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good feeding

References and sources

All [numbers] are references and sources used to substantiate our FAQ content, click here to return.

[1.] ‘Fast Facts Introducing foods and allergy prevention,’ Australasian Society of Clinical Immunology and Allergy Ltd (ASCIA), https://www.allergy.org.au/patients/fast-facts/food-and-allergy-prevention

‘How to introduce solid foods for allergy prevention,’https://www.allergy.org.au/images/pcc/ASCIA_PCC_How_to_introduce_solid_foods_FAQ_2019.pdf

‘Allergy Prevention FAQs,
https://www.allergy.org.au/images/pcc/ASCIA_PCC_Allergy_prevention_FAQs_2019.pdf
‘National Allergy Strategy Nip Allergies in the Bub,’ https://preventallergies.org.au/

[2.]  ‘A systematic review of practices to promote vegetable acceptance in the first three years of life,’ Coraline Barends, Hugo Weenen, Janet Warren, Marion M. Hetherington, Ceesde Graaf,  Jeanne H.M. de Vries, Appetite, Volume 137, 1 June 2019, pp 174–197, https://doi.org/10.1016/j.appet.2019.02.003

…Based on the papers reviewed, we conclude that introducing vegetables at the beginning of complementary feeding, giving a different type of vegetable every day and ensuring repeated exposure to the same vegetable following an interval of a few days are the most promising strategies to promote vegetable intake in children starting complementary feeding until they are 3 years of age…

[3.] ‘Complementary feeding: Vegetables first, frequently and in variety,’ L. Chambers, Nutrition Bulletin, Volume 41, Issue 2, June 2016, pp 142–146, https://doi.org/10.1111/nbu.12202

…The start of complementary feeding is a sensitive period for the development of food preferences, as infants will readily accept new foods and quickly learn to like them. Repeated exposure to a variety of vegetables during complementary feeding is an effective way to encourage infants to accept these foods. Recent research has suggested that offering vegetables exclusively for the first few weeks of complementary feeding offers additional benefits, but survey data indicate that this is not yet commonly practised…

[4.] Ibid. …The complementary feeding period, when foods other than milk are first offered, marks the beginning of infants’ food education and is often called the ‘sensitive period’ or ‘critical window’ for developing a broad repertoire of food preferences… 

[5.] Ibid. …Importantly, infants need not consume much of a food at each exposure to acquire liking – a mouthful or two is all that is needed…

[6.] Ibid. …Because fruits are sweet and not bitter, they can be more readily and enthusiastically accepted by infants than vegetables. This means that parents may need to be persistent when offering certain types of vegetables (particularly those that do not have much sweet flavour), but many presume that their child does not like a food after only limited number of rejections before the child has had the chance to learn to like the food. During complementary feeding, parents may cease to offer a food because interest or surprise expressed on their infant's face has been misinterpreted as disgust. Some parents may resort to serving vegetables mixed or hidden in dishes that include other more liked foods, and although this approach may increase infants’ intake of these vegetables in the short‐term, compared to serving individual unmixed vegetables, it may have less of a positive impact on liking for these foods over the longer term…

[7.] Ibid, …Recently, research from a number of groups provides evidence that a ‘vegetables first’ approach is a simple and effective way to promote vegetable liking in infants… 

[8.] ‘Developmental and Environmental Influences on Young Children’s Vegetable Preferences and Consumption,’ Susan L. Johnson, Adv Nutr, Jan 2016, 7(1):220S–231S, published online Jan 7, 2016, https://doi.org/10.3945/an.115.008706

…Children’s caregivers are the gatekeepers of exposure to a variety of foods. What, when, and how caregivers offer foods to children arguably has as much influence as biology on children’s food preferences and acceptance. Caregivers’ decisions about the foods they choose to consume (and model); which foods they offer to their children; the frequency, consistency, and amounts that they offer; and their expectations for children’s consumption are critically important in understanding children’s dietary intakes. The available evidence supports that early exposure to vegetable flavours in utero and through breastfeeding, as well as the timing, variety, and consistency of introduction of vegetables during the weaning period and beyond, sets the stage for optimal vegetable acceptance and consumption…

[9.] ‘Reaching consensus on a ‘vegetables first’ approach to complementary feeding,’ L. ChambersM. Hetherington L. CookeH. CoulthardM. FewtrellP. Emmett, Nutrition Bulletin, Volume 41, Issue 3, https://doi.org/10.1111/nbu.12220

 …With a focus on food acclimatisation rather than nutrition per se (i.e. ‘tiny tastes’ of small quantities of food that do not compromise breastfeeding), it was agreed that the 4–6 month period can be an appropriate time to introduce tastes of solid foods, if the foods are of the appropriate type, texture and amount for the developmental age of the infant…

[10.] Ibid. …Studies that have specifically tested the benefits of introducing a variety of vegetable tastes exclusively for the first 2 weeks of complementary feeding were discussed and it was agreed that this approach can increase vegetable acceptance in the short and longer term…

[11.] Ibid. …The complementary feeding period is a ‘window of opportunity’ to familiarise infants with a wide variety of foods because, at this stage, infants’ openness to trying new foods is at its peak and familiar foods are likely to become preferred foods, with these acquired preferences ‘tracking’ into later childhood. The lack of sweet flavour and low energy density of many vegetables and some fruits means that these foods may be rejected by children and extra efforts may need to be put in place to help them accept these foods. The scientific literature indicates that repeated exposure to vegetables, offering a wide variety of vegetables and introducing vegetables as first foods during complementary feeding can increase vegetable acceptance in early life and in later childhood…

[12.] ‘Complementary Feeding in Developed Countries: The 3 Ws (When, What, and Why?),’ C. Campoy, D. Campos,  T. Cerdó, E. Diéguez, J. A. García-Santos, Ann Nutr Metab, 2018:73(suppl 1):27–36, https://doi.org/10.1159/000490086

