ml breast milk 100 75 50 25 0 Percentage of daily needs (%) The largest gap is for iron, so it is especially important that complementary foods contain iron, if possible from animal-source foods such as meat, organs, poultry or fish. Pulses (peas, beans, lentils, nuts) fed with vitamin C-rich foods to aid absorption provide an alternative, but they cannot replace animal-source foods completely. Box 4 summarizes characteristics of good complementary foods. Box 4 Good complementary foods are: K Rich in energy, protein and micronutrients (particularly iron, zinc, calcium, vitamin A, vitamin C and folate); K Not spicy or salty; K Easy for the child to eat; K Liked by the child; K Locally available and affordable. The basic ingredient of complementary foods is usually the local staple. Staples are cereals, roots and starchy fruits that consist mainly of carbohydrate and provide energy. Cereals also contain some protein; but roots such as cassava and sweet potato, and starchy fruits such as banana and breadfruit, contain very little protein. A variety of other foods should be added to the staple every day to provide other nutrients. These include: K Foods from animals or fish are good sources of protein, iron and zinc. Liver also provides vitamin A and folate. Egg yolk is a good source of protein and 24 Infant and Young Child Feeding – Model Chapter for textbooks vitamin A, but not of iron. A child needs the solid part of these foods, not just the watery sauce. K Dairy products, such as milk, cheese and yoghurt, are useful sources of calcium, protein, energy and B vitamins. K Pulses – peas, beans, lentils, peanuts, and soybeans are good sources of protein, and some iron. Eating sources of vitamin C (for example, tomatoes, citrus and other fruits, and green leafy vegetables) at the same time helps iron absorption. K Orange-coloured fruits and vegetables such as carrot, pumpkin, mango and papaya, and dark-green leaves such as spinach, are rich in carotene, from which vitamin A is made, and also vitamin C. K Fats and oils are concentrated sources of energy, and of certain essential fats that children need to grow. Vegetarian (plant-based) complementary foods do not by themselves provide enough iron and zinc to meet all the needs of an infant or young child aged 6–23 months. Animal-source foods that contain enough iron and zinc are needed in addition. Alternatively, fortified foods or micronutrient supplements can fill some of the critical nutrient gaps. Fats, including oils, are important because they increase the energy density of foods, and make them taste better. Fat also helps the absorption of vitamin A and other fat-soluble vitamins. Some fats, especially soy and rapeseed oil, also provide essential fatty acids. Fat should comprise 30–45% of the total energy provided by breast milk and complementary foods together. Fat should not provide more than this proportion, or the child will not eat enough of the foods that contain protein and other important nutrients, such as iron and zinc. Sugar is a concentrated source of energy, but it has no other nutrients. It can damage children’s teeth, and lead to overweight and obesity. Sugar and sugary drinks, such as soda, should be avoided because they decrease the child’s appetite for more nutritious foods. Tea and coffee contain compounds that can interfere with iron absorption and are not recommended for young children. Concerns about potential allergic effects are a common reason for families to restrict certain foods in the diets of infants and young children. However, there are no controlled studies that show that restrictive diets have an allergy-preventing effect. Therefore, young children can consume a variety of foods from the age of six months, including cow milk, eggs, peanuts, fish and shellfish (18). A Guiding Principle 9. Use fortified complementary foods or vitamin-mineral supplements for the infant as needed Unfortified complementary foods that are predominantly plant-based generally provide insufficient amounts of certain key nutrients (particularly iron, zinc and vitamin B6) to meet recommended nutrient intakes during complementary feeding. Inclusion of animal-source foods can meet the gap in some cases, but this increases cost and may not be practical for the lowest-income groups. Furthermore, the amounts of animal-source foods that can feasibly be consumed by infants (e.g. at 6–12 months) are generally insufficient to meet the gap in iron. The difficulty in meeting the needs for these nutrients is not unique to developing countries. Average iron intakes in infants in industrialized countries would fall well short of recommended intake if iron-fortified products were not widely available. Therefore, in settings where little or no animal-source foods are available to many families, iron-fortified complementary foods or foods fortified at the point of consumption with a multinutrient powder or lipid-based nutrient supplement may be necessary. A Guiding Principle 10. Increase fluid intake during illness, including more frequent breastfeeding, and encourage the child to eat soft, favourite foods. After illness, give food more often than usual and encourage the child to eat more During an illness, the need for fluid often increases, so a child should be offered and encouraged to take more, and breastfeeding on demand should continue. A child’s appetite for food often decreases, while the desire to breastfeed increases, and breast milk may become the main source of both fluid and nutrients. A child should also be encouraged to eat some complementary food to maintain nutrient intake and enhance recovery (20). Intake is usually better if the child is offered his or her favourite foods, and if the foods are soft and appetizing. The amount eaten at any one time is likely to be less than usual, so the caregiver may need to give more frequent, smaller meals. When the infant or young child is recovering, and his or her appetite improves, the caregiver should offer 25 an extra portion at each meal or add an extra meal or snack each day. 3.2 Recommendations for micronutrient supplementation Micronutrients are essential for growth, development and prevention of illness in young children. As discussed earlier in Guiding