Hesperian Health Guides

Good nutrition for children

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Good nutrition is important for all children. It helps them grow physically, gives them the energy they need to develop in both body and mind, and protects them from illness.

Good nutrition is even more important for children living with HIV, as these children need more food to stay healthy than other children their age. Even though you cannot see it, the body of a child with HIV must work very hard to fight HIV. Medicines for HIV also work better when children have enough to eat.

Children with HIV more easily develop malnutrition or diarrhea. Having HIV also makes it more difficult for them to recover from either problem. Taking ART will help them avoid illness and get more nutrition from the food they eat. See signs of malnutrition and how to treat it, and information for diarrhea.

Malnutrition causes diarrhea — diarrhea causes malnutrition

For all children, not having enough to eat (malnutrition) and being ill each make the other worse. When children are ill, they cannot make use of all the nutrition from the food they eat, and they often eat less, making them even weaker and more likely to stay ill or become ill again soon.

Malnutrition can be caused by not having enough food, not having enough different kinds of food, or because an illness such as diarrhea makes it hard to absorb food. Malnutrition is very dangerous for children with HIV because it makes their weak immune systems even weaker. Any child who is malnourished gets other infections much more easily.

a sick looking baby on a blanket.
1. Not enough food (malnutrition) harms the whole body, including the gut.
2. The gut, damaged from malnutrition, cannot absorb food well. The food passes through too quickly. This is diarrhea.
3. Constant passing of stool drains the body of nutrients and weakens the child. Lack of nutrients from food is malnutrition.
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What to feed babies

For the first 6 months, the best food for babies is breast milk, even if the mother has HIV. To help a baby grow well up to 6 months old, breastfeed often and avoid giving other foods and drinks. For more about breastfeeding and HIV, see Chapter 9.

Feeding babies older than 6 months

Starting when a baby is about 6 months old, giving breast milk alone is not enough. It is time to add other foods. But also keep breastfeeding! To add foods, start with 1 or 2, like adding a little oil to a porridge made from your main food, such as rice, maize, cassava, wheat, or millet. If you add water later, after making your porridge, use boiled or treated water.

Soon add a spoonful or so of other foods, including:

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  • soft cooked beans or ground bean meal, pounded groundnuts, eggs, dairy, or dried fish flour. These protein foods help the baby’s body and mind grow well.
  • vegetables and fruits, such as well-cooked squash, peas, carrots, shredded or pounded green leafy plants or tomatoes. Add mashed fruits such as papaya, bananas, and mangoes. Use any orange or green foods eaten where you live. Vegetables and fruits have vitamins and minerals that help us stay healthy and fight infection.

Foods should be clean and unspoiled, soft and easy for the child to eat, and not too spicy or salty. Choose foods that are easy to buy or grow where you live, and easy to prepare.

By feeding himself, a baby learns how to use his hands and fingers to hold small things.
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Feed babies often

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Babies have small stomachs so they need to eat many small meals during the day as well as breastfeed. Usually 3 to 5 small meals are enough if you are breastfeeding. If you are not breastfeeding, feed your baby 5 to 7 small meals. Different foods help our bodies in different ways, so eating a variety of foods is important.

New foods sometimes upset a baby’s stomach. Try to give your baby one new food at a time. First give her only a little bit, then slowly give more. When the baby is used to the new food, then start another new food.

How and when should a woman with HIV stop breastfeeding?

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When you are on ART and your HIV is well controlled, HIV is not likely to spread from breastfeeding, so you can breastfeed for a year or more. Breast milk is the healthiest food for a baby and protects the baby in many ways. Many women stop breastfeeding when a child is older than 6 months but younger than 2 or 3 years old.

When a woman stops breastfeeding (sometimes called weaning), she needs to have enough other foods to feed her child. This change in foods can be difficult for a child. And the risk of malnutrition is worse for children with HIV.

If you are able to give plenty of healthy foods and other milks to your baby, and you want to stop breastfeeding, do this slowly, over about 3 weeks.

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Feed your baby soft, mashed, healthy foods 5 or 6 times a day (or more). You can also boil animal milk to give the baby.

If you do not have enough food or enough different foods to give the baby, it is better to keep breastfeeding until your baby is 2 years old or more.

The story Working together to feed babies the very best shows how one community helped families feed their young children enough.

