Complementary Feeding - Introduction

What is complementary feeding?

Complementary feeding means giving other foods in addition to breast milk. During the period of complementary feeding, a baby gradually becomes accustomed to eating family foods.

Why are complementary foods needed? 

As a baby grows and becomes more active, an age is reached when breast milk alone is not sufficient to meet the child's nutritional needs. So complementary foods are then needed to fill the gap between the total nutritional needs of the child and the amounts provided by breast milk.

When should complementary foods be started?

Complementary foods should be started when the baby can no - longer get enough energy and nutrients from breast milk alone.

Signs that a child is ready to start complementary foods are that the child: 

- is at least 4 months old and 

- receives frequent breastfeeds but appears hungry soon after or 

- is not gaining weight adequately.  

Giving complementary foods too soon is dangerous because: 

- a child does not need these foods yet, and they may displace breast milk. If foods are given, the child takes less breast milk, and the mother produces less, so later, it may be more difficult to meet the child's nutritional needs 

- a child receives less of the protective factors in breast milk, so the risk of illness increases 

- the risk of diarrhoea also increases because complementary foods may not be as clean as breast milk 

- the foods given instead of breast milk are often thin, watery porridges or soups because these are easy for babies to eat. These foods fill the stomach but provide fewer nutrients than breast milk, and so the child's needs are not met 

- mothers are at greater risk of becoming pregnant if they breastfeed less frequently. 

Starting complementary feeding too late is also dangerous because: 

- a child does not get the extra food needed to fill the energy and nutrient gaps 

- a child stops growing, or grows slowly 

- the risk of malnutrition and micronutrient deficiencies increases. 

WHO recommends that infants start receiving complementary foods at 6 months of age in addition to breast milk:

• 2-3 times a day between 6-8 months
• 3-4 times daily between 9-11 months 
• 3-4 times daily between 12-24 months with additional nutritious snacks offered 1-2 times per day

What are good complementary foods? 

Good complementary foods are: 

- rich in energy, protein and micronutrients (particularly iron, zinc, calcium, vitamin A, vitamin C and folate) 

- clean and safe: 

     no pathogens (i.e. no disease-causing bacteria or other harmful organisms) 

     no harmful chemicals or toxins 

     no bones or hard bits that may choke a child 

     not boiling hot 
- not too peppery or salty 
- easy for the child to eat 
- liked by the child 
- locally available and affordable 
- easy to prepare

Which mixtures of foods make good meals?
When discussing which mixtures of foods make good meals, it is helpful to start with the local staple and then decide which other foods to add.
- The staple
     cereals: rice, corn (maize), wheat, millet, siirghum, quinoa
     roots: cassava, yam, taro, cocoyam, sweet potato, potato
     starchy fruits: cooking banana, breadfruit, plantain
- Pulses and oil seeds
     low fat pulses: chick pea, pigeon pea, lentils, lablab, cowpea, blackeye pea, red bean, broad bean, mung bean, navy bean, lima bean, tarwi
     high fat pulses and oil seeds: peanut, bambarra, soybean, pumpkin seed
sunflower seed, melon seed, sesame, cashew nut, pine kernels
- Foods from animals
     beef, lamb, rabbit, kidney/liver, chicken, insects, duck, fish
     foods from milk: whole milk, skimmed milk, cheese, yoghurt, curds
     hen's eggs
- Dark-green leaves and orange-coloured fruits and vegetables
- Oils, fats and sugar
     fats: margarine, butter, fat from meat
     oils: soy oil, coconut oil, sunflower oil, peanut oil, olive oil, coconut cream, corn oil, palm oil, sesame oil

Source: WHO

Newborn Reflexes

MORO REFLEX (ALSO CALLED STARTLE REFLEX)

