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FAQs

Healthcare Professional Resources

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What is meant by ‘window of opportunity’?

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We know that babies are born with an ingrained preference for sweet and salty. However, the start of complementary feeding is a very sensitive and malleable period in an infant’s development. With the right exposure and experiences to a wide variety of healthy foods, he can and will develop lifelong healthy food preferences. Unfortunately, this also means that if an infant’s first exposures are limited to sugary processed foods, these can also enhance a lifelong preference to these foods. It is therefore important for caregivers to capitalize on this window of opportunity to introduce a wide variety of healthy nutritious foods and build healthy preferences. [4, 11, 14, 42, 50, 86] A spoonful is all that is required as this is about exposure to different tastes, not nutrition or to satisfy hunger (that is the role of milk in this early phase). [5, 13] The focus is very much on taste experiences and building the foundations for healthy preferences. 

It is also a huge advantage that by the time that solids do play an important role for nutritional requirements [14] (somewhere between 6 and 7 months), he has a good grasp and preference for these foods. If all he has been exposed to up until this point is sweet fruit and infant cereal you are more likely going to struggle to transition to healthier, more nutrient-dense alternatives. 

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My baby seems to be really hungry and has started waking at night. He is not yet 4 months old but can I start him on solids anyway?

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Some babies go through a growth spurt at around 12 weeks and may want more feeds. This is normal and does not signal the need to start solid foods. It is tempting to think that by giving some solids it may satisfy him for longer and therefore sleep for longer. Giving solids too early rarely helps these problems and may lead to other difficulties. These include:

  • Poor growth if solid food replaces breast milk or formula. Milk is a far better source of energy than solid food when babies are very young. This is because babies won’t actually get many calories from food in these early stages.
  • Loose bowel actions or diarrhea as his digestive system is not developmentally capable of digesting the food. A number of key enzymes required to digest solid foods do not start until closer to 5 and/or 6 months of age. Introducing solids before the gut is physically ready can lead to irritation and inflammation of the intestines.
  • Increased risk of tummy upsets and tummy bugs. Immune systems are still developing and will continue to do so over the next 1 to 2 years. Up until 4 months this immature immune system is unable to fight off pathogens that may be introduced with solid foods.
  • Obesity. Researchers have discovered that inflammation and changes in gut bacteria over a child’s first year of life can affect his metabolism. This can have long-term effects on energy production, insulin resistance, and the ability to burn fat. This places a child at risk of obesity and type 2 diabetes even before his 1st birthday.
  • Dehydration. Before 4 months of age, babies have a limited renal capacity to conserve fluids and excrete dissolved solids. 
  • Gagging and choking. Infants are born with a tongue-thrust reflex that automatically pushes food out of his mouth. They do not start to lose this reflex until 4 or 5 months of age. Introducing solids too early can cause babies to gag as they do not have the ability to move food to the back of the mouth to swallow. We want to keep this journey as positive as possible, even if it takes a little longer than expected. 
  • Allergies. Introducing solids too early may contribute to an increased allergy risk. [76] 

    So if he is going through a hungrier spell, instead of reaching for the solids, provide extra milk feeds.

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What does baby need from solids to optimize growth and development?

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By 6 to 7 months, his nutritional needs can no longer be filled by milk alone and the inclusion of nutrient-dense foods [23] are a must. It becomes hugely apparent that capitalizing on the window between 5 and 6 months [5] to prime his palate with a wide variety of healthy savoury flavors pays dividends. To be able to hit the ground running at 6 to 7 months with him already accepting these nutritious foods will ensure his nutrient needs to optimize growth and development are met. Adequate nutrition to optimize growth and development will not come from apple puree and infant cereal [11]! Although milk remains an important component of his diet, so do nutrient-rich foods, high in iron [24] and zinc, and balanced in good sources of fats [51], proteins [26], and carbohydrates [27].

