milk or infant formula is the primary source of nutrition in the first 6 months
of a baby’s life. During the second 6 months (6-12 months) of life, other foods
and beverages are required for nutritional and developmental reasons. It is generally agreed that solids should be
introduced no earlier than 4 months and no later than 6 months. However, it is
important to use the infant’s signs of readiness to introducing solids.3,4
Each baby will develop at their own pace, and demonstrate readiness for solids
at different ages. The baby’s gastro-intestinal tract and kidneys need to be
mature enough to process complementary foods, including solids and new liquids.
The baby needs to have lost the extrusion reflex (infants reject food placed on
the tip of the tongue) and developed the ability to chew using their gums.
Beyond 6 months, breast milk is no longer
adequate to meet baby’s nutritional needs for energy, protein, fat and micronutrients.
At this stage, most infants are ready to transition from milk feeds (breast
milk or infant formula) to family foods.
Adequate fat, protein, iron and zinc, provided by good quality
complementary foods, are essential during the second 6 months of life, when
energy requirements are high and growth is rapid.
Iron rich foods are an essential part of a
baby’s diet. From 6 months, baby’s stores of iron are depleted, so food sources
must be introduced to meet the baby’s nutrient needs. For the breastfed baby, more than 90% of iron
requirements need to be provided by solids during the second 6 months of
life. For the formula fed baby, iron
fortified infant formulas are available.
Iron fortified infant cereals are recommended; the absorption of the
iron will be enhanced if a vitamin C source, such orange or tomato, accompanies
the meal. Foods that are naturally high
in iron, especially beef and lamb, are also naturally high in zinc. Zinc is
another important mineral that is vital during this rapid growth phase.
Cow’s milk is not recommended as a drink until
after 24 months of age. Cow’s milk is unsuitable for a number of
reasons including the type and amount of protein, the amount of carbohydrate,
the type of fat, as well as the ability of the infant to absorb the vitamins
and minerals present. Full fat cow’s
milk can be used in cooking, however reduced fat or skim cow’s milk is not
recommended at all as it is too low in energy.
Recent research shows that delaying the
introduction of solid foods until after 6 months can increase the incidence of
allergy to foods.7 To reduce the incidence of food allergy or
intolerance it may be preferable for baby to commence solids between 4 and 6
months, if the infant is ready. If
possible, simultaneously breastfeeding and introducing new foods may help to
prevent the development of food allergies. It has not been shown
that avoidance of allergenic foods in the mother’s diet prevents allergies in
the infant. Eggs, peanuts, tree nuts,
cow’s milk, wheat, fish and seafood are potentially allergenic foods, but are
also rich sources of nutrition for both mother and infant. There is insufficient evidence to suggest
delaying or avoiding these foods will reduce or prevent food allergies even in
those with a family history of food allergy.7
When baby is ready for solids, commence with
very small amounts (1 teaspoonful) and increase the quantity of the new food
gradually. Only give one new food at a
time and wait 2 to 3 days before commencing the next new food, to check for
food allergy or intolerance. Soymilk and goat’s milk are not recommended for
allergy prevention; infants may be prescribed a hypoallergenic milk to manage
their allergies.7 Discuss appropriate options with an accredited
practising dietitian (APD), or your GP.
If your child exhibits any signs of a
food reaction you should seek medical advice and avoid that food until you have
consulted a medical practitioner with expertise in food allergy.
Gluten is a protein that is found in wheat,
rye, barley, and triticale. Coeliac
disease is an autoimmune disease that is influenced by the consumption of
gluten. Research shows that the risk of
coeliac disease may be reduced if small quantities of gluten are gradually
introduced while the infant continues to be breastfed.6 In
genetically predisposed infants, the introduction of gluten between 4 and 7
months may reduce the risk of developing active Coeliac disease, as well as
Type I Diabetes; as these 2 autoimmune disease states may occur together.6
If an infant is given a vegetarian diet it is
important that sufficient high energy and high protein foods are given. Sufficient milk (approximately 500mL per day)
and full fat dairy products as well as legumes and pulses are recommended. Vegan diets are discouraged in infancy,
particularly due to the real risk of vitamin B12 deficiency, which adversely
affects brain and nerve development.4 Seek advice from an accredited
practising dietitian (APD), to ensure your baby achieves adequate nutrition for
growth and development.
Salt And Sugar
Salt is not recommended for baby’s foods,
including home meals and snacks as well as processed foods, as their tiny
kidneys cannot cope with the processing of this sodium. Higher sodium intake even in the early years
is associated with higher blood pressure in later life.5 An infant
can also become accustomed to salty foods, which may affect future taste
preferences and lead to health problems.
Sugar plays a role in the development of dental caries. Infants
naturally prefer sweet foods / liquids, so it is important to start good dental
hygiene practices early, even before the first tooth erupts.
Whilst older children instinctively prefer high
energy foods with sweet and salty tastes; and reject new foods, these
predispositions may be modified during infancy when baby is receptive to the
introduction of a wide variety of foods and tastes. Make the most of this opportunity!
Parents and carers of infants play a crucial
role in establishing good dietary habits that will impact the health and
development of the child in the short and long term. This is a great time for the whole household
to ensure that they are practicing healthy eating habits for the benefit of all.
1. WHO: The Optimal Duration of Exclusive Breastfeeding.
Report of an Expert Consultation. Geneva, WHO, 2001.
2. Fewtrell MS, Morgan JB, Duggan C, Gunnlaugsson G, Hibberd
P, Lucas A, and Kleinman RE 2007: Optimal duration of exclusive breastfeeding:
what is the evidence to support current recommendations? American Journal of
Clinical Nutrition; 85S:635-8.
3. Weaning infants onto solid foods. Paediatric Group of the
Dietetic Association Position Paper. 4. Koletzko B 2008. Pediatric Nutrition in
Practice. Karger, Switzerland.
5. Geleijnse JM, Hofman A, Witteman JC et al, 1997. Long
term effects of neonatal sodium restriction on blood pressure. Hypertension:
6. Norris JM, Barriga K, Hofenberg EJ et al, 2005. Risk of
coeliac disease autoimmunity and timing of gluten introduction in the diet of infants
at increased risk of disease. JAMA;293:2343-51.
7. ASCIA infant feeding advice www.allergy.org.au