11.7.1  Identify feeding problems

You should complete the assessment of feeding and identify all the feeding problems before giving advice to the mother.

Based on the mother’s answers to your questions, you will be able to identify any differences between the recommendations for feeding and the child’s actual feeding. These differences are problems and you can see some examples of them listed in Table 11.5 below.

Table 11.5  Examples of feeding problems in infants and children.
A three-month-old is given sugar water as well as breastmilk.A three-month-old should be given only breastmilk and no other food or fluid.
A two-year-old is fed only three times each day.A two-year-old should receive two extra feedings between meals, as well as three meals a day.
An eight-month-old is still exclusively breastfed.A breastfed eight-month-old should also be given adequate servings of a nutritious complementary food three times a day.
A seven-month-old is given gruel with a bottle.A seven-month-old should be give soft porridge in addition to breastmilk.
A 12-month-old is given plain injera in addition to breastmilk.A 12-month-old should receive adequate servings of nutritious foods in the form of fit-fit, porridge, with some oil or butter added. In addition he should be given fruit and vegetables.
A nine-month-old is not breastfed and is given one third strength cow’s milk. A nine-month-old who is not breastfed should receive adequate servings of nutritious foods five times per day.
  • Can you think of other feeding problems that you might encounter?

  • You might have thought about some of these examples:

    • Use of a feeding bottle: feeding bottles should not be used because they transmit infection easily.
    • Lack of active feeding: young children often need to be encouraged and assisted to eat.
    • Relying on diluted milk or thin gruel (muk) for nutrition: dilution makes food less energy and nutrient dense and therefore might lead to malnutrition. Remind the mother that thick foods which are dense in energy and nutrients are necessary for infants and young children to grow.

Other examples of feeding problems that you might have identified include the following:

Not feeding well during illness

During illness the child may be eating much less or eating different foods. Children often lose their appetite during illness. However, they should still be encouraged to eat the types of food recommended for their age, as often as recommended, even if they do not eat much. They should be offered their favourite nutritious foods, if possible, to encourage eating.

Not enough variety in the diet

The mother may mention that she gives one bulky food (such as maize porridge) to the child. One bulky food alone does not provide adequate nutrient intake. You should encourage her to give other varieties of food to enrich locally available staple foods.

Not giving the young child a share of meat, chicken or fish when this is eaten by the family

Young children often need to be given their own portions of the protein- and nutrient-rich family foods (such as meat, liver and chicken). Encourage mothers to provide such foods whenever they are available in the household.

Not giving gommen or other foods with vitamin A

Mothers should always be encouraged to provide gommen or other food items (such as liver and carrots) which are rich in vitamin A.

In the sick child registration book, next to the feeding questions, there is a box labelled ‘Feeding Problems’. You should use that space to record any feeding problem found and counsel the mother about these feeding problems, remembering to praise her for good practices and encouraging her (in a non-judgmental way) to adopt positive feeding approaches for her infant or child.

The chart in Table 11.6 below shows you how you should record feeding problems for a 4-month-old infant for whom a feeding assessment has been carried out.

Table 11.6  Record chart showing feeding problems.
ASSESS CHILD’S FEEDING if child has ANAEMIA OR VERY LOW WEIGHT FOR AGE or is less than two years old Feeding problems
    Do you breastfeed your child? Yes No __
    If Yes, how many times in 24 hours? 5 times.Not breastfed often enough
    Do you breastfeed during the night? Yes No__
    Does the child take any other food or fluids? Yes No __Mixed Feeding
    If Yes, what food or fluids? cows milkGiving cow’s milk
    How much is given at each feed? _____________________
    How many times in 24 hours? ______ times.
    What do you use to feed the child? Cup___ Bottle Other_______Using feeding bottle
  • If on replacement milk: What replacement milk are you giving?_____
  • How many times in 24 hours? _____times
  • How much is given at each feed?_________
  • How is the milk prepared?_______________
  • How are you cleaning the utensils?________
  • If very low weight for age: How large are the servings? ______
  • Does the child receive his own serving? Yes___ No __
  • Who feeds the child and how? ___________________
  • During the illness, has the child’s feeding changed? Yes __ No If Yes, how? __________
Failed to increase feeding to help aid recovery

A feeding assessment should be done for all children who are less than two years old and for those who are classified as having anaemia or very low weight for age. If you find any feeding problems you should counsel the mother or the caregivers on the recommended feeding that corresponds to the child’s age. The tables with feeding recommendations, set out in this study session, provide useful guidance if you need to remind yourself about the different foods appropriate at different times in the child’s life.

In this study session, you have learned recommended feeding for infants and children according to their age. You have seen that complementary foods should be varied and energy rich, to promote growth and development of the child. The study session also stressed the importance of exclusive breastfeeding for infants of HIV-positive mothers. Additionally you have looked at how to assess and identify feeding problems, counselling and supporting the mother on recommended feeding practices, and how to record problems in the sick child registration book.

11.7  Assess the child’s feeding

Summary of Study Session 11