New feeding guidelines for babies
Feeding Guide for the First Year
Feeding Guide for the First Year | Johns Hopkins MedicineReviewed By:
Tiffani Hays, M.S., R.D., L.N., Director of the Pediatric Clinical Nutrition Education & Practice
Making appropriate food choices for your baby during the first year of life is very important. More growth occurs during the first year than at any other time. It’s important to feed your baby a variety of healthy foods at the proper time. Starting good eating habits at this early stage will help set healthy eating patterns for life.
Recommended Feeding Guide for the First Year
Breast milk and formula are designed to be the primary sources of nutrition throughout an infant’s first year of life. You should talk with your baby’s health care provider before starting solid foods. Solid foods should not begin before age 4 months because:
- Breast milk or formula provide your baby with all the nutrients that are needed.
- Your baby isn’t physically developed enough to eat solid food from a spoon.
- Feeding your baby solid food too early may result in poor feeding experiences and increased weight gain in both infancy and early childhood.
The American Academy of Pediatrics (AAP) recommends that all infants, children and adolescents take in enough vitamin D through supplements, formula or cow’s milk to prevent complications from deficiency of this vitamin. In November 2008, the AAP updated its recommendations for daily intake of vitamin D for infants, children, and adolescents who are healthy. It is now recommended that the minimum intake of vitamin D for these groups should be 400 IU per day, beginning soon after birth. Your baby’s health care provider can recommend the proper type and amount of vitamin D supplement.
Guide for Breast-feeding (Zero to 12 Months)
- In the early days after a baby’s birth, the mother should plan to breast-feed every two to three hours, including overnight.
The mother should respond to the infant’s cues of hunger in a prompt and relaxed manner, providing a quiet and comfortable environment for both herself and the baby. Frustrated or distracted infants may have difficulties latching on. - It is normal for infants to wake up overnight to feed for the first several months. If you have any concerns about overnight feeding, please discuss them with your health care provider.
- Alternate breasts to feed on, and allow the infant to completely empty the breast before switching to the other. This practice ensures the infant receives hindmilk, which is richer in nutrients.
- Follow your child’s feeding cues and resist forcing a schedule. Instead, rely on keeping track of wet diapers and your child’s growth to judge whether he or she is receiving enough breast milk. A mother’s milk changes as the infant grows, and feeding habits change as well in order to best meet a child’s needs.
If you have any questions about whether your child is receiving enough breast milk, ask your health care provider. - When not able to breast-feed, use a breast pump to extract milk and maintain milk supply. Pumped breast milk should be stored safely, using appropriate temperature guidelines. Pumped breast milk may be offered to infants in bottles, while responding to the same feeding cues to determine how much they take. Forcing bottles to be emptied may result in overfeeding and excess weight gain, even when feeding breast milk.
- With the proper support, a mother can meet the needs of most infants, even twins, so seek out help from your health care provider or lactation consultant for success.
Guide for Formula Feeding (Zero to 12 Months)
- When breast milk is not available, standard infant formula is an appropriate alternative for most healthy full term infants, but there are some differences between brands.
Do not hesitate to ask your health care provider for a recommendation if you are unsure which formula to use. - Bottle-feeding should be interactive, with the caregiver holding both the bottle and the infant. Propping a bottle has been linked to an increased risk of ear infections and tooth decay.
- Formula feeding should be in response to the infant’s needs and not based on a predetermined schedule. Look for cues of hunger and fullness to determine both when to feed and how much. The number of wet diapers per day and your child’s growth will reflect if he or she is getting enough formula. The chart below demonstrates common intakes for infants at various stages. However, ask your health care provider if you have any questions about how much formula your infant is taking.
- The amount of formula an infant takes will decrease as the baby increases intake of solid foods, but formula remains a significant source of calories, protein, calcium and vitamin D for the first year of life.
- Ask your health care provider before switching an infant less than 1 year of age from formula to cow’s milk or a cow’s milk alternative.
| Age | Amount of formula per feeding | Number of feedings per 24 hours |
|---|---|---|
| 1 month | 2 to 4 ounces | six to eight |
| 2 months | 5 to 6 ounces | five to six |
| 3 to 5 months | 6 to 7 ounces | five to six |
Complementary Feedings (After 6 Months of Age)
Beverages
- Offer only breast milk or formula in bottles until 1 year of age unless specifically advised by your health care provider.
