Breastfeeding/Baby-Friendly Hospital Initiative (BFHI)

The breast milk is very important for the wellbeing of a newborn baby as it helps in protecting the baby from various infections and also provide energy and nutrients in their correct amount compared to other complementary foods/feeds given to babies that when introduced to babies would do harm than good. W.H.O advocates for exclusive breast feeding as the best form of nutrition for a baby of less than 6 months.

This aims to encourage not only breast feeding but also breast feeding exclusively and on demand for the maximum growth and development of the baby. The article will also point out the period for introducing solid food to babies after breastfeeding and will explain the various types of solid food you can start giving a baby and how to prepare Pap (Akamu in Hausa). It will also show you the required amount needed and the nutrients content in the commercial feed formulas and the need to prepare it yourself when given the right formula and recipes to use.

What is Exclusive Breastfeeding?

It refers to the practice whereby a baby is not given any other food (whether it is solid food, water, sweets, fruits; not even a dummy (pacifier ) etc) apart from breast milk from the very moment the baby is born (day of birth) to the age of 6 months. This means that you should not give the baby anything apart from the breast milk. Even when the mother is not at home, you are not allowed to give the baby any food. If the mother is not always at home, then expressing the breast milk in a clean feeding bottle or container and giving it to the baby is the best option.

In the practice of Exclusive breast feeding, the baby usually breast feeds for at least 12 times in a day. It means then that the minimum number of time to feed the baby is 12 and the maximum times is based on demand by the baby. If the baby needs breast milk up to 24 times a day, then keep giving the baby on demand.

Partial breastfeeding means that a baby breastfeeds for some time and is then given some artificial foods or supplements another time to complement for breast milk, this, however, is not accepted. If your baby sleeps too much and you find out that you have not fed the baby for up to 12 times and the day is about to run out, then you must wake the baby up to suckle. This is the best way to keep a baby healthy and strong.

It is not that introducing the baby to solid foods or family diet at an earlier age could harm the baby, but it predisposes the child to infections, diarrhea, malnutrition and lots more, that may become overwhelming for the baby thereby causing failure to thrive(inability to grow) well, low IQ, poor performances, and host of other related health problems associated with infections and development. It is therefore important for mothers to adhere to this.

When to start breast feeding a newly born baby after delivery

Within 30mins after delivery place the baby on breasts to suckle, and allow the mother and baby to have skin to skin contact. The skin contact helps the mother to breastfeed for a long time and also helps generate heat and warmth for the baby because the newborn can easily get cold.

Using a warm cloth or coverlet, cover yourself and the baby for a minimum time of 30minutes. This act of creating the first bond between the baby and mother has importance which are: the first suckle on breast helps expulsion of placenta after delivery; it also reduce the rate of bleeding of the uterus; suckling also triggers the brain which in turn sends signals to the glands responsible for producing milk in the breast to start producing milk. This milk producing glands are triggered by sucking and also when the mother sees the baby.

Mother and baby should practice rooming in and bedding in. Rooming and bedding in allow the mother to breastfeed on demand and for not less than 12 times daily. It simply refers to the act of the mother and child staying indoors.

Maternal hormones responsible for the production of Milk with their functions

During pregnancy, the changes in hormones help to prepare the glands of the breast-tissue to make milk. Each of these hormones has its own functions and are outlined below.

Prolactin: This is responsible for secreting the milk. It works after the baby suckles and therefore makes milk for next feed. This means as the baby sucks, he/she is generating milk for the next feeding. There is a gland located in the brain called the Pituitary gland which secretes more prolactin at night. This means then that for women who are not producing enough milk for the baby, they should be encouraged to breastfeed at night because the hormone that produces the milk is best secreted in large amount at night. Remember that the hormone does not act unless the baby sucks.

This same Prolactin also suppresses activity of ovaries, making breastfeeding to delay the return of fertility and menstruation. This is why women who practice exclusive breast feeding may not get pregnant until they wean the child.

Another thing the mom needs to know is that if the secreted breast milk is not removed then the breast secretes less of it; the pressure of remaining milk on the gland cells decreases secretion. This happens when the mother does not feed the baby.

Oxytocin: another hormone is the oxytocin. This is responsible for ejecting the secreted milk so that the baby can take. Oxytocin causes fine streams of milk to flow from the nipples. You should know that it is not the sucking that is ejecting the milk but the action of the oxytocin. This hormone is produced when baby suckles and stimulates sensory nerves that cause contraction of the cisterns for ejecting of the milk.

Factors responsible for promoting continuous production of breast milk in the mother

There are some triggers that promote the production of milk by the mother. These factors include:

• Peaceful thoughts: whenever the mothers mind is not clouded by bad thoughts or fear or anything that upsets the mind, then the body can function normally for maximum secretion of milk for the baby.
• Feelings: the way the mom sees the baby also affects production of milk. If she has feelings of love and affection, then she can be able to produce enough milk for the baby. Also, the cry of the baby is a strong trigger for the mother to secrete and produce milk.
• Sensations: whenever the child touches the mother, it promotes production of milk.

These natural factors work together to bring about enough nutrition for the baby.

Problems responsible for lack of production of milk and hindering of breastfeeding

1. Anything that alters the peaceful mood of the mother hinders the production of milk. If she is worried or afraid for some reasons, then milk production is impaired; if she is in pains of whatever cause or she is embarrassed by some circumstances, these may hinder ejection of milk.
2. Engorgement– lack of feeding the baby may cause overfilling of the breast (engorgement), in a case where by feeding is done but there is still engorgement, then you can express some of the milk. However, when milk is express, it should not be left for long and should not exceed 24 hrs because microorganisms would definitely contaminate it. Mothers should therefore feed their babies frequently to remove the milk.
3. Milk fever– The engorgement of the milk sometimes comes with fever but this fever does not last for more than 24hrs (it does not need treatment and will resolve on its own). If it does become more than 24 hrs, then it means it is not caused by the engorgement of breast but by some infections that may need you to see your doctor.
4. Blocked duct- sometimes milk from one segment of breast does not drain, this could possibly be due to thickened milk that blocks the duct from that segment. A painful lump then forms in the breast. This blockage of duct could be as a result of wearing of tight clothing or when the baby fails to suck the segment.
5. Mastitis– This is the inflammation of the breast tissue. It is caused by a blocked duct or engorged breast that is not cleared; as a result of the blockage or engorgement, the breast tissue may become infected, leading to inflammation. The signs include: red, hot and swollen breast, fever and feeling of not being healthy or well (Malaise).
6. Breast abscess– in a condition whereby the mastitis is not treated early, it may develop into an abscess (large collection of pus) and when this occurs, the only treatment is to remove the engorged milk or collection of pus and this is done in the hospital.
7. Sores and cracked nipples could occur due to poor positioning and attachment of baby to breasts.

Composition and types of Breast Milk

The human breast milk is the best source of nourishment for babies as the nutritional composition is unique, perfectly matching the needs of fast growing babies. The nutrients are in correct proportion.

