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