many mothers fear that they will become fat and look clumsy. You must remember that
your child is your first responsibility and his growth depends on you. Secondly, research
has shown that mothers who breastfeed their babies are able to shed weight more
easily than those who don’t. Let us now see the detailed indian diet plan for lactating
mothers.
Indian diet plan for lactating mothers:
Here is an Indian diet plan for Lactating Mothers for reference.
Table
Chapter-5 Meal Planning for Infancy, Childhood
Infants and Preschool Children
Infancy is a period of rapid growth. During the first year of life, the infant grows and
develops far more rapidly than at any other time in life. This is accompanied by a
number of important physiological changes. Let us get to know what these changes.
Physiological Changes
Let us briefly understand some of these changes as they bear important relationship to
the care and development of infants. Some of these important changes can be briefly
discussed under the following heads:
Changes in physical development
Changes in mental development
Changes in gastrointestinal system
Development of excretory system
Changes in body composition
Changes in feeding behaviour
Let us review each of these and begin our discussion with the changes in their physical
growth and development.
Changes in Physical Development
It seems that all infants do is to sleep and hardly feed. Inspite of this observation, a wellfed and cared infant doubles its birth weight within 4 to 6 months of life and triples
within the first year. The birth weight of a normal infant should be more than 2.5 kg.
Average birth weight of Indian infants ranges from 2.7-2.9 kg. A well nourished mother
delivers baby weighing between 3.2-3.3 kg, which is comparable to NCHS standards.
Similarly, infants typically increase their length by 50% in the first year. At birth, their
length is 50 cm which increases to 75 cm by the first year. It is imperative to monitor
weight either by serially recording weight on growth charts or approximately @ 200
g/week in first three months; 150 g/week from 4-6 months; 100 g/week in 7-9 month and
50 g/week till one year.
Recommended body weights of children for Indian population
Table
During physical growth, the nutrient needs are high and when any nutrient is limiting at a
critical phase of growth and development, the growth of the body as a whole slows
down or even stops. Flattening of weight for 3-4 months indicates a danger of
developing malnutrition.
Since the baby’s head grows rapidly during foetal years and first year of life, by the time
the child is 2 years old, the head circumference achieves nearly 2/3rd of its final size. The
brain grows faster around the time of the birth than at any other time of life. To
accommodate this brain growth, the infant’s head is larger in proportion to the rest of
the body. After 18-24 months of age, the rest of the body eventually grows and head
circumference to height ratio continues to fall.
Changes in mental development
There is evidently an increase in the brain size. There is a rapid increase in the number of
brain cells in the first 5-6 months after birth. Thereafter, the cell division declines but
continues till the second year of age. By the age of 10 years, many children have a brain
weight of an adult. The effect of nutrition on brain development and IQ are difficult to
determine and as the child starts going to school, this relationship is even more difficult
to ascertain.
Changes in gastrointestinal tract
A full term baby has the ability to digest simple proteins, carbohydrates and emulsified
fats. In first 3-4 months, the production of starch-splitting enzymes is not satisfactory.
The usual yardstick to introduce starchy foods to infants is when their weight doubles,
which, in most well-nourished population, is around 4 months of age. The
disaccharides, including lactase, are secreted adequately at birth. Some infants have
inadequate lactase activity and can develop lactose intolerance. Milk protein
intolerance is also seen in infants. You will learn more about this later in GIT disorders.
Development of excretory system
The filtration rate of kidney is low and infants find it difficult to eliminate high
concentration of solutes. However, by the end of the first year, the functional capacity of
the kidneys becomes fully developed.
Changes in body composition
The weight gain comprises of growth in the muscle, organ tissue, adipose and skeletal
structure. One compartment of body which registers fall is body water. The infant at
birth has 75% body water which declines to 60% of the weight by the end of first year.
This value is closer to that of an adult. However, there is a tremendous increase in
absolute amount of water. Hence, depletion of water due to conditions like vomiting or
diarrhoea can prove to be fatal in infants.
The infants synthesize lean tissue hence there is an increase in body nitrogen from 2%
at birth to 3% at first year.
The skeletal system continues to gradually increase till adolescence. The infant is born
with 12-15% body fat. This rises to 23% at 12 months and declines to 18% at 6 years of
age. Hence, there is a net increase in body fat also.
Let us now see how these changes can ultimately lead to changes in the feeding
behaviour of the infants.
