Complementary Feeding – Practical Tips for Parents

Complementary feeding is simply defined as the start to offer solids foods along side liquids. This begins when breast milk alone is no longer sufficient to meet an infant’s nutritional needs, thus other nutrients are required.

Appropriate complementary feeding promotes growth and prevents stunting among children 6–24 months.

The period of complementary feeding is when other foods or liquids are provided along with breastmilk. Rates of malnutrition usually peak at this time with consequences that persist throughout life. Stunting is seldomly reversed in later childhood and adolescence. Inadequate feeding of girl children also affects nutrient stores, subsequent reproductive health, and the risk of maternal mortality

Appropriate complementary feeding involves a combination of practices to maintain breastmilk intake and, at the same time, improve the quantity and quality of foods children consume.

The 6–11 month period is an especially vulnerable time because infants are just learning to eat and must be fed soft foods frequently and patiently. Care must be taken to ensure that these foods complement rather than replace breastmilk. For older infants and toddlers, breastmilk continues to be an important source of energy, protein, and micronutrients. Therefore, breastfeeding should
continue through 24 months and beyond.

Improving complementary feeding requires a combination of strategies

Energy intake can be increased by increasing breastfeeding frequency, increasing food portion sizes, feeding children more frequently, and/or providing more energy-dense foods. Micronutrient intake can be increased by diversifying the diet to include fruits, vegetables, and animal products; using fortified foods; and/or giving supplements. Choosing food combinations that enhance micronutrient absorption is also important.

When to begin complementary feeding?

Its best to start complementary feeding at 6 months of age. The reason why 6 months is the best age to start is simply because biologically the child would be ready to digest and breakdown the nutrients present in the food. Thus making it readily available and easy to absorb.

The World Health Organization (WHO ) recommends starting complementary feeding from 6 months.

Now because complementary feeding is supporting breastmilk or formula, its important to ensure the child gets enough breastmilk or formula.

An appropriate amount would be 6-8 oz OR approximately 180-240ml every 3-4 hours. For every child this will differ but being within range is the most ideal while supporting with the meals.

What to give?

Always aim to offer meals  using the acronym CPFMV which stands for Carbohydrate, Proteins, Fats, Minerals and Vitamins.

 3 main things to do to ensure a successful complementary feeding

• Introduce one food option in multiple ways. You should not restrict your child to only purees or sweet flavours
• Quantity is not paramount, instead focus on learning your child’s choices
• If after several trials the baby has an acute dislike for a particular food, omit that food for a week or two and then try again.

Practical Tips for Complementary feeding

• 
  

  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.
• 
  

  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 favourite foods and encourage children to eat when they lose interest or have depressed appetites.
  • If children refuse many foods, experiment with different food combinations, tastes, textures, and methods for 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 more frequent breastfeeding, and patiently encourage children to eat favourite 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.

What to avoid?

While starting to offer complementary foods, please avoid the following:

1. Foods that are very likely to cause choking. Such as whole grapes, raw carrots, whole peanuts e.t.co

2. Honey before 12 months

3. Excessive use of artificial seasonings

4.  Hydrogenated fats

This article is written from the group discussion on Ask The Paediatricians Facebook group by Mrs Ifeyinwa Omesiete, Paediatric Nutritionist and supplemented with additional materials from the article “Facts for Feeding: Guidelines for Appropriate Complementary Feeding of Breastfed Children 6–24 Months of Age” by LINKAGES (Breastfeeding, LAM, Related Complementary Feeding, and Maternal Nutrition Program).