  • Vegetables. [11] Vegetables are the most amazing wholefood group. They are packed full of essential nutrients, carbohydrates, proteins, vitamins, minerals, fiber, and even some fat, and provide the perfect slow release of energy. Instilling a preference for these powerhouses is one of the most fantastic gifts you can give to your child in terms of future health and wellbeing. 
  • Iron-rich foods. [24] Infants are born with enough iron stores to see them through the first 6 months of life. Then, due to their rapid growth and development and very high iron requirements (a 6- to 24-month-old has a greater iron requirement per kilogram of body weight than any other time in their life), they must start receiving good sources of readily available iron from the foods they eat. Sufficient dietary iron is required to ensure proper weight gain, appetite, energy levels, a healthy immune system, and is essential for optimizing cognitive and behavioural development. Unfortunately, not all iron sources are created equally. The best sources of iron are the natural ones, in particular meat, eggs, and pulses. Although infant cereals claim to be good sources of iron, in reality, it is poorly absorbed. 
  • Fats. [51] Babies need fat! Not only is it an important energy source, but it is also essential for optimal brain development, building strong immune systems, and the absorption of important fat-soluble vitamins. Yet, the sad fact is, most infant diets consist of watery cereals and fruit purees, which are very high in carbohydrates and devoid of any fat at all. So don’t be afraid of giving him healthy fat (fats that haven’t been artificially made or altered). It is, and should be their primary fuel source and is vital for metabolic health, now, and the future.
  • Good sources of proteins and carbohydrates. [26, 27] Although both essential for overall health, they must be in balance. A diet too high in protein has shown a tendency for a more rapid weight gain (and propensity to obesity), and a diet too reliant on carbohydrates as the dominant energy source can be nutrient poor, especially if they are highly refined or over-processed.

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Should I cut back on the breast milk/formula when baby starts solid foods?

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Breast milk or infant formula remains the most important nutrient source for the first year of life, and complementary foods must not be given in amounts that will dramatically reduce milk intake. This can be achieved by giving a milk feed before giving solid foods, which are then used as a ‘top-up’ at the end of the meal. At around 8 to 9 months of age, complementary foods can be offered before the milk feed. Gradually, complementary foods displace milk feeds, but breast milk or infant formula should remain a prominent part of an infant’s diet until at least 12 months old.

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How much iron does baby need?

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All babies are born with enough iron stores, passed on from their mother, to sustain them for approximately 6 months, by which time the iron requirements can no longer be met by milk alone. (Premature and low birth-weight babies are a little different so it pays to check with your pediatrician.) [45, 57, 72, 80] In fact, a 6 to 8-month-old infant requires 9 times as much iron and 4 times as much zinc, per 100g of bodyweight, as an adult male! Iron is essential to optimize brain growth, and the development of a strong immune system. However, not all iron sources are created equal. 

  • Heme iron—found in animal proteins. The best sources are red meat and dark poultry meat. Heme iron has the highest rate of absorption and utilization within the body at 15% to 35% if consumed with a good source of vitamin C. 
  • Nonheme iron—found in green leafy vegetables, eggs, tofu, and legumes. Nonheme iron has an absorption rate of 5% to 12% Therefore, a lot more would need to be consumed to achieve daily requirements, which can be difficult with such small tummies.
  • Iron salts—found predominantly in fortified formulas and infant cereals. Iron salts have an absorption rate of 2 to 5%. Although many infant cereals claim to have high levels of iron, in reality, due its poor bio-availability (absorption), it is not the best source for infants.

Therefore, incorporating meat products into your baby’s diet will be hugely beneficial in terms of meeting his iron requirements.73 The World Health Organization recommends the inclusion of meat, poultry, fish, or eggs eaten daily, or as often as possible [54]. Now, this is not to say a vegetarian diet can’t be healthy, it will just take a lot more work to ensure all his nutritional requirements are met. It is strongly advised you consult a pediatric nutritionist if you decide to go down this route.

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How much food does baby need?

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All babies are different so there certainly is no ‘one size fits all’ on portion sizes. In the beginning, most of his nutrition will be coming from milk, so it is far more important to concentrate on the quality, not the quantity [5, 9], the development of taste preferences [4], and the overall sensory experience.