Changes in feeding behaviour
On maturation of neuro-muscular system, the body is able to coordinate sucking,
swallowing and breathing. Till about three months, the baby moves tongue up and down
and if a solid food is placed on the tongue, the food is pushed out (extrusion reflex).
Between 3 to 4 months, the tongue movement changes and the child is able to swallow.
By 6 months, the baby is able to chew.
The psycho social changes determine the feeding pattern. An infant identifies with his
mother but a pre-schooler develops a sense of individuality and imagination. Preschooler is in a period of sex identification and hence boys imitate father and girls
imitate mother. Hence, parents should inculcate and display healthy attitudes at
mealtime.
Having learnt about the physiological changes, let us next learn about the tool which
can be used to monitor the growth of the child i.e. growth monitoring.
Growth Monitoring
In third world countries, about half the children are short and underweight for their age.
Inadequate nutrient intake is the main reason. Inadequate nutrient intakes occur due to
a number of causes. Although breast-feeding is universal in India, many mothers do no
not exclusively breast feed their infants during the first six months. Introduction of
foods, other than breast milk earlier than 6 months of age, often prepared under not
very satisfactory hygienic conditions, causes diarrhoea and malnutrition in the children.
Introduction of appropriate complementary foods in adequate amounts is often
delayed to one year and beyond. As amount of breast milk secreted reduces after 6
months of lactation, sole reliance on breast milk beyond this period is inadequate and
the child develops malnutrition. Growth monitoring is a tool that helps to identify growth
faltering at an early stage and helps to institute corrective measures so that
malnutrition can be avoided. What is growth monitoring?
In growth monitoring, weight is plotted against age accurately on the growth chart which
is a growth chart used in a health centre. Growth charts are available with all
paediatricians, health workers, anganwadi worker and health centres. The growth chart
depicts vaccination schedule, birth history, general guidelines, disease history and one
year weight record with guidelines of infant feeding, as you may have noticed in. These
growth charts are recommended to regularly record weight, height etc. Till 6 years of
age.
14.2.3 Health Monitoring
Table Immunization schedule
Nutrient Needs and Recommended
Dietary Allowances
For infants and pre-schoolers, satisfactory growth is a sensitive criterion of whether
needs are met. 50th percentile of NCHS or growth of infants and children from well-todo families are acceptable Indian norms. The level of intake, which ensures these
growth profiles, determines their requirements. Let us briefly ascertain some nutrient
needs and derive guidelines of how the RDA will be met satisfactorily. The nutritional
requirements of infants are largely met by exclusive breast-feeding till 6 months, after
which it is imperative to introduce complementary feeding. Let us begin with energy
requirements.
Energy: Energy requirements of infants are based on the energy intake through breast
milk by infants of well-nourished mothers. Based on an average intake of breast milk/
day by infants of the well-nourished mothers, ICMR (2010) has recommended the
energy allowances for infants.
Table 14.3: Energy requirements of infants (Kcal/ d )
FAO/WHO/UNU 2004 has given the energy requirements for needs of breast-fed and
formula-fed infants. Total energy expenditure (TEE) is calculated with predictive linear
equation as follows:
Breast-fed
TEE (MJ / day) = – 0.635 + 0.388k ; n = 195 r = 0.87 see 0.453 MJ/day (108 kcal/day)
TEE (Kcal/day)= – 152 + 92.8kg
Formula-fed:
TEE (MJ / day) = – 0.122 + 0.346kg ) n = 125 0.85, see 0.463 MJ/day (110 Kcal/day)
TEE (Kcal/day)= – 29 + 82.6kg
Meal Planning for the Infant’”
It is Clear that the nutrient requirement is considerably high during infancy. The crucial
aspect to consider then is how to meet these requirements. What are the foods that
should be given to the infant that would help meet the requirement? This section
presents a detailed discussion on these aspects. You know that the first food normally
given to the infant is breast milk. Breast milk supplies all the nutrients needed by the
baby for the first few months. It is the best food for the baby. But after four to six months.
