‘Say aaa baby’

By Esther Williams

Life can be distressing for parents of underweight children. Seeing other bouncy children when theirs seem skinny in comparison, despite special care, nutrition and medication, makes them wonder where have they gone wrong.

As long as a child is active, responds to stimuli and has sparkling eyes, parents need not worry, says Consultant Paediatrician and Senior Lecturer in Paediatrics Dr. Rohitha Seneviratne, as a number of factors determine the weight of a child including genetic make-up, diet and physical activity.

While little can be done with regard to hereditary factors - such as a parent or grandparent being of slight build, parents can play an important role in ensuring that their child has a nutritious diet and adequate physical activity.

Why is weight important? "Weight and height of a child is one indicator of the child's health and development," Dr. Seneviratne says, "more so in the first two-three years as it ensures wellbeing in future adult life." Tracked over a period of time, the measurements indicate if a child is growing properly.

One of the main reasons a child may not gain weight is due to lack of proper nutritious food. "Parents are influenced by cultural and social beliefs and take suggestions from friends and relatives rather than medical advice," he says. To ensure that a child maintains healthy weight, he recommends the following:

Type of food:

A balanced diet should include fish, meat, eggs, fresh vegetables, green leaves, fruit, rice, pasta, noodles and pulses. Some parents believe that yoghurt, cheese, eggs and butter are too rich or can bring about cold, chest infections or wheezing, but these are calorie dense products, high in nutrition and provide children with the energy they need. It needs mention that adult diseases such as diabetes or hypertension can result from the type of nutrition taken as a child.

Children come in different sizes and weights and grow at different rates. As long as their weight gain is proportionate, irrespective of their weight at birth (First five months = 700 gm/month and next seven months = 500 gm/month) following the centile lines , it indicates a proper growth.

Feeding habits:

While exclusive breast feeding is imperative during the first six months, children should be weaned from the 7-12th month. From one year onwards a child should be encouraged to eat with the family and not separately, whatever everyone eats however messy the experience may be. The doctor dissuades mothers and grandmothers from force-feeding children, entertaining them with songs or TV or walking around with them during their lunch, lengthening the entire process for several hours. Bribing with gifts or outings is strongly discouraged.

Meal times should be pleasurable. Children only eat what they like and often convey their preferences through their actions. When a child sees a love for fruits and greens in the family, he too will follow the family food pattern. Initially a toddler may throw food around but will eventually learn by imitating his parents and be appreciative of meal time discipline.

Such discipline also helps the child understand that meals would be provided only at certain times of the day. Should a toddler not eat adequately, he should be ignored rather than punished. However he can be rewarded when completing a meal.

Four meals a day:

Children and toddlers should be fed what they like for breakfast, lunch, teatime snack and dinner. Attempts should be made to prepare food in the way they like, for instance fried fish instead of curry fish. It is often the case that underweight children are also picky eaters. Parents should ensure that the small amounts they eat are nutritious. An egg a day and dessert after every meal even ice cream which contains milk is recommended. Sweets in between meals should be disallowed as they can cause tooth decay.

Happy environment:

The home environment should be happy and stimulating, not stressful. An environment where routine and discipline is maintained will foster a child with healthy habits, as well as improve his/her growth and development. Adequate sleep and exercise is a must.

Concerns for underweight children:

Despite adequate nutrition some children show no weight gain. There are several possible reasons: not consuming enough food, an underlying illness, like a urinary tract infection or some disorder relating to the heart or lungs. Such cases would need further investigations. Dr. Seneviratne warns parents to watch out for signs such as weakness that would prevent day-to-day activities, excessive sleep, no sparkle in the eyes and lack of response to stimuli in which case they would need to seek immediate medical treatment. An under-nourished child is more likely to fall sick. Rather than preventing the child from eating adequate food when sick, a child should be given more food - for metabolic activities and fighting infection, failing which the child's stored fat would be used, reducing his/her weight further.

However, if a child has no interest in eating, it could be a sign of anxiety or even an eating disorder which needs to be checked by a health professional. Dr. Seneviratne cautions against food supplements. "If a balanced diet is given there is no need for appetite stimulants, vitamins or food supplements," he stresses unless there is a nutritional disorder such as a vitamin deficiency.

"Children need energy to build their bodies, for growth and for their daily activities which includes playing and metabolic functions," Dr. Seneviratne emphasizes. While some have energy for activities they do not have any left for growth. It is the parents' duty to set an example by eating nutritious food and ensuring that their offspring do the same.