There is growing evidence that healthy feeding practices during the CF period have positive short- and long-term effects on optimal growth, body composition, neurodevelopment, healthy food preferences, and gut microbiota composition and function; adequate and healthy CF may also diminish the risk of infections, allergies, type 1 diabetes mellitus, as well as celiac and non-communicable diseases… 

[13.] ‘An exploratory trial of parental advice for increasing vegetable acceptance in infancy,’

Fildes, C. Lopes, P. Moreira, G. Moschonis, A. Oliveira, C. Mavrogianni, Y. Manios, R. Beeken, J Wardle, L. Cooke, Br J Nutr, 2015, 114, 328–336, https://www.ncbi.nlm.nih.gov/pubmed/26063588

…An important predictor of children’s fruit and vegetable consumption is their enjoyment of these foods. Innate preferences for sweet tastes and dislike of sour or bitter tastes mean that fruit is readily accepted, but that liking for vegetables may be harder to achieve. However, innate preferences can be modified through pre- and post-natal experiences. Flavours become more acceptable as they grow in familiarity and there is unequivocal evidence in young children that intake and liking for unfamiliar foods can be increased through repeated exposure, i.e. providing repeated opportunities to taste small quantities of the food...

[14.] Ibid. …Between the ages of 4 and 7 months, infants are highly receptive to new flavours and textures, requiring fewer exposures than older children to increase acceptance. Exposing children to the taste of commonly rejected foods, such as vegetables, may be most effective in early infancy before the onset of food neophobia or pickiness (a normal developmental stage during the second year of life). Since food preferences develop early and have been shown to track through later childhood and into adulthood, early intervention is likely to reap the greatest benefit…

[15.] Ibid. …Findings provide support for previous research showing repeated exposure to vegetables during complementary feeding can impact positively on infants’ vegetable acceptance and daily changes in the variety of vegetables consumed increase acceptance of a novel food… 

[16.] ‘Baby’s first bites: a randomized controlled trial to assess the effects of vegetable-exposure and sensitive feeding on vegetable acceptance, eating behavior and weight gain in infants and toddlers,’ S.M.C. van der Veek, C. de Graaf, J.H.M. de Vries, G. Jager,  C. M. J. L. Vereijken, H. Weenen, N. van Winden, M.S. van Vliet, J.M. Schultink, V.W.T. de Wild, S. Janssen, J. Mesman, BMC Pediatrics, 2019, 19:266, published online Aug 1, 2019, https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-019-1627-z

…The start of complementary feeding in infancy plays an essential role in promoting healthy eating habits. Evidence shows that it is important what infants are offered during this first introduction of solid foods: e.g. starting exclusively with vegetables is more successful for vegetable acceptance than starting with fruits. How infants are introduced to solid foods also matter…

[17.] Ibid. …Poor eating habits, such as consuming too little vegetables and eating in the absence of hunger increase the risk of developing overweight and obesity, and related diseases such as type II diabetes, cardiovascular disease, and certain cancers. Both children’s food preferences and their ability to self-regulate their energy intake are influenced by their direct environment already in the first two years of life. Therefore, promoting a healthy diet and healthy eating habits and behavior from infancy is essential…

[18.] ‘Effects of repeated exposure on acceptance of initially disliked vegetables in 7-month- old infants,’ Andrea Maier, Clair Chabanet, Benoist Schaal, Sylvie Issanchou, Peter Leatherwood, Food Quality and Preference, Volume 18, Issue 8, December 2007, pp 1023–1032, https://doi.org/10.1016/j.foodqual.2007.04.005

…The present study shows that when a vegetable is initially disliked it is worth persisting in feeding it for at least eight subsequent meals…

[19.] ‘Effects of starting weaning exclusively with vegetables on vegetable intake at the age of 12 and 23 months,’ C. Barends C, J.H. de Vries, J. Mojet, C. de Graaf, Appetite, Oct 2014, 81:193–9, published online June 25, 2014, https://www.ncbi.nlm.nih.gov/pubmed/24973508 

…The low vegetable intake in children may be attributed to their low preference for vegetables. During the first year of life, first taste preferences are formed, which may track over time. In a previous study to increase infants’ vegetable intake and liking, we found that at the start of weaning, infants had a higher vegetable intake in the lab after repeated exposure to vegetable purées than to fruit purées. The current study is a follow-up of these infants at the age of 12 and 23 months, and examined whether the group that started weaning with vegetables continued eating more vegetables than the group that started weaning with fruits.

Conclusion: These findings suggest that weaning exclusively with vegetables results in a higher daily vegetable consumption until at least 12 months of age…

[20.] ‘Maternal feeding practices during the first year and their impact on infants’ acceptance of complementary food,’ C. Lange, M. Visalli, S. Jacob, C. Chabanet, P. Schlich, S. Nicklaus, Food Quality and Preference, Volume 29, Issue 2, September 2013, pp 89–98, https://doi.org/10.1016/j.foodqual.2013.03.005

…The introduction of weaning foods is a major transition in the development of infants’ eating behavior. Previous studies showed that greater variety at the beginning of the weaning period can later influence an infant’s acceptance of new foods…

[21.] Ibid. …The earlier vegetables were introduced, the higher the acceptance of new vegetables was. New food acceptance was significantly correlated with the number of different foods offered in the first two months of weaning, particularly for fruits and vegetables. These results highlight the ease of introducing new foods into a child’s diet in the period between 4 and 15 months and the role of maternal complementary feeding practices on infants’ acceptance of new foods… 

[22.] ‘Vegetable and Fruit Acceptance during Infancy: Impact of Ontogeny, Genetics, and Early Experiences,’ Julie A. Mennella, Ashley R. Reiter, Loran M. Daniels, Ann Nutr Metab, 2019,74(suppl 2):29–42, DOI:10.1159/000499145 

...Feeding fruits and vegetables to weaning infants activates distinct, stereotyped motor behaviors of the orofacial region: brow lowerer (A), inner brow raise (B), squint (C), nose wrinkle (D), upper lip raise (E), and gape (F). Reproduced with permission from Pediatrics, Vol 120, pp 1247–54, Copyright 2007 by the AAP (86). 

