Below is some evidence-informed information to help you with introducing complementary foods to your baby.  This is not a comprehensive resource so please check with your child’s primary care practitioner if you have any further questions or concerns not covered in this post.

 

Goals of introducing complementary foods

For your baby to…

  • explore and enjoy food
  • develop feeding independence
  • take part in the social experience of eating together as a family
  • expand the food repertoire
  • avoid any nutritional deficiencies

 

When to Introduce complimentary foods

The best time to start is when your baby begins showing signs of interest and readiness.  For the vast majority of babies, this tends to be between 4 and 6 months of age. Some signs of feeding interest/readiness include:

  • Good head control
  • Ability to sit up and lean forward
  • Ability to let parent/caregiver know when satiated (e.g, turns head away)
  • Keen interest in “joining in” when parents and others are eating
  • Reaching for and requesting food when others are eating or when food visible
  • Ability to pick up food and try to put it in the mouth.

 

Which foods to start with

The first foods chosen by parents can vary tremendously from culture to culture and from family to family.  There is no ‘best first food’.  Having said that, there are a few guiding principles to keep in mind when choosing.

  • First foods should be iron-rich.
    After 6 months of age, breast milk may not contain sufficient iron to fully meet baby’s nutritional requirements. If complementary foods are not rich in iron, there can be a risk of developing iron-deficiency anemia. Starting with iron-rich foods lowers or prevents this risk. Some examples of iron-rich foods include: meat, nuts, lentils, kidney beans, green-leafy vegetables, and iron-fortified baby cereals.
  • First foods should be soft and mushy.
    Many babies will require time and practice progressing their feeding skills from exclusive drinking to biting, chewing and swallowing.  Soft mushy foods are the logical next step after liquids in this learning sequence.  Examples of soft/mushy consistencies include smooth yogurt, pureed meats, well cooked vegetables (either pureed or cut into finger food-sized cubes), legume purees such as hummus, and very soft cheese like the inside of camembert. Consider pureeing the foods that you and your family eat so that everyone at the table is enjoying the same meal. You may also choose to use commercially prepared baby foods.
  • Avoid feeding honey before 1 year of age.
    Honey may contain botulism spores in sufficient amounts to cause illness in babies less than 1 year of age.  As a result, it is recommended to avoid honey until the second year of life

 

How to feed your baby

Health Canada’s infant nutrition experts recommend a feeding style called ‘Responsive Feeding’.

Responsive feeding means that a parent/caregiver responds in a prompt, emotionally supportive, and developmentally appropriate way to baby’s hunger and fullness cues. The essential principles of responsive feeding include:

  • Allowing the child to guide the eating experience
  • Promoting self-feeding as much as possible in a developmentally appropriate manner
  • Using eye contact and positive verbal encouragement, but not verbal or physical coercion
  • Offering age- and culture-appropriate eating utensils
  • Responding to hunger and fullness cues/behaviors
  • Minimizing distractions during meals and snacks
  • Offering broad varieties of food combinations, tastes, and textures

Practically speaking, you can cultivate a responsive feeding relationship with your baby by following the recommendations below:

  • Initiate the meal by allowing your baby to explore the food: squish it in her hands, slap it on her face, and throw it on the floor. This is how babies ‘get to know’ and become comfortable with their food.
  • Once a comfort level is established, load a very little bit of food on the tip of a soft spoon and present the tip of the spoon to your baby, just below her lower lip but not touching. Give her the time and space to open her mouth, to move her head forward and eat the food from the spoon.
  • Avoid pushing the spoon into her mouth as some babies interpret this as ‘forcing’. If she readily eats what’s offered, then keep going until your baby conveys to you that she’s done.
  • If your baby is initially uninterested or rejecting what’s offered, then quickly call it a day and try again tomorrow. Some babies need to try a food many times before accepting it.
  • Your baby may also wish to feed herself. Self-feeding is an important skill and should be encouraged as early as possible. Keep an extra few spoons available for your baby to use and experiment with. Offer small finger foods that are soft, mushy, and/or easily dissolved.
  • Mix the spoon feeding with self-feeding and allow your baby to lead the way. The more the experience is baby-initiated and baby-led the better.

