. 2019 Feb 12;15(Suppl 1):e12723. doi: 10.1111/mcn.12723

Table 2.

Key counselling messages on complementary feeding, children 6–23 months, by feeding problem, recommendation, and motivation, Migori and Kisumu counties, Kenya (source: Maternal and Child Survival Program, 2017)

Feeding problem	Recommendation	Motivation
Child has not been introduced to complementary foods, as mother does not have information on foods that are appropriate for child.	• Add other foods to “complement” breast milk. • Start feeding baby soft, mashed foods two times per day. • Food should be thick, not watery (should not fall‐off a spoon easily), for example, mashed vegetables (carrot, potato, tomato, green leafy vegetables—like spinach, sweet potato) and fruits (banana, mango, orange, etc.). • Introduce one food at a time. • Start with two tablespoons at each feed and increase to three tablespoons in the third to fourth week as the baby needs time to get used to new food. • Use a separate plate to feed the baby to make sure he or she eats all the food given. • Breastfeed before giving other foods.	• At this age, breast milk alone is not enough for your baby's development; your baby needs more food. • By 6 months, your baby is hungry for food. • Your baby needs other food in addition to breast milk to continue to grow well physically and mentally. • Baby can swallow well by now if foods are soft or mashed. • Feeding your baby with nutritious foods protects your baby against many illnesses.
Child is eating less than the required quantities of food per day and fed fewer times.	• Increase the frequency based on the age. • Feed the baby in their own bowl to ensure the baby eats all the food given. • Breastfeed between meals and at night. • Give the baby a variety of foods, including fruit, vegetables, cereals, meat, eggs, and dairy products (e.g., milk, fermented milk, and yogurt).	• Receiving adequate quantities of food protects your baby against many illnesses. • Your baby will be happier, more satisfied, and not hungry. • Your baby needs to eat more now to grow healthy, taller, play well, be active, and learn in school.
Baby is not eating enough meat (including beef and chicken).	• Increase the amount of animal‐source iron‐rich foods in the diet. This includes chicken, fish, beef, and liver. • Cook meat until it is well cooked and soft for the baby to chew. • Modify the meat to enable the child to chew and swallow easily (i.e., grinding, mincing, and cutting the meat into tiny pieces).	• Meat provides high‐quality protein and micronutrients. • Animal‐source foods are especially good for children to help them grow strong and healthy.
Baby's diet is not inclusive of enough fruits and vegetables.	• Mash the fruits and vegetables to enable the baby to eat comfortably. • Use fruits and vegetables that are available and in season. • If the baby does not like the fruit/vegetable, you can disguise it by adding it to other foods.	• Fruits and vegetables are rich in vitamins (vitamin C) and minerals to help the child grow well and to keep the child healthy. • Most fruits and vegetables are locally available and affordable when in season. • Green leafy vegetables are rich in vitamins and minerals, such as iron.
Baby's porridge is thin and watery in consistency.	• Porridge should be thick, not watery (should not fall‐off the spoon easily). • Porridge should be “eaten” not “drank.”	• Thick porridge is dense enough to provide the required energy for the baby. • Thick porridge keeps the baby satisfied for a prolonged period of time.
Child's food is not cooked with oil.	• Start cooking the baby food with a little bit of oil. • Use a moderate quantity of oil (one to two tablespoons) based on the quantity of food being prepared. • Use vegetable (liquid) oil, such as corn oil, olive oil, sunflower oil, which are healthier than cooking fats and margarine.	• The baby tends to enjoy food that is cooked with oil. • Oil is needed to help with the absorption of nutrients such as vitamins A, D, E, and K into the body as well as making the food energy dense. • The child can eat family foods prepared with oil. • Mother spends less time and money preparing separate foods for child.
Child is not eating family foods.	• Introduce the baby to family foods. • Give balanced diet just like the rest of the family. • As the child grows, change the consistency. • Use responsive feeding approach. • Increase amount of food to meet recommended daily caloric intake. • Avoid unhealthy snacks such as chips, soda, cake, and sweets, and instead, give fruits.	• Feeding the baby foods prepared for the family cuts down on preparation time. • It is cheaper since you use foods meant for the family and do not buy separate foods.
Child is eating unhealthy snacks (e.g., soda, processed juice, or fried potatoes with sauce) and tea given as a meal.	• Stop giving unhealthy processed “junk” foods, such as soda, processed juice, fried potatoes with sauce, and biscuits. • The healthy snacks recommended included locally available fruits, nuts, and porridge. • Give healthier snacks, such as fruits (e.g., whole bananas, avocado, mangoes, and oranges). • Avoid giving tea (with or without milk) to the baby at any time. • Give milk without mixing it with other foods.	• Unhealthy snacks only add fats and sugars and no other nutrients. • Unhealthy snacks are more expensive. • These foods will not help your child to grow well and do not contribute to good health. • Healthy snacks have more nutritive value. • Fruits and nuts—such as peanuts—are available locally and affordable. • Fruits improve the appetite of the child. • Tea has little nutritive value for the child. • Milk given separately provides protein and calcium needed for bone growth and strong teeth.
Child is eating less than the required quantities of food per day and fed fewer times.	• Increase the frequency based on the age. • Feed the baby in their own bowl to ensure the baby eats all the food given. • Breastfeed between meals and at night. • Give the baby a variety of foods, including fruit, vegetables, cereals, meat, eggs, and dairy products (e.g., milk, fermented milk, and yogurt).	• Receiving adequate quantities of food protects your baby against many illnesses. • Your baby will be happier, more satisfied, and not hungry. • Your baby needs to eat more now to grow healthy, taller, play well, be active, and learn in school.

