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Complementary
Feeding
DR. PRADEEP DUBEY ,
MD(Ped) DCH.
CONSULTANT DEV. &
NEURO PEDIATRICS
AADIGURU NEUROPEDIATRIC
CENTRE
NEAR PREM MANDIR , WRIGHT
TOWN JABALPUR
Children Under 3 years Who are
Underweight (NFHS-3, 2005-2006)

Not a change over
seven years
0-29 %
30-39 %
40-49 %
50 -100 %
Ranking by Children U-3 who are
underweight (NFHS-3)
Rank
States
% of Underweight
1
Madhya Pradesh
60.3
5
Gujarat
47.4
6
Uttar Pradesh
47.3
12
Karnataka
41.1
21
Delhi
33.1
26
Punjab
27.0
INDIA
45.9
Under-5 deaths preventable through universal
coverage with individual preventive
interventions
Percent
0% 2% 4% 6% 8% 10% 12% 14% 16% 18%
INDIA
Breastfeeding
Complementary feeding
Clean delivery
Hib vaccine
Clean water, sanitation, hygiene
Intervention
Zinc
Vitamin A
Antenatal steroids
Newborn temperature management
Tetanus toxoid
Antibiotics for PRM
Measles vaccine
Nivirapine and replacement feeding
Insecticide-treated materials
Antimalarial IPT in pregnancy
Source: Jones et al. LANCET 2003;362:65-71
Complementary Feeding, 6-9 months
(NFHS-3, 2005-2006)


Shown good change
in 7 years, national
average almost
doubled
Reaching Greens is a
challenge
0-59 %
60-79 %
80-94 %
95-100 %
Ranking by Complementary
Feeding (NFHS-3)
Rank
States
Complementary
Feeding
1
Kerala
93.6
2
Sikkim
89.6
11
Himachal
66.0
15
Delhi
59.8
25
Punjab
50.0
27
Uttar Pradesh
45.5
INDIA
55.8
Optimal Feeding Norms as per
National Guidelines on Infant and
Young Child Feeding

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Starting breastfeeding
within one hour of birth
Exclusive breastfeeding
for the first six months
Introducing appropriate
and adequate
complementary feeding
after 6 months along with
Continued breastfeeding
for two years or beyond
Definition of Complementary
feeding


The process of giving an
infant other foods and
liquids along with breast
milk or non-human milk
as breast milk alone is no
longer sufficient to meet
the nutritional
requirements.
These foods should
complement rather than
replace breastmilk.
Appropriate Complementary
Feeding

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Timely: Introduced when need for energy
and nutrients exceeds that provided by BF
Adequate: Should provide sufficient
energy, protein, and micronutrients
Properly Fed: Active feeding method and
proper frequency according for age
Safe: Should be hygienically prepared,
stored and fed
Timing of Complementary
Feeding
Soon after completing 6 months of age
 Breast milk sufficient to promote growth and
development till 6 months
 Energy and nutrient gap appears after 6 months
and widens thereafter
 Infant’s development and behavior makes him
ready for other foods

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Holds objects (e.g. biscuit) and takes everything to
mouth
Chewing movements start
Tendency to push solids out decreases
Eruption of teeth and beginning of biting movements
Age of Introduction
Energy Needs
1200
1000
800
746
600
0
269
3-6 mo
6-9 mo
0
451
Energy from
breastmilk
400
200
0
0-3 mo
Excl. Breastfeeding
9-12 mo
Energy Gap
12-24 mo
Comp. feeding & continued BF
Timing of Complementary
Feeding
Disadvantages of adding foods too soon
 Decrease the intake of breast milk resulting in a
low nutrient diet
 Increase risk of illness esp. diarrhea
Disadvantages of adding foods too late
 Growth and development slows down or stops
 Risk of deficiencies and malnutrition
Importance of continued breastfeeding
for 2 years and beyond
120
100
2
24
% daily needs
provided by
500ml breast
milk
80
45
63
60
95
98
40
20
76
55
37
5
0
Energy
Protein
Vit. A
Vit. C
Iron
Gaps to be filled by complementary foods
Energy and Nutrients from breastmilk
Why Continue Breastfeeding?


Vital source of energy (30-40%) and nutrients
into 2nd yr of life
Key source of


Good quality proteins & essential fatty acids
Micronutrients:

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45% of Vitamin A
40% of calcium & riboflavin
95% of Vitamin C
Fluids and nutrients during infection
Associated with greater linear growth
Linked to lower risk of chronic diseases &
obesity
Key Message-1 (Timely)

Complementary feeding should begin
soon after completing 6 months of age
along with continued breastfeeding
Adequacy (Quality)

