What is a “portion of food” for a baby

Now the topic of food portions in young babies (6 months – 1 year) is very close to my heart, as I think most tears in my practice have been cried about my “baby not eating enough”. What is enough for a baby when it comes to food? Is it what the food companies put in a jar/pouch? Is it what as a parent you feel is enough for your child? I can tell you certainly that what is in a jar/pouch is not a portion, so do not worry if your child does not finish this. Also, what you are dishing up in most cases will also not be a right portion for your baby – because this is highly influenced by  your own eating habits (we measure our babies portion to what we would eat). It is a myth that for babies < 1 year of age you have a “magical portion size” for all foods, as sometimes a 6 month old baby can be 6 kg and sometimes 4 kg, surely you would not expect them to eat the same?

So what is a portion? Firstly between 6-12 months you are introducing solids and then expanding the variety, whilst milk intake slowly reduces as solid volume goes up. In the initial phase its all about tastes and textures and really ensuring that your child gets exposed to a wide variety of different flavours. Of course as the variety of foods increase, the nutritional contributions of weaning foods also increases. In the vast majority of babies, they have very good appetite and satiety control and generally when they signal hunger they will eat and they will stop when they are not hungry. The ideal feeding style for parents is therefore “responsive feeding” – which means you are listening to your child’s cues and respond with portions sizes according to their hunger. Other feeding styles include indulgent, controlling and neglectful feeding, which all have a negative impact on your baby’s feeding – I will discuss these further when we get to feeding difficulties. Hand in hand with a responsive feeding style goes growth monitoring, if your child grows well, you can be assured that you are getting sufficient energy and protein in, if weight gain is excessive, then they are getting too much. When you have introduced a good variety of foods into your baby’s diet you can start looking at proportions – 1/5 protein, 2/5 carbs and 2/5 vegetables. This will ensure that you have sufficient non-protein energy for the protein to be used for growth and development.

Of course there are always exceptions when it comes to a appetite and satiety. In a small number of young children there can be a disregulation of appetite and satiety where professional help is required. On the other hand when your child is unwell, their food intake is altered and  you need to respect that, because as adults when we are unwell we also do not want to eat. Can you imagine somebody sitting in front of you when you have the flu and forcing food down you?!! There are also medical diagnoses that affect appetite and satiety, including non-IgE mediated gastrointestinal food allergies (which I will discuss in another blog entry) and other gastrointestinal diseases. If your baby’s growth drops down centiles you definitely need to speak to a healthcare professional.

Now, for toddlers > 1 year of age there are some portion sizes,  which the Infant and Toddler Forum have published and they regularly tweet photos of portion sizes which help put your portions into perspective. Again, a big boy may eat more than recommended portion sizes whereas a petite girl may eat less, so looking at the portions is a great guide, but also take your child’s appetite and satiety into account.  I will write more on older children and food intake in future blog entries, as behaviour does set in when they are older so eating can often be a difficult.

Introduction of Complementary Foods

The introduction of solids (also called weaning or complementary feeding) has become quite a complex topic for both healthcare professionals and parents. This is most probably related to the fact that although we have the World Health Organization (WHO) guidelines on complementary feeding many other health organizations have published their own guidelines on weaning, which do not reflect the same information as the WHO. Add on to this the worry about the increase in food allergy and confusion when to start solids to prevent the development of these and you have a perfect recipe for confusion.

So lets start with the basics: the WHO recommends that weaning is commenced at 6 months of age, with this recommendation being  backed up by a very good systematic review of many studies indicating that breastfeeding exclusively until this age provides a baby with all the nutrition that they need and has the added benefit of reducing infections (see blog post on the benefits of breast milk). So the ideal from the WHO perspective is to breast feed exclusively until 6 months and then introduce solids. This is the advice currently also supported by the Department of Health in the UK. However, the European Society of Paediatric Gastroenterology Hepatology and Nutrition and the American Academy of Pediatrics both recommend introduction of solids occur between 4-6 months of age, when the child is ready. The latter recommendations are also based on really good research indicating that too early (< 17 weeks) or too late (> 26 week) weaning can also introduce a multitude of problems, which I will discuss under feeding difficulties, food allergies and micro-nutrient deficiencies in future blog entries.

So what are parents supposed to do? For me as a healthcare professional the most important aspect to commencing solids in any infant is not to do any harm, so DEFINITELY no solids < 17 weeks and it is important NOT to delay solid introduction beyond 26 weeks. In between this age, each baby will indicate whether they are ready to be weaned. Generally this would include being able to sit upright and hold their head in a steady position, having eye-hand-mouth coordination with food (looking at food and wanting to grab it) and lastly that they are able to manage food in their mouth (babies who are not ready will push their food back out with their tongue). It is important not to miss these cues with your baby and rather follow your baby’s development for readiness for food introduction.

Babies start mouthing usually from 3 months of age, this means they are putting their fists/fingers in their mouth and can often be associated with a lot of salivation. This often gets misinterpreted as either early teething or that they are hungry. In fact, this is a wonderful developmental stage that all children go through, desensitizing their mouth for future solids and also learning to explore. In future you will not only see them explore their fingers in this way, but foods and toys as well. Similarly often parents interpret night time waking, when they have slept through as a sign to wean, when there are none of the other signs (i.e. eye-hand-mouth coordination ect)  present. Babies will go through these periods naturally, so it is not necessarily a sign that they need food.

So look and listen to your baby’s cues and start when your baby is ready, but remember never before 17 weeks! I will guide you through weaning with future posts.