The transition from exclusive breastfeeding to family foods referred to as complementary feeding. From 6 months of age your baby needs breast milk and solid foods to promote health, support growth and enhance development.
When to start/what is the right age?
As per WHO baby has to be exclusively breastfed for first 6 months (if breast milk is not sufficient then formula milk can be given). So complementary feeding should be started when the baby reaches 6 months of age.
Introduction of solid food to be led by infants developmental signs like
Baby can sit with or without support.
Showing interest towards food when others are eating
Likes to put things in their mouths
At this age frequent breastfeeding should continue despite foods being introduced. During the next few months the variety and amount of foods can be increased, while breastfeeding still continues.
How to start?
Solid foods to be started gradually after 6 months of age. At 6th month solid can be given once/twice. One feed /month needs to be increased.
So by 9th or10th month baby should be taking 3 meals + one or two snacks along with Breast milk/formula milk.
What type of foods to be given?
Good choices for complementary foods are those rich in energy, protein, essential fatty acids and micronutrients (particularly iron, zinc, calcium, vitamin A, vitamin C and folate). These will be supplied when breast milk and a variety of suitable complementary foods are given to a baby.
Gradually increase food consistency and variety as the child ages, adapting the diet to the infant’s requirements and abilities
At 6 months: Feed mashed and semi-solid foods, softened foods
Feed energy-dense combinations of soft foods.
At 8th month:Introduce “finger foods” (snacks that can be eaten by children alone),textured foods
At about 12 months of age: Most children can eat what rest of the family eats (Family Foods).
Principles of Complementary Feeding
No Sugar,No Salt, No Honey till one year of age
No other liquid form of food to baby other that water,Breast Milk/Formula milk.
Always make baby sit in upright position and feed.
Water 30-40ml/day till 12 months.
No cow milk to be given to baby as a drink till 12months,but it can be used as a cooking ingredient.
Practice responsive feeding
Feed infants directly and assist older children when they feed themselves.
Offer favorite foods and encourage children to eat when they lose interest or have low appetites.
If children refuse many foods, experiment with different food combinations, tastes, textures, and methods for encouragement.
Talk to children during feeding.
Feed slowly and patiently and minimize distractions during meals.
Craving for spicy foods means you are having a boy, and craving for sweet foods indicate a girl.
Pregnant women can catch a flu with cold and sour food items.
Papaya and pineapple can cause abortion or miscarriages.
The food you crave or eat more during pregnancy are going to be baby??s favorites.
There is no evidence to show that you need to eat for two. Eating a healthy, balance diet is important.
There is no evidence to support this belief.
Fish that contain high levels of mercury should be avoided. E.g. Shark, Sword Fish, King Mackerel and Tile Fish. Mercury consumed during pregnancy has been linked to developmental delays and brain damage.
Research shows that cravings have nothing to do with determining the sex of a baby.
These foods are loaded with vitamin (citrus fruits) especially vitamin C. It??s an important vitamin for iron absorption. Curd and butter milk provide probiotics which keep the mothers get healthy and help in digestion along with providing good immunity.
These fruits in their raw form contain certain enzymes, which if consumed in large quantities, can cause uterine contractions.
No real evidence for this but some studies have shown that food choices you made during pregnancy may shape baby??s food preference.
Breastfeeding is not just about milk, it is all about mother’s love & care for her little one. Breastfeeding sometimes requires moms to be in one position for quite a long-time due to which many moms may be predisposed to developing pain on their neck, shoulders, forearms, wrist and low back. New mums sometimes find breastfeeding uncomfortable due to wrong feeding positions, or lack of support. This can lead to breast and nipple discomfort. Physiotherapy plays an important role here to help overcome the discomfort and swelling of breast engorgement ad make the process comfortable and happy for both the mom and baby.
How Physiotherapy is helpful for a lactating mother?
One of the first things physio can help is in educating a good posture when mom is feeding. The mom should be able to sit comfortably and relaxed during the feeding time.
