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INFANT NUTRITION (0-2 YEARS OLD)
In children, the period from birth to the end of two years, where the growth and development is fastest, is the most critical period for a healthy start in life. For this reason, habits related to feeding of infants and young children should be gained in this period and mothers should be made aware of this issue. The most appropriate food for a newborn baby is BREAST MILK. Breast milk is an irreplaceable food for the baby to be healthy, to meet all nutrient requirements, to be easily digested and to protect against infections.
What is complementary feeding?
DURING THE FIRST 6 MONTHS, a newborn baby should be given ONLY THE MOTHER'S MILK. The period starting when mother’s milk does not capable of meeting infant’s energy and nutrition requirements by itself and other foods and beverages are given together with breast milk is called as “complementary feeding”. During this period, the baby meets different taste, flavor and foods with different structures. Complementary foods should be selected from foods that do not have allergen effects. Complementary feeding, started at the appropriate time and maintained in accordance with the rules, allows the baby to reach the maturity to be able to consume food at the family table around the age of one.
What are the factors that affect the time of transition to complementary feeding?
At the beginning (6-7 months), nutrients should be given in the form of a soft paste.In the 7-8 months, it should be continued with mashed nutrients and chewing movements and fluid drinking skills of baby should be monitored. Puree-shaped foods should be continued until the baby is able to chew, and then (8-12 months) consistency should be increased gradually (mashed consistency crushed foods). In these months, babies develop skills to turn the food in the mouth. At the age of one,baby should be ready to eat family meals and should take their place at the family table.
What are the unfavorable nutrients in baby nutrition?
Tea; may cause iron deficiency.
Honey; should not be included in the baby's diet until 1 year of age because of its allergic and infectious properties.
Candy; is an empty energy source. It does not have a nutritional value. Sugar added to milk, yogurt and to food and beverages like these can cause loss of appetite and tooth decays.
Salt;it should not be in the diet of your baby since it will cause a burden on your baby’s not yet developed kidneys.
Fava beans;Poisonings caused by toxins in fava beans are characterized with anemia (anemia), hemoglobinuria (blood in the urine) and high fever. The effect is seen 24-48 hours after toxic pods are eaten. Poisoning occurs when fresh raw fava beans are eaten. When the beans are cooked, the toxin has no effect. Broad beans are not recommended in infancy because it is thought to cause favism (severe hemolytic anemia).
How do I know if my milk is enough?
If babies born with normal birth weight (3000-3500 grams) have gained approximately 500 grams after the first 20 days, their milk is sufficient. In the following months, the weight is marked on the chart each time the baby is weighed. The points between 2 weighings are combined. If the line goes up, the baby has weight gain. If the line goes down, the baby may not be feeding well, and the milk may not be enough. Breast milk and complementary foods should not be given at the same time! Babies can have;
6. month full;
»Breast milk
»Yoghurt
»Egg yolk (1/8 ratio)
»Grated fruit juices using glass grater (apple juice, peach juice)
»Vegetable juices (carrot juice, etc.) using glass grater
When the 7. Month is full,in addition to the 6th month;
»Egg yolk (full) - (increased each time)
»Meat (chicken, veal, fish)
»Vegetable mash or vegetable soup
»Bread crumbs, rice, rice flour
When the 8th month is full, in addition to the 7th month;
»Full Egg
»Cheese (pasteurized and unsalted)
»Soups or purees made from dry legumes (beans, chickpeas, lentils)
»Fresh fruit juices or fruit puree
»Minced vegetable dishes or soups
»Tarhana, lentil soup, flour and yoghurt soups
9. month is full;
»Home cooked meals (without salt and seasoning) 
12. month full;
»Baby should be seated at the family meals and choose according to their own experiences.
What are the disadvantages of starting complementary feeding early?
• It reduces the absorption of many nutrients such as iron and zinc in breast milk.
• Breastfeeding and breastfeeding time are reduced.
• The protective factors in breast milk are taken less.
• The incidence of diarrhea and infectious diseases increases.
What are the disadvantages of starting complementary feeding late?