• Trigger: While some babies sometimes startle for no apparent reason, usually it’s in response to a loud noise, a sudden movement or the sensation of falling (say, when you put your little one down in his bassinet without enough support).
• Response: He’ll tighten his body, fling his arms up and out and open up his usually tightly clenched fists, draw up his knees and then bring his arms and re-clenched fists close to his body — almost as if he’s giving himself a hug. Seconds later, as abruptly as the startle started, it’s over.
• Reason: Baby’s first attempt to protect himself from harm.
• When does the startle relex start? It's present from birth.
• When does the startle reflex go away? By the time your baby’s about 6 weeks old, he’ll acclimate to life on the outside and feel more secure in his surroundings (thanks to you). His startle reflex will decrease and ultimately disappear when baby is 4 to 6 months old. In the meantime, don’t sweat the startles — but do try to offer your infant lots of extra support when you’re toting him from one place to another. 
• If baby startles himself awake: Try swaddling him to make him feel more secure.
• What does there mean if there's no startle reflex? Abnormalities in the moro reflex are usually discovered by your baby's doctor. But if you notice a change between visits, you should contact your pediatrician immediately. If your baby doesn't react, it could mean damage to his brain or spinal cord or another injury. Only your pediatrician will be able to perform the test to find out what's going on.

ROOT REFLEX

• Trigger: A gentle stroke on the newborn’s cheek
• Response: Baby turns toward the touch, with mouth open
• How long does the root reflex last? Appears at birth and lasts until baby is 3 to 4 months old (sometimes, babies continue doing this in their sleep past 4 months old)
• Reason: Helps baby find food

SUCK REFLEX

• Trigger: Something, such as a nipple (breast or bottle) or parent’s finger, touching roof of baby’s mouth
• Response: Baby sucks on nipple
• How long does the suck reflex last? Appears at birth and lasts until baby is 2 to 4 months old
• Reason: Helps baby eat

BABINSKI’S REFLEX

• Trigger: A gentle stroke on the sole of the foot (from heel to toe)
• Response: Foot turns in and toes flare up
• How long foes the Babinski's reflex last? Appears at birth and lasts until baby is 6 to 24 months old
• Reason: Perhaps an attempt to protect against falling

WALKING (OR STEPPING) REFLEX

• Trigger: Holding baby upright with his feet on a flat surface
• Response: Baby lifts one foot, then the other, as if walking
• How long does the steipping reflex last? Appears at birth and lasts until baby is 2 months old
• Reason: May prepare baby developmentally for walking several months from now

TONIC NECK REFLEX

• Trigger: Lying on his back with head turned to one side
• Response: The arm on that side extends, while the opposite arm bends at the elbow (a “fencing” position)
• How long does the tonic reflex last? Appears some time between birth and when baby is 2 months old and lasts until baby is 4 to 6 months old
• Reason: May prepare baby developmentally for voluntary reaching later

GRASP (OR PALMAR GRASP) REFLEX

• Trigger: Pressing a finger or other object, such as a rattle, into baby’s palm
• Response: Baby makes a fist and tries to grab finger or object
• How long does the grasp reflex last? Appears at birth and lasts until baby is 3 to 6 months old
• Reason: May prepare baby developmentally for voluntary grasping later
• Fun fact: Baby’s grip can be strong enough to support his entire body weight (but no need to test this out)

Source: whattoexpect.com

USA Trip - New York City

Kami berangkat dari Pittsburgh jam 12 tengah malem. New York City berada di area east coast Amerika. Dari Pittsburgh kami jalan ke arah timur, crossing Appalachian Mountains. Appalachian Mountain ini kalo dilihat dari googlemap, morfologinya terlihat memanjang dan katanya merupakan fold-thrust belt. Sebelum berangkat, saya sempet searching foto-foto outcrop di roadcut Appalachian Mountain. Sayangnya kami melewati Appalachian Mountain malam hari, gak keliatan apa-apa, selain kami juga memang tidur di bus. Dan sebenernya saya gak tau persis juga foto-foto yang saya lihat itu berada di jalur yang kami lewati atau di bagian lain dari jalur memanjang Appalachian Mountain.