It is important to sit with good posture, so that the strain to the body, neck and shoulders is less. Good posture will help the baby to latch well. A good latch can help minimise the amount of damage and irritation to the nipples
It will also help ensure that the breast drains well during feeds, and therefore decrease risk of developing blocked ducts and mastitis.
Physiotherapy can help reduce breast engorgement, inflammation and swelling, and instruction in gentle lymphatic massage to help reduce swelling.
PRINCIPLES OF ERGONOMICS WHILE BREASTFEEDING
Support your arms and baby while feeding
Positioning yourself and supporting your little one with pillows throughout the feeding will also help to avoid overuse of your arms and shoulders.
Be cautious of your positioning
Be conscious of your position throughout the feeding process. Try not to slide down into a slouched position, especially if feeding in bed or on the couch. It will put stress on your back and neck.
Try feeding
your baby while sitting upright with your back supported and your little one at the height of your breast.
Relax your muscles
You can get sore muscles caused by too much tension in your body. Unless necessary, always try to sit or lay down while breastfeeding. It will allow for extra support for your arms, neck, and back and will help to limit tension that you??d get from poor support while breastfeeding.
COMMON BREASTFEEDING POSITIONS
FAMILIAR PHYSICAL CHALLENGES OF BREASTFEEDING
Breast pain
Neck strain
Upper back & shoulder pain
Hunched posture of shoulder
Hand and wrist pain
Low back pain & Tail bone pain
TIPS FOR NURSING MUMS
Milk flow can be restricted by a poorly fitted bra, poor positioning of you and the baby or due to compression from your fingers holding the breast, if too firm.
Positioning yourself and your baby correctly to avoid back and neck pain as well as avoiding compression of the ducts is very important.
Breastfeeding helps your uterus to shrink to return to its pre-pregnancy size more quickly at about six weeks postpartum.
There is a general lack of awareness regarding the condition and it often remains undetected for years.
One in every 10 women in India has polycystic ovary syndrome (PCOS), a common endocrinal system disorder among women of reproductive age, according to a study by PCOS Society. And out of every 10 women diagnosed with PCOS, six are teenage girls.
PCOS was described as early as 1935. However, even today there is a general lack of awareness regarding the condition in India and it often remains undetected for years. This health condition is estimated to affect about 10 million women globally.
A study conducted by the department of endocrinology and metabolism, AIIMS, shows that about 20-25 per cent of Indian women of childbearing age are suffering from PCOS. While 60 per cent of women with PCOS are obese, 35-50 per cent have a fatty liver. About 70 per cent have insulin resistance, 60-70 per cent have high level of androgen and 40-60 per cent have glucose intolerance.
In studies conducted in South India and Maharashtra, prevalence of PCOS was reported as 9.13 per cent and 22.5 per cent, respectively.
Many aspects of the disorder are not understood properly as its symptoms and severity vary greatly. Women with PCOS are often found to have higher than normal insulin levels. Insulin is a hormone that??s produced in the pancreas. It helps the body cells turn sugar (glucose) into energy.
If you don’t produce enough insulin, your blood sugar levels can rise. This can also happen if you’re insulin resistant, meaning you aren’t able to use the insulin you do produce effectively. If you’re insulin resistant, your body may try to pump out high levels of insulin in an effort to keep your blood sugar levels normal.
Too-high levels of insulin can cause your ovaries to produce more androgens, such as testosterone. Insulin resistance may also be caused by having a body mass index above the normal range. Insulin resistance can make it harder to lose weight, which is why women with PCOS often struggle with this issue.
The incidence of PCOS among women and teenage girls has risen to such an extent that the Indian Council of Medical Research (ICMR) has taken up a nationwide survey. The reason it is dangerous is that if this condition is left unchecked or undiagnosed, it can lead to infertility among other long-term health concerns.
Early diagnosis and treatment is key to help prevent health problems. At Motherhood Hospitals alone, we have seen 4-5 cases of teenage girls suffering from PCOS, which is significantly high compared to 10 years ago. This is mostly due to unhealthy lifestyles, unhealthy diets and lack of exercise.
