Nutrition

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 PREGNANCY and BABY

This section includes information on introducing your baby to solid food.

Many parents worry about when and how to wean their little ones, but weaning needn't be a stressful time. Read our practical guide below to find out more about giving your baby his or her first solid foods. We have incorporated current guidance in this area to help your baby get a good start.

The term weaning is now often referred to as 'complementary feeding', to promote the continued use of breastfeeding beyond 6 months, so you might see this term used on some websites and information leaflets. In addition, many of the latest guides on weaning no longer use the idea of 'stages'; current information often refers to the introduction of different tastes and textures over time and developing eating and chewing at the baby's own pace so that by the age of 12 months your baby is having a variety of foods from all the major food groups and is eating three meals a day, in addition to healthy snacks.

When to wean

Exclusive breastfeeding is recommended for the first 6 months

The Department of Health recommends exclusive breastfeeding for the first 6 months. This is based on World Health Organization (WHO) guidelines because of the strong evidence of the benefits for both mother and child.

Breast milk (or infant formula) will usually provide all the energy, nutrients and fluids that your baby needs in order to grow and develop healthily during the first 6 months of life.

Wean your baby at the right time - around 6 months

  • Weaning too soon (before 4 months) can increase the risk of infections and allergies, as your baby's digestive system and kidneys are still developing.
  • It is important that weaning is not delayed much beyond 6 months. This is because stores of essential nutrients such as iron need to be replenished. Your baby's increased requirements of these nutrients cannot be provided by milk alone. Also, delays in the introduction of new flavours and textures at this stage may make it more difficult for your baby to accept new foods.

It is natural to want to progress onto the next step and some parents are anxious about when to start to wean their babies. If your baby seems hungrier after his or her usual milk feed, first try breastfeeding more often, or offering more milk at each bottle feed.

Babies who are born prematurely may need to be weaned at different times, depending on their individual needs. Speak to your midwife, health visitor, paediatric dietitian or GP for advice.

Signs that your baby is ready for weaning

Each baby is individual but by around 6 months, babies are ready for weaning. Signs that your baby is ready are indicated below:

weaning signsweaning signs mistaken

The aim of weaning is to gradually introduce your baby to a wide range of new tastes and textures so that, by the age of one year, your baby is enjoying a varied and healthy diet.

Introduction of foods (around 6 months)

You can begin by mixing a teaspoon of one of the following foods with your baby's usual breast or formula milk:

  • Non–wheat cereals, such as baby rice
  • Mashed or puréed fruit: soft fruits such as banana or avocado, or cooked fruit such as pear or apple
  • Mashed or puréed cooked vegetables, such as carrot, potato, sweet potato, parsnip or yam
  • You can also try finger sized pieces of soft/cooked fruit or cooked vegetables. The best finger foods are those that can be cut into pieces that are big enough for your baby to hold in their fist, and stick out of the top of it. Pieces about the size of your own finger work well.

Getting started

  • Place a small amount on a soft-tipped spoon and offer this to your baby before, in the middle of, or after, his or her usual milk feed. Wait for them to open their mouth first when food is offered and initially don't attempt to give more than one or two spoonfuls. Remember that first foods will taste and feel different from breast or formula milk, so don't worry if your baby spits out his or her first few spoonfuls!
  • Alternatively, your baby may like to hold the spoon, or pick up the food with their fingers and feed themselves.

Be safe

  • Always stay with your baby when they are eating. Remember to keep your baby sitting in an upright position, well supported (for example in a high chair) and facing forwards when introducing solid foods. This will help to reduce the risk of choking.
  • Never offer food from a bottle – not only can this cause choking but it can also damage your baby's teeth.
  • Initially offer foods one at a time in case of allergy (see page 10 for more details).

Your baby will still be getting most of his or her nutrients from breast or formula milk (at least 500ml-600ml formula per day), so don't worry if your baby only swallows small amounts of his or her first foods – at this stage the food is just a taster!

Once your baby is comfortably taking his or her first foods, start to introduce purees of different fruits and vegetables, such as broccoli, courgette, butternut squash, peach or melon. You can also start to combine different fruits or vegetables. The amount and frequency can be gradually increased, from once a day, to twice and eventually three solid feeds per day.

Take your time and don't rush

It is important to go at the baby's own pace and allow plenty of time for feeding. Never rush or try to force-feed your baby. Let your baby feed themselves and use their fingers to hold the food. It might be messy but it is an important part of their development.

Most babies know when they have had enough to eat and there is no point in trying to 'persuade' them to eat more. Similarly, if they refuse to try a new food then it is important not to make a fuss. Simply take the food away and try it again on another day. You may need to offer a food 10-15 times before it is accepted.

