Defective Feeding
Defective feeding can rise due to various reasons some of the factors are listed below.
Causes of defective feeding:-
(a) Improper proper weaning: - The most common cause of malnutrition is improper weaning. Defective feeding during weaning results in very severe complications. Improper weaning may be due to-
(1) Faulty food intake during meaning: If the choice of food is not proper during weaning, it may result in different types of malnutrition conditions. For example Introduction of a high carbohydrate, protein diet can lead to PEM. Starchy foods like rice should be avoided during weaning.
(2) Weaning before scheduled time: In some cases weaning may be started before the child is ready for it. On top of that if breast milk is stopped then it may lead to several deficiency diseases. Some children are even given commercial "baby-foods" which, if not properly planned, may lead to both over or undernutrition.
(3) Delayed weaning: Although breast milk is the best for the child, it becomes insufficient when the child starts growing. Till about 6 months, breast milk is adequate but after that gradual introduction of solid food is necessary. If it is not started timely then the child would be malnourished since only breast milk would then be unable to supply the required quantity of nutrients.
(b) Lack of awareness and knowledge about feeding amount coma frequency and type of food.
(c) Local perceptions about the acceptability of specific food for young children.
(d) Cultural beliefs and perceptions on the mode of feeding e.g. bottle feeding, feeding with hands.
(e) Ignorance about the easy availability of complementary foods.
(f) Inappropriate energy density and frequency of feeding complementary foods.
(g) Caregiver's education.
(h) Caregivers, especially mothers time commitments to other activities.
(I) Feeding schedule and time.
(j) Feeding environment of the Infant.
Effects of defective feeding: Defective feeding can lead to several complications that may be divided into two broad categories-
A. General malnutrition: It is obvious that an infant who is given improper food or who is not fed properly, will suffer from various types of malnutrition. Of these are the most common one is Protein
Energy Malnutrition (PEM) the term refers to a class of clinical conditions that may result from varying degrees of protein lack and energy (calorie) inadequacy. There are several types of PEM-
(a) Kwashiorkor- Gross deficiency of proteins though energy deficiency is also presented; marked by edema.
(b) Marasmus- Gross deficiency of energy, protein deficiency also accompanies each; marked by muscle wasting.
(c) Marasmic-Kwashiorkar - Presence of both protein and calorie deficiency; most common type of malnutrition is over the country.
(d) Nutritional dwarfing- reduction in total height and improper growth.
Another common feature in infants and children comedy due to improper feeding is severe acute malnutrition (SAM).
B. Physical problems: If there is defective feeding several physical problems are common-
(a) Vomiting- By definition, vomiting is the forceful expulsion of the content of one stomach through the mouth and sometimes the nose. It is also known as emesis and may be caused by a variety of conditions.
Vomiting, as a result of defective feeding, may be of various type-
1. Innocent vomiting (posseting): It is repeated, effortless regarding regurgitation of small quantities of milk soon after feeding. The child is otherwise well and thriving and may be suffering from Gastro-Oesophageal Reflux it usually resolves by the end of the first year of life.
2. Nervous vomiting: This is a term that has been used to characterize vomiting which goes together with other behavioral symptoms of Infant stress and empire in payment of maternal-infant interactions.
3. Persistent projectile vomiting: This condition may develop in some infants around two weeks of age and is usually due to stenosis (loss of movement) of the pyloric spinster.
Management:
(a) Correct position during feeding helps to reduce the incidence of vomiting.
(b) Feeding in the correct amount of milk / solid food to the Infant also helps.
(c) Early medical help should be sought if physiological problems exist, for example, stenosis of the pyloric sphincter.
(d) Parents counseling should be done about the correct feeding of infants.
(b) Colic: Infantile colic, or excessive crying in healthy, thriving in fans come up is a common problem during the first months of life. A baby with call extremes in pain and draws the knees up to the abdomen. This typically occurs from sometime in the first three weeks of life until three to four months of age and in the evening. The Infant may not be able to settle after the noontime order late evening feed or will suddenly wake from sleep soon after feeding.
Management:
(a) Avoidance of cow’s milk and new foods may help.
(b) Correct position during feeding of Infant may be beneficial.
(c) Wind: babies normally swallow some air while feeding. When feeds are taken too slowly or too quickly for some reason the amount of air swallowed may increase. This air or 'wind' may be trapped within the GI tract and cause this distension and discomfort.
This may be seen if the baby does not position his lips correctly around the nipple of the breast of the bottle.
Management:
(a) The mother should be careful during the process of feeding regarding the positioning of the lips.
(b) The Infant should be fed in semi recycling position-neither to vertical not to horizontal.
(c) Forceful burping of the child after feeding is necessary. This can be done by the positioning of the Infant on the Mother's shoulder, applying slight pressure on the Infant's stomach to release the air/wind by burping.
(d) Constipation: Constipation is the condition where there is difficulty in the passage of stool due to hardness of the stool or other conditions. Poor fluid intake in the Infant or excessive milk intake in the toddler predisposes to this condition.
In constipation, the accumulation of hard bulky stools in the rectum causes rectal distension which may lead to pain and discomfort.
