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