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ARTIFICIAL FEEDING,
SUPPLEMENTED
BREASTFEEDING, and
COMPLEMENTARY FEEDING
Prof. Dr. Emel Gür
İÜ CTF Çocuk Sağ ve Hast ABD
ARTIFICIAL FEEDING
Artificial Feeding
In this type of feeding, the baby receives
only non-breastmilk
İf the family can afford it, it is
best to substitue breastfeeding with industrial milk
formulae which all have
composition similar to
maternal milk.
If cow’s milk must be used, the
milk must be diluted with water in
proportions of 1:1 in the first
month, 2:1 between 1 and 4
months. No dilution is necessary
after 4 months. To increase calorie
content, 5g. (1 teaspoon) of sugar
is added to each 100g. diluted or
nondiluted milk.
AMOUNT OF MILK PER
MEAL

1-2 week
 3 wk - 2 mo.
 2-3 mo.
 3-4 mo.
 5-12 mo.
60-90 ml
120-150 ml
150- 180 ml
180-210 ml
210-240 ml
The number of feedings per
day

0-1 week
 1 week-1 mo.
 1-3 mo.
 3-7 mo.
 4-9 mo.
 8- 12 mo.
6-10
6- 8
5- 6
4- 5
3- 4
3
Principles of artificial
feeding
Fruit juıces can be started after the first month.
 Artificially fed babies do not need solid foods,
such as milk pudding before 4 months
 It is best to prepare milk formulae fresh at each
feeding
 Adequate preparation of the food, cleanliness
of the water, and the containers and utensils is
essential

Principles of artificial
feeding
Artificially fed babies do not need
solid foods, such as milk pudding
before 4 months
Principles of artificial
feeding

Bottles and nipples must first be washed with
soap and water using a long brush, than
sterilized in boiling water for 10 minutes and
left to cool on upside down position
 For the uneducated mothers, it is best to
recommended spoon feeding, using cups or
glasses even in very young babies.
 The nipple hole must be checked for size by
looking at milk flow
Adequacy of intake is
assessed by weight
monitoring
SUPPLEMENTED BREAST-FEEDİNG
(MIXED FEEDING)
Supplemented BREAST-FEEDİNG
(MIXED FEEDING)
An infant in his first 6 months is offered
breast milk and in addition, other milks
and milk products as supplements.
The main indication for
supplementing breastfeeding is an arrest weight
gain in a healthy breastfed
infant which is not corrected
despite all efforts to
increase the maternal milk
supply.
The decision for
supplementation is taken
only after one or two weeks
of monitoring.
Principles of supplemented
feeding

When the need for supplementation is
established, this is done gradually
 At first, the supplement is given once a day
preferably in the evening (6.00-7.00 pm.), a
time when the mother’s milk supply is usually
the lowest.
 The baby is breast-fed for 5-10 minutes and
the supplement (milk formula and cow’s milk)
is offered by spoon. İf the baby is not satisfied
by one supplementation, two or more meals
may be supplemented.
Principles of supplemented
feeding

Spoon feeding must be preferred to bottle
feeding. This is important for the
continuation of breast-feeding and
prevention of infections.

