Complementary Feeding or weaning Process CHILD HEALTH NURSING

2. SHIVANI THAKUR
ASSOCIATE PROFESSOR

3. INTRODUCTION:
 In the first year of life, infants undergo periods of
rapid growth and at that time good nutrition is
crucial.
 Breast milk is the ideal food for infants during
the first six months of life.
 But after the six months of life, breast milk
cannot provide all of the nutrients and calories
that allow infants to thrive.
 Other more nutritious foods should be added by
the time, to fulfil the nutritional demand of
infant.

4.  Weaning is the process of gradually introducing
an infant, to what will be its adult diet and
withdrawing the supply of its mother's milk.

5.  Replacement of breast for a cup or bowl.
 From the age of six months until approximately
two years, gradually introduce different types of
semi-solid or solid foods to the infant.
 Infant become accustomed to eating adult-type
foods and familiarizes them.

6.  Cultural groups define weaning in relation to
significant life events (e.g. teething) or reaching a
specific age.
 The age at which children are normatively weaned
can vary significantly between cultures, "from 6
months to 5 ½ years".

7.  After 6 month of age, addition of other food is
essential to prevent growth faltering, while breast
feeding is being continued.
 Delayed introduction of additional foods results
in malnutrition.

8.  Improper introduction of these foods leads to the danger of;
 Diarrhoea due to infection
from unhygienic preparation.
 Malnutrition related to inadequate calorie intake due to low
frequency of feeding and low calorie density of additional
foods.

9.  No one time for weaning is best for every child.
 Generally most child shows signs of readiness
during second half of the first year.
 Semi-solids should be introduced after 6 months of
age.
 According to growth performance and
physiological maturation of the infant, weaning
can be started earlier but not before 4 month.

10. CHILD’s
FACTOR
MATERNAL
FACTOR

11.  Mother’s physiologic state or willingness to
breast feed
 Mother’s exposure or level of awareness (i.e.
modernization)
 Mother’s economic status (i.e. relative
empowerment, poverty)
 Socio-cultural influences

12.  Child’s willingness to give up breastfeeding
 Developmental readiness, rather than
chronological age

13. The weaning food should be;
 Liquid at starting, then semi-solids and solid food
to be introduced gradually.
 Clean, fresh and hygienic
 Easy to prepare at home
 Not costly
 Easily digestible, acceptable and palatable
 High in energy density and low in bulk viscosity
 Contains all necessary nutrients
 Based on cultural practices and believes
 Well balanced, nourishing and suitable for the
infants

14.  After six months of breast feeding, infant's iron
stores will be low. He needs to start a solid food
diet to build his iron supply.
 Rapid growth and development of infant
indicates the need of more energy than the breast
milk alone can’t give.
 By six months, baby will be getting hungry soon.

15.  Infant needs to learn how to use his mouth to
develop eating skills and to experience new
textures and tastes.
 Starting solids will also help his developing teeth
and jaw.
 Solid food would not replace the breast for at least
12-18 months.

16. The baby will start giving clues that he wants more
in his mouth than milk, like....
 Becomes interested in what you're eating and starts
making a grab for it.
 Putting his fingers into his mouth.
 Opens his mouth if you offer him a spoon.

17.  Starts 'munching' on his gums.
 Starts waking at night.
 Strong neck and head control.
 Manipulate a cup on his lips.

19. A. PRINCIPLES FOR INTRODUCING
SOLIDS:
 Introduce the solids slowly and one at a time.
 Everything is smooth, thickened but mashed.
 Single supplementary food is added at a time.
 Additional food can be given at day time and when child is
hungry.
 Start by offering a teaspoon of rice cereal - it's plain, iron
rich.
 Breast milk can be added to thin the rice cereal.

20.  Small amount of new food is to be given in the
beginning and gradually the amount to be increased.
 Food items should be colourful and presented in a very
creative/ attractful manner.
 There should not be any strict rule for serving new
foods.
 Don't be discouraged if child seems to push back all
the feeding. For some babies, co-ordinating the
chewing and swallowing actions takes a bit of time to
master.

21.  Weaning should be started at 6 month of age but
breast feeding to be continued up to 2 years of age
or beyond.
 Family pot feeding_ giving family food in the
mashed form and add some oil/fats and green
vegetables (if needed). It is economical, saves time
and infant accustomed to the traditional food.

22. B. DIFFERENT FOOD FOR DIFFERENT
AGE GROUP:
Foods to introduce from 6-9 months:
 Start with cereal based porridge (suji, wheat
flour, ragi etc.) enriched with oil/fat and/or
animal milk (if possible)
 Mashed fruits like banana or seasonal fruits like
papaya, mango etc.