Start by offering 1 to 2 teaspoons of first foods after a breast or infant formula feed. Slowly increase this to 2 to 3 tablespoons. Start offering complementary foods once a day and, as they get accustomed to it, slowly build up to 3 times a day [17]. Offer more food as your baby grows. As a rough guide:

  • 5 to 6 months 1–2 tsp, 1–2 times per day
  • 6 to 7 months 2–4 tab, 2–3 times per day
  • 7 to 9 months 3–5 tab, 3 times per day
  • 9 to 12 months 4–5 tab, 3 times per day

It is important to listen to your baby and take his cue on this. Responsive feeding [36] is allowing him to eat only as much as he wants to satisfy hunger.

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Why is gut health important?

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During the first years of life, an infant’s diet undergoes its biggest change from an exclusively liquid diet to one with a variety of complementary foods in addition to milk. This transition is necessary to support his increasing nutrient requirements, and to prepare for the cessation of breastfeeding or infant formula feeding. During this transition, an infant’s renal and gastrointestinal function must undergo significant change and maturation in order to process nonmilk foods. So establishing a healthy microbiome in the gut is essential for the digestion and metabolism of food.

Infancy is a critical time as this is when an individual lays down the blueprint for how food is metabolized. Given the rise in metabolic disorders (obesity, diabetes, cardiovascular disease), this early stage of life is the prime opportunity to build a healthy microbiome, which in turn builds a robust immune system and enables the production of neurotransmitters that affect behaviour and cognitive function. 

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What are probiotics and does my baby need a probiotic supplement?

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Probiotics are living microorganisms, the ‘good bacteria’ that live in our gut. 

The colonization of the gut with microorganisms occurs naturally through the birth process (vaginal delivery), drinking breast milk, and everyday contact with the outside world. However, with the rise of cesarean sections (disrupting the transfer of beneficial microbiota from mother to infant), declining rates of breastfeeding (another source of beneficial microbiota), and the proliferation of antibiotic use (which can destroy the beneficial microbiota), many infants are on the back foot in terms of microbiome colonization. If this is the case, and given the importance probiotics play in overall health and wellbeing [32], a supplemental probiotic may be beneficial.

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What are prebiotics?

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Prebiotics are a type of fiber that the human body cannot digest. They serve as food for probiotics. In the newborn, both probiotics [33] and prebiotics are transferred through breast milk. On receiving solid foods these prebiotics are provided through vegetables and fruits.

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Why a vegetables-first approach?

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We are all born with an innate preference for sweet foods and a dislike for bitter. However, we all know that vegetables are nutrient powerhouses and as a nation we don’t eat enough of them. What if there was a way to not only get children to eat them, but want eat them [2]? Well, there is! [19, 51] Numerous studies have indicated that the beginning of introducing solid foods is a very sensitive time in terms of learning and processing. If we capitalize on this window of opportunity [5, 45] it is possible to train preferences for a wide range of flavor profiles, including bitter and sour. Offering small tastes of a wide variety of vegetables, in their single form not masked with a sweet puree [12], on multiple occasions, helps to promote willingness and acceptance of new foods beyond infancy and into childhood/adulthood.[10, 11] A spoonful is all that is required [5] as this is about exposure to different tastes, not nutrition or satisfying hunger. The focus is very much on taste experiences and building the foundations for healthy preferences. [3, 14, 15, 21, 32]

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What is responsive feeding?

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Although infants can’t verbally tell us when they are hungry or full, they do tell us in nonverbal ways. Responsive feeding is when caregivers acknowledge and respond to these cues in ways that will foster and reinforce healthy eating habits. [30, 49, 71] Failure to do so can lead to overconsumption, poor appetite control/regulation, emotional eating, and result in an increased obesity risk. [31] It is not OK to say “just two more mouthfuls” or “finish this before you can get down” or “I know you’re not hungry but have this anyway.” Forcing your baby to eat will create an unpleasant environment, cause elevated anxiety (for both you and him), and may lead to food phobias or not wanting to eat at all.

Responsive feeding is crucial for supporting babies and children in developing appetite regulation and form the basis for healthy feeding practices [37].