As a baby grow and develop, the nutritional need changes and hence, the need to adjust the feed accordingly. This adjustment has been done naturally by the Breast and hence there are different types of milk secreted by the mother as she continually feed the baby. These milk types have different composition and proportions of nutrients and the production of each passes through different stages due to physiologic processes.

The types of breast milk include:

1. Colostrum
2. Transitional milk
3. Mature milk

Colostrum

This is the first type of breast milk secreted by the breast. It is usually secreted few days before delivery and is continually secreted for few days again after delivery. Colostrum is sticky, yellowish and thicker than other types of milk.

The composition of Colostrum includes:

• Colostrum contains large quantities of antibodies and growth hormones. The antibodies help the baby to fight infections while the growth hormones help in growth of the baby.
• It enhances the development of babys gastro-intestinal tract.
• It acts as the first form of immunization for the baby.
• It is rich in Protein and hence helps in growth and development of the baby.
• Colostrum contains more of some minerals and fat soluble vitamins such as Vitamin A, E and K. (see the importance of each vitamin below)
• It has less carbohydrate and fat compared to other forms of breast milk

Colostrum has a laxative effect (aids bowel movement) which helps baby to pass meconium (first stool that a baby passes). Passing of meconium helps prevent neonatal jaundice caused by increased reabsorption of bilirubin from gut.

Colostrum is all a baby needs in its first few days of life after which it is replaced by another form of milk known as the Transitional milk.

Transitional Milk

This is a form of milk that the mother starts secreting around the 2^nd week after delivery. It acts as a transition from Colostrum to the mature milk and its contents are a mixture of colostrum and mature milk. Transitional milk increases in quantity more than colostrum and changes in appearance and composition. It is generally low in antibodies (immunoglobulins) and also low in protein content but there is an increase in fats and sugar contents to provide energy for the growing baby.

Mature Milk

A week or two after the start of production of transitional milk, the mature milk starts being secreted. The mature milk has two components: fore milk and hind milk. These two components are formed whenever the baby starts sucking. The fore milk is the first form of mature milk that a baby takes when he/she starts feeding, it comes at the beginning of every feed each time the baby starts sucking.

The mature milk appears grey and watery. It is rich in protein, lactose (the type of sugar found in milk), vitamins, minerals and water.

As the baby starts sucking and feed goes on, the milk changes to a different form known as the hindmilk.

Hind milk comes at the end of every breastfeeding and looks whiter than fore milk because it contains more of fat. The Fat content continues to increase from beginning to the end of feeding, providing more than half the energy in breast milk.

While the Foremilk quenches the babys thirst because of its water content, the hindmilk gives satiety (feeling of fullness) due to its high fats. Your Baby needs both fore milk and hind milk for proper growth and development, hence it is important not to take off a slow feeding baby, off the breast before he/she finishes or he/she may not get enough hind milk.

Benefits of Breast milk as the Perfect food for a baby compared to other forms of complementary feeds and babies formula

1. Breast milk contains all the nutrients a baby needs for the first 4- 6months of life.
2. It is quickly and easily digested easily by the immature gut of the baby compared to other feeds that may be difficult for the babys intestines to digest because they are not yet mature.
3. It contains the most suitable protein and fat in right quantities and proportion.
4. It contains more lactose than most other feeds. The lactose is needed for brain development.
5. There is no need for vitamin supplements because the breast milk provides it all.
6. It contains enough iron in the amount that can be well absorbed from babys intestine. Hence, breastfed babies do not develop Iron deficiency anemia compared to those fed on synthetic feeds.
7. It contains 70% water, which is enough for a baby even in a hot, dry climatic condition.
8. It has the correct amounts of salt, calcium and phosphate needed for metabolism and strong bones.
9. It also contain a special enzyme known as lipase which helps in fat digestion compared to complementary feeds that do not and hence the baby may find it difficult to digest the fat and therefore malnutrition could set in as result of the babys inability to absorb fat soluble vitamins such as Vitamin A, D, E and K (see their functions below).
10. The body tries to produce the perfect form of milk even if the woman is ill, pregnant, undernourished or menstruating; hence there is no contamination that could arise in the production process like other synthetic feeds.
11. Breastfeeding helps mother and baby develop a close love bond. This relationship may help the childs social relationship with other people. A baby that is bottle fed gets less affection.
12. Frequent breastfeeding helps protect against unwanted pregnancy due to release of prolactin as earlier stated.
13. Breast milk is clean and free of bacteria so it cannot make the baby sick.
14. It contains anti-infective (against infection) factors which prevent infections. These factors include :
    1. Live white blood cells (leucocytes) which kills bacteria.
    2. Antibodies (immunoglobulins) – to many common infections until baby can make its own antibodies.
    3. A substance call bifidus factor helps other special bacteria called Lactobacillus bifidus. The presence of these Lactobacillus bifidus bacteria prevents the growth of harmful bacteria that cause diarrhea in infants.
    4. Lactoferrin: this is a protein that binds iron and therefore prevents the growth of some harmful bacteria that need iron for growth.
15. Breastfed babies have less diarrhea and fewer respiratory and middle ear infections compared to other counterparts fed on synthetic feeds.
16. A baby who continues to breastfeed during infections recovers faster than a baby who stops breastfeeding.
17. Breast milk continues to help prevent illness and also help children recover during second and third years of life because, as lactation winds down, the breasts involute, the regression milk resembles colostrum in its high levels of immunoglobulin which protects the child from weanling diarrhea when solid food is started for a baby.

Conveniences of Breast milk

1. Breast milk is always ready to be given to baby and it needs no preparation.
2. It never goes sour or bad in breasts even if baby is not fed.
3. It is cheap and needs not to be bought.
4. It is for baby alone. Does not need to be shared.

10 Advantages of Breastfeeding

1. Ensures that baby is receiving perfect food for age.
2. Baby is protected against infections.
3. Creates bonding between mother and baby.
4. Helps mother regain her normal figure after birth and protects from unwanted pregnancy.
5. Protects baby from indigestion that artificially fed babies suffer from.
6. Protects baby from persistent diarrhea caused by contaminated artificial milk.
7. Protects baby from anaemia because iron content of breast milk is well absorbed.
8. Protects baby from allergic reactions such as asthma or eczema from bottle feeding.
9. Baby doubles birth weight by age of 5months.
10. It is economical and healthy way of feeding a baby.

