Module on “Annaprashana Samskara” by Dr. Vaibhav Jaiswal

Annaprashana samskara

Objectives

Annaprashana Samskara

Definition

How to start

Benefits

Brain develpoment

Micronutrient deficiency

Complementary feed

Annaprashan samskar should be performed at the time when the child had gain strength to digest cereals and other types of food products i. e at six month of life.  Parents who desire his child to be brilliant should cooked rice feed with ghee or rice with honey, curd and ghee. Our Acharyas have knowledge of introduction of weaning at six month of age in right way to ensure optimum growth.

Acharya Kashyap as mentioned about to prepare a Avleha(semi solid ) by combination of old husk free and well washed sati or sashti rice, mixed with oleaginous substances and salt. The powders of wheat and barley also should be given, according to Prakriti (congeniality). Warm leha (electuary) cooked with vidanga, lavan(salt), oleaginous substances is beneficial Acharya Kashyap also mentioned to start Fruits juices in infants from 6 month of life.

First two years of life is considered a “critical window” of opportunity for ensuring children’s appropriate growth and development through optimal feeding. Appropriate nutrition during infancy and early childhood ensures growth, health, and development of a child to its full potential.

Evidence-based studies also indicate that early nutritional inadequacy can lead to long-term impairment in growth and health of the growing child. Micronutrient deficiency leads to hidden hunger. Consequences of hidden hunger are serious. Micronutrient deficiencies lead to a cycle of poor health, poor educability, poor productivity and consequent economic losses. It can cause blindness and brain damage. It can induce stillbirths and abortions. It can make people fatigued and lethargic. Hidden hunger can aggravate ordinary childhood diseases such as diarrhoea, malaria and measles. It often contributes to high rates of maternal and child deaths.

After 6 months, the infant’s need for energy and nutrients starts to increase than what is provided by breast milk. Multiple studies which have conducted chemical analysis of breast milk at various stages of lactation has shown that from 6 months to 11 months postpartum, the micronutrient content namely the iron and zinc is insufficient to meet the needs of older infants. Moreover, the nutrient requirements of infants through complementary foods are much higher in comparison to that fulfilled by an adult’s diet. This is because infants consume small amounts of food other than breast milk. Hence, the food prepared for infants needs to be high in nutrient density i.e. the amount of each nutrient per 100 kcal of food. Iron and zinc has been found to be the problem nutrients since their concentration in human milk is much lesser than relative need. Therefore, infants should ideally be provided the most nutrient-rich foods available in the household, however often the infants from economically deprived families typically receive nutrient-poor, watery porridges.

Also, undernutrition increases remarkably from 3 to 18–24 months of age. Global statistics identify 6–18 months as the time when stunting and malnutrition sets in, exactly during complementary feeding period. This is the period of complementary feeding that has been recognized as a sensitive period of high risk for developing stunting, protein-energy malnutrition, iron-deficiency anemia and rickets. This is because complementary feeding period is associated with changes in a child’s dietary habits as well as rapid growth. Therefore this period is a sensitive period and nutritional influences at this time can exert long-term effects on later development and health of a child.

In Ayurvedic text there are many references to start complementary feeding in infants at six months of age to have better growth. According to Ashvalayana Grihsutra(1/16), mentioned that to get Tejashvi(Intellect) child those food recepie should be given that are prepare from curd, honey and butter oil from 6 months og age.

Apart from fulfilling nutritional voids, complementary feeding also helps in establishing healthy eating habits. Exposure to different flavours begins early in life via amniotic fluid/breast milk and continues during late infancy when the infants are introduced to complementary foods. Therefore, mothers should be encouraged to introduce repeatedly a variety of nutrient-rich fruits and vegetables, both within and between meals. This will help infants to get accustomed to novel foods and experience a variety of flavours which promotes the willingness of an infant to eat varied foods later in life.

Providing these types of diet in children will make them nourish and keep them away from deficiencies.  Ghee contains DHA along with fat-soluble vitamins, anti-oxidants, and conjugated linoleic acid (CLA), omega 3 acid could be responsible for health benefits in children. Honey also provides energy (~3kcal/gm) has antimicrobial action, immune-enhancing and wound healing properties. Contains 0.3-25 mg/kg choline and 0.06-5 mg/kg acetylcholine. Choline is essential for cardiovascular and brain function as well as for cellular membrane composition and repairing, while acetylcholine acts as a neurotransmitter.

So in today’s era, Complementary feeding should have

• Appropriately thick homogenous complementary foods made from locally available foods should be introduced at six completed months to all babies
• Breastfeeding should be actively supported during this time
• Each meal must be made energy dense by adding sugar/jaggery and ghee/butter/oil
• Thick in consistency: Thick enough to stay on the spoon without running off, when the spoon is tilted
• Hygienic practices for food safety to be followed during all the involved steps viz. preparation, storage and feeding.
• Infant food should be a “balanced food” consisting of various (as diverse as possible) food groups / components in different combinations.
• As the babies show interest in complementary feeds, adding new foods in the staple food one by one should increase the variety.
• Iron-fortified foods, iodized salt, vitamin A enriched food etc. are to be encouraged.