[23.] ‘Feeding Practices and Parenting: A Pathway to Child Health and Family Happiness,’ Lynne Allison Daniels, Ann Nutr Metab, 2019, 74(suppl 2):29–42, https://doi.org/10.1159/000499145

…genetics and the early feeding environment interact to shape child food preferences, dietary intake and behaviours [6]. These lay the foundation for life-long eating habits and behaviours, which in turn are powerful predictors of long-term health outcomes, such as obesity, diabetes, cardiovascular disease and some cancers…

[24.] Ibid. …Infants are born with predispositions that include a preference for sweet tastes and rejection of bitter/sour tastes and novel or unfamiliar foods. These genetic predispositions probably had evolutionary advantages whereby the child readily accepted sweet energy-dense foods (including breast milk) and avoided bitter (e.g., vegetables) and unfamiliar foods that were potentially toxic. These preferences are no longer adaptive in our current food environment where our food supply is largely safe, energy-dense foods are readily available and childhood obesity is prevalent [15-18]. Neophobia or rejection of novel foods is present from weaning and strengthens with child autonomy to peak at 2–5 years of age [1718]. These inborn heritable preferences can be modified by early feeding experiences, such as repeated neutral exposure to facilitate familiarity and acceptance [16-21]. It appears that food likes and dislikes are broadly established by 3–5 years of age and persist over time [1821]. Infants also have an inborn capacity to regulate their energy intake to need and operationalise this via cues of hunger and satiety. Parent recognition and responses to these cues are an integral component of food parenting and can either support or undermine this intrinsic self-regulation, which provides the foundation for healthy growth and long-term weight status…

[25.] Ibid. …From a sociological perspective, even in our contemporary societies, there are pervasive expectations that “good women” are “good mothers” and “good mothers” feed their children well. Adding to these pressures are well-intentioned but potentially misinformed and unhelpful advice from family and friends and an abundance of information of highly variable validity available on the internet. Despite good intentions, parents are likely to use traditional feeding practices advised and supported by family and friends without understanding the potential impact on child health in the context of the radically changed contemporary food supply [215]. The “obesity epidemic” further adds to parent pressure. There is heightened awareness of the adverse short- and long-term outcomes of overweight/obesity. With around 25% of children and up to 70% of adults above the healthy weight range [45], this is a salient issue for many families…

[26.] Ibid. …It is no wonder parents find the “what, when, where and how” of food parenting a source of concern and conflict…

[27.] Ibid. …Food preferences are an important factor in food acceptance and choice (“what”), which in turn are key determinants of eating habits [1718]. As indicated above, infants are born predisposed to prefer sweet tastes and reject bitter/sour and unfamiliar foods (neophobia). Whilst these traits are heritable, they are also modified by early feeding experience…

[28.] Ibid. …There is considerable evidence that repeated neutral (i.e., non-coercive) exposure to a wide variety of foods, particularly whilst neophobia is relatively low (4–10 months) [1637], can ameliorate these innate preferences and promote new food acceptance and improved dietary variety [19] and dietary quality…

[29.] Ibid. …In our current food environment, there are plenty of opportunities for infants/toddlers to experience and learn to like unhealthy (high-sugar/fat, low-nutrient) foods. Indeed, early exposure to unhealthy foods is associated with enhanced preference and potentially increased intake of these foods…

[30.] Ibid. …In summary, effective food parenting practices have the capacity to positively influence the development of early taste preference, texture tolerance and appetite regulation that lay the foundation for life-long healthy food preferences and eating behaviours…

[31.] Ibid. …Parents frequently misinterpret developmentally normal child eating behaviours, such as food refusal, as cause for concern and anxiety and respond with coercive feeding practices (pressure, restriction, emotional feeding). Clinical experience indicates that parents, in an attempt to just get a few more mouthfuls of food into their toddler, can resort to quite bizarre feeding practices that are a source of stress and distress for both parent and child. These parent-centred authoritarian practices may be well intentioned but are both counterproductive and associated with poor outcomes for child health, including development of food preferences and appetite regulation, which lay the foundation for life-long healthy eating habits and chronic disease risk…

[32.] ‘Reaching consensus on a ‘vegetables first’ approach to complementary feeding,’ L. Chambers, M. Hetherington, L. Cooke, H. Coulthard, M. Fewtrell, P. Emmett, Nutrition Bulletin, Volume, 41, Issue 3, September 2016, https://doi.org/10.1111/nbu.12220

…On 5 May 2016, the British Nutrition Foundation (BNF) invited leading infant feeding experts to discuss and debate the strength of the evidence base on a ‘vegetables first’ approach to complementary feeding. Consensus was reached on the translation of the science into practical messages for parents/carers. In particular, it is known that familiarising infants with a variety of vegetables from the start of complementary feeding increases the likelihood that vegetables will be accepted throughout childhood…

[33.] ‘Timing of Food Introduction and the Risk of Food Allergy,’ Valentina Ferraro, Stefania Zanconato and Silvia Carraro, Nutrients, May 2019, 11(5):1131, published online May 21, 2019, DOI:10.3390/nu11051131

…In the present review, focusing on cow’s milk protein, hen’s eggs, peanuts, soy, wheat and fish, we describe the current scientific evidence on the relationship between timing of these foods’ introduction in infants’ diet and allergy development... 

