Weaning

Weaning is the transferring of an infant from breast feeding to normal feeding. Breast feed should not be stopped all of a sudden. Weaning can start from the 5th or 6th month. The process should be gradual. The child can be completely weaned at the end of 9th or 10th month. The breast milk can be replaced by cow's milk and some solid foods.

Points to remember in the introduction of solids to infant's diet.

• Introduce only one new food item at a time. Allow the infant to become familiar with the same before starting the other.
• Give very small quantity of any new foods.
• Use very thin consistency when starting solid foods.
• Bribes or threats should never be used to get a child to eat.
• Whenever possible the child should be permitted to feed himself, but quietly give help when he shows his inability to eat.
• Never force an infant to eat more of a food than what he takes willingly.
• If after several trials, the baby dislikes a food, omit that item for a week or two and try it again. If the dislike persists, it is better to omit that food and substitute another.
• Use foods of smooth consistency. When the baby is able to chew, gradually substitute finely chopped fruits and vegetables.
• Mother or anyone feeding the baby must be careful to avoid showing any dislikes for the food given to the infant.
• There should be choice for food.

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Do you feed your infant not with Breast milk? | Artificial feeding for infants

Bottle feeding

It so familiar now a days, people are started to feed their infants with foods other than breast milk, even though breast feeding is better and good for an infant in early weeks. Artificial feeding is considered as feeding of an infant with other foods in the absence of breast milk. Breast milk is often substitute by cow's milk. The cow's milk is substitute by dried milk, evaporated milk.

Cow's milk can be humanised by diluting, boiling and adding sugar. It is not desirable to give whole milk to infant in the first few weeks, because the protein in the cow's milk is not in a easily digestible form. By 6 to 8 months, the baby can have undiluted milk.

Preparation of formula

The milk formula should be planned to meet the nutritional requirements of the infant which is based on his age and weight.

Caloric requirement - 110 calories per kg of body weight.

Fluid requirement - 165 ml per kg of body weight.

Milk requirement - 110 to 130 ml per kg of body weight.

Number of feeds in 24 hours - 7.

Intervals - 3 hourly.

To prepare the milk formula for a day

Take 460 ml of milk, 140 ml of water and add 9 teaspoon of sugar and boil it and keep it in the refrigerator. For each feed take 85 ml of milk, warm it and feed the baby.

Different ways of feeding an infant.

• By using the feeding bottle and teat.
• By belcroy feeder.
• By dropper.
• By using spoon.

Important points to remember when artificial feeds are given

1. Plan the formula according to the nutritional requirement of the baby.
2. The feeding bottle, eat and other articles used for the feeding should be sterile.
3. The milk feed should be warm. Test the temperature of the milk on your inner aspect of the wrist.
4. The mother and the child should be in a comfortable position. the bottle should be held at 45 degree so that the teat is filled with milk.
5. Ensure a slow and steady flow of milk by making a hole in the teat neither too big nor too small. This is done with a red hot needle.
6. Burp the child in between and at the end of every feed.
7. The mother should show no hurry or tension.
8. The feed should be given at regular intervals.
9. The mother should wash her hands thoroughly before preparing the feed and feeding the child.
10. Offer a small quantity of water after every feed.
11. Never pinch the baby's nose to make him to open his mouth; instead press his cheeks.
12. Add vitamin A in the form of liver oil, vitamin C in the form of orange juice and iron in the form of egg yolk from the first month itself.

Breast Feeding

Breast feeding is the best food for the baby. It is not only gives nourishment's but suffice the baby's emotional needs. The advantages of breast feeding are :

1. Makes the mother feel close to the baby emotionally.
2. Gives the baby a sense of security or oneness with the mother.
3. Protect the child from intestinal upsets as breast milk is sterile.
4. Protect the child from communicable diseases as it contains protective antibodies.
5. The mother's nipple satisfies the sucking reflex more adequately than the artificial nipple and infant is less likely to be a thumb sucker.
6. Aids in the involution of the uterus.
7. Breast milk is at correct temperature.
8. Breast fed baby is said to have better tissue and bone development and resistance to infection.

The contra-indications for breast feeding are:

• Diseases of the breast. eg; breast abscess, mastitis etc.
• Active tuberculosis, cancer, cardiac diseases, contagious diseases.
• Unconscious mother.
• Mental diseases in the mother.
• When another pregnancy ensues.
• Premature babies and sick babies who are very weak to suck.
• Babies with hare lip and cleft palate.

Obesity

Obesity is one of the major health problem that is quite common now a days. Obesity is a condition in which an individual's bodyweight is higher than the normal due to excess deposition of fat in the adipose tissue. The common cause obesity is the excess intake of foods than normal requirements and lesser physical activity. Excess food that consumed is converted into fat and stored in the adipose tissues. Obesity is very common among people living in Western countries and other developing countries. Excess intake of foods and increase in the bodyweight leads to some other major complications.

