information on complementary feed

1. Complementary Feeding, Issues
and concerns
Pediatric Nutrition
II CND, 2023

2. What is Complementary Feeding?
Complementary feeding or weaning is the process of giving an infant other foods and
liquids along with the breast milk after the age of 6 months as breastmilk alone is no
longer sufficient to meet the nutritional requirements of growing baby. It is the
process by which the infant gradually becomes accustomed to adult diet.
Switching baby from a milk-
only diet to one that includes
portions of milk and
solid/baby food

5. WHO Recommendations
Infants should start receiving complementary foods at 6 months of age in addition to breast milk
 Initially, between 6–8 months : 2–3 times a day
between 9–11 months : increase to 3–4 times daily
12–24 months : Additional 1–2 times nutritious snacks per day
Gradually increase food consistency and variety as the infant gets older and their adaptability
Infants can eat pureed, mashed and semi-solid foods beginning at 6 months
By 8 months most infants can also eat “finger foods” (snacks that can be eaten by children
alone).
By 12 months, most children can eat the same types of foods as consumed by the rest of the family
nutrient-dense foods, including animal-sourced foods like meat, poultry, fish, eggs and dairy
products.
Avoid foods in a form that may cause choking such as whole grapes or raw carrots
Avoid giving drinks with low nutrient value, such as tea, coffee and sugary soft drinks. Limit the amount of juice
offered, to avoid displacing more nutrient-rich foods

6. Why start at six months?
 Risk of hypersensitivity (allergic) reactions to
the proteins in complementary foods is
reduced
 Infants ability to digest and absorb proteins,
fats and carbohydrate other than in the
breast milk and formula increases rapidly
 The infant’s kidney develop the ability to
excrete the waste products from foods with
a high solute load such as meat
 Infants develop the neuromuscular
mechanisms needed for recognizing and
accepting a spoon , masticating, swallowing
non-liquid foods and appreciating variations
in the taste and color of foods
If started late……….
• Reject foods when they are introduced
at a later age – This may occur because
infants become comfortable with the
easier feeding style necessary to suck
from the breast or a bottle. The infant
may then have difficulty developing skills
to eat independently.
• Consume an inadequate variety and
amount of food to meet their nutritional
needs – Breast milk or infant formulas
alone do not provide an adequate
concentration or balance of nutrients for
the older infant.-Nutritional deficiencies
and malnutrition
• Growth or development slows down or
stops
• Iron deficiency anaemia is more common
in infants
If started soon………
• Choke on the food
• Develop food hypersensitivities
(allergies) because of an immature
digestive tract or
• Consume less than the appropriate
amount of breast milk or infant formula
• Increased risk of illness like diarrhoea

7. What are the signs that baby is ready for
Complementary Feeding?
• Sit up, alone or with support
• Hold his head steady and straight
• Open his mouth when he sees food coming
• Keep his tongue low and flat to receive the spoon
• Close his lips over a spoon and scrape food off as a spoon is removed from his
mouth and
• Keep food in his mouth and swallow it rather than pushing it back out on his chin. By
4 to 6 months of age, the infant’s tongue thrust reflex, which causes the tongue to
push most solid objects out of the mouth, usually disappears
• Not gaining weight adequately
• Receives frequent breastfeed but appear hungry soon after
• Interested in food what others eat

8. Nutrition of the
child is very
important
especially during
crucial 1000 days
for optimal growth
and development
of child

9. Importance of Gradually Introducing Each New Food
• Introduce new foods one at a time.
• Introduce “single-ingredient” foods initially to determine the infant’s
acceptance to each food (e.g., try plain rice cereal before rice cereal mixed
with fruit).
• Allow at least 7 days between the introduction of each new “single-
ingredient” food.1 Some research experts acknowledge that
complementary foods can be introduced at intervals of 2 to 4 days if the
infant is developmentally ready
• Introduce a small amount (e.g., about 1 to 2 teaspoons) of a new food at
first (this allows an infant to adapt to a food’s flavor and texture).
• Observe the infant closely for adverse reactions such as rash, wheezing, or
diarrhea after feeding a new food.