Saya terbangun bener-bener ketika udah hampir sampe terminal bis di New York. Bisa berkunjung ke kota ini berasa kayak mimpi. Berkali-kali saya nyubit tangan saya sendiri sebelum bangunin Maisi :P. Sekarang saya menginjakkan kaki di kota ini, the Big Apple, yang sebelumnya cuma saya liat di TV, di internet atau saya dengerin lagunya Frank Sinatra dan menebak-nebak kota yang gak pernah tidur ini kayak gimana, hehe.

Kami sampai di Port Authority terminal bus New York tepat pukul enam pagi. Langit masih agak gelap, berkabut, dan udaranya cukup dingin, mirip pagi-pagi di Lembang tanpa matahari. Terminalnya ada di basement, jadi kami harus naik ke atas lewat eskalator untuk sampai di jalan raya. Sepagi ini jalanan udah rame (atau masih rame?). Target tempat yang pengen saya kunjungin disini adalah Times Square, Central Park, Rockefeller Center atau Empire State Building, dan Liberty Statue. Dari terminal Port Authority kami jalan menuju Central Park ngelewatin West 42nd st., 7th ave., Broadway (dan Times Square tentunya!) sampai ke Colombus Circle. Udaranya dingin, suhunya mungkin gak terlalu rendah, tapi anginnya yang lumayan kenceng bikin udara terasa lebih dingin. Waktu kami sampai di Times Square langit masih agak gelap. Yeeeay, akhirnya saya liat langsung layar-layar besar di Times Square!, hahaha. Di jalan terlihat ada sisa-sisa panggung yang lagi di beresin. 

Port Authority --> Times Square

Port Authority --> Times Square

Port Authority --> Times Square

Port Authority --> Times Square

Port Authority --> Times Square

Port Authority --> Times Square

Port Authority --> Times Square

Port Authority --> Times Square

Times Square!

Times Square!

Times Square!

Sampai di Colombus Circle kami nyebrang menuju depan pintu masuk Central Park, foto foto di depan U.S.S Maine Monument lalu nyebrang ngelewatin Trump International Hotel and Tower New York menuju Starbucks di simpang Broadway - West 60th st. Di Starbucks saya beli vanilla latte sama lemon cake. Pas lagi antri saya liat ada Starbucks card, gambarnya macem-macem, kebanyakan sih skyline New York, dan bagus-bagus!. Di Starbucks card ini bisa dideposit sejumlah uang, jadi kalo beli sesuatu di Starbucks tinggal gesek dan bisa dapet point-point yang nanti bisa dituker sama minuman gratis. Saya ragu-ragu antara beli atau nggak, pengen tapi masih mikir-mikir takutnya kartunya gak kepake, karena di Indonesia belum ada Starbucks card waktu itu. Akhirnya saya gak jadi beli (dan berujung penyesalan! padahal toh bisa disimpen aja buat koleksi atau buat pamer, ahahaha). Mel sempet ngeline saya, nitip beli tumbler Starbucks yang ada tulisan atau gambar Pittsburgh atau apa aja yang cuma ada disini tumblernya. Saya gak sempet ke Starbucks lagi di Pittsburgh, jadi saya nyari di Starbucks di New York, tapi tetep gak nemu tumblernya, adanya mug bergambar skyline New York. Karena pesennya tumbler, jadi saya bertekad untuk nyoba nyari lagi nanti di airport Pittsburgh atau Houston sebelum balik ke Indonesia, hehe.

Colombus Circle, ditengahnya ada patung Colombus (yaiyalah!, hahaha)

U.S.S Maine Monument

U.S.S Maine Monument

U.S.S Maine Monument

Di depan U.S.S Maine Monument, pintu barat Central Park.