Spectrum of symptoms
Girls and women suffering from PCOS exhibit a range of symptoms such as weight gain, fatigue, unwanted hair growth, thinning hair, infertility, acne, pelvic pain, headaches, sleep problems and mood changes. Most symptoms begin shortly after puberty and they can also develop during late teens and into early adulthood.
Girls with PCOS typically have irregular periods or amenorrhea, and heavy or scanty bleeding during menses. Doctors also look for elevated levels of the male hormone androgen (testosterone) and polycystic ovaries.
With PCOS, women can develop cysts due to ovaries not being released on time. The follicles keep growing and form multiple cysts, which appear like a string of pearls. Women are likely to develop PCOS if their mother or sister also has the condition.
Not just that, women with PCOS have a higher risk of developing other health complications such as hypertension, high cholesterol, anxiety and depression, sleep apnea, heart attack, diabetes and endometrial, ovarian and breast cancer. Women who have PCOS have a higher rate of miscarriage, gestational diabetes, and premature delivery.
Recommended treatment
Unfortunately, PCOS cannot be cured. It can, however, be managed to a large extent by controlling symptoms. Exercise and a healthy diet are the best bet for women with PCOS as this will help to regulate their menstrual cycle and lower blood glucose levels.
High-fibre foods can help combat insulin resistance by slowing down digestion and reducing the impact of sugar on the blood. This may be beneficial to women with PCOS. Great options for high-fibre foods include broccoli, cauliflower and sprouts, red leaf lettuce, green and red peppers, beans and lentils, tomatoes, spinach, almonds and walnuts, olive oil, fruits, such as blueberries and strawberries, and fatty fish high in omega-3 fatty acids, such as salmon.
Lean protein sources like tofu, chicken and fish don’t provide fibre but are filling and a healthy dietary option for women with PCOS.
Instead of three big meals they should have five small meals, which helps metabolise food and in maintaining weight.
If women with PCOS are suffering from infertility, then fertility drugs may be administered to aid ovulation. On the other hand, if a woman does not want to get pregnant, then birth control pills may be prescribed.
In order to stop excess hair growth and help reduce acne, using anti-androgens is the recommended course of action. While many women have been recommended to regularly exercise, (minimum 45 minutes a day, five times a week) one refrain that we commonly hear is that they don’t have time.
Up to 5-10 per cent of weight loss will help improve the symptoms, hormonal balance and regularisation of menstrual cycle. PCOS among women, especially adolescents, is an urgent public health problem that needs careful assessment, timely intervention and appropriate treatment.
Promotion of healthy lifestyles, the need for regular exercise and increased awareness programmes on PCOS is the need of the hour to enable a holistic solution to this problem.
Endometriosis-An invisible disease yet painful.The woman suffers and fights within herself.She fights the pain , she fights to explain the unbearable and the unpredictable.Such is the situation of a woman having endometriosis.She has to know as to why she is hurt.She has to know that she has the chance to be pain-free.The below write up will help you to clarify your thoughts regarding endometriosis and to help you to come out of the stigma as well.
What is endometriosis?
The endometrium is the tissue that lines the inside of the womb (uterus).
Endometriosis is a condition where endometrial tissue is found outside the uterus. It is ‘trapped’ commonly in the pelvic area that is the pelvic cavity (including the ovaries) , lower abdomen and, rarely, in other areas in the body.
Which age group of Women are affected ?
Endometriosis is found almost exclusively in women of reproductive age, with diagnosis done usually during her 30s. It is uncommon in the under-20s.
Endometriosis has a much higher prevalence in infertile women, estimated as between 25% and 40%.
Endometriosis is estimated to affect 10-15% of women of reproductive age.However, it is difficult to determine the prevalence because of the diversity of symptoms and their severity and because endometriosis may be sometimes asymptomatic.
What are the risk factors?
Risk factors include: an early menarche, late menopause, delayed childbearing, short menstrual cycles or long duration of menstrual flow.
Obstruction to vaginal outflow eg, hydrocolpos, female genital mutilation or defects in the uterus or Fallopian tubes.