Introducing more tastes and textures (from around 7 months)

After you have introduced first foods to your baby, you can soon try a wider range of foods and textures. You can start combining foods to provide your baby with delicious and varied meals. weaning foods

As well as gradually increasing the quantity, you should also change the texture of the foods you give your baby, moving from smooth purees to mashed and lumpier foods.

After 6 months babies can be introduced to dairy foods*, foods containing wheat and varied sources of protein.

Once they have got used to eating simple foods, you can offer them foods such as cooked meat, fish, pasta, noodles, bread, chapatti, lentils, and mashed rice. You can also introduce them to well cooked eggs, and full fat dairy products like cheese, yogurt or fromage frais. Full fat rather than low fat dairy foods should be given as these are a better source of vitamin A and provide extra calories which babies need for growth and development. Make sure these are low in added sugars.

A special look at iron

Good sources of iron include red meat, such as pork, beef or lamb. Pulses, such as beans and lentils, also provide iron but this is less well absorbed. However, vitamin C from fruit and vegetables can help your baby to absorb iron from non-meat sources, so it is a good idea for fruit and vegetables to be given at mealtimes. This is particularly important for babies weaned onto vegan and vegetarian diets (see page 10 for more information).

Finger foods

It's a really good idea to try giving your baby soft finger foods. These allow your baby to practice chewing and can encourage them to feed themselves. Finger foods can also help to engage your baby's interest and some babies actually prefer foods they can hold themselves. Finger foods to try at this stage include:

  • cooked vegetables (e.g. sticks of carrot, pieces of broccoli, green beans)
  • pieces of peeled soft ripe fruit (e.g. banana, peach, pear, mango, melon)
  • fingers of pitta bread or toast
  • sticks of cheese

Getting ready for family food (from around 9 months) weaning

By this time your baby should be moving towards having three meals a day, in addition to healthy snacks as well as breast or formula milk. Water should be offered in an open cup or a free-flow lidded beaker with each meal.

It is important that you give your baby lumpier foods to encourage them to learn to chew, so foods should ideally be chopped or minced at this stage. Even if your baby doesn't have any teeth yet, he or she can chew. Finger foods will continue to help your baby learn to chew and feed themselves. Firmer finger foods like fresh fruit and veg, breadsticks and pieces of meat or fish can gradually be given as your baby gets older.

Offer your baby a wide range of foods to make sure they get all the vitamins and minerals they need. Encouraging your baby to try a wide range of foods will also make them more likely to accept new flavours and textures later on. You can give two courses at this stage e.g. a savoury course of meat, fish or pulses and vegetables followed by fruit or yogurt/fromage frais. As your baby moves towards one year of age they can enjoy healthy snacks like fruit and vegetable sticks, toast and rice cakes. Avoid giving your baby foods with added sugars or foods high in fat and/or salt, such as processed meat, deep fried foods, cakes, biscuits and chocolates, to encourage healthy eating patterns as they grow.

weaning food groups

What about milk feeds?

Solid foods should gradually start to replace milk feeds as weaning progresses, and you should find your baby will want less milk at each feed, or may even drop a milk feed altogether. You should still give your baby breast milk or formula as their main drink up to the age of 12 months (at least 500-600ml formula per day). Breast feeding can continue beyond 12 months for as long as you and your baby wish to continue.

Remember only breast milk and formula milk are suitable for babies under one year of age. Follow-on formula can be introduced after 6 months of age but it is not necessary and you can continue to use infant formula. Soya-based formula should only be used under the instruction of a GP. For information about other milks or dairy-free alternatives see our drinks section on the next page.

Suitable drinks

Milk

  • Your baby should still be given breast milk or formula as the main drink up to 12 months of age (at least 500-600ml formula per day).
  • Whole cows' milk is not suitable as a drink until after 12 months of age, but it can be used in cooking after 6 months.
  • Semi-skimmed milk is not suitable for babies and infants under 2 years of age and skimmed and 1% fat milks are not suitable as a main drink until your child is 5 years of age. This is because they do not contain enough calories and vitamin A to support a child's needs.
  • Goats' and sheep's milks are not suitable for babies under one year of age as they don't contain the right balance of nutrients for their growth and development.
  • Babies under one year of age should not be given other types of milk, such as condensed or evaporated milks, nor should they be given rice, oat or almond dairy-free alternatives as drinks.
  • Soya-based formula should only be used under the instruction of a GP. Soya-based drinks can be introduced after 12 months of age.

Water

Water is the best alternative to milk as a drink and should be offered with every meal. Give your baby tap water, rather than bottled water, as the mineral content can be too high in some bottled waters (if giving tap water to a baby under 6 months old, it should be boiled and cooled first).

