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Complementary feeding in infant IAP PROTOCOLS
Complementary feeding for healthy development
Experts
Dr C R Banapurmath (Convenor)
Dr K Kesavulu
Dr Sudhir Mishra
Dr Nagalatha.S
Dr Aarti Kinikar
Dr Dinesh Tomar
What is complementary feeding?
Complementary feeding, (CF) defined as the process of providing
foodsin addition to milk when breast milk is no longer adequate to
meet nutritional requirements, generally starts at the age of
completed 6 months and continues until 24 months of age,
although breastfeeding may be continued beyond this period
When to start complementary feeding
After the age of 6 months, breastmilk alone is no longer sufficient to
provide adequate nutrition to the child, and complementary feeding
must begin soon after completing 6 months of age i.e, at 180 days.
Why at 6 completed months?
This is a developmental period when it is critical for children to learn to
accept healthy foods and beverages and establish long-term dietary
patterns (WHO). It also coincides with the peak period for risk of growth
faltering and nutrient deficiencies
Age of Growth Faltering Energy Gap
The developmental factors……
The other reasons for complementary feeding at 6 months of age are
• Child develops neck/head control and hand-to-mouth coordination.
• Child starts enjoying mouthing and biting.
• The intestines are mature and ready to digest pulses and cereals.
• Baby likes chewing and gumming semisolids as there is
hardening of gums and eruption of teeth .
• Tendency to push solids out of mouth decreases
What happens if we give too early or too late?
If CF is started
too early it will
• Take the place of
breast milk
• Result in a low
nutrient diet
• Increasing risk of
illness
• Increase mother’s
risk of pregnancy
If CF is
started too
late it will
• The child does not
receive nutrients
needed
• Growth and
development slows
down or stops
• Risk of deficiencies
and malnutrition
Role of breastfeeding after 6months
• Continue frequent on-demand breastfeeding until 2 years of age or
beyond
• Breastfeeding should continue with complementary feeding up to 2
years of age or beyond.
Breast milk can provide
one half or more of a
child's energy needs
between 6 and 12
months of age
one third of energy
needs and other
high quality
nutrients between
12 and 24 months .
COMPLEMENTARY FEEDING - FOODS TO FILL THE
NUTRIENT GAP- THE WHENS AND HOWS
Start at 6 months of age with small amounts of food and increase the
quantity as the child gets older, while maintaining frequent breastfeeding
The purpose is to fill the energy gap and nutrients gap
ENERGY GAP NUTRIENT GAP
So to fill the gaps 2 things are to be followed
• Minimum Meal Frequency
• Minimum Dietary Diversity (MDD) is the consumption of five or more
food groups from the seven food groups
Minimum Meal Frequency (6-24 months)
AGE ENERGY NEEDED PER DAY
IN ADDITION TO BREAST
MILK
TEXTURE FREQUENCY AMOUNT OF FOOD AN
AVERAGE CHILD WILL
USUALLY EAT AT EACH
MEAL
a
6–8 months 200 kcal per day Start with thick porridge,
well mashed foods
Continue with mashed
family foods
2–3 meals per day
Depending on the child's
appetite, 1–2 snacks may be
offered
Start with 2–3
tablespoonfuls per feed,
increasing gradually to ½ of
a 250 ml cup
9–11 months 300 kcal per day Finely chopped or mashed
foods, and foods that baby
can pick up
3–4 meals per day
Depending on the child's
appetite, 1–2 snacks may be
offered
½ of a 250 ml cup/bowl
12–23 months 550 kcal per day Family foods, chopped or
mashed if necessary
3–4 meals per day
Depending on the child's
appetite, 1–2 snacks may be
offered
¾ to full 250 ml cup/bowl
How to fill the nutrient gap?
What is dietary diversity?
Minimum dietary diversity (MDD) is consumption of five or more
food groups from the eight food groups to meet daily energy and
nutrient requirements.