23.  1-2 teaspoon for 3-6 times/day.
 Quantity and frequency should be increased
gradually.
 At the end of 9 months, the
infant should consuming
half cup of food.

24. Foods at 9-12 months:
At about 9 months, the infant can start chewing
on soft food.
Food need not to be mashed but
can be chopped.
Finger food like pieces of soft fruit , cooked
vegetables.
Household food of different variety should be
given 4-5 times a day.

25.  Ground up meats and chicken, as tooth erupts in
this age (Chewing helps oral muscle
development, which is important for
speech development)
 Cereals such as whole rice and pasta (Cereals with
pulses, oil/fats or sugar to increase calories)
 Green vegetables for vitamin A,B
and C, and iron.
 Yoghurt

26. 12 months and beyond (solids)
 At 12 months, introduce cow's milk in baby's
diet.
 At this stage child is able to eat coarsely textured
foods, including meat.
 A child of 1-2 years need about half the food
that the mother eats.

27.  Child will also be able to handle a spoon but he
prefer the more 'hands-on' approach to eating.

28. Drinks for the child
 From 6 months, water and diluted, unsweetened
fruit juices can be offered at mealtimes.
 Drinks between meals should be tap water or breast
milk.
 Full-fat milk can be used as a drink after the age of
one.
 Don't give fruit squashes, tea, coffee or drinks with
artificial sweeteners to the baby.
 From the age of one, encourage baby to drink out
of a cup, as this is better for their teeth than a bottle.

30. Introduce (along with Breast Feeding)
Fresh milk 200-250ml/day
Mashed banana/ custard 1/4 - 1/2
Powdered murmura/ riceflakes 1/4- 1/2 katori
in milk+ sugar +fat
Khichri (Liquid consistency) 1/4 - 1/2katori
Washed moong dal + rice + fat
biscuit/ bread/ Suji in milk 1/4 - 1/2 cup
+ sugar +fat
Boiled mashed potato/ halwa

31. 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
Khichri (semisolid consistency) ½ - 1 katori
(dal + rice + fat) OR rice-dal
Biscuit/ bread in milk ½ - 1cup
+sugar+fat
Potato+ vegetable ½ - 1 cup

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

34. c. FOODS TO BE CAREFUL WITH:
 Salt
 Sugar
 Honey - don't give honey to baby until he is a year
old. There's a very small risk of a certain type of food
poisoning called infant botulism. By one year, baby's
digestive system has developed enough to stop the
bacteria growing.
 Nuts - whole nuts, including peanuts, should not be
given to children under five years old as they can
choke on them.

35.  Low-fat foods - fat is an important source of
calories and some vitamins for babies and young
children. It’s better for babies and young children
under two to have full-fat milk, yoghurt and
cheese rather than low-fat varieties.
 Raw shellfish can increase the risk of food
poisoning so it’s best avoided.
 Eggs can be given to babies over six months old,
but not half boiled.

37. 1. PREPARING BABY FOOD
When preparing first food, it is important to
start with food that will not pose any threat -
choking, allergies.
It is best to start with rice cereal and then to
move on to pureed cooked fruits and
vegetables such as apple, pear, pumpkin,
potato and peas.

38.  When preparing baby's food, ensure that all core,
bones, fat and seeds have been removed before
you begin cooking.
 Many fruits and vegetables have much of the
nutritional value in their skin, so don’t remove it.

39.  Steaming: Steaming in a little water is the best way to
cook food for the baby as this method will retain the
most nutrients of all cooking methods.
 Baking: Dry baking (where no oil is used) baby's
vegetables is a great way to intensify the
flavours of the vegetable without having
to add anything to the food.
 Microwaving: It helps to cook small
amounts efficiently.

40.  Suitable storage containers should
be available.
 Divide the servings before begin to feed the baby.
 NEVER store leftover food.
 Food can be stored in the fridge for one day.
 When planning to use baby food that's been
frozen, try to defrost it overnight in the fridge.

41.  Avoid additives such as salt, oil or sugar when
cooking baby food.
 Try and use only fresh fruits and vegetables.
 Throw away any unfinished food at the end of
each meal to avoid the risk of food poisoning.
 To thin the food, use breast milk, cooking water,
juice or water.
 Always freeze or refrigerate prepared baby food
immediately.

42.  Time of Day: Choose a time to introduce solids
when baby is happy and awake, hungry but not
starving - lunch time is usually the best.
 Position: Until he's big enough to sit in a high
chair, ask mother to feed him in her lap. Give
upright so that he won't gag on his food.
 Cutlery: Use the spoon of adequate size for
feeding the child. Spoon and bowl should be
round and free of sharp edges.

