Health Care Issues: Complementary Feeding
Complementary feeding is the term used for giving other foods and drinks in addition to breastfeeding after the completion of the 6 months exclusive breastfeeding period. The food and drink given should “complement” or make complete – the energy and nutrition provided by continued frequent breastfeeding up to two years and beyond. In other words, complementary foods are needed to fill the gap between the total nutritional needs of a child and the amounts provided by breastmilk.
Inadequate nutritional quality, or the baby is given complementary food too early or too late, in too small amounts, or not frequently enough are some common challenges that mothers or caretakers face when introducing complementary food to children 6-24 months old.
The feeding pattern in the first two years of life has tremendous impact on the individual, household and society as a whole. Poor infant feeding patterns often lead to malnutrition. Malnutrition occurring in the first two years of life is virtually irreversible and impairs:
1. Cognitive development
2. Intelligence and school performance
3. Physical strength, and stamina
4. Productivity of a nation
Between 6-24 months children grow rapidly and their energy, vitamin and mineral requirements increase, but their stomachs are still relatively small (30ml/kg body weight – about the size of a cup). Throughout this period, children need highly nutritious foods, which provide a lot of nutrients in a small quantity of food. Below is a guidance chart on the quality, frequency and amount of food to offer children 6-24 months of age who are breastfed on demand:
| Age | Texture | Frequency | Amount at Each Meal | Percentage of Calories From Breastmilk | Approximate Calories From Complementary Foods |
| 0-6 months | – | > 8 times per day | – | 100% | – |
| 6 – 8 months | Start with thick porridge, well mashed foods
Continue with mashed family foods (vegetable, meat, fruit) |
2-3 times per day plus frequent breastfeeds
Depending on the child’s appetite, 1-2 snacks may be offered |
Start with 2-3 tablespoonfuls per feed, increasing gradually to 1/2 of a 250 ml cup | 70% | 200 kcal |
| 9 – 11 months | Finely chopped or mashed foods, and foods that baby can pick-up | 3-4 meals plus breastfeeds
Depending on the child’s appetite, 1-2 snacks may be offered |
1/2 of a 250 ml cup/bowl | 55% | 300 kcal |
| 12 – 23 months | Family foods, chopped or mashed if necessary | 3-4 meals plus 1-2 snacks between meals plus breastfeeds
Depending on the child’s appetite, 1-2 snacks may be offered |
3/4 to full 250 ml cup/bowl | 40% | 550 kcal |
Source: WHO
It takes time for a young child to learn how to use his/her lips to clear food off the spoon, and how to move the new food to the back of the mouth, ready for swallowing. Some food may run down the chin, or be spat out. The health workers should tell the families that this dose not mean that the child dislike the food. With encouragement and patience, a child soon learns how to eat new foods and enjoy new tastes.
The Guiding principles for complementary feeding of the breastfed child, summarised in the box below, set standards for developing locally appropriate feeding recommendations. They provide guidance on desired feeding behaviours as well as on the amount, consistency, frequency, energy density and nutrient content of foods.
Guiding principles for complementary feeding of the breastfed child
1. Practise exclusive breastfeeding from birth to 6 months of age, and introduce complementary foods at 6 months of age (180 days) while continuing to breastfeed.
2. Continue frequent, on-demand breastfeeding until 2 years of age or beyond.
3. Practise responsive feeding, applying the principles of psychosocial care.
4. Practise good hygiene and proper food handling.
5. Start at 6 months of age with small amounts of food and increase the quantity as the child gets older, while maintaining frequent breastfeeding.
6. Gradually increase food consistency and variety as the infant grows older, adapting to the infant’s requirements and abilities.
7. Increase the number of times that the child is fed complementary foods as the child gets older.
8. Feed a variety of nutrient-rich foods to ensure that all nutrient needs are met.
9. Use fortified complementary foods or vitamin-mineral supplements for the infant, as needed
10. Increase fluid intake during illness, including more frequent breastfeeding, and encourage the child to eat soft, favourite foods. After illness, give food more often than usual and encourage the child to eat more.