• Suspension in the growth and development of the baby,
• Iron and zinc deficiency,
• There may be problems in the development of the baby's eating functions, such as chewing.
How should familiarization to complementary nutrients be?
• While breastfeeding continues, small amounts of complementary foods should be started in the sixth month and the amount should be increased in time.
• The amount of each new food to be tried should be a few teaspoons at first.
• New food should be given when the child is hungry.
• Unpalatable foods that are vomited or rejected by infant should be tried again after a few days or retried by adding it to favorite foods. For example, egg yolks can be added to soups, or into night milk mixing with molasses after 1 year of age.
• No more than one complementary food should be given on the same day.
How should the frequency of meals be?
• The number of meals in the period of complementaryfoods depends on the energy density and the amount of nutrients consumed at each meal.
• The number of daily meals of complementary foods that an infant breastfed by a healthy-fed mother should be;
• »2-3 times between 6 to 8 months,
• »3-4 times between 9 to 11 months,
• »3-4 times between 12 to 24 months.
• If the energy density of the food taken at each meal is low or the baby is not breastfeeding, the frequency of meals should be increased.
• If the frequency of meals is higher than itsnecessary, it causes less breast milk is taken.
What should be the amount of complementary foods?
In addition to breast milk, daily nutrition plan including complementary foods should be recommended as;
»200 calories / day in 6-8 months
»300 calories / day in 9-11 months
»500 calories / day in 12-18 months.
For example; a bowl of yogurt + an egg + a bowl of vegetable soup + a slice of bread serves about 300 calories.
FREQUENTLY ASKED QUESTIONS
Can I use goat milk in baby’s diet?
Goat milk contains 3 times more protein and sodium and less folic acid than breast milk. Each mother's milk is produced according to the needs of her own baby. Because gsoat and cow's milk proteins will put a load in the baby's underdeveloped kidneys,animalsmilk should not be given.
Should there be cheese in baby’s diet?
In baby’s diet, cheese made from PASTEURIZED MILK and SALT-FREEcan be used after the 8th month in small amounts.
Ispackaged fruit yoghurt / fresh cheese consumption suitable for babies?
It is harmful to children's health due to the colorants, sugar, oil, acid regulators and preservatives it includes.
What should be considered when selecting vegetables to be given to babies?
First of all, carrots, potatoes, spinach, zucchini (easy to digest and less allergenic effect) should be preferred. Then, other vegetable varieties are switched.
Can milk and molasses be given together?
The calcium in the milk and the iron in the molasses must be taken in the same and very large amounts (1 cup of milk and 1 cup of molasses) so as to compete and reduce each other's use. The small amount of molasses added to the milk does not have such an effect, since the amount of calcium in the molasses is high, it should be consumed instead of honey and sugar.
Can cow's milk be used until 1 year old?
Fresh cow's milk is an important food source for growing and developing children. However, cow milk should not be used in the first year of life due to the reasons that it causes micro-bleedings in the digestive system if used before the sixth months, it has low iron content, high protein and sodium content (2-3 times more than breast milk), and not being able to replace breast milk. However, in children who cannot get breast milk and cannot get instant formula, milk (UHT, pasteurized) can be used in mixed nutrition after 8-9 months.
Is the use of baby formula milks recommended?
Infant formulas are compositions attempted to make similar to breast milk and obtained from vitamin-mineral supplemented milk powder. If the baby can receive breast milk, there is no need to use ready-made infant formulas.
Can we use the baby biscuit?
Baby biscuits contain flour, fat, sugar. It should be used as little as possible because it contains high sugar and fat.
In what month should bakery products start to be used?
It can be started in small amounts to 6 months old babies (to give texture to their soup). The amount can be increased according to the baby's intake.
My baby's having trouble making feces. What should I do?
More fruit and vegetable puree should be added to the baby's diet. Boiled and warmed water between meals can soften constipation.
Can I use ready-made juices?
Prepared fruit juices may harm the baby because they contain substances such as colorants, additives, acid regulators. Home-made fresh fruit juices should be preferred.
Can I give quail eggs?
Quail eggs do not have any superiority over chicken eggs. It is also more expensive. It is easier and more convenient to choose chicken eggs in baby nutrition.
