Complementary Feeding

of Children of 6 to 24
Months Old
Training Manual for Health Extension Workers and Community
Volunteers to Train Mothers and Care Givers

Prepared by:
Food Science and Nutrition Program -Addis Ababa University

2011

WWW.AAU.EDU.ET/FOOD SCIENCE
Forward
Breast milk alone is ideal to start a child's life. It should be fed alone for the first 6 months of life.
However, after this period additional foods are needed. The foods that are given in addition to
breast milk are called complementary foods. To make sure that young children grow well and
stay healthy, they need complementary foods that are nutritious and safe and are fed in adequate
amounts. This training manual fills an important gap: it provides information and guidance on
the selection and preparation of locally available, nutritious and safe complementary foods that
are easy to prepare for feeding children of 6 to 24 months old. It is aimed at improving the skills
of health extension workers, community volunteers and care givers that are working with such
children in many parts of Ethiopia.

“HIS NAME IS TODAY”

“We are guilty of many errors and many faults, but our worst crime is
abandoning the children, neglecting the fountain of life. Many of the things we
need can wait, the child cannot. Right now is the time his bones are being
formed, his blood is being made and his senses are being developed. To him we
cannot answer tomorrow. His name is today.”

Gabriela Mistral
Nobel Prize Winning Poet from Chile

2
Contents
Forward ......................................................................................................................................... 2
Introduction ................................................................................................................................... 4
Training Duration ......................................................................................................................... 4
Sample schedule for the training ................................................................................................. 5
Alert for trainer............................................................................................................................. 6
DAY-1............................................................................................................................................. 6
Session 1: Registration ................................................................................................................ 6
Session 2: Welcoming, Introduction and Objectives .................................................................. 6
Session 3: Knowing Participants Expectations from the training ............................................... 7
Session-4: Review training schedule and set ground rules ......................................................... 8
Session 5: Problems of stunting and wasting and consequences for the child and the family ... 9
Session 6: Introduction to complementary feeding and the 4R's .............................................. 10
Session 7: Ingredients for complementary foods ...................................................................... 14
Session 8: Processing of Cereals and Legumes based on roasting ........................................... 17
Session 9: Processing procedures based on germination .......................................................... 19
Session-10: Key Messages of the day: Revisited ..................................................................... 20
DAY-2........................................................................................................................................... 21
Recap......................................................................................................................................... 21
Session-11: Preparation of ready to use complementary food mix .......................................... 21
Session 12: Texture (thickness/ consistency) of complementary foods ................................... 22
Session 13: Frequency and amount of complementary foods .................................................. 25
Session-14: Hygiene (cleanliness) and safety of Complementary food preparation ................ 28
Session 15: Active / Responsive Feeding ................................................................................. 31
Session 16: Enriching Complementary Foods .......................................................................... 33
Session-17: Making community decisions needed for monitoring and sustainability ............. 35
Session-18: Key Messages of the day: Revisited ..................................................................... 35
Session-19: Conclusion and wrap-up........................................................................................ 35

3
Introduction

This training guide is for the use of Woreda Trainers (Woreda CBN Master Trainers, Home
Economist, and HEWs) who will train mothers and caregivers in the preparation of ready to use
complementary food mix and in implementing this at their community level.
Training Duration
This training is for two days

Day-1

No. Session Time

1 Registration 30 m
2 Welcome, Introductions & Training Objectives 30 m
3 Knowing participants expectations from the training 15 m
4 View training schedule and set ground rules 15 m
5 Problems of stunting and its consequences 30 m
6 Introduction to complementary feeding and 4R's 1 hr
7 Ingredients for complementary foods 30 m
8 Processing cereals and legumes based on roasting 1 hr
9 Processing cereals and legumes based on germination 1 hr
10 Key messages of the day: Revisited 30 m
Total 6 hrs

Day-2

No. Session Time

Recap 20 m
11 Preparation of ready to use complementary food mix 40 m
12 Texture (thickness/ consistency) of complementary foods 30 m
13 Frequency and amount of complementary foods 30 m
14 Hygiene and safety of Complementary food preparation 30 m
15 Active / Responsive Feeding 30 m
16 Enriching Complementary Foods 1 hr
17 Making community decisions needed for monitoring 30 m
and sustainability
18 Key Messages of the day: Revisited 30 m
19 Conclusion and wrap-up 30 m
Total 5 hrs

4
Schedule for the training

Date Time Sessions Facilitator/

Co
Facilitator
DAY ONE
8:30 -9:00 am Registration
9:00-9:30 am Welcoming, Introduction and Objectives
9:30-9:45 am Knowing the participants expectations
9:45-10:00 am View training schedule and set ground rules
10:00-10:30 am Tea break
DD/MM/YY

