CLINICAL STUDY ON ASSESSMENT OF GROWTH AND …

CLINICAL STUDY ON ASSESSMENT OF GROWTH AND DEVELOPMENT IN

INFANTS WITH SHASHTIKASHALYADI CHURNA AS WEANING FOOD

By

Sharvari S Deshpande

Dissertation Submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka

Bangalore

In partial fulfillment of the requirements for the degree of

AYURVEDA VACHASPATI

M.D. (Ay.)

In

KAUMARABHRITYA

Under the guidance of

Dr. SHAILAJA U

M.D. (Ay.) Ph.D.

Professor

Department of Kaumarabhritya

DEPARTMENT OF POST GRADUATE STUDIES IN KAUMARABHRITYA

S.D.M. COLLEGE OF AYURVEDA AND HOSPITAL

HASSAN- 573201

2014

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled “Clinical study on assessment

of Growth and Development in infants with Shashtikashalyadi Churna as

weaning food ” is a bonafide and genuine research work carried out by me under

the guidance of Dr. Shailaja U, Professor & H.O.D., Department of P G Studies in

Kaumarabhritya, S. D. M. College of Ayurveda and Hospital, Hassan – 573 201.

Date: Signature of the Candidate

Place: Hassan SHARVARI S DESHPANDE.

DEPARTMENT OF POST GRADUATE STUDIES IN KAUMARABHRITYA

SHRI DHARMASTHALA MANJUNATHESHWARA

COLLEGE OF AYURVEDA & HOSPITAL, HASSAN – 573 201

(Affiliated to RGUHS, Karnataka, Bangalore)

Certificate

This is to certify that the dissertation entitled “Clinical study on

assessment of Growth and Development in infants with Shashtikashalyadi Churna as

a weaning food” is the record of research work conducted by Sharvari S Deshpande

under my direct supervision and guidance as a partial fulfilment for the award of the

degree of Ayurveda Vachaspati in Kaumarabhritya.

The candidate has fulfilled all the requirement of ordinances laid down in

the prospectus of Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore,

for the award of Degree of Ayurveda Vachaspati in Kaumarabhritya.

I am fully satisfied with her work and recommend this thesis to be

submitted for adjudication.

Date: Guide:

Dr. Shailaja U M.D. (Ay.), Ph.D

Place: Hassan Professor and H.O.D

Dept. of PG Studies in Kaumarabhritya

S D M College of Ayurveda & Hospital

Hassan 573 201

DEPARTMENT OF POST GRADUATE STUDIES IN

KAUMARABHRITYA

SDM COLLEGE OF AYURVEDA & HOSPITAL,

HASSAN – 573 201

(Affiliated to RGUHS, Karnataka, Bangalore)

ENDORSEMENT BY THE H O D &

PRINCIPAL / HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “Clinical study on assessment of

Growth and Development in infants with Shashtikashalyadi Churna as weaning

food” is a bonafide research work done by Sharvari S Deshpande under the

guidance of Dr. Shailaja U, Professor & HOD, Department of Post Graduate

Studies in Kaumarabhritya, S.D.M. College of Ayurveda and Hospital, Hassan -

573201.

Dr. Shailaja U Dr. Prasanna N. Rao

Professor & Head Principal

Dept. of PG Studies in Kaumarabhritya S D M College of Ayurveda

S D M College of Ayurveda & Hospital & Hospital.

Hassan. Hassan.

Date:

Place: Hassan

COPYRIGHT

I hereby declare that the Rajiv Gandhi University of Health

Sciences, Karnataka shall have the rights to preserve, use and disseminate this

dissertation / thesis in print or electronic format for academic / research

purpose.

Date: Signature of the Candidate

Place: Hassan. SHARVARI S DESHPANDE

© Rajiv Gandhi University of Health Sciences, Karnataka

Acknowledgement

This work is the combined effort of a good number of people, who include Researchers, Academicians, Friends, Colleagues, Parents, Laymen & above all the innocent infants who co-operated with us in all aspects. There is much greatness of mind in acknowledging a good turn as in doing it. First of all I bow my head to the feet of Lord Ganesha, Lord shiva & Lord Manjunatha for showering their blessings & empowering me to this eventful outcome without any impediments. It is because of God’s grace only the work could be completed as per my expectations. It is an inexplicable to offer my sincere & respectful regards to the persons whom I admire the most, my beloved Guruji- Sri Sri Ravishankar Guruji, with who’s Grace and Blessings am I here, blessings of my Mom-(Aai) Mrs. Sushama Sunil Deshpande. Dad-(Baba) Mr. Sunil Ganesh Deshpande & my Dearest grandparents for their untiring & indomitable support & out lasting affection be showed on me. I pay my respectful salutation to his holiness Pujya Shri. Virendra Heggadeji, founder of this institution for his blessings, which made me complete my thesis without hurdles. The inspiring work throughout this thesis work was Prof. Dr. Shailaja U., H.O.D. & Prof. Dept. of P.G. Studies in Kaumarabhritya, SDMCA&H, Hassan. The person who has devoted her life for the upliftment of this ancient system of Medicine, a person whose love & care like a Mother, who become a source of light whenever I was in darkness, who provided necessary fuel for my innovative thoughts. I am deeply indebted for her guidance broad mindedness & affection towards me. It gives me immense pleasure & proudness to offer profound gratitude to my beloved Principal Prof. Parasanna N. Rao for all his love guidance & co-operation in this work as well as throughout. I owe my humble gratitude & regard to Dr. Reena kulkarni. Ass0ciate. Prof. Dept. of Kaumarabhritya for evincing keen interest in my endeavors & for continued encouragement & valuable suggestions. I will be very thankful to her for kindest support. I am very much thankful to Dr. Sudhakar Powar, Prof, Dept. of K.B. Dr. Nithin, Associate. Prof Dept. of K.B., Dr. Vijaylakshmi Asst. Prof Dept. of K.B. And Dr. Nayan Kumar, Asst. Prof of Dept. of K.B. for their kind support during my thesis work. I am very much indebted to my mentor, esteemed & respected Dr. Sudheer for generating my keen interest in Kaumarabhritya.

Acknowledgement

I can’t forget guidance of Dr. Gurdip Singh, Dr. Girish K.J & Dr. Govind Sharma which gave me confidence to get along my work. I express my gratitude & cordial thanks to my close friends Dr.Arya, Dr. Nabisab, Dr. Vishvender, Dr. Chitrangana Chauhan, Dr. Archana Singh, Dr. Sreelakshmi, Dr. Mithuparvathy, Dr. Madhulika& who have helped me in shaping my thesis. I can’t forget my beloved seniors Dr. Sharashchandra R, Dr.Hrishikesh Tikole, Dr. Radha Jindal, Dr.Amal Babu, Dr. Ambika, Dr. Shital,. And my beloved Juniors Dr.Anand, Dr.Madhumita, Dr. Virupax Dr.Amrut Dr.Harikrishna, Dr.Nivya Dr.Shivanand, Dr.Dharmendra, Dr.Anjana, Dr. Shraddha,Dr. Deepthi ,Dr. Jitesh for their kind support. I am grateful to my colleagues & friends Dr.Shivjyothi, Dr.Sumeet for helping out with calculations and understanding result in SPSS. I also thank my other friends Dr. Arun Raj, Dr.Prashant. I am thankful to our librarian & Digital Library in-charge for their great co-operation also our Dept. attender Bhagyamma akka. I wish to thank physicians & all the staff of the hospital, the innocent infants & their parents for the kind co-operation whose total support made me to complete this work successfully. Last but not the least I extend my thanks to all those who have been directly or indirectly associated with study at various levels but not mentioned in this thesis.

Dr. Sharvari S Deshpande

Date: Place: Hassan

LIST OF ABBREVIATIONS

A.H - Astanga Hridaya

AT - After Treatment

A.S - Astanga Sangraha

B.P - Bhavaprakasa

B.S - Bhela Samhita

BT - Before Treatment

Cal. - Calories

Ch - Charaka Samhita

Chi - Chikitsa Sthana

gm. - Grams

Kcal - Kilo Calorie

Kg. - Kilogram

K.S - Kashyapa Samhita

Khi - Khila Sthana

mcg - microgram

Ni - Nidana

RDA - Recommended dietary Allowance

SD - Standard Deviation

SE - Standard Error

Sha - Shareera Sthana

Shar. - Sharangadhara Samhita

Sl.No. - Serial Number

Su - Sushruta Samhita

Su - Sutra Sthana

Ut - Uttara Sthana

Symbols Used

< - Less than

> - Greater than

% - Percentage

df - Degree of freedom

P - Probability

T - Test of Significance

ABSTRACT

Background -

Under nutrition and problems associated with complementary feeding are of great

concern in the field of paediatrics. It has been estimated that in India, 65 per cent i.e.,

nearly 80 million children under five years of age suffer from varying degrees of

malnutrition. Most of the children fall into the Malnutrition during the weaning and post-

weaning phase. Some even succumb to it. Mothers are expected to make a bridge of

complementary feeding. Some mother’s do not make a Bridge at all and some make a

bridge that may collapse into the pit. So, a ‘Safety Net’ is needed beneath the Bridge.

This includes utilization of ‘Supplementary Feeding Programmes’. The trial was

proposed to study the efficacy of Shashtikashalyadi Churna during complementary

feeding by using specific parameters for growth and development.

OBJECTIVE OF THE STUDY:

To assess the effect of Shashtikashalyadi Churna as weaning food on growth and

development of infants.

MATERIAL AND METHODS:

Infants were selected from OPD of S.D.M. College of Ayurveda and Hospital, HASSAN.

Apparently healthy infants of weaning period were selected. Study & control group each

containing 20 infants were included in the study.

Study group: Shashtikashalyadi churna was given 2 tsp. 2 times a day.

By mixing with water boiling it for 20 min. till to form semi-solid consistency added with

cow‘s ghee and 1 tsp. of sugar to make it energy dense. Along with this, breast milk

breast feeding was advised to be continued.

Control group: along with breast milk, home-made mashed food was advised.

Infants were assessed from age of 6months till the age of 9 months in various aspects of

Growth & Development.

Results –

Infants showed improvement in all aspects of Growth. Weight gain in treated group was

27 % (22% - Control Group), Height gain was 5.10 % (6.76 % - Control Group), and gain

Chest circumference was5.52 % (5.5% - Control Group). There was statistically

significant improvement in reduction of Attack of Disease and Sleep pattern.

Conclusion: Nutritional supplement Shashtikashalyadi churna containing was found

effective in accelerating Growth & Development during weaning period & it helped in

preventing Growth faltering.

Key Words: (Shashtikashalyadi churna, Growth & Development, Safety Net, weaning)

INDEX

SL. NO: CONTENTS PAGE NO:

1. INTRODUCTION 1-4

2 AIMS & OBJECTIVES 5-6

3 LITERARY REVIEW 1-69

I. WEANING 8-24

II. SAMVARDHANA 25-33

III. GROWTH & DEVELOPMENT 34-59

IV. EVALUATION OF DRUG FORMULATION 60-69

4 CLINICAL STUDY

I. MATERIALS & METHODS 70-73

II. OBSERVATIONS 74-86

III. RESULTS 86-95

5 DISCUSSION 96-112

6. SUMMARY 113-114

7. CONCLUSION 115-116

8. BIBLIOGRAPHIC REFERENCES 117-121

8. ANNEXURES I-VII

LIST OF TABLES

S.NO TABLES P.NO

1 Various food Articles mentioned in Ayurvedic

Samhitas which can be used as weaning/supplementary

food

13

2 Showing Carbohydrate contents of various foods 48

3 Comparing chemical scores & NPU 53

4 Protein values of different food articles 52

5 Balanced Diet for Infant – ICMR 55

6 Recommended Dietary Allowance for Infant 56

7 Assessment of development

Gross motor

79

8 Fine motor 82

9 Social / cognitive milestone 84

10 Language milestone 85

11 Paired ‘t’ test in Study group 90

12 Paired ‘t’ test in Control group 91

13 Un- paired ‘t’ test in both groups 92

14 Effect of weaning food on in control group 93

15 Effect of weaning food on in study group 94

16 Mann Whitney U Test between the GROUPS 95

LIST OF GRAPHS

S.NO GRAPHS P.NO

1 GENDER WISE DISTRIBUTION 74

2 RELIGION WISE DISTRIBUTION 74

3 BIRTH ORDERWISE 75

4 MONTHWISE DISTRIBUTION 75

5 VACCINATION 76

6 ANTE NATAL HISTORY 76

7 MODE OF DELIVERY 77

8 SMILES AT MIRROR IMAGE 77

9 FAMILYWISE DISTRIBUTION 77

10 NATURE OF FOOD 78

11 BREAST FEEDING AFTER DELIVERY 78

12 NECK HOLDING 80

13 ROLL OVER 80

14 SITTING WITH SUPPORT 81

15 SITTING WITHOUT SUPPORT 81

16 CRAWLING ON BELLY 82

17 TRANSFERES OBJECT HAND TO HAND 83

18 PINCER GRASP 83


20 BABBLES 85

21 IMITATES SOUND 86

22 STUDY GROUP WEIGHT 86

23 STUDY GROUP HEIGHT 86

24 STUDY GROUP HC 87

25 STUDY GROUP CC 87

26 STUDY GROUP MAC 87

27 CONTROL GROUP WEIGHT 87

28 CONTROL GROUP HEIGHT 88

29 CONTROL GROUP HC 88

30 CONTROL GROUP CC 88

31 CONTROL GROUP MAC 88

32 UN PAIRED T TEST BETWEEN THE GROUPS 89

INTRODUCTION

Clinical Assessment of Growth and Development in Infants with Shashtikashalyadi

Churna as weaning food. Page 1

INTRODUCTION

INTRODUCTION



INTRODUCTION

The dimensions of health are always changing. In the present era, health is

considered “not mainly an issue of doctors, social services, and hospitals. It is an

issue of social justice”. World Health Organization broadly defines health as “a state

of complete physical, mental, and social well being, not merely an absence of disease

or infirmity”. The above concept of health envisages several spiritual, emotional,

vocational, and political dimensions. Presently exploring medical requirements are,

most of the time incapable to fulfill these views. Therefore, Ayurveda, popularly

known as the Indian system of medicine, which is considering the living systems in its

physical, mental, and spiritual levels, gains high acceptance in the western scientific

world. The medical system is giving equal importance to preventive, curative, and

prophylactic aspects of medicine, there by maintaining the sensitive homeostasis of

the body, which is the foundation of happy and wholesome existence of every living

being.

Kaumarabhritya, is the branch of Ayurveda which elaborates pediatrics and

even more. It covers all aspects from genetics to dietetics in children. It gives a

complete guidance for reproductive child health care, infant and young child feeding

practices and adolescent care. The science had a very precise way to make out the

health and ill health of the child and the proper growth and development. It also has

immunization methods based on its principles.

INTRODUCTION



a. Need and significance of the study

Good health depends on an adequate food supply, which in turn depends on a

sound agricultural policy, a good food distribution system and proper health

education. A healthy younger generation with duly developed body, mind and brain is

the bedrock for a good future. Every child in every part of the world has the potential

to grow and develop as long as his and her basic needs are met. Adequate supply of

essential nutrients required as per age is the most important factor for the proper

growth and development.

Infant and young child feeding is the subject of great concern in the field of

nutrition since malnutrition in early childhood has serious, long-term consequences

because it I impedes motor, sensory, cognitive, social and emotional development.

Malnourished children are less likely to perform well in school and more likely to

grow into malnourished adults, at greater risk of disease and early death. One in three

of the world's malnourished children live in India. Where, around 46 per cent of all

children below the age of three are too small for their age, 47 per cent are

underweight and at least 16 per cent are wasted.

WHO Global Strategy for Infant and Young Child Feeding, advocates

exclusive breastfeeding for the first six month with the introduction of local and high

nutrient complementary foods after six months while continuing breastfeeding to two

years and beyond. After six months of age a child needs high-energy and high nutrient

foods that are rich in vitamin A, vitamin C, iron and other important minerals, in

addition to breast milk. Children are more physically active and they continue to grow

rapidly during the second half of first year.

INTRODUCTION



The introduction of complementary foods is a time of transition when children

gradually becomes used to eating semi solid and solid foods. The nutritional role of

mother‟s milk in the second year is inversely related to the adequacy of the

complementary diet. Improper nutrition during weaning and post weaning period is

the root cause of malnutrition in children. This is a period of great dilemma, stress and

humiliation to the child and is associated with many disorders like constipation,

diarrhea, colic etc. This physical and mental turmoil along with the need for a highly

nutritious diet points out the importance of an ideal weaning food. The present study

aims to find the solution for this grave problem.

b. Aim and objectives of the study

The study intends to find the efficacy of the formulation Shashtikashalyadi

churna in the growth and development of infants during complementary feeding. The

study aims not only to the efficacy of the formulation; as a broad objective, the ideal

time for its administration is also considered. Nationally accepted international

parameters are used for the assessment. These standards depict normal growth under

optimal environmental conditions and can be used to assess children everywhere,

regardless of ethnicity, socio-economic status and type of feeding

INTRODUCTION



c. Contents of the thesis

Title of the thesis is „CLINICAL ASSESSMENT OF GROWTH AND

DEVELOPMENT IN CHILDREN IN INFANTS WITH SHASHTIKSHALYADI

CHURNA AS A WEANING FOOD.’

The thesis consists of the following parts.

I. Introduction

II. Literature review

III. Methodology of research

IV. Observation, analysis and interpretation

V. Discussion, summary and conclusion

AIMS AND OBJECTIVES OF THE STUDY

Clinical Study on Assessment Of Growth and Development in Infants with Shashtikashalyadi Churna as Weaning food. Page 6

Aims & Objectives of the study

The principles of treatment described in Ayurvedic medicine, can be broadly

classified into two types. First is the Oorjaskara line of treatment, which aims at

increasing the body growth & strength & help in preventing the diseases (Tonics).

Second line of treatment is mainly concerned with the treatment of diseases

(Rogaghna).

Oorjaskara line of treatment is of two types Rasayana & Vajikarana. Rasayana

treatment is that line of treatment, which helps to decelerate the aging process & to

increase the general well being & resistance power of the body. Vajikarana (Vrishya)

treatment mainly aims at increasing the Shukra dhatu in the body, which ultimately

helps in the body growth & development in the children, and in men helps for

increasing sexual act and satisfaction (libido).

The development of human body from a single fertilized egg to a trillion of

cells involves cell growth, cell replication & cell differentiation. The Shukra Dhatu

can be attributed to cell reproduction, thereby effecting the growth & development

during the intrauterine life as well as during the extrauterine life until the maturity is

attained. Hence this may be the reason that the Madhura, Snigdha, Jeevaniya &

Brumhana Dravyas are indicated during the antenatal care, for the optimum growth &

development of the fetus.

The Shukra Dhatu is present in children also, in smaller quantity & this Shukra

Dhatu is increased with the passage of time and becomes distinct similar to the

fragrance perceived in a fully bloomed flower. The function of Shukra Dhatu appears

to be mainly the Garbhotpadana (reproduction), whether of the cell or of the organism

as a whole. (Dr. C H S Sastry).



Considering all these facts the described Shashtikashalyadi Churna as weaning

food told by Kashyapacharya as the food of supplemental value with all these

properties was selected for the study.

The study was undertaken with the objective-

To accelerate the Growth & Development of infant during weaning period

LITERARY REVIEW

Clinical Study on Assessment of Growth and Development in Infants with Shashtikashalyadi Churna as Weaning food. Page 8

Chapter 1

Weaning

Importance of Food –

“Deho Ahara Sambhavah” (Caraka)

Body is derived from Food. All living beings are formed from food. They sustain and

grow on food. The food is indispensable for living creatures.

Definition of Food-

Food is defined as essential substance having a pleasant aroma & taste which is

capable of being digested, absorbed & utilized when consumed in proper manner & in

appropriate quantity so as to help living organism to replenish the wear & tear of body

tissues, produces new body components & that which imparts energy, strength &

happiness.

Properties of Food –

Food provides life, building material for the body, strength, enthusiasm, a sense of

satiety, color, luster, memory, intellect inspiration and helps in conception and

propagation of the species. Food provides energy to carry out life activities which can

lead one to heaven or help one to attain „Moksha‟. Health and happiness depend on

food. A beneficial diet gives happiness, health and prolongs one‟s lifespan. A harmful

diet promotes disease and makes one depressed.

Importance of beneficial Diet1 –

Even if the patient does not take medication, the disease can be cured by taking a

beneficial diet and avoiding a harmful diet. If the patient does not follow the diet

advised by the physician, medication alone will not cure him.

LITERARY REVIEW


Anna-Prashana Sanskar –

There are scattered references available in literature regarding when to start the solid

foods in infant.

Grhya Sutras2 –

1. Paraskara Grhya Sutra – In Paraskara grhya Sutra, a simple principle has been

followed that food of all kinds of flavors should be mixed together and given to the

child.

2. Samkhyayana Grhya Sutra3 – Weaning food has it‟s effect on the child. (Shown

in Table No.)

3. Aapstambha Grhya Sutra, Aasvalaayana Grhya Sutra, Hiranyakeshiya Grhya

Sutra – Most of the Grhya Sutra have advocated the use of various birds and other

food articles for weaninig4.

Manusmrti5–

According to „Manusmrti‟ Anna-prashana should be started somewhat around sixth or

eighth month. Otherwise this samskara should be done in accordance with the family

custom (Kulachar).

Caraka Samhita -

There are no references available in Caraka Samhita regarding Anna-prashana.

Sushruta Samhita -

Acharya Sushruta also advises to start weaning after six month of age6. He advises to

offer Laghu (Easily Digestible) and Hitakara (Beneficial) Diet to child after six

months of age. He further explains the use of Yastimadhu, Vacha, Pippali, Chitraka

and Triphala siddha Ghrita in children which consume Kshira and Anna (Kshirannad

Avastha). This Ghrita increases Aarogya, Bala, Medha and Aayu7. While mentioning

LITERARY REVIEW


what food can be given in absence of Mother‟s Milk he explains the use of Goat‟s

Milk or Cow‟s Milk as Milk is considered Satmaya to Bala8.

Astanga Samgraha and Astanga Hridaya-

Astanga Smgrahakara also agrees with the opinion of the Sushruta and they also

advise that „During the sixth month, solid food should be given to the child gradually,

as much as it desires (without forcing it) and as it goes on discontinuing Breast Milk9.

In one other quotation he explains that with eruption of the teeth, the child should be

gradually weaned from the Breast; other kinds of milk (mentioned earlier, i.e. Goat‟s

or Cow‟s milk) and boiled rice and such foods which are easily digestible (Laghu) and

Nourishing (Brihmana) should be given10

.

Vagbhatacharya further explaining „Stanyabhave Upayaha‟10

says that „In the non-

availability of Breast milk, Milk of either a goat, or a cow having similar properties

can be given to drink, boiled along with the roots of Brihati, etc. (Laghu-Panchamoola

drugs) or the two sthira (Shaliparni, Prishniparni), Brihati etc.

He further explains few methods for weaning the child of the Breast „Stanyapanayana

Upayah11

as- Weaning from the Breast can be done by smearing it with oil, by making

it look ugly, making red colored marks on it resembling ulcers and showing them to

the child etc.

Vagbhatacharya‟s most important contribution while explaining weaning is use of

„Modakas‟12

which can be taken as the food of supplemental value.

He advises that in case of greater hunger in the child weaned of the Breast, he should

be treated as treating (the disease) Atyagni or as a case of Parigarbhika13

LITERARY REVIEW


Kashyapa Samhita14

-

Kashyapa Acharya advices that the physician should prescribe feeding (juice) of

various fruits in the same month (6th

month). Afterwards definitely after eruption of

teeth or in tenth month, the feeding of cereals (Anna-prashana) should be done.

Kashyapacharya opines that „Phala-prashan Samskara‟ should be performed

along with „Upaveshana Samskar‟ in the sixth month. On an auspicious day, after

worshiping gods and satisfying the Brahmans by diets and donations; the physician

having recitation of auspicious words, making rounded or square shaped altar with the

help of cow-dung and water, in clean place of the center of the house or

apartment/garden measuring four hasta (about 72 inches). A holy Fire is Lit & the

offerings are made to fire God with different Vyanjanas stating “As nectar is fior

gods, the sudha (wine) for king elephant, so are the cereals for life of living beings,

anna (cereal) is called prajapati. As the Trivarga (religion, wealth and desire) and

universe is born, so is the cereals. That is why the fire I perform oblation in you of

this cereal giving pleasure. Prajapati supports it Svaha.”

Kashyapacharya states that while holding the child, the leftover (food) after

oblation, in the quantity equal to thumb (small quantity), after making it soft by

mashing be given in his (infants) mouth. Three or five times; after feeding, should

touch him (clean with water); afterwards raising (increasing the quantity) twelfth

month onwards after desired for food, following should be given in small quantity.

Selection of Diet for the children – The diet consumed by the pregnant woman

become wholesome to the child, therefore only those articles should be offered to that

child. Place, time and digestive capacity should not be transgressed.

LITERARY REVIEW


Lehyas -

Kashyapacharya in Lehana adhyaya explains few lehyas, which we can use as

supplemental food for the child.

The children of mothers having no Breast- Milk, deficient Breast-Milk, or

vitiated milk, of parturient woman(mother) or of a wet nurse of similar conditions, (or

of the woman) having undergone difficult labor or severely ill; the children who have

predominance of Vata and Pitta, (but) not of Kapha, who do not get satisfied with

Breast milk and cry in spite of repeatedly sucking; the children who do not sleep in

the night, eat too much, pass scanty urine and feces, children who have increased

digestive power, though free from disease yet scraggy, have delicate body-parts and

are emaciated, do not pass urine and feces even for three days; such type of children

should be prescribed electuaries as said by Kashyapa.

Shrangdhara Samhita -

Sharangdhara Samhita also explains the same thing. That is - in „Stanyabhava‟15

one

should consider that Milk is Satmya to the child and child should be given either

goat‟s milk or cow‟s milk in the quantity that satisfies the child (child‟s hunger). And

regarding the period of introduction of solid food he opines that child should be given

solid food (Anna-prashana) in sixth or eighth month according to the Shastrokta

method16

. Child should be offered very small quantity of solid food initially and the

quantity should be increased gradually.

Indu (Astanga Samgraha Tika) 17

-

One should start Anna-prashan to the child in sixth month. Food should be given

gradually to the child. The very purpose of increasing the quantity of the food

gradually is that, as child accepts more and more solid food one misses the Breast

feeds in the same proportion.

LITERARY REVIEW


Bhavaprakash Nighantu18

–

Bhavaprakash advises to give child the food for the first time in sixth or eighth month.

And one should increase the quantity of food gradually according to the

avasthavriddhi.

Table No. 1 - Various food Articles mentioned in Ayurvedic Samhitas which can

be used as weaning/supplementary food –

S.No Samhita/ Grantha Food Article Effect on child

1. Samkhyayana

Grihya Sutra

Flesh of bird Bharadwaj Fluency of speech

Flesh of bird Kapinjal and Ghrita Proper nourishment

Flesh of bird Krkasa or rice mixed

with honey

Long life

Flesh of bird Ati Holy – lustre

Rice mixed with Ghrita

Curd and Rice

Brilliance

2. Paraskara Grhya

Sutra

all kinds of flavors should be mixed

together and given to the child

-

3. Aapastambha

Grhya Sutra,

Aasvalaayana

Grhya Sutra,

Hiranyakeshiya

GrhyaSutra

Most of the Grhya Sutra have

advocated the use of various birds

and other food articles

-

4. Manusmrti In accordance with the family custom

(Kulachar).

-

5. Caraka Samhita no references available -

6. Sushruta Samhita

Laghu (Easily Digestible) and

Hitakara (Beneficial) Diet

-

Yastimadhu, Vacha, Pippali, Chitraka

and Triphala siddha Ghrita in

Kshirannad Avastha

-

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7. Astanga

Samgraha and

Astanga Hridaya

Modaka (Sweet ball) made from

marrow of Priyala, Madhuka

(Yastimadhu), Madhu (Honey), Laja

and Sitopala

-

Modaka made from Dhataki Pushpa,

Sharkara and Laja tarpana

Is water absorbent

(Samgrahi,

constipating)

Modaka prepared with Bala, (tender)

Bilva, Ela, Sharkara and Laja Saktu

(flour of Laja)

carminative

8. Kashyapa

Samhita19

cooked liquid made with husk-free

well washed Sali or Sasti rice

especially old rice, mixed with

oleaginous substances and salt

Is promoter of

nourishment of the

child.

The powders (flour) of wheat and

barley can also be given according to

congeniality

Is promoter of

nourishment of the

child.

Hot electuary cooked with vidanga,

salt, oleaginous substances

is beneficial


salt, oleaginous substances + kodrava

Is beneficial to the

one having diarrhea

mrdvika with honey and ghrita Beneficial for one

having

predominance of

Pitta in constitution

diet with good quantity of juice of

matulunga and salt

Is beneficial in

predominance of

Vata in constitution.

In general one knowing place (of

living), fire (digestive/ Metabolic

fire), strength and period, whenever

observes (the child) as hungry, should

give him the food according to

congeniality with the gap of one or

two (periods)

-

Various Lehyas are described which

can be given in absence of breast

milk.

-

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9. Bhavaprakash,

Indu,

Sharangadhara

Have not mentioned anything specific

Various Indian Cultural Practices of Annaprashana Sanskara20

–

Karntaka – Traditionally the „Paramanna‟ containing Boiled rice, Sugar, milk

& Honey is placed in the infant‟s mouth

“Padracha Khava, pann Nazaracha khau naye” goes the Maharastrian

saying. It means „that you are welcome to have a ceremony and feed the baby what

you will, but do not make it to ostentatious that you invite the evil eye!

In the Maharashtra it‟s a small family affair in the seventh month, and the

mother‟s brother is the one who does the „Annaprashana‟ or the „Ushtavan‟ (as

they call it). On that day mother‟s parent and brother arrive with the gifts of silver

Katori and spoon, and a gold ring. He dips the gold ring in the prepared Kheer and

places a tiny bit in the baby‟s mouth.

While Gujarati adopt a more practical aspect and start weaning early, say in the third

month, with kheer and puri

Parsis give sweet Dahi with yellow lentil & rice called dhun dhar as first solid food.

Keralites have a ceremony called “Chor-oonnu”. Where after consulting Panchangam

for an auspicious day, parents take child to temple for blessings & morsel of Ghee rice

which is first offered to God is given. Followed by sweet milk & rice Payasam.

For Punjabi & Sikhs it is a quiet little ritual, take child to Gurudwara and priest chants

ardaas & offer Khadah Prasad (Delicious Halwa made from wheat, Ghee & Sugar)

Perhaps the most common ceremonial „Annaprashana‟ is the Bengali one. Baby

dressed as Bride or Bride Groom and seated in Mother's lap. After pooja mother dips

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a golden ring in „Payesh‟ & allows the baby to suck on it. Some may offer tiny bit of

boiled fish, shukto & sweetened doi( Dadhi)

Weaning

Weaning is the second step for self existence. The first step is cutting of the

umbilical cord

Breast feeding and weaning practices are two most important dietary habits

that determine child health as well as morbidity and mortality.

What is Weaning?

Even though the 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. And also it is essential to prevent growth faltering.

Weaning means to „accustom to‟ or „to free from a habit‟. It is the process to

accustom the baby to semisolids and solids in order to gradually free the baby from

the habit of sucking at the Breast. Weaning is defined as “The systematic process of

introduction of suitable food at the right time in addition to Mother‟s milk in order to

provide needed nutrients to the baby.” (UNICEF, 1984).

The term „Complementary feeding‟ is now preferred because weaning implies

abrupt stoppage of Breast feeding, at least to some mothers.

The process begins when the child is first offered food other than Breast-Milk

or formula. The process may be very gradual, with other foods forming an increasing

proportion of total energy intake over several months until Breast or formula is

eventually phased out completely. During Weaning, there is ideally gradual transition

from very high –fat, high-sugar diet, liquid diet to a starchy, moderate-fat, low-sugar

and fibre containing, solid diet. The magnitude of compositional and textural changes

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involved would seem to indicate the advisability of a gradual transition to allow

babies to adapt to them.

Time of Weaning or complementary feeding -

By five months of age, birth weight doubles and the nutritional demands

gradually increase and the calcium and iron stores get depleted. Baby needs around

600-700 cal/day, and around 600ml. of Breast milk can supply only 400 cal. And also,

the breast Milk supply increases till 6 months and then it plateaus off. By four months

of age, the baby achieves head control and develops hand to mouth co-ordination and

starts enjoying mouthing. Intestinal Amylase matures and the gut becomes ready to

accept Cereals and Pulses (Legumes). Gum hardens prior to teeth eruption and the

baby enjoys gumming semisolids. Thus, baby is „biologically ready‟ to accept semi-

solids by 4-6 months of age. In the report „Present day practice in infant feeding‟

(COMA, 1988), it was concluded that very few infants require solid foods before 3

months of age, but that the majority require them by 6 months of age. It was

recommended in this report that weaning should not begin before 3 months, but that

the infant should be offered a mixed diet by 6 months of age. After about 6 months, it

is thought that Breast milk can no longer supply all of the nutritional needs of the

infant and growth is likely to be impaired if the baby receives only Breast-Milk.

