complementary feeding.pptx

information on complementary feed

1. Complementary Feeding, Issues and concerns Pediatric Nutrition II CND, 2023

2. What is Complementary Feeding? Complementary feeding or weaning is the process of giving an infant other foods and liquids along with the breast milk after the age of 6 months as breastmilk alone is no longer sufficient to meet the nutritional requirements of growing baby. It is the process by which the infant gradually becomes accustomed to adult diet. Switching baby from a milk-only diet to one that includes portions of milk and solid/baby food

3. WHO Recommendations Infants should start receiving complementary foods at 6 months of age in addition to breast milk Initially, between 6–8 months : 2–3 times a day between 9–11 months : increase to 3–4 times daily 12–24 months : Additional 1–2 times nutritious snacks per day Gradually increase food consistency and variety as the infant gets older and their adaptability Infants can eat pureed, mashed and semi-solid foods beginning at 6 months By 8 months most infants can also eat “finger foods” (snacks that can be eaten by children alone).  By 12 months, most children can eat the same types of foods as consumed by the rest of the family nutrient-dense foods, including animal-sourced foods like meat, poultry, fish, eggs and dairy products.  Avoid foods in a form that may cause choking such as whole grapes or raw carrots Avoid giving drinks with low nutrient value, such as tea, coffee and sugary soft drinks. Limit the amount of juice offered, to avoid displacing more nutrient-rich foods

4. Why start at six months? Risk of hypersensitivity (allergic) reactions to the proteins in complementary foods is reduced Infants ability to digest and absorb proteins, fats and carbohydrate other than in the breast milk and formula increases rapidly The infant’s kidney develop the ability to excrete the waste products from foods with a high solute load such as meat Infants develop the neuromuscular mechanisms needed for recognizing and accepting a spoon , masticating, swallowing non-liquid foods and appreciating variations in the taste and color of foods If started late………. Reject foods when they are introduced at a later age – This may occur because infants become comfortable with the easier feeding style necessary to suck from the breast or a bottle. The infant may then have difficulty developing skills to eat independently. Consume an inadequate variety and amount of food to meet their nutritional needs – Breast milk or infant formulas alone do not provide an adequate concentration or balance of nutrients for the older infant.-Nutritional deficiencies and malnutrition Growth or development slows down or stops Iron deficiency anaemia is more common in infants If started soon……… Choke on the food Develop food hypersensitivities (allergies) because of an immature digestive tract or Consume less than the appropriate amount of breast milk or infant formula Increased risk of illness like diarrhoea

5. What are the signs that baby is ready for Complementary Feeding? Sit up, alone or with support Hold his head steady and straight Open his mouth when he sees food coming Keep his tongue low and flat to receive the spoon Close his lips over a spoon and scrape food off as a spoon is removed from his mouth and Keep food in his mouth and swallow it rather than pushing it back out on his chin. By 4 to 6 months of age, the infant’s tongue thrust reflex, which causes the tongue to push most solid objects out of the mouth, usually disappears Not gaining weight adequately Receives frequent breastfeed but appear hungry soon after Interested in food what others eat

6. Nutrition of the child is very important especially during crucial 1000 days for optimal growth and development of child

7. Importance of Gradually Introducing Each New Food Introduce new foods one at a time. Introduce “single-ingredient” foods initially to determine the infant’s acceptance to each food (e.g., try plain rice cereal before rice cereal mixed with fruit). Allow at least 7 days between the introduction of each new “single-ingredient” food.1 Some research experts acknowledge that complementary foods can be introduced at intervals of 2 to 4 days if the infant is developmentally ready Introduce a small amount (e.g., about 1 to 2 teaspoons) of a new food at first (this allows an infant to adapt to a food’s flavor and texture). Observe the infant closely for adverse reactions such as rash, wheezing, or diarrhea after feeding a new food.