Genetic factors: Sometimes it runs in families. Therefore, endometriosis is more common in close blood relatives of affected women. Risk for first-degree relatives of women with severe endometriosis is six times higher than that for relatives of unaffected women.
Endometriosis is rare in women past the menopause, as to develop endometriosis you need oestrogen, the female hormone. Oestrogen levels fall after the menopause.
The combined oral contraceptive pill reduces the risk of developing endometriosis. This protective effect may persist for up to a year after stopping ‘the pill’.
What are the causes of endometriosis?
There have been several theories over the years.One theory was that some cells from the endometrium gets outside the uterus into the pelvic area. They get there during the monthly periods by spilling backwards along the Fallopian tubes.This is called retrograde menstruation.Other theories are spreading through lymphatic or haematogenous spread, and metaplasia.
However, currently the consensus is that endometriosis has a multifactorial aetiology, involving possible genetic, immunological and endocrinological factors.
What are the symptoms of endometriosis?
The clinical presentation is variable, with some women experiencing several severe symptoms and others having no symptoms at all. The severity of symptoms tends to increase with age.
Women with endometriosis may have no symptoms and be diagnosed incidentally or during investigations for infertility.
The appearance or worsening of pain at the time of menstruation, or just prior to it, suggests endometriosis.
Painful periods The pain typically begins a few days before the period and usually lasts the whole of the period. The pain is different compared to normal period pain which is usually not as severe and doesn’t last as long.
Painfulintercourse The pain is typically felt deep inside and may last a few hours after intercourse.
Pain in the lower abdomen and pelvic area. Sometimes the pain is constant but it is usually worse on the days just before and during a period.
Other menstrual symptoms may occur – for example, heavy bleeding during periods.
Difficulty becoming pregnant (reduced fertility). This may be due to patches of endometriosis in the ovary which forms cysts and does not allow eggs to grow.
Other symptoms include dysuria that is pain during urination, painful defecation, abdominal pain, backache, menstrual irregularity, and cyclical pain or bleeding (eg, epistaxis, haemoptysis) at extrapelvic sites.
What are the complications of endometriosis?
Infertility: moderate-to-severe endometriosis can cause tubal damage leading to infertility. Lesser degrees of endometriosis, even in the absence of any obvious tubal damage, are also associated with subfertility and increased risk of ectopic pregnancy.
Adhesion formation may occur due to the endometriosis or following surgery.
Women with endometriosis have an increased risk of inflammatory bowel disease.
Endometriosis may also be associated with an increased risk of breast and other cancers, autoimmune and atopic disorders.Rarely it may be associated with invasive ovarian cancer.
What are the other conditions mimicking endometriosis?
Pelvic inflammatory disease.
Ectopic pregnancy.
Torsion of an ovarian cyst.
Appendicitis.
Primary dysmenorrhoea.
Irritable bowel syndrome.
Uterine fibroids.
Urinary tract infection.
It??s time to start the conversation It’s the conversation of positivity.You need to open up the other side of the conversation.You need to know that you can have better life which is pain free,just by knowing what you need and how to deal with it more better.
How is endometriosis diagnosed and confirmed?
Transvaginal ultrasound scanning appears to be a useful test, both to make and to exclude the diagnosis of an ovarian endometrioma.
MRI scan may be a useful non-invasive tool in diagnosis, especially for subperitoneal deposits.
CA 125 measurement has limited value as a screening test or diagnostic test.
For a definitive diagnosis of most forms of endometriosis, laparoscopy is the gold standard investigation but it is invasive with a small risk of major complications – eg, bowel perforation.On laparoscopic findings, endometriosis is divided into Grade 1 to grade 4.Grade 1 is minimum disease,grade 2 is mild, grade 3 is moderate and Grade 4 endometriosis is severe form.
How is endometriosis treated?
The treatment of endometriosis is usually individually based, depending on the nature and severity of symptoms and the need for future fertility.
Medical treatment may reduce symptoms in 80-90% of patients but none of the treatment options has been shown to reduce recurrence of symptoms once treatment has stopped.
