lecture note complementary feeding

1. COMPLEMENTARY FEEDING
Jimcale
Jimcale

2. Learning outcomes
After completing the students should be able to:
 Define Complementary feeding /weaning
process
 Identify Guiding principles for appropriate
complementary feeding
Jimcale

3. Introduction
 Around the age of 6 months, an infant’s need for energy
and nutrients starts to exceed what is provided by breast
milk, and complementary foods are necessary to meet
those needs.
 An infant of this age is also developmentally ready for
other foods. This transition is referred to as
complementary feeding.
 If complementary foods are not introduced around the
age of 6 months, or if they are given inappropriately, an
infant’s growth may falter.
Jimcale

4. Introduction
Jimcale
 Breast feeding alone is adequate to maintain
growth and development up to 6 months.
 complementary feeding should be given to
maintain their growth and development according
to age.
 So it is necessary to introduce more concentrated
energy riched nutritional supplements by this age.
 Infant also need iron containing food supplements
to prevent iron deficiency anaemia.

5. Definition of Complementary feeding
Jimcale
 Complementary feeding or weaning is the
process of giving an infant other foods and
liquids along with breast milk after the age of 6
months as breast milk alone is no longer
sufficient to meet the nutritional requirements of
growing baby.
 It is the process by which the infant gradually
becomes accustomed to adult diet.

6. 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.

7. Guiding principles for appropriate
complementary feeding
 Guiding principles for appropriate complementary feeding are:
 Continue frequent, on-demand breastfeeding until 2 years of
age or beyond;
 Practise responsive feeding (for example, feed infants directly
and assist older children.
 Feed slowly and patiently, encourage them to eat but do not
force them, talk to the child and maintain eye contact);
 Practise good hygiene and proper food handling;
 Start at 6 months with small amounts of food and increase
gradually as the child gets older;

8. Guiding principles for appropriate
complementary feeding
 Guiding principles for appropriate complementary feeding are:
 Gradually increase food consistency and variety;
 Increase the number of times that the child is fed: 2–3 meals per day
for infants 6–8 months of age and 3–4 meals per day for infants 9–
23 months of age, with 1–2 additional snacks as required;
 Use fortified complementary foods or vitamin-mineral supplements
as needed; and
 During illness, increase fluid intake including more breastfeeding,
and offer soft, favourite foods.
 It is advisable to start one or two teaspoons of new food at first
which should be given when baby is hungry, just before regular
feeding, during the day time.

9. Feeding in exceptionally difficult
circumstances
 Families and children in difficult circumstances require special attention and
practical support.
 Wherever possible, mothers and babies should remain together and get the
support they need to exercise the most appropriate feeding option
available.
 Breastfeeding remains the preferred mode of infant feeding in almost all
difficult situations, for instance:
 Low-birth-weight or premature infants;
 Mothers living with HIV in settings where mortality due to
diarrhoea, pneumonia and malnutrition remain prevalent;
 Adolescent mothers;
 Infants and young children who are malnourished; and
 Families suffering the consequences of complex emergencies.

10. HIV and infant feeding
 Breastfeeding, and especially early and exclusive breastfeeding, is one of the most
significant ways to improve infant survival rates.
 While HIV can pass from a mother to her child during pregnancy, labour or delivery,
and also through breast-milk, the evidence on HIV and infant feeding shows that
giving antiretroviral treatment (ART) to mothers living with HIV significantly reduces
the risk of transmission through breastfeeding and also improves her health.
 WHO now recommends that all people living with HIV, including pregnant women
and lactating mothers living with HIV, take ART for life from when they first learn their
infection status.
 Mothers living in settings where morbidity and mortality due to diarrhoea, pneumonia
and malnutrition are prevalent and national health authorities endorse breastfeeding
should exclusively breastfeed their babies for 6 months, then introduce appropriate
complementary foods and continue breastfeeding up to at least the child’s first
birthday.

11. Key facts
Jimcale
 Undernutrition is associated with 45% of child
deaths.
 Globally in 2020, 149 million children under 5
were estimated to be stunted (too short for
age), 45 million were estimated to be wasted
(too thin for height), and 38.9 million were
overweight or obese.
 About 44% of infants 0–6 months old are
exclusively breastfed.

12. Key facts
Jimcale
 Few children receive nutritionally adequate and safe complementary foods;
in many countries less than a fourth of infants 6–23 months of age meet the
criteria of dietary diversity and feeding frequency that are appropriate for
their age.
 Over 820 000 children's lives could be saved every year among children
under 5 years, if all children 0–23 months were optimally breastfed.
 Breastfeeding improves IQ, school attendance, and is associated with
higher income in adult life.
 Improving child development and reducing health costs through
breastfeeding results in economic gains for individual families as well as at
the national level.

