 Hello everyone, so now we will be talking about complementary feeding, okay. So so far we spoke about breastfeeding and you know breastfeeding issues and nipple conditions and breast conditions, now babies say 6 months complete. So now we will talk about complementary feeding. My experience is that you know of course I work in all different parts of India, urban slums, rural areas, tribal areas, I also work in US. So you know I have experience of not just developing world but also develop world and you know complementary feeding stage is one of the most difficult stage, okay. I do see of course you know breastfeeding issues we have tackled with this 45 points cross-caddle hold. In fact Gujarat state has taken up 45 points cross-caddle hold in each and every district 33 districts all of them are trained on that complementary feeding is the issue, okay. There are a lot of myths, a lot of this cultural biases, India the number of children or percent of children who are getting minimum adequate diet from 6 months to you know for younger children 23 months is only 11 percent, okay. So NFHS 5 data has come out you know in last data 5 years ago it was only 9 percent children were getting now it is almost 11 to 12 percent. So still we have very poor complementary feeding in our young children, okay. So please do understand this session very well do try to implement in your own homes if you have young children and if you do not then just kind of find out in your family extended family if you know mothers have young children do find out what they are eating whether it is adequate, whether frequencies good enough, what food groups they are getting with the dietary diversity is important you know. So please do learn about that, okay. So now what issue we found? So I will talk about my experience little bit before we go into complementary feeding tutorials main thing is most of the mothers they were not starting complementary feeding on time, okay. This was actually true in tribal areas and some of the rural areas also they are afraid that you know baby will choke or you know my milk is enough baby is growing okay you know they would have lot more other kind of concern. So many tribal areas they start complementary feeding at one year of age in fact in urban slums I had an opposite kind of experience they would start complementary feeding by four months of age. So what they would start with they would start with maori biscuit okay which is kind of soaked in cow's milk and they would feed that child that maori biscuit which is nothing but sugar and all purpose flour you know your white flour then they would start with lot of other kind of biscuits you know they just did not understand the concept of exclusive breastfeeding and I am sure you know they wanted to start complementary feeding because probably they realized that babies are not growing well and they were concerned. So I can understand their concern also so you know obviously work on the good latch and 45 points so that you know babies gain good weight and families do not feel the need to start complementary feeding early on okay because we do see this issue not only in poor children but also in kind of educated families and elite mothers, educated mothers you know they also have this concern of whether baby will like it whether baby will eat or not you know. So in this tutorial you know this coming to tutorials on complementary feeding guideline and on complementary food we have discussed how like how to start complementary feeding at the end of 6 months so once you complete your 180 days you know that is when you are at the beginning of 7 month that is when you start lot of time when you say 6 months you know mothers will let as soon as child complete 5th month and a 6 month started and they start complementary feeding. So it is not beginning of 6 months it is the end of 6 months okay one more thing we also experience that all these babies they were gaining good amount of weight on cross griddle hole there was no doubt you know they were they were almost 9 kg, 8 kg some of them were 10 kgs at 6 months of age but at complementary feeding stage you know a few years ago they were not gaining weight you know they would recommend you know give this vegetable give this fruit give this rice you know this kichidi and put this that you know but unfortunately it was not helping much. So we realized and this is I really thank one of my dear friend he kind of you know asked me to kind of joint one consensus statement where I heard Dr. Michael Golden you know so he was talking about the pathophysiology and biochemistry in children who was really acutely malnourished. So Sam children we were writing a guideline for management of Sam for Indian Academy of Pediatrics and you know this Dr. Michael Golden he is the guru of malnutrition and he spoke about what are these nutrients which are lacking in malnourished children and he spoke about how if we can include those nutrient in the food you know and if you give this food to malnourished children they would just basically not only have increased muscle mass but they would also kind of grow you know and height. So when I was thinking about that when I was understanding his concept you know of type 1 and type 2 nutrients where you know he discussed about how type 2 nutrients are kind of growth promoting nutrients which I have discussed in our you know first and second sessions on type 1 type 2 nutrient and also you know how type 1 nutrients are more for specific metabolic functions like anemia or sericates or any of those specific functions you know he is focused a lot on type 2 nutrient okay and he said that you know if you give food which is high in type 2 which is your high in protein your good essential fatty acids you know omega 3 and omega 6 in good