Ideally have a well nourished mother who breastfeeds. At 6 months, introduce mother's diet liquidised, as the immune system has been trained to accept this. Continue breastfeeding for at least 6 months. Progress to mother's diet mashed, and then bits of mother's food, when the baby is ready to grab it.

If mother isn't well nourished, mother should take good quality supplements.

If not breastfeeding, look for a formula containing taurine, omega three fatty acids, and minerals in organic form.

If necessary, use baby vitamin and mineral drops, but check the excipients. If the mother's vitamin D is low, the baby is at risk of fracture, which may be misdiagnosed as shaken baby syndrome.

Margaret ,  thank you  very  much  for  input  and  precious  advice  .   

( It's  true , we  must  go  back  to  the  basics   instructing  the  mothers / potential  mothers (  Sadly ,  in a  decade  since  I am  here ,  I met   very few  well educated  mothers - or ,  even  if  well  educated , not  always inclined  to  practice  what  they  know ) The  tradition  is  quickly  using  the  formula !  Sadly 

Dear Daniela and Margaret,

I have remembered now the Chinese proverb saying that pregnancy is one year not 9 months!. This means mother should prepare her self  with good nutrition  3 months before starting the pregnancy. If we started the right cycle probably we talk about females nutrition during teenage. So I have a TV programme in Egypt talking about dieters girls in teen age and focused specifically if they have not got good nutrition, enough mineral Ca and P  may lead to weak in the pelvic bones expectedly to have unsuccessful  pregnancy. (please have a look at the link). I agree with you to back to the track nutrition education, probably to be available  course from primary school to tertiary education for girls and boys. I still believe in Home Economics.

https://www.youtube.com/watch?v=hGHBdNYPYSs

Best regards

Aly R Abdel-Moemin

Offer toddler milk, which is a second stage follow-on formula as manufactured by infant and follow-on formulae producers like Danone an others.

For trace minerals (hard to get from food) I would suggest supplementing with PDCM72 from Millennium Select (can buy at Amazon).  This is a plant derived liquid colloidal minerals--very little taste.  Dose for a toddler--1/4 teaspoon per day mix in water or juice.   Hope this helps.

Jaap Schrijver ,  Danielle Monahan -  Thank you  very  much  for  input  and  precious  info ! 

Dear all,

I agree that maternal nutrition intervention is the best first way to have a well nourished todler. the concept of nutrition in the first 1000 days of life (from conception to when a child is 2 years) should be made well known to the mothers and those opting to conceive. I have chosen to work on Iodine nutrition for the next 3-4 years as deficiency in maternal iodine will very likely cause an irreversible congenital deformities such as cretinism, dwarfism, etc in children, aside from poor cognitive development. Other nutrients equally important!

I would like to add to Mr. Olum comments--to stay away from fluoride which interferes with iodine.  A 2012 Harvard study found fluoride lowered IQ in children by 7 points and an article in Lancet Neurology 2014 reclassified fluoride as a developmental neurotoxin!

Hello, All -

I have worked in pediatric nutrition for 6 years.  I would add that the calcium in cow's milk can inhibit the absorption of iron.  Thus, when a child is eating high iron foods cow's milk intake should be staggered by 1.5 to 2 hours to allow for absorption of iron.

Vitamin C promotes iron absorption.  Adding vitamin C rich foods (citrus, tomato, bell pepper, broccoli, kiwi, strawberry...) to meals high in iron is a good idea.

Adequate vitamin D status promotes the absorption of calcium, magnesium, zinc. Sunshine and/or supplementation.

Excess zinc inhibits copper absorption.  Excessive dietary fiber and dietary oxalates can bind to minerals to prevent absorption.

One mineral-rich food is bone broth.  I have had many malnourished patients rehabilitate through the use of bone broth as the main cooking liquid for grains, soups, etc.  Bone broth can be purchased or made at home.  It is best to use the bones from humanely raised, organically fed animals to minimize toxins.

Another area to explore for patients is their environmental toxins.  Lead is especially harmful in relation to iron status.

