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International Journal of Informative & Futuristic Research ISSN: 2347-1697

Volume 5 Issue 6 February 2018 www.ijifr.com

Abstract

Complementary feeding is very important for the infant at the age of 6 months that means time of introduction and transition of food pattern turns into infant’s growth, which triples his birth weight and 1 ½ times his length by the end of the 1 year. Infant and young child feeding is a key area to improve child survival and promote healthy growth and development. Timely and appropriate introduction of complementary feeding surely reduce the infant mortality rate.

[1] INRODUCTION

Breast-milk is the most natural and perfect food for normal growth and healthy

development of infants till 6 months of age.

Breast milk output starts to decline thereafter but infants physical and cognitive

development continues at a very fast till the end of 2 years.

At 6months of age complementary feeding must be initiated and continued breast

feeding-failing which will leads to maln

Infant Feeding : Switching To Complementary

Feeding Paper ID IJIFR/V5/ E6/ 007 Page No. 9107-9114 Subject Area Nursing

Key Words Complementary Feeding, Infant, Growth, Mortality

1st Kogila. P.

Research Scholar, Chettinad College of Nursing, Chettinad Academy of Research and Education, Tamil Nadu, India

2nd Dr. Sujatha Sridharan

Professor, Department of Pediatrics, Chettinad Hospital and Research Institute, Tamilnadu,India

3rd Dr.Rajalakshmi

Professor, Department of Pediatrics, Chettinad Hospital and Research Institute, Tamilnadu,India

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ISSN: 2347-1697 International Journal of Informative & Futuristic Research (IJIFR)

Volume - 5, Issue -6, February 2018 Page No. : 9107-9114

Kogila. P., Dr. Sujatha Sridharan, Dr.Rajalakshmi :: Infant Feeding : Switching To Complementary Feeding

Figure 1: Status of Infant Mortality

[2] JUSTIFICATION

WHO: 3key determinants to reduce infant malnutrition are

Adequate &appropriate feeding.

Health care and maternal education.

Environmental health

Many studies also revealed that educational inputs among women are emphasis to

improve the health status of infant.

Despite of high education, has a prominent malnutrition, one of the main reason is lack

of proper mother’s knowledge on complementary feeding, hence mothers education on

complementary feeding will potentially improve the nutritional status of infant.

As per National Family Health Survey reports 2015:

Tamilnadu state, despite of high education, has a prominent malnutrition .One of the

reason is lack of proper mothers knowledge on feeding practices.

The reason, why available food is not given to the child is that mother does not know

how much food the child needs. Most of the mothers do not understand the

importance of complementary feeding.

WO

RL

D W

IDE

•Every 6 seconds 1 infant is dying by malnutrition

•according to the United Nations and 42.09 as per Word Bank-The infant mortality rate of the world is 49.4

•In 2015, 4.5 million (75%) of all under-five deaths occurred within the first year of life

IND

IA

•Total Infant mortality rate:40.05 deaths/1000 live births

•Male: 39.2 deaths/1000 live births.

•Female:41.8deaths/1000 live births. The Rapid survey of children 2015 as per National Family Health Survey reports:

•38.7% are considered stunted(low height for age)

•29.4% are considered underweight(low weight for age)

•15% are considered wasted(low weight for height)

TA

MIL

NA

DU

•National Family Health Survey reports 2015:

•23% of children are under weight.

•While 25% of Chennai children moderately stunted growth

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Figure 2: Causes of Infant Mortality

Figure 3: Causes of Infant Mortality

[3] PRINCIPLES OF INTRODUCING COMPLEMENTARY FOOD

Start one/two teaspoons of new food at first time

It should be given when baby is hungry, just before regular feeding.

New food should be introduced during day time.

It may be continued for 3-7days until child gets used to the food.

Complementary feeding too early may leads to:

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Displacement of breast milk

Increase the high risk of infections like diarrhea, further leads to weight loss and

malnutrition

Adverse reactions to certain foods

Less protective factors

Difficult to digest foods due to immaturity of gastro intestinal system

Complementary feeding too late may leads to:

Result in child not receiving required nutrients

Result in slow child’s growth and development

Risk of causing deficiencies and malnutrition

The benefits of waiting until see the signs of readiness:

Most solid foods are lower in calories than human milk it can be difficult for

infants to digest.

Many foods can cause unpleasant reactions and even trigger allergies in infants

when complementary feeding introduced before six months of age.

