It is now a global consensus that a newborn baby must be exclusively breastfed up to the age of 6 months. By exclusive breast-feeding we mean that the baby is getting only mother’s milk and nothing else, not even a drop of water. A feeder bottle must not be used even for feeding expressed breast milk. In that case a cup and spoon should be used.

Why additional feeds are needed?
Exclusively breast fed babies can grow up and develop optimally up to 6 months of age. They become bigger and more active or playful requiring more calories (energy). An active playful child needs more energy than a child who is less active and less playful. It has been found that after the age of 6 months breast milk alone can no longer give sufficient calories to the baby. For this reason at this age we should give extra food besides breast milk to satisfy the extra requirement. These feeds are therefore called complimentary feeds. No rigid schedule should be imposed on the child. Children are very rational in amount of food they take. A child allowed to take foods according to his demand will not usually be obese. Children become hungry and then take food. Otherwise they will prefer to play rather than eat!

Some special points
1. Non milk sugar should be limited to no more than 10 per cent of the whole calorie intake.

2. Atopic children who are commonly allergic should better have late introduction of complimentary feeds to avoid allergy.

3. Wheat should better be excluded during the first 12 months of age.

4. Animal milk (e.g. cow’s milk) should not be given during first year of life

5. Complimentary feeding session should be enjoyable both for the mother and the child. War of will may harm the child-mother bonding.

6. One of the important causes of vomiting is forced feeding.

Sometimes infant feeding becomes unnecessarily complicated by people of vested interest. Food must be evaluated by their value (calorie or energy, minerals, vitamins, micronutrients, fiber, etc). A commercial pack of so called additional feed of one pound of weight hardly contains the food value Taka 10 only. So you should not use these sort of foods for your child.

Form of feeds
Liquid food like milk, juice, etc. are calorie thin. A baby’s stomach measures just like his or her fist. Therefore, calorie-thin feeds can no longer meet the increasing energy demand due to increasing activities. So, you need calorie-dense feeds which are usually solid (or semisolid). Complimentary feeds therefore, should be made at home using home food ingredients. This also helps the child to be accustomed with the family food items. The child also discovers the family through family foods. It is better to habituate them with his or her family foods earlier from the age of 6 months. A child not habituated at this age may reject family foods later.

Don’t use blender machine to make foods very easy to take in. It may cause a bad habit in your child. Always remember that natural way is the best way at least for eating foods.

When to give extra food
Paediatricians in Bangladesh recommend complimentary feeds from the age of 6 months. The initial feed should better be of plant origin to reduce hypersensitivity from food of animal origin. You can give rice powder (locally called suji) cooked well with sugar, oil, and some fragrant spice. Every baby likes it. You may add egg in small amount at the beginning; then increasing gradually. Never give egg in raw, poached, or half-boiled form. Cooking the egg well makes its allergenicity 70 per cent less. It also kills the poultry germs which may be present inside the eggs. So, always cook eggs well. If there is hypersensitivity, withhold eggs for 2 weeks to give it again. This time it may be better tolerated. Loving mothers think that egg should be fed separately, showing it to her baby! But it is easy to feed egg mixed with other foods to ensure proper cooking.

Eggs must not be given before 6 months. Egg protein may cause anaphylaxis (reaction of allergic origin). Usually there is no permanent egg allergy.

How to start?
Don’t force your child. In the beginning the child may refuse food. S/He may spill. Don’t expect that your child will take all the amount of feed you made. Usually 2-3 feeds are enough. Give these in between the breast-feeding.

Initially give thin feeds such as suji. It is mainly carbohydrate and of plant origin. It is supposed to be less allergenic. To make it tasteful you can add vegetable oil and flavouring spices to it. Gradually introduce rice and dal mix (khichury), soup, etc. There will be thus a transition from plant to animal origin foods. It is more tolerable for your child. Fruits should be given from the beginning of complimentary feeds.

Khichury can be kept as a basic food. You can add variable foods with it daily. For example you can add chicken one day and fish on another day. You can add vegetables easily to khichury. Children who do not like vegetables often do not dislike it when mixed with khichury. Adding new items will make the khichury different.

Stop feeding when the child refuses to take further. Never intimidate the child. Give some water at the end of feed. Don’t try to feed during sleep (only possible by using bottle). Remember that home made foods are always much better than the commercial foods. Family food is really good.

Breast milk should be continued up to 24 months of age. During this period no animal milk should be given.

The writer is a Professor of Paediatrics and Head of the Department of Paediatrics of Bangladesh Medical College.