Complementary feeding-what to do and what not to do !!

 

Your baby is growing nicely and has reached 5 to 6 months of age. She has started head holding and is sitting with some support. You notice that she makes chewing motions and observes you closely when you are chewing.

This is the right time to introduce complementary feeding. We call it complementary because it is in addition to breast feeding/non-human milk. Remember at this age milk is still the main diet for a growing baby. Complementary feeds are just an addition, a way to introduce new foods to your growing one.

Between 6 to 24 mnths, is a critical period for growth and development especially for brain. Complementary feeding helps to ensure this when breast milk/non-human milk alone cannot suffice the nutritional needs. Any laxity in this will lead to growth failure or poor weight gain and various nutritional deficiencies. From your baby’s perspective, it is an incredible adventure of new tastes, textures and smells. 

You will find loads of advice on this topic as everybody who has a kid has gone through this phase including your mother, mother-in-law and their mothers and aunties and friends around you (We don’t mind giving free advice). But mind you, each baby is different in their preferences and tastes. What might be liked by one baby might not be liked by your baby and vice versa. So you as a parent is the best person to take decisions, instead of blindly following everybody’s advice.

So with already loads of information, what new I can tell on this topic?

Being a pediatrician, I will only try to highlight some basic issues to help you and your baby to a smooth transition taking care of all the nutritional needs as per the current recommended guidelines, keeping in mind that a parent knows what is best for their kid. Here I wont be discussing about various food options (which we can discuss in some other post).

4 pillars of complimentary feeding are:

Timely (right time and frequency), Adequate (right amount), Appropriate (diversity in taste, texture, flavor, color and food groups) and Safe ( hygienic cooking).

1.What is the correct age of introduction of complementary feeding?

As per the current guidelines, the right age is 6 months.

Normal cues to look for readiness of a baby for introduction of solid foods are:

• Able to sit up alone or with support, steady head holding, opens her mouth on seeing food, keeps her tongue low and flat to receive the spoon etc.

Some people advocate starting as early as 4 months, due to some family issues (for e.g. parent has to join back work).

But too early introduction, say 4 months:

• Increases the chances of obesity in later life due to overfeeding.
• Also your baby has not developed suitable motor milestones to adjust to a change in their feeding patterns, thereby leading to serious medical issues like aspirations.
• Their digestive system may not be mature enough to digest solids, and this can lead to digestive problems and a higher risk of developing food allergies.

In contrast, too late introduction of solids ( > 6 months):

• Can affect the oral-motor development in infants, causing feeding difficulties later.
• Furthermore, it also increases malnutrition risks, including stunting.
• Beyond 6 months alone breast feeding/formula milk is not sufficient to meet the nutritional requirements for the growing baby and deficiencies like anemia (most common) might develop. It is not unusual in our practice to see babies being exclusively breast fed/given cows milk only even at 9 to 10 months of ages, coming with severe iron deficiency anemia, some even requiring blood transfusions. Breast feeding/formula milk though can be continued side by side till 2 years of age. Cow’s milk is not advisable before 1 year of age.

So the optimal choice might be somewhere between 5 to 6 months.

2. What precautions are to be observed as a primary caregiver while initiating complementary feeding?

Before moving on to actual feeding, keep in mind certain points for a smooth, risk free transition.

• Personal hygiene/hygienic preparation of food is of utmost importance. Hands should be washed properly before handling food by the parent or the caretaker and before the start of feeding both by the parent and the child.
• Keep your baby’s utensils separate from the rest household. They should be scrubbed properly, washed and dried and kept covered.
• After making the food, it should be handled as less as possible and be covered. Ideally should be consumed fresh, within 1 to 2 hrs of preparation. Any left over food should be discarded and fresh food be prepared for next meal.
• Initial consistency should be runny and should be gradually thickened as baby grows.

• Feed with baby in sitting upright position. A baby should never be fed in lying position as there is always a risk of choking.

• Use soft tipped spoon to decrease chances of injury to the soft tissues inside babies mouth.

3. What are the common mistakes made during introduction of complementary feeds?

A. Force feeding the baby:

Transitioning from breast milk to solid food is difficult for the baby. Babies take time to adjust to a new food especially with consistency so different from milk. Some may even dislike certain food. So all the effort put in by you to prepare a meal exclusively for your baby goes in vain. This might lead to frustration on part of the parent. But here patience is the key. If your baby does not like a particular food, try it reintroducing after a couple of weeks. Chances are that it will be liked. If still not, you can try again ( upto 7 to 8 times) and if the baby says no, she might actually not like that particular food.