Breast-Milk or formula may continue to make a contribution to total food supply long

after weaning has begun.

The COMA panel considered too early introduction of solid foods undesirable

because:

Some babies do not properly develop ability to bite and chew before 3-4

months

The infants gut is very much vulnerable to infection and allergy

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The early introduction of energy-dense weaning foods may increase

the likelihood of obesity

Continuation of Breast Feeding

Breast milk should continue to be the main food of the baby even when

weaning is started. To minimize interference with normal Breast feeding, it should be

given between two feeds. Breast feeding should continue for as long as feasible,

preferably till two years of age. This is important as the first two years is a period of

rapid brain growth and Breast milk contains factors for brain growth and

development.

It has been suggested that full production of pancreatic amylase does not occur

in human infants until 6-9 months of age. As milk contains no starch but most

weaning foods are starchy, this may be a physiological indicator that relatively late

introduction of starches into the diet is desirable. Introducing starchy solid foods may

produce symptoms similar to those of infectious gastroenteritis because of poor

digestion and absorption due to lack of pancreatic Amylase (COMA, 1988)

Dewey KG et al in a research conducted in Honduras, examined the effects of

introducing complementary foods at 4 months or 6 months of age on maternal and

infant outcomes. They concluded that exclusive breastfeeding until 6 months,

compared to only 4 months, results in increased maternal weight loss, longer duration

of amenorrhea, and earlier achievement of certain motor skills in the infants. In most

populations the advantages of exclusive breastfeeding for the additional 2 months

probably outweigh the disadvantages. In developing countries where concerns about

the mother‟s nutritional state exist, supplements provided to the mother may be the

preferred option over earlier weaning21

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Dewey KG et al in another research concludes that Iron supplements starting

at 2 months are important for small-for-gestational age, exclusively breastfed babies

and may be more effective at maintaining iron status than introducing iron-rich solid

foods at 4 months22

.

A study on Effects of age of introduction of complementary foods on iron

status of breast-fed infants in Honduras was made by Dewey KG et al. Authors

conclude that (assuming plasma ferritin is a good index of iron deficiency) breast-fed

babies weighing more than 3000 gm at birth may not need additional sources of iron

before 6 months. However, those with birth weights less than 2500 gm should receive

iron drops beginning at 2-3 months of age, since starting iron-enriched solids at four

months was not effective in preventing anemia. For breast-fed infants with birth

weights between 2500 and 3000 gm, more research is needed to determine the best

strategy to prevent anemia and promote health23

.

Norris JM et al. & Ziegler AG et al. in two different researches separately

concluded that parents should be encouraged to follow current guidelines and avoid

introducing cereal to infants before four months of age. The advice is especially

important for infants with a family history of type 1 diabetes24,25

.

Researches regarding why to introduce solid food in the Sixth month or why not

before six month -

Pancreatic Digestion -

Klumpp & Neale (1930) studied the enzymes in duodenal contents of infants. They

found that he proteolytic activity was quite high, the lipolytic activity fairly high,

while the amylolytic activity very low in infants 1 to 3 months old. The amylolytic

activity was found to increase steadily after the 5th

month. Due to lack of Amylase

activity young children can not digest starchy food to an appreciable extent.

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Wolman (1946) studied the pH of the Gastric contents over a period of 1 ½ hours

after the ingestion of cow‟s milk in the young infant (1 – 2 month old) as compared

with infants aged 6 to 11 months and young children. The result showed that

a) The pH of the gastric content of the infants aged 1 to 2 months was about 6 &

almost constant, and

b) The pH of the gastric content of the infants aged 6 – 11 months fell from 6 to 4.8

while the pH of the gastric content of the young children fell steadily from 5.6 to 2.5.

These results support the observations of the workers that the secretion of

hydrochloric acid is very low in young infants (1-2 months) & the amount of acid

secreted increases as infant grows.

What Weaning Foods?

In the UK, the first foods for most babies are cereals or commercial weaning foods

rather than home-prepared weaning foods (COMA, 1988) (Foster et al., 1997)

The Priorities for Weaning Foods -

In a recent review, Poskitt (1998) suggested that weaning food should be:

Rich in Energy

Rich in Vitamins and Minerals

Fed frequently

Initially used as a supplement to milk rather than a replacement

Fed in a form that develops the child‟s feeding skills whilst still allowing assistance

Weaning or Complementary Foods –

Mono-cereals is preferred initially followed by multi-cereals & cereal-pulse

combinations. They should be locally available, cheap & acceptable. Cereals like

Ragi, rice, wheat etc. are good weaning foods.

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Cereal – pulse combination is better due to fortification of Amino acids as Cereals

generally lack lysine & pulses lack Methionine.

Tubers, fruits, biscuits & banana powder are also popular weaning foods.

Addition of jaggery will increase Calories & Minerals.

Addition of milk will increase protein &

Oil will increase calorie intake.

Coconut milk can be added instead of cow‟s milk. It is rich in Lauric acid, which

promotes Brain Growth.

One of the main aims of weaning is to raise the energy density of the infant‟s

diet above that for Breast-Milk. The weaning food should have a suitable texture, but

be of high enough energy and nutrient density for the baby to meet its nutritional

needs without having to consume an excessive volume of food. If a very viscous food

is introduced too early in the weaning process, the infant may reject it by spitting it

out. A typical Third World weaning food made up to give a suitable viscosity from a

starchy cereal or root staple, such as cassava or millet flour, might contain only 0.3

kcal/g (1.3 kJ/g). This compares with around 0.7 kcal/g (3 kJ/g) for Breast milk and

perhaps 1.5 kcal/g (6 kJ/g) for a typical UK weaning diet (Church, 1979). At the

lower extreme, the child is incapable of consuming the volumes of food required to

meet its energy needs. This problem may be exacerbated if the child is fed

infrequently, has frequent periods of infection and anorexia, and perhaps by the poor

sensory characteristics of the food itself. In industrialized countries this could be a

problem if parents mistakenly apply the recommendations for low-fat, low-sugar and

high-starch diets in adults too rigorously to infants. Some strict vegetarian weaning

diets in industrialized countries may also be of insufficient energy density because of

their low fat and high starch content. The lower limit for the energy density of

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weaning foods should be 0.7 kcal/g (3kJ/g). Pureed fruit or vegetables are not suitable

for as weaning foods unless they have their energy density enhanced, e.g. by the

addition of a source of fat. Skimmed milk and semi-skimmed milk are not suitable for

very young children.

Weaning foods should be clean and not contaminated with infective agents.

Poverty, poor hygiene and contaminated food precipitate much malnutrition in the

Third World. Even when dietary intakes are judged sufficient to permit normal

Growth, infection and diarrhoea may be indirect causes of dietary deficiency. One

survey reported that 41% of traditional weaning foods and 50% of drinking water

specimens in rural Bangladesh were contaminated with fecal micro-organisms (See

Walker,1990)

In affluent countries, such as UK and USA, other aims are also considered

important for infant feeds. They should be:

Low in salt

Low in added sugar

Perhaps gluten free

High – salt foods expose the immature kidney to a solute load, increase the risk of

hypernatraemic dehydration and may increase the later risk of high blood pressure.

Sugar is regarded as empty calories and is detrimental to the baby‟s new teeth. Over-

consumption of sugar in infancy may also be creating bad preferences for the future.

There is a very strong evidence that fluoride is protective against dental caries. The

UK panel of DRVs suggested a safe fluoride intake for infant of 0.05mg/kg/day

around 50% of the amount likely to cause fluorosis. To achieve this safe intake, most

UK infants would need supplements. Swallowing fluoride tooth-paste is one way that

many young children receive supplemental fluoride.

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Whereas most babies suffer no harm from early exposure to the wheat protein

called Gluten, those sensitive to Gluten and thus at risk of Celiac disease cannot be

identified in advance. The incidence of Celiac disease in children has been falling in

recent years, at the same time as there have been trends towards later introduction of

solid food and towards the use of Gluten-free, rice based weaning cereals.

Family pot feeding –

It is essential to switch over to the usual family food. It can be given thickened

& mashed form from the family pot without adding hot spices. Provide little extra oil

or ghee, green leafy vegetables & seasonal foods to the baby. The infant should grow

up, accustomed to the traditional foods. Idli, Dosai, Soups, Payasam etc. are very

good foods for the babies. A new food should be introduced in the morning session &

only one item should be introduced at a time.

Around six months of age -

After four months of age Cereal based porridge (Ragi, Suji, Rice etc.) enriched

with Jaggery/ Sugar, Oil/ Ghee & Animal Milk can be started. Start with 1 – 2

spoonfuls & gradually increase to half to one cup per day in one to two servings in

addition to Breast feeding. Fruit juice also can be started.

6 – 9 Months of Age –

After 6 months of age, introduce mashed items from the family pot enriched

with Jaggery/ Sugar, Oil/ Ghee. Mashed rice with pulses, mashed tubers & vegetables,

soups, Mashed fruits, biscuits, egg yolk followed by egg - white etc. can be given 4 –

5times a day in addition to Breast milk. Egg white may be allergic to some.

9 -12 Months of age -

After 9 months, introduce soft food that can be chewed, avoiding hot spices.

Chapati & other hard items can be made soft by adding little milk. A variety of food

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from family pot can be given 4 – 6 times a day, gradually increasing the quantity. By

1 year of age, the baby should be taking everything cooked at home. This is called

Family Pot feeding.

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Chapter 2

Samvardhana

The considering term for Growth & Development available in Ayurveda

Samhita may be „Samvardhana‟. Which can be derived from the description of

„Samvardhana ghrita26

, indicated exclusively for developmental disorders like

Mukata, Pangu, Ashruthi etc.

Etymology of Samvardhana:

The word „Samvardhana is made up of two units i.e. „sam‟ and „vardhana‟.

Sam:

It is a prefix and carries different meanings in different contexts in Sanskrit literature

and here it is used as an upasarga. Here “Sam” means Good, Identical, and

Together27

. (Sanskrit English Dictionary)

Vardhana:

Means increasing, Growing, Thriving34

(Sanskrit English Dictionary)

Grossly the word Samvardhana implies smoothly growing, properly developing etc.

Thus the word “Samvardhana” together implies a smooth growth and development.

The term „Samvardhana‟ is not limited to physical growth. It also includes mental

social and personal development including performance skill development language

proficiency.

1. Factors influencing on Growth & Development prior to conception :

Samvardhana starts after conception but influencing factors for optimal growth and

development play the vital role which exists even prior to conception. If these

influencing factors get disturbed then it leads to a bad impact over Samvardhana.

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a) Shukra, Artava, Garbhashaya and Atma:

The union of sperm and ovum in the uterus when gets tranquillized with prakritha and

vikritha 26havas along with the union of Athma at a time is called Garbha9. Acharya

Charaka and Sushruta both opined that Shudha Shukra, Artava, Garbhashaya and

Atma all together are responsible for Shudha Garbha formation28

.

It means prior to conception, Shukra and Artava of the parents should be devoid of

any Doshas and Garbhashaya exisisting in healthy state, and is to be followed by

combination of Atma having the good deeds of past life; all these together give rise to

formation of foetus devoid of Balasamvardhana Vikrutis. Our Acharyas have gone

even to coding Ritumati Niyamah which help in growth and development of a healthy

Graffian follicle.

b) Atulya Gotra Vivaha:

Marriage between the partners belonging to different Gotra‟s influence over the

Samvardhana of Garbha by avoiding spread of disorders running in the families11

.

This refers to non -consanguineous marriage.

Acharya Bhela opined that Atulya Gotra Vivaha leads to birth of a child who is

brilliant and disease free.29

2. Factors influencing on Growth & Development during Pregnancy :

After Garbha formation with union of Shukra, Shonita and Atma, number of factors

take part in Samvardhana of Garbha. They are as follows

Panchtanmatras30

Panchamahabhutas31

Shad bhavas32

Garbhiniparicharya33

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Dauhrudyavastha34

Garbhopaghatakara bhavas35

Garbhaposhana36

Factors influencing Samvardhana during infancy:

Shareera Vriddhikara bhavas37

and Bala Vriddhikara 27havas play vital role in the

development of a child after birth till the attainment of adulthood.

Shareera Vriddhikara Bhavas:

As the name itself suggests shareera vriddhi i.e. development of bodily tissues is

contributed by the following factors.

a) Kala yoga

b) Swabhava samsiddhi

c) Ahara soustava

d) Avighata

a) Kalayoga:

The growth & development is time bound. Once a particular time or age is gone any

impairment that had happened can not be corrected nor does it wait for fulfilling

necessary requirements. E.g. the brain grows very rapidly during first six months of

life and the head circumference becomes 44 cm from 34 cm. During the late six

months the brain growth is only 3 cm and HC becomes 47 cm. if there is failure in

such growth, it can not be made good later. Thus Kala yoga may be taken as time

bound growth & development.

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b) Swabhava Samsiddhi (Innate potentiality)

Shareera (living body) has got its natural tendency of growth and development that is

called as Swabhava samsiddhi. Probably it can be correlated with genetic factors.

Because children of same parents with same factors grow differently with respect to

growth and development, (i.e. Shareerika and Manasika), this is because of swabhava

factor. Swabhava is „adhrista‟. It is nature‟s gift for individual.

Thus the Garbha is formed from the union of four bhuthas derived from four sources

and hence differ from each other in their innate potentiality, is termed as Swabhava

Samsiddhi, which plays an important role in Samvardhana of a child.

c) Ahara soustava:

The term implies that the nutritious and balanced diet with all the required proteins,

fats, carbohydrates and vitamins help for the optimal growth and development of the

child. After birth food alone is considered the most important factor for the

development, and it is considered as Bahya Prana. “Aharamekatva sharira vriddhikaro

bhavanti”

Kashyapa says that there is no better medicine than the food, to make the body

free from any disease. It can keep the individual healthy. Of all the four Shareera

Vrudhikara Bhavas, the Ahara is of paramount importance, and it is mainly

responsible for the body growth and development.

d) Avighata:

„Na vighata‟ is termed as Avighata. Vighatakarabhavas like injury, trauma, illness,

etc. to both the mind and shareera may hinder the growth and development of a

developing child. It is important to see that no injury of any sort is caused to mother

during pregnancy and no injury is caused to foetus and no mental injury caused to

mother during lactation period and no injury what‟s so ever to the growing child.

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Vighata to a growing child in the form of some illness may hinder the growth and

development of a child. Any type of Vighata during foetal life or after birth both

mental & physical results in to improper Samvardhana.

Balavriddhikara Bhavas:38

Balavriddhikara Bhavas means not only the factors which increase bodily strength but

also it includes the factors which influence or increase the immune system i.e.

29havas29shamatva in an individual. Because the definition of Samvardhana includes

physical, mental and spiritual well-being and this is possible when adequate and

proper balavriddhikara Bhavas are present or functions in an individual.

Bala Vriddhikarhavas includes:

Balvat purushe deshe janma Kalayoga

Sukhascha kala Beeja kshetra gunasampath

Ahara sampath Shareera sampath

Sathmya sampath Satva sampath

Swabhava samsiddhi Yauvana

Karma Samharsha

Balvat purushe deshe janma:

Balvatdesha may lead to an offspring with good strength and immunity and this will

be one among the contributing factors for proper Samvardhana.

Sukhascha Kala: Moderate climate when there is neither excess heat nor cold,

and which is pleasant, helps in promoting .

Balvat Kala: This bhava indicates that when a child takes birth in a Balavan

family and in good season like Visarga kala, which is known to be Balavan naturally,

it shows its impact over his Samvardhana

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Beeja kshetra sampath39

: Acharya Charaka and Sushruta both opined that

Shudha Shukra, Artava, Garbhashaya and Atma all together are responsible for

Shudha Garbha formation.

Ahara Sampath: Food is the most important factor for the growth &

development of the body. The food should be very much balanced with all nutritional

rasas containing adequate quantities of carbohydrates, fat, protein, vitamins, minerals

etc.

Shareera Sampath: This results from the chromosomes of parents or due to

virtuous actions of past life. Genetically some races have better physique.

Satmya Sampath: Sathmya is anything, which an individual assimilates or

accommodates without causing any injury to both mind and physique. After birth of a

child when fed with Ahara, which is Shad rasayuktha, and Satmya with proper Vihara

(like sadvritta, etc.) this helps the Shareera to undergo Samvardhana.

Satva Sampath: A good proportionate combination of aggression and libido

(Raja and Satva) helps in building up proper Samvardhana.

Swabhava Samsiddhi: Favorable disposition of the nature or innate potentiality

of an individual.

Yauvana: The prepubertic spurt of growth helps in bringing better strength to the

body. This is kalayogaja bala.

Karma: Karma includes normal activities, which keeps body organs strong &

steady. E.g. Vyayama.

Samharsha: The psychic development of a child depends upon interaction

between endowment and environment. The child with contentment never suffers from

psychological disorders.

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Influence of Samskara‟s over the growth & Development of a child:

The word meaning of Samskara changes according to different contexts; here i.e. in

the context of Kaumarabhirthya it can be interpreted as follows:

Samskara is a religious rite and ceremony, which sanctify the body, mind and intellect

of a child, so that child can become fit for the society40

.

Samskara is a time or opportunity provided to the physician to check the periodic

growth and developmental milestones attained by the child.

Number of Samskaras are explained in the classics, which influence over the

Samvardhana of a child after birth. Various Samskaras have been interpreted for their

developmental role in the growing child by Dr. C.H.S. Shastry (1976) in his PhD

Thesis at Banaras Hindu University entitled “Principles and Practice of Paediatrics in

Ayurveda”24

and here we are concentrating on few Samskaras. Samskara refers to

refinement activity and is done and promoted when the child becomes fit for such

faculty to develop.

Nishkramana samskara:41

This Samskara has to be performed either during 3rd

or

4th

month from the date of birth. In this Samskara infant is exposed to external

environment so that he responds to external stimuli looking to moon/hanging object,

may help the macular fixation and pupillary adjustment of the child can occur and the

sound produced from bells of temple may stimulate auditory system of child.

Upaveshana samskara42

: This Samskara is performed during 5

th month. According

to this samskara baby is made to sit on the ground for some time so that stimulation

will be given for the developmental phase of ability to sit.

Phalaprashana samskar43

: It is performed during 6th

month and it is a special

contribution of Acharya Kashyapa. In this samskara baby is supplemented with fruits,

which are rich in vitamin C (e.g. Orange) but absent in mother‟s milk. Vitamin C is an

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essential component in the development of Immune system and it also has antioxidant

property. It helps in the formation of connective tissue in a growing body.

Annaprashana samskara44

:This Samskara is performed at the age of 10 months.

According to Kashyapa from the time of this Samskara baby starts getting food with

required nutrient, so that requirement of tissues in the body get fulfilled leading to

Samvardhana. In this way above Samskaras have an influence on both i.e.

physiological and psychological development of a child leading to Samvardhana.

Milk alone is not sufficient at this age for growth and development. Complex

Carbohydrate and Proteinous substances get digested with the secretions that start

flowing in the stomach etc and then the child has to be slowly converted to Annada.

The third point is considered most important – “vividha anna

anupasevanata”. The development of the gastro intestinal tract (GIT) depends on

exposure to different food components slowly. The growth factors present in the

breast milk contribute to early development of GIT. That is why Ayurveda has given

a functional classification, which completely depends on the development of the GIT

judged by the intake of different type of foods, rather than an age wise classification

for the administration of medicine.

1. Jathamatran -just born

2. Pakshatheethan -after fifteen days

3. Athipakshan -after one month

4. Thriamasikan -three months of age

5. Shanmasikan -six months of age

6. Ekabdan -one year old

7. Thraibdan -three years old

8. Panchahayanan -five years old

9. Ashtabdan -eight years old

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10. Dasabdan -ten years old

11. Dwadashabdan -twelve years old

The classifications above are typically based on some important developmental

milestones of the GIT45. In this classification, jathamatran, pakshatheethan and

athipakshan are particularly important as they belong to neonate.

In pakshatheethan, the development of GIT is acquiring, not all dosage forms

may be suitable. Therefore, medicine administration should be very careful and

avoided as far as possible.

5.5.2 Classification of children based on diet patterns

As far as the administration of different food and medicines and for the

determination of dose is considered, rather than the age wise classification, the

classification based on diet and growth and development should be considered. This

is because of the fact that, the classification is based on the functional development of

GIT.

Ksheerapa

Infant who depends only on breast milk (or any other similar milk or feeds if

breast milk is not available or conditions of intolerance). It was considered up to one

year of age classically, but presently up to four to six months (WHO).

Ksheera annada

Infant who has started feeds other than milk. It was considered up to one to

two years of age classically, presently four to six months is the lower limit; upper

limit two years (WHO).

Annada

Withdrawn from breast milk and depends only on other feeds, above two years

of age to 16 years classically, presently lower limit is 2 years of age.46

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Chapter 3

Growth and Development

Definitions47

–

The term „Growth‟ implies a net increase in the size or a mass of tissue. It

occurs due to multiplication of cells and increase in the intracellular substances.

Hypertrophy contributes to a lesser extent.

„Development‟ is defined as maturation of function. It depends on maturation

and myelination of the nervous system and denotes acquisition of a variety of

competencies for optimal functioning of the individual.

Physical Growth & Development- It implies molecular level of enzyme

activation, differentiation which is manifested at puberty, adolescence, etc.

Laws of Growth & Development48

–

1. Growth & Development of children is a continuous & orderly process.

2. Sequence of the Growth is the same but the pace of Development can be non-

uniform.

3. Growth pattern of every individual is unique, but general pattern of Growth in

human is „Cephalocaudal‟.

4. Different tissues of the body grow at different rates.

General Body Growth – Rapid in Fetal life, first 3 – 4 years of life & puberty.

Brain Growth – Rapid in later months of pregnancy & early months of post-natal

life. 90% growth is achieved by 2 yrs.

Gonadal / Reproductive Growth – Pronounced by puberty.

Lymphoid Growth – Pronounced at mid-childhood (4-8 yrs.)as it acts as organ for

immunity in children (Tonsils, Thymus & Lymphoid gland)

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5. There is a sequence of Development within each developmental field, but the

development in one field does not necessarily run parallel with that in other field. This

is called „Dissociation‟

6. Development is intimately related to the maturation of nervous system.

7. Generalized mass activity (e.g. wild movements of trunk & limbs) is replaced by

specific individual response (e.g. reaching for a particular object).

8. Certain primitive reflexes such as the grasp reflex & walking reflex have to be lost

before corresponding voluntary movements are acquired.

A. Genetic factors

Phenoytpe

Parental characteristics

Race

Sex

Biorhythm & Maturation

Genetic disorders –

i. Chromosomal Abnormalities

ii. Gene mutation

B. Environmental factors49

–

a) Prenatal period –

Maternal malnutrition is associated with IUGR & Small babies

Multiple pregnancies

Medical illness in the mother

Maternal infection

Drugs taken during pregnancy

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Maternal endocrinal disorders

Irradiation in pregnancy

Placenatal & uterine problems

Maternal Stress

Abnormal presentations

Post–Maturity

b) Post-natal Period50

–

Neonatal Hypoxia

Neonatal Convulsion

Birth injury, Brain damage & Cerebral Palsy

LBW babies

Social Factors

Socioeconomic level – determine the standard of living & quality of life of the

child

Natural resources – Better nutrition of child is possible in region of good

natural resources.

Climate – Velocity of Growth is usually higher in spring & slow in summer.

Age of Mother – Older the mother greater are the chances of congenital

anomalies.

Age of the father – Advanced paternal age is associated with congenital

disorders.

Personal Factors – Couple‟s desire for the desired sex determines the further

development.

Nutrition – One of the most important factors. Growth retardation occurs in

PEM, anemia & vitamin deficiency.

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Chemical Agents – Androgenic hormones can accelerate growth but epiphyseal

fusion occurs earlier.

Trauma – fracture of epiphyses can retard the bone growth.

Infection & Infestations – Reduces the velocity of Growth.

Emotional factors – Anxiety, lack of security, lack of emotional support & love

can adversely affect the neurochemical regulation of Growth.

Cultural Factors – Child rearing & feeding are determined by cultural taboos

which can sometimes adversely affect the mental constitution or the nutrition of

the child.

Importance of study of Growth & Development –

Public health screening

Indicator of the general health & nutrition of the community

Evaluation of social action (medical or social measures)

Suitability of the baby for adoption

Clinical importance – Early diagnosis of moderate to severe mental sub

normality, Cerebral palsy, deafness, visual handicaps, neurological & metabolic

disorders, disorders of muscle tone, congenital dislocation or sub-luxation of hip etc.

Developmental history can help in defining the time of onset of a disease from the

time at which arrested or delayed development has occurred.

Assessment of Growth51

–

Examination of physical Growth can be done by –

Body measurements – e.g. body weight, length & head circumference etc.

Velocity of Growth

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Techniques of measurements –

Weight – Nude weight of the child to be recorded on a lever type weighing scale

as spring balances are less accurate. Recent weighing scales are fairly reliable.

Length – For babies less than two years of age with infantometer.

Chest circumference – Measured at the level of nipples midway between

inspiration & expiration with child in recumbent position.

Head circumference – Maximum circumference of the head from occipital

protuberance to the forehead (supra-orbital ridge).

Growth tables & Mnemonics52

–

I. Weight - Weight gain is at the rate of 25 to 30 gms. per day for the first three

months of life. There after weight is gained at the rate of 400 gms. per month. An

infant doubles his birth weight at the age of 5 months. Birth weight trebles at 1 year of

age. Birth weight quadruples at two years.

II. Length or height –

At Birth – 50 cms.

3 months – 60 cms.

9 months - 70 cms.

1 year - 73-75 cms.

2 years - 90 cms.

4 ½ years - 100 cms.

III. Head Circumference –

At Birth - 35 cms.

3 months - 40 cms.

12 months - 45 cms.

2 year - 48 cms.

7 years - 50 cms.

12 years - 52 cms.

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Clinical Study on Assessment of Growth and Development in Infants with Shashtikashalyadi Churna as weaning food. Page 42

Chest Circumference –

At Birth - about 3 cms. Less than the Head Circumference

Equal to head circumference at 1 year

Thereafter it increase than head circumference

Growth Chart & their significance –

Introduction –

Also called „Road to health chart‟.

Definition – Growth chart is a visible graphical display of a child‟s Growth &

Development designed primarily for the longitudinal follow up (growth monitoring)

of the child, so that changes over time can be interpreted & progress of Growth

interpreted.

Visits to be recorded –

Weighing should be done at least once every month for the first year

Every 2 months during second year.

Every 3 months up to age of 5 -6 years.

This is done in a pattern of „weight for age‟ on the chart.

Types of Growth Chart –

WHO Growth Chart – it has two reference curves. The upper reference curve

represents the median (50th

percentile) for boys (slightly higher than that for girls) &

the lower reference curve represents the percentile for girls (slightly lower than that

for girls). The space in between two growth curves (weight channel) is called „Road

to Health‟. This includes children with +/- 2 SD on each side of standard weight.

Growth chart recommended by Govt. of India & IAP (Indian Academy of

Pediatrics). – It has 4 reference curves.53

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ICDS Chart- 3 reference lines in addition to standard representing 80%, 60% &

50% of the reference standards.

Use of Growth charts –54

1. Growth monitoring – To detect malnutrition or infections by periodic assessment

in progress of weight

2. Diagnostic tool – to identify „High risk children‟. Malnutrition can bee detected

long before signs & symptoms of it become apparent.

3. Planning & Policy making – By grading malnutrition it is possible to evolve an

objective basis for planning & policy making in relation to child health care at local &

central levels.

4. Education tool – Mothers can be taught care of her own child & encourage her to

actively participate in Growth monitoring with the help of visual character of the

Growth chart.

5. Tool for action – Helps the health workers to decide type of interventions that is

needed, which helps making referrals an easier jobs.

6. Evaluation – growth chart provides a good method to evaluate the effectiveness of

corrective measures & impact of a program or of special intervention for improving

child Growth & Development.

7. Tool for teaching – i.e. importance of adequate feeding, deleterious effects of

diarrhea.

8. Other miscellaneous information – Identification & registration, Birth date

&weight, chronological age, history of sibling health, immunization procedures,

introduction of supplementary foods, episodes of sickness, child spacing & reasons

for special care.

The Growth Chart has been aptly described as „A passport to child health care‟.

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Growth & Development during 6–12 Months of age55

–

During the age of 6 –12 months the infant develops increased mobility and

tries exploring the things around, advances in cognitive understanding and

communicative competence. The infant develops will and intentions, characteristics

that most parents welcome but still find challenging to manage.

Physical Development -

During this period Growth slows down.

Infant is able to sit unsupported at around 7 months & can pivot while sitting

(around 9–10 month) and also emergence of a pincer grasp, provides increasing

opportunities to manipulate several objects at a time and to experiment with objects.

Many infants begin crawling and pulling to stand around 8 months and walk before

their first birthday either independently or in a walker.

Motor achievements correlate with increasing myelination and cerebral &

cerebellar growth.

These ambulatory achievements provide opportunities for learning.

Tooth eruption occurs, usually starting with the mandibular central incisors. Tooth

development also reflects, in part, skeletal maturation and bone age.

Cognitive Development –

At first, everything goes into the mouth (mouthing/ oral phase).

Later child develops Hand-to-Hand co-ordination, objects are picked up, inspected,

passed from hand to hand, banged, dropped, and then mouthed.

The pleasure, persistence, and energy with which infants tackle these challenges

suggest the existence of an intrinsic drive, or mastery motivation. Mastery behaviour

occurs when infants feel secure; those with less secure attachments show limited

experimentation and less competence.

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A major milestone is the achievement (about 9 month) of object constancy. At 4 –

7 month, the infant looks down for a yarn ball that has been dropped but quickly gives

up if it is not seen. With object constancy, the infant persists in searching, finding

objects hidden under a cloth or behind the examiner's back.

Emotional Development –

Emergence of object constancy brings qualitative changes in social and

communicative development. E.g. The infant looks back and forth between an

approaching stranger and a parent, as if to contrast known from unknown, and may

cling or cry anxiously.

Separations often become more difficult. Infants who have been sleeping through

the night for months begin to awaken regularly and cry, as though remembering that

parents are in the next room.

At the same time, a new demand for autonomy emerges. The infant no longer

consents to be fed but turns away as the spoon approaches or insists on holding it him-

or herself. Self-feeding with finger foods allows the infant to exercise newly acquired

fine motor skills (the pincer grasp); it may be the only way to get the child to eat.

Tantrums make their first appearance.

Communication –

The infant at 7 months is adept at nonverbal communication, e.g. around 9 months,

the infant becomes aware that emotions can be shared between people; he or she

shows parents toys gleefully, as if to say, "When you see this thing, you'll be happy,

too!"

Between 8th and 10th month child is able to speak multiple syllables ("ba-da-ma")

and inflections that mimic the native language.

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At this age, picture books provide an ideal context for verbal language

acquisition. With a familiar book as a shared focus of attention, the parent and

child engage in repeated cycles of pointing and labeling, with elaboration and

feedback by the parent.

Implications for Parents and Pediatricians –

With the developmental reorganization around 9 month, previously resolved issues

of feeding and sleeping re-emerge.

Poor weight gain at this age often reflects a struggle between the infant and parent

over control of the infant's eating.

The infant's wariness of strangers often makes the 9-mo examination difficult,

particularly if the infant is temperamentally prone to react negatively to unfamiliar

situations.

Time spent talking with the mother and playing with the child will be rewarded by

more cooperation.

Nutrition

Nutrition is defined as „the process by which the organism utilizes food.‟ It

signifies the dynamic process in which the food that is consumed is utilized for

nourishing the body56

.

Ayurveda does not classify foods in the categories like Carbohydrates, Fats,

Proteins, Minerals & Vitamins. The actions of different grains, vegetables and fruits

are described in terms of their Rasa, Guna, Veerya and Vipaaka. The nutritive values

of different foods of vegetable and animal source are described in a number of

chapters. Cure of disease is not merely achieved by medicine; but by Pathya Bhojan.

Diet not only cures, but also prevents diseases if properly used. So it is the duty of the

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physician to prescribe appropriate diet in any particular condition. Man cannot live on

medicines alone without food57

. Diet is the fuel for internal fire58

i.e. to say it is

responsible for heat production in the body measured in terms of calories.

Nutrition and its disorders form the main pediatric problems and hence a little

knowledge of the food values described in Ayurvedic texts as well as in contemporary

science is very much essential for a pediatrician. The diets we get may be either of

vegetable source or of animal origin. Thus the wholesome diet should consists of all

six Rasas with sufficient Drava and Snigdha Gunas so as to give energy on one hand

and nourish and promote the growth of the seven Dhatus of the body on the other.

Nutritive Values of food –

Food items are divided into;

1. Energy yielding foods (Carbohydrates & Fats)

2. Body building foods (Protein)

3. Protective foods (Vitamin & Minerals)

4. Carbohydrate, fat and protein are the major nutrients

5. Sodium, potassium, calcium, phosphorus etc. are the macro nutrients and

6. Vitamins, Minerals with RDA less than 100 mg. / day are micro nutrients.

Carbohydrates59

-

They are the main source of energy for doing work. On an average about 50 – 70% of

energy is obtained from carbohydrates in the diet.

