Infant Feeding Guidelines - Introducing Solids to Infants
Introducing solids to infants:
Starting infants on solids is an important milestone – for everyone involved, however it can also be an incredibly stressful time as a parent. This is especially the case when it’s your first baby and you are incredibly sleep deprived…often second guessing everything you do!
As new parents, we get bombarded with information from everywhere and it can be SO overwhelming!
As mums, all we want is the right information in simple terms, so that we can best nourish our children, setting them up for a healthy future!
Leading Paediatric Dietitian Karina (and mum of 2) is here to give you all the latest info in simple and practical terms. For more support and guidance introducing solids to your baby, check out my evidence based Feeding Babies Program with private support group and zoom calls!
When to start solids:
Until around six months of age, your baby’s nutritional needs are met 100% by either breast milk or infant formula alone and nothing else is required. Even after your baby has started on solid foods, breast milk or infant formula is still a significant and important source of their nutrition.
When they are around six months old, their nutrition needs start to change and this is why we need to start solids – to support their needs for growth and development
There are some clear signs that your baby is ready to start solid foods:
· They are able to hold their head upright unassisted (without you holding it)
· They need to be able to sit up (with support)
· They are losing or have lost the “tongue thrust” reflex which pushes food back out
· They are interested in what others are eating around them – they will often be watching you eat, reaching towards your food and trying to grab some
· They may be hungry, even after a breastfeed or bottle
Starting Solids too early….. (do not start before 4 months)
It is definitely not a competition and mums should not feel pressured to start too early as it can be problematic for a number of reasons. If they are not developmentally ready on the outside, then they may not be ready on the inside either – meaning that their digestive system may not be ready to cope with food yet. Their swallowing skills may also not have properly developed yet. Introducing solids at 4 months is completely fine if you think your child is developmentally ready.
Introducing Solids too late……(do not start after 6 months)
Starting solids too late can increase their risk of nutrient deficiency and for this reason should be started by 6 months of age so that babies can start getting these nutrients (such as iron) from food.
Starting solids too late can increase the risk of feeding issues and speech problems. Babies need to start solids to develop their eating skills – which strengthens their mouth and tongue muscles and improves coordination - which is important for later speech.
Solids at 6 months is completely fine if you want to wait until then - just make sure you start by 6 months. Delaying the introduction of allergenic foods also increases the risk of food allergy.
How to start introducing solids
Solids should be started as a snack in between milk feeds, ideally mid-morning, so if they do react to a food, you can watch them over the day. One snack, will eventually become 2 and so on.
Some parents prefer to start with pureed foods and progress to mashed, then finger foods by 9 months, whereas others prefer to go down the baby led weaning (BLW) or infant led feeding path and offer finger foods from the beginning.
Is baby led weaning OK?
Baby led weaning option is fine, it’s really down to personal choice. The research shows that when you compare babies given purees versus finger foods, their nutritional intake is very similar. If you give your baby finger foods, make sure they are soft and big enough for your baby to pick up with their hand, as their pincer grip (ability to pick up with thumb and pointer finger) is not yet developed.
Iron for babies
By 6 months, your baby is running out of the iron stores that they were born with and in addition, the iron content in breastmilk is very low (by 6 months). For this reason, the national recommendation is for a baby’s “first food” to be iron rich - this is important for the development of their brain - neuro-cognitive development.
Infant feeding guidelines specify iron containing foods include iron-fortified cereals, meat and poultry, tofu and legumes/beans (think kidney beans). Best purees to start with include iron fortified cereals, pureed legumes, pureed meat and veg. With infant led feeding or baby led weaning, you can give cooked legumes (can partly squash before you give them), tofu, boiled egg, soft meats, meat balls, fish patties, soft shredded chicken.
Care needs to be taken particularly with a plant-based diet to ensure that supplies of iron are adequate as plant sources of iron are not as well absorbed. Pairing these foods with Vitamin C rich foods (such as citrus, strawberry, kiwi, tomato, red capsicum and broccoli) will significantly improve the absorption of the iron from plant sources.
Variety and repetition when introducing solids to your baby
Research tells us that when our children are exposed to a greater variety of foods when they are young, it leads to a greater acceptance and broader intake of foods as the child develops.
For this reason, we need to offer babies a wide variety of tastes… and keep offering them, even if they refuse! Babies need 10-15 exposures to a new food before they necessarily accept it. This is because they need to learn about a food and develop a trust for it before the necessarily eat it. Babies tend to enjoy the foods that are familiar to them, so if you are eating these foods with them, they are more likely to gain trust and accept that food.
Once an iron rich food has been introduced, try a variety of vegetables before you move onto sweeter fruits.
Introducing allergens to babies
Food allergy is very common these days - 10% of Australian children have a food allergy. Common allergies include milk allergy/dairy allergy, egg allergy, peanut allergy, tree nut allergy, shellfish allergy and soy allergy. FPIES (food protein induced enterocolitis) have also increased significantly over recent times.
Infant feeding guidelines have changed and we now recommend the introduction of food allergens earlier than we used to.
We need to make sure that our babies are given all the allergenic foods (milk, soy, wheat, fish, egg, nut) within the first year of life. This will actually reduce their risk of developing a food allergy. In particular egg and peanut should be introduced before your baby is 8 months.
Once introduced into their diet, the allergenic food should be included weekly to minimise the risk of a food allergy developing. For more information on this topic head to the ASCIA Introducing Solids information sheet.
Note: if your baby already has an existing allergy, dietary advice is slightly different and you should consult a paediatric dietitian for more individualised advice.
If your baby has eczema, there are no foods to avoid with eczema unless they have already reacted to a food. You should still introduce the allergenic foods before the age of 1 year.
Allergic reaction to egg is common as egg allergy is the most common food allergy in Australia. Having said that, more than 90% of children will still tolerate any egg product (give babies cooked egg - yolk and white).
If you suspect your baby has a food allergy, food intolerance treatments are not recommended for babies, but you may wish to talk to a paediatric allergist for more information.
Vitamin D
Vitamin D deficiency is becoming more common in Australia and is something we need to be mindful of in babies too. In many developed countries there is the suggestion of the rising incidence of rickets. A number of countries are now supplementing infants with Vitamin D, and this has its merits, however it is still not a national recommendation in Australia.
Vitamin D is primarily obtained from sunlight exposure, however, when sun exposure is inadequate to maintain Vitamin D status, dietary sources make a small but useful contribution.
Dietary sources of Vitamin D include fish, eggs (cooked for babies) and mushrooms (especially when left in the sun for 1-2 hours).
Sugar
We shouldn’t be adding sugar or honey to baby food as it increases the risk of tooth decay and infant botulism (honey <1 year is a risk factor for infant botulism). Another important reason for limiting all foods with added sugar is to reduce the risk of them developing a “sweet tooth” which may lead to a preference for high sugar foods later in life.
Avoid buying products with added sugar for babies, instead sweeten baby food with fruit.
Salt
Salt should not be added to foods for babies. This is an important safety issue as babies’ kidneys are immature and unable to excrete excess salt. Instead of using salt, food for babies should be flavoured with herbs and spices, which will not only add flavour, but are rich sources of antioxidants and other nutrients.
Other helpful websites for feeding guide for infants and introducing solids to infants:
Paediatric Dietitian Sydney I Paediatric Dietitian Brisbane I Paediatric Dietitian Melbourne I Paediatric Dietitian Adelaide I Paediatric Dietitian Perth I