Makanan Pejal Bayi

Menu 1: Puri Sawi (6 bulan)

1. Ambil 1/2 cawan daun sawi, cuci bersih dan potong kecil.
2. Kemudian rebus sehingga menjadi lembut.
3. Setelah itu, ambil daun sawi yang telah lembut tadi dan cincang sehingga halus.
4. Tambahkan sedikit air rebusn untuk mencapai kepekatan yang diingini. Sedia untuk dihidangkan.

Myth of Breastfeeding

Breastfeeding continues to be surrounded by a multitude of myths. Here are some of the more common ones:

MYTH: ‘I AM ON MEDICATION; SO BREASTFEEDING WILL HARM MY BABY.’

Many medications can be consumed while you are breastfeeding, but it is important to note that at least a small amount of these drugs will make their way into breast milk and can occasionally affect your milk supply. Always consult your doctor before taking any medication. 

MYTH: ‘MY BABY KEEPS CRYING FOR MILK. MAYBE I’M NOT PRODUCING ENOUGH.’

It is perfectly normal for your baby to ‘demand’ a feed every 2-3 hours. Breast milk is digested very easily and this may cause your baby to become hungry fast. Frequent ‘demand’ feeds have nothing to do with your milk supply.

MYTH: ‘I NEED TO TAKE A REST FROM BREASTFEEDING EVERY FEW DAYS.’

Some women say that skipping a feed during the day will produce milk more at night. Perhaps there is a connection between that and the origin of this myth. Unfortunately, skipping a feed will only result in lower amount of milk being produced the next day, as it is continuous breastfeeding that ensures a constant supply of milk. Therefore, there is no need to ‘take a breastfeeding break’. 

MYTH: ‘I’M NOT PRODUCING ENOUGH MILK.’

Many women come up with this line when they notice that the amount of milk produced in the first few days of delivery is relatively small. Do not be fooled by this! The ‘milk’ produced in the first days is actually not milk, but a substance called colostrum. Colostrum is a thin, white fluid excreted at the end of pregnancy and contains more lactoalbumin and lactoprotein than regular breast milk. It is rich in antibodies, proteins, and vitamins that are crucial in providing passive immunity to a newborn-that’s why it is called “liquid gold”. Colostrum is enough to nourish your baby until you start producing breast milk.

MYTH: ‘MY BREASTS WILL SAG IF I BREASTFEED’

Contrary to popular belief, sagging of breasts is not in any way related to breastfeeding. In fact, genetics and body type are responsible for this so-called ‘gravitational pull’, so don’t let this deter you from ensuring that your baby gets the best nutrition and protection that he or she can receive.

Exercise

I think it is very good to educate the patients. Lets practice it!

Panduan Pemakanan bagi Kanak-Kanak yang Kekurangan Zat Makanan

Sewaktu posting di Poliklinik Komuniti Beserah (PKB) (10 Ogos-27 Ogos 2009), kumpulan kami dikehendaki mengendalikan satu kelas Pemakanan bagi Kanak-kanan yang Kekurangan Zat Makanan (KZM) a.k.a Failure to Thrive (FTT). Kelas ni merupakan aktiviti berkala yang dirancang pada setiap minggu ketiga setiap bulan oleh Klinik Kesihatan Keluarga (MCH), PKB. If I not mistaken that class on 19th August. Oleh yang demikian, kami telah menyediakan bahan-bahan yang berkaitan untuk dikongsi ersama-sama dengan ibu-ibu di luar sana (As group 1st to handle FTT class, so excited to lebih skit. Sigghhh..^_+) Walau bagaimanapun, impian dan cita-cita kami tak kesampaian. Huhu.. Kelas to cancel pulak.. Mungkin disebabkan kes H1N1 yang melanda, tambah pulak bulan Ramadhan bakal menjelang minggu depannya jadi patient agak ramai juga minggu tu. Jadi eloklah rasanya nak kongsi bersama-sama tetamu sekalian. Moga ada khairnya!

