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 babys 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 babys
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?
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.
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.
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.
4. Why is iron critical at this age and which foods can supply sufficient iron?
During pregnancy, the mothers 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.
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. Breast milk 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 babys 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.
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.
7. Why is continued breastfeeding emphasized?
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 babys immune system has not yet fully matured.
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.
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 under nutrition. Visible signs of under
nutrition 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 babys growth can be monitored are therefore important. Clinics also provide other
important services such as immunization and vitamin A supplementation.

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 flavor of breast milk also changes
according to the mothers diet. This allows the baby to learn about and enjoy different flavors.
These preferences may even track into childhood and adolescence.
It is beneficial to expose babies to various food tastes during complementary feeding. These
include flavors 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.
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.
12. What can families do to protect the quality and safety of food for babies?
Contamination of foods is a major cause of diarrhea, which is very common among babies
between the ages of 6 and 12 months. But safe preparation and use of foods can prevent
diarrhea.
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.
13. When can a baby start to drink cows milk?
Breast milk should remain the main source of milk until at least 12 months of age. Pasteurized
cows 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 cows milk can be introduced as the main
milk source depends on individual factors that take into account normal feeding practices and
food availability.
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.
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.
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 babys
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.

Important Messages per Age/Months

Babies aged 6 months or younger
Exclusive breastfeeding is recommended for babies from birth until 6 months of age. This means
that the baby receives only breast milk, on demand, often during the day and the night. No other
fluids should be given and foods must not be introduced before 6 months of age.
Introducing foods too soon is dangerous because:

at this age, a baby cannot yet fully digest foods

foods may displace breast milk, hence reducing the intake of available nutrients

the less breast milk the baby drinks, the less the mother supplies; the mother may
subsequently find it difficult to supply enough breast milk to meet the babys needs

fewer of the protective factors in breast milk are supplied and so the risk of illness
increases

food that has not been properly cleaned may increase the risk of diarrhea

The foods given instead of breast milk are often very watery, so they have very few
nutrients. They have a very high risk of being contaminated when they are given from a
baby bottle.

foods may damage the babys immature intestines and provide an easy entry for
infectious bacteria

Mothers who do not breastfeed exclusively for the first 6 months have a greater risk of
becoming pregnant.

Babies aged 6 - 8 months

From 6 months of age, new foods can be introduced every few days, while continuing
to give breast milk between or with meals.

At 6 months of age babies are ready to learn to eat foods with different textures, consistencies
and tastes. At this age babies:

have better control over their tongues than earlier

start to make up-and-down 'munching' movements

start to develop visible teeth

like to put things in their mouths

Are interested in new tastes.

Good choices for complementary foods are those rich in energy, protein, essential fatty acids and
micronutrients (particularly iron, zinc, calcium, vitamin A, vitamin C and folate). These will be
supplied when breast milk and a variety of suitable complementary foods are given to a baby.
Suitable foods include chicken, fish, meat, eggs and liver; dry beans and soya; enriched cereals;
orange and dark-green leafy vegetables, and peanut butter.
The taste of a new food may surprise a baby; therefore, introduce new foods one at a time, every
few days. The new food may have to be offered several times before it is accepted; it can be
mixed with a favorite food initially to encourage the baby to try it.
At this age babies should receive 23 meals per day, as well as breast milk. The meal size will
initially be small, usually 2 or 3 teaspoons of soft foods. By the time your baby is 8 months old,
though, the volume will be about half or two-thirds of a cup. Depending on the babys appetite,
1 or 2 snacks, such as fruit pieces, yoghurt or bread, may be given.
The consistency and texture of foods used should be changed from soft and smooth to include
lumpier and firmer foods. Learning how to chew and swallow these foods fits into your babys
developmental process before the age of 10 months and therefore should not be delayed. It may
seem easier to continue to use soft foods, but for optimal child development it is important to
gradually increase the solidity of foods. A soft complementary food should be thick enough to
stay on a spoon, without dripping off. Foods that can cause choking (e.g. peanuts) should be
avoided.
Finger foods can be started from about 8 months of age.

Babies aged 9 - 12 months

Babies should be eating a variety of foods from all the food groups by the time they are 9 months
old. A varied complementary diet should offer food from at least four food groups, as well as
breast milk each day. Variety includes varied choices from a single food group, as well as across
different food groups.
By this age, babies should receive 34 meals per day. The meals should consist of finely chopped
food and foods that they can pick up. About half to three-quarters cup of food per meal should
be given. Depending on the babys appetite, 1 or 2 snacks may be given.
Breastfeeding should continue during complementary feeding, up to 2 years of age or beyond. It
should be on demand, as often as the child wants.
The nutritional contribution of breast milk is especially important during illness, when the childs
appetite for other foods decreases. It plays a key role in preventing dehydration and providing
the nutrients required for recovery from infections.

Children aged 12 - 24 months

Children between 12 and 23 months old should receive 3 4 meals per day. They should be
given a full cup of family food, chopped or mashed only if necessary. Depending on the childs
appetite, 1 or 2 snacks may be given.