Q1) Government suggests that 6 months is the right time to start weaning, but my children were ready at four months and they thrived on it. What are your thoughts? How do I go about introducing solid foods to my baby?
Although the World Health Organization and Department of Health suggest that weaning should not be started before six months (26 weeks), many parents still choose to offer solids to their babies before 6 months of age. As health care professionals we advise and encourage parents not to consider weaning before 4 months (17 weeks).
Your baby will let you know when he or she is ready to be weaned. If your baby can sit up comfortably and shows an interest in your food from 4 months onwards he might be ready for weaning. Other signs that your baby is ready to be weaned include; still hungry after milk feeds, demand feeds more frequently and wakes at night for a feed having previously slept through the night.
It is also important to bear in mind that delaying weaning beyond six months of age can have negative consequences too. With delayed weaning there is a risk of developing multiple nutrient deficiencies and it is likely that your baby can become a fussy eater.
With weaning it is important to start slowly and don’t expect your baby to have more than a few spoonfuls at first. The first step in weaning is to get your baby used to the texture of food. At this point milk feeds remain vital to ensure your baby is getting all the nutrients required for growth. Babies are able to manage lumps from six months onwards, so be ready to move forward with textures. After the first 3-4 weeks of weaning you can get creative and as eating habits and tastes are formed in early childhood, it is important to introduce a variety of fresh flavours to help your baby establish a healthy eating pattern for life.
All children are different and various medical conditions often impact the timing of weaning. In some cases weaning might be suggested from as early as three months, where at other times it should be slightly delayed or slower progression is advised. Speak to your GP, paediatrician or dietitian if you have concern regarding weaning.
Q2) When is the best time to encourage drinking from a cup and when can I give my baby juice and squashes?
A cup should be introduced from around 6 – 8 months. A non-rigid beaker with a long spout will ease the transition from bottle to beaker. You can continue to offer a bottle at bedtime if you choose to, but aim to have your baby off the bottle by the age of 1 year.
Although milk and water are the best drinks for your baby’s teeth, well-diluted juice can also be offered as soon as your baby is on three solid meals per day. Offering fluids at mealtimes can easily fill your child up and reduce their appetite for food, be careful not to give too much fluid.
To dilute baby juice or squash add 1 part juice to a minimum of 2 parts water.
Q3) How do I ensure my daughter gets all the milk feeds she needs as well as eating solids?
Breast milk or formula milk should provide all the nutrients your baby needs for the first six months. As your baby’s intake of solid food gradually increases, milk intake will naturally decrease.
It is important that you continue to breastfeed or offer formula milk in adequate amounts when weaning is started. Between the ages of 4 – 6 months babies should still have 700 – 1000 ml of breast or formula milk each day. From 6 months to 9 months, as weaning progress babies should have between 500 – 900ml of breast, formula / follow-on milk each day and after 9 months aim to offer 400 – 600ml of milk per day. If less milk is consumed, ensure that your baby is having calcium rich foods in his diet such as yogurt and milk can also be added to cooking.
Take care to never add any solid foods to the milk in your baby’s bottle.
Q4) What is baby-led weaning? Is it better?
An increasing number of parents are now opting for baby led weaning. With baby led weaning you are offering easy to grip, table foods instead of the traditional purees on a spoon to your baby. No bowls or cutlery – food is put directly onto the highchair tray.
This allows babies to control their solid food intake by feeding themselves from their first encounter with food. Your baby decides the what, when and how of mealtimes. Hunger might be frustrating for your baby when they are still figuring the feeding thing out. As with traditional weaning, it is important to time meals between milk feeds and stick to the same times daily.
With baby-led weaning you are not feeding your baby directly but rather offering guidance during the meal. Your baby should be in control of what they put in their mouth, it is important that you never put any pieces of food directly into your baby’s mouth. First foods often include: steamed carrots, cucumber or mango pieces, toast finger etc. But can also be anything that you are having for your lunch or dinner (without the added salt and sugar).
This type of weaning does work wonderfully for some, whilst other struggle and revert back to traditional weaning and some parents follow a combination method. Do remember that babies should be at least 6 months old when baby-led weaning is started, they should be able to sit up unassisted, grasp and hold onto foods.
Advocates for baby led weaning often say that baby should eat what the rest of the family is eating and if they refuse the food, you should relax as baby will be getting the calories from their milk. As babies love their milk, this approach can easily lead to undesirable behaviour – babies learn fast and they will soon realise that if they refuse the solid food, mum will happily offer them some milk.
