The first solid food for your baby.

Every infant and child has the right to good nutrition according to the “Convention on the Rights of the Child” – WHO

After exclusive breastfeeding for 6 months, it’s time to introduce solid foods to your little one. Complementary feeding as it is called, involves giving foods without stopping breast or formula feeding. It is a gradual process to wean the baby from breast or formula feed. WHO recommends frequent on-demand breastfeeding until 2 years of age or beyond. Before giving complementary foods, there are many things to consider. Some babies are ready for solid foods even by 4 months while some are ready by 6 months. Recent research has shown that early introduction of complementary foods even before 4 months poses a risk for babies being overweight during childhood (1) while late introduction of complementary foods poses a risk for nutrient deficiencies and allergies and can also result in babies being picky in eating foods during their childhood.

Do you know?

Few children receive nutritionally adequate and safe complementary foods; in many countries less than a fourth of infants 6–23 months of age meet the criteria of dietary diversity and feeding frequency that are appropriate for their age (WHO,2018).

Is your baby ready for solids?

Eating solid food is a major milestone in a baby’s life but there are few other milestones to check for before giving your baby the first complementary food. Your baby should be able to:

Hold his/her head straight.

Sit up with/without support.

Be able to open his/her mouth when he/she sees the food coming.

Be able to swallow the food. 

Your baby is ready for the new food. What next?

Introduction of complementary foods should be gradual. Few important things to consider while feeding solids are:

Type of food – A fortified baby cereal is the best to start with. This can be made at home or bought from store. There are variety of brands to choose from. If the cereal is prepared at home, traditional staple foods should be chosen and care should be taken to give vitamin-mineral supplement for the baby based on a consultation from the pediatrician. After the baby tolerates the cereal, other foods can be slowly introduced like another kind of cereal, pureed vegetables and fruits followed by snacks like baby fruits. Egg whites should be avoided till 12 months since it is known to cause allergies.

Home fortification of complementary foods with multiple micronutrient powders (MMP) is recommended in a study to reduce child anemia in resource-poor settings (2). 

The consistency of food – Initially, the consistency of food has to be a little bit watery and not completely solid or lumpy. It is good to mix the food with breast milk or formula (1 to 2 tablespoons of baby cereal with 30 to 60 ml of breast milk or formula) in a small bowl.  The consistency can be made thicker after a few days by adding more cereal. Hard boiled egg yolk is good for the baby at 9 months compared to egg whites. Feeding with a spoon helps the baby to eat on his/her own in the future.

Nutrient adequacy –In the first year, babies triple their birth weight. To achieve this, they need more nutrients. It is important to make sure that the baby’s food is nutrient dense. Some important nutrients to concentrate on include carbohydrates, protein, vitamin a, vitamin d, vitamin c, iron, calcium, zinc and omega 3. Energy density and protein quality (cereal-legume mix to improve protein quality) are also important things to concentrate in an infant’s food. These will be discussed in detail next week.

Recent research showed that complementary foods incorporating Moringa leaf powder either as part of a cereal–legume complementary food blend or when sprinkled as a food supplement on infant’s usual foods were well accepted (3).

Fortified complementary foods (FCF) and home fortificants – single-sachet micronutrient powders (MNP) or small-quantity lipid-based nutrient supplements to be added to a child’s food immediately before consumption – have been shown to be efficacious to improve the micronutrient status and some functional outcomes in children 6-23 months of age (4).

Frequency of feeding – WHO recommended complementary feeding is initially 2-3 times a day between 6-8 months, increasing to 3-4 times daily between 9-11 months and 12-24 months with additional nutritious snacks offered 1-2 times per day, as desired.

Food safety – Good hygiene and proper food handling should always be practiced when preparing complementary foods. Unsafe and unhygienic food will cause diarrhea and make the baby sick and malnourished. Washing hands before and after preparing baby food, scrubbing and washing the utensils in hot water and keeping it covered, cooking the baby food properly, covering the prepared food, discarding the left-over food and not storing prepared food for too long are some of the food safety measures to be followed.

Checking for allergies – Whenever a new food is introduced to the baby, it has to be tried for at least 4 to 5 days in a row to rule out food allergies. Foods have to be introduced one at a time to better understand which food is causing allergy.  Some allergic reactions to food include diarrhea, vomiting and rashes. If allergies occur, that particular food should be stopped and then another new food should be given after those 4 to 5 days. While earlier food allergy prevention strategies implemented avoidance of allergenic foods in infancy, the current paradigm is shifting from avoidance to controlled exposure (5).

Active and responsive feeding – A mother should actively feed her baby. She should talk with the baby while feeding and have a caring attitude and not rush the child to eat. If a baby does not like a food, the food can always be re-introduced in a different way. Playing before feeding stimulates baby’s appetite and development. Television, tablets, mobile phones or any kind of electronic devices while feeding should be avoided and baby should actually know and interested in what he /she is eating.

Feeding during illness – Increase fluid consumption during illness (breast milk/formula) and soft mashed foods.

The process of complementary feeding is a tedious task that requires lot of patience, love and care but the result is totally worth it. It is always tough at the beginning but remember you are creating a happy and healthy eater.

-Dr. Triveni Chandraprakasam

For further reading:

http://www.fao.org/3/am866e/am866e00.pdf

http://www.wcd.nic.in/sites/default/files/nationalguidelines.pdf

References:

1. https://www.ncbi.nlm.nih.gov/pubmed/29470690

2. https://www.fasebj.org/doi/abs/10.1096/fasebj.31.1_supplement.165.7

3. https://journals.sagepub.com/doi/full/10.1177/0379572117708656

4. https://www.karger.com/Article/Abstract/449210

5. https://www.karger.com/Article/Abstract/457928