- Begin offering breast milk and/or formula in a cup starting at 6 months of age. Infants should drink breast milk and/or formula for the first year of life.
- Fruit juice is not recommended under 1 year of age.
- When introducing juice, offer 100% pasteurized juice and limit it to 4–6 ounces per day. Do NOT place juice in a bottle.
- Avoid giving any sugar-sweetened beverages to infants.
Solid Foods
- Introduce solid foods when your infant is ready, at around 6 months of age depending on the infant’s development. Infants are ready to start eating solid foods when they can:
- sit up on their own or with a little support
- reach for and put things in their mouth
- open their mouth when seeing something coming
- keep food in their mouth rather than pushing it out onto the chin
- move food to the back of their mouth with their tongue
- turn their head away when they do not want something
- Prepare to introduce solid foods in a calm feeding environment where the infant is sitting upright and is appropriately supported and moderately hungry.
- Start with small amounts of solid food, feeding with a spoon or allowing finger feeding, then gradually increase the amount as the infant eats more and develops. Avoid offering breast milk or formula until after the solid-food experience has wound down.
- Expose infants to a wide variety of flavors and textures of healthy food. Don’t limit your baby’s food choices to the ones you like. Offering a range of foods early will pave the way for healthy eating habits.
- Maintain the division of responsibility when feeding.
- The caregiver is responsible for what to eat (offering appropriate variety and textures).
- The child is responsible for deciding whether to eat and how much.
- Avoid adding salt or sugar to make baby foods more appealing. Many babies and toddlers need to experience a new food multiple times before accepting it, and increased intakes of salt and sugar among children are associated with obesity in adults.
- Observe infants for any signs of intolerance when introducing a new food or texture, and discuss all concerns with your health care provider.
- Although convenient and safe, commercial baby foods are not required. Young children are more likely to eat foods they see others eating, so as long as they are observed to see how they handle new food in their mouths, baby-led weaning using table foods is an appropriate way to introduce solids.
- Avoid honey in any form during your child’s first year, as it can cause infant botulism. Address any concerns about developing food allergies with your health care provider.
- Don’t restrict fat and cholesterol in the diets of very young children, unless advised by your child’s health care provider. Children need calories, fat and cholesterol for the development of their brains and nervous systems, and for general growth.
Updated on July 26, 2019.
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By Dr. Carina Venter, PhD, RD, Associate Professor, Pediatrics-Allergy/Immunology, University of Colorado School of Medicine
For the first time in history, the 2020-2025 USDA Dietary Guidelines provide recommendations for all life stages, including infants and toddlers.
This guide is intended to help pediatric healthcare practitioners have conversations with their patients and provide tips for establishing smart, lifelong habits for babies when it can matter most -- at the start.
1) Make every bite count.
- Infants consume small quantities of foods, so it’s important to make sure that parents are really paying attention to what they feed their babies.
- Portion sizes are helpful to ensure adequate nutrient intake but all babies are different. Listen to your baby’s cues of being hungry and satisfied. Let them be your guide on how much they should eat!
HELPFUL TIP: More information on establishing healthy eating patterns in infants are available from: Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Child and Adult Care Food Program (CACFP), Supplemental Nutrition Assistance Program (SNAP)
2) Aim to breastfeed until your baby is ready to eat, ideally until around 4-6 months.
- Although breastmilk is considered the best food for your growing baby, babies will still need a daily vitamin D supplement beginning soon after birth.
- If breastfeeding is not possible, infants should be fed an iron fortified infant formula.
HELPFUL TIP: Parents can easily find vitamin D drops at any grocery store or online. Look for brands with 400 IU of vitamin D3 per drop.
3) Feed allergenic foods early and often.
- When parents introduce foods at 4-6 months, introduce allergenic foods such as peanuts, egg, cow milk products, tree nuts, wheat, shellfish, fish, and soy.
- Waiting to introduce allergenic foods may increase the risk of your baby developing a food allergy to that particular food, so don’t delay!
HELPFUL TIP: It’s important that, once allergenic foods are introduced, they stay in the baby’s every day diet. Parents can buy products that are a blend of these foods to make daily feeding easy.
