Complementary Feeding

1. DEFINITION:
The concept of food
complementary is relatively recent. If dice of
that complements breastfeeding maternal, but
without canceling it. It revalues breastfeeding maternal like
an optimal food for the first 6 months of life.

The right time to introduce the nutrition

complementary is to the six months of age, when
the requirements must be met nutritional and
an adequate development of the functions
digestive renal y the ripening neurological. In
relationship with nutrition, because children they can
maintain a normal weight gain, while having a deficit in vitamins and
minerals, without clinical manifestation. Therefore, the introduction of other foods becomes necessary.
that provide those nutrients that breastfeeding supplies in small amounts. As a component
maturative, because from four months of age the child acquires the necessary abilities to
similar a diet more varied.

Starting from 6 months of age for the girl or boy, in addition to continuing with breastfeeding.
needs to start complementary feeding.
When the child starts eating other foods different from breast milk, it is necessary
be very patient, do not force it, shout at it, or scare it. The time to eat should be calm
and full of affection.
A constant communication through singing, tender words, and caresses on the skin are the
best ways to stimulate this emotional relationship between children and their caregivers.

2. OBJECTIVES

Complementary feeding pursues several objectives, including:

Contribute to the development of the device digestive.
Supplement insufficient nutrients.
Teach to distinguish flavors, colors, textures and temperatures
different.
Collaborate in the formation of habits of nutrition
healthy.
Prevent energy deficiencies and proteins
Develop skills for a transition fluid between the
total dependence of the child on the parents for feeding, to self-feeding.

3. Laws of Nutrition
. Law of QUANTITY: the nutrients contents in the
foods must be in the amounts caloric y
nutritional requirements to meet the demands
energetics of the organism.
. Law of QUALITY:
Foods must contain the necessary nutrients.
. Law of HARMONY: the quantities of the various nutrients
they must keep a proportional relationship between them Hydrates of
55-60%

. Law of
ADJUSTMENT: every diet must be appropriate for each
individual considering age, sex, physical activity, state of
health, tastes, culture and adjusted to their economic resources.
. Safety Law: that its regular consumption does not imply
health risks because it is exempt from organisms
pathogens, toxins, and contaminants

4. WHY THE FEEDING

SUPPLEMENTARY STARTS AT 6 MONTHS?

The introduction of solid foods implies a

transition period between the nutrition
liquid (breast milk or formula) infant) and the
characteristic feeding of the rest of life
(mainly solid).

They can make movements of

chewing of above towards
down.
They can control better his language.
It is the age in that your system
digestive is
sufficiently mature for
digest a variety of foods.

It is a complex and gradual process that, among other things, requires a reasonable amount of time.
so that the child's neuromuscular, renal, digestive, and immune systems acquire the
necessary maturity.

In particular, one must take into account the physical maturation and that of the different
systems to consider whether the baby is ready to start with foods other than
milk. To do this, the following aspects must be valued and the appearance of 'signals' observed:

Neuromuscular system
At birth, the healthy baby already has sucking and swallowing reflexes. However, the ability to
swallowing semi-solid food offered with a spoon reaches its maturity between the fourth to
sixth month of postnatal life. Likewise, children have the extrusion reflex, which consists of
in which the child expels objects and food that come near to his mouth with his tongue.
lips, this reflection disappears around the fourth month. Another factor that facilitates the supply
the control of the neck (head support) and the trunk (sitting) is essential for semi-solid foods
alone), which also appears around the fourth month.

The child is ready to start eating other foods.

when is he/she able to sit up with little support
supports and leans forward while observing the
food, showing interest, opens the mouth easily when
to brush their lips with a spoon, does not push with the
tongue out and can move the food
backwards and swallow it.

In addition, to start with solid foods, it is

it is necessary for rhythmic movements to exist
 chewing, which develops around 7-9 months of age. This is a fundamental point, not
only in terms of 'nutrition', of promoting chewing and swallowing, but
also for aspects related to phonation and language.

When this 'window or critical stage' is surpassed, the likelihood of developing increases
difficulties in getting the child to acquire these skills.

Gastrointestinal system

Around 4-6 months of age, the intestine acquire a

sufficient development to serve as a 'barrier' y in good
proportion to prevent the entry of allergens food-related. To your
time, quantity, and quality of enzymes result sufficient; this
this aspect, added to the previous one, facilitates digestion and the absorption,
protecting from food intolerances (manifested, by
example, with vomiting and diarrhea).

On the other hand, when starting feeding complementary, it

promote changes in the microbial flora intestinal
specifically, in the protective species (bifidobacteria and lactobacilli) with a possible
impact on the larger 'barrier' and 'immune' system available to the being
human, located at the intestinal level.