[34.] Ibid. …The available studies suggest that the introduction of allergenic foods should not to be postponed beyond 4–6 months of age, both in high- and low-risk infants. Nonetheless, based on existing data, the only clear recommendation concerns the early introduction of peanut between 4 and 11 months of age as a prevention measure to reduce food allergies in infants at high risk, even if the safety and practicality of doing so has not yet been fully explored…

[35.] Learning Early About Peanut allergy, Immune Tolerance Network, www.leapstudy.co.uk

…Given its severe nature and the absence of a cure, prevention remains our best hope to reduce peanut allergy in children. But how exactly can peanut allergy be prevented? Does eating peanuts during infancy make the immune system tolerant or sensitive to peanuts consumed later on? Does one approach work better than the other in preventing peanut allergy in children? These are the important questions the LEAP Study seeks to answer…

[36.] Ibid. …LEAP (Learning Early About Peanut allergy) is a randomized controlled clinical trial designed and conducted by the Immune Tolerant Network (ITN) to determine the best strategy to prevent peanut allergy in young children. 640 children between 4 and 11 months of age who were identified as high risk for peanut allergy, based on an existing egg allergy and/or severe eczema, were enrolled in the study...

[37.] Ibid. …“For decades allergists have been recommending that young infants avoid consuming allergenic foods such as peanut to prevent food allergies,” notes Professor Lack, the lead investigator for the LEAP study. “Our findings suggest that this advice was incorrect and may have contributed to the rise in the peanut and other food allergies.” 

[38.] ‘The AAP’s New Guidelines for Infant Food Allergy Prevention: What Families Need to Know,’ Jessica Huhn, https://readysetfood.com/blogs/community/the-aap-s-new-guidelines-for-infant-food-allergy-prevention-what-families-need-to-know

On March 18, 2019, the American Academy of Pediatrics (AAP) released new guidelines for preventing childhood food allergies and other allergic conditions, such as eczema. These guidelines are based on a review of all current evidence from clinical studies, including the recent landmark LEAP (Learning Early About Peanut Allergy) and EAT (Enquiring About Tolerance) studies on food allergy prevention. Most notably, the new guidelines recommend introducing your baby to allergenic foods as early as 4 to 6 months of age, to help reduce their risk of developing food allergies. 
“After a thorough review of the latest research on allergy prevention, the AAP issued updated guidance that reinforces that there is no reason for parents to delay allergen introduction, explains Board-certified Allergist Katie Marks-Cogan, M.D. “In fact, parents should introduce allergens as early as 4-6 months according to the AAP and recent landmark studies. In addition, the AAP simplifies the advice for prevention by recommending early allergen introduction as the first line of defense against food allergies, even for breastfed or hydrolyzed formula-fed infants.”   

[39.] ‘Baby-led weaning: what a systematic review of the literature adds on,’ Enza D’AuriaMarcello BergaminiAnnamaria StaianoGiuseppe BanderaliErica Pendezza, Francesca PenaginiGian Vincenzo ZuccottiDiego Giampietro PeroniItal J Pediatr, 2018, 44:49, published online May 3, 2018, DOI:10.1186/s13052-018-0487-8

There are still major unresolved issues about baby-led weaning that require answers from research and that should be considered when advices are requested from health professionals by parents willing to approach this method…

[40.] ‘American Heart Association baby choking classes in Concord, CA,’ ConcordCPRClasses, https://www.youtube.com/watch?v=Qtn6LYszD

[41.] ‘Iron requirements of infants and toddlers,’ M. Domellöf, C. Braegger, C. Campoy, V. Colomb, T. Decsi, M. Fewtrell, I. Hojsak, W. Mihatsch, C. Molgaard, R. Shamir, D. Turck, J. van Goudoever,  ESPGHAN Committee on Nutrition, J Pediatr Gastroenterol Nutr, Jan 2014, 58(1):119–29, DOI:10.1097/MPG.0000000000000206

…Iron deficiency (ID) is the most common micronutrient deficiency worldwide and young children are a special risk group because their rapid growth leads to high iron requirements. Risk factors associated with a higher prevalence of ID anemia (IDA) include low birth weight, high cow's-milk intake, low intake of iron-rich complementary foods, low socioeconomic status, and immigrant status…

[42.] ‘Managing weaning problems and complementary feeding,’ Lucy Cooke, Úna McCrann, Claire Higgins, Paedeatrics and Child Health, August 2013, Volume 23, Issue 8, pp 346–350, https://doi.org/10.1016/j.paed.2013.06.010 

…There is some evidence of a critical period for flavour acceptance between 4 and 7 months, when infants are particularly receptive to new tastes. It is important to capitalize on this window of opportunity…

[43.] Ibid. …There is no doubt as to the importance of introducing texture to an infants diet as soon as possible after 6 months. Studies have shown that pickiness us reduced and dietary variety increased when children experience lumpy textures relatively early on… 

[44.] Ibid. …Allow them to explore the food so that they can see, touch and smell the food, regardless of the resulting mess. It is vital that an infant explores food for themselves. Giving an extra spoon allows them to begin to learn…

[45.] ‘Development of healthy eating habits early in life. Review of recent evidence and selected guidelines,’ C. Schwartz, P.A. Scholtens, A. Lalanne, H. Weenen, S. Nicklaus, Appetite, Dec 2011, 57(3):796–807, published online May 27, 2011, DOI:10.1016/j.appet.2011.05.316 

… Introduction of new foods at weaning is relatively easy: between 5 and 7 months, most initial reactions to new foods were positive and even the most bitter or sour tasting foods were accepted. The beginning of weaning thus appears to be a particularly favourable period to discover new foods and in particular vegetable flavors… 

[46.] Ibid. … At least 8 repeated exposures were found to be needed to achieve that an initially rejected vegetable is consumed as much as an initially accepted vegetable… 

[47.] Ibid. …Children should be given textured foods to increase their oral motor skills at the time they are developmentally ready, that us around 6-7 months to prevent from developing later feeding problems. Children who were introduced to lumpy foods after the age of 10 months had more feeding problems at the age of 15 months than those introduced to lumpy foods before the age of 10 months. Likewise, 7-year-old children who were introduced to lumpy foods after 10 months had more feeding problems (including “not eating sufficient amounts”, “refusal to eat the right amount” and “being choosy with food”…

