Complementary Feeding

As with breast-feeding, child deaths can be reduced by 6 per cent by improving complementary feeding. Complementary feeding (CF) is one of the top three preventative interventions impacting child mortality. Appropriate CF refers to the requirements for feeding an infant and includes timely introduction of solid, semisolid or soft foods in the period of 6–8 months of age in addition to, or complementary to, breast milk. It is important to emphasise that CF is taken together with continued breast-feeding. It also includes the Minimum Acceptable Diet which has two separate components:

1. Minimum Dietary Diversity - receiving foods from four or more different food groups in a single day
2. Minimum Meal Frequency - the number of times per day that a young child receives solid, semi-solid or soft food. The appropriate number of times per day differs by age group, as follows:

• 6-8 months, breast-fed: 2-3 meals/day
• 9-11 months, breast-fed: 3-4 meals/day
• 12-24 months, breast-fed: 3-4 meals + 1-2 snacks/day
• 6-24 months, but not breast-fed: 4 meals + 1-2 snacks/day

Appropriate CF also includes iron-rich foods. This includes iron-fortified foods that are specially designed for infants and young children, home-based fortified products, such as Sprinkles, and foods naturally rich in iron, such as animal-source foods and dark green leafy vegetables. 7-11 programming raises awareness around all of these appropriate CF components, especially promoting locally available foods. Again, in order to ensure that the child is eating appropriately and is healthy, the caregivers should participate in a growth monitoring and promotion programme. Once the child has completed his/her immunisations, he/she should be taken for weighing every two to three months, which provides another opportunity to reinforce the above messages.

Definitions:

• Attend growth monitoring 
• Responsive feeding with continued breast-feeding
• Diet includes minimum acceptable diet

Breast-fed infant:

• 6-24 months: give 4-5 meals + 1-2 snacks per day from 4 food groups

 Target Behaviours/Results:

• Caregiver provides variety of food that includes animal-source foods using responsive feeding techniques
• 6-8 months: small frequent feeds through the day and no watery foods (2-3 meals/day)
• 9-11 months: increase frequency and amount of foods (3-4 meals/day)
• 12-24 months: 3-4 meals + 1-2 snacks/day
• Caregiver takes child to growth monitoring and promotion every month until immunisations are complete and then every 2-3 months, to ensure appropriate weight gain and identify problems before the child becomes undernourished

 Vitamin A Supplementation 

Vitamin A is essential to health. When the body does not have enough vitamin A, the immune system function is compromised, making the child more susceptible to disease, and more likely to die from that disease. by providing vitamin A (through supplements, fortification or adequate diet) to children under 5 years in vitamin-A-deficient areas, mortality rates in general could be reduced by up to 23 per cent.

As with iron, there are two primary ways to increase the intake of vitamin A: 1) dietary improvements such as animal-sourced foods and the consumption of red palm oil, and yellow and orange fruits and vegetables; 2) vitamin A supplementation. Children should receive their first vitamin A capsule at the age of 6 months. Between 6 and 9 months, children should receive a vitamin A capsule every six months. 7-11 programming makes this information known to households and make appropriate referrals to health clinics to access the supplements.

DEFINITIONS:

• Child 6-24 months old receives a vitamin A capsule every 6 months

TARGET BEHAVIOURS/RESULTS:

• Post-partum mother takes single, high-dose vitamin A within four weeks of delivery, following national guidelines
• Caregiver gives vitamin A-rich foods to child, including fruits or vegetables yellow or orange in colour and animal-source foods
• Child 6-24 months takes a vitamin A capsule every 6 months

Questions: 

What constitutes a balanced diet? 

Eating from all of the food groups in the recommended quantites

How many food groups are there, and what are they?

Each country has their own guidance, but two commonly used food groups are 7 food groups and the 3 food groups:

 7 Food groups include: 

• Grains, roots, and tubers
•  Legumes and nuts
•  Dairy products (milk, yogurt, cheese)
•  Flesh foods (meat, fish, poultry, and liver/organ meats)
•  Eggs (Grow Foods)
•  Vitamin A rich fruits and vegetables (Glow Foods)
•  Other fruits and vegetables 

3 Food groups include:

• Carbohydrates (or “Energy-giving foods”, or “Go” foods) should be eaten every day. Examples of high carb foods include: bread, oil, rice, maize flour, cassava flour, peanuts/groundnut flour. o Vitamins (or “Protective foods”, or “Glow” foods) should be eaten every day. They also enhance the absorption of other nutrients.
•  Vitamin-rich foods are usually red/orange fruits and vegetables and green-leafy vegetables. Examples of vitamin-rich foods include: Orange, lemon/lime, amaranth, pumpkin leaves, sweet potato leaves, orange-fleshed sweet potato, mango, papaya, etc.
• Protein-rich (or “Body building” or “Grow” foods) should be eaten everyday. Examples of protein-rich foods include: Eggs, groundnut/peanuts, small dried fish, beans and lentils, fish, soya beans, cowpeas, and other animal source foods, etc. 

