RND20604
COMMUNITY HEALTH NURSING
COMPLEMENTARY DIET
&
BREASTFEEDING
INTRODUCTION
Well-balanced nutrition will helps prevent disease and
promote health.
Nutrition is essential for the growth and development
throughout our entire lifespan.
The vulnerable & high risk group that requires close
monitoring on the adequacy of their nutrition intake:
‒ children aged 0 – 6 years
‒ Teenagers
‒ Pregnant & lactating mother
‒ Elderly people 2
THE IMPORTANCE OF NUTRITION
Promote and maintain rapid tissue growth among
children especially from 0 to 6 years old.
Provide energy and nutrients to carry out normal
daily activities.
Develop youth stages of sexual maturation (before
menarche in girls and when secondary
characteristics appear in boys).
Sustain good health and prevent illness
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RECAP… SIX CLASSES OF NUTRIENTS
Carbohydrates
Lipids
Proteins
Vitamins
Minerals
Water 4
RECAP … VITAMINS & MINERALS
Folic
acid
Iron Zinc
Vitamin
Vitamins
B12
& Iodine
Minerals
Vitamin Calcium
C
Vitamin
A 5
RECAP … EXCESS AND INADEQUACY
OF NUTRITION
Excess intake may cause obesity that leads to
morbidity due to heart disease, diabetes mellitus,
certain types of cancer, etc.
Inadequate intake causes Protein-Energy
Malnutrition (PEM) such as:
‒Kwashiorkor: characterized by edema and fatty
infiltration of the liver and is associated with a
relative deficit of protein.
‒Marasmus: generalized wasting due to overall
nutritional deprivation. 6
RECAP … EXCESS AND INADEQUACY
OF NUTRITION
Kwashiorkor Marasmus
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RECAP … NUTRITIONAL ASSESSMENT
Clinical
examination
24-Hour
dietary Nutritional Anthropometry
recall assessment measurement
Biochemical
investigation 8
COMPLEMENTARY DIET
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LEARNING OUTCOMES
At the end of the topic, you should be able to:
• define complementary diet;
• explain the management of complementary diet;
• explain the need of breastfeeding;
• explain the recommended food for pregnant and lactation
mother.
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DEFINITION OF COMPLEMENTARY DIET
• Complementary feeding is defined as the process of
giving infant other foods and liquids in addition to
breast milk/formula milk.
• At six months of age, breast milk/formula milk alone is
no longer adequate to meet the infant’s nutritional
requirements. They need additional nutrients for his or
her growth and development.
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DEFINITION OF COMPLEMENTARY DIET
• Introducing complete food to infant teaches he/she
to eat foods other than milk.
• Introduce a variety of flavour to infant.
• Teaches infant to get used to solid food.
• To supplement his/her stores of iron and zinc that
begin to fall and energy needs that are starting to
increase.
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WHEN TO START COMPLEMENTARY DIET?
• Introduce to infants at SIX months of age while continuing
breast feeding on demand until he is TWO years old.
I am
6 months old
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WHEN TO START COMPLEMENTARY DIET?
• Signs indicate that infant is ready for complimentary diet:
‒ Infant can hold his head up steady and can sit or
supported by caregiver.
‒ Infant opens his mouth when mother puts a spoon near
him or sees food coming.
‒ Infant is able to swallow instead of just being able to suck.
‒ Closes his lips over a spoon and scrape food off as a
spoon is removed from his mouth.
‒ He makes “munching” motion when there is nothing in his
mouth.
‒ Infant is getting interested in the surrounding environment.
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CONSEQUENCES IF COMPLEMENTARY DIET
NOT GIVEN AT THE APPROPRIATE AGE
Before 6 months old After six months old
Possibility of infant refusing milk
Delay in adaptation of new food
because of satiety
Causes impairment to infant’s
Delayed growth and
digestive and renal function due
development.
to organ immaturity
Exposed to risk of infection and
Risk of nutritional deficiency
allergy reactions
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WHAT TO FEED THE INFANT?
• Plain rice cereals
• 100 percent fruit juice
• Vegetables and fruits containing carbohydrates, including
fiber, vitamin A and C and minerals.
