COMPLEMENTARY FEEDING

WHEN TO INTRODUCE SOLIDS

The timing of introducing complementary feeding (foods other than breast milk or infant formula) should be no earlier than 17 weeks of age and no later than 26 weeks. Generally, solids are being introduced at 4-6 months of age depending on the babies ‘readiness’ in terms of development. This is the time when the baby’s kidney and gastrointestinal tract are able to digest solids foods and solids given earlier can cause gastrointestinal damage. This is also the time when the baby is neurologically ready for solids and the time when breast milk or formula milk is thought to no longer provide the baby with their nutritional requirements (energy, protein, iron, zinc and some fat soluble vitamins A and D)

SIGNS OF READINESS FOR SOLIDS/COMPLIMENTARY FEEDING

  1. The baby is able to hold their own head up and sit without support
  2. The baby is showing interest in other foods and their surroundings and tries to put things such as food/ fork in their mouth.
  3. Baby is ready and willing to chew
  4. Baby has lost the tongue-thrust reflux and doesn’t push all food out of the mouth with their tongue

 

STORING HOME-MADE BABY FOOD

  1. You can make use of Ice trays to freeze home-made baby food. Once frozen you can also distribute them to ‘ziplock’ bags with the name and date on.
  2. Defrost and use as needed. It is suggested to defrost the baby food naturally or in a pot on the stove. Be careful of microwave heating as this can cause heat pockets in the food. Always test the appropriate temperature of the baby food before feeding your baby.
  3. Make sure that all food made is done so in a sterile and clean manner to prevent your baby from getting sick. This also means don’t leave the food out before freezing and don’t reheat the food more than once.

THE FEEDING ENVIRONMENT

  1. Ensure that the feeding environment is in a relaxed space
  2. It is important not to force feed your baby or get impatient and fight with your baby to eat
  3. Allow your baby time to swallow between spoonful’s.
  4. Allow the introduction of solids to be messy and allow your baby to touch and experience the foods. This is all part of development.
  5. Always supervise your baby/ infant while feeding

 

WHICH FOODS TO DO FIRST

  1. Start with typical foods that the family eats
  2. Introduce 1 new food every 2-3 days
  3. It may take up to 20 times for a new taste/food to be accepted. If your baby spits out the food initially it must be introduced again on more than one occasion.
  4. Sweeter foods such as fruit may be tolerated better so start with vegetables before fruits for increased acceptance and vegetables may be needed to be tried more than once especially the one’s that are more bitter.
  5. You can make use of processed/convenient baby foods but often the flavours are mixed and makes exploring the individual flavours hard to identify. It is better to do one flavor at a time. Home-made family foods are the best.
  6. There is no evidence to delay the introduction of allergen foods (soy, dairy, wheat, eggs, nuts, fish) unless it has been suggested by your paediatrician.
  7. Cow’s milk should not be given before 1 year of age. This is due to the fact that cow’s milk is not a good source of Iron and may result in Iron deficiency and due to the fact that it may cause intestinal bleeding or upset.
  8. It is not recommended that babies be weaned onto a vegetarian or vegan diet due to their nutritional needs at this age.

STARTING THE PROCESS

  1. Continue to breast feed or give your baby their formula.
  2. After feeding offer the baby 1-2 teaspoons of the solid food. (At a time when baby is awake and not half asleep)
  3. A soft edge spoon is preferred so that you don’t hurt the baby’s gums with an adult/ metal spoon.
  4. You can add some of the formula/ breast milk to make the solid’s runny.
  5. In the beginning the baby may only have solids once a day and as they get a bit older maybe twice a day and eventually three times a day by 8 months of age.

WHAT SHOULD YOUR BABY NOT HAVE:

  1. Salt should not be added to any baby foods.
  2. Sugar and sugary foods/ snacks shouldn’t be given to your baby
  3. Avoid sugary drinks such as fruit juice as well as drinks such as tea.
  4. Honey should be avoided until 1 year of age
  5. When your baby is on the ‘finger food’ stage salty snacks such as chips should be avoided
  6. Drinks other than breast milk or formula should be discouraged. Water can be given in very hot months.
  7. You should never add solids/porridge to the baby’s bottle.
  8. Cow’s milk, rice milk, almond milk and goat’s milk are not nutritionally adequate to give your baby. Rather continue to breast feed or give formula until 1 year of age.

 

VEGETARIAN/VEGAN DIETS IN CHILDREN AND INFANTS

It is generally not recommended for children under the age of 2 years to follow a vegetarian/vegan diet. This is due to the fact that a vegetarian/vegan diet places them at risk of numerous nutritional deficiencies and insufficient growth.

