COMPLEMENTARY FEEDING

OF THE BREAST FED CHILD

DR. JAVERIA SALEEM

Baby-friendly Hospital Initiative
To enable mothers/parents/caregivers to
establish and sustain exclusive breastfeeding
for six months, WHO and UNICEF
recommend:
 immediate and uninterrupted skin-to-skin
contact from birth and initiation of breastfeeding
within the first hour of life;
 exclusive breastfeeding – the infant only receives
breast milk, and no other foods or fluids;
 breastfeeding responsively – that is, as early and
often, and as long as the baby wants, day and
night;
 counselling mothers on the risks and use of
feeding bottles, teats or pacifiers.
To enable mothers/parents/caregivers to
establish and sustain exclusive breastfeeding
for six months, WHO and UNICEF
recommend:
• Improve the nutritional status, growth and
development, health, and survival of infants and
young children through optimal feeding practices.
• Support exclusive breastfeeding for six months,
followed by timely, adequate, safe, and
appropriate complementary feeding.
• Breastfeeding should continue for up to two years
and beyond.
• Support maternal nutrition through social and
community support initiatives.
TEN STEPS TO SUCCESSFUL BREASTFEEDING:
CRITICAL MANAGEMENT PROCEDURES
 1a. Comply fully with the International Code of
Marketing of Breast-milk Substitutes and
relevant World Health Assembly
Resolutions.
 1b. Have a written infant feeding policy that is
routinely communicated to staff and parents.
 1c. Establish ongoing monitoring and data-
management systems.
 2. Ensure that staff have sufficient knowledge,
competence and skills to support breastfeeding.
TEN STEPS TO SUCCESSFUL BREASTFEEDING:
CRITICAL MANAGEMENT PROCEDURES
 3.Discuss the importance and management of
breastfeeding with pregnant women and their
families.
 4.Facilitate immediate and uninterrupted skin-
to-skin contact and support mothers to initiate
breastfeeding as soon as possible after birth.
 5.Support mothers to initiate and maintain
breastfeeding and manage common difficulties.
 6.Do not provide breastfed newborns any food or
fluids other than breast milk, unless medically
indicated.
TEN STEPS TO SUCCESSFUL BREASTFEEDING:
CRITICAL MANAGEMENT PROCEDURES
 7.Enable mothers and their infants to remain
together, and to practice rooming-in 24 hours per
day.
 8. Support mothers to recognize and respond to
their infants’ cues for feeding.
 9. Counsel mothers on the use and risks of
feeding bottles, teats and pacifiers.
 10.Coordinate discharge so that parents and
their infants have timely access to ongoing
support and care.
DEFINITIONS: COMPLEMENTARY
FEEDING

• Period of complementary Feeding (CFg): when

other foods or liquids are given along with
breast milk (previously “weaning period”)
• Complementary Foods (CFs): food or liquids
other than breast milk given to young children
during the period of complementary feeding
• Transitional Foods (TF): nutrient dense CFs
designed meet nutritional needs of child
• Weaning: complete cessation of any breast
feeding
THE "WEANLING'S DILEMMA"

• Delayed introduction of complementary foods may

lead to insufficient energy and nutrient intakes and
poor growth
BUT
• Premature introduction of CF can increase pathogen
exposure, risk of infection and mortality
COMPLEMENTARY FEEDING
Appropriate complementary feeding promotes
growth and prevents stunting among children 6-
24 months.

Appropriate complementary feeding involves a

combination of practices to maintain breast milk
intake and, at the same time, improve the
quantity and quality of foods children consume.

Improving complementary feeding requires a

combination of strategies.

Programs to improve complementary feeding must

conduct assessments.
RECOMENDATIONS
 Continue frequent, on-demand breastfeeding,
including night feeding for infants.
 Introduce complementary foods beginning at
six months of age.
 Increase food quantity as the child ages-
while maintaining frequent breastfeeding.
Provide 6-8 month old infants approximately 200 kcal per day from
complementary foods.
Provide 9-11 month old infants approximately 300 kcal per day from
complementary foods.
Provide 12-24 month old children approximately 550 kcal per day
from complementary foods.
Local research is needed to determine the best combinations of
foods and practices to achieve these levels of energy intake.
  Increase feeding frequency as the child ages

Feed 6-8 month old infants complementary foods 2-3

times per day.

Feed 9-11 month old infants complementary foods 3-4

times per day.

Feed 12-24 month old children complementary foods 3-

4 times per day.

Offer nutritious snacks 1-2 times per day, as desired.

Gradually increase food consistency and variety
as the child ages, adapting the diet to the infant’s
requirements and abilities.

Feed mashed and semi-solid foods, softened with

breastmilk, if possible, beginning at 6 months of age.

Feed energy –dense combinations of soft foods to 6-11

month olds.

Introduce “finger foods” (snacks that can be eaten by

children alone) beginning around 8 months of age.

Make the transition to the family diet at about 12 months

of age.
  Diversify the diet to improve quality and
micronutrient intake

Feed vitamin A-rich fruits and vegetables daily.

Feed meat, poultry, or fish daily or as often as possible, if feasible

and acceptable.

Use fortified foods, such as iodized salt, vitamin A-enriched sugar,

iron-enriched flour or other staples, when available.

Give vitamin-mineral supplements when animal products and/ or

fortified foods are not available.

Avoid giving drinks with low nutrient value, such as tea, coffee
and sugary beverages.
  Practice responsive feeding

Feed infants directly and assist older children when they feed
themselves.

Offer favorite foods and encourage children to eat when they lose
interest or have depressed appetite.