Globe di depan Trump International Hotel and Tower New York

Karena gak dapet tempat duduk di Starbucks, akhirnya kami bawa sarapannya ke Central Park. Duduk-duduk di bangku taman sambil sarapan. Terlihat beberapa orang jalan pagi bareng sama anjingnya. Ada juga yang jogging atau bersepeda. Aril sempet kena tegur orang karena ngerokok, orang itu bilang disini gak boleh ngerokok. Temen saya Bari berhenti merokok pas dia start sekolah di New Jersey, awalnya dia bilang karena disini rokok mahal banget. Harga rokok disini 10 kali lipat harga rokok di Indonesia. Peraturannya pun lebih ketat tentang batas umur orang yang bisa beli rokok dan tempat-tempat dimana dilarang merokok. 

Bangku-bangku taman banyak berderet di tepi jalan beraspal. Saya sempet lihat ada dua orang tunawisma masih tidur dibangku taman. Selesai sarapan kami jalan sambil foto-foto, ketemu jembatan lalu ketemu outcrop di deket taman bermain. Outcrop yang namanya Rat Rock atau Umpire Rock ini ternyata adalah schist dari Manhattan Formation yang berumur Ordovician, sekitar 450 juta tahun yang lalu. Senangnya bisa ketemu schist outcrop di tengah kota ini, yang sebelumnya batuan serupa saya pernah lihat di Karangsambung 5 tahun lalu. How lucky i am! haha!.

Sarapan Starbucks di Central Park (asek! hahaha)

Central Park

Central Park

Central Park

Central Park

Central Park

Central Park

Central Park

Central Park

Central Park

Rat Rock!. Saya pernah baca blog seorang geologist di Amerika, Steven Schimmrich, dia bilang di Rat Rock ini ada jejak glaciers dari ice age 18000 tahun yang lalu. Barangkali ini mirip atau setidaknya sisi lain dari foto jejak glaciers yang dimaksud, hehe.

Central Park

Di Central Park kami gak lama, gak sempet ke Jacqueline Kennedy Onassis Reservoir di tengah Central Park karena kejauhan. Dari Central Park kami jalan menuju Rockefeller Center. Rockefeller Center ini punya observation deck, sama halnya dengan Empire State Building. Namanya Top of the Rock observation deck. Saya memilih untuk ke Rockefeller Center, dengan begitu saya bisa dapet view Empire State Building nya. Saya kelupaan untuk beli tiket sehari sebelumnya seperti saran Bari. Akhirnya saya memutuskan untuk beli langsung disana, walaupun gak tau boleh atau nggak. Sampai kami tiba di depan Rockefeller Center langit masih mendung dan berkabut. Kami nanya orang yang jaga di depan pintu masuknya, ternyata boleh beli langsung disitu, tapi dia tidak menyarankan untuk naik saat itu karena cuaca yang kurang bagus, jadinya gak akan bisa liat apa-apa. Aaaaaaaaak!. Temen-temen saya jadinya pada gak mau diajak ke atas. Dilema, udah kebawa mimpi ini naek ke observation deck, tapi kalo maksain malah kecewa udah keluar USD 27 tapi gak bisa liat apa-apa. Akhirnya saya ngalah, ngikut aja anak-anak mau kemana. 

Central Park --> Rockefeller Center

Central Park --> Rockefeller Center

Central Park --> Rockefeller Center

Central Park --> Rockefeller Center

Ade, LOVE sign NYC (Central Park --> Rockefeller Center)

Chesa, LOVE sign NYC (Central Park --> Rockefeller Center)

Maisi, LOVE sign NYC (Central Park --> Rockefeller Center)

LOVE sign NYC (Central Park --> Rockefeller Center)

Central Park --> Rockefeller Center

Temen-temen saya pada beli mini poster ini (Central Park --> Rockefeller Center)

Berkabut :( (Central Park --> Rockefeller Center)

Di depan pintu masuknya Rockefeller Center Observation Deck.

