How do I introduce solids to my baby?

INTRODUCTION TO SOLID FOODS,
By Emma McShane, Dietitian

The World Health Organisation states ‘infants should be exclusively breastfed for six months and after this time continue breastfeeding with appropriate introduction to solids’ (2020).
When breastfeeding is not possible, bottle feeding is recommended.

How do you know if your baby is ready for solid foods?

Your baby has good head and neck control and can sit upright when supported
Your baby shows an interest in food e.g. looks at or reaches out for your food
Your baby opens their mouth when offered food on a spoon
Your baby has an increased appetite, is feeding more often, and wants more breast milk or formula at the end of their usual feed.

VARIETY OF FOODS:
It is important to include a variety of foods from the five core food groups in your baby’s diet.

CEREAL FOODS
Be sure to offer a variety of grains including wheat, rice, oats and corn.
Example of cereal foods: Bread, crackers, pasta, iron-fortified cereals e.g. Weet-bix, all bran

DAIRY FOODS
Yoghurt, cheese, and cow’s milk on cereal.
Cow’s milk should not be given as a drink (instead of breastmilk or formula), for babies under 12 months of age.

MEAT AND MEAT ALTERNATIVES
Beef, lamb, poultry, well-cooked egg, fish, other seafood, legumes (e.g. lentils and chickpeas)

VEGETABLES AND FRUITS
Can be grated, cooked, pureed or mashed.

Introducing Common allergy causing foods:

Common allergy causing foods should be included in your baby’s diet before nine months of age, as research has shown that early introduction may reduce the chance of your baby developing a food allergy.
These common allergy causing foods are: Eggs, Cow’s Milk, Wheat, Soy, Peanut, Tree nuts, Sesame Fish, Shellfish
It is important to introduce one new allergy causing food at a time, early in the day, and then wait a few days to try another new food, so that you can identify any foods that may cause an allergic reaction.
An example of how to introduce an allergy causing food, is to mix a small amount (1/4 tsp) of an allergy causing food e.g. hard-boiled egg or smooth peanut butter into your baby’s usual food e.g. vegetable puree. If there are no signs of an allergic reaction (These signs include: hives, welts, swelling of the lips, vomiting, or change in behaviour), then gradually increase the amount next time (1/2 tsp). If your baby does show signs of an allergic reaction, stop offering the food and seek immediate medical attention.
It is important that once you have introduced these foods, to include these foods in your baby’s meals at least twice a week.

The below is a guide of solids progression, showing texture, quantity and breast/bottle feeds; it may be highly variable for each baby. You may also choose a ‘Baby Led Weaning’ approach, this involves introducing solids through appropriately textured and sized finger foods and allows your baby to explore the food themselves. There is no set way to feed your baby, so do what feels best for your family.
The above is an approximate guide for food quantities and expected number of breast and bottle feeds, this is because there are no set guidelines, as each baby will progress differently. If you feel unsure about how to introduce solids to your baby, a Children’s Dietitian (Paediatric Dietitian) can provide specialised feeding advice.

6 MONTHS

TEXTURES
Coarsely pureed/mashed

QUANTITIES
1-2 tablespoons, twice a day (start with 1 meal and progress to 2 over weeks).

EXPECTED NUMBER OF BREASTFEEDS
Breastmilk is the main nutrition source. Continue breastfeeding on demand.

EXPECTED NUMBER OF BOTTLE FEEDS
If your baby is not breastfed, continue with bottle feeds, as this is still the baby’s main nutrition source. Slight decreases may be seen in the amounts taken.

EXAMPLE OF FOODS
Start with iron-rich foods; as your baby’s iron stores gained during pregnancy start to run low. These foods include fortified baby cereals, eggs, beans, lentils and soft cooked and pureed meat. Introducing allergy causing foods e.g. yoghurt added to pureed fruit and vegetables, Semolina porridge made with breast milk or infant formula.

6-8 MONTHS

TEXTURES
Lumpy, finely chopped, progressing to finger foods

QUANTITIES
Progressing 1-4 tablespoons of food 1-3 times/day by 8 months (slow progression) – up to ½ cup of food

EXPECTED NUMBER OF BREASTFEEDS
On demand

EXPECTED NUMBER OF BOTTLE FEEDS
3-5 times per day at 6-8 months

EXAMPLE OF FOODS
Peanut butter added to mashed foods or porridge, hummus mixed into mashed vegetables, finely shredded, soft meat added to puree vegetables.

