Child health and development
1 July 2011 | Questions and answers
Breast milk is the best food for the healthy growth and development of infants. Infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. After six months, they should be fed adequate and safe complementary foods while continuing breastfeeding for up to two years or beyond.
Complementary foods should be rich in nutrients and given in adequate amounts. At six months, caregivers should introduce foods in small amounts and gradually increase the quantity as the child gets older. Young children should receive a variety of foods including meat, poultry, fish or eggs as often as possible. Infants can eat pureed, mashed and semi-solid foods beginning at 6 months, from 8 months, most infants can eat 'finger' foods, and from 12 months, most children can eat the same types of foods as consumed by the rest of the family. The consistency of foods should be appropriate for the child's age. Complementary foods should be given 2–3 times a day between 6–8 months, increasing to 3–4 times a day between 9–11 months. Between 12–23 months of age, 3–4 meals should be given. Also, depending on the child's appetite, 1–2 nutritious snacks can be offered between meals.
In addition to providing an adequate variety, amount and frequency of foods, it is important that caregivers practice responsive feeding. That is, they should feed infants directly and assist older children when they feed themselves; feed slowly and patiently and encourage children to eat, but not force them; and when children refuse to eat, experiment with different combinations of foods. Feeding times are periods of learning and love - they are a time for caregivers to talk to the child, making eye to eye contact.
Infants should be exclusively breastfed – i.e. receive only breast milk – for the first six months of life to achieve optimal growth, development and health. Exclusive breastfeeding is defined as giving no other food or drink – not even water – except breast milk. It does, however, allow the infant to receive oral rehydration salts (ORS), drops and syrups (vitamins, minerals and medicines). Breast milk is the ideal food for the healthy growth and development of infants; breastfeeding is also an integral part of the reproductive process with important implications for the health of mothers.
These recommendations are made in the Global Strategy for Infant and Young Child Feeding, which was jointly developed by WHO and UNICEF in 2003.
The strategy is a guide for countries to develop policies and implement activities addressing feeding practices and the nutritional status, growth and health of infants and children. It is based both on the evidence that nutrition plays a crucial role in the early months and years of life, and on the importance of appropriate feeding practices in achieving optimal health.
Lack of appropriate feeding in early childhood is a major risk factor for ill-health throughout the course of life. The life-long impact may include poor school performance, reduced productivity, impaired intellectual and social development, or chronic diseases.
WHO recommends that infants start receiving complementary foods at six months (180 days) of age in addition to breast milk. Foods should be adequate, meaning that they provide sufficient energy, protein and micronutrients to meet a growing child's nutritional needs. Foods should be prepared and given in a safe manner to minimize the risk of contamination. Feeding young infants requires active care and stimulation to encourage the child to eat.
The transition from exclusive breastfeeding to full use of family foods is a very vulnerable period. It is the time when many infants become malnourished, contributing significantly to the high prevalence of malnutrition in children under five years of age worldwide. It is essential therefore that infants receive appropriate, adequate and safe complementary foods to ensure the right transition from the breastfeeding period to the full use of family foods.
Amounts of foods to offer
| Age | Texture | Frequency | Amount at each meala |
|---|---|---|---|
6-8 months | Start with thick porridge, well mashed foods | 2–3 meals per day, plus frequent breastfeeds | Start with 2–3 tablespoonfuls per feed, increasing gradually to ½ of a 250 ml cup |
| 9–11 months | Finely chopped or mashed foods, and foods that baby can pick up | 3–4 meals per day, plus breastfeeds Depending on the child's appetite, 1–2 snacks may be offered | ½ of a 250 ml cup/bowl |
| 12–23 months | Family foods, chopped or mashed if necessary | 3–4 meals per day, plus breastfeeds Depending on the child's appetite, 1–2 snacks may be offered | ¾ to full 250 ml cup/bowl |
a Note: If baby is not breastfed, give in addition: 1-2 cups of milk per day, and 1-2 extra meals per day.