COMPLEMENTARY FEEDING:

COMMON PROBLEMS & FAQ

Dr. Meta Herdiana Hanindita, dr., SpA(K)

KSM Ilmu Kesehatan Anak
FK Universitas Airlangga/ RSUD Dr. Soetomo Surabaya

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No conflict of interest to declare
related to this presentation

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 Should be given in amounts,
frequency, consistency and
variety of foods to cover the
nutritional needs

Adequate

Infant should start CF

Minimize the risk of
when breastmilk
alone is no longer Timely Safe contamination with
pathogens
sufficient

Appropriate

Appropriate texture
for the age , applying
responsive feeding
WHO, 2001

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Timely
WHO—> 6 months
ESPGHAN : 17-26 weeks
AAP: Approximately 6 months

While exclusively breastfeeding to 6 months

is recommended, all infants should be
managed individually so that insufficient
growth is not ignored.
Fewtrell, 2003

Growth faltering happens mostly from 3 to

18 –24 months of age. Children from low-
and middle-income countries —> early
growth faltering is even faster than currently
assumed.
Victora et al, 2010

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 Inadequate breastmilk

Lactation Management
Evaluation 1-2 weeks

Weight gain not~ target,

Weight gain ~ target continue breastmilk plus:

Continue breastmilk,
evaluate weight gain Age < 4 mo 4-6 mo

Breastmilk Start
donor/ formula Complementary
Feeding if ready

Sjarif et al, 2015

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Preterm infants —>vulnerable group:
-increased nutritional requirements
-at risk of developing gastro-esophageal reflux,
-respiratory problems,
-have delayed early gross motor development.
Bacharetti et al, 2017

Individual advice should take into account the

gestational age, early nutritional intake, current
nutritional status & requirements, developmental
progress & readiness. Palmer et al, 2012

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Adequate Age
Frequency
Total energy
(Months from solid food Consistency
(x/day)
old) (Kcal/d)
6-8 2-3 200 Puree, mashed
Minced, chopped,
9-11 3-4 300
finger foods
12-23 3-4 550 Family foods
GAIN 2012; WHO 2001

*Kuadran tidak menggambarkan proporsi

7 UKK NPM 2019, Cameron 1983
MENU TUNGGAL 14 HARI ALA WHO

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Menu 4 Bintang
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 Rudloff et al, 2019

Descriptive cohort studies have demonstrated an identical

growth and weight evolution in lacto(-ovo)-vegetarian
children and adolescents compared to their omnivorous
peers, whereas vegan children tend to be leaner and
smaller. Nathan 1997; Hebbelinck 1999; Leung 2001
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 Semba, 2016

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Superfood: term popularized in media to refer to
foods that believed to have health-promoting
properties such as reducing one risk of disease.

Superfood—> mostly plant-based-nutrition.

Example: chia seed, quinoa, gojiberry, acaiberry,
flaxseed, oat, zucchini, etc.

Plant-based nutrition are frequently related to

antinutrients which interfere with absorption of
nutrients, and act to reduce nutrition intake,
digestion, utilization and may produce other
adverse effect.
Popova, 2019

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Decrease Nutrient Avaibility

Rehman et al, 2014

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Decrease Nutrient Utilization

Rehman et al, 2014

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Safe

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Himalayan salt—> rock salt mined from the
Himalayas.

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Cusick, 2016
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Heating at 170 - 280 F ~ 76,6 - 137,7 C

Cook food slowly at low temperature (all-day

cooking without looking)

Hazards for complementary foods preparation:

- Do not lift the lid/cover unnecessarily during the
cooking cycle. Each time the lid is raised, the
internal temperature drops 10-15 degrees, the
cooking process is slowed by 30 minutes—>
bacterial growth
- Follow the direction of using slow cooker
carefully
Commercially food should comply Codex
Alimentarius Commission and also the Codex
Code of Hygienic Practice for Foods for Infants
and Children Requirement.

All regulations based on government

responsibilities—> BPOM

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Although organic foods are produced without or
limited pesticides, there is no definitive
evidence that reduction in pesticide residue is
actually clinically relevant long term.
Beal et al, 2015

Current evidence does not support any

meaningful nutritional benefits or deficits from
eating organic compared to conventionally
grown foods.
AAP, 2004

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Monosodium glutamate (MSG) is the sodium salt
of the common amino acid glutamic acid.
Glutamic acid is naturally present in our bodies,
and in many foods and food additives.
FDA, 2018

Concentration of MSG in a variety of common foods

Food Concentration (mg/100 g)
Cow milk 2
Apple 13
Human milk 22
Eggs 23
Beef 33
Chicken 44
Almond 45
Carrot 54
Onion 118
Garlic 128
Potato 102
Walnut 757

27 Kazmi, 2017
FDA considers the addition of MSG to foods to be “Generally recognized as
safe” (GRAS).

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Responsive

Baby-led weaning is a method for introducing

complementary foods in which the infant feeds
themselves hand-held foods or finger foods
instead of being spoon-fed by an adult. The infant
is in control of exactly what and how much they
eat. Rapley, 2008

Infants following BLW have significantly lower

intakes of iron, zinc and vitamin B12, ate more
fruits and vegetables which were low-iron foods.
Morison, 2016; Cameron, 2012

Infants following BLW are in higher risk of iron

deficiency anemia, underweight and stunted than
those who were fed traditionally.
Hanindita, 2019

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6 mo baby, 8 kgs
Liquid requirement ~ RDA: 125-145 ml/kgBW/day
Calories requirement : 8 x 110 kcal = 880 kcal
Calories from CF : breastmilk = 30%: 70%

Liquid req. = 8 x (125-145) = 1000-1160 ml

Liquid from CF = 20% (1000-1160)= 200-232 ml
Liquid from breastmilk = 800 - 928 ml

Calories from breastmilk = 70% x 880 = 616 kcal

~ 920 ml
928 ml - 920 ml = 8 ml/day

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10 mo baby, 9 kgs
Liquid requirement ~ RDA: 125-145 ml/kgBW/day
Calories requirement : 9 x 110 kcal = 990 kcal
Calories from CF : breastmilk = 50%:50%

Liquid req. = 9 x (125-145) = 1125-1305 ml

Liquid from CF = 20% (1125-1305)= 225-261 ml
Liquid from breastmilk = 900 - 1045 ml

Calories from breastmilk = 50% x 990 = 495 kcal

~ 750 ml

(900 - 1045) - 750 = 150 - 250 ml/day

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 AAP, 2018

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Thank You