Breastfeeding in special medical conditions

1. Multiple Gestations/Twins Feeding twins or triplets depends on the choice of the mother. Some mothers feed both twins at the same time while others feed one at a time and then the other, whereas some mothers feed Baby A from one breast and then Baby B on another and then they are interchanged. It all depends on your judgment.
2. Low birth weight (Preterm babies) – Preterm milk contains more protein than mature milk. Preterm babies need extra protein and they grow better on their mothers preterm milk than on donated mature milk from other women. Mother should express her milk as preterm babies find it difficult to suck. Babies who weigh less than 1600g (1.6kg) are fed by using a Nasogastric (NG) tube in the hospital. If a baby weighs 1.6kg and can swallow, then the mother can feed from a cup which is safer than tube (Infection may develop from the tube).
3. Cleft lip or palate This refers to the incomplete closure of the lips or palate of a baby. Some of the babies need to be fed by Express Breast Milk (EMB) using a tube or with a cup until the baby can suckle.
4. Baby with Jaundice – colostrum helps to clear meconium (first stool) and thereby prevents jaundice from occurring. Breast milk helps to clear early physiological jaundice, but glucose water, plain water or other supplements do not help. If the jaundiced baby sleeps too much or does not suckle strongly enough wake him/her up and give expressed breast milk using a cup.

Breast feeding your baby will ensure that the baby attains the normal developmental stages and also gain normal weight, height and size.

Complementary and Supplementary Feeding Practices

The period of 0-12 months is referred to as the Infancy period. It is a period whereby the baby grows rapidly and demands for nutrients and energy are higher than any other period of life. The need for Human milk is the first ideal food for human infants from 0-6months only, beyond which additional food has to be given to complement that of the breast milk. This is where complementary feeding comes in.

A well-nourished mother produces about 850ml of milk daily for the first 6 months after delivery and after that, the volume of milk drops to 600ml/day with the amount of nutrients dropping too. Therefore, at the age of 6 months, breast milk is no longer adequate both in volume and nutrients and solid family diet or other complementary feed must be introduce before the baby is weaned.

Differences between supplementary feed and complementary feed

Most times, people are confused as to what supplementary feed is and what complementary feed is.

1. Complementary feed is given to a child after 6 months of age because the breast milk at that time lacks all the nutrients a baby needs at 6 months. And at this age, the babys demand is more than what the mother can offer.
2. Supplementary feed is a feed containing needed nutrients that may not be available in another feed. ( I will clarify)
3. When you give a child biscuit after 6 months and that child is still taking breast milk, it means that the biscuit is a complementary feed that is given to the child to provide for energy. If you were to give the child breast milk alone, the child may not be full and hence the biscuit has complemented the milk.
4. By using the same example in (3) above, will you keep giving the child biscuit alone? The answer is NO because biscuit has no nutrients apart from energy. In order to provide energy and nutrients to your baby while interchanging with breast milk, you need to add a feed that contains nutrients. You can decide to add fruits juice or even make fruit smoothie that will provide vitamins and minerals for the child together with the biscuit that provides the energy. This added fruits juice or smoothie is a supplementary feed because it contains vitamins and other nutrients.
5. Another example is: What if there is a feed that has been made commercially that contains all the energy and the nutrient combined and packaged into one container and sold? Of course such feeds exist and are commonly used. In this instance, anytime you give it to a baby you are providing complementary as well as supplementary feed because it is providing for nutrients that the breast milk could not provide all (at 6 months) and also providing the needed quantity to make the baby full (achieve satiety).
6. If you have been feeding a child with just pap and sugar, that is not supplementary feeding, because it is not providing for nutrients apart from the energy. In such an instance, you are giving complementary feed

TYPES OF COMPLMENTARY FEEDS FOR BABIES

There are various commercial complementary foods for kids such as Nutrend, Cerelac, Babeena etc. that can be bought in the market. These complementary foods are always costly and most families may not be able to afford it for their kids especially in developing countries. Buying something that cost about 2500 to 3500 naira every week in Nigeria for a woman that is finding it difficult to pay hospital bills may just be a waste of time and advice. It is necessary to educate women on the need for nutrition for their infants and children and also teach them how to prepare traditional and locally made formula at home for feeding their already malnourished children. They are thought on how to do it themselves by using the common recipes they have at home such as cereals, groundnut, soybeans etc. These types of recipes are mostly planted by these women and they are told how to feed the children.

Commercial complementary food provides energy density of about 2Kcal/g if instructions are followed while traditional/locally made complementary food from cereal alone has energy density of 1Kcal/g.

Advantages of commercial complementary foods over homemade food

1. Commercial complementary foods are easier to prepare and contain all the nutrients that an infant needs to grow and be healthy if the instructions are followed.
2. It helps reduce contamination compared to the traditional food that might easily be contaminated in the process of preparing it.

Disadvantages of commercial and complementary foods

1. Commercial complementary foods are too expensive for average families. You may need 10,000 naira to feed a child for one month; even a civil servant earning a minimum wage of 18,000 naira may not afford it.
2. It has the problem of mothers not following the instructions on the label mostly due to ignorance or illiteracy.
3. There is the problem of over dilution of the feed in order to last longer at the expense of the infants health. As a result of this, a kid stands the risk of having malnutrition.

When and How to wean a baby (Child)

What is Weaning?

Weaning is a process whereby a child of any age is introduced to other foods that is different from the usual breast milk for whatever reason. It is mostly a gradual process that may take months or weeks depending on the mothers choice. Weaning is not done abruptly as it could cause malnutrition in the child with other consequences such as allergic reactions to newly introduced complementary or supplementary feeds. No matter how long it takes, the child must definitely stop breastfeeding one day and as the child becomes more of age (from 6 months and above), the breastmilk will not be able to provide all the nutrients that the child needs and therefore, it becomes a must to introduce complementary and supplementary feeds and from there, the child starts the process of weaning.

When is the right time for Weaning?

Unfortunately, there is no specific right time for a child to be weaned as circumstances arise when weaning might be done within the shortest time possible and other times may warrant taking a longer time. The truth is that, it all depends on you but it is highly advisable that weaning should be started only after 6 months of exclusive breastfeeding as stated above. Once a child is 6 months, you can start to introduce complementary feeding as earlier stated. This introduction of complementary feeds is the beginning of the weaning process. What this means is that you are introducing your child to new foods and this might at first be difficult for the child because he/she might have been used to breastmilk and tasting this new food may just be something that the child may not like. Most children would not like it at first but when they are continually forced into taking it, they may end up liking the new food than the breast milk. The right time for weaning therefore depends on the mom and most mothers who have given birth several times have no problem as to when they need to wean the child because it is something that they have experienced. If it is your first time, then continue to breastfeed until it is 6 months. After 6 months, you will then introduce the child to complementary feeds even as you alternate with breastmilk and once the child starts taking the feed enough, you can then start initiating the family diet that the adults eat regularly at home. When introducing the family diet, it should be a gradual process too and the child should be able to eat small and then gradually increase the quantity. Once a child starts eating the family diet to an extent that the child gets full (achieves satiety), then you should know that it is time to completely wean the child off the breast milk.

The best time for complete weaning therefore is the time the mom observes that the child can eat the food that is normally eaten within the family (Family diet) and gets full. Once this occurs, the child is ready to be weaned completely. Some children may cry and disturb you when you deny them of breast milk but after crying, they have no choice than to take the delicious family diet available.

