Guidelines for Appropriate Complementary Feeding of Breastfed Children 6-24 Months of Age
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Guidelines for Appropriate
Complementary Feeding of Breastfed
Children 6-24 Months of Age - extracted text
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Guidelines for Appropriate
Complementary Feeding of Breastfed
Children 6-24 Months of Age
Notes to Communicators
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Appropriate complementary feeding promotes growth and prevents stunting among children
6-24 months. The period of complementary feeding is when other foods or
liquids are provided along with breastmilk. Rates of malnutrition usually peak at
this time with consequences that persist throughout life. Stunting is seldom
reversed in later childhood and adolescence. Inadequate feeding of girl children
also affects their nutrient stores, subsequent reproductive health, and risk of
maternal mortalin'.
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Appropriate complementary feeding involves a combination ofpractices to maintain
breastmilk intake and, at the same time, improve the quantity and quality offoods children
consume. The 6-11 month period is an especially vulnerable time because infants
are just learning to eat and must be fed soft foods frequently and patiently. Care
must be taken to ensure that these foods complement rather than replace
breastmilk. For older infants and toddlers, breastmilk continues to be an
important source of energy, protein, and micronutrients. Therefore,
breastfeeding should continue through 24 months and beyond.
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Improving complementary feeding requires a combination of strategies. Energy intake
can be increased by increasing breastfeeding frequency, increasing food portion
sizes, feeding children more frequently, and/or providing more energy-dense
foods. Micronutrient intake can be increased by diversifying die diet to include
fruits, vegetables, and animal products, using fortified foods, and/or giving
supplements. Choosing food combinations that enhance micronutrient
availability and absorption is also important.
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Programs to improve complementary feeding must conduct local assessments. These
assessments will help determine the appropriate emphasis to give each of the
practices listed on the following pages. Local studies should identify local diets
and current good practices to be supported, test options for improving the
traditional diet and related feeding practices, and identify target audiences and
effective strategies for reaching them.
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Recommended Practices for
Continue frequent, on-demand breastfeeding, including night feeding
for infants
Introduce complementary foods beginning around six months of age
Increase food quantity as the child gets older-while maintaining
frequent breastfeeding
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Provide 6-8 month old infants approximately 280 kcal per day from
complementary foods.
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Provide 9-11 month old infants approximately 450 kcal per day from
complementary foods.
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Provide 12-24 month old children approximately 750 kcal per day from
complementary foods.
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Local research is needed to determine the best combinations of foods
and practices to achieve these levels of energy intake.
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Increase feedingfrequency as the child gets older, using a
combination of meals and snacks
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Feed 6-8 month old infants complementary foods 2-3 times per day.
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Feed 9-11 month old infants complementary foods 3-4 times per day.
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Feed 12-24 month old children complementary foods 4-5 times per day.
Gradually increase food consistency and variety as the infant gets
older, adapting the diet to the infant’s requirements and abilities
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Feed mashed and semi-solid foods, softened with breastmilk; if possible,
beginning around 6 months of age. "
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Feed energy-dense combinations of soft foods to 6—1 -J. month olds.
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Introduce “finger foods” (snacks that can be eaten by children alone)
beginning around 8 mon ths of age.
♦
Make the transition to the family diet at about 12 months ofageL- •
Facts for Feeding
Breastfed Children 6-24 Months
Diversify the diet to improve quality and micronutrient intake
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Feed vitamin A-rich fruits and vegetables daily.
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Feed meat, poultry, or fish dailv or as often as possible, if feasible and
acceptable.
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Use fortified foods, such as iodizedisalt, vitamin A-enriched sugar, ironenriched flour or other staples, when available. ■.
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Give vitamin-mineral supplements when animal products and/or
fortified foods are not available.
Pra ctice active feeding
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Feed infants directly and assist older children.when they feed themselves.
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Offer favorite foods and encourage children to eat when they lose
interest or have depressed appetites.
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If children refuse many foods, experiment with different food
combinations, tastes, textures, and methods for encouragement.
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Talk to children during feeding.
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Feed slowly and patiently and minimize distractions during meals.
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Do not force children to eat.
Practice frequent and active feeding during and after illness
♦
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During illness, increase fluid intake by more frequent breastfeeding and
patiently encourage children to eat favorite foods.
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After illness, breastfeed and give foods more often than usual and
encourage children to eat more food at each sitting.
Practice good hygiene and proper food handling
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Wash caregivers’ and children’s hands before food preparation and
eating.
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Serve foods immediately after preparation.
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Use clean utensils to prepare and serve food.
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Serve children using clean cups and bowls, and never use feeding bottles.
Appropriate Complementary Feeding Practices
Supporting advice for caregivers and families
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Make sure childien’s immunization schedules arc < om-picic by I year ol age.
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Use ORT to rehydrate children during diarrhea.
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Give liquid iron supplements daily (i 2.5 mg/day) to infants 6 months to I
year of age if daily vitamin-mineral supplements or iron fortified foods are
not being given. If the prevalence of anemia is known to be very high (d0
percent or more) continue supplementation until 24 months of age. For low
birthweight infants, start supplementation at 3 months.
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Give semi-annual, high-dose vitamin A supplements after 6 months (100,000
IU for infants and 200,000 IU for children 12 months and older) in areas
where vitamin A deficiency occurs.
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Seek appropriate health care for fever, diarrhea, respiratory infections,
malaria. hookworm, and.othcr infections.
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Encourage children's psycho-social development by providing them with
opportunities for exploration and autonomy.
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Ensure adequate maternal nutrition and micronutrient status to improve
women’s health and support optimal breastfeeding.
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Give mothers a high-dose vitamin A supplement (200,000 IU) immediately
after delivery or within 8 weeks post-partum in areas where vitamin A
deficiency occurs.
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Practice family planning that does not interfere with breastfeeding to space
children and allow for maternal recuperation.
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Use condoms, consistently and correctly, to prevent transmission of HIV.
•*
References
Brown KH, Dewey KG, Allen LH. Complementary Feeding of Young Children in Developing
Countries: A Review Of Current Scientific Knowledge. WHO/UNICEF, 1998.
Dickin K, Griffiths M, Piwoz E. Designing by Dialogue: A Program Planners Guide to
Consultative Research to Improve Young Child Feeding. Washington DC: Academy for
Educational Development, 1997.
Nestel P, Alnwick D. Iron/Mulli-Micronutrient Supplements [or Young Children: Summary and
conclusions of a consultation held al UNICEF, Copenhagen, Denmark. August 19-20, 1996. OMNI.
1997.
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