Question: Hai doktor.Saya mempunyai seorang anak lelaki saya berusia 5 bulan. Sehingga kini dia masih lagi menyusu badan sepenuhnya. Dalam 1 hari biasanya dia akan minum sehingga 45oz. Saya risau anak saya tak kenyang dengan hanya minum susu. Soalan saya,bilakah waktu yang sesuai untuk saya berikannya makanan tambahan? Bagaimanakah untuk saya mengetahui bahawa anak saya sudah bersedia untuk makanan pelengkap? Untuk pengetahuan doktor,anak saya G6PD. Answer: Biasanya susu badan akan dihasilkan setimpal dengan keperluan anak. Sekiranya anak menyusu dengan kerap, penghasilan susu badan akan bertambah. Kuantiti makanan pejal boleh ditambahkan secara beransur-ansur, supaya anak lebih kenyang dan mengelakkan risiko kekurangan zat makanan. Sebenarnya, tiada halangan untuk makanan pejal diberikan selepas 7 petang. Apabila anak membesar, dan pengambilan makanan pejal bertambah, anak tidak perlu bangun begitu kerap untuk menyusu. Diharapkan artikel ini dapat sedikit sebanyak menjawab soalan anda. Makanan Permulaan untuk Bayi Bayi sebaik-baiknya harus diberi susu badan secara eksklusif bagi enam bulan pertama.  Apabila bayi membesar, dari umur 6 bulan, bayi perlu diberikan makanan pejal secara beransur-ansur. Proses ini dipanggil ‘weaning’. Ini tidak bermaksud susu hari ini, dan besok terus makanan pejal! Sebaliknya, bayi haruslah diberi peluang untuk menyesuaikan diri perlahan-lahan. Di samping makanan pejal, penyusuan bayi dengan susu badan boleh diteruskan sehingga umur dua tahun atau lebih. Makanan pejal tidak boleh diberikan sebelum umur 6 bulan kerana: Bayi belum dapat mengunyah dan menggigit dengan berkesanMakanan yang paling seimbang dan lengkap adalah susu badan.Meningkatkan risiko alahan makanan dan jangkitan kuman.Usus belum matang dan terdapat risiko kecederaan / usus tersumbat (‘intestinal obstruction‘).Buah pinggang belum cukup matang untuk mengendalikan beban berlebihan dengan makanan pejal.Namun, selepas umur 6 bulan, bayi memerlukan makanan pejal, kerana susu badan sahaja tidak mencukupi untuk keperluan badan. Bayi yang tidak diberi makanan  pejal selepas 6 bulan akan mengalami kekurangan zat makanan, terutamanya zat besi. Ini pula akan menjejaskan pertumbuhan dan perkembangan minda bayi. Bayi perlu membiasakan diri dengan kaedah pemakanan baru apabila diberi makanan pejal. Kaedah-kaedah berikut mungkin membantu: Mula-mula, gunakan sudu untuk memberikan sedikit susu. Apabila bayi telah biasa makan menggunakan sudu, makanan pejal yang lembut boleh diberikan.Mulakan dengan satu atau dua sudu makanan. Selepas beberapa hari, makanan pejal boleh diberikan dua, dan seterusnya tiga kali sehari. Makanan pejal yang sesuai untuk permulaan adalah makanan dengan tesktur yang rata dan rasa yang tawar (‘smooth consistency and flat taste’). Contohnya, kanji, ubi kentang yang dilenyetkan, sayur-sayuran yang tidak berserabut, seperti lobak merah atau lobak putih, atau puri buah-buahan yang lembut, seperti pisang atau epal.Jangan tambahkan makanan pejal ke dalam botol susu.Jangan tambahkan garam atau gula kepada makanan bayi.Makanan pejal boleh dicampurkan dengan sedikit susu badan atau air masak.Mulakan makanan baru satu demi satu supaya dapat mengenalpasti apa-apa alahan makanan.Sekiranya bayi tidak mahu makan sesuatu makanan baru, cuba berikan makanan itu sekali lagi, selepas beberapa hari. Kadangkala bayi akan mengambil makanan tersebut setelah mencuba beberapa kali dan telah membiasakan dirinya dengan rasa baru.Apabila bayi berumur 6 bulan, makanan pejal harus dimulakan dan ditingkatkan perlahan-lahan. Dalam beberapa minggu, makanan dengan rasa, tekstur, warna dan suhu yang berlainan boleh diperkenalkan. Apabila bayi mengambil lebih banyak makanan pejal, pengambilan susu akan berkurangan. Pada tahap ini, bayi perlu diberi sedikit ikan, ayam atau sumber protein lain, untuk menggantikan protein dalam susu. Pastikan tiada tulang dalam makanan bayi. Pada umur 6 hingga 9 bulan, makanan yang lebih berketul (lumpy) boleh dimulakan. Apabila bayi boleh duduk, berikan makanan yang