Complementary Feeds

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. 

WHO, Infant and Young Child Feeding: Key Facts

Complementary Feeding means giving other foods in addition to breastmilk to meet the needs of the growing child. The information is compiled from World Health Organization. Combined course on growth assessment and IYCF counselling. Geneva, WHO, 2012.

These ten nutrition principles from the World Health Organization apply to children all over the world.

1. Breastfeeding for 2 years or longer helps a child to develop and grow strong and healthy.
2. Starting other foods in addition to breastmilk at 6 months helps a child to grow well.
   • At six months a baby shows interest in the food others are eating, likes to put things in his mouth, can control the tongue better to move food around the mouth, and starts to make up and down munching movements with the jaw.
   • Adding complementary feeds too early can result in poor nutrition because the cereals are too watery, increased risk of illness because of less breastmilk protective factors, increased diarrhea, increased wheezing and allergies, and increases the mom’s chance of pregnancy.
   • Adding complementary feeds too late can result in malnutrition and anemia because the growing baby needs more energy than breastmilk alone. The 6 month old needs both breastfeeds and complimentary feeds.
3. Foods that are thick enough to stay in the spoon give more energy to the child. The baby’s stomach is small, so if he fills up on thin cereal or porridge he won’t get enough energy. The food needs to be thick enough to stay on the spoon.

Here are some ways you can add energy to a baby’s food:

Use thick cereals

Mash up the main ingredients of soup or stew

Stir in paste of ground nuts or other seed

Add a little margarine or oil (1/2 teaspoon). Too much will make the baby fill up and he won’t eat other nutritious food.

A little sugar can add energy, but not too much.

Breastmilk is rich in essential fatty acids that a baby needs for a healthy brain, eyes, and blood vessels. This comes at the end of a breastfeed, so be sure to leave your baby on the breast long enough to get this energy rich food.  (If a baby is not taking breastmilk, they need fish, avocado, nut paste, vegetable oil, and animal sources to get the essential fatty acids.)

4. Animal Source foods are especially good for children to help them grow strong and lively.

• Iron and zinc are needed to make new blood to assist in growth and development and to help the body fight infections. 

• The best source of iron and zinc can be found in animal source foods, such as fish, meat, and eggs. 

• Liver and other organ meat are rich sources of iron. Feed your child the cooked chicken liver, whenever your family eats chicken.  The body absorbs the iron from meat sources best. 

5. Peas, beans, lentils, nuts and seeds are also good for children.

There is also iron in cereals, seeds, and dark green leafy vegetables, but they are not as easily absorbed. 

Eating the following foods that are rich in Vitamin C can help the body absorb the iron: Tomato, guava, mango, pineapple, papaya, and any citrus fruit. 

Eating the following, can decrease iron absorption: Drinking teas and coffees, foods high in fibre-bran, and foods rich in calcium.

Some cereals, such as Likuni Pala, have iron added to them. If a child is not getting any animal source of iron, then give iron fortified cereals with a vitamin C rich food.

Eating a variety of vegetables and fruits each day helps meet many nutrient needs.

6. Dark green leaves and yellow colored fruits and vegetables help a child have healthy eyes and fewer infections.

Vitamin A is needed for healthy eyes, skin and to help the body fight off infections. Here are some Vitamin A rich foods:

• Dark green vegetables, yellow colored vegetables, and fruit.

• Organ foods (liver) from animals.

• Egg yolks

• Unbleached red palm oil

• Margarine, dry milk powder, and other foods are fortified with Vitamin A.

Try to give your child a dark-green vegetable or yellow fruit or yellow vegetable each day.

7. A growing child needs 2-4 meals a day plus 1-2 snacks if hungry; give a variety of food. 

Age of child	Texture	Frequency	Amount of food with each meal
6-8 months	Start with thick porridge, well mashed foods. Continue with mashed family foods.	2-3 meals per day, plus frequent breastfeeds.Depending on the child’s appetite, 1-2 snacks may be offered.	Start with 2-3 Tablespoons per feed, slowly increasing to ½ a 250 ml cup.
9-11 months	Finely chopped or mashed foods and foods the baby can pick up.	3-4 meals plus breastfeedsDepending on the child’s appetite, 1-2 snacks may be offered.	½ a 250 ml cup/ bowl.
12-23 months	Family foods, chopped or mashed if necessary.	3-4 meals plus breastfeeds.Depending on the child’s appetite, 1-2 snacks may be offered.	¾ to one 250 ml cup/ bowl.

