Feeding guidelines
Complimentary food is important for establishing future healthy eating habits in infants and children. Studies show that children who are well-nourished in the first two years of life are more likely to stay well-nourished later in life. The ideal age to start introducing solids is between 4 and 6 months. Not before 4 months and not after 6 months. The WHO recommends exclusive breastfeeding for up to 6 months where after complementary feeding is introduced while continuing breastfeeding up to 2 years of age.
Your baby enters the Learner Eater stage when you start introducing solids to your little one. Your baby's diet mainly consists of milk feedings (breastmilk or formula feed) in the learner stage. But milk alone no longer meets the baby's energy needs, Iron reserves are also depleted. The Learner Eater stage is also an educational stage where babies learn
about different tastes and textures.
Signs of readiness to introduce solids feed
Your baby has good head and neck control and can sit upright if supported.
The tongue-thrust reflex is gone and your baby no longer pushes the tongue out when stimulated. If you put food on the baby's tongue the baby will swallow it and not push it out.
Your baby shows interest in the food you eat and or opens its mouth when food is offered.
Your baby pushes up on its arms when placed on the stomach.
The HabEat study’s findings give insights on effective strategies for improving feeding practices.
Infants who are introduced to a variety of plain vegetables (everyday vegetables for example pumpkin, sweet potatoes, carrots), will be more acceptive to new and interesting flavours.
Repeated exposure to the same taste and texture leads to acceptance.
Infants who are familiar with different vegetables are more likely to consume a greater variety of vegetables and fruits when older.
Food should be offered at least eight times before deciding that the child does like it.
World Health Organization Guiding principles for complementary feeding:
Practice responsible feeding.
It is important to take care of what the baby is fed and how, when, where, and by whom.
Practice good hygiene and proper food handling.
Safe preparation and storage of food are crucial. Good hygiene includes thorough washing of eating utensils, washing hands before preparation of food and before feeding, and cleaning the preparation and feeding areas. Separate raw and cooked food and cook food thoroughly. Use safe and clean ingredients and water when preparing food.
Gradually increase food quantity
Quantity to be increased monthly. As the child grows, the need for milk reduces and more food is needed to fill the energy gap. Your baby will guide you ― look out for hungry and full cues.
Gradually increase the consistency of complementary food
The consistency of complementary foods should be increased based on the infant’s age and neuromuscular development. It is proven that thicker and more solid foods provide more energy and nutrient density if compared to thinner food. Move from puree food to mash to crush to finger food.
Gradually increased meal frequency
Meal frequency increased according to the energy required. More meals will be required if the food’s energy density is low (eg. thin food). One or two nutritious snacks per day are allowed depending on the child's appetite. Start with one meal a day between milk feeds and increase to two meals a day, for example, midmorning, then midmorning and mid-afternoon and thereafter morning, midday, early evening. Bear in mind that complimentary food does not replace milk feedings, it should be given in addition to milk feedings.
Add a variety of nutrient-rich foods
Nutrient needs for growing are from a variety of food sources and should be added to the usual staple food used for complementary feeding complimentary food needs to provide sufficient quantities of micronutrients such as iron, vitamin A, zinc, calcium, and vitamin C. These nutrients are important for growth, development and preventing illness.
Increase fluid intake during illness and continue breastfeeding
When your baby is ill they will require more fluid. Offer more fluid and continue with the milk feeds. Usually, the baby's appetite decreases during illness and you need to give a smaller amount of food and more meals.
Fortified complimentary food or vitamin-mineral supplements
Plant-based and/or unfortified complimentary food does not have sufficient quantities of iron, zinc, and vitamin B as recommended for 6-23 months. The inclusion of animal source food may meet this gap.
Guidelines when feeding complementary foods:
Feed your infant slowly and patiently.
Do not force-feed your child, the baby needs to be able to express feelings and actions when feeding solids.
Assist older children.
Minimize distraction.
Talk to your child.
Introduce one food at a time, usually three times before moving on to a new food.
Introduce new foods repeatedly.
Introduce new foods until your baby happily accepts them.
Finger feed (baby-led weaning) can be done when the baby is 6 months old. Use food that you can squish between your fingers comfortably.
Add water to diet when you introduce solids to your child, water is also not replacing a milk feed.
Introduce spoon-feeding:
Use a soft-tipped baby feeding spoon.
Hold the spoon to the baby's lips and let the baby suck the content off.
Do not put too much on the spoon or put it too far back in the baby's mouth, it may cause the baby to gag.
Do not put the food on the front of your baby's tongue, it will dribble out.
Offer a small amount of food at a time.
Read baby's cues: showing interest for more or showing that baby had enough.
Hungry cues:
Getting excited when the baby sees you head to the fridge or preparing the meal.
Kicking little legs when anticipates food being put onto the highchair.
Leaning towards you when you have food on a spoon or in your hand
Focusing on the food
Opening the mouth eagerly when the baby sees food coming
Smacking the lips
Pointing at the fridge or food
Becoming a little fractious and irritable
Moaning and grizzling
Had enough cues:
Turning away from the food
Clamping mouth closed when the spoon comes close
Losing interest and wanting to get off the highchair
Pushing the bowl or spoon away
Baby is rubbing ears and eyes
Spitting out food
Maintain eye-to-eye contact.
