Complementary feeding

• Giving other foods in addition to breast milk.

• These other foods and drinks are called
complementary foods as they are additional
or complementary to breastfeeding rather
than adequate on their on as a diet.
• Complementary foods must be nutritious and
in adequate amounts so that the child can
continue to grow.
• From 6-12 months, breastfeeding continues to
provide half or more of the child’s nutritional
needs
• From 12-24 months, at least 1/3 of their
nutritional needs
• As well as nutrition breastfeeding continues to
provide protection from many illnesses for the
child and provides closeness and contact that
helps psychological development.
• From about 6 months onwards there is a gap
between the total energy needs and the energy
provided by breast milk.
• The gap increases as the child gets bigger.
• Therefore for most babies, six months is a good
time to start complimentary foods.
• At 6 completed months of age it becomes easier
to feed thick porridge, puree and mashed food
because babies:
• Show interest in other people eating and reach for food
• Like to put things in their mouth
• Can control their tongue better to move food around their
mouth.
• Start to make up and down ‘munching’ movements with their
jaws.
• Digestive systems are mature enough to begin to digest a
range of foods
• If baby is not being breast fed, continue using adequate
replacement milk feeding until 6 months of age rather than
add complementary foods early.
 Consequences of
Starting complementary food early Starting complementary food late
Takes the place of milk. Nutritional The child does not receive the extra food
requirements cannot be met required to meet his/her growing needs

If thin watery soups and porridges are The child grows and develops slower
prepared, results in diet low in nutrients

Increase risk of illness because less of Might not receive the nutrients to avoid
protective factors in breast milk are malnutrition and deficiencies such as
consumed. anemia from lack of iron.

Increase the risk of diarrhea, because

complementary foods may not be as clean
and easy to digest as breast milk

Increase the risky of wheezing and other

allergic conditions because the baby
cannot digest and absorb non-human
proteins well