Breast milk alone is not sufficient to meet the growing needs of the infant. Certain other
foods need to be provided along with breast milk so as to supplement the shortfall in
the nutrients. This process of introducing foods other than breast milk in the diet of the
infant is called supplementary feeding. It is also referred to as weaning Supplementary
feeding is a gradual process which begins from the moment other foods (liquid food
preparations and solid food preparations) are started and continues till the time the
child is completely taken off the breast. Any food other than breast milk given to the
infant is referred to as a supplement or supplementary food. But what are
supplementary foods that can be given to the infant? What is the right age to introduce
these supplementary foods? Which food would be easily accepted and tolerated by the
infant? How much of these foods should be given? You will find the answer to these
questions in this section. The specific considerations one should keep in mind in
addition to those mentioned in’ the margin are discussed below: Whom are we planning
for?
What is the stage of infancy-0-4 months, 4-6 months, 6-8 months or 9-12 months?
What is the expected body weight “f the infant at that particular age?
What is the income level of the family to which the infant belongs?
Where does the infant live (region)?
Information on these aspects will help you decide on the RDIs and kind and amount of
food to be served to the infant. Based on the information first list the RDIs for the infant.
Which are the nutrients of particular Importance? The need for the following nutrients is
considerable during infancy: energy-giving nutrients (carbohydrates and fats)
Protein
Calcium
Iron
Vitamin A and
Vitamin C.
Which foods to select?
The first few months after birth, breast milk alone provides most of the nutrients
required by the baby: Thereafter, in addition to breast milk, one should introduce
supplementary foods. What are the supplementary foods that can be given? Before we
go on to discuss this, let us first learn about the importance of breast milk. For your
convenience the discussion in this subsection is given under three headings.
Importance of breast milk
When to introduce supplementary foods?
What kind of supplementary foods should be given?
Importance of breast ‘milk: Breast milk is the best and the only food for the infant for the
first few months after birth. It contains most of the nutrients the baby needs. As soon as
possible after birth; the infant should be put to the breast, since sucking stimulates milk
production. But before milk is secreted colostrum is produced by the breast. Colostrum
should be fed to the baby as it is good for growth and general wellbeing. What is
colostrum? Why is it important to feed colostrum to the baby.
Table 9.2: Comparison of Nutrient Composition in Various Milks/100 ml
BREAST MILK IS THE BEST FOOD FOR THE INFANT
It protects the infant from infections and food allergies
It is free from contamination
It is safe and easily available
It is economical
It helps to develop strong bond between mother and child.
When to introduce supplementary foods: In many families you would have noticed
that the introduction of solid food is associated with a religious ceremony commonly
known as ‘Anna prasana’. This ceremony takes place at around 6 months in some
communities and in some as late as one year. But, what is the right time for
supplementary feeding? The right time to start with supplements is between four to six
months. If you start too early you risk diarrhoea and if you start too late you risk
malnutrition. Hence introduce supplementary foods only around 4-6 months. But
continue breastfeeding. What kind of supplementary should be given:
In general, based on the age of the infant, one could vary the texture and consistency of
the supplements as follows:
(a) Liquid Supplements at -4”6months
(b) Semisolid to solid supplements well cooked and mashed
between 6-8 months
(c) Solid supplements chopped or lumpy between 8-12 months “t us
learn what liquid and solid supplements can be given. A) Liquid
Supplements: To begin with, at about 4 months, along with
breast milk, certain liquid supplements like juices, soups or
other milk substitutes (like animal i milk) Juices of seasonal fruits
such as oranges, musambi and grapes provide protective
nutrients (likely vitamin C) which are not present in sufficient
amounts in breast milk.
Along with fruit juice, soups of green leafy vegetables may be given. The soup can be
prepared by boiling the vegetable in minimum water and a little ‘salt and then straining it
through a sieve. The liquid obtained may then be fed to the baby. In addition, ‘thin dal
soup can also be given.
Now, what we need to know is how much of these liquid supplements should we give to
the infants? In the early stages fruit juices can be diluted with equal amounts of boiled
water and only a couple of teaspoons can be fed. Thereafter, the amount can be
gradually increased and at the same time the dilution can be cut down. In a few weeks
the baby can, be given 3 ounces or 85 ml (a little less than half glass) of. Orange juice or
the soup.