boleh dipegang sendiri, seperti biskut atau buah-buahan yang dipotong kecil seperti tembikai dan pisang. Seboleh-bolehnya, bayi perlu beransur-ansur diberi makanan yang biasa dimakan oleh keluarga, supaya bayi dapat membiasakan diri dengan tekstur dan rasa makanan keluarga. Apabila bayi menghampiri umur satu tahun, bayi boleh makan bersama-sama dengan keluarga. Makanan seperti ayam, ikan, sayur dan nasi boleh diberikan. Makanan boleh dikisar atau dipotong kecil. Elakkan makanan kecil yang keras seperti kacang ‘pea’ yang mungkin boleh tersumbat dalam salur pernafasan bayi. Elakkan makanan yang terlalu pedas, serta garam dan gula berlebihan. Bayi boleh cuba makan sendiri dengan menggunakan sudu. Makanan yang perlu dielakkan pada peringkat awal Jangan berikan madu lebah kepada bayi di bawah umur 1 tahun, kerana madu kadangkala mengandungi kuman, yang boleh menyebabkan penyakit berbahaya dalam bayi (‘infant botulism’).Telur tidak patut diberikan sebelum umur 6 bulan. Selepas itu, bayi boleh diberikan telur yang perlu dimasak penuh, sehingga putih dan kuning telur menjadi keras, untuk mengelakkan jangkitan kuman.Kacang keras tidak boleh diberikan kepada bayi di bawah umur 5 tahun, kerana bahaya tersumbat dalam salur pernafasan. Kacang yang dikisar atau ditumbuk halus boleh diberikan selepas 6 bulan.Makanan rendah-lemak, rendah-kalori dan serat-tinggi  tidak sesuai untuk bayi. Bayi memerlukan tenaga yang tinggi untuk tumbesaran dan memerlukan makanan yang berlemak, dengan kandungan vitamin dan mineral yang mencukupi.Bayi perlu diperhatikan dengan teliti ketika makan, untuk memastikan bayi tidak tercekik. Kita boleh meningkatkan minat bayi dengan membenarkan bayi untuk cuba makan dengan sendiri, menggunakan tangan atau sudu. Sekiranya bayi digalakkan duduk dan makan bersama-sama dengan keluarga, bayi akan cuba meniru ahli keluarga lain, dan mencuba makanan yang dimakan oleh keluarga. Sekiranya bayi tidak mahu makan, kita tidak perlu paksa, tetapi boleh cuba lagi pada masa lain. Pemulaan makanan pejal akan membuka dunia baru untuk bayi, dengan banyak peluang pembelajaran. Jadikanlah masa makan suatu pengalaman yang seronok dan menarik untuk bayi anda!  baby led weaning ( BLW) is gaining popularity with most parents compared to the traditional “spoon feeding” . The whole concept  of baby led weaning centers around the research by Gill Rapley the ex-Deputy Programme Director of UNICEF UK Baby Friendly Initiative but just as yourself, Haliza, there are still questions asked with regards to baby led weaning. In the medical standpoint there are many reasons why baby led weaning (BLW) is becoming more popular however there are still some concerns with regards to BLW. Pros of BLW 1.     BLW Enhances Development Readiness of babies for solid foods coincides with their developing abilities to take food to their mouths and begin to chew. If they have the opportunity, many babies will show their parents they are ready simply by helping themselves to food from someone’s plate. Allowing the babies to follow their instincts plays an important part of their development. BLW infants have lots of practice exploring different shapes and textures in food, learning how to grip them and get them to their mouth. This improves both hand –eye coordination and dexterity. ( Study on BLW led by Professor Charlotte M Wright, Professor of Community Child Health from University of Glasgow which has shown the following1       Infants who had reached out for food at six months were more likely to be walking unaided at one year than those who had not.2       They were also more likely to be speaking meaningfully at one year. For example children who reached out for finger foods between four and five months were speaking, compared with those who reached out at seven to eight months. ) 2. BLW enhances digestion BLW experience a range of textures from the start, allowing chewing skills to develop naturally. This helps speech development and reduce the need for orthodontic treatment later.  