What to do when you start introducing your child to babys formula and family diet

It is very important that you observe if there could be likely changes that may occur when a child is introduced to supplementary feeding. The child may have diarrhoea or may develop allergies or may vomit. Always look out for these signs.

A child that develops a rash, change in skin colour, redness of the throat or have difficulty in breathing after the supplementary feed was introduced is likely allergic to the protein content of the feed. Stop the formula immediately and change to another type that is different in protein content or you may make your own baby formula at home from the procedure below.

A child that is having persistent diarrhoea after being introduced to supplementary feed or family diet shows that the procedure for making the food is unhygienic or that the child may be allergic to the food. Other associated signs could be: increasing flatulence, abdominal distension etc. Any change noticed after commencing supplementary feeding should be taken serious and alternatives to feeding should be sought.

Methods of weaning babies

There are various ways in which you can wean a child. These are based on what other women have been doing and may not work perfectly for you but have been found to work most of the times. Remember that the process of weaning is like a struggle between the child and mother and whoever wins will enjoy the benefit, though the mom always mean well for the child, the child may not understand why the mom is denying him/her of the usual breast milk. Here are the methods of weaning:

1. Use of bitter but harmless substances on the breast
A baby that has been sucking knows how milk tastes and any taste different from the normal would prevent them from further taking the breast milk. Use something bitter and rub it on the breast at the areola and nipple. Anytime the child needs breast milk, do not deny him/her but gladly give. If the child tastes and finds out that it is bitter, the child may not want to take it again. It is good that when you are doing this, you should have made formula for the child so that anytime the child feels the breast is bitter, he/she will have no choice than to take the one that is available. Using bitter but harmless substances might make the child not to take the breast milk again on the first trial. Other babies might want to try it again to see if it may taste normal again. Continue doing this for 1 week. It is most likely that the child would not be interested again in the breast milk because it tastes bitter. If after a week the child still tries to suck the breast, then you may need to change to another method.

The method may not work for children that have been taking bitter drugs because the bitter substance will taste just like the normal bitter drug they have been taking. If the child has been taking drugs but the drugs are not bitter, then this method is the best to try out. Even if the child has been on bitter medications, still try out this method.

A good example of a harmless and bitter substance is bitterleaf (used in making bitterleaf soup). When using the bitter leaf, always wash the leaf properly with salt and enough water to prevent any infection to the child. After washing the leaf, pound it into tiny pieces and make a paste from it. Do not drain the bitter water. Apply the paste to the nipple and areola area. Anytime the baby tastes it, he/she would remove the mouth immediately and stop sucking. Allow the child for 1 or 2 minutes to see if the child may try sucking again; if the child tries sucking again, the bitter taste will prevent the child from sucking again. This is the time to then give the prepared formula or supplementary feed to the child. Continue to do this for about week. Most times, the child stops immediately and may never want to take the breast again even when given. It is then left for you to prepare the complementary feed and give the child anytime the child wants to eat or suckle.

2. Use of Pepper on the breast
Pepper is very hot to taste and even some adults do not like the taste of it. This therefore is the effective way of weaning babies off milk and there is no child that can become used to taking of pepper. When applying it, grind it and keep aside. Do not apply it immediately because it may hurt the skin. Anytime a child wants to suckle, just rub a little around the areola and then allow the child to suckle. This may seem harsh but it is the effective way to wean a child. Do not put overwhelming amount that may disturb the child, just rub it by using your finger to rub it round the areola (You may use three drops). Make sure you have a formula to give the child immediately because the pepper will make the child to cry and would gladly take whatever you give in order to quench the hotness of the pepper. The formula will help the child quench the hot feeling of pepper at the same time gives satiety to the child.

3. Outright denial of breastmilk
This requires the mother denying the child of breastmilk. This is less effective because the child may cry and tumble around in order to get the mother to succumb to the demand. The cry of the child may provoke sympathy and the mother may end up giving the child the breast milk. Denying the child without giving the child reasons to stop may make the child continually cry out anytime he/she needs to take breast milk. But when the child finds reasons such as the breast suddenly becoming bitter or having the taste of pepper, the child would not really want to take the breast milk again.

Weaning twins and other multiple gestations

In order to wean off twins, triplets or more, the mother may have to start introducing supplementary feed earlier than in single babies because the mother may not meet the demands of the children especially for triplets. The rate of production of breast milk may not be enough to feed all the children and hence, when the mom observes that she cannot meet the demand, it is better to start the complementary feeding and then the complete weaning follows after the children start eating the family diet in an amount that gets them full. The method for the weaning is the same as stated above.

Problems associated with weaning

Weaning when not properly done may cause problems to both the child and the mom. It is therefore necessary to understand and adhere to the right steps to carry in order to wean a baby.

The problems that may arise include:

1. Malnutrition

Malnutrition may arise when a child is weaned off the breast. This happens due to the fact that the food given to the child is not providing for all that the child needs. Sometimes, the same type of food is given to a child simply because the mother may not have time again for the child due to some Job engagement or other social activities. Other times, it is due to poverty, especially in developing countries where a child hardly have enough food to eat not to even talk of other important but yet costly ingredients of food such as meat, eggs etc. Due to this fact, the cases of protein energy malnutrition mostly occur at the age of 1 year and above because the children were weaned from breastmilk and now have little to eat and the little does not have all the nutrients needed by the child for growth and development.

The solution to this problem is for the mother to know that weaning a child does not mean that the child can now be neglected. The child still needs balanced diet which should contain all six classes of food: carbohydrate, protein, vitamins, mineral salt, fats and water. The child needs all of these to grow and develop well like other children of his/her age. It is therefore necessary for all mothers to know the common food varieties and their associated nutritional benefits as outline below at the end of this article. The mother should know of micronutrients and the foods that contain these nutrients, she should know of the vitamins and their sources and their functions and she should also know how to make a mix for the child. When a mother has the knowledge of all these, then the child is unlikely to be malnourished after breastfeeding unless the child is chronically ill. The knowledge therefore is the most important factor because a babys parents could still be rich and yet the child may be malnourish due to ignorance on the side of the mother.

2. Infection

Infections are commonly the problems that may occur when a child is weaned. This is largely because of the procedures taken while making the food or preparing the complementary feed for the child. It is therefore necessary that hygiene should be strictly followed in the preparation of food for the baby. Another factor that causes disease indirectly after weaning is a dirty environment. At the time a child is weaned, it happens coincidentally too that it is the same time that a child might have learnt how to walk or atleast crawl. This mobility of the child makes the child to move around and anything that they come in contact with would be taken to the mouth leading to infections and diarrhoea. It is advisable to keep their environment neat.

