Feeding Baby in the First Year

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A baby’s nutrition in the first year has life-long effects.  Inadequate nutrition is responsible for more than 35% of child-deaths, and higher rates of illness and developmental delays (World Health Organization, 2009).  Even in affluent North America babies and children are malnourished, often due to misinformation and poor food choices.

Health Canada (2012):  Breastfeeding – exclusively for the first six months, and sustained for two years or longer with appropriate complementary feeding – is important for the nutrition, immunologic protection, growth, and development of infants and toddlers.  Several international health organizations such as UNICEF, WHO, and the American Academy of Pediatrics make the same recommendation. 

Birth to 6 months
Babies should be exclusively breastfed until at least 6 months of age. There are no nutritional benefits to early complimentary feeding, only risks.  Babies who are only partially breastfed (i.e. supplemented with formula or other liquids or solids) in the first 6 months are healthier than those who are not breastfed at all, but risks are significantly higher than in exclusively breastfed babies.

If you think your baby is ready for solids before 6 months then please see section below regarding signs.

Benefits of breastfeeding, i.e. why formula should be used only as medicine
Human breastmilk is uniquely designed for human babies and contains all the required nutrients.   It’s the only thing an infant’s gut is designed to digest and assimilate until at least 6 months of age.  Breastmilk contains substances that augment the immature immune system, and aid in digestion and absorption of nutrients.  Anything else is likely to ferment, lead to gas, colic, poor nutrient absorption (malnourishment), illness and food-allergies.

Babies who are breastfed:

  • Decreased risk of SIDS, less likely to die of other causes in first months
  • Lower rates and severity of diarrhea and pneumonia
  • Lower rates and severity of ear-aches, flu, meningitis, bladder infections, respiratory illness, and other acute infections
  • Decreased risk of childhood leukemia
  • Decreased risk of long term chronic illness such as asthma, diabetes, gastro-intestinal disease (celiac, ulcerative colitis, Crohn’s), cardiovascular disease, obesity
  • Higher cognitive function / greater intelligence

Benefits of breastfeeding to mother include decreased risk of post-partum hemorrhage, breast and ovarian cancers, late-onset diabetes, and heart disease; faster loss of weight gained in pregnancy, and delayed return of fertility (although this is not necessarily a birth-control method).

6 to 12 months
Baby’s weight / size has nothing to do with readiness for solids.  At 6 months a baby’s digestive & immune systems have developed enough to introduce solids.  Earlier is correlated with allergies, digestive problems, immune problems, and obesity.  After 6-8 months caloric and nutrient needs exceed those provided by exclusive breastfeeding.  Further delay of complementary foods may stunt growth.  Start with breastmilk then finish with solids from 6-12 months.  Do encourage – but do not force nor coerce – the baby to eat.

STEP-1:  6 months, or whenever baby shows interest in food (whichever is later)
Offer breast-milk first then finish the meal with solids.  Introduce 1 food at a time for a few days, in small amounts, and then try another.  This helps the caregiver be aware of allergies or intolerances.  Simple, natural, pureed, unprocessed, organic – whole foods, like they came from earth.  There’s no need to buy special baby food – healthy family food, properly prepared, is just fine.

  • 200 kcal/day (in addition to about 400 kcal breastmilk) of mushy or runny foods
  • Offer 30-45 ml (2-3 tbsp) food per feed, at 2-3 meals daily
  • Pureed, raw or lightly cooked, non-citrus fruits e.g. apples, pears, bananas, blueberries
  • Cooked & pureed veggies – start with avocados, roots (carrots, yams, beets) and squashes
  • Cooked whole gluten-free grains (rice, quinoa) or oatmeal
  • Egg -yolks (yolks are usually not an allergen; whites may be)

STEP-2:  7-8 months, or 1 month after beginning step-1 (which-ever is later)
Continue with step-1.  Increase portions gradually up to 125-250 ml (1/2-1 cup) per meal and the following:

  • As child grows used to solids can also offer 1-2 snacks daily
  • Organic meats, pureed
  • Other cooked, pureed veggies
  • Can start combining foods that are tolerated

STEP-3:  8-10 months, or 1 month after beginning step-2 (which-ever is later)
Continue with step-2 and add:

  • 300 kcal/day (in addition to about 400 kcal breastmilk) of mashed food or finely chopped that baby can pick up
  • Offer 125-250 ml (1/2-1 cup) per feed at 3-4 meals daily, and 1-2 snacks if needed
  • Whole eggs
  • More variety

12 months and beyond … or 2 months after beginning step-3 (whichever is later)

  • See general recommendations below
  • Baby can eat regular family foods but watch for allergy or sensitivity
  • 550 kcal daily (in addition to about 350 kcal breastmilk)
  • 175-250 ml (3/4-1 cup) per meal for 3-4 meals daily and 1-2 snacks
  • Continue to breastfeed until 2 years of age

Signs that baby’s ready to start complimentary feeding
Solids can be introduced when baby shows signs of being ready, but only after 6 months of age.  Some babies take longer than 6 months but most are ready for solids by 8 months.

  • 6 to 8 months of age
  • Can sit unsupported
  • Doesn’t automatically push solids out of mouth with tongue (a reflex present until at least 6m in most babies)
  • Willing and able to chew
  • Can pinch or pick up food or other objects between thumb and forefinger
  • Eager to participate in mealtime
  • Shows interest in food – e.g. reaches for food at mealtime, crawls to dog’s dish to steal food
  • Long-term increased need to nurse, unrelated to illness, teething pain, stress or growth spurt
    Note: this is only an indication if other signs are present; not a sign on its own

If baby shows signs before 6 months

Eagerness to engage in mealtimes doesn’t mean ready for solids.  It’s likely a social behaviour rather than a physiological one.  Baby can be included in family mealtimes without eating solid foods.