8. Dietary diversity Dietary diversity means feeding a child different types of food so that his/her nutrient requirements are adequately met Minimum 4 or more food groups from the seven food groups to meet daily energy and nutrient reequirements Ensures that the child has a likelihood of consuming at least one animal source food and one fruit or vegetables in addition to the staple food(grain, root or tuber)

9. Finger foods for Infants

10. Amount of complementary food needed Start at six months of age with small amounts of food and increase the quantity as the child gets older, while maintaining frequent breastfeeding 6-8 months: 200 kcal per day: 250ml 9–11 months : 300 kcal per day: 12–23 months of age : 550 kcal per day

11. Feeding Techniques Feed Infants directly and assist older toddlers Take care of hunger and satiety signs given by infant Feed patiently and encourage but don’t force If child refuses, experiment with different food combinations, tastes and textures

12. Growth Monitoring: Measure weight and length periodically and plot growth curves Investigate causes of poor growth like dietary history and evaluate for any illness Counsel mother/caregivers on growth, feeding and caring practices

13. Modify the nutritive value of complementary foods Nutritive value of foods can be improved by increasing the energy density of food by addition of ghee, sugar, jaggery, vegetable oils, butter, etc. The protein content of foods can be improved by combining cereals and pulses to ensure delivery of all essential proteins, also by using different cooking methods such as milling, germination, and fermentation of different food items. The viscosity of foods can be reduced by malting so that a child can eat more. It is the process of germinating whole grain, and then the germinated cereal or pulse is dried and grinded. Malted cereal or pulse-mixed infant foods provides more energy. Amylase-rich flour (ARF) or flours of malted foods increases the energy density of food. Feed with thick but smooth mixtures. Thin gruels do not provide enough energy, hence, a young infant around 6–9 months requires thick and smooth food preparations. The fortification of complementary foods with micronutrients such as iodine, zinc, iron, vitamin D, vitamin A, calcium, phosphorus, etc. However, this will involve commercial foods or sprinkles of micronutrients to be added to food.

14. TYPES OF COMPLEMENTARY FOODS

15. 1. Iron-Fortified Infant Cereal(Rice) appropriate first complementary food for infants because Digests easily Least likely to cause a hypersensitivity (allergic) reaction Contains important nutrients iron and zinc Can be altered in texture to meet an infant’s developmental needs. The infant’s first cereal feeding should be soupy in texture with the texture becoming thicker and lumpier as feeding skills progress. After introducing rice infant cereal, oat and barley infant cereals can be added at 1week intervals. Wheat infant cereal should be introduced at 8 months of age-hypersensitivity Mixed-grain infant cereals and infant cereal and fruit combinations may be introduced after an infant has been introduced separately to each food in the mixture or combination

16. 2. FRUIT JUICES fruit juices contain carbohydrates and may contain vitamin C 100 percent fruit juice or reconstituted juice can be consumed as part of a well-balanced diet fruit juice should be fed only in moderation since it might cause diarrhea, abdominal pain, or bloating Never feed infants unpasteurized juice

17. Here is a list of healthy juice for babies: Stewed boiled apple juice Tender coconut Grape juice (raw) Muskmelon juice (raw) Watermelon juice (raw) Boiled carrot juice Orange juice (raw) Boiled tomato juice Sapota juice (raw) Boiled pear juice Boiled peach juice Papaya juice (best avoided during summers) Banana juice (raw) Lychee juice (raw) Mango juice (raw)

18. 3. Grain Products grain products that are appropriate for infants include: plain ground or mashed rice or barley Grain products provide carbohydrates, thiamin, niacin, riboflavin, iron, other minerals, and, in the case of whole-grain products, fiber to the diet these foods should be cooked until very soft and then pureed or finely mashed or put through a sieve before serving

19. 4. Vegetables and Fruits Vegetables mashed, or soft cooked sticks of  parsnip, broccoli, potato, yam, sweet potato, carrot, apple or pear Vegetables and Fruits provide infants with carbohydrates, including fiber; vitamins A and C; and minerals. risk of choking not to feed infants less than 6 months old those home-prepared vegetables potentially high in nitrates ( spinach, beets, turnips, carrots, or collard greens )

20. Iron rich foods for infant

21. With rapid growth of the infant esp. during 9 months to 24 months, iron stores in the infant may not be suffiecient therefore , Supplement of iron might be required