Increase the mother’s risk of another

pregnancy if breastfeeding is less frequent
 Foods that feel the energy gap
• Staples provide much of the energy needed.
• Staples also provide proteins and other
nutrients but cannot provide all the nutrients
needed on their own.
• Foods of thick consistency help fill the energy
gap.
 Ways to enrich a child’s food.
• Prepare with less water and make a thicker
porridge.
• Use roasted flour as it does not thicken so much
so less water is needed to make porridge.
• Mash solid pieces of beans, pumpkin leaves and
meat to a thick puree and feed to a child.
• Enrich porridge, soup or stew with fresh/sour
milk.
• Add a spoonful of milk powder after cooking
• Mix legume flour with mealie meal before
cooking
• Stir in nut paste (peanut butter or pumpkin
seed paste.
• Add a spoonful of margarine, butter, red palm
oil.
 Oils and fats
• A little oil or fat, such as 1 ½ teaspoon to a
child's bowl of food gives extra energy, makes
thicker porridge and other staple softer and
easier to eat.
• Too much fat added a child may get the energy
from the oil but less of other nutrients because
they eat less food overall.
• Avoid too much oil like from fried foods to avoid
a child getting overweight.
• Sugar and honey added in small quantities
increase the energy concentration but do not
contain any other nutrients.
• Avoid sugary foods (sweets, sweet biscuits and
sugary drinks
• Essential fatty acids are needed for a child’s
growing brain and eyes, and for healthy blood
vessels. These essential fatty acids are present
in breast milk.
• For children over six months who are not
breastfed good sources of EFAs are;
- Fish, avocado, nut pastes and vegetable oil.
Animal source foods also provide EFAs.
 Fermented porridge or germination of grain
for flour
• Fermented porridge:
- grain can be mixed with water and set to ferment
overnight before cooking.
- The ground grain and water is cooked into porridge
and then fermented.
- Sometimes a portion of previous batch of fermented
porridge is added (starter) to speed up the
fermentation process.
- Porridge made from germinated ground grain can also
be fermented.
• Advantages of using fermented porridge
- It is less thick than plain porridge so more grain/flour can
be used for the same amount of water.
- This means each cupful of porridge contains more energy
and nutrients than plain (unfermented porridge)
- Children may prefer the test of sour porridge so eat more.
- The absorption of iron and some other minerals is better
from the soured porridge.
- It is more difficult for harmful bacteria to grow in soured
porridge. Can be kept for a day or two.
• Germinated or sprouted flour
- This type of flour does not thicken much during cooking so
less water can be added.
- Add a pinch of germinated flour to cooked thick porridge
that has cooled a little bit. The porridge should be boiled
again for a few minutes after adding the germinated flour in
order to kill off any micro-organisms that may be in the
germinated cereal flour.
- The addition of germinated cereal flour makes the porridge
softer and easier for the child to eat.
- Germination helps more iron to be absorbed.
 Foods to fill Iron and Vitamin A gaps
• The young child needs iron to make new blood, to assist in
growth and development and to help the body fight infections.
• The young child grows faster in the first year than in the
second year. This is why the need for iron is higher when the
child is younger.
• Child’s iron stores are used up over this first six months, so
after that time we see a gap between the child’s needs and
they receive from breast milk. This gap need to be filled by
complementary foods.
• Zinc is another nutrient that helps children to grow and stay
healthy. It is usually found in the same foods as iron.
Importance of animal source foods
• Meat and organs of animals, birds and fish
(including kapenta) as well as foods prepared with
blood, are best sources of iron and zinc. Liver is
not only a good source of iron but also vitamin A.
• Foods from animals such as milk and eggs are
good for children because they are high in protein
and other nutrients. However milk and milk
products such as cheese and yoghurt are not good
sources of iron.
• Milk fat (cream) contains vitamin A so foods made from
whole milk are good sources of vitamin A.
• Foods made from milk (whole milk or skimmed or
powdered) and any food containing bones, such as egg yolk
is another store of nutrients and a rich source of vitamin A.
• Some children may need supplements if they do not eat
enough iron containing foods or if they have particularly
high needs for iron.
• In Zambia vitamin A supplementation programs are
conducted at children’s clinics during CHW.
 Importance of legumes, pulses
• Groundnuts, beans, cowpeas, and peas as well
as other nuts and seeds are good sources of
protein.
• Legumes are a source of iron as well.
• Ways of preparing for children
- Roast nuts and seeds and pound to paste
- Add beans/lentils to soups or stews
- Mash cooked beans as well
• Eating a variety of foods at the same meal can
improve the way the body uses the nutrients.
• For example combining cereal with legume
(e.g. nshima and beans), or adding a milk
product or egg to the legume (e.g. maize meal
with milk).
 Iron Absorption
• Depends on
- Amount of iron in the food
- Type of iron (iron from the meat is better
absorbed than iron from plants and eggs)
- Types of other foods present in the same meal
(some increase iron absorption and others
reduce absorption)
- Whether the child has anemia (more iron is
absorbed if anemic).
 Eating foods together to increase iron
absorption
• Foods rich in vitamin C such as tomato,
broccoli, guava, mango, pineapple, pawpaw,
orange, lemon and other citrus fruits
• Small amounts of meat or offal of animals,
birds, fish, and other sea foods.
 Absorption is decreased by
• Drinking teas and coffee
• Foods high in fiber such as bran
• Foods rich in calcium
 Foods that can fill the vitamin A gap
• Vitamin A is needed for healthy eyes and skin
and to help the body fight infections.
• Breast milk supplies a large part of the vitamin
needed provided the child continues to receive
breast milk and the mother's diet is not
deficient in vitamin A.
• As the young child grows, there is a gap for
vitamin A that needs to be filled by
complementary foods.
 Good food to fill this gap
• Dark green leafy vegetables such as
- Pumpkin leaves
- Amaranthus
- Rape
- Spinach
- Sweet potato and yellow coloured vegetables
and fruits such as carrots, pumpkins, yellow
sweet potatoes, pawpaw, mangoes
- Liver
- Milk and milk products
- Egg yolks
- Margarine, dried milk powder and other foods
fortified with vitamin A
- Unbleached red palm oil (Chinkondya)
 Fortified Complementary Foods
• A staple with some vegetables, fruit or animal
source foods.
• Added iron and vitamins can be useful,
particularly if there are few other iron containing
foods in the diet.
• Sugar or oil if added are a useful source of
energy, if the child’s diet is low in energy.
• Limit use of foods that are high in sugar and
oil/fat but with few other nutrients.
• Complementary foods should not be marketed
or used in ways that undermine breastfeeding.
To do so is a violation of International Code of
Marketing of Breast-milk substitutes and
subsequent resolutions and should be
reported to the company concerned and the
appropriate government authority.
 Fluid Needs of Young Children
• The baby who is exclusively breastfeeding
receives all the liquid he needs in breast milk.
• When other foods are added to the diet, the
baby may need extra fluids
• A baby who is under six months of age and only
receiving replacement milks does not need extra
water.
• Extra fluid is needed when the child has fever or
diarrhea.
• Water is good for thirst.
• A variety of pure fruit juices can be used also.
• Too much fruit juice can cause diarrhea and
may reduce the child’s appetite for foods.
• Drinks that contain a lot of sugar may actually
make the child thirstier as their body has to
deal with extra sugar
• Fizzy drinks are not suitable for young children
• Teas and coffee reduce the iron that is absorbed from foods
• They should not be given at the same time as food or within
two hours before or after food.
• Sometimes a child is thirsty during a meal. A small drink will
satisfy the thirst and they may then eat more of their meal.
• Drinks should not replace food or breastfeed.
• If a drink is given with a meal, give only small amounts and
leave most until the end of the meal.
• Drinks can fill up the child’s stomach so that they do not
have room for foods.
• Children who are not receiving breast milk need
special attention and special recommendations.
• A non-breastfed child aged 6-24 months of age
needs approximately 4-6 cups of water per day
in hot climate.
• This water can be incorporated into porridges or
stews, but clean water should also be offered to
the child several times a day to ensure that the
infant’s thirst is satisfied.
 Quantity, Variety and Frequency of Feeding