3. Painful breast due to engorgement

This is a problem that is likely to occur following the sudden weaning of a child. Remember that breast milk production occurs under the influence of some hormones in the body of the woman as stated earlier. If the mother all of a sudden stops breastfeeding, then the hormones may keep secreting milk which may lead to engorgement of the breast. When this occurs, the mother may have pains that may be very discomforting that she may not sleep well. To prevent this from happening, the mother should slowly wean the child to give room for the body to adjust accordingly; but if it still happens that the breast becomes engorge, then the mother should treat as follows:

1. Express the breast into a clean container. You have to keep doing this anytime the breast becomes engorge. This will relief the pains immediately. Expressing the breast means you should extract the milk in a container by pressing gently on it. You have to keep doing this for some few days and the body will adjust. Remember that sucking the breast by the baby triggers more production; hence, the lack of sucking now inhibits the production of the breast milk.
2. Use of pain relievers to reduce the pain: if the pains become unbearable, then you could still take pain relievers such as Paracetamol.
3. If all fails, you may likely need Bromocriptine but this should be with your doctors prescription.

Kids Daily Intake of Food

After weaning, the mother needs to know the daily requirements of food and nutrients that a child needs in order to remain healthy and grow well.

In order to meet the daily nutritional requirements of an infant on locally made or traditional complementary food, the daily food should include the following:

1. Body building protein-containing-foods needed for growth and development:
   1. Frequent breastfeeding: remember that these recipes are for making complementary feeds and should be given in addition to breastmilk as explained above. There is need to continuously give the child both until the child is completely weaned, after which he/she is introduced to solid family diet alone.
   2. Addition of animal products such as egg (especially the yolk), minced meat, liver, fish, crayfish. There are some traditional taboos that are still practiced in some countries. In some places in Nigeria, kids are prevented from eating eggs, that it will make a child to learn how to steal. Another one is that children should not take honey because it will make them grow additional teeth and that the liver of any slaughtered chicken or animal is only reserved for the father of the house and not for children. As we would see below, the liver and egg yolk which children are prevented from eating are the most important source of vitamins, minerals and proteins.
   3. Large quantities of plant proteins of legumes like peas, beans, groundnuts, and sesame seed.
2. Protective foods like fresh ripe and sweet fruits, fruit juice, dark green leafy vegetable (DGLV). This is where Calabar and Igbo people of Nigeria are doing very good at. They have varieties of vegetable soup recipes such as Editan soup,Edika Ikong, Abak Atama, Oha soupand they know how to cook the vegetable while retaining the nutritional value by not overcooking it.
3. Foods that give energy – staple foods like rice, guinea corn (dawa in Hausa, Ikur in Taroh), fonio(acha), and millet. Remember that these staple foods should be added with other food types in this list. Continuous giving of solely energy-foods like cassava (or Garri) is the cause of Kwashiorkor.
4. Fat containing foods like palm oil, vegetable oil, margarine (butter) etc.

List of foods and their associated deficient Amino Acids

It is advisable to try and add animal protein to diet of kids because it contains complete amino acids. Plants do not contain all the amino acids; here is a list of each type of plant and the associated deficient amino acid.

1. Cereals: do not have Isoleucine and Lysine.
2. Legumes are deficient in Tryptophan and methionine
3. Nuts and Seeds do not contain Isoleucine and Lysine
4. Vegetables do not have Isoleucine and Methionine

How to mix and vary traditional complementary feeds (locally made) for kids

When preparing any meal for infants, cereals should always be the staple food (the larger or dominant food in a meal) plus any of these: Dark green leafy vegetable (DGLV), legumes, or Animal products; from these 4 types of foods, you can then have 3 mixes which are:

1. Double mix of:
   1. a staple (maize or rice) versus a legume like groundnut or soybeans
   2. a staple (maize or rice) versus Dark Green Leafy Vegetable (DGLV) such as spinach or ugwu leaves
   3. a staple (maize or rice) and animal product such as egg or meat
2. Triple mix of:
   1. a Staple plus DGLV plus Animal Product
   2. a Staple and Legume and Animal Product
   3. a Staple and Legume and DGLV
3. Quadri mix of a Staple + Legume + DGLV + Animal Product. This is always the best type of mix. The more the combination, the better it is for the kid because the combination would provide more nutrients to the baby.

Recipes for preparing infant formula mix at home for children greater than 6 months

In doing this at home, you must make sure that the ingredients are gotten from clean sources and that they are properly stored to avoid food contamination and afflatoxins especially in the maize, legumes and vegetables. Make sure that the containers are clean and wash your hands with soap before you start.

The container for feeding the child should be washed with soap and rinsed properly with clean water.

Feed the child as much as you can. Kids may not like it and would just prefer the breast milk they were used to taking. You have to make them learn how to take it because it is better for them now. Remember that the breast milk cannot meet the requirements of the infant again.

How to make Maize and Groundnut mix (Double mix)

Ingredients include:

• Maize flour = 3 heaped tablespoons
• Sugar = 1 level tablespoon
• Roasted/fried groundnut(pea nuts)(grinded) = 1 heaped tablespoon.
• Fruit juice = 1 level tablespoon
• Cold water = 60ml = Cup
• Hot water = 480ml= 2 Cups

Procedure

1. Add the grinded groundnut and maize flour together in a clean container
2. Add 60 ml of water to the mixture of maize flour and grinded groundnut and make a paste with it. Making the paste prevents the pap from forming balls/clumps
3. Boil about 600 ml of water
4. Pour 480 ml of the boiled water into the maize paste and keep stirring it until it is thick.
5. Add the sugar and fruit juice to it and stir
6. Allow it to cool and feed the kid with it. Make sure it is not too hot so as not to burn the childs mouth. Depending on the weather, if the weather is cold, you can serve the child with a warm pap.

How to prepare Maize and Soybean flour Pap (Double mix)

• Maize paste = 3 heaped tablespoon

• Soybean flour = heaped tablespoon
• Cold water = 60ml = cup
• Boiling water = 480 = 2cups
• Sugar = 1 level tablespoon

The procedure is the same as the one above, but this time, you will mix the soybean flour with the maize to make a paste.

The soybean should be fried until it is completely brown in color in order to destroy the phytic acid present in the bran/hull. This phytic acid is present in high levels and is responsible for blocking the absorption calcium, magnesium, copper, iron and zinc. Not frying the soybeans causes abdominal pains to the infant and will make the above listed minerals not available to the child. Do not give soybeans mix to babies that are less than 6 months because their intestines are not yet develop to digest it. These recipes are for infants that are greater than 6 months of age.

Recipe for preparing Maize and Crayfish or Dry fish Pap

Ingredients:

• Maize paste = 3 heaped tablespoon
• Grinded Crayfish or Dry fish powder = 1 heaped tablespoon.
• Cold water = 60ml = cup
• Boiling water = 480ml = 2cups
• Sugar = 1 level tablespoon
• Palm oil = 1 teaspoon

Procedure:

1. To the boiling water, add the palm oil
2. Mix the grinded fish powder with maize to make a paste by adding 60ml of cold water. Stir it to form a paste.
3. Add 480 ml of the boiled water and keep stirring until it becomes thick.
4. Add sugar and stir
5. Allow to cool and give the child.