If baby is not breastfed, give in addition: 1-2 cups of milk and 1-2 extra meals per day.

Try each day to give in addition to the staple food an animal-source food (fish, organ meat, eggs, or milk), AND a dark-green leafy vegetable or yellow colored fruit or vegetable (pumpkin, carrot, yellow sweet potato, papaya, mango, orange, etc…)

8. A growing child needs increasing amounts of food.
9. A growing child needs to learn to eat: encourage and give help … with lots of patience.
   • Respond positively with smiles. Make eye to eye contact and talk to the child with encouraging words while you are feeding.
   • Feed child slowly and patiently with good humor.
   • Wait when the child stops feeding to offer again.
   • Give finger foods that the child can feed him/ herself.
   • Minimize distractions if the child loses interest easily.
   • Stay with the child through the meal.
   • Family meals: 
     • Sit as a family
     • Child may eat more seeing how parents eat
     • Parents can set a good example by eating healthy foods
     • Feed child from a separate bowl, so you can see how much he eats
10. Encourage children to drink and eat during illness and provide extra food after illness to help them recover quickly.
    • Feeding child while ill:
      • Encourage child to eat and drink with lots of patience
      • Offer foods the child likes
      • Feed small amounts frequently
      • Give a variety of nutrient rich foods
      • Continue to breastfeed- often ill children breastfeed more frequently
    • Feeding during recovery:
      • Give extra breastfeeds
      • Feed an extra meal each day
      • Give extra amount with meals
      • Use extra rich foods 
      • Feed with extra patience and love
    • Feeding low birth weight babies (less than 2,500 grams).
      • All low birth weight babies should be encouraged to have skin to skin contact (kangaroo care). Baby can stay warm and be close to breastfeed by snuggling between mom’s breasts and under her clothes.
      • For all babies, but especially low birth weight babies, try to breastfeed within two hours if possible.
      • If baby is too young to breastfeed, mom should try to express breastmilk within 6 hours of delivery, if possible, to get her milk supply going.
      • A premature baby born <30 weeks gestation will most likely receive expressed breast milk by tube in the hospital under expert care.
      • A premature baby 30-32 weeks gestation can usually take feeds of expressed breast milk from a cup or spoon.  This is important for baby to have the experience of expecting food by mouth, so that he is ready to breastfeed when old enough.
      • A premature baby >32 weeks gestation usually can start suckling from the breast.  A baby this young, though able to suckle, needs lots of time to learn how to coordinate sucking, swallowing, and breathing. He may take 4 or 5 sucks then pause for up to 5 minutes. Be patient, knowing it will take longer than normal to feed a young baby.
    • The following food preparation guidelines reduce the risk of infection:
      • Wash hands with soap and water: after using the toilet or cleaning the baby’s bottom, before preparing or serving food, before feeding children or eating, and after handling raw meat or other contaminated foods.
      • Clean utensils immediately after using with soap and water and keep covered.
      • Separate raw and cooked foods. 
      • Cook meat thoroughly.
      • Complimentary foods should be served within one hour of being prepared.
      • Do not use bottles. They are difficult to clean, causing bacteria to build up and making baby sick. If baby needs expressed breast milk or formula, use cup feeds.
      • Drinking water should come to a rolling boil to be clean enough to give to baby. Afterwards cooled water needs to be stored in a covered container with a narrow opening so that nothing can be dipped into it. If not used within 2 days, don’t give to children under 2 years of age. May use for older children or adults instead.

Helpful Resources:

Here is comprehensive, but useful Malawi specific guide for addressing nutrition needs in Africa. Annex 1-1 gives specific suggestions for nutrition with food that is available in Malawi.

Here is the document on complimentary feeds that can be printed out. This was prepared directly from World Health Organization. Combined course on growth assessment and IYCF counselling. Geneva, WHO, 2012