Is meat / bone juice useful?
Some mothers think that juice of the meat is very useful and only give their children the broth. However, the broth only plays a role in enhancing the flavor, the fat passes into the broth, but the protein remains in the meat itself. Therefore, the meat itself should be given to the child as cooked and crushed. If not, minced meatcan be added to their soups.
Can I use infant formulas?
They are available in many different forms (such as fruit, vegetables, cereals, milk or mixtures). It contains high-value milk proteins and vegetable proteins, easy-to-digest vegetable oils, carbohydrates with reduced sucrose levels, and high-value milk minerals (such as calcium and phosphorus) and iron. It can be recommended especially for working mothers because of difficulties in preparing food during working periods.
Is it harmful to consume chicken liver?
It is a very rich source of protein and micro nutrients. Due to the fact that it has low fat content, easily cooked and made puree, it is a rare recommended complementary food. After 1 1 year of age,liver, as a good source for vitamin B12, can be used in soups and meals in small amounts provided that it is obtained from healthy animals.
How appropriate is it to make food with corn starch?
Rice has the highest quality among cereals and corn protein has the lowest. Therefore, it is recommended to use rice as a cereal source in infant nutrition due to its high protein quality and easy digestion.
6 MONTH
NUTRITION
After completing the first 6 months with breast milk, vitamin and iron supplements, you can gradually start complementary foods to your baby. All foods you give to your baby should be clean, fresh and unadulterated. Foods containing additives and canned foods with chemical preservatives should not be given. Fresh food should be prepared for the baby in every meal and these foods should not be kept at room temperature for a long time. During this period, take care to ensure the continuity of breast milk while increasing complementary foods.
Ideally, you should only breastfeed your baby for the first 6 months. However, it may be recommended by your physician to start additional foods within the period of 4-6 months. The foods given in the first 4-6 months should be smooth, free of lumps, and no salt or sugar should be added. During these months, you can start to fruit juices and yoghurt. Do not give your baby cow's milk (including pasteurized milk in boxes or bottles). The basic rules are always the same when starting any complementary food.
- The food must be fresh.
- It should be tried when baby is hungry.
- It should be started with small amounts and increasedgradually.
- Two new type of foods should not be started within the same week.
To illustrate, give 1-2 teaspoons when starting in fruit juices or yogurt. Then, try to increase the amount you provide by preparing fresh juice or yoghurt every day. At the end of a week, you can go up to 50-100 milliliters. It is normal for your baby to push the food out with its tongue. In time, it will learn to use the tongue effectively and this problem will disappear. However, if your baby persistently refuses to take the recommended food, try to start again after a few days' break.Never force to eat something the baby doesn't like. Switch to each new nutrient individually and wait 1 week to introduce a new nutrient. For example, do not try to start carrot juice on the very same week you started to apple juice. First make sure that baby had some, liked it, and is able to digest it, then start second food. Give all the nutrients to the baby's mouth with a suitable spoon.
You can prepare daily yoghurt by yourself or use pure pasteurized yoghurts that have not expired yet and unpacked. If you prepare the yoghurt yourself, boil the milk you will ferment for at least 10 minutes. This makes pasteurized milk easier to hold. Make sure that the yogurt you give to your baby is not sour. In the first attempt, give a few teaspoons and gradually increase the amount over time.
After getting used to complementary food, babies usually adjust the daily intake themselves. Along with the complementary foods, now it's time to give your baby water. Offer water occasionally during the day. If it does not want it, it means that it does not need it. Boil the drinking water you give to your baby for 10 minutes and give it after cooling. Store boiled water in a glass bottle. Take care of your baby continues to have breast milk and vitamin support.Discuss with your doctor if your baby needs iron support.
