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Complementary Foods and Feeding:

Nutritional companion to breastfeeding after 6 months

As breastfeeding continues after six months, it is the time to introduce complementary foods, i.e. foods that are readily consumed and digested by the young child and that provide addition nutrition to meet all the growing child's needs. Although exclusive breastfeeding provides the best start, after six month and as long as breastfeeding continues, the child needs more vitamins, minerals, proteins and carbohydrates than are generally available from breastmilk alone. Any non-breastmilk foods or nutritive liquids that are given to young children during this period are defined as complementary foods, and complementary feeding is the process of introducing these foods.

This is a very important time in every child's life for health, growth and psychosocial development. Nonetheless, childhood malnutrition remains a major health problem in resource-poor settings. Approximately one-third of children less than five years of age in developing countries have low height-for-age (<-2 SD with respect to reference data) (ACC/SCN 2000), and even larger proportions are deficient in one or more micronutrients. Much of this may be due to other causes, such as slow fetal growth caused, in large part, by maternal undernutrition before and during pregnancy and maternal infectious diseases. However, lack of quantity and quality of the complementary foods, poor child-feeding practices, and high rates of infections, contribute to health and growth in these important years, and of these are impacted by underlying poverty, certainly adding to the problem. Development of successful interventions to improve child feeding practices, in particular, are necessary to begin to overcome earlier insults and to mitigate the effects of poverty.

Complementary feeding practices must be improved. Too often, complementary foods are introduced too soon or too late. The frequency and amounts of food that is offered may be less than required for normal child growth, or their consistency or energy density may by inappropriate in relation to the child's needs. Conversely, too much of a poor complementary food could displace the more nutritive breastmilk in the child's diet. Other factors, such as the pattern of feeding (e.g., whether to breastfeed and follow it with complementary foods, or vice versa) may effect breastmilk intake. In addition, the nutrient content of these foods may be inadequate or the absorption could be impaired by other components in these foods. Storage safety is important as well.

Also very importantly, responsive feeding, maternal encouragement to eat and other psychosocial aspects of care during feeding likely to be important for ensuring adequate food and nutrient intake of the child. The complete understanding of what must be done to improve complementary feeding is somewhat limited due to the complexity of the behaviour. The necessary behavior's and foods change rapidly with the child's age and breastmilk intake. Caretakers must understand this and be responsive to the child's expressed needs, while ensuring adequate intake.

The World Health Organisation (WHO) and UNICEF jointly published a document entitled: "Complementary feeding of young children in developing countries: a review of current scientific knowledge" (Brown et al 1998)

Updated WHO UNICEF policy will be available shortly.