4 complementary-feeding
- 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
- 13. Stomach size
- 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.
- 34. Thank You