Complementary Feeding

Mwangi K Wangari
Nassir Diin
 Objectives

 Definition of Complementary Feeding

 Factors to Consider when Introducing Complementary Foods (WHO)
 Feeding an Infant 6-8 months
 Feeding of an Infant 12-24 months
 Feeding a Child more than 24 Months
 Definition

 The addition of other foods for infants between 6 and 18-24 months who have
otherwise been feeding exclusively on breast milk.
 The justification for the addition of other foods, which are often referred to
as complementary feeds, is that breast milk is no longer sufficient to meet an
infant’s nutritional and fluid needs.
Appropriate complimentary feeding
practices
 Timely

 Adequate

 Safe

 Properly fed
Timely Feeding

Complementary feeds should be timely which means that they should a child
should be given alternative foods in addition to breast milk from 6 months of age
onwards

 jhhttp://www.who.int/nutrition/topics/complementary_feeding/en/
Adequate Feeding

 The amounts of food given and their caloric value should be sufficient for the
chronological needs of the child.
Safe Feeding

 Measures should be taken to reduce the risk of contamination of complementary feeds

for children
 washing caregivers’ and children’s hands before food preparation and eating;
 storing foods safely and serving foods immediately after preparation;
 using clean utensils to prepare and serve food;
 using clean cups and bowls when feeding children;
 avoiding the use of feeding bottles, which are difficult to keep clean

 http://www.who.int/nutrition/topics/complementary_feeding/en/
Properly Fed

 Food given should be in accordance to the child’s signals for appetite and
satiety with a meal frequency and feeding method suitable for age.
 Factors to Consider when Introducing
Complementary Foods (WHO Recommendations)

1. The energy needs of the children with reference to their age in months
should be met

Age of Child Daily Recommended Caloric Intake

6 to 8 months 600

9 to 11 months 700

12 to 23 months 900
 Factors to Consider when Introducing
Complementary Foods (WHO Recommendations)

2. Food Consistency
The variety and consistency of foods should be increased as children grow older.
Younger children may be unable to eat foods of inappropriate consistency and
may be resistant to try some types of foods which may compromise their
nutrition
3. Meal Frequency and Energy density
Meals for infants should be given four or five times a day and supplemented with
nutritious snacks once or twice daily
 Factors to Consider when Introducing
Complementary Foods (WHO Recommendations)

4. Nutrient Content of Foods

Special attention should be paid to meat and animal products such as milk and
eggs which provide a wide range of nutrients essential to growth and calcium.
The diet should have adequate amounts of vitamin A (beef liver, carrots, leafy
green vegetables, chicken, eggs, fortified milk, sweet potatoes), Zinc (pumpkin
seeds, dark chocolate, yoghurt, spinach, chicken) and fats (margarine,
avocadoes, cheese, eggs, fatty fish).
Examples of Foods and their Caloric
Value
Carbohydrates [16kj(4cal/g)]
Cereals
Rice, maize, wheat, sorghum, millet
Roots
Cassava, yam, sweet potato, potato
Starchy fruits
Cooked banana, ripe banana

Fats and oils [37kj(9cal/g)]

Fats:- Margarine, butter, fat from meat, ghee.
Oils:-Soy ,coconut, sunflower, olive, groundnut, corn, palm and Sim-sim.
Examples of Foods and their Caloric
Value
 Plant protein
 Cowpeas, Soybean, Black-eyed pea ,Pumpkin seed, Red bean, broad beans,
Sunflower seeds, Green gram, Melon seed, Pigeon pea, simsim, broad beans,
cashew nuts, groundnut
Animal proteins [17kj(4cal/g)]
Beef, mutton, goat, lamb, pork, liver, kidney, other offal, rabbit, chicken, wild
animals and insects, duck and other birds, fresh, dried, canned and shell
fish.
Milk and milk products.
Hen’s eggs
Factors to Consider when Introducing
Complementary Foods (WHO Recommendations)

5. Vitamin-Mineral Supplements or Fortified Products

Vitamin-mineral supplements and fortified products should be given to children
who do not eat enough meat and Vitamin A should be given in high doses in
places where VAD is endemic and in places with high infant mortality. (give the
name and dose of the satchet of mineral supplements given in Mbagathi MCH,
take a photo- or ask Dr Mutai to send you a photo showing its contents)
Why Different Types of Foods Need to
be Combined
 Different types of foods provide different types and amounts of key nutrients
 A varied diet protects the body against various illnesses such as obesity,
cardiovascular diseases, some malignancies and musculoskeletal disorders
 Healthy and varied diets are opportunities to experiment with different foods from
different cultures and how to prepare them
 The benefits of eating a wide variety of foods are also emotional, as variety and
colour are important ingredients of a balance diet.