Predisposing factors and occurrence of obesity

Many factors contribute to the development of obesity. Some of these are discussed below:

Age and sex: Obesity can occur at any age in either sex. But the incidence is higher in persons who lead sedentary lives.

Economic status: Obesity is found more common among the higher status groups as they consume excess food and do less physical work than the low status groups.

Physical activity: Obesity occurs rarely among persons who do hard physical work. With the extensive use of transport facilities and mechanisation of industry, the proportion of people who lead sedentary lives has been increasing. And this will increases the chance for obesity.

Body weight assessment

Proneness to obesity: Some individuals are more prone to develop obesity than others. Recent study's about obesity  have shown that these individuals are having usually large proportion of adipose tissue cells compared with normal persons. These cells are filled with fat when there is an excess intake of food.

ASSESSMENT OF OBESITY

Obesity can be assessed by (1)body weight (2)estimation of total body fat (3)skin-fold measurements. A persons whose body weight is higher than normal by 20 percent may be considered as obese. An approximate classification of different degrees of obesity based on body weight is given below:

COMPLICATIONS OF OBESITY

Obesity leads to the development of several complications such as: (1)Physical disability, (2)Metabolic disorders, (3)Cardiac disorders, (4)Proneness to accidents and (5)Low life expectancy. Obese persons suffer more often from metabolic disorders such as diabetes mellitus, atherosclerosis and heart diseases. They meet with accidents more frequently. The life expectancy is also reduced in view of the above hazards.

Diseases and Diet modification

HYPERTENSION

High blood pressure is a common disorder occurring among the middle and old age groups. This condition has been called as Essential hypertension. The predisposing factors for hypertension are (1) Hereditary, (2) Obesity and (3) Stress and strain of modern life. Systolic pressure over 150mmhg and diastolic pressure over 100mmhg is considered as hypertension. In some other disease conditions like cardiac diseases, CVA ( Cerebro Vascular Accident), the blood pressure seems to be increased. If an uncontrolled hypertensive state may leads to further complications like brain damage. The most recommended diet for hypertension are low sodium-low fat-low calorie diets.

Kempner's rice diet:

Kempner (1948) has recommended a rigid rice-fruit-sugar diet for hypertension. It provides about 2000KCal, 5g fat, 20g proteins, 150mg sodium and 200mg calorie. All the fruit juices are permitted. The fluid intake is limited to meet the daily needs. Vitamin supplements are given to meet the daily needs of different vitamins.

RENAL CALCULI

Renal calculi consists of mucopolysaccharides, urates, calcium oxalate, calcium phosphate and calcium carbonate. Urate and oxalate stones are the most common and cysteine stones are very rare.

Aetiology

Some of the factors contribute to the formation of stones are:

• Climate
• Occupation
• Infection in the urinary tract
• Dietary habits (habitual intake of foods rich in oxalate's,calcium phosphates and purines).
• Hereditary

Diet for the prevention of renal calculi

A planned diet can prevent the occurring of kidney stones. The diet which is intended for the prevention of renal calculi should be low in oxalic acid and purine contents. The intakes of calcium and phosphates should also be reduced to a moderate level.Some of the diet that should be controlled are;

-Leafy vegetables.

-Milk and milk products.

-Whole cereals.

-Legumes.

-Nuts and oil seeds.

-Meat,fish and egg.

-Tea, cocoa.

-Rhubarb.

The subject should consume large amounts of fluids so as to increase the urine output to 2-2.5 litres per day.

Doubt about Diabetes ?

Q. I was recently diagnosed with type 2 diabetes. How long after my meal should i check my blood glucose level?

Monitor your glucose level

A. A holistic management of diabetes requires frequent monitoring of blood glucose levels to know whether your diabetes is on the right track. If you have been recently diagnosed with diabetes, then this becomes an important part of your routine. For the initial few weeks, it is important that you monitor blood glucose levels regularly. Generally, pre-and post meal (two hours after start of the breakfast, lunch or dinner) sugars are checked. If you are on oral medications, you can check blood glucose less frequently. But if you're taking insulin shots, you may need to check more frequently, depending on your physician's instructions.

Add more Fluids

Q. How should i handle my diabetes when i am not feeling well and have no appetite? I have quit taking the medicines that release insulin during meals, because i am not eating anything. Am i doing right?

A. Food and blood glucose have directly proportional relationship. Even if your appetite is low, medications need to be continued. However you can adjust the dosages of your medications as advised by your physician. Your doctor may advise you to lower the ones which release insulin. It is important to take small and frequent meals and plenty of fluids when appetite is low.

