Complementary feeding

In this Quotation Slide, i wished to summarise one chapter, in doing so i suggest this open source textbook for any medical students; Infant and Young Child Feeding

1. Session 3; Complementary Feeding, Quotation Slide Cihan Durmuş Saydam, 165114006, E-mail: [email protected]

2. Guiding Principles for Complementary Feeding of Breastfed Child 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. Continue frequent, on-demand breastfeeding until 2 years of age or beyond. Practise responsive feeding, applying the principles of psychosocial care. Practise good hygiene and proper food handling. S tart at 6 months of age with small amounts of food and increase the quantity as the child gets older, while maintaining frequent breastfeeding. Gradually increase food consistency and variety as the infant grows older, adapting to the infant’s requirements and abilities. Increase the number of times that the child is fed complementary foods as the child gets older. Feed a variety of nutrient-rich foods to ensure that all nutrient needs are met. U se fortified complementary foods or vitamin-mineral supplements for the infant, as needed 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.

3. In settings where environmental sanitation is very poor, waiting until even later than 6 months to introduce complementary foods might reduce exposure to food-borne diseases. However, because infants are beginning to actively explore their environment at this age, they will be exposed to microbial contaminants through soil and objects even if they are not given complementary foods. Thus, 6 months is the recommended appropriate age at which to introduce complementary foods . WHO. The optimal duration of exclusive breastfeeding: report of an expert consultation. Geneva, World Health Organization, 2001 (WHO/NHD/01.09, WHO/FCH/CAH 01.24).

4. Microbial contamination of complementary foods is a major cause of diarrhoeal disease, which is particularly common in children 6 to 12 months old Bern C et al. The magnitude of the global problem of diarrhoeal disease; a ten-year update. Bulletin of the World Health Organization, 1992, 70:705–714 Safe preparation and storage of complementary foods can prevent contamination and reduce the risk of diarrhoea. The use of bottles with teats to feed liquids is more likely to result in transmission of infection than the use of cups, and should be avoided Black RE et al. Incidence and etiology of infan-tile diarrhoea and major routes of transmission in Huascar, Peru. American Journal of Epidemiology, 1989, 129:785–799

5. Eating by hand is common in many cul-tures, and children may be given solid pieces of food to hold and chew on, sometimes called “finger foods”. It is important for both the caregiver’s and the child’s hands to be washed thoroughly before eating F ive keys to safer food : Keep clean Separate raw and cooked Cook thoroughly Keep food at safe temperatures Use safe water and raw materials

6. B reast milk covers all needs up to 6 months, but after 6 months there is an energy gap that needs to be covered by complementary foods. The energy needed in addition to breast milk is about 200 kcal per day in infants 6–8 months, 300 kcal per day in infants 9–11 months, and 550 kcal per day in children 12–23 months of age. The amount of food required to cover the gap increases as the child gets older, and as the intake of breast milk decreases WHO. Complementary feeding. Family foods for breastfed children. Geneva, World Health Organi-zation, 2000

7. Gradually increase food consistency and variety as the infant grows older,adapting to the infant’s requirements and abilities Beginning at 6 months, an infant can eat pureed, mashed or semi-solid foods. By 8 months most infants can also eat finger foods. By 12 months, most children can eat the same types of foods as consumed by the rest of the family. As a child gets older and needs a larger total quantity of food each day, the food needs to be divided into a larger number of meals. The number of meals that an infant or young child needs in a day depends on: how much energy the child needs to cover the energy gap the amount that a child can eat at one meal the energy density of the food offered :

8. If a complementary food is more energy dense, then 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 his or her intake of breast milk decreases, so the food effectively 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. Drewett R et al. Relationships between nursing patterns, supplementary food intake, and breastmilk intake in a rural Thai population. Early Human Development, 1989, 20:13–23.

9. The largest gap is for iron, so it is especially important that complementary foods contain iron, if possible from animal-source foods such as meat, organs, poultry or fish. Pulses (peas, beans, lentils, nuts) fed with vitamin C-rich foods to aid absorption provide an alternative, but they cannot replace animal-source foods completely. Vegetarian (plant-based) complementary foods do not by themselves provide enough iron and zinc to meet all the needs of an infant or young child aged 6–23 months. Animal-source foods that contain enough iron and zinc are needed in addition. Alternatively, fortified foods or micronutrient supplements can fill some of the critical nutrient gaps.

10. During an illness, the need for fluid often increases, 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 both fluid and nutrients. A child should also be encouraged to eat some complementary food to maintain nutrient intake and enhance recovery. Intake is usually better if the child is offered his or her favourite foods, and if the foods are soft and appetizing. The amount eaten at any one time is likely to be less than usual, so the caregiver may need to give more frequent, smaller meals.

11. Reference Infant and young child feeding , Model Chapter for textbooks for medical students and allied health Professional , World Health Organization 2009, ISBN 978 92 4 159749 4