Top of the Rock Observation Deck, Rockefeller Center

Kalo gak berkabut harusnya bisa liat ini dari Observation Deck nya (foto dari sini)

Radio City Music Hall di seberang Rockefeller Center

Kami naik subway dari stasiun dekat Rockefeller Center menuju South Ferry Station. Tiketnya USD 2,5 sekali jalan kalo gak salah. Rencananya kami mau ke Battery Park, taman di ujung lower Manhattan, berharap dari taman itu Liberty Statue nya terlihat cukup jelas. Gak sah kalo belum foto dengan background Liberty Statue, hehe. Keluar dari stasiun subway ada yang nawarin buat naik ferry. Kami bayar USD 19 per orang, lalu naik ferry buat liat-liat Liberty Statue, Ellis Island, Brooklyn Bridge dan Manhattan Bridge. Buat short trip, alternatif keliling naik ferry ini lumayan menghemat waktu, dibanding naik ferry dan turun di Liberty Islandnya.

Di dalam subway menuju South Ferry Station

Staten Island Ferry

Staten Island Ferry

Pak Ismail, yang nawarin tiket ferry. Bayarnya bisa cash atau pake debit/credit card.

Battery Maritime Building. Kapalnya dibalik gedung ini.

Foto sebelum masuk antrian.

Antrian sebelum naik ferry. Difoto per group, tapi sampe pulang saya gak tau fotonya diambil dimana, hahaha.

Kapal yang kami naiki.

Battery Maritime Building

Sebelum kapalnya jalan.

U.S. Coast Guard

Colgate Clock di New Jersey.

Central Railroad of New Jersey Terminal

Ellis Island

Saaaaah.. XD

Saaaaah.. XD

Saaaaah.. XD

Saaaaah.. XD

Brooklyn Bridge

Manhattan Bridge

Turun dari kapal kami langsung jalan menuju South Ferry station lagi. Tadinya sempet mikir buat balik lagi ke Rockefeller Center, tapi dengan berbagai pertimbangan akhirnya kami memutuskan untuk turun di Times Sq.- 42 st station. Saya, Chesa dan Maisi ke Madame Tussauds, sedangkan Aril dan Ade pergi cari oleh-oleh sekalian makan siang. Kami beli tiket Madame Tussauds langsung disana seharga USD 36. Sebenernya bisa lebih murah kalau beli tiketnya online beberapa hari sebelumnya. Tapi kunjungan ke Madame Tussauds ini memang di luar rencana, kami kesini karena batal ke observation deck Rockefeller Center. Setelah puas foto-foto di Madame Tussauds, Chesa nyusul Aril dan Ade makan di McD persis sebelah Madame Tussauds, sedangkan saya dan Maisi muter-muter cari-cari souvenir di sekitar W 42 st. Kalau cari souvenir disini saya sarankan jangan langsung beli ketika nemu barang yang disukai, cari dan cek dulu ke toko-toko disekitarnya. Saya beli magnet kulkas yang sama, harganya  USD 7,5 di satu toko dan USD 4 di toko sebelahnya :(. Barang-barang lain juga, sebaiknya dibanding-bandingin dulu harganya. Btw, beli souvenir disini kalau mikir dirupiahkan pasti jadi urung beli, hahaha. Beli magnet kulkas harganya sekitar USD 4-9 per item, gantungan kunci USD 2-7, piring pajangan minimal harganya USD 16, t-shirt (dengan kualitas yang lebih jelek dibanding kaos yang saya beli di Westin Pittsburgh) minimal harganya USD 10. Sebagian souvenir saya beli di terminal Port Authority sebelum balik ke Pittsburgh. Harganya lebih murah, tapi tentunya gak lebih bagus, yang penting ada tulisan New York nya, hehehe.