[48.] Early Flavor Learning and its Impact on Later Feeding Behavior,’ G.K. Beauchamp, J.A. Mennella, J Pediatr Gastroenterol Nutr, Mar 2009, 48 Suppl 1:S25–30, DOI:10.1097/MPG.0b013e31819774a5

…Sweet, umami, and salty substances are innately preferred, whereas bitter and many sour substances are innately rejected. Nevertheless, these innate tendencies can be modified by pre- and postnatal experiences…

[49.] ‘Responsive feeding: establishing healthy eating behaviour early on in life,’ J. Harbron, S. Booley, B. Najaar (Mnutrition), C.E. Day, S Afr J Clin Nutr, 2013, 26(3)(Supplement):S141–149, https://www.ajol.info/index.php/sajcn/article/viewFile/97829/87130

…Responsive feeding (RF) refers to a reciprocal relationship between an infant or child and his or her caregiver that is characterised by the child communicating feelings of hunger and satiety through verbal or nonverbal cues, followed by an immediate response from the caregiver. The response includes the provision of appropriate and nutritious food in a supportive manner, while maintaining an appropriate feeding environment. The literature indicates that RF is the foundation for the development of healthy eating behaviour and optimal skills for self-regulation and self-control of food intake. Therefore, practising RF is associated with ideal growth standards, optimal nutrient intake and long-term regulation of weight. On the other hand, nonresponsive feeding (NRF) practices are associated with feeding problems and the development of under- or overnutrition. Different types of NRF behaviour have been described, where the caregiver is either uninvolved during meals, too restrictive or controlling, or allows the child to control mealtimes. Consequently, mealtimes may become cumbersome, characterised by inconsistent, nonresponsive interaction, and may result in a relationship that is lacking in trust. The effects of RF and NRF are reviewed in this article and the practical guideline to “Feed slowly and patiently, and encourage your baby to eat, but do not force them”… 

[50.] ‘Promoting healthy food preferences from the start: a narrative review of food preference learning from the prenatal period through early childhood,’ S. Anzman-Frasca, A.K. Ventura, S. Ehrenberg, K.P. Myers, Obes Rev, Apr 2018, 19(4):576–604, publishised online Dec 20, 2017, DOI:10.1111/obr.12658 

…The palatable, energy-dense foods that characterize modern environments can promote unhealthy eating habits, along with humans’ predispositions to accept sweet tastes and reject those that are sour or bitter. Yet food preferences are malleable, and examining food preference learning during early life can highlight ways to promote acceptance of healthier foods. Exposure to a variety of healthy foods from the start, including during the prenatal period, early milk-feeding and the introduction to complementary foods and beverages, can support subsequent acceptance of those foods. Yet development is plastic, and healthier food preferences can still be promoted after infancy. In early childhood, research supports starting with the simplest strategies, such as repeated exposure and modelling, reserving other strategies for use when needed to motivate the initial tasting necessary for repeated exposure effects to begin. This review can help caregivers and practitioners to promote the development of healthy food preferences early in life… 

[51.] ‘The role of taste in food acceptance at the beginning of complementary feeding,’ Camille Schwartz, Claire Chabanet, Christine Lange, Sylvie Issanchou, Sophie Nicklaus, Food Quality and Preference, Volume 29, Issue 2, September 2013, pp 157–165,

https://doi.org/10.1016/j.physbeh.2011.04.061

…At the beginning of complementary feeding, no clear rejection of the most bitter and sour tasting foods were evidenced since most infants accepted newly introduced foods…

[52.] ‘Guiding Principals For Complementary Feeding,’ World Health Organization,

https://www.who.int/nutrition/publications/guiding_principles_compfeeding_breastfed.pdf

…Adequate nutrition during infancy and early childhood is fundamental to the development of each child’s full human potential. It is well recognized that the period from birth to two years of age is a “critical window” for the promotion of optimal growth, health and behavioral development… 

[53.] Ibid. …Because of the rapid rate of growth and development during the first two years of life, nutrient needs per unit body weight of infants and young children are very high. Breast milk can make a substantial contribution to the total nutrient intake of children between 6 and 24 months of age, particularly for protein and many of the vitamins. However, breast milk is relatively low in several minerals such as iron and zinc, even after accounting for bioavailability. At 9-11 months of age, for example, the proportion of the Recommended Nutrient Intake that needs to be supplied by complementary foods is 97% for iron, 86% for zinc, 81% for phosphorus, 76% for magnesium, 73% for sodium and 72% for calcium (Dewey, 2001). Given the relatively small amounts of complementary foods that are consumed at 6-24 months (see #5 above), the nutrient density (amount of each nutrient per 100 kcal of food) of complementary foods needs to be very high… 

[54.] Ibid. …Feed a variety of foods to ensure that nutrient needs are met. Meat, poultry, fish or eggs should be eaten daily, or as often as possible. Vegetarian diets cannot meet nutrient needs at this age unless nutrient supplements or fortified products are used…

[55.] ‘Food allergy: Update on prevention and tolerance,’ George Du Toit, MB, BCh, Hugh A. Sampson, MD, Marshall Plaut, MD, A. Wesley Burks, MD, Cezmi A. Akdis, MD, Gideon Lack, MB, BCh, FRCPCH, Journal of Allergy and Clinical Immunology, Volume 141, Issue 1, January 2018, pp 30–40, https://doi.org/10.1016/j.jaci.2017.11.010

Health recommendations now actively encourage the early introduction of peanut for the prevention of peanut allergy, and other countries/settings recommend the inclusion of potential common food allergens, including peanut and egg, in complementary feeding regimens commencing at approximately 6 months but not before 4 months of age.

