How to feed your child up to two years old - Nutrition Guide

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NOTE: This document is Brazilian, but it can be a good contribution for Portuguese parents in this area.

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So that the breastfeeding exclusive is successful, it is important that, in addition to the mother being motivated, the health professional knows how to guide her and present proposals to solve the most common problems she faces during breastfeeding. Why do mothers offer tea, water or other food? Because they think the child is thirsty; to reduce cramps; to calm her down so she can sleep longer, or because they think her milk is weak or not enough and is not adequately supporting the child. In this case, it is necessary to admit that mothers are not confident about their ability to breastfeed. They need to be guided:

• that the milk from the first days postpartum, called colostrum, is produced in small quantities, and is the ideal milk in the first days of life, especially if the baby is premature, due to its high protein content.
• that breast milk contains everything the baby needs until the 6th month of life, including water. Therefore, offering teas and water is unnecessary, and can harm the baby's sucking, causing him to drink less breast milk, as the volume of these liquids will replace it. These represent a means of contamination that can increase the risk of disease. Providing these liquids in pacifiers or bottles causes the baby to swallow more air (aerophagia), causing abdominal discomfort due to the formation of gases, and consequently, colic in the baby. Furthermore, there is a confusion of nipples when feeding at the breast, making it difficult for the baby to latch on to the breast correctly (see table alongside).

The wrong latch will impair the total emptying of the breast, preventing the baby from sucking the hind milk (milk at the end of the feeding) which is rich in fat, reducing satiety and shortening the intervals between feedings. Thus, the mother may think that her milk is insufficient and weak. These shorter intervals between feedings lead to increased lactose (milk sugar) fermentation, worsening the baby's colic.

If the breasts are not emptied properly, they become engorged, which can reduce milk production. This occurs due to the increased concentration of inhibitory substances
of milk production.

What Mom Should Know

• That breast milk contains enough water to meet the baby's needs, even in very hot climates.
• Offering water, tea or any other solid or liquid food increases the baby's chance of getting sick, in addition to replacing the volume of breast milk to be ingested, which is more nutritious.
• The time for emptying the breast depends on each baby; There are those who can do it in a few minutes and those who can do it in thirty minutes or more.

Indicative Signs that the Child is Breastfeeding Adequately

• Good catch

The chin is touching the breast
Lower lip turned out
There is more areola visible above the mouth than below
When breastfeeding, the mother does not feel pain in the nipple

• Good position

The baby's neck is erect or slightly curved backwards, without being distended
The mouth is wide open
The child's body is facing the mother's body The baby's belly is against the mother's chest The baby's entire body is supported
The baby and mother must be comfortable

Production Versus Ejection of Breast Milk

A adequate milk production will predominantly depend on the baby's sucking (correct latch, frequency of feedings), which stimulates blood levels prolactin (hormone responsible for milk production). However, the production of oxytocin, which is responsible for milk ejection, is easily influenced by the mother's emotional condition (self-confidence). The mother may report that she is low on milk. In these cases, the baby generally gains less than 20g per day, wets less than six diapers per day and, when touched, the mother's breasts appear saggy. The health professional can reverse this situation by advising the mother to place the child on her breast more often to breastfeed, including at night, observing whether the baby's latch is correct.

When Breastfeeding

• The mother should not be tired, her back needs to be supported on a sofa or armchair and the baby supported on the mother's lap. The use of cushions or pillows can be useful;
• She shouldn't feel pain, if this is happening, it means the latch is wrong.
• The breastfeeding mother should drink at least one liter of pure water daily and encourage the baby to suck correctly and more frequently (including at night).

Gradually Introduce New Foods

Step 2: From six months onwards, slowly and gradually introduce other foods, maintaining breast milk until the age of two or more.

Reviewing Your Knowledge

A child's nutritional needs are no longer met with breast milk alone, although this still remains an important source of calories and nutrients.

From six months of age, the child already has physiological and neurological maturity to receive other foods.

Even when receiving other foods, the child must continue to breastfeed until the age of two or more. Breast milk continues to nourish the child and protect it against illnesses.

With the introduction of complementary foods, it is important that the child receives water at intervals.

From six months onwards, the child no longer presents the tongue protrusion reflex, which makes it easier to ingest semi-solid foods; produces digestive enzymes in sufficient quantities for this new phase; and, when sitting, the neck no longer falls, making it easier to eat with a spoon.

