1. Complementary feeding Complementary food is any food locally prepared or manufactured, suitable as a complement to mothers milk after it is insufficient to satisfy nutritional requirements of the infant after 6 mths of age

2. Weaning vs complementary food Home made food to be emphasized Avoid use of word Weaning as it almost implies that we advise to discontinue BF Reinforce the need to continue BF in addition to CF Emphasize the need to start CF after completion of 6 months

3. Why 6 months Energy gap at 6 mths 70% of cals and 80% proteins are provided by breast milk At 9 mths 50% cals and 60% proteins At 12-24 mths 30% cals and 40% proteins By 6 months voluntary control of sucking swallowing is achieved and child doesnt push solids out of the mouth Pancreatic enzymes are fully matured. By 9 months child can use lips to clear a spoon and use spoon to move food between teeth

4. When complementary foods are introduced too late …… Nutrition suffers Growth & development slows downs or stops Risk of deficiencies – iron, vit A,Vit C Increase risk of diarrhoea, pneumonia due to malnutrition 60 % of Under 5 deaths occur in malnourished children

5. What to introduce ? Family food always First food - staple – rice / wheat / maize/ ragi/ corn - Starch – potato - Fruits- banana /chickoo/sitaphal - Vegetables – green leafy, peas, beans - Amylase rich flour- can be added to staple

6. Proteins Legumes:Matki Dals: Moong, Masoor Nuts: Almonds Dairy items : Butter, Paneer Balanced Diet Staple Cereals: Wheat, Rice Millets: Ragi, Bajra Energy JaggeryButter SugarPaneer GheeOil Cheese Vitamins & Minerals Fruits &Vegetables Breastmilk

7. Foods to enrich staple Oil, butter, ghee Pulses – use in ratio of 1:3 Coconut, groundnut No sugary drinks – soda, coffee, tea… Use spoon & katori but never BOTTLE Consistency of food – should be like ghee which stays easily on spoon without running off when tilted. Later foods – meat, poultry, eggs if consumed by family Mash food with hand and not mixer Avoid dal water,thin soups

8. Responsive feeding Practice responsive feeding- by giving help and encouragement to the child & by feeding slowly and patiently and by experimenting with diff. foods, taste, combinations & textures. Minimize distractions Use plenty of smiles, eye contact and encouraging words so that feeding becomes a time for learning and love Dont force feed

9. Hygiene & Sanitation Store food safely Use fresh foods if possible Use within 2 hrs if unrefrigerated Wash and clean hand and utensils before preparing food and feeding Avoid Feeding BOTTLES Kitchen garden

10. Frequency of feeding Energy needs from CF are - 200kcal /day at 6-8 months - 300kcal/day 9-11 months - 350kcal/day 12- 23 months 6 – 8 months feed 2-3 times a day 9- 24 months feed 3-4 times a day Nutritious snack can be given 1-2 times /day Continue breastfeeding till minimum 2 years

11. Consistency and Variety Begin with soft foods, but child learns to chew by 8 months By 8 months give them finger foods By 12 months they can eat all of family food from family pot cut into small bits and softened if needed. By 12 months the child is able to eat ½ of what an adult eats

12. Disadvantages of processed complementary foods (tinned food, biscuits, bread etc) Main food may be starch & sugar May be deficient in micronutrients Colour & preservatives are added Bacterial contamination COST

13. Feeding the child who is ill Encourage the child to eat and drink with lot of patience Feed small amounts frequently Give foods that the child likes Give variety of nutrient rich foods Continue to breast feed

14. Feeding during recovery EXTRA Meal EXTRA amount of food EXTRA rich food EXTRA patience while feeding EXTRA breast feeds EXTRA love EXTRA duration for at least 2 weeks after illness