10. Dietary diversity
• Dietary diversity means feeding a
child different types of food so that
his/her nutrient requirements are
adequately met
• Minimum 4 or more food groups
from the seven food groups to meet
daily energy and nutrient
reequirements
• Ensures that the child has a
likelihood of consuming at least one
animal source food and one fruit or
vegetables in addition to the staple
food(grain, root or tuber)

15. Finger foods for Infants

16. Amount of complementary food needed
Start at six months of age with small amounts of food and increase the quantity
as the child gets older, while maintaining frequent breastfeeding
• 6-8 months: 200 kcal per day: 250ml
• 9–11 months : 300 kcal per day:
• 12–23 months of age : 550 kcal per day

23. Feeding Techniques
• Feed Infants directly and assist older toddlers
• Take care of hunger and satiety signs given by infant
• Feed patiently and encourage but don’t force
• If child refuses, experiment with different food
combinations, tastes and textures

24. Growth Monitoring:
• Measure weight and length periodically and plot growth curves
• Investigate causes of poor growth like dietary history and
evaluate for any illness
• Counsel mother/caregivers on growth, feeding and caring
practices

26. Modify the nutritive value of complementary foods
Nutritive value of foods can be improved by increasing the energy density of food by
addition of ghee, sugar, jaggery, vegetable oils, butter, etc.
The protein content of foods can be improved by combining cereals and pulses to ensure
delivery of all essential proteins, also by using different cooking methods such as milling,
germination, and fermentation of different food items.
The viscosity of foods can be reduced by malting so that a child can eat more. It is the
process of germinating whole grain, and then the germinated cereal or pulse is dried and
grinded. Malted cereal or pulse-mixed infant foods provides more energy. Amylase-rich
flour (ARF) or flours of malted foods increases the energy density of food.
Feed with thick but smooth mixtures. Thin gruels do not provide enough energy, hence, a
young infant around 6–9 months requires thick and smooth food preparations.
The fortification of complementary foods with micronutrients such as iodine, zinc, iron,
vitamin D, vitamin A, calcium, phosphorus, etc. However, this will involve commercial
foods or sprinkles of micronutrients to be added to food.

28. TYPES OF COMPLEMENTARY FOODS

29. 1. Iron-Fortified Infant Cereal(Rice)
• appropriate first complementary food for infants because
 Digests easily
 Least likely to cause a hypersensitivity (allergic) reaction
 Contains important nutrients iron and zinc
 Can be altered in texture to meet an infant’s developmental needs. The
infant’s first cereal feeding should be soupy in texture with the texture
becoming thicker and lumpier as feeding skills progress.
• After introducing rice infant cereal, oat and barley infant cereals can be added
at 1week intervals.
• Wheat infant cereal should be introduced at 8 months of age-hypersensitivity
• Mixed-grain infant cereals and infant cereal and fruit combinations may be
introduced after an infant has been introduced separately to each food in the
mixture or combination

30. 2. FRUIT JUICES
• fruit juices contain carbohydrates and may contain vitamin C
• 100 percent fruit juice or reconstituted juice can be consumed as part of a well-
balanced diet
• fruit juice should be fed only in moderation since it might cause diarrhea, abdominal
pain, or bloating
• Never feed infants unpasteurized juice

31. Here is a list of healthy juice for babies:
1.Stewed boiled apple juice
2.Tender coconut
3.Grape juice (raw)
4.Muskmelon juice (raw)
5.Watermelon juice (raw)
6.Boiled carrot juice
7.Orange juice (raw)
8.Boiled tomato juice
9.Sapota juice (raw)
10.Boiled pear juice
11.Boiled peach juice
12.Papaya juice (best avoided during summers)
13.Banana juice (raw)
14.Lychee juice (raw)
15.Mango juice (raw)

32. 3. Grain Products
• grain products that are appropriate for infants include: plain ground or
mashed rice or barley
• Grain products provide carbohydrates, thiamin, niacin, riboflavin, iron,
other minerals, and, in the case of whole-grain products, fiber to the
diet
• these foods should be cooked until very soft and then pureed or finely
mashed or put through a sieve before serving

33. 4. Vegetables and Fruits Vegetables
• mashed, or soft cooked sticks of parsnip, broccoli, potato, yam,
sweet potato, carrot, apple or pear
• Vegetables and Fruits provide infants with carbohydrates, including
fiber; vitamins A and C; and minerals.
• risk of choking
• not to feed infants less than 6 months old those home-prepared
vegetables potentially high in nitrates (spinach, beets, turnips, carrots,
or collard greens )

34. • Iron rich foods for infant

35. With rapid growth of the infant esp. during
9 months to 24 months, iron stores in the
infant may not be suffiecient therefore ,
Supplement of iron might be required

