This document defines complementary feeding as providing other foods and liquids to an infant along with breast milk after 6 months when breast milk alone is no longer sufficient. Complementary foods should be introduced timely, adequately in terms of nutrients, and properly through active feeding. Continued breastfeeding for 2 years is important as breast milk provides significant energy and nutrients. Complementary foods should be of appropriate consistency, nutrient-dense, varied, and hygienically prepared and fed to support growth and development from 6 months onwards.

1. BY
Complementary
feeding

2. 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.

3. 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

4. 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
 Infant’s 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

5. Age of Introduction
0
0 269
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0
200
400
600
800
1000
1200
0-3 mo 3-6 mo 6-9 mo 9-12 mo 12-24 mo
Energy Gap
Energy from
breastmilk
Energy Needs
Excl. Breastfeeding Comp. feeding & continued BF

6. 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

7. Importance of continued breastfeeding for 2
years and beyond
37
55
76
98
5
63
45
24
2
95
0
20
40
60
80
100
120
Energy Protein Vit. A Vit. C Iron
% daily needs
provided by
500ml breast
milk
Gaps to be filled by complementary foods
Energy and Nutrients from breastmilk

8. 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

9. 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.

10. Other Attributes of
Complementary Foods
 Right consistency
 Soft
 Easy to digest
 Inexpensive
 Locally available
 Culturally acceptable
 Easily prepared at
home

11. Variety of Foods
 Start at 6 months 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
months;
 Can feed finger foods by 8-9 months
 By 12 months, family foods can be eaten
 Combine foods (e.g. rice and legumes) to provide
good mixture of amino acids

12. 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

13. Stomach size

14. How to initiate weaning and progress
 Consistency:Introduction of right consistency of food at
the right age is important to develop good food behaviors.
Essentially follow the sequence :
 Breast feeds (0-6 months)
 Semi-liquid (after 5-6 months) Easy to digest,
smooth and gentle on baby’s stomach.
 Semi-solid (after 8-9 months) Baby now needs food
with taste and texture.
 Semi solid (after 10 months) Baby now needs food
that satisfy his urge to chew-complex taste and
texture
 Solid diet including variety of food items (1-1.2 yrs).

15. How to initiate weaning and progress
Frequency:
 Energy requirement on a per kg basis, is 3 times more than the
adults in infants and 2 times more than the adults in case of
children till 2 years of age.
 Children have to be fed frequently since they can eat small amount
at a time due to their little capacity.
Till 5-6 months - child is given breast feeds on demand i.e. 9-10 times over 24
hours.
From 6- 8 months - As the child grows, his requirements increase and he starts to
accept larger volume and thicker consistency at a time - feed
him 7-8 times/d
From 9- 12 months - child normally eats 6-7 times per day and each time.
By 12 - 15 months - child eats at least 6 times per day.
By 18 months - child’s eating schedule of 5-6 times /day gets fixed
3 regular meals – Breakfast, Lunch and dinner and
3 in-between healthy snacks – midmorning (recess time),
evening at 4:30 – 5 PM
bedtime.

16. How to initiate weaning and progress
Volume:
Children have little capacity due to their smaller surface
area. Initially accepts small amount but as he increases in
size, accepts larger volume.
Till 5-6 months - Few spoons to 30ml at a time
From 6- 7 months - 50-75 ml/g at a time
From 7-8 months - 75 - 100 ml/g at a time
From 9- 12 months - 100 - 150 ml/g at a time

17. From 6-7 months
Introduce (along with BF)
Fresh milk 200-250ml/day
Mashed banana/ custard ¼ - ½ katori
Powdered murmura/riceflakes ¼ - ½ katori
in milk+sugar+fat

18. Cont.
Khichri (Liquid consistency) ¼ - ½ katori
Washed moong dal + rice + fat
Biscuit/ bread/Suji in milk ¼ - ½ katori
+sugar+fat
Boiled mashed potato/ halwa ¼ - ½ katori

19. From 8-9 months
Continue breast feeds
Fresh milk (includes curd) 250-400 ml/day
Banana OR any other ¾ - 1
seasonal fruit
Suji/sago/Dalia in milk ½ - 1 katori
+sugar+fat

20. Cont.
khichri (semisolid consistency) ½ - 1 katori
(dal + rice + fat) OR rice-dal
Biscuit/ bread in milk ½ – 1 katori
+sugar+fat
Potato+ vegetable ½ - 1 katori

21. From 10 - 12 months
Continue breast feeds
Fresh milk (includes curd) 400 - 500 ml/day
Banana OR any other 1 or more
seasonal fruit
Suji/sago/Dalia/sevian in 1 katori or more
milk +sugar+fat (Thick)

22. Cont.
Khichri (semisolid consistency) 1katori or more
(dal + rice + fat) OR rice-dal
Biscuit/ bread/chapati/ paratha 1katori or more
(by 1 year)
Potato + any other vegetable as desired
Curd/ paneer/ groundnut/Egg

23. Amounts of foods to offer
Age Texture Frequency Amount of each meal
6 months Soft porridge, well mashed
vegetable, fruits
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)

24. 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

25. Feeding Techniques
 Feed infants directly & assist older toddlers eat; be
sensitive to hunger & satiety cues
 Feed patiently; encourage, but don’t force
 If child refuses, experiment with different food
combinations, tastes, textures
 Minimize distractions during meals
 Talk to child during feeding; maintain eye contact

26. Responsive feeding

27. Suitable Feeding Situation

28. Safe
Unhygienic feeding
 the risk of infectious illness (esp. diarrhea)
compromising nutritional status
 Undermines the parents’ confidence leading to delay
in CF

29. Ensuring Food Hygiene
 Washing caregiver’s and child’s 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

30. 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

31. 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

32. 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.

33. Important Precautions:
 Use only clean utensils
 Use prepared feed within half an hour
 Discard unused feed
After the initial phase of hard work by the mother, there
will be no need of forcing, coaxing, fussing or running
after the child to eat food. It will be very natural for him
to eat at all meal times and adequately.

34. Thank You