Complementary feeding

If you are a mother of a child of two years old or less the biggest problem of you in these days would be feeding. When your child is not fed properly, then he /she will get many health problems which can affect his/her later life as well. Thus the ‘complementary feeding’ plays an important role

What is complementary feeding?

This is the process starting when the breast feeding alone is not sufficient, the infant is given other foods and liquid along with the breast milk in order to meet nutritional requirement. World health organization (WHO) recommends to start the complementary feeding after the exclusive breast feeding (where no other liquid or food is given other than breast milk) of six months and to continue up to two years. Unless the proper foods are given at proper timings the health of child can be affected.

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Why after six months? Why not earlier or lately?

Unless the infant is having a problem in getting the breast milk or any growth faltering has been seen in spite of the proper breast feeding, it is being advised to continue exclusive breast feeding for six months. But, after that the nutritional requirement of the infant increases whereas, breast feeding alone is not sufficient to meet the needs. Further the stores of micro nutrient are getting depleted. Thus the requirement of those important nutrients should be given through the feeding. For  eg: ‘Iron-During exclusive breast feeding period the stored iron of infant is used ,after six months those stores become depleted and breast milk contain less iron, thus it is important to meet the requirement of iron through breast feeding. Further the late introduction of the complementary feeding will result in the micro nutrient deficiencies.

Not only that the disappearance of the tongue extrusion reflexes and the appearance of the sucking and biting motor skills at the seven-nine months will mark the introduction of the solid food.so, if the solid foods are not introduced at the correct time, the optimal development of the motor skills in the infant can be affected. Other than this the organs and the systems like brain, cardiovascular organ, metabolic organs, gastrointestinal tract, kidneys gets mature after six months, therefore introducing of the solid foods after six months is important. More over if the solid foods are introduced too late the immunity system in the infant will not be well developed.

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In contrast, some mothers may find that solid foods other than breast milk should be introduced earlier as their infants lose weight. But introducing solid foods too earlier can lead to several problems. Food allergies can be developed in infants and diarrheal disease can be resulted due to the exposure to the pathogens. Further as the reflexes of infants are not developed to receive the food mothers/ caregivers may find as infant rejecting the food, which can further prolong the length of introduction. More over as the systems and organs are not well developed it can lead to many other malfunction. The breast milk production can be reduced as the time spent on the breast feeding is less, which can also affect the mother’s health

What, when and How should you feed?

The infant or the child will decide whether to eat and when to eat, but it is the duty of the mother to decide what to eat. Which means complementary feeding should be a responsive feeding; whenever the baby feels hungry the feeding should be done.

During the meal time the distraction should be minimized and the eye to eye contact should be ensured while feeding. The food should not be given as a reward for them, because this can misguide the children in adapting to good dietary habbits. Further if the child is refusing food, different combinations, tastes, preparations and textures should be experimented. Make sure that every three days’ time a new additional food is given to the child to adopt. Some mothers complain that their baby is not eating well. But they do not understand that babies are babies, not adults. The stomach capacity of a child around two years only 200ml-300ml, which can hold only less amount of food. This is enough for them. So as mothers’ it is your duty to provide nutrient dense foods. These foods contain more nutrients compared to the calories. For eg. Liver, pureed meats, meshed fruits, soup broth, pureed vegetables etc. Always remember that do not force feed your infant or young child.

As per infant and young child feeding guidelines for SriLanka finger feeding is started at the 9th months. Initially the breast milk can be mixed with the food to increase gradually from semi solid to solid and also the amounts and frequency of meals are also increased gradually. It should be made sure that family food should be given after 1st year. During the preparation of the food in the 1st year sugar and salt should be avoided. Further the late introduction of sugar and salt will improve the health in later life as well.

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Good hygiene practices should also be adopted when feeding your child, such as usage of clean utensils in the preparation of foods, clean foods should be given, the foods should be thoroughly cooked and etc. Most importantly the bottle feeding should be avoided, because this can result in ‘’baby bottle tooth decay’’ which is an oral health problem.

Variation in the diet

The variety of the foods should be ensured in every meal. Within a day the child should have tasted the correct portion from each food groups. The following table shows the servings that should be given from different food groups at different age.

Number of servings of different food groups

Food groups 7-9 months 9-12 months 1+-2 years 2+-5 years
Cereals 2-3 3-4 3-4 3-4
Breast milk As desired After meal as desired After meal as desired After meal as desired
Milk product is curd,yoghurt,cheese ½ -1 1 1 1-2
Fish, meat, and egg 1 1-2 1-2 2
Lentils, pulses, nuts 1 1 1-2 1-2
Fruits 1 1-2 2 2
Vegetables 1 1-2 2 2
Fat based foods 1 tea spoon/meal 1-2 tea spoon/meal Small amount Small amount
Sugar based foods          –          – Small amount of sweet after meal time Small amount of sweet after meal time
In case of formula 500-600 ml 500-600ml 2 2

Source: IYCY guidelines for Sri Lanka

Serving size

Rice, bread, other cereals

  • ½ tea cup of cooked rice/cooked cereals/pasta
  • 1 slice of bread (450g bread into 9 slices), ½ tea bun
  • 2 egg size potato
  • 1 egg size sweet potato
  • 3 crackers
  • 3 table spoon of breakfast cereals

A standard tea cup = 200 ml

Milk and dairy products

  • 100ml milk
  • 1 cup of yoghurt/curd
  • 1 small match box size piece of cheese
  • 3 heaped tea spoons of milk powder

A standard tea cup = 200 ml

Meat, fish and alternatives

  • 3 table spoons cooked dhal
  • 1hen’s egg
  • ½ duck’s egg
  • 25-50g cooked fish/chicken/lean meat (equals a piece the size of a match box), 6 sprats
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Fruits

  • 1 medium size banana, orange

Vegetables

  • 3 tables spoons of cooked fruit and vegetables
  • ½ tea cups of cooked leafy vegetables
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Among the provision of nutrient it is important that a good supply of Iron, Calcium, Vitamin A and Protein should be there in the complementary feeding. Fish, sprats, meat, poultry, liver which are very source of iron should be included in the complementary feeding. However the vegetarian families can include iron rich foods gotukola, sarana, tambala, soya, green gram, cowpea in their diet. But to increase the bioavailability of the iron in these foods the source of vitamin C added to the same meal. In pulses it can be done by soaking, germinating, and fermenting. Vitamin A rich foods like liver, egg yolk, yellow pumpkin, yellow sweet potato, carrot, papaw, mangoes can be include in daily or given as often as possible. Likewise if all the food groups are included in the recommended level you can ensure that all the nutrients will be provided.

Other than this fortified complementary food can be used for example Triposa. On medical advice if needed vitamin and mineral supplements can be given. Make sure to maintain the nutrition of the infants during the illness. Do not reduce the frequency or amount because it can result in growth faltering. If the growth faltering is noted extra meal has to be included at least for two weeks until their weight return to original growth potential. It is better if the energy dense small meals can be given frequently to them, as it helps them to get well. Margarine, ghee, and oil can be added to make foods more energy dense.

Monitoring the growth of the infants and young children is also a part of the   complementary feeding. The growth monitoring is done in the clinics held in MOH Office. So it is your duty to take your children to get the proper nutritional advice and maintain the status. If the proper care is not taken and the feeding is done per recommendation it can result in many disease conditions later in his life. For example obesity, type one diabetes, allergic disorders, respiratory infections, chronic gastrointestinal tract disorders. As mothers you should be careful as this can even lead to sudden infant death syndrome.

So as wise mothers always remember feeding your child is not like feeding yourself. It will mater more!

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