The WHO and the main pediatric scientific societies recommend exclusive breastfeeding for the first six months of life. From that moment on, babies begin to need other nutrients and must supplement the milk with different foods. It is what we know as complementary feeding .
The recommendations on this subject have been changing a lot and it is a subject that generates many doubts for parents. Below we answer the most frequent questions that arise in the consultation about the introduction of solid foods in babies.
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1.When do I start?
To start eating other foods, the baby needs, on the one hand, that his intestine, his kidneys and his immune system are prepared . On the other hand, he needs to be ready on a neurological level as well (be able to stay seated, show interest in food, have the extrusion reflex disappear…). This usually happens around 4-6 months in most babies.
As we have mentioned, the current recommendation is to maintain exclusive breastfeeding for up to six months . It has been proven that maintaining exclusive breastfeeding until that age offers certain advantages over introducing other foods at four months, and no significant differences have been seen in terms of growth or nutritional deficiencies.
In babies who take artificial formula, the time to start complementary feeding is not so well established, although the same guidelines are usually followed as for breastfed babies. Check out more interesting article on out parenting site.
For premature babies there is no consensus either and it is important to individualize each case, taking into account the psychomotor development of each child; starting around six months corrected age could be an option.
2. With what food first?
There is currently no evidence that starting with one or the other food is better. Each family will choose those that best suit their needs. But we must prioritize foods rich in iron and zinc , as they are very necessary nutrients at these ages.
Except for the exceptions that we will comment on below, we can offer practically any food from six months of age. It is recommended to introduce the foods separated from each other 2 or 3 days , to check that the infant tolerates them well.
3. Crushed or solids?
This decision must be made by each family after receiving information about both methods. Complementary feeding with mashed foods (purées and porridges) is well known. In recent years, the method called Baby-Led-Weaning (BLW) is gaining popularity and the Spanish Association of Pediatrics considers it a valid alternative, as long as correct prior information is received, as published in its latest 2018 guide . In BLW, different foods are offered to the baby (most of them are usually solid) and he decides what, how and how much he eats.
In the event that we decide to feed with crushed foods, it is important to note that between 8 and 9 months we should begin to offer less crushed foods (for example crushed or more lumpy) and gradually increase the texture. The delay in the introduction of the coarser textures has been related to problems in the transition to solids and with lower consumption of vegetables and fruits.
4. How much should they eat?
Like breastfeeding and artificial formula , complementary feeding should be offered on demand and respecting the babies’ signals of hunger and satiety. Babies have the innate ability to regulate their intake . At first it is common for them to just take a few spoonfuls or suck on a few pieces; They will progressively take more. Let us remember that milk continues to be the main food throughout the first year of life .
Only qualify that, although our children eat on demand, we must be careful with the amount of protein they eat per day . Thus, between 6 and 12 months of age, 20-30 grams of meat per day or 30-40 grams of fish per day or a small egg (size S) is usually sufficient .
5. You do not want to eat certain foods, do I insist?
Babies also have their tastes and it is common for them to initially reject certain foods. There are studies that indicate that, in some cases, it may be necessary to try a food up to 15 times before we like it . Breastfed babies seem to have better acceptance of new flavors, because different flavors are transmitted through breast milk.
So, if you don’t like something, we can continue to offer it to you, but always without forcing it. Eating with screens or rewarding or punishing with food should never be an option for them to eat better .
6. Can I add salt to food?
Before the year of life it is recommended to avoid salt , because the kidneys of babies are still immature. The WHO recommends that infants consume less than 1 gram of salt per day for the first 12 months of life. Between the year and the years, they should not exceed 2 grams of salt per day.
7. When can they take sugar?
Most scientific societies recommend avoiding free and added sugars in children under two years of age . We must be especially careful with cereal porridges that contain honey or added sugars or with those that, despite being without added sugars, have a high content of free sugars as a result of their dextrination process.
The WHO recommends avoiding sugary drinks and desserts as well as juices or smoothies . The consumption of sugars in children over two years of age should not exceed 5% of the total caloric intake (around 15 g for young children).
Honey should be avoided for at least the first year of life due to the risk of botulism .
8. Should some foods be delayed due to the risk of allergies?
Although years ago we recommended delaying allergenic foods until 9 or 12 months (fish, eggs, fruits with hair, legumes); With the current evidence, it is not recommended to delay any food for this reason , since it has been seen that the appearance of allergy is not avoided by offering these foods later, and it could even be the other way around. It is recommended, however, to introduce new foods 2-3 days apart from each other.