If children refuse many foods, experiment with different food

combinations, tastes, textures, and methods of encouragement.

Talk to children during feeding.

Feed slowly and patiently and minimize

distractions during meals.
Do not force children to eat.
 Practice frequent and responsive feeding during
and after illness

During illness, increase fluid intake by most frequent

breastfeeding, and patiently encourage children to eat
favorite foods.

After illness, breastfeed and give foods more often than

usual, and encourage children to eat more food at each
sitting.
 Practice good hygiene and proper food handling

Wash caregivers’ and children’s hands

before food preparation and eating.

Store foods safely and serve foods immediately after preparation.

Use clean utensils to prepare and serve food.

Serve children using clean cups and bowls, and never use feeding
bottles.
COMPLEMENTARY FOODS VARY IN
QUALITY

RICE FISH + VEGETABLE + OIL

COMPLEMENTARY FOOD
1. Multimix khichri
2. Qima ki khichri
3. Egg khichri
KHEERS:
Recipies with breast milk, peanut kheer,
phirni, rice kheer, suji kheer, porridge, potato
& milk
Banana kheer, custard, saonwin ki kheer,
family foods
FRESH FRUITS
Banana, apple, plum, fresh juices

FINGER FOODS
French fries, buiscuits, roti-chicken, boti
COMPLEMENTARY FOODS
AGE RECIPY
6–8 Yakhni with rice – pulao
Months
Multimix khichri, rice, vegetables mix with yakhni
Banana, plum, stewed apple
All kheers in breast milk

9 – 12 Multimix khichri with chicken / fish / qima

Months
Egg full boiled yolk first can mix butter, finger foods

13 Months Family food

onwards
FORTIFIED COMPLEMENTARY FOODS
 What are the main contents or ingredients?
staple food , cereal product, flour, vegetables,
fruit and animal source foods.
 Is the product fortified with micronutrients such
as iron, vitamin A or other vitamins?
 Does the product contain ingredients such ass
sugar and/or oil to add energy?
 What is the cost compared to
 similar home-produced foods?
 Read Expiry Date
WATER NEEDS OF THE INFANT
 No need of water for Breastfed baby.
 A non-breastfed child aged 6-24 months of
age needs approximately 2-3 cups of water per day in a
temperate climate and 4-6 cups of water per day in a hot
climate. Water should be offered to the child several times
a day.
 Drinks that contain a lot of sugar may actually make the
child thirstier, pure juices & Fizzy drinks(sodas) are not
suitable for young children.
 Teas and coffee reduce the iron that is absorbed from
foods.
 When a child is thirsty during a meal, A small drink will
satisfy the thirst.
 Drinks should not replace foods or breastfeeding. If a drink
is given with a meal, give only small amounts .
STARTING OTHER FOODS TOO SOON
Adding foods too soon may
 take the place of breast milk
 result in a low nutrient diet

 increase risk of illness

 less protective factors
 other foods not as clean
 difficult to digest foods
 increase mother’s risk of pregnancy
STARTING OTHER FOODS TOO LATE
Adding foods too late may
 result in child not receiving required
nutrients
 slow child’s growth and development

 risk causing deficiencies and malnutrition

KEY MESSAGE 1
Breastfeeding for two years or longer helps a child to
develop and grow strong and healthy
KEY MESSAGE 2
Starting other foods in
addition to breast milk at
6 completed months helps
a child to grow well
KEY MESSAGE 3
Foods that are thick
enough to stay in the
Just right
spoon give more energy
to the child

Too thin
KEY MESSAGE 4
Animal-source foods are especially good for children, to
help them grow strong and lively

poultry fish

meat
liver

cheese

eggs
yoghurt
KEY MESSAGE 5
Peas, beans, lentils, nuts and seeds are also good for
children

seeds

lentils Groundnut
paste

beans

peas nuts
KEY MESSAGE 6
Dark-green leaves and yellow-coloured fruits and
vegetables help a child to have healthy eyes and fewer
infections

carrot

pumpkin yellow sweet

potato

mango
papaya spinach
KEY MESSAGE 7
A growing child 6 – 8 months needs 2 – 3 meals a day
A growing child 9 – 24 months needs three to four meals a day
Plus additional 1 – 2 snacks if the child is hungry:
Give a variety of foods
KEY MESSAGE 8
A growing child needs increasing amounts of food
FATS AND OILS

butter / margarine / ghee

coconut
FEEDING SITUATION
KEY MESSAGE 9
A young child needs to learn to eat: encourage and
give help
… with lots of patience
KEY MESSAGE 10
Encourage children to drink and eat during illness
and provide extra food after illness to help them
recover quickly
RECOMMENDATIONS FOR FEEDING THE
NON-BREASTFED CHILD

The non-breastfed child should receive:

 extra water each day (2-3 cups in
temperate climate and 4-6 cups in hot
climate)
 essential fatty acids (animal-source foods,
fish, avocado, vegetable oil, nut pastes)
 adequate iron (animal-source foods,
fortified foods or supplements)
 milk (1-2 cups per day)

 extra meals (1-2 meals per day)

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 – often ill children

breastfeed more frequently
FEEDING DURING RECOVERY
 Give extra breastfeeds
 Feed an extra meal

 Give an extra amount

 Use extra rich foods

 Feed with extra patience and love

FEEDING LOW-BIRTH-WEIGHT BABIES
 32 weeks gestation
– able to start suckling from the breast
 30-32 weeks gestation

– can take feeds from a small cup or spoon

 Below 30 weeks gestation

– usually need to receive feeds by tube in hospital