8 Food groups
Eight food groups
Group 8 Breast milk
Consistency of CF ……….. The questions to be
answered?
What should be the consistency of food in complementary feeds?
Thickness of Feed- to begin with Later Texture and Consistency
Examples of some complementary foods
• Appropriate Combination of cereals and pulses (Khichdi, Dalrice,
etc.), locally available staple foods such as Idli, Dosa, Dhokla, Ragi,
Chapati, Roti, Paratha with oil/ ghee, and some amount of sugar.
• Mashed banana, other pulpy fruits (e.g., mango, papaya), sweet
potato, and potato
• Milk-based cereals preparations
• Sprouts, pulses, legumes, groundnuts, almonds, cashewnuts, raisins
Avoidable foods
• Avoidable Biscuits, breads, pastry, chocolates, cheese, softy, ice cream,
doughnuts, cakes, etc.
• Tinned foods, packaged or stored foods, artificially
cooked foods with preservatives or chemicals
• Fruit juices and fruit drink
• Commercial breakfast cereals
• Repeatedly fried foods containing trans-fatty
problems in future
• Any food containing HFSS- (high in fat, salt and sugar)
How to make CF more nutritive?
• Increasing the energy density of food by addition of ghee,
jaggery, vegetable oils, butter, etc.
• 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
• Feed with thick but smooth mixtures
• Fortification iodine, zinc, iron, vitamin D, vitamin A,
calcium, phosphorus,
Feeding techniques, Strategies
Optimal complementary feeding depends not only on what is fed but
also on how, when, where and by whom a child is fed.
Practice responsive feeding so that the child enjoys the process of
feeding
Responsive feeding in younger child Suitable Feeding Situation-in bigger children
Precautions while preparing CF
Follow clean hands, clean vessels, clean storage, clean cups and plates to feed.
Avoid using feeding bottle. Food that looks fresh and smells good shall be offered.
The perishable foods (meat, milk, etc.) and prepared food shall be stored in a refrigerator.
Cover the food properly and feed to the child within 2 hours if refrigerator is not available..
Other important facts in complementary feeding
Role of commercial foods in complementary feeding
They are expensive, and often have tall and exaggerated health claims.
As far as possible, child’s food should be prepared at home using
commonly available ingredients.
Feeding during Illness feeding
Increase fluid intake during illness,
Including more frequent breastfeeding,
Encourage the child to eat soft, favourite foods.
Feeding after illness/Recovery:
• Feed extra meal
• Give extra amount
• Use extra rich foods
• Feed with extra patience
• Give extra breastfeeds as often as child wants
Don’ts in CF
• Avoid delay in starting complementary feeding.
• Avoid outside, artificial, packaged, and commercial and Junk
foods or JUNCS.
• Avoid foods with excess of sugar, salt, and trans-fatty acids.
• Avoid ultra-processed and refined foods.
• Bottle-feeding has only disadvantages; STOP IT.
Continue..
• Avoid feeding while watching television or mobile instead involve the
baby in conversation.
• Do not force to feed. Feeding should not be an unpleasant
experience.
• Avoid overfeeding.
• Avoid foods that may cause choking
Key Messages
1. Breastfeeding for two years age helps the child to grow strong and
healthy.
2. Children who start complementary feeding at 6 months grow better.
3. Family food with thick consistency that stays on spoon, nourish and
fill the child.
4. Animal origin food (milk and milk products for vegetarians) must be
included in a child’s diet.
5. Legumes, peas, beans, lentils and nuts are good source of proteins,
minerals and vitamins.
Continued..
6. Multicolored fruits and vegetables help children to keep eyes healthy
and prevent vitamin deficiency and infections.
