Weaning : Starting Your Baby on Food

What is Weaning OR Complementary feeding?

 Feeding only breast milk (exclusive breastfeeding) is adequate
for baby till 6 months of life.

 After the age of 6 months, breastfeeding alone is no longer

enough for optimal growth and development of the child.

 It it is necessary to start complementary feeding (CF) along with

breast milk.

The word “weaning” is now replaced by

complementary feeding —
the process of introduction of suitable semi-solid food
at the right age.

Indian Academy of Pediatrics (IAP); Complementary Feeding: Feeding of an Infant Beyond 6 Months Age;
Under the Auspices of the IAP Action Plan 2020–2021
 Importance of Complementary feeding
 Crucial time of initial 2 years : as growth and development of
a child is concerned.

 As infants grow, their nutrient needs change rapidly.

 In fact, the nutritional needs for growth and development in

children 6–23 months of age are greater per kilogram of body
weight than at any other time in life. 

Therefore, frequent feeding of a variety of foods is important to

help ensure nutrient needs are met.

 Milk is not an adequate source of iron, zinc and other

essential elements.

Solids are more packed with energy and nutrients in smaller

volume, compared to liquids
https://data.unicef.org/topic/nutrition/diets / ; Approach to weaning in infants August 2020, Internation pediatric congress virtual congress 2020
 Importance of Complementary feeding

 Natural progression from milk to solid food in all

mammalian species - digestive ability, fibre intake, ability to
chew with developing teeth, satiety

The concept of “1000 days” :

9 months of pregnancy plus first 2 years of life during which

optimal breastfeeding (for first 6 months of age) and timely and
appropriate complementary feeding (at 6 months of age) are
extremely important.

 If complementary foods are not introduced around the

age of 6 months, or if they are given inappropriately, an
infant’s growth may falter.

https://www.who.int/health-topics/complementary-feeding#tab=tab_1 ; Indian Academy of Pediatrics (IAP); Complementary Feeding:

Feeding of an Infant Beyond 6 Months Age; Under the Auspices of the IAP Action Plan 2020–2021
 UNICEF Data: Diets & feeding Practice of
children aged 6-23 months

https://data.unicef.org/topic/nutrition/diets/
 Feeding the Baby

Before 6 months, breast milk alone meets Start to introduce soft foods at 6 months when
all your baby’s energy and nutrition needs. your baby needs more energy and nutrients
than your milk alone can provide. 

At 6 months, start giving your baby just two to Your baby has a small stomach and needs to be
three spoonfuls of soft food, such as porridge, eating small amounts of soft nutritious food
mashed fruits or vegetables, twice a day. frequently throughout the day. 
https://www.unicef.org/parenting/food-nutrition/feeding-your-baby-6-12-months; https://www.unicef.org/parenting/food-nutrition/feeding-
 Feeding the Baby

In addition to grains and tubers, feed your Start feeding both breastfed and non-breastfed
baby a variety of foods – especially animal babies solid foods at 6 months. Waiting too
foods (dairy, eggs, meat, fish and poultry), long can put your baby at risk.
fruits and vegetables – every day.

https://www.unicef.org/parenting/food-nutrition/feeding-your-baby-6-12-months; https://www.unicef.org/parenting/food-nutrition/feeding-
your-baby-when-to-start-solid-foods
 Feeding the Baby

Ensuring that infants nutritional needs are met requires that

complementary foods be:

timely – meaning that they are introduced when the need for
energy and nutrients exceeds what can be provided through
exclusive breastfeeding;

adequate – meaning that they provide sufficient energy, protein

and micronutrients to meet a growing child’s nutritional needs;

safe – meaning that they are hygienically stored and prepared, and
fed with clean hands using clean utensils and not bottles and teats;

properly fed – meaning that they are given consistent with a child’s
signals of appetite and satiety, and that meal frequency and feeding
are suitable for age.

https://www.who.int/health-topics/complementary-feeding#tab=tab_1
 When to start complementary foods ?
o The biting movement of jaw appears around 5 months.

o Around 6–7 months, swallowing of solid foods occurs.

o The side-to-side movement of tongue develops by 8–12 months.

o The introduction of complementary feeding around 6 months is

the ideal time or “sensitive period”.

o If introduction of complementary feeding is delayed, then child may

enter “critical period”

o After critical period the infant may always be a poor chewer and
may be poor in eating solids later.

