Some Advice from the Start Healthy Feeding Guidelines

When, in what order, and how quickly should solid foods be introduced?

For most infants, breast milk and/or iron fortified formula provide all the nutrients required for the first six months after birth. After that, breast milk and/or iron-fortified infant formula should remain an infant's primary beverage until after first year of life, but solid, or complementary, foods should also be given to provide needed nutrients and to expose infants to a wide variety of flavors. Introducing a variety of flavors and foods before age 2 may increase acceptance of a wider variety of flavors and foods in later childhood.

The order in which complementary foods are introduced is not important. However, they do need to provide certain nutrients, including iron, zinc, vitamin D, vitamin, E, niacin, thiamin, phosphorus, magnesium, fluoride, manganese, biotin, and vitamin B6. Because meat and fortified infant cereals provide many of these, they make good first foods for infants.

  It is generally recommended that single-ingredient foods be started first, one at a time, allowing for at least a two-day interval between new foods. Combination foods may be given to older infants after testing for tolerance to the individual components.

  What about textures?

A gradual exposure to different textures during the developmentally sensitive period when infants are learning to chew (from about 6 to 10 months of age) is suggested and may decrease the risk of rejection, refusal to chew, or vomiting.

What foods should be avoided to reduce the risk of food allergies?

In infants without a family history of food allergies, there is no need to restrict or avoid any specific foods. However, caregivers are advised to introduce single-ingredient foods first and watch for adverse reactions.

Infants with a strong family history of food allergies should be breastfed as long as possible and complementary foods should not be given before six months of age. Eggs, milk, wheat, soy, peanuts, tree nuts, shellfish, fish, and foods containing these major food allergens should not be given before one year of age. Decisions regarding the use of hypoallergenic infant formulas, the duration of formula feeding, and any dietary restrictions should be made in consultation with the infant's healthcare provider.

How can parents create a healthy eating relationship?  

Establishing a division of responsibilities between child and parent during feeding is at the core of healthy feeding relationships. The parents' responsibility is to create a nurturing feeding environment and providing healthy foods, while allowing the child to determine how much he/she will eat. Parents should also learn to recognize a child's developmental ability with respect to eating, balance a child's need for feeding assistance with encouragement to self-feed, and respond early and appropriately to a child's hunger and fullness cues.

How do infants and toddlers indicate hunger and fullness?

Being sensitive to hunger and fullness cues can help parents avoid over- or underfeeding infants and toddlers.

Hungry infants often cry, move their arms and legs in an excited fashion, swipe at the spoon holding food, open the mouth, and move the head toward the spoon. They may also coo, smile, and gaze at the food-provider during feeding to signal a desire for feeding to continue. Infants who are no longer hungry may fall asleep, become fussy, slow the pace of eating, stop suckling, spit out or refuse the nipple or spoon, bat away the spoon or close the mouth when food approaches.

Toddlers may signal hunger by pointing, asking or reaching for food or beverages, and fullness by slowing the pace of eating, becoming distracted, playing with or throwing food, wanting to leave the chair or table, or refusing to eat.

Editor's Note:  Adapted from Butte N, Cobb K, Dwyer J, Graney L, Heird W, Rickard K; American Dietetic Association; Gerber Products Company. The Start Healthy Feeding Guidelines for Infants and Toddlers. J Am Diet Assoc. 2004;104(3):442-54.

Also see: StartHealthyGuidelines for the full text of the guidelines (reprinted with permission).