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The introduction of semi-solid and solid foods to feeding infants Priyani Soysa A workshop was convened during the International Union of Nutritional Sciences (IUNS) meeting in Brighton, England, in early 1986 to discuss the introduction of semi-solid and solid foods during infancy and the early preschool years.
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There is much confusion about the meaning of the word "weaning, " although the definition of "wean" given in the Concise Oxford Dictionary, to "accustom to food other than milk, " was quoted. In the context of the present need to promote breast-feeding for as long as possible, the term "complementary food" was recently defined by the ACC Sub-committee on Nutrition Consultative Task Force on Maternal and Young Child Nutrition [1, 2] . This emphasizes that foods should be used in addition to breast milk and not as mere replacements for it.
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It has not been necessary in most parts of the world to advise mothers to add formula to the infant's diet when their milk appeared inadequate. Most mothers do this on their own, quite often even when it is unnecessary. There was no intention, therefore, to discuss the use of formulae.
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In many countries, however, the introduction of semi-solids and solids to infants' diets is unsatisfactory in timing, and the quality and quantity of the foods are insufficient. The effect on infants is growth faltering, which incipiently worsens from around six months of age and results in malnutrition in later months and years.
lobal review of infant-feeding practices and maternal attitudes

Developed countries
Feeding patterns in the United States, the United Kingdom, and Scandinavia are somewhat similar. In Scandinavia [Y. Hofvander, personal communication], mothers generally know the current recommendations for introducing semi-solids and solids around the age of four months (sometimes postponed to five months). This usually starts with purees of legumes and/or fruits. By the time the infant is six months old, at least one meal is a full meal with fish and/or eggs and/or meat as well as cow's milk, based on advice given at child health centres. Growth curves show a rate of weight gain in excess of the current normal standards during the first three to four months, after which they fall off a little. There was general agreement in the group that the growth curves used presently are based on data that refer mainly to bottle-fed infants. It was observed that when infants are fed breast milk and the current recommendation to introduce semisolids by about the fourth month is observed, the curves are different: growth "appears to falter" This faltering is probably due to the use of inappropriately high "normal" weight-for-age values in later infancy.
Developed countries
Approximately 60% of all infants in the United States today begin breast-feeding at birth [ B. Nichols, personal communication]. By two months of age, 61% of all infants are receiving prepared formula. When they are three to four months old, formula usage peaks at approximately 67%, then falls to 64% at five and six months, 41% at eight months, 30% at ten months, and 14% at twelve months.
Developed countries
By two months of age, approximately 15% of the caloric intake is derived from prepared baby foods or pureed home food items. The proportion of calories from these sources increases to approximately 25% at six months of age, and is associated with a decrease in caloric intake from milk from 100% at birth to 60% at six months of age. At twelve months of age, approximately 35% of energy intake is derived from milk and approximately 12% of total calories is derived from prepared baby foods. Between six and twelve months, energy intake from table foods increases from 5% to almost 50%.
Developing countries
The position is different in the developing countries.
Developing countries
In many African countries, some premasticated food such as rice or a tuber is introduced to infants very early. In rural Gambia [3, 4] , semi-solids are introduced around the age of four months, although the amounts given tend to be very small. They consist largely of rice, millet, and sorghum, and do not contain more than 30 kcal per 100 g. Deficiencies in vitamins and minerals are even more marked, but this is not the main problem. The foods contain potentially hazardous micro-organisms 2
Developing countries
The introduction of semi-solid and solid foods to feeding infants that are little affected by the rather perfunctory boiling the gruels undergo in the course of preparation. If they are cooked too much, the gruels become over-thick for younger infants' consumption.
Developing countries
In Thailand [5] premasticated rice and banana are usually offered by the end of an infant's first month. No other food is introduced before 20 weeks of age, and then only sugar-based snacks are added by six months. The mothers do not perceive that rice is needed to increase the amount of calories and nutrients for increased needs of growth. Thus the weaning diet through infancy is limited in quantity and variety.
Developing countries
In Cuba [6] fruit juices and purees are popular and are fed to infants before two months of age. Tubers (molonga) are introduced before three months of age. Besides their nutritional value, mothers consider them to be good for digestive function. Although precooked cereals are available, mothers prefer to cook rice and mix it with meat or other foods. Bread is also offered at this age, before the fifth month by 50% of mothers. Legumes, eggs, yellow vegetables, and leafy foods are introduced at about the same time.
