. Session 2.3 Complementary Feeding Practices - PowerPoint Presentation

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Session 2.3Complementary Feeding Practices

Integrating Nutrition Assessment,

Counselling

, and Support into Health Service Delivery

Training Course for Facility-Based Health Providers

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Session ObjectivesBy the end of the session, participants will be able to:Describe what complementary feeding is and why it is neededDiscuss nutrition gaps in breast milk after 6 months and foods to supplement the gapsDescribe optimal principles and practices for complementary feedingDemonstrate ability to use locally available foods for complementary feeding

Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery2

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Topic 1. introduction to complementary feedingIntegrating Nutrition Assessment, Counselling, and Support into Health Service Delivery3

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Introduction to Complementary FeedingComplementary feeding: giving other foods in addition to breast milk to a baby starting at 6 months (180 days) of age‘Timely’ introduction of complementary foods is important:Too early—risk of infection and worsened nutritional intake; infant may not be developmentally readyToo late—breast milk alone no longer provides the infant with all the energy and nutrients neededIntegrating Nutrition Assessment, Counselling, and Support into Health Service Delivery

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Introduction to Complementary FeedingDuring the period of complementary feeding, the young child gradually becomes accustomed to eating family foods. Breastfeeding should continue until the child is at least 2 years old.Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery

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Topic 2. nutrient gaps in breast milk after 6 monthsIntegrating Nutrition Assessment, Counselling, and Support into Health Service Delivery6

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BrainstormWhat nutrient gaps exist in breast milk after 6 months of age?Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery7

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Nutrient Gaps in Breast Milk after 6 MonthsThe nutrient gaps left by breast milk after age 6 months include:EnergyProteinIronZincCalciumVitamin AB Vitamins and IodineComplementary foods need to fill these gaps

Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery8

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Energy GapComplementary foods need to be energy rich. Energy-rich foods include maize, millet and wheat flour, rice, cassava, potatoes, matoke, and yams.Fats and oils are also good sources of energy and an important component of the diets of infants and young children.~ 30-45% of calories from breast milk and complementary foods should be provided by fat for a child under 2 years.Fats also provide essential fatty

acids and improve the absorption of fat-soluble vitamins (vitamins A, D, E, and K). Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery9

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Energy Gap

Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery10

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Protein GapProteins are required for growth, development, repair, and maintenance of the body.Slightly less than half of a 12-23 month child’s protein requirements need to come from complementary foods.Protein-rich foods include:Animal sources: milk and milk products, fish, and eggs

Plant sources: beans, groundnuts, peas, simsim, and soybeansIntegrating Nutrition Assessment, Counselling, and Support into Health Service Delivery11

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Foods Rich in ProteinIntegrating Nutrition Assessment, Counselling, and Support into Health Service Delivery

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Iron GapIron is needed to make new blood cells to assist in growth and development.Insufficient iron causes:AnemiaNegative and permanent effects on brain development Iron stores at birth are high but are gradually used up over the first 6 months.Breast milk is low in iron (though the iron is well-absorbed).Main source of iron after 6 months is complementary

foods.Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery13

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Iron Gap

Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery14

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Iron GapIron-rich foods include:Animal sources: meat, organs/offal (liver, heart, and blood), and seafood such fish and crab Plant sources: legumes or pulses such as beans, peas, and lentils; nuts and seeds; dark green leafy vegetables such as nakati, boo/gobe, malakwang, dodo, pumpkin leaves, yam leaves, cassava leaves, and potato leaves; seaweed Foods/condiments fortified with iron, such as fortified wheat flour

Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery15

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Iron GapThe amount of iron that a body absorbs depends on:Amount of iron in the foodSource of iron: animal-source iron is better absorbed than plant-source ironConsumption of foods rich in vitamin C, which facilitate absorption (e.g., fruits such as oranges, tangerines, pineapples, and pawpaw) Consumption of foods that interfere with absorption, such as tea and coffee, high fibre foods (e.g., yams), and calcium-rich foods (e.g., milk) Iron-status of the individual: iron-deficient individuals will absorb more iron from the diet

Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery16

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Calcium GapCalcium is required for healthy bones and teeth, and needed for muscle function, nerve transmission, and contraction and dilation of blood vessels.Foods that are rich in calcium include:

Animal sources: milk and milk products (yoghurt, cheese), small fish with bonesPlant sources:

leafy

greens (cabbage, kale, collards); legumes or pulses such as beans, peas, and

lentils

Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery

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Zinc GapZinc is important for immune function and normal growth and development during pregnancy, childhood, and adolescence.A daily intake of zinc is required because the body has no zinc storage system.