Panduan Pemakanan bagi Kanak-kanak yang Kekurangan Zat Makanan
oleh: Ayat, Salihah, Zairunida, Nadirah & Hazirah

Kekurangan berat badan tidak bermaksud kurus ataupun langsing. Sesetengah kanak-kanak secara semulajadi, bertubuh agak besar dan mengekalkannya dengan mengamalkan diet yang seimbang serta melakukan aktiviti fizikal. Ada sesetengah yang lain pula secara semulajadinya bertubuh kecil, namun mereka bukanlah kekurangan berat badan. Walau bagaimanapun, kekurangan berat badan yang sebenarnya mungkin petanda kepada masalah pemakanan, kesihatan, atau emosi.

Bagaimanakah cara untuk mengetahui anak saya mengalami kekurangan zat makanan?

1. Pertumbuhan kanak-kanak mestilah mengikut corak pertumbuhannya.

2. Timbang berat dan ukur ketinggiannya, buat perbandingan dengan standard-carta pertumbuhan (Growth Chart). Plot nilai berat badan dan ketinggian anak pada carta berat badan & ketinggian mengikut jantina. (Refer growth chart CDC-weight and stature for age for boys and girls).

3. Selain itu, Indeks Jisim Tubuh (IJT) a.k.a. Body Mass Index (BMI) boleh dikira dengan rumus BMI= Berat (kg) / (Tinggi X Tinggi) (m2). Kemudian, plotkan BMI anak pada carta BMI. If your child's BMI is:

- <5th percentile: underweight
- between 5th percentile to 85th percentile: normal
- >85th percentile: overweight
- >95th percentile: obese


* Oleh yang demikian, KZM boleh didefinisikan apabila BMI anak anda < 5th percentile.

Apakah yang patut anak saya makan?

Oleh kerana makanan kurang diambil, ibu bapa atau penjaga harus memberi makanan berkalori tinggi. Apabila menyediakan makanan, utamakan sumber lemak tambahan yang sihat seperti minyak sayuran sebagai pengganti mentega atau marjerin. Contoh penyediaan makanan berkalori tinggi:

1. Tambahkan marjerin, mentega kacang atau keju ke atas biskut kraker


2. Tambahkan marjerin lembut (soft margerine), mentega kacang (peanut butter) atau keju ke atas roti


3. Tambahkan ayam / daging / minyak / marjerin ke dalam masakan bubur


4. tambahkan susu / minyak / marjerin / keju ke dalam telur


5. Tambahkan serbuk coklat atau ais krim ke dalam susu


6. Tambahkan susu / minyak / merjerin ke dalam kentang lenyek


Sebagai pelajar dietetik, penyediaan menu amatlah dititik beratkan. Bak kata Sr. Aishah, "Menu sangat penting bagi dietitian, tu la yang nak bezakan antara kita dengan orang lain. Bukan senang nak prepare menu, saya nak awak semua biasakan diri dari sekarang. Nanti senang bile awk dah keje nanti"
Ya, bukan senang nak sediakan menu. Kalau setakat menu yang biasa tu semua orang boleh, tapi menyediakan menu sihat tu yang payah.. Mesti memenuhi keperluan tenaga yang disyorkan seperti dalam RNI..Di sinilah pentingnya peranan dietitian, inilah juga yang membezakan antara dietitian dengan chef / tukang masak. Betul tak kawan-kawan??

Berikut, kami sediakan contoh menu untuk kanak-kanak 1-3 tahun dan 4-6 tahun yang mengalami masalah KZM:

Menu bagi Kanak-kanak 1-3 tahun (950 kcal)

Sarapan Pagi
1/2 gelas susu penuh krim
1 keping roti bakar

Minum Pagi
1/2 gelas susu penuh krim

Makan Tengahari
1/2 cawan nasi putih
1 keping telur dadar (1 biji telur + kobis bunga + putik jagung + bayam)
Sup sayur (sawi + lobak merah+ kobis bunga + putik jagung)
1 gelas air kosong
1 potong betik

Makan Malam
Mi sup
- 1/2 cawan mi
- ayam + kentang
- sayur (sawi + kobis + lobak merah + kobis bunga)
1 gelas air kosong

Menu Kanak-kanak 4-6 tahun (1300 kcal)

Sarapan Pagi
1/2 gelas susu penuh krim berperisa coklat
1 keping lempeng kentang (+ 1/2 cawan susu penuh krim)

