Complementary feeding, or weaning, is the introduction of solids into an infant’s diet. Introduction of solids is crucial for physical, mental and social development of the infant as well as for nutritional adequacy.
Introduction of solids is an evolutionary process and so should be simple but there is a lot of conflicting information about how this should be done, so I thought I would take a little time and explain my point of view as a nutritionist (and mother of two) of the main elements of complementary feeding and how to get it right.
As the infant grows nutrient requirements become too great to be met by milk alone. Stores of iron for example can get very low by about 6 months of age and additional dietary sources are needed. The optimum age to wean an infant is around 6 months (recommended by the WHO) of age but in some cases this can be done earlier and some parents choose to wean at the age of around 4 months.
There are many signs that can tell the parent that the infant is ready to start on solids. Babies will begin to watch as others around eat. Their core strength improves and their hand-eye co-ordination will allow them to reach out for things and put it in their mouth.
You might also notice that the baby will show signs of hunger between feeds regardless of larger amounts of milk being offered. When food is being offered, the baby should be able to take it from a spoon by sweeping the spoon with their top lip rather than sucking the food from the spoon. They should also be able to move the food around their mouth using their tongue before swallowing.
Because all infants develop individually, not all of them will be ready to be weaned at the same age. It is therefore important to look out for the signs. In 2001 the WHO recommended that babies should be exclusively breastfed until the age of 6 months, however this recommendation was made to reduce infant m
mortality in developing countries and in the fear of low hygiene in food practices in developing countries. Therefore there has been considerable debate about wether this recommendation should be applicable to developed countries like the UK. The debate continues!
Baby rice and pureed apple and banana tends to be the most common first food. There are many commercially available foods suitable for weaning which are safe to use. However, in a recent study (1) it was found that commercial baby foods is inferior to that of homemade weaning foods. The same research found that homemade foods had nearly twice as much calories and protein compared to bought ones. So, make it yourself. It is quick, easy and will cut money off your shopping bill.
It is important to repeatedly expose babies to different foods whilst weaning has been established to promote acceptance of a wide variety of foods. Try and avoid very sweet and very salty foods as not only are these generally unhealthy for babies, this is likely to influence their food preference later on - the start of a healthy life is now.
Complementary feeding should be introduced slowly (ie one meal a day in addition to breast milk or formula for the first few days- incorporate foods at times when you feel your baby is most hungry). Begin with one food type at a time (for example apple puree) and try not to mix different foods together until weaning has been established. It is important to offer the baby finger foods and more lumpy foods before 9 months of age to make sure they become used to more “normal” foods. Remember never to leave your baby unattended at meal times due to risk of choking.
Nutritional Adequacy during complementary feeding
Many recent researches have shown that there is no concern about meeting the recommended nutrient intake in weaned babies in the UK. The only exemption being vitamin D. There is a risk of deficiency between the ages of 0 and 1 due to the rapid bone growth and lack of exposure to sun during the firsts months of life. The Department of Health therefore recommends that children ages 6 months to 5 years should receive around 7 micrograms of vitamin D supplements per day. Vitamin D has recently become a major public health concern as the occurrence of rickets and hypocalcaemic tetany have slightly increased in the UK.
Another nutrient worth noting is iron. Infants are born with enough iron to last them until around 6 months of age but after this point adequate iron intake is important to avoid anaemia.
Although the availability of iron from breast milk is generally good, babies that continue to exclusively have breast milk after the age of six month could be at a risk of low iron (2).
Foods to avoid
There has been a lot of conflicting information on the web about arsenic in rice. The Food Standard Agency (FSA) has advised that there are no harmful levels of arsenic in these foods that cause concern and are therefore safe to have. However, the FSA advised that rice based drinks should not be consumed by children under the age of five due to the high concentration of arsenic relative to body weight of a child.
Honey should not be given to babies under the age of 1 due to a risk of infant botulism.
There are foods that are more likely to cause and allergic reaction, such as egg, wheat, nuts, sesame seeds, fish and shellfish. it is advisable not to introduce these foods before the age of 6 months.Studies however are inconsistent regarding whether excluding potentially allergenic foods can prevent allergy from occurring later on. Emerging evidence suggest that allergen (something that causes and allergic reaction) avoidance may actually increase the risk of developing a food allergy. In Israel for example, peanut allergy has a much lower occurrence rate possibly due to early exposure to a popular peanut based snack, “bamba”. Of course, wherever there are any concerns that a child may have allergies, formal medical advice should be sought.
As always, I am happy to answer questions so either leave a comment or send a message through my blog.