Make sure to look for products that cover a wide range of allergens, especially difficult to feed foods like shellfish or fish.
4) Focus on diet diversity.
- This is the time to expose your infant to many different foods. A baby may need to try a new food a number of times before they accept it - don't be discouraged!
- For breastfed infants: Make sure foods are rich in nutrients, such as iron (e.g., meats and seafood) and Zinc (e.g., meats, beans, zinc fortified infant cereals)
HELPFUL TIP: Be encouraged to feed babies a diversity of nutrient dense foods in infant safe formats in their first year of life; however, make sure to stay away from honey, unpasteurized foods and beverages, and limit foods with added sodium and sugars.
5) Be mindful of beverages.
- In general, infants should not consume beverages outside of human milk, formula and small amounts of water.
- Cow milk or any plant based beverages should not be offered as a drink in the first year of life
- Fruit juice should not be fed, even 100% fruit juice.
HELPFUL TIP: Parents often wonder whether infants need to drink water. In fact, breastmilk or formula should provide the hydration a baby needs in the first 6 months of life! Half a cup to one cup of water may be given when babies are starting to eat solids. In order to facilitate transition from a bottle to cup or breast feeding to a cup, it is advisable to offer milk (formula/breast milk) and water randomly from a cup to the infant - that way, infants learn that cups are not only meant for drinking water.
About the author: Dr. Carina Venter is a PhD Registered Dietician and Associate Professor of Pediatrics in Allergy and Immunology at University of Colorado School of Medicine. She has focused her research and clinical practice over the past 20 years on the prevention, diagnosis and management of food allergies and other allergic diseases.
Russian Union of Pediatricians
Introduction of complementary foods
How to introduce complementary foods correctly is one of the most pressing issues that concern parents.
In the first months of life, the main food for the baby is breast milk or an adapted milk formula, however, as the child grows and develops, this becomes insufficient and it is necessary to think about the introduction of complementary foods. nine0003
Your baby is over 4 months old. He has noticeably grown up, become more active, is interested in objects that fall into his field of vision, carefully examines them and reaches for them. The child's emotional reactions have become much richer: he smiles happily at all people, makes various sounds. Perhaps you notice that the child looks into your plate with interest, closely monitors what and how you eat, does this mean that it is time to introduce complementary foods? And where is the best place to start? Let's figure it out! nine0003
When should complementary foods be started?
According to the Program for optimizing the feeding of infants in the first year of life in the Russian Federation (2019), the recommended age for the introduction of complementary foods is in the range from 4 to 6 months.
The following points will help determine the readiness of the baby for the introduction of complementary foods:
1. Food interest - you can check its presence as follows: during your meal, give the baby an empty spoon or fork, and if he plays with it, licks it, then there is no food interest yet; but if the child is dissatisfied with the fact that the spoon is empty, food interest has probably appeared. “But how does a child understand that there should be food in a spoon?” Parents often ask. The answer is quite simple: take your baby to the table with you so that he can see how you eat! nine0003
2. The child can sit alone or with support. It is unacceptable to feed the child lying down, because he may choke.
3. Extinction of the “pushing out” reflex - when the baby pushes out of the mouth both the offered food and the pacifier, etc.
Why is it not recommended to introduce complementary foods before 4 and after 6 months of life?
Before 4 months of life, the baby is not yet ready to digest food other than breast milk or infant formula.
By this age, a number of digestive enzymes mature, a sufficient level of local immunity is formed, which reduces the risk of developing allergic reactions, the child acquires the ability to swallow semi-liquid and thicker food, which is due to the extinction of the “spoon ejection reflex”. The introduction of complementary foods after 6 months can cause a pronounced deficiency of micronutrients (iron, zinc, etc.) and lead to a delay in the formation of chewing skills for thick foods. Too late the introduction of a variety of products increases the risk of allergic reactions. Remember that the timing of the introduction of complementary foods is set individually, taking into account the readiness of the child to accept new foods. nine0003
Complementary feeding guidelines:
1. introduce a new product in the first half of the day to track possible reactions to it;
2. cereals, vegetable / fruit / meat purees should be introduced, starting with monocomponent ones, gradually adding other products of this group;
3.
start giving a new product with 1/2 teaspoon, gradually increasing the volume to the age norm within a week;
4. It is not recommended to introduce new products during acute infectious diseases or at some special moments (moving to another apartment, leaving the city, on vacation, illness of parents, etc.). nine0003
What is the best way to start complementary foods?
