INTRODUCTION: Breastfeeding alone is adequate and sufficient to maintain optimum growth and

development of an infant up to the age of 6 months. It is therefore, necessary to introduce more

concentrated energy rich nutritional supplements by this age. The breast milk in reasonable quantities alone
cannot meet all the energy and protein requirement for maintaining an adequate velocity of growth for the
infant after the age of 4-6 months. Full term, healthy infants attain developmental readiness to begin
complementary foods between 4 and 6 months old. By this age, infants begin to express their desire for
food by drooling opening their mouths, and leaning forward. Infants also required iron containing food
supplements after this age to prevent iron deficiency anaemia.

DEFINITION: Weaning or complementary feeding is the process of giving an infant other foods and
liquids along with breast milk after the age of 6 months as breast milk alone is no longer sufficient to meet
the nutritional requirements of growing baby. The word “wean” means “accustom”. Therefore it is the
process by which the infant gradually accustomed to adult diet.

QUALITIES OF COMPLEMENTARY FOODS: The weaning foods should be:

 Consistency: Liquid at starting then semisolid and solid foods to be introduced gradually. Food
should be soft by adding fats and oil. The consistency of gruel becomes solid when cool and
difficult to eat by infant. When oil is added to the gruel it remains soft, even after getting cold.
 Well-balanced, nourishing and suitable for the infant : High in energy density and low in bulk
viscosity and contains all nutrients necessary for the baby. There are basic mix with two ingredients,
for example, cereal mixed with a legume or multimix with four ingredients such as a staple, a
protein supplement, an energy supplement and a vitamin and mineral supplement. When these four
ingredients are used together in desirable proportions they form a complete meal. A diet prepared as
a mixture of a staple (carbohydrate), and a legume with an animal proteins (protein) and a dark
green leafy vegetable (vitamins and minerals) with added oils (fat) will be nutritionally well
balanced and energy dense. The adding of oil and sugar are the best way to make the weaning food
energy dense and less bulky.
 Clean and safe : Food should be clean, fresh and hygienic. The hands should be clean. Freshly
prepared food should be server and leftover should be discarded. so that no infections can occur.
 Easy to prepare at home with the available food items and not costly.
 Easily digestible, easily acceptable and palatable for the infants.
 High in energy density and low in bulk viscosity and contains all nutrients necessary for the baby.
 Food should be based on cultural practices and traditional beliefs.

STAGES OF WEANING:

 Stage 1(6-7month): This lasts for one month starting from 6 months. At this stage, a small amount
of food, such as cereal gruel, followed by a basic mix, is introduced and the food is given after the
breastfeeding.
 Stage 2(7-9 months): In this stage, the weaning foods are offered gradually in increasing quantity,
switching to the multimix along with the breastfeeding. The aims is to accustom the child to the
family foods by the first birth/day.
 Stage 3(9-12month): There is decreasing amount of breast milk from partial to token breastfeeding
with increasing amount of family foods, ultimately to a meal to complete weaning.
PRINCIPLES OF INTRODUCTION OF WEANING FOODS: During introduction of weaning foods
following principles-

 Milk is the main food of infant, so additional feeds should provide extra requirements as per needs
of the baby that must be obtained from good quality food items and should be homemade.
 A small amount of new foods to be given in the beginning and gradually the amount of food to be
increased during the course of a week.
 New food to be placed over the tongue of the baby to get the taste of the food and to feel the
consistency. The baby may spit the food out, but with patience the feed to be given again to get
accustomed with it. A single weaning food is added at a time.
 Additional food can be given in the day time. Initially it can be given once, then twice or thrice.
 There should not be any strict rule for serving new foods, it may be modified. But the foods to be
given regularly.
 New foods should be given when the infant is hungry, but never force the child to take the feeds.
 Observe the problems related to weaning process. The infant may have indigestion, pain in
abdomen, weaning diarrhoea, skin rash, especially in case of food allergy and psychological upset
of the baby due to withdrawn from breast milk and sucking. The problems should be managed
carefully.
 Weaning should be started at 6 months of age to all children but breastfeeding to be continued up to
2 years of age or beyond.
 Delayed weaning result in malnutrition and growth failure.

