Complementary feeding
Starting at about 6 months of age, feed children freshly prepared energy and nutrient rich complementary foods, while continuing to breastfeed up to two years or longer.
Complementary feeding refers to feeding solid or semisolid foods in addition to—and not in replacement of—breastmilk to meet child’s increased nutritional requirements. Breastfeeding should continue as an important source of nutrients up to two years of age or longer.
Solid or semi-solid foods are often introduced in the infant’s diet too early, i.e. before 6 months of age, but in some cases complementary feeding may also be delayed for many months.
Complementary feeding practices are often inadequate in developing countries.
Complementary feeding is not only about what to give, how much and how often, but also about food hygiene and, more in general, a number of appropriate feeding behaviours.
Large-scale interventions have usually adopted comprehensive approaches on feeding promotion, often using mass media communication and face-to-face counselling.
The use of a nutrition counselling protocol derived from IMCI (Integrated management of childhood illness) in a randomized trial in Brazil resulted in better provider nutrition counselling and caretaker recall of feeding messages, caretaker satisfaction with the consultation and improved feeding practices, and improved diet and weight gain in children 12 months of age or older. These findings were confirmed by a cluster-randomized controlled trial carried out in Pakistan more recently. A large-scale community-based project, in addition to improving complementary feeding practices, resulted in increased utilisation of government health services. The Lancet series on maternal and child undernutrition (2008) confirmed that counselling on complementary feeding is effective at reducing stunting.
Major challenges to caretakers, which have been identified in complementary feeding programmes, are represented by time and resource constraints.
Interventions to improve complementary feeding practices in infants 6-12 months of age have resulted in improved energy intake and growth, corresponding to a decrease in the prevalence of malnutrition by 20% and in malnutrition-associated deaths from 6 months of age by an estimated 2% 13%. A reduction in diarrhoea-associated mortality of similar magnitude and a reduction in ARI (acute respiratory infections)-associated mortality have also been suggested (Family and community practices that promote child survival, growth and development: a review of the evidence).
A review on child survival interventions published in The Lancet estimated that with universal coverage (99%) of this intervention, 6% of under-five deaths could have been prevented in the 42 countries where 90% of worldwide under-five deaths occurred (Lancet 2003; 362:65-71), while observational studies suggested that “improving feeding practices could save 800 000 lives per year” globally (The Review). Promoting continued breastfeeding and complementary feeding from age 6 months has been confirmed more recently as one of the key evidence-based interventions to reduce child mortality.
Related link:
The Lancet Child survival series
