2. 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.
3. 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
4. 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
5. Age of Introduction
0
0 269
451
746
0
200
400
600
800
1000
1200
0-3 mo 3-6 mo 6-9 mo 9-12 mo 12-24 mo
Energy Gap
Energy from
breastmilk
Energy Needs
Excl. Breastfeeding Comp. feeding & continued BF
6. 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
7. Importance of continued breastfeeding for 2
years and beyond
37
55
76
98
5
63
45
24
2
95
0
20
40
60
80
100
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
8. 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
9. 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 micronutrents
e.g. iron and vitamins. Supplements e.g. iron might
be required.
10. Other Attributes of
Complementary Foods
Right consistency
Soft
Easy to digest
Inexpensive
Locally available
Culturally acceptable
Easily prepared at
home
11. 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
12. 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
14. 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).
15. How to initiate weaning and progress
Frequency:
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.
16. 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
17. 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
18. 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
19. 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
20. 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
21. 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)
22. 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
23. 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)
24. 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
25. 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
28. Safe
Unhygienic feeding
the risk of infectious illness (esp. diarrhea)
compromising nutritional status
Undermines the parents’ confidence leading to delay
in CF
29. 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
30. 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
31. 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
32. 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.
33. 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.
