All you need to know about complementary feeding for your baby

Breastfeeding exclusively for the first six months of a baby’s life is the most natural way to feed your baby.  However, what comes next is also important because of the extraordinary growth and development that takes place in the first 1000 days of an infant’s life. 

After six months of age, breastmilk is no longer sufficient as the only food source.  For example, there’s not enough iron and zinc in breastmilk to meet a baby’s growing needs for these micro-nutrients after the age of six months.  Mothers are definitely encouraged to continue breastfeeding, but also advised to introduce small amounts of soft, nutrient-dense foods as complementary feeding.

Estelle Strydom, registered dietitian and ADSA spokesperson (The Association for Dietetics in South Africa) says, “A 2018 review of complementary feeding practices in South Africa revealed that the diets of many older infants do not meet the criteria for a minimally acceptable diet.  In addition, it was reported that many babies between six months and one year are regularly given processed meats, soft drinks, sweets and salty crisps, which are all nutrient-poor foods that are not suitable for babies.”

Furthermore, Professor Lize Havemann-Nel, registered dietitian and researcher in the Centre of Excellence for Nutrition at North-West University, also points out that your baby’s nutrition is a vital part of a foundation for a healthy life.  There’s no other time when a child grows and develops faster; it’s both a window of opportunity to set your child on the path to good health, and a time of great vulnerability.  Malnutrition, in all its forms, from underweight and overweight to the nutritional deficiencies that cause lasting damage, can be avoided through optimal complementary feeding.

Professor Havemann-Nel says, “It’s important to get the timing right by introducing complementary foods from six months onwards.  It’s also vital to know what foods are appropriate so that you are providing your little one with a variety of nutrient-dense meals and avoiding harmful practices.  The other goal of complementary feeding is to set your baby up to try new foods so that as they grow they transition to eating nutrient-dense family foods, which makes life much easier for parents and caregivers.”

Registered Dietitian, Mbali Mapholi emphasises the importance of parents’ awareness of the accepted complementary feeding guidelines.  She says, “Parents and caregivers need to understand what nutrient-dense foods are suitable for their babies.  The transition from only breastmilk to suitable complementary foods, along with continued breastfeeding, works well if the food offered to baby is soft and easy to digest, which is why the first solid foods are usually pureed and mashed.  We start out with mashed, soft foods, and as they develop, the food becomes more textured and soft finger foods can be offered.”

An important guideline is that meat, fish, chicken and eggs should be offered daily.  Mbali says, “These foods are high in protein which is essential for growth and development.  They also contain important vitamins and minerals that support the immune system and healthy body functioning.  Eating these foods every day prevents deficiencies of important nutrients such as iron.  Plant protein sources such as soya, beans, peas and lentils are affordable and are also important to include in the diet regularly.”

Another important nutrition guideline is making dark green leafy vegetables and orange-coloured fruit and veg available daily to your baby.  Mbali says, “Spinach is easy for us to grow in our gardens or in pots so that we can harvest the leaves we need each day, while the plant keeps on growing and providing more.  Vegetables such as butternut and carrots, and fruits such as citrus, paw-paw and mangoes are good sources of vitamins A and C that help to maintain your baby’s good health.  It works out well to buy seasonal fruit and veg because it’s more economical.”

For a toddler between 12 and 36 months, you need to provide five small meals per day with starchy foods in most meals.  Dairy such as milk, maas and yoghurt should be consumed every day – 500ml is recommended so that your child gets sufficient calcium intake for strong bones and healthy teeth.

There’s also a list of nutrient-poor foods that parents and caregivers need to stay clear of:

  • Avoid tea and coffee as these drinks contain caffeine
  • Avoid sugary drinks and juices which are high in sugar
  • Avoid highly processed and high fat foods
  • Avoid salty foods

Registered dietitian, Carey Haupt says, “Under 12 months of age, a baby’s kidneys are not yet fully developed.  These types of unsuitable foods can put strain on the kidneys.  Foods that are high in sugar and fat can lead to overweight and childhood obesity, which is an increasing problem in South Africa.  Use herbs for flavour instead of adding salt.  Substitute clean water in place of juices and soft drinks that are high in sugar and can damage new teeth.”

Throughout this introduction of complementary foods, mothers should be supported in continuing to breastfeed. Parents can start with offering their child a pureed meal (traditional complementary feeding) or soft finger foods (baby lead weaning).

