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JULY 2010 Bulletin

2010 Nutrition Month Celebration




“Sa pagkaing tama at sapat, wastong timbang ni baby ang katapat!”

What is Nutrition Month?

This year, the country is celebrating the 36th Nutrition Month. Section 7 of Presidential Decree No. 491 or Nutrition Act of the Philippines designates the month of July as Nutrition Month to create greater awareness among the people on the importance of nutrition.

What is the theme for this year’s celebration?

 
The theme for this year’s celebration is
“Sa pagkaing tama at sapat, wastong timbang ni baby ang katapat!”.
The theme focuses on the importance of giving appropriate complementary foods starting at six months while continuing breastfeeding as a strategy to promote nutrition and health among children and prevent childhood malnutrition.

Why focus on complementary feeding?



Malnutrition among young children continues to be a major challenge especially in developing countries including the Philippines. Scientific studies have shown that levels of malnutrition are three to four times higher among older children when compared to infants.



Results of the 7th National Nutrition Surveys (2008) show that:
 
8.2 % of infants,
25.4% of 1-year old,
31.8% of 2-year old,
37.9% of 3-year old,
34.4% of 4-year old
and 38.2% of 5 year-old children were undernourished.

 
The first two years are considered the most critical in the life of the child. This is the “critical window” for the promotion of optimal growth, health, and development. Insufficient quantities and inadequate quality of complementary foods, poor child-feeding practices and high rates of infection have a detrimental impact on health and growth during these important years. Even with optimum breastfeeding, children can become stunted if they do not receive sufficient quantities of quality complementary foods at six months of age
(Lancet, 2008).


Thus, improved feeding of children under two years of age is important.
Continued breastfeeding beyond six months accompanied by the consumption of nutritionally adequate, safe and appropriate complementary foods will help meet nutritional requirements of infants when breastmilk is still important but is no longer sufficient.


In the Philippines, only about 59% receive complementary feeding between 6-9 months (Figure 1). The regions with complementary feeding rates below national average are regions 1, 4, 5, 9, 11, 12 and NCR. On the other hand, 11.8% of infants below six months received complementary feeding earlier than six months (Figure 2). Infants are
worse off than the national level in regions NCR, CAR, 2, 5, 7, 9 and CARAGA.


What is complementary feeding?


Complementary feeding is the giving of foods to infants starting at six months, in addition to breast milk. The additional foods and liquids are called complementary foods because these are only additional or supplemental to breastfeeding, and not sufficient on their own as a diet.


Complementary foods used to be more commonly called "weaning foods". However, some experts advise that the use of the term "weaning foods" should be avoided so as not to imply that complementary foods are meant to be given to infants as they are weaned or “removed” from the breast.
Complementary feeding should not displace breast milk or initiate the withdrawal of breastfeeding.


What are the characteristics of desirable complementary feeding practices?


Infants and young children are very vulnerable to malnutrition during the transition period from exclusive breastfeeding to complementary feeding. Thus, it is important that their nutritional needs are met through appropriate complementary feeding practices.

Complementary foods must be:




a. given timely – meaning that they are given at six completed months when their need for energy and nutrients exceeds what can be provided through exclusive and frequent breastfeeding;



b. nutritionally adequate – meaning that the recommended amount for his/her age provide sufficient energy, protein, micronutrients and other essential nutrients to meet a growing child’s nutritional needs;



c. safe – meaning that they are hygienically stored and prepared, and are fed with clean hands using clean utensils;



d. properly fed – meaning that foods are given consistent with a child’s signals of appetite and satiety, and that meal frequency and feeding method are suitable for age.


When is the right time to start complementary feeding?

From six months and older, there is a gap between the total energy needs of the baby and energy and nutrients provided by breast milk. As the baby grows, the energy and nutrient gap increases. Thus, the sixth month is the best time to start giving complementary foods.



Exclusive breastfeeding from birth up to six months and starting complementary feeding at six completed months while continuing breastfeeding up to two years and beyond will help a child to grow healthy.