7. A growing child needs frequent meals and snacks:give variety of
foods
8. A growing child needs increasing amount of food
9. Young child need to learn to eat. Encourage patiently.
10. Encourage the child to eat and drink during illness. Offer food and
fluids more frequently
Complementary feeding in infant IAP PROTOCOLS

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Complementary feeding in infant IAP PROTOCOLS

  • 2. Complementary feeding for healthy development Experts Dr C R Banapurmath (Convenor) Dr K Kesavulu Dr Sudhir Mishra Dr Nagalatha.S Dr Aarti Kinikar Dr Dinesh Tomar
  • 3. What is complementary feeding? Complementary feeding, (CF) defined as the process of providing foodsin addition to milk when breast milk is no longer adequate to meet nutritional requirements, generally starts at the age of completed 6 months and continues until 24 months of age, although breastfeeding may be continued beyond this period
  • 4. When to start complementary feeding After the age of 6 months, breastmilk alone is no longer sufficient to provide adequate nutrition to the child, and complementary feeding must begin soon after completing 6 months of age i.e, at 180 days.
  • 5. Why at 6 completed months? This is a developmental period when it is critical for children to learn to accept healthy foods and beverages and establish long-term dietary patterns (WHO). It also coincides with the peak period for risk of growth faltering and nutrient deficiencies Age of Growth Faltering Energy Gap
  • 6. The developmental factors…… The other reasons for complementary feeding at 6 months of age are • Child develops neck/head control and hand-to-mouth coordination. • Child starts enjoying mouthing and biting. • The intestines are mature and ready to digest pulses and cereals. • Baby likes chewing and gumming semisolids as there is hardening of gums and eruption of teeth . • Tendency to push solids out of mouth decreases
  • 7. What happens if we give too early or too late? If CF is started too early it will • Take the place of breast milk • Result in a low nutrient diet • Increasing risk of illness • Increase mother’s risk of pregnancy If CF is started too late it will • The child does not receive nutrients needed • Growth and development slows down or stops • Risk of deficiencies and malnutrition
  • 8. Role of breastfeeding after 6months • Continue frequent on-demand breastfeeding until 2 years of age or beyond • Breastfeeding should continue with complementary feeding up to 2 years of age or beyond. Breast milk can provide one half or more of a child's energy needs between 6 and 12 months of age one third of energy needs and other high quality nutrients between 12 and 24 months .
  • 9. COMPLEMENTARY FEEDING - FOODS TO FILL THE NUTRIENT GAP- THE WHENS AND HOWS
  • 10. Start at 6 months of age with small amounts of food and increase the quantity as the child gets older, while maintaining frequent breastfeeding The purpose is to fill the energy gap and nutrients gap ENERGY GAP NUTRIENT GAP
  • 11. So to fill the gaps 2 things are to be followed • Minimum Meal Frequency • Minimum Dietary Diversity (MDD) is the consumption of five or more food groups from the seven food groups
  • 12. Minimum Meal Frequency (6-24 months) AGE ENERGY NEEDED PER DAY IN ADDITION TO BREAST MILK TEXTURE FREQUENCY AMOUNT OF FOOD AN AVERAGE CHILD WILL USUALLY EAT AT EACH MEAL a 6–8 months 200 kcal per day Start with thick porridge, well mashed foods Continue with mashed family foods 2–3 meals per day Depending on the child's appetite, 1–2 snacks may be offered Start with 2–3 tablespoonfuls per feed, increasing gradually to ½ of a 250 ml cup 9–11 months 300 kcal per day Finely chopped or mashed foods, and foods that baby can pick up 3–4 meals per day Depending on the child's appetite, 1–2 snacks may be offered ½ of a 250 ml cup/bowl 12–23 months 550 kcal per day Family foods, chopped or mashed if necessary 3–4 meals per day Depending on the child's appetite, 1–2 snacks may be offered ¾ to full 250 ml cup/bowl
  • 13. How to fill the nutrient gap? What is dietary diversity? Minimum dietary diversity (MDD) is consumption of five or more food groups from the eight food groups to meet daily energy and nutrient requirements.
