Weaning practices in Nepal

by Sanjay Kumar Nidhi.

In Nepal, weaning traditionally begins with the Rice Feeding Ceremony (Pasne) where children receive their first meal. The ceremony is performed at five months of age for a girl and six months for a boy.

Common traditional weaning foods include:

• porridge (lito), made from roasted rice flour (occasionally maize or millet), ghee (clarified butter) and sugar
• jaulo, made from rice and turmeric or rice and salt
• dhiro, made from maize flour (or millet or wheat)
• maar, made in lowland areas by cooking rice, cracked maize and soybeans together
• khichari, a mix of rice, pulses and vegetables.

Some of these traditional foods are high in energy and nutrients and should be encouraged. These include maar and khichari. Others are poor weaning foods with little protein or nutrients, such as jaulo, so adding pulses, green leafy vegetables or fruit to these foods is encouraged.

Another traditional food which has been shown by scientists to be very nutritious, is a porridge made from the finely ground flour of roasted cereal grains and pulses. In Nepal this is known as super-flour porridge or sarbottam pitho ko lito. 

Ingredients for the super-flour porridge

The flour is made from:

• Two parts pulse – soybeans are best, but other small beans, grams and peas can also be used
• One part whole grain cereal such as maize or rice
• One part another whole grain cereal such as wheat, millet or buckwheat. The pulses and grains need to be cleaned, roasted well (separately) and ground into fine flour (separately or together). The flour can then be stored in an airtight container for one to three months. The flour is stirred into boiling water and cooked for a short time. The proper amount and consistency of the porridge will depend on the age and condition of the child. Salt should not be added, especially if the child is malnourished.

Super-flour porridge

The recipe developed out of experience and research by Miriam Krantz, working with Nepalese mothers and with the foods they grow. The Nutrition Programme of the United Mission to Nepal fully supports the use of super-flour porridge and it is now promoted throughout the country by the government as the ideal weaning food.

The flour makes full use of whatever local foods are most readily available. Any pulse can be used instead of soybeans, and combinations of any two cereal grains can be substituted for the wheat and maize.

For babies of six months of age or more, porridge made with one or two teaspoons of super-flour given two or three times a day is enough with breast-feeding. As the child grows, the amount of porridge used will gradually increase until about 100gm (four tablespoons) of super-flour is used each day – enough to prepare three feeds of porridge. This amount will provide most of a one to three year old’s requirements of protein, calcium, iron and various vitamins. If a young child is also breast-fed and eats two small portions of their family’s meal of dhal-bhat (pulses and rice), all their needs for energy and protein will be met.

The nutritional content of super-flour varies according to the ingredients used, but analysis shows that 100gm of flour will contain 13.5–25gm of protein and 345–370 calories. Super-flour porridge does not supply enough vitamin A for a child’s daily need. Health workers therefore teach mothers to add ground leafy greens or other family vegetables to the porridge.

The nutritional value of the porridge is also improved by adding ghee (clarified butter) or other fat or vegetable oil. A recipe that meets the WHO recommendation for severely mal-nourished children uses 30gm (one heaped tablespoon) of super-flour cooked with 15ml (three teaspoons) of oil and made up to 150ml with water. This is being used for malnourished children in UMN Hospitals.

Advantages of super-flour

• Super-flour is a convenient and adaptable food that stores well. For older children the flour can be eaten dry (as sattu) or added to fresh boiled milk or any other liquid without further cooking, since all the ingredients are pre-roasted. The flour can also be used for baking breads and biscuits.
• Infants like the roasted flavour.
• Mashed vegetables and fruits can be added to the porridge to improve the nutritional value and vary the flavour.
• Super-flour porridge is highly recommended for use with severely malnourished children.

Sanjay Kumar Nidhi has worked as a nutrition assessment and support officer in the Nutrition Programme, United Mission to Nepal. His address is Nutrition Programme, UMN, PO Box 126, Kathmandu, Nepal. E-mail: [email protected]
 

Case-study: On the road to recovery

Kamali brought her two year old son, Arjun, to the District Health Office with tears in her eyes. She brought him there as a last resort after he had received treatment from local traditional healers. Arjun had diarrhoea all the time, had lost his appetite and had been constantly losing weight.

Arjun was immediately referred to the Nutrition Programme of UMN. He had severe weight loss and looked just ‘skin and bones’. He was irritable, very slow, dehydrated and was crying all the time. It was a clear case of severe protein energy malnutrition. Arjun’s mother, Kamali, was advised about his situation and given suggestions for feeding him.

Three days later, UMN staff visited his home and talked with his mother about the family situation. They discovered that she was not aware of the importance of good child feeding and hygiene practices.

The nutrition programme staff taught the mother how to prepare super-flour porridge. She was encouraged to feed Arjun this porridge four to five times a day (fortified with ghee or oil) along with other food, fruits and vegetables. During later home visits, Kamali was given practical suggestions regarding weaning foods, feeding sick children, personal hygiene, balanced diet and nutritious local foods. The nutrition field staff also monitored Arjun’s weight during regular home visits.

Arjun gained weight slowly but steadily. When he returned to the nutrition unit for a check-up visit he was a different child – happy and full of energy. He had gained weight, could walk easily, his appearance had improved and he wanted to feed himself. The clear joy in his mother’s eyes said it all.

We hope that our experience in Nepal with home processed weaning foods can be duplicated in other countries. Sound, home-based approaches to child feeding should be recognised and encouraged by policy makers, community leaders and public health workers.