Complementary Feeding

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Complementary Feeding
DR. PRADEEP DUBEY , MD(Ped) DCH. CONSULTANT
DEV. NEURO PEDIATRICS
AADIGURU NEUROPEDIATRIC CENTRE NEAR
PREM MANDIR , WRIGHT TOWN JABALPUR
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Children Under 3 years Who are Underweight
(NFHS-3, 2005-2006)

• Not a change over seven years

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Ranking by Children U-3 who are underweight
(NFHS-3)
Rank States of Underweight
1 Madhya Pradesh 60.3
5 Gujarat 47.4
6 Uttar Pradesh 47.3
12 Karnataka 41.1
21 Delhi 33.1
26 Punjab 27.0
INDIA 45.9
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Under-5 deaths preventable through universal
coverage with individual preventive interventions
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Complementary Feeding, 6-9 months(NFHS-3,
2005-2006)

• Shown good change in 7 years, national average
  almost doubled
• Reaching Greens is a challenge

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Ranking by Complementary Feeding (NFHS-3)
Rank States Complementary Feeding
1 Kerala 93.6
2 Sikkim 89.6
11 Himachal 66.0
15 Delhi 59.8
25 Punjab 50.0
27 Uttar Pradesh 45.5
INDIA 55.8
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Optimal Feeding Norms as per National Guidelines
on Infant and Young Child Feeding

• Starting breastfeeding within one hour of birth
• Exclusive breastfeeding for the first six months
• Introducing appropriate and adequate
  complementary feeding after 6 months along with
  Continued breastfeeding for two years or beyond

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Definition of Complementary feeding

• The process of giving an infant other foods and
  liquids along with breast milk or non-human milk
  as breast milk alone is no longer sufficient to
  meet the nutritional requirements.
• These foods should complement rather than replace
  breastmilk.

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Appropriate Complementary Feeding

• Timely Introduced when need for energy and
  nutrients exceeds that provided by BF
• Adequate Should provide sufficient energy,
  protein, and micronutrients
• Properly Fed Active feeding method and proper
  frequency according for age
• Safe Should be hygienically prepared, stored and
  fed

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Timing of Complementary Feeding

• Soon after completing 6 months of age
• Breast milk sufficient to promote growth and
  development till 6 months
• Energy and nutrient gap appears after 6 months
  and widens thereafter
• Infants development and behavior makes him ready
  for other foods
• Holds objects (e.g. biscuit) and takes everything
  to mouth
• Chewing movements start
• Tendency to push solids out decreases
• Eruption of teeth and beginning of biting
  movements

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Age of Introduction
Energy Needs
Excl. Breastfeeding
Comp. feeding continued BF
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Timing of Complementary Feeding

• Disadvantages of adding foods too soon
• Decrease the intake of breast milk resulting in a
  low nutrient diet
• Increase risk of illness esp. diarrhea
• Disadvantages of adding foods too late
• Growth and development slows down or stops
• Risk of deficiencies and malnutrition

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Importance of continued breastfeeding for 2 years
and beyond
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Why Continue Breastfeeding?

• Vital source of energy (30-40) and nutrients
  into 2nd yr of life
• Key source of
• Good quality proteins essential fatty acids
• Micronutrients
• 45 of Vitamin A
• 40 of calcium riboflavin
• 95 of Vitamin C
• Fluids and nutrients during infection
• Associated with greater linear growth
• Linked to lower risk of chronic diseases obesity

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Key Message-1 (Timely)

• Complementary feeding should begin soon after
  completing 6 months of age along with continued
  breastfeeding

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Adequacy (Quality)

• Staples Cereals (Rice, wheat, maize, millets)
  and Legumes
• Fats (Vegetable oils/butter/ghee 1g 9 Kcal)
  and sugars to improve energy density and taste
• Foods of animal origin (Milk, curd, eggs, meat,
  fish) to provide good quality proteins, vitamin A
  and calcium.
• Vegetables and Fruits to provide micronutrents
  e.g. iron and vitamins. Supplements e.g. iron
  might be required.

