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Management of Breast-Feeding: Immediately after birth, while the mother still in the delivery room, all mothers should have the opportunity to hold the baby for 10-15 minutes quietly and contently. If the mother tends to breast-feed, she should suckle her infant for 1-2 minutes at each breast. Skin-to- skin contact and early suckling are important at this time in promoting “bonding” and to encourage the release of the prolactine and oxytocine hormones which stimulate milk secretion and help the uterus to contract. B) Weaning Food: The age at which solid foods can be introduced to the infants depend upon individual family circumstances. Most authorities agree, however, that it should be some time between 3 and 6 months of age for the normal healthy infant. Principles of weaning: 1. Start with one food at one feed time, offering a small quantity only 2. Introduce new foods one at a time at 3-4 day intervals Pediatric Nursing and child health care 89 3. Introduce second meal after 3-4 weeks. Include iron containing foods, e.g. liver, green vegetables 4. As solid foods increased and milk volumes reduced, remember to offer dilute fruit juice or water from a cup to infant atleast twice a day particularly during hot weather. 7.2 Assessment of Nutritional Status: Growth Monitoring: The first step in appraising the growth of a child is by comparing the child with others of the same age and sex. A child, generally, is healthy if she/he grows well and gains weight. When a child is not growing well, he is probably not healthy. The causes for this ill health could be infection or inadequate food intake. Because of these, the growth of a child will slow down or stop months before clear signs of protein energy malnutrition (PEM). Thus, measuring the growth of a child helps to understand if the child is healthy or not. Growth monitoring is particularly important for follow-ups for children under 3 years of age. You are advised to refer growth-monitoring chart. How to interpret the growth chart: The first sign of protein energy malnutrition (PEM) is growth failure. Weighing a child regularly on a growth chart and understanding the direction of the growth line are the most important steps in detection of early malnutrition. Pediatric Nursing and child health care 90 Table 3. Gomeze classification of Nutrition Status Weight for age/reference weight Edema present Edema absent 60-80% Kwashiorkor Underweight < 60% Marasmic Kwashiorkor Marasmus It is very important to follow subsequent measurements and plotting, to watch the direction of the line showing the child’s growth. Table 4 Interpretation and the findings of growth charts Indication Child’s condition Good gaining weight Danger sign Stagnant Very Dangerous Losing weight Indication of the growth Monitoring chart Interpretation Child is growing well Not gaining weight Find out why Poor nutrition infection Losing weight may be ill, needs care Intervention Complement the mother Instruct the mother, support her Careful counseling return soon, admit or refer Pediatric Nursing and child health care 91 7.3 Protein Energy Malnutrition The most common form of malnutrition in the world today is that associated with diarrhea, as well as an inadequate diet in the young children. The side effects of malnutrition include hypoglycemia, hypothermia, hypotonic and mental apathy. Severe malnutrition (Kwashiorkor and Marasmus) contributes to high mortality and morbidity of children less than five years in developing countries and to mental and physical impairment in those who survive. A) Kwashiorkor: The most acute form of malnutrition is generally found in a child of 10-14 months who has had an excessive carbohydrate diet containing relatively little protein. Edema and enlargement of liver may later mask a slight loss of weight. Coldness of the extremities is well marked and the child is miserable but apathy when anorexia and/or diarrhea set in, there is loss of weight in spite of edema. This marsmic stage may be due to mal absorption rather than deficiency in caloric intake. Chronic cases show depigmentation of skin and hair, with the hair losing its luster, becoming straight, dry and sparse. Marasmus: This condition, seen in children whose weight is markedly
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