Guest Post by Laurel Kimball, RDN, LDN
Choosing to breastfeed your little one may be one of the first decisions you make regarding the health and nutrition of your baby. It is a wonderful choice—the benefits are extensive for you and your little one. But the decision making doesn’t end there. There is still more to know about feeding an infant, and it can be especially confusing when mom is telling you one thing and sister another. However, you can be confident you are making the best nutritional choices for your baby, by reading this blog with the most current recommendations and information on the basics of nutrition for your baby during their first year of life.
Nutrients to Consider
The nutritional and health advantages of human milk and breastfeeding are numerous. Your breast milk gives your baby the most superior nutrition available. For the first 4-6 months of life, it will be the baby’s primary source of nourishment. There are, however, a few vitamin of concern recommended for supplementation during this time, including vitamin K and D.
Vitamin K is given as a single dose at the time of birth. It protects infants from hemorrhagic disease.
Vitamin D: The American Academy of Pediatrics (AAP) recommends supplementing all newborn infants with 400 IU vitamin D per day from the first few days of life until the baby transitions to drinking vitamin-D fortified milk (11-12 months of life). Vitamin D protects against Rickets, infection, and is important for the utilization of calcium in the body for the development of bone.
The first transition in the infant’s diet begins around 4-6 months of life. At this time, solid foods and infant cereals should be introduced for nutritional and developmental purposes. Nutrients of concern at this time for exclusively breastfed infants are iron, zinc, and fluoride, and also to be considered is DHA.
Iron: Full term infants usually have adequate iron stores until 6 months of life, but then require additional iron (11 mg per day until 12 months of life). This is met most often through the introduction of iron-fortified infant cereals and meats. Maintaining adequate iron status will decrease the risk of the baby developing anemia and will protect against cognitive and motor skill impairments.
Zinc: The zinc present in breastmilk is not sufficient to meet the needs of the baby after 6 months of life. 3 mg per day is recommended at this time, and like iron is met through fortified infant cereals and meats. Zinc is vital for normal growth and development, a proper sense of taste and smell, and plays a role in immune and cellular functions.
Fluoride: The AAP recommends daily supplements of 0.25 mg fluoride for infants over 6 months of age who live in areas where the water supply contains less than 0.3 ppm of fluoride, and/or are at high risk developing tooth decay.
DHA: Docosahexaenoic acid is an omega-3 fatty acid important for brain and eye development. Sources for infants include salmon, tuna, and fortified eggs. Current recommendations are 10-12 mg per kilogram of body weight.
Getting Started with Solids
Introducing solids into your infant’s diet is an exciting, and for the most part, enjoyable, a milestone. These complimentary foods will expose your infant to a variety of flavors and food textures that will influence life-long eating habits. There is no nutritional benefit to adding solids to your baby’s diet before 4 months of age, and the latest recommendations from the AAP, the World Health Organization, and the United Nations Children’s Fund encourage waiting until closer to 6 months of age.
Since all infants develop at different rates, it is important for you to look for signs of readiness in your baby and not get caught up in comparing your baby’s progression with those of another baby. Physical signs of readiness include baby being able to sit independently and maintain balance while using hands to reach and grasp for objects. They have good head and neck control. It is equally important to look out for the psychological signs of readiness. These are expressions of feelings, for example, an infant may indicate hunger by leaning toward the food and opening their mouth, or leaning back and turning away from the food to show disinterest or satiety. Respecting these expressions can reduce the anxiety that sometimes accompanies feeding a baby and will also prevent against overfeeding. It will also aid in building the foundation for self-regulation, which is very important for lowering the risk of obesity.
First foods, for nutritional reasons already discussed, are fortified infant cereals thinned to a semi-liquid consistency with breast milk. These should be introduced on a small spoon and not through a bottle or sippy cup. Pureed meats are another good first food, along with pureed vegetables and fruits. The most current AAP recommendations state that there is no need to wait a long time between introducing new foods, that 2 days is sufficient. Once a variety of single ingredient foods have been introduced and tolerated, a combination of these foods can be offered. Your baby may still have a sensitive gag reflex until about the age of 7 to 9 months, so don’t let excessive spit up alarm you. Choking, however, may indicate your baby is not quite ready for the transition inconsistency.
The introduction of solid foods does not mean the consumption of breast milk becomes any less important. The number of feedings at the breast will slowly decrease as baby’s consumption of solid foods increases between 6 to 12 months of life, but breast milk will still be the primary source of your infant’s nutrition and calories. So continue to breastfeed your baby!
Additional water is not necessary during the first year of life. Even in hot months, a baby will obtain adequate amounts of free water from breast milk. Consult your doctor on additional fluid intake if your baby experiences severe vomiting or diarrhea. The AAP strongly encourages the avoidance of juices in the first 6 months of life. Never add honey, sugar, or salt to baby food in order to entice your baby into eating it. Recent research shows that avoidance or late introduction to common allergenic foods (such as dairy products or foods made from peanuts/other nuts) may actually increase your baby’s risk for developing food allergies rather than preventing them. Yogurt can be introduced as early as 6 months, cheese around 8 months, and cow’s milk around 11-12 months of life. Peanut-containing products, eggs (yolk and white), and citrus fruits can be introduced into baby’s diet, even high-risk infants, between 4 to 11 months, but shouldn’t be the first solid foods a baby gets.
Time moves quickly, so don’t get too comfortable with the feeding stage your baby is in. Before you know it, it will be time to move onto the next step. Yes, babies do progress at different rates, but it is important to keep moving forward. Here is a general outline for age appropriate food consistencies and progression.
4-6 months: Progress from a thinned, watery texture to a pureed, smooth texture.
6-8 months: Progress from pureed texture to mashed, lumpy texture. Start practicing self-feeding skills with soft finger foods.
8-10 months: Progress from mashed, lumpy foods to soft, chopped finger foods. Just because a baby doesn’t have all their teeth doesn’t mean they can’t chew! Don’t be afraid of messes, let your baby start to play with the spoon and explore their foods. Let baby start to learn to drink from a cup by using a training cup.
10-12 months: Progress to eating mainly chopped table foods and eating with the family. Encourage self-feeding, even if it means a big mess to clean up afterward. Continue to offer a wide variety of foods. Repeated exposure will lead greater food acceptance.
Taking care of baby’s nutritional needs and leading their progression during their first year of life can be a roller coaster. Don’t get discouraged; just do your best. Try to be patient when things don’t go as planned and be sure to celebrate the victories. Together, you and baby can make the whole eating experience into a fun adventure.