Parents must be warned that baby-led weaning is messy. You might want to do your homework and read up on this method before you decide to start. Forums are a good place to learn from parents who have followed this method. This will help ease your mind and somewhat prepare you for what to expect. Bear in mind that babies are all different and that they will eat at their own pace.
So is this the type of weaning for your baby? Only you can decide if baby led weaning is right for your baby. Both traditional weaning and baby led weaning have pros and cons. If you are uncertain or have any questions, discuss this method with your health care professional.
Q5) What foods should I avoid giving my baby and can I add salt and sugar to my baby’s food?
First foods should be easy to digest and unlikely to provoke an allergic reactions. The best foods to start with include:
FRUITS – Apple, pear, banana, papaya (banana and papaya do not require any cooking, provided that they are ripe and can be pureed or mashed on their own or with a little milk).
VEGETABLES – Carrot, potato, swede, parsnip, pumpkin, butter squash and sweet potato. These vegetables tend to have a naturally sweet flavour and smooth texture, once pureed.
BABY RICE – Mixed with water, breast or formula milk. It is easily digested and the milky taste makes for an easy transition onto solids. There are varieties available which are sugar free and have added vitamins and minerals. Baby rice also combines well with both fruit and vegetable purees.
It is always a good idea to taste any food that you’ve prepared, before giving it to your baby.
And what not to offer your baby include;
SALT – Babies under a 1 year should not have any salt added to their foods as this can strain their immature kidneys and cause dehydration. A preference for salt can be established at an early age and eating too much salt may lead to high blood pressure later in life. Also avoid any smoked foods.
SUGAR – Try to avoid foods with added sugar. Adding sugar to your baby’s food increases the risk of tooth decay and may be habit forming.
GLUTEN – If you have a family history or allergy, such as gluten intolerance or eczema, avoid foods containing gluten (wheat contains a natural protein called gluten). Similar proteins are found in other cereals such as rye or barley. When buying baby cereals and rusks around 4 to 6 months, check the food label if you want to avoid gluten. Baby rice is the safest to try first.
RAW, LIGHTLY COOKED or SOFT EGGS – Due to the risk of salmonella infection, eggs should not be given before 6 months and once introduced they should be cooked until both the yolk and white is solid. Soft eggs (scrambled) can be offered after 1 year.
UNPASTURISED CHEESES and PATE – Avoid Brie, Camembert or Danish Blue cheese before 12 months due to the risk of listeria infection.
SHELLFISH – Should not be given until at least 1 year. If there is a family history of a shellfish allergy, avoid feeding your baby shellfish.
NUTS – Chopped and whole nuts are not recommended before the age of 5 due to the high risk of choking. There is also the risk of allergic reaction to nuts.
HONEY – Should not be given before 1 year. Very occasionally honey can contain a type of bacteria which can result in a potentially serious illness to your baby called infant botulism
ARTIFICIAL ADDITIVES – Avoid giving foods or drinks that contain artificial additives for example sweeteners and colourings. These are banned by law from baby foods and drinks.
COFFEE & TEA – Compounds in tea and coffee interfere with your child’s nutrient absorption, thus it is best to avoid these.
Q6) My baby is 9 months old – can I give my baby cow’s milk to drink?
You should continue to give breast or formula milk to your baby as their main drink for their entire first year of life. Cow’s milk does not contain enough iron or other nutrients to ensure adequate growth. However you can use full fat cows’ milk with cereal and in cooking from 6 months onwards.
Many parents opt for follow-on or growing up milks as these are enriched with added vitamins and minerals. If your child is a fussy eater it might be a good idea to rather offer one of these milks to ensure they will be getting adequate amounts of these nutrients.
Below is an indication of how much calcium your child requires at a certain age. Calcium does not only come from milk but also from calcium rich desserts, cheese and other dietary sources.
0 – 12 months – Calcium 520mg
1 – 3 years – Calcium 350mg
4 – 6 years – Calcium 450mg
Q7) My baby is not a good eater and weaning has been difficult. I’m worried – what can I do?
When you start weaning, your baby will only take a small amount of food, approximately 1 – 2 teaspoons once daily. Aim to get your timings right, avoid offering solids when your baby is tired or hungry and also not shortly after a milk feed.
Gradually increase the quantity and number of times that you offer solids to you baby in a day. Do not worry if your baby refuses the food on the first introduction, this is often the case, stay positive and try again later. Continue to offer the same food on another day to increase your baby’s exposure to this particular food.