Minum Pagi
1 keping kek coklat
1 gelas air kosong

Makan Tengahari
1/2 cawan nasi
Sup ayam (+ 1/2 kentang, lobak merah, seleri, bayam)
1 gelas air kosong
1 potong tembikai

Minum Petang
1 ketul cekodok pisang (sederhana besar)
1 gelas air kosong

Makan Malam
1 set sandwich ayam
-1 ketul ayam yang dicarik isinya
-Timun + salad + tomato
-1/2 sudu teh marjerin lembut + 1/2 sudu teh mayonis
1 gelas jus epal tanpa gula

Minum Malam
1 gelas susu penuh krim berperisa coklat

p/s: sekadar ini dahulu perkongsian untuk kali ini, moga kita dapat manfaat daripada sedikit usaha ini ;)

D.I.E.T.E.T.I.C.S

Bachelor of Dietetics

Saya terpana ketika mendapat surat tawaran daripada IIUM, Alhamdulillah pilihan pertama saya berjaya diterima. Saya sendiri pun kurang pasti apa yang bakal saya belajar dalam bidang ini, cuma rough idea yang saya tahu tentang makanan. Saya masih ingat soalan yang ditanya semasa temuduga nak pilih kos di Kuantan.

"Please introduce yourself and give your reasons why you choose that course.." ask the interviewers.

Saya tidak ingat apa jawapan yang saya bagi, tapi apa yang pasti saya betul-betul nekad untuk pilih kos diet pada malamnya. Namun, saya betul-betul buntu adakah pilihan saya adalah yang terbaik. Kepada mak dan ayah, saya mohon mereka doakan kelancaran tutur kata saya pada hari ni. Alhamdulillah lebih kurang 15 minit interview selesai.

"Belajar kat mana sekarang? Ambik kos ape kat sana?" soalan2 favourite yang selalu ditanya. Tak kira la kawan ayah, kawan mak, saudara mara, jiran-jiran hatta rakan-rakan sepersekolahan pun.

"Kat UIA, ambik kos dietetik," jawapan ringkas.

"Ha, ape die? Kos ape tu?" Pulak. Apa jawapan yang sesuai yang saya nak jawap nih. Macam pelik sangat kos ni.Buntu.

"Bidang pemakanan."

"Oooo..."

Hmm. Itu adalah perbualan biasa yang saya dan kawan-kawan alami. Bidang Dietetik merupakan salah satu cabang dalam bidang Sains Kesihatan Bersekutu yang agak baru di Malaysia kalau nak dibandingkan dengan doktor, jururawat, doktor gigi dan bidang-bidang yang lain.

"Anak Cikgu S tu pun ambik bidang pemakanan juga, katanya food technology tapi tak pulak praktikal kat hospital," kata mak.

Hmm, apa jawapan yang terbaik nak bagitahu mak ni. "Tu lain mak, kos tu lebih kepada teknologi makanan. Macam mana nak hasilkan makanan baru, ubah suai yang sedia ada. Kan kita selalu tengok, banyak je produk2 baru kat kedai. Food technologist la yang reka. Selalunya diorang kat bahagian industri, kos angah ni kat hospital."

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What is Dietetics?

"The scientific study of food preparation and intake" (Web definition)

"The study and regulation of the diet" (Hyperdictionary definition)

"The science or study and regulation of the diet" (Dorland's Illustrated Medical Dictionary, 30th ed.)

These definitions are woefully inadequate for what dietetics has grown to become. The basis of dietetics is the firm belief that optimal nutrition is essential for the health and well being of every person. This is why is an integral component of the healthcare field.

What is a Dietitian?

"A professional person who is translator of the science and art of foods, nutrition, and dietetics in the service of people- whether individually or in families or large groups; healthy or sick; and at all stages of the life cycle"

Dietetic practice is defined as the application of principles derived from the integration of knowledge of food, nutrition, biochemistry, physiology, management, and behavioral as well as social science to achieve and maintain the health people.

According to Malaysian Dietetic Association (MDA), dietitian:

* a professional trained in translating the science of food, nutrition and medical nutrition therapy to meet the needs of individual or target groups, whether in disease or health.

