Early Nutrition - Introducing Solids

Establishing healthy eating

What do babies need to grow and develop into bouncing babies and healthy active toddlers? Looking after the nutritional needs of an infant until six months is fairly easy: feed them breastmilk (ideally) or formula. But at around six months, a baby’s nutritional needs exceed what he or she can get from milk feeds, which is why we begin complimentary feeding or solids. Breastmilk or formula will still remain a considerable part of their nutritional requirements right through until at least 12 months.

What foods when?

It's important to start bub on solids at between four and six months, as babies are still developing their digestive system and starting on solids too early can also have implications for nutrition balance and allergies.

Many parents ask “What should I feed my baby?” In the past, guidelines recommended a fairly rigid timetable for introducing foods at certain ages. While there are still some age-defined guides to introducing certain foods, such as cows milk from 12 months, today the timelines of many foods are best guided by babies themselves. This is why many of the health department guidelines are more flexible and sometimes differ from each other.

The World Health Organisation defines four phases in the introduction of “complimentary foods”. They are set in relation to baby’s motor development:

1. Stage one is getting baby used to eating from a spoon, so offering pureed foods once or twice a day.
2. Stage two marks baby’s increasingly developed motor skills; for example, chopping motions and better hand control is about getting baby accustomed to texture.
3. Stage three is the introduction of lumpy texture and thick consistencies as their motor skills continue to advance, hence many bubs around this age begin to take the reins and self-feed via finger foods.
4. Stage four is increased self-feeding and getting close to eating meals that are shared by the rest of the family.

Guiding principles in baby nutrition

Baby nutrition is as much about nutrients as it is about establishing healthy eating habits. And while I could bore you with details on carbohydrates, protein, fat, and vitamins and minerals, at this early stage it is far more relevant and helpful to stick to important dietary principles and guidelines – such as VARIETY!

At the end of this article you’ll find the government healthy eating guidelines for children, and variety is centre stage.

Rules and principles of a good diet

The three basic principles of a good diet – both for bub and for you – are variety, wholesomeness and unprocessed food. These help ensure that a diet is nutritionally sound and can be applied to all age groups. In some sense, it is fairly traditional: as grandma says, “Good ole fashioned healthy eating!”

Variety is the spice of life

Variety in a diet refers to eating a variety of food groups but it also means variety within a food group. With a wide array of foods from the same food group in your child’s diet you can increase the number of nutrients bub is eating; for example, two different types of fruit a day. A great, easy way to ensure variety is to check that there is a good range of colours; for example, red fruits and berries (an excellent source of vitamin C), green and yellow vegetables (high in vitamin A), wholegrain and brown bread (high in zinc), white meat (providing protein and iron), dairy (for calcium and riboflavin) and so on.

Select food from a wide variety of sources each day. Diets that exclude one or more food groups are associated with an increased risk of many diseases, but bear in mind that it isn’t necessary to eat from each food group at every meal. Eating a little of all sorts of foods can dilute your exposure to problem food components and undesirables, potentially reducing the risk of a reaction.

Now that you are on track with variety, don’t stop there! Keep it going by regularly introducing new foods and meals to your child right throughout their lives

Wholesomeness is next to goodness

Choose foods made from whole products; for example, wholegrain bread contains the goodness of entire grain; similarly with whole bean soy drinks. A good diet should rely primarily on food that is wholesome and resembles, as far as possible, its original state. This can ensure your diet is rich in important nutrients and will also limit any possible contamination from nasties. Nature has packaged food the way it is for a reason. Why process something and then add back the ‘stuff’ that has been lost along the way?

Unprocessed food

Ideally, a diet shouldn’t rely too much on processed food such as pre-prepared food, fast-food, processed meat (sausages and salami), biscuits, cakes, chocolates, savoury biscuits and chips and so on. I hear you gasp as you think of your cupboard which includes tinned and packet foods – but don’t worry; we all live in the real world! Just as long as this isn’t your family staple. As a general rule, the less processed a food is, the greater its nutrient content. Furthermore, the less a food is processed, the fewer preservatives, colours, flavours and additives it may contain. However, given the advanced processing techniques used today, there is an increasing range of frozen and pre-prepared produce that may be quite nutritionally sound.