ratio then also you know magnesium potassium chloride sodium zinc it is sulphur so he discussed a lot about those nutrients and it just stuck to my mind and I said that if malnourished children can grow so kind of so well on this kind of food which is high in type 2 nutrient then why not children who are stuck who are like you know for 2-3 months they have not gained weight at all and I kind of came back in my clinic and I spoke to our nutritionist you know and the Pali for good day and I said the Pali we need to include this food which will improve children's weight okay because children are growing leaps and bound when they are young so I wanted I did not want them to stagnate for a long time because then the height would suffer right so and then we also knew that the children had very small appetite so again you know we I told her I said I want some kind of homemade recipes which would not fill up baby's stomach because it is very small you know like a nine month old hardly has 200 ml capacity where you cannot feed 200 ml just maybe 100 to 150 ml you know so then I said why you come up with something where I want magnesium in that food natural food I want potassium in the food I want you know protein of protein I want all these nutrients which are nutrient dense food in powder form which you can just add in children's food so they will get all this nutrient from the diet you know and no behold you know I had all these demands and she came up with some recipes you know it took us some time to figure out but what she did she basically took you know some peanuts some seeds like sesame seeds and other you know like pumpkin seeds and lot of other seeds which are available in the market then she what she did is she made sprouts and dried roots sprouts you know and then make powder from the sprouts is also called malted flowers and then she used all these different you know like curry leaf powder she made she made kind of moringa powders you know moringa leaves or your drumstick leaves which are very very healthy and then she created all this kind of micron nutrient dense powders you know and then we said that okay let us try in children's recipes you know and when suppose mother would make a kichiri so she would say have rice and dal but we said now you also while you're cooking a kichiri you add one or two powders in this and then try to feed the baby and you know as soon as we started this powders we again started seeing amazing weight gain in this children now this issue we found more in children who are vegetarian okay because of course vegetarian children they don't have get enough protein from the diet okay believe me they don't get a good quality protein mothers are not kind of mothers are skeptical to start you know paneer or dahi or curd and you know any of those products they get predominantly dal and rice very ponotonous diet they get we have lot of studies which are already there in the in you know magazines and all your journals and you know children they get hardly 203 kind of food groups so again for non-veg children you know when they were eating eggs when they were eating meats when they were eating say bone broth and all those kind of non-veg food we were not seeing lot of deficiency in those children because those non-veg food is nutrient dense okay so when even if they eat little bit you know they get all kind of nutrients they get kind of vitamin A retinol they get vitamin you know B12 they get choline they get all these nutrients you know except one nutrient which they lack if they are they eating predominantly non-veg food is magnesium but then we told them how to add magnesium rich food which is your nuts and seeds and also some of the beans are very high in magnesium right so once we understood this type one type of nutrients we kind of became more like pharmacist but food pharmacist you know not not the pharmacist which gives you medicine we would tell them okay looks like you are not eating good food which is high in zinc you know so zinc which would be like high in some of this again you know rajma has good amount of zinc and some of these other foods are high in zinc so we said okay now give child more rajma or give rajma is your kidney beans or give food which is you know like cashew so people like lot of tribals they have cashew trees you know so for example one of the tribal area that we work in Dharampur you know in Gujarat every tribal has a cashew tree so we said don't just give cashews don't sell it keep some cashews and make a powder and put in children's food and amazing weight in that we saw not only weight gain but height gain or length gain also okay so here again I have also shown what are those powder recipes that our nutritionist had created do use those recipes in children's diet mothers can use it in her diet she I mean she can just eat she doesn't have to make powder but you know these powders are nutrient dense okay so you just use a little bit and it will be lot of increase in nutrient density okay nutrient density is just basically the amount of nutrients that they will get from that amount of food okay and also another thing we also recommend that if parents are okay definitely start with non-veg food first okay especially eggs meat chicken you know fish is really good very high in omega 3 omega 6 omega 3 actually not omega 6 so much of course but do focus on starting with non-veg food if parents are vegetarian that's fine start with protein rich food like for example your you know beans sprout them very important cook them don't give them raw that's again very critical and give more millets don't give too much of grain avoid rice avoid wheat those are nothing but carbohydrates you know give her give them much more millets you know your jawar bajra ragi they're high in minerals they're