The first complementary food can be anything. Often parents worry that if the child first tries the fruit, then because of its sweet taste, he will refuse other foods. We hasten to reassure you: breast milk is also sweet, so babies may like sweet fruits / berries more, but this does not mean at all that he will refuse vegetables or cereal. Traditionally, they begin to introduce complementary foods in the form of mashed potatoes, but if the child shows interest in “pieces”, then, observing the safety rules, you can give them. Also, along with the introduction of complementary foods, you can offer the child water.
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With the start of the introduction of complementary foods, the child is gradually transferred to a 5-time feeding regimen. If the baby shows that he is full and no longer wants to eat (for example, leaning back or turning away from food), then you should not continue to force him to feed, because this can lead to eating disorders in the future. Also, do not force the child to eat as much as possible before bedtime in the hope that he will not wake up for nightly feedings.
Traditionally, in our country, complementary foods begin with vegetables or cereals. nine0003
Vegetables: zucchini, broccoli, cauliflower, pumpkin, etc. If the child did not like the dish, for example, broccoli, do not give up on your plan and continue to offer this vegetable in small quantities daily, you can even not once, but 2-3 times, and after a while (7-14 days) the baby will get used to the new taste. This diversifies his diet, will help form the right taste habits in the child.
As for cereals, it is worth starting with dairy-free gluten-free ones - buckwheat, corn, rice.
You can use commercial baby food porridge, which is enriched primarily with iron. In addition, such porridge is already ready to eat, you just need to dilute it with water, which will save you a lot of time. nine0003
It is also recommended to add oil to food, for example, vegetable puree to vegetable puree, and butter to porridge.
Of meat products, lean meats, such as mashed turkey or rabbit, are most preferred to start complementary foods. Meat puree contains iron, which is easily absorbed, and adding meat to vegetables improves the absorption of this micronutrient from them. Subsequently, the daily use of children's enriched porridge and mashed meat allows you to meet the needs of babies for iron, zinc and other micronutrients. nine0003
When introducing fruit purees (apple, pear, peach, prunes, etc.) into your baby's diet, you should pay special attention to the composition of the product - it is important that it does not contain added sugar.
Fish is a source of easily digestible protein and contains a large amount of polyunsaturated fatty acids, including the omega-3 class, as well as vitamins B2, B12, and minerals.
Preference should be given to oceanic fish, preferably white (cod, hake, pollock, sea bass, etc.), salmon can be recommended from red, and pike perch from river. nine0003
Fermented milk products are prepared using a special starter culture that breaks down milk protein, so that the baby can get an indispensable set of amino acids in a well-available form. Some foods have added prebiotics, certain vitamins and minerals. Their regular use favorably affects the functioning of the intestines, increases appetite and the absorption of micronutrients.
Recommendations and timing of the introduction of complementary foods for children at risk of developing food allergies and suffering from food allergies are the same as for healthy children. Delayed introduction of highly allergenic foods has previously been recommended to prevent the development of allergic diseases in children at risk. There is now evidence that this practice may lead to an increase rather than a decrease in the incidence of food allergies.
The most common highly allergenic foods include cow's milk, chicken eggs, soybeans, wheat, peanuts, tree nuts, shellfish and fish. If a child has a high risk of developing allergies or an existing allergic disease, it is recommended to consult a pediatrician, an allergist-immunologist before introducing highly allergenic products. nine0003
By the age of 8 months, when all the main food groups have already been introduced and your baby is improving his skills to eat on his own, special attention should be paid to the diversity of the composition of dishes and the change in food consistency - from puree to finely and coarsely ground. Soft foods cut into small pieces (fruits, vegetables, meat, etc.) are perfect for a little gourmet, which diversifies his diet and will contribute to the formation of chewing skills.
By 9-12 months, most babies have the dexterity to drink from a cup (holding with both hands) and to eat foods prepared for other family members. This behavior needs to be encouraged, but combined with regular feeding to meet energy and nutrient requirements.
