Infants (birth to six months)
Making the right choices when it comes to feeding new babies will help them get a good start in life.
The Department of Health recommends that, wherever possible, infants are breastfed exclusively until six months of age.
Breastmilk is the best source of nutrition for newborn babies, as it provides easily digestible nutrients in the right quantities. It's also packed with antibodies and helps to establish the baby's immune system.
Babies breastfed exclusively are reported to be at less risk of stomach upsets and ear, respiratory and urinary tract infections than those who are bottle-fed formula milk. They're also less likely to become obese or experience constipation and vomiting. If there's a family history of allergies or diabetes, breastfed babies are less likely to develop these.
Breastmilk contains substances that help the development of a baby's brain, retinas, gut lining and protective sheath for the central nervous system. Breastmilk also contains hormonal factors that help the baby's growth and development. It carries digestive enzymes, too, which help to digest the nutrients in milk, helping the baby's immature digestive tract.
Breastfeeding isn't recommended for all women. For example, those who are HIV-positive risk transmitting the disease to their baby through their milk. If you're taking any medication, you should also check with your doctor or midwife before breastfeeding.
During the first few days after birth, the mother's breasts produce a substance called colostrum. This yellowish fluid is packed with antibodies and is rich in protein, making it ideal for newborn babies.
The colostrum soon changes and becomes thin and white (transitional milk). Then, after three or four days, the mature breastmilk starts to come through.
At each feed the breasts produce two types of milk: foremilk, produced at the beginning of a feed; and hindmilk, which has more fat, energy and essential nutrients. As babies grow, it's important they receive the hindmilk in order to meet their nutritional needs.
Breastfeeding uses at least 500 calories a day. Much of this energy can be derived from fat stores laid down in pregnancy, but many women also experience an increase in their appetite. Sensations of hunger and thirst are particularly intense during this period, and new mothers should be encouraged to respond to these signals. The stress and tiredness of early motherhood, as well as the demands of breastfeeding, mean this isn't a good time to diet or limit your food intake.
It's important this increased appetite is satisfied with foods of a high nutritional quality, not fatty and sugary foods alone. The need for protein, calcium, folate and vitamins A and C increase while breastfeeding. General healthy eating recommendations apply, but looking after a newborn baby often leaves little time to prepare meals, so it's important to keep them simple and easy to make.
The only nutrient that might not be provided in sufficient amounts in breastmilk is vitamin D, so the Department of Health recommends that all breastfeeding mothers take a vitamin D supplement (10 micrograms per day).
Sufficient fluid is also vital. All breastfeeding women should drink more than usual and shouldn't ignore thirst; it's often the first sign of dehydration. Caffeine (from tea, coffee and some soft drinks) is excreted in breastmilk, so excessive quantities should be avoided.
There should be no need to avoid any particular foods while breastfeeding. Some mothers say certain foods, such as onions, garlic and citrus fruits, seem to upset their babies. However, you should always check with a health professional before omitting any foods from your diet to avoid any potential deficiency in vitamins or minerals.
Small amounts of alcohol pass into breastmilk, making it smell different, which may affect your baby's feeding, sleeping or digestion. Stick within the daily limits for women of between two and three units.
It has been suggested that avoiding potentially allergenic agents during early life could reduce the incidence of allergies. The Department of Health advises that women who are atopic (have inherited allergies such as eczema, hayfever or asthma) or who have an atopic partner may consider avoiding obvious sources of peanuts during pregnancy and lactation. But a lack of research data means advice has not yet been extended to other allergenic foods.
Using formula milk is sometimes necessary and may be the preferred option for some mothers. While formula milk can't match the important immunological benefits of breastmilk, its nutritional composition is as close to breastmilk as possible.
There are two types of formula milk: whey-dominant and casein-dominant. Both are based on cow's milk. Whey-dominant milks are the most highly modified and closest to breastmilk, so are considered to be the most suitable for babies from birth onwards. Casein-dominant feeds are marketed as more suitable for older or hungrier babies. Although they have the same nutritional composition, it has been suggested that the type of curds formed in the stomach from casein take longer to digest, leaving the baby feeling fuller for longer - but no hard evidence exists to support this.
