GNPC: Infant & Child Feeding

Introduction

Feeding only breast milk (exclusive breastfeeding) is adequate for baby till 6 months of life. After the age of 6 months, breastfeeding alone is no longer enough for optimal growth and development of the child. Hence, it is necessary to start complementary feeding (CF) along with breast milk. The word “weaning” is now replaced by complementary feeding—the process of introduction of suitable semi-solid food at the right age.

There is a very critical window of opportunity during the first 2 years of life as far as growth and development of child is concerned. The concept of “1000 days” is 9 months of pregnancy plus first 2 years of life during which optimal breastfeeding (for first 6 months of age) and timely and appropriate complementary feeding (at 6 months of age) are extremely important.

What is complete food and balanced food?

A food containing carbohydrates, proteins, minerals, fats, fibers, vitamins, etc. is “Complete Food” while the food that contains these components in appropriate proportions can be labeled as “Balanced Food”. No food can be labeled as perfectly balanced or complete food. So, in order to make it complete and balanced, there is need to combine various foods in a child’s diet (Fig. 1)

Examples

A cereal (rice/wheat) based food mixed with pulses/nuts, vegetables, and cooked in oil/ghee makes it a balanced food; for example, Upma, Pulao, Biryani,
and Poha.
A food also becomes balanced by the addition of cereals, nuts/raisins, etc. in the milk; for example, Dalia, Kheer (Figs. 1 and 2)

1. Combination of these makes a
balanced food.

1. Kheer is one of the examples of
balanced food.

When to start complementary feeding and why?

As discussed earlier, after 6 months of life, breastmilk alone is not sufficient to provide adequate nutrition to the child, and one must begin complementary feeding soon after 6 months age completion. Moreover, the jaw biting movement appears app. around 5 months. Swallowing of solid foods occurs around 6–7 months side-to-side movement of tongue develops around 8–12 months. Around 6 months is the ideal time for introduction of complementary feeding or “sensitive period”. If complementary feeding is delayed, then child may enter “critical period” after which infant may always be a poor chewer and may be poor in eating solids later.

The other reasons for complementary feeding starting at 6 months are:

Child develops neck/head control and hand-to-mouth coordination.
Child starts enjoying mouthing and biting.
The intestines are mature and ready to digest pulses and cereals.
Baby enjoys chewing & gumming semisolids as there is hardening of gums and eruption of teeth.
Tendency to push solids out of mouth decreases.

Which foods should be used for complementary feeding?

Table 1 Appropriateness of complementary foods for infants.

Appropriate	Lastname
Combination of cereals & pulses (Khichdi, rice,daal etc.), locally available staple foods such as idli, ragi, dosa, dhokla, roti/paratha with oil/ ghee, and some amount of sugar.	*Chocolates, biscuit bread pastry cheese, softy, ice cream, doughnuts, cakes, etc. #Packaged or stored foods,Tinned foods, , artificially cooked foods with preservatives or chemicals
Mashed banana, other pulpy fruits (e.g., mango, papaya), sweet potato, and potato	#Fruit juices and fruit drinks
Milk-based cereals preparations	*Commercial breakfast cereals
Sprouts, pulses, legumes, groundnuts, almonds, cashewnuts, raisins (Note: Any nut should be well grinded and mixed with food as solid pieces may cause choking in young children)	#Repeatedly fried foods containing trans-fatty- acids (which predispose to diabetes, atherosclerosis, obesity, cardiac, and neurological problems in future)

*These foods must not become the main bulk of complementary foods and may be offered occasionally only.

#These foods should be avoided in children below 2 years of age.

(a) What are the important characteristic of foods for complementary feeding?

Easy availability of clean and safe ingredients for foods.
Simple and less time-consuming method to prepare/cook the foods.
Affordability by the family.
Prefer the regular family food that is locally available and culturally acceptable rather than cooking special foods. The recent concept of “Baby-led Weaning”, i.e., feed as per baby’s choice shall be practiced (Fig. 3).
Nutritive value of the food as per the requirement of growing infant.
Easily digestible and nourishing food.
Taste and palatability of food for the infant.
Start feeding with small amounts and gradually increase the quantity with the increasing age of the child.
The consistency, frequency, and variety should change as the infant grows, depending upon the requirements and the feeding abilities (Fig. 4).
A variety of nutrient-rich foods shall be offered to ensure the body requirements.
During illness, the principle of more fluids including frequent breastfeeding and encouragement to eat soft, favourite foods should be followed. After illness, increase feeding more than usual so as to replenish the deficiency.

Fig. 3: Baby-led weaning.

Fig. 4: Perfect food consistency: The food that just drips slowly from spoon and not flows.

(b) What are staple foods?

Every community has a staple food—the food that forms the main bulk; for example, wheat, rice.
Parents must identify the staple home-made food.
The families can promote kitchen garden, harvesting, and processing and storing the staple food as per their choice and convenience in rural area.
In urban areas, the staple food can be purchased depending upon their choice and affordability.
Staple foods can be cooked, served, and are good sources of energy and protein.

(c) What precautions are needed while preparing food for complementary feeding?

Follow proper hand washing with soap before preparing and eating the food.
The foods shall be stored safely and served fresh after preparation.
Use clean utensils for preparing and serving the food.
Spoon, cups, and bowls used for feeding the children shall be clean.
Avoid using feeding bottle as it is difficult to clean and maintain the hygiene. “Bottle feeding is deleterious to health of the child.” Dehydration, Diarrohea and malnutrition are usually the results of unsafe bottle-feeding.

(d) How to keep food hygienic and safe for feeding?

Keep food safe from contaminated environment.
Food that looks fresh and smells good shall be offered.
The perishable foods (meat, milk, etc.) and prepared food shall be stored in a refrigerator.
Cover the food properly and feed to the child within 2 hours if refrigerator is not available.
If stored for longer duration, reheat the food before consumption so as to kill the contaminating germs.
Care should be taken to protect the food from rats, mice, cockroaches, flies, and dust.
Prevent the contamination of drinking water.

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