[56.] ‘Gagging and Choking when Starting Solid Foods,’ New Ways Nutrition, https://www.youtube.com/watch?v=2u2IpbP-aBU

Choking and Gagging when Starting Solids with Baby,’ Jennifer House, https://www.youtube.com/watch?v=kvoE2EhEQiM

Choking or Gagging?,’ First Aid For Life, https://www.youtube.com/watch?v=ZRp99WrVaRs

[57.] ‘First Aid for the choking child or baby,’ CPR Kids TV, https://www.youtube.com/watch?v=94j_xAhNR9s

[58.] ‘Variety and content of commercial infant and toddler vegetable products manufactured and sold in the United States,’ Kameron J. ModingMackenzie J. FerranteLaura L. BellowsAlyssa J. BakkeJohn E. HayesSusan L. Johnson, Am J Clin Nutr, Apr 2018, 107(4): 576–583, published online 9 Apr, 2018, DOI:10.1093/ajcn/nqx079

…The flavors infants and toddlers are exposed to during complementary feeding provide the foundation for later food acceptance (4–6). Infants are predisposed to accept sweetness with ease, but they must learn to accept the bitterness commonly found in dark green vegetables (23). Eventual acceptance of initially aversive flavors can be accomplished through repeated exposure (15). However, the present data suggest the commercially available ITFs in the United States may not provide caregivers with the variety and specificity of products they need to adequately expose their infants and toddlers to vegetable flavors…

[59.] Ibid. …It is recommended that older infants and toddlers be exposed to the natural textures of foods (i.e., lumpy or mixed textures) to assist their transition from puréed foods to table foods (7). Present analyses suggest the US ITF market lacks single-vegetable products that vary in type and texture, leaving caregivers without adequate options for convenient products that facilitate future acceptance of the flavors and textures found in a variety of vegetables…

[60.] Ibid. …Infants introduced to a limited variety of nutrient-dense foods may have limited opportunities to build positive eating habits (17). Furthermore, greater vegetable consumption associates with decreased chronic disease risk [e.g., cardiovascular disease (18) and diabetes (19)]. Consumption of dark leafy greens, in particular, has been linked to the largest risk reduction in both cardiovascular disease and cancer (18). Evidence shows that micronutrients and other components from fruits and vegetables are biologically beneficial (7). Fiber intake from vegetable (and fruit) consumption is important as fiber intake in young children seldom approaches recommendations and often relates to common issues (e.g., constipation) that are reported during well-child visits (2021)…

[61.] ‘Developmental and Environmental Influences on Young Children’s Vegetable Preferences and Consumption,’ Susan L. Johnson, Adv Nutr, Jan 2016, 7(1):220S–231S, https://doi.org/10.3945/an.115.008706

…The case for focusing on improvements in early childhood eating behaviors, with the aim of achieving optimal health and mitigating later chronic disease, is strongly made in the Scientific Report of the 2015 Dietary Guidelines for Americans…

[62.] Ibid. …Numerous studies have reported a positive relation between maternal vegetable intake and children’s vegetable consumption, and this effect has been attributed to both the availability of vegetables in the home and to parental modeling of vegetable consumption…

[63.] Ibid. …Positive parental feeding practices that have been associated with greater acceptance and ingestion of vegetables by young children are child-centered in nature and are consistent with what has been termed “responsive feeding” …

[64.] Ibid. …Children’s caregivers are the gatekeepers of exposure to a variety of foods. What, when, and how caregivers offer foods to children arguably has as much influence as biology on children’s food preferences and acceptance. Caregivers’ decisions about the foods they choose to consume (and model); which foods they offer to their children; the frequency, consistency, and amounts that they offer; and their expectations for children’s consumption are critically important in understanding children’s dietary intakes. The available evidence supports that early exposure to vegetable flavors in utero and through breastfeeding, as well as the timing, variety, and consistency of introduction of vegetables during the weaning period and beyond, sets the stage for optimal vegetable acceptance and consumption…

[65.] ‘Environmental Forces that Shape Early Development: What We Know and Still Need to Know,’ Kartik ShankarR.T. PivikSusan L. JohnsonBen van OmmenElieke DemmerRobert Murray, Curr Dev Nutr, Aug 2018, 2(8):nzx002, DOI:10.3945/cdn.117.001826

…Research has shown the importance of initial experiences with food on later food preferences and dietary habits (96, 97). Typically, nonmilk foods offered during the second 6 mo of life represent the child’s most intensive period of exposure to the many tastes, textures, and colors of foods and beverages. But it is not the first exposure. Studies show that both the fetus and the neonate can experience flavors through swallowed amniotic fluid and through breastmilk, both of which reflect components of the mother’s diet, which are hypothesized to influence the infant food acceptance and preference (9698)… 

[66.] ‘Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition,’ Mary Fewtrell, Jiri Bronsky, Cristina Campoy, Magnus Domellöf, Nicholas Embleton, Nataša Fidler Mis, Iva Hojsak, Jessie M. Hulst, Flavia Indrio, Alexandre Lapillonne, Christian Molgaard, J Pediatr Gastroenterol Nutr, Jan 2017, 64(1):119-132,  DOI:10.1097/MPG.0000000000001454.

