Complementary feeding is the term used to describe the addition of other meals and beverages after the six months of exclusive breastfeeding are up. The energy and nourishment provided by prolonged frequent nursing up to two years and beyond should be “complemented” or “made complete” by the food and drink delivered. To put it another way, supplemental foods are required to bridge the gap between a child’s overall nutritional requirements and the levels supplied by breast milk.

When a child reaches the age of six months, he or she should begin receiving safe and adequate supplemental nutrition while still nursing. The most widely used indications, which centre on ongoing breastfeeding and timely introduction, frequency, and diversity of foods taken, are regularly used to describe ideal complementary feeding practices. These make up the main elements of effective complementary feeding, however responsive feeding and feeding cleanliness in relation to food preparation and handling are subsidiary elements that are sometimes disregarded. It is crucial to stress that good complementary feeding includes continuous nursing. 

Up until the child is at least two years old, breastfeeding should be frequent and available on demand. After six months, a baby’s nutritional and energy requirements start to outpace those of breast milk, necessitating the consumption of supplemental foods. At this age, a baby is also developmentally prepared to eat other foods. An infant’s growth may stall if supplemental foods are not introduced by the time they are six months old or if they are administered improperly. At 12-23 months of age, breastfed infants get about 35–40% of their total energy needs from breast milk, while the other 60–65% comes from supplemental foods. 

In order to prevent malnutrition, supplemental feeding must be effective. Between 6 and 11 months, when foods with poor nutrient densities start to replace breast milk and the rates of diarrheal disease brought on by contaminated food are at their peak, growth faltering is most noticeable. It can be challenging to make the transition safely from exclusive breastfeeding to the introduction of supplemental foods. Infants and young children may be exposed to malnutrition from incorrect feeding or disease from contaminated food and water when new meals are introduced to them. Checking the availability and affordability of the correct food, with the recommended ratios of macronutrients (carbohydrate, protein, and fat), as well as micronutrients (vitamins and minerals), is vital. The right kind of intervention can be chosen in accordance with the assessment’s findings.

As we’ve discussed, infants should begin taking complementary foods, in addition to breast milk, at the age of six months. The intake should be increased to three to four times per day after six to eight months and 1-2 healthy snacks should be added each day starting at 9 to 11 months. When they are between 12 and 23 months old, additional healthy snacks can be given 1-2 times a day, as preferred. In order to prevent excessive energy consumption, it’s crucial that breastfeeding is supported by dietary diversity and the inclusion of high-quality local foods in a child’s diet (where they are available and accessible) (or reduced appetite for breast milk). In developing nations, a breastfed infant aged 6 to 8 months and 9 to 11 months only needs 200 and 300 kcal from all supplemental foods, respectively, whereas a breastfed child aged 12 to 23 months only requires 550 kcal.

Health professionals and managers can utilize a decision framework to determine the options and activities required to improve the quality of complementary foods, particularly when the child’s existing diet is insufficient in terms of micronutrient requirements. The key guidelines for giving counselling and assistance for complementary feeding to children who have been breastfed and those who haven’t are presented below. These guidelines must be followed by all medical professionals and community health workers. The main guidelines that must be followed while giving supplemental meals to a nursing infant are shown below.

Guiding principles for complementary feeding of the breastfed child 

1. Breastfeed exclusively for the first 180 days after birth, then at six months (180 days) of age, start introducing supplemental foods.
2. Continue on-demand, frequent breastfeeding for at least two years.
3. Practice responsive feeding while using psychosocial care principles.
4. Maintain good hygiene and handle food safely.
5. While continuing to often breastfeed the infant, start with little amounts of food at six months old and gradually increase the amount as the child gets older.
6. As the baby gets older, gradually increase dietary variety and regularity while taking into account their needs. 
7. As the child gets older, enhance the frequency of feeding them complementary foods.
8. To meet nutrient needs, feed a variety of locally obtainable seasonal foods (such as those rich in Vitamin A, green leaves, and iron-rich foods).
9. As needed, give the baby vitamin-mineral supplements or supplementary foods that have been fortified.
10. Encourage the child to eat soft, varied, tasty, and favourite meals when they are ill, including more frequent breastfeeding. When a child is ill, give them food more frequently than normal and urge them to eat more.

For more information regarding breastfeeding and nutrition of the baby, feel free to check out our Maternal, Infant, and Young Child Nutrition course here.