It's vital to pay attention to your baby’s nutrition in the first year of life.
Breastmilk is the best source of infant nutrition. It's recommended that mothers exclusively breastfeed their babies for the first six months of life. Then, from the baby's six months of age to at least 12 months, breastfeeding should continue with the gradual addition of complementary foods to the baby’s diet.
Following this feeding pattern ensures that babies do not develop any nutrient deficiencies. In addition, this feeding pattern is associated with a lower risk of an infant developing obesity and cardiovascular risk factors, such as high blood pressure and insulin resistance, in later life.
Breastfeeding vs infant formulas: what you need to know
Human breastmilk contains over 300 components and has numerous health benefits for infants. It is the gold standard for infant feeding as it provides all the energy and nutrients that an infant needs in the first six months, as well as growth factors and immunological components that help protect the baby from infections.
Fun fact: As the baby grows older, the mother’s breast is able to dynamically change the nutritional composition of her milk in order to meet the changing nutrient needs of her developing infant.
The infant formulas present in the market aim to mimic breastmilk as closely as possible. However, they are currently still unable to replicate breast milk identically and are missing some very beneficial components.
Breastmilk is also better tolerated by the baby’s sensitive digestive system, leading to fewer episodes of diarrhoea and smelly stools. Mothers should be made aware of this and encouraged to exclusively breastfeed if they are physically able to do so. If they are unable to, then infant formula should be given as a second choice.
The ingredients and nutritional composition of infant formulas are strictly regulated. These regulations aim to ensure that infant formulas contain the recommended amounts of vitamins and minerals for infant growth. In general, the nutrient content of different brands of infant formula is very similar.
However, they may differ in the source of protein used (cow’s milk, soya protein, hydrolyzed protein) or the addition of some novel ingredients. Soya-based formulas should only be given after seeking advice from a dietitian or doctor, and should not be given to babies under six months of age. Goat’s milk-based formula is not recommended under 12 months of age.
What supplements does your baby need?
Babies need to be fed two main supplements in the first year of life:
Vitamin D: The American Academy of Pediatrics (AAP) now recommends that exclusively breastfed babies should be given Vitamin D drops (400 IU) in the first few days of life until the baby is weaned. This is because only small amounts of vitamin D are transferred in breast milk. Infants receiving 500ml or more of infant formula per day do not need vitamin D drops since infant formulas are vitamin-D fortified. However, partially breastfed babies who receive less than 500 ml of infant formula also need to take vitamin D drops.
Iron: Infants are born with a store of iron in their bodies that lasts them about four to six months. The American Academy of Pediatrics recommends an iron supplement starting at four months for infants who are exclusively or mostly breastfed. Talk to your doctor about how long to continue an iron supplement after your baby is introduced to iron-rich solid foods. Infant formulas are iron-fortified, so infant formula-fed babies rarely need an iron supplement.
How do you introduce solid foods in your baby's diet?
Weaning is the introduction of complementary foods, or ‘solid’ foods, into the baby’s diet, in addition to breast milk or infant formula.
It isn't recommended to introduce any complementary foods before four months of age as this increases the baby’s risk of choking, getting food poisoning and developing food allergies. This gradual process should start at around six months of age and continues into the baby’s first year. Weaning becomes important at around six months of age because the baby’s energy needs and the needs of some nutrients (vitamin A, vitamin D, zinc and iron) can't be met with just breastmilk. Delaying weaning can lead to growth retardation and later feeding problems.
The first stage of weaning is a sensitive time for the development of taste. It is recommended to introduce a wide variety of different foods at this stage as it helps prevent your child from becoming a fussy eater later on.
Solid foods should start to gradually replace milk feeds as weaning progresses, but babies should still be given breast milk or infant formula (at least 500-600ml formula per day) as the main drink up to 12 months of age. Breastfeeding can continue beyond 12 months, for as long as mother wishes to continue.
Here's how first solids can be introduced after 6 months:
1) Start with pureed food, then gradually change food textures. Over time, move from smooth purees to mashed and lumpier foods.
2) Focus on introducing iron-rich foods. These include iron-fortified baby cereal, meat, poultry, fish, avocado, baked potato, broccoli, chickpeas, eggs, prunes, soybeans and spinach. Babies who do not eat enough iron-rich foods may need an iron supplement.
3) Introduce only a few teaspoons once a day, when the baby is not overly tired or hungry. The amount and frequency should be gradually increased. Introduce the new food once a day, to twice and eventually three times a day.
4) Watch out for allergies. Common allergenic foods include cow’s milk, egg, soya, wheat (and other cereals containing gluten e.g. rye, barley and oats), nuts, seeds, fish and shellfish. After introducing a common allergenic food, observe your baby to see if he or she gets an allergic reaction. Wait three days before introducing another common allergenic food to your child.
5) Be patient. Go with the baby’s own pace and do not force feed. Allow plenty of time for feeding.
6) Support self-feeding skills by allowing your baby to play with food and try to feed themselves with their hands (finger foods) or a spoon. Finger foods include cooked vegetables (e.g., sticks of carrot, pieces of broccoli), pieces of fruit (e.g., banana, slices of peeled apple), pieces of toast or roti.
7) Introduce your baby to meals prepared for the rest of the family at the table. These meals can be adapted for babies by not adding any salt or sugar when preparing the baby’s portion.
8) Ensure that fruit and vegetables are given along with meats or legumes at meal time. The vitamin C in fruits and vegetables can help enhance iron absorption from the meats or legumes.
By 9-12 months, babies should be fed three meals a day, in addition to healthy snacks. Foods should be chopped, mashed or minced. A balanced and varied diet for a baby ensures that they obtain all the vitamins and minerals they need. Include the following foods in your baby’s diet everyday:
1) Starchy foods, such as bread, rice, pasta or potatoes.
2) Fruit and vegetables – these can now be given raw, as finger foods, or cooked and given with meals.
3) Whole, full-fat milk, yogurt or cheese. Limit cow’s milk to no more than 2-3 cups per day.
4) Soft cooked meat, fish, well-cooked eggs and pulses (e.g., beans and lentils).
5) Red meat, such as beef or lamb, as it is an excellent source of iron. Pulses, such as beans and lentils, also provide iron but these are less well absorbed.
What foods should you avoid feeding your baby?
The following are foods that should not be in your baby's solid diet in the first 12 months:
1) Salt: Avoid adding salt to foods prepared at home and don't give your child salty foods. Infants under 12 months should not have more than 1g of salt per day as it's hard on their kidneys. Commercial baby foods don't contain any salt.
2) Refined sugar: Avoid giving your infant any sweetened drinks, fruit juice, desserts or sugary biscuits. These can lead to tooth decay.
3) Processed deli meats like sausages and salami: They contain nitrates that can be harmful for your baby.
4) Certain types of fish: It is advised to avoid smoked and raw fish due to a lack of thorough cooking, which can cause food poisoning. An infant’s developing nervous system can be harmed by mercury intake, so avoid feeding your infant large game fish (e.g., fresh and frozen tuna, canned white tuna, shark, swordfish, marlin, and trout).
5) Honey: Honey should not be given to babies under 12 months due to the high risk of infant botulism, which is a serious bacterial illness.
6) Low-fat dairy products
7) Raw eggs: Infants should not be given runny eggs or products containing partially-cooked eggs. Ensure the eggs are cooked until the white and yolk are completely solid.
8) Small foods that can cause choking: These include whole nuts, popcorn, grapes, large berries, peanut butter, marshmallows, ice cubes and hot dogs in chunks.
All illustrations by Munnazzah Raza