Management:
(a) Fluid intake should be increased; this can be done with the help of milk, fruit juices, or even plain water.
(b) Solid food introduction may help in the elimination of food
(c) Over-concentrated formula feeding can also lead to constipation; so the delusion of the formula is beneficial.
(d) the regularity of stool elimination should be started as soon as possible.
(e) if the problem is due to some physical problems like spinster stenosis or other causes of coma then medical help has to be taken as soon as possible.
(e) Diarrhea: Diarrhea can be defined as the condition when there is the passage of loose and watery stools frequently. Acute diarrhea is frequently due to wider Gastroenteritis and remains one of the most common reasons for morbidity in young children. The most dangerous consequence of diarrhea is the loss of nutrients and fluids leading ultimately to dehydration.
The main cause of diarrhea is usually infections arising due to the invasion of microorganisms. The causative organisms are most commonly viral (rotavirus, adenovirus, etc.), but maybe bacterial (Salmonella, Shigella, E. coli, Campylobacter, etc.) or protozoa (Giardia Zambia, etc.). Other causes like overeating Malabsorption etc. may also lead to diarrhea.
Management:
(a) Prevention of diarrhea is the most important management. This can be done by providing Oral Rehydration Solution (ORS) to the Infant. This provides the correct fluid and electrolyte balance. The Who ORS or home-based ORS can both be used according to suitability.
(b) Cow's milk should be avoided completely but breast milk should be continued.
(c) Introduction of solid food, especially new food should be stopped for some time.
(f) Food allergy and intolerance: Food intolerance is a reproducible and unpleasant reaction, not physiological based, to a specific food or ingredients. It is mainly a response to the digestive system. For example- lactose intolerance, where lactose cannot be tolerated by the digestive system and leads to gastrointestinal disturbances like diarrhea.
A food allergy or food hypersensitivity: There is usually an abnormal immunological response to a particular food/nutrients mediated by antibody T-lymphocyte or both resulting in several different types of responses.
Both of these are together referred to as adverse reactions to food.
The permeability of the gastrointestinal tract mucosa to food allergens is thought to be an important factor in the pathogenesis of antigenic food reactions gradually as the mucosa matches, food allergy also subsides usually.
Management:
(a) The parents should be tried to identify the offending food i.e. the food that is responsible for causing the allergy.
(b) More than one food item should not be introduced at the time so that it be understood which food is the cause of allergy.
(c) The most common foods that cause an allergy that is, Cow's milk, wheat, egg, some nuts should be eliminated from the diet completely.
(d) Small portion of new food should be given first and when the Infant is well adjusted to it then normal quantities can be given.
(e) Allergy tests can be done, if suggested by the doctor, to find out the exact food that is causing the problem.
(g) Overfeeding and Underfeeding: Appetite and satiety mechanism enable most babies to control the amount of energy ingested. But if the baby is overfed forcefully or even underfed then there will be several complications. Continuous overfeeding during infancy can lead to obesity in later life. Overthinking and also lead to vomiting and diarrhea etc. Underfeeding can also lead to malnutrition and growth failure.
Management:
(a) Force full feeding of Infant should never be done.
(b) The amount of food to be given should be calculated properly, or according to the doctor's suggestion.
(c) Homemade food should be given as compared to Commercial formula since these as calorie-dense usually.
(d) The feed should be planned according to the child's demand and not the convenience of the parent.
(e) Continuous nibbling of food or continuous access to a bottle should be restricted.
(h) Gastro-Oesophageal Reflux (GOR): It is a pathological complication resulting in the upward movement of food from the stomach to the esophagus that is in opposite direction, due to immaturity of the cardiac sphincter or other anatomical abnormal.
GOR can lead to-
1. Inadequate weight gain
2. Feed refusal or pain on feeding
3. Blood in the vomitus
4. Recurrent cough, wheezing for choking
5. Episodes of apnoea
6. Failure to thrive
7. Oesophagitis (infection in the esophagus)
8. Excessive crying
9. Heartburn and wind
Management:
(a) Small quantities of feed should be given since large volumes can cause you are. Small frequent meals are better tolerated.
(b) Burping after feeding can also be beneficial for stuff.
(c) Correct positioning of infants during feeding.
(d) Using food of correct consistency.
(e) Feeding the child patiently and gradually may help to prevent GOR.
(f) If necessary, medical help should be sought.
Failure-to-thrive (FTT): FTT is common, resulting from a combination of dietary, organic, and social factors that lead to undernutrition. It is a condition when there is a failure to gain weight.
Cause of FTT:
1. Neglect by parents or caregivers
2. Unintentional inadequate energy intake
3. Subtle oro-motor problems making food intake difficult,
compromising energy intake.
4. Children with difficult behavior of food refusal.
5. Disturbed parents and child interactions.
6. Chronic illness or disability adversely affecting a nutritional status-the minority.
Management:
(a) Better interaction between child and parents
(b) Counselling of parents so that they can understand the child signals relating to food is important.
(c) Specialist-support may be used.
(d) Correct feeding volume and amount is important.
(e) Patience during feeding is necessary.
(f) correct posture during feeding is extremely important.
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