Indian Academy of Pediatrics (IAP); Complementary Feeding: Feeding of an Infant Beyond 6 Months Age;
Under the Auspices of the IAP Action Plan 2020–2021
 When to start complementary foods ?

The other reasons for complementary feeding at 6 months of age

are:

 Child develops neck/head control and hand-to-mouth coordination.

 Child starts enjoying mouthing and biting.

 The intestines are mature and ready to digest pulses and cereals.

 Baby likes chewing and gumming semisolids as there is hardening of

gums and eruption of teeth.

 Tendency to push solids out of mouth decreases.

Indian Academy of Pediatrics (IAP); Complementary Feeding: Feeding of an Infant Beyond 6 Months Age;
Under the Auspices of the IAP Action Plan 2020–2021
 WHO Recommendation: When to start
complementary foods
 Infants start receiving complementary foods at 6 months of age in
addition to breast milk.

 Initially, they should receive complementary foods 2–3 times a day

between 6–8 months and increase to 3–4 times daily between 9–11
months and 12–24 months.

 Additional nutritious snacks should also be offered 1–2 times per day
for ages 12–24 months, as desired. 

 Gradually increase food consistency and variety as the infant gets

older.

 Infants can eat pureed, mashed and semi-solid foods beginning at 6

months.

 By 8 months most infants can also eat “finger foods” (snacks that
can be eaten by children alone). 

https://www.who.int/health-topics/complementary-feeding#tab=tab_2
 First food for the baby

The staple cereal of the family should be used to make the first food
for an infant.

Porridge can be made with suji (semolina), broken wheat, atta (wheat
flour) ground rice, ragi, millet etc, by using a little water or milk, if
available.

Roasted flour of any cereal can be mixed with boiled water, sugar and
a little fat to make the first complementary food for the baby and could be
started on the day the child becomes six months old.

Adding sugar or jaggery and ghee or oil is important as it increases

the energy value of the food.

In the beginning the porridge could be made a little thinner but as the
child grows older the consistency has to be thicker.

A thick porridge is more nutritious than a thin one.

NATIONAL GUIDELINES ON INFANT AND YOUNG CHILD FEEDING; MINISTRY OF WOMEN AND CHILD DEVELOPMENT (FOOD AND NUTRITION
BOARD) GOVERNMENT OF INDIA 2006
 First food for the baby

If not possible with the porridge, pieces of half chapati could be soaked
in half a cup of milk or boiled water, mashed properly and fed to the baby
after adding sugar and fat.

Soaked and mashed chapatti could be passed through a sieve so as to get

a soft semi-solid food for the infant

Fruits like banana, papaya, chikoo, mango etc could be given at this age
in a mashed form.

NATIONAL GUIDELINES ON INFANT AND YOUNG CHILD FEEDING; MINISTRY OF WOMEN AND CHILD DEVELOPMENT (FOOD AND NUTRITION
BOARD) GOVERNMENT OF INDIA 2006
 First food for the baby
Traditional foods for infants :

Once the child is eating the cereal porridge well, mixed foods including
cooked cereal, pulse and vegetable(s) could be given to the child.

Most traditional foods given to infants in different parts of the country

are examples of mixed foods like khichidi, dalia, suji kheer, upma, idli,
dokhla, bhaat-bhaji etc.

Sometimes traditional foods are given after a little modification so

as to make the food more suitable for the child.

 For instance, mashed idli with a little oil and sugar is a good
complementary food for the infant.

 Similarly bhaat can be made more nutritious by adding some cooked

dal or vegetable to it.

 Khichidi can be made more nutritious by adding one or two

vegetables in it while cooking.
NATIONAL GUIDELINES ON INFANT AND YOUNG CHILD FEEDING; MINISTRY OF WOMEN AND CHILD DEVELOPMENT (FOOD AND NUTRITION
BOARD) GOVERNMENT OF INDIA 2006
 First food for the baby
Protective foods:

Protective foods like milk, curd, lassi, egg, fish and fruits and
vegetables are also important to help in the healthy growth of the infants.

Green leafy vegetables, carrots, pumpkin and seasonal fruits like

papaya, mango, chikoo, banana etc., are important to ensure good vitamin
A and iron status of the child.