• Avoid raw vegetables, hard pieces of raw fruit, whole fish or
meat ball, fish or poultry with bone and nuts or beans
• Protein
• Egg yolk: 6 months old
• Whole egg: 1 year old
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HOW TO START FEEDING INFANT WITH
COMPLEMENTARY FOOD?
• Good timing
• Make food smooth and mushy
• No sugar, honey or salt
• Begin with half teaspoon, increase gradually
• Continue breast feeding
• Commence at 6 months old
• Give twice a day for 7–12 months old
• Do not force infant to eat
• Begin with single foods 17
HOW TO START FEEDING INFANT WITH
COMPLEMENTARY FOOD?
• Introduce new food one at a time
• If allergy to food, stop and try after 12 months
• Give fresh food for each feeding
• Start to give cool boiled water from a cup with a
spoon
• Continue breast feeding on demand
• Monitor infant’s weight gain frequently
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RECOMMENDE REGIME
Regime of introducing complete food per day according to age
Food grouping grouping
6-8 months 9-11 months 1-3 years
Cereals, cereal-based 1 ½ cup porridge 2 ½ cup thick porridge 2 cups rice
products & tubers
Vegetable ¼ cup cooked vegetable ½ cup cooked 1 cup cooked
vegetable vegetable
Fruits ¼ slice of papaya OR 1 slice papaya OR 1 slice papaya OR
½ small-sized banana 2 small-sized bananas 2 small-sized
(1 pisang Mas) bananas
Milk & dairy products Breast feeding on demand Breast feeding on Breast feeding on
demand demand OR 3
glasses of milk
Meat, poultry, fish & 2 teaspoon of any type of 2 teaspoon of any type ½ medium sized
legumes meat OR edible portion of of meat OR edible Kembong OR 1
fish (1/4 medium-sized fish) portion of fish (1/4 egg
medium-sized fish) OR
1 egg
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Fats and oils 1 teaspoon of oil 1 ½ teaspoon of oil 1 teaspoon of oil
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EXCLUSIVE
BREASTFEEDING
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EXCLUSIVE BREASTFEEDING
• Is defined as giving only breast milk
to infants, and no other fluids.
• The MOH recommends giving
infants exclusive breastfeeding
from birth to 6 months and continue
to 2 years old.
• The frequency of feeding varies
from 8-12 times, and depends on
the infant’s demands
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DIET FOR PREGNANT &
LACTATING MOTHER
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NUTRITION DURING PREGNANCY &
LACTATION
Nutrition During Pregnancy Nutrition During Lactation
Aim: Aim:
To maintain a healthy fetal To sustain an adequate diet
development To replenish stores that were
To ensure good maternal diminished during pregnancy
health Promote production of milk
To provide adequate and sufficient milk for growth
nutrient requirements and of the infant
ensure appropriate weight To maintain ideal weight
gain during pregnancy
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NUTRITION FOR PREGNANT &
LACTATING MOTHER
• Pregnant and lactating mother require more food
quantities than normal women to apply their own
needs as well as the development of the fetus .
• Prepare food according to Malaysia food pyramid
and emphasis on the following nutrients:
‒ Folic acid
‒ Iron
‒ calcium
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NUTRITION FOR PREGNANT &
LACTATING MOTHER
Folic acid Calcium
Iron 37
FOLIC ACID
• It is important for the growth and
development of the fetus in early
pregnancy.
• It is important for the formation of red
blood cells.
• Source:
‒ Chicken
‒ Egg
‒ Chicken liver
‒ Meat
‒ Green vegetables
‒ Nuts
‒ Brown rice
‒ Barley
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‒ Oat
IRON
• Supports increased blood volume of mother and baby
• Increase blood flow to promote oxygenation for mothers and
babies.
• Source
‒ Meat
‒ Internal organ
‒ Shell sea food
‒ Fish
‒ Green leafy vegetables
‒ Food enriched with iron,
e.g. milk, bread, biscuits
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CALCIUM
• Important for the formation of fetal bones.
• Preventing loss of calcium in mothers.
• Build calcium storage of mothers in preparation for
breastfeeding.
• Source
‒ Milk
‒ Dairy product, e.g. yogurt, cheese
‒ “ikan bilis”
‒ Sardine with bones
‒ Soy products
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‒ Green leafy vegetables
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A healthy mother will deliver 45
a healthy baby
