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At What Age Should Breast Milk Be Stopped?
Question: My daughter is 13 months old, birth weight 2.64 kg, current weight 7.86kg, reacts actively towards movements and life usually, head circumference just below the third centile, my local paediatricians says she looks normal from outside. My question is at what age she should stop taking breast milk? She doesn't like eating or drinking anything despite our continous efforts. Also, today her blood lymphocytes came to be 61%, I saw normal range to be 20%-40%. She is getting light fever in every 2-3 days since 25 days which lasts for 1-2 hours only, her blood reports except lymphocytes is fine and in range , urine reports yet to come. Attaching some reports as of today
Brief Answer:
Breastfeeding till 15-18months
Detailed Answer:
Namasthe
Welcome to Healthcare-Magic
Greetings of the day
Dear XXXX
Ideally breast feeding is to be continued for 15 to 18 months. Over next couple of months, you can slowly take her off breast feeding.
As the total leucocyte count is normal, there is nothing to worry about lymphocyes. Children may sometimes have elevated lymphocytes. Fever in child usually denotes infective etiology. A normal urine examination report will rule out urinary tract infection.
I would suggest the following for further investigation of fever
1. Chest X ray
2. PPD testing to rule out tuberculosis
If these reports are normal there is no cause for concern.
Being a parent myself, i can understand your concern and apprehensions.
It is important that you start introducing a variety of food in your toddler's diet gradually. These will provide the calories, proteins, vitamins and minerals that are essential for his growth. The amount of food eaten would vary from child to child and would also depend on when you introduce a particular food to your toddler. Most of the times it is "Try and Error" method. Lots of patience would be required from your end to find out what is that diet which tickles your toddlers tastebuds which also contains maximum nutrients. You need to try multiple ones and find which your child loves to eat amongst those. Initially it may be difficult from shifting to solid/semi-solid feed from milk based diet, continued perseverance and trying out what the baby likes is the key. Try the below suggestion, if still there is refusal to take diet, then do consult your Pediatrician
One recipe which the kid will like is as below
Ingredients needed: Ghee( 2 spoons), Whole wheat flour ( 2 spoons) , Pista( 50 gms), Cardomom ( 6 in number), Almonds( 50 gms), Khajur( Dried dates 50 gms), water/milk
In a pan pour 2 spoons of ghee, heat it, add 2 spoons of wheat flour (Atta), cook it till golden brown on low flame till its slightly golden in color. Add 2 Cups of water or Milk and keep stirring it continuously making a thin water paste( same like sira consistency). To this add powdered mixture of rest of ingredients grinded in mixer ( pista, almond, khajur, cardomom).
Supplement baby breakfast with this recipe, and also can be consumed at night when baby is hungry. In this way his quota for milk will also be fulfilled.
Other suggestions are
1.Veg soup:
Contents: tomato -2, potato-1small, Onion - 1 small, Carrot-1 small.
Preperation: Wash all veggies properly peel potato, onion and carrot. Boil tomato in water for 5 to 6 mins sothat u can see the skin of tomato cracks. Now gently remove skin of tomato. Add tomato and the peeled veggies to a cooker with 1/2 a glass of water. Add pinch of salt and whistle the cooker for 2 to 3 times (veggies shud be cooked well). Now bring it to room temp and blend them in a mixer. Strain the contents to remove any lumps and now boil the soup with cinammon sticks (1or 2piece very small one) added to it. Boil it till it reaches the required consistency and then feed LO.
Note:You can add any veggie to make this soup including leafy veggies like spinach, amaranthus, cabbage etc.
2.Pumpkin: Take peeled pumpkin. dice the pumpkin and then presure cook it with little salt. mash well with hands and feed it along with rice or as such.
3.Gourds (any ashgourd, rich gourd etc etc): Make it finger size and then pressure cook it or boil in water till it becomes soft. You can either feed as a finger food or you can mash it and feed it along with rice or as such.
4. Boiled potatos and carrots. Pressure cook well and mash it with hands and add pinch of salt and feed baby as such.
5. Caramalised plums: Peel the plum. Put it on hot tawa and get it caramalised on both sides and then feed it mashed. Apple also u acn do the same way.