These should be used with caution for children who are sensitive to cow's milk protein. For infants under the age of six months, they should be avoided if at all possible. Speak to your health visitor or midwife about suitable alternatives if you suspect your baby might be sensitive to cow's milk.
Diarrhoea and vomiting
These are potentially serious problems that can cause life-threatening dehydration and an electrolyte imbalance. A combination of vomiting and diarrhoea is more serious than diarrhoea alone.
Many babies regurgitate small amounts of milk at the end of a feed. This is completely normal. However, projectile vomiting, vomiting both after and between feeds, or blood- or bile-stained vomit must be reported immediately to your doctor. Feeding should be stopped and replacement fluids may be recommended. Feeds should then be reintroduced gradually until symptoms disappear. With bottle-fed babies, your midwife may suggest that you reintroduce the milk at a reduced strength, gradually building up to full strength.
Poor weight gain
A slow rate of growth isn't necessarily a cause for concern. Your midwife and health visitor will monitor your baby's weight gain and offer appropriate advice if necessary. Typical causes of poor weight gain include: inadequate nutrient intake due to poor breastfeeding technique, incorrect formula, inadequate milk supply or a baby's inability to feed properly (such as poor suckling position), and inadequate absorption due to food intolerance or intestinal disturbances.
Excessive weight gain
This is rare in babies who are breastfed exclusively. Bottle-fed babies often grow at a more rapid pace and, if weight gain is excessive, your health visitor or midwife should check the amount of formula and its dilution.
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Weaning (six months to one year)
By around six months of age, your baby's energy and nutrient requirements become difficult to meet with breastmilk or formula alone, so it's time to start weaning them on to food.
At six months, a baby's digestive system has
matured enough to cope with solid food, and other developmental changes (such as the ability to bite and chew) mean your baby is ready to experience new tastes and textures.
The Department of Health recommends that weaning shouldn't be introduced until the age of six months, but your baby may show signs of wanting to try solids earlier than this. If this is the case, discuss your baby's readiness to try weaning foods with your health visitor.
The aim of weaning is gradually to introduce a variety of tastes and textures so that, by the age of one, your baby's enjoying a varied and healthy diet.
Every baby's different. Some enjoy trying new tastes and textures, moving through weaning quickly and easily, while others need a little more time to get used to new foods. Proceed at your baby's pace, moving on to each new food and weaning stage when it's right for them.
How to start
Before you begin, here are some general tips for successful weaning:
- Choose a good time of day for your baby to start on solids. This should be when they're not too tired or hungry (in the early stages, offering a breastfeed or a little formula beforehand will mean your baby is not too hungry and so is less frustrated with learning to take solids from a spoon).
- Allow plenty of time.
- Don't force food on your baby. If they don't want to try a food, stay calm, take the food away and offer it again later or in a few days' time.
- Prepare for some inevitable mess by keeping plenty of bibs and cloths to hand.
- Only heat up a small amount of food each time so you don't waste food your baby doesn't eat. You can always heat up more if your baby is keen.
- Don't reheat previously uneaten food.
- Always stay with your baby when they're eating.
- Always test the temperature of food before you give it to your baby - it shouldn't be too hot.
- Encourage self feeding. As your baby develops and shows signs of wanting to feed independently, give them a spoon or finger foods to try.
Stages of weaning
There are three main stages:
1. In the first stage, you start to introduce the feeling of a spoon in your baby's mouth, along with first tastes and textures.
Mix some of the following foods with a teaspoon of either breastmilk or formula (whatever your baby's usual milk is):
- Pureed vegetables such as carrot, swede or potato
- Pureed fruit such as banana, or cooked pear or apple
- A non-wheat-based cereal such as baby rice, sago or cornmeal
Don't force food on your baby, especially at this stage. Remember they're getting most of their nutrients and energy from breast or formula milk. If your baby refuses to eat, it might be too early for them, so try offering the food again in a few days.