Complementary foods, especially prepared for the child, are called transitional foods. From eight months of age, the child can already receive foods prepared for the family, as long as they are without spicy seasonings and offered crushed,
crushed or chopped into small pieces.

What Mom Should Know

• The introduction of complementary foods should be slow and gradual. The mother must be informed that the child tends to reject the first offers of the food(s), as everything is new: the spoon, the consistency and the flavor.
• Complementary feeding, as the name suggests, is to complement breast milk, not replace it. The introduction of meals should not replace feedings.
• At first, the amount of food the child eats is small and the mother can offer the breast after the meal with complementary foods. There are children who adapt easily to new stages and accept new foods very well. Others need more time, and this fact should not be a cause for anxiety and anguish for mothers.
• Once complementary foods are introduced, it is important to offer the child water that is as clean as possible (treated, filtered or boiled).

Suggestions for Different Combinations of Savory Porridge

POTATO + cabbage + fish
AIPIM/CASAVA + okra + shredded chicken NOODLES + Green beans + (Minced or shredded chicken) SWEET POTATOES + zucchini + chicken giblets RICE + lentils + tomato
BAROA POTATO + pumpkin + bredo + ground liver
FUBÁ + chopped green leaf + ground meat RICE + mashed beans + carrot YAM + beetroot + beef liver
CASSAVA FLOUR + green leaves + ground meat

Intersperse Complementary Food with Breastfeeding

Step 3: After six months, give complementary foods (cereals, tubers, meat, legumes, fruits, vegetables) 3 times a day, if the child receives breast milk, and 5 times a day, if the child is weaned.

Reviewing Your Knowledge

Complementary foods are made up of most of the basic foods that make up the Brazilian diet.

The supply of breast milk is supplemented with foods that are more common to the region and the family's eating habits.

Complementary foods, such as a basic meal, three times a day, in the first year of life, will contribute to the supply of energy, protein and micronutrients, in addition to preparing the child for the formation of future eating habits. In the second year of life, two snacks a day should be added in addition to meals.

If the child is no longer being breastfed, the daily supply of these foods should be five times, starting from six months of age.

From the moment the child begins to receive any other food, the absorption of iron from breast milk reduces significantly; For this reason, the introduction of meat and offal, even if in small quantities, is very important.

The savory porridge must contain one food from the group of cereals or tubers, one from the vegetables (leaves or legumes) and one from the group of foods of animal origin (chicken, beef, fish, offal, egg yolk) or legumes (beans, soybeans, lentils, chickpeas).

What Mom Should Know

• If the child is breastfed, from six to eleven months offer 3 meals/day with complementary foods.
• In the sixth and seventh month, these meals consist of two fruit porridges and a savory one, prepared with vegetables, cereals or tubers, and meat or offal or beans.
• From the eighth month onwards, these meals consist of two savory porridge and one fruit porridge.
• From twelve months onwards, add two more snacks a day to three meals, with fruit or porridge.
• The introduction of complementary foods must be done with a spoon or glass in the case of offering liquids.
• If the child is not receiving breast milk, offer 5 meals with complementary foods, from the age of six months: fruit twice a day in puree form and salty porridge twice a day, in addition to cereal porridge, flour or starch. When using flours such as corn, wheat, rice or cassava, prefer those that are enriched with iron.

Foods That Can Be Offered to Children as Snacks

• Fruits (banana, mango, avocado, cashew, apple, papaya)
• Porridge made with milk (preferably breast milk*) and cereals
• Breads and cookies without filling
• Natural yogurt or homemade curd**
• Boiled potato or cassava/cassava
• * In this case, use cooked flour to avoid causing breast milk to heat up.
• ** When the child no longer breastfeeds

Food groups:

Cereals and tubers:
Rice, cassava, sweet potatoes, pasta, potatoes, yams, flour, baroa potatoes and yams.
(*) Important: Mothers are advised to use flour enriched with iron and vitamin A. Grains:
Beans, lentils, dried peas, soybeans and chickpeas.

Vegetables and fruits:
Green leaves, orange, pumpkin, banana, beetroot, avocado, okra, papaya, carrot, watermelon, tomato and mango.

Animal origin:
Chicken, quail, duck fish, beef, eggs and offal (offal).

Respecting Food Tastes and Quantities

Step 4: Complementary food should be offered without rigid schedules, always respecting the child's wishes.