Recipe for making Soymilk Pap

Ingredients:

• Maize paste = 3 heaped tablespoon
• Soymilk (cold) = 60ml ( cup)
• Boiling soy milk = 480 (2cups)
• Sugar = 1 level tablespoon

Guinea corn/Soybean flour and groundnut

• Guinea corn paste = 6 heaped tablespoon
• Soy flour = 1 heaped tablespoon
• Groundnut flour = 1 heaped tablespoon
• Sugar = 2 level tablespoon

Malnutrition arises when you are not able to give a child the required or needed quantity and quality of food. Such malnutrition could be in the form of Kwashiorkor, Marasmus, Micronutrients deficiency and Obesity. Over feeding a child is another form of malnutrition too as it can tip the child into obesity. Give as it is expected and follow instructions even when you are using the commercial complementary feed. It is therefore of importance that the mother should be aware of the nutrients contained in any food that she intends to feed her baby with. These nutrients (Vitamins and minerals) as wells as carbohydrates and proteins have been listed below.

When Malnutrition occurs, the child would need a completely different amount of nutrients and energy which are explained below.

Types of Therapeutic diets needed by malnourished children

Most times, protein energy malnutrition (PEM) is the most likely type that affects children and treating these children requires a special diet depending on their age, their type of malnutrition and the extent of damage that the malnutrition has caused. Basically, the important factor is the source of protein. Once the appropriate protein is available, then other nutrients can easily be added to form a diet for the malnourished child.

There are three (3) types/sources of proteins commonly used for malnourished children which are:

1. Milk: this is the most frequent source of protein used for making therapeutic diets. However, dry skimmed milk should be used for children that have difficulty in digesting fats-containing food. A child with pancreatic problems may not be able to digest fats and the signs you will see include: floating of fecal matter which is difficult to flush because the fats in the faeces makes it difficult to flush. Other signs include pale color of feces and fowl smelling faeces. If a child has problem in absorbing fats, then the child cannot absorb some vitamins that require fats for their absorption (fat soluble vitamins). These vitamins are mentioned below.
The appropriate milk as source of protein for these children would be Skimmed milk because all the fats have been removed.

2. Casein Preparation: when the gastrointestinal tract of a child have been damaged such that the enzyme lactase, which is responsible for breaking down lactose (milk sugar) into glucose and galactose, is no more available; then the best milk to give should have less lactose but the protein content should be retained. This is so because giving lactose-containing milk will cause lactose intolerance leading to diarrhoea in the child. This is where Casein preparation becomes useful. Examples of such casein preparations include Casilan and Complan.

3. Milk substitute from Plant proteins: remember that plant proteins have deficiency of some amino acids compared to animal protein that has complete aminoacids. Because of this, any preparation that you make should be a combination of different plant sources in a way that you could get all the combination of these amino acids. In order to achieve this, you have to combine maize, soybeans and groundnut in the ratios: 60%, 30% and 10% respectively. This will form milk substitute protein.

Having these great protein sources, you can now learn how to make a pap for malnourished children (Kwashpap). Kwashpap is just like the normal pap but it has been enriched and nutrients have been added to suit the need of the malnourished child. There are three types of kwashpap: kwashpap 1,2 and 3. The procedure for making them and their reasons are stated below.

Recipes for making Kwashpap for malnourished children

1. Kwashpap 1: this is prepared for treatment of children with Protein Energy Malnutrition (PEM) that are over the age of 6 months. The ingredients required include:
   • 4 eggs as additional source of Protein to make complete amino acids
   • 1 ripe banana as source of Potassium
   • 30mls of vegetable oil
   • 45 grams of sugar
   • Combination of maize, soybeans and groundnut (this combination should be grinded)

Procedure for making Kwashpap 1

• Blend the banana and keep aside
• Measure out 100 grams of combination of the grinded maize, soybeans and groundnut and add the blended banana together with the four eggs to form a paste.
• Boil about 600 ml of water and add to the paste and stir very well until it becomes thickened
• Add the 30mls of vegetable oil and keep stirring it
• If after adding the hot water and the mixture is still watery or did not cook well, you need to pour it in a clean pot and warm it on heat until it becomes thick and well cook
• Allow it to cool and add 45 grams of sugar and serve it to the child. Make sure the child takes as much as possible

b. Kwashpap 2: this is also known as enriched pap and it is prepared for children that are less than 6 months of age whose intestines may not be able to digest soybeans; hence, the use of soybeans in preparing this type of pap should be avoided.

Ingredients include:

• 100 g of custard, Akamu, or maize flour
• 2 eggs
• 1 banana
• 50 grams of powdered milk
• 30 ml of vegetable oil

Procedure

• Break the eggs and add to the custard
• Blend the banana and also add to the custard or maize flour
• Add the 30ml of vegetable oil and the 50g of milk to the custard
• Sir the contents very well
• Boil about 600 ml of hot water and keep adding it slowly to the mixture as you stir until it becomes thick or well cooked. If it is watery, you need to pour it in a clean pot and put on heat until it becomes thickened and well cooked. While on heat, make sure you keep stirring it to avoid forming balls/clumps.
• Bring it down and allow it to cool and serve the child as much as possible.
• Do not add Sugar

The video below shows you how to make kwash pap 2 and could serve as a guide to making other types.

c. Kwashpap 3: this is also called rice pap and is used for children of any age that have persistent diarrhea.

Ingredients

• A cup of unpolished raw rice
• 1 egg
• 3 bananas
• 30ml of vegetable oil

Procedure

• Wash the raw rice and pour in a clean pot
• Add water to it to a level that covers the rice and put on heat to boil the rice
• Blend the 3 bananas and keep aside
• Bring down the boiled rice and add to a blender and blend immediately
• Add the blended bananas , vegetable oil and the egg (make sure you break the egg before adding it) into the blended rice and stir properly
• Serve it to the child as much as possible and any time the child passes stool
• When the diarrhea stops, you can discontinue it and continue with either Kwashpap 1 or kwash pap 2 depending on the age of the child

It is highly advisable that the entire process of making food for any child should always be hygienic and use clean water.

Sometimes malnutrition occurs as a result of Micronutrients and not just protein or energy malnutrition. There are so many micronutrients needed by the body for important functions. The best way to make these nutrients available is to vary the childs meals and not to feed the child the same kind of food always. Below is the list of vitamins and other micronutrients with their sources, functions and deficiency states.

Micronutrients

Micronutrients are substances needed by the body in very small amounts because they cannot be synthesized in the body. They include Vitamins and Traced elements. They are also called Essential elements.

Without these micronutrients, our bodies cannot function optimally and different health problems occur. They are however needed in small amounts by the body and excess levels in the body could cause serious health effects again. It is therefore important that you should not take less or take much.