*He / she is equipped with the knowledge and skills to conduct nutritional assessment, prescribe medical nutrition therapy, provide dietary consultation for the treatment of diseases / illness, in both acute and chronic care.

* also play an important role in providing expertise in the promotion of wellness through proper eating, development of modified diets/ meals/recipes in the food service organization, catering industry and food manufacturing industry in various sectors.

* participate in research and apply practice, based on scientific – evidence.

* also involved in providing input for the formulation of policies, protocols, clinical practice guidelines, medical nutrition therapy guidelines, planning and implementation of programmes, to support the current healthcare needs of the population.

* He/she provide education and disseminate nutrition information through community activities, various modes of mass media like giving talks through radio, television, and writing in newsprint, professional articles for release in newspapers, journals, magazines, etc.

Types of dietitians

1. Clinical Dietitian

Clinical Dietitians, provide their services to inpatients and outpatients at hospitals or medical centres. Doctors refer patients to the dietitian for consultation on the nutritional modifications required for the treatment of the disease or condition for the critically ill or chronic diseases. Clinical dietitians conduct nutritional assessment, and prescribe the diet based on the anthropometry, biochemical, clinical diagnosis and dietary intake. Recommendation is made for the individual’s meal plan for a normal or therapeutic diet, to be administered either orally or via tube feeding. In certain cases, if tube feeding is not possible or unable to meet the nutritional requirements, parenteral nutrition will be required.

Clinical Dietitians work closely in a multidisciplinary team approach with the doctor and other Allied Health Professionals like nurses, pharmacists, physiotherapists, speech therapists, etc. to provide holistic care to the patients. The dietary advice, together with other aspects of care, for the patient and his/her carer/s are very important to ensure comprehension, compliance of treatment and reduce risk of morbidity.

2. Foodservice / Catering Dietitian

Food Service Dietitians or managers are responsible for planning and management of the meal production ( normal or therapeutic meals ) and delivery system to ensure quality and safety of foods provided to the patients or clients. The food service organizations include hospitals or medical centres, institutions, prisons, airline catering, staff cafetarias, food chain outlets, restaurants, etc. The dietitian’s responsibility encompass understanding of organizational policies, management of manpower, budgeting, procurement, purchasing, storage, food preparation, cooking, meal presentation and serving to the patients or clients.

Quality control and compliance to food safety standards and guidelines are crucial. Effort on obtaining feedback on customer’s satisfaction, customer’s expectation and continuous quality improvement are an aset to the organization.

3. Community Dietitian

Community Dietitians work closely with wellness programmes from health organizations from both local and international. These dietitians apply and disseminate knowledge about food and nutrition to individuals and target groups in the lifespan. They can be involved in coordinating nutritional programs in public health agencies, daycare centers, health clubs, recreational camps and resorts. Some community dietitians carry out clinical - based patient care in the form of Home - Visits for patients who are too ill physically, to attend consultation at health facilities or require the services of a dietitian for home-care services like meal planning, proper food preparation techniques and management of feeding regime for those on tube feeding.

There are also community dietitians that managed their own Private Consultation Practice. They contract independently, to provide nutrition and dietetic services, educational programmes and advice to individuals, nursing homes, private schools and in healthcare facilities.

4. Research Dietitian

Research Dietitians work at universities or research organizations. They conduct research studies in various aspects that support further development in nutrition and dietetics research. Some of the research scope may include studies on nutrients in foods, nutrient intake, clinical intervention, food preparation methods, dietary compliance studies, KAP studies and others. They may work closely with other universities, and research organizations, from local or international agencies in collaborating research. He/she also work with dietitians in clinical practice sector, to collaborate efforts, to further improve patient care.

Besides being involved in research, dietitians working in the University sector are also involved in providing teaching and education of undergraduates and postgraduate students. They are also involved in giving talks and provide education to other organizations and the mass media.

5. Sport Dietitian

Sports Dietitians work with sports organizations, and agencies involved in the promotion of sports among our population. The dietitian will conduct nutritional assessment based on the type of sports and requirements, prescribe the recommended diet for individuals to achieve peak performance in competitive sports and advice on food choices, food preparation techniques and eating habits. Besides sports, he/she is involved in promotion of sports, exercise and encourage a physically active lifestyle to support the Healthy Lifestyle Programme of the National Healthcare.

