Feeding and protecting infants

Nutrition is 'food at work': the process by which the body takes in nutrients and uses them for growth, repair and well-being. Children grow fast in body and mind, so a shortage of nutrients now can cause lifelong harm, while good nutrition helps them reach their full potential: it supports the organs, thinking and learning, fighting disease and healing, energy, and a cheerful outlook.

Infancy (birth to 12 months) is a time of very rapid growth:

• Weight doubles by 6 months and triples by 1 year.
• Length grows from about 50-55 cm at birth to about 75 cm at one year; head and chest also grow.
• An infant needs about twice as many calories per kg of body weight as an adult doing heavy work, plus protein (muscle growth), calcium (bones) and iron (growing blood volume).
• A well-nourished mother produces about 850 ml of milk a day, enough for the first months, so the mother's own diet (protein, calcium, iron, plenty of fluids) matters too.

Breast milk is nature's gift to the newborn. WHO recommends exclusive breastfeeding for six months: not even water is needed. Feeding should start soon after birth. The thick yellow milk of the first 2-3 days, colostrum, is rich in antibodies and protects against infection, so the baby must be given it.

• Tailor-made: all nutrients in the right proportion and an easily absorbed form; its low protein spares the baby's kidneys.
• Hygienic and convenient: always available, at the right temperature.
• Protects against stomach, chest and urinary infections, and is free from allergens.
• Protects the mother against breast and ovarian cancer and weak bones.
• Builds a warm, happy bond between mother and baby. At first, 'the best clock is the baby's hunger'; feeding times can be made more regular after about a month.
• A low-birth-weight baby (under 2.5 kg) has weak sucking and a small stomach but high needs; its own mother's milk is still the best food.

Complementary foods are other foods introduced gradually alongside breast milk, from about 6 months. They should be calorie-dense, give at least 10 per cent of energy from protein, and be prepared and fed hygienically (clean bottles and utensils).

• Introduce one food at a time, in small amounts at first, increasing slowly.
• Do not force a disliked food: try something else and offer it again later.
• Avoid spicy and fried foods; do not show your own dislikes; offer variety.
• Foods move from liquids (diluted milk, juices, clear soups) to semi-solids (mashed dal, cereal, vegetables, egg yolk) to solids as teeth come, around 10-12 months.
• Low-cost home mixes use roasted local cereals, pulses and groundnut, often with jaggery: Balahar (wheat, groundnut, Bengal gram), Poshak, malt food, Win food (pearl millet, green gram, groundnut, jaggery), Amritham and others.

Immunisation. A vaccine contains an inactive form of a germ or its toxin. It cannot cause the disease, but it makes the body's white blood cells produce antibodies, which later kill the real germ. India's schedule for the first year:

• At birth: BCG (against TB), OPV (oral polio), Hepatitis B.
• At 6, 10 and 14 weeks: OPV and pentavalent (DPT for diphtheria, pertussis and tetanus, plus Hepatitis B and Hib).
• At 9 months: MR (measles and rubella).

Common problems. Malnutrition grows out of poverty, illiteracy, lack of knowledge and poor access to health care, and often begins when breast milk is no longer enough. Diarrhoea drains water and salts from the body and is a major cause of infant death. Infection and malnutrition make each other worse. Deficiency diseases include:

• Protein-energy malnutrition (PEM): poor growth and frequent infections.
• Anaemia: from lack of iron.
• Nutritional blindness: from lack of vitamin A.
• Rickets: from lack of vitamin D and calcium.
• Goitre (swollen thyroid gland): from lack of iodine.
• Clean food, safe water, sanitation and hand-washing are as important as diet.