Feeding a baby: how to start food diversification?

Baby is already 4 months old and never ceases to impress you with his progress and growth. Nourished exclusively milk until now, breastmilk or infant formula (1st age milk), he must now venture gradually into new flavors and new contributions. According to European recommendations, the food diversification must intervene between 4 and 6 months, not before or after. As explained by Dr Alain Bocquet, pediatrician, head of the Nutrition Group of the French Association of Ambulatory Pediatrics (AFPA) and member of the Nutrition Committee of the French Society of Pediatrics (SFP):

The National Nutrition and Health Program (PNNS) (source 1) uses European recommendations. So finished this “exclusive” communion between a nursing mother and her little one. Baby must experiment with new flavors for his well-being!

During his growth at high speed, your child has impressive new needs: 7 times more iron than an adult (in relation to its weight), 5 times more calcium4 times more vitamin C. On the other hand, it needs much less salt.

Complex carbohydrates (previously called slow sugars) – cereals and pseudo-cereals, starches and pulses – must represent 40 to 50% of the total energy intake (TEI). They provide long-term energy, both for the brain than for the muscles.

However, the WHO recommends reduction in free sugar intake (previously called fast sugars) at less than 5% of the AET. Due to the risk of overweight and dental caries sugary foods should be limited.

We distinguish the animal protein (meat, fish, eggs, milk and dairy products) and vegetable proteins (cereals and legumes).

Indispensable to the growth of the child from diversification, proteins allow the construction of the organism. A baby with a protein deficiency (a rare case in France!) may suffer from growth retardation both in size and in the brain. “In France protein intake is very excessive in most children, with the risk of kidney fatigue and excess weight later” warns the pediatrician. “From the age of 6 months baby should consume about 10g per day. Note that 100 g of meat or fish contain around 20 g of protein”.

Did you know? Fatty substances also are indispensable to the infant. “We must not demonize them because they allow an important energy contribution, and also the brain, eye, skin development and the absorption of fat-soluble vitamins” recalls Dr. Bocquet. Lipids should represent 45% of TEI before 3 years (more than 50% of children aged 18 months to 3 years have lower intakes). Adequate intake is essential to prevent epigenetic adaptation conducive to the onset of later obesity. Lipids can be of vegetable origin (vegetal oils) or animal (milk cream and butter, fat from meat and fish). Prefer vegetable oils rich in omega 3 without excess omega 6 such as rapeseed and walnut oils: they must be added to vegetables at the rate of 1 to 2 teaspoons per day at the beginning. Butter and cream can sometimes replace oils. The fish, especially oily fishare rich in long-chain polyunsaturated fatty acids, in particular omega-3, essential for the brain.

Your child needs water on a daily basis to meet his hydration needs: it must be offered to him regularly, and even more in the event of strong heat, or illness (fever, diarrhea, vomiting, etc.). Which water to choose? Low mineral water (less than 500mg of dry residue at 180°: value indicated on the label), or even tap water ; In contrast, limit fruit juice and we do without sugary drinks.

Essential for building bones and teeth, calcium is very present in milk and dairy products. From the diversification, the contributions of milk and dairy equivalents are still important (between 500 and 750 ml / day), provided by breastfeeding or a second-age milk and/or dairy products and cheeses.

This trace element is essential for the red blood cell production and brain development. However, at 4 – 6 months, baby has exhausted his iron stock present at birth and must replenish his reserves. In addition to the 2nd age milk, fortified with ironbabies must supplement their iron intake with consumption of iron-fortified meat and cereals. “Red meat is rich in easily absorbed heme iron: 3 times more than pork, 7 times more than poultry, 6 times more than fish and 10 times more than eggs. The offal, usually started after 1 year (without scientific justification to wait until this age), provides even more iron”, evokes the pediatrician.

From 4 months, dietary diversification consists of introduce a variety of foods very gradually to the baby. According to the new recommendations of Public Health France (source 2), there is no no order to introduce the different food groups even if we usually start with vegetables.