6. Poached pear: peel and pit the pear. Take 1/2 glass of water and add cinammon sticks, grated garlic, cloves etc and bring it to boil. Slip the pears into this boiling fluid and cook until its soft and the fluid is just about to disappear. Now remove all the sticks garlic cloves etc from the fluid and mash the pear in the same fluid and can feed the lo. Its really yumm. And for elders you can add sugar and honey while boiling which makes it a decent desert.
7.Avocado apple puree. Take avocado and peeled and diced apple in equal qty and grind well in blender. Directly feed the baby.
8.Banana: Ripened banana made to thin long slices. Heat tawa add little butter or olive oil and then saute the banana until its soft. mash and feed. If you wish you can add bit of sugar or honey to this
9.Oats and apple breakfast: ground oats and diec apple. Boil apples until its soft and add ground oats cook until oats is done and a yumm breakfast is raedy.
10.Daal : Cook daal in cooker with salt and curry leaves added to it. Mash it add few drops of ghee and u can feed it either with rice or as such.
Here are few meals suggestions and diet plan for your kid
Monday
Early Morning: 1 cup milk and 2 almonds soaked overnight and peeled. Almonds needs to be crushed into smooth paste like texture.
Breakfast: 1-1½ moong dal cheela (Moong dal dosa) or plain ghee dosa with coriander chutney.
Mid morning: 1 fresh fruit cubed into small pieces or 1 cup of fruit or vegetable juice or 1 cup of tomato or vegetable soup.
Lunch: ½ cup chicken or mutton kofta curry with ¾ cup rice or 1-2 chapattis.
Evening snack: Fruit smoothie (Seasonal like XXXXXXX puree) and 1 wholegrain cracker.
Dinner: ½ - 1 cup dhal khichri, ½ cup seasonal vegetables like methi, palak, or lauki.
Tuesday
Early Morning: 1 cup milk.
Breakfast: ½ cup cereal such as ragi (nachni) or XXXXXXX cooked in whole cream milk with chopped nuts such as almonds, walnuts, raisins and pistachios.
Mid morning: 1 fresh fruit cubed into small pieces or 1 cup of fruit or vegetable juice or 1 cup of tomato or vegetable soup.
Lunch (Curd optional): ½ cup dal, 3-4 spoonfuls of seasonal vegetables such as methi, lauki, etc. with ¾ cup rice or 1-2 chapattis.
Evening snack: Corn chaat or fruit chaat.
Dinner: ½ cup baked vegetables with cheese and 1 slice whole wheat bread.
Wednesday
Early Morning: 1 cup milk and 2 almonds soaked overnight and peeled.
Breakfast: ½ cup bhaji with 1 or 2 pavs.
Mid morning: 1 fresh fruit or 1 cup of fruit or vegetable juice or 1 cup of tomato or vegetable soup.
Lunch (Curd optional): ½ cup egg curry (1 whole boiled egg), ¾ cup rice or 1-2 chapattis.
Evening snack: 1 banana puree with ½ cup milk.
Dinner: ½ cup mutton stew with vegetables like beans and peas and 1-2 appams.
Thursday
Early Morning: 1 cup milk.
Breakfast: 1 whole wheat buttered toast with 1 egg omelette.
Mid morning: 1 fresh fruit or 1 cup of fruit or vegetable juice or 1 cup of tomato or vegetable soup.
Lunch (Curd optional): ½ cup potato soya gravy and 1 parantha or ¾ cup rice.
Evening snack: A whole wheat bread coriander or tomato chutney sandwich.
Dinner: ½ cup tomato fish curry,¾ - 1 cup rice.
Friday
Early Morning: 1 cup milk and 2 almonds (paste like) soaked overnight and peeled.
Breakfast: ½-1 cup suji upma with vegetables such as beans, peas, carrots and coconut.
Mid morning: 1 fresh fruit or 1 cup of fruit or vegetable juice or 1 cup of tomato or vegetable soup.
Lunch (Curd optional): ½ cup butter chicken or chicken curry with ¾ cup rice or 1-2 chapattis.
Evening snack: ½ cup moong sprouts salad with tomatoes, onions, coriander and lemon juice.