10:30-11:00 am Problems of stunting and consequences for the child and

the family
11:00-12:00 am Complementary Feeding and the 4R's
12:00-1:00 pm Lunch break
1:00-1:30 pm Ingredients for complementary food
1:30-2:30 pm Processing of cereals and legumes based on roasting
2:30-3:00 pm Tea break
3:00-4:00 pm Processing of cereals and legumes based on germination
4:00-4: 30 pm Key messages of the day
DAY TWO
8:30-8:50 am Recap
8:50-9:30 am Preparation of ready to use complementary food mix
9:30-10:30 am Texture (thickness/ consistency) of complementary foods
10:30-11:00 am Tea break
11:00-11:30 am Frequency and amount of complementary foods
DD/MM/YY

11:30-12:00 am Hygiene and safety of Complementary food preparation

12:00 -1:00 pm Lunch break
1:00 -1:30 pm Active / Responsive Feeding
1:30-2:30 pm Enriching Complementary Foods
2:30-3:00 pm Making community decisions needed for monitoring
and sustainability
3:00-3:30 pm Key Messages of the day: Revisited
3:30-4:00 pm Conclusions and wrap-up

5
Alert for trainer
 Since germination will take 36-48 hours, germinate the cereals and legumes 4-5 days before
the start of training. The germinated cereal will be used on session-9 of day-1 of the training.

DAY-1
SESSION 1: REGISTRATION
Time: 30 minutes
Materials:
 List of trainees who have been invited for training
 Registration form
 Badges/ name tags for trainees
Activity: Trainers arrange a pleasant and welcoming environment and register all trainees using
the sample form given.
Sample Registration form
No. Name of Woreda Kebele Badge received Materials Received (if any)
trainee
1
2
3
4
5

SESSION 2: WELCOMING, INTRODUCTION AND OBJECTIVE

Introduction:

In this session trainers will welcome the trainees and the trainees will introduce themselves to
each other. The purpose of the training and what will be their role the program will be explained.

Objectives: At the end of this session, trainees will be able to:

 Understand the purpose of the training and what their role will be in the program
 Know each other and have laid the foundation for relationship building
 Understand what is expected from them
 Feel comfortable and understand the approaches and principles of the training
Time: 30 minutes
6
Methodology: Introductory games or introduction in pairs
Materials:
 Flip charts and markers
 Any material for any introductory game (ex. small ball)

Handout 2: Objective of the training

Activities:
1. Welcome
 Welcome participants to the training.
 Explain that the Kebele has been chosen to implement an integrated community
grants to improve children of age 6 to 24 months, especially complementary
feeding.
2. Introduction and Objective of the training
 Explain to mothers and care givers who is training them and the objectives of the
training (see from handout 2 below)
 Explain to mothers and care givers why the need of the training

Handout 2: Objective of the training

General Objectives
The overall aim of these training manual is to provide nutritious and safe complementary food
preparation skills to mothers, health extension workers and care givers from locally available
food products in complementary food piloting areas.
Specific Objectives

 To provide insight on the importance of breast feeding and complementary food

 To provide appropriate blending proportions in the preparation of complementary
foods with optimal quality.
 To train mothers, other family and community members to adopt desired
complementary feeding behaviours.
 To demonstrate appropriate complementary food preparation for mothers and
caregivers
 To provide possible mechanisms to enrich complementary foods with energy and
micronutrients (vitamins and minerals) using means like fortification and others

7
 SESSION 3: KNOWING PARTICIPANTS EXPECTATIONS FROM THE TRAINING
Objective: At the end of the session, participants will:
 Share their expectations of the training and create a common understanding of the scope
of the training.
Time:  15 minutes
Materials:
 Pieces of paper and tape
 Marker
Activities:
 Ask participants what they expect from the training and do this in groups.
 Let participants write their expectations on a flip chart and post it on the wall.
 Reflect on their expectations and the nature of the training.

SESSION-4: REVIEW TRAINING SCHEDULE AND SET GROUND RULES

Objective: At the end of the session, participants will:
 Know and agree on training schedule and set ground rules for the training
Time:  15 minutes
Methodology: Interactive presentation
Materials: Pieces of paper and tape, Marker
Activities:
 Post the training schedule and ask participants to come up with the ground rules that will
be used throughout the training
 Record the agreed up on ground rules on a flip chart
Possible ground rules can be:
 Listen  Share personal examples
 Participate actively,  Be on time
Energizers elected  Do not interrupt when
 Respect each other's opinions someone else is talking
and experiences
 Understand that there are no
right and wrong opinions
 Post the ground rules in a visible spot in the training place
8
SESSION 5: PROBLEMS OF STUNTING AND WASTING AND CONSEQUENCES
FOR THE CHILD

Objective: At the end of this session, the participants will be able to:
 Possible causes and prevention of stunting/wasting
 Explain the right age for intervention to prevent stunting.
 Explain the level of malnutrition in their Kebele in simple terms.
Time:  30 minutes
Materials
 Picture of a stunted and wasted child
Handout
Handout 4: Picture of a stunted/wasted child