47.  Learning to eat can be a very messy and slow
process.
 Baby will learn how to eat by touching food and
carrying it to his mouth.
 Parents should eat with the child but in separate
plate to develop good eating habits in
the child.
 Never leave the baby while he is eating,
as child needs constant supervision.

48.  Many babies will reject a new food not because
he doesn't like it but rather because it's a new
taste. Offer a new food multiple times before
giving up on it.
 To begin with, solids should supplement baby's
milk diet not replace it. Initially offer solids after
a milk feed, or between feeds. Once he's eating
solids three times a day and is eating a good
portion at each meal, then begin to serve solids
first.

49. Leans
back
Turns
head
away
Doesn’t
open
his
mouth

50.  Feeding should continue during ailments like
diarrhoea, respiratory infections, etc. Unless the
medical condition of the child contradicts it.
 Restriction or dilution of food should be
discouraged.
 Despite anorexia, the infant can eat in small
quantities but more frequently, i.e. after every 2-3
hours.
 After illness, the child should be provided more
than the usual diet, to regain the weight lost.

51.  If breast feeding is stopped suddenly, it can have
psychological and nutritional effects on the
infant.
 Solid food can cause diarrhoea, if prepared un-
hygienically or not digested properly.
 If weaning foods are too poor to provide
adequate nutrients, the infant can develop
malnutrition.

52. Rashes
Vomiting
Diarrhoea
Stomach Pain
Breathing Problems

54. DEFINITION:
Supplementary feeding describes the method of
giving additional fluids aside from breast milk to a
breastfed baby because of breast milk supply
issues or attachment issues.

55. It means to feed the child other than breast milk.
It involves the use of breast milk substitutes in the
form of liquid milk, i.e. fresh cow/buffalo’s milk
or commercially prepared/available dried whole
milk.

56.  Death or absence of mother
 Prolonged maternal illness
 Complete failure of breast milk
production

57.  Lack of interest in breast feeding by the mothers &
family members.
 Wrong beliefs & ignorance related to breast feeding.
 Increasing number of working mothers.
 Aping the western countries.
 Changing lifestyle.
 Availability of alternatives to mother’s milk.
 Urge to be sophisticated.

58. Aims of artificial feeding are similar to those of
breast feeding;
 Provide adequate nutrition to the infant
 Be free from bacterial contamination
 Be economical
 According to the need of the child

59. In normal, healthy infant artificial feeding should
be given by;
Bowl and spoon
Cup or glass

60. In sick/hospitalized and preterm infants, feeding
should be given by;
 Dropper

61.  Oro-gastric or naso-gastric tube

62.  Strict cleanliness in the preparation is to be
maintained.
 Correct feeding procedure is to be followed.
 Milk should be warm, and not hot/cold.
 Feeding must be given with the calculated
amount of fluids and calories in the infants
according to their expected weight.

63.  Bottle feeding must be avoided.
 Time taken for feed depends on the child, but the
average 15-20 minutes may be needed to feed the
total quantity.
 Cow’s milk is considered as the cheaper alternative.
 During illness, the calorie need is increased.
 Feeding should not be given before or after any
painful procedure.

64. Regurgitation
Vomiting
Dehydration
Fever
Excessive crying
Swallowing difficulties
Under or overfeeding

65. ...............????????
IS THERE ANY
DOUBT??????

66. So today we had discussed about;
 Weaning
 Definition
 Process of weaning
 Cultural variation in age at the time of weaning
 Importance of weaning
 Age of weaning
 Factors affecting weaning age
 Problems during weaning
 Qualities of weaning foods
 Purposes

67.  Indications of weaning
 First solid food for baby
 Preparing, cooking and storing baby food
 Starting solid food
 Feeding during illness
 Artificial / supplementary feeding
 Indications
 Purposes
 Methods of giving artificial feeding

68. Books:
 Parthasarathy A, “IAP Textbook of Paediatrics” 4th
edition, Jaypee publishers,. P.p-131-133
 Marlow . A . Dorothy and Redding . A . Barbara,
“Textbook of Paediatric Nursing”, 6thed,
Saunder’s publishers; 2004 , p.p.
 Ghai O.P. “Essential Paediatrics” ,seventh edition
published by CBS publishers & distributors. P.p. -
96-100
 Hockenberry J. Marilyn , “Wong’s Nursing Care
of Infants and Children” , 8th edition, Saunder’s
Publishers 2005, p.p. -531-532

69.  Wilson , “Nursing Care of Infants and Children” ,
7th edition, Wilson & Wilkelstein Kline
publication, 2003. P.p- 543-546
 Datta Parul, “Pediatric Nursing” 1st edition,
Jitender publications, 2007. P.p- 56-58
Internet:
 www.babycentre.co.uk
 www.bbc.co.uk/health/treatments/healthy