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Functions of Carbohydrates-

1. Most important function is to provide energy for the various body functions. They

supply energy for immediate use. Especially Brain depend on glucose for their

metabolism. Brain tissue is very sensitive to glucose, deficiency even for few minutes

can lead to permanent damage to nervous tissue.

2. Since Carbohydrates are utilized for energy purpose, they spare protein for Growth

& repair.

3. They provide carbon skeleton for essential Amino-acids.

4. They are required for the functioning of Liver. Glycogen protects liver against the

Bacterial toxins and poisonous substances. Glucoronic acid converts harmful

substances into harmless substances.

5. For proper functioning of Heart, As Heart obtains carbohydrates from blood sugar

& glycogen of cardiac muscles.

6. Excess Carbohydrates are converted into fats & stored.

Table No.2 Showing Carbohydrate contents of various foods -

Food Carbohydrate (in gm. /100 gm.)

Cereal 60 – 70

Pulses 55 – 60

Honey 80

Jaggery 95

Fresh Fruit 10 - 25

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Importance of Carbohydrate in Diet -

It has “Protein Sparing Effect”. When Carbohydrate & fats are provided to meet the

demand for energy, Proteins are spared for Growth & repair (Protein – sparing –

effect). The endogenous break down of protein is reduced if one is given a daily

minimum of 150 gm. (600 Kcal) carbohydrate for energy.

When carbohydrates are insufficient to meet the requirements, amino acids are

deaminated for glucose formation, and nitrogen is converted into Urea by Liver &

excreted by kidney.

Fats60

–

Fats provide convenient & concentrated source of energy. They also contain

essential nutrient as Essential Fatty-Acids (EFA) & fat soluble vitamins. Therefore

fats are essential for maintaining for good health. Fat acts as a reserve fuel.

Poly-unsaturated fatty acids are of special interest. Linoleic & Linolenic acid

can not be synthesized in the body & are known as essential fatty acids (EFA).

Arachidonic acid can be formed from Lenolenic acid in the body. These fatty acids

are essential for Growth & well being. Therefore animals require small amounts of in

their diet (As they are not synthesized in their body). They are present in Marine oils

(Whale, shark) and vegetable oils (except coconut and palm oil)

Essential Fatty Acids (EFA)61

-

The essential & non-essential is applied to a nutrient according to its relative necessity

in the diet. A nutrient is essential if

Its absence will create a specific deficiency disease

The body can not manufacture it & must obtain it from the diet.

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A diet with 10% or less of its total calories from the fat can not supply adequate

amount of essential fatty acids (EFA).

The only Fatty acids known to be essential for complete human nutrition are the Poly-

Unsaturated fatty acids, Linoleic and Linolenic. Essential Fatty acid must come from

the foods we eat. The body is capable of producing saturated fatty acids,

monounsaturated fatty acids and Cholesterol. Therefore there is no set

recommendation of daily intake for these. Essential Fatty Acids are required in

quantity of 0.5 mg./kg./day for infants. The DRIs (Dietary Reference intakes) for

Linoleic acid, found in polyunsaturated vegetable oils, are set at 17 gms./ day for men

& 12 gms. per day for women. Linolenic acid is primarily found in milk, soybeans

and flaxseed oil & is necessary in much lesser quantities than Linoleic acid. The

recommendations for Linolenic acids intake are 1.6 & 1.1 gm/day for men & women

respectively. These fatty acids serve important functions related to tissue strength,

cholesterol metabolism, muscle tone, blood clotting & heart action.

Functions of Lipids –

1. Act as concentrated source of energy. They yield about double energy as compared

to Carbohydrate per unit weight.

2. They are essential for fat soluble vitamins A, D, E and K.

3. EFA (Essential Fatty Acids) act as a precursor of Prostaglandins. They are

therefore important for maintaining tissue in normal health.

4. Some fats are essential components of nervous tissue (E.g. sphingo myelins, cell

membrane glycolipids)

5. Fats deposited in the adipose tissues acts as a reserve source of energy during

starvation.

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6. Fats supply essential fatty acids which are necessary for Growth & functions.

Proteins62

–

Proteins are nitrogenous organic substances. Protein is the basic chemical unit

of living organism essential nutrition, growth & repair. Every cell in the body is partly

composed of proteins which are subject to continuous wear & replacement.

Plant can synthesize all amino acids they need, from simple inorganic

chemical compound. Animals can not synthesize NH2 (Amino) group & therefore can

not synthesize all amino acids. Animals therefore depend upon plants for building up

of their protein.

Human body has limited capacity to convert one amino acid into other. There

are several amino acids which body can not synthesize and therefore this must be

taken in diet. Such amino acids are called as „Essential Amino Acids‟. There are about

10 essential Amino Acids required for Growth.

1. Histadine

2. Lysine

3. Tryptophan

4. Phenylalanine

5. Methionine

6. Threonine

7. Leucine

8. Isoleucin

9. Valine

10. Arginine

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Clinical study on Assessment of Growth and Development in infants with Shashtikashalyadi Churna as a Weaning food. Page 52

Table No. 3- Comparing chemical scores & NPU (Net Protein Utilization) 62

Food Chemical Score NPU (Net Protein Utilization)

Rice 67 63

Wheat 53 49

Human Milk 10 94

Cow‟s milk 95 81

Children require protein for proper growth. In poor countries many children

die from lack of sufficient dietary protein & many more suffer from serious ill health,

grow slowly and fail to develop their full physical potential.

Table No.4 Protein values of different food articles.

Food Protein(in gm./100 gm.)

Cereal & millets 6 to 14

Pulses 18 to 24

Milk (Fresh) 3.5 to 4

Egg 12 to 20

Oil, Seeds & Nuts 18 to 40

Functions of Proteins –

1.Replacement of daily loss of body protein due to which nitrogen balance is

maintained.

2.To supply amino acid for formation of tissue protein during Growth (Carbohydrate

& Fats can not substitute Protein as they do not contain Nitrogen Molecule).

3.Body‟s „wear & tear‟ is repaired by proteins.

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4.To supply Amino acids for the synthesis of enzymes, plasma proteins, hormones

(certain), hemoglobin and vitamin.

5.To supply amino acid for the Growth of the fetus during pregnancy.

6.To supply amino acid for the formation of milk during lactation.

7. Proteins function as buffer & maintain body fluid pH.

8.Helps in transport of nutrients (lipo-protein) & drugs.

Nutritive values of food described in Ayurveda63

-

Vegetable Foods:

These consist of different grains, fruits, vegetables and honey.

The grains64

are classified into Saali, Vreehi, Sooka, Simbi, and Kshudra Dhaanya.

The paddy crop that comes out in Hemantharitu is Sali; the crop that is reaped

in Varsharitu is Vreehi. The barely and wheat come under Sookadhanya while all

Daals are grouped under Simbi Dhanyas. Kodrava is a variety of Kshudra Dhaanya

whose dietetic value is poor and is advised to be used when the child suffers from

loose motions during weaning.

Sali65

is sweet and astringent like milk; has mild laxative and diuretic effect;

helps to construct the body. The Shasti66

has similar effect with mainly astringent

taste and constipate the bowels. The barley is agreeable and improves retention of

memory and Agni. It is Kaphahara and dissolves the fat in obesity. The wheat67

is

anabolic and restorative. Excepting the green gram and lentil, all Simbidhaanya

produce gaseous distension of abdomen and are Kaphapitta Hara. Kodrava has a

constipating effect and is Kaphapitta Hara.

Among the fruits orange juice is said to make the mouth palatable, is cordial

and is Vatahara68

. The sour juices promote Pitta and Kapha. The sweet pomegranate

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juice is Tridosha Hara, makes the tissues pleasant and increases Sukradhatu69

. Cold

water extracts of dates supply iron in sufficient quantities and may be supplemented

from fourth month onwards otherwise the child may go into a state of iron deficiency

anemia. Dates are anabolic and act mainly on Shamanavata in Kostha and probably

correct liver functions as it is said to counter act the diseases born of alcohol and

epilepsy. It is anti-emetic, anti-diarrheal and relieves cough and breathlessness70

.

Bananas offer proteins and calories and are well tolerated even at four months of age.

The vegetables1 are put to bad repute and abuse in Ayurveda. They are said to

destroy the bones, the blood, the Sukradhatu and color of the skin. Vegetables are

harmful for eyes. They make the person unwise and loose intelligence with premature

greying of hairs. Many diseases have their abode in vegetables. Again Bhavamishra

further describes many of the Saakash, possessing Shukravardhaka property, which is

contradictory to the above statement. However, they may be a source of worm

infestation, infections and huge phosphate intake from vegetable leaves may cause

withdrawal of calcium from bones and disturb the dietetic balance. Still

Moolaiyoosha72

is good and widely used to cure all diseases, especially of the

respiratory tract.

Nutritional requirement of an Infant73

–

Balanced Diet -

A Balanced Diet is one which supplies all the nutrients in the right quantity &

proportion. It is essential for Growth, to maintain good health & to prevent

deficiencies.

A Balanced Diet is one in which –

Carbohydrate yields 55 – 60 % of the calories.

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Protein yields 30 – 35 % of calories.

The Diet should also contain enough Vitamins, Minerals, Fibre, water etc.

The Diet should preferably contain all the food items listed in the food Triangle.

Table No. 5 - Balanced Diet for Infant – ICMR – 199874

Sr. No. Food Group Recommendation (Portions)

1. Cereals & Millet 1.5

2. Pulses 0.5

3. Milk (ml.) 5 a

4. Roots & Tubers 0.5

5. Green leafy Vegetables 0.25

6. Other Vegetables 0.25

7. Fruits 1

8. Sugar 5

9. Fats / Oils (Visible) 2

Note: For infants introduce Egg/ Meat/ Chicken/ Fish around 9 months.

1) a - Quantity indicates top milk for Breast fed infants. 200 ml. top milk is required.

2) One portion (50gm.) of pulses may be exchanged with one portion (50gm.) of egg/

meat/ chicken/ fish.

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Table No. 6 - Recommended Dietary Allowance for Infant (6 – 12 months) 75

–

Net Energy Kcal/day 108 Kcal/Kg/ day

Protein (gm/day) 1.65 gm/day

Calcium 500 mg/day

Iron 10gm./day

Vitamin A Retinol 350

β Carotene 1200

Thiamin 50 µ / Kg.

Riboflavin 60 µg / Kg.

Nicotinic Acid 650 µg / Kg.

Pyridoxine 0.4 mg./day

Ascorbic Acid 25 mg./day

Folic Acid 25 mcg./day

Vit. B12 0.2 mcg./day

Effect of Nutrition over Growth & Development

Relationship between Nutrition, Growth & Development-

In children, nutrition, growth and development are intricately inter-linked -

aberrations of one aspect tend to significantly influence the others. Thus, for example,

for optimal growth and development of an infant, appropriate nutritional practices

play a pivotal role.

It is a known fact that Malnutrition is a "man made disease 'which often' starts

in the womb and ends in the tomb". Malnutrition and the associated retarding

influences cause a lot of morbidity, growth faltering, developmental retardation and

significant mortality. This is the significant job of all healthcare professionals to

prevent & manage those malnourished children.

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Interaction between Various Factors and Child Development76

-

There is an interplay between genetic, nutritional and environmental factors that

influence growth, development and intelligence. The effect of malnutrition in

reducing the intellectual achievement is difficult to separate from other associated

retarding social and environmental factors. The child's ultimate intelligence is the

result of the interaction between host, nutrition and environment.

Various studies have shown better growth and development in children from

high socio-economic status and reduced growth and development in children from

low socio-economic status.

Genetic Endowment Nutrition Environment

For Growth & Socio Economic

Development Microenvironment

Resistance Infection Child rearing

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Growth & Nutritional Status Environmental

Stimuli

Development

Education & Learning

Skill

Total Development

( Interaction between Various Factors & Child Development)

Majority of the children in India who live below the poverty line in an environment of

multideprivation and starvation have physical and developmental retardation. It has

been estimated that in India, 65 per cent i.e., nearly 80 million children under five

years of age suffer from varying degrees of malnutrition. 77

Environmental factors like parental education, socio- economic status, sani-

tation, standard of living, parental attitudes and child rearing practices influence the

growth and development of children.

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Nutritional factors like breast feeding practices, weaning practices and diet

during illness influence the growth and development of children. Maternal malnutri-

tion, low birth weight (LBW) and recurrent infections are other important factors that

lead to malnutrition. Severe forms of malnutrition like marasmus and kwashiorkor

represent only a tip of the iceberg. Many more suffer from moderate, mild or invisible

PEM. Malnutrition increases morbidity and mortality. It has been estimated that for

every diagnosed case of PEM, there are 10 others with borderline Malnutrition

undetected in the community.

During development of the brain, the most important phase of neuronal

proliferation and migration occurs in the intrauterine period. Hence antenatal care is

of utmost importance. After birth, the first two years of life include a period of rapid

brain growth and myelination. Hence any program aimed at the developing brain

should be started before the age of two. Autopsy studies and animal studies have

shown that malnutrition causes structural changes in the growing brain. Various

studies suggests significant reduction in serum and CSF proteins and lipids, serum

trace elements and other macro elements. Serum enzymes, developmental quotient

(DQ), motor nerve conduction velocity and brain stem auditory evoked potentials

(BAEP) were also low when compared with appropriate controls. 78

Among various interventional strategies, single point interventions like

nutritional supplementation and primary health care have failed to deliver the desired

outcome. There is an interplay of various factors that influence the intellectual

development namely genetic, nutritional and environmental. Hence the mode of

intervention has to be multidisciplinary.

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Chapter 4

Evaluation of the formulation under consideration

Different cereals form the staple diet in various parts of the country. Rice is popular in

the south and east while in other regions Wheat, Jowar, and millets are consumed.

Cereals contain 7-12% protein, and about 75% carbohydrates. They form an

important source of energy, iron, and protein in Indian diet and also supply certain

amount of fat which is referred as invisible fat. A thick creamy porridge made from

cereals in water/ milk/milk-water mixture is a good weaning food for babies.79, 80

Preparation of weaning food- Shashtikashalyadi churna:

Malting Process: 80,81

Cereal grains were soaked in water over night ( 2-3 times its volume of water)

The moist swollen grains were germinated in a moist dark environment

covered with a cloth for 2 days.

After sprouts were formed, they were shade dried for half day.

The grains were slightly roasted in pan to remove excess moisture

Sprouts were removed and given for milling.

Rest drugs like Jatiphala, Ela,Vidanga churna obtained from SDMCA&H,

HASSAN pharmacy, and were evenly mixed to form homogenous mixture.

Prepared food was packed in airtight container weighing 250g.

7.1 Ingredients of the formulation82

1. ShashtikShali

2. Godhuma

3. Yava

4. Jati

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5. Ela

6. Vidanga

7. Ghrita

8. Sitopala(sugar)

Shashtikshali83

Botanical name - oryza sativa Linn.

Family - Poaeceae ( Graminae)

Synonyms -

Sanskrit - Shali, Tandula, Laja, Dhanya

Hindi - Chaval, Dhan

Kannada - Nellu, Bhatta, Akki

English - Paddy, Rice

Marathi -Tandula, Dhan, Bhat

Chemical Constituents:

The Chemical composition of rice is influenced to some extent by generic and

environmental factors. Analysis of rice gave the following ranges of value:

moisture10.9-13.78,0.59-2.59ether extract, protein 5.50-9.32, carbohydrates73.35-

80,fibre 0.18-0.95 and mineral matter0.72-2.00% Enzymes like alpha amylase, B-

amylase, amylosynthase, lipase, phenolase.

Pharmacological Activities:

Plant was reported to have, anti-inflammatory (Hu et al., 2003), anti-diahorreal, anti-

dysenteric, anti-oxidant (Chung and woo; 2001; Moon et al., 2002)

Dose - powder 5-10 gm. Decoction 50-100ml

Gana - Dhanya varga

LITERARY REVIEW


Properties and action

Rasa - Madhura, Anurasa: Kashaya

Guna - Guru, Snigdha

Virya - Sheeta

Vipaka - Madhura

Dosha karma: Pittaghna, Vatakaphavardhna

Therapeutic actions

Besides the common utility of shali, as food article, the drug shali is

possessing medicinal properties and useful for preventive and curative purpose

medicine as well as whole some pathya. It is hrdya, ruchya, brihmana

,vrsya,balya,swaryaand jvaraghna.Rice gruel is useful in impaired digestion like

diarrhea and dysentery(Chatterjee and Pakrashi,2001;Chopra et al.,

1958)Tryptophan,Phenyalanine(Balasubramaniam,1952)

Rice is a complex carbohydrate, which contains starch, and fibre, which is digested

slowly allowing the body to utilize the energy released over a longer period which is

nutritionally efficient. It contains only a trace amount of fat. Rice is gluten free, so

suitable for coeliacs and it is easily digested and therefore a wonderful food for the

very young and elderly.

Important formulations that contains shali

Abhayarista, Kumaryasava, Brahma Rasayana,Shashtikadi Brinhanai gutika

Godhuma84

Botanical name - Triticum aestivum Linn.

Family - Gramineae

LITERARY REVIEW


Synonyms

Sanskrit - Gudhuma, Yavanaka, Madhulika, Nistusa, Sumana Ksiri, Rasala, .

Hindi - Kanak, Genhu, Gehu, Gehub

Marathi - Gahu, Ghawn, Margham, Kapale

English - Wheat


Grains contain Mg. Mn. Zn. Fe, Ca, fresh plant contains oxalic acid.


Parts used - Wheat bran – seed

Dose - Wheat flour-Edible–food article (dietary component)


Rasa - Madhura

Guna - Guru, Singdha

Virya - Shita

Vipaka - Madhura

Dosha karma- Vata-Pittahara, Kaphavardhaka

Therapeutic actions

It mitigates vata and pitta, increases strength and bulk of body, cures diseases

of throat,rakta, anemia, itching, burning sensation, cough, good for skin and increases

complexion,aphrodisiac,relieves pain,promotes intelligence and reduces kapha.

Yava85

Botanical name - Hordeum vulgare Linn. .

Family - Poaceae

Synonyms

Sanskrit -Yava,Akshata, Kunchakin,Hayapriya,Teekshnashushka .

LITERARY REVIEW


Hindi -Jav,Jawa,Suj,Jau

Marathi -Yava, satu,Java

English - Barley

Kannada - Jovegodhi,Yava


Cyanogenic glycoside characterized as 2-B-D-glucopyranosyloxy-3-methyl(2R)-

butyronitrile,Proteins,Carbohydrates,Calcium, Phosphorus,Iron(grains


Hypocholestric,Antifungal,Antiprotozoal,Anti-oxidant.

Parts used - Seeds (grains)

Dose - Barley flour-Edible–food article (dietary component)

Gana - Shuka Dhanya varga

Rasa - Kashaya, Madhura,

Guna - Guru, Ruksha, Mridu

Virya - Sheeta

Vipaka - Katu

Dosha karma- Kapha-Pittashamaka

Therapeutic actions:

Barley contains approximately 10% dietary fibres and easily cooked with rice. Grains

are astringent demulcent, emollient, intellect promoting, digestive and tonic. They are

useful in throat, fever, gastric disorders, abdominal pain, and anemia. Yava is one the

oldest cultivated cereals and extensively used as food.it enters several products like

malt, infant foods, malted milk extracts; etc.

LITERARY REVIEW


Important formulations that contains Yava: Agastiharitaki rasayana, Dhanwantara

ghrita, Gandharvahastadi taila, Dhanwantara taila, Eladya modaka, Yavapatola

Kwatha.

Vidanga:86

Botanical name - Embelia ribes Burm.f. .

Family - Myrsinaceae

Synonyms

Sanskrit - Krimighna,Chitratandula,Jantunashana,vella,Kitashatru,kitari

.

Hindi -Vayavidanga,Baberanga

Marathi -vidanga,Karkannie

English - Embelia

Kannada - Vayuvilanga


Embelin, quercitol, tannin, christembine, volatile oil (vol.5 database, p480)


Nematicidal, anti-helminthic, Anti-inflammatory, Anti-helminthic, Anti-biotic,

immunostimulant, Anti-pyretic.

Parts used - fruit, roots, leaf

Dose - Fruit powder-5-10g

(vol.5 database, pg479)


LITERARY REVIEW


Rasa - Tikta, Katu ,

Guna - Laghu, Ruksha,Teekshna

Virya - Ushna

Vipaka - Katu

Dosha karma- Kapha-Vatashamaka

Prabhava - Krimighna

Therapeutic actions: Clinical studies on fruits of Embelia ribes have shown that when

administered in doses of 200mg /kg to patients of worm infestation, produced good

results. Drug is well tolerated and safe for use. The chief active principle Embelin is

reported to be effective against tape worm.aqueuos extracts of the fruits show anti-

bacterial activity against staphylococcus and Escherichia coli; etc.

Important formulations that contains Vidanga:

Eranda paka, vidangadi churna, Abhayarista, Pippalyasava, Kaishora guggulu,

Chandraprabha vati, Vidanga taila.

Ela 87

Botanical name - Eletharia cardamomum Matom .

Family - scitaminaceae

Synonyms

Sanskrit - Ela,Triputa-truti,sukshma,Dravini,Upakunchika.

Hindi -Choti Ilaychi

Marathi -Yelachi

English - Lesser cardamomum

LITERARY REVIEW



Seeds contain essential oil, principal constituents of the oil are cineol, terpineol,

terpinenein the form of formic and acetic acid.

Pharmacological Activities: It is aromatic, Carminative,Digestive,

Expectorant,Stimulant tonic. Studies have shown that Ela(elettaria cardamomum) is

expectorant and its Alexetric property controls infection.Chemical components of

cardamom oil(a-pinene, b-pinene, sabinene, myrcene, a-phellandrene) are expectorant

and carminative.

Parts used - fruit- seed

Dose - 0.5-1g


Rasa - Katu, Madhura

Guna - Laghu, Ruksha

Virya - Sheeta

Vipaka - Madhura

Dosha karma- Tridoshahara

Therapeutic actions: The fruits are mainly carminative, expectorant, and anodyne

medicine in various ailments. The fruits are useful in preparing infusion which is

useful for countering the condition of loss of appetite, flatulence ,gastric trouble,

dyspepsiaand respiratory infections.

Important formulations that contains Ela: Eladi churna, Eladi gutika, Eladimodaka,

Talisadi Churna,Sitopaladi churnaEladyarista.

LITERARY REVIEW


Jatiphala88

Botanical name - MyristicaFragnance Houtt. .

Family - Myristicaceae

Synonyms

Sanskrit - Jatiphala, Malatiphala.

Hindi - Jaiphala

Marathi - Jaiphala

English - Common Nutmeg, True Nutmeg

Chemical Constituents: Contains essential oils, saponin, volatile oil, protein fats,

starch, Fixed oil contains-myristin, myristic acid.

Pharmacological Activities: The essential oils of Jatiphala have shown antibacterial

activity against staph. Aureus ( Pathak et al) which causes URTI. certain chemical

extracts of Jatiphala like Ligroin extract, Trymristin has anxiolytic effect and

increases duration of sleep. It is aphrodisiac,anodyne, antihelminthicexpectorant

The essential oils showed antibacterial activity against B.anthracis, Staph.aurens;etc

(pathak et al)

Parts used - seed,oil

Dose - 1-2g, oil-1-3 drops


Rasa - Tikta Katu,

Guna - Laghu,Tikshna

Virya - Ushna

Vipaka -Katu

Dosha karma- Kapha-vata hara

Therapeutic actions: It is useful in Atisara-Grahani,,Visuchika.

LITERARY REVIEW


MATERIALS & METHODS


MATERIALS & METHODS

Objective of the study: To Assess the effect of Shashtikashalyadi Churna as a

weaning food on growth and development of infants.

Materials for the study –

SOURCE OF DATA:

Infants were randomly selected from OPD of S.D.M. College of Ayurveda and

Hospital, HASSAN.

Methods of collection of data:

Inclusion Criteria:

Infants between the age group of 6 to 9 months in whom weaning has not been

started yet were included in the study.

Exclusion Criteria:

1: Infants of Premature birth

2: Infants having malnutrition disorders like Protein energy malnutrition, Marasmus,

etc.

3: Infants having congenital disorders like cleft palate, etc.

4: Infants suffering from systemic diseases like tuberculosis; etc.

5: Infants having CNS disorders like cerebral palsy, mental retardation, congenital

diseases.

MATERIALS & METHODS


Securing of drugs:

Shashtikashali Shali, Godhuma (Wheat grain) and Yava were purchased from

Hassan local market of Hassan.

Vidanga churna, Jatiphala Churna, Ela Churna prepared from S D M

Ayurveda pharmacy, Hassan, Karnataka was taken.

The drugs were identified from Dept. of Dravya Guna.

Drug Preparation –







Rest drugs like Jatiphala, Ela, Vidanga churna obtained from SDMCA&H,



How Soaking, Malting, Sprouting improve nutritive value?

Soaking – Soaking in the water for some time initiates enzyme action &

germination. It increases Vitamins, Digestibility & also makes cooking easier.

All legumes may be soaked before cooking.

Malting – Soaking of some cereals overnight improves digestibility &

enhances vitamins. This is called as malting.

Sprouting / Germination – Germination of cereals & legumes augments

digestibility, increase Vitamins, reduces bulk on cooking & decreases phytate

levels. Digestibility increases due to production of Amylase.

MATERIALS & METHODS


Method of study:

40 infants between the age group of 6 - 9 months attending the Kaumarabhritya OPD

of SDM College of Ayurveda and Hospital Hassan and who were living in & around

Hassan city who are to be put to weaning were selected randomly & were taken up for

the study after following the criteria laid as above. Their age, sex, religion,

socioeconomic status, food habits family history, Anthropometric measurements etc.

were noted as given in master chart.

These 40 infants were divided randomly in to two groups:

1. Group A – Study group – containing 20 infants.

2. Group B – Control group – containing 20 infants.

Out of a total number of 40 infants taken for the study, three dropped out in the

middle and did not continue treatment in the study group. While out of 20 in control

group, 4 dropped out.

Complete history and clinical examination of all these infants was carried out and

recorded in a specially designed pro-forma by the Post-Graduate Department of

Kaumarabhritya of S D M College of Ayurveda and Hospital Hassan. Their findings

are given in the enclosed master chart.

Mode of Administration of supplementation –


By mixing with water boiling it for 20 min. till to form semi-solid consistency

added with cow‘s ghee and 1 tsp. of sugar to make it energy dense. Along with

this, breast milk breast feeding was advised to be continued.

Control group: along with breast milk, home-made mashed food was

advised.

MATERIALS & METHODS


Duration of study:

All the infants were given (of Study group) weaning powder for the period of 2

months.

Periodical evaluation was made once every month in all parameters of motor

skills.

Their achievement in various mile stones in Growth & Development was

recorded with the help of a Proforma prepared for the study.

Follow up Study:

After the completion of the study the parents and their infants were asked to

attend the OPD once in a month for 1 month to know whether the

improvement provided by the weaning powder (churna) is sustained.

OBSERVATIONS & RESULTS


GRAPH 1

GENDER WISE DISTRIBUTION

GRAPH 2

RELIGION WISE DISTRIBUTION



GRAPH 3

BIRTH ORDERWISE

GRAPH4

MONTHWISE DISTRIBUTION



GRAPH 5

VACCINATION

GRAPH 6 ANTE NATAL HISTORY



GRAPH 7

MODE OF DELIVERY

GRAPH 8 GRAPH 9

SMILES AT MIRROR IMAGE FAMILYWISE DISTRIBUTION



GRAPH 10

NATURE OF FOOD

GRAPH 11

BREAST FEEDING AFTER DELIVERY



TABLE NO. 7

ASSESSMENT OF DEVELOPMENT

GROSS MOTOR

Mile stone Actual Age

NECK HOLDING

3MONTHS(12 WEEKS BEYOUND)

ROLLING OVER

5MONTHS(20WEEKS)

SITTING

• WITH SUPPORT

• WITHOUT SUPPORT

24WEEKS

28WEEKS

STANDING

• WITH SUPPORT

• WITHOUT SUPPORT

32WEEKS

36WEEKS

CRAWLING

• CRAWLING ON BELLY

32WEEKS



OBSERVATIONS BASED ON TRIVENDRUM DEVELOPMENTAL SCALE

GRAPH 12

NECK HOLDING

GRAPH 13

ROLL OVER



GRAPH 14

SITTING WITH SUPPORT IN BOTH GROUPS

GRAPH 15

SITTING WITHOUT SUPPORT IN BOTH GROUPS



GRAPH 16

CRAWLING ON BELLY

TABLE NO.8 FINE MOTOR

MILE STONE

ACTUAL AGE

TRANSFORMS OBJ. HAHD TO

HAND

6-8MONTHS

PICER GRASP

9MONTHS



GRAPH 17

TRANSFERS OBJECT HAND TO HAND

GRAPH 18

PINCER GRASP



TABLE NO.9 SOCIAL / COGNITIVE MILESTONE

MILE STONE ACTUAL AGE

SMILES AT MIRROR IMAGE 6 MONTHS

GRAPH 19

SMILES AT MIRROR IMAGE



TABLE NO.10 LANGUAGE MILESTONE


BABBLES 6 MONTHS

IMITATES SOUND 9 MONTHS

GRAPH 20

BABBLES



GRAPH 21

IMITATES SOUND

GRAPH 22 GRAPH 23

STUDY GROUP STUDY GROUP



GRAPH 24 GRAPH 25


GRAPH 26 GRAPH 27

STUDY GROUP CONTROL GROUP



GRAPH 28 GRAPH 29

CONTROL GROUP CONTROL GROUP

GRAPH 30 GRAPH 31




GRAPH 32

UN PAIRED T TEST BETWEEN THE GROUPS



TableNo.11 showing Paired ‘t’ test in Study group

Parameter Mean BT Mean AT Mean

difference

SD SE mean T value P value

WEIGHT 6.2438 7.9250 -1.68125 .28802 .07201 -23.349 <.001

HEIGHT 64.6765 68.0471 -3.37059 .65361 .15852 -21.262 <.OO1

HC 42.7941 43.6294 -.83529 .27143 .06583 -12.688 <.OO1

CC 41.5312 43.6562 -2.12500 .78528 .19632 -10.824 <.001

MAC 13.7059 15.0882 -1.38235 .37622 .09125 -15.149 <.001

The initial mean weight of the infants in the study group before starting the weaning

food was 6.2438kg.

After the completion of intervention the mean weight was 7.9250kg.

There was 27 % improvement within the study group at p value < 0.001 on applying

the paired ‘t’ test within the group.

The initial mean Height of the infants in the study group before starting the weaning

food was64.67cm.

After the completion of intervention the mean Height was 68.04cm.

There was 5.52% improvement within the study group at p value < 0.001 on applying


The initial mean Head circumference (HC) of the infants in the study group before

starting the weaning food was42.79 cm.

After the completion of intervention the mean HC was43.62 cm.

There was 2% improvement within the study group at p value < 0.001 on applying the

paired ‘t’ test within the group.

The initial mean Chest circumference (CC) of the infants in the study group before

starting the weaning food was 41.53 cm.

After the completion of intervention the mean CC was 43.65 cm.

There was a 5.10 % improvement within the study group at p value < 0.001 on

applying the paired ‘t’ test within the group.

The initial mean Mid Arm circumference (MAC) of the infants in the study group

before starting the weaning food was 13.70 cm.

After the completion of intervention the mean MAC was 15.08 cm.

There was a 10 % improvement within the study group at p value < 0.001 on applying




TableNo.12 showing Paired ‘t’ test in Control group

Parameter Mean

BT

Mean

AT

Mean

difference

SD SE

mean

T value P

value

WEIGHT 6.5488 8.0188 -1.47000 .38609 .09652 -15.230 <.001

HEIGHT 61.9375 66.1250 -4.18750 1.75000 .43750 -9.571 <.001

HC 42.0000 44.7500 -2.75000 1.03280 .25820 -10.651 <.001

CC 40.5625 42.8125 -2.25000 .73030 .18257 -12.324 <.001

MAC 13.6250 15.2188 -1.59375 .27195 .06799 -23.442 <.001

The initial mean weight of the infants in the Control group was6.548 kg.

After the completion of intervention the mean weight was 8.018 kg.

There was 22 % improvement within the Control group at p value < 0.001 on


The initial mean Height of the infants in the Control group before starting the

weaning food was61.93 cm.

After the completion of intervention the mean Height was 66.12 cm.

There was 6.76 % improvement within the Control group at p value < 0.001 on


The initial mean Head circumference (HC) of the infants in the study group


After the completion of intervention the mean HC was 44.75 cm.



The initial mean Chest circumference (CC) of the infants in the Control group



There was a 5.55 % improvement within the Control group at p value < 0.001 on


The initial mean Mid Arm circumference (MAC) of the infants in the Control

group before starting the weaning food was 13.62 cm.


There was an 11.67 % improvement within the Control group at p value < 0.001

on applying the paired ‘t’ test within the group.



Table No.13showing Un- paired ‘t’ test in both groups

Parameters Group

STUDY

Group

CON.

