Preventing Malnutrition: Importance Of Appropriate Complementary Feeding

As per the National Family Health Survey (NFHS) 4, India has a high prevalence of malnutrition – underweight (36%) stunting (38%), and wasting (21%) among under-5 children in India.

Dr Bhavneet Bharti, Professor Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research Chandigarh, India

The first 1000 days of life is a critical period in the growth and developmental trajectory of every infant. Any compromise in the infant’s nutrition during this period can have adverse consequences.

As per the National Family Health Survey (NFHS) 4, India has a high prevalence of malnutrition – underweight (36%) stunting (38%), and wasting (21%) among under-5 children in India.

Among various public health interventions to prevent malnutrition-related morbidity and mortality, optimal breastfeeding followed by the timely introduction of appropriate complementary foods are two most important pillars for prevention of stunting (low height-for-age ) and wasting (low weight-for-height) among infants.

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Poshan Abhiyan – A flagship programme launched by the Govt of India recently in 2018 addresses these nutritional issues of the community with special emphasis on first 1000 days of life.

The two most important strategies envisaged in this programme are exclusive breastfeeding for the first 6 months of age and appropriate complementary feeding thereafter along with the continuation of breastfeeding until 2 years of age.

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The recommended transition age from exclusive breastfeeding to initiation of complementary diet is typically around 6 months- popularly known as weaning.

Scientifically, it is better known as complementary feeding as failure to introduce complementary feeds and standalone use of breastfeeding after 6 months of age can jeopardize the growth of an infant and infant may deviate below the optimal trajectory.

Problems of nutritional deficiencies and infections like diarrhoea can result in growth faltering (wasting and stunting of children) which is difficult to reverse after 2 years.

Breast milk alone is not sufficient to meet the nutritional requirements of babies after six months and therefore, other foods are required. It must be emphasized that the introduction of complementary feeds does not mean the stoppage of breastfeeding. In fact, breastfeeding has to be continued till 2years or more.

Optimum and appropriate complementary feeding addresses various questions for example what to feed, how to feed, when, and where to feed.  Complementary feeding should therefore ensure timeliness, appropriateness, diversity, density and safety.

The complementary feeding is usually started with soft, well-cooked and mashed or pureed foods. Many time caregivers give liquid or watery foods like Daal ka paani/Chawal ka paani which should be avoided. The complementary foods offered must be thick that means have high density and as the age advances consistency of the food offered can be solid.

At 6-8 months, 2-3 meals can be given per day (total of at least 2 katoris per day). At 9-11 months, give 3-4 meals a day (total of at least 3 katoris per day)at 12-23 months, add 2 additional healthy snacks besides 3 meals per day.

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Nutritious foods which can be offered to the baby include milk (with cream), dahi, dal, green and yellow/orange vegetables and fruits. Animal source foods are also a good source of proteins and iron and should be offered wherever culturally acceptable.

Finger foods can be given as the age of the baby advances that is around 7-9 months. Finger foods are usually the size of an adult finger and encourage independence, motor, feeding and chewing skills.

Each day, the infant should receive a minimum of four different types of complementary foods from different food groups: grains,  roots and tubers, legumes and nuts, dairy products such as milk, curd, cheese; flesh foods such as meat, fish, poultry, and liver/organ meats, eggs, vitamin A-rich fruits and vegetables, all other fruits and vegetables.

The 2015-16 NFHS indicates that only twenty percent of breastfed children are offered adequately diverse diet after 6 months of age, while only 31 percent had been fed the minimum number of times appropriate for their age.

These data indicate the urgent need to optimize feeding practices especially during the 1000 days of life. To achieve the global nutrition targets, concerted efforts are required to scale up various nutrition-specific and nutrition-sensitive interventions using inter-sectoral approach at the policy, health-system and community levels.

Some of the Do’s and Don’ts for complementary feeding

DO’s DON’TS
Start complementary feeding around six months of age

 

Don’t stop breastfeeding after  the introduction of complementary feeding
Continue frequent, on-demand breastfeeding until 2 years of age or beyond Don’t give thin watery feeds. it displaces more nutritious foods

 

  • Gradually increase the frequency of complementary feeds
  • 2–3 times a day between 6–8 months,
  • 3–4 times daily between 9–11 months and 12–24 months.
  • In addition  nutritious snacks 1–2 times per day for ages 12–24 months

 

Avoid giving drinks of low nutrient value (e.g. tea, coffee, No sugar-sweetened beverages

 

Feeding the infant – make it a pleasant time. Encourage “Serve and return” interactions Don’t force-feed the baby, Minimize  distractions

 

Every meal should have at least four different types of  food items

 

Carotene rich yellow fruits  are better than fruit juices
Animal source foods can be included if the families are non-vegetarian Don’t give too sweet foods or salty food
Offer finger foods around 7-9 months Avoid almonds, peanuts etc to avoid choking. Can be given beyond 1 year if they are pounded in powder form.

 

Complementary foods are introduced either too early or too late. Only 55% of the infants receive timely semisolid or solid foods in addition to breast milk during 6-8 months of age, showing faulty complementary feeding practices to be a significant public health problem in India. Failure to timely introduce a variety of nutrient-rich foods with varied tastes and textures can lower subsequent food acceptance and also morph an infant into picky food eater.

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