Get Up & Grow: Healthy Eating and Physical Activity for Early Childhood - Directors/Coordinators Book
Healthy Eating Guideline 3Breastmilk or formula provides all of the necessary nutrients for babies from birth to six months. From around six months, babies need solid foods in addition to breastmilk or formula for adequate nutrients and energy.
Moving from breastmilk or formula to eating a variety of foods should be a positive experience. Experiences with eating early in life can affect attitudes and habits later on, as well as influence health. The skills that babies learn when starting on solid foods and their experiences with new tastes and textures are the foundations for future eating behaviours and preferences.
When to introduce solidsShowing interest in food and an increased appetite are signs that a baby is ready to be introduced to solid foods. It is also important that the baby can sit upright with limited support, and control the head and neck. Around six months of age, most babies show signs that they are ready to try new foods.
It is strongly recommended that solids are not introduced before four months of age, as a baby’s system is still immature. At this age, the digestive system, immune system, kidneys and ability to chew and swallow are not yet fully developed or ready for solids.
As solids are introduced, there is often a reduction in breastfeeding. Early introduction of solids increases the likelihood that a mother will be unable to maintain lactation, and so breastfeeding will be unable to continue.
Breastfeeding or bottle-feeding should continue while solids are being introduced. Breastmilk (and/or an age-appropriate infant formula where breastmilk is not available) should continue to be the main milk drink until a baby is around 12 months of age.
Delaying the introduction of solids much beyond six months may result in the baby not getting enough nutrients, and may increase the possibility of allergies. Babies are usually willing to try new foods at around seven to eight months, making this a good time to introduce a variety of foods.
Ideally, breastfeeding should continue for at least the first year of life. Breastfeeding is especially important when a baby is starting new foods, as it may reduce the chance of the baby developing food allergies.
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How to introduce solidsThe introduction of solids aims to:
- use babies’ existing capacities to help them learn the new skills needed for eating
- maximise babies’ willingness to accept new tastes.
The first food offered to young babies is often iron-fortified infant cereal, as it is smooth, easy to mix in small amounts and provides extra iron, which is the additional nutrient most needed by babies. Water, formula or a mother’s breastmilk can be mixed with the cereal. Other good first foods are smooth fruits or vegetables cooked, and then either mashed or pureed. Smooth foods should be offered in the beginning. Foods of various textures and thickness can be gradually introduced after babies have taken well to eating. If food is provided by the setting, ensure that culturally and religiously appropriate foods are available.
There is no need to add salt, sugar or other flavours to infant foods. Plain water can be added to pureed foods if liquid is needed. Where food is being prepared separately for each child, either in home or family day care, breastmilk from the mother or infant formula provided by the parents can be added to the child’s meal.
Some families will choose to offer pre-prepared baby food from cans or jars, or frozen infant foods. These can be useful for convenience occasionally. To ensure children eat a variety of foods and experience different textures, mashed, minced and shredded foods as well as finger foods can be introduced as babies’ eating skills develop.
Working with parents to introduce solidsWork with parents around introducing solids. A baby’s first solids are an important milestone for parents as well as for babies. Discuss family views and offer current information on introducing solids. Some parents may be eager to start solids very early and others may need advice about when to start solids. Some parents will have strong views that come from their cultural or religious backgrounds. Always let parents know where they can get further information.
|Age||Types of food and consistency||Examples of foods that can be consumed|
|Birth-around 6 months||Liquids||
|6-7 months||Finely mashed or pureed foods (no salt, sugar, fat or other flavour added)||
|8-12 months||Mashed or chopped foods and finger foods (no salt, sugar, fat or other flavours added)||
In addition to foods for 8-12 months:
|12 months +||Family foods||
Caution must be taken with hard foods, as choking is still a risk.
Progressing to feeding from a cupBabies can learn to use a cup from an early age, and are usually ready to try from around seven months. For some babies, this will be a progression from bottle-feeding to cup-feeding, while breastfed babies may skip using a bottle completely and start using a cup, often while continuing to breastfeed.
Breastmilk can be offered to babies from a cup if the mother has expressed milk and has chosen not to bottle-feed. Cooled boiled water can be offered as an additional drink in a bottle or cup after six months of age.
Although water is sometimes offered in a bottle after six months, it is best to use a cup. By around 12 to 15 months of age most babies can manage a cup well enough to satisfy their own thirst, and the bottle can be stopped. Babies who continue to drink from the bottle well into the second year may drink a lot of milk and have a reduced appetite for other foods – which increases the likelihood of a baby becoming iron-deficient. Stopping the bottle is often difficult for parents, so discuss this with them and offer some suggestions for further advice.
Babies do not need sweet drinks such as cordial, soft drink and fruit juice, or other drinks such as tea or coffee. These should not be offered, especially from a bottle. Sweet drinks can reduce a baby’s appetite for nutritious foods and increase the risk of dental decay. Breastmilk and infant formula are appropriate drinks for babies.
Choking risks for babiesIt is important for staff and carers to be alert when it comes to the risk of babies choking. Babies are still mastering the skills of feeding, and have no or few teeth, no molars (back teeth) for chewing harder foods and a smaller trachea (windpipe), which can become more easily blocked at this age. It is important that babies sit to eat and that they are supervised while eating.
It is common for young children to ‘gag’, with coughing or spluttering, while they are learning to eat. This is different to choking and is not a cause for concern. However, choking that prevents breathing is a medical emergency.
To reduce the risk of choking:
- Supervise babies whenever they are feeding.
- Avoid putting babies in a cot or bed with a bottle.
- Never prop a bottle up for a baby.
- Make sure babies are developmentally ready to eat before offering solids.
- Ensure that babies are awake and alert when fed.
- Never force a child to eat.
- Offer foods that are a suitable texture, starting with smooth and soft foods and then progressing on to a wider variety of tastes and textures.
- Grate, cook or mash hard fruits and vegetables, such as apples or carrots.
- Never give babies pieces of hard, raw fruits and vegetables, nuts, popcorn or other hard foods.
Special feeding needsDisabilities, early illnesses and invasive procedures that may affect feeding will impact on the age at which solids should be introduced. Additionally, a baby’s acceptance of solids and progress toward increasing the variety of foods may be slower.
Working closely with parents is particularly important in these situations. Finding out about any specific plans they may have developed with specialists or other health professionals is critical. Getting additional information and advice from a family’s doctor or an Accredited Practising Dietitian may be useful.
- Introducing solids is discussed and decided on collaboratively with parents, taking into consideration the baby’s signs of readiness and any special needs the child has.
- Suitable solid foods are introduced from around six months of age, if appropriate.
- Choking risks for babies are minimised through supervision – babies are never left unattended with a bottle, and always offered foods of the appropriate texture.
- Staff or carers and parents are reminded that the progression from breastfeeding or formula to a variety of foods is a positive experience for children, and is likely to influence long term eating patterns.