This week we get some insight into weaning in INDONESIA, for this particular area I would like to include a summary of a study done recently.
The actual practices relating to child feeding and child care noted at the time of the study:
First month of life
– Prelacteal feeding with sugar water, honey or teas, for one to three days is very common to mark the newborn’s freedom from the womb and to give the infant something until the breast milk flows.
– Generally, but not universally, the initial colostrum is discarded because it is thought to be dirty and there is a fear it will do harm. Prelacteal feeds replace the colostrum. Traditional midwives (dukun bayi) encourage this practice.
– By 48 hours after birth, almost all mothers have begun to breastfeed and continue to breastfeed confidently and properly during this first month.
- Few infants are exclusively breastfed. Continuing from the prelacteal feeding, infants receive small tastes of food, particularly from family members other than the mother, “to keep them quiet”.
Months two to four
– Breastfeeding is continued on demand, but generally is not done exclusively.
– Predominant use of the left breast begins, due in part to mothers breastfeeding more while working.
– By the third month, many infants, especially in semi urban areas, are receiving rice porridge in addition to tastes of other foods, pre-chewed and fermented rice is given.
- Very small amounts of food are given at a time for fear of harming the child. This fear is especially prevalent among mothers with undernourished children.
Months five to eight
- Nutrient intake begins to be inadequate: infants meet about 66 percent of their calorie and 50 percent of their protein requirement. This situation is aggravated by a sharp increase in diarrhea and respiratory infections.
- Breastfeeding continues as per the two to four month period: on demand and primarily from the left breast.
- By the fifth month, infants in semi urban areas are receiving a variety of starchy “soft” foods.
- Mothers often prepare a “special” porridge for the child because they believe the child’s food must be much softer than adult food.
- As the infant gets teeth, the rice porridge becomes thicker. Green vegetables are often added to the rice porridge. However, in rural areas through this period infants get only breast milk and rice.
- By six months, many infants receive some protein foods (tahu or tempe – soya or eggs) and in semi urban areas, snack foods appear in the diet. However, food variety is kept at a minimum so “the child will not develop expensive habits”.
- Diets are extremely low in fat. Some children have virtually no fat in their diets.
- Semi-solids are often given three times/day with the well-nourished children being more likely to get food three times/day while the undernourished receive food less than three times/day.
- Food quantities are not measured. Children are fed while the caretaker walks with the child. And, the child is fed until “satisfied”.
- Semi-urban mothers, because they are often out of the house, are likely to entrust child feeding to other members of the family.
Months 9 to 18
Nutritional status documented by monthly weighing deteriorates further among this age group as dietary intake meets only half of the calorie and protein requirement and illness increases. (On any given day, approximately one-third of disease children have some symptoms of an illness.)
- Most children continue to be breastfed but frequency declines in the semi urban areas and some mothers in disease areas wean their children at this age.
- This is a time of true transition to an adult diet. At about ten months, children begin to receive foods from the family pot and at 18 months they received a full family diet.
- Food variety increases and is greater for the better nourished children, the semi-urban children, and the Javanese and Balinese children.
- Fish, commonly available, is not given to children because it is thought to cause worms and accustom children to foods that are too expensive.
- Feeding frequency remains at three meals per day although many children are given snacks to quiet them.
- Food quantity per meal is not measured. Mothers tend to stop feeding when the child loses interest—consequently, many children eat very little.
- Frequently, mothers with children in this age period report that their child “does not want to eat”.
Months 19 to 24
- Although nutrient intake seems to improve, rates of malnutrition remain high as illness is not abated.
- Over half of the semi urban children are weaned during this age, because children at this age are thought to be “big enough” not to receive breast milk. In rural areas, this is less true.
- The child’s diet does not change much during this period from that of children in the younger group.
- Feeding frequency continues to be three times per day. These children are more likely to eat without adult supervision, receive snacks more frequently, and have no notice taken as to the amounts of food they eat.