B. Introduction of too many foods at same time:

Let your baby develop taste for a particular food and then switch over to a new one. The normal switch over period varies as per different babies, but normally its somewhere between 3 to5 days. This approach will also help you determine if your baby has an allergy to a particular food.

C. Addition of salt to babies diet:

As per the current recommendations, no additional salt is to be added in baby’s food till 9 months to 1 year of age ( preferably). Normal baby’s salt requirement is adequately met by mother’s milk ( I wont go into numbers like sodium levels, as this might not be important). Introduction of salt puts a high solute load (i.e sodium load) on your baby’s kidneys as they are still very tiny and immature and might lead to problems especially hypertension in later life. Don’t worry about the baby feeling the food as bland, as your baby does not know as of yet what is bland. She has no idea…!!

D. Giving biscuits to your baby:

Something which is found in each Indian household and is advocated by everybody is handing a baby, biscuit. But mind you biscuits are a strict no for babies. One because they are made of processed wheat with hundreds of additives and loads of sugar in them ( even the so called healthy ones). The sheer number of harmful ingredients added to a packaged and processed food is alarming (learn label reading Figuring out Food labels;what to eat and what not to eat?). So much so that I wont even advice giving them on a regular basis to your older child also. If you still feel biscuits are an essential part of growing up, try some home made, preservative free ones.

E. Sweetening of foods:

Honey is a strict no till 1 year of age because of that minimal chance of infant botulism, no matter how pure your source might be. Sugar and jaggery might be used but in very minimal quantities. I would instead advice using natural sweeteners like fruits. In this way your baby will also develop a habit of eating fruits in early life.

F. Juices:

Juices in any form should be avoided (tetrapacks are a big no-no and fresh home made juices can be given occasionally in small amounts). Recently we have had guidelines about the same. Instead focus on giving whole fruit to your baby as this will help develop their interest in fruits and when they grow up you will find them gobbling up fruits easily.

G. Use of packaged weaning foods.

You will find lots of packaged foods available in market which are easy to carry, prepare and give and obviously with todays socio economic profile, easily affordable. I am not against these foods but nothing can match a fresh home made healthy meal for your precious one. It might take some time to prepare a meal at home, but it is more nutritious, cost effective, helps build a strong immunity and has loads of your love in it.

While there are many choices available in the market today, be sure to read labels (ingredients and nutrition information panel) carefully and choose wisely. First, look at the age category, texture and the types of complementary foods. Some are single-food based (e.g. cereal-based), while others offer a combination of food groups or are a complete meal on its own and there are some that are suitable as a snack. This check will ensure that your choice is as free of additives as possible (e.g. preservatives, thickening agents, salt, and sugar).

Core messages:

1. Minimum number of times a baby should eat is 2 times per day from 6 to 8 months of age and 3 times per day from 9 to 24 months.
2. Continue frequent on demand breast feeding till 2 years of age.
3. Consistency of food should vary as per age. At 6 months: puree/mash, 7-9 months- lumpy, and beyond 9 months- finger foods. By the end of 1 year, baby should be eating the family meal ( as biting skills develop).
4. Practice responsive feeding (baby led feeding) by responding promptly and on demand to your baby’s signs of hunger or fullness, and by being warm and nurturing while feeding them.
5. Give food with less of sugar, no salt and spices.
6. Encourage home based, freshly cooked food.
7. Choose a time for feeding when baby isn’t tired, is fully alert and hungry and you are not busy, as feeding a baby requires lots of patience. Allow them to make a mess.
8. No distractions like TV, mobiles etc during feeding,

This is a never ending topic and I can go on and on. But in short, I normally follow the WHO recommendations for introduction of solid foods and I am advising this only in my article, but you are free to choose from a wide range of products as per your religion and customs. By implementing good complementary feeding practices with your baby, you will be able to ensure their optimal growth and development, and secure a good start to their future.

In the end, everybody’s aim is a healthy and strong baby with happy parent.

As our motto goes: Healthy kids, happy kids !!

 

Dr Garima| themoppetsclinic 🙂

Sources:

1. Journey of the first 1000 days by National health mission, MoHFW India

(An excellent, easy to read and understand, guide for any parent, starting from conception to first 2 years of child’s life. If you would like a copy of this wonderful write up, do message me directly. I would be more than happy to share it !!)