When you’ve tried everything to get your baby weaned without success, it is possible that the timing might not be right. I know it’s easier said than done, but try to relax; your baby might be picking up on your tension and frustration. Your baby might be feeling unwell or adjusting to the fact that you’ve gone back to work? Do not compare your baby with other babies. Babies clearly indicate when they’ve had enough by turning their heads away.
If your baby is refusing a meal do not offer milk directly after that, let your baby wait until the next snack or meal and offer some food again. But be careful as snacks between meals can often spoil your baby’s appetite.
If your baby is losing or not gaining weight, their appetite has been poor for quite some time or they are also refusing milk feeds, speak to your GP or health visitor.
Q8) At what age can I stop sterilising her feeding equipment?
Milk is a good breading base for bacteria and babies are quite vulnerable to germs that cause diarrhoea and vomiting, thus it is best to continue to sterilise your baby’s feeding equipment until he or she is 1 year old.
If you are using a cup or beaker for your baby (advised from 6 month’s onwards) no sterilisation is required. Cups and beakers are easier to clean than bottles or teats and they can be washed in warm, soapy water together with your baby’s plates and cutlery. But do remember to wash your baby’s things separate from the rest of the dishes.
Q9) When is a good time to stop my child’s daytime bottle feeds?
Once your baby is having 3 solid meals per day with a calcium rich foods and the age appropriate volume of milk, you can stop offering daytime bottle feeds. Aim to start using a cup or beaker from 6 months onwards.
Q10) Once my baby starts on solids, will his bowel movements change? What can I include in my baby’s diet to avoid/cure constipation? I hear too much fibre is not good for them.
Most definitely, it is quite normal to see changes in your baby’s nappies once solid food is introduced and the nappies will differ from day to day, depending on what you are feeding your baby.
Babies and toddlers needs are different from an adults – a low fat, high fibre diet is not appropriate as young children require more fat and concentrated sources of calories and nutrients to fuel their rapid growth.
They should not be given too much fibre as excess fibre may remove valuable vitamins and minerals or can cause diarrhoea. Fibre is also quite bulky and can easily fill your children up before they get all the nutrients they need for proper growth and development. Fruit and vegetables are all rich in natural fibre and will help to avoid constipation. Weetabix is also an excellent fibre source when weaning.
Ensure that your baby is having a varied diet and sufficient amounts of fluid from water or well-diluted juice. Extra fluid will be required in warm weather and when on long haul flights.
If your baby is constipated, speak to your health care professional, who will suggest a few things to get rid of constipation.
Q11) Since I stopped breastfeeding my child has been on formula milk, he is nearly 2yrs, when is the earliest I can start on cows milk and how much does he need? Is full-fat best?
Breast or formula milk should be to your baby’s main drink until they reach 1 year. Cows’ milk can be used in cooking or with cereal from 6 months onwards.
As cows’ milk does not contain enough iron or other nutrients to ensure proper growth, it is not recommended before the age of one. Once your baby has reached 12 months, you can change from formula or breast milk to full fat cows’ milk. I often advise parents to gradually wean their baby onto the full fat cows milk to avoid your baby refusing the milk.
All children younger than 2, should be on full fat cows milk or a growing up milk with added vitamins and minerals. A growing-up milk would usually be recommended if your child is a fussy eater.
Q12) I don’t have a lot of money, how can I make sure my baby gets a varied diet on a small budget?
Even on a shoe string budget you can still ensure that your baby will have a balanced, varied diet. If money is limited it’s best to rather opt for home-made foods instead of ready-to-serve baby food in supermarkets. These baby food jars and pouches are very convenient and have come a long way over the past few years, but can be quiet expensive. It is always a good idea to have a couple of jars just as a back-up in your house (buy these when your supermarket has a special deal).
The bonus of making food at home is that you know exactly what you are adding to your baby’s meals and you can freeze any leftovers or prepare food in advance. You can also make your own baby rusks and biscuits at home, there are various recipes online. Making a home-made baby custard or rice pudding is a good alternative to yogurts.
Custard (egg based)
- 2 beaten egg yolks
- 250ml full fat milk (custard will NOT set well with formula)
- 1 tsp vanilla extract
- 1 small, sweet apple, peeled, cored and diced (optional and can be substituted for pears, peaches etc.)
- Simmer the apple in a very little water until tender, then mash thoroughly or puree.