Pain management
The major goal of treatment is to reduce pain.There are 2 options in the management of pain one is non invasive medical line of treatment and the other is invasive surgical line of treatment.
Medical line of treatment
Non-steroidal anti-inflammatory drugsmay be effective in reducing the pain associated with endometriosis, although the evidence to date is inconclusive.Paracetamol, with or without added codeine, is an alternative.
Hormonal drugs: are equally effective: the COCP, danazol, oral or depot medroxyprogesterone acetate are as effective as the GnRH analogues and can be used long-term.Approximately 80-85% of patients improve with treatment.
Ablation of endometrioid lesions reduces endometriosis-associated pain. The smallest effect is seen in patients with minimal disease.
The levonorgestrel intrauterine system has also been shown to be effective.
Surgical line of treatment
Surgical options include removing severe and deeply infiltrating lesions (which may reduce pain related to endometriosis), ovarian cystectomy (for endometriomas), adhesiolysis and bilateral oophorectomy (often with a hysterectomy).Laparoscopic excision or ablation at the time of diagnostic laparoscopy.
The main conservative surgical techniques performed by laparoscopy are thermal or laser ablation, excision, ovarian cystectomy and denervation procedures.
Management of infertility associated with endometriosis
Medical treatment for endometriosis should be avoided for women who are trying to conceive.
In minimal-mild endometriosis, ablation of endometrioid lesions plus adhesiolysis is effective compared to diagnostic laparoscopy alone.
The use of laparoscopic surgery in the treatment of subfertility related to minimal and mild endometriosis may improve future fertility.
In moderate-to-severe endometriosis ,In vitro fertilisation (IVF) is appropriate treatment, especially if there are coexisting causes of infertility and/or other treatments have failed.
Success of treatment and side-effects
Overall, the hormone treatment options, all have about the same success rate at reducing pain.
What is the recurrence rate of endometriosis?
The natural course of the disease is variable and may or may not be progressive
In the five years after surgery or medical treatment, 20-50% of women will have a recurrence. Long-term medical treatment (with or without surgery) has the potential to reduce recurrence but there is no clear evidence for this.
Relapse following surgical treatment is common. 20% recurrence rate at two years and 40-50% at five years is known.
Effect of diet and exercise in endometriosis:
As we know there are a variety of treatments for endometriosis??ranging from medications to surgery??lifestyle changes should not be neglected. We know that lifestyle changes, including what you eat and how much physical activity you get, affect estrogen-dependent conditions like endometriosis.
Unfortunately, there are very few studies on endometriosis and lifestyle focus on whether certain diets or levels of activity are connected to endometriosis.This doesn’t mean that they’re not worth a try.
Healthy diet and physical activity helps in improved immunity which inturn helps reduce inflammation in endometriosis to some extent.
The following are the lifestyle and dietary changes:
Following a balanced diet rich in iron, fibre and essential fatty acids (EFAs).
PREGNANCY can be as confusing as it is elating and it??s not always easy to tell which changes are normal and which are cause of concern .one such change is vaginal discharge; which can vary in consistency or thickness frequency and amount during pregnancy.
Not many women are aware that a certain amount of discharge during pregnancy is normal. It may vary time to time. It is important to monitor consistency and colour to prevent any risk to the pregnant mother and growing foetus. Early intervention and getting the specialized prenatal care for the same increases your chance of a healthy pregnancy.
What causes changes to the vaginal discharge:
As cervix and vagina softens with the ongoing pregnancy, the discharge increase in pregnancy. The baby??s head may press against the cervix and often lead to increased discharge.
When is the discharge a cause to worry in pregnancy:
Lots of thin clear discharge could be amniotic fluid leak calls for an immediate visit with your clinical practitioner.
Discharge is tinged with blood and you??re not yet 37 weeks then call your doctor immediately.
It smells strange and suggests infection you need to see your gynaecologist immediately.