A word of Caution: Juices, soups when diluted with excess water and strained may not
be able to provide adequate nutrients. Hence, it is advised to use minimum of water for
dilution. Similarly mash the dal with the water used for cooking and feed it to the infant
instead of serving ‘dal ka pani’.
b) Semisolid and, Solid Supplements: As the child grows, the kind and quality of food
given changes. From liquid supplements’ there is a gradual transition to semisolid/solid
foods. The first solid food commonly offered at 5-6 months is a soft thin, liquidy porridge
made from the staple food of the community. The porridge can be prepared by cooking
the ‘cereals (Le. Wheat, rice, semolina etc.) with milk and sugar. Such a preparation is
called the basic mix i.e. when the staple (cereal) has one food (usually a protein source)
added to it. A common basic mix served to the infants in the south is ‘ragi kanjee’ and in
the north ‘suji kheer’.
A few other common examples of basic mix with the method of preparation is given in,
Annexure 3 at the end of the block. A staple porridge can be made with any cereal flourmaize, jowar, sago, semolina etc. The addition of just one-fourth to half a teaspoon of
germinated wheat flour to the porridge will ensure that it does not thicken at all and will
be in a form that the baby can swallow easily.
Other than the porridge, starchy fruits and vegetables which are cooked well and
mashed can be given round 5-6 months. Roots and tubers, vegetables that can be given
10 the mashed. State include potatoes, sweet potatoes, yam, carrots, green leafy
vegetables, It IS advisable to boil these vegetables in minimum water till tender and
then to mash them properly. The mashed vegetable can be fed as such or with a little
salt or/and ghcelb-tter could be added O provide more energy. Remember, only the pulp
of vegetables 15 to be given. The skin and seeds, if any, and other fibrous matter IS to be
discarded.
Among the fruits-bananas, papaya, mangoes or any other-seasonal fruit could be
mashed and given’ as such, whereas, other fruits like pineapple, peaches etc.need to
be first stewed (Le, boiled in a little water and sugar tili tender) and mashed before being
served, Remember to discard skin, seeds of the fruits before serving. Other
supplements which could be given include yolk of a hard-boiled egg, finely minced and
cooked meat, mashed fish (without bone), well cooked and mashed dais.
NOTE: Salt, can be added to taste. Small amount of fat (i.e. butter) can also be added to
provide more energy.
Reducing the bulk of thick staple porridges
Staple porridges especially cereal based porridges have the disadvantage of being
bulky. Rice, for example, absorbs more than twice its own volume of water before it
becomes soft enough. Even small amounts of rice when cooked become bulky. It is,
therefore, very difficult for the infant to eat this at one time. His stomach is also too
small to take all this bulk. So what does one do? One could quite simply dilute the
preparation with water and serve. But by diluting with water the nutrient content of the
preparation will be lowered. We need to avoid this. Instead one other simple way of
making thick/bulky porridges thin would be to add a few grams of Amylase-Rich-Food
(ARF) to the porridge.
What is ARF? ARF is nothing but flour obtained from germinated grain. Germinated
grain flour contains a lot of amylase (an enzyme) which makes the porridge soft, thin
and easy to eat, without taking away any of its nutritive value. (Amylases as you studied
in Unit 2, Block 1 are enzymes which aid in splitting starches). All that a mother has to
do is to germinate 200 g of wheat grain (by soaking them in triple volume of water for 12
hours, and then wrap it in a wet cloth for 48 hours), sun dry (6-8 hours) them, remove
the sprout and then make a powder of the remaining grains
Preparation of ARF powder
Sun dry
Remove the sprout
Grind the grains
Store in air tight container
Put ¼ tsp powder in the porridge.
Cereal grains like bajra, jawar, maize may also be used to make the powder. This powder
can be stored in an air-tight container for one month. It will suffice for one child’s
porridge for 30 days. Use only few grams ie. 1-2g (not more than one-fourth of a
teaspoon) of thispowder in the porridge. You would notice that the porridge becomes
thin and can be easily swallowed.
d)Solid Supplements: By eight months, you would notice that the baby starts teething.