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Other Attributes of Complementary Foods

• Right consistency
• Soft
• Easy to digest
• Inexpensive
• Locally available
• Culturally acceptable
• Easily prepared at home

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Variety of Foods

• Start at 6 mo with small amounts of food
  increase quantity with age, maintaining frequent
  breast feeding
• Increase food consistency variety with age
• Can feed mashed semi-solids (e.g. porridge) at
  6 mo
• Can feed finger foods by 8-9 mo
• By 12 mo, family foods can be eaten
• Combine foods (e.g. rice and legumes) to provide
  good mixture of amino acids

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Foods to Avoid

• Tea coffee interfere with iron absorption
• Aerated beverages No nutritional value
• Too much sugary drinks Fruit juices cause
  decreased appetite for other nutritious foods and
  also may cause loose stools.
• Nuts may cause choking

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Stomach size
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Adequacy (Frequency and Amount)6-12 months

• Give at least one katori (150-200 mL) serving
  at a time of
• Khichdi or dalia or sooji (semolina) with added
  oil/ghee
• Mashed roti/rice/bread mixed in thick dal or
  sweeetened undiluted milk
• Add cooked/pureed vegetables or meat also in the
  servings
• Sevian/dalia/halwa/kheer/biscuits prepared in
  milk or any cereal porridge cooked in milk
• Mashed boiled/fried potatoes
• Mashed banana/cheeko/ mango/ papaya
• 3 times per day if breastfed
• 5 times per day if not breastfed

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Frequency and Amount (1-2 yrs)

• Offer food from the family pot
• Give at least 1½ katori (250 mL) serving at a
  time of
• Mashed roti/rice/bread mixed in thick dal with
  added ghee/oil or khichri with added oil/ghee.
  
• Add cooked vegetables/meat also in the servings
• Mashed roti/ rice /bread/biscuit mixed in
  sweetened undiluted milk
• Egg preparations/ soft meat pieces without bones
• - Sevian/dalia/halwa/kheer prepared in milk or
  any cereal porridge cooked in milk OR
• Fruits (banana/cheeko/apple/orange/mango/papaya)
• 5 times per day.

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Amounts of foods to offer
Age Texture Frequency Amount of each meal
6 months Soft porridge, well mashed vegetable, meat fruit 2 times per day plus frequent breastfeeds 2-3 tablespoonfuls
7-8 months Mashed foods 3 times per day plus frequent breastfeeds Increasing gradually to more than 3/4 of katori (150ml)
9-11 months Finely chopped or mashed foods, and foods that baby can pick up 3 meals plus 1 snack between meals plus breastfeeds a full katori (200ml)
12-24 months Family foods, chopped or mashed if necessary 3 meals plus 2 snacks between meals plus breastfeeds more than katori (250ml)
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Ensure Adequacy

• Growth Monitoring Measure weight and length
  periodically and interpret by plotting in growth
  curves.
• Investigate causes of poor growth Dietary
  history evaluate for any illness.
• Counsel mother/caregivers on growth, feeding and
  caring practices

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Key Message-2 (Adequacy)

• Complementary foods should be of right
  consistency, energy dense and the variety to
  provide all nutrient demands of a growing child.

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Feeding Techniques

• Feed infants directly assist older toddlers
  eat be sensitive to hunger satiety cues
• Feed patiently encourage, but dont force
• If child refuses, experiment with different food
  combinations, tastes, textures
• Minimize distractions during meals
• Talk to child during feeding maintain eye contact

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Responsive feeding
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Suitable Feeding Situation
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Key Message-3 (Properly Fed)

• Child should be fed patiently giving adequate
  attention and time

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Safe

• Unhygienic feeding
• ?the risk of infectious illness (esp. diarrhea)
  compromising nutritional status
• Undermines the parents confidence leading to
  delay in CF

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Ensuring Food Hygiene

• Washing caregivers and childs hands before
  preparing, handling and eating food
• Clean water and raw materials to cook food
• Storing foods safely Keeping food covered and
  serving shortly after preparation
• Use clean utensils to prepare serve food
• Use clean bowls cups when feeding child
• No feeding bottles

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Key Message-4 (Safety)

• Foods should be prepared, stored and fed
  hygienically to the children.

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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

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Feeding during Recovery

• Feed an extra meal
• Give an extra amount
• Use extra rich foods
• Feed with extra patience
• Give extra breastfeeds as often as child wants

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Key Message-5 (During Illness)

• Continue feeding during illness and increase
  during convalescence.

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Key Messages

• Complementary feeding should begin soon after
  completing 6 months of age along with continued
  breastfeeding
• Complementary foods should be of right
  consistency, energy dense and the variety to
  provide all nutrient demands of a growing child.
• Child should be fed patiently giving adequate
  attention and time
• Foods should be prepared, stored and fed
  hygienically to the children.
• Continue feeding during illness and increase
  during convalescence.

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Thank You