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Complementary feeding

Definition of Complementary feeding

The process of giving an infant other foods and liquids along with breast milk or non-human milk as breast milk alone is no longer sufficient to meet the nutritional requirements.

These foods should complement rather than replace breastmilk.

Appropriate Complementary Feeding

Timely: Introduced when need for energy and nutrients exceeds that provided by BF

Adequate: Should provide sufficient energy, protein, and micronutrients

Properly Fed: Active feeding method and proper frequency according for age

Safe: Should be hygienically prepared, stored and fed

Timing of Complementary Feeding

Soon after completing 6 months of age Breast milk sufficient to promote growth and

development till 6 months Energy and nutrient gap appears after 6 months

and widens thereafter Infant’s development and behavior makes him

ready for other foods Holds objects (e.g. biscuit) and takes everything to mouth Chewing movements start Tendency to push solids out decreases Eruption of teeth and beginning of biting movements

Age of Introduction

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200

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800

1000

1200

0-3 mo 3-6 mo 6-9 mo 9-12 mo 12-24 mo

Energy Gap

Energy frombreastmilk

Energy Needs

Excl. Breastfeeding Comp. feeding & continued BF

Timing of Complementary Feeding

Disadvantages of adding foods too soon

Decrease the intake of breast milk resulting in a low nutrient diet

Increase risk of illness esp. diarrhea

Disadvantages of adding foods too late

Growth and development slows down or stops

Risk of deficiencies and malnutrition

Importance of continued breastfeeding for 2 years and beyond

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20

40

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120

Energy Protein Vit. A Vit. C Iron

% daily needs

provided by

500ml breast

milk

Gaps to be filled by complementary foods

Energy and Nutrients from breastmilk

Why Continue Breastfeeding?

Vital source of energy (30-40%) and nutrients into 2nd yr of life

Key source of Good quality proteins & essential fatty acids Micronutrients:

45% of Vitamin A 40% of calcium & riboflavin 95% of Vitamin C

Fluids and nutrients during infection

Associated with greater linear growth Linked to lower risk of chronic diseases & obesity

Adequacy (Quality)

Staples: Cereals (Rice, wheat, maize, millets) and Legumes

Fats (Vegetable oils/butter/ghee; 1g ~ 9 Kcal) and sugars to improve energy density and taste

Foods of animal origin (Milk, curd, eggs, meat, fish) to provide good quality proteins, vitamin A and calcium.

Vegetables and Fruits to provide micronutrentse.g. iron and vitamins. Supplements e.g. iron might be required.

Other Attributes of Complementary Foods

Right consistency

Soft

Easy to digest

Inexpensive

Locally available

Culturally acceptable

Easily prepared at home

Variety of Foods

Start at 6 months with small amounts of food; increase quantity with age, maintaining frequent breast feeding

Increase food consistency & variety with age

Can feed mashed & semi-solids (e.g. porridge) at 6 months;

Can feed finger foods by 8-9 months

By 12 months, family foods can be eaten

Combine foods (e.g. rice and legumes) to provide good mixture of amino acids

Foods to Avoid

Tea & coffee: interfere with iron absorption

Aerated beverages: No nutritional value

Too much sugary drinks & Fruit juices: cause decreased appetite for other nutritious foods and also may cause loose stools.

Nuts: may cause choking

Stomach size

How to initiate weaning and progress Consistency:Introduction of right consistency of food at

the right age is important to develop good food behaviors.

Essentially follow the sequence :

Breast feeds (0-6 months)

Semi-liquid (after 5-6 months) Easy to digest, smooth and gentle on baby’s stomach.

Semi-solid (after 8-9 months) Baby now needs food with taste and texture.

Semi solid (after 10 months) Baby now needs food that satisfy his urge to chew-complex taste and texture

Solid diet including variety of food items (1-1.2 yrs).

How to initiate weaning and progressFrequency: Energy requirement on a per kg basis, is 3 times more than the

adults in infants and 2 times more than the adults in case of children till 2 years of age.

Children have to be fed frequently since they can eat small amount at a time due to their little capacity.

Till 5-6 months - child is given breast feeds on demand i.e. 9-10 times over 24 hours.

From 6- 8 months - As the child grows, his requirements increase and he starts to accept larger volume and thicker consistency at a time - feed

him 7-8 times/d

From 9- 12 months - child normally eats 6-7 times per day and each time.

By 12 - 15 months - child eats at least 6 times per day.

By 18 months - child’s eating schedule of 5-6 times /day gets fixed

3 regular meals – Breakfast, Lunch and dinner and

3 in-between healthy snacks – midmorning (recess time),

evening at 4:30 – 5 PM

bedtime.