If the child refuses to eat try different combinations, tastes, and textures of foods. For example, add a new taste to a favourite taste and slowly reduce the favourite taste and increase the new taste. Do the same with textures.
Avoid adding food into the milk bottle, rather use a cup and a spoon.
Use appropriate bottle feeding practice:
No bottle propping
Observe satiety cues
No overfeeding of your child
Use a bottle for liquid/milk till the age or where they can use a sippy cup.
Which food to start with:
Any food can be given as a first food as long it is pureed and served on its own. For example, carrots, not carrots and sweet potatoes.
Do not add sugar, salt, herbs or butter to food.
Pureed fruits and vegetables are ideal first foods for the first three weeks, followed by proteins (meat, chicken, fish, eggs)
Choose seasonal vegetables and fruits
Baby cereal used to be the first weaning food but due to commercial pressed
carbohydrates, they are now seen as the second choice.
Proteins are safe and beneficial to introduce early on
Fats include omega 3, 6, and 9 essential nutrients for your baby's developing brain and immune system. Healthy fats include: olive oil, avocado, nuts, seed oils, walnut, almond, sesame, and flaxseed
Choose full-cream dairy, not low fat or fat-free
Add sweetness from nature, not refined sugar
Porridge: oats, maltabella, maize meal
First vegetables: baby marrows, sweet potato,
Orange vegetables: carrots, pumpkin, sweet potato, Hubbard pumpkin, potatoes
Green vegetables: spinach, peas, beans,
Fruit: apple, pear, peach, prunes, avocado, banana, mango, spanspek
Guidelines for solid feeding:
6 - 8 Months 2 - 3 meals / day
Meals 2 - 3 tablespoons and
increase gradually to ½ of 250 ml cup
9 - 11 Months 3 - 4 meals / day
½ of 250 ml cup
12- 23 Months 3 - 4 meals / day
¾ of 250 ml of cup
1 - 2 nutritious snack according to
appetite
Feeding your baby in the sensory world and personality:
Your baby's personality will guide you when it is best to wean your baby, which food to offer, and also at what pace. Understanding your child's sensory personality not only influences their sleeping pattern and when to stimulate them but you will benefit from this understanding when you feed your baby.
Social butterfly:
Very active baby, always on the move
Smiled early and loves the sound of their own voice. Happily entertained by various people. Invites interaction when out and about, smile, flirt with strangers
Good eater from start but can be distracted while breastfeeding
Life and soul of the party
Enjoys and even seek strong flavours
Loves stimulation like being thrown in the air
Practical tip:
Prepare food with flavour enhancers like herbs
Add new foods at a rapid rate to avoid that baby become fussy due to the same food, taste and texture
Offer solids after a milk feed
Change the location: go outside for a picnic
Distraction works well
Slow to warm up:
Irritable baby
Easily upset by sudden noises
Doesn't sleep well in new places
Shy and wary of people until she knows them but when she warms up is happy and gregarious
Prefers one type of bottle teat or to be only breastfed, doesn't easily switch from breast to bottle
Resists new food experiences and tastes
Calmer when in a routine and life is predictable
Practical tip:
Prefers a slower introduction to texture
Don't avoid the introduction of new food but understand baby need to explore new food, taste and texture a few times before eating
Feed when the baby is calm and rested
Sensitive:
Separation anxiety is higher than most and does not like to be passed to strangers
Tricky feeder who took time to settle into a feeding method
Gags easily, whether on a dummy or new food textures
Gets a fright easily and may cry at sudden sounds or long drives
Needs a routine to stay calm
Becomes unsettled in busy social spaces like parties or shopping centres
Practical tips:
Keep sensory challenge to a minimum and feed after asleep
May have experience more colic than other babies
Feed-in a place that does not smell and is too busy
You can put a bean bag on the babies lap to calm the sensory system
Do not wipe the baby's face repeatedly during feeds
Leave the bib off altogether rather change the shirt
Less likely to self-feed because she doesn't like to get her hands dirty
Settled:
Laidback little one who rarely cries
Settled into a routine easily
Goes to anyone
Good feeder and moves onto solids happily
Generally good sleeper
I May have had to wake her to feed, especially in the early days
May have to work hard to get those little smiles out of her
Practical tip:
Set up a routine and lead weaning a little more with these babies
Guidelines for food portions will be helpful due to signs of hunger and full is not clear for these babies
Offer high flavour and texture variety
Sucking on fruit wedges is fabulous for these babies
Use information as a guideline only. Please contact a dietician if you have a baby with special needs.
References:
Boston University, post graduate program in Pediatric Nutrition, module 7: Appropriate complementary feeding: an opportunity to prevent malnutrition; 2020
Meg Faure, Katherine Megaw, Dr Simon Strachen; Sinvolle voeding; Metz press 2010
Meg Faure, Katherine Megaw; Weaning sense; Quivertee publications
www.ourgreenishlife.org, nutripeads weaning guide
www.babyandme.nestele.co.za when do we introduce solids to the diet
www.healthyparenthealthychildren.co.za starting solids 6 - 12 months