Activity

 Ask participants of their knowledge on stunting and wasting

 Ask their knowledge on the causes of stunting and wasting
 Ask their knowledge on the prevention of stunting and wasting
 Summarize their ideas
 Show them pictures/posters of stunted child

Handout 4: Picture of a stunted/wasted child

 Here is a picture that you can use while starting discussions on stunting/wasting
among children. Find your own picture also

9
 SESSION 6: INTRODUCTION TO COMPLEMENTARY FEEDING AND THE 4R'S
Introduction:

This session covers the importance of continuing breastfeeding, the optimal age for children to
start complementary feeding, the current complementary feeding practices in the participants'
community, what might happen if complementary foods are started too soon or too late, and the
key messages to deliver to mothers or caregivers about when to start complementary foods.
Objectives:
At the end of this session, participants will be able to:
 Explain the importance of complementary feeding.
 Explain the importance of continued breastfeeding.
 State the optimal age to start complementary feeding.
 Name the characteristics/elements of complementary feeding.
 Review key messages.
Time:  1 hour

Methodologies: Brainstorming, Group discussion

Materials:

 Flip chart, markers

 3 glasses with water: completely full, ½ and ⅓ filled respectively
Handouts:

Handout 6a: Why complementary feeding in the first two years of life matters and the
importance of continued breastfeeding
Handout 6b: Timely introduction of complementary foods
Handout 6c: Four R's of complementary foods
Activities:
 Ask participants to name all the things necessary to have a healthy child and write them
on the flipchart.
 Write "energy needs” of a child from 0 up to 6 months, 6 up to 12 months and from 12 up
to 24 months on a flipchart; leave posted throughout the training.
10
 Demonstrate the same information using 3 glasses: completely full, half (½) and one third
(⅓) filled. Explain the following with regards to energy needs:
From 0 up to 6 months breast milk supplies all the "energy needs" of a child
From 6 up to 12 months breast milk continues to supply about half (½) the "energy needs" of
a child; the other half of "energy needs" must be filled with complementary foods
From 12 up to 24 months breast milk continues to supply about one third (⅓) the energy
needs of a child; the missing "energy needs" must be filled with complementary foods
 Ask what might happen if complementary foods are started too soon. And assign 3
groups to discuss what might happen if complementary foods are started too late
 Brainstorm with participants the question: What are the characteristics/elements of
complementary feeding?
 Probe until the following characteristics/elements are mentioned: Right Consistency
(thickness), Right Time, Right Amount and Right Quality (4'Rs)

11
Handout 6a: Why complementary feeding in the first two years of life matters and the importance
of continued breastfeeding
 The first two years of life are a critical period since rates of malnutrition usually peak at this time with
consequences that persist throughout life.
 This period is also important for optimal growth, health and development
 It is during this period that children become vulnerable to growth retardation, micronutrient
deficiencies, and common childhood illnesses.
Complementary feeding and continued breastfeeding
 Feeding only breast milk to babies for the first six months provides them with the best nourishment
possible. It also protects them from common childhood illnesses such as diarrhea and respiratory
infections.
 However, after six months breast milk alone is no longer sufficient to meet the energy as well as the
micronutrient requirements, such as iron, of the growing baby.
 Breast milk can provide half or more of the energy requirement between 6 up to 12 months and one third
of the energy requirement and other nutrients between 12 up to 24 months of age. Thus, complementary
feeding is needed to fill the gap between total nutritional needs of the baby and the nutrients provided by
breast milk.
 Complementary feeding is giving suitable foods in addition to breast milk to babies.
 These foods should complement, not replace, breast milk.
 Breast milk continues to make important nutritional contributions. Thus, continued, frequent, and on-
demand breastfeeding until 2 years of age or beyond is crucial.
 Children 6 up to 24 months are at an increased risk of illness and malnutrition. Continued breastfeeding
protects them from illness and malnutrition.
 During the period of complementary feeding, a baby gradually becomes accustomed to eating soft family
foods.
 Complementary foods should be introduced at 6 months. At this age, babies‟ digestive systems are mature
enough to digest different foods. Both early and delayed introduction of complementary foods have
negative consequences.
 Before 6 months babies have a sucking reflex enabling them to draw milk from the mother's breast.
However after the 6 months infants develop a chewing reflex that enables them to swallow soft porridges.
As a result mothers / caregivers should not be afraid that the food will choke the child, as often assumed.
 Hence, timely introduction of complementary feeding, at 6 months, is important so babies can grow
healthy and strong.
 Besides nutrition, breastfeeding continues to:
 Provide closeness, comfort, and contact that help development
12
 Handout 6b: Timely introduction of complementary foods

Timely introduction of complementary foods is important since both delayed and early initiation of
complementary foods is harmful.
Early introduction of complementary foods:

 Displaces breast milk: If other foods are given, the baby breastfeeds less and the mother produce less
breast milk. Thus it will be more difficult to meet the child's nutritional needs.