Fruit juices are started at 4 weeks and
milk pudding at 4 months in babies on
supplemented feedings
COMPLEMENTARY
FEEDING
FEEDING BETWEEN 6-12
MONTHS
Breastfeeding will not meet
the requirements of the
babies over 6 months
After 6 months, breastfeeding is supplemented with
more concentrated foods.
Time of introduction of
supplemental foods
(6 months or earlier) should
be decided by weight
monitoring
Until 9th month breast-milk
is the primary diet of the
baby.
Foods initially supplement
breast-feeding gradually
replace breast-feeding and
at 9-12 months become the
primary diet of the baby
RESULTS OF EARLY AND LATE
INTRODUCTION OF THE SUPPLEMENTAL
FOODS
EARLY
 Decreasing of breastmilk
 Gastroenteritis
 Allergy
 Malnutrition
 Obesity
LATE
 Growth retardation
 Infection
 Gastroenteritis
 Malnutriion
 Vitamin ve mineral
deficiency
REQUIREMENT OF ENERGY ACCORDING TO AGE
Age
<3 mo.
3-6 mo.
6-8 mo.
9-1 mo.
1-3 mo.
4-6 mo.
7-10 mo.
11-14 yr.
15-18 yr.
E
K
E
Energy (kcal/kg/day)
120
115
110
105
100
85
85
60
50
45
Supplementary foods must
be foods of high energy
content, easy to digest, low
in fiber, in puree
consistency, easy to
prepare and free of spices.
Supplementary foods are
best given by cup and
spoon, and introduced one
at a time and in small
amounts (1-2 teaspoons),
and the amount increased
every day
Fruit juice and fruit puree
(apples or peaches) and
milk pudding prepared with
rice flour are the first
supplementary foods to be
started. Vegetable purees,
yoghurt, eggs, meats are
gradually introduces
The nitrat content of
spinach must be given as
soon as prepared. Fava
beans are not
recommended becouse of
favism, eggplants are not
recommended because they
are poor in minerals and
vitamins
Points to remember when
starting supplements

They must be prepared fresh, kept in a cool
place away from insects
 Some babies prefer a salty taste, while others
like sweet taste. The choice of the food must be
done with some flexibility to suit the baby’s
preference
 The baby must not be forced . İf the baby
refuses the food, that particular food is
withheld for a few days
Points to remember when
starting supplements

Water given to babies younger than 12 months
must always be boiled. Water used in the
preparation of supplemental foods must also be
clean
 In preparing the foods, attention must be paid
to measure the right amounts
 (1 teaspoon=5ml; 1 tablespoon =15ml; 1 cup or
1 water glass=200ml; 1 tea glass=100ml)
AMOUNT OF SUPPLEMANTARY
FOODS PER MEAL
Age (month)
6
7
8
9
10
11
12-24
Tablespoon
6
7
8
9
10
11
at least 10
Time of introduction of
supplemental foods


6th-7th months
7th-8th months

Fruit juice and puree
Vegetable purees
Milk pudding
Yoghurt

Meat, chicken, fish
Lentile, chickpea, bean
Egg yolk (It ıs initially is
given hard boiled
and started in small
amount)
Time of introduction of
supplemental foods

8th-9th months

Cereals (rice, wheat,
macaroni, bread )

9th-12th months

Children can be
introduced to the
family table
FEEDİNG BETWEEN 1-5
YEARS
After 9 months, breastfeeding ceases to be the
basic diet of the baby. The
baby should be completely
weaned at 2 years
Children can be trained to
self feed by spoon starting
at age 12 months and can
be introduced to the family
table
The child must have his/her
own separate plate and
must be carefully observed
to note what he/she eats
and how much
Between 1 and 5 years,
children need to have four
meals a day
The diet should include
basic foodstuffs which are;
milk and milk foods, meats
and eggs, fruits and
vegetables, starchy foods
A child of this age must
receive

500g milk daily
 Two servings of either meats
 An egg every day (on alternate days if
eating meats regularly)
 Vegetables once or twice a day
 Fruits once or twice a day
 One or two servings of starchy food and 3
slices of bread
Food requirements are
different in induvidual
children and children must
never be forced to eat
Children should not eat
candies and other sweet
frequently
Tea and coffee are
stimulants which should
not be given to young
children
All children should have their
own tooth-brush starting at
age 18 month
FEEDING AT SCHOOL AGE
FEEDING AT SCHOOL AGE

Breakfast is an important meal
 Usually the reason for this is faulty family eating
habits and neglect of meeting around the
breakfast table regularly
 Parents should abstain from negative comments
on the food at meals
 Serving should not be too large and each member
of the family must try to finish his serving
FEEDING AT SCHOOL AGE

It must be remembered that a child under 5 can eat
only half the amount of an adult, and a 12 year old
boy only 2/3 the amount of the teenager
 The child is encouraged to finish his plate by
educating him about changing food requirements
by age, sex, size and physical activity
 School age children also need to have a balanced
diet including the basic foods