Feeding Advice For Infants

Patient Education

After 6 months of age, it becomes increasingly difficult for breastfed infants to meet their nutrient needs from human milk alone. Furthermore, most infants are developmentally ready for other foods at about 6 months. At about 6 months of age, an infant is also developmentally ready for other foods. The digestive system is mature enough to digest the starch, protein, and fat in a non-milk diet. Very young infants push foods out with their tongue, but by between 6 and 9 months infants can receive and hold semi-solid food in their mouths more easily. Thus, 6 months is the recommended appropriate age at which to introduce complementary foods.

During the period of complementary feeding, children are at high risk of undernutrition. Complementary foods are often of inadequate nutritional quality, or they are given too early or too late, in too small amounts, or not frequently enough. Premature cessation or low frequency of breastfeeding also contributes to insufficient nutrient and energy intake in infants beyond 6 months of age. Therefore, certain principles must be followed while introducing complementary foods so as to allow adequate growth and development of the infant.

1. Continue frequent on-demand breastfeeding until 2 years of age or beyond Breastfeeding should continue with complementary feeding up to 2 years of age or beyond, and it should be on-demand, as often as the child wants.

   Breast milk can provide one half or more of a child’s energy needs between 6 and 12 months of age and one-third of energy needs and other high-quality nutrients between 12 and 24 months. Breast milk continues to provide higher quality nutrients than complementary foods, and also protective factors.

   Breast milk is a critical source of energy and nutrients during illness. In addition, breastfeeding reduces the risk of a number of acute and chronic diseases. Children tend to breastfeed less often when complementary foods are introduced, so breastfeeding needs to be actively encouraged to sustain breast-milk intake.

2. Practise responsive feeding
   • Feed infants directly and assist older children when they feed themselves. Feed slowly and patiently, and encourage children to eat, but do not force them.
   • If children refuse many foods, experiment with different food combinations, tastes, textures and methods of encouragement.
   • Minimize distractions during meals if the child loses interest easily.
   • Remember that feeding times are periods of learning and love
   • talk to children during feeding, with eye-to-eye contact.
   • A child should have his or her own plate or bowl so that the caregiver knows if the child is getting enough food. A utensil such as a spoon, or just a clean hand, may be used to feed a child.
3. Practise good hygiene and proper food handling Microbial contamination of complementary foods is a major cause of diarrhoeal disease, which is particularly common in children 6 to 12 months old.
   • Safe preparation and storage of complementary foods can prevent contamination and reduce the risk of diarrhea.
   • The use of bottles with teats to feed liquids is more likely to result in the transmission of infection than the use of cups and should be avoided.
   • All utensils, such as cups, bowls and spoons, used for an infant or young child’s food should be washed thoroughly.
   • It is important for both the caregiver’s and the child’s hands to be washed thoroughly before eating.
   • When food cannot be refrigerated it should be eaten soon after it has been prepared (no more than 2 hours) before bacteria have time to multiply
4. Start at 6 months of age with small amounts of food and increase the quantity as the child gets older, while maintaining frequent breastfeeding
   • 6-8 months - Start with thick porridge or well-mashed foods, 2-3 meals per day, 2-3 tablespoonfuls per feed, increasing gradually to ½ of a 250 ml cup, 1-2 snacks may be offered
   • 9-11 months-Finely chopped or mashed foods, and foods that baby can pick up, 3-4 meals per day, ½ of a 250 ml cup/bowl
   • 12-23 months- Family foods, 3-4 meals per day, ¾ to full 250 ml cup/bowl
5. Gradually increase food consistency and variety as the infant grows older, adapting to the infant’s requirements and abilities

   Beginning at 6 months, an infant can eat pureed, mashed or semi-solid foods. By 8 months most infants can also eat finger foods. By 12 months, most children can eat the same types of foods as consumed by the rest of the family. Foods that can cause choking, such as whole peanuts, should be avoided.

   Complimentary food should be thick enough so that it stays on a spoon and does not drip off. Generally, foods that are thicker or more solid are more energy- and nutrient-dense than thin, watery or soft foods. The introduction of lumpy foods should not be delayed beyond 10 months.

6. Feed a variety of nutrient-rich foods to ensure that all nutrient needs are met
   • The basic ingredient of complementary foods are staples like cereals, roots and starchy fruits that consist mainly of carbohydrate and provide energy.
   • Foods from animals or fish are good sources of protein, iron and zinc. The liver also provides vitamin A and folate. Egg yolk is a good source of protein and vitamin A, but not of iron. A child needs a solid part of these foods, not just the watery sauce.
   • Dairy products, such as milk, cheese and yogurt, are useful sources of calcium, protein, energy and B vitamins.
   • Pulses - peas, beans, lentils, peanuts, and soybeans are good sources of protein and some iron. Eating sources of vitamin C (for example, tomatoes, citrus and other fruits, and green leafy vegetables) at the same time helps iron absorption.
   • Orange-coloured fruits and vegetables such as carrot, pumpkin, mango and papaya, and dark-green leaves such as spinach, are rich in carotene, from which vitamin A is made, and also vitamin C.
   • Fats and oils are concentrated sources of energy, and of certain essential fats that children need to grow.Vegetarian (plant-based) complementary foods do not by themselves provide enough iron and zinc to meet all the needs of an infant or young child aged 6-23 months. Animal-source foods that contain enough iron and zinc are needed in addition. Alternatively, fortified foods or supplements can fill some of the critical nutrient gaps.
   • Fats, including oils, are important because they increase the energy density of foods, and make them taste better. Fat should comprise 30-45% of the total energy provided by breast milk and complementary foods together.
   • Sugar is a concentrated source of energy, but it has no other nutrients. It can damage children’s teeth, and lead to overweight and obesity. Sugar and sugary drinks, such as soda, should be avoided because they decrease the child’s appetite for more nutritious foods.
   • Tea and coffee contain compounds that can interfere with iron absorption and are not recommended for young children.