• Young children should eat a mix of complementary

foods
• The gaps for iron and energy may be the hardest to fill.
• Animal source foods are special for children.
• If foods fortified with iron are available, these should
be used to help fill the iron gap.
• Micronutrient supplementation can also be
recommended where necessary to ensure sufficient
iron and other micronutrients.
• Give more energy foods.
• Give some extra foods(snacks) between meals
that are easy to prepare (not sweets, crisps,
jiggies.
• Good snacks provide both energy and nutrients.
• Sour milk and other milk products
• Bread or biscuits spread with butter, margarine,
nut paste or honey, fruit, bean cakes, cooked
potatoes.
• Families should try each day to give a dark-
green vegetable such as pumpkin leaves,
amaranthus, rape, spinach and sweet potato
or yellow-coloured fruit or vegetable such as
carrots, pumpkins, yellow sweet potatoes,
pawpaw and mangoes and animal-source food
in addition to the staple food.
Recommendations for feeding non-breastfed
child
• Should receive:
- Extra water each day (2-3 cups in temperate
climate and 4-6 cups in hot climate
- Essential Fatty Acids (animal-source foods, fish,
avocado, vegetable oil, nut pastes)
- Adequate iron (animal source foods, fortified foods
or supplements)
- Milk (1-2 cups per day)
- Extra meal (1-2 meals per day)
Amount of complementary food offered
Age Texture Frequency Amount of
Food an
average child
will usually eat
at each meal
6-8 Start with thick 2-3 meals per day plus frequent Start with 2-3
months porridge, well breastfeeds tablespoonfuls
mashed family Depending on the child’s appetite 1- per feed
foods 2 snacks may be offered increasing
gradually to ½
of a 250ml cup
9-11 Finely chopped or 3-4 meals plus breastfeeds ½ of a 250ml
months mashed foods, and Depending on the child’s appetite 1- cup/bowl
foods that baby 2 snacks may be offered
can pick up
Age Texture Frequency Amount of food an
average child will
usually eat at each
meal
12-24 months Family foods, 3-4 meals plus ¾ to 1 of a 250 ml
chopped or mashed breastfeeds cup/bowl
if necessary Depending on
child’s appetite 1-2
snacks may be
offered

