The practice of introducing complementary foods (solid foods and liquids other than breast milk or infant formula) during the first year of life is variable. The American Academy of Pediatrics and World Health Organization recommend that complementary foods be introduced around six months of age

What is the ideal time to start complementary feeding?

The optimal time to start solid foods depends on the child’s age, the child’s ability to sit up, support his or her head, and meet other developmental milestones. These guidelines apply to all children, including those who have delays with gross motor skills. Your infant should be able to do the following: sit with support, have good head and neck control, must be ready for varied textures of supplemental foods by placing their hands or toys in their mouth and lean forward and open the mouth when interested in food, and lean back and turn away when uninterested in the food or not hungry.

Why should solids not be introduced earlier?

Introducing solid foods before age four to six months is not helpful and could be harmful. Reasons for delaying the introduction of solid foods include the following:

1. Introducing solid foods before your infant is four to six months of age may interfere with his or her ability to take in an adequate number of calories or nutrients.

2. Young infants do not have the coordination and/or skills to safely swallow solid foods, which could lead to aspiration (inhaling food/liquid into the lungs).

3. Infants younger than 4-6 months  have a reflex (called the extrusion reflex) that causes them to raise the tongue and push against any object that is placed between their lips. 

What are the ideal foods to start complementary feeding?

There is no single preferred food that is recommended as a first food. Single-ingredient foods should be introduced first, one at a time, every few days, to determine if the child is developing an allergic reaction. As solid foods are introduced, infants should not consume too much milk t volumes exceeding 800 ml/day . Breastfed children are allowed to nurse on demand.

Cereal — Single-grain infant cereal is a good first supplemental food because it supplies additional calories and iron. Rice cereal is traditionally offered first because it is widely available and is least likely to cause an allergic reaction. Oat cereal is also a good choice. Likewise, wheat products (in cereal or other foods) may be offered by six months of age.

Infant cereals can be prepared by adding breast milk, infant formula, or water. The consistency should initially be thin and may be made thicker over time. Cereal should be offered initially by spoon in small amounts (one teaspoon) at the end of breast- or bottle-feeding. Spoon-feeding helps to develop your infant’s ability to coordinate mouth and swallowing movements as well as enhance future speech development. Gradually increase the amount of cereal to two tablespoons two to three times per day by 8 to 10 months of age and four times per day by 12 months of age.

What are some important tips to prepare ideal complementary feeding?

(a) Complementary feeds must be made in a thick, homogenous consistency from locally available food while continuing on demand breast feeding. During this phase, one must support breast feeding optimally. Complementary feeding should be projected as the bridge that the mother has to make between liquid to solid transition and to empower the baby to ‘family pot feeding’.

(b) In order to increase calorie density of the food, each meal must be made energy dense by adding sugar / jaggery and ghee/butter/oil. To provide more calories from smaller volumes, food must be thick in consistency– thick enough to stay on the spoon without running off, when the spoon is tilted .

(c) Foods can be enriched by making a fermented porridge, use of germinated or sprouted flour and toasting of grains before grinding .

d) One to two nutritious snacks must be interspersed between the  three main meals to provide optimal calories and proteins. Snacks are in addition and should not replace meals. They should not to be confused with foods such as sweets, chips or other processed foods.

(e) Parents must identify the staple homemade food (as these are fresh, clean and cheap), comprising of cereal pulse mixture in the ratio 3:2, and make them caloric and nutrient rich with locally available products.

(f) Research has time and again proved the disadvantages of bottle feeding. Hence bottle feeding shall be discouraged at all levels.

(g) The food should be a balanced diet consisting of various (as diverse as possible) food groups /

components in different combinations. Easily available, cost-effective seasonal uncooked fruits, green and other dark colored vegetables, milk and milk products, pulses/ legumes, animal foods, oil/ butter, sugar/ jaggery may be added in the staples gradually.

(h) . Hand washing with soap and water at critical times- including before eating or preparing food and after using the toilet .

(i) Practice responsive feeding. Self-feeding should be encouraged despite spillage.  Forced feeding, threatening and punishment interfere with development of good/ proper feeding habits . 

(j) Consistency of foods should be appropriate to the developmental readiness of the child in munching, chewing and swallowing.  Introduce lumpy or granular foods and most tastes by about 9 to 10 months.