By waiting for him to be developmentally ready (positive extrusion reflex), he

becomes an active participant in eating, rather than merely a passive recipient.

Then the new food item may be started, one at a time.

Table 1: Complementary Feeding: Signs of Readiness &Signs of Being Mistaken

Signs of Readiness Mistaken of Baby Being Readiness

Infant is about six months old.

Infant can sit up hold his head

straightly.

Infant has lost his extrusion reflex-

does not push food outside the

mouth.

Infant shows interest pick things up

between his finger and thumb keeps

putting things in the mouth.

Shows signs of hunger before the

usual feeding times.

Keeps chewing on things.

Waking in the night when they

Have previously slept.

Increased frequency of milk feeds.

Chewing fist.

Table: 3 Textures, Frequency, Amount and Energy Density of Complementary Food:

Age Texture Frequency Average amount at

each meal and energy

density/day

6-8 months Start with thick

porridge, well mashed

foods

2-3 meals/day plus

frequent BF

Start with 2-3 Table

spoon full:

200kcal/day

9-11

Months

Finely chopped/

mashed foods

3-4 meals plus BF.

Depending on appetite

1/2 of a 250 ml

cup/Bowl:

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offer 1-2 snacks 300kcal/day

At12 months

and above

Family foods, chopped/

mashed

3-4 meals plus

BF. Depending

on appetite

offer 1-2 snacks

3/4 to one 250 ml

cup/bowl

550kcal/day

IV. FOOD GROUPS

i. Grains, roots, tubers

ii. Legumes and nuts

iii. Dairy products-milk, cheese

iv. Green and yellow vegetables

v. Fruit

vi. Meat, poultry, fish or eggs

vii. Small amount of ghee/oil

There should be 4 or > 4 food groups to be utilized/day by the infant as a complementary

food.

Table 4: Foods to Give

6 months 7 months-8 months 9-11 months

Start with thick porridge,

well mashed foods

1.Non–wheat cereals, such

as baby rice with

breast/formula milk,

Powdered rice

2.Vegetable soup

3.Mashed banana, avocado,

or cooked fruit such as pear /

apple

4. Boiled and Mashed

vegetables, such as carrot,

potato, sweet potato

5.Kichiri,suji

*Note cows’ milk is not

suitable as a main drink until

1 year of age.

well mashed foods

1.mashed rice

2.mashed vegetables, beans and

chicken or meat,

3.mashed Cooked fish

(without bones)

4.Well cooked eggs

5.Full fat dairy foods such as

cheese,

6.rice pudding and custard

Finger food at 8months

7.cooked vegetables (e.g. sticks

of carrot, pieces of broccoli,

green beans)

8.pieces of peeled soft ripe fruit

(e.g. banana, peach, pear,

mango, melon)

9.fingers of pitta bread or toast

10. sticks of cheese.

Finely chopped/mashed foods

1.mashed rice

2.mashed vegetables, beans and

chicken or meat,

3.mashed Cooked fish (without bones)

4.Well cooked eggs

5.Full fat dairy foods such as cheese,

6.rice pudding and custard

7.cooked vegetables (e.g. sticks of

carrot, pieces of broccoli, green beans)

8.pieces of peeled soft ripe fruit (e.g.

banana, peach, pear, mango, melon)

9.fingers of pitta bread or toast

10.sticks of cheese

12months

Family solid food

VI. WHAT ARE GOOD COMPLEMENTARY FOODS?

Good complementary foods are:

Rich in energy, protein and micro nutrients ( particularly iron, zinc, calcium,

vitamin A, vitamin C and folate)

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Clean and safe:

No pathogens

No harmful chemicals/toxins

No bones or hard bits that may chock a child

No too much hot boiling

Not too peppery or salty

Easy for the child to eat

Liked by the child

Locally available and affordable

East to prepare

Suitable drinks:

Milk

Water

Fruit juice

Contaminated complementary foods:

Sources of raw/cooked food contamination are,

Contaminated hands

Flies and pets

Contaminated household water

Polluted environment( soil, dust)

Dirty cooking utensils

Cross contamination by

Human and animal excreta

Infected animal food

Domestic animal

Time – temperature abuse

Foods that should be avoided before 6 months of age:

Foods containing wheat/gluten e.g. bread, pasta, breakfast cereals not offered till 6

months old as Gluten can cause Celiac disease.