Renal system

Close to six months of age, the infant's kidney gains greater functional suitability, in
filtration and maturity terms, sufficient to handle a higher solute load,
reaching close to 75-80% of adult function
around 12 months.

The start of complementary feeding is mediated

due to the aforementioned physiological factors and, furthermore, by
nutritional, socioeconomic, and cultural factors.

Another constraint of that beginning is the requirement

nutritional, which changes proportionally with growth
of the baby. Characteristically, starting from the sixth month
the baby needs a greater energy contribution and of
some specific nutrients (for example: iron, zinc,
calcium and vitamins A, C, and D); with just milk those
needs are impossible to meet. If the baby does not receive
additional amounts of those nutrients, will not be able to
progress appropriately in growth and development.

5. What type of foods should be used for the

complementary feeding?
The main reason why the baby should start eating foods other than milk is that
as has been expressed, it is of nutritional type.
The needs for energy, protein, vitamins, and minerals increase starting from the sixth.
months of life, and, for this reason, the selected foods must be rich in: calories, proteins,
iron, zinc, calcium, vitamins A-C-D, among others. The chosen foods will 'complement' the
basic food that continues to be milk (at least until the first year of life) and will help
with the coverage of nutrient requirements.
Foods with appropriate nutritional value, easy to digest, and low should be used.
voluminous, fresh, and hygienically prepared.
The choice of foods depends on geographic factors, cultural habits, availability,
family customs and the family's socioeconomic level, among others.
Likewise, the chosen foods must be free of toxic substances, aflatoxins, hormones and
pesticide residues.

Fruits and cereals

The AAP Nutrition Committee recommends iron-fortified infant cereals and the
fruits (in compote) as first-line semi-solid foods to start this work.

Meats

However, the Nutrition Committee of the Espghan emphasizes that by the sixth month or at least by six
At six months and a half, lean meat (without visible fat) should be incorporated, preferably red meat,
in small portions and with appropriate consistency for the child (ground, purees, smoothies), for
cover the main 'limit' nutrients in postnatal, particularly iron and zinc.

Gluten

The ESPGHAN and NASPGHAN recommend the introduction of gluten (wheat, oats, barley, and rye
they are the cereals that together with water lead to their formation) between the fourth and
seventh month of life, noting that inclusion should be gradual and that it is ideal
parallel accompaniment with breast milk. Apparently, BM protects the infant from developing
autoimmune diseases, such as type 1 diabetes, celiac disease, and wheat allergy,
related to the incorporation of cereals.
Cereals should not be introduced either before four months or after seven.
Cases in which this early or late introduction has occurred have demonstrated an increase in the
susceptibility or in the incidence of the aforementioned diseases.

Juices
The AAP recommends that infants and children up to six years of age consume as
a maximum of six ounces of juice per day. This is due to findings that certify that drinking amounts
Higher education is associated with an increase in energy intake, displacement of milk or
nutritious foods, decrease in the intake of vitamins and minerals, particularly those
linked to bone health, such as calcium and vitamin D, increase in malabsorption and
chronic diarrhea, stunted growth, and predisposition to obesity, among other disadvantages.

Cow's milk
The AAP, Espghan, and Naspghan disapprove of the introduction of cow's milk during the
first year of life, primarily due to its negative impact on iron nutritional status
in the infant, among other aspects.
Allergenic foods
According to Espghan, Naspghan, and AAP, there is insufficient and compelling evidence that
validate the need and advantages of restricting foods with potential allergens, such as
egg, fish, wheat, during the first year of life in healthy children or those who have
family history of allergies, as a protective mechanism for their development.
On the contrary, prohibiting foods like eggs or fish can impose conditions.
specific deficiencies and endanger the coverage of certain nutrients such as in the case of
docosahexaenoic acid (LC-PUFA omega 3), whose main source is fish and that fulfills
critical functions at the level of the nervous system and the retina.

Iron and zinc

The Espghan and the Naspghan indicate in their most current recommendations (2008) that 90% of
iron and 90% of the zinc required by the infant must be covered by solid foods. This
to prevent iron deficiency and iron deficiency anemia, as well as zinc deficiency
respectively, issues of serious impact in the world and, in particular, in Colombia.

Salt and sugar

The WHO, Espghan, and Naspghan reinforce the concept put forth by the AAP of avoiding salt and
sugar in the preparations, beverages, and juices of infants during the first year of life. In
In this sense, the use of other sweeteners typical of the culture would also be prohibited.
Colombian, just like "panela", which increases sweet flavor, the "empty" calories and the
osmolarity of the preparation and/or drink.