22. 5. Protein-Rich Foods Infants can be offered well-cooked strained or pureed lean beef, pork, lamb, veal, chicken, turkey, liver, boneless finfish (fish other than shellfish), egg yolk, legumes, tofu, sliced or grated mild cheese, yogurt, or cottage cheese. Home- or commercially prepared meats are a good source of iron and zinc, in addition to iron-fortified infant cereal Iron and zinc are nutrients of concern for exclusively breastfed infants Certain fish have been found to have high levels of mercury that may harm an infant’s developing nervous system ( Shark, swordfish or marlin )

23. Eggs not recommended until 1 year of age due to hypersensitivity reactions caused by egg protein properly prepared to reduce the possibility of contamination with Salmonella enteritidis and other bacteria Cheese and Yogurt Cottage cheese, hard cheeses, and yogurt can be gradually introduced as occasional protein foods. Cheese can be eaten cooked in foods or in the sliced form. Small slices or strips of cheese are easier and safer to eat than a chunk of cheese, which could cause choking Legumes (Dry Beans or Peas) and Tofu Cooked legumes (dry beans and peas) or tofu (bean curd made from soybeans) Protein rich foods best to introduce small quantities (1 to 2 teaspoons) of mashed or pureed and strained legumes initially (whole beans or peas could cause choking)

24. Water Feeding Water should be started once Protein-rich Foods Are Introduced Protein-rich foods (e.g., home-prepared meats, commercially prepared plain meats and mixed dinners, egg yolks, cheese) have a higher renal solute load than some other foods may recommend feeding a small amount of sterile water (100- 200 ml per day) in a cup when complementary foods rich in protein are introduced

25. General Guidelines for Feeding Complementary Foods Wash an infant’s hands before eating Position the infant appropriately Feed the infant using a spoon

26. Issues and concerns

27. Adverse reactions to food include: 1. Food hypersensitivities (allergies) Occur in approximately 2 percent to 8 percent of infants and children less than 3 years old Involve a reaction of the immune system to a food; a reaction may occur immediately or hours after eating May cause any of the following symptoms: ◾ Systemic – anaphylactic shock, failure to thrive ◾ Gastrointestinal – diarrhea, vomiting, abdominal pain ◾ Respiratory symptoms – coughing, wheezing, ear infections ◾ Cutaneous – skin rashes (like eczema Are associated most with consumption of these foods by infants: cow’s milk, whole eggs (or egg white), wheat, peanuts or tree nuts, finfish (e.g., flounder, trout, cod) and shellfish (e.g., shrimp, crab, lobster, scallop, oyster, clamps) Caregivers should not feed any shellfish, peanut butter, whole eggs, or egg whites to their infants before 1 year of age

28. 2 . Food intolerances: Involve reactions stemming from an enzyme deficiency, a toxin, or a disease (the immune system is not affected); and • May cause some of the similar symptoms as food hypersensitivities. Examples of food intolerances are lactose intolerance (caused by a lack of lactase, the intestinal enzyme that digests the sugar lactose) and celiac disease (in which gluten, a combination of proteins found in wheat, rye, oats, barley, and buckwheat, destroys the lining of the small intestine) 3. Other adverse reactions to food that do not involve the immune system include reactions to the following: food additives (e.g., artificial food colorings ), MSG (monosodium glutamate), natural substances in food such as caffeine, or substances or micro-organisms that cause food poisoning. Some infants may develop excessive intestinal gas after consuming certain foods (e.g., certain vegetables, legumes).

29. Concerns: Infants at high risk for developing allergy, identified by a strong family history of allergy or infants with at least one first-degree relative (parent or sibling) with allergic disease – should adhere to the following recommendations: Complementary foods should not be introduced until 6 months of age. Dairy products should be delayed until the infant is 1 year old. Eggs should be delayed until the infant is 2 years old. Peanuts, nuts, and fish should be delayed until 3 years of age.

30. Feeding ill-child

31. Feeding ill-child Encourage the child to drink and eat Feed small amounts frequently Give foods that the child likes Give a variety of nutrient rich foods Continue to breast feed

32. Feeding during Recovery Feed an extra meal Give an extra amount Use extra nutrient rich foods Feed with extra patience Give extra breastfeeds as often as child wants

33. THANK YOU