Since the traced elements cannot be made by our body system, it means that they must be provided by the diet we eat.

If these nutrients are missing during the phases of rapid growth and development like in infants or children, then some important biological functions like intellect and life itself can be threatened. The child can become mentally retarded and growth itself will be retarded. A lot could go wrong both with adults and children such conditions are different in adults and in children. I will point out the various deficiencies of all the micronutrients and their toxicities.

The people at risk of developing micronutrients deficiencies are children and pregnant women because their body demands are high. Deficiency arising from micronutrients is also known as Hidden hunger because it may not be known and might be thought of as behavioral changes or some illnesses while in the real sense, it is your body that is in hunger for the specified nutrient.

Lists of Micronutrients

• Traced Elements

1. Zinc
2. Iron
3. Selenium
4. Iodine

• Vitamins
  1. Vitamin A
  2. Thiamin (Vitamin B₁)
  3. Riboflavin (Vitamin B₂)
  4. Niacin(Vitamin B₃)
  5. Vitamin C
  6. Vitamin D
  7. Vitamin E
  8. Vitamin K

Vitamins: A, D, E, and K are known as the Fat soluble vitamins while Vitamins: B and C are called the Water Soluble Vitamins.

Fat soluble vitamins are vitamins that require fats for their absorption from the intestines (gut) into the body for use. Without fats, the absorption of these vitamins is not possible and a deficiency of these vitamins can occur. Because they require fats, they also require proteins in the body for transportation to where they are need. Water soluble vitamins are vitamins that can dissolve in water and their absorption does not need fats. These vitamins are easily excreted in the urine since they are water soluble; hence, their toxicity is rare even when taken in large amount.

Micro-nutrients Deficiency

The three major micronutrient deficiencies emphasized by the UNICEF and World Health Organisation (WHO) worldwide are: Vitamin A, Iron deficiency and iodine deficiency

Most of the micronutrients such as zinc, iron, selenium, vitamin A, thiamin (B1), riboflavin (B2) and vitamin C are needed during the period of rapid growth as in infancy, adolescence and late pregnancy.

1. Vitamin A

Vitamin A may be taken as a preformed vitamin or as a provitamin.

Provitamins occur in vegetable foods and pre-vitamin occur in animals.

They are highly coloured, either carotene or closely related substances.

They are converted in the walls of the intestine into vitamin A.

Vitamin A benefits:

• For normal vision, in formation of rhodopsin (visual purple).
• Helps in the differentiation of epithelial cells (lining of body)
• It helps the Immune system in response against infections.
• It is required for bone formation

Deficiency State of vitamin-A leads to:

• Night blindness ( inability to adjust to vision in dim light)
• Keratinization (dry and hardened cells, cells lack ability to form and secret mucus).
• Xerophthalmia (dry and inflammed eyes).
• Bitots spot (accumulation of increased number of dead cells of the eyes leading to problems with sight)

Vitamin-A rich foods include:

• Palm oil
• Red, yellow and orange fruits
• Red, yellow and orange Vegetables and Dark green leafy vegetables (DGLV)
• Liver
• Milk
• Fish oil
• Meat

When vitamin A is taken in excess, it causes hypervitaminosis A and also Carotenodermia (the skin changes to orange color, the condition is reversible once the excess beta carotene is broken down by the body). Carotenodermia is also known as artificial jaundice, Carotenosis, Xanthaemia or Xanthosis. It is harmless and disappears after you stop taking excess carrots even though it might trick your doctor to think as if it were jaundice.

2. Thiamin (B1)

The active form of Vitamin B, used in the body is known as thiamin pyrophosphate (TPP) and it acts as a coenzyme in carbohydrate, fat, and protein metabolism for the release of energy.

Functions of Vitamin B₁:

• It maintains the normal function of heart, muscles and nervous system.

Good sources of Vitamin B1 include:

• Dairy products such as milk, yoghurt, and cheese
• Meat (kidney, liver)
• Fish
• Dark green and leafy vegetables
• Egg yolk

Deficiency state for Vitamin B1:

• Deficiency of vitamin B1 (thiamin) alters entire metabolism of fats, carbohydrate and protein causing a disease known as Beri-beri. It is a disease of nervous system that causes extensive damage to nervous and cardiovascular systems and manifesting with different symptoms. Beri beri is usually characterized by rapidly progressive paralysis starting from the feet and moving upwards to other muscles. It is caused by over consumption of highly polished rice.Symptoms and signs of Beri-beri depends on the type.
  • Wet beri-beri causes swollen hands and legs.
  • Dry Beri-beri causes loss of body tissue
    Other symptoms of beri beri include:
  • Fatigue feeling of being tired
  • Loss of appetite (anorexia)
  • Irritability

Sources of Vitamin B1:

• Dairy products
• Meat ( kidney, liver)
• Fish
• Dark green leafy vegetables
• Egg yolk.

3. Riboflavin ( Vitamin B2)

The active forms are Flavin mononucleotide (FMN) and Flavin Adenine Dinucleotide (FAD) and they are coenzymes important for the release of energy in glucose, fatty acids and amino acids metabolism.

Functions of Vitamin B2

• Is coenzyme in hydroxylation reaction
• It is essential for tissue respiration.

Good sources of Vitamin B2:

• Meat( liver, and kidney)
• Milk
• Dairy products
• Fish
• Dark green leafy vegetables such as spinach and Ugwu

Deficiency of Vitamin B2:

• Skin lesions which reflect impaired maturation of collagen.
• Blurred vision
• Cheilosis (dry scaly lips and corners of mouth)
• Reduction in resistance and vitality
• Dermatitis – around nose and mouth
• Growth retardation

4. Vitamin B3 (Niacin)

Active forms are Nicotinamide Adenine Dinucleotide (NAD) and Nicotinamide Adenine Dinucleotide Phosphate (NADP) for metabolism of fat, carbohydrate and amino acids.

The active forms of vitamin B3 serve as coenzyme in dehydrogenase systems.

Deficiency of Vitamin B3 causes a condition known as Pellagra. The health effects of having pellagra can be remembered with 4Ds: Diarrhoea, Dermatitis, Dementia, and Death.

Dermatitis refers to the redness and swelling of the skin and could be associated with heat, pains or itching.

Dementia is loss of memory and an inability to recognise people you once know.

Other symptoms and signs of vitamin B3 deficiency include:

• Rough skin
• Swelling of tongue
• Enteritis (inflammation of intestines)

Sources of Vitamin B3

• Liver
• Meat
• Fish
• Yeast
• Dark green leafy vegetables
• Eggs
• Chicken
• Peanuts

5. Vitamin C

This is the most common vitamin that is widely known even by kids.

