Complementary feeding

At 6 months of age breast milk alone is no longer sufficient to meet the nutritional needs of a baby, and therefore other foods and liquids are needed, along with breastmilk. Complementary feeding is the transition from exclusive breastfeeding to family foods. Starting to give other foods in addition to breast milk at 6 months of age helps a child to grow and develop well. 
 

The introduction of complementary foods at 6 months of age

 

Complementary feeding can be introduced after the period of exclusive breastfeeding at 6 months of age in addition to breastfeeding.

  • Guidelines on the introduction of complementary foods at 6 months of age:
    - Introduce new foods one at a time
    - Introduce “single-ingredient” food initially to determine the infant’s acceptance of each ingredient (for example try plain cereal before cereal mixed with fruit)
    - Allow at least 7 days between the introduction of each new “single-ingredient” food
    - Introduce a small amount (about 1 to 2 teaspoons) of a new food at first, to let a baby adapt slowly to a food’s flavor and texture
    - Observe the infant closely for adverse reactions such as rash, wheezing, or diarrhea after feeding a new food

  • The sequence of introducing complementary foods:
    Appropriate textures of complementary foods, feeding styles, and quantity and frequency of giving food differ per age.

    An overview is given in the image below.

CFP introducing table.png

Frequency and quantity of food per age (for breastfed and formula-fed babies):

  • At 6 months of age:
    Few tablespoons

  • At 6-8 months of age:
    2-3 times a day (small bowl) + healthy snacks between meals

  • At 9-11 months of age:
    3-4 meals (small bowl) + healthy snacks between meals

  • At 12-24 months old:
    3-4 meals (larger amount) + healthy snacks between meals.
    At this age meals can be the same as for the rest of the family.

  • Guidelines for complementary feeding for a child that doesn't receive breastmilk/formula milk during the complementary phase:
    A child needs to eat more often and other foods (including milk products) to get all the nutrition he/she needs:
    - At 6 months of age: Give as much as a breastfed baby would need; begin with 2-3 spoonful of soft and mashed food 4 times a day, which will give all the nutrients needed for a child without breastmilk
    - From 6-8 months old: 4 meals (small bowl) a day + a healthy snack
    - From 9-11 months old: 4-5 meals (small bowl) + 1-2 healthy snacks

Video - introducing complementary foods at 6 months of age

Video - quantity of food with age

Risks of introducing complementary foods too early or too late
It is dangerous for a baby to introduce complementary foods too early or too late.

Risks of introducing complementary foods too early:

  • Babies can choke on food 

  • Babies can develop food hypersensitivities (allergies) 

  • Babies may consume too little breastmilk (which contains essential nutrients and antibodies for the baby which protects against disease)

Risks of introducing complementary foods too late:

  • Babies do not get the energy and nutrients they need for optimal growth and development

  • Babies are more likely to reject foods

What children should eat during the complementary feeding phase
The following foods a child should eat during the complementary feeding phase for optimal growth and development:

what children should eat.png

Children who are fed a diverse range of foods are more likely to meet their micronutrient requirements, including the need for vitamin A, iron, calcium, thiamine, folate, zinc, vitamins B6 and B12.
 
Young children have a little stomach and must therefore eat small, nutrient-rich meals to maximize the nutrition in each bite:
- Meat, eggs, and other animal-source foods and legumes are important for infants and young children
- Cereals or plant-based porridges alone do not provide enough energy, protein and micronutrients to fill the gap between breastmilk and the child’s nutrient requirements

Video - important food groups for young children

Foods to avoid during the complementary feeding phase
Some foods should be avoided during the complementary feeding phase because they might pose danger to the baby's health. 

May cause choking.png
May cause choking 2.png

What to do when the child refuses to eat solid foods
 

It might be the case that a child refuses to eat solid foods during the complementary feeding phase.

However, there are a few things parents can do to stimulate their children to accept solid foods.

  • Key messages: 
    It's common for young children to eat very small amounts, to be fussy eaters, or not eat at all
    Give young children healthy food, and let them decide how much food to eat
    Try to judge the child's appetite over a week, rather than over a single day
    Try to create a positive eating environment, persist with new food and follow the child's lead

  • The reasons why a child is not eating or not eating enough:
    Young children's appetites vary constantly because of growth spurts and variations in activity
    From 1 year of age, young children aren't growing as fast as babies, so they need less food
    Young children have small stomachs
    Young children are very interested in the world around them, so they have short attention spans for food
    Young children want to push boundaries and show how independent they can be


    Note: It can help to think about refusing food this way "You provide healthy food options for the child, and the child decides how much food to eat - or not to eat. 
     