 WHO Regional Office for Europe: http://www.euro.who.int/en/health-

topics/disease-prevention/nutrition/a-healthy-lifestyle/benefits-of-a-balanced-diet
 Factors to Consider when Introducing
Complementary Foods (WHO Recommendations)

6. Fluid Needs (Clean water offered several times in a day)

Children need an additional 400-600 ml of water daily. For those that are not
breastfed, their fluid needs should include the 200-700 ml of water per day
which is often given through breast milk.
7. Safe Preparation and Storage of Food
The caregiver and the child should wash hands before handling food. Food should
be handled in clean containers and stored in a clean environment.
After how long is food stored in room air considered unsafe without reheating?
 Factors to Consider when Introducing
Complementary Foods (WHO Recommendations)

8. Responsive Feeding
Responsive Feeding is the recognition of cues that the baby wants to feed and offering food and the provision
of food by a mother in response to her desire to feed a baby. Responsive feeding employs the principles of
psycho-social care such as
 feed infants directly and assist older children when they feed themselves, being
sensitive to their hunger and satiety cues;
 feed slowly and patiently, and encourage children to eat, but do not force them;
? if children refuse many foods, experiment with different food combinations, tastes,
textures and methods of encouragement;
 minimize distractions during meals if the child loses interest easily;
 remember that feeding times are periods of learning and love − talk to children
during feeding, with eye to eye contact.
https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2017/12/Responsive-Feeding-
Infosheet-Unicef-UK-Baby-Friendly-Initiative.pdf
 Factors to Consider when Introducing
Complementary Foods (WHO Recommendations)

9. Feeding During and After Illness

During illness or convalescence, children should be fed with lots of fluids and
soft, tasty and palatable food to encourage their feeding. The food portions
should be increased during this time.
 Feeding an Infant 6-8 months
(please present the next 3 slides in one table so that
we can appreciate the difference )
In this age, the total energy requirement is 1025ml/day or 615Kcal.
Energy from the breast milk are:
 688ml/day or 413Kcal in developing countries.
 810ml/day or 486Kcal in developed countries.
Contents include pureed, mashed foods and semi foods.
Frequency of complementary feeds are 2-3 times with breastfeeding.
Variety: dairy products like whole milk and yoghurt, fruits e.g mashed avocado
and apples, vegetables like mashed potatoes or sweet potatoes, proteins:
small peaces of beef or chicken. Oil seeds and pulses e.g ground nuts.
Feeding of an infant 9-11 months.

Total energy requirements are 1143ml/day or 686 Kcal.

From breast milk we get:
 632ml/day or 379Kcal in developing countries.
 625ml/day or 375Kcal in developed countries.
Frequency of complementary feeding is 3-4 times a day with breastfeeding.
Content of the feeds are FINGER FOODS i.e. food which the infant can eat on
his/her own.
Variety include meals, with milk-only feeds, other food and combination of milk-
feeds and other food.
Feeding of an infant 12-24 months.

Total daily energy requirements are 1490ml/day or 849kcal.

Breast milk provides:
 577ml/day or 346kcal in developing countries.
 522ml/day or 313kcal in developed countries.
Frequency of complementary feeds is 3-4 times a day.
The content are now feeds that are consumed by other members of the family.
Energy from Breast Milk and
Complementary Feeds According to Age
Feeding a child >24 months.

Variety of a balanced diet is observed to served the fast growth rate of this
phase.
Total carbohydrate intake should be about 45-65% of total caloric intake.
Dietary fats should make up:
 30-35 % of total caloric intake in ages between 1-3 years.
 25-35 in ages between 3-18 years.
Dietary fats should contain at least 3% of essential free fatty acids.
Proteins should make up 6-20% in ages 1-3 years and 10-30 in ages 3-18 years.
The frequency of the meals should be 3 well balanced meals and at least 2
snacks in between.
Energy requirements of ages 1-18 years.
History Taking for Complimentary
Feeding
 History of Breastfeeding
 History of Feeding Difficulties
 Explore illnesses which may result in feeding problems

 Kutty, P. K. (2016). The Link: Pediatric History Taking and Physical Diagnosis. JP
Medical Ltd. https://books.google.co.ke/books?
id=_nSJDAAAQBAJ&pg=PA80&lpg=PA80&dq=History+taking+for+complementary+feed
ing&source=bl&ots=3EcrSpve9C&sig=KXGH6KAOox4ecEHlPz6JEudbg0A&hl=en&sa=X&
ved=0ahUKEwi-2PSUgJLZAhVF8RQKHYIFC68Q6AEITDAE#v=onepage&q=History
%20taking%20for%20complementary%20feeding&f=false
Questions?
Thank You