In addition, at six months, the baby’s digestive system is mature enough to digest a range of foods. The baby also begins to develop the coordination skills to move solid food from front to back of the mouth for ingestion. The control of the baby's head is improved and the baby is able to sit with support. These are important skills in eating solid foods. A 6-month old baby who looks and grabs at foods is a clear sign that he/she is ready to eat.

The following are some common signs to indicate that a child is ready
to start complementary feeding at six months:

a. holds his/her head straight when sitting down
b. opens his/her mouth when food approaches
c. is interested in food when others eat
d. receives frequent breastfeeds but appears hungry soon after
e. is not gaining weight adequately.


What are the risks of starting complementary feeding too early or too late?

Starting complementary feeding before the sixth month may:



a. Reduce breast milk production or intake. The early introduction of other foods into the infant's diet decreases the frequency of breastfeeding and intensity of suckling and as a consequence breast milk production also decreases. When this happens, the additional food may take the place of breast milk, making it difficult to meet the child’s nutritional needs.




b. Contribute to increased rates of infant mortality and morbidity. The early introduction of complementary foods increases the risk of illness, diarrhea, wheezing and other allergic conditions because a child receives less of the protective factors present in breast milk. Studies have shown that the incidence of diarrhea is 3 to 13 times higher when breastfed infants are given complementary foods between 4 to 6 months than when they are exclusively breastfed. Furthermore, babies fed early with restricted diets and living in unsanitary environments suffer from more frequent diarrheal episodes. The incidence of diarrhea is attributed to the lack of potable water, the use of water contaminated with Escherichia coli, and improper food storage.

c. Increase the risk of mothers becoming pregnant. Breastfeeding mothers are protected from getting pregnant because breastfeeding is considered a natural contraceptive. With shorter duration and less frequent breastfeeding, mothers lose this inherent protective factor.

d. Interfere with iron absorption. Studies have also shown that the early introduction especially of cereals and vegetables can interfere with the absorption of breast milk iron, which is normally low in concentration at the age of six months. Unless the child is fed with iron-rich food preparations, a child may be at a greater risk to iron deficiency or anemia.

On the other hand, delaying the giving of complementary foods is not beneficial and is dangerous because the child will not get the energy and nutrients required to meet his/her growing needs. As a result, the child's physical and mental development is affected and may lead to growth faltering and eventually malnutrition.


What are recommended complementary foods?

Breastmilk is considered the complete food for the baby from birth up to six months. This means that breastmilk alone is what a baby needs for the first six months of life. At the sixth month, the baby should be given additional foods in the recommended amount for his/her age that will provide sufficient energy, protein, micronutrients and other essential nutrients to meet the growing child’s nutritional needs.



Parents should choose and prepare foods from the different food groups: energy-giving, body-building, and body regulating foods or
what we know as GO, GROW and GLOW foods.





Energy-giving (GO) foods:
The main nutrients in this food group are carbohydrates and fats. Carbohydrates and fats are chief sources of energy. Examples of foods in this group are: rice, corn, root crops, bread and bakery products, noodles, cooking oil, butter, margarine and other fats, and sugars.




Body-building (GROW) foods:

These foods are high in protein and minerals needed for growth and repair of body tissues. Protein also gives energy, but it is important as a body-building nutrient. The foods in this group are: meat, fish, poultry, eggs, organ meats, milk and milk products, and dried beans like mongo and nuts. These foods are also high in vitamin A and iron that can be used readily by the body.
Regulating (GLOW) foods:
Included in this group are fruits and vegetables high in vitamins, minerals and fiber. Vitamins and minerals are essential for growth, for healthy eyes, for strong bones and teeth and high resistance to infections. Fiber is important for regular bowel movement.

What are some guideposts when giving or preparing complementary foods for the child?


a. Introduce one new food at a time.
Continue with the same food for 3 to 4 days until such time that the child gets used to the taste of the food. Introducing mixed foods is not advisable, as this will only create confusion to the child.


b. Start with small amounts of any food.
Prepare only a small amount (about 1 teaspoon) of the food to be introduced to avoid wastage. Increase the food quantity as the child ages while still maintaining frequent breastfeeding.