How much is enough?

Again, the issue of how much should a baby eat (or drink for that matter) depends on bub and what’s going on around him or her. While there are guides on how much a bub should eat and drink, they are just that – GUIDES. Don’t get too hung-up on figures; your baby’s growth and development remains one of the best guides. Baby should be reasonably consistent with his or her growth as well as their bowel habits and wet nappies.

What can affect baby’s eating?

There can be many reasons why a baby doesn’t take to solids, or starts solids and then goes off them. Listed below are just a few possible factors:

• When baby starts teething. Don’t be put off if they seem to have lost interest at this point; it is likely to be temporary.
• When bub starts to become mobile, they sometimes temporarily lose interest in food as this new-found movement is more interesting to them. This phase will pass, and they will be fine.
• It can take up to 10 or more tries for a baby to take to something new; perseverance is important! Don’t confuse rejection with permanent dislike.
• Tired infants generally won’t have the inclination to eat solids; the moment has gone. Better to avoid trying to feed a baby who is tired and irritable. Give yourself the best possible chance for success.

Some other tips to good nutrition for bubs

Breast/formula first

Feed baby breastmilk or formula before solids to ensure that they receive all their vital nutrients and health-giving factors before filling up on solids. This will also reduce the likelihood of baby fussing from hunger before you start out, and sets a relaxed and positive atmosphere. At around nine months, this often reverses and food comes first.

Liquid to puree to lumps and bumps

Baby is moving from nutrition that was completely liquid, and consistent in taste and texture, so bub must now adapt to an entirely new experience. Food is thicker, varies in taste and texture as well as colour. Ensure that all foods are either cooked or pureed (by hand, blender or baby food appliance) into a smooth ‘liquidy’ paste resembling runny yoghurt (breastmilk or formula can be used to thin the food). To check for reactions, introduce a new food once every 3-5 days.

Start as you mean to continue

Initially baby will consume only very small amounts – maybe a teaspoon or so – so the quality of what they eat is important. Offer baby good quality food, dense in nutrients and free from additives. This remains true even for toddlers who have much larger appetites but still relatively small tummies.

Keep in mind that as baby becomes more independent, what counts is the food that is offered as we have less control over what is actually eaten. Be persistent and consistent, don’t make a fuss, and be a good role model.

Don’t miss the boat

With the hectic pace of life today, it is easy for bub to miss a meal or snack. But try hard not to fall into this trap. A regular flow of nutrients throughout the day will ensure that your little one has all the energy they need as well as building blocks for their growing brain and body. Missing a meal or even being as little as 10 minutes late can leave you with a cranky baby or child.

A special note on iron

At around six months the store of iron your baby was born with begins to get a little low. Your baby needs a good supply of iron for development and healthy growth. This is why baby cereal fortified with iron is recommended from six months.

Messy but fun

Food should be a positive experience. Encouraging baby’s enjoyment in eating may mean getting in ‘boots and all’ and letting baby feel the food, mix it around on their highchair table, some may even like to wear it: personally I thought my son suited red beetroot horns sticking out of either side of his head.

Having introduced the idea of fun, saying mealtimes are going to be messy affairs is probably an understatement. Set baby up in a comfortable and easy-to-clean space ie a highchair (or similar), with a bib (I like to try to match the bib colour to the food to hide those hard-to-remove stains). It’s also handy to have some baby wipes or a soft damp face-washer close by.

Take your time

Introduce new foods one at a time, trialling it over a 3 to 5 day period. So if bub has a reaction to a food it is easier to determine the culprit.

Babies have personalities too

We all beat to our own drums and babies are no different: they each have different bodies, personalities, preferences, abilities, skills and tolerance levels. Some babies will take to a spoon very quickly while others may need practice over several attempts/days. Some bubs will move quickly from being fed to preferring to feed themselves.

Warm, hot or cold?

Room temperature is most babies’ preference in terms of food temperature, although some may prefer it slightly warmer, for example, at body temperature (given milk straight from the breast is at this warmth). Place baby’s bowl into a bowl of hot water to warm it to the desired temperature. Take care when using a microwave oven as they tend to heat foods unevenly – suddenly hitting a hot spot of food can be distressing and burn baby’s soft mouth.