8-10 MONTHS

TEXTURES
Grated, diced, chopped finger foods, progressing to regular menu
You’ll find your baby starts to play with their spoon.

QUANTITIES
Up to 1 cup of food at each meal
At 9 months: 3 meals
At around 10 months: Introduce mid-meals, roughly ½ to ¾ cup of food (e.g. ½ cup full fat yoghurt with cut up banana).

EXPECTED NUMBER OF BREASTFEEDS
On demand; By 9 months: 4-5 breastfeeds

EXPECTED NUMBER OF BOTTLE FEEDS
3-4 formula feeds at 9-12 months

EXAMPLE OF FOODS
Well-cooked spiral pasta as finger food, hard-boiled egg with mashed avocado, soft grated cheese as finger food, pikelets.

10-12 MONTHS

TEXTURES
Chopped finger foods, Begins spoon feeding

QUANTITIES
Small balanced meals 3x/day e.g. 1 scrambled egg, chopped soft fruit, 1 Weetbix with cow’s milk, plus mid-meal snacks 1-2x/day.

EXPECTED NUMBER OF BREASTFEEDS
On demand; 3-4 breastfeeds per day

EXPECTED NUMBER OF BOTTLE FEEDS
600mL Bottle feed/day

EXAMPLE OF FOODS
Omelettes, cottage cheese and fruit mixed together, bread offered as toast fingers or sandwiches, homemade fish fingers, pesto sauce with pasta.

1-5 YEARS

Family foods (avoid small, hard pieces of food). Can offer cow’s milk as a drink after 12 months.
Example foods: Scrambled eggs, Crumbed fish, vegetables dipped in hummus, pastas, cereals with cow’s milk

References:

Australian Breastfeeding Association. Breastfeeding and family foods. ABA, 2020. (Available from: https://www.breastfeeding.asn.au/, accessed May 31st, 2021).
Australasian Society of Clinical Immunology and Allergy. Introducing foods and allergy prevention fast facts. ASCIA, 2019. (Available from https://www.allergy.org.au/images/pcc/ff/ASCIA_Introducing_Foods_Fast_Facts_2019.pdf, accessed May 31st, 2021).
NIP Allergies in the Bub. Introducing solid foods. Prevent Allergies, 2018. (Available from https://preventallergies.org.au/introducing-solid-foods/, accessed 31st May 2021).
NIP Allergies in the Bub. Around 6 months (not before 4 months). Prevent Allergies, 2018). (Available from https://preventallergies.org.au/wp-content/uploads/2020/10/Food-Ideas-for-Babies-around-6-Months.pdf, accessed May 31st 2021).
NIP Allergies in the Bub. Around 7 to 9 months. Prevent Allergies, 2018. (Available from: https://preventallergies.org.au/wp-content/uploads/2020/06/RECIPE-IDEAS-FOR-BABIES-7-9-MONTHS.pdf, accessed May 31, 2021).
NIP Allergies in the Bub. Around 10 to 12 months. Prevent Allergies, 2018. (Available from: https://preventallergies.org.au/wp-content/uploads/2020/06/RECIPE-IDEAS-FOR-BABIES-10-12-MONTHS.pdf, accessed May 31, 2021).
Castle J., Jacobson M. (2013). Fearless Feeding. Jossey Bass. pp 40-54. Accessed May 31, 2021.
Surwald, D. (2017). Baby-led weaning & introduction of solids. Peninsula Health. Accessed June 10th 2021. Available from: https://www.peninsulahealth.org.au/2017/08/25/baby-led-weaning-introduction-of-solids/

April 23, 2023

How do I deal with my toddler’s fussy eating?