A large portion (as much as 85%) of the zinc requirements for children 6-23 months needs to come from complementary foods.

Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery

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Zinc GapFoods that are rich in zinc include: Animal sources: meat (chicken and beef); organ meats/offal (liver, blood); fish and shellfish (oysters, crab); dairy products; egg yolkPlant sources: whole grains; legumes or pulses such as beans, peas, and lentils; nuts and seedsIntegrating Nutrition Assessment, Counselling, and Support into Health Service Delivery19

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Vitamin A GapVitamin A deficiency causes poor vision, lowered immunity, and dry skin and mucous membranes. Vitamin A is required in minimal amounts and is stored for a limited period in the body.Breast milk supplies a large part of vitamin A the child needs if the mother’s diet is not deficient.However, in many situations, the vitamin A status of the mother may be inadequate, and a greater proportion of a child’s requirements will need to come from complementary foods.

Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery20

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Vitamin A Gap

Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery

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Vitamin A GapFoods rich in vitamin A include:Plant sources: dark green leafy vegetables (e.g., spinach) and orange-fleshed vegetables and fruits (e.g., carrots, pumpkins, orange-fleshed sweet potatoes, mangoes, papaya)Animal sources: organ foods/offal from animals, milk and milk products, egg yolkMargarine and foods fortified with vitamin A, such as cooking oil

Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery22

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Other Nutrient GapsSome B vitamins (thiamin and riboflavin) and iodine may also be inadequate in breast milk after 6 months of age, particularly if mothers are deficient in these nutrients and thus less is provided through breast milk.Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery23

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Summary: Gaps To be Covered by Complementary Foods at 12-23 MonthsIntegrating Nutrition Assessment, Counselling, and Support into Health Service Delivery24

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Topic 3. Principles for optimal complementary feedingIntegrating Nutrition Assessment, Counselling, and Support into Health Service Delivery25

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Principles for Optimal Complementary FeedingComplementary feeding practices should reflect the FATVAH principles: Frequency of feedingAmount/quantity of foodThickness of food

Variety of foodActive feedingHygiene Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery

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FATVAH PrinciplesFrequency of feeding is important:Too few meals = child will not meet energy requirements

Too many meals = child will reduce breast milk intake, which may reduce the child’s overall nutrient intake and diet quality

Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery

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FATVAH PrinciplesFrequency of feeding is dependent on:Stomach size: Infants have small stomachs and can only eat small amounts at each meal.Energy requirements: Older infants/children will need more meals to meet their requirements.Energy density of the food: Foods that are less energy dense must be provided in larger quantities and more frequent meals.Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery

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FATVAH PrinciplesAmountThe stomach of a young child is small and at 8 months of age (~8 kg) the stomach can hold about 240 ml (1 cup) at one time. The amount given to a child should increase as the child grows.Start with 2–3 small spoonfuls of food twice a day and increase gradually as summarized in the following table.Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery

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 Age

 

Texture

 

Frequency

 

Amount

 

6–8

months

Start

with thick porridge, well mashed

foods; continue

with mashed family

foods

Use only treated water to prepare foods

2-3

meals per day plus frequent

breastfeeding

Based

on a child’s appetite, 1-2 snacks may be

offered

Start

with 2-3

tbsp

per feed, increasing gradually to ½ of a

250 ml

cup

9–11

months

Finely

chopped or mashed food and foods that the baby can pick up with his/her

fingers

Wash children’s hands before they feed themselves

3-4

meals  per day plus frequent

breastfeeding

Based

on a child’s appetite, 1-2 snacks may be

offered

½

cup at each meal

12–23

months

Family

foods, chopped or mashed if

necessary

Wash children’s hands before they feed themselves

3-4 meals per day plus frequent

breastfeeding

Based

on a child’s appetite, 1-2 snacks may be

offered

¾

to 1

250 ml

cup

Recommended

Food Texture

,

Frequency

, and

Amount

, by

Age

Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery

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FATVAH PrinciplesThicknessComplementary food should be thick enough so that it stays on a spoon and does not drip off.Generally, foods that are thicker or more solid are more energy- and nutrient-dense than thin, watery or soft foods.As a child develops, the child is able to handle increasingly more solid foods that are finely

chopped.Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery31

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FATVAH PrinciplesIntegrating Nutrition Assessment, Counselling, and Support into Health Service Delivery32