What makes the best complementary foods? 

 Babies can only eat small amounts of food at a time, so it is important to continue feeding them often with breastmilk and thick foods that have a lot of energy and nutrients.

How do you prepare complementary foods? 

Washing your hands with soap or ash after using the latrine, after cleaning young children, and before preparing, eating, or feeding food to young children, to protect your child from diarrhea.

Cleaning everything used to cook and feed a child is important for protecting a child from illness

Cooking foods fully will make food safe for a child to eat.  Serve food to a child right after cooking it to prevent illness. 

What amounts and type of food should be provided for infants? 

0-6 months: Only breastmilk

6-8 months: Foods that can be mashed up until smooth and soft, such as fruits, vegetables, and animal source foods (for example, mashed cooked liver). Thick pooridge with the addition of a little oil, nut, or seed paste and milk, eff, or animal source food (for example, mashed liver, dried catepillars ground into powder, and dried fish pounded and sieved into fine powder). Germinated or sprouted flour or toasted grain ground into flour to make porridges. Fermented porridges. 

9-11 months: Foods that can be mashed up or cut up into very small pieces including food the family eats. Include different types of foods, especially animal-source foods, fruits and vegetables

12-23 months: Foods that the fmaily eats, mashed up or cut up into small pieces and mixed with porridge, include different types of foods, especially animal-source foods, fruits and vegetables. Snacks include mashed or chopped fruits and vegetables, and breads, chapattis, and mandazis, either dipped in soured or boiled milk to soften spread with groundbut paste or honey

What is responsive feeding? 

Young children need to learn to eat: encourage and help them – with a lot of patience – so that they can grow healthy. This includes looking at the child in the eyes, smiling and watching for when the young child is ready to eat.

What are some things to avoid feeding children?  

Avoid giving unfiltered/untreated water to children to prevent diarrhea. It is highly encouraged to give breast milk instead, or serve water that has been boiled, or is from a safe water source.  Avoid:

• feeding black tea (including tea made with milk and sugar) or any other liquids high in ‘tannins’, such as coffee and cola drinks, as they prevent the absorption of iron, which could lead to iron deficiency anemia.
• sugary beverages such as soda/pop, and powdered juice
• highly processed foods and snacks
•  thin gruels and porridges and make them thicker consistency 

How should I feed my child when he or she is sick? 

Less than 6 months of age: Breastfeed more frequently during illness. This will help the baby to fight sickness, recover more quickly and not lose weight.  Give only breastmilk and prescribed medicine to your baby. If the baby is too weak to suckle, express breastmilk and give to the baby by cup. This will help you to keep up your milk supply and prevent breast swelling. DO NOT use bottles, teats or spouted cups. They are difficult to clean and can cause your baby to become sick.

 When baby is recovering from illness, the baby will breastfeed more than usual. The baby is replacing what was lost during illness.  Take enough time to actively encourage your child to breastfeed more frequently when the baby’s appetite returns.

6 months of age and older: Breastfeed more frequently and offer additional food during illness. This will help the baby to fight sickness, recover more quickly and not lose weight. DO NOT use bottles, teats or spouted cups. They are difficult to clean and can cause your baby to become sick.  Take time to patiently encourage your sick child to eat as the child’s appetite may be decreased due to illness. Offer the baby simple foods like porridge and fruits and other foods the child likes to eat, not too thick and not too dry, in small quantities throughout the day.  Avoid spicy or fatty foods.

When a child is recovering from illness, the child will breastfeed and eat more than usual. The child is replacing what was lost during illness. Give your child one additional meal of solid food each day during the first 2 weeks of recovery. This will help regain weight lost during the illness. Take enough time to actively encourage your child to eat the extra food and to breastfeed more frequently when the child’s appetite returns.

What is the feeding requirement for children older than 23 months of age? 

Serve children from 2 to 5 years of age on their own plate, served from teh fmaily pot to ensure they consume an adequate amount and diverse diet. 

What are the guidelines for high-dose of Vitamin A in areas of high child mortality? 

For infants from 6 months of age to one year should receive one dose of Vitamin A at the health center or outreach clinic. 

Children between the ages of 1 and 5 will receive one dose every 4-6 months. 

Can newborns or children who are HIV+ also receive the Vitamin A? 

Yes!

7-11 HEALTH STRATEGY

NEXT INTERVENTION: Adequate iron