  • 14. 8 Food groups Eight food groups Group 8 Breast milk
  • 15. Consistency of CF ……….. The questions to be answered? What should be the consistency of food in complementary feeds? Thickness of Feed- to begin with Later Texture and Consistency
  • 16. Examples of some complementary foods • Appropriate Combination of cereals and pulses (Khichdi, Dalrice, etc.), locally available staple foods such as Idli, Dosa, Dhokla, Ragi, Chapati, Roti, Paratha with oil/ ghee, and some amount of sugar. • Mashed banana, other pulpy fruits (e.g., mango, papaya), sweet potato, and potato • Milk-based cereals preparations • Sprouts, pulses, legumes, groundnuts, almonds, cashewnuts, raisins
  • 17. Avoidable foods • Avoidable Biscuits, breads, pastry, chocolates, cheese, softy, ice cream, doughnuts, cakes, etc. • Tinned foods, packaged or stored foods, artificially cooked foods with preservatives or chemicals • Fruit juices and fruit drink • Commercial breakfast cereals • Repeatedly fried foods containing trans-fatty problems in future • Any food containing HFSS- (high in fat, salt and sugar)
  • 18. How to make CF more nutritive? • Increasing the energy density of food by addition of ghee, jaggery, vegetable oils, butter, etc. • 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 • Feed with thick but smooth mixtures • Fortification iodine, zinc, iron, vitamin D, vitamin A, calcium, phosphorus,
  • 19. Feeding techniques, Strategies Optimal complementary feeding depends not only on what is fed but also on how, when, where and by whom a child is fed. Practice responsive feeding so that the child enjoys the process of feeding Responsive feeding in younger child Suitable Feeding Situation-in bigger children
  • 20. Precautions while preparing CF Follow clean hands, clean vessels, clean storage, clean cups and plates to feed. Avoid using feeding bottle. Food that looks fresh and smells good shall be offered. The perishable foods (meat, milk, etc.) and prepared food shall be stored in a refrigerator. Cover the food properly and feed to the child within 2 hours if refrigerator is not available..
  • 21. Other important facts in complementary feeding Role of commercial foods in complementary feeding They are expensive, and often have tall and exaggerated health claims. As far as possible, child’s food should be prepared at home using commonly available ingredients.
  • 22. Feeding during Illness feeding Increase fluid intake during illness, Including more frequent breastfeeding, Encourage the child to eat soft, favourite foods. Feeding after illness/Recovery: • Feed extra meal • Give extra amount • Use extra rich foods • Feed with extra patience • Give extra breastfeeds as often as child wants
  • 23. Don’ts in CF • Avoid delay in starting complementary feeding. • Avoid outside, artificial, packaged, and commercial and Junk foods or JUNCS. • Avoid foods with excess of sugar, salt, and trans-fatty acids. • Avoid ultra-processed and refined foods. • Bottle-feeding has only disadvantages; STOP IT.
  • 24. Continue.. • Avoid feeding while watching television or mobile instead involve the baby in conversation. • Do not force to feed. Feeding should not be an unpleasant experience. • Avoid overfeeding. • Avoid foods that may cause choking
  • 25. Key Messages 1. Breastfeeding for two years age helps the child to grow strong and healthy. 2. Children who start complementary feeding at 6 months grow better. 3. Family food with thick consistency that stays on spoon, nourish and fill the child. 4. Animal origin food (milk and milk products for vegetarians) must be included in a child’s diet. 5. Legumes, peas, beans, lentils and nuts are good source of proteins, minerals and vitamins.
  • 26. Continued.. 6. Multicolored fruits and vegetables help children to keep eyes healthy and prevent vitamin deficiency and infections. 7. A growing child needs frequent meals and snacks:give variety of foods 8. A growing child needs increasing amount of food 9. Young child need to learn to eat. Encourage patiently. 10. Encourage the child to eat and drink during illness. Offer food and fluids more frequently

Editor's Notes

  1. Practical guidance on the quality, frequency and amount of food to offer children 6–24 months of age who are breastfed on demand-