SEM

Mean

Difference

t p

MEAN MEAN

WT _AT 7.8722 8.1067 -.23444 -1.182 >0.05

HC_AT 45.3333 44.6667 .66667 1.345 >0.05

CC_AT 43.5833 42.7667 .81667 1.390 <0.05

MAC_AT 15.0556 15.2667 -.21111 -1.282 >0.05

HT_AT 68.0444 66.0000 2.04444 2.943 <0.05

On applying un-paired ‘t’ test between the groups, the results showed that though

P value was >0.05 but comparing the mean weight of both groups- Study group

7.87 and Control group 8.10 kg respectively, shows that weight gain in the study

group is as good as and at par with that of control group.

On applying un-paired ‘t’ test between the groups, the results showed that P value

was >0.05 but comparing the mean Head Circumference of both groups- Study

group45.33cm and Control group44.66cm respectively, shows that Head

Circumference gain in the study group is as good as and at par with that of control

group.


P value was <0.05 but comparing the mean Chest Circumference of both groups-

Study group43.58 cm and Control group42.76 cm respectively, shows that Chest

Circumference gain in the study group is 2 % over control group.


P value was >0.05 by comparing the mean Mid Arm Circumference of both

groups- Study group15.05 cm and Control group 15.26cm respectively, shows

that Mid Arm Circumference gain in the study group is as good as and at par with

that of control group.


P value was <0.05 by comparing the mean Height of both groups- Study

group68.04 cm and Control group66.00 cm respectively, shows that Height gain

in the study group is 3% over control Group.



TableNo.14 showing Effect of weaning food on in control group

(Wilcoxon signed rank test as post hoc test)–

Negative ranks Positive ranks Ties Total Z Value P value

N MR SR N MR SR

Disease Attacks 1 4.00 4.00 6 4.0 24.00 9c 16 1.890 .059

Sleep pattern 4 2.50 10.00 0 .00 .00 12c 16 2.000 .046

Bowel pattern 6 3.50 21.00 0 .00 .00 10 16 2.449 .014

Post hoc analysis with Wilcoxon signed rank test was conducted with a

Bonferroni correction applied, resulting in a significance level set at p<0.05.

It was found that there was no statistically significant reduction in frequency

of attack of disease (Z=1.890) (P=0.59) in the control group.

There was statistically significant improvement in Sleep pattern after the study

in 4 infants with no change ( but not altered sleep pattern either) in the 12

infants, with 0 patients with altered sleep pattern (Z=2.000) (P=0.46)

There was statistically significant improvement in Bowel pattern after the

study in 6 infants, with no change ( but not altered Bowel pattern either) in

the 10 infants, with 0 patients with altered sleep pattern (Z=2.449) (P=0.14)



TableNo.15 showing Effect of weaning food on in study group


Parameters Negative ranks Positive ranks Ties Total Z

Value

P

value

N MR SR N MR SR

Disease

Attacks

3 2.00 6.00 0 0 .00 14 17 1.732 0.001

Sleep

pattern

11 6.00 66 0 .00 .00 6 17 3.317 0.001

Bowel

pattern

14 7.50 105.0 0 .00 .00 3 17 3.742 0.002

After the study was completed there was statistically significant improvement

in reduction of disease attack in 3 infants, with no change in 14 infants,

increase in 0 patients (Z=1.732) (p=0.001)









TableNo.16 showing Mann Whitney U Test between the Groups

Parameters STUDY GR CONTROL GR Z Value P

value

Remark

MR SR MR SR

BOWEL 15.92 286.50 18.30 274.50 1.247 .213 NS

Sleep 17.42 313.50 16.50 247.50 .913 .361 NS

DISASE

ATTACK

19.58 352.50 13.90 208.50 2.373 .018 S

Despite of improvement in Bowel pattern in both the groups assessed

separately but comparing both groups no significant improvement was found

study group over the control group.

At (Z=.913) (P=.361) mean rank (MR=17.42) (MR=16.50) the improvement

in the sleep pattern of Study and control groups resp. was not found to be

highly significant though individually in Wilcoxon sign rank test were

statistically significant.

There was statistically significant improvement in Attack of Disease with

mean rank (MR=19.58) (MR=13.90) (Z=2.373) (p=0.18) of the Study and

control Group resp. over control group.

DISCUSSION


DISCUSSION

For dehavrudhi factors like, Kalayoga, swabhava Samsidhi, Avighata are also

essential along with aahar saushthava. Among these aahar saushthava plays very

important role, as through aahar only nutrition can be supplied for growth and

development. Providing good complementary food is of prime importance.

The Research was conducted to evaluate the effect of Shashtikashalyadi Churna in

accelerating Growth & Development in infant during weaning period. The study

included 40 infants. The selected infants were divided into two groups, with 20

infants in each group. Infants of Control group (Group –B) had been asked to

continue with food from family pot. The infants of Treated Group (Group-A) received

ShashtikashalyadiChurna as semisolid porridge twice daily for 2 months. After the

study period infants were followed for another 1 month.

The discussion on Materials & Methods as well as on Observations & Results is as

given below.

Discussion on Objective

Weaning is a critical period of child’s life. It is termed as second step for self-

existence. This is the period where the transition from liquid milk diet to solid

complex diet occurs. If the child does not get proper nourishment during this period

the growth falters. Most of the children fall into the pit of malnutrition during this

period only. Studies on growth and development are of prime importance as far as the

pediatric field is concerned. The amplified concern is due to the fact that under

nutrition is still a burning problem, even with so many intervention modalities are

administered throughout the globe. The study intends to assess the efficacy of the

classical formulation by using present parameters of growth and development in

DISCUSSION


children. The broad objective of the study is to get an ideal palatable complementary

feed, which can meet the nutritional requirements, as well as to reduce the weaning

associated clinical conditions existing in the population. The search for such a

complementary feed begins with the formulation under consideration

Shashtikashalyadi Churna.

Discussion on Weaning Food.

Kashyapa has mentioned use of Shashtika shali or Purana shali which is husk-free,

well washed. Along with fine powders (Churna) of wheat(Godhuma), Barley(Yava),

that should given as semi-solid porridge cooked duly adding oleaginous substances

and salt. Also Vidanga is added to prevent further gastrointestinal disorders.

Further Kashyapa mentions that Vaidya should also take into considerations factors

like Desha

(Region/ Place- where child is living), Agni (Digestive Fire/ Metabolism), Bala

(strength), Kala (time), or whenever child is hungry, according to congeniality.

Ingredients of Weaning food contain shali, Yava, Godhuma, Jatiphala, Ela, and

Vidanga. Among them Shali, Yava, Godhuma are the main ingredients of the trial

drug Shali is bhrihmana hridya, balya,ruchya pittagna.Godhuma is balya,bhrihmana,

hridya, ruchiprada pathya, kasaghna, sara,sheeta, sandhana krut, Vata pittagnha.

Yava is krimi shleshmahara, visha hara, Pushti, Bala kara, pitta hara agni vardhaka.

Drugs like Jatiphala and Ela are mainly kasa- shwasaghna, ruchya , deepana.Vidanga

is mainly krimihara, deepana-pachana.

Discussion on Preparation and Storage of weaning food-

Careful hygienic preparation and storage of weaning foods is crucial to

prevent contamination.

DISCUSSION


Hands should have been thoroughly washed with soap and water before

preparation and feeding, and must be clean.

The foods should be preferably fresh cooked or boiled well and feasible,

prepared immediately and eaten.

Discussion on Family Pot food in Control Group

Out of 20 infants, 15 were given food like Ragi-sari and also “Anna-Saru” i.e. Dal

water with cooked rice and other mashed item like Banana. While 5 infants were fed

on Ragi sari only. Ragi malt is common weaning food in southern parts of India

where Ragi eaten. This diet is found to be rich in Carbohydrates, Proteins, calcium

and iron. Feeding from pot also has advantages in that it is economical, saves time

and infant grows up accustomed to foods traditionally eaten by family.

Developmental signs of readiness to feed:

There is a five-week gestational age range of term babies (born between 37 and 42

weeks gestation) and babies grow and develop at different rates. This means some

infants will be ready to begin weaning at an earlier postnatal age than others rather

than all being ready on one postnatal day (Platt 2009). Mothers usually begin weaning

large infants and male infants earlier than others (Wright et al 2004).

In practice the developmental signs that suggest that an infant is ready to accept solid

foods are:

Putting toys and other objects in the mouth

Chewing fists

Watching others with interest when they are eating seeming hungry between

milk feeds or demanding feeds more often even though larger milk feeds have been

offered

DISCUSSION


These developmental signs are generally seen between 4 and 6 months and this seems

to be the best time to start solids because from this age infants learn to accept new

tastes and textures relatively quickly (Harris 2000).

ESPGHAN Recommendations 2008 (Agostoni et al 2008)

The European Society for Pediatrics Gastroenterology, Hepatology and Nutrition and

the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

reviewed the literature on complementary feeding for healthy term infants in 2008 and

recommend that:

Exclusive breastfeeding for around 6 months is a desirable goal

Weaning onto solid foods should begin by 6 months but not before 4 months

Breastfeeding continues throughout weaning particularly the early stages

Introducing gluten between 4 and 7 months while breastfeeding may reduce

the risk of coeliac disease, type 1 diabetes and wheat allergy.

Ref: ( BDA Paediatric Group Position Statement:)

Weaning infants onto solid foods, Judy More, Catherine Jenkins, Caroline King and

Vanessa Shaw.

Concept of Amylase Rich Food:

The concept of Amylase –Rich Food or ARF directly addresses the twin

problems of dietary bulk and poor energy density of the weaning foods.

ARF is nothing but germinated cereal flours which are extremely rich in the

enzyme alpha amylase.

Alpha amylase cleaves the long chains of carbohydrates into shorter dextrins.

The single and unique contribution of ARF is that it can permit the mother to

mix in much more quantity into gruel and consequently make it high in energy

density, yet low in viscosity and dietary bulk.

The malting process increases the riboflavin, niacin, and iron content.

DISCUSSION


Discussion on Trivandrum scale:

It is used for assessing the development in infants. This test developed at

Trivandrum. This is a simplified version of Baroda development screening test. TDSC

was designed and developed at the Child Development Centre, SAT Hospital College,

Trivandrum. The Trivandrum Developmental Screening chart has shown a clinically

acceptability sensitivity of 68.8% and Specificity of 78.8% against DDST as gold

Standard. Hence, this chart is being recommended to be used as a mass screening test

for the detection of development delay in Children under 2 years of this.

Discussion on Observations

Gender wise:

As female and male ratio is equal i.e. 50% each. So, to comment on Growth &

Development in gender wise has no relevance.

Religion:

All the infants selected for the study were belonging to the Hindu

religion. As the infants selected for the study were from the area in and

around Hassan, which is Hindu predominant region.

Birth order:

Excluding the drop outs (total 7), 77.5 % infants were of birth order 1st and

remaining 5% of 2nd

in their families. As only 5% infants were of Birth order

2nd

among both groups, nutritional needs of babies were taken care adequately

as with the proven researches that malnutrition is much higher in families of

birth order 4th.

DISCUSSION


Vaccination:

All the infants (100%) were vaccinated that shows the awareness about

the immunization among the parents, which also contributes to the “Herd

immunity and Herd effect.”

Family Type:

87.5% were from the nuclear family, which was possible for parents to

early intervene with feeding pattern and other care.

Ante-natal history & Hospital delivery:

As all the infants were delivered in hospitals and cried immediately after

the birth, with no history of any assisted ventilation or NICU admission

for any Jaundice, or seizures or encephalopathy changes; etc. and mothers

having normal ante-natal history so other prejudiced risks like baby

suffering from HIE leading to brain damage and consequences which

would hamper further hamper growth and development at motor,

language, and cognitive, sensory aspects were ruled out. All the infants

included in the study were apparently healthy, so all of them were having

normal development.

Neck holding:

Among 40 infants selected for study, 87.5% had achieved neck holding at

3months, 7.55 at around 3.5 months and 5% at around 4 months, as the

actual age of appearance of milestone is between 3-4months, thus it

appears that all infants had achieved this milestone at proper time, and

there was no lag.

DISCUSSION


Roll over:

Among 40 infants selected for study, 90% had achieved Roll-Over at

5months, 7.5% at around 5.5 months and 2.5% at around 6 months, as the

actual age of appearance of milestone is between 5months and upper

limit till 6 months, thus it appears that all infants had achieved this

milestone at proper time, and there was no lag.

Sitting with Support:

In the study group out 17 completed patients, 76% have achieved sitting

with support at 6 months, 12% at 5months, i.e. a month earlier which can

be attributed to combine action of drugs like Shali which is of Madhura

Kashaya rasa, Shali is bhrihmana, hridya, balya, and ruchya pittagnha.

Godhuma is balya, bhrihmana, hridya, ruchiprada, sandhana krut. It is

anabolic and restorative. Yava is Balya, Agni vardhaka.

In control group all infants achieved at 6 months of age.

Sitting without support:

In the study group out of 17 completed patients, 83% achieved at 28

weeks (7months) while 17% achieved a week earlier. In control group 94

% achieved at 28 weeks and 6% at a week earlier. Thus it appears that all

infants had achieved this milestone at proper time, and there was no lag.

Crawling on Belly:


weeks (8 months) while 12% achieved a week earlier. In control group 94


infants had achieved this milestone at proper time, and there was no lag

DISCUSSION


within the group, and comparing both groups both achieved at

appropriate time.

Transfers object from hand to hand:

In the study group out of 17 completed patients, 71 % achieved at 6 -

6.5months while 17% achieved a week earlier, 12% achieved at 7months.

In control group 62% achieved at 6-6.5months and 12% at a week earlier,

25% achieved at 7months. Thus comparing both the groups, study group

shows more % in achieving milestone early, which can be attributed to

the action of the drugs like Shashtikashali, Yava, and Godhuma which

have contributory effect on Dhatu Vriddhi.

Due to the Tikta rasa of drugs in the formulation, this has Medhya karma,

Madhura, rasa which are aajanma –satmya, sarvadhatu vivardhana.

Pincer Grasp:

In the study group out of 17 completed patients, 95 % achieved at 9

months while 5% achieved a month earlier, In control group 100%

achieved at 9months.Thus 5% had achieved this fine motor development

earlier as effect of the drugs which is having Medhya action, Sarva Dhatu

vivardhana, as food is given along with “Go-ghrita” which helps to cross

the Blood-Brain Barrier and acts on various areas of CNS including

motor cortex, increased myelination of cortico-spinal tract is responsible

for pincer grasp.

DISCUSSION


DISCUSSION ON SOCIAL/ COGNITIVE MILESTONE:

Smiles at mirror image:

In the study group out of 17 completed patients, 83% achieved at 6-6.5 months while

12% achieved a month earlier, in control group 82 achieved at 6-6.5% months and 12

% achieved a month earlier. Thus 12% had achieved this cognitive development

earlier. As the cereals contain DHA which helps in brain development and increases

cognition capacity.

DISCUSSION ON LANGAUGE MILESTONE

Babbles:

In the study group out of 17 completed patients, all infants achieved at 9

months, in control group also all 16 achieved at 9months.Some of the

researches say that Babbling is determined by Neurological mechanisms

driving the motor control of speech production and physical maturation of

vocal tract. Infants at this age become aware that emotions can be shared

between people, they express as babbling , making different sounds, showing

toys to parents as way of expressing happiness.

Imitates sound:

In the study group out of 17 completed patients, 88 % achieved at9 months

while 12% achieved a month earlier, in control group 100% achieved at

9months.Thus it can be attributed to the Medhya action and balya action of the

drugs acting on CNS system.

DISCUSSION ON RESULTS:

Weight:

The initial mean weight of the infants in the study group before starting the

weaning food was 6.2438kg and Control group was 6.548 kg.

DISCUSSION


After the completion of intervention the mean weight was 7.92kg in Study

group and in control group 8.018 kg.

There was 27 % improvement within the study group and22 % improvement

within the Control group, after the completion of intervention. This

improvement can be attributed to the ingredients of the Weaning food.

As the drugs like Shalishashtik Godhuma are Madhura rasa predominant ,

Snigdha, balya, bhrihmana, Sandhana krut, while Yava is Pushti kara,balya,

helped in improving the weight in this group

As Shali, Godhuma mainly contains carbohydrates and proteins.

As the main function of carbohydrate is to supply energy for the body

processes. A greater part of the energy in the diet (more than 50-80%) is

supplied by carbohydrates

Recent studies have shown that carbohydrate is essential for oxidation of fats,

in presence of carbohydrates fats get oxidized to yield energy

Proteins polymers of amino acids, essential amino acids like leonine,

isoleucine, valise, lysine, threonine, tryptophan that cannot be synthesized by

body, are found in wheat, rice mainly; barley to some extent.

With the addition of ghrita as it is snigdha, Balya and agnivardhaka is

contributory.

The Studies have shown that the drugs that are rapidly absorbed from the gut

because of their lipid solubility are known to readily diffuse into the CSF and

the brain.

http://en.wikipedia.org/wiki/Leucine

http://en.wikipedia.org/wiki/Isoleucine

http://en.wikipedia.org/wiki/Valine

http://en.wikipedia.org/wiki/Lysine

http://en.wikipedia.org/wiki/Threonine

http://en.wikipedia.org/wiki/Tryptophan

DISCUSSION


Height:

The initial mean Height of the infants in the study group before starting the

weaning food was64.67cm and 61.93 cm in Control group.

After the completion of intervention the mean Height was 68.04cm in Study

group and66.12 cm within the Control group.

There was 5.52% improvement within the study group and was 6.76 %

improvement within the control Group.

In the study group improvement in the height was as good as with that of

control group, and can be attributed to, Shali, Godhuma, and Yava which have

contributory effect on Dhatu vriddhi.

Polyunsaturated fatty acids cannot be synthesized by the body. Two families of

the PUFA are important, namely Omega-6 (Linoleic acid and Arachindonic

acid) and Omega- 3. They should be available in the diet for better growth.

A child’s height depends upon pituitary and thyroid hormones and is strongly

influenced by genetic and socio-economic factors, especially nutrition.

Infants have different growth rhythms. ( The Normal Child, Ronald s

Illingworth, Published by Harcourt(India) Pvt.Ltd. reprint 2002,pg67-69)

In this age growth acceleration especially in height will be more.

Head circumference:


before starting the weaning food was 42.79cm and in the Control group

was42.00 cm.

After the completion of intervention the mean HC was 45.62 cm in Study

group and 44.65 in Control group.

DISCUSSION


There was 6.8 % improvement within the Study group whereas improvement in

control group was 6.3%.

Head circumference is measured as maximum point of the external occipital

protuberance posteriorly and a point just above the glabella anteriorly. The size

of the brain and ventricles. Brain is compared with the Mastulunga majja, skull

is asthi Dhatu, and srotomula is asthi Dhatu.

Asthi Dhatu is responsible for nourishment of the majja Dhatu. Shali,

Godhuma, Yava which have contributory effect on Dhatu vriddhi.

Also physical property of majja Dhatu is extreme unctuousness which is

capable of offering strength to the body.

DHA present in the cereals especially in Yava and Godhuma. They serve as

raw material for the synthesis of the eicosanoid which plat important role in the

regulation of Lipid metabolism. DHA is helps in better growth of cerebral

cortex and functioning of the retina.

The velocity of HC is 1/3 i.e. 2cm/3months (from 3months – 1year) of the

initial velocity (till 3 months- 2cm/1month) (IAP, Vol-1pg36,4th

ed, A

Parthasarathy, Jaypee Brothers Medical Publishers.)

Chest-Circumference:

The initial mean Chest circumference (CC) of the infants in the study group

before starting the weaning food was 41.53 cm and in the Control group was

40.56 cm.

After the completion of intervention the mean CC was 43.65 cm in the study

group and in the Control group was 42.81cm.

DISCUSSION


There was a 5.10 % improvement within the study group and that of control

group is 5.55%.

There is only 0.45 % improvement of Control group over Study, hence as it can

be taken as the improvement in the study group is as good as with that of the

control group in terms of chest circumference.

As the drugs like Shalishashtik Godhuma are madhura rasa predominant ,

snigdha, balya, bhrihmana, while Yava is pushti kara , balya helped in

improving the Chest circumference in this group.

Mid Arm-Circumference:

The initial mean Mid Arm circumference (MAC) of the infants in the study

group before starting the weaning food was 13.70 cm and in the Control group

was 13.62 cm..

After the completion of intervention the mean MAC was 15.08 cm in the Study

group and 15.21 in the control group.

There was a 10 % improvement within the study group there was an 11.67 %

improvement within the Control group.

There won’t be much difference in the increase in the MAC, as in infants

MAC is because of the subcutaneous fat but as the babies grow old, it is

replaced by muscle bulk.

Mid arm circumference is useful to detect malnutrition in young children.

Values more than13.5cm may be considered as normal, while values less than

12.5cm indicate significant under nutrition. (IAP, Vol-1pg37, 4th ed., A


Here the values in both groups were in the normal range.

DISCUSSION


Discussion on sleep pattern:


in 11 infants with no change (but not altered sleep pattern either) in the 6

infants, with 0 patients with altered sleep pattern (Z=3.317) (P=0.001) in study

group.



infants, with 0 patients with altered sleep pattern (Z=2.000) (P=0.46) in control

group.

This can be attributed due to the certain chemical extracts of Jatiphala like

Ligroin extract, Trymristin has anxiolytic effect and increases duration of sleep

Pattern of sleep and growth are related. Studies have shown that GH plasma

level during sleep is at peak than in day time. So it can be concluded sound

sleep is essential for normal growth pattern

During the initial days of weaning, solid foods must be given only during the

morning hours, and infant’s other normal feeding schedule should not be

disturbed, as this might leave infant hungry to wake up in night for feeds.

Discussion on Bowel Pattern:

In the study group (p 0.002) as compared to control group(p=0.14) the change

in the Bowel pattern, as the Yava is agnivardhaka, deepana, bahumala krut.

Studies have shown that soluble fibers found in barley increase bulk, soften

stools

Snigdha guna provides softness, vishada guna of tikta rasa helps in proper

srotoshodhana

DISCUSSION


So also Vidanga is jantughna, deepana-pachana, ushna which helps in ama

nirharana, thereby helps in proper stool formation.

Discussion on Attack of disease:

It was found that there was no statistically significant reduction in frequency of

attack of disease (Z=1.890) (P=0.59) in the control group, except for relief for

1 infant.




There was statistically significant improvement in Attack of Disease with mean

rank (MR=19.58) (MR=13.90) (Z=2.373) (p=0.18) of the Study and control

Group resp. over control group.

URTI and GIT are common in this age group, due to action of Jatiphala and

Ela as kasaghna , also Vidanga and Jatiphala as krimi hara, pachana

respectively

As malabsoption and nutritional disorders- Avighata is prevented by the

merit of these drugs

Studies have shown that Ela(elettaria cardamomum) is expectorant and its

Alexetric property controls infection

Chemical components of cardamom oil(a-pinene, b-pinene, sabinene, myrcene,

a-phellandrene) are expectorant and carminative.

The essential oils of Jatiphala have shown antibacterial activity against staph.

aureus ( Pathak et al) which causes URTI.

DISCUSSION


Eicosanoids play important role in the immune response and inflammatory

response to injury and infection.

Deficiency of EFA in the diet may result in growth retardation, skin and

increased susceptibility to infections.

Also shareera vridhhikara Bhavas like

Kaal-yog : effect of time, different seasonal changes on the body.

Swabhava- samsidhhi: natural pattern growth and development of an individual.

Aahar-Saushthav: quantity and quality of food consumed.

Avighata: Absence of factors affecting growth and development like diseases,

infections (Ati, Ayog,Mithya Yog)

If above factors are favorable, definitely growth and development are accelerated.

The results of the study showed that nutritional supplement provided was very

effective in accelerating Growth & Development of the body in general and of brain

in particular. And it helps in preventing Growth faltering. However it is suggested that

only nutritional supplement does not help accelerating Growth & Development. So,

along with nutritional supplementation one should also advise regarding Development

stimulation programs.

The composite Stimulation Package includes following attributes –

1. Medical –

Primary health care

Immunization

Treatment of intercurrent infections

Inpatient services

Periodic deworming

DISCUSSION


2. Nutritional

Dietary evaluation

Nutritional assessment and monitoring

Nutritional supplementation

Specific nutrient supplementation

Nutrition education

3. Stimulation

Developmental evaluation

Developmental information

Individualized tasks for catch up

Play therapy

Motor co-ordination tasks

Training activities of daily living

4. Psycho-Social

Social interview

Psycho-social counseling

Decision making Child rearing skills.

SUMMARY & CONCLUSION


SUMMARY

Weaning is the second step for self-existence. The first step is cutting of the

umbilical cord.


that determine child health as well as morbidity and mortality. Most of the children

fall into the Malnutrition during the weaning and post-weaning phase. Some even

succumb to it.

The objective of the study was to assess Growth & Development during weaning

period. The weaning period was selected because maximum & rapid growth occurs

during first two years of life including Brain development. And any improper

nutrition during this period may lead to unwanted out comes.

The study was able to satisfy its objectives quite comfortably. The methodology

adopted for the study helped to attain another objective – the ideal time for

administration of the formulation during the complementary feeding. No conclusions

regarding the sustained efficacy of the intervention as the study proper in each group

was only for two months

The entire work was divided into two parts. Part - I consists of review of

literature & part-II consists of Materials & Methods, Observations & Results,

discussion & Conclusion.

Twenty infants were selected for the study from OPD, IPD of SDMCA& H,

and Hassan and through home survey by simple random sampling method. The

selected infants were divided into two groups Group-A (Study Group) and Group – B

(Control Group). The total duration of the study was 2 months and infants were

followed once every month and were assessed in various parameters.



The drugs selected and given comprise of -

For Control Group (Group-B): along with breast milk, home-made mashed

food was advised.

For Study Group (Group –A): Shashtikashalyadi churna was given 2 tsp. 2

times a day.




The given nutritional supplement was highly appreciated by the mothers, as

the acceptance of product by the infant was very good & no un - towards

effects were reported and also the taste of the given nutritional supplement-

Shashtikashalyadi churna showed better palatability than routine food in the

control group.



CONCLUSION

1. The Study group infants showed equal improvement in various aspects of

Growth & Development including the Chest- circumference, weight, Height in

comparison with control group.

2. In the study group improvement in the height was significant than in control

can be attributed to, Shali, Godhuma, Yava which have contributory effect on

Dhatu vriddhi. Godhuma is Sandhana krut which can have contributory effect

on height.

3. The infants among Study group had sound sleep during night time in

comparison to control group.

4. The infants from both the groups attained their milestones at proper age.

5. Shashtikashalyadi Churna had better taste and was well accepted by the

infants as informed by the mothers.

6. The infants from treated group had less attacks of illness as compared to

control group. Drugs which were included in the food supplement helped in

reducing the frequency of attack of diseases.

7. Improvement in Bowel Pattern in the Study group than in Control Group was

due to effect of drugs in the formulation(weaning Food)

8. The overall result shows that the Nutritional supplement in the form of

Shashtikashalyadi churna as a weaning Food is effective in accelerating

Growth & Development of the child both in weight gain & in increase in head

circumference. This is because it provides the child extra calories, protein &

Essential Fatty Acids necessary for Growth of body & Brain. They

compensate the gap between the required and provided nutrition (calories).

9. The malting process increases the riboflavin, niacin, and iron content.



Limitations:

2 months of study period is not sufficient enough to claim any significant

improvement in growth and development in infants.

Less sample size.

Scales and instruments used must be standardized for uniformity.

Suggestions:

Further study can be taken up with at least for 6 months to claim any

significant improvement in growth and development in infants.

Comparative study can be taken with classical formulation with that of

available market complementary feeds.

Needs extensive research with larger sample size for longer duration.

A multi-disciplinary approach to make the formulation more stable and more user friendly.

A detailed experimental research to evaluate the nutritive value of the formulation.

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ANNEXURE

Clinical Study on Assessment of Growth and Development in Infants with Shashtikashalyadi Churna as Weaning food. Page I

RESEARCH PROFORMA

DEPARTMENT OF KAUMARABHRITYA

S.D.M.COLLEGE OF AYURVEDA &HOSPITAL, HASSAN.

Title :

Scholar : Sharvari S Deshpande.

Guide : Dr. Shailaja U

Name: Sl. No.:

Address: O.P.D.No.:

Age: I.P.D.No.:

Sex: Male / Female

Date of commencement of supplement:

Religion:

Informant:

Birth order: 1 / 2 / 3

Born of Consanguineous / Non- Consanguineous marriage.

Maternal history:

G P A L

H/ o Chronic illness

Birth History:

Antenatal history:-

Whether mother was antenatally registered at some Clinic/ Hospital/ Health centre?

Yes/No

Whether she suffered from any infection/ disease during pregnancy? e.g. TORCH,

Rubella.

Yes / No

Whether she suffered from other condition like PIH/ DM? Yes / No

Whether she was on any drugs except vitamin/ calcium/ Iron & folic acid

supplement? Yes / No. If Yes Specify…………..

Whether she received 2 doses of Inj. T.T. during pregnancy? Yes / No

Perinatal History:

Whether child was full term/ Pre term/ post term?

Born normally (vaginally) or by caesarean section or with help of forceps or vaccum?

Born at Hospital or Home?

Whether child cried immediately or required some sort of resuscitation like oxygen,

artificial ventilation?

Immediate Post natal History:

Whether child developed Icterus, Cyanosis? Yes / No

Whether child had Fever, Convulsion? Yes / No

Whether child was Breast-fed or was on Top feeds?

The No. of days the child was kept in Hospital.

ANNEXURE

Clinical Study on Assessment of Growth and Development in Infants with Shashtikashalyadi Churna as Weaning food. Page II

Immunization History:

B.C.G. – Given/ Not Given (At Birth)

Hepatitis B- Given/ Not Given (0 dose, 1 month, 6 months.)

OPV- Given/ Not Given (At birth, 6 wks, 10 wks, 14 wks.)

DPT- Given/ Not Given (6 wks, 10 wks, 14 wks.)

Any other vaccine

Family history:

H/o hereditary/ congenital diseases in the siblings? Yes/ No. if Yes specify………….

Dietary History:

Breast Feeding:

Whether Child has been breast-fed or not? Yes/ No

When was the Breast feeding started? Immediately after birth/ after …… Hrs.

Breast-feeding for ……. months.

Frequency……. /day.

Type of schedule (time or demand)

Whether feeds at night? Yes/ No

Whether breast milk vitiation is there? Yes/ No. If Yes …………(specify)

Whether any history of early cessation of breast feeding due to

1. Ignorance

2. Working Mother

3. Breast abnormalities

4. Increased use of subsidized use of milk powders

Maternal health during this period

Whether mother used contraceptives during the period of breast-feeding? Yes/No.

If Yes specify………..

Lacking child care due to

1. Unwanted pregnancy

2. Female child

3. Illegitimate child

4. Mental/ sub normal child

5. Chronic ill mother & child

6. Too many children

Top feed:

If top feed, whether it was Cow’s milk or formula milk?

What was the dilution used?

Whether he was bottle-fed or fed with wait-spoon?

Whether bottle, nipple were washed regularly before each feed?

Weaning:

Started or not started?

If started;

1. At what age?

2. Nature of food given to the child?

3. Amount of food given to the child?

4. Whether child was given fruit juice? Yes/ No. If Yes Then at what age………

ANNEXURE

Clinical Study on Assessment of Growth and Development in Infants with Shashtikashalyadi Churna as Weaning food. Page III

5. Is there any history of allergy towards any particular food?

6. Frequency of feeding?....../ day

7. Estimation of approximate caloric value of the food ……/ day

If formula feeds are given;

1. Improper dilution

2. Unhygienic preparation

Faulty feeding & customs:

Others:

1. Prejudice towards colostrum.

2. Lacking Amino protein in the diet.

Socio-economic History:

Type of Family- Nuclear / 3rd generation / Joint

occupation of father:

occupation of mother:

Education of father:

Education of mother:

Total income of the family / month:

Housing condition: living in chawl/ flat/slum:

Water supply:

water disposal & Sewage disposal:

General Examination:

Level of consciousness:

General condition:

Vital parameters:

Temperature:

Pulse:

Respiration rate:

Anthropometry:

1. Weight:

2. Height:

3. Head circumference:

4. Chest circumference:

5. Mid –Arm circumference:

6. upper segment / Lower segment ratio:

Examination of Head, Face & Neck: Ant. Fontanel

Examination of Mouth & Throat: Cleft Lip/ Cleft Palate

Dentition started or Not started

Whether any evidence of Protein or Vitamin deficiency? Yes / No.

Examination of Skin:

Signs of Dehydration / Vit. A deficiency/ Rash/ Signs of PEM

Examination of Nail:

Pallor/ Cyanosis/ Clubbing/ Koilonychia/ Brittleness (PEM)

ANNEXURE

Clinical Study on Assessment of Growth and Development in Infants with Shashtikashalyadi Churna as Weaning food. Page IV

Examination of Hair:

Light colored hair/ thin hair/ sparse hair/brittle hair with area of Alopecia (PEM).