Nutrition after the first year

Children need the same variety of healthy foods anyone needs — starchy main foods that give us energy, proteins that help us grow and develop our minds, and vegetables and fruits to help us stay healthy and fight infections.

examples of different types of foods
proteins: beans, eggs, pulses, fish, nuts, seeds, yogurts, milk, meat
starchy foods: rice, cassava, maize, wheat, millet
fruits and vegetables: leafy greens, carrots, peppers, bananas, tomatoes, mangos, melon, squash, and pumpkins

Feed a child enough food and enough different kinds of foods to stay healthy. You do not need costly foods to have a balanced diet. To make sure children get enough food:

  • For extra energy, add a small spoon of oil to your child’s food. Many small children cannot eat enough starch to get all the energy they need.
  • Give smaller or disabled children their own food in small bowls. Check to see that each child gets their share, and ask older children or other caregivers to do this as well. Feed girls as much as boys.
  • Give children several small meals throughout the day. Four meals is usually good. Try to give more if the child is not breastfeeding.
  • Treat diarrhea right away with rehydration drink. Diarrhea prevents children from absorbing all they should from their food.
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Sweet or fried snacks are found in shops everywhere, and children like them, so it may seem OK to feed them to children. But these and many other packaged foods have too much fat and sugar in them and very little nutrition. Roasted or baked snacks, or fresh fruit, are better for children.

Vegetables and fruits protect our bodies

Fruits and vegetables are full of vitamins and minerals, which our bodies need to be healthy. A child will get all the vitamins and minerals she needs if you give her lots of vegetables and fruits of different colors, especially orange ones and leafy greens. Vegetables and fruits you grow yourself are just as healthy as imported ones.

Certain foods, and the vitamins and minerals in them, are especially good for people with HIV. This is because they help build a strong immune system, which helps people with HIV fight infection and disease.

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Vitamin A helps fight infection. It also helps us have healthy skin and bones and protects our ability to see. Foods that have a lot of vitamin A include most orange vegetables and fruits, such as carrots, pumpkin, sweet potatoes, papaya, and mango, and green vegetables, such as leafy greens and green peas. Eggs also have vitamin A.

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Zinc is a mineral that helps children grow well and fight infection, especially diarrhea and pneumonia. It also helps us have healthy skin and nails. Foods with zinc include wild spinach, meats, oysters, eggs, milk products, nuts and seeds, and whole grains. See information about zinc supplements.

Selenium is a trace mineral (we only need a little) that helps our bodies fight infection. Foods with selenium include Brazil nuts and sunflower seeds, many types of sea fish, coconuts, some fortified cereals, and aloe juice. Just one of these foods each week is enough.

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If you have these foods in your community, it is good to feed them to your children. Eat some yourself too. Dark leafy greens, for example, grow all over the world and many have vitamins and minerals to make the body strong and healthy. Talk to healers, midwives, and nurses about local plants that are good for health.

a woman speaking
I use meal times to wash children’s hands, teach them to share and help others, and help them learn to feed themselves.
Working together to feed babies the very best
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In Zambia, many children 2 years old and younger are sickly and do not grow well. Sometimes they become very weak from malnutrition, or even die. Those who live are too small and often lack skills and abilities they would have if they had been given enough food in their first few years. A group of parents, caregivers, health workers, and others formed to work on this problem in Luapula province.

To try to find out why so many children were not growing well, the group visited many villages and homes and asked what everyone fed their babies. One problem was that, since HIV had come to Zambia, advertizing formula and questioning the safety of breast milk had confused families. Another problem was that families did not know how much of what foods were good to give small children.

The group decided to create a recipe book for feeding babies 6 months to 2 years old. As they developed and tested the recipes, they held meetings in the community and learned how to explain what foods children need at this age, and how different foods help a child stay healthy and grow well. Then they used what they learned in the meetings to explain these ideas in the book. The recipes are based on local Zambian foods that most families are able to grow or buy. There are recipes for both rainy and dry seasons, and recipes for feeding sick children. All the recipes were tested to make sure they tasted good to children and worked well for families. See how to get this cookbook.

a woman talking to a child
These greens help us see better and make our bones strong.
I will be as strong as Lucy!

