I receive a number of letters from anxious parents (usually for their first child) with queries: How do I breast feed? When do I wean? How do I wean? And, the most common of all, why does my child refuse to eat?

In the traditional Indian set up, the joint family had many “experienced elders” available 24X7 for advice, support and help. So these queries did not arise. It was not the parents who raised the child, it was the entire village!

Fortunately, healthy children are hardy and resilient. They find ways to communicate their needs to the parents even before they can speak. Instinctively, most parents manage to do the right thing.

Breast milk is the best for baby and should be continued exclusively as far as possible till the age of four months (120 days). Initially, milk may seem insufficient but with frequent demand feeding, milk production increases and keeps pace with demand. Remember, women successfully breast fed their children from the time they lived in caves!

Anxiety, depression and pressure tend to interfere with this natural process. The new mother should get plenty of rest, eat a nutritious diet and take the prescribed iron and calcium supplements.

Although four months is the recommended age for starting solids, all children are not ready to start eating at that time. They need to be able to hold their head upright and steady. Feeding solids in the lying down position can lead to choking. Also, babies are born with an extrusion reflex. This is protective, and helps them to push anything that is not liquid out of their mouths. For successful weaning, the nervous system has to mature and this primitive reflex has to disappear.

Cereals like rice and wheat cooked fresh at home are preferable to milk biscuits or ready-to-serve commercial infant foods. Cereals can be cooked in milk with some sugar (but no salt) added. The food should be placed on the tongue and not at the lips. It may be discouraging initially as the child may totally reject the feed. Since most of the nutrition at that age comes from breast milk, this is not really cause for concern. The same food should be retried after 3-4 days. At first only one or two spoonfuls may be taken.

Every two weeks a new food can be introduced, like boiled carrots or potatoes, mashed bananas. After the child is 6-7 months old, cooked mashed rice and dal can be added to the diet. By the age of one year, the child should be eating everything the family eats. The food, however, should be well mashed and less spicy.

After the age of one, tension may gradually build up between the parent and child at feeding time. The child may refuse food, the parent may try to force feed or substitute milk and snacks for food. Anxiety may set in as other children of the same age may appear bigger, stronger and healthier.

The rate of growth is dependent on the birth weight. A child growing normally doubles the birth weight at the end of the fifth month and triples it at the end of the first year. This means that the expected weight of a child that is 2kg at birth is 6kg on their first birthday. In sharp contrast is a child who was 3.5kg at birth. The weight on the first birthday should be 10-11kg, almost double the weight of the other baby, who is also growing normally.

After the age of two, online calculators can be used to read off ideal body weight. Alternatively, the formula (age+3)x5 gives the weight in pounds. This divided by 2.2 gives the weight in kilos.

Children have inbuilt instincts which enable them to regulate their food intake. They may refuse food if they are unwell. They tend to eat when hungry and stop when full. These self regulating instincts can be overridden with repeated force feeding. A pattern of overeating sets in, leading to recalcitrant adult obesity.

If a child refuses a certain food, offer it again a few days later. Do not try to bribe the child to eat it or substitute it with unhealthy snacks.

A child that has had enough to eat may try to:

Hit the spoon away.

Spit out the food

Turn away its face

Start crying.

If this is the case, stop the feeding.

Good food habits need to be inculcated from early childhood. Have fixed timings for food and snacks and serve them in the same place. If the child refuses to eat don’t immediately cook something else. That only leads to frustration, exhaustion and more tension. A little starvation never did any harm, and, by the time the next meal or snack time comes around, your child may be ready to eat again!

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in