Developing countries
In most areas in India [7] mothers are totally unaware of children's nutrition needs. Breast-feeding continues for over a year. Fruits and green leafy vegetables are rarely fed. At about one year some family food is given but is very short of children's requirements. There is a belief that children should not be given solids until they "cut some teeth. "
Developing countries
In Sri Lanka [8] about 25% of mothers in urban areas commence semi-solid feeding after the fourth month versus 6% of those in rural areas. Solids such as rusks and biscuits are offered in significant amounts only after the child is six months old. It takes twelve months for 80% to 100% of mothers to give solids. Faltering growth (in comparison with NCHS standards) may be observed around the fourth month in urban areas and earlier in rural areas. This relates to the late complementary feeding in Sri Lanka. Mothers are reluctant to feed earlier because of a traditional rice-eating ceremony around the end of the year or until teeth have erupted. Furthermore, there is a real fear of diarrhoea. This illustrates the observation by Mata and Behar [9] that children in the developing world are constantly exposed to infection and the frequency of diarrhoea increases after complementary feeding commences.
Developing countries
Thus in the developing world, the quality and quantity of the weaning diet require, in addition to more energy and protein, more iron, calcium, vitamins A and D, and trace elements. Also, the diet is monotonous.
Developing countries
Summarizing maternal attitudes, many sociocultural considerations, specific to the different regions, alter the timing of introduction of semi-solids and solids into infants' diets. The privileged populations follow the so-called Western system of feeding. Thus economic background appears to govern the timing and the quality of complementary feeding. The variety of foods offered is limited by the fuel available to cook them and the employment status of mothers. Certainly, the more literate or educated mothers introduce semi-solids and solids earlier than the others.
Strategy
It is necessary to consider the appropriate timing and quality of complementary foods (semi-solids and solids) because of the prevalence of under-nutrition beginning in late infancy. The strategy for improving the nutrition of young children in underprivileged populations during infancy would be to continue breast-feeding as long as possible, to promote the use of high-quality homeprepared weaning or complementary foods as well as village-prepared weaning foods, and to increase the availability of low-cost, indigenous, centrally processed foods marketed through commercial channels.
Weaning foods
Home-prepared weaning foods In a series of experiments in India [7] it was shown that simple mixtures of malted cereals, pulses, and oilseeds (in proportions of 4:1:1) are acceptable to mothers and children. Malting consists of steeping for 12 hours, germinating for 24 to 72 hours, sun drying, roasting, and milling. The process is time-consuming and requires space, however. The viscosity of the malted mix is far less than that of roasted mixes (this viscosity is contributed by the malted cereal rather than the pulses).
Weaning foods
The most recent experiment was to add a small amount of amylase-rich food (ARF) to a large amount of raw cereal flour. A cooked hot paste of this is thinner than one without ARF. Sorghum germinates well. Its malted germinate is used as the catalytic material. A gruel of 100 g cereal powder.
Weaning foods
10 g malt. and 200 ml water is boiled. The cost of the ARF is infinitesimally small compared to that of Takadiastase, a pure amylase enzyme. It is suggested that rice ARF would be best used for rice, wheat ARF for wheat, maize ARF for maize, etc.
Village-prepared weaning foods
In Thailand, formulation of foods prepared at the home or village level is based on locally available raw ingredients. A rice-legume mixture has been developed that can be roasted simply in a household pan. Proportions are determined by weighing scales or by volumes using a typical village bowl. Manually packed bags may be kept for six to eight weeks. Commercially prepared weaning foods Several countries have projects to produce low-cost weaning foods as an intervention for childhood malnutrition. This is especially useful for working mothers. In India several mixtures have been developed, including Indian multipurpose food and corn-soy mixture (CSM). Other mixtures have been developed, for example, in the Sri Avnashilingam Home Science College in Coimbatore.
Village-prepared weaning foods
In Sri Lanka the Food and Nutrition Policy Planning Division has promoted a low-cost weaning food produced by extrusion and consisting of rice flour, soya flour, and green gram flour [7] that is now commercially marketed. Its approximate composition is protein 21%, carbohydrate 62%, and fat 8% (2.5% linoleic acid); its NPU is 79. A vitamin-mineral premix must be imported, but its cost per unit of product is very small.
The choice of strategy
There is no universal way to wean. Each country has its own situation, and within a country there are variations with respect to the privileged and the underprivileged, working and non-working mothers, and urban and rural settings.
The choice of strategy
The following steps are suggested as a problemsolving strategy.
Define the dimensions of the problem:
-the percentage of infants at risk for malnutrition if adequate food is not given at the appropriate time; -the availability of nutritious foods. 2. Establish the etiology of the problem: a. the situation -the mother's lack of time to prepare and resources (in terms of health and economics) to purchase and prepare foods and fuel; -household access to water, etc.: -how foods are obtained, stored, prepared, and fed to children; the manner of feeding: quantity, quality, and variety (descriptive). b. attitudes -beliefs, fears (diarrhoea, etc.), and values:
Define the dimensions of the problem:
-intrafamilial relationships and the mother-child relationship; -the mother's access to household income; -organization; c. access to nutritious food.
Determine locally oriented interventions:
-education of the community in general and parents in particular; -communication of information relevant to the promotion of good weaning practices, such as food hygiene and sanitation, signals of the need to introduce foods (timing), e.g., growth faltering, crying due to hunger; -development of new foods.

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