Fruit juice

Unsweetened fruit juice contains natural sugars and is acidic; it can cause tooth decay if given too frequently. You can give your baby unsweetened fruit juice after 6 months of age, but always dilute it well, serve in an open cup and restrict to mealtimes only.

Drinks to avoid

Drinks containing added sugars, like squashes and fizzy drinks, are not suitable for babies. They should also avoid energy and diet drinks. These should be restricted because they can be damaging to teeth and may contain ingredients (e.g. caffeine) that are unsuitable for this age group. They also have very few nutrients and can fill your baby up meaning that they can miss out on important nutrients from food.

Tea and coffee should not be given to babies. They can reduce the amount of iron and other nutrients absorbed from food, especially if they are given with meals.

Cups

  • Your baby can move on to drinking from a cup around the age of 6 months, once he or she can sit up and hold their head steady
  • Drinks should be given from an open cup or a lidded free-flow beaker with two handles and no valve, rather than a bottle. This will help your baby learn to sip rather than suck, which is important for the development of muscles used for speech, and is better for their teeth
  • Cups and beakers with non-drip valves are not suitable
  • An open cup should fully replace a bottle by around one year of age.

Family Foods

It is a good idea to encourage your baby to try family foods from quite early on. If they see you eating these foods too they are more likely to copy you and want to eat them themselves! Healthy family meals can be adapted for your baby, but it is important not to add any salt or sugar when preparing them. To save time, you can also prepare food in batches and then freeze individual portions (e.g. in ice cube trays with lids) to be used later.

Eating together as a family and eating the same foods will help your baby adopt good habits and learn about mealtimes. Talking to your baby and smiling at these times will also help them develop social skills.

What about ready-made baby foods?

Ready-made baby foods are sometimes convenient, particularly if you are on the go, but the portion size may not be ideal for your baby's appetite. If you do buy ready-made foods, check the label and avoid buying ones that contain added sugars in the ingredients list (these can be labelled as honey, sucrose, glucose, maltose, fructose, hydrolysed starch or maize syrup). It is important to give your baby homemade food to introduce them to different textures and it's simple and cheaper too!

Baby-led weaning

You may have heard the phrase baby-led weaning. Some experts suggest that the focus should be on eating which is 'baby-led', where the infant is encouraged to feed themselves as much as possible and be involved in mealtimes.

Keeping your baby safe when weaning

Food safety

Remember to defrost frozen food, and do not refreeze. Food should be heated thoroughly until it is piping hot all the way through. Let it cool down and make sure you check the temperature before giving to your baby. Food should not be reheated more than once. Throw away any leftover food that isn't eaten.

Beware of choking hazards

Remember to cook vegetables first and avoid giving hard or unripened fruit and vegetables like raw apple and raw carrot. Small round foods like grapes and cherry tomatoes should be cut into smaller pieces rather than given whole. Foods with skin (e.g. sausages) or bones (e.g. fish) can also be a choking hazard. Care should be taken to remove any stones, pips, skin and bones before feeding these types of foods to your baby.

What to avoid when weaning

The following should be avoided when weaning:

Salt – babies under one year should have less than 1g (less than ¼ tsp) of salt per day as their kidneys cannot cope with very much salt. Foods prepared at home should have no salt added. While most baby foods do not contain added salt, other processed foods (e.g. crisps, gravy, soups) do, so it is important to check the label and avoid foods high in salt.
Sugar – frequently consuming sugar-containing foods and drinks can lead to tooth decay, especially in-between meals. Avoid adding sugar to foods, as well as giving foods and drinks with added sugars, such as biscuits, cakes and fruit squash to your baby.
Honey – honey should not be given to babies under one year because there is a risk it can contain bacteria that can cause a serious illness called infant botulism.
Shark, marlin and swordfish – these types of fish should not be given because the levels of mercury they sometimes contain can affect the developing nervous system.
Raw or undercooked eggs – eggs should be cooked until the white and yolk are both solid. Avoid any foods containing raw or partially cooked eggs.
Whole nuts - should not be given to children under 5 years of age because of the risk of choking. Current advice states that crushed or finely ground nuts and peanut or other nut butters can be given from 6 months of age providing there is no history of allergies (asthma, eczema, hayfever or other food allergy) in the child's immediate family (parents or siblings).
Raw shellfish – raw shellfish should not be given to infants as they are at an increased risk of food poisoning.

Foods to avoid before 6 months

If for any reason you are thinking of weaning your baby earlier than 6 months, speak to your health visitor or GP for advice. Babies should never be given any solid foods before they are 17 weeks (four months) old. This is because the digestive and immune systems of young babies have not developed sufficiently to cope with food other than breast or formula milk.

Allergy alert

If you do decide to introduce solid foods before 6 months, there are certain foods that need to be avoided (see table below).