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FATVAH PrinciplesVarietyComplementary feeding should include a variety of foods to ensure the child is getting a variety of nutrients.Serve foods with a range of colours—yellow, red, orange, brown, green, and white.Plant and animal sources will help ensure that the child is

getting a variety of nutrients.Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery33

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FATVAH PrinciplesActive feedingHow, when, where, and by whom the child is fed are important.Active feeding (also called ‘responsive feeding’) means engaging a child while feeding to encourage the child to eat. Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery

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FATVAH PrinciplesActive feeding practices include: Talking to the child and making eye contact while feeding the child Minimizing distractionsFeeding infants directly and assisting older children when they feed themselvesFeeding slowly and patiently, and encouraging children to eat, but not forcing themIntegrating Nutrition Assessment, Counselling, and Support into Health Service Delivery

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FATVAH PrinciplesHygienePractice good hygiene when preparing food and feeding children:Always wash hands with soap or ash and clean flowing or poured water before preparing food and feeding baby.Use only treated water for drinking and mixing into food.Store treated drinking water in a covered container and serve by pouring.

Cover food when storing.Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery36

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WASHWASH includes:Water—access, quantity, and quality Sanitation—safe handling and disposal of human excreta, management of waste, and control of disease vectors (such as mosquitoes and flies)Hygiene—handwashing with soap/ash, treatment and safe storage of drinking water, safe preparation and storage of food

Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery37

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Importance of WASH Integration in Health Care and Nutrition ProgramsWASH practices help to prevent water- and food-related diarrhoeal diseases.Integrating WASH practices helps improve overall health outcomes.Focus on practices that are feasible for each household.Negotiate a commitment to try 1–2 practices that seem feasible, worth changing and safe, from the point of view of the

household.Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery38

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Water: Priority Actions Treat drinking water Chlorination (Aqua Safe, Water Guard)Solar disinfectionBoilingFiltrationUse treated water to wash or mix into foods that won’t be cooked furtherStore treated water safelyCovered container with narrow neck

Serve by pouring, or using clean ladleIntegrating Nutrition Assessment, Counselling, and Support into Health Service Delivery39

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Sanitation: Priority ActionsHandle and dispose of faeces safely:Latrine use by all household members.Maintain latrines according minimum standards, keep clean and adapt for those with limited mobility.Maintain a clean environment:Keep animals out of house and away from food preparation.

Sweep compound to remove animal faeces.Ensure that toddlers do not crawl in areas with faeces.Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery40

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Proper handwashing:Using soap or ash every time you wash your handsWashing hands under poured or flowing waterBefore handling/preparing/eating foodBefore feeding others or giving medicines

Hygiene: Priority ActionsIntegrating Nutrition Assessment, Counselling, and Support into Health Service Delivery41

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Hygiene: Priority ActionsProper handwashing (cont’d):After going to the toilet or cleaning others who have defecated; blowing your nose; coughing/sneezing; handling animal/animal wasteBefore and after tending to someone who is sickInstalling a tippy tap near latrine and food preparation areas can promote handwashingIntegrating Nutrition Assessment, Counselling, and Support into Health Service Delivery

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Hygiene: Priority ActionsPrepare, handle, and store food safelyKeep food preparation areas and serving/eating utensils clean.Separate raw and cooked food.Cook food thoroughly.Keep foods at safe temperatures.Use treated water.

Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery43

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Group WorkPrepare a nutritious complementary meal with the food provided.Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery44

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SummaryStart providing children with complementary foods, in addition to breastfeeding, at 6 months.Continue breastfeeding until the child is 2 years of age.Gradually increase frequency, amount, and texture as child gets older.Provide a variety of foods—animal and plant sources and a variety of colours. Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery45

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Summary (Cont’d)Actively engage the child while feeding to encourage the child to eatPractice good hygiene, including good food hygieneWash hands with soap/ash and clean flowing/poured water before preparing food or feeding among other key timesTreat drinking water and water used in non-cooked foodsIntegrating Nutrition Assessment, Counselling, and Support into Health Service Delivery

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Summary (Cont’d)Store treated drinking water in a covered container with a small mouth; pour water to serveCover food with a cloth, net, or lidAvoid contamination of cooked food with raw foodCook and reheat food thoroughlyIntegrating Nutrition Assessment, Counselling, and Support into Health Service Delivery47

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Thank you!

Questions, additions,

and clarifications?

Integrating Nutrition Assessment, Counselling, and Support into Health Service Delivery