 7 MONTH
NUTRITION
It's time for your baby to start eating grainy foods without interrupting breastmilk. You can start with crumbling egg yolk, vegetable soup with minced meat, white meat fish, meatballs, unsalted pasteurized cheese and white chicken meat. You should give these foods after familiarizing them as described earlier. Boil the egg for 10 minutes and start by giving a chickpea size of its yellow part.Gradually increase. Once you are sure that your baby is not disturbed, you can give one to three egg yolks a week. Due to allergy risk,do not start the egg white before the age of one. Use labne cheese orunsalted pasteurized white cheese waited in water for 45 minutes. You can reduce the consistency with fruit juice or formula while giving foods such as eggs, cheese, which are thicker than your baby is used to.
You can prepare vegetable soup as follows:
Three glasses of water, two medium-sized carrots, one medium-sized potato, two teaspoons of semolina, one teaspoon of lentils and adding a new seasonal vegetable every day to and cook for 45 minutes. For example, the first day 3-4 leaves of cooked parsley, a few leaves of spinach, the next day in addition to these, you can add a quarter of zucchini, etc.After you drained the vegetables through a wire strainer, add a teaspoon of olive oil to the mash. Use butter instead of olive oil once a week. Adding a tablespoon of minced meat or a few pieces of chicken meat to the vegetable soup will increase protein intake.
In the first days, start with a few teaspoons of the warm soup. You can increase the amount after you are sure that it does not disturb. If a new vegetable does disturb, do not use this vegetable for a while. Consume spinach and beet as soon as you cook, because if they are left to wait for a long time harmful substances (nitrites) will occur. As the salt requirement of infants is very small compared to adults do not add salt or add too little (up to a flick).
Slowly diversify the baby's meals. Give up the wire strainer after the 7th month. Crush its, food with a fork. Around nine months, you can start giving soft foods in small bites. By 9th month, support your child to sit with you and eat with its hands. They engage in imitative learning in these months and they have a lot to learn while you eat. Therefore, your baby should eat with you and gradually become a tablemate for you.
Approachingthe first year, your baby can eat all the foods you eat with a few exceptions.
»Eggplant contains almost no vitamins and minerals; sütlü therefore, it is not preferred in infant nutrition.
»It is better not to give cow's milk and milk pudding (including pasteurized box milk) until one year of age.
»A breed of germs that can grow in honey can paralyze bowel movements and respiratory muscles in children under one year of age. Therefore, it is not recommended to be used in the first 15 months.
»Tea should not be given to babies because it has no nutritional value and prevents iron absorption.
»Egg white should not be used below one year of age due to its allergic properties.
»Food juices, broth and bone water are foods that do not have nutritional value. Not their juices, but the foods themselves should be given to the baby after they have been properly prepared.
»Soft drinks and ready-made fruit juices should not be given to babies.
»Food such as sausages, small sugars, grapes, peanuts should not be given due to the risk of escaping into the respiratory tract.
»Potatoes, rice, pasta, bread, baby biscuits contain high calories. As a rule, give your baby these foods after your baby starts taking vitamins, minerals, high-value nutrients regularly.
Babies between 6-12 months can take approximately one cup of food at a meal. Do not force your baby if it prefers to take less. They usually prefer 3-4 main meals between 6-9 months and three main meals between 9-12 months.
Ensure that the baby is actively involved in feeding before the age of one. Usually, it can hold the bottle for about 6 months, and the glass about two or three months later. They can eat their own bread or biscuits for seven or eight months. Around 10-12 months, they can learn to hold the spoon and take it to their mouth. Mothers suppress this learning because the environment will get dirty. Towards the end of the meal, make baby learn to take the spoon, use it even though its slow and pouring around. Gaining the ability to feed themselvescreates a positive effect on the future responsibilities and self-care.
Do not feed babies and children while they are lying down. Do not let them sleep by sucking the bottle, even if it is full of formula, juice or just water. This habit can disrupt the baby's dental health in laterages,increase the risk of having ear inflammation and escaping drinks to the trachea.
Do not stop giving breastmilk to your baby while increasing complementary foods. Although other food stuffs provide a high degree of saturation, continuing breast milk until 12-18 months is very valuable for the baby. Continuing breastmilk will provide a stronger immunity, less risk of allergy and obesity, and a positive impact on psychological development.