The months of trying and fretting over conception are finally over and you can now feel part of that magical world of new parents:
Once you are pregnant, it is rather important you eat the right type of food, in right quantity, and right intervals, to ensure a healthy mother and a healthy foetus. A balanced diet, containing low carbs, high proteins, necessary vitamins, minerals, micro nutrients and antioxidants along with fats in moderate amounts is what very pregnant mother should look forward to.
Even though your doctor might have prescribed folic acid pills/supplement you still need to include folate rich foods in your diet. Foods rich in folate include enriched white rice, cooked lentils / cooked spinach, chick peas, oranges, broccoli & eggs.
Vitamin B6 is important during the first trimester as it can inhibit nausea and vomiting. Rather than taking medicines include vitamin B6 rich foods like whole grains/walnuts/bananas jowar in your pregnancy diet.
If you can digest it, milk is a wonderful source of protein, vitamins, calcium, water, healthy fats and fortified vitamin D, Dairy products like curds and yogurt can add variety to your meal.
Fruits are rich in vitamins, antioxidant, fibre and water content. They are a perfect recipe for healthy pregnancy.
Iodine rich diet like eggs, cow’s milk ,strawberry ,walnuts to ensure proper mental development of the foetus
Tips for a healthy pregnancy:
Aim for 5-6 meals per day
Eat when you are hungry & stop when your full
Select fruits & Vegetables from different colours of the rainbow,
For a lot of women post coital pee is regular. Peeing after sex as your doctor, best friend and mom have probably told you countless number of times, is the best way to avoid UTI. But what about when you are trying to get pregnant?
The commonly asked question in the outpatient clinic is will peeing after sex force the sperm outside my vagina. Good News is NO! Peeing after sex has no impact on your chances of conceiving. But don??t hop up and run to the bathroom right after a sexual intercourse. Lying down at least for 2 to 5 minutes after intercourse increases the odds that the sperm might reach its date with the egg. If you are prone to UTI??S go ahead and pee after 5 minutes. If not, you can enjoy a good cuddle.
Here it is important to understand how the sperm works towards a pregnancy. Every time there is ejaculation millions of sperms are released and it takes only one to cause a pregnancy. Immediately after an ejaculation, with a favourable cervical mucus, sperm are off like a racing team speeding up the vagina through to the cervix to get you pregnant and set you on a journey towards a healthy pregnancy.
Classically, we thought of PCOS primarily as an infertility disorder or as a cosmetic annoyance, but we now know it’s also a metabolic disorder and a serious long-term health concern.
Polycystic ovary syndrome, widely known as PCOS is a condition characterised by chronic failure of ovulation (anovulation) and excessive production of male hormones (hyperandrogenism). It is characterised by a varied combination of clinical (oligo/amenorrhoea, hirsutism and obesity) biochemical (increased S.LH and androgens) and sonographic (enlarged polycystic ovaries) along with insulin resistance and compensatory hyperinsulinemia.
The heterogeneous nature of the disease, along with lack of precise diagnostic criteria has made the determination of true epidemiology of PCOS difficult.
Symptoms of PCOS:
Acne
Weight gain and trouble losing it.
Extra hair on face /chest/belly.
Thinning of hair on scalp.
Insulin resistance/Type 2 Diabetes.
Irregular periods/no/heavy periods.
Fertility issues/ not getting pregnant
Depression/sleep disorder/anxiety.
Tests and diagnosis of PCOS:
There is no single test to determine the presence of PCOS.A combination of medical history, physical examination, blood tests, ultrasound findings help to diagnose the same.
Treatment:
Management should consist of addressable of immediate complaints as well as planning preventive strategies for long term health sequale.
Healthy diet and exercise is the first line of treatment recommended. A 5 to 7 percent reduction of body weight over six-month period can lower insulin and androgen levels restoring ovulation and fertility in more than 75 percent of patients.
Birth control pills to regulate periods.
Diabetic medicine if necessary.
Fertility medicine if pregnancy desired.
Cosmetic treatment/spironolactone for hirsutism.
Conclusion:
Although the cause of PCOS are unclear, early diagnosis is important; if you think you may have PCOS, consult a doctor. If you have already been diagnosed, make sure to eat healthy and exercise.
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