high in protein also high in fiber also and also give them you know dahi so more of dairy products don't give them milk because baby is getting mother's milk you do not give outside milk no cow milk but you can give dairy I mean dairy product which is your your dahi your yogurt curd your paneer you can also if mother can afford cheese is given to no problem so give those high protein rich foods vegetables are good some of the vegetables are high in protein so your you know cauliflower is has good amount of protein your spinach is good amount of protein you know if you look at the protein energy ratio also start vegetables after the protein rich food group okay so start with protein group first then start with vegetables and then fruit should come last now what I see in in the field especially with the educated mothers they are so fascinated by fruits you know they feel that if I give fruits baby will be healthy it's not that I'm against fruit but issues that I see in in the field is babies who are started with fruits first all mothers who kind of mix fruit in all the different foods that they give so they give they put apple puree and kichidi they put you know some kind of puree banana puree in some other food you know those are the babies they do have sweet taste and once they start liking sweet taste it's very difficult for them to like other vegetables and other foods okay so I don't recommend starting fruits first you start fruits last as a last group so maybe by 7 or 8 month you can start fruits do not mix with any other food groups give fruits more as a dessert just maybe one or half of fruit in a day after the meal okay don't give fruit by itself it's very high in fructose and you know it's natural but still it's fructose okay so give it more in a dessert form and it's separately okay and it's not necessary to kind of you know give fruits with every meal do not mix it with any other food groups okay so again enjoy your you know complimentary feeding video after 2 years of age of course when you start you can continue breast milk for 3 years 4 years 5 years but if you're starting cow milk do not do not give cow milk first give them breakfast first and then give cow milk after once you stop breastfeeding after 2-3 years you know that's important because don't fill up their stomach with breast milk okay and in situation where if mothers are not breastfeeding or say mother is passed away or there are any other issues please do remember that you should kind of you know increase your number of you know solids that you're going to give it you know so number of times which I've given shown in the video so do remember that we have to do that okay and mother's milk is the best continue mother's milk at least till 2 years of age do not stop it during daytime I recommend to give more food after giving food then give breast milk and nighttime you can continue breast milk you know do not breastfeed first and then give food because that will fill up the stomach it's just a common sense okay so just give food first and then give breast milk another thing I'm also going to I want you guys to understand about junk food mothers have this tendency to start a lot of junk food when they're young please avoid that because junk food will cause a lot of issues with growth it will also cause issue with a lot of metabolic health we don't want children to become diabetic or have say high triglyceride level or any of those you know fatty livers now there was one very good data which just came out by government of India it's called CNNS data and in that we found that children between 5 to 9 years of age you know 30% children have high triglyceride level okay that's a very high number and you don't want children to have such high triglyceride because that will cause kind of fatty liver and it will cause eventual problems with you know blood pressure or diabetes or heart disease or any of those okay so all that basically that foundation starts from conception to breast feeding to complementary feeding and what food you're kind of giving okay so all that will basically it's basically part of the same it's a journey okay and you know that nowadays we see young adults getting heart attacks young people getting you know diabetes blood pressure they have big belly and this all because of wrong foods so when you give wrong foods what happens in young children they don't grow they don't grow in height they become more like you know this way they grow and if the wrong food is started then and you know young children then eventually they continue to eat that wrong food and they put on a lot of weight and then they have all this metabolic diseases now one more thing I want to discuss about Indian children or Indian phenotype that we have something called 50 gene that means that lot of time many of us are very thin we may not put on weight we may not look fat like a lot of these Americans and Europeans you know they look fat they look obese we have something where we have fat inside our body we may not look fat from outside but when you do so MRI when you do look at the visceral fat we have lot more visceral fat visceral means organ so we have lot more fat around our organs and that will cause metabolic diseases much early on early on so do not think that oh my child is thin or I am thin so nothing will happen to me it's all about what how much fat you have around your liver you know around your pancreas around your heart and that will cause problems later on okay so remember healthy food healthy life and healthy aging okay thank you so much welcome to the spoken tutorial on general guidelines for complementary feeding in this tutorial we will learn about the importance of starting complementary food for six month old babies and complementary feeding guidelines for