Healthy Start, Healthy Future: Dr. Lakshmikanth Rajaiah on Childhood Nutrition (Part-1)
In our exclusive feature on MedBound Times' DocScopy segment, we have Dr. Lakshmikanth Rajaiah, a distinguished Consultant Pediatrician from Tirunelveli, Tamilnadu, India. He completed his MBBS degree at Tirunelveli Medical College, Tamilnadu, India followed by Diploma in Child Health (DCH) degree at Aligarh Muslim University, Uttar Pradesh, India. He further pursued his DNB (Pediatrics) course at CSI Kalyani Hospital, Chennai, India.
During this comprehensive discussion conducted by Dr. Nirainila Joseph from MedBound Times, Dr. Lakshmikanth delved into a range of crucial topics, including essential aspects of childhood nutrition, optimal breastfeeding practices, the introduction of solid foods, managing food allergies, and identifying common nutrient deficiencies. He also addressed significant issues such as childhood obesity, the growing popularity of vegan diets and health drinks, and effective strategies for dealing with picky eating habits.
Join us as we explore Dr. Rajaiah's expert perspectives, offering practical guidance for parents on nurturing healthy eating behaviors from infancy through adolescence, ensuring a foundation for lifelong wellness.
Dr. Nirainila Joseph: Please introduce yourself to our readers.
Dr. Lakshmikanth Rajaiah: Hi, I am Dr. Lakshmikanth Rajaiah, MBBS, DCH, DNB (Pediatrics). I am currently working as a Consultant Pediatrician in Nambiyappan Hospital, a private hospital, located in Tirunelveli, Tamil Nadu, India. I completed my undergraduate studies at Tirunelveli Medical College in 2011 and finished my postgraduation at Aligarh Muslim University in 2016. Then I completed my DNB course at CSI Kalyani Hospital, Chennai in 2019. For the past 4 years, I have been working as a consultant in Neonatal Intensive care Unit (NICU) and pediatric wards.
Dr. Nirainila Joseph: Before we dive into our topic of discussion, 'Childhood Nutrition,' with your expert insights, let's explore the public perception on the topic. In your experience, what are some of the most common nutritional concerns parents have about their children?
Dr. Lakshmikanth Rajaiah: Some common questions that parents ask me regarding their children's nutritional concerns are:
1. Doctor, as we both parents are short, we are worried about our child’s height. Please recommend some supplements (protein powder to be mixed with milk) to increase his height.
2. Can we give some supplements to our child for increasing the mental ability and intelligence?
3. Does a newborn baby need any vitamin supplements? Is only breast milk adequate?
4. Can we give any supplements to increase a child’s immunity?
5. What supplements are good for children’s eyes (vision)?
Dr. Nirainila Joseph: I believe many parents share these doubts. With information overloaded on the internet and through word of mouth, misconceptions abound on every topic, including children's nutrition. What common misconceptions do you often encounter?
Dr. Lakshmikanth Rajaiah: The misconceptions that I commonly encounter are:
Babies and young children don't need to take vitamin supplements.
Babies only like sweet foods.
Baby will starve if they skip a meal.
Fruit juice is healthy for a child.
Eating frequently makes a child healthy.
Dr. Nirainila Joseph: I hope this article will help clarify these misconceptions among the public. So, let's begin with the basics. What are the basic nutritional requirements for children at different developmental stages?
Dr. Lakshmikanth Rajaiah: According to the Indian Council of Medical Research (ICMR) 2020 recommendations, these are the values for the nutrition requirement of children:
Infants
0-6 months: 550 kcal/day
6-12 months: 670kcal/day
Children
1-3 years: 1010 kcal/day
4-6years: 1360kcal/day
7-9 years: 1700 kcal/day
Age 10-12 years
Boys: 2200 kcal/day
Girls: 2060 kcal/day
Age 13-15 years
Boys: 2800 kcal/day
Girls: 2400 kcal/day
Age 16-18 years
Boys: 3320 Kcal/day
Girls: 2500 Kcal/day exclusive demand feeding is accepted as the only mode of early infant feeding.
Dr. Nirainila Joseph: That was a very detailed insight. Before eating solid foods, babies are breastfed, making it an integral part of childhood nutrition. How long do you recommend exclusive breastfeeding, and when should parents start introducing solid foods? What are the best first foods to introduce to an infant, and why?
Dr. Lakshmikanth Rajaiah: After the introduction of the ‘Baby Friendly Hospital Initiative’ (BFHI) in 1992, exclusive demand feeding is accepted as the only mode of early infant feeding. Babies are well known to thrive on breast milk alone during the first 6 months of age.
