COMPLEMENTARY FEEDING

COMPLEMENTARY FEEDING

The term weaning means “to be taken off the breasts” or “introduction of top feed”. The latter meaning is more relevant in infant nutrition. Though in vogue for several decades, the “wearing” is an inappropriate  terminology. The better terminology is complementary feeding.

Definition

By definition, complimentary feeding means introduction of nutritious foods over and above breastfeeding. These energy dense food should be cost-cost effective, affordable, easily available and well tolerated.

Recommended age

Just after six months of age is the most appropriate time for introducing complementary feeding. The whole process should be gradually completed by 9 months to 1 year of age when the child should be taking almost the adult diet.

Whereas delayed introduction of complementary foods is known to cause malnutrition and growth retardation, premature introduction of such foods exposes to the risk of infection and the resultant morbidity and mortality.

Besides infections, too early introduction of complimentary feeds, including cow milk, or buffalo milk has other problems as follows

Problem associated with too early initiation of complementary feeds

Short term

1. Decreased suckling frequently and intensity, leading to decreased milk production.
2. Iron deficiency unless cereal preparations used are rich in iron
3. Hypernatremia
4. Weaning diarrhea

Long term

1. Malnutrition in the poor
2. Obesity in the affluent
3. Hypertension
4. Arteriosclerosis

It is not recommended under special circumstances such as when the mother is not able to produce sufficient milk despite the best of efforts.

Prerequisites/Attributes of an Ideal Complementary Food

Home-made / available : These foods are fresh, easily available, economical and provide exposure to variety.  Home available readymade foods e.g. biscuits, bread, pastry, etc, come in handy at odd times.

Fresh and hygienic: Food must be freshly and hygienically prepared, avoiding prolonged storage.

Palatable : Soft, easy to eat and tasty

Cost-effective /affordable: The foods should be in keeping with the socioeconomic status of the family.

Culturally acceptable: It is preferable to employ available food and culturally acceptable foods normally taken by the family with appropriate modification.

Energy dense: Food can be made energy dense by adding oils and fat. In addition, such an addition increase palatability of food, provides essential fatty micronutrients. Amylase-rich foods can be prepared by germinating cereal flours. Spouting increases the vitamin B content. Malting increases the digestibility and vitamin (riboflavin and niacin) and iron content.

Types of complementary foods used by the community

Appropriate (first line) weaning food

Fresh home-made, locally available, culturally acceptable, hygienically prepared, energy dense and cost effective foods like.

1. Combination of cereals and pulses
2. Mashed banana, sweet potato and potato
3. Milk added to cereals preparations.
4. Sprouted legumes, nuts, dry fruits etc. depending upon the affordability

Acceptable (second line) weaning foods

These includes home available food like

1. Breads, cakes, pastry, biscuits, cheese, ice cream, etc.
2. Caloric dense fruits etc.

Avoidable (third line) weaning foods

1. Commercially available artificial foods or tinned foods.
2. Fast food or junk food
3. Low caloric fruits juices, soups.
4. Repeatedly fried foods containing trans fatty acids(which predispose to obesity, atherosclerosis, cardiac and neurological problems in future life)

Complementary feeding regimen

To begin, with one of the foods like mashed ripe banana, mashed potato a cereal, curd, pulses, khichri, dalia etc. should be introduced the form of a soft porridge when the child is just beyond 6 months of age. The food should be given in small amount(say 2-3 tablespoonfuls). The moment can be built up slowly. Likewise, frequency too is increased from twice a day to 3 or 4 times a day by the fagend of the first year. Every one or two weeks, a new food may be added. If the child does not like a particular food, this may be omitted for the time being. A one year old should be taking the family food which, if need be may be mashed or chopped. Germinated cereal floor or pulse floor is an amylase rich food(ARF) and is able to dramatically reduce the viscosity of high dietary porridges. It makes an excellent weaning food. Fish, egg, meat, etc. should be introduced later in view of the possible risk of allergy to proteins. In case of egg, begin with the “yolk”. Addition of animal protein makes up for the deficiency of limiting amino acid, methionine, which may be seen in infants exclusively on a staple cereal and a legume. Staple cereal as such is deficient in lysine but this deficiency is made up when legumes are concurrently.