Dinner: ½ cup palak paneer, 1 chapatti or ½ - 1 cup rice.
Saturday
Early Morning: 1 cup milk.
Breakfast: 1 parantha stuffed with egg bhurji or scrambled, hard boiled or poached eggs with toast.
Mid morning: 1 fresh fruit or 1 cup of fruit or vegetable juice or 1 cup of tomato or vegetable soup.
Lunch (Curd optional): ½-1 cup rajma with ½ – ¾ cup rice.
Evening snack: 1 chicken nugget with 1 small slice of garlic bread.
Dinner: 1 cup pasta in tomato sauce with vegetables such as cabbage, peas and cauliflower and ¼ cup fresh green salad with tomatoes, onions and carrots.
Sunday
Early Morning: 1 cup milk.
Breakfast: 1 parantha roll with a stuffing of paneer and other seasonal vegetables.
Mid morning: 1 fresh fruit or 1 cup of fruit or vegetable juice or 1 cup of tomato or vegetable soup.
Lunch (Curd optional): ¼ cup haryali chicken cooked in spinach puree with ¾ cup rice or 1-2 chapattis.
Evening snack: 1 slice walnut/fruit bread with ½ cup milk.
Dinner: ½ cup de-boned and mashed fish and potato curry with ½-1 parantha.
Occasionally, you may want to serve desserts. Do remember to keep your toddler's daily sugar intake to about 1-2 tsp, and use honey or jaggery (gur) to sweeten the dessert instead of sugar.
Do get back to me if you need any further assistance, will be glad to assist you.
Take Care
Best Regards
Dr Deepak Kishore K
MBBS,MS,MCH
Consultant Pediatric Surgeon
Breastfeeding till 15-18months
Detailed Answer:
Namasthe
Welcome to Healthcare-Magic
Greetings of the day
Dear XXXX
Ideally breast feeding is to be continued for 15 to 18 months. Over next couple of months, you can slowly take her off breast feeding.
As the total leucocyte count is normal, there is nothing to worry about lymphocyes. Children may sometimes have elevated lymphocytes. Fever in child usually denotes infective etiology. A normal urine examination report will rule out urinary tract infection.
I would suggest the following for further investigation of fever
1. Chest X ray
2. PPD testing to rule out tuberculosis
If these reports are normal there is no cause for concern.
Being a parent myself, i can understand your concern and apprehensions.
It is important that you start introducing a variety of food in your toddler's diet gradually. These will provide the calories, proteins, vitamins and minerals that are essential for his growth. The amount of food eaten would vary from child to child and would also depend on when you introduce a particular food to your toddler. Most of the times it is "Try and Error" method. Lots of patience would be required from your end to find out what is that diet which tickles your toddlers tastebuds which also contains maximum nutrients. You need to try multiple ones and find which your child loves to eat amongst those. Initially it may be difficult from shifting to solid/semi-solid feed from milk based diet, continued perseverance and trying out what the baby likes is the key. Try the below suggestion, if still there is refusal to take diet, then do consult your Pediatrician
One recipe which the kid will like is as below
Ingredients needed: Ghee( 2 spoons), Whole wheat flour ( 2 spoons) , Pista( 50 gms), Cardomom ( 6 in number), Almonds( 50 gms), Khajur( Dried dates 50 gms), water/milk
In a pan pour 2 spoons of ghee, heat it, add 2 spoons of wheat flour (Atta), cook it till golden brown on low flame till its slightly golden in color. Add 2 Cups of water or Milk and keep stirring it continuously making a thin water paste( same like sira consistency). To this add powdered mixture of rest of ingredients grinded in mixer ( pista, almond, khajur, cardomom).
Supplement baby breakfast with this recipe, and also can be consumed at night when baby is hungry. In this way his quota for milk will also be fulfilled.
Other suggestions are
1.Veg soup:
Contents: tomato -2, potato-1small, Onion - 1 small, Carrot-1 small.