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Staples: Cereals (Rice, wheat, maize, millets)
and Legumes
Fats (Vegetable oils/butter/ghee; 1g ~ 9 Kcal)
and sugars to improve energy density and taste
Foods of animal origin (Milk, curd, eggs, meat,
fish) to provide good quality proteins, vitamin A
and calcium.
Vegetables and Fruits to provide micronutrents
e.g. iron and vitamins. Supplements e.g. iron
might be required.
Other Attributes of
Complementary Foods
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Right consistency
Soft
Easy to digest
Inexpensive
Locally available
Culturally acceptable
Easily prepared at
home
Variety of Foods
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Start at 6 mo with small amounts of food;
increase quantity with age, maintaining frequent
breast feeding
Increase food consistency & variety with age

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Can feed mashed & semi-solids (e.g. porridge) at 6
mo;
Can feed finger foods by 8-9 mo
By 12 mo, family foods can be eaten
Combine foods (e.g. rice and legumes) to
provide good mixture of amino acids
Foods to Avoid

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Tea & coffee: interfere with iron
absorption
Aerated beverages: No nutritional value
Too much sugary drinks & Fruit juices:
cause decreased appetite for other
nutritious foods and also may cause loose
stools.
Nuts: may cause choking
Stomach size
Adequacy (Frequency and Amount)
6-12 months
Give at least one katori (150-200 mL) serving* at a time
of
 Khichdi or dalia or sooji (semolina) with added oil/ghee
 Mashed roti/rice/bread mixed in thick dal or sweeetened
undiluted milk
 Add cooked/pureed vegetables or meat also in the
servings
 Sevian/dalia/halwa/kheer/biscuits prepared in milk or
any cereal porridge cooked in milk
 Mashed boiled/fried potatoes
 Mashed banana/cheeko/ mango/ papaya
*3 times per day if breastfed;
5 times per day if not breastfed
Frequency and Amount (1-2 yrs)
Offer food from the family pot
Give at least 1½ katori (250 mL) serving* at a time of:
 Mashed roti/rice/bread mixed in thick dal with added
ghee/oil or khichri with added oil/ghee.
 Add cooked vegetables/meat also in the servings
 Mashed roti/ rice /bread/biscuit mixed in sweetened
undiluted milk
 Egg preparations/ soft meat pieces without bones
 - Sevian/dalia/halwa/kheer prepared in milk or any
cereal porridge cooked in milk OR
 Fruits (banana/cheeko/apple/orange/mango/papaya)
* 5 times per day.
Amounts of foods to offer
Age
Texture
Frequency
Amount of each
meal
6 months
Soft porridge, well
mashed vegetable, meat
fruit
2 times per day plus
frequent breastfeeds
2-3 tablespoonfuls
7-8 months
Mashed foods
3 times per day plus
frequent breastfeeds
Increasing gradually
to more than 3/4 of
katori (150ml)
9-11 months
Finely chopped or
3 meals plus 1 snack
mashed foods, and foods between meals plus
that baby can pick up
breastfeeds
a full katori (200ml)
12-24 months
Family foods, chopped
or mashed if necessary
more than katori
(250ml)
3 meals plus 2
snacks between
meals plus
breastfeeds
Ensure Adequacy
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Growth Monitoring:
Measure weight and
length periodically and
interpret by plotting in
growth curves.
Investigate causes of
poor growth: Dietary
history; evaluate for any
illness.
Counsel
mother/caregivers on
growth, feeding and
caring practices
Key Message-2 (Adequacy)

Complementary foods should be of right
consistency, energy dense and the variety
to provide all nutrient demands of a
growing child.
Feeding Techniques
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Feed infants directly & assist older
toddlers eat; be sensitive to hunger &
satiety cues
Feed patiently; encourage, but don’t force
If child refuses, experiment with different
food combinations, tastes, textures
Minimize distractions during meals
Talk to child during feeding; maintain eye
contact
Responsive feeding
Suitable Feeding Situation
Key Message-3 (Properly Fed)

Child should be fed patiently giving
adequate attention and time
Safe
Unhygienic feeding
 the risk of infectious illness (esp.
diarrhea) compromising nutritional status
 Undermines the parents’ confidence
leading to delay in CF
Ensuring Food Hygiene
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Washing caregiver’s and child’s hands before
preparing, handling and eating food
Clean water and raw materials to cook food
Storing foods safely: Keeping food covered and
serving shortly after preparation
Use clean utensils to prepare & serve food
Use clean bowls & cups when feeding child
No feeding bottles
Key Message-4 (Safety)

Foods should be prepared, stored and fed
hygienically to the children.
Feeding the child who is ill
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Encourage the child to drink and to 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
Feeding during Recovery
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Feed an extra meal
Give an extra amount
Use extra rich foods
Feed with extra patience
Give extra breastfeeds as often as child
wants
Key Message-5 (During Illness)

Continue feeding during illness and
increase during convalescence.
Key Messages
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Complementary feeding should begin soon after
completing 6 months of age along with continued
breastfeeding
Complementary foods should be of right consistency,
energy dense and the variety to provide all nutrient
demands of a growing child.
Child should be fed patiently giving adequate attention
and time
Foods should be prepared, stored and fed
hygienically to the children.
Continue feeding during illness and increase during
convalescence.
Thank You