Weaning or complementary feeding after 6 months is extremely important due to the high risk of micronutrient deficiencies and malnutrition. Even though babies may thrive on breast milk alone during the first 6 months of life, they become biologically fit to accept semisolids after 4 months of age.
Complementary foods can be homemade or instant foods. In any case, it is better to start with mono cereals, followed by multi cereals and cereals-pulse combination. Cereal-like rice is the best choice to start weaning as it is gluten-free and easily digestible. Cereal-pulse combination is better due to the fortification of amino acids as cereals generally lack lysine and pulses lack methionine. Tubers, fruits, biscuits, and banana powder are also popular weaning foods.
Dr. Nirainila Joseph: When we talk of introducing new foods, we need to be aware of allergies since we don't know what foods may be allergenic to our babies and need to be avoided. How can parents identify and manage potential food allergies when introducing new foods?
Dr. Lakshmikanth Rajaiah: Food allergy is the clinical reactions to food components that are caused by pathological immune reactions; manifesting in any organ but principally in the gastrointestinal (GI) tract, skin, and respiratory tract. A variety of food items are identified as food allergens like cow’s milk protein, soya protein, egg white, peanuts, cocoa, and peas. Shrimp, crustaceans, and fish are rare causes of food allergy. Spices and yeast too are in the line of food allergens. Ingredients of Chinese cooking like Aginomoto or monosodium glutamate are often the culprits.
Signs and symptoms of food allergy in general are anaphylaxis and shock. The gastrointestinal symptoms are nausea, vomiting, diarrhea, malabsorption, failure to thrive, intestinal loss of blood, abdominal pain, and bloating. The respiratory signs are sneezing, rhinorrhea, wheezing, cough, bronchospasm, and dyspnea. Allergic symptoms manifest in the skin as lip swelling, angioedema, itching, rash, urticaria, and eczema. The other symptoms are joint swelling, arthralgia, headache, apathy, and irritability.
Dr. Nirainila Joseph: We've discussed recommended nutritional levels; now, let's discuss nutrient deficiencies. Are there specific nutrients that children commonly lack and what are the signs of nutrient deficiencies in children?
Dr. Lakshmikanth Rajaiah: Calcium is essential for bone and teeth formation, functions of calcium channels, normal muscle contraction, nervous activity, and coagulation. Hypocalcemia produces tetany and convulsion.
Vitamin C (ascorbic acid) is a water-soluble vitamin that is lost during washing and cooking. It is involved in collagen synthesis and bone and teeth formation. It also increases iron absorption. It is also important as an antioxidant due to its reducing properties. The deficiency leads to scurvy, defective bone growth, bleeding gums, and delayed wound healing. There will be subperiosteal bleeding and calcification.
Vitamin D is a fat-soluble vitamin essential for bone growth and calcium absorption. In rickets, failure of mineralization leads to bony deformities, large head, wide open anterior fontanel (AF), frontal, parietal and occipital bossing (hot cross bun appearance or caput quadratum), craniotabes, pigeon chest, rachitic rosaries, pectus carinatum, Harrison’s sulcus, knock knee, lateral bowing of tibia, widening of wrist, double malleoli.
Iron is the mineral essential for the synthesis of hemoglobin and for oxygen transport. It is also important in oxidation-reduction reaction and enzyme function. It is the most abundant mineral on earth and it produces the commonest deficiency as well. Iron deficiency leads to microcytic hypochromic anemia, lack of concentration, and koilonychia. It produces geophagia (eating mud), amylophagia (eating raw rice), and pagophagia (eating ice cubes).
Dr. Nirainila Joseph: How are common nutrient deficiencies treated in children once identified?
Dr. Lakshmikanth Rajaiah: 1. Egg yolk, fish, and tropical plants are rich sources of Vitamin D. Summer milk produced by cows grazing on green plants is found rich in vitamin D. The traditional practice of exposing the babies to sunlight after oiling is good for vitamin D synthesis. The prevention dose of Vitamin D is 600 IU per day, while the treatment dose is 60,000 IU orally for 6 weeks.
2. The requirement of Vitamin C is 40-50 mg/day. Amla, citrus fruits, sprouting cereals, potatoes, and pulses are rich sources of vitamin C.
3. Milk, millets, greens, fish, oyster, and crab are rich sources of calcium. The requirement is 500-1000mg/day; Treatment dose is 100- 200mg/kg/day.
4. Iron-rich foods are fish, meat, cereals, legumes, greens, jaggery, dates, and watermelon. Treatment for deficiency is oral iron 6mg/kg/day and the prophylaxis dose is 10-20mg/day.
Stay tuned for Part-2 of the interview!