In addition, no matter what nutrients are delivered via mouth, if a child's gastrointestinal tract is not functioning optimally, he/she is less likely to absorb the nutrients.  If his/her protein status is poor he/she will not have adequate carrier proteins in the blood to shuttle the minerals to their respective destinations in the body.  Looking at GI health and ensuring that not just supplements, but well-cooked high protein/mineral whole foods are provided to the child are important steps in rehabilitating a malnourished toddler.  Soups, purees, broths (of tolerated foods) are easy on the digestive system.

Doing some food allergy testing, and having the care takers do a food/symptoms/stool journal is very helpful.

Feel free to message me if you'd like more info.

Emily

 Till 6 months of age, if the baby is on breast milk, there is no need for any external supplements. Exposure to vitamin D {natural sunlight} is advised for proper absorption of  calcium. After 6 months, when the baby is weaned, the selection of complementary foods is crucial to ensure adequate mineral nutrition. Whole grains are richer in minerals than refined / polished ones. Germinated, dehusked pulses are good sources of both vitamins and minerals and easy to digest too. Mothers can be advised to prepare supplementary foods based on locally available diet patterns and ingredients. Generally, if the baby feeds well, deficiencies will not occur. In case of severe deficiencies, therapeutic supplements can be given based on medical advice.

If you are dealing with mothers directly, I suggest training them to prepare nutritious food supplement at home and use it. We have many, which we use for our women, but they are suitable to our locale, hence you may need to develop region-specific supplementary foods.     

Hi Daniela, 

I would recommend referring to a pediatric dietitian who can assess the child's feeding and diet, advise on introduction of appropriate foods to meet the short fall and prescribe an appropriate supplement wherer necessary.  if there are physical swallowing problems refer to a speech and language pathologist too.  If the reasons for this toddler only having milk are unknown a referral to a pediatric doctor too to rule out any medical causes.  I hope that helps. 

Zoe (Paediatric Dietitian)

Hello  All 

And  a big  "Thanks"  for  your very   precious answers  ,  contributing   to  developments  researching   on this  topic ! 

Hello Emily  Parker , 

Thanks  so  much  for  precious input  and  very  interesting  detailed  answer .  Once  again  I  am  reminded  that   nutrition  is  much  more  than  only  about  foods ,  and  that  interfering  factors   should  never be  forgotten .

(  Now , on  a  practical  side -  as  you  mentioned  that  Vit.C  promotes  the  absorption of  iron ,  as  my  present  research  is  dealing with  the  preschoolers  among  whom  many   seems  to  be   iron  deficient ,  it's really   nice  to  learn  about  the  strawberries  or  citrus  fruits ,  in  order  to  better  motivate  them )     

Thanks  once  again  !  

For toddlers (aged between 1-3 years) whose diet is principally focused around milk perhaps look for micro-nutrient fortified milks. While paediatric evidence illustrates  children who drink milk regularly are more likely to meet dietary recommendations for many nutrients, thus bolstering nutritional status, consuming a fortified milk (delivering more micro-nutrients than traditionally found in milk) may help treat and prevent nutritional inadequacies in a safe and effective manner.

I'd suggest encouraging them towards hard cheese rather than milk, as cheese contains vitamin K2, which helps bones and arteries. Ultimately a milk habit is dangerous, leading to glycation by galactose, and thus to artery disease.  To balance the calcium in cheese, you need magnesium from vegetables, lentils, and/or cashew-nut butter. If you use fortified products, make sure they are fortified with minerals in bioavailable organic forms, rather than cheap inorganic ones.

Dear  Margaret ,

Thank you  once  again  for  precious  contribution !  

The only  problem -  in  this  part  of  the  world -  with  going  into  the  direction  you  suggested  ,  is  that  both  kids  and  parents  are  culturally  mind set  for  UHT milk  packs ! ehehe ... That's  my  main  heartache :  how  to  help  them  improve  and  maybe  change  this tradition towards  a  healthier  way ?!