Signs of hunger at 6 to 12 months old:

  • Reaches for the spoon
  • Points to the food
  • Gets excited when food is presented
  • Leans forward with mouth open
  • Distress when cues aren’t listened to

Signs baby has had enough:

  • Shakes head
  • Turns head away
  • Pushes spoon away
  • Easily distracted
  • Indicates wants to get down

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Should my baby be eating meat?

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Yes! Red meat in particular is an excellent source of iron [24, 73] which is easily absorbed, and recommended by the World Health Organization to be eaten on a regular basis [54]. Meat also provides important sources of dietary fat, B vitamins, and zinc. 

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When is it safe to introduce potentially allergenic foods?

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Although it can feel daunting to introduce potentially allergenic foods, research now shows us that leaving it for too long can actually exacerbate the problem. Evidence affirms that the early introduction of potential allergens, even in high-risk infants, can actually help protect against the development of an allergy [1]. In light of this, most guidelines around the world advise to introduce all potential allergens in the first year of life, but not before 4 months. [34, 36, 37, 55, 77] 

However, if someone in your baby’s immediate family (mother, father, sibling) is known to have a severe allergy to any of the food groups, please consult with your pediatrician first.

The American Academy of Pediatrics (AAP) New Guidelines for Infant Food Allergy Prevention

What Families Need to Know 

  1. The AAP guidelines recommend early “purposeful” introduction of allergens to help reduce your baby’s food allergy risk. 
  2. Introduce foods like peanut, egg, and milk when baby is 4 to 11 months old, regardless of baby’s risk for food allergies. 
  3. Families with infants at high risk for peanut allergies (due to family allergy history and/or severe eczema) should introduce peanuts into their baby’s diet at 4 to 6 months. 
  4. Breastfeeding alone is not enough to prevent food allergies, although it may help prevent eczema. 
  5. Feeding your baby hydrolyzed formula will not reduce your baby’s food allergy risk.

How to Introduce Allergenic Foods

  • Only introduce one new ‘allergenic food’ at a time so that if a reaction does occur, the problem food can be more easily identified. 
  • Try the food at a convenient time, earlier in the day if possible (in case there is an allergic reaction).
  • Ensure the child is otherwise well.  

Peanuts
Rub a small amount of smooth peanut butter (a good-quality peanut butter without added salt or sugar) on the inside of the infant’s lip (not on their skin). 

  • If there is no allergic reaction after a few minutes, increase to 1⁄4 teaspoon and observe for 30 minutes. 
  • If there is no allergic reaction, give 1⁄2 teaspoon and observe for a further 2 hours. If there is going to be an allergic reaction it will occur with 2 hours of exposure. If there is no allergic reaction, parents should continue to include peanuts in their infant’s diet in gradually increasing amounts at least weekly. Regular exposure helps to build immunity and decrease chances of allergies.
  • If there is an allergic reaction at any step, stop feeding peanuts to the infant and seek medical advice.

Egg
Repeat the steps above but with well-cooked egg. You can mix a small amount (1⁄4 teaspoon) of mashed hard-boiled egg with a liquid such as breast milk or formula, or into the baby’s usual food (such as vegetable puree). There is no need to separate the white and yolk.

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Can an allergic reaction happen after subsequent exposures to a food baby has previously had no reaction to?

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Yes. Allergic reactions do not always occur on the first exposure to the new food. Monitor him if it is a common allergen (e.g. peanuts, egg, dairy) for at least 6 exposures. Once introduced, it is a good idea to keep exposing him to that food on a regular basis (once a week is good) as this helps to build up his immune system to that particular food.

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What is the difference between a food allergy and a food intolerance?

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A food allergy stimulates an immune response and can result in these symptoms [46] within 2 hours of exposure. A food intolerance, on the other hand , results in a range of mainly digestive symptoms, including abdominal bloating, wind, diarrhea, nausea, and indigestion. However, a food intolerance can also result in eczema flare-ups and/or asthma. Sometimes these symptoms can mimic other medical conditions and it’s advised you follow up with your pediatrician.

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What are the signs my baby might be constipated?

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Some straining during pooping is OK. However, if coupled with the following symptoms, it might pay to have it checked out with your pediatrician.

