New Delhi: Reiterating that breast milk alone is not adequate for the infant to sustain optimal growth beyond six months of age, a new study of Indian Council of Medical Research (ICMR)-National Institute of Nutrition (NIN) has suggested timely introduction of complementary foods with appropriate quality and adequate quantity will ensure optimal growth.
“Feeding of adequate and appropriate complementary foods along with breastfeeding is essential for meeting increased nutrient requirements of growing infants soon after completion of six months of age,” the study said.
It also recommended breastfeeding to be continued along with complementary foods for at least up to two years.
“Breast milk is the best and complete food for an infant. However, often, children are solely breastfed even beyond six months in the belief that breast milk alone is adequate for a child until the baby is able to pick up food and eat. Such a belief leads to poor complementary feeding practice that causes undernutrition among young children, since breast milk alone is not enough to fulfill the increase in nutrition requirements for optimal growth and development from six months onwards. Therefore, complementary foods prepared appropriately should be fed soon after six months. Feeding practices comprising selection of foods, quantity to be fed, consistency of feed and frequency of feeding are crucial,” the study revealed.
It said that feeding of adequate and appropriate complementary foods along with breastfeeding is essential for meeting increased nutrient requirements of growing infants soon after completion of six months of age.
What is complementary feeding: Breast milk (mother’s milk) alone or exclusive breastfeeding is not adequate for the growth and development of a baby when the baby turns six months. Hence, breast milk should be complemented with feeding semisolid foods to breastfed infants from 6 to 12 months.
Why feed complementary foods and when: During the first six months of life, mother’s milk alone or exclusive breastfeeding is adequate for the growth and development of a baby. Requirements of all nutrients per kg of body weight are higher for infants as they are in a rapid growth phase. Moreover, the volume as well as nutrient concentrations of breast milk gets reduced from six months onwards.
What should be included in complementary foods: The total energy and protein requirements for an infant from 6 to 12 months range is from 650 to 720 Kcal/day, and 9–10.5g/day respectively. But, on an average, after six months, breast milk provides about 500 Kcal and 5g protein per day, which is inadequate for optimal growth of infants after six months of age. Hence, introduction of complementary foods for six months old infants is crucial to prevent growth faltering. In addition, micronutrient needs of infants are higher, about five to ten times higher than adult requirements on a body weight basis. This is a very big challenge; hence, foods that are fed to infants need to be micronutrient-dense and should have good quality protein.
How to introduce complementary foods to infants: According to the findings of the study, while introducing complementary foods at six months, start with thin but not watery porridge (dal gruel etc) for 4–5 days and gradually increase its thickness to slurry consistency (well mashed/pureed foods). Include new foods (rice slurry, mashed potato, steamed and pureed apple etc.), one at a time, and continue feeding it regularly for 4–5 consecutive days to establish acceptance by the child. This will not only help the child to get acclimatized to the food introduced but will also inform if there is any associated food intolerance or allergy.
Minimum meal frequency: The minimum number of meals apart from breastfeeding needed for the child vary depending on the age of the child and whether the child is currently breastfed. During 6–8 months of age, a breastfed child needs to be given complementary feeds at least twice a day and during 9–24 months, this frequency needs to be increased to at least three times a day. Non-breastfed children aged 6–24 months need to be fed at least four times in a day in addition to milk.
What are the ‘hygiene practices’ to be adopted: The ICMR-NIN said that most often, diarrhea is caused by unhygienic practices followed by mothers and caregivers. It is important to ensure that hygienic practices are scrupulously followed. All the dietary ingredients should be thoroughly cleaned. Vegetables should be washed well to remove contaminants, parasites, pesticides before cutting.
“Vegetables should preferably be steam-cooked to reduce nutrient losses due to cooking. At the time of preparation of food or while feeding a child, mothers and caregivers should observe proper personal hygiene. Utensils used for cooking and feeding should be thoroughly washed. As feeding is likely to be time consuming, a cup or plate or any other feeding utensils used for feeding a child should be kept covered to protect it from flies and insects,” the study said.
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