Preperation: Wash all veggies properly peel potato, onion and carrot. Boil tomato in water for 5 to 6 mins sothat u can see the skin of tomato cracks. Now gently remove skin of tomato. Add tomato and the peeled veggies to a cooker with 1/2 a glass of water. Add pinch of salt and whistle the cooker for 2 to 3 times (veggies shud be cooked well). Now bring it to room temp and blend them in a mixer. Strain the contents to remove any lumps and now boil the soup with cinammon sticks (1or 2piece very small one) added to it. Boil it till it reaches the required consistency and then feed LO.
Note:You can add any veggie to make this soup including leafy veggies like spinach, amaranthus, cabbage etc.
2.Pumpkin: Take peeled pumpkin. dice the pumpkin and then presure cook it with little salt. mash well with hands and feed it along with rice or as such.
3.Gourds (any ashgourd, rich gourd etc etc): Make it finger size and then pressure cook it or boil in water till it becomes soft. You can either feed as a finger food or you can mash it and feed it along with rice or as such.
4. Boiled potatos and carrots. Pressure cook well and mash it with hands and add pinch of salt and feed baby as such.
5. Caramalised plums: Peel the plum. Put it on hot tawa and get it caramalised on both sides and then feed it mashed. Apple also u acn do the same way.
6. Poached pear: peel and pit the pear. Take 1/2 glass of water and add cinammon sticks, grated garlic, cloves etc and bring it to boil. Slip the pears into this boiling fluid and cook until its soft and the fluid is just about to disappear. Now remove all the sticks garlic cloves etc from the fluid and mash the pear in the same fluid and can feed the lo. Its really yumm. And for elders you can add sugar and honey while boiling which makes it a decent desert.
7.Avocado apple puree. Take avocado and peeled and diced apple in equal qty and grind well in blender. Directly feed the baby.
8.Banana: Ripened banana made to thin long slices. Heat tawa add little butter or olive oil and then saute the banana until its soft. mash and feed. If you wish you can add bit of sugar or honey to this
9.Oats and apple breakfast: ground oats and diec apple. Boil apples until its soft and add ground oats cook until oats is done and a yumm breakfast is raedy.
10.Daal : Cook daal in cooker with salt and curry leaves added to it. Mash it add few drops of ghee and u can feed it either with rice or as such.
Here are few meals suggestions and diet plan for your kid
Monday
Early Morning: 1 cup milk and 2 almonds soaked overnight and peeled. Almonds needs to be crushed into smooth paste like texture.
Breakfast: 1-1½ moong dal cheela (Moong dal dosa) or plain ghee dosa with coriander chutney.
Mid morning: 1 fresh fruit cubed into small pieces or 1 cup of fruit or vegetable juice or 1 cup of tomato or vegetable soup.
Lunch: ½ cup chicken or mutton kofta curry with ¾ cup rice or 1-2 chapattis.
Evening snack: Fruit smoothie (Seasonal like XXXXXXX puree) and 1 wholegrain cracker.
Dinner: ½ - 1 cup dhal khichri, ½ cup seasonal vegetables like methi, palak, or lauki.
Tuesday
Early Morning: 1 cup milk.
Breakfast: ½ cup cereal such as ragi (nachni) or XXXXXXX cooked in whole cream milk with chopped nuts such as almonds, walnuts, raisins and pistachios.
Mid morning: 1 fresh fruit cubed into small pieces or 1 cup of fruit or vegetable juice or 1 cup of tomato or vegetable soup.
Lunch (Curd optional): ½ cup dal, 3-4 spoonfuls of seasonal vegetables such as methi, lauki, etc. with ¾ cup rice or 1-2 chapattis.
Evening snack: Corn chaat or fruit chaat.
Dinner: ½ cup baked vegetables with cheese and 1 slice whole wheat bread.
Wednesday
Early Morning: 1 cup milk and 2 almonds soaked overnight and peeled.
Breakfast: ½ cup bhaji with 1 or 2 pavs.
Mid morning: 1 fresh fruit or 1 cup of fruit or vegetable juice or 1 cup of tomato or vegetable soup.
Lunch (Curd optional): ½ cup egg curry (1 whole boiled egg), ¾ cup rice or 1-2 chapattis.
Evening snack: 1 banana puree with ½ cup milk.
