Diarrhoea : especially Infantile diarrhoea : PREVENT IT.

 

Diarrhoea is a condition in which loose or watery stools are passed frequently. 

It occurs frequently in a large majority of weaned infants in developing countries. The infecting organisms are of non pathogenic type.

It may be dangerous. Infants are easily dehydrated as they lack the ability to express their feelings. 

See a doctor right away.

Children dehydrate easily.

 Do not rehydrate the child with fruit juice or water.

 Oral rehydration solution is perfect for them. Add a teaspoon of sugar and a pinch of salt to a litre of clean water. But do not make a mistake by adding more salt. Do not overload the baby with salt. WHO has recommended oral rehydration therapy. Commercial preparation is also available which can be used for the treatment. The osmolarity is 330 mmol/l. It contains glucose 111 mmol/l (20g/l) , sodium 90 mmol /l (sodium chloride 3.5g/l) , potassium 20 mmol/l (potassium chloride 1.5 g/l) , chloride 80 mmol/l , bicarbonate 30 mmol/l (sodium bicarbonate 2.5g/l)

Sufficient fluids are given to ensure 125 -400 ml urine (according to age) every six hours. It is advisable to give extra water rather than adding water to the solution.

If clean water is not available, two handfuls of rice powder with one teaspoon of salt cooked in one litre of water is equally good as ORS. This solution is nothing but Indian rice kanji.

Continue breastfeeding the child. 

Avoid any other  milk for a day.

Slowly introduce a bland diet. Start with a BRAT diet. These binding foods are suggested as the first to try after an episode of  diarrhoea. BRAT diet is Banana, Rice,Applesauce,Toast. Bananas are easily digested and contain high levels of potassium which help replace the electrolytes lost in the excessive elimination of fluids. Rice is high in complex carbohydrates and tends to be bland and easily digestible. Applesauce and bananas contain soluble fiber pectin and other nutrients the body needs. Because the apples are cooked they are easier to digest. These foods slow down the transit time of waste in the colon. Be sure to eat white rice and peeled potatoes as the bran layers of  brown rice and the potato skin contains insoluble fiber that can actually worsen diarrhoea.

The biggest mistake people make is that they don't know when to stop the treatment. If the child is okay and has one or two watery stools a day , do not restrict the diet for long.

Carrots may help enhance recovery by replacing electrolytes and minerals lost during diarrhoea. Give the child potato carrot soup and dry toast. The soup delivers fluid and minerals without further irritating the intestinal mucous membrane. 

Potato carrot soup -

250 ml water

2 medium potatoes

1 carrot

1 pinch salt

Bring the water to the boil. Add the peeled and chopped vegetables. Cook over a low heat until tender, then puree and season with salt.

After a couple of days, yoghurt tends to repopulate the bowel with good bacteria.  This is for the older children.

Diarrhoea can happen to anyone. The dietary suggestions are almost the same for all the sufferers. 

 Traveller's diarrhoea and nervous diarrhoea are the two types which have to be dealt differently.

 Many patients resort to self imposed starvation which may be harmful. 

Adequate intake of fluids and electrolytes is very important. While travelling, hot foods are safe to consume. Freshly prepared chapattis , rice , idli , toasted bread , freshly cooked vegetables, pulses or dals , eggs , meat and poultry, tea or coconut water are the safest options while travelling. Avoid uncooked foods , fruit salad, cold foods , cold desserts, curd , buttermilk, cold sweets or any food touched by hands before serving.

If vomiting accompanies diarrhoea, immediate medical attention is required.

My baby's first tooth!!

A baby! A small bundle of joy for the whole family and especially the mother who has taken care of it from the beginning and bears all the trouble and pain happily. It's a wonderful sight to see the baby's movements and expressions. The baby's first walk and it's first tooth are worth seeing. But most of the infants are a little fussy and cranky with the first two to four teeth.

Interesting part which most of us are unaware of is that an infant's teeth start developing months before birth. The tooth buds develop in the foetus by the fifth or sixth week of pregnancy. By the time the baby is born , all the primary teeth are already present and accounted for in the jawbone. The first tooth is visible about four to eight months after birth. Baby's gums become swollen and tender and the little ,cute bundle of joy is the most irritable and restless person in the world. Teething has begun!

If the baby has the complete set of teeth from the very beginning the care has to be taken from the day the baby comes from the hospital. A small gauge pad wrapped around your forefinger, lightly moistened is perfect. Daily massaging makes healthier gum tissue especially at bedtime. When the first tooth comes ,start brushing it but don't use toothpaste.

Babies put everything in their mouth and chew. Teething rings are available in different sizes and shapes. Put it in the refrigerator and keep it cold , works well and feels good on the baby's gums. But teething rings are tasteless. 