The regulation of the appetite must be respected, and it is necessary avoid forcing a child to finish his bottle or his plate. Parents must recognize the child’s signals of hunger (crying, but not all crying is synonymous with hunger, flailing of arms and legs, opening of the mouth when the breast, bottle or spoon approaches) and signals of satiety (the child falls asleep on the breast or the bottle, he pushes the spoon away with his hand, his mouth is closed, his head is turned to the side, he wants to get off his chair, etc.).

When you start food diversification, milk, whether maternal or not, remains the main food of your baby. Bottle feeding, at the rate of 4 bottles per day of 210 ml each, continues. The quantities gradually decrease for 150 ml bottles, as the food portions increase.

The entry of vegetables into the diet is a giant step. They must be cooked without salt, preferably steamed and mixed. These can be given to baby during one of 4 meals a day, usually at noon. Vegetables can be offered in the form of a smooth puree with a spoon, whether it is “homemade” or from a “small pot” before or after breastfeeding or bottle feeding. According to the baby’s hunger, the quantity can then go gradually up to 100 or 130 g of vegetable purée (while lowering the quantity of milk). For reluctant children we can offer at the beginning, vegetables in milk bottle. Here again you can increase the quantity of vegetables up to approximately 130 g while decreasing the quantities of milk powder, to obtain a bottle with 5 measures of milk and vegetables.

The nutrition expert is formal, there are a few rules to properly start the relationship between the child and the entry of vegetables.

• One vegetable a day in its mash (in addition to the potato which can serve as a binder) allows the baby to learn and become familiar with the taste of each vegetable. In case of small pot, prefer those of a single flavor.
• Change vegetables every day also accustoms the child to accepting new tastes.
• He is no need to force a baby to eat if he refuses a vegetable or other food. But it is advisable to propose to him again another day, without forcing him, up to 10 times, the vegetable or the food that he had not initially accepted: most often he will end up accepting it.
• All vegetables are possible, but those that have a strong taste will not necessarily be appreciated at first.
• “Homemade” purées, with fresh or frozen seasonal vegetablesare perfectly suitable for baby’s health, but short and organic circuits are to be preferred.

In theory, fruit in the form of smooth compotes can be given to your infant before or at the same time as vegetables, but parents are generally advised towait for the introduction of vegetables : the sweet taste being preferred by children, the baby could lose interest in vegetables in favor of a sweeter snack! The dessert of ripe cooked or raw fruit can be given before or after feeding or bottle feedingoften at teatime, to begin. Just like vegetables:

• All fruits can be offeredeven strawberries, exotic fruits or kiwis, in the form of cooked fruit compotes or very ripe and mixed raw fruits.
• It is better to get your baby used to it by introducing one fruit a day, for the discovery of flavors. In the case of a small pot, prefer unique flavors. It is advisable to change fruit every day.
• No added sugar with homemade compotes.
• Peanuts and tree nuts are reputed to be allergenic but are introduced at the start of diversification, mixed or pulverized, in dry cakes or dairy desserts, to promote the acquisition of their tolerance. However, they will not be given whole before the age of 3 to limit the risk of accidental inhalation.

It is recommended to add complex carbohydrates at all meals (1/4 of the amount of vegetables at noon and in the evening) in the form cereal (wheat, rice, corn, barley, oats, rye, etc.) and pseudo-cereals (buckwheat, quinoa) or starches : potatoes, sweet potato, cassava (tapioca), and dried vegetables (lentils, split peas, chickpeas, dried beans, broad beans, etc.).

Meat, fish and eggs should be offered to baby regularly from the start of diversification eating. However, the quantity remains light: 10g/day per year of age in progress, i.e. 10 g / day before 1 year, then 20 g / day from 1 to 2 years, then 30 g / day from 2 to 3 years, etc. (10g = 2 teaspoons of mixed meat or fish).

Cereals can be added to the bottle in the morning or in the evening, at the rate of one to two teaspoons in milk, at first. “The latest recommendations propose the introduction of gluten from 4 to 6 monthsbut out of habit we start with gluten-free 1st age cereals and we start 2nd age cereals with gluten in the 7th month”.