Importance of Complementary Feeding
From 6 months of age your baby needs breast milk and solid foods to promote health, support growth and enhance development. This is called complementary feeding.
From the age of 6 months a baby needs more energy and nutrients than can be provided by breast milk alone. At this age a baby’s digestive system is mature enough to digest a range of foods.
Complementary feeding is needed to provide energy and essential nutrients required for continued growth and development. The nutrients in recommended complementary foods complement those in breast milk, hence the name. Complement means they go well together, each have a role to play.
The recommended feeding practices during this time ensure that your baby receives all the necessary nutrients, including those that are sometime missing for many babies (iron, zinc and vitamin A). Contrary to popular practice, introducing foods like meat, eggs and liver in the early stages of complementary feeding is recommended, because these foods are good sources of these nutrients.
But breastfeeding still has an important place; breast milk provides about one half of your baby’s energy needs between the ages of 6 and 12 months, and up to a third during the second year of life. In addition, breast milk not only supplies nutrients in a form that is easily absorbed but also contains protective factors that are not available from food or other sources. These protective factors play an important role in the overall health of your baby, as its immune system is still immature and cannot fight all infections.
After about 2 years of age breast milk is replaced entirely by family foods, although a young child may still sometimes suckle for comfort. However, breast milk is still a good source of nutrients to babies in families with food insecurities.
1. At what age should complementary feeding for a baby start?
2. Which nutrients are important during complementary feeding?
3. What should mothers and caregivers do to ensure that their babies get enough energy?
4. Why is iron critical at this age and which foods can supply sufficient iron?
5. Why should complementary feeding ideally start at the age of 6 months?
6. What aspects of complementary feeding have an impact on health, growth and development?
7. Why is continued breastfeeding emphasised?
8. When should the consistency of foods be changed from soft to lumpy to solid?
9. What could happen if a baby does not receive enough meals a day?
10. Should baby food taste bland?
11. What drinks can be given to babies during complementary feeding?
12. What can families do to protect the quality and safety of food for babies?
13. When can a baby start to drink cow’s milk?
14. Are there foods that babies should not eat?
15. What tips do you have for feeding babies who do not seem interested in meal times?
16. What determines whether foods are suitable for complementary feeding?
1. At what age should complementary feeding for a baby start?
Complementary feeding should start when a baby is 6 months old. At this age frequent breastfeeding should continue despite foods being introduced. During the next few months the variety and amount of foods can be increased, while breastfeeding still continues. When a baby is about 12 months old many of its food requirements can be met by family meals, although continued breastfeeding is recommended. Breast milk continues to provide protection against illness and breastfeeding continues to be beneficial. Thus, the period of complementary feeding stretches from 6 months to about 24 months, after which children stop breastfeeding and their food intake is based largely on family foods. However, in families where food supply is uncertain, breast milk remains a good source of nutrients for the young child.
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2. Which nutrients are important during complementary feeding?
There are two parts to this answer. In general, all nutrients are important. Babies have relatively high metabolic rates and grow rapidly. So, during this time they have proportionately higher nutrient needs.
The second part of the answer, though, is that some nutrients are especially important because babies in South Africa often do not get enough of them. These include energy and iron, which will be provided through suitable choices of complementary foods.
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3. What should mothers and caregivers do to ensure that their babies get enough energy?
There are a number of easy steps to achieve the intake goal for energy. Babies have small tummies and therefore cannot consume a lot of food at once. So, to ensure sufficient energy intake:
- feed the baby several small meals a day
- feed the baby enough food at each meal
- avoid serving food that is very runny.
Health workers may advise caregivers to increase the energy in some meals, for example by adding a bit of oil or peanut butter to the food. It is also important to remember that while sufficient energy supply is important, too much is not beneficial.
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4. Why is iron critical at this age and which foods can supply sufficient iron?
During pregnancy, the mother’s diet and iron stores provide her unborn baby with its required iron and some iron is stored. After birth, the baby receives some iron from breast milk, but also draws from its own stores. At 6 months of age these stores have usually been used up, so food sources have to supplement the amount of iron supplied by breast milk.
Some good iron-rich food sources are liver, meat, egg and Mopani worms. Few mothers use these foods early in complementary feeding, yet they can be introduced from the age of 6 months, together with enriched cereals and vegetables. These animal food sources are good choices not only for iron but also for other important nutrients. The foods should be well cooked and pureed or minced and, if possible, given every day.
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5. Why should complementary feeding ideally start at the age of 6 months?
By this age babies have doubled their birth weight and become more active. Breastmilk cannot supply all the necessary nutrients and therefore needs to be supplemented with complementary foods. Developmentally this is also the age at which infants can eat semi-solid foods successfully from a spoon and swallow them. The digestive system is mature enough to digest the starch, protein and fat from the solid foods.
However, exclusive breastfeeding for the first 6 months after birth is important; foods should not be introduced before this age. Breast milk not only provides protective factors that strengthen the baby’s immune system but also lowers the risk of introducing potentially harmful organisms before the immune system can cope with contamination adequately. Delaying complementary feeding until the age of 6 months thus allows the immune system to develop sufficiently.
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6. What aspects of complementary feeding have an impact on health, growth and development?
There are several; one of them is the continued role of breastfeeding. Breastfed babies, in developed and developing countries have less sickness due to respiratory and gastrointestinal illness than do babies who are breastfed only for a short time, or who are not exclusively breastfed initially. Breastfeeding continues to supply health protective substances to the baby from the mother; the baby will not get this protection without receiving breast milk.