As a baby's immune system takes time to develop, it is currently recommended that certain foods should never be introduced before 6 months of age, to reduce the risk of allergies developing. These include foods containing gluten/wheat, eggs, fish and shellfish, nuts, seeds, liver and cows' milk.

In addition, certain cheeses (e.g. soft or unpasteurised cheeses) may contain bacteria that the baby's immune system is not yet ready for. Hard cheeses are safe to introduce from 6 months.

foods to avoid

Special Groups

Weaning onto a vegetarian or vegan diet

With appropriate care, a varied vegetarian diet can provide all the nutrients your baby needs for growth and development. The principles of weaning are the same for vegetarian as non-vegetarian babies. However, a vegetarian weaning diet may provide less energy and iron (and more fibre) compared to a non-vegetarian weaning diet.

It is important that you give your baby other sources of the nutrients that would be provided by meat or fish, like protein, iron and B vitamins. You should give pulses (e.g. beans, lentils, chickpeas), and eggs or other meat alternatives such as tofu after 6 months. It is also a good idea to give fruit and vegetables alongside meat alternatives, as the vitamin C will help your baby to absorb more iron.

You should speak to your GP or health visitor for advice about weaning onto a vegan diet as it can be particularly difficult for young babies to obtain all the energy and nutrients they need. You should take care to plan your baby's diet carefully so that nutrients typically obtained from animal products, like iron and calcium, are included.

For babies being weaned onto a vegan diet, soya formula can be used from 6 months, both as a drink and to replace cows' milk in recipes such as rice pudding, or in soups. Calcium can also be obtained from green leafy vegetables like curly kale and watercress, from sesame seed paste (tahini) and smooth almond butter, from white and brown bread, and from fortified soya products like soya yogurts. For nutrients such as vitamin B12, supplements may be required. For example, it may be necessary to give B12 supplements if you are breastfeeding and weaning your baby onto a vegan diet. Check with your health professional.

What about food allergy?

There are some foods that may trigger food allergies and should never be given before 6 months. These include:

  • milk
  • egg
  • soya
  • wheat (and other cereals containing gluten e.g. rye, barley and oats)
  • nuts
  • seeds
  • fish and shellfish

Foods that have the potential to cause allergic reactions should be introduced gradually. Introduce these one at a time, and leave a gap of about three days in between each one to allow time to spot any reactions that may develop. Always wait until after the age of 6 months before introducing these foods and start with a very small amount.

Food allergies are more likely to develop if a close family member (parent or sibling) suffers from allergies, such as asthma, eczema, hay fever or food allergies. If this is the case it is a good idea to speak to your GP or health visitor before introducing your baby to these foods. If you suspect your baby does have a reaction to a food, consult your GP or health visitor.

What about peanut allergy?

 Current Government recommendations state that parents can give their baby foods containing peanuts from 6 months of age, but not before this time. Finely chopped/ground peanuts and peanut butter are ok to be introduced from 6 months of age in babies with no known allergies and no history of allergy in their immediate family. If you are concerned you can pay close attention to your baby for a few days after eating peanuts to spot any reaction. Note that chopped or whole nuts should not be given to children under 5 because of the risk of choking.

If your baby already has a known allergy (such as a diagnosed food allergy or diagnosed eczema), or if there is a history of allergy in your baby's immediate family (if their parents, brothers or sisters have an allergy such as asthma, eczema, hayfever or other types of allergy), then your baby has a higher risk of developing peanut allergy. In these cases you should talk to your GP, health visitor or medical allergy specialist before you give peanuts or foods containing peanuts to your baby for the first time.

Supplements

If you are still breastfeeding, it is recommended that you give your baby a supplement of vitamins A and D from the age of 6 months. Vitamin drops including vitamins A, C and D are available through the Healthy Start scheme for low income families. See http://www.healthystart.nhs.uk/ for further details or speak to your health visitor.

If you are giving your baby at least 500ml of infant formula per day, you do not need a vitamin supplement since these vitamins are already added to the formula. If your baby is having formula milk in smaller amounts, it is advisable to give them a supplement of vitamins A and D.

Babies being weaned onto a vegan diet may need additional supplements, including vitamin B12. Consult your health professional for more information.

First Foods, Complementary Feeding and Obesity

The British Nutrition Foundation is delighted to present a factsheet and videos summarising outcomes from its recent symposium, New Perspectives on First Foods, Complementary Feeding and Obesity, held on 28th April 2015 at Governors' Hall, St Thomas' Hospital, London. These are based on the expert presentations on the day that discussed the relationship between early years feeding and childhood obesity. Presentations focused on national and international research in this area, and looked at the role of public health, health professionals and parents in obesity prevention in infants. There is also a more detailed summary for health professionals in 10 key facts.



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