The 10 Guiding principles of complementary feeding

Most parents still find it difficult to transition from breastfeeding to complementary feeding. What foods to give, frequency of feeding, and how to feed the baby are questions I never miss during consultation. Our article today is going to highlight the ten principles of complementary feeding.

PRINCIPLE 1: Exclusively breastfeed your child from birth to 6 months, then introduce complementary feeding at six months with continued breastfeeding.

Never be in a hurry to introduce food to your baby before six months. Exclusive breastfeeding has several benefits, including protection against gastrointestinal infections. By six months, a baby's digestive system is mature enough to digest starch, protein, and fat in a non-milk diet. A baby is supposed to have doubled its birth weight at six months. Exclusive breastfeeding is no longer sufficient to meet all energy and nutrient needs by itself, and that’s why complementary foods should be introduced to make up for the difference.

PRINCIPLE 2:  Continue frequent on-demand breastfeeding until two years of age or beyond

Never assume that it is time to stop breastfeeding since your baby is getting enough food.

Breastfeed your baby on demand, as often as the child wants, up to 2 years of age or more. Complementary foods are meant to complement and not replace breastfeeding.

Between the ages of 6 and 12 months, breast milk can provide up to half of a child's energy demands; between the ages of 12 and 24 months, it can meet up to one-third of those needs. In addition to offering protective qualities, breast milk continues to offer nutrients of greater quality than supplemental foods. Breast milk is an essential source of nutrition and energy for a sick child, and it also lowers mortality rates for malnourished kids. Additionally, breastfeeding lowers the risk of several acute and chronic illnesses. When complementary foods are provided, children tend to breastfeed less frequently, so breastfeeding needs to be actively promoted to maintain breast-milk consumption.

PRINCIPLE 3:  Practise responsive feeding by applying the principles of psychosocial care

Most parents have adopted the ‘I will thrash you if you don’t eat” formula of feeding, especially if their children are poor feeders. This is inappropriate. Always practice responsive feeding.

Feed infants directly, and help older kids who are feeding themselves.

Please do not force them to eat; instead, feed them slowly and patiently.

Try experimenting with various food combinations, flavors, textures, and ways of encouragement if your kids consistently reject food.

If the child becomes easily distracted during meals, try to limit distractions.

Remind yourself that feeding times are learning opportunities, and show your child you care by engaging with them in conversation while eating.

A child should have a separate plate or bowl so that the caregiver can monitor whether the child is eating enough.

PRINCIPLE 4. Practice good hygiene and proper food handling

Diarrhoeal illness, most prevalent in young children aged 6 to 12 months, is primarily caused by microbial contamination of supplemental foods. Complementary foods can be safely prepared and stored to limit the risk of infection and diarrhea. Avoid using bottles with teats to feed liquids since they increase the risk of transmission of infection compared to cups.

All utensils, such as cups, bowls, and spoons, used for an infant or young child's food should be washed thoroughly. Always wash your baby's hands and yours before offering them "finger foods."

PRINCIPLE 5. Start at six months of age with small amounts of food and increase the quantity as the child gets older while maintaining frequent breastfeeding

 For complementary foods to have 1.0 kcal per gram, it is necessary for them to be quite thick and to contain fat or oil, which are the most energy-rich foods.

Complementary foods should have a greater energy density than breast milk, at least 0.8 kcal per gram. If a complementary food is more energy dense, a smaller amount is needed to cover the energy gap. A complementary food that is more energy-dilute needs a larger volume to cover the energy gap.

When complementary food is introduced, a child tends to breastfeed less often, and their breast milk intake decreases, so the food displaces breast milk. If complementary food is more energy diluted than breast milk, the child's total energy intake may be less than it was with exclusive breastfeeding, an important cause of malnutrition.

A young child's appetite usually guides the amount of food that should be offered. However, illness and malnutrition reduce appetite, so sick children may take less than they need. A child recovering from illness or malnutrition may require extra assistance with feeding to ensure adequate intake. If the child's appetite increases with recovery, then extra food should be offered.

PRINCIPLE 6. Gradually increase food consistency and variety as the infant grows older, adapting to the infant's requirements and abilities

Age and neuromuscular development determine the best food consistency for infants and young children. A baby can begin eating pureed, mashed, or semi-solid foods at the age of six months. Most babies can eat finger foods by the time they are eight months old. By the age of one year, the majority of kids can eat the same meals that the rest of the family does. Children require a nutrient-rich diet, and foods that might lead to choking, such as whole peanuts—should be avoided.

A complimentary food should be thick enough to stick on a spoon without dripping. Generally speaking, dense foods are more nutrient- and energy-rich than thin, watery, or soft foods. When a child consumes thick, solid foods, providing more calories and a range of nutrient-rich substances, such as those derived from animals, is simpler. There is evidence that there is a key window for introducing "lumpy" meals; if this window is missed by more than ten months, there may be a higher chance that the child will experience feeding issues in the future. Although continuing to feed semi-solid foods may save time, it is crucial to progressively increase food solidity as a child gets older to promote optimal child development.

PRINCIPLE 7. Increase the number of times that the child is fed complementary foods as the child gets older

As a child grows bigger and consumes more food every day, meals must be spread out over a greater number of hours.

