by Dr Louise Santhanam, General Practitioner
The WHO recommends exclusive breastfeeding for the first six months of a baby’s life1, followed by breastfeeding alongside the introduction of complementary solid food, continuing to two years of age and beyond if desired by mother and baby.
Around the age of six months, an infant’s need for energy and nutrients starts to exceed what is provided by breastmilk, and complementary foods are necessary to meet those needs1. Infants who are artificially fed are similarly advised to commence solid foods at around six months.
Signs of developmental readiness for solid foods are:
- The infant can stay in a sitting position and hold their head steadily
- The infant can co-ordinate their eyes, hands and mouth so they can look at the food, pick it up and put it in their mouth, independently
- The infant is able to swallow food, and will not push it out of their mouth with their tongue
The WHO also recommends1:
- Responsive feeding
- Feed infants directly and assist older children
- Feed slowly and patiently, encourage them to eat but do not force them
- Talk to the child and maintain eye contact
- Practise good hygiene and proper food handling.
- Start at six months with small amounts of food and increase gradually as the child gets older.
- Gradually increase food consistency and variety.
- Increase the number of times that the child is fed: 2–3 meals per day for infants 6–8 months of age and 3–4 meals per day for infants 9–23 months of age, with 1–2 additional snacks as required.
- Use fortified complementary foods or vitamin-mineral supplements as needed
- During illness, increase fluid intake including more breastfeeding, and offer soft, favourite foods.
Introducing Solid Foods
Start 4 Life: First Foods NHS information for parents on starting solids foods
Start 4 Life: Foods for Your Growing Baby NHS information to support an infant’s progress with solid foods. Also includes information about Vitamin Supplements.
First Steps Nutrition Trust: Eating Well- The First Year Information and practical advice on introducing solid foods to babies, with recipes and photos to show portion sizes.
First Steps Nutrition: Eating Well-Vegan Infants and Under 5s Information, recipes and portion sizes for families who choose to bring their child up on a vegan diet.
NHS Choices: Solid Foods Includes information on readiness for solid foods, how to start solid foods and information on infant milks after 6 months for babies who are not breastfed.
Start 4 Life: Foods to Avoid Important advice on the small number of inappropriate foods for infants and young children, and how to introduce foods known to be allergenic.
Drinks and Cups
NHS Choices: Drinks and Cups for Babies and Toddlers Includes information on appropriate cups and infant milks.
Importantly in ordinary circumstances:
- WHO and UNICEF recommend continued breastfeeding up to 2 years of age or beyond1
- Whole cows’ milk can be given as a drink after 12 months (but need not replace breastmilk)
- Whole goats’ and sheep’s milk are only suitable as a drink after 12 months
- If babies are formula fed, first infant formula (‘Stage 1’ formula) can be used throughout the first 12 months of life2
- There is no evidence to support the use of follow-on formula or toddler milks for healthy children2, 3
First Steps Nutrition: Eating Well-Vegan Infants and Under 5s Gives information on suitable drinks for under 5 year olds including advice on alternatives to dairy drinks from 6 months old (see especially p10-14).
- There are no infant formulas suitable for vegan infants currently for sale in the UK
- Rice milk should not be given to children under the age of 5 years, due the risk of very young children exceeding their tolerable daily intake of arsenic (present in rice milk in trace amounts)
Start 4 Life: Vitamins Your Baby Needs Scroll to the end of the page for information on vitamin supplements.
GPIFN: Vitamin D Supplementation Our webpage explaining the rationale and practicalities of vitamin D supplementation for infants.
Healthy Start UK-wide government scheme to improve the health of low-income pregnant women and families with young children on benefits and tax credits. Women who are pregnant or have a child under four years can apply for means-tested vouchers to spend with local retailers. The vouchers can be spent on: plain cow’s milk, plain fresh or frozen fruit and veg (with no added ingredients) and Stage 1 infant formula milk based on cow’s milk. The scheme also gives access to Healthy Start vitamins for pregnant women and children.
Healthy Start: Information for Professionals Applications for Healthy Start must, by law, be supported by a registered health professional– usually a midwife or health visitor. There should not be a charge applied for this.
A recent study demonstrated that infants following a baby-led approach to feeding that included advice on minimizing choking were not more likely to choke than infants following more traditional feeding practices4. However in this study both groups were given foods that posed a choking risk by parents. Management of choking is an important first aid skill.
Resuscitation Council UK: Paediatric Choking Poster Can be found under the Paediatric Basic Life Support Section
The following are useful resources supporting good dental care with links to infant feeding issues:
- WHO: Infant and Young Child Feeding Fact Sheet Updated Sept 2016
- First Steps Nutrition Trust: Infant Milks- A Simple Guide February 2017
- First Steps Nutrition Trust: Fortified Milks for Children June 2013
- Fangupo L, Heath A, Williams S, Erickson Williams L, Morison B, Fleming E et al. A Baby-Led Approach to Eating Solids and Risk of Choking. Pediatrics. 2016;138(4):e20160772-e20160772.