Give the child a piece of cold apple or papaya. Children love to nibble on these tasty teethers. Cut the piece lengthwise so that he can hold. A piece of dry rusk is also a tasty option.

It's a common myth that babies will run a fever when teething. Visit a doctor if there is fever.

REDUCE THE BULK OF CEREAL GRAINS

We feed the child traditional porridges like ragi porridge , wheat porridge, rice porridge and many more. A child is too small and so is his stomach. These porridges are bulky. They absorb about twice as much water to become soft. Even a small amount of this porridge fills the baby's stomach and they feel uncomfortable. If diluted with water, the nutrient content lowers. So what is the solution?

Try ARF

Add one -fourth of a teaspoon or 1 to 2 gms (not more than that) to the cereal porridge.

ARF is Amylase rich foods. It is a flour obtained from germinated cereal flour. Germinated grain flour contains a lot of an enzyme , amylase which makes the porridge less bulky , soft , thin and easy to eat. The best part is that it does not reduce the nutritive value. Amylase is an enzyme which aids in splitting starches so that it is easily digested.

HOW TO MAKE ARF POWDER?

It is very easy to make . Take 200 gms of wheat grain. Bajra , jowar or maize can also be used if wheat is not available. Soak the grain in triple volume water (600 ml)for 12 hours. After 12 hours , remove the grains from water and wrap it in a wet cloth for 48 hours or 2 days. You will see grain sprouts. Dry it in the sun for about 6 to 8 hrs . Remove the sprouts from the well dried grain . Take the grain and grind it to a powder. Store it in an airtight container. Do not use more than 1/4th tsp in a bowl of porridge. The powder is sufficient for 30 days .

Preparing it is a bit tiring but we all want to give our child the best ,isn't it?

A BABY IN THE HOUSE. .

WEANING

Science is fascinating. I used to love studying Human Physiology, Child Development, Human Nutrition, Food Science while in college. Counseling patients gives satisfaction but  implementation of these subjects in one's own life is more satisfying and helps to counsel others in a better way.

When I was blessed with a baby, academics became practical for me. After all, I had to take care of it on my own. I had to manage the home , the work,and the baby. I had to give him the best. Started with the purest food, breast milk. But a child needs nutrients as it grows up. Breastfeeding is no doubt the best but the demand for iron and other nutrients is important for a growing baby.

I started weaning early.

Children love to explore different foodstuffs but they get confused easily. Start with a food item at a time. I started with orange juice when he was three months old. On the first day I gave him only a teaspoon of orange juice in the midmorning. Next day I increased the amount to two teaspoons. By the end of the week he was enjoying half a cup of orange juice. The next week started with apple juice and so on. When he was a year old he knew the taste of most of the food.

Start with orange juice followed by soft rice , mashed cereals , soft fruits , soft cooked potatoes and other vegetables, and puddings. When the baby is about a year old , start with hard boiled egg yolk, then egg white, fish , chicken or poultry , meat.

Children enjoy finger foods , finger sized pieces of papaya , apple or toast massages the gum when teething begins.

I used to have lunch alone when he was not there but after his "annaprashan"(the introduction of cereals to a child at about six months or appearance of the first tooth , whichever is first), we enjoyed lunch together. I used to cook rice , dal , veggies, sweet chutney , set the table, take him on my lap, and eat. Yes , the food was normal, less spicy but children love the texture, appearance and aroma of food.

Fix a proper mealtime and place for the child. No television, no mobile phones, no laptop, no bird watching at the time of meal. Mealtimes is only mealtime and children will be grown up in some time. Good habits should be implemented from the beginning.

The meal time should be relaxing.

I have food preferences and everyone has it. A child is an individual and he also has it. But don't show your preferences to the child. They are good at grasping the words. "What tasty food !" helps the child to eat it instead of "ohho!again this dal ." Acceptance of food helps in proper feeding.

Children love colour. The food should be colourful

Food should not be used as reward or punishment. Don't bribe the child with his favourite food. We want our children to be good citizens .

Don't force the child to eat. How would you feel if someone forces you to eat his favourite dessert but you don't like the smell of it? Insulting. So why a child? If he doesn't like any food item just remove it. Try again after a few days.

Don't give anything to the child in between meals except water.

A child may eat less sometimes or more, it depends upon the weather, the room temperature, etc, don't force the child and the food should be given according to the season

Children love to act as a grown up. Let them feed on themselves. Clear the mess afterwards. Provide proper utensils for them.

Along with the supplementary food or weaning food , breastfeeding should be continued.

The food should neither be too hot or too cold

Don't overfeed the child , give small helpings at a time .

