Breastfeeding and Complementary Nutrition

Use these illustrations when helping educate Central American communities. You can download and print full-size versions by clicking on the thumbnail-size versions below.

feeding chart

Illustration of how to prepare various foods for infants

Example feeding timeline of breastfeeding and when to introduce complementary foods

Illustration: Illustration: Illustration: Baby bottle Illustration:

Illustration of exclusive breastfeeding for the first six months of life

Illustration discouraging soda and coffee in baby's bottle

Nutrition from 0 to 6 Months of Age

The World Health Organization recommends newborns begin breastfeeding within the first hour after birth and continue to exclusively breast-feed until six months. Exclusive breastfeeding means breast milk is the only nutrition the infant consumes. A mother's milk is the ideal nutrition for her infant for the first six months of life. Helping mothers understand that the milk she produces contains the correct amount of macronutrients and micronutrients her child needs is essential. Exclusive breastfeeding also helps protect infants from potentially life-threatening diarrheal illnesses caused by contaminated water used to make infant formulas or substitute beverages.

Breastfeeding is the accepted norm for infant nutrition in Central America. In 2013, 38% of infants born in Latin America were exclusively breast-fed during their first six months of life, which is slightly above the global average. Reasons mothers in Central America may not exclusively breast-feed during the first six months of their child's life include:

  • They are unaware of the many benefits breastfeeding provides.
  • They receive advice from other mothers to add supplemental foods and beverages.
  • They supplement with or switch completely to formula. There are a variety of reasons mothers may feed formula to their child, but it's important to note that in Central America, there is a great deal of infant formula marketing, which may persuade mothers to not exclusively breast-feed.
  • They receive a lack of support from family and community members, or receive advice contradicting recommendations. In particular, adolescent mothers may be less comfortable breastfeeding as their social circles may be less supportive.

Nutrition after the First Six Months

As infants grow and approach one year of age, breast milk continues to be a significant source of protein and other nutrients However, complementary foods – especially food sources containing iron – should be introduced to infants at six months to provide sufficient nutrition to support their growth. Delaying the introduction of complementary foods has been associated with stunting in some communities in Central America. The World Health Organization urges that when introducing complementary foods, breastfeeding should continue and not decrease.

Central American Foods to Include after Six Months

A baby's iron stores begin to deplete around six months, making it necessary to introduce iron-rich foods at this time. This includes beans, beef, chicken, fish and eggs. Since beans are typically the most accessible iron source, simultaneously introducing foods rich in vitamin C, such as cantaloupe, mango, potatoes and plantains, is essential to enhance iron absorption.

Rice that is enriched with iron may not be available in many areas of Central America. Iron-enriched oatmeal and grain drinks may be available but may not be affordable to many families in these areas. Depending on availability and cost, iron-fortified infant cereal is a good complement to breast milk. Cereal may be mixed with breast milk or infant formula if the formula has already been introduced. Also, cereal should never be served in a bottle.

When infants reach six months of age, complementary foods should be pureed or mashed and initially offered only a few spoonsful a day. Mothers should remember to maintain the frequency of breastfeeding to avoid malnutrition and stunting. Infants should also be introduced to drinking from a cup around six months. When introducing a cup, it should be filled with nutritious options such as small amounts of potable water, cooked grain drinks and 100% fruit juices. Still, those drinks should complement, not replace, breast milk. Fruit drinks with added sugar, coffee and other sugar-sweetened beverages are not appropriate infant beverages and can lead to oral health issues.

Around nine months, foods that are easily picked up with a thumb and index finger, or "finger foods," can be introduced. By 12 months, infants are generally able to eat most of the same foods eaten by the rest of family, with modifications to make them easier and safer to chew and swallow. Foods that carry a high choking hazard like nuts, whole grapes, hard candy, chunks of meat, cheese and many raw vegetables should be avoided until the child is at least four years old.

Introducing one new food at a time is recommended so the food source of any allergic reactions can be easily identified.

Examples of Complementary Foods and Feeding Frequencies for Infants 6 to 12 Months Old in Central America

6 Months: Offer 2 – 3 Times Per Day

  • Ground, cooked grains in cereal or drink such as rice, corn, oats and barley
  • Mashed bananas and plantains
  • Mashed potatoes and yucca
  • Mashed beans
  • Mashed egg
  • Mashed avocado
  • Mashed mango

9 Months: Offer 3 – 4 Times Per Day

  • Cooked beans
  • Small pieces of tortilla
  • Slices of banana and plantain
  • Small pieces of melon
  • Sliced cooked eggs
  • Grated coconut
  • Minced meats

12 Months: Offer 3 Meals and 2 Snacks

  • Whole eggs
  • Soft cooked meats
  • Tortillas
  • Soups with little broth
  • Small pieces of fruit including citrus
  • Small pieces of cooked vegetables including tomatoes
  • Milk or powdered milk

How to Educate Mothers and Caregivers about Breastfeeding and Complementary Foods

Health educators should include lessons on the importance of breastfeeding as well as the benefits of exclusively breastfeeding for the first six months. It is important for educators to explain that human breast milk provides all essential nutrients needed for healthy infant development along with antibodies to fight illness. Proper breastfeeding techniques and the importance of mother and infant bonding time should be explained. Mothers should understand that their breast milk is the ideal nutrition and most sanitary food for their infants and therefore, if possible, it should be the only source of nutrition until the infant is six months old.

It is also important to educate mothers and caregivers that although grain beverages may seem to satisfy their baby's hunger, grain beverages do not contain the same nutrients as breast milk and are not a good substitute for it. Due to the low protein content of these beverages, babies consuming them in place of breast milk will be at risk of stunting and poor immunity.

When introducing complementary foods, cross-contamination of pathogens may occur. Education on feeding infants must include instruction on proper hand-washing and produce washing in addition to maintaining food hygiene in the food preparation area, which requires potable water. Infants' and caregivers' hands should be properly washed with soap and water before preparation and eating. Food should be prepared with clean utensils and clean cups and bowls should be used to serve food. Bottles should be avoided as much as possible as they are hardest to clean and may hide harmful bacteria. Uneaten food should be discarded and not saved for later.

When educating mothers on how to introduce complementary foods, educators should present food visuals and discuss how to prepare these foods that are familiar and available to the community. The health educator may use the illustrations below to provide examples of how to prepare foods to feed infants at different ages as well as feeding schedules that include breast milk and complementary foods. A hands-on demonstration of how to prepare complementary foods for children of various ages is another effective method of nutrition education for mothers. For instance, the health educator may demonstrate washing hands, mashing infant foods and keeping food preparation equipment clean.

Additional Resources