03 June 2012

The essence of Complementary Feeding

I can still remember my first task during my internship in National Nutrition Council Region 7.  Dr. Parolita Mission, Nutrition Program Coordinator of NNC-7 gave me a task- to lay-out a broadcasters’ manual with a topic about Complementary Feeding. I admit I have no knowledge with this topic, at the back of my mind there is doubt if I could finish this manual for 3 days. During my working hours I started browsing the internet and the files which was given to me for my reference. If there’s one thing I learned with this task it is about the whole complementary feeding topic.
Complementary feeding should be focus since malnutrition is very rampant nowadays. Based on the Social Weather Station January 31, 2012 latest survey- hunger affects 22.5% or an estimated 4.5 million families. According to the results of the 7th National Nutrition Surveys (2008) 8.2 % of infants, 25.4% of 1-year old, 31.8% of 2-year old, 37.9% of 3-year old, 34.4% of 4-year old and 38.2% of 5 year-old children were undernourished. The first two years are considered the most critical in the life of the child. This is the “critical window” for the promotion of optimal growth, health, and development. Insufficient quantities and inadequate quality of complementary foods, poor child-feeding practices and high rates of infection have a detrimental impact on health and growth during these important years. Even with optimum breastfeeding, children can become stunted if they do not receive sufficient quantities of quality complementary foods at six months of age (Lancet, 2008).

1.      What is Complementary Feeding?
Complementary feeding is the giving of foods to infants starting at six months, in addition to breast milk. The additional foods and liquids are called complementary foods because these are only additional or supplemental to breastfeeding, and not sufficient on their own as a diet. Complementary foods used to be more commonly called "weaning foods". However, some experts advise that the use of the term "weaning foods" should be avoided so as not to imply that complementary foods are meant to be given to infants as they are weaned or “removed” from the breast. Complementary feeding should not displace breast milk or initiate the withdrawal of breastfeeding.
2.      When is the right time to start complementary feeding?
From six months and older, there is a gap between the total energy needs of the baby and energy and nutrients provided by breast milk. As the baby grows, the energy and nutrient gap increases. Thus, the sixth month is the best time to start giving complementary foods. Exclusive breastfeeding from birth up to six months and starting complementary feeding at six completed months while continuing breastfeeding up to two years and beyond will help a child to grow healthy.
In addition, at six months, the baby’s digestive system is mature enough to digest a range of foods. The baby also begins to develop the coordination skills to move solid food from front to back of the mouth for ingestion. The control of the baby's head is improved and the baby is able to sit with support. These are important skills in eating solid foods. A 6-month old baby who looks and grabs at foods is a clear sign that he/she is ready to eat.

3.      What are the risks of starting complementary feeding too early or too late?

Starting complementary feeding before the sixth month may:
a.Reduce breast milk production or intake. The early introduction of other foods into the infant's diet decreases the frequency of breastfeeding and intensity of suckling and as a consequence breast milk production also decreases. When this happens, the additional food may take the place of breast milk, making it difficult to meet the child’s nutritional needs.
b.Contribute to increased rates of infant mortality and morbidity. The early introduction of complementary foods increases the risk of illness, diarrhea, wheezing and other allergic conditions because a child receives less of the protective factors present in breast milk. Studies have shown that the incidence of diarrhea is 3 to 13 times higher when breastfed infants are given complementary foods between 4 to 6 months than when they are exclusively breastfed. Furthermore, babies fed early with restricted diets and living in unsanitary environments suffer from more frequent diarrheal episodes. The incidence of diarrhea is attributed to the lack of potable water, the use of water contaminated with Escherichia coli, and improper food storage.
c. Increase the risk of mothers becoming pregnant. Breastfeeding mothers are protected from getting pregnant because breastfeeding is considered a natural contraceptive.
d. Interfere with iron absorption. Studies have also shown that the early introduction especially of cereals and vegetables can interfere with the absorption of breast milk iron, which is normally low in concentration at the age of six months. Unless the child is fed with iron-rich food preparations, a child may be at a greater risk to iron deficiency or anemia.
On the other hand, delaying the giving of complementary foods is not beneficial and is dangerous because the child will not get the energy and nutrients required to meet his/her growing needs. As a result, the child's physical and mental development is affected and may lead to growth faltering and eventually malnutrition.

4.      What are recommended complementary foods?

Breastmilk is considered the complete food for the baby from birth up to six months. This means that breastmilk alone is what a baby needs for the first six months of life. At the sixth month, the baby should be given additional foods in the recommended amount for his/her age that will provide sufficient energy, protein, micronutrients and other essential nutrients to meet the growing child’s nutritional needs. Parents should choose and prepare foods from the different food groups: energy-giving, body-building, and body regulating foods or
what we know as GO, GROW and GLOW foods.

Energy-giving (GO) foods:
The main nutrients in this food group are carbohydrates and fats. Carbohydrates and fats are chief sources of energy. Examples of foods in this group are: rice, corn, root crops, bread and bakery products, noodles, cooking oil, butter, margarine and other fats, and sugars.

Body-building (GROW) foods:
These foods are high in protein and minerals needed for growth and repair of body tissues. Protein also gives energy, but it is important as a body-building nutrient. The foods in this group are: meat, fish, poultry, eggs, organ meats, milk and milk products, and dried beans like mongo and nuts. These foods are also high in vitamin A and iron that can be used readily by the body.
Regulating (GLOW) foods:
Included in this group are fruits and vegetables high in vitamins, minerals and fiber. Vitamins and minerals are essential for growth, for healthy eyes, for strong bones and teeth and high resistance to infections. Fiber is important for regular bowel movement.

5.      How do we know that the child is getting enough breast milk and complementary foods?
Regularly monitoring the growth (weight and height) of the child is a useful and important way to know if he/she is taking enough breast milk and complementary food and is healthy. Measure his/her height and weight regularly and plot these on a growth chart.
With sufficient breast milk and food of good nutritional quality, the child's weight and height will continue to increase correspondingly with his/her age. The growth chart can also be used as a tool for teaching mothers and caregivers if they are feeding the child properly. A decrease in the weight of the child is a signal that she/he is not properly fed and or cared for.

Source: clinicanutrition.page