Honey
It is recommended to avoid it during the first year of life unless it has undergone a
special industrial treatment (high temperature and high pressure) that leads to reducing the
probability of survival, for example, of botulinum toxin (Espghan and Naspghan).

Dangerous Foods

The AAP considers that nuts, peanuts, popcorn, and raisins, among others, are foods.
dangerous for children under four years of age, given the risk of choking,
bronchoaspiration, or the likelihood that they will be introduced out of curiosity into the nasal cavities or
ears.

Vegetarian diets

The 'strict' vegetarian diet is prohibited for children under 12 months. If by conviction the
Parents subject their children to this type of diet, it must be 'at least' of the type
lactoovovegetarian and include at least 500 ml of breast milk or infant formula (Espghan and
Naspghan). Another related factor is that this type of diet provides a high fiber content,
what can condition the availability of micronutrients, as well as energy and fatty acids
essential, and consequently affect the normal growth and development of the child.

The dizzying advance of science highlights the influence of a child's nutrition in their early years.
24 months regarding short-term, medium-term, and long-term health. Therefore, it is essential that the
health professional, particularly the one responsible for guiding the child, consider the
implications of proper nutrition and the correct progression as a mechanism of
promotion of growth and development, but at the same time, as a method of prevention of
different pathological entities of immune type, chronic non-communicable, alterations in the
nervous system, cancer, among others.

6. How should their diet be according to their age?

From 6 to 8 months
. Consistency: Porridges, mushes, or purees.
. Recommended foods: The girl or boy should eat 2 tablespoons of:
Animal-origin foods: liver, blood sausage (guinea pig or chicken), spleen or others.
Besides:
Cereals and tubers: noodles, potato, sweet potato, semolina, cornstarch, etc.
Vegetables: Add a tablespoon of pumpkin, carrot to all the purees.
spinach and others. Vegetables of different colors (green, orange or yellow).
Frutas:Plátano de la isla, durazno, papaya y pera (incluir en la media mañana
in the form of porridge, diced or grated.
Fats: Add a teaspoon of oil or butter to the food

. 3 to 5 tablespoons of papilla = ½ plate medium.

. Frequency: 3 meals a day (mid-morning, lunch, and dinner).

From 9 to 11 months

. Consistency: chopped foods.

. Recommended foods: The girl or boy should eat 2 tablespoons of:
Foods of origin animal liver, blood (guinea pig or chicken) fish
Hey, what's up.
Cereals and tubers: noodles, potato, sweet potato, semolina, cornstarch, etc.
Vegetables: Add a tablespoon of pumpkin, carrot, spinach to all foods.
and others. Vegetables of different colors (dark green, red, orange, or yellow).
Island banana, peach, papaya, and pear (in orange-red or yellow color).
Fats: Add a teaspoon of oil or butter to the main meal.
(lunch or dinner).

. Quantity: 5 7 tablespoons of food = ¾ medium plate.

 . Frequency: 4 meals per day (mid-morning, lunch, afternoon snack, and dinner)

From 12-23 months

. Consistency: preparation of the family pot. Preferably main courses.

. Recommended foods: The girl or boy should eat 2 tablespoons of:
Foods of origin blood (cuy or chicken), chicken liver, fish
both, you see.
Cereals and tubers: noodles, potato, sweet potato, semolina, cornstarch, etc.
Vegetables: Add a tablespoon of pumpkin, carrot, spinach to all foods.
and others. Vegetables of different colors (dark green, red, orange or yellow)
Frutas:Plátano de la isla, durazno, papaya y pera (de color anaranjado rojo o amarillo).
Fats: Add a teaspoon of oil or butter to the main meal.
lunch or dinner

. Quantity: 7 to 10 tablespoons of food = one medium plate.

. Frequency: 5 meals per day (mid-morning, lunch, afternoon snack, and dinner)

7. Complications of late initiation of complementary feeding

Increases the risk of malnutrition

Nutrient deficiencies
Delay in neurological development
Avoid the acceptance of new flavors and textures
It hinders the optimal development of motor skills (CHEWING).

8. Disadvantages of the early introduction of complementary feeding

Competitive activity with breastfeeding

Risk of hypersensitivity and food allergy
Early introduction of masked gluten
Adverse effects of additives
Control failure of intake
Risk of overfeeding
Tendency to vomiting and/or diarrhea
Increased risk of infections
Renal overload of solutes
Accidents due to poor oral motor coordination
Deficiency situations due to absorption deficit