What do babies on solids need to drink?

Babies’ kidneys are not as adept as adults at handling the waste products from the digestion of food. As bub begins on solids, it becomes increasingly important to monitor the amount of water your little one is drinking, particularly in the case where milk feeds are being replaced by solid foods. Water is best, other fluids such as juices and cordials are not necessary. Young children don’t have fully developed thirst cues so it is important to offer your little one a drink at regular intervals all day. Ensure that drink bottles and cups are placed in easy-to-see and reachable positions for toddlers and check the levels throughout the day.

What about a little fruit juice?

Usually parents give fruit juice to children to assist with their dietary intake of vitamin C. While milk, fruit juice and water are the three most popular fluids for children under one, water is the preference. Fruit juice doesn’t afford any particular nutritional benefits for bubs (and should not be given to bubs under six months) compared to breast milk or formula. While some intake of fruit juice is fine (in moderation), excessive intake can lead to gastric upset, loose stools and may interfere with your child’s appetite and in severe cases their physical development. Dietary guidelines recommend that children:

• Are not given any fruit juice before twelve months of age.
• Are not given juice in bottles or other vessels that pour easily, allowing a child to drink juice over the day.
• Are not given juice at bedtime.

When can cows’ milk be offered?

It is not recommended to introduce cow's milk before 12 months of age as it does not have the required nutritional composition that breast milk or formula has.

At what age should we swap to reduced-fat milk?

Reduced-fat products including milk are not recommended for young children. At around two years your little one can share the reduced-fat dairy products that the rest of the family uses, although it is not absolutely necessary to use these products for toddlers, especially if they are getting their nutritional needs meet by a wide range of foods. Remember to look for the quality of fat because not all fat is bad and in fact even saturated fat in the right amount is important for growth and development.

Alternatives to cows’ milk

We know that formula or breast milk provides a child under the age of one with most of their nutritional requirements. So milk substitutes to replace breast milk or formula is not recommended at this stage, however small amounts are fine and can help with variety, for example as an additional drink or in cooking or on cereals. Offer after meals so bub doesn’t fill up on a drink.

Milk alternatives can be a great option after the first year; many are fortified with calcium to make up for any shortfalls (generally if you check the 100ml column calcium should be 100mg, McVeagh and Reed, 2001). Such drinks also offer a variety of fluids and nutrients, and may benefit children who are lactose intolerant or have other allergies and sensitivities.

Milk alternatives include:

• Soy, a number of which are now fortified with calcium (opt for those made from whole soybeans)
• Nut, such as almond milk (high in essential fats and calcium)
• Oat (notably low-glycaemic index and reputed to be good for the nervous system)
• Rice (can be quite sweet)

Home-made vs. commercial baby foods

Few of us can argue that commercially prepared baby foods are convenient, hygienic and increasingly nutritionally sound. Nevertheless, we should be selective when choosing commercially prepared baby foods, opting to use them occasionally and being sure they are age-appropriate, contain quality ingredients, have minimal or no additives or preservatives and contain no salt or sugar (albeit it in the form of fruit juice).

Avoid feeding your baby solely on commercially prepared foods. This can cause problems such as:

• A reduction in variety of taste, nutrients and textures: Infants who eat home-made foods tend to get a wider variety of tastes, foods, nutrients and food textures.
• Exposure to hidden sweeteners: Fruit juice or skim milk is often used to sweeten a product (even those labelled ‘no added sugar’). This is why some babies develop strong preferences for commercially prepared baby foods.
• Preference for softer and smoother texture: For obvious safety reasons, manufacturers of commercial baby foods generally produce foods that are softer and smoother in texture than home-prepared meals. An over-reliance on soft food for too long can slow the progression to meals. Increasingly lumpier-textured food is given at around seven months, leading to finger foods at around nine months. Lumpy food is best for normal development (including speech), growth and dentition. Also, lumpy food appears to be important in avoiding food fussiness later.
• Confusion about quantity: Quantity can be confusing: the use of a jar may suggest it is the ideal serving for all babies and be confusing for some parents who are left wondering if they should feed their baby more or if their baby should have eaten the whole jar (or two).
• Choices based on adult preferences: Marketing of baby foods is sometimes aimed at us, with terms such as ‘dinner’ or ‘dessert’ reflecting our eating patterns. Mix it up as much as possible and leave the habits to form later.