Teach children about healthy eating

If you teach your children about foods that keep them healthy, they will eat these foods with less fuss. They will also learn healthy eating habits as they grow older. Have children help grow, collect, wash, and prepare food. Give children a good example by choosing healthy foods over sweets and fried food yourself.

How to feed a sick child

Sick children need food but often lack the appetite or desire to eat. Do not force a sick child to eat. If the child gags or pushes food out, stop feeding. But keep offering small amounts of food every few minutes and gently encourage eating. Children can take in more food than you think, even by eating only a spoonful at a time. Be patient. It can be frustrating, especially if you are feeling busy or sick too. Ask for help if you become tired or impatient.

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Give the foods your child most likes. When children are eating only very small amounts, add a few drops of vegetable oil to their main food to increase the energy in the food. Even better, add a little protein such as beans or egg to the main food if possible.

Do not feed a child lying down — this can cause choking. It is best to hold the child on your lap or sit her up in bed.

If your child vomits, wait 10 minutes and then continue to offer fluids or food.

Offer a breastfeeding baby the breast often, even if she takes only a little milk at a time. When a baby is very weak and cannot suck on the breast, you can squeeze milk from your breast and feed the baby with a clean cup and spoon.

Children with HIV often have a sore mouth from thrush or herpes. These children eat less, because eating is painful. See Sore throat, mouth sores, and thrush for how to care for problems in the mouth. Make sure children keep taking any daily medicines they need. See Chapter 11.

When a child is recovering from illness

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Good nutrition is most important when children are recovering from illness. This is especially true for HIVpositive babies and children. They need a lot of extra food for a long while after they recover. A child often has a growth spurt after an illness and may need up to twice the amount of food he usually eats. Try to give extra meals or snacks for 2 weeks, especially if the child is acting hungry and is willing to eat.

Also give children with tuberculosis (TB) extra food. Without it they have a much higher risk of dying from their TB. See how to treat TB.

Eating enough when you do not have much money or land

Many people struggle to have enough food. The inequality in our world between people who have too much and people who have too llittle, whether of land, money, or power, has to change. We have to find ways to get people with HIV more food, even though so many farmers and wage earners have fallen ill, died, or lost access to land. How can people get enough food?

Many things need to change for everyone to have enough to eat all the time. But one family or one community can usually eat better even if they have little. Here are some ideas that may help (also see Chapter 15).

  • Buy healthy foods that are less costly, such as beans and grains.
  • Buy food during times of plenty and keep some for times of scarcity.
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  • Keep chickens for both eggs and meat.
  • Buy foods in bulk if you are able to properly store them (in a dry place where no insects or animals can get to the food).
  • Feed babies breast milk instead of formula. It is healthier for them, and it costs nothing!
  • Do not waste what you have. After cooking beans and vegetables in water, save the water. It is full of vitamins and is very good for you to drink or use to cook grains.

Grow more of your own food

Many people already grow food on the land they have available. You might be able to grow a bit more, or plant greens among other crops.

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Make compost from food waste.

Even in a city, you can grow food. Use a rooftop or a small area near your house, or organize to grow food in a vacant area. You can even grow a few things in a sack or pot on a window sill or in front of your home.

To make a home garden produce more, be easier to care for, and need less water, use compost. To make compost: Mix food wastes and plant waste, such as leaves or grass, with some soil and manure. Let the compost sit and blend together for several months. Then mix it into the ground where you plant. Compost makes your soil stronger and your vegetables grow better.

You can also change or combine your crops. Some crops wear out the soil while others, such as beans, peanuts, and peas, make the soil stronger. You can grow different crops next to each other, or plant different crops after one another in the same soil. Combining the crops you grow can also help fight pests and plant diseases.

women working in a garden.

For more information on growing your own food, see A Community Guide to Environmental Health, and also Chapter 15.

Help those who have less

Most communities have ways to help those who are hungry or lack other basic necessities. Some do this through their religious organizations. Some use government bodies to provide food or money to people who need it. Schools, childcare programs, places of worship, or community kitchens may provide a daily meal for young children or others who would not eat otherwise.

If you need food, ask for help. There is no shame in asking — the shame should be felt by employers who pay so little that people cannot buy enough food, and by property owners, bankers, and trade ministers who directly or indirectly drive people off the land.

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This page was updated:23 Jan 2020