     

 
c. Increase food consistency and variety as the child ages, adapting the diet to the infant's requirements and abilities.
Use thick lugao and well mashed foods when starting solid food then gradually shift to a more viscous food with higher nutrient density as the child gets older and become more active. For instance, at six months, mothers can start giving thick lugao and well mashed vegetables then shift to thick lugao and mashed vegetables with minced fish then to soft rice with chopped meat or fish and vegetables. Make a transition to family diet at about 12 months.

d. Diversify the diet of the child to improve quality and micronutrient intake.
A variety of foods from the three food groups and in the right quantity will assure the child of the nutrients she/he needs for optimum growth.
e. Never force an infant to eat.
One common mistake among mothers and caregivers is feeding the child when he/she does not feel like eating. To ensure that the child eats when fed, mothers and caregivers should space the time between breastfeeding and mealtime. It is good to give complementary foods only after breastfeeding is done.



f. Never force a child to eat foods that he/she does not like.
If the baby objects to taking some foods, mix it with other foods he/she likes until he/she becomes accustomed to the flavor.




g. Season baby’s foods very slightly.
When starting, the baby's food should be bland ─ not too spicy, peppery, pungent, salty or oily. When family foods are to be given, mothers should make sure that she separates some amount for the baby before this is seasoned with salt or pepper. It is also important that salt should not be added to the diet of the infant before the age of 1 year because the baby's maturing kidneys cannot handle sodium effectively.

h. Be patient when feeding the child.
Mothers and caregivers should possess a positive attitude when dealing with, caring or feeding the child. A cheerful disposition of the mother and caregiver will help encourage him/her to eat more. It will also help if mothers or caregivers talk or interact with the child during feeding sessions as this will stimulate the senses of the child.


What are some guideposts to maintain cleanliness?

Parents and caregivers must practice good hygiene and proper food handling by:
a. washing with soap and clean water the caregiver’s and children’s hands before food preparation and eating



b. using clean or potable water for food preparation
 
c. using only fresh foods


d. storing foods safely and serve foods immediately after food preparation
e. keeping perishable foods and cooked foods in a refrigerator or in a cool place
 
f. keeping away flies by covering cooked foods



g. letting the child eat prepared foods within two hours if there is no refrigerator
h. storing leftovers properly



i. feeding the child with a clean spoon, cup and plate



j. keeping the house and the surroundings clean
 
k. disposing children's waste properly and washing hands
afterwards



l. keeping food and utensils in clean cabinets
 
X
m. NOT "cooling" the baby's food by blowing on it

n. NOT chewing the food first before giving it to the child.





To keep foods free from toxin and harmful chemicals, parents and caregivers must:

a. keep and store foods properly

b. not use foods with molds and foods with signs of spoilage

c. keep chemicals away from children and in a separate cabinet.


How do we know that the child is getting enough breast milk and complementary foods?


Regularly monitoring the growth (weight and height) of the child is a useful and important way to know if he/she is taking enough breast milk and complementary food and is healthy. Measure his/her height and weight regularly and plot these on a growth chart.

With sufficient breast milk and food of good nutritional quality, the child's weight and height will continue to increase correspondingly with his/her age. The growth chart can also be used as a tool for teaching mothers and caregivers if they are feeding the child properly.
A decrease in the weight of the child is a signal that she/he is not properly fed and or cared for.

Source: 2010 Nutrition Month Talking Points, National Nutrition Council


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Nutrition Month Theme 2011
The theme for the 2011 Nutrition Month is "Isulong ang BREASTFEEDING – Tama, Sapat, at EKsklusibo". The theme focuses on key messages to ensure successful breastfeeding practices. The theme supports the Department of Health's campaign on Communication for Behavioral Impact on breastfeeding which is "Breastfeeding TSEK (Tama. Sapat. EKsklusibo)." The objective of this year's Nutrition Month celebration is to encourage all sectors of society to help promote, protect and support correct breastfeeding practices.
 
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