2. Once your baby's used to taking food from a spoon, start to slowly increase the amount and number of times a day you offer it. Initially, you'll probably just offer food once a day, but you can now start to introduce it twice and then three times. Remember to go at your baby’s pace.
At this stage, start to introduce the following:
- Full-fat cow's milk products such as full-fat yoghurt or a cheese sauce (you can use full-fat milk in cooking, but avoid giving it as a drink until your baby is over a year old)
- Purees of meat, or pulses
- Gradually cut down the amount of cereals you offer, but continue introducing new fruit and vegetables
You can also now begin to use some of the foods you cook for yourself. Homemade pureed foods are cheaper than shop-bought products, and have the added benefit of introducing your baby to the kinds of foods your family eats. Freeze small amounts of home-made food (try using ice cube trays for handy portion sizes). Remember you don't need to add salt, honey or sugar to your baby’s food.
3. Start to offer thicker purees and then introduce soft lumps. By the end of this stage, your baby will also be moving on to mashed and chopped foods. Remember to offer a variety of foods to ensure your baby receives all the necessary vitamins and minerals.
Things to remember at this stage are:
- Your baby should still be having 500ml to 600ml of breastmilk or formula every day.
- Aim for a starchy food, a fruit and a vegetable at each meal.
- Every day your baby should have one serving of protein-rich food such as soft cooked meat, fish, tofu or pulses such as lentils. Eggs should be thoroughly cooked so the yolk is hard.
Around this stage, your baby might start to enjoy finger foods, such as chopped fruit and vegetables (initially vegetable sticks should be lightly steamed to make them a little easier to chew), bread sticks or toast.
Chewing helps with oral muscle development, which is important for speech development. Try to avoid biscuits and snacks that are high in sugar.
Always stay with your baby to make sure they don't choke on any finger foods.
You're now moving towards including all the foods your family usually eats in your baby's diet. You'll probably still need to modify the texture by mashing or chopping as appropriate for your baby.
Salt - avoid adding salt during cooking, and limit foods with high salt levels, such as bacon.
Sugar - avoid adding sugar to foods and drinks.
Honey - don't give honey to your baby until he or she is a year old. There's a very small risk of a certain type of food poisoning called infant botulism. By one, your baby's digestive system has developed enough to stop the bacteria growing.
Avoid the following foods, as there's a potential risk of an allergic reaction:
- Nuts and seeds, including peanut butter. Peanuts can be given from six months of age if they're crushed, but whole peanuts should be avoided in children under five because of the risk of choking. If you, or a family member, has a history of food allergy or other allergic conditions, avoid peanuts and peanut products altogether until your baby is three.
- Wheat-based foods
- Eggs
- Fish and shellfish
- Liver
From six months, water and diluted, unsweetened fruit juices can be offered at mealtimes. Drinks between meals should be tap water or breastmilk/formula. Full-fat milk can be used as a drink after the age of one. Semi-skimmed and skimmed milk are not suitable for this age group.
Don't give your baby fizzy drinks, fruit squashes, tea, coffee or drinks with artificial sweeteners.
From the age of one, encourage your baby to drink out of a cup, as this is better for their teeth than a bottle.
Iron
By six months, your baby's iron stores are reduced significantly and they'll need extra iron from their diet. Rich sources of iron include red meat. Iron present in vegetable sources is not as efficiently absorbed, but including vitamin C-rich foods with these sources helps to increase iron absorption.
Vitamin D
There's a risk of vitamin D deficiency in babies under a year old. Certain groups in the UK, such as babies born to mothers who have low vitamin D status, babies of Asian or African origin, or whose mothers cover most of their skin up when outside, are most at risk.
The Department of Health recommends a supplement of vitamins A and D for breastfed infants from six months, or from one month if the mother's nutritional status was poor during pregnancy. Formula-fed infants over six months who are receiving less than 500ml of formula each day should also receive this supplement.
