Preventing Obesity, Allergies, and More! The Importance of Complementary Feeding:
6 Months - 24 Months
Complementary feeding: the transition from exclusive breastfeeding to family foods. It’s a vulnerable period of time in your infant’s life that can bring on frustration and picky eating. It must be timely, adequate, safe, and appropriate according to the World Health Organization, but how can we assure we’re giving them foods that fit those requirements? A few rules of thumb can help us make the best educated decisions for our little ones. By making appropriate choices, we can help set them up for a healthy future and decrease their chances of health problems down the road.
Timely: All infants should start receiving foods in addition to breast milk from 6 months onwards. Much later than this could cause nutritional deficiencies. Some choose to start their infants with family foods around 4 months, although 6 months continues to be more widely recommended. A good general guideline is that it’s typically safe to begin complementary feeding (around this age) when your child can sit up well without support, hold their head up independently, and hold their necks high. At this age they will also begin to lose the “tongue-thrust reflex” or extrusion reflex. While this reflex is important for sucking the breast or bottle when they are younger, it interferes with feeding complementary foods. Some evidence suggests that very early introduction (at or before 4 months), rather than at 4-6 months or > 6 months, may increase the risk of childhood obesity. It has also been shown that infants introduced to solids earlier are more commonly diagnosed with food allergies by the time they are 2 years of age. Children are even more likely to be diagnosed with food allergies if they are not receiving breast milk throughout the introduction of family foods, suggesting a protective factor in breast milk. The current American Academy of Pediatrics’ allergy prevention recommendations and the European Society of Pediatric Gastroenterology, Hepatology and Nutrition recommendations on complementary feeding are to not introduce solids before 4 to 6 months of age. The American Academy of Pediatrics’ breastfeeding recommendations also state that breastfeeding should continue while solids are introduced into the diet and that breastfeeding should continue for 1 year, or longer, as mutually desired by mother and infant.
Adequate: Complementary foods should be given in the adequate amounts, frequency, and consistency, using a variety of foods to cover the nutritional needs of the growing child while still maintaining breastfeeding. Babies need practice and experience with first feedings. Do not be discouraged if the feeding does not go as planned at first or if your child rejects the food being given. You may have to try multiple times before a food is accepted. If your infant is rejecting a certain food, wait a few days and then try again. Here are some tips on getting started:
- Pick a time when both you and baby are in a good mood and baby is not too tired or too hungry.
- Hold baby on your lap or sit him/her up in an infant seat.
- Start with iron-fortified rice cereal. This is easiest on baby's stomach. A tablespoon mixed with 3 or 4 tablespoons of breast milk or formula is all you need at first. Keep the cereal very thin.
- Use a small spoon, and put cereal only on the tip.
- If baby does not seem very interested in eating off the spoon, let him/her smell and taste the cereal.
- If baby has trouble swallowing, he/she may not be ready for solids yet. Wait a few days and try again.
- Feed baby the same single-ingredient food for one week before changing to another food.
- Thicken the consistency of the cereal slowly over a period of several weeks.
Start with 1-2 tablespoons, 2-3 times per day, while continuing to breastfeed. Remember, their tummies are tiny and although it may not seem like a lot, they will still be feeding on mostly breastmilk or formula at this point in time. After beginning with cereal, we can slowly begin to introduce fruits and vegetables in purée 3-4 times per day at 2-3 tablespoons and then strained meats and beans. Slowly the consistency will change to small chopped pieces of food as your little one begins to work more on their chewing control. There are a few foods that are very important to withhold until at least 12 months of age including honey and corn syrup (due to botulism risk), sugar, salt, and cow’s milk. This section will be discussed in much greater detail at our Well Child/Niño Sano Nutrition Clinic on November 4th at 6:00pm at Play Works.
Safe: Measures should always be taken to minimize the risk of contamination with pathogens. Infants’ immune systems fully develop around 6 months of age. Breastfeeding is an extremely important part of building a strong immune system in our newborns, if you are able to breastfeed, due to the immunoglobulins passed from mother to infant. When an adult contracts a foodborne illness and experiences diarrhea or vomiting, a significant amount of weight is probably not lost and we recuperate rapidly. Infants, on the other hand, can lose a large percentage of their body weight through diarrhea and vomiting, landing them in the hospital. It is important that proper hygiene and sterilization of all foods and appliances is followed to protect your infant from foodborne illnesses that could cause serious harm.
Appropriate: Appropriate means that foods are of appropriate texture for the age of the child and that we apply responsive feeding following the principles of psycho-social care. Responsive feeding refers to a reciprocal relationship between a child and their caregiver characterized by the child communicating feelings of hunger and satiety through verbal or nonverbal cues, followed by an immediate response from the caregiver. The response includes the provision of appropriate and nutritious food in a supportive manner, while maintaining an appropriate feeding environment. Eating strictly for nourishment (versus emotionally or for enjoyment) is where infants strongly differ from adults. It is important to respect responsive feeding principles in order to develop healthy eating behavior and optimal skills for self-regulation and self-control of food intake in our children, preventing obesity and it’s complications in the future. This will also be discussed in further detail at our Well Child/Niño Sano Nutrition Clinic.
Please attend our Well Child/Niño Sano Nutrition Clinic Friday, November 4th at Play Works at 6:00pm. We will have a 45 minute informational presentation on Complementary Feeding and plenty of time to respond to individual questions and concerns. We will be weighing and measuring each child (if desired) and providing a brief nutritional evaluation. If private nutritional counseling is recommended at this point in time, you will be able to receive appointments at a discounted rate. Cost for the Clinic is $25/family. We hope to see you there!
Caitlyn Witte, B.S. Nutrition Counselor