10 Recommended Feeding Practices for Children 6 Months to 2 Years

It is the pride of every mother to carry a normal pregnancy, deliver a healthy baby and watch that baby grow optimally; both physically and mentally. For this to happen, the mother ensures that the baby receives all the required foods and nutrients the baby needs for healthy growth and development.  Lack of adequate foods or nutrients especially in the first two years of life (also called the “critical window” ) put the child at risk of acquiring infections such as pneumonia, diarrhoea and becoming malnourished. Studies have shown that the best time for babies to receive the best foods and nutrients is within the first two years of life; when crucial physical growth and brain development occurs.

Complementary feeding is defined as the process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast milk-WHO

Inadequate or delay in the optimal feeding of a child within the first two years leads to poor child development, particularly stunting (that is when height-for-age (HFA) is below-2 z-scores for a healthy child of the same sex and age from reference standard). Martorell et al (1994) demonstrated that it is difficult to reverse stunting after a child has reached 2 years of age.

To ensure breastfed babies are given foods and nutrients in the right amount, feeding frequency and quality, WHO recommends and promotes ten principles that guide complementary feeding of the breastfed child from 6 months to 2 years.

The objective of the audio series is to break down complex information related to the WHO recommended principles on the complementary feeding of the breastfed child so that women that find it easier to communicate in pidgin, will benefit from the audio series.

The 10 recommended guiding principles cannot be covered in detail in this article. Therefore I have extracted major highlights of each principle for easy reading and understanding.

Here is a summary of the 10 guiding principles for complementary feeding of the breastfed child:

1. Exclusive Breastfeeding (EBF) for 6 months and the introduction of complementary foods at 6 months.

• Initiating breastfeeding within 1 hour of birth
• Breastfeed baby exclusively for 6 months (not giving infant formula, water or other fluids except medicines prescribed during illness).

2. Maintenance of Breastfeeding for up to 2 years and beyond

• While they introduce complementary foods at 6 months, mothers are expected to continue to breastfeed their babies for up to 2 years or beyond,

3. Responsive feeding

• Responsive feeding means a baby is fed when he or she really requires food and the mother can detect when her baby is hungry and when they are satisfied.
• Being patient enough during feeding and showing love and affection while feeding a baby
• Actively offering food and encouraging feeding at regular Intervals with love and patience
• Not being negatively responsive e.g. forcing the baby to feed, or haphazardly changing feeding times.
• Not being active in feeding the baby- laissez-faire feeding, that is, showing lack of interest or concern during feeding,
• Inadequate intake of food if a child has poor appetite due to illness or nutrient deficiencies

4. Safe preparation and storage of complementary foods

• Diarrheal disease is commonest in second half of infancy; microbial contamination of food is a major cause of childhood diarrhoea
• Practice good hygiene and proper food handling to prevent food contamination; caregivers should wash their hands and child’s hands before each feeding episode.
• Cook foods thoroughly and serve immediately after preparation
• Store foods in clean, closed containers.
• Use clean utensils, bowls, and cups.
• Avoid using baby bottles, teats, Sippy cups etc.

5. Adequate amount of complementary foods needed

• Amount of food served needs to respond to increasing requirements for optimal growth-gradually increasing serving sizes
• Suggested serving sizes per meal are:
• 6-8 months: 30-45 mL (2-3 tablespoons) increased to ½ of 250 mL cup.
• 9-11 months: ½ of 250 mL cup
• 12-24 months: ¾ to full 250 mL cup

   6   Appropriate food consistency

• Food consistency should be appropriate to child development- consider the reflexes and skills the child has developed at that age.
• Foods could be soft or semi-solid. Children do not need teeth to consume foods such as eggs, meat or green leafy vegetables. These can be prepared in semi-solid or soft forms for the baby to swallow and digest them easily

7. Adequate meal frequency and energy density

• Babies need high energy content in the small volume of food. As food energy density goes up, the number of times an infant needs to be fed each day goes down.
• Fats should be included in babies’ food because fat is a major source of energy and determines energy density of foods.
• Infants need certain types of fat (essential fatty acids) for their rapidly growing brains and nervous systems.

8. Adequate nutrient content

• Protein is required for adequate growth but protein-deficient diets are uncommon
• If the infant’s energy (calorie) needs are met, the protein requirement will almost certainly be met.
• Better sources of protein for babies include breast milk, animal source foods and diets that combine grains and legumes.
• Poor sources of protein for babies: cassava, sago palm and some other starchy root staples.

9. Use of vitamin-mineral supplements or fortified products for infant and mother

• Problem micronutrients for infants include: Iron and Zinc
• For some nutrients, the amount in the breast milk depends on the mother’s nutritional status e.g. Thiamine, Riboflavin, Vitamin B6, Vitamin B12, Selenium, Vitamin A and Iodine
• Nutrients not affected by maternal status include: Folic acid, Vitamin D, Calcium, Iron, Copper and Zinc

10. Increase feeding during illness and after illness (e.g. diarrhoea)

• Common illnesses cause poor appetite. Increase frequency of feeding in small amounts but be patient and show love. Longer periods of poor appetite require active feeding.
• Micronutrient deficiencies also cause poor appetite– E.g. zinc, iron.
• Natural fluctuations in appetite require responsive feeding, so, be patient and show love.
• Severe or recurrent episodes require screening for moderate or severe malnutrition and possibly a referral for therapeutic feeding and medical intervention.

Not to worry! I have made life a little easier by creating a one-page printable for you. You can download and print a PDF file. Click here>>> 10 guiding principles of complementary feeding of the breastfed child-AC 

The healthy growth and development of every child depend on adhering to these 10 guiding principles. It’s about patience, love and commitment from mothers and caregivers. But in the long run, having a healthy child is worth it.

Credit:

The content of this article was adapted from the sources below:

Guiding Principles of Complementary Feeding of the Breastfed Child-WHO

Programming for IYCF: UNICEF & Cornell University. 2015

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Maryam Al-Mansur