Baby needs all foods from six months namely:

o cereals, pulses, vegetables particularly green leafy vegetables, fruits,
milk and milk products,

o egg, meat and fish if non-vegetarian,

o oil/ghee, sugar and iodised salt in addition to breastfeeding.

A diversified diet of the infant along with breastfeeding will also

improve the micronutrients’ status of the child.
NATIONAL GUIDELINES ON INFANT AND YOUNG CHILD FEEDING; MINISTRY OF WOMEN AND CHILD DEVELOPMENT (FOOD AND NUTRITION
BOARD) GOVERNMENT OF INDIA 2006
 First food for the baby
Energy Density of Infant Foods

Low energy density of complementary foods and low frequency of feeding

result in inadequate calorie intake and thus the malnutrition.

 It is important to give small energy dense feeds at frequent intervals

to the child with adequate energy intake by the child.

 Energy density of foods given to infants and young children can be

increased in four different ways:

1. By adding a teaspoonful of oil or ghee in every feed.

2. By adding sugar or jaggery to the child’s food

3. By giving malted foods.

4. By feeding thick mixtures.

NATIONAL GUIDELINES ON INFANT AND YOUNG CHILD FEEDING; MINISTRY OF WOMEN

AND CHILD DEVELOPMENT (FOOD AND NUTRITION BOARD) GOVERNMENT OF INDIA 2006
Which foods should be used for complementary
feeding?

Indian Academy of Pediatrics (IAP); Complementary Feeding: Feeding of an Infant Beyond 6 Months Age;
Under the Auspices of the IAP Action Plan 2020–2021
 The important attributes of foods for
complementary feeding
Easy availability of clean and safe ingredients for foods.

Simple and less time-consuming method to prepare/cook the foods.

Prefer the regular family food that is locally available and culturally
acceptable rather than cooking special foods.

The recent concept of “Baby-led Weaning”, i.e., feed as per baby’s

choice shall be practiced

Nutritive value of the food as per the requirement of growing infant.

Easily digestible and nourishing food.

Taste and palatability of food for the infant.

Start feeding with small amounts and gradually increase the quantity
with the increasing age of the child.

 The important attributes of foods for
complementary feeding
The consistency, frequency, and variety should change as the infant
grows, depending upon the requirements and the feeding abilities

A variety of nutrient-rich foods shall be offered to ensure the body

requirements.

During illness, the principle of more fluids including frequent

breastfeeding and encouragement to eat soft, favourite foods should be
followed.

After illness, promote feeding more often than usual so as to replenish

the deficient intake.
 Baby-Led Weaning (BLW)
 It is an alternative method for introducing complementary foods to infants  

In this method; the infant feeds themselves hand-held foods instead of being
spoon-fed by an adult.

It means that although parents offer foods, the child himself controls the
weaning process (thus the term “baby-led”): infants decide what, how much
and how quickly to eat.

 It promotes infant self-feeding from six months of age.

BLW may also be defined as auto-weaning, which means offering chopped

and minced family meals to the infants.

This approach also causes concerns, regarding iron adequacy energy and
nutrient intake and choking risk.

ESPGHAN 2017, in a recent position paper, stated that there is not enough
evidence to draw conclusions about the BLW approach.
 Ital J Pediatr 44, 49 (2018).
 The important attributes of foods for
complementary feeding
To change food consistency and type for growing child

Indian Academy of Pediatrics (IAP); Complementary Feeding: Feeding of an Infant Beyond 6 Months Age;
Under the Auspices of the IAP Action Plan 2020–2021
 The important attributes of foods for
complementary feeding
Precautions are needed while preparing food for complementary feeding

Follow proper hand washing with soap before preparing and eating the
food.

The foods shall be stored safely and served fresh after preparation.

Use clean utensils for preparing and serving the food.

Spoon, cups, and bowls used for feeding the children shall be clean.

Avoid using feeding bottle as it is difficult to clean and maintain the

hygiene.

 “Bottle feeding is injurious to health of the child.” Diarrhea, dehydration,

and malnutrition are usually the results of unsafe bottle-feeding.

Indian Academy of Pediatrics (IAP); Complementary Feeding: Feeding of an Infant Beyond 6 Months Age;
Under the Auspices of the IAP Action Plan 2020–2021
 The important attributes of foods for
complementary feeding
To keep food safe and hygienic for feeding

Keep food safe from contaminated environment.