If a baby is not breastfed, give in addition: 1-2 cups of milk per day, and 1-2 extra
meals per day
• As the child gets older, the amount of food
offered increases. Give as much as the child
will eat.
 Feeding techniques
• Feeding care practices and their effect on intake.
• Care refers to the behaviors and practices of the
caregivers and family that provide the food,
health care, stimulation and emotional support
necessary for the child’s healthy growth and
development.
• An important time to use good care practices is at
meal times- when helping young children to eat.
 Responsive feeding practices
• Assist children to eat, being sensitive to their
cues or signals.
• Feed slowly and patiently, encourage but do
not force
• Talk to the children during feeding with eye-
to-eye contact
 Assist children to eat, being sensitive to their cues or
signals.

• A child needs to learn how to eat, to try new

food tastes and textures.
• A child needs to learn to chew, move food
around the mouth and to swallow food.
• The child needs to learn how to get food
effectively into the mouth, how to use a spoon
and how to drink from a cup.
 Families tend to feed their young children in one of the three
different ways

• High control of feeding by the caregiver who

decides when and how much the child eats. This
may include force feeding.
• Children are left to feed themselves. The
caregiver believes that the child will eat if hungry.
The caregiver may also believe when the child
stops eating that they have had enough to eat.
• Feeding in response to the child’s cues or signals
using encouragement and praise.
Feed slowly and patiently, encourage but do not force

• Respond positively to the child with smiles,

eye contact and encouraging words
• Feed the child slowly and patiently with good
humor
• Try different food combinations, tastes and
textures to encourage eating
• Wait when the child stops eating and then
offer again
• Give finger foods that the child can feed
him/herself
• Minimize distractions if the child loses interest
easily
• Stay with the child through the meal and be
attentive.
Talk to the children during feeding with eye-to-eye contact

• Feeding times are periods of learning and love.

• Children may eat better if feeding times are
happy.
• Feed when the child is alert and happy
• If the child is sleepy or over-hungry and upset, he
may not eat well.
• Regular meal times and the focus on eating
without distractions, may also help a child learn
to eat.
Feeding During Illness and Low-Birth-Weight
Babies
• Why children need to continue to eat during illness
- During infections, the child needs more energy and
nutrients to fight the infection.
- If they do not get extra food, their fat muscle tissue is
used as fuel.
- This is why they lose weight, look thin and stop
growing.
- The goal in feeding a child during and after illness is to
have him return to the growth he had before illness.
 Appropriate feeding during illness
• Sick children often need extra drinks and food
during illness-for example if they have fever or
diarrhea.
• A sick child may prefer breastfeeding to eating
other foods
• Do not withhold food from a sick child.
 Feeding the child who is ill
• Encourage the child to drink and 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 – often ill children
breastfeed more frequently
 Feeding during recovery
• A child’s appetite may be poor during illness.
• Even with encouragement to eat, the child may not eat well.
• The child’s appetite usually increases after the illness so it is
important to continue to give extra attention to feeding after
the illness.
• This is a good time for families to give extra food so that lost
weight is quickly regained.
• This allows catch up growth.
• Young children need extra food until they have regained all
their lost weight and are growing at a healthy rate.
• Give extra breastfeeds
• Feed an extra meal
• Give an extra amount
• Use extra rich foods
• Feed with extra patience
 Key messages
• Breastfeeding for two years or longer helps a child to develop and
grow strong and healthy.
• Starting other foods in addition to breast milk at 6 completed
months helps a child grow well.
• Foods that are thick enough to stay in the spoon give more
energy to the child.
• Animal-source foods are especially good for children, to help
them grow strong and healthy.
• Peas, beans, lentils and nuts and seeds are also good for children.
• Dark green leaves and yellow-coloured fruits and vegetables help
a child to have healthy eyes and fewer infections.
 Key messages
• A growing child needs 3 meals plus snacks per
day; give a variety of foods.
• A growing child needs increasing amounts of
food.
• A young child needs to learn to eat; encourage
and give help with lots of patience.
• Encourage the child to drink and to eat during
illness and provide extra food after illness to help
a child recover quickly.