Proper coordination between mother and child creates a positive and happy environment and the child is not a fussy eater.

MY EXPERIENCE AS A NEW MOM

I am blessed with a child and I am grateful for it. When I was pregnant, my doctor told me that the child is in breech presentation. I was mentally prepared to feed my child with "my milk" for two years. I was selfish. I knew the advantages of mother's milk and the most precious colostrum. When the child is born by C section, the hormone prolactin activates after a few days unlike a normal delivery where the brain gets the signal that the child is delivered and the milk production starts instantly. I had to be patient. I attempted the next day, it was my first attempt and with few trial and error both of us succeeded.The suckling stimulation of the child helped. It helped in the production of colostrum.

Colostrum is a thick sticky yellowish fluid. It has life saving properties. It has an especially high concentration of antibodies and white blood cells which protect the newborn from infections. It also contains certain growth promoting substances. The infant body does not contain these substances nor does the body have the capacity to make them.

I fed the child with the purest food. Mother's milk is free from contamination. Yes , human milk does have a low concentration of certain nutrients as compared to other animal milk but it is specially designed for human babies. It suits the baby's tender digestive system and it gets easily assimilated in the body. Breast milk has a high content of carbohydrates, especially lactose ,essential fatty acids and certain protective nutrients like vitamin A and Vitamin E which are beneficial for the infant.

Olden time Indian houses were filled with lots of people. They all used to take care of a child. The mothers used to take care of the household tasks but now most of the families are nuclear and both the parents are working. I was not the exception. I started working as a consultant  when my child was about 3 months old. I used to take my child to the office. It was easy. I did not have to carry any bottles . The bottles have to be cleaned thoroughly and sterilised. I didn't have to buy any milk formula , medicines for colic , fever , etc  so I saved the cost ,time and energy of purchasing and making the formula . It takes time for a baby to learn to be hungry at a certain hour. During the early weeks of life a flexible feeding time can be done but as the child grows a schedule is important. If the child feeds all the time, it would have been very difficult for me to take care of myself , my home, my work, everything. A child has to be disciplined,after all he would be a responsible person in a few years. I had a special bonding with my child. Breastfeeding is psychologically valuable. I felt that I am giving something no one else can.  My child was not constipated or digestive upset  , did not cry from colic pain , did not suffer from any cold , cough, infection, fever. He had a healthy, happy ,active childhood. He never cried of hunger because I didn't leave him to prepare the milk in the pantry , it didn't disturb my husband's sleep as well. He had an ideal weight for height. The teeth and gums were healthy and strong. He didn't suffer from dental problems which the bottle fed him. He was not getting sucrose or sugar. The active suckling needed to draw milk from the breast stimulates the development of the lower part of the baby's face. The best part was I lost my excess weight. I was slim. The baby's suckling stimulates the breasts and helps speed the return of the uterus to its former size and condition. Breastfeeding is a very important method of contraception. The hormone prolactin which is secreted by the anterior pituitary gland in response to baby's suckling has an anovulatory effect. In many societies sexual abstinence is practised during lactation amenorrhoea. This too helps to increase the birth interval.

Sometimes I felt uncomfortable, tired , nervous and irritable but it was my fault. Food is very important for a nursing mother.

Once I had mastitis. My grandma advised that my child can only rescue me from this problem. Continuous breastfeeding only helped me from the pain. 

Breast milk is good for health and to be fed excessively  till the start of supplementary feeding to the child. It can be gradually reduced after the child is six month old and can be further reduced when the child is a year old and then stopped gradually. Mother's diet and health is more important at this stage.

In spite of the advantages of breastfeeding it should not be done if the mother's or father's attitude toward it is not good . The love the baby receives during a feeding period is far more important than the method of feeding.

MOTHER'S MILK: Nature's gift

WHERE DOES THIS MILK COMES FROM?ROLE OF HORMONES AND ENZYMES

The stimulus for active milk secretion comes largely from the hormone prolactin, which acts on mammary alveolar cells and promotes continual milk production and release. The enzymes lipase and transferase are stimulated by prolactin. Hormonal control of the glycerol precursors and the enzymatic release of fatty acids is also associated with insulin, which stimulates the uptake of glucose into the mammary cells.

Oestrogen level is higher during pregnancy which inhibits the secretion of prolactin. If the level of oestrogen is too low then also there is no prolactin secretion. If the level is normal then the pituitary  gland discharges prolactin.

It is a complicated theory made simplified by Mother Nature in the form of inexpensive Mother's milk "a perfect food for the child".