 Increases risk of diarrhea: Child receives less of the protective factors in breast milk, so the risk of
diarrheal diseases increases since complementary foods may not be as clean as breast milk.

 Results in un-met nutritional needs: Nutritional needs may not be met because the foods given are
usually thin and watery to make them easy for babies to eat and for the thin gruel to pass through the
teat of a bottle. These foods fill the stomach but provide fewer nutrients than breast milk, and so the
child's needs are not met.
Late introduction of complementary foods is dangerous because:
 Child does not get extra food needed to fill the energy and nutrient gaps
 Child stops growing or grows slowly
 The risk of malnutrition and micronutrient deficiencies increases

Handout 6c: Four R's of complementary foods

Right Time Timely Complementary foods should be introduced, at 6 months, when

the child's need for energy and nutrients exceeds what can be
provided through exclusive breastfeeding
Right Amount Adequate Complementary foods should provide sufficient energy, protein
and micronutrients to meet the nutritional needs of the growing
child. Therefore, complementary food should be prepared in
such a way that it will provide the appropriate amount, density,
diversity and consistency
Right Quality Safe Complementary foods should be hygienically prepared and fed
with clean utensils, but not in bottles.
Right Frequency Properly fed Complementary foods are fed based on the child's signal of
appetite and satiety. The meal frequency and feeding methods are
suitable for age
Key Messages for Mothers and Fathers

Introduce complementary foods at 6 months of age to make your baby grows healthy and
strong.

 Continue to breastfeed your child on demand, at least 8 times, day and night until two
years and beyond to maintain child’s strength.
13
 SESSION 7: INGREDIENTS FOR COMPLEMENTARY FOODS
Introduction: In this session, local foods that can be used to prepare complementary foods will
be identified. The benefits of the different food groups will be explained.
Objectives:
At the end of this session, participants will be able:

 Identify different types of local foods that can be used as complementary foods.
 Explain the benefits of the different types of foods.
 Discuss the importance of feeding a variety of complementary foods to the child
throughout the day.
Time:  30 minutes

Materials: Flip charts, markers

Methodologies: Group discussion, Game, Brainstorming,

Handouts:
Handout 7a: Different types of local foods
Handout 7b: Benefits of different types of local foods
Activities:
 Ask participants to identify common foods in their communities.
 With examples of local foods or illustrations of local foods (staples, legumes and seeds,
vitamin A rich fruits and vegetables, other fruits and vegetables, animal-source foods,
and oils), ask participants to choose from the local foods or illustrations and match to the
right group.
 Discuss Breastfeeding (Breastfeed as often as the child wants) + Animal foods (local
examples) + Staples (porridge, other local examples) + Legumes (local examples) +
Fruits/Vegetables (local examples).
 Share Handout 7a: Different types of local foods. Ask each group to share the benefit of
one food from their bowl, and other groups add additional points.
 Ask: which foods will make the child healthy and strong?
 Share Handout 7b: Benefits of different types of local foods
 Fill-in gaps, summarize
14
Handout 7a: Group of ingredients for complementary food preparation

Cereals (staples)
Grains such as maize,
wheat, rice, millet and
sorghum and roots and
tubers such as cassava
and potatoes
Legumes
such as beans, lentils, peas,
groundnuts and seeds such as
sesame

Fruits
such as mango, papaya, passion
fruit, oranges, dark-green leaves,
carrots, yellow sweet potato and
pumpkin and other fruits

Vegetables
such as banana, pineapple,
avocado, watermelon, tomatoes,
eggplant and cabbage
NOTE: include locally-used wild
fruits and other plants.

Animal Source foods

including flesh foods such as
meat, chicken, fish, liver and eggs
and milk and milk products
Note: animal foods should be
started at 6 months

Oil and fat such as oil seeds,

margarine, ghee and butter added to
vegetables and other foods will
improve the absorption of some
vitamins and provide extra energy.
Infants only need a very small
amount (no more than half a
teaspoon per day). 15
Handout 7b: Benefits of different types of local foods
No. Food Group Purpose
1 Good sources of energy
Grains, root and tubers
2
Legumes and Nuts: Peas, beans, lentils and nuts Important for growth repair
( good sources of protein) and body building
3
Milk other than breast milk, cheese or yogurt For the child to grow health
and have strong bones
4
Flesh foods (meat, fish, poultry and liver/organ Will assist in growth and
meats development and will help
( Good sources of iron, vitamin A and zinc ) children stay active
5 Help child to grow
Eggs
6
vitamin-A rich fruits and vegetables Help the child to have healthy
Papayas, mangos, bananas, avocados, pumpkin, eyes and fewer infections
orange fleshed sweet potato and carrot.
7
Oils, fats and sugars Provide energy, fuel
8
Other fruits and Vegetables: Provide protection from illness

