# Situation: The nurse holds a weekly well-baby clinic at a Barangay Health Station (BHS) for infants who come for immunization, growth monitoring, and feeding counseling. The nurse teaches the mother of a 6-month-old about starting complementary foods. Which statement by the mother shows a need for **FURTHER** teaching?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629435  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: The nurse holds a weekly well-baby clinic at a Barangay Health Station (BHS) for infants who come for immunization, growth monitoring, and feeding counseling.

The nurse teaches the mother of a 6-month-old about starting complementary foods. Which statement by the mother shows a need for **FURTHER** teaching?

## 보기

1. "I will start with iron-rich foods such as mashed fish, egg, or beans."
2. "I will offer one new food at a time and watch closely for any reaction."
3. "I will keep breastfeeding her while she learns to eat other foods."
4. "When she is 9 months old, I will give her cow's milk as her main drink." **✔ 정답**

**정답: 4**

## 해설

Cow's milk is not given as the main drink before 12 months, because it is low in iron, can cause intestinal blood loss, and has a high renal solute load. Complementary feeding starts at 6 months with iron-rich foods, one new food at a time, while breastfeeding continues to 2 years and beyond.

## 심화 해설

Core issue: timing and safety of cow’s milk introduction during complementary feeding

The question targets a classic infant-nutrition safety point. A 6-month-old infant is ready to begin complementary foods, but the type of milk given as the main drink must remain developmentally appropriate. The mother’s statement about giving cow’s milk at 9 months reflects a misunderstanding that requires correction.

Cow’s milk should not replace breast milk or infant formula as the primary beverage before 12 months of age. The reasons are physiological and nutritional. Cow’s milk is low in iron, and early introduction can provoke occult intestinal blood loss, which further depletes iron stores. It also imposes a high renal solute load because of its elevated protein and electrolyte content, placing unnecessary stress on the infant’s immature kidneys. These concerns are most pronounced when cow’s milk becomes the main drink rather than a minor ingredient in cooked foods.

The other three statements align with current complementary feeding guidance. Starting at 6 months with iron-rich foods such as mashed fish, egg, or beans is appropriate because breast milk alone no longer supplies sufficient iron after approximately 6 months. Introducing one new food at a time allows caregivers to identify allergic or intolerance reactions. Continuing breastfeeding while the infant learns to eat solid foods is consistent with recommendations to breastfeed up to 2 years or beyond.

| Feeding practice | Recommended timing | Key rationale |
| --- | --- | --- |
| Iron-rich complementary foods (fish, egg, beans) | Begin at 6 months | Breast milk iron becomes insufficient; iron needs rise to 11 mg/day for infants 6–12 months [1] |
| One new food at a time | From 6 months onward | Allows detection of food reactions |
| Continued breastfeeding | Up to 2 years or beyond | Supports immunity, bonding, and overall nutrition [4] |
| Cow’s milk as main drink | Not before 12 months | Low iron, risk of intestinal blood loss, high renal solute load |

Watch out! The question asks which statement shows a need for further teaching. The mother who plans to give cow’s milk at 9 months as the main drink is the one who needs correction. Do not confuse “cow’s milk as an ingredient in small amounts” with “cow’s milk as the main drink.” The latter is the unsafe practice before 12 months.

Key point! Iron is the central nutrient concern during the 6–12 month window. Breastfed infants are at particular risk for iron deficiency because breast milk contains less iron than formula [4]. This is why complementary foods must be iron-rich from the start, and why cow’s milk—being a poor iron source—must not displace breast milk or iron-fortified formula during this period [1].

The rationale for delaying cow’s milk is not about allergy alone. Even in infants without cow’s milk protein allergy, the combination of low iron content, potential for microscopic gastrointestinal bleeding, and high renal solute load makes it an inappropriate main drink before the first birthday. These risks diminish after 12 months as the infant’s diet becomes more varied and renal function matures.References (research sources)

- [1]Dietary Iron Sources Among 9-Month-Old Infants from Low-Income Households.Research articleAcquah EF, Labban JD, Armah SM, Black MM, Jenkins M, Andoh DC, Dharod JM. (2026) · DOI: 10.3390/nu18091417

- [4]Feeding Type at 6-12 Months and Early-Life Iron-Related Hematologic Changes in Infants: A Longitudinal Birth Cohort Study.Research articleJeong J, Jung M, Song J, Kim S, Ahn J, Kwon M, Kim MJ, Yang YJ, Kim J, Ahn K. (2026) · DOI: 10.3390/nu18132197

## 임상 시나리오

Cow's Milk Introduction TimingSafe complementary feeding for infants 6-12 months
Cow's milk should not be the main drink before 12 months of age. It is low in iron, can cause occult intestinal blood loss, and imposes a high renal solute load on immature kidneys.

At 6 months, start complementary feeding with iron-rich foods such as mashed fish, egg, or beans. Introduce one new food at a time to monitor for reactions.

Continue breastfeeding while the infant learns to eat solids, up to 2 years or beyond. Breast milk or infant formula remains the primary milk source during the first year.

CautionCow's milk may be used as a minor ingredient in cooked foods before 12 months, but never as the main drink. Early introduction as primary beverage increases risk of iron deficiency anemia and dehydration from high solute load.

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## 핵심 개념

- **Complementary feeding** — Introduction of solid or semi-solid foods alongside breast milk or formula starting around 6 months of age.
- **Renal solute load** — The amount of solute (protein, electrolytes) the kidneys must excrete; cow's milk has a high load that stresses immature infant kidneys.
- **Occult intestinal blood loss** — Hidden bleeding in the GI tract that can occur with early cow's milk introduction, worsening iron deficiency.
- **Iron-rich foods** — Foods such as mashed fish, egg, beans, or fortified cereals recommended as first complementary foods to meet iron needs after 6 months.
- **Breastfeeding duration** — WHO recommends continued breastfeeding up to 2 years of age or beyond while complementary foods are introduced.

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