  • How to handle the child's appetite:
    If the child won't eat or won't eat whole meals, try to reduce the amount of food you're offering - it's normal for young children to need only small servings at mealtimes
    Try to avoid forcing the child to finish everything on the plate, because this can make mealtimes stressful - praise the child for trying a spoonful or having a sip of water if that's all they want
    At regular times between meals, healthy snacks like fruit or vegetables can be offered to the child 
    As long as healthy food is offered, try not to worry if the child doesn't eat very much sometimes - the child won't starve, children are actually very good at judging how much food they need


    Note: it can help to judge the child's appetite over a week, rather than over a single day. It's OK if the child eats less today - they might be hungrier tomorrow.
     

Tips to try new foods
 

Sometimes, a child is fussy and will eat only one or two particular foods - sometimes young children will try new foods if you just keep trying. A few things might help, such as creating a positive eating environment, serving new foods, or following the child's lead.

 

  • Creating a positive eating environment
    - Make mealtimes a happy, regular and social family occasion - sit together to eat with the child 
    - Show the child how much you enjoy eating the food you've prepared
    - Get the child involved in helping to prepare and cook family meals
    - Offer new food when the child is relaxed and isn't distracted by other things
    - Set a time limit of about 20 minutes for a meal, if the child hasn't eaten the food, take it away and don't offer an alternative snack or meal
    - Avoid punishing the child for refusing to try new food - this can turn tasting new foods into a negative thing
    - Avoid giving the child treats just so they'll eat some healthy foods - this can make the child more interested in treats than healthy food and sends the message that eating healthy food is a chore

     

  • Serving new foods:
    - Keep offering new foods - it can take 10-15 tries for children to accept and enjoy new foods
    -
    Serve the child the same foods as the rest of the family (from 1 year of age) - the child will get the nutritional benefits of a wide range of foods, and accept new tastes and textures as 'normal'
    - Offer new foods with foods that the child already knows and likes
    - If the child refuses something, offer it again in a week or so - the child's interest in food can differ per day or week

     

  • Following the child's lead 
    - Let the child touch, lick, and play with food, and expect some mess as they learn to eat
    - Let the child feed him/herself, and give the child some help if needed
    - If the child loses interest, or seems tired/cranky/unwell, take the food away


    Note: It's important to keep offering the child lots of different foods because children need to eat a wide variety of foods to get all the nutrients they need for growth and development. Offer a variety of foods from the 7 important food groups for young children. 
     

Signs young children might need help from a healthcare professional with food and eating
 

If the child is generally healthy and growing well (according to the growth curve), and has enough energy to play, learn and explore, the child is probably eating enough.

However, check with a health professional when:

  • The child only eats a very small range of foods

  • The child won't eat entire food groups for a time

  • The child consistently refuses food

  • There are concerns about the child's growth (not following the growth curve) and overall nutrition

refuse food.jpg

Sources:

  1. Certa Nutritio. (2020, 1 April). GloCal Nutrition [Video]. YouTube. https://www.youtube.com/channel/UCvxwMjlLzZP_l3CvIWPZHCg

  2. Feeding your baby: 6–12 months. (n.d.). UNICEF Parenting. https://www.unicef.org/parenting/food-nutrition/feeding-your-baby-6-12-months

  3. Toddler not eating? Ideas and tips. (2020, 25 mei). Raising Children Network. https://raisingchildren.net.au/toddlers/nutrition-fitness/common-concerns/toddler-not-eating#:%7E:text=Offer%20new%20foods%20when%20you,refusing%20to%20try%20new%20foods.

  4. U.S. Dept of Agriculture. (2019). Chapter 5: Complementary feeding. In Infant nutrition and feeding guide (pp. 101–128). U.S. Dept. of Agriculture, Food and Nutrition Service.

  5. World Health Organization. (2012). Guideline: Daily iron and folic acid supplementation in pregnant women. https://apps.who.int/iris/bitstream/handle/10665/77770/9789241501996_eng.pdf?ua=1