Another important aspect of complementary feeding is the way in which food is given to the baby, how, when, where and by whom. Children should have their own plates or bowls so that it is easy to gauge the amount they have eaten. The utensil used for feeding should be the correct size. The person who is feeding the baby should be able to concentrate on that task, and should interact with the baby during feeding times.
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7. Why is continued breastfeeding emphasised?
Breast milk supplies a large proportion of the nutrients a baby needs. In addition, breast milk also supplies protective factors that help to protect the baby against common infectious diseases and are especially important while the baby’s immune system has not yet fully matured.
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8. When should the consistency of foods be changed from soft to lumpy to solid?
Foods with some lumps can be introduced at about 8 months. By this age babies have developed enough tongue mobility to enable them to chew and swallow these foods. Babies can start to hold finger foods from the age of 9 to 12 months and have the manual skills to feed themselves and drink from a cup by this age.
These periods are critical windows for progressing from soft to lumpy food and then on to solid foods. If they are not introduced at the correct age, it may lead to feeding difficulties developing later on.
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9. What could happen if a baby does not receive enough meals a day?
A baby who does not get enough meals during a day or whose meal sizes are too small will not take in all the necessary nutrients. This can lead to undernutrition. Visible signs of undernutrition include a slower increase in growth than expected according to the growth chart, growth leveling off or, in severe cases, weight loss. All of these signs are potentially dangerous and feeding patterns should be corrected as quickly as possible. Regular visits to the clinic so that the baby’s growth can be monitored are therefore important. Clinics also provide other important services such as immunisation and vitamin A supplementation.
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10. Should baby food taste bland?
Baby food does not have to taste bland. Babies are introduced to different tastes already in the womb, depending on their mothers’ diets. Similarly, the flavour of breast milk also changes according to the mother’s diet. This allows the baby to learn about – and enjoy – different flavours. These preferences may even track into childhood and adolescence.
It is beneficial to expose babies to various food tastes during complementary feeding. These include flavours commonly used in their culture, the taste of different kinds of vegetable and those already introduced during pregnancy and breastfeeding. Repeated exposure to foods that are initially disliked will break down resistance to that food taste.
Adding extra sugar or salt to baby food is not necessary; rather, it could set an undesirable threshold for sweet or salty tastes.
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11. What drinks can be given to babies during complementary feeding?
Breast milk will supply most of the fluid needed. Other fluids that can be given are clean water (after or between meals) or fruit juice. If fruit juice is used it should be diluted with water and be used only occasionally. It should not replace fruit in the diet, as it is important that the baby learns the distinctive textures of different fruits. Drinks should be given from a cup; there is no need for a bottle at any stage.
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12. What can families do to protect the quality and safety of food for babies?
Contamination of foods is a major cause of diarrhoea, which is very common among babies between the ages of 6 and 12 months. But safe preparation and use of foods can prevent diarrhoea.
Food should not be left to stand after being cooked. Bacteria multiply quickly on warm food and in hot weather, and even small numbers of bacteria can quickly multiply to dangerous levels.
People who handle baby food, whether during its preparation or during feeding time, should wash their hands properly (with soap and water) before handling the food. This washing should reach all parts of the hand: between the fingers, under the nails and around the thumbs. Hands should be dried with a clean cloth afterwards.
All utensils used for cooking and feeding babies should be very clean. When children start eating finger foods, their own hands should also be thoroughly cleaned.
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13. When can a baby start to drink cow’s milk?
Breast milk should remain the main source of milk until at least 12 months of age. Pasteurised cow’s milk can, however, be used in mixed dishes (e.g. soft porridge or white sauce on pasta) from the age of 6 months. The age at which full-cream cow’s milk can be introduced as the main milk source depends on individual factors that take into account normal feeding practices and food availability.
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14. Are there foods that babies should not eat?
Babies need lots of nutrients. If they are given foods with a low nutrient content, they will not have enough space to eat the nutrient-rich foods they need. Babies and young children should not be given foods like sweets, sugary drinks, chips, cakes, ice cream, non-dairy creamers and artificial sweeteners.
Honey should be avoided as it may contain spores that cause botulism.
Leftover foods or foods that have been cooked and left standing for a long time should be avoided. Such foods may contain dangerous levels of harmful bacteria, since these microorganisms multiply quickly on warm food. Rather prepare clean, fresh food.
Meat products that still contain blood must not be given to babies; all meat products must be well cooked.
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15. What tips do you have for feeding babies who do not seem interested in meal times?
Ensure that the baby is being fed in a place free from distractions. The person feeding the baby should concentrate on the baby and ensure interaction during the feeding time.
It does not matter whether breast milk or complementary foods are given first during a meal; the mother can decide what is most convenient and what her child would prefer.
If a baby does not readily accept a new food the mother can mix it with some familiar food; for example, mixing breast milk into mashed butternut, or butternut into mince meat puree.
Remember that babies may reject a food when they taste or experience its texture for the first time. Persevere and offer the food again, as it is usually accepted on subsequent introductions.
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16. What determines whether foods are suitable for complementary feeding?
The foods given to babies should match their stage of development. At 6 months of age, a baby’s gastrointestinal tract is not fully mature and muscle coordination is still developing, both factors that influence the ability to chew and swallow food. The immune system is also still immature, which means that babies of this age are more likely than older children to become sick if they eat contaminated foods.