How to initiate weaning and progress

Volume:Children have little capacity due to their smaller surface

area. Initially accepts small amount but as he increases in

size, accepts larger volume.

Till 5-6 months - Few spoons to 30ml at a time

From 6- 7 months - 50-75 ml/g at a time

From 7-8 months - 75 - 100 ml/g at a time

From 9- 12 months - 100 - 150 ml/g at a time

From 6-7 months

Introduce (along with BF)

Fresh milk 200-250ml/day

Mashed banana/ custard ¼ - ½ katori

Powdered murmura/riceflakes ¼ - ½ katori

in milk+sugar+fat

Cont.

Khichri (Liquid consistency) ¼ - ½ katori

Washed moong dal + rice + fat

Biscuit/ bread/Suji in milk ¼ - ½ katori

+sugar+fat

Boiled mashed potato/ halwa ¼ - ½ katori

From 8-9 months

Continue breast feeds

Fresh milk (includes curd) 250-400 ml/day

Banana OR any other ¾ - 1

seasonal fruit

Suji/sago/Dalia in milk ½ - 1 katori

+sugar+fat

Cont.

khichri (semisolid consistency) ½ - 1 katori

(dal + rice + fat) OR rice-dal

Biscuit/ bread in milk ½ – 1 katori

+sugar+fat

Potato+ vegetable ½ - 1 katori

From 10 - 12 months

Continue breast feeds

Fresh milk (includes curd) 400 - 500 ml/day

Banana OR any other 1 or more

seasonal fruit

Suji/sago/Dalia/sevian in 1 katori or more

milk +sugar+fat (Thick)

Cont.

Khichri (semisolid consistency) 1katori or more

(dal + rice + fat) OR rice-dal

Biscuit/ bread/chapati/ paratha 1katori or more

(by 1 year)

Potato + any other vegetable as desired

Curd/ paneer/ groundnut/Egg

Amounts of foods to offer

Age Texture Frequency Amount of each meal

6 months Soft porridge, well mashed

vegetable, fruits

2 times per day plus

frequent breastfeeds

2-3 tablespoonfuls

7-8 months Mashed foods 3 times per day plus

frequent breastfeeds

Increasing gradually to

more than 3/4 of katori

(150ml)

9-11 months Finely chopped or mashed

foods, and foods that baby can

pick up

3 meals plus 1 snack

between meals plus

breastfeeds

a full katori (200ml)

12-24 months Family foods, chopped or

mashed if necessary

3 meals plus 2 snacks

between meals plus

breastfeeds

more than katori (250ml)

Ensure Adequacy

Growth Monitoring: Measure weight and length periodically and interpret by plotting in growth curves.

Investigate causes of poor growth: Dietary history; evaluate for any illness.

Counsel mother/caregivers on growth, feeding and caring practices

Feeding Techniques

Feed infants directly & assist older toddlers eat; be sensitive to hunger & satiety cues

Feed patiently; encourage, but don’t force

If child refuses, experiment with different food combinations, tastes, textures

Minimize distractions during meals

Talk to child during feeding; maintain eye contact

Responsive feeding

Suitable Feeding Situation

Safe

Unhygienic feeding

the risk of infectious illness (esp. diarrhea) compromising nutritional status

Undermines the parents’ confidence leading to delay in CF

Ensuring Food Hygiene

Washing caregiver’s and child’s hands before preparing, handling and eating food

Clean water and raw materials to cook food

Storing foods safely: Keeping food covered and serving shortly after preparation

Use clean utensils to prepare & serve food

Use clean bowls & cups when feeding child

No feeding bottles

Feeding the child who is ill

Encourage the child to drink and to eat - with lots of patience

Feed small amounts frequently

Give foods that the child likes

Give a variety of nutrient-rich foods

Continue to breastfeed

Feeding during Recovery

Feed an extra meal

Give an extra amount

Use extra rich foods

Feed with extra patience

Give extra breastfeeds as often as child wants

Key Messages

Complementary feeding should begin soon after completing 6 months of age along with continued breastfeeding

Complementary foods should be of right consistency, energy dense and the variety to provide all nutrient demands of a growing child.

Child should be fed patiently giving adequate attention and time

Foods should be prepared, stored and fed hygienically to the children.

Continue feeding during illness and increase during convalescence.

Important Precautions:

Use only clean utensils

Use prepared feed within half an hour

Discard unused feed

After the initial phase of hard work by the mother, there

will be no need of forcing, coaxing, fussing or running

after the child to eat food. It will be very natural for him

to eat at all meal times and adequately.

Thank You