Feeding problem

Recommendation

Motivation

Child has not been introduced to complementary foods, as mother does not have information on foods that are appropriate for child.

• Add other foods to “complement” breast milk.

• Start feeding baby soft, mashed foods two times per day.

• Food should be thick, not watery (should not fall‐off a spoon easily), for example, mashed vegetables (carrot, potato, tomato, green leafy vegetables—like spinach, sweet potato) and fruits (banana, mango, orange, etc.).

• Introduce one food at a time.

• Start with two tablespoons at each feed and increase to three tablespoons in the third to fourth week as the baby needs time to get used to new food.

• Use a separate plate to feed the baby to make sure he or she eats all the food given.

• Breastfeed before giving other foods.

• At this age, breast milk alone is not enough for your baby's development; your baby needs more food.

• By 6 months, your baby is hungry for food.

• Your baby needs other food in addition to breast milk to continue to grow well physically and mentally.

• Baby can swallow well by now if foods are soft or mashed.

• Feeding your baby with nutritious foods protects your baby against many illnesses.

Child is eating less than the required quantities of food per day and fed fewer times.

• Increase the frequency based on the age.

• Feed the baby in their own bowl to ensure the baby eats all the food given.

• Breastfeed between meals and at night.

• Give the baby a variety of foods, including fruit, vegetables, cereals, meat, eggs, and dairy products (e.g., milk, fermented milk, and yogurt).

• Receiving adequate quantities of food protects your baby against many illnesses.

• Your baby will be happier, more satisfied, and not hungry.

• Your baby needs to eat more now to grow healthy, taller, play well, be active, and learn in school.

Baby is not eating enough meat (including beef and chicken).

• Increase the amount of animal‐source iron‐rich foods in the diet. This includes chicken, fish, beef, and liver.

• Cook meat until it is well cooked and soft for the baby to chew.

• Modify the meat to enable the child to chew and swallow easily (i.e., grinding, mincing, and cutting the meat into tiny pieces).

• Meat provides high‐quality protein and micronutrients.

• Animal‐source foods are especially good for children to help them grow strong and healthy.

Baby's diet is not inclusive of enough fruits and vegetables.

• Mash the fruits and vegetables to enable the baby to eat comfortably.

• Use fruits and vegetables that are available and in season.

• If the baby does not like the fruit/vegetable, you can disguise it by adding it to other foods.

• Fruits and vegetables are rich in vitamins (vitamin C) and minerals to help the child grow well and to keep the child healthy.

• Most fruits and vegetables are locally available and affordable when in season.

• Green leafy vegetables are rich in vitamins and minerals, such as iron.

Baby's porridge is thin and watery in consistency.

• Porridge should be thick, not watery (should not fall‐off the spoon easily).

• Porridge should be “eaten” not “drank.”

• Thick porridge is dense enough to provide the required energy for the baby.

• Thick porridge keeps the baby satisfied for a prolonged period of time.

Child's food is not cooked with oil.

• Start cooking the baby food with a little bit of oil.

• Use a moderate quantity of oil (one to two tablespoons) based on the quantity of food being prepared.

• Use vegetable (liquid) oil, such as corn oil, olive oil, sunflower oil, which are healthier than cooking fats and margarine.

• The baby tends to enjoy food that is cooked with oil.

• Oil is needed to help with the absorption of nutrients such as vitamins A, D, E, and K into the body as well as making the food energy dense.

• The child can eat family foods prepared with oil.

• Mother spends less time and money preparing separate foods for child.

Child is not eating family foods.

• Introduce the baby to family foods.

• Give balanced diet just like the rest of the family.

• As the child grows, change the consistency.

• Use responsive feeding approach.

• Increase amount of food to meet recommended daily caloric intake.

• Avoid unhealthy snacks such as chips, soda, cake, and sweets, and instead, give fruits.

• Feeding the baby foods prepared for the family cuts down on preparation time.

• It is cheaper since you use foods meant for the family and do not buy separate foods.

Child is eating unhealthy snacks (e.g., soda, processed juice, or fried potatoes with sauce) and tea given as a meal.

• Stop giving unhealthy processed “junk” foods, such as soda, processed juice, fried potatoes with sauce, and biscuits.

• The healthy snacks recommended included locally available fruits, nuts, and porridge.

• Give healthier snacks, such as fruits (e.g., whole bananas, avocado, mangoes, and oranges).

• Avoid giving tea (with or without milk) to the baby at any time.

• Give milk without mixing it with other foods.

• Unhealthy snacks only add fats and sugars and no other nutrients.

• Unhealthy snacks are more expensive.

• These foods will not help your child to grow well and do not contribute to good health.

• Healthy snacks have more nutritive value.

• Fruits and nuts—such as peanuts—are available locally and affordable.

• Fruits improve the appetite of the child.

• Tea has little nutritive value for the child.

• Milk given separately provides protein and calcium needed for bone growth and strong teeth.