  • Join the family at mealtime in a lap, booster seat or high chair
  • Give a sippy-cup containing some expressed milk (if baby is more interested in playing with the cup than drinking the contents, you may wish to use water instead of valuable pumped milk)
  • Provide baby-safe cutlery and dishes to play with
  • Give baby an ice cube (baby-safe size & shape) or ice chips to play with
  • Offer a cube, popsicle or slushy frozen breastmilk to eat with a spoon

Food intolerance or sensitivity, allergy
Common allergens include soy, wheat, dairy, peanuts, egg-whites, food colouring, corn, citrus, strawberries, raspberries, kiwis, pork and shellfish.

The following correlate with food intolerance or allergy:  mucous conditions, ear infections, runny nose, rashes (including diaper rash), colic, green stools, digestive issues (diarrhea, constipation, gas, vomiting), undigested food in diaper, asthma, wheezing, and /or behavioural changes after eating given food.

Safety precautions

  • Proper food storage and handling
  • Foods that are choking hazards; can block or wedge into wind-pipe
    • Hard and small sized, smooth / sticky solids g. popcorn, meat chunks meat, hard pieces of fruit / veggies, candies, hot dogs (unless cut lengthwise and cubed), gum, whole nuts and seeds, fruit-pits or seeds, cough drops, raisins, fish-bones, food on toothpicks or skewers.
    • Thick creamy texture e.g. a blob of nut-butter
  • Always supervise infants when they eat or drink
  • Mealtime supervisor should be familiar with baby’s chewing and swallowing abilities
  • Upright and secured position
  • Do not allow baby to eat while laying, running, walking, distracted, nor eat in the car
  • Avoid sharp objects
  • Take an infant / child choking & CPR class to be prepared in case of choking

General Recommendations

  • Organic, whole foods i.e. how they come from nature e.g. baked potato rather than French-fries
  • Purified water, if water is used
  • If juice is used, then fresh & home-made
  • Baby stomach is about the size of her/his fist – portion accordingly, considering breastmilk
  • Take time for eating patiently – meal time should be enjoyable
  • Feed infants directly and assist older children when they feed themselves
  • Feed slowly and patiently, and encourage children to eat, but do not force them
  • Variety of foods
  • Iron fortified food or easily digestible supplement (e.g. Floradix) in case of immediate cord clamping or anemia
  • Whole spectrum salt – Himalayan, Celtic
  • The Kidco Food Mill is a brilliant device for creating baby food on the fly. It’s affordable, simple to use and easy to clean.
  • Ice-cube trays make perfect infant-sized meals – nice to have on hand for child-care or those busy days that run away from us. Puree a few foods and freeze for later use.  Best for 1-3 months in fridge-freezer, and 6 months in chest-freezer.

Avoid

  • Foods that are choking hazards; can block or wedge into wind-pipe (see “Safety”)
  • Common allergens (see intolerance section), foods with family history or allergies, or that baby reacted to in mother’s breastmilk
  • Processed foods – fried, unhealthy fats, high-sugar e.g. chips, crackers, French-fries
  • Chemical additives
    • Fluoridated water, artificial colours & flavours, MSG, aspartame & derivatives
  • Unpasteurized honey, as it may contain spores that can be life-threatening to baby (after 1 year these have no effect on a mature digestive system)
  • Sugary drinks – pop, store-bought fruit-juices
  • Caffeine – coffee, tea, chocolate
  • Under-feeding – babies let us know when they’re hungry (crying, fussing, listless); avoid portion-control as needs change e.g. growth-spurt, immune system fighting a bug
  • Rushing through eating
  • Avoid distractions
  • Strong tastes – spicy, salty, overly sweet
  • No store-bought goat/cow milk until 8-10m of age, and only if child has no sensitivities (but it’s best to avoid non-human milk at all stages of life)

Special Circumstances
In the rare case that a mother is not able to breastfeed her baby, the following options can be considered.  They’re listed in order of healthiest to least.

  1. Pumped mother’s milk, if inability to breastfeed is due to a “mechanical problem” e.g. cleft-palate
  2. Fresh donor milk e.g. close relative, friend in the community (not recommended by public health due to worries about disease transmission)
  3. Frozen human milk from milk-bank
  4. Home-made formula (this is not recommended by public health regions) with added high quality probiotics and fish-oil / ω-3 EFA
  5. Organic formula from a reputable company with added high quality probiotics and fish-oil / ω-3 EFA
  6. Regular store-bought formula with added high quality probiotics and fish-oil / ω-3 EFA

Note: if the inability to breastfeed happens after 6m (e.g. medical problem) then it’s preferable to start on real food and purified water rather than store bought formula (World Health Organization, 2009).

 

References

Gaskin, I. M. (2009). Ina May’s guide to breastfeeding. New York: Bantam Books.

Hass, E. M. (2006). Staying healthy with nutrition. Toronto: Celestial Arts.

Health Canada. (2012). Infant feeding. Retrieved from Health Canada (Government of Canada): http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/index-eng.php

KellyMom. (2011). Is my baby ready for solid foods? Retrieved from Kelly Mom Parenting & Breastfeeding: http://kellymom.com/nutrition/starting-solids/solids-when/

La Leche Leage International. (2010). The womanly art of breastfeeding. Ballantine Books: New York.

Ochoa, S., & Kline, A. (2011). BIOL404 Chemistry & nutrition student syllabus. SLC: Midwives College of Utah.

Stuebe, A. (2009). The risks of not breastfeeding for mothers and infants. Reviews in Obstetrics & Gynecology , 2 (4), 222-231.

World Health Organization. (2009). Infant and young child feeding – Model Chapter for textbooks for medical students and allied health professionals. Geneva: WHO Press.