Personal History:

1. Ahara: Kshirad/ Annada

2. Matra: Hina/ Madhyam/ Adhika/ Sama.

3. Nidra: Samyak/ Alpa/ Prabhuta/ asamyaka.

4. Kostha: Mridu/ Krura/ Madhyam.

5. Mutra: Samyak/ Alpa/ Prabhuta.

6. Satmya: Specific Rasa/ Sarva Rasa/ Mishra Rasa.

Systemic Examination:

Respiratory System:

Cardiovascular System:

Gastro intestinal System:

Central Nervous System:

Anthropometry:

Age of the infant & progress in each month.

6th

month

7th

month

8th

month

9th

month

10th

month

11th

month

12th

month

Date

Weight

Height

H.C.

C.C.

M.A.C.

Skin fold

thickness

Assessment of well being of child:

6th

month

7th

month

8th

month

9th

month

10th

month

11th

month

12th

month

Date

Attacks of

disease

Type of

Disease

ANNEXURE

Clinical Study on Assessment of Growth and Development in Infants with Shashtikashalyadi Churna as Weaning food. Page V

Sleep:

6th

month

7th

month

8th

month

9th

month

10th

month

11th

month

12th

month

Date

How many

times a day

Duration of

sleep

Sleep is

sound or

disturbed

Bowel:

6th

month

7th

month

8th

month

9th

month

10th

month

11th

month

12th

month

Date

Avg. no. of

times a child

passes a

stool/day

Consistency

Pakwa/

Apakwa.

Loose/Formed/

Hard

Whether child

complains of

abdominal

pain

Assessment of Development:

Gross-motor Development:

Mile stone Appearance Actual Age

Neck Holding

Lifts head well beyond the plane of the

body. Good head control achieved (Ventral

Suspension)

Prone position- Lifts chin & shoulder above

the ground.

Sitting position- Head lag is very slight.

Head maintained well in supine position

3 months

(12 wks. &

beyond)

Rolling over: From prone to supine.

20 Wks.

ANNEXURE

Clinical Study on Assessment of Growth and Development in Infants with Shashtikashalyadi Churna as Weaning food. Page VI

Sitting:

Sits on floor with hands forward for support.

Sits without support

24 wks.

28 wks.

Standing:

with support

without support

32 wks.

36 wks.

Crawling:

Crawling on belly

Crawling on Knee

32wks.

40 wks.

Walking:

Walks two hand held

Walks one hand held

Walks without support

48 wks.

52 wks.

58wks.

Fine Motor Mile stones:


Grasp reflex disappears 3 Month

Ulnar grasp 4 Month

Transforms object from one hand to

another

6-8 Month

Pincer grasp achieved 9 Month

Releases an object on command 1 Year

Hand to Mouth Co-ordination 28 Weeks

Hand to Hand Co-ordination 28 Weeks

Social / Cognitive Mile stone:


Looks at the face intently when spoken to 1 month

Social Smile 1 ½ -2 month

Recognizes mother,

Shows interest in surrounding

3 month

Smiles at mirror image,

Stretches arms out when mother is going

to lift him up.

6 month

Enjoys Peek-a-boo games.

Resists pulling away of toys.

9 month

Comes when called:

Pulls mother’s clothes to draw attention.

1 year

ANNEXURE

Clinical Study on Assessment of Growth and Development in Infants with Shashtikashalyadi Churna as Weaning food. Page VII

Language Mile stone:


Responds to sound 1 month

Coos, Laughs aloud 3 month

Babbles (Gaga, Dada, Mama) 6 month

Imitates sound;

Responds to Name

9 month

Speaks one word with meaning: 10 month

Speaks 1-2 meaningful words

(Monosyllables)

1 year

Sign of Scholar Sign of Guide Sign of HOD

Acknowledgement

This work is the combined effort of a good number of people, who include Researchers, Academicians, Friends, Colleagues, Parents, Laymen & above all the innocent infants who co-operated with us in all aspects. There is much greatness of mind in acknowledging a good turn as in doing it. First of all I bow my head to the feet of Lord Ganesha, Lord shiva & Lord Manjunatha for showering their blessings & empowering me to this eventful outcome without any impediments. It is because of God’s grace only the work could be completed as per my expectations. It is an inexplicable to offer my sincere & respectful regards to the persons whom I admire the most, my beloved Guruji- Sri Sri Ravishankar Guruji, with who’s Grace and Blessings am I here, blessings of my Mom-(Aai) Mrs. Sushama Sunil Deshpande. Dad-(Baba) Mr. Sunil Ganesh Deshpande & my Dearest grandparents for their untiring & indomitable support & out lasting affection be showed on me. I pay my respectful salutation to his holiness Pujya Shri. Virendra Heggadeji, founder of this institution for his blessings, which made me complete my thesis without hurdles. The inspiring work throughout this thesis work was Prof. Dr. Shailaja U., H.O.D. & Prof. Dept. of P.G. Studies in Kaumarabhritya, SDMCA&H, Hassan. The person who has devoted her life for the upliftment of this ancient system of Medicine, a person whose love & care like a Mother, who become a source of light whenever I was in darkness, who provided necessary fuel for my innovative thoughts. I am deeply indebted for her guidance broad mindedness & affection towards me. It gives me immense pleasure & proudness to offer profound gratitude to my beloved Principal Prof. Parasanna N. Rao for all his love guidance & co-operation in this work as well as throughout. I owe my humble gratitude & regard to Dr. Reena kulkarni. Ass0ciate. Prof. Dept. of Kaumarabhritya for evincing keen interest in my endeavors & for continued encouragement & valuable suggestions. I will be very thankful to her for kindest support. I am very much thankful to Dr. Sudhakar Powar, Prof, Dept. of K.B. Dr. Nithin, Associate. Prof Dept. of K.B., Dr. Vijaylakshmi Asst. Prof Dept. of K.B. And Dr. Nayan Kumar, Asst. Prof of Dept. of K.B. for their kind support during my thesis work. I am very much indebted to my mentor, esteemed & respected Dr. Sudheer for generating my keen interest in Kaumarabhritya.

Acknowledgement

I can’t forget guidance of Dr. Gurdip Singh, Dr. Girish K.J & Dr. Govind Sharma which gave me confidence to get along my work. I express my gratitude & cordial thanks to my close friends Dr.Arya, Dr. Nabisab, Dr. Vishvender, Dr. Chitrangana Chauhan, Dr. Archana Singh, Dr. Sreelakshmi, Dr. Mithuparvathy, Dr. Madhulika& who have helped me in shaping my thesis. I can’t forget my beloved seniors Dr. Sharashchandra R, Dr.Hrishikesh Tikole, Dr. Radha Jindal, Dr.Amal Babu, Dr. Ambika, Dr. Shital,. And my beloved Juniors Dr.Anand, Dr.Madhumita, Dr. Virupax Dr.Amrut Dr.Harikrishna, Dr.Nivya Dr.Shivanand, Dr.Dharmendra, Dr.Anjana, Dr. Shraddha,Dr. Deepthi ,Dr. Jitesh for their kind support. I am grateful to my colleagues & friends Dr.Shivjyothi, Dr.Sumeet for helping out with calculations and understanding result in SPSS. I also thank my other friends Dr. Arun Raj, Dr.Prashant. I am thankful to our librarian & Digital Library in-charge for their great co-operation also our Dept. attender Bhagyamma akka. I wish to thank physicians & all the staff of the hospital, the innocent infants & their parents for the kind co-operation whose total support made me to complete this work successfully. Last but not the least I extend my thanks to all those who have been directly or indirectly associated with study at various levels but not mentioned in this thesis.

Dr. Sharvari S Deshpande

Date: Place: Hassan

ABSTRACT

Background -

Under nutrition and problems associated with complementary feeding are of great

concern in the field of paediatrics. It has been estimated that in India, 65 per cent i.e.,

nearly 80 million children under five years of age suffer from varying degrees of

malnutrition. Most of the children fall into the Malnutrition during the weaning and post-

weaning phase. Some even succumb to it. Mothers are expected to make a bridge of

complementary feeding. Some mother’s do not make a Bridge at all and some make a

bridge that may collapse into the pit. So, a ‘Safety Net’ is needed beneath the Bridge.

This includes utilization of ‘Supplementary Feeding Programmes’. The trial was

proposed to study the efficacy of Shashtikashalyadi Churna during complementary

feeding by using specific parameters for growth and development.

OBJECTIVE OF THE STUDY:

To assess the effect of Shashtikashalyadi Churna as weaning food on growth and

development of infants.

MATERIAL AND METHODS:

Infants were selected from OPD of S.D.M. College of Ayurveda and Hospital, HASSAN.

Apparently healthy infants of weaning period were selected. Study & control group each

containing 20 infants were included in the study.


By mixing with water boiling it for 20 min. till to form semi-solid consistency added with

cow‘s ghee and 1 tsp. of sugar to make it energy dense. Along with this, breast milk

breast feeding was advised to be continued.

Control group: along with breast milk, home-made mashed food was advised.

Infants were assessed from age of 6months till the age of 9 months in various aspects of

Growth & Development.

Results –

Infants showed improvement in all aspects of Growth. Weight gain in treated group was

27 % (22% - Control Group), Height gain was 5.10 % (6.76 % - Control Group), and gain

Chest circumference was5.52 % (5.5% - Control Group). There was statistically

significant improvement in reduction of Attack of Disease and Sleep pattern.

Conclusion: Nutritional supplement Shashtikashalyadi churna containing was found

effective in accelerating Growth & Development during weaning period & it helped in

preventing Growth faltering.

Key Words: (Shashtikashalyadi churna, Growth & Development, Safety Net, weaning)

LIST OF ABBREVIATIONS

A.H - Astanga Hridaya

AT - After Treatment

A.S - Astanga Sangraha

B.P - Bhavaprakasa

B.S - Bhela Samhita

BT - Before Treatment

Cal. - Calories

Ch - Charaka Samhita

Chi - Chikitsa Sthana

gm. - Grams

Kcal - Kilo Calorie

Kg. - Kilogram

K.S - Kashyapa Samhita

Khi - Khila Sthana

mcg - microgram

Ni - Nidana

RDA - Recommended dietary Allowance

SD - Standard Deviation

SE - Standard Error

Sha - Shareera Sthana

Shar. - Sharangadhara Samhita

Sl.No. - Serial Number

Su - Sushruta Samhita

Su - Sutra Sthana

Ut - Uttara Sthana

Symbols Used

< - Less than

> - Greater than

% - Percentage

df - Degree of freedom

P - Probability

T - Test of Significance

INDEX

SL. NO: CONTENTS PAGE NO:

1. INTRODUCTION 1-4

2 AIMS & OBJECTIVES 5-6

3 LITERARY REVIEW 1-69

I. WEANING 8-24

II. SAMVARDHANA 25-33

III. GROWTH & DEVELOPMENT 34-59

IV. EVALUATION OF DRUG FORMULATION 60-69

4 CLINICAL STUDY

I. MATERIALS & METHODS 70-73

II. OBSERVATIONS 74-86

III. RESULTS 86-95

5 DISCUSSION 96-112

6. SUMMARY 113-114

7. CONCLUSION 115-116

8. BIBLIOGRAPHIC REFERENCES 117-121

8. ANNEXURES I-VII

LIST OF TABLES

S.NO TABLES P.NO

1 Various food Articles mentioned in Ayurvedic

Samhitas which can be used as weaning/supplementary

food

13

2 Showing Carbohydrate contents of various foods 48

3 Comparing chemical scores & NPU 53

4 Protein values of different food articles 52

5 Balanced Diet for Infant – ICMR 55

6 Recommended Dietary Allowance for Infant 56

7 Assessment of development

Gross motor

79

8 Fine motor 82

9 Social / cognitive milestone 84

10 Language milestone 85

11 Paired ‘t’ test in Study group 90

12 Paired ‘t’ test in Control group 91

13 Un- paired ‘t’ test in both groups 92

14 Effect of weaning food on in control group 93

15 Effect of weaning food on in study group 94

16 Mann Whitney U Test between the GROUPS 95

LIST OF GRAPHS

S.NO GRAPHS P.NO

1 GENDER WISE DISTRIBUTION 74

2 RELIGION WISE DISTRIBUTION 74

3 BIRTH ORDERWISE 75

4 MONTHWISE DISTRIBUTION 75

5 VACCINATION 76

6 ANTE NATAL HISTORY 76

7 MODE OF DELIVERY 77


9 FAMILYWISE DISTRIBUTION 77

10 NATURE OF FOOD 78

11 BREAST FEEDING AFTER DELIVERY 78

12 NECK HOLDING 80

13 ROLL OVER 80

14 SITTING WITH SUPPORT 81

15 SITTING WITHOUT SUPPORT 81

16 CRAWLING ON BELLY 82

17 TRANSFERES OBJECT HAND TO HAND 83

18 PINCER GRASP 83


20 BABBLES 85

21 IMITATES SOUND 86

22 STUDY GROUP WEIGHT 86

23 STUDY GROUP HEIGHT 86

24 STUDY GROUP HC 87

25 STUDY GROUP CC 87

26 STUDY GROUP MAC 87

27 CONTROL GROUP WEIGHT 87

28 CONTROL GROUP HEIGHT 88

29 CONTROL GROUP HC 88

30 CONTROL GROUP CC 88

31 CONTROL GROUP MAC 88

32 UN PAIRED T TEST BETWEEN THE GROUPS 89

INTRODUCTION



INTRODUCTION

INTRODUCTION



INTRODUCTION

The dimensions of health are always changing. In the present era, health is

considered “not mainly an issue of doctors, social services, and hospitals. It is an

issue of social justice”. World Health Organization broadly defines health as “a state

of complete physical, mental, and social well being, not merely an absence of disease

or infirmity”. The above concept of health envisages several spiritual, emotional,

vocational, and political dimensions. Presently exploring medical requirements are,

most of the time incapable to fulfill these views. Therefore, Ayurveda, popularly

known as the Indian system of medicine, which is considering the living systems in its

physical, mental, and spiritual levels, gains high acceptance in the western scientific

world. The medical system is giving equal importance to preventive, curative, and

prophylactic aspects of medicine, there by maintaining the sensitive homeostasis of

the body, which is the foundation of happy and wholesome existence of every living

being.

Kaumarabhritya, is the branch of Ayurveda which elaborates pediatrics and

even more. It covers all aspects from genetics to dietetics in children. It gives a

complete guidance for reproductive child health care, infant and young child feeding

practices and adolescent care. The science had a very precise way to make out the

health and ill health of the child and the proper growth and development. It also has

immunization methods based on its principles.

INTRODUCTION



a. Need and significance of the study

Good health depends on an adequate food supply, which in turn depends on a

sound agricultural policy, a good food distribution system and proper health

education. A healthy younger generation with duly developed body, mind and brain is

the bedrock for a good future. Every child in every part of the world has the potential

to grow and develop as long as his and her basic needs are met. Adequate supply of

essential nutrients required as per age is the most important factor for the proper

growth and development.

Infant and young child feeding is the subject of great concern in the field of

nutrition since malnutrition in early childhood has serious, long-term consequences

because it I impedes motor, sensory, cognitive, social and emotional development.

Malnourished children are less likely to perform well in school and more likely to

grow into malnourished adults, at greater risk of disease and early death. One in three

of the world's malnourished children live in India. Where, around 46 per cent of all

children below the age of three are too small for their age, 47 per cent are

underweight and at least 16 per cent are wasted.

WHO Global Strategy for Infant and Young Child Feeding, advocates

exclusive breastfeeding for the first six month with the introduction of local and high

nutrient complementary foods after six months while continuing breastfeeding to two

years and beyond. After six months of age a child needs high-energy and high nutrient

foods that are rich in vitamin A, vitamin C, iron and other important minerals, in

addition to breast milk. Children are more physically active and they continue to grow

rapidly during the second half of first year.

INTRODUCTION



The introduction of complementary foods is a time of transition when children

gradually becomes used to eating semi solid and solid foods. The nutritional role of

mother‟s milk in the second year is inversely related to the adequacy of the

complementary diet. Improper nutrition during weaning and post weaning period is

the root cause of malnutrition in children. This is a period of great dilemma, stress and

humiliation to the child and is associated with many disorders like constipation,

diarrhea, colic etc. This physical and mental turmoil along with the need for a highly

nutritious diet points out the importance of an ideal weaning food. The present study

aims to find the solution for this grave problem.

b. Aim and objectives of the study

The study intends to find the efficacy of the formulation Shashtikashalyadi

churna in the growth and development of infants during complementary feeding. The

study aims not only to the efficacy of the formulation; as a broad objective, the ideal

time for its administration is also considered. Nationally accepted international

parameters are used for the assessment. These standards depict normal growth under

optimal environmental conditions and can be used to assess children everywhere,

regardless of ethnicity, socio-economic status and type of feeding

INTRODUCTION



c. Contents of the thesis

Title of the thesis is „CLINICAL ASSESSMENT OF GROWTH AND

DEVELOPMENT IN CHILDREN IN INFANTS WITH SHASHTIKSHALYADI

CHURNA AS A WEANING FOOD.’

The thesis consists of the following parts.

I. Introduction

II. Literature review

III. Methodology of research

IV. Observation, analysis and interpretation

V. Discussion, summary and conclusion



Aims & Objectives of the study

The principles of treatment described in Ayurvedic medicine, can be broadly

classified into two types. First is the Oorjaskara line of treatment, which aims at

increasing the body growth & strength & help in preventing the diseases (Tonics).

Second line of treatment is mainly concerned with the treatment of diseases

(Rogaghna).

Oorjaskara line of treatment is of two types Rasayana & Vajikarana. Rasayana

treatment is that line of treatment, which helps to decelerate the aging process & to

increase the general well being & resistance power of the body. Vajikarana (Vrishya)

treatment mainly aims at increasing the Shukra dhatu in the body, which ultimately

helps in the body growth & development in the children, and in men helps for

increasing sexual act and satisfaction (libido).

The development of human body from a single fertilized egg to a trillion of

cells involves cell growth, cell replication & cell differentiation. The Shukra Dhatu

can be attributed to cell reproduction, thereby effecting the growth & development

during the intrauterine life as well as during the extrauterine life until the maturity is

attained. Hence this may be the reason that the Madhura, Snigdha, Jeevaniya &

Brumhana Dravyas are indicated during the antenatal care, for the optimum growth &

development of the fetus.

The Shukra Dhatu is present in children also, in smaller quantity & this Shukra

Dhatu is increased with the passage of time and becomes distinct similar to the

fragrance perceived in a fully bloomed flower. The function of Shukra Dhatu appears

to be mainly the Garbhotpadana (reproduction), whether of the cell or of the organism

as a whole. (Dr. C H S Sastry).



Considering all these facts the described Shashtikashalyadi Churna as weaning

food told by Kashyapacharya as the food of supplemental value with all these

properties was selected for the study.

The study was undertaken with the objective-

To accelerate the Growth & Development of infant during weaning period

LITERARY REVIEW


Chapter 1

Weaning

Importance of Food –

“Deho Ahara Sambhavah” (Caraka)

Body is derived from Food. All living beings are formed from food. They sustain and

grow on food. The food is indispensable for living creatures.

Definition of Food-

Food is defined as essential substance having a pleasant aroma & taste which is

capable of being digested, absorbed & utilized when consumed in proper manner & in

appropriate quantity so as to help living organism to replenish the wear & tear of body

tissues, produces new body components & that which imparts energy, strength &

happiness.

Properties of Food –

Food provides life, building material for the body, strength, enthusiasm, a sense of

satiety, color, luster, memory, intellect inspiration and helps in conception and

propagation of the species. Food provides energy to carry out life activities which can

lead one to heaven or help one to attain „Moksha‟. Health and happiness depend on

food. A beneficial diet gives happiness, health and prolongs one‟s lifespan. A harmful

diet promotes disease and makes one depressed.

Importance of beneficial Diet1 –

Even if the patient does not take medication, the disease can be cured by taking a

beneficial diet and avoiding a harmful diet. If the patient does not follow the diet

advised by the physician, medication alone will not cure him.

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Anna-Prashana Sanskar –

There are scattered references available in literature regarding when to start the solid

foods in infant.

Grhya Sutras2 –

1. Paraskara Grhya Sutra – In Paraskara grhya Sutra, a simple principle has been

followed that food of all kinds of flavors should be mixed together and given to the

child.

2. Samkhyayana Grhya Sutra3 – Weaning food has it‟s effect on the child. (Shown

in Table No.)

3. Aapstambha Grhya Sutra, Aasvalaayana Grhya Sutra, Hiranyakeshiya Grhya

Sutra – Most of the Grhya Sutra have advocated the use of various birds and other

food articles for weaninig4.

Manusmrti5–

According to „Manusmrti‟ Anna-prashana should be started somewhat around sixth or

eighth month. Otherwise this samskara should be done in accordance with the family

custom (Kulachar).

Caraka Samhita -

There are no references available in Caraka Samhita regarding Anna-prashana.

Sushruta Samhita -

Acharya Sushruta also advises to start weaning after six month of age6. He advises to

offer Laghu (Easily Digestible) and Hitakara (Beneficial) Diet to child after six

months of age. He further explains the use of Yastimadhu, Vacha, Pippali, Chitraka

and Triphala siddha Ghrita in children which consume Kshira and Anna (Kshirannad

Avastha). This Ghrita increases Aarogya, Bala, Medha and Aayu7. While mentioning

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what food can be given in absence of Mother‟s Milk he explains the use of Goat‟s

Milk or Cow‟s Milk as Milk is considered Satmaya to Bala8.

Astanga Samgraha and Astanga Hridaya-

Astanga Smgrahakara also agrees with the opinion of the Sushruta and they also

advise that „During the sixth month, solid food should be given to the child gradually,

as much as it desires (without forcing it) and as it goes on discontinuing Breast Milk9.

In one other quotation he explains that with eruption of the teeth, the child should be

gradually weaned from the Breast; other kinds of milk (mentioned earlier, i.e. Goat‟s

or Cow‟s milk) and boiled rice and such foods which are easily digestible (Laghu) and

Nourishing (Brihmana) should be given10

.

Vagbhatacharya further explaining „Stanyabhave Upayaha‟10

says that „In the non-

availability of Breast milk, Milk of either a goat, or a cow having similar properties

can be given to drink, boiled along with the roots of Brihati, etc. (Laghu-Panchamoola

drugs) or the two sthira (Shaliparni, Prishniparni), Brihati etc.

He further explains few methods for weaning the child of the Breast „Stanyapanayana

Upayah11

as- Weaning from the Breast can be done by smearing it with oil, by making

it look ugly, making red colored marks on it resembling ulcers and showing them to

the child etc.

Vagbhatacharya‟s most important contribution while explaining weaning is use of

„Modakas‟12

which can be taken as the food of supplemental value.

He advises that in case of greater hunger in the child weaned of the Breast, he should

be treated as treating (the disease) Atyagni or as a case of Parigarbhika13

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Kashyapa Samhita14

-

Kashyapa Acharya advices that the physician should prescribe feeding (juice) of

various fruits in the same month (6th

month). Afterwards definitely after eruption of

teeth or in tenth month, the feeding of cereals (Anna-prashana) should be done.

Kashyapacharya opines that „Phala-prashan Samskara‟ should be performed

along with „Upaveshana Samskar‟ in the sixth month. On an auspicious day, after

worshiping gods and satisfying the Brahmans by diets and donations; the physician

having recitation of auspicious words, making rounded or square shaped altar with the

help of cow-dung and water, in clean place of the center of the house or

apartment/garden measuring four hasta (about 72 inches). A holy Fire is Lit & the

offerings are made to fire God with different Vyanjanas stating “As nectar is fior

gods, the sudha (wine) for king elephant, so are the cereals for life of living beings,

anna (cereal) is called prajapati. As the Trivarga (religion, wealth and desire) and

universe is born, so is the cereals. That is why the fire I perform oblation in you of

this cereal giving pleasure. Prajapati supports it Svaha.”

Kashyapacharya states that while holding the child, the leftover (food) after

oblation, in the quantity equal to thumb (small quantity), after making it soft by

mashing be given in his (infants) mouth. Three or five times; after feeding, should

touch him (clean with water); afterwards raising (increasing the quantity) twelfth

month onwards after desired for food, following should be given in small quantity.

Selection of Diet for the children – The diet consumed by the pregnant woman

become wholesome to the child, therefore only those articles should be offered to that

child. Place, time and digestive capacity should not be transgressed.

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Lehyas -

Kashyapacharya in Lehana adhyaya explains few lehyas, which we can use as

supplemental food for the child.

The children of mothers having no Breast- Milk, deficient Breast-Milk, or

vitiated milk, of parturient woman(mother) or of a wet nurse of similar conditions, (or

of the woman) having undergone difficult labor or severely ill; the children who have

predominance of Vata and Pitta, (but) not of Kapha, who do not get satisfied with

Breast milk and cry in spite of repeatedly sucking; the children who do not sleep in

the night, eat too much, pass scanty urine and feces, children who have increased

digestive power, though free from disease yet scraggy, have delicate body-parts and

are emaciated, do not pass urine and feces even for three days; such type of children

should be prescribed electuaries as said by Kashyapa.

Shrangdhara Samhita -

Sharangdhara Samhita also explains the same thing. That is - in „Stanyabhava‟15

one

should consider that Milk is Satmya to the child and child should be given either

goat‟s milk or cow‟s milk in the quantity that satisfies the child (child‟s hunger). And

regarding the period of introduction of solid food he opines that child should be given

solid food (Anna-prashana) in sixth or eighth month according to the Shastrokta

method16

. Child should be offered very small quantity of solid food initially and the

quantity should be increased gradually.

Indu (Astanga Samgraha Tika) 17

-

One should start Anna-prashan to the child in sixth month. Food should be given

gradually to the child. The very purpose of increasing the quantity of the food

gradually is that, as child accepts more and more solid food one misses the Breast

feeds in the same proportion.

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Bhavaprakash Nighantu18

–

Bhavaprakash advises to give child the food for the first time in sixth or eighth month.

And one should increase the quantity of food gradually according to the

avasthavriddhi.

Table No. 1 - Various food Articles mentioned in Ayurvedic Samhitas which can

be used as weaning/supplementary food –

S.No Samhita/ Grantha Food Article Effect on child

1. Samkhyayana

Grihya Sutra

Flesh of bird Bharadwaj Fluency of speech

Flesh of bird Kapinjal and Ghrita Proper nourishment

Flesh of bird Krkasa or rice mixed

with honey

Long life

Flesh of bird Ati Holy – lustre

Rice mixed with Ghrita

Curd and Rice

Brilliance

2. Paraskara Grhya

Sutra

all kinds of flavors should be mixed

together and given to the child

-

3. Aapastambha

Grhya Sutra,

Aasvalaayana

Grhya Sutra,

Hiranyakeshiya

GrhyaSutra

Most of the Grhya Sutra have

advocated the use of various birds

and other food articles

-

4. Manusmrti In accordance with the family custom

(Kulachar).

-

5. Caraka Samhita no references available -

6. Sushruta Samhita

Laghu (Easily Digestible) and

Hitakara (Beneficial) Diet

-

Yastimadhu, Vacha, Pippali, Chitraka

and Triphala siddha Ghrita in

Kshirannad Avastha

-

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7. Astanga

Samgraha and

Astanga Hridaya

Modaka (Sweet ball) made from

marrow of Priyala, Madhuka

(Yastimadhu), Madhu (Honey), Laja

and Sitopala

-

Modaka made from Dhataki Pushpa,

Sharkara and Laja tarpana

Is water absorbent

(Samgrahi,

constipating)

Modaka prepared with Bala, (tender)

Bilva, Ela, Sharkara and Laja Saktu

(flour of Laja)

carminative

8. Kashyapa

Samhita19

cooked liquid made with husk-free

well washed Sali or Sasti rice

especially old rice, mixed with

oleaginous substances and salt

Is promoter of

nourishment of the

child.

The powders (flour) of wheat and

barley can also be given according to

congeniality

Is promoter of

nourishment of the

child.


salt, oleaginous substances

is beneficial


salt, oleaginous substances + kodrava

Is beneficial to the

one having diarrhea

mrdvika with honey and ghrita Beneficial for one

having

predominance of

Pitta in constitution

diet with good quantity of juice of

matulunga and salt

Is beneficial in

predominance of

Vata in constitution.

In general one knowing place (of

living), fire (digestive/ Metabolic

fire), strength and period, whenever

observes (the child) as hungry, should

give him the food according to

congeniality with the gap of one or

two (periods)

-

Various Lehyas are described which

can be given in absence of breast

milk.

-

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9. Bhavaprakash,

Indu,

Sharangadhara

Have not mentioned anything specific

Various Indian Cultural Practices of Annaprashana Sanskara20

–

Karntaka – Traditionally the „Paramanna‟ containing Boiled rice, Sugar, milk

& Honey is placed in the infant‟s mouth

“Padracha Khava, pann Nazaracha khau naye” goes the Maharastrian

saying. It means „that you are welcome to have a ceremony and feed the baby what

you will, but do not make it to ostentatious that you invite the evil eye!

In the Maharashtra it‟s a small family affair in the seventh month, and the

mother‟s brother is the one who does the „Annaprashana‟ or the „Ushtavan‟ (as

they call it). On that day mother‟s parent and brother arrive with the gifts of silver

Katori and spoon, and a gold ring. He dips the gold ring in the prepared Kheer and

places a tiny bit in the baby‟s mouth.

While Gujarati adopt a more practical aspect and start weaning early, say in the third

month, with kheer and puri

Parsis give sweet Dahi with yellow lentil & rice called dhun dhar as first solid food.

Keralites have a ceremony called “Chor-oonnu”. Where after consulting Panchangam

for an auspicious day, parents take child to temple for blessings & morsel of Ghee rice

which is first offered to God is given. Followed by sweet milk & rice Payasam.

For Punjabi & Sikhs it is a quiet little ritual, take child to Gurudwara and priest chants

ardaas & offer Khadah Prasad (Delicious Halwa made from wheat, Ghee & Sugar)

Perhaps the most common ceremonial „Annaprashana‟ is the Bengali one. Baby

dressed as Bride or Bride Groom and seated in Mother's lap. After pooja mother dips

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a golden ring in „Payesh‟ & allows the baby to suck on it. Some may offer tiny bit of

boiled fish, shukto & sweetened doi( Dadhi)

Weaning

Weaning is the second step for self existence. The first step is cutting of the

umbilical cord


that determine child health as well as morbidity and mortality.

What is Weaning?

Even though the 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. And also it is essential to prevent growth faltering.

Weaning means to „accustom to‟ or „to free from a habit‟. It is the process to

accustom the baby to semisolids and solids in order to gradually free the baby from

the habit of sucking at the Breast. Weaning is defined as “The systematic process of

introduction of suitable food at the right time in addition to Mother‟s milk in order to

provide needed nutrients to the baby.” (UNICEF, 1984).

The term „Complementary feeding‟ is now preferred because weaning implies

abrupt stoppage of Breast feeding, at least to some mothers.

The process begins when the child is first offered food other than Breast-Milk

or formula. The process may be very gradual, with other foods forming an increasing

proportion of total energy intake over several months until Breast or formula is

eventually phased out completely. During Weaning, there is ideally gradual transition

from very high –fat, high-sugar diet, liquid diet to a starchy, moderate-fat, low-sugar

and fibre containing, solid diet. The magnitude of compositional and textural changes

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involved would seem to indicate the advisability of a gradual transition to allow

babies to adapt to them.

Time of Weaning or complementary feeding -

By five months of age, birth weight doubles and the nutritional demands

gradually increase and the calcium and iron stores get depleted. Baby needs around

600-700 cal/day, and around 600ml. of Breast milk can supply only 400 cal. And also,

the breast Milk supply increases till 6 months and then it plateaus off. By four months

of age, the baby achieves head control and develops hand to mouth co-ordination and

starts enjoying mouthing. Intestinal Amylase matures and the gut becomes ready to

accept Cereals and Pulses (Legumes). Gum hardens prior to teeth eruption and the

baby enjoys gumming semisolids. Thus, baby is „biologically ready‟ to accept semi-

solids by 4-6 months of age. In the report „Present day practice in infant feeding‟

(COMA, 1988), it was concluded that very few infants require solid foods before 3

months of age, but that the majority require them by 6 months of age. It was

recommended in this report that weaning should not begin before 3 months, but that

the infant should be offered a mixed diet by 6 months of age. After about 6 months, it

is thought that Breast milk can no longer supply all of the nutritional needs of the

infant and growth is likely to be impaired if the baby receives only Breast-Milk.

Breast-Milk or formula may continue to make a contribution to total food supply long

after weaning has begun.

The COMA panel considered too early introduction of solid foods undesirable

because:

Some babies do not properly develop ability to bite and chew before 3-4

months

The infants gut is very much vulnerable to infection and allergy

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The early introduction of energy-dense weaning foods may increase

the likelihood of obesity

Continuation of Breast Feeding

Breast milk should continue to be the main food of the baby even when

weaning is started. To minimize interference with normal Breast feeding, it should be

given between two feeds. Breast feeding should continue for as long as feasible,

preferably till two years of age. This is important as the first two years is a period of

rapid brain growth and Breast milk contains factors for brain growth and

development.