The dietitian works closely with the team of professionals like doctors, physical fitness instructors, physiotherapists, sports psychologists and others in managing the well being of the atletes.

6. Corporate Dietitian

Business Dietitians encompass dietitians working in sectors whereby consultancy and professional advice is required in disseminating professional and accurate information about a particular product, consultancy or service.

The Business dietitian may work with other categories of dietitians, other organizations to network, share knowledge and experience, so as to help and meet the needs of the client. This may involved sectors like food manufacturing industry, food service industry, pharmaceutical industry and others.

Training, education and imparting professional information to the clients, whether healthcare professionals or the public are important to address the current healthcare needs. He/she may be expected to work closely with other local or international organizations and facilities.

Sources: Malaysian Dietetic Association (MDA) and Lecture note Introduction to Patient Care

OPD setting bermula

Alhamdulillah minggu pertama OPD di Poliklinik Beserah selesai, saya hanya mampu memberi kaunseling kepada 2 orang pesakit sahaja lantaran kurangnya pesakit yang datang membuat pemeriksaan.

Pesakit pertama saya dirujuk kerana HPT dan hypercholesterolemia. Agak berdebar juga saya untuk mengambil kes ni, tambahan patient agak kurang memberikan respon yang baik. dari segi lifestyle agak sukar untuk saya manage, eating out every meal due to living alone here in Kuantan. The family members are in Rompin. After taking the diet history, all the dietary intake leads to the problem..In addition, he shows low motivation to change even though he is obese, has hypertension and hypercholesterolemia... What I have to rite now?

I advise on the healthy eating out tips since the patient is eating out most of the time. What is it?

1. Choose healthy cooking method - steaming, grilling, baking, boiling instead of frying

2. Choose soup based dishes instead of fried food. Limit the intake of fried food to twice per week only. Aviod to drink the soup (because loooots of MSG there!)

3. Trim visible fat from poultry and meat, kalau yang ada kulit tu buang kulit dia ye.. Choose lean meat only.

4. Scoop out the oil in the soup / gravy

5. Increase the fiber intake from fruits and vegetables

6. Educate patient also on hidden salt - processed food (nugget, fishball, burger patty) and canned food (sardine, tomato puree, all canned items la..) because they use looooots of salt as preservative agent. Beware!!

All the recommendation is actually combination of low fat and low salt diet..

The next advise is on being active! Recommend the patient on doing physical activity, at least 30 minutes per session 3X per week. Besides, we also can perform the exercise at working area. Examples; using stairs instead of lift. Park the car far from the building so that we will walk to the office.

Maka selesailah sudah tugas saya untuk pesakit tersebut..

The next 2 days, I manage another patient. Of course man too! Diagnosed as DM, HPT, Hypercholesterolemia and Hyperurecemia (which will lead to gout soon. Aouch!!).. The management is almost same like previous patient, but I need more advise on controlling his blood sugar and also uric acid. I'm very happy to see this patient, very cooperative and gives respons. He also has high motivation to change. Saya bersemangat semula ^_^

Management of DM:

1. Educate patient on continuing regular meal time to avoid hypoglycemia

2. Emphasize on complex CHO (e.g. bread, rice, cereals) and avoid refined sugar (sweet foods and drinks).

3. Increase fiber intake (fruits & vegetables-twice per day, wholemeal cereals and bread)

4. Educate patient on fruits portion size (e.g: watermelon , honey dew, & papaya- 1 slice; apple, orange, banana- 1 no; dates- 2 pieces, etc)

5. Suggest patient to consume artificial sweetener, however it is better not to consume any sweet food and drink..

For uric acid management:

1.Educate patient on avoiding high purine food such as anchovies, seafood, yeast

2. Drink a lot of water.

* Since the patient also has HPT, I suggest to reduce the amount of cigarettes per day. Smoking also leads to constriction of blood vessels, lead to increaseng the blood pressure and affect the heart. Caffeinated drink also is limited to 2 cup per day only as it is vasoconstrictor and not good to our health ^_+

That's all for today, we will meet the 2nd week of posting. Iam waiting for Gestational Diabetes Mellitus (GDM) and Chronic Kidney Disease (CKD) patient..Hopefully ;)