16
 SESSION 8: PROCESSING OF CEREALS AND LEGUMES BASED ON ROASTING
Introduction: There are different food processing methods that could be carried out before
preparing foods for consumption. Household strategies such as germination, roasting, soaking
and fermentation can enhance nutrient quality of complementary foods, thereby helping to better
utilize the available nutrients in foods.
Objectives:
At the end of the lesson, participants will be able to:
 Clean cereals and legumes properly before roasting
 Roast cleaned cereals and legumes properly before de-hulling them
 De-hull roasted cereals and legumes before milling them
 Pack flours in plastics properly using polyethylene bag sellers
Time:  1 hour
Materials: Roasting Pan, Tray (traditional sefed), Mortar and pestle (Traditional mukecha),
polyethylene bags, containers (for the rural setup)
Methodology:
Demonstration of cleaning, roasting, de-hulling, Mixing, milling and packing and distribution
Activities:
 Ask participants to share experiences about what they know or have heard with regards to
household food processing strategies practiced in their community.
 Explain household food processing strategies (roasting, germination, fermentation,
soaking).
 Explain how household food processing strategies can improve the quality of
complementary foods.
 Measure 3 parts of cereals and 1 pert legume (ex. 3 kg cereals and 1 kg legumes) as the
decision of the trainer
 Keep 15 % of the cereal for next session (germination)
 Demonstrate how to do the cleaning, roasting, de-hulling and packing of cereals and
legumes
 Roast cereals and legumes in different temperature and ask participants which one of the
three is properly roasted

17
  Show the flowchart of handout 8 and summarize

Handout 8: Processing procedures based on roasting

Figure 2: Flow chart of processing cereals and legumes based on roasting

N.B: 15 % of the cleaned cereals should be kept for the next session of germination

Cleaning
Manual cleaning
Maize, sorghum, wheat, teff, broad
beans, field peas, chick peas, kidney By spreading or sifting the grain on tray or sifed
beans remove impurities manually. Sieve also through
available sieve until the grain is clean. Wash the
grain with hygienically clean water

Roasting
Roasting
Maize, sorghum, wheat, broad
beans, field peas, chick peas, using traditional roasting pan and wood fire
kidney beans Roast using traditional roasting pan and wood fire
cereals and legumes
roast cereals are roasted
and legumes until itexcept teffgolden
attains
brown color and attractive aroma released except
teff

Dehulling

Maize, sorghum, wheat, Dehulling

broad beans, field peas,
or grinding mill De-hull all cereal grain and legumes using traditional
chick peas, kidney peas mortar and pestle or with grinding mill except tef.
Remove the fiber manfully by sifting or winnowing

Retain 15 % of germinated cereal

Mixing
(to be used in session 9-following
Mix 3 parts of cereals and 1 part session)
of legume

Packing
Milling Pack the flour in polyethylene bags of 1, 2 or
Mixed cereals and legumes (roasted + 5 kg at the production centre or in a suitable
germinated-from session 9) can be
container at household level
milled at the production centre or at a
service mill
18
.

SESSION 9: PROCESSING PROCEDURES BASED ON GERMINATION

Objectives: At the end of the lesson, the trainees will be able to:
 Describe germination as one food processing strategy to improve nutrient quality of foods
Time:  1 hour

Methodology: Demonstration

Materials:

 Cereal (15 % from the previous session 8) and legume

 Cotton (abujede) 1 meter
 Clean Water
 Container

Activities:

 Ask volunteers to clean and wash the cereals and legumes

 Ask participants to soak and steep in an appropriate volume of water
 Explain to them this water will be drained after 24 hours and covered with a clean cloth
and keep it for 36-48 hours until it germinate
 Show them what the product will be like after 48 hours of germination from product you
already prepared before 4 days
 Mix proportionally the two products (product from the roasted session 8 and product
from the germination session 9) and mill them together

19
Handout 9: Processing based on germination

Cereals such as maize and sorghum can be germinated up to 36-48 hours and mixed with the
rest of the formula before milling. The germination process that will be followed during the
training is described in flow chart seen below (Figure 3).

Figure 3: Flow Chart of complementary foods production through germination

Cleaning
Cleaning Manual cleaning using sefed to
maize, sorghum, wheat remove impurities

Steeping and Soaking

Cleaned and washed cereals (15%)
will be soaked in a volume of water 3
times the weight of seed for 24 hr

Germination Germination
maize, Drain soaking water and wash the
sorghum, wheat grains
Cover soaked seed with wet clean
cloth and place in a basket for 36
Drying
hr at room temperature
Germinated maize,
sorghum, wheat
Drying and Milling
Milling
After proportional mix of Germinated seed
with the rest of the formula

SESSION-10: KEY MESSAGES OF THE DAY: REVISITED

 The trainer summarize the key concepts of the day

20
 DAY-2

RECAP

 The trainer ask participants to revise yesterdays activities and ask questions

SESSION-11: PREPARATION OF OF PORRIDGE

Objective: At the end of this session, participants will be able to:

 Prepare porridge with an appropriate mix

Time:  40 minutes

Methodology: Demonstration

Materials

 Flour prepared from Day-1

 Stove and vessels, pans
 Clean water salt, sugar

Activity

 Demonstrate the preparation of thick porridge as described below:

 Measure 1 coffee cup of complementary mixture and put in a cooking pot

 Add 2 and a half coffee cup of water to the pot
 Add 1 soup spoon full of oil, Iodized salt and mix all together
 Cook the mixture for until it is well cooked and serve cool

21
 SESSION 12: TEXTURE (THICKNESS/ CONSISTENCY) OF COMPLEMENTARY
FOODS
Introduction:
In this session, the importance of having appropriate texture (thickness/consistency) of
complementary foods for different age groups of children, how to prepare the appropriate texture
(thickness/consistency) and the key messages to be delivered to mothers or caregivers will be
discussed.
Learning objectives:
At the end of this session, participants will be able to:
 Explain the appropriate texture (thickness/consistency) of complementary foods for
different age groups.
 Review key message.
Time:  30 minutes
Methodology: Demonstration
Materials:
 Two plastic bowls
 2 coffee cups of porridge made from local staple food (porridge must be thick enough to
be fed by a spoon or with hand)
 Clean hot water to dilute porridge
 Two tablespoons
 Materials for cleaning and hand washing
Handout:
Handout 10: Texture (thickness/consistency) of complementary foods
Activities:
 Introduce the session.
 Explain to the participants that you are going to prepare a complementary food for an 8-
month-old child. .
 Divide the cooked porridge into two even portions. Put one portion of the porridge in one
of the bowls and dilute it with one coffee cup of hot water.
 Ask: what do you see? “the porridge is thin and watery.”.

22
 Pass around the bowl with runny porridge to the participants and have them examine the
consistency with a spoon.
 Display the undiluted half of the porridge and tell the participants that this is the
consistency of the porridge if the mother did not add extra water.
 Pass around the bowl with thick porridge to the participants and have them examine the
consistency with a spoon.
 Ask: 1) Which porridge would you feed your 8-month old? Why? 2) Can an 8-month-old
child eat all of the thin porridge at one time? 3) Will an 8-month-old child be able to eat
the thick porridge? 4) Why do mothers add water to porridge?
 Share hand out 12 and discuss

23
Handout 10: Texture (thickness / consistency) of complementary foods

To understand why the consistency or thickness of the porridge is important, explain to trainees that
stomach of a young child is small using the figure below. At eight months of age the stomach can hold
about 200 ml at one time. Thin foods and liquids fill it quickly.

 Families are usually afraid that thick foods are difficult 6 up to 9 months Soft porridge, well
for the baby to swallow and will choke the child or mashed vegetable,
cause constipation. Thus extra liquid, mostly water, is meat, fruit
added to complementary foods to make them easy for
the child to eat.
 The consistency or thickness of foods is an
important factor that determines whether Soft thick porridge,
complementary foods are nutrient dense or not. 9 up to 12 months mashed vegetables,
finely chopped meat
 A porridge that is so thin that it can be fed from a and fruit and foods
feeding bottle or drunk from a cup, does not provide the child can hold
enough energy or nutrients a child needs to grow in his/ her hands
strong and healthy.
 Complementary foods should be thick enough to be
fed by hand.
 Cooking porridges with less water makes them
thicker and denser.
 For optimal child growth, thicken porridge given to
12 up to 24 months Family foods,
a child as he or she grows older. chopped or mashed
if necessary,
 At 6 months infants can eat pureed, mashed, and enriched porridge
semi-solid foods. Beginning at 8 months they can
also eat foods that they can hold in their hands, like
a piece of fruit.
 And at 12 months, most children can eat family
foods which are modified to meet their needs.
Modification can be mashing or adding extra foods
like mashed vegetables to the family foods.

Key Messages for mothers and fathers

 The consistency of the porridge should be thick enough to be fed by hand or

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spoon
Too thin Just Right
 SESSION 13: FREQUENCY AND AMOUNT OF COMPLEMENTARY FOODS

Introduction:
In this session the recommended frequency and amount of complementary foods for children in
different age groups and related key messages will be discussed.
Objectives:
At the end of this session, participants will be able to:
 Discuss the frequency of complementary foods for different age groups.
 Explain the amount of complementary foods for different age groups.
 Describe key messages pertaining to the amount and frequency of complementary foods.
Time:  30 minutes
Methodologies: Group discussion, Brainstorming
Materials:
 Flip charts and markers
 Illustration of size of baby's stomach (from handout 12)
Handouts:
Handout 11: Recommended complementary feeding practices
Activities
 Prepare flipchart with columns: Age, Variety, Texture (thickness/consistency),
Frequency, and Amount, and Rows: 6 up to 9 months, 9 up to 12 months, and 12 up to 24
months.
 Ask participants to fill the flipchart content from their experience first and then fill in
gaps
 Distribute Handout 13: Recommended complementary feeding and summarize

