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Introduction of Solid Foods to Infants

Breast milk is the only food an infant needs for the first six months of life; however, after six months, extra nutrients, like iron, are needed from complementary foods. Healthcare providers should encourage mothers to continue breastfeeding combined with solid foods for the first two years of life or longer if they wish. It is important to establish healthy eating patterns early in childhood to ensure proper growth and development and the continuation of those healthy eating patterns into adulthood.1

 

When should solid foods be introduced?

Current recommendations encourage the introduction of solid foods at about six months of age when an infant is showing signs of readiness.  An infant should be able to hold their head up, sit up in a high chair, open their mouth to accept food, close their mouth around a spoon and refuse food by turning their head away. However, it is important to remember that the introduction of solid foods should not interfere with the continuation of breastfeeding.

Parents/caregivers should be counseled by healthcare providers that the early introduction of solid foods may lead to a decrease in breast milk production and a subsequent early discontinuation of breastfeeding. Breast milk is still the most important source of nutrition while solid foods are being introduced. An infant may show signs of readiness a few weeks before or after the six month mark; however, the introduction of solid foods should not be delayed much past six months as an infant’s iron stores are generally depleted.1

In what order should solid foods be introduced?1

Healthcare providers should encourage parents/caregivers to select iron-rich foods as the first foods introduced to an infant. Examples include iron-fortified infant cereals, meat, fish, tofu, cooked eggs and well-cooked legumes, to help meet the nutrient needs of the rapidly growing infant. After an infant is eating iron-rich foods twice a day, other foods, such as vegetables, fruits, whole grains and milk products, can also be introduced. No particular order is recommended; however, honey should be delayed until after one year of age due to risk of botulism.

Parents/caregivers should be encouraged by healthcare providers to delay the introduction of homogenized cow’s milk (3.25% M.F.) until nine to 12 months, once an infant is eating a variety of iron-rich foods. It should be offered in an open cup and intake should not exceed 750 mL per day as it may displace other foods and nutrients. Skim, 1%, and 2% milks should not be provided until two years of age. Milk alternatives, such as fortified soy, coconut, rice and almond beverages should not be provided prior to two years of ages. These beverages do not provide the necessary nutrients required for proper growth and development.

A variety of soft textures, such as puréed, minced, mashed, lumpy foods and finger foods, should be introduced at six months of age. A child should be consuming only a few puréed foods past one year of age. Some textures and food shapes, such as hard, crunchy foods and round foods, like whole grapes, raw carrots, whole nuts, and popcorn, should not be offered to children younger than four years due to the risk of choking. Otherwise, delaying the introduction of lumpy textures beyond the age of nine months is associated with feeding difficulties in older children and may negatively impact their intake of nutritious foods, like vegetables and fruit.

 

How much should an infant consume?

Healthcare providers should encourage parents/caregivers to utilize an infant’s hunger and satiety cues to direct the quantity of food that is consumed at meals and snacks. Breastfeeding should continue to be the primary source of nutrition as complementary foods are introduced. An infant should never be forced to eat or to consume a certain quantity of food. If an infant refuses a food parents can try again another day. Infants often require 10-15 exposures to a certain food before it is accepted. Infants should be offered foods as long as they are happy and interested in eating.

Generally, infants six to eight months should be offered two to three ‘meals’ and one to two snacks; infants nine to 11 months will consume three meals with one to two snacks per day. After one year of age, parents should be encouraged to establish a regular routine of meals and snacks guided by Canada’s Food Guide, if this is not already occurring. The amount and frequency of solid foods consumed will increase as a child gets older. The amount consumed should always be decided by the child. 

Establishing a Healthy Eating Environment

Parents/caregivers should be encouraged to include infants in family meals. These should occur at the table with minimal distractions, such as telephones and televisions. Family meals provide an opportunity for parent/caregivers to model healthy eating habits and provide infants a chance to experience foods of different textures, colours and tastes. Introducing an infant to solid foods should occur in a relaxed setting when the infant is content.

As a child gets older, parents/caregivers are responsible for when and what foods are served, while a child is responsible for deciding which foods and how much of those foods to eat.2 Parents/caregivers should be encouraged to respond to an infant’s hunger and satiety cues rather than trying to force a certain amount of food to be consumed.2

Other Concerns

Food Allergies3

Delaying the introduction of allergenic foods (i.e. whole eggs, milk, peanuts, fish and shellfish, tree nut butters, soy, mustard, sesame, and wheat products) is not recommended and may increase the risk of food allergies. These foods should be introduced from six months on. These foods should be introduced one at a time with at least two days in between introducing a new food. During these two days, the infant should be monitored for any signs of an allergic reaction. Once introduced these foods should be included regularly in an infant’s diet to help decrease the risk of food allergies occurring. Parents/caregivers do not need to wait between introducing foods not found in the above list of allergenic foods.

Vitamin D1

Infants receiving breast milk should receive a supplement of vitamin D (400 units) daily. Vitamin D supplements should continue until the child is two years of age and is receiving adequate amounts of vitamin D in their diet.

Food Safety

Homemade baby food can be a healthy choice. Parents/caregivers should be encouraged to choose nutritious ingredients, cook and store foods properly and be extra diligent about cleanliness. Videos about making baby food are available to provide parents with education and guidance. 

 
Date of creation: November 12, 2017
Last modified on: October 14, 2018

References

1Health Canada, Canadian Paediatric Society, Dietitians of Canada, and Breastfeeding Committee for Canada. (2015, January 19). Nutrition for Healthy Term Infants: Recommendations from Six to 24 Months. Retrieved from
https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/infant-feeding/nutrition-healthy-term-infants-recommendations-birth-six-months/6-24-months.html
2Ellyn Satter. (2017). Division of Responsibility in Feeding. Retrieved from
https://www.ellynsatterinstitute.org/how-to-feed/the-division-of-responsibility-in-feeding/
3Canadian Paediatric Society and Canadian Society of Allergy and Clinical Immunology. (2016, February 1). Dietary exposures and allergy prevention in high-risk infants. Retrieved from
https://www.cps.ca/en/documents/position/dietary-exposures-and-allergy-prevention-in-high-risk-infants