 

Number of feeds per day

The number of meals is entirely up to you.  Some families keep it at once a day for a few months.  Others like their children to eat solids with the family at every meal.  There are no absolute rules here.  In all likelihood you and your baby will soon work out together the most suitable schedule.  In the second year of life it will become more important to establish scheduled meal and snack times.  Until then, feel it out and choose what works best for you, your baby, and your family.

 

Amounts to feed

The amount to eat should depend entirely on your baby’s preference.  There is tremendous variability, from baby to baby and from meal to meal, in terms of how much babies choose to eat.  Some babies will eat through multiple jars of baby food in a single sitting whereas others will be done after 3 small bites.  It is important to respect your baby’s wishes both when she asks for more and when she gestures ‘all done’. Resist the urge to sneak in one last bite as this can be perceived as deceiving and undermining.  The key is to resist setting any expectations around amounts and ensuring that the experience is fun, stress-free (for you and your baby), and baby-led.

 

Water, milk, and juice

  • Water
    Breast milk (or formula) provides more than enough hydration for your baby in the first 6 months of life. At 4-6 months of age, as your baby begins to eat other foods, you can start to offer water occasionally.
  • Milk
    Milk should not be offered to babies under 1 year of age since it is not a good alternative to breast milk (or formula). After 12 months of age, it is appropriate to introduce homogenized cow’s milk or calcium/vitamin D-enriched milk alternatives (12-18 ounces or 350-500 ml per day).
  • Juice
    Juice is not necessary and possibly unhealthy; it is essentially sugar and water and therefore has very little nutritional value. Furthermore, juice can overly satiate babies thereby decreasing their interest in eating more nutritious foods.  Excess juice can also cause early childhood tooth decay and contribute to the development of childhood obesity. If it is important to you that your child drink juice, make sure you offer no more than 4 oz, or 120 ml per day.

 

Foods and textures to avoid

  • It is a good idea to avoid feeding sugary drinks or foods – such as candies, soda/pop or energy drinks. These items give babies calories without any nutrients and can lead to obesity and/or malnutrition.
  • As mentioned above, don’t give honey to babies under 1 year old as there is a risk of infant botulism (food poisoning).
  • Any food considered to be a choking hazard should be avoided or modified to eliminate the risk of choking (for further information see next section on choking).
  • Avoid feeding foods with advanced textures until your baby is developmentally ready to eat them. Examples of advanced textured foods include
    • Multiple textures (e.g. soup with noodles, purees with chunks
    • Rice (scatters in the mouth making oral control difficult)
    • foods requiring significant amounts of chewing (eg. Large pieces of tough meat, raw vegetables, chunks of hard cheese)

 

Choking Prevention

The following foods have been known to cause lethal choking in infants:

  • hard candies, cough drops, gum, gummy candies and chewable vitamins
  • peanuts, sunflower seeds
  • fish with bones
  • snacks on toothpicks or skewers
  • grapes
  • hot dogs, sausages
  • raw carrots, apples

You can reduce the risk of choking by following these recommendations:

  • Always supervise babies and children while they are eating. They should be sitting down.
  • Dice or slice lengthwise round foods such as wieners or grapes.
  • Grate raw fruits/vegetables such as apples/carrots to make them easier to chew.
  • Avoid serving large globs of firm, sticky foods (like thick peanut butter). Water them down or present in very small dollops.
  • Remove pits from fruits.
  • Cook hard fruits and vegetables to soften them.

 

Preventing food allergies

In the past, it was thought that parents should delay feeding babies certain ‘allergenic foods’ (e.g. nuts, egg and seafood) to prevent the development of food allergies. Recent scientific research actually suggests doing the opposite; it seems the best way to prevent your baby from developing food allergies is to introduce these allergenic foods early and to feed them regularly and indefinitely.  So don’t hesitate to routinely give your baby small dollops of peanut butter, loosely scrambled eggs (white and yolk) or small pieces of very soft flaky fish; not only will the early and routine consumption of those foods lower your baby’s risk of allergies, but nuts, egg, and fish are iron-rich foods as well.

 

More Questions?

If you have additional questions, please book an appointment with your child’s primary care provider for further discussion and counselling.