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Handout 11: Recommended complementary feeding frequency based on age

Age Texture Frequency (per Amount of food an average child

day)
Start complementary Soft thick 2 to 3 meals Start with 2 to 3 tablespoons
foods when baby porridge plus frequent Start with 'tastes' and gradually increase amount
reaches 6 months breastfeeding

From 6 to 9 months Soft thick 2 to 3 meals 2 to 3 tablespoons per feed, increasing gradually
porridge plus frequent to 2 full coffee cups
breast feeding

From 9 to 12 months Soft thick 3 to 4 meals 2 full coffee cups

porridge plus breast
feeding

From 12 to 24 months Soft thick 3 to 4 meals 3 full coffee cups

porridge, if plus breast
necessary feeding
enrich it

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Key Messages for Mothers and Fathers

 From 6 up to 9 months of age feed your baby soft thick porridge

 When available add a pinch of meat powder, beans or pea flour and minced kale to the soft
porridge

 Feed the enriched thick soft porridge at least 2-3 times.

 From 9 up to 12 months of age, feed your child soft thick porridge enriched with dried meat
powder, minced kale, pumpkin, etc at least 3-4 times a day along with 1-2 other solid foods
(mekses) each day to ensure healthy growth.

 Continue breast feeding

 Start soft thick porridge when baby is exactly 6 months old (180 days).

 Start with "tastes"(2-3 table spoons) and gradually increase amount.

 Provide 2-3 meals plus frequent breast feeding

 When your child is 12 months of age, start to feed him or her family foods, chopped or mashed
and if necessary, enriched porridge.

 Continue breast feeding

 From 12 up to 24 months of age, feed your child at least 3-4 times a day along with 1-2 other
solid foods (mekses) each day to ensure healthy growth.

 As your baby grows older, feed more food at each meal in order to ensure that they are eating
enough to maintain healthy growth.

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 SESSION-14: HYGIENE AND SAFETY OF COMPLEMENTARY FOOD
PREPARATION
Introduction:
In this session, hygiene (cleanliness), the reasons why safe preparation and storage of
complementary foods is needed, and the ways to keep complementary foods safe and clean will
be discussed.
Objectives:
At the end of this session, participants will be able to:
 List good hygiene practices that help prevent illnesses.
 Describe safe preparation of complementary foods.
 Review key messages.
Time:  30 minutes
Materials:
 Flip charts and markers
 Small cards
Handout
Handout 12: Hygiene and Safe preparation and storage of complementary foods
Methodologies: Brainstorming, Group discussion
Activities:
 Introduce the session.
 Ask participants to brainstorm good hygiene (cleanliness) practices and list on flipchart.
 Ask each group to write down on a separate card: a food preparation and/or storage
practice in their community.
 Discuss and fill-in gaps.
 Share Handout 14

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Handout 12: Hygiene and Safe preparation and storage of complementary foods

Hygiene (cleanliness)
 Feed your baby using a clean cup and spoon; never use a bottle as this is difficult to clean and
may cause your baby to get diarrhoea.

 Wash your hands with soap and water before preparing food, before eating, and before
feeding young children (see figure 1).

 Wash your child's hands with soap before he or she eats.

 Protect kitchen areas and food from insects, pests, and other animals.

 Wash your hands after going to the toilet

 Always cover the toilet opening after use

Safe preparation and storage of complementary foods

 After six months of age, as the intake of complementary foods increases the incidence of
diarrheal diseases also increases.

 Contamination of complementary food along with children getting in contact with different
things when they start crawling is known as a possible cause of diarrheal diseases in children
6 up to 12 months of age.

 Safe preparation and feeding of complementary foods are essential to reduce the risk of
contamination and the illnesses.

 Some Ethiopian families use bottles with teats to feed liquid foods such as animal milk, gruel,
tea with sugar, etc. The use of bottles is a harmful practice in increasing the risk of diarrheal
diseases and should not be practiced at all.

 Thus, complementary foods need to be prepared in very small amounts to be served soon.
Keeping complementary foods safe and clean
The main points to remember for clean and safe preparation of foods are:
Clean hands
 Clean utensils
 Separate raw and cooked
 Safe water and food
 Safe storage
 Cook thoroughly
 Keep food at safe temperature
Safe Storage
 Store foods in covered containers (see figure 2)
 Don't store for a long period of time 29
 Cook small amounts to avoid long periods of storage and spoilage
 Figure 1: Mothers should always wash their hands with soap and water before food preparation and
before feeding the child.

Figure 2: Food should be covered to protect it from flies and other pests

Key Messages for mothers and fathers

 Feed your baby using a clean cup and spoon. Never use a bottle as this may cause your
baby to get diarrhea.

 Wash your hands with soap and water before preparing food, before eating, and
before feeding young children, to avoid diarrhea.