If you choose to give your child a vegetarian/vegan diet then it is recommended that you consult with your practitioner or dietitian for growth monitoring and to ensure that you avoid nutritional deficiencies by giving your child a well-planned diet.

Here are some nutrients to take note of if your child is on a vegetarian/vegan diet:

ENERGY 

Most vegetarian and vegan diets are higher in fibre and bulk due to the types of foods included (more cereals, fruits and vegetables). This may fill your baby/toddler up quickly on low energy foods which can affect growth.

It is suggested that energy dense foods be included in the vegetarian diet and close growth monitoring is essential. Energy dense foods could be nut butters, nuts and soya products as well as including fats such as avocado or olive oil added to foods. Frequent eating and snacking may also help prevent your child filling up too quickly.

PROTEIN

Babies need sufficient protein for growth. Even though adult vegetarian diets provide sufficient essential amino acids, it is thought that due to the low digestibility of plant proteins and the bioavailability of the amino acids, that children/ infants following a vegetarian diet should consume more protein compared to non-vegetarian children

  • 30-35% more protein in infants under the age of 2 years
  • 20-30% more protein for 2-6 year olds
  • 15-20% more protein for children older than 6 years of age

Plant proteins are deficient in one or more essential amino acids. To enhance the protein content when weaning, continue to offer your child sufficient breast milk or soy-based formula together with plant based proteins.

Plant sources of protein include beans (soybeans), lentils, chickpeas, cereals, nuts, seeds and their butters. Lacto-ovo vegetarian infants can get extra protein from eggs, yoghurt, cheese and milk. Other sources that can be included in the diet includes almonds and quinoa.

IRON

Babies are born with enough iron for the first 4-6 months. After this age iron should come from the diet. Vegetarian/vegan diets are low in heme iron which is found in animal proteins such as poultry, fish and meat. High Iron foods include legumes, dark green vegetables (e.g. spinach, kale), dried fruits, prune juice, pumpkin seeds and soy nuts. Try and choose iron fortified cereals/grains. An iron supplement may also be necessary in some cases.

Vitamin C may enhance the absorption of Iron and should be included in the diet. Examples include tomato, oranges, coloured peppers, lemons, berries, guavas, citrus fruits, broccoli.

There are also a few things that can hinder Iron absorption such as dietary fibre, tannins and phytates. Avoid giving your child tea with meals.

CALCIUM

Calcium is essential for bone and teeth development. If dairy products are avoided in the diet then focus on other rich sources such as dark green leafy vegetables (kale, bok choy, spinach), broccoli, legumes, tofu (processed with calcium), sunflower seeds, almonds, chia seeds, dried figs, calcium-fortified cereals and drinks.

Cow’s milk, soya milk, goat’s milk, rice and coconut milk are not appropriate as a baby’s milk in the first year of life. This is because they have the incorrect ratio of carbohydrates, protein and fat and they are missing essential nutrients which can affect your child’s growth and development.

OMEGA 3

Omega 3 is an essential fatty acid that has many proven health benefits. Vegetarian/vegan diets that are lacking in oily fish/seafood may result in an Omega 3 deficiency. Foods to include are walnuts, flaxseeds/flaxseed oil, chia seeds and canola oils. A vegetarian suitable Omega 3 supplement may also be beneficial.

VITAMIN B12

A deficiency in Vitamin B12 is most common in Vegan diets. Foods fortified with Vitamin B12 should be included such as commercial breakfast cereals, or fortified soya milk. In some cases a supplement may also be necessary.

VITAMIN D

A rich source of Vitamin D is found in dairy products. If you have cut this out your child’s diet a supplement may be necessary. Other food sources include fortified milks.

ZINC

A Zinc deficiency is not very common but it is mainly found in animal foods so if this is eliminated from the vegetarian diet it is suggested to include other food sources.

For example, wheat germ, tofu, nuts (cashews, almonds), seeds (poppy seed, flax and chia seeds), dried beans and fortified breakfast cereals.

BREAST FEEDING

Breast feeding moms should be encouraged to continue breast feeding beyond a year in vegan/vegetarian babies.

References

  1. Position Statement on Vegetarian diets in children and Adolescents, Revised 2016. Canadian Paediatric Society.
  2. Koletzko, B, et al. Paediatric Nutrition in Practice, 2008. Pp130-132.
  3. Mahan, L et al. Krause’s Food and The Nutrition Care Process. 14th Ed. 2017.

Kelly Ansley.   Registered Dietitian