- Put the apple into the bottom of a small oven-proof dish. Preheat oven to 180° C
- Stir the beaten egg yolk and the vanilla into the milk, then pour the mixture over the cooked apple.
- Sit the dish in the middle of a baking pan and pour in hot water until it comes about halfway up the side of the dish (this creates a simple bain-marie).
- Bake for 30 minutes until the custard has set.
- Cool and serve chilled.
Egg-free custard (1 serving)
- 150ml full fat milk
- 3 teaspoons corn or maize flour
- ½ teaspoon sugar (optional or vanilla essence can also be added)
- Add the maize or corn flour into a saucepan
- Gradually add the milk to form a smooth paste.
- Add the remaining milk and sugar.
- Heat over medium heat, stirring constantly to prevent lumps forming.
- Custard will thicken after 1 – 2 minutes.
Rice Pudding (2 servings)
- 3 tbsp baby rice
- 100ml full fat or formula milk
- 1-2 drops vanilla essence
- 1 tsp caster sugar / golden syrup
- Heat the milk in a pan until hot.
- Add the baby rice and whisk until the mixture is smooth and lump free.
- Remove from the heat. Add the vanilla and sugar and stir well.
- Serve warm or cold.
When working with a tight budget it is advisable to plan your meals ahead with weekly or monthly menus and stick to the menu. The menu planning can be done for the whole family. As babies can eat the same food as the rest of the family; you do not have to buy special foods for your baby, just avoid adding sugar, salt or too many spices to your baby’s food.
Babies and toddlers should eat a wide variety of fruit and vegetables to ensure they get plenty of vitamins, minerals and adequate fibre from their diet. When you do the shopping, buy fruit and vegetables that are in season and frozen vegetables are also a good option as they are slightly cheaper than fresh vegetables.
Stick to appropriate portion sizes, do not dish up too much food, this will just end up in the bin.
Experiment with plant-based proteins and aim to have a meat-free meal two – 3 times per week, but ensure that your baby has some protein at every meal.
Nutrients that are particularly important in the early years include;
Iron is very important for your baby’s physical and mental development. Babies are born with limited iron stores that will last for about 6 months. Iron deficiency is the most common nutrient deficiency in young children and can cause your child to feel tired, run down and more prone to infection.
Iron foods of animal origin like red meat or poultry are better absorbed than the iron in plant foods like green vegetables or cereal. Vitamin C helps with the absorption of iron so give your baby vitamin C rich fruits or vegetables like sweet pepper, broccoli, berry fruits or citrus.
Animal sources of iron are; red meat, particularly liver, chicken or turkey – especially the dark meat, well cooked egg yolk and oily fish such as canned sardines, salmon, mackerel and tuna. Non-animal iron sources include; lentils, beans and pulses, wholemeal bread, spinach and broccoli and dried apricots. Follow-on formula is also a good source of iron.
Calcium is essential for building strong, healthy bones and teeth. It is also important for the smooth functioning of muscles, including the heart. Dairy products like milk, cheese and yoghurt are excellent sources of calcium and protein. Other sources include salmon, broccoli and dried fruit. Always choose full fat dairy products for children under the age of two.
Zinc is important for normal growth, it helps boost the immune system and speeds the healing of wounds. Red meat, eggs, wholegrain and fortified cereals as well as pulses are all rich in zinc. Vitamin C also works with zinc so ensure that plenty of vitamin C rich foods are included in your baby’s diet.
Vitamin C is needed for growth, healthy tissue and healing of wounds. It also helps with the absorption of iron and zinc. Vitamin C is abundantly found in strawberries, apples, pears, peaches and other summer tropical fruits and also in broccoli, cauliflower, spinach, potatoes and sweet peppers.
Vitamin A is essential for growth, healthy skin, teeth, bones and good vision. Best vitamin A foods include; liver, butter, cheese, eggs, oily fish, carrots, sweet potato, tomatoes, dark green vegetables such as broccoli and orange-coloured fruits such as mangoes.
ESSENTAIL FATTY ACIDS
Essential fatty acids (EFAs) are important for your baby’s brain and visual development especially in early life. There are two essential fatty acids – linoleic acid (omega 6) and linolenic acid (omega 3). In general we get enough omega 6 fats form seed oils – sunflower and corn and omega 3 fats from oily fish such as salmon, trout, fresh tuna and sardines.
Bianca Parau Senior Paediatric Dietitian| Bupa Cromwell Hospital, Cromwell Road, London, SW5 0TU
T: 020 7460 5566 | F: 020 7835 2518 |