This is the right time to change him over to chopped and lumpy (thick) foods. The foods
which were boiled and mashed earlier should be now just boiled and cut into small
pieces before being served. For instance, vegetables like potato and carrots could be
boiled and cut into small pieces. Minced meat and fish could be boiled and served as
such instead of mashing. Soft cooked rice or small pieces of chapaties may also be
introduced at this stage. As the infant ‘is teething, it is beneficial to give more of crunchy
foods like a hard biscuit or a piece of toast/rusk or a slice of raw carrot or a fruit segment
(seeds and skin removed) which would be ideal for the child to chew. These foods would
aid in teething and provide exercise to the gums. In addition to this, thick porridges can
be prepared and served to the infant. Earlier you studied about the basic mix i.e. cereal
porridges prepared by adding milk and sugar. Now other than milk, foods like pulses,
animal foods, green leafy vegetables, other vegetables can also be added to the staple
to form a multimix (Figure 9.7). When the staple i.e. the cereal has more foods added to
it, (protein source plus vitamin/mineral source) we call it a multimix. A commonly used
multi mix in the north is ‘khichri’ and ‘pongal’ in the south. Multimixes can be prepared
by mixing the following food items:
(a) Cereal pulse + green leafy vegetable or
(b) Cereal + pulse + milk or
(c) Cereal pulse + vegetable + curd or
(d) Cereal + animal food green leafy vegetable or
(e) Cereal + milk fruit nuts (finely ground) or
(f) Cereal + animal food or green leafy vegetable or
(g) Cereal + animal food orange fellow vegetable (carrot, pumpkin etc.)
Diagram (Multimix)
Multimixes can be introduced as early as 6-7 months of age. You could add one-fourth
of a teaspoon of ARF powder to the multimix to make it thin and easy to swallow. Some
of the multi mixes or infant foods that can be prepared daily for the infants are given in
Annexure 4 at the end of the block. What foods to give at 12 months i.e. one year? By the
age of one year (i.e. 12 months) the baby can take all solid foods. In fact, the infant
should be eating foods prepared for the family, for example rice/dal; chapati dal;
rice/fish; chapati subji. A chapati can be crumpled into small pieces and softened with
milk, dal or curd and salted or sweetened according to the baby’s taste and served. Rice
can be served with dal and vegetable all mixed well. Attempts should be made to get the
infant slowly on to the family meal pattern. Along with these foods breastfeeding should
be continued. But if breast milk has ceased; then the child can be given half a liter of
animal milk per day either as such or as curd, cottage cheese or milk pudding or
porridge. Along with the supplementary foods, one should provide plenty of water/fluids
to the infants. Small amounts of boiled and cooled water should be given 2 to 3 times a
day or more often, depending on the need. More water needs to be given during hot
seasons and especially if the baby has diarrhoea.
What should be meal pattern? The type and quality of food given would depend on
the age of the infant. Consider the meal patterns A, B, C and D.
Table
From birth to four month only breast milk is to be given. There is no rigid rule for the
number of times the infant should be fed each day. Feeding on a self-demand schedule
is recommended. However, roughly 6-8 feeds can be given during the first few months
which can be reduced slowly. By the age of 6 months babies should be given some
staple-based porridge about twice a day. One to two teaspoonful’s are enough to start
with. Followed by about 3-6 large spoonful’s at each feed subsequently. By 9 months,
however, at least 4-5 supplements in addition to regular breastfeeding should be given.
The frequency of breastfeeding should be gradually reduced. In fact, by the time the
child is 12-18 months, attempts should be made to take the baby off the breast. By one
year, the child is capable of eating and digesting a variety of foods. The child is ready to
eat the family food i.e. chapati, dal, rice, vegetables etc. But the child may not be able to
eat much at one time. On the other hand, the child’s energy needs, are greater than is
indicated by its size. So the problem is how to provide enough energy food to the child.
The answer is:
Feed the child frequently-five to six times a day in addition to breast milk/and
The Preschool child
Who is a preschool child? Here we will consider a child in the age group 1-6 years as a
preschool child From the growth and development standpoint, the preschool child, like
the infant is extremely vulnerable. A pre-schooler grows rapidly, but when compared to
infancy, the rate of growth is somewhat slower and more gradual. The average gain in
weight during the preschool age is only about 2-2.5 kg each year.
Meal Planning for the Preschool Child
The preschool years are the time to establish good eating habits in children. Ai the same
time the influenced of parents, friends, television, activities associated with food, help
to shape the child’s food habits. Providing an adequate diet for the child is, therefore, a
challenging task. What dietary measures should one keep in mind while
planning/preparing a diet for children? How to plan balanced meals keeping the
likes/dislikes in mind? How much of which food item should be included? These are
some of the questions which are often asked in the context of feeding pre-schoolers
In this subsection, you will find the answer to these questions. We begin meal planning
for the preschool child by taking into consideration the basic four factors listed in the
margin. The other considerations include:
Whom are we planning for?
Is the child in the 1-3 year age group or in the 4-6 year age group?
What is the income of the family to which the child belongs?