 
 
COMPLEMENTARY FEEDING SCHEMA
6 months
Continue to Breastfeeding
»Yoghurt
»Grated fruit juices using glass grater (apple juice, peach juice), vegetable juice and puree
 »Sugar free custard (water + whole rice flour or barley or wheat flour)
»Egg yolk (1/4 ratio)
8 Months
Continue toBreastfeeding
»Yoghurt
»Fruit juice, vegetable juice
»Molasses (not mixed with soil)
»Meat (fish, chicken and red meat), lamb or chicken liver
 »Vegetable oils (Hazelnut, olive oil, sunflower oil)
»Good crushed home dishes (with minced meat and vegetables)
»Whole eggs or pasteurized cheese
7 months
Continue to Breastfeeding
»Yoghurt
»Fresh fruit juice, vegetable juice
»Rice flour, rice
»Egg yolk (full)
»Meat (fish, chicken and red meat)
»Vegetable oils (Hazelnut, olive oil, sunflower oil)
»Vegetable mash or vegetable soup
12 months
Continue to Breastfeeding
»Yoghurt
»Fruit or freshly squeezed fruit juice, vegetable juice
»Molasses
»Eggs (whole) or pasteurized cheese
»Sitting at the family table and choosing according to their own taste (home cooked meals, stuffed peppers, minced vegetable dishes, tarhana, lentil, flour and yoghurt soups, pasta, rice etc.)
SOUP RECIPES EXAMPLES
 
VEGETABLE SOUP
INGREDIENTS
1 small carrot
1 small tomato
1 small potato
1 small zucchini
¼ shallots
2 tablespoons lean ground beef
1 tablespoon of oil
DIRECTIONS
After washing and cleaning all vegetables, chop or grate into small pieces. Add minced meat and oil and boil by adding 2 glasses of water. The amount of water to be used may vary depending on the size of the vegetables. After the soup is cooked, it can be passed through a wire strainer or crushed with a fork, depending on the child's month. In addition, the vegetables can be changed according to the season. It is generally preferred not to used fiber-rich vegetables such as okra, green beans or leek. It can soften the stool by increasing bowel movements.
VEGETABLE SOUP WITH LENTILS
INGREDIENTS
1 small carrot
1 small potato
1 tablespoon semolina
1 tablespoon of red lentils
2 tablespoons lean ground beef
1 tablespoon oil
Directions
The above materials are thoroughly boiled together after being washed and peeled.  Then, the mixture is strained through a wire strainer.
NOODLES VERMICELLI SOUP
INGREDIENTS
2 cups of water
4 tablespoons noodle
1 egg yolk
½ lemon
Chicken meat up to 1 matchbox
2 tablespoons oil
DIRECTIONS
Boil until the noodle is putty. Chicken meat is finely chopped with a knife and minced. It is added to boiling noodles. Add lemon and egg to the soup by whisking in a separate bowl and boil for three more minutes.
YOGHURT SOUP
INGREDIENTS
4 tablespoons rice
1 cup yogurt
2 tablespoons oil
1 egg yolk
Directions
Rice is boiled thoroughly in 1 ½ cup water. It is then filtered and the yogurt is diluted with the filtered water. An egg yolk is mixed into the mixture and filtered rice with oil is added and boiled for three more minutes.

FOODS TO AVOID
Some foods can cause a choking hazard to infants and children:
- Grapes
- Popcorn
- Hard candies, jelly tots
- Nuts such as nuts, peanuts, roasted chickpeas
- Raw carrots, green beans or any hard vegetables
- Kernels (pumpkin seeds or sunflower seeds)
- Large pieces of any food: such as meat or potatoes
The following are some tips for young babies of different ages and with different appetites.
1 YEAR
Your 1-year-old seems to be eating less, as his appetite and growth rate have declined. This is one reason why you should try to lure him with delicious and healthy snacks. Babies of this age are ready for "hand-eaten food".
• Eggs are a good source of balanced nutrient components. Babies can benefit from the extra iron in the egg yolk. But some babies may be allergic to egg white, so watch your baby carefully for a reaction. Scrambled, cooked in oil is a delicious option for all day. Don't worry about cholesterol - babies need it more than you do. Three or four eggs a week is good.