six to 24 month old babies let us begin a baby must be breastfed exclusively from the time of birth to six months of age six months of age does not mean the start of the sixth month of a baby's life she has completed six months and started the seventh month of her life at this age exclusive breastfeeding is not enough for a baby along with breast milk nutritious home cooked food must be given to the baby this food is called complementary food it must be given to a baby from six months to 24 months of age it plays a crucial role in making the baby tall healthy and intelligent it is important to start complementary feeding at six months of age otherwise the baby's growth and development will be hindered there are also chances that the baby might reject solid food at a later age remember complementary food supports breastfeeding therefore breastfeeding must be continued till at least two years of age the type consistency and amount of complementary food varies with baby's age there are specific recommendations for each age group they are discussed in detail in another tutorial in the same series now let's discuss important guidelines for complementary feeding at all ages any new food must be first given separately to a baby it should be combined with other foods later this will help to assess if the baby is allergic to a particular food eating a variety of foods is essential for good nutrition every fourth day add a new food to the baby's diet start with one tablespoon of the new food along with previously given food gradually increase its amount every day nutrient dense food from all eight food groups must be added gradually the first food group is grains roots and tubers legumes seeds and nuts is the second group third group is milk products fourth group is meat fish and chicken egg is the fifth group vitamin A rich fruits and vegetables is the sixth group seventh group is other fruits and vegetables lastly breastfeeding is the eighth group but the most important one it must be included every day along with other food groups ideally a baby's diet must include all eight food groups if a baby's diet has less than five of these groups it is a severe problem it must be corrected immediately some babies do not have access to breast milk at all include food from the remaining seven groups every day in their diet also give them 500 milliliters of animal milk and two extra servings of meals per day always boil the animal milk before feeding it to the baby now let's discuss the order of adding new food groups to a baby's diet along with breast milk start giving complementary food from the first five groups baby needs a higher quantity of nutrients after six months of age however the quantity of food that can be given in the initial days is small therefore nutrient dense food from the first five groups can be given these foods are rich in nutrients such as protein and good fats they are important for the development of the baby's height and muscle mass good fats are important for baby's brain development after these foods start giving vegetables and fruits vegetables and fruits are high in vitamins and minerals however they are not as dense in protein and fat as the first five groups therefore they are started later to avoid weight stagnation or loss also fruits are sweet to taste it is important that babies try a variety of taste before the sweet taste trying different taste helps babies to accept more foods this reduces the chances of them becoming a picky eater later hence fruits are added to a baby's diet after adding all other types of food giving fresh seasonal local fruits once or twice a day is recommended fruit can be given as a dessert after a regular meal fruit puree should not be mixed with baby's regular meals fruit juice is not recommended for this age group it includes both homemade and ready-made fruit juice remember continue breastfeeding up to two years avoid giving hard foods that may cause a baby to choke whole nuts, grapes, chickpeas and raw carrot pieces are examples of such foods freshly cooked homemade food prepared hygienically is the best for the baby if baby food is to be stored please watch our tutorial on safe storage safe preparation and serving of baby food is also discussed in the same tutorial please visit our website for more details along with food boiled and cooled water can also be given to a six-month-old baby start with 30 to 60 millilitres of water twice a day it should be increased in hot weather and as per baby's demand breast milk and water are the best drinks for a baby however they must be timed correctly do not breastfeed or give water to a baby before a meal a hungry baby is more likely to try new foods baby can be breastfed or given water 20 to 30 minutes before or after a meal adequate complementary feeding is necessary for a baby to grow well this brings us to the end of this tutorial welcome to the spoken tutorial on complementary food for six to 24-month-old babies in this tutorial we will learn about homemade nutritious complementary food we will discuss its amount type and frequency let us begin with complementary food for a six-month-old baby remember complementary food should be started after a baby completes six months baby's first meal should be a thick puree or paste made of only one food let's see some examples of foods which can be used for this meal whole beans like sprouted, cooked and pureed chickpeas can be used grains such as sprouted, cooked and pureed finger millet can also be chosen split pulses like soaked, cooked and pureed split green gram beans can be used non-vegetarian foods like cooked and pureed egg, chicken, fish can also be used choose any one of them to make a thick paste here sprouted, cooked and pureed red kidney beans is chosen as the first food if required add a