4.8 Key messages for optimal complementary feeding practices
Both the quantity and quality of complementary foods are important to ensure good health and development for the baby and young child. Infants older than six months should eat a variety of nutrient-rich foods, including animal products (e.g. eggs, beef, chicken, lamb, milk, cheese and butter), fruits, and vegetables. It is usually not possible for an infant to consume sufficient quantities of plant foods to meet their needs for iron, zinc and calcium. Therefore, the addition of animal source foods enables the different nutrients to be absorbed more easily and is essential in the preparation of complementary foods.
When you are advising mothers and caregivers about optimal complementary feeding, there are a number of key messages you can give. These are set out below.
At six months, the mother or caregiver must introduce soft, appropriate foods and continue breastfeeding on demand.
- When the infant is six months old the mother must give the infant complementary foods in addition to breastmilk to help the infant grow strong and healthy. At this age, breastmilk alone cannot meet all the nutritional needs for growth and development
- The mother should continue to give breastmilk as the main food throughout the infant’s first year. Breastmilk will continue to protect the child against illness
- The mother or caregiver should begin complementary feeding by adding available, feasible, local foods (vegetables, fruits, eggs, milk) to staple foods (cereals and legumes) and increase the amount of food as the child grows
- The mother should continue breastfeeding until child is at least two years old.
Breastmilk constitutes the largest portion of young child’s food during the first two years. Figure 4.5 shows what percentage of breastmilk should be in a child’s diet from birth to two years.
Here are some additional important messages about feeding.
Increase frequency of feedings
As the child gets older, the mother needs to provide more food and increase the frequency of meals.
- The mother or caregiver should increase the frequency of feedings and the amount of food as the child gets older
- The mother or caregiver should use a separate bowl for the child and continue frequent breastfeeding
- The mother or caregiver should give young children small feeds frequently throughout the day (both day and night) because they have very small stomachs
- As the child grows, the mother or caregiver should give the child more food. One way to know children are getting enough food is to put their portions in separate bowls and to help them eat. This is known as responsive feeding. Table 4.3 summarises the frequency of meals, and their number according to the age of the child.
| Age (months) | Meal frequency per day for breastfed baby | Meal frequency per day for non-breastfed baby |
|---|---|---|
| 6-9 | 2-3 times + 1-2 snacks | 4-5 times + 1-2 snacks |
| 10-23 | 3-4 times + 1-2 snacks | 4-5 times + 1-2 snacks |
Increase food thickness and variety
Increase food thickness (density) and variety as the child gets older, to meet changing nutritional requirements, and the child’s physical abilities.
At six months, the mother or caregiver can give the infant puréed (softened), mashed and semi-solid foods. She should also add protein-rich foods (animal/plant); beans, soya, chick peas, groundnuts, eggs, liver, meat, chicken and milk. Adding germinated (malt) flour to the gruel liquefies cereal gruels and helps to increase the energy value and other nutrient density. At eight months the mother or caregiver can give foods that infant can eat alone, such as cut-up fruit and vegetables (for example, mangoes, papaya, leafy greens, oranges, bananas, pumpkin, carrots and tomatoes). During complementary feeding, the aim is for the mother or caregiver to gradually accustom the child to family foods. By 12 months the child should be eating family foods.
Interact with the child during feeding
The mother or caregiver should interact with the child during feeding. This is known as active or responsive feeding. This helps the child take in the food they need and stimulates the child’s verbal and intellectual development. The mother or caregiver should also feed the infant directly and help older children eat and experiment with food combinations, tastes and textures. Most mothers will be able to find ways to encourage children who refuse certain foods. In order to help the baby finish its food, the mother or caregiver should minimise distractions during meals, especially if the child loses interest easily. The mother or caregiver has to remember that feeding times are periods of learning and love; talking to a child during feeding, with eye-to-eye contact and patience, encouraging but not forcing the infant to eat, is important. The mother can also sing songs or tell stories to make feeding enjoyable.
Practice good hygiene and safe food preparation
In resource-poor settings, the mother or caregiver can feed liquids to the child from a small cup or bowl, as bottles are difficult to keep clean, and contaminated bottles can cause diarrhoea. Before feeding the child, the mother or caregiver should wash their hands and the child’s hands with soap and water and use clean utensils and bowls or dishes to avoid introducing dirt and germs that might cause diarrhoea and other infections. The mother or caregiver can use their fingers (after washing) to feed the child. Food can be contaminated as a result of poor basic hygiene, poor sanitation, and poor methods of food preparation and storage, so food should be served immediately after preparation.
Increase the amount of food provided each day
As children grow older, they need to eat more food each day. Table 4.4 shows the increase in calories needed every day by a child according to their age.
| Age (months) | Amount of kilocalories for the breastfed baby | Amount of kilocalories for the non-breastfed baby |
|---|---|---|
| 6-8 | 200 Kcal | 600 Kcal |
| 9-11 | 300 Kcal | 700 Kcal |
| 12-23 | 550 Kcal | 900 Kcal |
Increases complementary food if the child becomes sick
The mother should continue to breastfeed when the child is ill and should encourage the child who is older than six months to eat during and after illness (sick child feeding). The mother should offer the child who is older than six months soft, mashed favourite foods. Breastfeeding is extremely important during illness. Children who are ill will often continue to breastfeed even if they refuse other foods.
The mother diversifies the complementary food
The mother should mix foods from plant sources such as fruits, vegetables, cereals and legumes with foods of animal origin in order to diversify the complementary food. During illness and for two weeks after illness, the mother or caregiver should increase the quantity of food and feed the child more often so that the child recovers quickly. Children are often very hungry during recovery from illness and need more food to support catch-up growth and to replace nutrient stores.
Kedija’s daughter is six months old and she wants to start giving her complementary food. What do you advise Kedija about feeding her child at this age?
You would talk to Kedija about the different types of food she can give her daughter to promote optimum growth and the baby’s health. At six months Kedija can give her daughter puréed, mashed and semi-solid foods. She should also add protein-rich foods (animal/plant): beans, soya, chick peas, groundnuts, eggs, liver, meat, chicken, milk. Adding germinated (malt) flour to the gruel liquefies cereal gruels, and helps to increase the energy and other nutrient density. You should also advise her to continue breastfeeding until her daughter is at least two years old.
The first 24 months of life provide a critical opportunity to ensure a child has a healthy start through optimal feeding. You have learned that malnutrition can be prevented through exclusive breastfeeding for the first six months of a baby’s life, followed by the introduction of complementary food.
Complementary food should be started at exactly six months, not before or after six months, as either would lead to poor nutritional status of the young child. The consequences of poor nutritional status include morbidity, poor growth and development and mortality.
4.7 Breastfeeding difficulties