Reviewing Your Knowledge

Breastfed children very early develop the ability to self-control their food intake, according to their needs, by learning about satiety after eating and the physiological sensation of hunger during the fasting period.

Later, depending on the foods and the way they are offered, they also develop self-control over food selection. Therefore, the practice of mothers/fathers or health professionals who adopt rigid feeding schedules harms the adequate development of self-control of food intake by the child.

It should also be noted that children who start complementary feeding are learning to test new flavors and textures of food and that their gastric capacity is small. After six months, the baby's gastric capacity is 20-30ml/kg of weight.

There are several factors that can cause mothers/fathers to interfere with the child's self-control due to the demand for food. Among them, the following stand out:

The lack of knowledge about the normal behavior of children, even as babies, on the part of mothers/fathers. Their difficulty in distinguishing the discomfort felt by the child as a result of the feeling of hunger, from those caused by other types of factors such as thirst, discomfort caused by dirty and wet diapers, heat or cold, need for affection and the presence of the mother/father. Therefore, mothers/fathers may be tempted to offer food all the time, even when the child is not hungry.

There is generally a much higher expectation about the amount of food that children need to eat. Thus, offering a volume of food greater than the small child's gastric capacity results in the refusal of part of the food and consequently an increase in anxiety on the part of the parents. On the other hand, in the case of older children, this behavior can be a risk factor for excessive food intake and overweight in the child.

Meal size is positively related to the intervals between meals. That is, large meals are associated with long breaks and vice versa.

The baby should be given food when he shows hunger. Rigid schedules for offering food harm the child's ability to distinguish the feeling of hunger and being satisfied after a meal
What Mom Should Know

• Distinguish the discomfort of a hungry child from other situations such as thirst, sleepiness, cold, heat, wet or dirty diapers and do not offer food or insist that the child eat when he or she is not hungry.
• Offer complementary food regularly, without rigid schedules, in periods that coincide with the child's desire to eat. After food is offered, the child should receive breast milk if he or she shows that he or she is not satiated.
• Offer three complementary meals (mid-morning, lunch, mid-afternoon) for breastfeeding children; for those already weaned, add two more meals: early in the morning and mid-afternoon or early evening.
• Harmful practices of gratification (prizes) or coercive practices (punishments) to get children to eat what they (the parents) believe is what they need are inadvisable.
• Some children need to be encouraged to eat, never forced.

Complementary Nutrition for Breastfed Children Between 6-7 Months

• Free breastfeeding on demand
• 1 fruit porridge mid-morning
• 1 fruit porridge in the late morning
• 1 fruit porridge in the middle of the afternoon

Note: From the eighth month onwards, replace fruit porridge in the middle of the afternoon with salty porridge.

Know that Consistency of Complementary Food is Important

Step 5: Complementary food must be thick from the beginning and offered with a spoon; start with a pasty consistency (porridge/purées) and gradually increase the consistency until it reaches the family's diet.

It is necessary that health professionals no longer use the term vegetable soup, as this
gives the idea of ​​liquid and semi-liquid consistency, reinforcing with the mother the use of the terms porridge or food.

What Mom Should Know

• At the beginning of complementary feeding, the food offered to the child must be prepared especially for him. Food must be well cooked. When cooking, there should be little water left in the pan, meaning the food must be cooked in enough water to soften it.
• When placing food on the plate, mash it with a fork. The consistency will have a pasty appearance (paste/puree). There is no need to pass it through a sieve. Using a blender is completely contraindicated, because the child is learning to distinguish the consistency, flavors and colors of new foods. Furthermore, liquidized foods will not encourage chewing.
• From 8 months onwards, some homemade preparations such as rice, beans, meat or vegetable stews can be offered to the child, as long as they are crushed or shredded and have not been prepared with spicy condiments (seasonings).

Reviewing Your Knowledge

• Diets, the thicker and more consistent, have greater energy density
• (calorie/gram of food) than diluted diets, such as juices and thin soups.
• As the child has a small gastric capacity and consumes few spoonfuls at the beginning of the introduction of complementary foods, it is necessary to guarantee caloric intake with high energy density porridge.
• At six months, additional grinding of food is carried out with gums that are already sufficiently hardened (due to the teeth moving closer to the gum surface). The introduction of thick complementary food will stimulate the child in the lateralization functions of the tongue, throwing food to
• grinding teeth, and the chewing reflex.
• At eight months, a child who is encouraged to receive porridge with a thick consistency will better develop facial muscles and chewing capacity. This way, she will accept family food more easily from this age onwards.
• Do not offer liquid foods with low energy density, such as soups and juices, as meals.
• The food offered to children must, from the beginning, be thick in the form of porridge and purees because it guarantees the amount of energy they need to gain weight and be healthy.