The number of meals that an infant or young child needs in a day depends on the following:

·         An infant or young child's daily calorie requirements and the amount of energy required to fill the energy. More meals are required daily to guarantee that a child gets enough nourishment.

·         The amount that a child can eat in one meal. This depends on the capacity or size of the child's stomach, usually 30 ml per kg of the child's body weight. An 8 kg child cannot be expected to take more than 240 ml—roughly one large cupful—of food in one sitting because of their stomach capacity.

·         The food's caloric content, if any. Complementary foods should have an energy density of at least 0.8 kcal per gram higher than breast milk. A larger volume of food sometimes split up into numerous meals, is required to compensate for decreased energy density in food.

PRINCIPLE 8. Feed a variety of nutrient-rich foods to ensure that all nutrient needs are met

When combined with breast milk, complementary foods should meet a child's nutritional and energy demands by offering enough calories, protein, and micronutrients to fill in any gaps. Typically, the regional staple serves as the primary component of complementary foods. Cereals, roots, and starchy fruits that are high in carbohydrates and offer energy are considered staples. While starchy fruits like bananas and breadfruit and roots like cassava and sweet potatoes also contain some protein, cereals have a far lower protein content.

• Various other foods should be added to the staple daily to provide other nutrients. Proteins, iron, and zinc are abundant in foods derived from animals or fish. Vitamin A and folate are also found in the liver. Protein and vitamin A are abundant in egg yolks, but iron is not. The whole dish, not just the watery sauce, is what a child needs.
• Milk, cheese, and yogurt are examples of dairy products that are good providers of calcium, protein, energy, and B vitamins.
• Pulses are excellent protein sources and contain some iron, including peas, beans, lentils, peanuts, and soybeans. Iron absorption is aided by consuming foods high in vitamin C, such as tomatoes, citrus and other fruits, and green leafy vegetables.
• Fruits and vegetables that are orange in color, such as carrots, pumpkins, mangoes, and papayas, as well as dark-green leaves like spinach, are high in carotene, which is used to make vitamin A, as well as vitamin C.
• Oils and fats are rich sources of energy and some critical fatty acids that children need to grow.

The iron and zinc requirements of a baby or young child between the ages of 6 and 23 months cannot be fully satisfied by vegetarian (plant-based) supplemental foods on their own. Iron and zinc-rich diets from animal sources are also necessary. Alternatively, some of the vital nutrient shortages can be filled by fortified foods or micronutrient supplements. Oils and other types of fats are crucial because they improve food flavor and boost food's energy density. Additionally, fat aids in absorbing fat-soluble vitamins such as vitamin A. Some fats also offer necessary fatty acids, particularly soy and rapeseed oil. Breast milk and supplemental foods should give between 30 and 45 percent of the total energy as fat. Fat should not provide more than this proportion, or the child will not consume enough foods high in protein and other vital nutrients, such as iron and zinc.

Sugar is a concentrated energy source, but it has no other nutrients. It can damage children's teeth and lead to overweight and obesity. Sugar and sugary beverages like soda should be avoided since they reduce a child's desire for more nourishing foods. Young children should avoid tea and coffee because they contain substances that may hinder iron absorption.

Families frequently limit specific foods from infants and young children's diets out of concern about possible allergic reactions. However, according to controlled trials, restrictive eating plans do not appear to be effective in preventing allergies. Therefore, young children can eat various things from the age of six months, such as eggs, peanuts, fish, and shellfish.

PRINCIPLE 9. Use fortified complementary foods or vitamin-mineral supplements for the infant as needed

Unfortified complementary foods that are predominantly plant-based generally provide insufficient amounts of certain key nutrients (particularly iron, zinc, and vitamin B6) to meet recommended nutrient intakes during complementary feeding. 

In some circumstances, foods derived from animals can fill the gap, but doing so raises costs and might not be feasible for those with the lowest incomes. Additionally, the amounts of animal-source foods that can realistically be taken by newborns (for instance, between the ages of 6 and 12) are typically insufficient to fill the iron void. Not only in developing nations do people struggle to get enough of these nutrients in their diets. If iron-fortified goods weren't widely available, newborn iron intakes in industrialized nations would fall far short of recommended intake. As a result, iron-fortified complementary foods or foods fortified at the moment of consumption with a multi-nutrient powder or lipid-based nutrient supplement may be required in environments where many families have limited access to animal-source foods.

PRINCIPLE 10. Increase fluid intake during illness, breastfeed frequently, and encourage the child to eat soft, favorite foods. After illness, give food more often than usual and encourage the child to eat more.

The need for fluid often increases during an illness, so a child should be offered and encouraged to take more, and breastfeeding on demand should continue. A child's appetite for food often decreases while the desire to breastfeed increases and breast milk may become the main source of fluid and nutrients.

A child should also be encouraged to eat complementary food to maintain nutrient intake and enhance recovery. Intake is usually better if the child is offered their favorite foods and if the foods are soft and flavorful. The amount eaten at any time is likely less than usual, so the caregiver may need to give more frequent, smaller meals.

When the infant or young child is recovering, and their appetite improves, the caregiver should offer an extra portion at each meal or add an extra meal or snack each day.