Which region does this child belong to? Information on these aspects would help us
select the right kinds of foods (in the right amounts and proportions) that would be
included in the day’s diet. Based on the information the RDIs can be listed. Which are
the nutrients of particular importance? Some of the nutrients which are crucial for the
growth and development of a preschool child include:
Energy-giving nutrients (carbohydrates and fats)
Protein
Calcium
Iron and
Vitamin A
The diet of the preschool child must include’ at least one food item from each of the
three’ major food groups namely energy-giving, body-building and protective I
regulatory. But you are also aware that the need for energy, protein, calcium, iron and
vitamin A is considerable during the preschool age, Hence, include more of energy-rich
foods, especially cereals; protein-rich foods such as pulses, meat, egg: calcium-rich
foods particularly milk and milk products and iron-rich foods such as meat (particularly
liver) pulses and green leafy vegetables in the diet. A list of food items rich in energy,
protein, calcium, and iron is given in Annexure 1: You could consult it and select food
items according to the likes/dislikes of the child and availability of the food-item. As for
the vitamin A-rich food sources one can select.
What should be the meal pattern? Always remember that a regular meal pattern
should be maintained.
Too long or too short an interval between successive meals should be avoided. The
preschool child may not be able to eat much at one meal. Hence, small frequent meals
need to be given. A preschool child would benefit from three small meals plus 2 to 3
snacks in-between meals per day. The meal pattern adopted would actually depend on
the age of the preschool child. Consider the list of meals given under A and B.
A
Early Morning
Breakfast
Mid-morning meal
Lunch
Mid-afternoon meal
Tea
Dinner
Bed Time
B
Early morning
Breakfast
Mid-morning meal
Lunch
Tea
Dinner
Bed Time
A) Is likely to be adopted for a ½ old child, The child needs to be given food every 3-
4 hours. Alteast-2-3 milk feeds (early morning, tea, bed time) should be given. In
addition foods of high protein and energy content should be given 4-) times a
day. B) is likely to be adopted for a 3-5 year’ old child. In addition to 2 milk feeds,
and three main meals (breakfast, lunch, dinner) other nutritious foods, snacks
and food preparations should be served in-between meals.
What are the food preparations/snacks suitable fer the preschool child?
Any snack/food preparations based on the common locally available cereals and pulses
can be prepared The snack should provide on an average 300-400 kcals. But, ensure
that the bulk of the preparation fed to the child is not very large. A child will remain
healthy and well nourished provided food/snacks of high energy protein
calcium/vitamin A content are given (without increasing the bulk/volume). Snacks
should supplement not substitute the main meals. Snacks should be such that are easy
to prepare and should be in a form easily handled by the child.
A few ideas for snacks for preschool children are given.
What are the other specific considerations?
Mealtime for children should be relaxing and enjoyable. Children learn to enjoy food
when they are allowed to feed themselves. It is easier for the child to feed on his own if
food is cut into bite-sized pieces that Can be readily handed and lifted to the mouth.
When introducing ‘new foods to the child, offer one at a time. Give only small amounts
at first. Let the child make the decision of liking or disliking the food. Never make an
issue of food acceptance. Forcing the child to eat a particular food may establish an
unfavourable attitude towards that food. If the food is rejected, wait for a few weeks and
then try again.
Children of preschool age develop very strong likes and dislikes for certain foods They
might avoid eating one or more essential foods. For example, green leafy vegetables,
milk are usually disliked by children. In such situations, therefore, it is advisable to
change the form of the food and then serve it to the child rather than totally omit it from
the diet. Fewer difficulties are likely to be encountered if foods which are disliked by
children are given when the child is hungry.
Children are easily influenced by ‘the parents attitudes towards food. Parents, should
therefore, be extra careful of not to express their likes and dislikes in front of children
Foods served to children should be warm and not too hot or too cold.
Children usually have a very high taste sensitivity, they do not enjoy highly, flavoured
foods. Only mildly flavoured foods should be included in the diet.
The digestive tract of the preschool child is easily irritated by spicy food, very sweet or
fried foods. Hence, such foods should be avoided, Further consuming excessive
amounts of fibrous food also irritates the tender digestive tract. It is, therefore,
advisable to use a minimum of fibre-rich foods for preschool children
Preschool children are almost constantly active. Their interest is readily diverted from
food. Hence, it is essential to prepare meals that look colourful, attractive and catch the
attention of the child and motivate them to eat.
