Katie Angotti: Complementary feeding – introducing foods to babies

Introducing foods is an important step in a baby’s development. Although milk remains an infant’s main source of nutrients throughout the first year, the introduction of solids is needed to learn how to chew, swallow and develop all the skills needed to feed themselves proficiently. This period of introducing foods has also been shown to influence later eating habits that continue into adulthood (1).

 

Age of introduction

Signs of readiness

Important nutrients

Introducing allergens

 

Age of introduction

Both the World Health Organisation and Public Health England recommend that food is introduced around 6 months of age, following the observation of developmental signs of readiness (2,3). Research indicates that the introduction of solids before 17 weeks of age is not recommended, due the immaturity of the infant digestive system (4).

Waiting until around 6 months of age allows a baby to develop so that they are able to cope with solid foods, including being able to move food around their mouth more easily. By waiting until around 6 months of age, parents can introduce soft mashed foods and soft finger foods from the start, and may not need to use smooth, pureed foods at all. Some parents may choose to allow their baby to feed themselves from the start – called Baby Led Weaning.

 

Signs of readiness

As it is not possible to see when a baby’s gut is mature enough for food, parents need to be supported in looking for external developmental signs of readiness.

The main signs that a baby is ready for solid foods are (3):

  • They can stay in a sitting position and hold their heady steady. Some babies, including those who were born prematurely, may need extra support to sit.
  • They are able to co-ordinate their hands and mouth, so that they can see food, reach out for it and bring it to their mouth easily.
  • They are able to swallow more food than they spit out, due to physical changes in their oral anatomy and the ‘tongue-thrust’ reflex diminishing (5)

Babies experience many developmental changes in the first 6 months of life, which may be incorrectly interpreted as signs of readiness for weaning. These include:

  • Increased hunger for milk feeds
  • Waking in the night
  • Showing an interest in others around them eating food
  • Chewing fists

On their own, these are not signs that a baby is ready for solid foods, however they may appear alongside the developmental signs for readiness.

 

Important nutrients

From 6 months of age, it is recommended that babies are given a daily supplement containing vitamins A, C and D, unless they are having 500ml infant milk formula a day (6). Iron is an important nutrient for normal cognitive development (7). Babies are typically born with enough iron stores to last until around 6 months age, after which a source of iron needs to be provided by the diet (8). Thus, iron-rich foods should be introduced to babies from the start of weaning. Suitable iron-rich foods include red meat, beans, pulses and lentils, green leafy vegetables, fortified cereals, small amounts of wholewheat products.

Omega 3 fatty acids are important for visual and brain development, and can be introduced to babies through oily fish, rapeseed oil, chia and flax seeds, and omega 3-rich eggs (9).

 

Introducing allergens

Recommendations have changed over the years around when to introduce the main allergenic foods, creating confusion amongst parents and professional alike. The main allergens of concern are:

  • Cows’ milks
  • Eggs
  • Soya
  • Foods that contain gluten (including wheat, barley and rye)
  • Sesame and other seeds
  • Fish
  • Shellfish
  • Nuts and peanuts

 

Current UK guidelines advise introducing these foods from 6 months of age, one at a time, in small amounts (10). Once these foods have been safely introduced into the diet, it is important that they are offered regularly to maintain tolerance. Evidence suggests that delaying the introduction of eggs and peanuts beyond 6-12 months could actually increase the risk of developing an allergy to these foods (11).

For babies who already have a diagnosed food allergy or eczema, or have a close family history of allergies, it is advised to work with health care professionals before introducing foods. Some studies suggest that babies with a high risk of developing food allergies may benefit from earlier introduction of foods, but a recent report from the Scientific Advisory Committee on Nutrition concluded that this evidence is not strong enough to recommend widely (11).

 

About the Author: Katie Angotti is a Registered Public Health Nutritionist, specialising in maternal, infant and child health. Katie has worked with children and families in the NHS, in the baby food industry and now works in private practice with pregnant women and parents.

 

References

  1. Nicklaus, S. et al. A Prospective Study of Food Preferences in Childhood. Food Quality and Preference 2004;15: 805-818.
  2. World Health Organisation. 2021. Complementary Feeding [online] accessed at: https://www.who.int/health-topics/complementary-feeding#tab=tab_1
  3. Public Health England. 2021. Weaning. [online] Accessed at: https://www.nhs.uk/start4life/weaning/
  4. ESPGHAN Committee on Nutrition. Complementary feeding: a commentary by the ESPGHAN committee on nutrition. J Pers Soc Psychol 2008; 46: 99-110.
  5. Naylor AJ, ed. and Morrow A, co-ed. 2001. Developmental Readiness of Normal Full Term Infants to Progress from Exclusive Breastfeeding to the Introduction of Complementary Foods: Reviews of the Relevant Literature Concerning Infant Immunologic, Gastrointestinal, Oral Motor and Maternal Reproductive and Lactational Development. Wellstart International and the LINKAGES Project/Academy for Educational Development, Washington, D.C.
  6. Public Health England (2021). Baby Vitamins. [online] Accessed at: https://www.nhs.uk/start4life/baby/baby-vitamins/
  1. Scientific Advisory Committee on Nutrition. Iron and Health Prevention. London; 2010.
  2. Iron needs of babies and children. Paediatr Child Health. 2007;12(4):333-336.
  3. Ruxton, C., Calder, P., Reed, S., & Simpson, M. (2005). The impact of long-chain n-3 polyunsaturated fatty acids on human health. Nutrition Research Reviews, 18(1), 113-129
  4. Public Health England. 2021. Safe Weaning [online] Accesssed at: https://www.nhs.uk/start4life/weaning/safe-weaning/food-allergies/#anchor-tabs
  5. Scientific Advisory Committee on Nutrition. Feeding In The First Year Of Life. London; 2018.
Katie Angotti: Complementary feeding – introducing foods to babies

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