13. Why start at six months
 Infant’s intestinal tract develops immunologically with
defense mechanisms to protect the infant from foreign
proteins.
 The infant’s ability to digest and absorb proteins, fats, and
carbohydrates, other than those in breast milk increases
rapidly.
 The infant’s kidneys develop the ability to excrete the waste
products.
 The infant develops the neuromuscular mechanisms needed
for recognizing and accepting variation n the taste and color
of foods.

14. What are the signs that baby is ready for
complimentary feeding
Jimcale
 Hold his/her head straight when sitting down.
 Opens his/her mouth when others eat
 Is interested in foods when others eat.
 Receives frequent breast feed but appear hungry
soon after.
 Is not gaining weight adequately.

15. Preparation for weaning food
 Wash hands.
 Keep food in clean utensils.
 Separate raw and cooked food.
 Cook food thoroughly.
 Keep food at safe temperatures.
 Use safe water and raw material.
 Give freshly prepared food.
 Keep the cooked food covered.

16. Qualities for complimentary feeding
 Weaning food should be liquid at first, then
semi solid and solid food to be introduced
gradually.
 Clean, fresh and hygienic, so that no infection
can occurs.
 Easy to prepare at home with the available
food items and not costly.

17. Cont….
 Easily digestible, easily acceptable and palatable
for infants.
 High in energy density and low in bulk viscosity
and contains all nutrients necessary for the baby.
 Based on cultural practice and traditional beliefs.
 Well balanced, nourishing and suitable for the
infant

18. Complimentary feeding at different ages
 6 to 9 months –
 biscuit socked with milk, vegetable soup,
mashed banana, mashed vegetable.
 Each food should be given with one or two
teaspoon at first for 3 to 6 times per day.
 Food item to be given at this period include soft
mixture of rice and vegetables, pulses, mashed
and boiled potato, bread or roti soaked with
milk, mashed fruits, egg yolk, curd.
 Amount of food should increase gradually.

19. Complimentary feeding at different ages
 9 to 12 months –
 More variety of household food can be added.
 Fish, meat, chicken can be introduced.
 Food need not to be mashed but should be soft and
well cooked.
 12 to 18 months –
 The child can take all kind of cooked food.
 The amount and frequency should increase
gradually.

20. Problems during feeding
 If on starting weaning, breast feeding is stopped
suddenly, it can have adverse psychological effect on
the child.
 Weaning food, if prepared unhygienically or not digested
properly can cause diarrhoea.
 If weaning food are not nutrient rich, the child can
develop malnutrition.
 Children may develop indigestion, abdominal pain,
diarrhoea or rashes if they are allergic to certain foods.

21. ADVANTAGES & DISADVANTAGES
 ADVANTAGES:-
 It prevents malnutrition.
 It prevents deficiency diseases, e.g.anemia.
 Promotes growth.
 DISADVANTAGES:-
 It may lead to diarrhea, if the food is
preparing an unhygienic way.
 Negligence in choosing nutritious weaning
food can lead to either calorie, protein,
vitamin or mineral deficiencies.

22. Appropriate Complementary Feeding
 Ensuring that infants nutritional needs are met requires that complementary
foods be:
 Timely – meaning that they are introduced when the need for energy
and nutrients exceeds what can be provided through exclusive
breastfeeding;
 Adequate – meaning that they provide sufficient energy, protein and
micronutrients to meet a growing child’s nutritional needs;
 Safe – meaning that they are hygienically stored and prepared, and
fed with clean hands using clean utensils and not bottles and teats;
 Properly fed – meaning that they are given consistent with a child’s
signals of appetite and satiety, and that meal frequency and feeding
are suitable for age.
 Caregivers should take active care in the feeding of infants by being
responsive to the child’s clues for hunger and also encouraging the child to
eat.
Jimcale

23. 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 VitaminA
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

24. 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.

25. Other Attributes of Complementary Foods
Soft
Easy to digest
Inexpensive
Locally available
Culturally acceptable
Easily prepared at
home

26. 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

27. 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

28. 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

29. Safe
Unhygienic feeding
The risk of infectious illness (esp. diarrhea)
compromising nutritional status
Undermines the parents’ confidence leading to delay
in Cystic fibrosis (CF)

30. 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

31. 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

32. 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

33. 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

34. 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.