…There is some evidence to suggest that there may be a critical window for introducing lumpy solid foods, and that failure to introduce such foods by approximately 9 to 10 months of age is associated with an increased risk of feeding difficulties and reduced consumption of important food groups such as fruits and vegetables later on (24,25). It is therefore important for both developmental and nutritional reasons to give age-appropriate foods of the correct consistency and by a method appropriate for the infant’s age and development…

[67.] Ibid. …A recent systematic review and meta-analysis (48) concluded that there was moderate-certainty evidence from 5 trials (1915 participants) that early egg introduction at 4 to 6 months was associated with reduced egg allergy risk. The meta-analysis also concluded that there was moderate-certainty evidence from 2 trials (1550 participants; 1 normal-risk [13 (EAT)], 1 high-risk (49) [learning early about peanut allergy (LEAP)]) that early peanut introduction at 4 to 11 months was associated with reduced peanut allergy risk…

[68.] Ibid. …A low-fat CF diet will typically result in a diet with a low energy density, which may mean that the total amount of food needed to meet energy requirements is so large that the infant is unable to eat enough (63,64). Conversely, a high-fat diet (with fat content >50%) may lead to reduced dietary diversity…

[69.] Ibid. …A considerable amount of learning about food and eating occurs during the transition from an exclusive milk diet to the diet consumed in early childhood. Infants have innate, evolutionary-driven preferences for sweet and salty tastes, which would have been advantageous in situations in which energy and mineral-dense foods were scarce but which are likely to be a disadvantage in current obesogenic environments. They also have an innate dislike of bitter taste, which may indicate potentially toxic foods (100). There is, however, evidence that these predispositions can be modified by early experience, and parents thus play an important role in establishing good dietary habits…

[70.] Ibid. …Thus it appears that parents and caregivers can modify the innate preferences of their infant, but these preferences (good or bad) will only be reinforced if the infant continues to be exposed to the food. Preferences for healthy foods can be developed, for example, repeated early exposure to the taste of some vegetables enhances liking for those vegetables with effects persisting up to 6 years later (104,105). Infants exposed to an intervention with greater variety of vegetables during CF also consumed a greater variety at 6-year follow-up (105). This emphasizes the importance of optimizing dietary variety and including healthy foods during CF. Importantly, an infant may need to receive a new flavour 8 to 10 times before accepting it, and parents should therefore be encouraged to persist in offering infants a new food as long as they continue to accept it, even if the infant's facial expression may suggest it is disliked (104)

[71.] Ibid. …Parents play a major role during the CF process, making decisions on the timing and content of the diet, and also the way in which the infant is fed, setting rules and expectations, and providing a role model. In addition to the timing and content of the CF diet, it is likely that the way in which foods are given to the infant, and the interaction between parent and infant during CF may influence outcomes such as food and dietary preferences and appetite regulation…

[72.] Ibid. …By 6 months of age, the infant’s endogenous iron stores will have been used up and the need for exogenous iron increases rapidly as the physiological requirement per kg body weight becomes greater than later in life…

[73.] Ibid. …Two studies have reported on the effects of meat intake during CF on later development. Meat is a good source of iron and zinc, but also arachidonic acid, which is important in brain development…

[74.] Ibid. …Particular care is required to ensure an adequate nutrient intake during CF when vegetarian or vegan diets are used, and the nutrients that may be insufficient increases as the diet becomes more restricted. Vegan diets have generally been discouraged during CF. Although theoretically a vegan diet can meet nutrient requirements when mother and infant follow medical and dietary advice regarding supplementation, the risks of failing to follow advice are severe, including irreversible cognitive damage from vitamin B12 deficiency, and death. If a parent chooses to wean an infant onto a vegan diet this should be done under regular medical and expert dietetic supervision and mothers should receive and follow nutritional advice… 

[75.] Ibid. …Salt and sugar should not be added to complementary foods, and the intake of free sugars (sugars added to foods and beverages by the manufacturer, cook, or consumer, and sugars naturally present in syrups and fruit juices) should be minimized. Sugar-sweetened beverages should be avoided. Honey should not be introduced before 12 months of age unless the heat-resistant spores of Clostridium botulinum have been inactivated by adequate high-pressure and high-temperature treatment, as used in industry (116) since the consumption of honey has been repeatedly associated with infant botulism. Fennel, which is sometimes used in the form of a tea or infusion as a treatment for infant colic and digestive symptoms, contains estragole, which is a naturally occurring genotoxic carcinogen. Although occasional exposure to fennel products in adults is unlikely to be of concern, an expert panel of the European Medicines Agency concluded that fennel oil and fennel tea preparations are not recommended in children younger than 4 years of age due to the lack of adequate safety data (117). To reduce exposure to inorganic arsenic, which is considered a first-level carcinogen, this Committee previously recommended that rice drinks should not be used for infants and young children…

[76.] Ibid. There may be an increased risk of allergy if solids are introduced before 3 to 4 months. There is, however, no evidence that delaying the introduction of allergenic foods beyond 4 months reduces the risk of allergy, either for infants in the general population or for those with a family history of atopy.

[77.] Ibid. Infants at high risk of peanut allergy (those with severe eczema, egg allergy, or both as defined in the LEAP study) should have peanut introduced between 4 and 11 months; following evaluation by an appropriately trained professional.

[78.] Ibid. Gluten may be introduced into the infant's diet when CF is started, anytime between 4 and 12 months of age. Based on observational data consumption of large quantities of gluten should be avoided during the first weeks after gluten introduction and during infancy. 

[79.] Ibid. A high protein intake during CF may increase the risk of subsequent overweight or obesity, especially in predisposed individuals, and the mean protein:energy% should not be >15%. Large volumes of cows’ milk are associated with high intakes of energy, protein, and fat and with low iron intake.

[80.] Ibid. Iron requirements are high during the CF period and there is a need for iron-rich foods, particularly for breast-fed infants.

[81.] Ibid. Vegan diets with appropriate supplements can support normal growth and development. Regular medical and dietetic supervision should be given and followed to ensure nutritional adequacy of the diet. The consequences of failing to do this can be severe and include irreversible cognitive impairment and death.

[82.] Ibid. Foods should be of an appropriate texture and consistency for the infant’s developmental stage, ensuring timely progression to finger-foods and self-feeding. Prolonged use of pureed foods should be discouraged and infants should be eating lumpy foods by 8 to 10 months at the latest. By 12 months, infants should drink mainly from a cup or training cup rather than a bottle.

[83.] Ibid. Parents should be encouraged to respond to their infant’s hunger and satiety queues and to avoid feeding to comfort or as a reward.

