Complementary Feeding

1. Complementary Feeding DR. PRADEEP DUBEY , MD(Ped) DCH. CONSULTANT DEV. & NEURO PEDIATRICS AADIGURU NEUROPEDIATRIC CENTRE NEAR PREM MANDIR , WRIGHT TOWN JABALPUR

2. 0-29 % 30-39 % 40-49 % 50 -100 % Children Under 3 years Who are Underweight (NFHS-3, 2005-2006) • Not a change over seven years

3. Ranking by Children U-3 who are underweight (NFHS-3)

4. Percent INDIA 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% Breastfeeding Complementary feeding Clean delivery Hib vaccine Clean water, sanitation, hygiene Zinc Vitamin A Intervention 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 Under-5 deaths preventable through universal coverage with individual preventive interventions

5. 0-59 % 60-79 % 80-94 % 95-100 % Complementary Feeding, 6-9 months(NFHS-3, 2005-2006) • Shown good change in 7 years, national average almost doubled • Reaching Greens is a challenge

6. Ranking by Complementary Feeding (NFHS-3)

7. Optimal Feeding Norms as per National Guidelines on Infant and Young Child Feeding • 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

8. 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.

9. Appropriate Complementary Feeding • 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

10. 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 • 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

11. Age of Introduction Energy Needs Excl. Breastfeeding Comp. feeding & continued BF

12. 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

13. Importance of continued breastfeeding for 2 years and beyond

14. 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: • 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

15. Key Message-1 (Timely) • Complementary feeding should begin soon after completing 6 months of age along with continued breastfeeding

16. Adequacy (Quality) • 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.

17. Other Attributes of Complementary Foods • Right consistency • Soft • Easy to digest • Inexpensive • Locally available • Culturally acceptable • Easily prepared at home

18. Variety of Foods • Start at 6 mo with small amounts of food; increase quantity with age, maintaining frequent breast feeding • Increase food consistency & variety with age • 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

19. Foods to Avoid • 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

20. Stomach size

21. 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

22. 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.

23. Amounts of foods to offer

24. Ensure Adequacy • 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

25. 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.

26. Feeding Techniques • 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

27. Responsive feeding

28. Suitable Feeding Situation

29. Key Message-3 (Properly Fed) • Child should be fed patiently giving adequate attention and time

30. Safe Unhygienic feeding • the risk of infectious illness (esp. diarrhea) compromising nutritional status • Undermines the parents’ confidence leading to delay in CF

31. Ensuring Food Hygiene • 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

32. Key Message-4 (Safety) • Foods should be prepared, stored and fed hygienically to the children.

33. Feeding the child who is ill • 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

34. Feeding during Recovery • Feed an extra meal • Give an extra amount • Use extra rich foods • Feed with extra patience • Give extra breastfeeds as often as child wants

35. Key Message-5 (During Illness) • Continue feeding during illness and increase during convalescence.

36. Key Messages • 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.

37. Thank You