It is advisable to use industrial products that are designed specifically for young children after a year.
What should not be given to the baby? nine0006
It is not recommended to add salt or sugar to food to enhance the taste.
Drinks that should be avoided include fruit juices, whole cow and goat milk (whole milk is not recommended for children under one year old, and even longer, due to a high risk of developing iron deficiency and increased kidney stress), sweet fruit drinks, compotes and carbonated drinks.
Also, some foods should be excluded from the diet of infants: solid round foods (for example, nuts, grapes, raw carrots, raisins, peas, etc.), due to the fact that the child can choke on them. nine0003
It is not recommended to eat products with added sugar, for example, confectionery (marshmallow, marshmallow, marmalade, jam, jam, cookies, waffles, etc.), etc.
You should not give your child the meat of large predatory fish (shark, bigeye tuna, king mackerel, swordfish): these types of fish accumulate more harmful substances than others.
It is forbidden to give honey to children under one year old due to the fact that it may contain spores of Clostridium botulinum bacteria, which in the still immature digestive system of babies are able to multiply, produce toxins directly inside the intestines and, thus, cause infant botulism, which can be fatal. outcome. nine0003
Do not give babies raw meat, fish, eggs, caviar, salted fish, soft pickled cheeses because of the risk of intestinal infections.
If you follow all these simple rules, your baby will grow up healthy and happy!
Diets for different ages
References:
1. Methodological recommendations. The program for optimizing the feeding of children in the first year of life in the Russian Federation. [Internet]. - M.: Union of Pediatricians of Russia, 2019. [Methodicheskie rekomendaczii. Programma optimizaczii vskarmlivaniya detej pervogo goda zhizni v Rossijskoj Federaczii. [Internet]. – Moscow: Soyuz pediatrov Rossii, 2019.
(In Russ.).] Available: http://www.pediatr-russia.ru/information/dokumenty/other-docs/nacprog1year_2019.pdf Link active as of 20.04.2020
2. Duryea T.K. Introducing solid foods and vitamin and mineral supplementation during infancy. In: Post T, ed. UpToDate . Waltham, Mass.: UpToDate; 2020. www.uptodate.com. Accessed April 20, 2020. nine0003
3.Fleischer D.M. Introducing highly allergenic foods to infants and children. In: Post T, ed. UpToDate . Waltham, Mass.: UpToDate; 2020. www.uptodate.com. Accessed April 20, 2020.
WHO Breastfeeding Guidelines
Share this information
Medela fully supports the World Health Organization's recommendation for breastfeeding duration. nine0129
WHO recommends that mothers around the world exclusively breastfeed their babies for the first six months of their lives to ensure optimal growth, development and health.
After that, they should be given age-appropriate complementary foods and continue breastfeeding up to two years or more.
International health organizations recognize that breastfeeding, as the best way to eat during this period, promotes brain development in children, stimulates their growth, improves their school performance and reduces the risk of diseases such as diabetes and obesity in the future life. nine0135 1 Medela fully recognizes this.
The first thousand days of your baby's life—from conception to two years of age—gives you an excellent opportunity to lay the foundation for his future health and well-being. 2 As soon as pregnancy occurs, your body begins to create a new person. And within a month, the development of a new amazing feeding system also begins. 3 Not only is your breast milk perfectly matched to your baby's protein, mineral, vitamin, and fat needs, it contains thousands of protective substances, growth factors, and cells that fight infection, support baby's brain development, and lay the foundation for future health for babies.
you and your child. Breastfeeding gives you protection against breast cancer and may also protect you from ovarian cancer and type 2 diabetes. nine0135 1
At every stage of development from birth to one year, the needs of the baby change daily, and milk changes with them. 4 Your breast milk contains thousands of ingredients, the vast majority of which cannot be replaced with artificial additives.
You don't have to lead a perfect life to breastfeed. In fact, studies around the world show that even with malnourished moms 5 Breastfeeding has many advantages over formula feeding. 1
And that's not all! Breastfeeding is better for the environment than formula feeding because it does not require intensive animal husbandry and excessive water consumption, it does not require fossil fuels and factory emissions, it does not use transportation fuels and there is no exhaust fumes, and it does not require packaging. . In the US alone, 550 million packages of artificial formulas are used each year.