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Pre-school children (one to four years)
The pre-school years are a crucial time for learning good dietary habits that can lay the foundations for future good health.
Food and nutrients help to form strong teeth and bones, muscles and a healthy body. A good diet can also help to protect your child against illness now and in the future.
This is a critical time to complete the weaning process, reducing the amount of milk and establishing the foundations of your child’s diet. A young child's diet needs special care and planning - the need for energy and nutrients is high, but appetites are small and eating habits can be fussy. Their diet must be made up of small, regular, nutrient-dense meals.
Suitable foods
Base your child's intake on the following food groups to help ensure they’re getting all the important nutrients. Remember pre-school children should be allowed to eat according to appetite, as there are no definitive recommendations on portion sizes for this age group. At this age, children are often good at regulating their appetite.
There's no need to rely on pre-prepared toddler foods. If the family diet is healthy, children can just have family food.
1. At least one kind of starchy carbohydrate, such as bread, rice, pasta, noodles, cereals or potatoes, should be served with all meals.
Young children have small appetites, so fibre-rich carbohydrates can be bulky and inhibit the absorption of some minerals. Gradually introduce higher fibre carbohydrate foods, such as wholewheat pasta and brown rice, so that by the time children are five, they're eating the same fibre-rich foods as the rest of the family.
2. Fruit and vegetables should be eaten often. Aim for at least five servings a day, where a serving is about a handful in size.
- Use fruit in puddings and as snacks
- Frozen and canned fruit and vegetables can be just as nutritious as fresh varieties
- Vegetables can be eaten raw or cooked (serve crunchy rather than very soft to preserve the vitamins and minerals)
- If vegetables aren't a favourite, try hiding them by pureeing in to soups, sauces, casseroles and pizza toppings
3. Milk and dairy foods are an important source of calcium. Your child should be having about one pint (500 to 600ml) of milk a day.
- Use full-fat varieties; semi-skimmed may be given from the age of two if the overall diet contains enough energy and nutrients
- Milk can be used on cereals or in drinks, puddings and sauces
- Cheese, fromage frais or yoghurt can be given instead of some milk
- Grated cheese, cheese spread or cheese portions can be used on sandwiches or toast
- Try yoghurts as a pudding or snack between meals, served alone or with fruit
4. Meat, fish and alternatives should be eaten once or twice a day.
- Minced beef, turkey, chicken and pork should be cooked slowly to ensure it's soft and tender
- The Food Standards Agency recommends at least two servings of fish a week, one of which should be oily. But don't give your child more than four servings of oily fish a week for boys and two servings a week for girls. Shark, swordfish or marlin should also be avoided, as these contain high levels of mercury, which might affect a child's developing nervous system
- Use eggs, either boiled, in sandwiches, as omelettes or scrambled
- Try different beans and pulses, such as lentils, baked beans, peas and chickpeas
Foods to be careful with
Fatty and sugary foods include spreading fats, cooking oils, sugar, biscuits, cakes, crisps, sweets, chocolate, cream, ice cream and sugary drinks. These shouldn't be given too often and, when they are, only in small amounts. Many of these could affect your child’s intake of more nutritious foods and lead to a less healthy diet.
Sugary foods and drinks (including fruit juice) can also significantly contribute to dental decay, especially when consumed between meals. Some sugar-free or diet drinks can also cause decay because of their acidity. Milk or water are the best drinks to have between meals.
Try to limit the amount of sweets your child eats. Offer them at the end of a meal rather than between meals as a snack.
Particularly important nutrients for pre-school children include:
Iron
Iron deficiency is common in this age group as iron requirements are relatively high but dietary intake is often low, especially if little or no meat is eaten. Foods rich in vitamin C, eaten at the same time, can help to maximise iron absorption from non-meat sources, so include a glass of orange juice with the evening meal, or citrus fruit and vegetables rich in vitamin C.