April 23, 2023

1) Is it normal for a toddler to be a fussy eater?
By Melbourne Dietitian, Nicole Bando
As a children’s dietitian, this is a commonly asked question. Many parents feel concerned about the variety and quantity of food their toddler eats. A fussy eater is defined as a child who refuses to try a new food at least 50% of the time. Fussy eating behaviours in the second year of life are normal and part of how your child expresses their new found independence whilst exploring the world around them. It is normal for children to be uncertain of new tastes and textures; an evolutionary mechanism designed to keep us safe from danger! We have a natural preference for sweeter foods as they are higher in calories, another survival mechanism which no longer serves us.
Establishing healthy habits early in life is important for a child’s optimal growth and development, and reduces the risk of obesity and chronic disease later in life. When a child develops fussy eating behaviours, meal times can become stressful for the whole family. There are many strategies to prevent and manage selective eating habits, making meal times enjoyable once again.

2) When should I worry about my toddler’s eating?

Growth slows during a child’s second year, and so their intake reduces. Many parents worry that their child isn’t eating enough, however may have unrealistic expectations of how much their child needs each day. Toddlers have a small stomach capacity and need to graze frequently throughout the day. Remember that a healthy child will never go hungry, and if energetic and thriving, they are likely eating enough. Seek help from your GP, Maternal Health Nurse or Paediatric Dietitian, if your child is:

exhibiting extreme fussy eating behaviours and mealtimes are very difficult
lethargic and lacks energy for daily activities
appears unwell
gagging or vomiting often, or has problems with chewing or swallowing
eating a very limited variety of foods and missing out on entire food groups
unable to drink from a cup from around 16 months
rejecting whole food groups or groups of foods of a similar texture
not growing or developing as expected

3) How can I encourage my toddler to eat what I offer them?
Are you or any other adults in the house fussy eaters? Research shows that eating meals (as often as possible) demonstrates positive role modelling. If children see their parents eating a variety of foods, they are more likely to learn and copy that behaviour. These times give opportunity to chat, as well as share a meal. Try to cook 1 family meal, so that everyone is eating the same food (may need slight modification for texture), together as often as possible. It doesn’t matter if your child doesn’t want to eat or try everything on the plate. Repeated and exposure of a variety of new foods will help your child to develop healthy habits.

The below strategies can help manage fussy eating behaviours:
Parents use a consistent approach with all strategies
Keep calm, avoid a fuss as this gives issue more attention which can lead to a power struggle
Avoid using punishment or bribes e.g. dessert as reward for eating vegetables
Minimise distractions: eat at table, away from television, devices or toys.
The Division of Responsibility: it is the parent’s job to offer a variety of healthy foods at the right times and the child’s role to decide what, and how much to eat.
Offer foods in different ways e.g. broccoli with melted cheese, or stir-fried to promote enjoyment and acceptance
Keep meal times to a reasonable time limit and develop a routine around meals.
A new food may need to be offered up to 15 times before it is accepted. Many parents give up after a few times.
Harness your toddler’s independence and encourage self-feeding, with a mixture of finger foods and mixed textured foods, requiring a spoon or fork
Children love helping and can assist with shopping for the family’s food and simple meal preparation.
Your child’s appetite can vary considerably day-to-day depending on activity and growth. If your child rejects the food offered, avoid offering an alternative, instead reoffer the food at a later stage, perhaps they are just not hungry.
Sometimes children can be filling up on milk and this takes away their appetite for other foods. They may not be fussy, just full.
Toddler formula is not necessary in a child’s diet. It displaces food gives preference to sweet tasting drinks. After 12 months, cow’s milk or a suitable dairy alternative can be provided as a drink. Breastfeeding may continue for as long as mother and child are enjoying it.
Keep high sugar and high fat treat foods to a minimum. These can take place of foods from the other food groups, which means your child does not have the appetite for nutritious foods.

4) Should I force my toddler to eat?
Forcing a child to eat will create a negative association with food, which can have long-lasting effects, such as poor relationship with food, food aversions and worsening fussy eating behaviours, a high level of stress at mealtimes and reinforcing an idea that healthy foods are bad. It also overrides your child’s own hunger and fullness cues, and this can contribute to weight gain and obesity in later life. Forceful behaviour includes coercion, ‘have one more mouthful’ and negotiation, ‘eat this and you can have dessert’. If your child does not want to eat at a particular time, it can be for a whole range of reasons, so if you feel concerned, see your health professional to discuss. Children are excellent at regulating their own appetites and by using the above strategies, you can help your child to create a healthy relationship with food.

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How do I introduce solids to my baby?

How do I deal with my toddler’s fussy eating?

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