Micronutrient deficiency or hidden hunger is widespread among infants and young children. Micronutrient requirements during complementary feeding  may be left unfulfilled. Nutritional influences during complementary feeding can exert long-term effects on development and health of a child. so Start Right at the right time and with right feed is need for the optimum growth and development of child. Annaprashan samakara described in our Ayurvedic text is focusing on the same issue for children growth. Providing complementary feed containg Ghee, honey jaggery and others with right quantity keeps the optimum growth of child. The methodology given in our text is very important and helpful to find out food allergens as weaning of child is started gradully. The time invested in counselling mothers by medical personnel has shown to give returns in terms of improved nutritional status of the children.

Study Material

1. Infant and young child feeding Model Chapter for textbooks for medical students and allied health professionals. WHO. 2009.
2. The Micronutrient Initiative and UNICEF. Vitamin & mineral deficiency a global progress report. 2010. Available at: http://www.unicef.org/media/files/vmd.pdf. Accessed on: 28 August, 2015
3. Dewey KG. The Challenge of Meeting Nutrient Needs of Infants and Young Children during the Period of Complementary Feeding: An Evolutionary Perspective. J Nutr. 2013;143:2050–2054
4. Michaelsen KF. What is known? Short-term and long-term effects of complementary feeding. In: Hernell O, Schmitz J (eds). Feeding during Late Infancy and Early Childhood: Impact on Health. Nestlé Nutr Workshop Ser Pediatr Program. , vol 56, pp 185–205.
5. Mennella JA, Trabulsi JC. Complementary Foods and Flavor Experiences: Setting the Foundation. Ann Nutr Metab. 2012;60(suppl 2):40–50.
6. Joshi KS. Docosahexaenoic acid content is signicantly higher in ghrita prepared by traditional Ayurvedic method. J Ayurveda Integr Med. 2014;5:85-88
7. Honey for Nutrition and Health: A Review Stefan Bogdanov, PhD, Tomislav Jurendic, Robert Sieber, PhD, and Peter Gallmann, PhD Swiss Bee Research Centre, Agroscope Liebefeld-Posieux Research Station ALP, Berne, switzerland
8. Infant and Young Child Feeding Guidelines: 2010. Accessed online at: http://www.indianpediatrics.net/dec2010/dec-995-1004.htm. Accessed on 20th August 2015
9. Charak samhita with Chakrapani commentary by Pt. Kashi Nath Shastri ; 1^st edition ; chaukhambha saskrit series office.
10. Kasyapa Samhita by Vrddha Jivaka revised by Vatsya; Sanskrit introduction by Nepal Rajaguru Pandit Hemaraja Sharma; Vidyotini Hindi commentary Chaukhambha Sanskrit sansthanvaransi; Edition reprint 2012;
11. Sushruta samhita hindi commentary by Kaviraj Dr Amballika Dutta shastri ; 3^rd edition ; chaukhambha saskrit series office,
12. Text book of Balroga Kaumarbhritya by Prof B.M.singh, 1st edition; chaukambha orientellia Varanasi
13. Kasyapa Samhita by Vrddha Jivaka revised by Vatsya; Sanskrit introduction by Nepal Rajaguru Pandit Hemaraja Sharma; Vidyotini Hindi commentary Chaukhambha Sanskrit sansthan varansi; Edition reprint 2012; Khilasthana Jatkarmottara Adhyaya; chapter12 verse13 p. 318.

Assessment

Q1. When Annaprashana samskars should be performed according to Ayurveda?

1. 4 months
2. 6 months
3. 8 months
4. 11 months

Q2. According to Acharya Kashyapa when Phalprashana should be performed?

1. 4 months
2. 6 months
3. 8 months
4. 10 months

Q3. Critical window period in children is consider as?

1. 1 months of life
2. 5 to 10 years of life
3. first 2 years of life
4. none

Q4. Micronutrient deficiency in children is also called?

1. Hidden hunger
2. Hidden deficiency
3. Child hunger
4. Nutrional deficiency

Q5.  Following are the Consequences of hidden hunger except?

1. Blindness
2. Brain damage
3. Still birth
4. All of above

Q6. Exclusively Breast-feed should be done in children up to?

1. 2 year
2. 1 year
3. 1 month
4. 6 months

Q7. Which of the elements got deficient in children if not proper given complementary feed?

1. Calcium
2. Iron
3. Zinc
4. b and c

Q8.  According to Ashvalayana Grihsutra to get Intellect child food recepie should contain all exept?

1. Milk
2. curd
3. honey
4. butter oil

Q9.  Mothers should be encouraged to introduce repeatedly a variety of nutrient-rich fruits and vegetables in children ?

1. within the feed
2. Between the feed
3. both within and between meals
4. none

Q 10.  Undernutrition increases remarkably in children?

1. from 3 to 18–24 months
2. From 2 to 3 years
3. from 4 to 6 years
4. from 6 to 8 years