Recommendations for Salty Porridge

1. Cook all foods well to make them very soft.
2. Mash with a fork, do not blend and do not pass through a sieve.
3. The porridge must be consistent, in the form of a thick puree.
4. offer the first savory porridge at lunch and when the baby is 7-8 months old, offer another savory porridge at dinner.

Offer a Colorful Food

Step 6: Offer the child different foods a day. A varied diet is a colorful diet.

Reviewing Your Knowledge

Nutrients are distributed in foods in different ways. Foods are classified into groups, according to the nutrient they contain in the greatest quantity. Foods that belong to the same group can be sources of different nutrients.
Example: Fruit group: papaya is a source of vitamin A and cashew is a source of vitamin C. Food from all groups should be offered every day and the foods varied within
of each group. Offering different foods during meals, such as fruits and savory porridge, will ensure the supply of all the nutrients necessary for normal growth and development.

Meat and liver, in addition to containing organic iron with high biological utilization, facilitate the absorption of inorganic iron contained in vegetables and other foods, even if added in small portions. Liver is also an excellent source of vitamin A.

Beans and other legumes are also important sources of inorganic iron.

What Mom Should Know

• Offer two different fruits a day, selecting seasonal fruits, especially those rich in vitamin A, such as yellow or orange.
• Introduce a new food each day;
• Choose a food from each group of the Children's Food Pyramid to prepare savory porridge, varying the choice at each meal.
• Whenever possible, offer meat at meals.
• When it is not possible to have meat at meals, offer 50 ml to 100 ml of fruit juice rich in vitamin C, immediately after finishing food intake, to facilitate the absorption of inorganic iron;
• Offer dark green leafy vegetables, which are important sources of iron, associated with a small portion of meat or foods rich in vitamin C, to increase iron absorption;

Encourage the Consumption of Vegetables and Fruits

Step 7: Encourage daily consumption of fruits and vegetables at meals.

Reviewing Your Knowledge

Fruits and vegetables (vegetables) are the main sources of vitamins, minerals and fiber. Normally, foods from the vegetable group are initially little accepted by children because, in part, young children tend to accept sweet foods better.

Inadequate techniques used when introducing complementary foods can also harm the acceptance of these foods, such as:

• Giving up offering foods that the child did not accept well, the first few times, because they thought they did not like them;
• The use of mixtures of various foods, commonly liquidized, making it difficult for the child to test the different flavors and textures of the new foods being offered;
• Replacing the meal with dairy drinks when the child first refuses the new food.

It has been scientifically demonstrated that children, even small ones, are conditioned by the offer of a substitute for refused food. The family's eating habit that does not include vegetables and fruits daily.

What Mom Should Know

• If the child refuses a certain food, offer it again at other meals.
• Remember that it takes, on average, eight to ten exposures to a new food for it to be accepted by the child.
• In the first year of life, it is not recommended that foods be mixed a lot, because the child is learning to discover new flavors and textures of food. Offer one fruit, vegetable or vegetable at a time, in the form of porridge or puree; When offering more than one fruit or vegetable per meal, they should be mashed and placed in separate portions. This way, your taste will be better perceived by the child.
• When the child already sits at the table, the example of the family's consumption of these foods will encourage the child to consume them.
• Children who eat a variety of fruits and vegetables from an early age receive greater amounts of vitamins, iron and fiber, in addition to acquiring healthy eating habits.
• With small portions of suitable foods and in just one meal, it is possible to significantly increase the intake of protein and iron, in addition to their bioavailability.

Avoid Foods That Are Not Nutritious

Step 8: Avoid sugar, coffee, canned foods, fried foods, soft drinks, candy, snacks and other treats in the first years of life. Use salt in moderation.

Reviewing Your Knowledge

It has already been proven that children are born with a preference for sweet tastes; however, added sugar is unnecessary and can be avoided in the first two years of life. This attitude will prevent the child from losing interest in cereals, vegetables and foods that have other flavors. Until the child is one year old, their gastric mucosa is sensitive and, therefore, the substances present in coffee, canned food and soft drinks can irritate them, compromising digestion and absorption of nutrients, in addition to having low nutritional value.