DEVELOPMENTAL CHANGES INDICATING INFANT'S READINESS TOLERATE

COMPLEMENTARY FOODS:

 The infant's intestinal tract develops immunologically with defence mechanisms to protect the infant
from foreign proteins.
 Ability to digest and absorb proteins, fats, and carbohydrate, other than those in breast milk and
formula, increases rapidly.
 Kidneys acquire the ability to excrete the waste products from foods with a high renal solute load.
 Infant develops the neuromuscular mechanisms responsible for recognizing and accepting a spoon.
masticating, swallowing non liquid foods, and appreciating various taste and color of foods.
 Weaning before 4 months is called early and after 9 months is called late weaning. Early weaning is
associated with reduction of breastfeeding, diarrhoea, increased morbidity and mortality. The late
weaning put the child at risk of developing malnutrition, anaemia and poor growth.

TYPES OF COMPLEMENTARY FOOD :

i) Stage 1

 Breast milk 600 mL/day.

 Starchy food--cereal such as rice, wheat.
 Mashed, pureed and starchy vegetable like potato, carrot.
 Fruit juice not before 6 months and should be freshly prepared or 100% fruit juice.
  Soft cooked and pureed vegetables and fruits -apple, banana, mango, chikoo.
 Nonfibrous vegetables like cauliflower, pureed spinach.
 Food should not be sweetened and salted.

ii) Stage II

 Gradually increase the amount and frequency.

 Continue breastfeeding.
 Starchy foods 2-3 servings: Wheat-based cereal khichri, sooji-halwa porridge, raggi mixed with
milk.
 Vegetable 2 servings: Soft cooked carrot, green beans, stewed apple, spinach or tomato soup.
 Egg yolk/cheese: 1 serving.
 Try crackers, bread, noodles, macaroni, and other grain products like plain ground or mashed rice or
barley, noodles, plain enriched or whole grain crackers, preferably low in salt, small pieces of toast
or crust of bread.

iii) Stage III

 Continue breastfeeding.
 Starchy foods: 3-4 servings.
 Vegetable and fruits: 3-4 servings, raw or chopped finger food.
 Fish and minced meat: 1 serving.
 Sample menu for complementary feeding.
 Breakfast: Raggi/rice khir, suji halwa, stewed apple with curd, boiled egg and bread finger.
 Lunch: Khichri, mixed vegetable soup, rice with curd.
 Dinner: Same as lunch.

Frequency of Complementary Feeds :

Initially give 1-2 times a day in small amount and gradually increase 3-4 times daily along with
breastfeeding. After one year, food should be given 4-5 times daily with night time breastfeeding.

PROBLEMS DURING WEANING : Several problems may be encountered during weaning, which are
as follows-

i) If on starting weaning, breast feeding is stopped suddenly, it can have adverse psychological effect on
the child.

ii) Weaning food, if prepared unhygienically or not digested property can cause diarrhoea.

iii) If weaning foods are not nutrient rich, the child can develop malnutrition.

iv) Children may develop indigestion, abdominal pain, diarrhoea or rashes if they are allergic to certain
foods.
POINTS TO BE REMEMBER:

 Learning to eat can be a very messy and slow process.

 Baby will learn how to eat by touching food and carrying it to his mouth.
 Parents should eat with the child but in separate plate to develop good eating habits in the child.
 Many babies will reject a new food not because he doesn't like it but rather because it's a new taste.
Offer a new food multiple times before giving up on it.
 To begin with, solids should supplement baby's milk diet not replace it. Initially offer solids after a
milk feed, or between feeds. Once he's eating solids three times a day and is eating a good

CONCLUSION: This helps infants to develop self-feeding and social skills and promotes good
eating habits from an early age. Seeing the family enjoying a variety of foods will encourage
infants to try new foods and mean they are less likely to be fussy eaters as they get older.Mothers
need to be educated about the importance of weaning, the recommended age of weaning and
about the types of weaning food. This can be achieved by using lady health workers and lady
health visitors and the mass media. Importance of continued breast feeding with weaning diet
should be emphasized upon.
BIBLIOGRAPHY:

1. Pal P., Textbook of Pediatric Nursing for Nursing Students,2nd edition 2021, Delhi , CBS Publishers &
Distributers Pvt Ltd, pg no-106-108

2.Dutta P. , Pediatric Nursing, 3rd Edition 2014, New Deldi, Jaypee Brohers Medical Publisher(P) Ltd. Pg
no.56-57

3. Sharma R, Essentials of Pediatric Nursing ,#rd edition 2021, New Delhi, Jaypee Brothers Medical
Publishers(p)Ltd. Pg no.117-120