Strategies for incorporating commercially prepared baby foods

Ensure you use home-prepared foods first when starting solids; in fact, they should be used most of the time. Save pre-prepared foods for when it is difficult to access home-made foods, such as when you are out or running late. Sometimes baby foods can be used as a quick and convenient sauce for other foods such as pasta or rice where the sauce the rest of the family is eating is not appropriate (for example when dad has made one of his famous hot curries).

Foods not suitable for infants and toddlers

The following is a guide to foods that should be avoided and for how long:

• Honey should not be given to children under 12 months due to high amount of simple sugars and spores of potential bacteria (Clostridium botulinum). While this bacteria is harmless to adults, in children under one it can cause constipation, changes in appetite, lethargy, and even changes in sucking, resulting in dehydration and pneumonia. It appears that Australian honey is relatively safe with only a few cases being reported, but it is always best to err on the side of caution.
• Tea contains tannin which has a strong drying effect on the body’s liquid stores and therefore reduces iron-absorption.
• Nuts should not be given to infants due to the risk of inhaling and possible allergy. Nut pastes are a better form of introducing nuts. These can be given safely; however, avoid introducing peanuts in the six months, and first three if there is a family history of allergy.
• Small, hard foods should be avoided as they pose a risk of choking, eg. nuts, seeds, popcorn, whole grapes and whole beans.
• Wholegrain products are not suitable for babies due to the seeds, although light wholemeal bread is fine.
• Soy, cows’ milk, goats’ milk, almond milk or oat milk are not suitable formula substitutes, although fine for cooking or small drinks from ten months. Alternative fluids as drinks are fine after the first year.
• Low-fat or fat-reduced products are not suitable for children under two years as they do not provide enough of a child’s energy needs.
• Caffeine-containing drinks such as tea, coffee, cola, caffeinated drinks or drinks with Guarana are not suitable for children.
• Sugar and salt should not be added to food for children; this includes breakfast cereals, porridge, and baked goods. Read labels to check for these additives.
• Fruit juices are not recommended (unless well-diluted) as they pose a risk of tooth decay and diarrhoea (especially apple juice).
• Fizzy drinks or soft drinks contain a lot of sugar and some contain artificial sweeteners; none provides any nutritional benefit.
• Avoid the use of margarine; butter is nutritionally a far better choice. Adult concerns regarding the composition of fat in butter are not relevant for young children. A great additional option is avocado or nut spreads.
• Fish intake should be limited, especially those high in mercury, e.g. shark, marlin and swordfish.

A final note

Remember, babies’ growth and developments are important indicators of how your baby is going. Well-meaning comments and advice from friends and family can sometimes make even the most confident mum question her abilities, but be assured by taking your cues from the one who knows best: your bub! You can also find more information in the Infant Feeding Guidelines.

The Australian Dietary Guidelines for Children, 2011

Encourage and support breastfeeding

• Generally most research supports exclusive breastfeeding for between four and six months of age

Children and adolescents need sufficient nutritious foods to grow and develop normally

• Growth should be checked regularly in young children
• Physical activity is important for all children and adolescents

Enjoy a wide variety of nutritious foods

Children and adolescents should be encouraged to:

• Eat plenty of vegetables, legumes and fruits.
• Eat plenty of cereals (including breads, rice, pasta and noodles), preferably wholegrain.
• Include lean meat, fish, poultry and/or alternatives.
• Include milks, yoghurts, cheese and/or alternatives. Reduced-fat milks are not suitable for young children under two years, because of their high energy needs, but reduced-fat varieties should be encouraged for older children and adolescents.
• Choose water as a drink. Alcohol is not recommended for children.

and care should be taken to:

• Limit saturated fat and moderate total fat intake. Low-fat diets are not suitable for infants.
• Choose foods low in salt.
• Consume only moderate amounts of sugars and foods containing added sugars.