Carey says, “It makes good sense at this very young age to let your baby play with their food.  Picking up a stem of broccoli enables them to look, feel, smell and taste.  By letting them explore and interact with new foods, you may avoid picky eating later on.”

ADSA has released a series of three short, informative videos about complementary feeding for South African parents and caregivers.  Join the ADSA dietitian team to learn more about the nutrients that babies require after six months of age; get tips on how to make complementary feeding easy for you, and for baby.  Each episode also features a recipe for a simple yet nutrient-dense complementary baby meal that is quick and convenient for busy moms and caregivers.

Meet the Dietitian: Philna Eksteen

Philna Eksteen serves on the ADSA Executive Committee 2021 – 2023 in the Portfolio CPD (Continuous Professional Development). Read on to get to know her better!

  • Tell us a bit more of yourself?

I was born, raised and went school and university (North West University – NWU) in Potchefstroom. Having a father as a lecturer at the university and a mother as a school teacher, I know very early in my life that would like to be ‘some form of teacher’, later it became clear to me that I would like to work with students at a university. I am therefore very fortunate to have been involved in academics as a registered dietitian in the training of dietetic students for the last 25 years, at first at SMU (Pretoria) and the last 10 years at NWU (Potchefstroom).

  • Why did you become a Registered Dietitian?

As a student, I first enrolled for Home Economics (now known as Consumer Sciences). I did ballet and modern dance for many years and continued with it into my student years. This created a natural interest in general health and fitness and triggered as much bigger passion for evidence-based nutrition, leading to me changing my studies to Dietetics already early in my 1st years at the university. With more studies, I learnt that general health & fitness and weight management are only very small components of the scope of dietetic practice. Since I also seriously considered studying medicine at a point in time, medical nutrition therapy and the difference we a registered dietitians can make in the life of patients and clients, made a big impact on me.

  • What would you have wanted to do if not Dietetics?

Becoming a medical doctor or an accountant.

  • Where did you study (degree and/ or postgraduate)?
  • BSc Dietetics (1992) and BSc Honours (Dietetics) (1993) degrees – North West University (NWU), Potchefstroom Campus
  • Post-graduate Diploma in Hospital Dietetics (1995) – at University of Pretoria (UP)
  • MSc (Dietetics) degree (2014) – NWU (Potchefstroom Campus)
  • Where do you work and what does your job entail?

From 2010, I have been working at the NWU, Potchefstroom in the Dietetics department, mainly as a lecturer & the internship coordinator of the 4th year Dietetics students, travelling to students at training facilities, evaluating and supporting them and ensuring quality control of the internship training.

  • Walk us through a day in your life?

Not one day is the same, depending on where I need to do visits to and evaluate my students in the internship – hospitals, various community settings or foodservice units. A day when visits are not required will be typically spent at the office, managing admin and other academic duties.

  • What do you enjoy most about the work you do? What are the most satisfying moments?

Working with my students and encouraging them to do their best and becoming the best young dietitian they can be. Nothing is more satisfying when students improve on their performance with hard work and dedication, and receiving positive reports from training personnel.

  • What has been your career highlight?
  • Every year bring highlights, especially when the 4th year Dietetic students graduate
  • Obtaining my MSc in Dietetics and publishing my 1st article
  • Serving my profession by serving on ADSA branch committees (NW and Pretoria) in several portfolios and also several terms as chairlady
  • Serving my profession by serving on the ADSA executive committee (terms 2009 – 2011 and 2011 – 2013 in the membership portfolio and also, the current term 2021 – 2023 in the CPD portfolio)
  • What are the most challenging aspects of your career?

Act as a go-between my students and dietetic internship training personnel, always having to have an open ear, mind and heart for both parties, not judging either side too quickly and facilitating good communication between the parties involved to ensure quality training of the students. And also, not getting angry too quickly about incompetent individuals in my profession.

  • What is something that people don’t know about you?

I am a dancer in my heart, doing ballet for most of my young life as a child, young girl and student. I love music and also want to dance when I hear good music.

  • What are your favourite foods?

Salads, eggs, pasta, pizza and seafood dishes

  • What are the three things that you think people should stop saying when they meet a dietitian?

“Hey, maybe you should work out a diet for me, then I will lose weight!”

“I should actually not eat this in front of you”

“Have you heard about this …….. (newest fad) diet? It really works!!”