Food that looks fresh and smells good shall be offered.

The perishable foods (meat, milk, etc.) and prepared food shall be
stored in a refrigerator.

Cover the food properly and feed to the child within 2 hours if
refrigerator is not available.

If stored for longer duration, reheat the food before consumption so
as to kill the contaminating germs.

Care should be taken to protect the food from rats, mice, cockroaches,
flies, and dust.

Prevent the contamination of drinking water.

 The important attributes of foods for
complementary feeding
Are their some foods ‘hot’ or ‘cold’?

Indian Academy of Pediatrics (IAP); Complementary Feeding: Feeding of an Infant Beyond 6 Months Age;
Under the Auspices of the IAP Action Plan 2020–2021
 Dietary diversity : Various food groups
Minimum dietary diversity (MDD) is consumption of four or more food groups
from the seven food groups to meet daily energy and nutrient requirements.

This ensures that the child had a high likelihood of consuming at least one animal-source
food and one fruit or vegetable that day, in addition to a staple food (grain, root, or tuber).
 The role of feeding in child’s growth and
development
The feeding practices that are satisfying and comfortable to mother and
child are crucial for the emotional development.

Mother and family should be motivated, encouraged, educated and,

supported regarding proper feeding practices.

Follow the principles of psychosocial growth and development specifically:

 Many food preparations may be refused by the child - try different

food combinations, with different tastes, textures and methods of
encouragement

 The feeding times are periods of learning and love - talk to children
while feeding

 Avoid comparison with other children or even siblings regarding choice

of the food.

Indian Academy of Pediatrics (IAP); Complementary Feeding: Feeding of an Infant Beyond 6 Months Age;
Under the Auspices of the IAP Action Plan 2020–2021
 The role of feeding in child’s growth and
development
Children under 1 year should be fed by mother/caregiver.

The toddlers/young children shall preferably be fed in a separate plate

promoting self-feeding with parent’s help.

Eating at the same time and same place by family members helps in
improving appetite and avoids distractions.

Do not force to feed the child. This way the child starts disliking
food and the process of feeding.

The distractions such as viewing TV or mobile phone while feeding is

strongly discouraged.

Indian Academy of Pediatrics (IAP); Complementary Feeding: Feeding of an Infant Beyond 6 Months Age;
Under the Auspices of the IAP Action Plan 2020–2021
 Potential Dangers : Food Allergy

Although weaning should be fun and engaging, there are a few

risks to be aware of.

Some babies may be allergic to cow’s milk protein or/and soya protein.

 The other foods to which some children may be allergic are: eggs,
peanuts and some food additives, and spices.

Fortunately, these allergies are not very common in Indian children.

 Consult your paediatrician, if the child is allergic to a particular food.

https://www.healthline.com/nutrition/weaning#dangers
Indian Academy of Pediatrics (IAP); Complementary Feeding: Feeding of an Infant Beyond 6 Months Age; Under the Auspices of the IAP
Action Plan 2020–2021
 Potential Dangers :Choking
Choking can be a significant concern when starting a baby on solid food.

it’s important to know that gagging is a completely normal part of

learning to eat. It acts as a safety reflex to prevent babies from choking

Signs of gagging include opening the mouth and thrusting the tongue
forward, spluttering and/or coughing. baby may appear red in the face.

It is important not to panic or get very anxious when a baby gags.

But choking is much more serious. It occurs when food blocks the
airways ; baby cannot breathe properly.

Signs include turning blue, silence and inability to make noise. Baby
may also start coughing or — in severe cases — lose consciousness.

https://www.healthline.com/nutrition/weaning#dangers
 Potential Dangers :Choking
Some tips to reduce the risk of choking:

o Sit the baby upright while eating.

o Never leave baby unattended while eating.

o Avoid high-risk foods, such as whole nuts, grapes, popcorn,

blueberries and meat and fish that could contain bones.

o Don’t give too much food at once or force-feed your baby.

o If child does choke, aware of appropriate next steps. Taking a first

aid course can be helpful.

o If child is choking and isn’t able to cough up the food, call emergency
services immediately.

https://www.healthline.com/nutrition/weaning#dangers
Important Points.....