Vitamin C health benefits include:

• It helps the body to fight infections
• Vit. C also helps in the maintenance of intracellular materials and collagen that supports body structures
• Vitamin C is also involved in the healing processes after injury

Vitamin C deficiency

• A deficiency of Vitamin causes a disease called scurvy that leads to bleeding of the gums.
• Impairment of collagen synthesis.
• Reduction in resistance to infection
• Poor wound healing
• Tiredness (fatigue) and irritability
• Defects in tooth formation
• Rupture (tear) of blood vessels (capillaries)

Food sources of Vitamin C:

• Fruit juice
• Tomatoes
• Fresh green vegetables
• Citrus fruits

6. Vitamin D

This is produced endogenously within the body when the skin is exposed to sunlight.

Functions of vitamin D

• It promotes calcium absorption in the gut to enable bone mineralization.
• It is need for bone growth and remodeling
• It prevents thin, brittle and misshaped bones
• It prevents the rickets in children and osteomalacia in adults which are the conditions that occur if there is deficiency of this vitamin

People at risk of vitamin D deficiency include: premature babies, aged people, people with long standing kidney diseases and those who are not exposed to the sun for a long time.

Food sources of Vitamin D include:

• Cod liver oil
• Salmon fish
• Tuna fish
• Eggs
• Sardines

7. Vitamin E

It is an antioxidant that helps to protect the cells of the body from damage due to free radicals.

Functions of vitamin E:

• Prevents oxidation of low density lipoproteins cholesterol
• It is necessary for structural and functional maintenance of the skeletal, cardiac and smooth muscles.
• It assist in the formation of Red blood cells in the body
• It helps to maintain the stores of vitamin A, vitamin K, iron and selenium
• It is an integral part of the skin oxidant defenses primarily providing protection from ultraviolet radiations

Food Sources of vitamin E

• Shrimps
• Fish
• Plant oils like olive oil
• Fruits such as mangoes
• Dark green leafy vegetables

Deficiency of vitamin E leads to:

• Birth defects
• Dry skin
• Hair loss
• Sow tissue healing
• Inability to secrete bile
• Anaemia could occur due to degradation of red blood cells

Toxicity of vitamin E occurs due to excess consumption of foods rich in vitamin E and it manifest with prolong bleeding from cuts because vitamin E interrupts the aggregation of platelets (they are the cells that help to stop bleeding in the body).

8. Vitamin K

It is an important vitamin that regulates the clotting of blood and hence, it prevents bleeding after injury.

There are three types of vitamin K which are: K₁-known as Phylloquinone(this occurs in plants, especially green vegetables), when eaten, it is converted to K₂ by the bacteria in the intestines; K₂ known as Menaquinone is gotten from animal products such as meat, eggs and cheese; K₃ is also known as Menadione and it is the synthetic form of vitamin K which is not recommended.

Functions of Vitamin K

• It helps in blood clotting
• It prevents easy breaking of bones (osteoporosis) by serving as bio glue that helps to plug calcium and other bone minerals into the bone matrix
• It helps to slow down growth of cancer cells

Food sources of Vitamin K

• Green vegetables like spinach
• Fermented foods like yoghurt and fermented soybeans

Deficiency of vitamin K leads to uncontrolled bleeding and easy breaking of bones. People at risk are those that use antibiotics excessively and also the newborn because their liver is not yet mature

9. Iron

Iron is an important component of hemoglobin (a protein that helps in transportation of oxygen and carbon dioxide in the body). It is also found in Myoglobin and many other enzymes in the body.

Deficiency of iron causes:

• Fewer red blood cells which reduce the capacity of blood to transport oxygen- a condition referred to as Anemia.

Other symptoms of Iron deficiency are:

• Fatigue
• Inability to concentrate
• Impaired physical and perceptive development in children.

The most common reasons for iron deficiency among children and infants is inadequate iron intake from foods and also severe infections by parasites.

Iron rich foods include:

• Liver
• Egg yolk
• Meat
• Dark green leafy vegetables
• Cereals
• Legumes

10. Zinc

It is an essential part of many enzymes in the body and plays an important role in the synthesis of protein and also in cell division.

A deficiency of zinc causes poor immune system function that is characterized by increased rates of infections such as diarrhea.

Other symptoms of zinc deficiency include:

• Growth retardation
• Delay in sexual maturity in children
• Dermatitis
• Impaired wound healing.
• Failure to grow properly in children with moderate deficiency of zinc

Food sources of Zinc

• Meat
• Liver
• Eggs
• Sea foods ( such as oyster)
• Milk.

11. Selenium

• It is a major antioxidant which protects cell membranes and prevents free radical formation in the body thereby decreasing the risk of cancer, heart disease and vascular tear.
• Selenium is also a constituent of the enzyme, glutathione peroxidase isolated from human red blood cells.
• Increased selenium intake decreases the risk of breast cancer, and cancers of the colon, prostate and lungs.
• It also helps to preserve tissue elasticity.
• Selenium slows down aging and hardening of tissues through oxidation
• Helps in treatment and prevention of dandruffs

Sources of Selenium include:

• Sea foods such as crayfish
• Meat
• Oranges

12. Iodine

Iodine is an important nutrient required and used by the thyroid gland for production of thyroid hormones (thyroxine and triiodothyronine) that regulate body metabolism.

Deficiency of Iodine

Iodine deficiency could have serious effects on growth and development. Consumption of foods that bind iodine and make them unavailable for the body is one of the common causes of iodine deficiency. These foods are called Goitrogens and they include: cabbage, broccoli, mustard, brussel sprouts, and kale. Lack of iodine in the body causes irritation to the thyroid gland leading to a condition known as Goitre which manifest with swelling of the thyroid gland in front of the neck.

Other effects of Iodine deficiency include:

• Reduced mental function.
• Increased risk of still birth
• Increased risk of abortions and infant death.
• When it occurs during pregnancy, it leads to the women giving birth to babies with severe mental and neurological impairment.
• If the deficiency occurs during infancy or childhood, it causes irreversible mental retardation, growth failure, speech and hearing defects.

Even mild deficiency could cause a low intellectual capacity.

A very good and rich source of Iodine that I will recommend is Cray fish. Cray fish and other sea foods are rich in iodine.

There are various efforts put in place by governments and public health organization to reduce micronutrient deficiencies. These include:

• Dietary diversification: changing different variety of foods in order to be able to get all the nutrients since there is no single food that contains all the nutrients.
• Food fortification such as addition of iodine to salt, addition of vitamin A in sugar and addition of iron to wheat flour
• Pharmaceutical supplementation: common micronutrients are available as supplements in the pharmacies. This involves either giving a tablet containing the micronutrient or by giving as an injection to provide sufficient stores for a long period of time. Vitamin A capsules provide sufficient vitamin A from 6 months upward.
• Public health measures such as enlightenment of the general public
• Fermentation of foods: this leads to the hydrolysis of some factors in food that make nutrients unavailable to the body. These compounds include: phytates, tannines and oxalates. Fermentation also reduces the incidence of diarrheal disease among children consuming fermented complementary foods by reducing the pH on the gut to become more acidic that pathogenic organisms cannot survive.