Iodized salt, in addition to providing iodine, is important for the child to adapt to the family's diet; however, its use should be moderate and restricted to that added to savory porridge.

The use of processed foods, canned foods, sausages and fried foods, which contain excessive salt, additives and artificial preservatives, should be avoided. Fried foods are unnecessary, especially in the first years of life. The source of lipid for the child is already present naturally, in milk, protein sources and vegetable oil used for cooking. The oil used for frying is overheated, releasing free radicals that are harmful to the baby's intestinal mucosa and, in the long term, have harmful effects on health.
Honey is completely contraindicated in the first year of life due to the risk of contamination with
Clostridium botulinum.

What Mom Should Know

• Offer fresh foods without added sugar; prefer fruits that do not need to be sweetened (orange, cashew, apple, pear, papaya, banana, watermelon, guava, mango) or vegetables such as carrots or tomatoes. While the family is consuming these foods, offer only fruits, juices or cereals, which are more suitable and healthy for the child.
• Instruct older siblings not to offer sweets, ice cream and soft drinks to the young child.
• Instruct the mother to read the label of baby foods before purchasing them to avoid offering the child foods that contain artificial additives and preservatives.
• Some foods should not be given to young children because they are unhealthy, in addition to depriving the child of their appetite and competing with nutritious foods.

The WHO recommends the following warning to mothers:

• Liquids and drinks must be free from contamination. Therefore, the water used must always be boiled and the milk, fresh or pasteurized, must also be boiled.
• Wash the skin of fruits before peeling them or making juice. Drinks such as juices and soft drinks should not replace solid foods or breast milk. Any liquid should always be offered after meals.
• Black tea, mate tea, coffee and mate reduce iron absorption, therefore they should not be offered close to meals.

Foods that Should NOT Be Offered to Young Children

• soft drinks
• industrialized products with preservatives
• products with artificial colors
• sausages and canned
• industrialized sweets
• coffee
• teas
• fried foods
• very salty or sweet foods

Take Care of Hygiene

Step 9: Take care of hygiene when preparing and handling food; ensure adequate storage and conservation.

Reviewing Your Knowledge

While exclusive breastfeeding protects children against exposure to pathogenic microorganisms, the introduction of other foods exposes them to the risk of infections.

When children begin to receive complementary foods, the possibility of diarrheal diseases, which are an important cause of morbidity and mortality among young children, increases.

The biggest problems of this order are the contamination of water and food during their handling and preparation, inadequate personal and utensil hygiene, undercooked food and storage of food at an inadequate temperature.

Food consumed by children or used to prepare their meals must be stored in clean, dry containers, in a cool place, covered and away from contact with flies or other insects, animals and dust.

Using a bottle poses a risk of food contamination due to the difficulty of cleaning and adequate hygiene.

Prepared foods can be more easily contaminated by the proliferation of microorganisms that cause disease if they remain at room temperature for more than six hours before being offered to the child or if the refrigerator cannot maintain the appropriate temperature (around 4 o C and 5 o C).

What Mom Should Know

• O Offer the cleanest water possible (treated, filtered or boiled) for the child to drink. The same care must be taken with the water used to prepare food.
• The mother or responsible person must wash their hands thoroughly with soap and water every time they prepare or offer food to the child.
• Fruits must be washed under running water before peeling, even those that are not consumed with the peel.
• Every utensil that will be used to feed the child needs to be washed and rinsed with clean water.
• Food must be well cooked and offered in clean, sanitized containers.
• Prepare the portion (amount of food) that the child normally eats. If, after the meal, there is food left on the plate (leftovers), they cannot be offered later.
• The family, and especially children, should not open the refrigerator all the time. Make sure it is always closed and that the door is in good sealing condition.
• If the family does not have a refrigerator or it does not have adequate temperature conditions, the child's food must be prepared close to each meal.

Cleanliness and hygiene when preparing and offering food prevents contamination and diseases such as diarrhea

It's important

1. Wash your hands under running water and soap before preparing and offering food to the child.
2. Always keep food covered.
3. Use boiled and filtered water to offer the child and also to prepare meals.
4. Do not offer the child leftover food from the previous meal.