Lec. 7 Complementary feeding.pptx

lecture note complementary feeding

1. complementary feeding Jimcale Jimcale

2. Learning outcomes After completing the students should be able to: Define Complementary feeding /weaning process Identify Guiding principles for appropriate complementary feeding Jimcale

3. Introduction Around the age of 6 months, an infant’s need for energy and nutrients starts to exceed what is provided by breast milk, and complementary foods are necessary to meet those needs. An infant of this age is also developmentally ready for other foods. This transition is referred to as complementary feeding. If complementary foods are not introduced around the age of 6 months, or if they are given inappropriately, an infant’s growth may falter. Jimcale

4. Introduction Jimcale Breast feeding alone is adequate to maintain growth and development up to 6 months. complementary feeding should be given to maintain their growth and development according to age. So it is necessary to introduce more concentrated energy riched nutritional supplements by this age. Infant also need iron containing food supplements to prevent iron deficiency anaemia.

5. Definition of Complementary feeding Jimcale Complementary feeding or weaning 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. It is the process by which the infant gradually becomes accustomed to adult diet.

6. Definition of Complementary feeding The process of giving an infant other foods and liquids along with breast milk or non-human milk as breast milk alone is no longer sufficient to meet the nutritional requirements. These foods should complement rather than replace breastmilk.

7. Guiding principles for appropriate complementary feeding Guiding principles for appropriate complementary feeding are: Continue frequent, on-demand breastfeeding until 2 years of age or beyond; Practise responsive feeding (for example, feed infants directly and assist older children. Feed slowly and patiently, encourage them to eat but do not force them, talk to the child and maintain eye contact); Practise good hygiene and proper food handling; Start at 6 months with small amounts of food and increase gradually as the child gets older;

8. Guiding principles for appropriate complementary feeding Guiding principles for appropriate complementary feeding are: Gradually increase food consistency and variety; Increase the number of times that the child is fed: 2–3 meals per day for infants 6–8 months of age and 3–4 meals per day for infants 9–23 months of age, with 1–2 additional snacks as required; Use fortified complementary foods or vitamin-mineral supplements as needed; and During illness, increase fluid intake including more breastfeeding, and offer soft, favourite foods. It is advisable to start one or two teaspoons of new food at first which should be given when baby is hungry, just before regular feeding, during the day time.

9. Feeding in exceptionally difficult circumstances Families and children in difficult circumstances require special attention and practical support. Wherever possible, mothers and babies should remain together and get the support they need to exercise the most appropriate feeding option available. Breastfeeding remains the preferred mode of infant feeding in almost all difficult situations, for instance: Low-birth-weight or premature infants; Mothers living with HIV in settings where mortality due to diarrhoea, pneumonia and malnutrition remain prevalent; Adolescent mothers; Infants and young children who are malnourished; and Families suffering the consequences of complex emergencies.

10. HIV and infant feeding Breastfeeding, and especially early and exclusive breastfeeding, is one of the most significant ways to improve infant survival rates. While HIV can pass from a mother to her child during pregnancy, labour or delivery, and also through breast-milk, the evidence on HIV and infant feeding shows that giving antiretroviral treatment (ART) to mothers living with HIV significantly reduces the risk of transmission through breastfeeding and also improves her health. WHO now recommends that all people living with HIV, including pregnant women and lactating mothers living with HIV, take ART for life from when they first learn their infection status. Mothers living in settings where morbidity and mortality due to diarrhoea, pneumonia and malnutrition are prevalent and national health authorities endorse breastfeeding should exclusively breastfeed their babies for 6 months, then introduce appropriate complementary foods and continue breastfeeding up to at least the child’s first birthday.

11. Key facts Jimcale Undernutrition is associated with 45% of child deaths. Globally in 2020, 149 million children under 5 were estimated to be stunted (too short for age), 45 million were estimated to be wasted (too thin for height), and 38.9 million were overweight or obese. About 44% of infants 0–6 months old are exclusively breastfed.

12. Key facts Jimcale Few children receive nutritionally adequate and safe complementary foods; in many countries less than a fourth of infants 6–23 months of age meet the criteria of dietary diversity and feeding frequency that are appropriate for their age. Over 820 000 children's lives could be saved every year among children under 5 years, if all children 0–23 months were optimally breastfed. Breastfeeding improves IQ, school attendance, and is associated with higher income in adult life. Improving child development and reducing health costs through breastfeeding results in economic gains for individual families as well as at the national level.

13. Why start at six months Infant’s intestinal tract develops immunologically with defense mechanisms to protect the infant from foreign proteins. The infant’s ability to digest and absorb proteins, fats, and carbohydrates, other than those in breast milk increases rapidly. The infant’s kidneys develop the ability to excrete the waste products. The infant develops the neuromuscular mechanisms needed for recognizing and accepting variation n the taste and color of foods.

14. What are the signs that baby is ready for complimentary feeding Jimcale Hold his/her head straight when sitting down. Opens his/her mouth when others eat Is interested in foods when others eat. Receives frequent breast feed but appear hungry soon after. Is not gaining weight adequately.

15. Preparation for weaning food Wash hands. Keep food in clean utensils. Separate raw and cooked food. Cook food thoroughly. Keep food at safe temperatures. Use safe water and raw material. Give freshly prepared food. Keep the cooked food covered.

16. Qualities for complimentary feeding Weaning food should be liquid at first, then semi solid and solid food to be introduced gradually. Clean, fresh and hygienic, so that no infection can occurs. Easy to prepare at home with the available food items and not costly.