Food that requires chewing spends longer time being mixed with saliva in the mouth hence BLW may promote enhanced digestion. However this issue is still debatable as there are some who disagree as there infants have immature gut with immature digestive systems. 3      BLW reduces incidence of obesity in childhood When an infant starts weaning on solid foods traditionally he will be spoon fed pureed food, one taste at a time, in a schedule decided by his parents. This causes mealtime battles and many children end up with a diet which is essentially soft processed foods giving rise to childhood obesity. By allowing your child to explore healthy foods in his own time allows gradual transition and your baby sets the pace for progress with solid foods and decides how quickly he cuts down his milk feeds.  Your baby is allowed to eat according to their appetite. They can stop eating when they are no longer hungry and are not encouraged to eat more quickly than they want to, or  forced to have ‘one more spoonful’ /’make a clean plate’. Many non-BLW babies have their natural appetite recognition overridden and are encouraged to eat more than they need from the earliest age. Research suggests lower BMI in children age 2-6 years who have done BLW. Cons of BLW 1.     Concerns of choking or gagging Literatures published about BLW suggests that associated choking is actually LESS compared with traditional spoon feeding. The gag reflex prevents food being pushed too far back without having been chewed adequately, and it is particularly sensitive between six and eight months. Although gagging is alarming to parents, babies are rarely bothered by it, and it may be that it is an important part of helping them to learn not to overfill their mouths. A paper published earlier this year by researchers in University of Otago  revealed that there were incidences of choking however all the incidents were dealt by the infant independently by expelling the foor from their mouth through coughing and parents did not intervene with first aid.  However it is a good idea to be prepared on how to deal with a choking incident. 2.     Nutritional problems Parents maybe concerned that their infant will not eat as much as he actually needs. You maybe reassured to discover that babies are actually very good at deciding just how much food their bodies require. Energy needs maybe insufficient if food is predominantly fruit and vegetable based. There are concerns about intake of nutrients  such as iron which is given in fortified infant cereal  and pureed meat which may not be given to BLW.  To date no research has examined the food and nutrition intake of children following BLW. There is a need for good quality research before firm guidelines and recommendations can be made. There are many trials still ongoing with regards to BLW. 3.     Food intolerance/ allergy and digestive problems If you are starting baby led weaning it has been suggested the 4 day rule – that is if you try new food introduce them separately at least 4 days apart.  This will help you spot any sigh of digestive discomfort or allergic reaction. 4.     BLW not feasible for infants with delayed motor skills and premature babies BLW may not be appropriate for children with delayed motor skills or oral motor function who would need to wait before they could self feed effectively. BLW may not be suitable for babies with specific dietry needs  such as infants with reflux, low birth weight or premature babies. Haliza, I hope that I was able to answer your question and the choice to either follow the conventional feeding or “ baby led feeding” should be a informed choice.  The topic is still debatable with no clear guidelines however there are many clinical trials which are still ongoing to help answer many of the parental concerns. Professor Wright at the end of her study suggested that baby led weaning maybe feasible for most infants, it is more realistic to encourage infants to self-feed with solid finger food during family meals but also give them spoon fed purees.