• Choose fresh fruits and your own hand-made juices; Fruits are an important source of vitamins and other components. Give your child small slices of fresh, juicy peaches, or delicious soft bananas and see how much he will love them!
• Small cheese cubes are a good way to give it calcium, whether he/she likes milk or not.
• Cooked diced potatoes are a good choice. Be careful not to give your child fried potatoes.
18 MONTHS
Your toddler at this age needs two or three nutritious snacks per day in addition to his meals. Try these:
• Cut the ripe bananas into pieces.
• Toast, preferably wheat bread, is a basic food for toddlers. For a more nutritious mixture, try applying a thin layer of cream cheese.
• Cheese slices or cubes - whichever works. If you find a cheese that your toddler likes, let him/her to eat.
2 YEARS
Keep your child's diet under control to ensure that your child receives enough nutrients, such as iron, calcium, Vitamin B, and protein. It is difficult to know whether he gets the things he needs every day with his appetite these days. Here are great, chewable snacks for your little child;
• Scrambled eggs, boiled egg - a great source of iron and protein. Make tiny omelettes and cut them into bite-sized pieces.
• Cheese strips, cheese slices and cubes - a rational way for your child to get calcium and protein.
• Fish pieces - a favorite dinner and a good source of calcium. Combine with delicious mashed potatoes for carbohydrates and your food is ready!
• Unsalted bread, toast - any cereal product is a good source of vitamin B and toddlers often choose according to their taste. For a healthy combination, try applying some cream cheese that is rich in protein and carbohydrates.
• Apple slices, peach slices, orange slices - fresh fruits are the best choice.
• Cut the dried fruits into pieces and make sure to remove the kernels of prunes and dates you have given. Toddlers like to take chopped, dried fruits from their favorite cups.
• Boiled pieces of broccoli and cauliflower can be given alone or in mashed potatoes. These foods can be your favorite snacks if given early.
3 YEARS
Your 3-year-old is constantly busy with many daily activities and imagination which makes good nutrition more important than ever.
• Scrambled eggs, boiled eggs - a great source of iron and protein. Make tiny omelettes and cut them into bite-sized pieces.
• Cheese slices and cubes - a rational way for your child to get calcium and protein.
• Fish pieces - a favorite dinner and a good source of calcium. Combine with delicious mashed potatoes for carbohydrates and your food is ready!
• Unsalted bread, toast - any cereal product is a good source of vitamin B and toddlers often choose according to their taste. For a healthy combination, try applying some cream cheese that is rich in protein and carbohydrates.
• Apple slices, peach slices, orange slices - fresh fruits are the best choice.
• Cut the dried fruits into pieces and make sure to remove the kernels of prunes and dates you have given. Toddlers like to buy chopped dried fruits from their favorite cups.
• Boiled pieces of broccoli and cauliflower, either alone or in mashed potatoes. These foods can be your favorite snacks if given early.
• Biscuits - choose fig-filled and oatmeal varieties rather than other sugary types.
Now your child is a little older. Here are some general suggestions to feed it:
• Choose snacks rich in complex carbohydrates such as bread, crackers and pasta salads. You can add cream cheese to make them even more nutritious.
• Your child will willingly consume any snacks that he helps you to prepare. Let him help.
• Avoid many snacks sold for children that are rich in salt, fat and sugar. Read the labels of even food products made especially for children. Try to understand how much salt or fat your child receives in a day. For example, a quarter of the recommended daily salt consumption is too much for a single snack.
• At the age of 3, your child needs less fat and fatty acids than before. Ask your doctor if your child is ready to drink low-fat milk. But remember, skimmed milk contains very little fat for young children.
• Dairy products are important, but do not overdo them. Your child needs 480 - 720 ml of milk (or dairy products such as yogurt and cheese) for strong bones and growth. However, more than 720 ml may cause your child to lose appetite for other nutrients that contain important nutrients that milk does not have.
• Breakfast cereals, a fiber product, can be a choice for your child's snack as long as you choose a cereal that doesn't add much sugar.
Author

Uzm. Dr. Şenay Mevlitoğlu

APPOINTMENT DOCTOR PROFILE
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