Eggs

Fish and shellfish

Citrus fruits

Nuts and seeds

Liver can be introduced after 6 months but it is recommended that infants and

young

Children do not have liver or liver products more than once a week Soya products

(e.g. soya milk)

Dairy foods

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Soft and unpasteurized cheeses

Cows’ milk (before 12 months of age)

Honey (before 12 months of age)

Foods to avoid during Complementary feeding:

Salt:

Babies under one year should have less than 1g (less than ¼ tsp.) of salt per day as their

kidneys cannot cope with very much salt.

Foods prepared at home should have no salt added.

While most baby foods do not contain added salt, other processed foods (e.g. crisps,

gravy, soups) do, so it is important to check the label and avoid foods high in salt.

Sugar:

Frequently consuming sugar-containing foods and drinks can lead to tooth decay,

especially in-between meals.

Avoid adding sugar to foods, as well as giving foods and drinks with added sugars,

such as biscuits, cakes and fruit squash to your baby.

Drinks containing added sugars should be restricted because they damaging to teeth

and may contain ingredients (e.g. caffeine) that are unsuitable for this age group.

They also have very few nutrients and can fill your baby up meaning that they can miss

out on important nutrients from food

Honey:

Honey should not be given to babies under one year because there is a risk it can contain

bacteria that can cause a serious illness called infant botulism.

Raw or undercooked eggs:

Eggs should be cooked until the white and yolk are both solid. Avoid any foods

containing raw or partially cooked eggs.

Whole nuts:

It should not be given to children under 5 years of age because of the risk of choking.

Current advice states that crushed or finely ground nuts and peanut or other nut butters can

be given from 6 months of age providing there is no history of allergies (asthma, eczema,

hay fever or other food allergy) in the child’s immediate family (parents or siblings).

Raw shellfish:

Raw shellfish should not be given to infants as they are at an increased risk of food

poisoning. Shark, marlin and swordfish – these types of fish should not be given because

the levels of mercury they sometimes contain can affect the developing nervous system

Avoid Junk and Commercial food which are high in fat, sugar, salt &

pesticides/additives.

Avoid giving ready-made, processed commercial food from the market, e.g. tinned

foods/juices, colas & carbonated drinks, cold-drinks, chocolates, crisps, health drinks

bakery products etc.

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Tea and coffee should not be given to babies. They can reduce the amount of iron and

other nutrients absorbed from food, especially if they are given with meals.

Table 5: Key Messages

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.

Mother should sit near to the baby while feeding so that baby does not choke,

never force to feed the baby

Foods should be prepared, stored and fed hygienically to the children.

Make sure that the food is in right temperature; do not make it too hot

If baby refuses to eat a particular type of food, consider to stop and offer it later on.

Offer a baby wide range of foods so that they get used to different flavors

Introduce only one food at a time as it will be easier to detect if baby is allergic to

any particular food.

Feed himself

Use only clean utensils

Use prepared feed within one to two hours

Discard unused feed

Continue feeding during illness and increase during convalescence.

.

VII. REFERENCES

[1] Seema Hasnain, Muhammad Ashraf Majrooh and Raana Anjum. Knowledge and Practices

of Mothers for Complementary Feeding In Babies Visiting Pediatrics Outpatient

Department of Jinnah Hospital, Lahore. Biomedica2013; Vol. 29. (Accessed )

[2] Mother’s Knowledge Regarding Weaning Process in Infants. International Journal of

Science and Research (IJSR); 3, (7): 1194, 1195. (Accessed July 2014).

[3] WHO. Global Health Observatory (GHO) data on infant mortality and causes of death.

WHO website (accessed 2015).

[4] WHO and UNICEF, Joint child malnutrition estimates - Levels and trends (2016 edition).

(Accessed 2015).

[5] Dr. R K Aggarwal et.al, Infant and Young Child Feeding Guidelines; 2015. (Accessed

2015).

[6] Ekerette Emmanuel Udoh et.al, Complementary feeding practices among mothers and

nutritional status of infants in Akpabuyo Area, Cross River State Nigeria. Springer plus,

PMC 2016; 5(2073): 18. DOI 10.1186/s40064-016-3751-7 (accessed 2016).

PAPER CITATION

Kogila. P., Sridharan, S. , Rajalakshmi :: “Infant Feeding : Switching To

Complementary Feeding” International Journal of Informative & Futuristic Research

(ISSN: 2347-1697), Vol. (5) No. (6), February 2018, pp. 9107-9114, Paper ID:

IJIFR/V5/E6/007. Available online through- http://www.ijifr.com/searchjournal.aspx

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