It has been suggested that full production of pancreatic amylase does not occur

in human infants until 6-9 months of age. As milk contains no starch but most

weaning foods are starchy, this may be a physiological indicator that relatively late

introduction of starches into the diet is desirable. Introducing starchy solid foods may

produce symptoms similar to those of infectious gastroenteritis because of poor

digestion and absorption due to lack of pancreatic Amylase (COMA, 1988)

Dewey KG et al in a research conducted in Honduras, examined the effects of

introducing complementary foods at 4 months or 6 months of age on maternal and

infant outcomes. They concluded that exclusive breastfeeding until 6 months,

compared to only 4 months, results in increased maternal weight loss, longer duration

of amenorrhea, and earlier achievement of certain motor skills in the infants. In most

populations the advantages of exclusive breastfeeding for the additional 2 months

probably outweigh the disadvantages. In developing countries where concerns about

the mother‟s nutritional state exist, supplements provided to the mother may be the

preferred option over earlier weaning21

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Dewey KG et al in another research concludes that Iron supplements starting

at 2 months are important for small-for-gestational age, exclusively breastfed babies

and may be more effective at maintaining iron status than introducing iron-rich solid

foods at 4 months22

.

A study on Effects of age of introduction of complementary foods on iron

status of breast-fed infants in Honduras was made by Dewey KG et al. Authors

conclude that (assuming plasma ferritin is a good index of iron deficiency) breast-fed

babies weighing more than 3000 gm at birth may not need additional sources of iron

before 6 months. However, those with birth weights less than 2500 gm should receive

iron drops beginning at 2-3 months of age, since starting iron-enriched solids at four

months was not effective in preventing anemia. For breast-fed infants with birth

weights between 2500 and 3000 gm, more research is needed to determine the best

strategy to prevent anemia and promote health23

.

Norris JM et al. & Ziegler AG et al. in two different researches separately

concluded that parents should be encouraged to follow current guidelines and avoid

introducing cereal to infants before four months of age. The advice is especially

important for infants with a family history of type 1 diabetes24,25

.

Researches regarding why to introduce solid food in the Sixth month or why not

before six month -

Pancreatic Digestion -

Klumpp & Neale (1930) studied the enzymes in duodenal contents of infants. They

found that he proteolytic activity was quite high, the lipolytic activity fairly high,

while the amylolytic activity very low in infants 1 to 3 months old. The amylolytic

activity was found to increase steadily after the 5th

month. Due to lack of Amylase

activity young children can not digest starchy food to an appreciable extent.

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Wolman (1946) studied the pH of the Gastric contents over a period of 1 ½ hours

after the ingestion of cow‟s milk in the young infant (1 – 2 month old) as compared

with infants aged 6 to 11 months and young children. The result showed that

a) The pH of the gastric content of the infants aged 1 to 2 months was about 6 &

almost constant, and

b) The pH of the gastric content of the infants aged 6 – 11 months fell from 6 to 4.8

while the pH of the gastric content of the young children fell steadily from 5.6 to 2.5.

These results support the observations of the workers that the secretion of

hydrochloric acid is very low in young infants (1-2 months) & the amount of acid

secreted increases as infant grows.

What Weaning Foods?

In the UK, the first foods for most babies are cereals or commercial weaning foods

rather than home-prepared weaning foods (COMA, 1988) (Foster et al., 1997)

The Priorities for Weaning Foods -

In a recent review, Poskitt (1998) suggested that weaning food should be:

Rich in Energy

Rich in Vitamins and Minerals

Fed frequently

Initially used as a supplement to milk rather than a replacement

Fed in a form that develops the child‟s feeding skills whilst still allowing assistance

Weaning or Complementary Foods –

Mono-cereals is preferred initially followed by multi-cereals & cereal-pulse

combinations. They should be locally available, cheap & acceptable. Cereals like

Ragi, rice, wheat etc. are good weaning foods.

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Cereal – pulse combination is better due to fortification of Amino acids as Cereals

generally lack lysine & pulses lack Methionine.

Tubers, fruits, biscuits & banana powder are also popular weaning foods.

Addition of jaggery will increase Calories & Minerals.

Addition of milk will increase protein &

Oil will increase calorie intake.

Coconut milk can be added instead of cow‟s milk. It is rich in Lauric acid, which

promotes Brain Growth.

One of the main aims of weaning is to raise the energy density of the infant‟s

diet above that for Breast-Milk. The weaning food should have a suitable texture, but

be of high enough energy and nutrient density for the baby to meet its nutritional

needs without having to consume an excessive volume of food. If a very viscous food

is introduced too early in the weaning process, the infant may reject it by spitting it

out. A typical Third World weaning food made up to give a suitable viscosity from a

starchy cereal or root staple, such as cassava or millet flour, might contain only 0.3

kcal/g (1.3 kJ/g). This compares with around 0.7 kcal/g (3 kJ/g) for Breast milk and

perhaps 1.5 kcal/g (6 kJ/g) for a typical UK weaning diet (Church, 1979). At the

lower extreme, the child is incapable of consuming the volumes of food required to

meet its energy needs. This problem may be exacerbated if the child is fed

infrequently, has frequent periods of infection and anorexia, and perhaps by the poor

sensory characteristics of the food itself. In industrialized countries this could be a

problem if parents mistakenly apply the recommendations for low-fat, low-sugar and

high-starch diets in adults too rigorously to infants. Some strict vegetarian weaning

diets in industrialized countries may also be of insufficient energy density because of

their low fat and high starch content. The lower limit for the energy density of

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weaning foods should be 0.7 kcal/g (3kJ/g). Pureed fruit or vegetables are not suitable

for as weaning foods unless they have their energy density enhanced, e.g. by the

addition of a source of fat. Skimmed milk and semi-skimmed milk are not suitable for

very young children.

Weaning foods should be clean and not contaminated with infective agents.

Poverty, poor hygiene and contaminated food precipitate much malnutrition in the

Third World. Even when dietary intakes are judged sufficient to permit normal

Growth, infection and diarrhoea may be indirect causes of dietary deficiency. One

survey reported that 41% of traditional weaning foods and 50% of drinking water

specimens in rural Bangladesh were contaminated with fecal micro-organisms (See

Walker,1990)

In affluent countries, such as UK and USA, other aims are also considered

important for infant feeds. They should be:

Low in salt

Low in added sugar

Perhaps gluten free

High – salt foods expose the immature kidney to a solute load, increase the risk of

hypernatraemic dehydration and may increase the later risk of high blood pressure.

Sugar is regarded as empty calories and is detrimental to the baby‟s new teeth. Over-

consumption of sugar in infancy may also be creating bad preferences for the future.

There is a very strong evidence that fluoride is protective against dental caries. The

UK panel of DRVs suggested a safe fluoride intake for infant of 0.05mg/kg/day

around 50% of the amount likely to cause fluorosis. To achieve this safe intake, most

UK infants would need supplements. Swallowing fluoride tooth-paste is one way that

many young children receive supplemental fluoride.

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Whereas most babies suffer no harm from early exposure to the wheat protein

called Gluten, those sensitive to Gluten and thus at risk of Celiac disease cannot be

identified in advance. The incidence of Celiac disease in children has been falling in

recent years, at the same time as there have been trends towards later introduction of

solid food and towards the use of Gluten-free, rice based weaning cereals.

Family pot feeding –

It is essential to switch over to the usual family food. It can be given thickened

& mashed form from the family pot without adding hot spices. Provide little extra oil

or ghee, green leafy vegetables & seasonal foods to the baby. The infant should grow

up, accustomed to the traditional foods. Idli, Dosai, Soups, Payasam etc. are very

good foods for the babies. A new food should be introduced in the morning session &

only one item should be introduced at a time.

Around six months of age -

After four months of age Cereal based porridge (Ragi, Suji, Rice etc.) enriched

with Jaggery/ Sugar, Oil/ Ghee & Animal Milk can be started. Start with 1 – 2

spoonfuls & gradually increase to half to one cup per day in one to two servings in

addition to Breast feeding. Fruit juice also can be started.

6 – 9 Months of Age –

After 6 months of age, introduce mashed items from the family pot enriched

with Jaggery/ Sugar, Oil/ Ghee. Mashed rice with pulses, mashed tubers & vegetables,

soups, Mashed fruits, biscuits, egg yolk followed by egg - white etc. can be given 4 –

5times a day in addition to Breast milk. Egg white may be allergic to some.

9 -12 Months of age -

After 9 months, introduce soft food that can be chewed, avoiding hot spices.

Chapati & other hard items can be made soft by adding little milk. A variety of food

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from family pot can be given 4 – 6 times a day, gradually increasing the quantity. By

1 year of age, the baby should be taking everything cooked at home. This is called

Family Pot feeding.

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Chapter 2

Samvardhana

The considering term for Growth & Development available in Ayurveda

Samhita may be „Samvardhana‟. Which can be derived from the description of

„Samvardhana ghrita26

, indicated exclusively for developmental disorders like

Mukata, Pangu, Ashruthi etc.

Etymology of Samvardhana:

The word „Samvardhana is made up of two units i.e. „sam‟ and „vardhana‟.

Sam:

It is a prefix and carries different meanings in different contexts in Sanskrit literature

and here it is used as an upasarga. Here “Sam” means Good, Identical, and

Together27

. (Sanskrit English Dictionary)

Vardhana:

Means increasing, Growing, Thriving34

(Sanskrit English Dictionary)

Grossly the word Samvardhana implies smoothly growing, properly developing etc.

Thus the word “Samvardhana” together implies a smooth growth and development.

The term „Samvardhana‟ is not limited to physical growth. It also includes mental

social and personal development including performance skill development language

proficiency.

1. Factors influencing on Growth & Development prior to conception :

Samvardhana starts after conception but influencing factors for optimal growth and

development play the vital role which exists even prior to conception. If these

influencing factors get disturbed then it leads to a bad impact over Samvardhana.

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a) Shukra, Artava, Garbhashaya and Atma:

The union of sperm and ovum in the uterus when gets tranquillized with prakritha and

vikritha 26havas along with the union of Athma at a time is called Garbha9. Acharya

Charaka and Sushruta both opined that Shudha Shukra, Artava, Garbhashaya and

Atma all together are responsible for Shudha Garbha formation28

.

It means prior to conception, Shukra and Artava of the parents should be devoid of

any Doshas and Garbhashaya exisisting in healthy state, and is to be followed by

combination of Atma having the good deeds of past life; all these together give rise to

formation of foetus devoid of Balasamvardhana Vikrutis. Our Acharyas have gone

even to coding Ritumati Niyamah which help in growth and development of a healthy

Graffian follicle.

b) Atulya Gotra Vivaha:

Marriage between the partners belonging to different Gotra‟s influence over the

Samvardhana of Garbha by avoiding spread of disorders running in the families11

.

This refers to non -consanguineous marriage.

Acharya Bhela opined that Atulya Gotra Vivaha leads to birth of a child who is

brilliant and disease free.29

2. Factors influencing on Growth & Development during Pregnancy :

After Garbha formation with union of Shukra, Shonita and Atma, number of factors

take part in Samvardhana of Garbha. They are as follows

Panchtanmatras30

Panchamahabhutas31

Shad bhavas32

Garbhiniparicharya33

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Dauhrudyavastha34

Garbhopaghatakara bhavas35

Garbhaposhana36

Factors influencing Samvardhana during infancy:

Shareera Vriddhikara bhavas37

and Bala Vriddhikara 27havas play vital role in the

development of a child after birth till the attainment of adulthood.

Shareera Vriddhikara Bhavas:

As the name itself suggests shareera vriddhi i.e. development of bodily tissues is

contributed by the following factors.

a) Kala yoga

b) Swabhava samsiddhi

c) Ahara soustava

d) Avighata

a) Kalayoga:

The growth & development is time bound. Once a particular time or age is gone any

impairment that had happened can not be corrected nor does it wait for fulfilling

necessary requirements. E.g. the brain grows very rapidly during first six months of

life and the head circumference becomes 44 cm from 34 cm. During the late six

months the brain growth is only 3 cm and HC becomes 47 cm. if there is failure in

such growth, it can not be made good later. Thus Kala yoga may be taken as time

bound growth & development.

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b) Swabhava Samsiddhi (Innate potentiality)

Shareera (living body) has got its natural tendency of growth and development that is

called as Swabhava samsiddhi. Probably it can be correlated with genetic factors.

Because children of same parents with same factors grow differently with respect to

growth and development, (i.e. Shareerika and Manasika), this is because of swabhava

factor. Swabhava is „adhrista‟. It is nature‟s gift for individual.

Thus the Garbha is formed from the union of four bhuthas derived from four sources

and hence differ from each other in their innate potentiality, is termed as Swabhava

Samsiddhi, which plays an important role in Samvardhana of a child.

c) Ahara soustava:

The term implies that the nutritious and balanced diet with all the required proteins,

fats, carbohydrates and vitamins help for the optimal growth and development of the

child. After birth food alone is considered the most important factor for the

development, and it is considered as Bahya Prana. “Aharamekatva sharira vriddhikaro

bhavanti”

Kashyapa says that there is no better medicine than the food, to make the body

free from any disease. It can keep the individual healthy. Of all the four Shareera

Vrudhikara Bhavas, the Ahara is of paramount importance, and it is mainly

responsible for the body growth and development.

d) Avighata:

„Na vighata‟ is termed as Avighata. Vighatakarabhavas like injury, trauma, illness,

etc. to both the mind and shareera may hinder the growth and development of a

developing child. It is important to see that no injury of any sort is caused to mother

during pregnancy and no injury is caused to foetus and no mental injury caused to

mother during lactation period and no injury what‟s so ever to the growing child.

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Vighata to a growing child in the form of some illness may hinder the growth and

development of a child. Any type of Vighata during foetal life or after birth both

mental & physical results in to improper Samvardhana.

Balavriddhikara Bhavas:38

Balavriddhikara Bhavas means not only the factors which increase bodily strength but

also it includes the factors which influence or increase the immune system i.e.

29havas29shamatva in an individual. Because the definition of Samvardhana includes

physical, mental and spiritual well-being and this is possible when adequate and

proper balavriddhikara Bhavas are present or functions in an individual.

Bala Vriddhikarhavas includes:

Balvat purushe deshe janma Kalayoga

Sukhascha kala Beeja kshetra gunasampath

Ahara sampath Shareera sampath

Sathmya sampath Satva sampath

Swabhava samsiddhi Yauvana

Karma Samharsha

Balvat purushe deshe janma:

Balvatdesha may lead to an offspring with good strength and immunity and this will

be one among the contributing factors for proper Samvardhana.

Sukhascha Kala: Moderate climate when there is neither excess heat nor cold,

and which is pleasant, helps in promoting .

Balvat Kala: This bhava indicates that when a child takes birth in a Balavan

family and in good season like Visarga kala, which is known to be Balavan naturally,

it shows its impact over his Samvardhana

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Beeja kshetra sampath39

: Acharya Charaka and Sushruta both opined that

Shudha Shukra, Artava, Garbhashaya and Atma all together are responsible for

Shudha Garbha formation.

Ahara Sampath: Food is the most important factor for the growth &

development of the body. The food should be very much balanced with all nutritional

rasas containing adequate quantities of carbohydrates, fat, protein, vitamins, minerals

etc.

Shareera Sampath: This results from the chromosomes of parents or due to

virtuous actions of past life. Genetically some races have better physique.

Satmya Sampath: Sathmya is anything, which an individual assimilates or

accommodates without causing any injury to both mind and physique. After birth of a

child when fed with Ahara, which is Shad rasayuktha, and Satmya with proper Vihara

(like sadvritta, etc.) this helps the Shareera to undergo Samvardhana.

Satva Sampath: A good proportionate combination of aggression and libido

(Raja and Satva) helps in building up proper Samvardhana.

Swabhava Samsiddhi: Favorable disposition of the nature or innate potentiality

of an individual.

Yauvana: The prepubertic spurt of growth helps in bringing better strength to the

body. This is kalayogaja bala.

Karma: Karma includes normal activities, which keeps body organs strong &

steady. E.g. Vyayama.

Samharsha: The psychic development of a child depends upon interaction

between endowment and environment. The child with contentment never suffers from

psychological disorders.

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Influence of Samskara‟s over the growth & Development of a child:

The word meaning of Samskara changes according to different contexts; here i.e. in

the context of Kaumarabhirthya it can be interpreted as follows:

Samskara is a religious rite and ceremony, which sanctify the body, mind and intellect

of a child, so that child can become fit for the society40

.

Samskara is a time or opportunity provided to the physician to check the periodic

growth and developmental milestones attained by the child.

Number of Samskaras are explained in the classics, which influence over the

Samvardhana of a child after birth. Various Samskaras have been interpreted for their

developmental role in the growing child by Dr. C.H.S. Shastry (1976) in his PhD

Thesis at Banaras Hindu University entitled “Principles and Practice of Paediatrics in

Ayurveda”24

and here we are concentrating on few Samskaras. Samskara refers to

refinement activity and is done and promoted when the child becomes fit for such

faculty to develop.

Nishkramana samskara:41

This Samskara has to be performed either during 3rd

or

4th

month from the date of birth. In this Samskara infant is exposed to external

environment so that he responds to external stimuli looking to moon/hanging object,

may help the macular fixation and pupillary adjustment of the child can occur and the

sound produced from bells of temple may stimulate auditory system of child.

Upaveshana samskara42

: This Samskara is performed during 5

th month. According

to this samskara baby is made to sit on the ground for some time so that stimulation

will be given for the developmental phase of ability to sit.

Phalaprashana samskar43

: It is performed during 6th

month and it is a special

contribution of Acharya Kashyapa. In this samskara baby is supplemented with fruits,

which are rich in vitamin C (e.g. Orange) but absent in mother‟s milk. Vitamin C is an

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essential component in the development of Immune system and it also has antioxidant

property. It helps in the formation of connective tissue in a growing body.

Annaprashana samskara44

:This Samskara is performed at the age of 10 months.

According to Kashyapa from the time of this Samskara baby starts getting food with

required nutrient, so that requirement of tissues in the body get fulfilled leading to

Samvardhana. In this way above Samskaras have an influence on both i.e.

physiological and psychological development of a child leading to Samvardhana.

Milk alone is not sufficient at this age for growth and development. Complex

Carbohydrate and Proteinous substances get digested with the secretions that start

flowing in the stomach etc and then the child has to be slowly converted to Annada.

The third point is considered most important – “vividha anna

anupasevanata”. The development of the gastro intestinal tract (GIT) depends on

exposure to different food components slowly. The growth factors present in the

breast milk contribute to early development of GIT. That is why Ayurveda has given

a functional classification, which completely depends on the development of the GIT

judged by the intake of different type of foods, rather than an age wise classification

for the administration of medicine.

1. Jathamatran -just born

2. Pakshatheethan -after fifteen days

3. Athipakshan -after one month

4. Thriamasikan -three months of age

5. Shanmasikan -six months of age

6. Ekabdan -one year old

7. Thraibdan -three years old

8. Panchahayanan -five years old

9. Ashtabdan -eight years old

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10. Dasabdan -ten years old

11. Dwadashabdan -twelve years old

The classifications above are typically based on some important developmental

milestones of the GIT45. In this classification, jathamatran, pakshatheethan and

athipakshan are particularly important as they belong to neonate.

In pakshatheethan, the development of GIT is acquiring, not all dosage forms

may be suitable. Therefore, medicine administration should be very careful and

avoided as far as possible.

5.5.2 Classification of children based on diet patterns

As far as the administration of different food and medicines and for the

determination of dose is considered, rather than the age wise classification, the

classification based on diet and growth and development should be considered. This

is because of the fact that, the classification is based on the functional development of

GIT.

Ksheerapa

Infant who depends only on breast milk (or any other similar milk or feeds if

breast milk is not available or conditions of intolerance). It was considered up to one

year of age classically, but presently up to four to six months (WHO).

Ksheera annada

Infant who has started feeds other than milk. It was considered up to one to

two years of age classically, presently four to six months is the lower limit; upper

limit two years (WHO).

Annada

Withdrawn from breast milk and depends only on other feeds, above two years

of age to 16 years classically, presently lower limit is 2 years of age.46

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Chapter 3

Growth and Development

Definitions47

–

The term „Growth‟ implies a net increase in the size or a mass of tissue. It

occurs due to multiplication of cells and increase in the intracellular substances.

Hypertrophy contributes to a lesser extent.

„Development‟ is defined as maturation of function. It depends on maturation

and myelination of the nervous system and denotes acquisition of a variety of

competencies for optimal functioning of the individual.

Physical Growth & Development- It implies molecular level of enzyme

activation, differentiation which is manifested at puberty, adolescence, etc.

Laws of Growth & Development48

–

1. Growth & Development of children is a continuous & orderly process.

2. Sequence of the Growth is the same but the pace of Development can be non-

uniform.

3. Growth pattern of every individual is unique, but general pattern of Growth in

human is „Cephalocaudal‟.

4. Different tissues of the body grow at different rates.

General Body Growth – Rapid in Fetal life, first 3 – 4 years of life & puberty.

Brain Growth – Rapid in later months of pregnancy & early months of post-natal

life. 90% growth is achieved by 2 yrs.

Gonadal / Reproductive Growth – Pronounced by puberty.

Lymphoid Growth – Pronounced at mid-childhood (4-8 yrs.)as it acts as organ for

immunity in children (Tonsils, Thymus & Lymphoid gland)

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5. There is a sequence of Development within each developmental field, but the

development in one field does not necessarily run parallel with that in other field. This

is called „Dissociation‟

6. Development is intimately related to the maturation of nervous system.

7. Generalized mass activity (e.g. wild movements of trunk & limbs) is replaced by

specific individual response (e.g. reaching for a particular object).

8. Certain primitive reflexes such as the grasp reflex & walking reflex have to be lost

before corresponding voluntary movements are acquired.

A. Genetic factors

Phenoytpe

Parental characteristics

Race

Sex

Biorhythm & Maturation

Genetic disorders –

i. Chromosomal Abnormalities

ii. Gene mutation

B. Environmental factors49

–

a) Prenatal period –

Maternal malnutrition is associated with IUGR & Small babies

Multiple pregnancies

Medical illness in the mother

Maternal infection

Drugs taken during pregnancy

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Maternal endocrinal disorders

Irradiation in pregnancy

Placenatal & uterine problems

Maternal Stress

Abnormal presentations

Post–Maturity

b) Post-natal Period50

–

Neonatal Hypoxia

Neonatal Convulsion

Birth injury, Brain damage & Cerebral Palsy

LBW babies

Social Factors

Socioeconomic level – determine the standard of living & quality of life of the

child

Natural resources – Better nutrition of child is possible in region of good

natural resources.

Climate – Velocity of Growth is usually higher in spring & slow in summer.

Age of Mother – Older the mother greater are the chances of congenital

anomalies.

Age of the father – Advanced paternal age is associated with congenital

disorders.

Personal Factors – Couple‟s desire for the desired sex determines the further

development.

Nutrition – One of the most important factors. Growth retardation occurs in

PEM, anemia & vitamin deficiency.

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Chemical Agents – Androgenic hormones can accelerate growth but epiphyseal

fusion occurs earlier.

Trauma – fracture of epiphyses can retard the bone growth.

Infection & Infestations – Reduces the velocity of Growth.

Emotional factors – Anxiety, lack of security, lack of emotional support & love

can adversely affect the neurochemical regulation of Growth.

Cultural Factors – Child rearing & feeding are determined by cultural taboos

which can sometimes adversely affect the mental constitution or the nutrition of

the child.

Importance of study of Growth & Development –

Public health screening

Indicator of the general health & nutrition of the community

Evaluation of social action (medical or social measures)

Suitability of the baby for adoption

Clinical importance – Early diagnosis of moderate to severe mental sub

normality, Cerebral palsy, deafness, visual handicaps, neurological & metabolic

disorders, disorders of muscle tone, congenital dislocation or sub-luxation of hip etc.

Developmental history can help in defining the time of onset of a disease from the

time at which arrested or delayed development has occurred.

Assessment of Growth51

–

Examination of physical Growth can be done by –

Body measurements – e.g. body weight, length & head circumference etc.

Velocity of Growth

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Techniques of measurements –

Weight – Nude weight of the child to be recorded on a lever type weighing scale

as spring balances are less accurate. Recent weighing scales are fairly reliable.

Length – For babies less than two years of age with infantometer.

Chest circumference – Measured at the level of nipples midway between

inspiration & expiration with child in recumbent position.

Head circumference – Maximum circumference of the head from occipital

protuberance to the forehead (supra-orbital ridge).

Growth tables & Mnemonics52

–

I. Weight - Weight gain is at the rate of 25 to 30 gms. per day for the first three

months of life. There after weight is gained at the rate of 400 gms. per month. An

infant doubles his birth weight at the age of 5 months. Birth weight trebles at 1 year of

age. Birth weight quadruples at two years.

II. Length or height –

At Birth – 50 cms.

3 months – 60 cms.

9 months - 70 cms.

1 year - 73-75 cms.

2 years - 90 cms.

4 ½ years - 100 cms.

III. Head Circumference –

At Birth - 35 cms.

3 months - 40 cms.

12 months - 45 cms.

2 year - 48 cms.

7 years - 50 cms.

12 years - 52 cms.

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Chest Circumference –

At Birth - about 3 cms. Less than the Head Circumference

Equal to head circumference at 1 year

Thereafter it increase than head circumference

Growth Chart & their significance –

Introduction –

Also called „Road to health chart‟.

Definition – Growth chart is a visible graphical display of a child‟s Growth &

Development designed primarily for the longitudinal follow up (growth monitoring)

of the child, so that changes over time can be interpreted & progress of Growth

interpreted.

Visits to be recorded –

Weighing should be done at least once every month for the first year

Every 2 months during second year.

Every 3 months up to age of 5 -6 years.

This is done in a pattern of „weight for age‟ on the chart.

Types of Growth Chart –

WHO Growth Chart – it has two reference curves. The upper reference curve

represents the median (50th

percentile) for boys (slightly higher than that for girls) &

the lower reference curve represents the percentile for girls (slightly lower than that

for girls). The space in between two growth curves (weight channel) is called „Road

to Health‟. This includes children with +/- 2 SD on each side of standard weight.

Growth chart recommended by Govt. of India & IAP (Indian Academy of

Pediatrics). – It has 4 reference curves.53

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ICDS Chart- 3 reference lines in addition to standard representing 80%, 60% &

50% of the reference standards.

Use of Growth charts –54

1. Growth monitoring – To detect malnutrition or infections by periodic assessment

in progress of weight

2. Diagnostic tool – to identify „High risk children‟. Malnutrition can bee detected

long before signs & symptoms of it become apparent.

3. Planning & Policy making – By grading malnutrition it is possible to evolve an

objective basis for planning & policy making in relation to child health care at local &

central levels.

4. Education tool – Mothers can be taught care of her own child & encourage her to

actively participate in Growth monitoring with the help of visual character of the

Growth chart.

5. Tool for action – Helps the health workers to decide type of interventions that is

needed, which helps making referrals an easier jobs.

6. Evaluation – growth chart provides a good method to evaluate the effectiveness of

corrective measures & impact of a program or of special intervention for improving

child Growth & Development.

7. Tool for teaching – i.e. importance of adequate feeding, deleterious effects of

diarrhea.

8. Other miscellaneous information – Identification & registration, Birth date

&weight, chronological age, history of sibling health, immunization procedures,

introduction of supplementary foods, episodes of sickness, child spacing & reasons

for special care.

The Growth Chart has been aptly described as „A passport to child health care‟.

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Growth & Development during 6–12 Months of age55

–

During the age of 6 –12 months the infant develops increased mobility and

tries exploring the things around, advances in cognitive understanding and

communicative competence. The infant develops will and intentions, characteristics

that most parents welcome but still find challenging to manage.

Physical Development -

During this period Growth slows down.

Infant is able to sit unsupported at around 7 months & can pivot while sitting

(around 9–10 month) and also emergence of a pincer grasp, provides increasing

opportunities to manipulate several objects at a time and to experiment with objects.

Many infants begin crawling and pulling to stand around 8 months and walk before

their first birthday either independently or in a walker.

Motor achievements correlate with increasing myelination and cerebral &

cerebellar growth.

These ambulatory achievements provide opportunities for learning.

Tooth eruption occurs, usually starting with the mandibular central incisors. Tooth

development also reflects, in part, skeletal maturation and bone age.

Cognitive Development –

At first, everything goes into the mouth (mouthing/ oral phase).

Later child develops Hand-to-Hand co-ordination, objects are picked up, inspected,

passed from hand to hand, banged, dropped, and then mouthed.

The pleasure, persistence, and energy with which infants tackle these challenges

suggest the existence of an intrinsic drive, or mastery motivation. Mastery behaviour

occurs when infants feel secure; those with less secure attachments show limited

experimentation and less competence.

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A major milestone is the achievement (about 9 month) of object constancy. At 4 –

7 month, the infant looks down for a yarn ball that has been dropped but quickly gives

up if it is not seen. With object constancy, the infant persists in searching, finding

objects hidden under a cloth or behind the examiner's back.

Emotional Development –

Emergence of object constancy brings qualitative changes in social and

communicative development. E.g. The infant looks back and forth between an

approaching stranger and a parent, as if to contrast known from unknown, and may

cling or cry anxiously.

Separations often become more difficult. Infants who have been sleeping through

the night for months begin to awaken regularly and cry, as though remembering that

parents are in the next room.

At the same time, a new demand for autonomy emerges. The infant no longer

consents to be fed but turns away as the spoon approaches or insists on holding it him-

or herself. Self-feeding with finger foods allows the infant to exercise newly acquired

fine motor skills (the pincer grasp); it may be the only way to get the child to eat.

Tantrums make their first appearance.

Communication –

The infant at 7 months is adept at nonverbal communication, e.g. around 9 months,

the infant becomes aware that emotions can be shared between people; he or she

shows parents toys gleefully, as if to say, "When you see this thing, you'll be happy,

too!"

Between 8th and 10th month child is able to speak multiple syllables ("ba-da-ma")

and inflections that mimic the native language.

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At this age, picture books provide an ideal context for verbal language

acquisition. With a familiar book as a shared focus of attention, the parent and

child engage in repeated cycles of pointing and labeling, with elaboration and

feedback by the parent.

Implications for Parents and Pediatricians –

With the developmental reorganization around 9 month, previously resolved issues

of feeding and sleeping re-emerge.

Poor weight gain at this age often reflects a struggle between the infant and parent

over control of the infant's eating.

The infant's wariness of strangers often makes the 9-mo examination difficult,

particularly if the infant is temperamentally prone to react negatively to unfamiliar

situations.

Time spent talking with the mother and playing with the child will be rewarded by

more cooperation.

Nutrition

Nutrition is defined as „the process by which the organism utilizes food.‟ It

signifies the dynamic process in which the food that is consumed is utilized for

nourishing the body56

.

Ayurveda does not classify foods in the categories like Carbohydrates, Fats,

Proteins, Minerals & Vitamins. The actions of different grains, vegetables and fruits

are described in terms of their Rasa, Guna, Veerya and Vipaaka. The nutritive values

of different foods of vegetable and animal source are described in a number of

chapters. Cure of disease is not merely achieved by medicine; but by Pathya Bhojan.

Diet not only cures, but also prevents diseases if properly used. So it is the duty of the

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physician to prescribe appropriate diet in any particular condition. Man cannot live on

medicines alone without food57

. Diet is the fuel for internal fire58

i.e. to say it is

responsible for heat production in the body measured in terms of calories.

Nutrition and its disorders form the main pediatric problems and hence a little

knowledge of the food values described in Ayurvedic texts as well as in contemporary

science is very much essential for a pediatrician. The diets we get may be either of

vegetable source or of animal origin. Thus the wholesome diet should consists of all

six Rasas with sufficient Drava and Snigdha Gunas so as to give energy on one hand

and nourish and promote the growth of the seven Dhatus of the body on the other.

Nutritive Values of food –

Food items are divided into;

1. Energy yielding foods (Carbohydrates & Fats)

2. Body building foods (Protein)

3. Protective foods (Vitamin & Minerals)

4. Carbohydrate, fat and protein are the major nutrients

5. Sodium, potassium, calcium, phosphorus etc. are the macro nutrients and

6. Vitamins, Minerals with RDA less than 100 mg. / day are micro nutrients.

Carbohydrates59

-

They are the main source of energy for doing work. On an average about 50 – 70% of

energy is obtained from carbohydrates in the diet.

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Functions of Carbohydrates-

1. Most important function is to provide energy for the various body functions. They

supply energy for immediate use. Especially Brain depend on glucose for their

metabolism. Brain tissue is very sensitive to glucose, deficiency even for few minutes

can lead to permanent damage to nervous tissue.

2. Since Carbohydrates are utilized for energy purpose, they spare protein for Growth

& repair.

3. They provide carbon skeleton for essential Amino-acids.

4. They are required for the functioning of Liver. Glycogen protects liver against the

Bacterial toxins and poisonous substances. Glucoronic acid converts harmful

substances into harmless substances.

5. For proper functioning of Heart, As Heart obtains carbohydrates from blood sugar

& glycogen of cardiac muscles.

6. Excess Carbohydrates are converted into fats & stored.

Table No.2 Showing Carbohydrate contents of various foods -

Food Carbohydrate (in gm. /100 gm.)