Subway South Ferry --> Times Sq-42 st

Subway South Ferry --> Times Sq-42 st. Abang-abang sebelahnya Ade yang kami mintain tolong buat foto. Dia senyam senyum dengerin kami ngomongin rambutnya, curiga dia ngerti kami ngomongin apa, karena sebelum dia turun tiba-tiba dia bilang adeknya pernah tinggal di Indonesia, hahaha.

Subway South Ferry --> Times Sq-42 st

W 42 st

W 42 st

Madame Tussauds New York!

Dwayne Johnson (Madame Tussauds New York)

Madame Tussauds New York

Gorilla (Madame Tussauds New York)

W 42 st dari lantai 2 Madame Tussauds New York

W 42 st dari lantai 2 Madame Tussauds New York

Brad Pitt (Madame Tussauds New York)

Nicolas Cage (Madame Tussauds New York)

Julia Roberts (Madame Tussauds New York)

Ozzy and Sharon Osbourne (Madame Tussauds New York)

Jennifer Aniston (Madame Tussauds New York)

Johnny Depp (Madame Tussauds New York)

Robert Pattinson (Madame Tussauds New York)

Daniel Craig as James Bond (Madame Tussauds New York)

Duke William and Duchess Catherine of Cambridge (Madame Tussauds New York)

Princess Diana (Madame Tussauds New York)

President of United States (Madame Tussauds New York)

Barrack and Michelle Obama (Madame Tussauds New York)

We are the people of the United States (Madame Tussauds New York)

Oprah Winfrey (Madame Tussauds New York)

(Madame Tussauds New York)

Charlie Chaplin (Madame Tussauds New York)

Dalai Lama (Madame Tussauds New York)

Mahatma Gandhi (Madame Tussauds New York)

Albert Einstein (Madame Tussauds New York)

Pablo Picasso (Madame Tussauds New York)

Salvador Dali (Madame Tussauds New York)

James Brown (Madame Tussauds New York)

Louis Armstrong (Madame Tussauds New York)

Duke Ellington (Madame Tussauds New York)

Bob Marley (Madame Tussauds New York)

Stevie Wonder (Madame Tussauds New York)

Woody Allen (Madame Tussauds New York)

Marilyn Monroe (Madame Tussauds New York)

Liberty Statue (Madame Tussauds New York)

Elvis Presley (Madame Tussauds New York)

Elton John (Madame Tussauds New York)

The Beatles! (Madame Tussauds New York)

Mark Spitz (Madame Tussauds New York)

Tina Turner (Madame Tussauds New York)

Jon Bon Jovi (Madame Tussauds New York)

(Madame Tussauds New York)

Yellow Cab (Madame Tussauds New York)

The New York Times, 8th ave

Port Authority Bus Terminal, 8th ave

Pukul 3 sore kami sudah di Port Authority. Saya sama Maisi beli makan di kantin. Saya beli nasi goreng (gak ada rasanya!) sama semacam semur daging sapi berpaprika seharga USD 8. Jam menujukkan pukul 4 waktu bus mulai jalan meninggalkan Port Authority. Di luar masih terang jadi masih sempet liat-liat waktu kami lewat New Jersey dan Philadelphia. Kami transit setengah jam di Philadelphia untuk beristirahat sebelum melanjutkan perjalanan ke Pittsburgh. 

New York --> Philadelphia

Philadelphia

Philadelphia

Philadelphia

Philadelphia City Hall

Philadelphia

Tepat pukul 12 tengah malam kami tiba di Pittsburgh disambut hujan deras. Untungnya dari terminal ke hotel tidak terlalu jauh. Akhirnya kami memutuskan untuk lari nerobos hujan menuju hotel. Alhamdulillaah, walaupun basah kuyup kami akhirnya sampai di kamar hotel, dan segera beresin barang-barang yang belum dipacking sebelum pergi tidur dan besok  siangnya pulang ke Indonesia. 
Selamat malam! :)

Photo courtesy of: Bachesha W., Maisi A.R., Risca M.S.