Diet For Children And Adolescents
The School Going Child
After preschool, the child enters the school going age. This is the period (7-12 years), the
child prepares for adolescence. The growth rate is slow but the organs/tissues improve
in their functioning. You might recall reading earlier that during preschool years the
nutrient need for both boys and girls are the same But it is no longer so during school
going years. Sex differences appear (around 10 years) and begin to influence nutrient
needs, the Recommended Dietary Intakes (RDI) for children. Almost all nutrients are
essential for the school going children but energy giving nutrients (carbohydrates and
fat) and proteins need to be emphasized. Protective nutrients like calcium, iron, Vitamin
A and Vitamin C are also important.
Day’s Recommended Dietary Intakes (RDI) for School Children
Table
Now, keeping the nutrient need of children in mind, let us translate these requirements
into foods, food items that the child need to consume to meet the requirements. The
following section presents tips on healthy eating for children.
Healthy Eating for Children How to Ensure a Healthy Diet?
Eating the right kind of food is very important for children. Providing well-balanced
meals (breakfast, lunch, dinner) supplemented with nutritious snacks in between (tea
time, midmorning, mid-afternoon) will ensure good health of children. But very often
under the influence of the peer groups and advertisement or mass media children pick
up wrong eating habits. Munching fatty snacks and sweet food items in between meals,
and replacing main meals with those foods results in poor dietary habits than can lead
later to chronic diseases like obesity and cardiac problems. Here are some tips on how
to ensure healthy meals and good eating habits in children.
Make sure that the child begins the day with a good breakfast. Breakfast should be
substantial based on cereal-pulse/egg preparation. Include milk fruits/vegetables as
well. Few breakfast ideas are given in this text.
Main needs (lunch, dinner) should be well-balanced. Each should provide one-third of
the day’s energy requirements. Dinner is one meal when the family eats together. This
meal can, therefore, be made more elaborate and include more variety.
Look up the main meal ideas given in the text. I Packed lunches should be balanced.
The packed lunch must include one food item from each of the three food groups
energy-giving, body-building and protective/regulatory. This, however, does not mean
that you have to provide three different dishes. One dish meals can be prepared which
will provide all nutrients. A few interesting packed lunch ideas are presented in the text.
Remember packed lunch food items/dishes should be easy to handle. (You might be
aware that the government has initiated mid-day meal programme for school children.
Under this nutrition program, children are provided meals/snacks which should provide
one-third of the day’s calorie and fifty per cent of the total protein for the day.)
Provide nutritious snacks in between meals. Snacks should be nutritious rather than
energy-rich. They should provide substantial amount of protective nutrients such as
calcium, iron and Vitamin A. Few nutritious snack ideas have also been given. I
Encourage the children to eat lots of fresh fruits, vegetables and salads. These are rich
sources of vitamins and minerals.
Encourage the child to cut down the fatty snacks. Excess of frequent intake of foods
such as samosa, bread pakora, potato chips, potato burgers, patties and sweet items
like pastries, cakes, sweets, chocolates, cream rolls are not good for health. I
Discourage the child from frequently drinking soft and carbonated beverages. These
drinks not only provide empty calories (energy without any other nutrient) but are also
harmful for the teeth.
Encourage the child to have milk-based nutritious beverages such as milk shakes, lassi,
fruit juices etc. I Provide variety of foods and prepare attractive and colourful meals.
This would motivate the child to eat.
Provide small but frequent meals (5-6 meals a day). This would help the child eat less at
one time, while taking in more food in the whole day. I Avoid serving snacks very close to
main meals.
Do not serve snacks to replace the main meals. Remember snacks should only
supplement and not substitute the main meals.
Prepare meals keeping the individual preferences in mind. But make sure that personal
likes/dislikes do not interfere with meeting the nutrient needs. If a particular food is
disliked it is better to change the form of food. For example, if milk is disliked, it is better
to serve milk in the form of curd or cheese or paneer or custard or whatever milk
product the child likes.
Encourage the children to drink plenty of water each day. After tips on healthy eating, let
us now lock at few interesting main meal, packed-lunch, snack and breakfast ideas for
children. Here, examples of food items/dishes from different regions have been
included. These are, however, a few examples only. You can add more to the list, based
on what is acceptable and are the traditional food items in your region.
What Should be the Meal Pattern?