[84.] ‘Maternal diet during lactation and breast-feeding practices have synergistic association with child diet at 6 years,’ Jacob P. Beckerman, Emily Slade and Alison K. Ventura, published online by Cambridge University Press, July 10, 2019, https://doi.org/10.1017/S1368980019001782

…Higher maternal vegetable consumption and longer breast-feeding duration were synergistically associated with high child vegetable consumption at 6 years, independent of sociodemographic characteristics and fruit and vegetable availability. Exposures to vegetable flavour through breast milk may promote later child vegetable consumption…

[85.] Pediatric Food Preferences and Eating Behaviors, Julie Lumeng and Jennifer Fisher, eds, Academic Press, Cambridge, MA, 2018, pp 35–52

…Humans readily accept sweet tastes and reject those that are sour or bitter. While these predispositions were adaptive in earlier periods of human history, motivating humans to seek out calories and avoid potential poisons, they can set the stage for unhealthy eating habits in the modern obesogenic environment. Correspondingly, many children are not meeting dietary recommendations. Yet children’s food preferences are malleable. In this chapter, we explore repeated exposure as a simple and promising technique for promoting healthy food preferences during infancy and childhood, as well as additional learning paradigms that have been studied alongside it. Based on the evidence supporting the roles of repeated exposure and other types of learning in the establishment of healthy food preferences, we conclude with recommendations of ways that caregivers and broader environments can support the development of healthier eating among children…

[86.] 1,000 Days, https://thousanddays.org/about/our-story

…1,000 Days was born in 2010 in response to ground-breaking scientific evidence that identified a powerful window of opportunity from a woman’s pregnancy to a child’s 2nd birthday when nutrition has a long-term impact on the future health and development of both children and societies. We coined this window of opportunity the first 1,000 days…

[87.] ‘Infant Cereals: Current Status, Challenges, and Future Opportunities for Whole Grains,’ Michelle KlerksMaria Jose BernalSergio RomanStefan BodenstabAngel Gil, and Luis Manuel Sanchez-Siles, Nutrients, Feb 2019, 11(2):473, published online Feb 23, 2019, DOI:10.3390/nu11020473

The existing evidence reviewed in this article suggests that whole grains are more beneficial for health compared to refined cereals. Whole grains are rich in compounds that induce several mechanisms that aid in reducing the risk of non-communicable diseases.

[88.] Ibid. The complementary feeding period is an important time for shaping the infant’s food preferences, eating skills, and habits, and therefore, it is the right time to introduce whole grain infant cereals for the acceptance of whole grains across the entire lifespan.

[89.] Ibid. From the ages of six to 12 months, it is recommended by Healthy Eating Research to offer the infant a variety of whole grain products, such as brown rice or whole grain cereals. For infants and young children between 12–36 months old, it is recommended to start with two ounces cereals/day, starting with one ounce of whole grains at 12 months, and increasing intake to at least 1.5–2.5 ounces of whole grains/day at 36 months of age It is specified that in general, one ounce is equal to one slice of bread, one cup of ready-to-eat cereals, or half a cup of cooked rice, pasta, or cereals. 

[90.] Ibid. One main compound that is removed during the refining of cereals is dietary fiber. Dietary fibers (e.g., β-glucans, arabinoxylans, resistant starch, and inulin) are a major contributor to several health benefits 

[91.] ‘Early Taste Experiences and Later Food Choices,’ Valentina De CosmiSilvia ScaglioniCarlo Agostoni, Nutrients, Feb 2017, 9(2):107, DOI:10.3390/nu9020107

Neophobic tendencies can be reduced and preferences can be increased by exposing infants and young children repeatedly to novel foods. Children need to be exposed to a novel food between 6 and 15 times before increases in intake and preferences are seen. A recent study found that repeatedly exposing children to a novel food within a positive social environment was especially effective in increasing children’s willingness to try it. These findings suggest the importance of both the act of repeatedly exposing children to new foods and the context within which this exposure occurs. 

[92.] Ibid. Parents create food environments for children’s early experiences with food and eating, and also influence their children’s eating by modeling their own eating behaviors, taste preferences, and food choices. 


Resources for Healthcare Professionals

‘Feeding Guidelines for Infants and Young Toddlers: A Responsive Parenting Approach February 2017,’ Healthy Eating Research, Rafael Pérez-Escamilla, Sofia Segura-Pérez, Megan Lott, https://healthyeatingresearch.org/wp-content/uploads/2017/02/her_feeding_guidelines_report_021416-1.pdf

…The first 1,000 days of life represent a highly sensitive period of time for children to learn to accept and like healthy food. Given that the food and beverages infants and toddlers are exposed to depend primarily on their caregivers, it is crucial that caregivers have access to the foods and tools necessary to foster healthy eating practices, such as those recommended in this expert panel report. While previous guidelines in the United States and other countries have included responsive parenting/feeding principles, the evidence-based guidelines produced by the expert panel provide the most comprehensive and pragmatic approach to date for communicating to caregivers what and how best to feed infants and toddlers, while also taking into account the rapidly changing developmental stages during the first two years of life… 

‘Marion Hetherington on Kids, Vegetables and Appetite,’ Duke Sanford University World Food Policy Center, January 10, 2019, https://wfpc.sanford.duke.edu/podcasts/e3-marion-hetherington-kids-vegetables-and-appetite

‘An exploratory trial of parental advice for increasing vegetable acceptance in infancy,’

Br J Nutr, Jul 2015, 114(2):328-36, published online Jun 11, 2015, DOI:10.1017/S0007114515001695

‘How to Introduce Solid Foods,’ 1,000 Days, https://www.youtube.com/playlist?list=PLNEN4w93BoO3zAE0xADCe8ij03N7ewPel

1,000 Days has developed helpful videos about introducing solid foods to your baby. Topics include:

All [numbers] are references and sources used to substantiate our FAQ content, click here to return.

Disclaimer: The information provided is the opinion of Good Feeding, 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.