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9107 This work is published under Attribution-NonCommercial-ShareAlike 4.0 International License
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
9108
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
9109
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 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:
9110
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
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:
9111
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
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)
9112
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
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
9113
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
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.
9114
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
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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