17. Cont …. Easily digestible, easily acceptable and palatable for infants. High in energy density and low in bulk viscosity and contains all nutrients necessary for the baby. Based on cultural practice and traditional beliefs. Well balanced, nourishing and suitable for the infant

18. Complimentary feeding at different ages 6 to 9 months – biscuit socked with milk, vegetable soup, mashed banana, mashed vegetable. Each food should be given with one or two teaspoon at first for 3 to 6 times per day. Food item to be given at this period include soft mixture of rice and vegetables, pulses, mashed and boiled potato, bread or roti soaked with milk, mashed fruits, egg yolk, curd. Amount of food should increase gradually.

19. Complimentary feeding at different ages 9 to 12 months – More variety of household food can be added. Fish, meat, chicken can be introduced. Food need not to be mashed but should be soft and well cooked. 12 to 18 months – The child can take all kind of cooked food. The amount and frequency should increase gradually.

20. Problems during feeding If on starting weaning, breast feeding is stopped suddenly, it can have adverse psychological effect on the child. Weaning food, if prepared unhygienically or not digested properly can cause diarrhoea. If weaning food are not nutrient rich, the child can develop malnutrition. Children may develop indigestion, abdominal pain, diarrhoea or rashes if they are allergic to certain foods.

21. ADVANTAGES & DISADVANTAGES ADVANTAGES:- It prevents malnutrition. It prevents deficiency diseases, e.g.anemia . Promotes growth. DISADVANTAGES:- It may lead to diarrhea , if the food is preparing an unhygienic way. Negligence in choosing nutritious weaning food can lead to either calorie, protein, vitamin or mineral deficiencies.

22. Appropriate Complementary Feeding Ensuring that infants nutritional needs are met requires that complementary foods be: Timely – meaning that they are introduced when the need for energy and nutrients exceeds what can be provided through exclusive breastfeeding; Adequate – meaning that they provide sufficient energy, protein and micronutrients to meet a growing child’s nutritional needs; Safe – meaning that they are hygienically stored and prepared, and fed with clean hands using clean utensils and not bottles and teats; Properly fed – meaning that they are given consistent with a child’s signals of appetite and satiety, and that meal frequency and feeding are suitable for age. Caregivers should take active care in the feeding of infants by being responsive to the child’s clues for hunger and also encouraging the child to eat. Jimcale

23. Why Continue Breastfeeding? Vital source of energy (30-40%) and nutrients into 2nd yr of life Key source of Good quality proteins & essential fatty acids Micronutrients:  45% of Vitamin A  40% of calcium & riboflavin  95% of Vitamin C Fluids and nutrients during infection Associated with greater linear growth Linked to lower risk of chronic diseases & obesity

24. Adequacy (Quality) Staples: Cereals (Rice, wheat, maize, millets) and Legumes Fats (Vegetable oils/butter/ghee; 1g ~ 9 Kcal) and sugars to improve energy density and taste Foods of animal origin (Milk, curd, eggs, meat, fish) to provide good quality proteins, vitamin A and calcium. Vegetables and Fruits to provide micronutrents e.g. iron and vitamins. Supplements e.g. iron might be required.

25. Other Attributes of Complementary Foods Soft Easy to digest Inexpensive Locally available Culturally acceptable Easily prepared at home

26. Variety of Foods Start at 6 months with small amounts of food; increase quantity with age, maintaining frequent breast feeding Increase food consistency & variety with age Can feed mashed & semi-solids (e.g. porridge) at 6 months; Can feed finger foods by 8-9 months By 12 months, family foods can be eaten Combine foods (e.g. rice and legumes) to provide good mixture of amino acids

27. Foods to Avoid Tea & coffee: interfere with iron absorption Aerated beverages: No nutritional value Too much sugary drinks & Fruit juices: cause decreased appetite for other nutritious foods and also may cause loose stools. Nuts: may cause choking

28. Feeding Techniques Feed infants directly & assist older toddlers eat; be sensitive to hunger & satiety cues Feed patiently; encourage, but don’t force If child refuses, experiment with different food combinations, tastes, textures Minimize distractions during meals Talk to child during feeding; maintain eye contact

29. Safe Unhygienic feeding T he risk of infectious illness (esp. diarrhea) compromising nutritional status Undermines the parents’ confidence leading to delay in Cystic fibrosis ( CF )

30. Ensuring Food Hygiene Washing caregiver’s and child’s hands before preparing, handling and eating food Clean water and raw materials to cook food Storing foods safely: Keeping food covered and serving shortly after preparation Use clean utensils to prepare & serve food Use clean bowls & cups when feeding child No feeding bottles

31. Feeding the child who is ill Encourage the child to drink and to eat - with lots of patience Feed small amounts frequently Give foods that the child likes Give a variety of nutrient-rich foods Continue to breastfeed

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

33. Key Messages Complementary feeding should begin soon after completing 6 months of age along with continued breastfeeding Complementary foods should be of right consistency, energy dense and the variety to provide all nutrient demands of a growing child. Child should be fed patiently giving adequate attention and time Foods should be prepared, stored and fed hygienically to the children. Continue feeding during illness and increase during convalescence.

34. Important Precautions : Use only clean utensils Use prepared feed within half an hour Discard unused feed After the initial phase of hard work by the mother, there will be no need of forcing, coaxing, fussing or running after the child to eat food. It will be very natural for him to eat at all meal times and adequately.