36. 5. Protein-Rich Foods
• Infants can be offered well-cooked strained or
pureed lean beef, pork, lamb, veal, chicken, turkey,
liver, boneless finfish (fish other than shellfish), egg
yolk, legumes, tofu, sliced or grated mild cheese,
yogurt, or cottage cheese.
• Home- or commercially prepared meats are a good
source of iron and zinc, in addition to iron-fortified
infant cereal
• Iron and zinc are nutrients of concern for
exclusively breastfed infants
• Certain fish have been found to have high levels of
mercury that may harm an infant’s developing
nervous system (Shark, swordfish or marlin)

37. Eggs
• not recommended until 1 year of age due to hypersensitivity reactions caused by egg protein
• properly prepared to reduce the possibility of contamination with Salmonella enteritidis and
other bacteria
Cheese and Yogurt
• Cottage cheese, hard cheeses, and yogurt can be gradually introduced as occasional protein
foods.
• Cheese can be eaten cooked in foods or in the sliced form. Small slices or strips of cheese are
easier and safer to eat than a chunk of cheese, which could cause choking
Legumes (Dry Beans or Peas) and Tofu
• Cooked legumes (dry beans and peas) or tofu (bean curd made from soybeans)
• Protein rich foods
• best to introduce small quantities (1 to 2 teaspoons) of mashed or pureed and strained
legumes initially (whole beans or peas could cause choking)

38. Water
• Feeding Water should be started once Protein-rich Foods Are
Introduced
• Protein-rich foods (e.g., home-prepared meats, commercially prepared
plain meats and mixed dinners, egg yolks, cheese) have a higher renal
solute load than some other foods
• may recommend feeding a small amount of sterile water (100- 200 ml
per day) in a cup when complementary foods rich in protein are
introduced

39. General Guidelines for Feeding Complementary
Foods
1. Wash an infant’s hands before eating
2. Position the infant appropriately
3. Feed the infant using a spoon

40. Issues and concerns

42. Adverse reactions to food include:
1. Food hypersensitivities (allergies)
 Occur in approximately 2 percent to 8 percent of infants and children less than 3 years old
 Involve a reaction of the immune system to a food; a reaction may occur immediately or hours after eating
 May cause any of the following symptoms:
◾ Systemic – anaphylactic shock, failure to thrive
◾ Gastrointestinal – diarrhea, vomiting, abdominal pain
◾ Respiratory symptoms – coughing, wheezing, ear infections
◾ Cutaneous – skin rashes (like eczema
 Are associated most with consumption of these foods by infants: cow’s milk, whole eggs (or egg white), wheat,
peanuts or tree nuts, finfish (e.g., flounder, trout, cod) and shellfish (e.g., shrimp, crab, lobster, scallop, oyster,
clamps)
 Caregivers should not feed any shellfish, peanut butter, whole eggs, or egg whites to their infants before 1 year
of age

43. 2. Food intolerances:
Involve reactions stemming from an enzyme deficiency, a toxin, or a disease (the
immune system is not affected); and • May cause some of the similar symptoms as
food hypersensitivities.
 Examples of food intolerances are lactose intolerance (caused by a lack of
lactase, the intestinal enzyme that digests the sugar lactose) and celiac disease
(in which gluten, a combination of proteins found in wheat, rye, oats, barley, and
buckwheat, destroys the lining of the small intestine)
3. Other adverse reactions to food that do not involve the immune
system include reactions to the following:
food additives (e.g., artificial food colorings), MSG (monosodium glutamate), natural
substances in food such as caffeine, or substances or micro-organisms that cause
food poisoning. Some infants may develop excessive intestinal gas after consuming
certain foods (e.g., certain vegetables, legumes).

44. Concerns:
Infants at high risk for developing allergy, identified by a strong family
history of allergy or infants with at least one first-degree relative (parent
or sibling) with allergic disease – should adhere to the following
recommendations:
• Complementary foods should not be introduced until 6 months of age.
• Dairy products should be delayed until the infant is 1 year old.
• Eggs should be delayed until the infant is 2 years old.
• Peanuts, nuts, and fish should be delayed until 3 years of age.

45. Feeding ill-child

46. Feeding ill-child
• Encourage the child to drink and eat
• Feed small amounts frequently
• Give foods that the child likes
• Give a variety of nutrient rich foods
• Continue to breast feed

47. Feeding during Recovery
• Feed an extra meal
• Give an extra amount
• Use extra nutrient rich foods
• Feed with extra patience
• Give extra breastfeeds as often as child
wants

48. THANK YOU