Calcium
This is vital for the growth of bones and teeth. A child's requirement will usually be met if milk and other dairy products are consumed daily as a regular part of the diet. Good sources of dietary calcium are shown above.
Vitamins A, C and D
Vitamin A is needed for healthy skin and cell development and can often be lacking in diets within this age group.
Vitamin C is important for the immune system and growth, and its intake may be low in children who don't eat much fruit or vegetables.
Vitamin D is essential for the body's calcium metabolism and can be produced by the body when skin is exposed to sunlight.
In winter, and if your child is always covered when outside, make sure you include dietary sources of vitamin D, along with supplements (in tablet or liquid form) containing this vitamin.
Young children can be given extra A, C and D vitamins in supplements. These are available from your local health centre.
- Give your child regular meals and snacks, and try to time these for when your child isn't too tired or hungry
- Sit down and eat together as a family - "Conversation is the best seasoning"
- Try including children in buying and preparing foods to encourage their interest
- Have a wide variety of foods and choose ones that are colourful and interesting
- Offer small portions on a small plate, and allow your child to have more if they're still hungry.
- Keep sweet foods out of sight until the main meal has been eaten
Advice about meals
Breakfast
This is a very important meal - not only does it break the overnight fast, but it can provide essential nutrients, too.
Breakfast cereals are ideal, especially if served with a glass of fresh fruit juice or fruit - it's a nutrient-packed meal that will provide starchy carbohydrates, vitamins, calcium, iron and protein. But toast, fruit and yoghurt, egg or beans can all be offered as an alternative.
Snacks
Nutritious snacks are important to supply essential nutrients and energy, but avoid giving large snacks too close to meals.
Healthy snacks include fresh fruit, vegetable sticks (such as carrots and peppers), dried fruit, cheese cubes and crackers, toast, small sandwiches, and yoghurt or fromage frais.
Faddy eating and refusing food
Many children go through phases of refusing to eat certain foods or anything at all. This is particularly common for children up to the age of five, and is a normal part of growing up and asserting independence. Children won't harm themselves if they don't eat for a short while.
It's quite normal for young children to refuse a new food without even trying it. If this happens, stay calm and don't force your child to eat it. Take the food away and introduce it again in a few days' time. Research shows new foods often need to be offered several times before some children will try them.
Offer regular meals and snacks to establish a structured eating pattern rather than allowing your child to pick at food throughout the day. Make meal times fun. Use brightly coloured plates, present the food in an attractive way, and try to remain calm and relaxed. If the problem shows no sign of improving, speak to your health visitor, GP or dietitian to get further advice.
Excess weight
If your child’s putting on too much weight, cut down on snacks, particularly sweets and chocolate, and give sugar-free or no-added-sugar drinks. Seek advice from your health visitor or GP, who may refer your child to a dietitian.
Poor weight gain
If your child isn't gaining weight well, talk to your health visitor or GP who will check for any underlying medical reasons. As some children have very small appetites, try to make all meals and snacks as nutritious and calorific as possible (see 'Snacks' section above).
Allergies
If you ever notice swelling of your child's mouth or face, or breathing difficulties during or after eating, seek medical advice immediately. Keep a diary of all foods and drinks consumed and try to pinpoint which foods triggered the reaction.
Symptoms such as a rash or vomiting after eating may also suggest there has been a reaction to a food.
Don't diagnose allergies yourself or eliminate foods from your child's diet without medical advice, as this may compromise the quality of their diet and result in nutritional deficiencies.
To lessen the risk of peanut allergies, foods containing peanuts should not be given to children under three if the child has a parent or sibling with a diagnosed allergy.
Whole nuts shouldn't be given to any child under five because of the risk of choking.
Diarrhoea
Episodes of diarrhoea are fairly common in young children who are otherwise healthy. Sometimes called 'toddler diarrhoea', the condition usually resolves by four years of age.
Excessive fluid intake, particularly fruit squashes and fruit juices such as apple juice, may worsen the condition. If the diarrhoea is prolonged, tell your doctor or health visitor.
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