Dinner: ½ cup mutton stew with vegetables like beans and peas and 1-2 appams.
Thursday
Early Morning: 1 cup milk.
Breakfast: 1 whole wheat buttered toast with 1 egg omelette.
Mid morning: 1 fresh fruit or 1 cup of fruit or vegetable juice or 1 cup of tomato or vegetable soup.
Lunch (Curd optional): ½ cup potato soya gravy and 1 parantha or ¾ cup rice.
Evening snack: A whole wheat bread coriander or tomato chutney sandwich.
Dinner: ½ cup tomato fish curry,¾ - 1 cup rice.
Friday
Early Morning: 1 cup milk and 2 almonds (paste like) soaked overnight and peeled.
Breakfast: ½-1 cup suji upma with vegetables such as beans, peas, carrots and coconut.
Mid morning: 1 fresh fruit or 1 cup of fruit or vegetable juice or 1 cup of tomato or vegetable soup.
Lunch (Curd optional): ½ cup butter chicken or chicken curry with ¾ cup rice or 1-2 chapattis.
Evening snack: ½ cup moong sprouts salad with tomatoes, onions, coriander and lemon juice.
Dinner: ½ cup palak paneer, 1 chapatti or ½ - 1 cup rice.
Saturday
Early Morning: 1 cup milk.
Breakfast: 1 parantha stuffed with egg bhurji or scrambled, hard boiled or poached eggs with toast.
Mid morning: 1 fresh fruit or 1 cup of fruit or vegetable juice or 1 cup of tomato or vegetable soup.
Lunch (Curd optional): ½-1 cup rajma with ½ – ¾ cup rice.
Evening snack: 1 chicken nugget with 1 small slice of garlic bread.
Dinner: 1 cup pasta in tomato sauce with vegetables such as cabbage, peas and cauliflower and ¼ cup fresh green salad with tomatoes, onions and carrots.
Sunday
Early Morning: 1 cup milk.
Breakfast: 1 parantha roll with a stuffing of paneer and other seasonal vegetables.
Mid morning: 1 fresh fruit or 1 cup of fruit or vegetable juice or 1 cup of tomato or vegetable soup.
Lunch (Curd optional): ¼ cup haryali chicken cooked in spinach puree with ¾ cup rice or 1-2 chapattis.
Evening snack: 1 slice walnut/fruit bread with ½ cup milk.
Dinner: ½ cup de-boned and mashed fish and potato curry with ½-1 parantha.
Occasionally, you may want to serve desserts. Do remember to keep your toddler's daily sugar intake to about 1-2 tsp, and use honey or jaggery (gur) to sweeten the dessert instead of sugar.
Do get back to me if you need any further assistance, will be glad to assist you.
Take Care
Best Regards
Dr Deepak Kishore K
MBBS,MS,MCH
Consultant Pediatric Surgeon
Above answer was peer-reviewed by :
Dr. Raju A.T
Thanks for your reply sir. We did an x ray sometimes 2 months before because we thought she has galloped a stapler pin but that time fever problem was not there, do you suggest one more chest x ray this time? If yes, do I have to inform the laboratory guy some specific instructions for ppd and chest x ray or they are the general one which everybody understands.
Brief Answer:
PPD is not done in routine laboratory
Detailed Answer:
Namasthe XXXX
PPD or Purified protein derivative is not any test to be done in laboratory. PPD is available with Pediatrician , small quantity has to be injected on the forearm of baby and the induration interpretted after 48 hours.
I would suggest you to consult Pediatrician and discuss the management . Repeat Chest X ray is definitely indicated if the baby has persistent documented fever of more than 99.8 F.
For any further queries write directly o me.
Take CAre
Regards XXXXXXX
PPD is not done in routine laboratory
Detailed Answer:
Namasthe XXXX
PPD or Purified protein derivative is not any test to be done in laboratory. PPD is available with Pediatrician , small quantity has to be injected on the forearm of baby and the induration interpretted after 48 hours.
I would suggest you to consult Pediatrician and discuss the management . Repeat Chest X ray is definitely indicated if the baby has persistent documented fever of more than 99.8 F.
For any further queries write directly o me.
Take CAre
Regards XXXXXXX
Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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