Cereal 60 – 70

Pulses 55 – 60

Honey 80

Jaggery 95

Fresh Fruit 10 - 25

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Importance of Carbohydrate in Diet -

It has “Protein Sparing Effect”. When Carbohydrate & fats are provided to meet the

demand for energy, Proteins are spared for Growth & repair (Protein – sparing –

effect). The endogenous break down of protein is reduced if one is given a daily

minimum of 150 gm. (600 Kcal) carbohydrate for energy.

When carbohydrates are insufficient to meet the requirements, amino acids are

deaminated for glucose formation, and nitrogen is converted into Urea by Liver &

excreted by kidney.

Fats60

–

Fats provide convenient & concentrated source of energy. They also contain

essential nutrient as Essential Fatty-Acids (EFA) & fat soluble vitamins. Therefore

fats are essential for maintaining for good health. Fat acts as a reserve fuel.

Poly-unsaturated fatty acids are of special interest. Linoleic & Linolenic acid

can not be synthesized in the body & are known as essential fatty acids (EFA).

Arachidonic acid can be formed from Lenolenic acid in the body. These fatty acids

are essential for Growth & well being. Therefore animals require small amounts of in

their diet (As they are not synthesized in their body). They are present in Marine oils

(Whale, shark) and vegetable oils (except coconut and palm oil)

Essential Fatty Acids (EFA)61

-

The essential & non-essential is applied to a nutrient according to its relative necessity

in the diet. A nutrient is essential if

Its absence will create a specific deficiency disease

The body can not manufacture it & must obtain it from the diet.

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A diet with 10% or less of its total calories from the fat can not supply adequate

amount of essential fatty acids (EFA).

The only Fatty acids known to be essential for complete human nutrition are the Poly-

Unsaturated fatty acids, Linoleic and Linolenic. Essential Fatty acid must come from

the foods we eat. The body is capable of producing saturated fatty acids,

monounsaturated fatty acids and Cholesterol. Therefore there is no set

recommendation of daily intake for these. Essential Fatty Acids are required in

quantity of 0.5 mg./kg./day for infants. The DRIs (Dietary Reference intakes) for

Linoleic acid, found in polyunsaturated vegetable oils, are set at 17 gms./ day for men

& 12 gms. per day for women. Linolenic acid is primarily found in milk, soybeans

and flaxseed oil & is necessary in much lesser quantities than Linoleic acid. The

recommendations for Linolenic acids intake are 1.6 & 1.1 gm/day for men & women

respectively. These fatty acids serve important functions related to tissue strength,

cholesterol metabolism, muscle tone, blood clotting & heart action.

Functions of Lipids –

1. Act as concentrated source of energy. They yield about double energy as compared

to Carbohydrate per unit weight.

2. They are essential for fat soluble vitamins A, D, E and K.

3. EFA (Essential Fatty Acids) act as a precursor of Prostaglandins. They are

therefore important for maintaining tissue in normal health.

4. Some fats are essential components of nervous tissue (E.g. sphingo myelins, cell

membrane glycolipids)

5. Fats deposited in the adipose tissues acts as a reserve source of energy during

starvation.

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6. Fats supply essential fatty acids which are necessary for Growth & functions.

Proteins62

–

Proteins are nitrogenous organic substances. Protein is the basic chemical unit

of living organism essential nutrition, growth & repair. Every cell in the body is partly

composed of proteins which are subject to continuous wear & replacement.

Plant can synthesize all amino acids they need, from simple inorganic

chemical compound. Animals can not synthesize NH2 (Amino) group & therefore can

not synthesize all amino acids. Animals therefore depend upon plants for building up

of their protein.

Human body has limited capacity to convert one amino acid into other. There

are several amino acids which body can not synthesize and therefore this must be

taken in diet. Such amino acids are called as „Essential Amino Acids‟. There are about

10 essential Amino Acids required for Growth.

1. Histadine

2. Lysine

3. Tryptophan

4. Phenylalanine

5. Methionine

6. Threonine

7. Leucine

8. Isoleucin

9. Valine

10. Arginine

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Table No. 3- Comparing chemical scores & NPU (Net Protein Utilization) 62

Food Chemical Score NPU (Net Protein Utilization)

Rice 67 63

Wheat 53 49

Human Milk 10 94

Cow‟s milk 95 81

Children require protein for proper growth. In poor countries many children

die from lack of sufficient dietary protein & many more suffer from serious ill health,

grow slowly and fail to develop their full physical potential.

Table No.4 Protein values of different food articles.

Food Protein(in gm./100 gm.)

Cereal & millets 6 to 14

Pulses 18 to 24

Milk (Fresh) 3.5 to 4

Egg 12 to 20

Oil, Seeds & Nuts 18 to 40

Functions of Proteins –

1.Replacement of daily loss of body protein due to which nitrogen balance is

maintained.

2.To supply amino acid for formation of tissue protein during Growth (Carbohydrate

& Fats can not substitute Protein as they do not contain Nitrogen Molecule).

3.Body‟s „wear & tear‟ is repaired by proteins.

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4.To supply Amino acids for the synthesis of enzymes, plasma proteins, hormones

(certain), hemoglobin and vitamin.

5.To supply amino acid for the Growth of the fetus during pregnancy.

6.To supply amino acid for the formation of milk during lactation.

7. Proteins function as buffer & maintain body fluid pH.

8.Helps in transport of nutrients (lipo-protein) & drugs.

Nutritive values of food described in Ayurveda63

-

Vegetable Foods:

These consist of different grains, fruits, vegetables and honey.

The grains64

are classified into Saali, Vreehi, Sooka, Simbi, and Kshudra Dhaanya.

The paddy crop that comes out in Hemantharitu is Sali; the crop that is reaped

in Varsharitu is Vreehi. The barely and wheat come under Sookadhanya while all

Daals are grouped under Simbi Dhanyas. Kodrava is a variety of Kshudra Dhaanya

whose dietetic value is poor and is advised to be used when the child suffers from

loose motions during weaning.

Sali65

is sweet and astringent like milk; has mild laxative and diuretic effect;

helps to construct the body. The Shasti66

has similar effect with mainly astringent

taste and constipate the bowels. The barley is agreeable and improves retention of

memory and Agni. It is Kaphahara and dissolves the fat in obesity. The wheat67

is

anabolic and restorative. Excepting the green gram and lentil, all Simbidhaanya

produce gaseous distension of abdomen and are Kaphapitta Hara. Kodrava has a

constipating effect and is Kaphapitta Hara.

Among the fruits orange juice is said to make the mouth palatable, is cordial

and is Vatahara68

. The sour juices promote Pitta and Kapha. The sweet pomegranate

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juice is Tridosha Hara, makes the tissues pleasant and increases Sukradhatu69

. Cold

water extracts of dates supply iron in sufficient quantities and may be supplemented

from fourth month onwards otherwise the child may go into a state of iron deficiency

anemia. Dates are anabolic and act mainly on Shamanavata in Kostha and probably

correct liver functions as it is said to counter act the diseases born of alcohol and

epilepsy. It is anti-emetic, anti-diarrheal and relieves cough and breathlessness70

.

Bananas offer proteins and calories and are well tolerated even at four months of age.

The vegetables1 are put to bad repute and abuse in Ayurveda. They are said to

destroy the bones, the blood, the Sukradhatu and color of the skin. Vegetables are

harmful for eyes. They make the person unwise and loose intelligence with premature

greying of hairs. Many diseases have their abode in vegetables. Again Bhavamishra

further describes many of the Saakash, possessing Shukravardhaka property, which is

contradictory to the above statement. However, they may be a source of worm

infestation, infections and huge phosphate intake from vegetable leaves may cause

withdrawal of calcium from bones and disturb the dietetic balance. Still

Moolaiyoosha72

is good and widely used to cure all diseases, especially of the

respiratory tract.

Nutritional requirement of an Infant73

–

Balanced Diet -

A Balanced Diet is one which supplies all the nutrients in the right quantity &

proportion. It is essential for Growth, to maintain good health & to prevent

deficiencies.

A Balanced Diet is one in which –

Carbohydrate yields 55 – 60 % of the calories.

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Protein yields 30 – 35 % of calories.

The Diet should also contain enough Vitamins, Minerals, Fibre, water etc.

The Diet should preferably contain all the food items listed in the food Triangle.

Table No. 5 - Balanced Diet for Infant – ICMR – 199874

Sr. No. Food Group Recommendation (Portions)

1. Cereals & Millet 1.5

2. Pulses 0.5

3. Milk (ml.) 5 a

4. Roots & Tubers 0.5

5. Green leafy Vegetables 0.25

6. Other Vegetables 0.25

7. Fruits 1

8. Sugar 5

9. Fats / Oils (Visible) 2

Note: For infants introduce Egg/ Meat/ Chicken/ Fish around 9 months.

1) a - Quantity indicates top milk for Breast fed infants. 200 ml. top milk is required.

2) One portion (50gm.) of pulses may be exchanged with one portion (50gm.) of egg/

meat/ chicken/ fish.

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Table No. 6 - Recommended Dietary Allowance for Infant (6 – 12 months) 75

–

Net Energy Kcal/day 108 Kcal/Kg/ day

Protein (gm/day) 1.65 gm/day

Calcium 500 mg/day

Iron 10gm./day

Vitamin A Retinol 350

β Carotene 1200

Thiamin 50 µ / Kg.

Riboflavin 60 µg / Kg.

Nicotinic Acid 650 µg / Kg.

Pyridoxine 0.4 mg./day

Ascorbic Acid 25 mg./day

Folic Acid 25 mcg./day

Vit. B12 0.2 mcg./day

Effect of Nutrition over Growth & Development

Relationship between Nutrition, Growth & Development-

In children, nutrition, growth and development are intricately inter-linked -

aberrations of one aspect tend to significantly influence the others. Thus, for example,

for optimal growth and development of an infant, appropriate nutritional practices

play a pivotal role.

It is a known fact that Malnutrition is a "man made disease 'which often' starts

in the womb and ends in the tomb". Malnutrition and the associated retarding

influences cause a lot of morbidity, growth faltering, developmental retardation and

significant mortality. This is the significant job of all healthcare professionals to

prevent & manage those malnourished children.

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Interaction between Various Factors and Child Development76

-

There is an interplay between genetic, nutritional and environmental factors that

influence growth, development and intelligence. The effect of malnutrition in

reducing the intellectual achievement is difficult to separate from other associated

retarding social and environmental factors. The child's ultimate intelligence is the

result of the interaction between host, nutrition and environment.

Various studies have shown better growth and development in children from

high socio-economic status and reduced growth and development in children from

low socio-economic status.

Genetic Endowment Nutrition Environment

For Growth & Socio Economic

Development Microenvironment

Resistance Infection Child rearing

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Growth & Nutritional Status Environmental

Stimuli

Development

Education & Learning

Skill

Total Development

( Interaction between Various Factors & Child Development)

Majority of the children in India who live below the poverty line in an environment of

multideprivation and starvation have physical and developmental retardation. It has

been estimated that in India, 65 per cent i.e., nearly 80 million children under five

years of age suffer from varying degrees of malnutrition. 77

Environmental factors like parental education, socio- economic status, sani-

tation, standard of living, parental attitudes and child rearing practices influence the

growth and development of children.

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Nutritional factors like breast feeding practices, weaning practices and diet

during illness influence the growth and development of children. Maternal malnutri-

tion, low birth weight (LBW) and recurrent infections are other important factors that

lead to malnutrition. Severe forms of malnutrition like marasmus and kwashiorkor

represent only a tip of the iceberg. Many more suffer from moderate, mild or invisible

PEM. Malnutrition increases morbidity and mortality. It has been estimated that for

every diagnosed case of PEM, there are 10 others with borderline Malnutrition

undetected in the community.

During development of the brain, the most important phase of neuronal

proliferation and migration occurs in the intrauterine period. Hence antenatal care is

of utmost importance. After birth, the first two years of life include a period of rapid

brain growth and myelination. Hence any program aimed at the developing brain

should be started before the age of two. Autopsy studies and animal studies have

shown that malnutrition causes structural changes in the growing brain. Various

studies suggests significant reduction in serum and CSF proteins and lipids, serum

trace elements and other macro elements. Serum enzymes, developmental quotient

(DQ), motor nerve conduction velocity and brain stem auditory evoked potentials

(BAEP) were also low when compared with appropriate controls. 78

Among various interventional strategies, single point interventions like

nutritional supplementation and primary health care have failed to deliver the desired

outcome. There is an interplay of various factors that influence the intellectual

development namely genetic, nutritional and environmental. Hence the mode of

intervention has to be multidisciplinary.

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Chapter 4

Evaluation of the formulation under consideration

Different cereals form the staple diet in various parts of the country. Rice is popular in

the south and east while in other regions Wheat, Jowar, and millets are consumed.

Cereals contain 7-12% protein, and about 75% carbohydrates. They form an

important source of energy, iron, and protein in Indian diet and also supply certain

amount of fat which is referred as invisible fat. A thick creamy porridge made from

cereals in water/ milk/milk-water mixture is a good weaning food for babies.79, 80

Preparation of weaning food- Shashtikashalyadi churna:

Malting Process: 80,81







Rest drugs like Jatiphala, Ela,Vidanga churna obtained from SDMCA&H,



7.1 Ingredients of the formulation82

1. ShashtikShali

2. Godhuma

3. Yava

4. Jati

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5. Ela

6. Vidanga

7. Ghrita

8. Sitopala(sugar)

Shashtikshali83

Botanical name - oryza sativa Linn.

Family - Poaeceae ( Graminae)

Synonyms -

Sanskrit - Shali, Tandula, Laja, Dhanya

Hindi - Chaval, Dhan

Kannada - Nellu, Bhatta, Akki

English - Paddy, Rice

Marathi -Tandula, Dhan, Bhat


The Chemical composition of rice is influenced to some extent by generic and

environmental factors. Analysis of rice gave the following ranges of value:

moisture10.9-13.78,0.59-2.59ether extract, protein 5.50-9.32, carbohydrates73.35-

80,fibre 0.18-0.95 and mineral matter0.72-2.00% Enzymes like alpha amylase, B-

amylase, amylosynthase, lipase, phenolase.


Plant was reported to have, anti-inflammatory (Hu et al., 2003), anti-diahorreal, anti-

dysenteric, anti-oxidant (Chung and woo; 2001; Moon et al., 2002)

Dose - powder 5-10 gm. Decoction 50-100ml

Gana - Dhanya varga

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Rasa - Madhura, Anurasa: Kashaya

Guna - Guru, Snigdha

Virya - Sheeta

Vipaka - Madhura

Dosha karma: Pittaghna, Vatakaphavardhna

Therapeutic actions

Besides the common utility of shali, as food article, the drug shali is

possessing medicinal properties and useful for preventive and curative purpose

medicine as well as whole some pathya. It is hrdya, ruchya, brihmana

,vrsya,balya,swaryaand jvaraghna.Rice gruel is useful in impaired digestion like

diarrhea and dysentery(Chatterjee and Pakrashi,2001;Chopra et al.,

1958)Tryptophan,Phenyalanine(Balasubramaniam,1952)

Rice is a complex carbohydrate, which contains starch, and fibre, which is digested

slowly allowing the body to utilize the energy released over a longer period which is

nutritionally efficient. It contains only a trace amount of fat. Rice is gluten free, so

suitable for coeliacs and it is easily digested and therefore a wonderful food for the

very young and elderly.

Important formulations that contains shali

Abhayarista, Kumaryasava, Brahma Rasayana,Shashtikadi Brinhanai gutika

Godhuma84

Botanical name - Triticum aestivum Linn.

Family - Gramineae

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Synonyms

Sanskrit - Gudhuma, Yavanaka, Madhulika, Nistusa, Sumana Ksiri, Rasala, .

Hindi - Kanak, Genhu, Gehu, Gehub

Marathi - Gahu, Ghawn, Margham, Kapale

English - Wheat


Grains contain Mg. Mn. Zn. Fe, Ca, fresh plant contains oxalic acid.


Parts used - Wheat bran – seed

Dose - Wheat flour-Edible–food article (dietary component)


Rasa - Madhura

Guna - Guru, Singdha

Virya - Shita

Vipaka - Madhura

Dosha karma- Vata-Pittahara, Kaphavardhaka

Therapeutic actions

It mitigates vata and pitta, increases strength and bulk of body, cures diseases

of throat,rakta, anemia, itching, burning sensation, cough, good for skin and increases

complexion,aphrodisiac,relieves pain,promotes intelligence and reduces kapha.

Yava85

Botanical name - Hordeum vulgare Linn. .

Family - Poaceae

Synonyms

Sanskrit -Yava,Akshata, Kunchakin,Hayapriya,Teekshnashushka .

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Hindi -Jav,Jawa,Suj,Jau

Marathi -Yava, satu,Java

English - Barley

Kannada - Jovegodhi,Yava


Cyanogenic glycoside characterized as 2-B-D-glucopyranosyloxy-3-methyl(2R)-

butyronitrile,Proteins,Carbohydrates,Calcium, Phosphorus,Iron(grains


Hypocholestric,Antifungal,Antiprotozoal,Anti-oxidant.

Parts used - Seeds (grains)

Dose - Barley flour-Edible–food article (dietary component)

Gana - Shuka Dhanya varga

Rasa - Kashaya, Madhura,

Guna - Guru, Ruksha, Mridu

Virya - Sheeta

Vipaka - Katu

Dosha karma- Kapha-Pittashamaka

Therapeutic actions:

Barley contains approximately 10% dietary fibres and easily cooked with rice. Grains

are astringent demulcent, emollient, intellect promoting, digestive and tonic. They are

useful in throat, fever, gastric disorders, abdominal pain, and anemia. Yava is one the

oldest cultivated cereals and extensively used as food.it enters several products like

malt, infant foods, malted milk extracts; etc.

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Important formulations that contains Yava: Agastiharitaki rasayana, Dhanwantara

ghrita, Gandharvahastadi taila, Dhanwantara taila, Eladya modaka, Yavapatola

Kwatha.

Vidanga:86

Botanical name - Embelia ribes Burm.f. .

Family - Myrsinaceae

Synonyms

Sanskrit - Krimighna,Chitratandula,Jantunashana,vella,Kitashatru,kitari

.

Hindi -Vayavidanga,Baberanga

Marathi -vidanga,Karkannie

English - Embelia

Kannada - Vayuvilanga


Embelin, quercitol, tannin, christembine, volatile oil (vol.5 database, p480)


Nematicidal, anti-helminthic, Anti-inflammatory, Anti-helminthic, Anti-biotic,

immunostimulant, Anti-pyretic.

Parts used - fruit, roots, leaf

Dose - Fruit powder-5-10g

(vol.5 database, pg479)


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Rasa - Tikta, Katu ,

Guna - Laghu, Ruksha,Teekshna

Virya - Ushna

Vipaka - Katu

Dosha karma- Kapha-Vatashamaka

Prabhava - Krimighna

Therapeutic actions: Clinical studies on fruits of Embelia ribes have shown that when

administered in doses of 200mg /kg to patients of worm infestation, produced good

results. Drug is well tolerated and safe for use. The chief active principle Embelin is

reported to be effective against tape worm.aqueuos extracts of the fruits show anti-

bacterial activity against staphylococcus and Escherichia coli; etc.

Important formulations that contains Vidanga:

Eranda paka, vidangadi churna, Abhayarista, Pippalyasava, Kaishora guggulu,

Chandraprabha vati, Vidanga taila.

Ela 87

Botanical name - Eletharia cardamomum Matom .

Family - scitaminaceae

Synonyms

Sanskrit - Ela,Triputa-truti,sukshma,Dravini,Upakunchika.

Hindi -Choti Ilaychi

Marathi -Yelachi

English - Lesser cardamomum

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Seeds contain essential oil, principal constituents of the oil are cineol, terpineol,

terpinenein the form of formic and acetic acid.

Pharmacological Activities: It is aromatic, Carminative,Digestive,

Expectorant,Stimulant tonic. Studies have shown that Ela(elettaria cardamomum) is

expectorant and its Alexetric property controls infection.Chemical components of

cardamom oil(a-pinene, b-pinene, sabinene, myrcene, a-phellandrene) are expectorant

and carminative.

Parts used - fruit- seed

Dose - 0.5-1g


Rasa - Katu, Madhura

Guna - Laghu, Ruksha

Virya - Sheeta

Vipaka - Madhura

Dosha karma- Tridoshahara

Therapeutic actions: The fruits are mainly carminative, expectorant, and anodyne

medicine in various ailments. The fruits are useful in preparing infusion which is

useful for countering the condition of loss of appetite, flatulence ,gastric trouble,

dyspepsiaand respiratory infections.

Important formulations that contains Ela: Eladi churna, Eladi gutika, Eladimodaka,

Talisadi Churna,Sitopaladi churnaEladyarista.

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Jatiphala88

Botanical name - MyristicaFragnance Houtt. .

Family - Myristicaceae

Synonyms

Sanskrit - Jatiphala, Malatiphala.

Hindi - Jaiphala

Marathi - Jaiphala

English - Common Nutmeg, True Nutmeg

Chemical Constituents: Contains essential oils, saponin, volatile oil, protein fats,

starch, Fixed oil contains-myristin, myristic acid.

Pharmacological Activities: The essential oils of Jatiphala have shown antibacterial

activity against staph. Aureus ( Pathak et al) which causes URTI. certain chemical

extracts of Jatiphala like Ligroin extract, Trymristin has anxiolytic effect and

increases duration of sleep. It is aphrodisiac,anodyne, antihelminthicexpectorant

The essential oils showed antibacterial activity against B.anthracis, Staph.aurens;etc

(pathak et al)

Parts used - seed,oil

Dose - 1-2g, oil-1-3 drops


Rasa - Tikta Katu,

Guna - Laghu,Tikshna

Virya - Ushna

Vipaka -Katu

Dosha karma- Kapha-vata hara

Therapeutic actions: It is useful in Atisara-Grahani,,Visuchika.

LITERARY REVIEW


MATERIALS & METHODS


MATERIALS & METHODS

Objective of the study: To Assess the effect of Shashtikashalyadi Churna as a

weaning food on growth and development of infants.

Materials for the study –

SOURCE OF DATA:

Infants were randomly selected from OPD of S.D.M. College of Ayurveda and

Hospital, HASSAN.

Methods of collection of data:

Inclusion Criteria:

Infants between the age group of 6 to 9 months in whom weaning has not been

started yet were included in the study.

Exclusion Criteria:

1: Infants of Premature birth

2: Infants having malnutrition disorders like Protein energy malnutrition, Marasmus,

etc.

3: Infants having congenital disorders like cleft palate, etc.

4: Infants suffering from systemic diseases like tuberculosis; etc.

5: Infants having CNS disorders like cerebral palsy, mental retardation, congenital

diseases.

MATERIALS & METHODS


Securing of drugs:

Shashtikashali Shali, Godhuma (Wheat grain) and Yava were purchased from

Hassan local market of Hassan.

Vidanga churna, Jatiphala Churna, Ela Churna prepared from S D M

Ayurveda pharmacy, Hassan, Karnataka was taken.

The drugs were identified from Dept. of Dravya Guna.

Drug Preparation –







Rest drugs like Jatiphala, Ela, Vidanga churna obtained from SDMCA&H,



How Soaking, Malting, Sprouting improve nutritive value?

Soaking – Soaking in the water for some time initiates enzyme action &

germination. It increases Vitamins, Digestibility & also makes cooking easier.

All legumes may be soaked before cooking.

Malting – Soaking of some cereals overnight improves digestibility &

enhances vitamins. This is called as malting.

Sprouting / Germination – Germination of cereals & legumes augments

digestibility, increase Vitamins, reduces bulk on cooking & decreases phytate

levels. Digestibility increases due to production of Amylase.

MATERIALS & METHODS


Method of study:

40 infants between the age group of 6 - 9 months attending the Kaumarabhritya OPD

of SDM College of Ayurveda and Hospital Hassan and who were living in & around

Hassan city who are to be put to weaning were selected randomly & were taken up for

the study after following the criteria laid as above. Their age, sex, religion,

socioeconomic status, food habits family history, Anthropometric measurements etc.

were noted as given in master chart.

These 40 infants were divided randomly in to two groups:

1. Group A – Study group – containing 20 infants.

2. Group B – Control group – containing 20 infants.

Out of a total number of 40 infants taken for the study, three dropped out in the

middle and did not continue treatment in the study group. While out of 20 in control

group, 4 dropped out.

Complete history and clinical examination of all these infants was carried out and

recorded in a specially designed pro-forma by the Post-Graduate Department of

Kaumarabhritya of S D M College of Ayurveda and Hospital Hassan. Their findings

are given in the enclosed master chart.

Mode of Administration of supplementation –





Control group: along with breast milk, home-made mashed food was

advised.

MATERIALS & METHODS


Duration of study:

All the infants were given (of Study group) weaning powder for the period of 2

months.

Periodical evaluation was made once every month in all parameters of motor

skills.

Their achievement in various mile stones in Growth & Development was

recorded with the help of a Proforma prepared for the study.

Follow up Study:

After the completion of the study the parents and their infants were asked to

attend the OPD once in a month for 1 month to know whether the

improvement provided by the weaning powder (churna) is sustained.



GRAPH 1

GENDER WISE DISTRIBUTION

GRAPH 2

RELIGION WISE DISTRIBUTION



GRAPH 3

BIRTH ORDERWISE

GRAPH4

MONTHWISE DISTRIBUTION



GRAPH 5

VACCINATION

GRAPH 6 ANTE NATAL HISTORY



GRAPH 7

MODE OF DELIVERY

GRAPH 8 GRAPH 9

SMILES AT MIRROR IMAGE FAMILYWISE DISTRIBUTION



GRAPH 10

NATURE OF FOOD

GRAPH 11

BREAST FEEDING AFTER DELIVERY



TABLE NO. 7

ASSESSMENT OF DEVELOPMENT

GROSS MOTOR

Mile stone Actual Age

NECK HOLDING

3MONTHS(12 WEEKS BEYOUND)

ROLLING OVER

5MONTHS(20WEEKS)

SITTING

• WITH SUPPORT

• WITHOUT SUPPORT

24WEEKS

28WEEKS

STANDING

• WITH SUPPORT

• WITHOUT SUPPORT

32WEEKS

36WEEKS

CRAWLING

• CRAWLING ON BELLY

32WEEKS



OBSERVATIONS BASED ON TRIVENDRUM DEVELOPMENTAL SCALE

GRAPH 12

NECK HOLDING

GRAPH 13

ROLL OVER



GRAPH 14

SITTING WITH SUPPORT IN BOTH GROUPS

GRAPH 15

SITTING WITHOUT SUPPORT IN BOTH GROUPS



GRAPH 16

CRAWLING ON BELLY

TABLE NO.8 FINE MOTOR

MILE STONE

ACTUAL AGE

TRANSFORMS OBJ. HAHD TO

HAND

6-8MONTHS

PICER GRASP

9MONTHS



GRAPH 17

TRANSFERS OBJECT HAND TO HAND

GRAPH 18

PINCER GRASP



TABLE NO.9 SOCIAL / COGNITIVE MILESTONE


SMILES AT MIRROR IMAGE 6 MONTHS

GRAPH 19

SMILES AT MIRROR IMAGE



TABLE NO.10 LANGUAGE MILESTONE


BABBLES 6 MONTHS

IMITATES SOUND 9 MONTHS

GRAPH 20

BABBLES



GRAPH 21

IMITATES SOUND

GRAPH 22 GRAPH 23




GRAPH 24 GRAPH 25


GRAPH 26 GRAPH 27

STUDY GROUP CONTROL GROUP



GRAPH 28 GRAPH 29


GRAPH 30 GRAPH 31




GRAPH 32

UN PAIRED T TEST BETWEEN THE GROUPS



TableNo.11 showing Paired ‘t’ test in Study group

Parameter Mean BT Mean AT Mean

difference

SD SE mean T value P value

WEIGHT 6.2438 7.9250 -1.68125 .28802 .07201 -23.349 <.001

HEIGHT 64.6765 68.0471 -3.37059 .65361 .15852 -21.262 <.OO1

HC 42.7941 43.6294 -.83529 .27143 .06583 -12.688 <.OO1

CC 41.5312 43.6562 -2.12500 .78528 .19632 -10.824 <.001

MAC 13.7059 15.0882 -1.38235 .37622 .09125 -15.149 <.001

The initial mean weight of the infants in the study group before starting the weaning

food was 6.2438kg.

After the completion of intervention the mean weight was 7.9250kg.

There was 27 % improvement within the study group at p value < 0.001 on applying


The initial mean Height of the infants in the study group before starting the weaning

food was64.67cm.

After the completion of intervention the mean Height was 68.04cm.

There was 5.52% improvement within the study group at p value < 0.001 on applying


The initial mean Head circumference (HC) of the infants in the study group before

starting the weaning food was42.79 cm.

After the completion of intervention the mean HC was43.62 cm.

There was 2% improvement within the study group at p value < 0.001 on applying the

paired ‘t’ test within the group.

The initial mean Chest circumference (CC) of the infants in the study group before

starting the weaning food was 41.53 cm.


There was a 5.10 % improvement within the study group at p value < 0.001 on


The initial mean Mid Arm circumference (MAC) of the infants in the study group



There was a 10 % improvement within the study group at p value < 0.001 on applying




TableNo.12 showing Paired ‘t’ test in Control group

Parameter Mean

BT

Mean

AT

Mean

difference

SD SE

mean

T value P

value

WEIGHT 6.5488 8.0188 -1.47000 .38609 .09652 -15.230 <.001

HEIGHT 61.9375 66.1250 -4.18750 1.75000 .43750 -9.571 <.001

HC 42.0000 44.7500 -2.75000 1.03280 .25820 -10.651 <.001

CC 40.5625 42.8125 -2.25000 .73030 .18257 -12.324 <.001

MAC 13.6250 15.2188 -1.59375 .27195 .06799 -23.442 <.001

The initial mean weight of the infants in the Control group was6.548 kg.

After the completion of intervention the mean weight was 8.018 kg.

There was 22 % improvement within the Control group at p value < 0.001 on


The initial mean Height of the infants in the Control group before starting the

weaning food was61.93 cm.

After the completion of intervention the mean Height was 66.12 cm.





After the completion of intervention the mean HC was 44.75 cm.



The initial mean Chest circumference (CC) of the infants in the Control group



There was a 5.55 % improvement within the Control group at p value < 0.001 on


The initial mean Mid Arm circumference (MAC) of the infants in the Control

group before starting the weaning food was 13.62 cm.


There was an 11.67 % improvement within the Control group at p value < 0.001

on applying the paired ‘t’ test within the group.



Table No.13showing Un- paired ‘t’ test in both groups

Parameters Group

STUDY

Group

CON.

SEM

Mean

Difference

t p

MEAN MEAN

WT _AT 7.8722 8.1067 -.23444 -1.182 >0.05

HC_AT 45.3333 44.6667 .66667 1.345 >0.05

CC_AT 43.5833 42.7667 .81667 1.390 <0.05

MAC_AT 15.0556 15.2667 -.21111 -1.282 >0.05

HT_AT 68.0444 66.0000 2.04444 2.943 <0.05


P value was >0.05 but comparing the mean weight of both groups- Study group

7.87 and Control group 8.10 kg respectively, shows that weight gain in the study

group is as good as and at par with that of control group.

On applying un-paired ‘t’ test between the groups, the results showed that P value

was >0.05 but comparing the mean Head Circumference of both groups- Study

group45.33cm and Control group44.66cm respectively, shows that Head

Circumference gain in the study group is as good as and at par with that of control

group.


P value was <0.05 but comparing the mean Chest Circumference of both groups-

Study group43.58 cm and Control group42.76 cm respectively, shows that Chest

Circumference gain in the study group is 2 % over control group.


P value was >0.05 by comparing the mean Mid Arm Circumference of both

groups- Study group15.05 cm and Control group 15.26cm respectively, shows

that Mid Arm Circumference gain in the study group is as good as and at par with

that of control group.


P value was <0.05 by comparing the mean Height of both groups- Study

group68.04 cm and Control group66.00 cm respectively, shows that Height gain

in the study group is 3% over control Group.



TableNo.14 showing Effect of weaning food on in control group


Negative ranks Positive ranks Ties Total Z Value P value

N MR SR N MR SR

Disease Attacks 1 4.00 4.00 6 4.0 24.00 9c 16 1.890 .059

Sleep pattern 4 2.50 10.00 0 .00 .00 12c 16 2.000 .046

Bowel pattern 6 3.50 21.00 0 .00 .00 10 16 2.449 .014

Post hoc analysis with Wilcoxon signed rank test was conducted with a

Bonferroni correction applied, resulting in a significance level set at p<0.05.

It was found that there was no statistically significant reduction in frequency

of attack of disease (Z=1.890) (P=0.59) in the control group.









TableNo.15 showing Effect of weaning food on in study group


Parameters Negative ranks Positive ranks Ties Total Z

Value

P

value

N MR SR N MR SR

Disease

Attacks

3 2.00 6.00 0 0 .00 14 17 1.732 0.001

Sleep

pattern

11 6.00 66 0 .00 .00 6 17 3.317 0.001

Bowel

pattern

14 7.50 105.0 0 .00 .00 3 17 3.742 0.002












TableNo.16 showing Mann Whitney U Test between the Groups

Parameters STUDY GR CONTROL GR Z Value P

value

Remark

MR SR MR SR

BOWEL 15.92 286.50 18.30 274.50 1.247 .213 NS

Sleep 17.42 313.50 16.50 247.50 .913 .361 NS

DISASE

ATTACK

19.58 352.50 13.90 208.50 2.373 .018 S

Despite of improvement in Bowel pattern in both the groups assessed

separately but comparing both groups no significant improvement was found

study group over the control group.