9. Can you have any fruit and vegetables?
From the age of six months, babies can eat any fruit, ideally eating seasonal foods. As for vegetables, the Spanish Association for Food Safety and Nutrition (AESAN) recommends avoiding those with broad green leaves (chard, spinach, borage) due to the risk of metahemoblobinemia (a blood disease). Between one year and 3 years of age, children can eat small amounts of Swiss chard or spinach (maximum 45g/day). Borage should not be offered before 3 years of age.
10. Can you eat any fish?
From the age of six months, babies can eat both white and blue fish. They should only avoid the very large ones: bluefin tuna, pike, shark (also called dogfish or mako shark) and emperor or swordfish . These fish are large predators and accumulate a lot of mercury, which can influence the brain development of the little ones. Therefore, its consumption is not recommended for children under 10 years of age , pregnant or lactating mothers. Children between 10 and 14 years old should not consume more than 120 grams of these sins per month.
11. How do I introduce the egg?
Traditionally, the introduction of the egg was delayed because it is an allergenic food . With current knowledge, it can be introduced from six months. Nor does it seem necessary to introduce the white first and then the yolk as was done in the past.
It is important to start offering small amounts and gradually increase it and offer it well cooked . We can add a little hard-boiled egg to the puree in the case of children fed with mashed potatoes or offer it as a well-curdled omelette or as part of batters or pancakes, for example, in the case of babies who do Baby-Led-Weaning .
12. How much milk do they need to drink when we start complementary feeding?
As we have previously explained, foods other than milk are complementary, and milk continues to be essential and must continue to be offered on demand .
If breastfeeding is maintained and the baby feeds 4-5 times a day , no other dairy products are needed. In the case of formula-fed babies, it is recommended that they drink at least 500 ml a day.
13. When can you have yogurt?
Before one year of life, babies should not drink cow’s milk as their main drink . However, after nine or ten months they can drink small amounts of cow’s milk or derivatives , including yogurt here.
There are also yogurts on the market made with follow-on formula and therefore labeled “suitable from six months”. However, let us remember that the reason for starting complementary feeding at six months is that milk is beginning to be insufficient to provide all the nutrients they need, and they must complement it with other foods. These “first -yogurts” suitable from six months would not provide any additional nutrients to breast milk or formula.
14. Are growth formulas necessary?
No. From the age of 12 months, children can drink cow’s milk . However, let us remember that the WHO recommends maintaining breastfeeding for up to 2 years or more , as long as the mother and baby so wish.
Healthy children who eat a varied diet do not need any other supplements or special diets to get all the nutrients they need.
15. When are cereals introduced?
Cereals can be offered from six months. Unfortunately, we do not know the best time to introduce gluten in order to avoid celiac disease, and the recommendations have changed over the years as different scientific studies have been carried out.
Currently, the European Society of Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommends introducing gluten between 4 and 12 months , and, although we do not know how much babies should take, it recommends avoiding large amounts at the beginning .
The way of offering cereals does not necessarily have to be in the form of porridge; most porridges on the market have high amounts of sugar. And, of course, the breastfeeding mother does not have to express milk to make a porridge. Bread, pasta, rice, oatmeal… they are also cereals.
16. How do I know if I have a food allergy?
This is one of the most frequent doubts when we talk about food allergies with parents. The foods that most often cause allergic reactions in our environment are milk and eggs , followed by fish , nuts and some fruits.
In the case of IgE-mediated food allergies, spots on the skin usually appear within minutes (less than 2 hours) of having eaten the food in question. In the most severe cases, respiratory symptoms (difficulty breathing, wheezing) and/or digestive symptoms (nausea, vomiting, abdominal pain) may also appear.
In the case of allergies not mediated by IgE (commonly called intolerances ), the predominant symptoms are digestive, they are usually more subtle symptoms and appear hours after the food is eaten.
17. He barely drinks water, am I worried?
When our babies start complementary feeding, it is time to offer them water . However, we must bear in mind that they continue to drink a significant amount of milk (and that many foods, such as purees or fruit, have a high water content).
For this reason, it is usual that at first they hardly want to drink water (and even less so those who breastfeed on demand; for them, breast milk continues to be their main source of hydration). Even so, we will continue to offer, but never oblige .