  • Gone longer than 5 days without a bowel movement
  • Significant discomfort and off his regular feeds
  • Pellet-sized and/or dry hard stools
  • Firm, distended belly
  • Blood in stools or nappy (not to be confused with beetroot as it can look alarmingly similar!)

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What are the common causes of constipation?

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  • Immature digestive system. While his digestive system adapts to digesting solids, constipation and/or diarrhea can be common. Generally, this subsides as his body learns to process food, however, you might want to take it slowly on the solids until then, or try different foods [link 58]. 
  • Dehydration through too much solid food and not enough milk. Sometimes his eagerness to consume large amounts of solids can result in little room for his milk feeds. It is therefore important that, especially in the early phases of introducing solids, that the milk feed comes before his solid feeds. Remember, his solids should be complementary to his milk, not replacing it. You can also introduce a small amount of water in a cup at meal times.
  • Dehydration through illness. A recent tummy upset can result in dehydration, especially if he had been vomiting and/or had diarrhea. A common cold can also make it harder for him to breath and drink at the same time as well as decrease his appetite. Try smaller, more regular feeds to keep hydration levels up and if concerned, contact your pediatrician.
  • Some medications. Iron supplements in particular are known to firm up stools. Note: It is important you discuss any discontinuation of medication with your pediatrician before you make assumptions and stop on your own accord.
  • Travel, heat, and stress. Increasing fluids during particularly warm weather can help prevent dehydration.
  • Lack of fiber. A diet limited to low-fibre solid foods (highly refined infant cereal, apple sauce, dairy products) can result in constipation. A diet rich in a rainbow of vegetables (and some fruits) and when appropriate, wholegrains [57], will provide the fiber necessary for normal bowel movements [60].

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How can you relieve and manage constipation?

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Providing there are no underlying causes, constipation can be quickly turned around without medical intervention. Here are some things to keep in mind:

  • Avoid constipating foods. Foods known to increase constipation include apple sauce, baby rice, white bread, pasta, and high-fructose fruits such as banana. 
  • Include high-fiber foods regularly in his diet. Most vegetables are high in fiber so make excellent first food choices! Fibrous green leafy vegetables and sweet potato are particularly good, as are many of the fruits beginning with ‘P’—prunes, pears, plums, and papaya. However, all fruit must be provided in balance with the rest of his diet.
  • Leg action! Lying him on his back and doing bicycle-leg actions can help, as can a warm bath (also great for leg actions). Giving his tummy a gentle massage can also encourage bowel movements.
  • Probiotics. If constipation becomes a regular occurrence, an infant probiotic [33] might be beneficial.

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His stools have changed color—is that normal?

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You may notice a change in his stools when he starts solids. It is quite normal for them to change in color, consistency, and even smell. Typically stools will become more solid and stronger in odor. Peas and other green vegetables can result in green-colored stools while beets can make them red. Stools may also contain undigested pieces of food. This is normal as the immature gut needs time before it can fully process these new foods. If the stools are extremely watery or full of mucous, it may mean the digestive system is irritated. Try cutting back on the amount of solids but ensure he is still receiving the milk feeds. If it continues, consult with your pediatrician.

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When is it OK to give him cereals and grains?

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In order for him to be able to digest cereals and grains he needs to make use of enzymes he produces to break these down to release nutrients. However, the particular enzyme he requires, pancreatic amylase, is not produced until the second half of his first year (6 to 12 months). Although there will be no drastic effect (in most children) in introducing grains before this enzyme is present, it will mean that the nutrients from the grains may not be well absorbed. Undigested product can also begin to irritate an immature digestive system, effecting the balance of bacteria and microbiota [32]. Therefore, the general consensus is to wait until at least 6 months before incorporating small amounts of cereals/grains, preferably wholegrain, [87, 89] into his diet. It is also important to offer a nutritionally dense [23] diet of varied flavors and textures to train healthy eating habits [1], and to limit highly refined and processed foods [50].

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Disclaimer: The information provided is the opinion of Good Feeding, it has not been evaluated by healthcare professionals, and is for educational purposes only.  Before starting any new foods or feeding practices, please consult your baby's healthcare professional.