Q. My grandmother had diabetes. I have heard that diabetes skips a generation, and my physician tells me she believes i have pre-diabetes. Is there any way i can prevent actual diabetes from happening?

Aerobic workouts

A. Genetics has a major contribution in diabetes. If you have a family history of diabetes, be it in 2-3 generations, you still have some predisposition to developing diabetes. Over and above this, if your lifestyle is not correct, you will develop diabetes very faster. For those who have pre-diabetes, intensive lifestyle modifications are required (maintaining body weight, reducing the consumption of excessive intake of saturated fats and refined carbohydrates. 45-60 minutes of aerobic and work related activity), so as to prevent development of diabetes. You need to get your blood glucose tested if you are more than 35 years of age.

ORAL HYGIENE

Oral Hygiene

The oral cavity or buccal cavity is bounded by the lips in front, the cheeks on the sides, the mandibles at the floor of the mouth, the palantine bones at the roof and the pharynx at the back. The mouth contains the tongue, the teeth, the gums and the openings of the salivary glands.

The teeth consists of three part - the crown, the neck and the root. The outer white part is the enamel, inner to the enamel is a hard substance called dentine and inside to the dentine is the pulp cavity which contains the blood vessels and nerves. The root is surrounded by the gums.

The buccal cavity is connected to the nasal cavity through the posterior nares, to the oesophagus and trachea through their openings. The two Eustachian tubes open from the pharynx to the middle ear.

EFFECTS OF NEGLECTED MOUTH.

Local Infections

The mouth presents all requirements for bacterial growth such as warmth, moisture, food supply from the residual foods on and between the teeth and a protected environment. The number of bacteria in the mouth depends upon the degree of cleanliness of the mouth. A very neglected mouth can cause various types of infections in the oral cavity.

Gingivitis : Inflammation of the gums.

Glossitis : Inflammation of the tongue.

Root abscess : Pus formation in the root of the teeth.

Stomatitis : Inflammation of the mucus membrane of the mouth.

Cancrum oris : Gangrenous stomatitis.

Dental caries

Bacillus acidophiles, a normal inhabitant of the mouth cavity acts on the carbohydrate material that has been left on the surfaces, pits and fissures of the teeth, produce lactic acid that dissolves the tooth structure.Later this will form cavities reach the pulp, pain ensures and the pulp cavity dies. Once the decay has started there is no cure.

Periodontal diseases

This is also known as 'Pyorrhoea' or pus formation in the sockets of teeth. This is the common cause for the loss of teeth in people over 40 years of age. It develops in four stages.

Gingivitis, characterised by the bleeding gums is the first stage. Periodontists is the second stage in which there is inflammation if the tissue that supports and surrounds the teeth. In the third stage acute necrotizing  ulcerative gingivitis develops which cause mobility of the teeth, purulent discharges and tissue atrophy. The patient may experience severe pain. Destruction of the teeth supporting structures is the fourth stage. The peridontium (gums) atrophies to the point that appears to have completely receded away from the tooth. Without adequate supporting structure, the teeth become loose and they fall out.

 

Formation of sordes

 Brown crusts which are formed on the teeth and lips are called sordes. It is a collection of food , mucus and bacteria. Lack of oral hygiene, insufficient intake of fluids in illness, the drying of mucus membrane particularly in case of mouth breathing are the common cause of formation of sore and crusts on the teeth and gums.

 

Formation of calculus

In neglected mouth, a sticky colourless layer of mucus material containing streptococcus forms on the teeth. If it is allowed to remain on the teeth it becomes calcified. This calcified, hard and tenacious material is called calculus (tartar). Ordinary brushing will not remove this calculus. It needs a cleaning by dentist. Calculus is a primary cause for gum diseases and dental caries. 

 

PREVENTION OF COMPLICATIONS

•  A clean mouth makes a person feel clean and comfortable. A set of sound teeth is a valuable asset because it contributes to the personal appearance. Good oral hygiene makes a person feel socially acceptable and to have self respect. Hence it is advised to have brushing of teeth in the morning as well as in the evening. The mouth should be rinsed after every meal to dislodge any food particle left between the teeth.
• Prevent dehydration of the tissues by the administration of enough fluids.
• Care must be taken in brushing the teeth, not to cause any injury to the gums by the hard bristles. After brushing the teeth, the gums should be massaged with the fingers to stimulate the circulation.
• Care must be taken to select a good dentifrice. Dentifrices clean the mouth through mechanical action rather than by chemical action on the bacteria.
• The brushing of teeth should be done in such a way that the brush reaches all five surfaces of every teeth - the inner surface, the outer surface, the two sides, the lower surfaces of the upper row and the upper surface of the lower row. Brushing is done from the gum to the enamel.
• The use of emollients such as creams, aids in softening the dry lips and prevent cracking of lips.
• For healthy teeth and gums a well balanced diet is necessary.