The number of meals a child can consume in a day would depend on
The School Timings: Most schools function from 7.30 a.m. or 8 a.m. to 1.00/1.30 p.m. or
9 a.m. to 4 p.m.
The number and nature of meals need to be adjusted according to these timing. Look at
meal patterns A and B. Pattern A is likely to be followed when school timings are 7.30 to
1.00 p.m. and B is typical for 9 to 4 p.m. schedule.
A
Breakfast
Packed-Lunch
Late Lunch
Tea
Dinner
Bed-time
B
Breakfast
Packed-Lunch
Mid-afternoon
Tea
Dinner
Bed-time
Breakfast Ideas
Paushtik Roti/Parantha with curd
Missi Roti with lassi
Omelette with toast
Milk
Paneer sandwich and fruit juice
Scrambled egg on toast, fruit juice
Peanut butter sandwich and milk
Fresh fruit 99
Cheese, vegetable sandwich and milk
Fruit juice
Porridge, egg or toast
Fresh fruit
Doodh Moori (Preparation made of puffed rice with milk)
Banana
Main Meal Ideas (Table)
Packed Lunch/Tiffin Ideas (Table)
Snack Ideas
I Bonda (round deep friend preparation made of potato, vegetables, nuts etc.)
Spinach vada (flattered round preparation made of chana dal, onion, spinach, nuts)
Pakora (deep fried preparation made from besan mixed with vegetables, potato spinach
and onion)
Chidwa (preparation made from fried rice flakes, puffed rice, peanuts, coconut, curry
leaves)
ISingara (Samosa) (refined wheat flour, potato preparation. Can be enriched by adding
peas, groundnuts).
Peanut, jaggery burfi I Kofta (flattered deep fried preparation made from potato, chana
dal, onion, ginger)
Wheat-basen ladoo Note: Items under packed-lunch/tiffin can also be served as
snacks.
You have just gone through a simple guide on how to ensure healthy meals for children.
Based on these facts, now can you plan diets for children. Use the same steps involved
in planning balanced diets.
Specific Considerations while Planning Meals for Adolescents
Do you recall the handy tips on how to ensure healthy meals for school children? Those
tips are applicable for adolescents as well. Here’s a quick review.
Provide 5-6 meals per day to the adolescent.
Ensure that the adolescent does not miss the main meals (breakfast, lunch, dinner),
Meals should be well-balanced, including rich sources of energy, protein, calcium and
iron, Foods such as cereals, pulses, milk, dark green leafy vegetables, orange-yellow
coloured vegetables, fruits need to be emphasized. I Packed lunches/snacks should be
nutritious and substantial.
Ensure increased food intake so as to meet the increased additional need for nutrients.
In addition to these, some other issues are also to be considered.
They are:
1) The pressure of peer group, advertising and television very often encourage the
teenagers to conform to eating practices which may not provide healthy diets. To
illustrate, adolescent girls cut down on their food in an attempt to look slim and
beautiful (inspite of the fact that their weight is normal). Such practices can lead
to anorexia nervosa (loss of appetite), a disorder which in its chronic form can
cause major health problems. Similarly, adolescent boys adopt diets based on
protein food in the illusion of developing good muscle and good body. This too
can, lead to serious health consequences. Such absurd practices, inerefore,
need to be checked. Importance of consuming balanced meals need emphasis.
2) Fewer meals appear to be eaten by teenagers perhaps a bite from the
school/college canteen in the morning. Some snack from carry-away/fast food
joint substituting for an evening meal, accompanied by soft drinks/carbonated
beverages. Such practices need to be avoided. Consumption of frequent, regular
meals (5-6 meals/day) need to be encouraged.
3) Meals are missed and snacks, sweets and take-away/fast foods substituted.
Most of the time these foods are energy-rich (fat or carbohydrate or sugar or salt
rich items). Consuming too much of these fatty, strachy, sweet and salty foods
often are the cause of obesity. Such eating habits need to be checked.
Consuming nutritious snacks (along with energy providing substantial amount of
protein, iron and calcium) needs to be emphasized. Remember snacks should
contribute to 1/5th of the day’s energy, protein and vitamin/mineral requirement.
4) This is the period when experimentation with alcohol, drugs also begins. This
required careful handling. Advantages of consuming nutritious diets and
emphasis on harmful effect of drugs/alcohol need to be highlighted.