NUTRIENTS IN MOTHER'S MILK

Mother's milk contains energy,protein, fat,lactose,calcium,phosphorus,magnesium,zinc,trace of iron,copper,iodine,selenium,vitamin A, vitamin B1,vitamin B2,niacin,vitamin B6,folate, ,vitamin C,vitamin D. A mother should be healthy and well fed to provide such a nutritious milk. What else does an infant need from its mother!

Synthesis of protein in milk

Proteins present in normal milk are specific to mammary secretions and are not identified in any quantity elsewhere in nature. The protein in milk is derived in two ways. Some protein is synthesized in the mammary gland and rest by the plasma. Plasma derived proteins are found abundantly in the early secretory product colostrum. Casein, lactalbumin, beta-albumin, which is the main component of milk, are synthesized in the gland from amino acid precursors . The essential amino acids and some of the non essential amino acids are directly from the plasma. Some of the non essential amino acids are synthesized by the alveolar cells of the gland.

The uniqueness of the mother's milk cannot be prepared in any factory but only by a mother. It is the best food for an infant.

FOOD

My cousin delivered a baby, the baby was crying, we fed it soft drink.

I went to a funeral, I took a box of chocolate pastries for the grieving family.

I went to a North big fat Indian wedding , the menu was thin sambhar and boiled rice.

Such weird statements. Crazy isn't it. Have you ever thought of something like it ?Just think ,went to a dinner party, took out two pieces of dried bread from the purse on the dinner plate and started eating it . !!! Totally abnormal. These are all food items but food is intimately woven into the physical, economic, psychological, intellectual and social life of man. It is a part of his culture and is filled with many different meanings and symbolism for all individuals at various age and stages of their maturity.

Man's basic drive for food is to satisfy his hunger.

A mother is fed her favourite food on the occasion of a baby shower. A child is fed payasam or rice kheer or rice pudding on it's Annaprashan. Birthday is incomplete without cake. Wedding parties are served with a variety of food. We celebrate any occasion with a variety of food items. So food has a Sociological factor.

All through history food has played important roles besides that of nutrition. Wars were fought for food. People had to steal , rob , and kill for food. Explorers have searched the world for new foods.

We all are individuals. A toddler also has his own choice of food. Some of us like sweets , some sour , some spicy, some sweet and sour. Some like crispy food and some soft mushy food. So there is individual preference related to food.

Food is a source of power. People have been starved for submission. Wars have been won by blockading food supplies to the enemies. Power of food is used in society and in the family as a reward or punishment. A child may be sent to bed without food because of bad behaviour or given something special for some achievement.

Food is a source of security. An infant learns security from the way his mother feeds him. His behavioural pattern will be influenced by the extent to which he feels secure regarding his food supply. Similarly a growing child gains confidence and a feeling of belonging when he is assured that there is food in the house and he is well fed. People feel secure when they have enough food at the time of scarcity. Familiar foods give a sense of security when one is eating away from home.

The economically poorest society spends sixty percent of their monthly budget on food and the top quintile spends about forty four percent of their monthly budget on food in India. The economic factors depend on food selection, purchase and consumption.

The well-to-do eat foods the common man cannot afford may not be nutritious. It is prestigious to buy expensive food items like white rice , white flour , etc. We serve certain foods for family meals and different foods when we have guests. Food is a status symbol.

India is famous for its cultural diversity. Food is related to festivals, localities, religion and part of India. Sevaiyan is related to Id , Gujiyas for holi , til ladoo for sankranti. Some foods are specifically designed for certain areas of India like Hyderabadi biryani , Agra petha , Amritsari Kulche.

"Loose motions,eat thin khichdi . Non oily food for stomach ailments, Non spicy food for liver disease , green leafy vegetables to cure anemia. Acceptance of food is related to our physiological factors.

Food is a symbol of hospitality and friendship throughout the world. We express our hospitality to a guest through an offer of food or drink. In times of disaster or sorrow we take food to the affected person. Offering a cup of tea or coffee is a gesture of friendship.

Feeling happy, enjoying food. Feeling stressed out, frisk out in the refrigerator or cabinet for something to munch or stop eating anything. Loneliness and boredom are relieved by continuous nibbling of food. Anger and frustration may turn one against food. Specific foods are associated with unhappy experiences. Food consumed by some is unacceptable and even revolting for others. These types of concepts have no rhyme or reason nor are they related to nutritive value ;they are just emotional reactions. Food is an outlet of emotions.

Food fads are also a factor for accepting food. Foods are classified as "hot"foods and "cold" foods. People avoid milk and fish together in some communities and are believed to produce white patches. Some people avoid onion with curd as onion is hot and curd is cold. There are numerous fads.

Food is not just to fill the stomach but the factors are more important to lead a healthy happy life.

Enjoy food!Love your food! Stay healthy!