 Use safe water that comes from pipe, protected springs, or protected wells, or
treat water by boiling or adding water guard to make drinking water safe

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 SESSION 15: ACTIVE / RESPONSIVE FEEDING
Introduction:
In this session, how a child is fed in the participants' community and ways to encourage a child
to eat and finish the recommended amount of food will be discussed.
Objectives:
At the end of this session, participants will be able:
 Explain ways to encourage young children to eat.
Time:  30 minutes
Materials: Flip charts and markers
Handout:
Handout 13: Active/responsive feeding
Methodology: Brainstorming, Interactive presentation
Activities:
 Introduce the session.
 On a flipchart draw 2 columns. Ask participants to share how a child is fed in their
communities and record responses in 1st column.
 Ask participants to state how they think a child should be fed and record responses in
2nd column.
 Compare the 2 responses.
 Fill-in the gaps about active/responsive feeding.
 Review together Handout 15: Active/responsive feeding

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Handout 13: Active/responsive feeding

Optimal complementary feeding depends not only on what is fed, but also on how, when, where,
and by whom the child is fed. In active/responsive feeding, mothers and caregivers should encourage
children to eat to increase dietary intake.

To practice active/responsive feeding;

 Mother or caregivers should feed infants and assist older children when they feed
themselves, being sensitive to their hunger and fullness signs.
 Feed slowly and patiently, and encourage children to eat, but do not force them.
 If children refuse many foods, try out different food combinations, tastes, textures, and
methods of encouragement.
 Minimize distractions during meals if the child loses interest easily.
 Remember that feeding times are periods of learning and love - talk to children and play with
them during feeding, with eye to eye contact.
 When the child is old enough, offer foods that the child can take and hold, as children often
want to feed themselves. Encourage them too, but make sure most of the food goes into
his/her mouth.
 If the child refuses to eat, wait and offer again.
 Congratulate the child when he/she eats.
 Parents, family members (older children), child caregivers can participate in
active/responsive feeding.

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 SESSION 16: ENRICHING COMPLEMENTARY FOODS

Introduction: In this session, how to enrich complementary foods and key messages on
improvement of complementary foods will be discussed.

Objective: At the end of this lesson, the participants will be able to:
 Explain how complementary foods can be enriched
 Review the key messages.
Time:  1 hr

Methodology: Brainstorming, interactive presentation, group discussion,

Materials: Flip chart, markers

Handout 14: Enriching complementary foods

Activities:
 In a plenary, ask participants: what can mothers/caregivers add to baby's porridge to
enrich it?
 Record responses in a flipchart
 Stress the need to consider the seasonality and availability of fruits and vegetables when
counselling mothers.
 Discuss the key points from the Handout 16: Enriching complementary foods
 Summarize the session.

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Hand out 14: Enriching complementary foods

Cereal and legume based complementary foods can be enriched by:

 Replacing water used for preparing porridges with milk.

 Adding butter/oil which will enrich the porridge and will also makes the thick porridge
softer, easier to eat.

 Mixing legumes such as pea, chick pea or broad beans flour with the staple flour before
cooking in a proportion (1/3 legume flour to 2/3 cereal flour).

 Adding finely chopped meat / eggs.

 Adding finely chopped kale or carrots.

 Adding mashed avocado, banana, or papaya

 Using iodized salt when preparing complementary foods.

Note: All of the above actions will improve the nutrient quality of complementary foods.

 Animal foods should be eaten as often as possible.

 Adding even small amounts of an animal food to the meal when available adds nutrients and is
good for the child. Organ meats such as liver, heart, and kidney are often less expensive and
have more iron than other meats.

Preparation of animal foods

 Animal foods such as flesh and organ meat can be mashed or chopped into small pieces to
make them easy for the child to eat.

Fruits and vegetables

 Encourage families to feed orange and colored fruits and vegetables and dark green leafy
vegetables and as often as possible when these foods are available, ideally every day.

 Availability of vegetables and fruits can be improved by.

 Home gardens and planting fast growing vegetables such as kale, carrots, and tomato if a
small plot of land near the home is available.

 If families can afford to do so and if they are available, fruits and vegetables can be purchased
from the local markets.

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 SESSION-17: MAKING COMMUNITY DECISIONS NEEDED FOR MONITORING
AND SUSTAINABILITY

Objective: At the end of this session, trainees will be able to:

 Explain how they will raise the issue of improving complementary feeding in their
community
 List ways of making this activity sustainable at community level
 Give their commitment by soul swearing in front of each other
Time:  30 minutes

Methodology: Discussion

Materials: Flip Charts and markers

Activity

 Request the participants to mention their commitment in front of the audience they will
continue to practice appropriate feeding

SESSION-18: KEY MESSAGES OF THE DAY: REVISITED

 The trainers summarize the key concepts and messages of the day

Time:  30 minutes

SESSION-19: CONCLUSION AND WRAP-UP

 Closing remark from official person from the Woreda or Kebele

Time:  30 minutes

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