At (Z=.913) (P=.361) mean rank (MR=17.42) (MR=16.50) the improvement

in the sleep pattern of Study and control groups resp. was not found to be

highly significant though individually in Wilcoxon sign rank test were

statistically significant.

There was statistically significant improvement in Attack of Disease with

mean rank (MR=19.58) (MR=13.90) (Z=2.373) (p=0.18) of the Study and

control Group resp. over control group.

DISCUSSION


DISCUSSION

For dehavrudhi factors like, Kalayoga, swabhava Samsidhi, Avighata are also

essential along with aahar saushthava. Among these aahar saushthava plays very

important role, as through aahar only nutrition can be supplied for growth and

development. Providing good complementary food is of prime importance.

The Research was conducted to evaluate the effect of Shashtikashalyadi Churna in

accelerating Growth & Development in infant during weaning period. The study

included 40 infants. The selected infants were divided into two groups, with 20

infants in each group. Infants of Control group (Group –B) had been asked to

continue with food from family pot. The infants of Treated Group (Group-A) received

ShashtikashalyadiChurna as semisolid porridge twice daily for 2 months. After the

study period infants were followed for another 1 month.

The discussion on Materials & Methods as well as on Observations & Results is as

given below.

Discussion on Objective

Weaning is a critical period of child’s life. It is termed as second step for self-

existence. This is the period where the transition from liquid milk diet to solid

complex diet occurs. If the child does not get proper nourishment during this period

the growth falters. Most of the children fall into the pit of malnutrition during this

period only. Studies on growth and development are of prime importance as far as the

pediatric field is concerned. The amplified concern is due to the fact that under

nutrition is still a burning problem, even with so many intervention modalities are

administered throughout the globe. The study intends to assess the efficacy of the

classical formulation by using present parameters of growth and development in

DISCUSSION


children. The broad objective of the study is to get an ideal palatable complementary

feed, which can meet the nutritional requirements, as well as to reduce the weaning

associated clinical conditions existing in the population. The search for such a

complementary feed begins with the formulation under consideration

Shashtikashalyadi Churna.

Discussion on Weaning Food.

Kashyapa has mentioned use of Shashtika shali or Purana shali which is husk-free,

well washed. Along with fine powders (Churna) of wheat(Godhuma), Barley(Yava),

that should given as semi-solid porridge cooked duly adding oleaginous substances

and salt. Also Vidanga is added to prevent further gastrointestinal disorders.

Further Kashyapa mentions that Vaidya should also take into considerations factors

like Desha

(Region/ Place- where child is living), Agni (Digestive Fire/ Metabolism), Bala

(strength), Kala (time), or whenever child is hungry, according to congeniality.

Ingredients of Weaning food contain shali, Yava, Godhuma, Jatiphala, Ela, and

Vidanga. Among them Shali, Yava, Godhuma are the main ingredients of the trial

drug Shali is bhrihmana hridya, balya,ruchya pittagna.Godhuma is balya,bhrihmana,

hridya, ruchiprada pathya, kasaghna, sara,sheeta, sandhana krut, Vata pittagnha.

Yava is krimi shleshmahara, visha hara, Pushti, Bala kara, pitta hara agni vardhaka.

Drugs like Jatiphala and Ela are mainly kasa- shwasaghna, ruchya , deepana.Vidanga

is mainly krimihara, deepana-pachana.

Discussion on Preparation and Storage of weaning food-

Careful hygienic preparation and storage of weaning foods is crucial to

prevent contamination.

DISCUSSION


Hands should have been thoroughly washed with soap and water before

preparation and feeding, and must be clean.

The foods should be preferably fresh cooked or boiled well and feasible,

prepared immediately and eaten.

Discussion on Family Pot food in Control Group

Out of 20 infants, 15 were given food like Ragi-sari and also “Anna-Saru” i.e. Dal

water with cooked rice and other mashed item like Banana. While 5 infants were fed

on Ragi sari only. Ragi malt is common weaning food in southern parts of India

where Ragi eaten. This diet is found to be rich in Carbohydrates, Proteins, calcium

and iron. Feeding from pot also has advantages in that it is economical, saves time

and infant grows up accustomed to foods traditionally eaten by family.

Developmental signs of readiness to feed:

There is a five-week gestational age range of term babies (born between 37 and 42

weeks gestation) and babies grow and develop at different rates. This means some

infants will be ready to begin weaning at an earlier postnatal age than others rather

than all being ready on one postnatal day (Platt 2009). Mothers usually begin weaning

large infants and male infants earlier than others (Wright et al 2004).

In practice the developmental signs that suggest that an infant is ready to accept solid

foods are:

Putting toys and other objects in the mouth

Chewing fists

Watching others with interest when they are eating seeming hungry between

milk feeds or demanding feeds more often even though larger milk feeds have been

offered

DISCUSSION


These developmental signs are generally seen between 4 and 6 months and this seems

to be the best time to start solids because from this age infants learn to accept new

tastes and textures relatively quickly (Harris 2000).

ESPGHAN Recommendations 2008 (Agostoni et al 2008)

The European Society for Pediatrics Gastroenterology, Hepatology and Nutrition and

the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

reviewed the literature on complementary feeding for healthy term infants in 2008 and

recommend that:

Exclusive breastfeeding for around 6 months is a desirable goal

Weaning onto solid foods should begin by 6 months but not before 4 months

Breastfeeding continues throughout weaning particularly the early stages

Introducing gluten between 4 and 7 months while breastfeeding may reduce

the risk of coeliac disease, type 1 diabetes and wheat allergy.

Ref: ( BDA Paediatric Group Position Statement:)

Weaning infants onto solid foods, Judy More, Catherine Jenkins, Caroline King and

Vanessa Shaw.

Concept of Amylase Rich Food:

The concept of Amylase –Rich Food or ARF directly addresses the twin

problems of dietary bulk and poor energy density of the weaning foods.

ARF is nothing but germinated cereal flours which are extremely rich in the

enzyme alpha amylase.

Alpha amylase cleaves the long chains of carbohydrates into shorter dextrins.

The single and unique contribution of ARF is that it can permit the mother to

mix in much more quantity into gruel and consequently make it high in energy

density, yet low in viscosity and dietary bulk.

The malting process increases the riboflavin, niacin, and iron content.

DISCUSSION


Discussion on Trivandrum scale:

It is used for assessing the development in infants. This test developed at

Trivandrum. This is a simplified version of Baroda development screening test. TDSC

was designed and developed at the Child Development Centre, SAT Hospital College,

Trivandrum. The Trivandrum Developmental Screening chart has shown a clinically

acceptability sensitivity of 68.8% and Specificity of 78.8% against DDST as gold

Standard. Hence, this chart is being recommended to be used as a mass screening test

for the detection of development delay in Children under 2 years of this.

Discussion on Observations

Gender wise:

As female and male ratio is equal i.e. 50% each. So, to comment on Growth &

Development in gender wise has no relevance.

Religion:

All the infants selected for the study were belonging to the Hindu

religion. As the infants selected for the study were from the area in and

around Hassan, which is Hindu predominant region.

Birth order:

Excluding the drop outs (total 7), 77.5 % infants were of birth order 1st and

remaining 5% of 2nd

in their families. As only 5% infants were of Birth order

2nd

among both groups, nutritional needs of babies were taken care adequately

as with the proven researches that malnutrition is much higher in families of

birth order 4th.

DISCUSSION


Vaccination:

All the infants (100%) were vaccinated that shows the awareness about

the immunization among the parents, which also contributes to the “Herd

immunity and Herd effect.”

Family Type:

87.5% were from the nuclear family, which was possible for parents to

early intervene with feeding pattern and other care.

Ante-natal history & Hospital delivery:

As all the infants were delivered in hospitals and cried immediately after

the birth, with no history of any assisted ventilation or NICU admission

for any Jaundice, or seizures or encephalopathy changes; etc. and mothers

having normal ante-natal history so other prejudiced risks like baby

suffering from HIE leading to brain damage and consequences which

would hamper further hamper growth and development at motor,

language, and cognitive, sensory aspects were ruled out. All the infants

included in the study were apparently healthy, so all of them were having

normal development.

Neck holding:

Among 40 infants selected for study, 87.5% had achieved neck holding at

3months, 7.55 at around 3.5 months and 5% at around 4 months, as the

actual age of appearance of milestone is between 3-4months, thus it

appears that all infants had achieved this milestone at proper time, and

there was no lag.

DISCUSSION


Roll over:

Among 40 infants selected for study, 90% had achieved Roll-Over at

5months, 7.5% at around 5.5 months and 2.5% at around 6 months, as the

actual age of appearance of milestone is between 5months and upper

limit till 6 months, thus it appears that all infants had achieved this

milestone at proper time, and there was no lag.

Sitting with Support:

In the study group out 17 completed patients, 76% have achieved sitting

with support at 6 months, 12% at 5months, i.e. a month earlier which can

be attributed to combine action of drugs like Shali which is of Madhura

Kashaya rasa, Shali is bhrihmana, hridya, balya, and ruchya pittagnha.

Godhuma is balya, bhrihmana, hridya, ruchiprada, sandhana krut. It is

anabolic and restorative. Yava is Balya, Agni vardhaka.

In control group all infants achieved at 6 months of age.

Sitting without support:


weeks (7months) while 17% achieved a week earlier. In control group 94


infants had achieved this milestone at proper time, and there was no lag.

Crawling on Belly:


weeks (8 months) while 12% achieved a week earlier. In control group 94


infants had achieved this milestone at proper time, and there was no lag

DISCUSSION


within the group, and comparing both groups both achieved at

appropriate time.

Transfers object from hand to hand:

In the study group out of 17 completed patients, 71 % achieved at 6 -

6.5months while 17% achieved a week earlier, 12% achieved at 7months.

In control group 62% achieved at 6-6.5months and 12% at a week earlier,

25% achieved at 7months. Thus comparing both the groups, study group

shows more % in achieving milestone early, which can be attributed to

the action of the drugs like Shashtikashali, Yava, and Godhuma which

have contributory effect on Dhatu Vriddhi.

Due to the Tikta rasa of drugs in the formulation, this has Medhya karma,

Madhura, rasa which are aajanma –satmya, sarvadhatu vivardhana.

Pincer Grasp:

In the study group out of 17 completed patients, 95 % achieved at 9

months while 5% achieved a month earlier, In control group 100%

achieved at 9months.Thus 5% had achieved this fine motor development

earlier as effect of the drugs which is having Medhya action, Sarva Dhatu

vivardhana, as food is given along with “Go-ghrita” which helps to cross

the Blood-Brain Barrier and acts on various areas of CNS including

motor cortex, increased myelination of cortico-spinal tract is responsible

for pincer grasp.

DISCUSSION


DISCUSSION ON SOCIAL/ COGNITIVE MILESTONE:

Smiles at mirror image:

In the study group out of 17 completed patients, 83% achieved at 6-6.5 months while

12% achieved a month earlier, in control group 82 achieved at 6-6.5% months and 12

% achieved a month earlier. Thus 12% had achieved this cognitive development

earlier. As the cereals contain DHA which helps in brain development and increases

cognition capacity.

DISCUSSION ON LANGAUGE MILESTONE

Babbles:

In the study group out of 17 completed patients, all infants achieved at 9

months, in control group also all 16 achieved at 9months.Some of the

researches say that Babbling is determined by Neurological mechanisms

driving the motor control of speech production and physical maturation of

vocal tract. Infants at this age become aware that emotions can be shared

between people, they express as babbling , making different sounds, showing

toys to parents as way of expressing happiness.

Imitates sound:

In the study group out of 17 completed patients, 88 % achieved at9 months

while 12% achieved a month earlier, in control group 100% achieved at

9months.Thus it can be attributed to the Medhya action and balya action of the

drugs acting on CNS system.

DISCUSSION ON RESULTS:

Weight:

The initial mean weight of the infants in the study group before starting the

weaning food was 6.2438kg and Control group was 6.548 kg.

DISCUSSION


After the completion of intervention the mean weight was 7.92kg in Study

group and in control group 8.018 kg.

There was 27 % improvement within the study group and22 % improvement

within the Control group, after the completion of intervention. This

improvement can be attributed to the ingredients of the Weaning food.

As the drugs like Shalishashtik Godhuma are Madhura rasa predominant ,

Snigdha, balya, bhrihmana, Sandhana krut, while Yava is Pushti kara,balya,

helped in improving the weight in this group

As Shali, Godhuma mainly contains carbohydrates and proteins.

As the main function of carbohydrate is to supply energy for the body

processes. A greater part of the energy in the diet (more than 50-80%) is

supplied by carbohydrates

Recent studies have shown that carbohydrate is essential for oxidation of fats,

in presence of carbohydrates fats get oxidized to yield energy

Proteins polymers of amino acids, essential amino acids like leonine,

isoleucine, valise, lysine, threonine, tryptophan that cannot be synthesized by

body, are found in wheat, rice mainly; barley to some extent.

With the addition of ghrita as it is snigdha, Balya and agnivardhaka is

contributory.

The Studies have shown that the drugs that are rapidly absorbed from the gut

because of their lipid solubility are known to readily diffuse into the CSF and

the brain.

http://en.wikipedia.org/wiki/Leucine

http://en.wikipedia.org/wiki/Isoleucine

http://en.wikipedia.org/wiki/Valine

http://en.wikipedia.org/wiki/Lysine

http://en.wikipedia.org/wiki/Threonine

http://en.wikipedia.org/wiki/Tryptophan

DISCUSSION


Height:

The initial mean Height of the infants in the study group before starting the

weaning food was64.67cm and 61.93 cm in Control group.

After the completion of intervention the mean Height was 68.04cm in Study

group and66.12 cm within the Control group.

There was 5.52% improvement within the study group and was 6.76 %

improvement within the control Group.

In the study group improvement in the height was as good as with that of

control group, and can be attributed to, Shali, Godhuma, and Yava which have

contributory effect on Dhatu vriddhi.

Polyunsaturated fatty acids cannot be synthesized by the body. Two families of

the PUFA are important, namely Omega-6 (Linoleic acid and Arachindonic

acid) and Omega- 3. They should be available in the diet for better growth.

A child’s height depends upon pituitary and thyroid hormones and is strongly

influenced by genetic and socio-economic factors, especially nutrition.

Infants have different growth rhythms. ( The Normal Child, Ronald s

Illingworth, Published by Harcourt(India) Pvt.Ltd. reprint 2002,pg67-69)

In this age growth acceleration especially in height will be more.

Head circumference:


before starting the weaning food was 42.79cm and in the Control group

was42.00 cm.

After the completion of intervention the mean HC was 45.62 cm in Study

group and 44.65 in Control group.

DISCUSSION


There was 6.8 % improvement within the Study group whereas improvement in

control group was 6.3%.

Head circumference is measured as maximum point of the external occipital

protuberance posteriorly and a point just above the glabella anteriorly. The size

of the brain and ventricles. Brain is compared with the Mastulunga majja, skull

is asthi Dhatu, and srotomula is asthi Dhatu.

Asthi Dhatu is responsible for nourishment of the majja Dhatu. Shali,

Godhuma, Yava which have contributory effect on Dhatu vriddhi.

Also physical property of majja Dhatu is extreme unctuousness which is

capable of offering strength to the body.

DHA present in the cereals especially in Yava and Godhuma. They serve as

raw material for the synthesis of the eicosanoid which plat important role in the

regulation of Lipid metabolism. DHA is helps in better growth of cerebral

cortex and functioning of the retina.

The velocity of HC is 1/3 i.e. 2cm/3months (from 3months – 1year) of the

initial velocity (till 3 months- 2cm/1month) (IAP, Vol-1pg36,4th

ed, A


Chest-Circumference:

The initial mean Chest circumference (CC) of the infants in the study group

before starting the weaning food was 41.53 cm and in the Control group was

40.56 cm.

After the completion of intervention the mean CC was 43.65 cm in the study

group and in the Control group was 42.81cm.

DISCUSSION


There was a 5.10 % improvement within the study group and that of control

group is 5.55%.

There is only 0.45 % improvement of Control group over Study, hence as it can

be taken as the improvement in the study group is as good as with that of the

control group in terms of chest circumference.

As the drugs like Shalishashtik Godhuma are madhura rasa predominant ,

snigdha, balya, bhrihmana, while Yava is pushti kara , balya helped in

improving the Chest circumference in this group.

Mid Arm-Circumference:

The initial mean Mid Arm circumference (MAC) of the infants in the study

group before starting the weaning food was 13.70 cm and in the Control group

was 13.62 cm..

After the completion of intervention the mean MAC was 15.08 cm in the Study

group and 15.21 in the control group.

There was a 10 % improvement within the study group there was an 11.67 %

improvement within the Control group.

There won’t be much difference in the increase in the MAC, as in infants

MAC is because of the subcutaneous fat but as the babies grow old, it is

replaced by muscle bulk.

Mid arm circumference is useful to detect malnutrition in young children.

Values more than13.5cm may be considered as normal, while values less than

12.5cm indicate significant under nutrition. (IAP, Vol-1pg37, 4th ed., A


Here the values in both groups were in the normal range.

DISCUSSION


Discussion on sleep pattern:



infants, with 0 patients with altered sleep pattern (Z=3.317) (P=0.001) in study

group.



infants, with 0 patients with altered sleep pattern (Z=2.000) (P=0.46) in control

group.

This can be attributed due to the certain chemical extracts of Jatiphala like

Ligroin extract, Trymristin has anxiolytic effect and increases duration of sleep

Pattern of sleep and growth are related. Studies have shown that GH plasma

level during sleep is at peak than in day time. So it can be concluded sound

sleep is essential for normal growth pattern

During the initial days of weaning, solid foods must be given only during the

morning hours, and infant’s other normal feeding schedule should not be

disturbed, as this might leave infant hungry to wake up in night for feeds.

Discussion on Bowel Pattern:

In the study group (p 0.002) as compared to control group(p=0.14) the change

in the Bowel pattern, as the Yava is agnivardhaka, deepana, bahumala krut.

Studies have shown that soluble fibers found in barley increase bulk, soften

stools

Snigdha guna provides softness, vishada guna of tikta rasa helps in proper

srotoshodhana

DISCUSSION


So also Vidanga is jantughna, deepana-pachana, ushna which helps in ama

nirharana, thereby helps in proper stool formation.

Discussion on Attack of disease:

It was found that there was no statistically significant reduction in frequency of

attack of disease (Z=1.890) (P=0.59) in the control group, except for relief for

1 infant.




There was statistically significant improvement in Attack of Disease with mean

rank (MR=19.58) (MR=13.90) (Z=2.373) (p=0.18) of the Study and control

Group resp. over control group.

URTI and GIT are common in this age group, due to action of Jatiphala and

Ela as kasaghna , also Vidanga and Jatiphala as krimi hara, pachana

respectively

As malabsoption and nutritional disorders- Avighata is prevented by the

merit of these drugs

Studies have shown that Ela(elettaria cardamomum) is expectorant and its

Alexetric property controls infection

Chemical components of cardamom oil(a-pinene, b-pinene, sabinene, myrcene,

a-phellandrene) are expectorant and carminative.

The essential oils of Jatiphala have shown antibacterial activity against staph.

aureus ( Pathak et al) which causes URTI.

DISCUSSION


Eicosanoids play important role in the immune response and inflammatory

response to injury and infection.

Deficiency of EFA in the diet may result in growth retardation, skin and

increased susceptibility to infections.

Also shareera vridhhikara Bhavas like

Kaal-yog : effect of time, different seasonal changes on the body.

Swabhava- samsidhhi: natural pattern growth and development of an individual.

Aahar-Saushthav: quantity and quality of food consumed.

Avighata: Absence of factors affecting growth and development like diseases,

infections (Ati, Ayog,Mithya Yog)

If above factors are favorable, definitely growth and development are accelerated.

The results of the study showed that nutritional supplement provided was very

effective in accelerating Growth & Development of the body in general and of brain

in particular. And it helps in preventing Growth faltering. However it is suggested that

only nutritional supplement does not help accelerating Growth & Development. So,

along with nutritional supplementation one should also advise regarding Development

stimulation programs.

The composite Stimulation Package includes following attributes –

1. Medical –

Primary health care

Immunization

Treatment of intercurrent infections

Inpatient services

Periodic deworming

DISCUSSION


2. Nutritional

Dietary evaluation

Nutritional assessment and monitoring

Nutritional supplementation

Specific nutrient supplementation

Nutrition education

3. Stimulation

Developmental evaluation

Developmental information

Individualized tasks for catch up

Play therapy

Motor co-ordination tasks

Training activities of daily living

4. Psycho-Social

Social interview

Psycho-social counseling

Decision making Child rearing skills.



SUMMARY

Weaning is the second step for self-existence. The first step is cutting of the

umbilical cord.


that determine child health as well as morbidity and mortality. Most of the children

fall into the Malnutrition during the weaning and post-weaning phase. Some even

succumb to it.

The objective of the study was to assess Growth & Development during weaning

period. The weaning period was selected because maximum & rapid growth occurs

during first two years of life including Brain development. And any improper

nutrition during this period may lead to unwanted out comes.

The study was able to satisfy its objectives quite comfortably. The methodology

adopted for the study helped to attain another objective – the ideal time for

administration of the formulation during the complementary feeding. No conclusions

regarding the sustained efficacy of the intervention as the study proper in each group

was only for two months

The entire work was divided into two parts. Part - I consists of review of

literature & part-II consists of Materials & Methods, Observations & Results,

discussion & Conclusion.

Twenty infants were selected for the study from OPD, IPD of SDMCA& H,

and Hassan and through home survey by simple random sampling method. The

selected infants were divided into two groups Group-A (Study Group) and Group – B

(Control Group). The total duration of the study was 2 months and infants were

followed once every month and were assessed in various parameters.



The drugs selected and given comprise of -

For Control Group (Group-B): along with breast milk, home-made mashed

food was advised.

For Study Group (Group –A): Shashtikashalyadi churna was given 2 tsp. 2

times a day.




The given nutritional supplement was highly appreciated by the mothers, as

the acceptance of product by the infant was very good & no un - towards

effects were reported and also the taste of the given nutritional supplement-

Shashtikashalyadi churna showed better palatability than routine food in the

control group.



CONCLUSION

1. The Study group infants showed equal improvement in various aspects of

Growth & Development including the Chest- circumference, weight, Height in

comparison with control group.

2. In the study group improvement in the height was significant than in control

can be attributed to, Shali, Godhuma, Yava which have contributory effect on

Dhatu vriddhi. Godhuma is Sandhana krut which can have contributory effect

on height.

3. The infants among Study group had sound sleep during night time in

comparison to control group.

4. The infants from both the groups attained their milestones at proper age.

5. Shashtikashalyadi Churna had better taste and was well accepted by the

infants as informed by the mothers.

6. The infants from treated group had less attacks of illness as compared to

control group. Drugs which were included in the food supplement helped in

reducing the frequency of attack of diseases.

7. Improvement in Bowel Pattern in the Study group than in Control Group was

due to effect of drugs in the formulation(weaning Food)

8. The overall result shows that the Nutritional supplement in the form of

Shashtikashalyadi churna as a weaning Food is effective in accelerating

Growth & Development of the child both in weight gain & in increase in head

circumference. This is because it provides the child extra calories, protein &

Essential Fatty Acids necessary for Growth of body & Brain. They

compensate the gap between the required and provided nutrition (calories).

9. The malting process increases the riboflavin, niacin, and iron content.



Limitations:

2 months of study period is not sufficient enough to claim any significant

improvement in growth and development in infants.

Less sample size.

Scales and instruments used must be standardized for uniformity.

Suggestions:

Further study can be taken up with at least for 6 months to claim any

significant improvement in growth and development in infants.

Comparative study can be taken with classical formulation with that of

available market complementary feeds.

Needs extensive research with larger sample size for longer duration.

A multi-disciplinary approach to make the formulation more stable and more user friendly.

A detailed experimental research to evaluate the nutritive value of the formulation.



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2012.p392.

ANNEXURE

Clinical Study on Assessment of Growth and Development in Infants with Shashtikashalyadi Churna as Weaning food. Page I

RESEARCH PROFORMA

DEPARTMENT OF KAUMARABHRITYA

S.D.M.COLLEGE OF AYURVEDA &HOSPITAL, HASSAN.

Title :

Scholar : Sharvari S Deshpande.

Guide : Dr. Shailaja U

Name: Sl. No.:

Address: O.P.D.No.:

Age: I.P.D.No.:

Sex: Male / Female

Date of commencement of supplement:

Religion:

Informant:

Birth order: 1 / 2 / 3

Born of Consanguineous / Non- Consanguineous marriage.

Maternal history:

G P A L

H/ o Chronic illness

Birth History:

Antenatal history:-

Whether mother was antenatally registered at some Clinic/ Hospital/ Health centre?

Yes/No

Whether she suffered from any infection/ disease during pregnancy? e.g. TORCH,

Rubella.

Yes / No

Whether she suffered from other condition like PIH/ DM? Yes / No

Whether she was on any drugs except vitamin/ calcium/ Iron & folic acid

supplement? Yes / No. If Yes Specify…………..

Whether she received 2 doses of Inj. T.T. during pregnancy? Yes / No

Perinatal History:

Whether child was full term/ Pre term/ post term?

Born normally (vaginally) or by caesarean section or with help of forceps or vaccum?

Born at Hospital or Home?

Whether child cried immediately or required some sort of resuscitation like oxygen,

artificial ventilation?

Immediate Post natal History:

Whether child developed Icterus, Cyanosis? Yes / No

Whether child had Fever, Convulsion? Yes / No

Whether child was Breast-fed or was on Top feeds?

The No. of days the child was kept in Hospital.

ANNEXURE

Clinical Study on Assessment of Growth and Development in Infants with Shashtikashalyadi Churna as Weaning food. Page II

Immunization History:

B.C.G. – Given/ Not Given (At Birth)

Hepatitis B- Given/ Not Given (0 dose, 1 month, 6 months.)

OPV- Given/ Not Given (At birth, 6 wks, 10 wks, 14 wks.)

DPT- Given/ Not Given (6 wks, 10 wks, 14 wks.)

Any other vaccine

Family history:

H/o hereditary/ congenital diseases in the siblings? Yes/ No. if Yes specify………….

Dietary History:

Breast Feeding:

Whether Child has been breast-fed or not? Yes/ No

When was the Breast feeding started? Immediately after birth/ after …… Hrs.

Breast-feeding for ……. months.

Frequency……. /day.

Type of schedule (time or demand)

Whether feeds at night? Yes/ No

Whether breast milk vitiation is there? Yes/ No. If Yes …………(specify)

Whether any history of early cessation of breast feeding due to

1. Ignorance

2. Working Mother

3. Breast abnormalities

4. Increased use of subsidized use of milk powders

Maternal health during this period

Whether mother used contraceptives during the period of breast-feeding? Yes/No.

If Yes specify………..

Lacking child care due to

1. Unwanted pregnancy

2. Female child

3. Illegitimate child

4. Mental/ sub normal child

5. Chronic ill mother & child

6. Too many children

Top feed:

If top feed, whether it was Cow’s milk or formula milk?

What was the dilution used?

Whether he was bottle-fed or fed with wait-spoon?

Whether bottle, nipple were washed regularly before each feed?

Weaning:

Started or not started?

If started;

1. At what age?

2. Nature of food given to the child?

3. Amount of food given to the child?

4. Whether child was given fruit juice? Yes/ No. If Yes Then at what age………

ANNEXURE

Clinical Study on Assessment of Growth and Development in Infants with Shashtikashalyadi Churna as Weaning food. Page III

5. Is there any history of allergy towards any particular food?

6. Frequency of feeding?....../ day

7. Estimation of approximate caloric value of the food ……/ day

If formula feeds are given;

1. Improper dilution

2. Unhygienic preparation

Faulty feeding & customs:

Others:

1. Prejudice towards colostrum.

2. Lacking Amino protein in the diet.

Socio-economic History:

Type of Family- Nuclear / 3rd generation / Joint

occupation of father:

occupation of mother:

Education of father:

Education of mother:

Total income of the family / month:

Housing condition: living in chawl/ flat/slum:

Water supply:

water disposal & Sewage disposal:

General Examination:

Level of consciousness:

General condition:

Vital parameters:

Temperature:

Pulse:

Respiration rate:

Anthropometry:

1. Weight:

2. Height:

3. Head circumference:

4. Chest circumference:

5. Mid –Arm circumference:

6. upper segment / Lower segment ratio:

Examination of Head, Face & Neck: Ant. Fontanel

Examination of Mouth & Throat: Cleft Lip/ Cleft Palate

Dentition started or Not started

Whether any evidence of Protein or Vitamin deficiency? Yes / No.

Examination of Skin:

Signs of Dehydration / Vit. A deficiency/ Rash/ Signs of PEM

Examination of Nail:

Pallor/ Cyanosis/ Clubbing/ Koilonychia/ Brittleness (PEM)

ANNEXURE

Clinical Study on Assessment of Growth and Development in Infants with Shashtikashalyadi Churna as Weaning food. Page IV

Examination of Hair:

Light colored hair/ thin hair/ sparse hair/brittle hair with area of Alopecia (PEM).

Personal History:

1. Ahara: Kshirad/ Annada

2. Matra: Hina/ Madhyam/ Adhika/ Sama.

3. Nidra: Samyak/ Alpa/ Prabhuta/ asamyaka.

4. Kostha: Mridu/ Krura/ Madhyam.

5. Mutra: Samyak/ Alpa/ Prabhuta.

6. Satmya: Specific Rasa/ Sarva Rasa/ Mishra Rasa.

Systemic Examination:

Respiratory System:

Cardiovascular System:

Gastro intestinal System:

Central Nervous System:

Anthropometry:

Age of the infant & progress in each month.

6th

month

7th

month

8th

month

9th

month

10th

month

11th

month

12th

month

Date

Weight

Height

H.C.

C.C.

M.A.C.

Skin fold

thickness

Assessment of well being of child:

6th

month

7th

month

8th

month

9th

month

10th

month

11th

month

12th

month

Date

Attacks of

disease

Type of

Disease

ANNEXURE

Clinical Study on Assessment of Growth and Development in Infants with Shashtikashalyadi Churna as Weaning food. Page V

Sleep:

6th

month

7th

month

8th

month

9th

month

10th

month

11th

month

12th

month

Date

How many

times a day

Duration of

sleep

Sleep is

sound or

disturbed

Bowel:

6th

month

7th

month

8th

month

9th

month

10th

month

11th

month

12th

month

Date

Avg. no. of

times a child

passes a

stool/day

Consistency

Pakwa/

Apakwa.

Loose/Formed/

Hard

Whether child

complains of

abdominal

pain

Assessment of Development:

Gross-motor Development:


Neck Holding

Lifts head well beyond the plane of the

body. Good head control achieved (Ventral

Suspension)

Prone position- Lifts chin & shoulder above

the ground.

Sitting position- Head lag is very slight.

Head maintained well in supine position

3 months

(12 wks. &

beyond)

Rolling over: From prone to supine.

20 Wks.

ANNEXURE

Clinical Study on Assessment of Growth and Development in Infants with Shashtikashalyadi Churna as Weaning food. Page VI

Sitting:

Sits on floor with hands forward for support.

Sits without support

24 wks.

28 wks.

Standing:

with support

without support

32 wks.

36 wks.

Crawling:

Crawling on belly

Crawling on Knee

32wks.

40 wks.

Walking:

Walks two hand held

Walks one hand held

Walks without support

48 wks.

52 wks.

58wks.

Fine Motor Mile stones:


Grasp reflex disappears 3 Month

Ulnar grasp 4 Month

Transforms object from one hand to

another

6-8 Month

Pincer grasp achieved 9 Month

Releases an object on command 1 Year

Hand to Mouth Co-ordination 28 Weeks

Hand to Hand Co-ordination 28 Weeks

Social / Cognitive Mile stone:


Looks at the face intently when spoken to 1 month

Social Smile 1 ½ -2 month

Recognizes mother,

Shows interest in surrounding

3 month

Smiles at mirror image,

Stretches arms out when mother is going

to lift him up.

6 month

Enjoys Peek-a-boo games.

Resists pulling away of toys.

9 month

Comes when called:

Pulls mother’s clothes to draw attention.

1 year

ANNEXURE

Clinical Study on Assessment of Growth and Development in Infants with Shashtikashalyadi Churna as Weaning food. Page VII

Language Mile stone:


Responds to sound 1 month

Coos, Laughs aloud 3 month

Babbles (Gaga, Dada, Mama) 6 month

Imitates sound;

Responds to Name

9 month

Speaks one word with meaning: 10 month

Speaks 1-2 meaningful words

(Monosyllables)

1 year

Sign of Scholar Sign of Guide Sign of HOD

Documents

CLINICAL STUDY ON ASSESSMENT OF GROWTH AND …