little breast milk to the food to make a paste use boiled and cooled water only if breast milk is not available the consistency of puree or paste is extremely important it must be thick enough to easily stay on the spoon even when tilted feed one tablespoon of the first food for the baby's first meal on the first day give another tablespoon of the first food for a second meal on the same day along with these two meals on the first day breastfeed the baby adequately please note the tablespoon used in this tutorial holds about 15 grams of food on the second day feed two tablespoons of the same food per meal give two such meals on that day along with breastfeeding on the third day feed three tablespoons of the same food in each meal give two such meals on that day along with breastfeeding fourth day is the day to start giving a second new food choose one new nutrient dense food from any food group food groups are explained in another tutorial of the same series here sprouted, cooked and pureed finger millet is chosen as the second food make a thick paste of this food with breast milk or with boiled and cooled water start with one tablespoon of the second food paste per meal give it along with three tablespoons of the first food paste a total of four tablespoons of food paste must be given in each meal give two such meals on the fourth day along with breastfeeding on the fifth day increase the amount of the second paste to two tablespoons per meal give it along with two tablespoons of the first food paste in each meal give two such meals on the fifth day along with breastfeeding on the sixth day increase the amount of the second paste to three tablespoons per meal give it along with one tablespoon of the first food paste in each meal give two such meals on the sixth day along with breastfeeding on the seventh day start giving a third new nutrient dense food paste in this picture egg is chosen to make the third new food paste start with one tablespoon of the third food paste per meal give it along with three tablespoons of the first and second food paste a total of four tablespoons of food paste must be given in each meal give two such meals on the seventh day along with breastfeeding gradually increase the amount of the third food paste to three tablespoons per meal always give it along with all the previously given paste feed a total of four tablespoons of food paste in each meal give two such meals a day to a six month old baby along with breastfeeding similarly give a fourth new nutrient dense food paste on the tenth day in this picture fish is used to make the fourth new food paste then give a fifth new food on the thirteenth day and so on keep adding a new food every fourth day continue until the baby eats a wide variety of foods from all food groups after starting new cereals and pulses always combine them in a baby's meals give such combinations as soon as possible after six months of age they will provide complete protein to a baby use various techniques that increase the absorption of nutrients from food some examples are roasting, soaking, germinating, fermenting and cooking these techniques are discussed in detail in other tutorials of the same series freshly cooked homemade food prepared hygienically is the best for the baby if baby food is to be stored please follow the recommended safety guidelines safe preparation and storage of baby food is explained in another tutorial safe serving of baby food is also discussed in the same tutorial please visit our website for more details now let's discuss complementary feeding for a seven month old baby at this age gradually increase the quantity of food to half cup per meal also increase the number of meals to three per day along with breastfeeding please note the cup used in this tutorial has a capacity of 250 milliliters at this age the consistency of the food must be changed the food given to a seven month old baby should be mashed or lumpy an example of such food is jackfruit seeds porridge when the baby is eight months old increase the number of meals to four per day continue giving half cup of food per meal continue breastfeeding at this age stop giving food puries and paste to the baby start giving soft chunky nutritious food an example of such food is sprouted and cooked chickpeas when the baby is nine to eleven months old start giving soft finger foods finger foods are foods meant to be eaten directly with hands boiled egg and cooked vegetable pieces are examples of such foods at this age increase the number of meals to five per day continue giving half cup of food in each meal continue breastfeeding after completing 12 months a baby can start eating a part of the family meals at this age increase the amount of food to one cup per meal continue giving five meals a day along with breastfeeding five meals a day can also be given as three main meals and two snacks for a snack one cup of nutritious food should be given fruit curd cooked cottage cheese and cooked vegetables are examples of snacks add nutritious nuts seeds and leaf powders to these snacks while cooking nutritious powder recipes are discussed in another tutorial of the same series remember continue breastfeeding at least till two years before the baby's first birthday do not feed prawns and shellfish also do not add salt to the food prepared for the baby before completing two years of age do not give any type of sugar to the baby it includes jaggery honey and fruit juices also do not give tea coffee packaged food or drinks and any outside food these were specific complementary feeding guidelines as per baby's age there are many more important feeding guidelines for babies of all ages they are discussed in detail in another tutorial in the same series this brings us to the end of this tutorial thank you for joining