Fact sheetDiet specifications

Published on 1 Nov 2012


Infant 6 months+

This document is part of the ACI Diet Specifications for Paediatric Inpatients. It is not to be used for patient education.

Aim

To provide developmentally appropriate range of solids of manageable texture for children from approximately 6 months of age who have been introduced to solids and are ready for a puree texture.

Characteristics

A diet that conforms to the Nutrition standards for paediatric inpatients in NSW hospitals for infants 6-12 months of age. Infant solids supplement breast milk and/or infant formula. Developmentally appropriate foods include infant cereals, vegetables, fruits, dairy, eggs, bread, meat and meat products, chicken and fish.

Foods are given individually i.e. 1 ingredient only, with no combination foods given, to keep flavours separate and to allow digestive system to adapt. Food is prepared without salt or sugar and with minimal fats. Texture of food is pureed to a thick but uniform consistency and may contain soft lumps. No hard or crunchy food is offered. Dissolvable and very soft solids are included such as soft fresh fruit, cheese sticks and infant rusks.

Indications

Suitable for infants from 6-12 months, when developmentally appropriate and at parent/carer discretion.

Suitable for infants who are nutritionally well and nutritionally at-risk.

May be combined with other therapeutic diet orders for children who have special or high nutritional needs. This diet may be combined with thickened fluids/texture modifications.

Nutritional adequacy

Nutritionally adequate.

Solids at this stage make partial contribution to nutrient requirements. Breast milk and/or infant formula provides most of nutrient requirements if age appropriate.

½ serve size is appropriate.

Refer to the Paediatric Nutrition Standards for Minimum Menu Choice for serve size requirements for varying ages.

Precautions

Breast milk and/or infant formula is the main source of nutrition in the early stages of introduction of solids. In the early stages of solids progression, solids are offered after breast milk or formula feed or at a separate time so they do not detract from feed volume taken. As infants progress, solids are offered before breast milk or formula feed.

In early stages of solids progression, single ingredient foods are offered, with a new food every 2-3 days to allow easier identification of any foods which may trigger allergic reaction or be difficult to digest. Fruits, vegetables and cereals are usually offered first, followed by dairy, eggs and meat. Cereals should be iron fortified. Menu items can be chosen depending on stage of each individual infant in progression with solids.

Care should be taken to choose food that is suitable for the child’s age and stage of development.

Texture progression will develop at different rates in individual children.

Appropriate seating giving support to the head and neck should be available. Age appropriate cutlery should be used. Infants need to be supervised at all times when feeding to prevent choking.

Note: ½ serve sizes to ensure sufficient food variety and manageable serve size.

For children with altered nutrition needs, additional therapeutic diet orders will affect textures and foods allowed.

Specific menu planning guidelines

Allowed Not allowed
Hot main dishes

½ serve size

Preferably one ingredient only

Meats, chicken, fish pureed to a thick moist texture

Pureed legumes with no husk in final puree

Large lumps

Foods thicker than pureed texture

Sauces, gravies

Gravy

Cheese-based/white sauce without lumps

Spicy or highly flavoured sauces

Sauces with lumps

Starchy vegetables/pasta/rice

½ serve size

Smooth mashed potato

Pasta, Rice
Vegetables

½ serve size

Smooth mashed sweet potato/pumpkin

All other vegetables – cooked, pureed

Salad, uncooked veg
SoupsNoneAll
SandwichesNoneAll
Salads, dressingsNoneAll
Breads, cereals

Iron-fortified infant cereals

Strained porridge

All others
SpreadsNoneAll
Hot breakfast choices

Scrambled/boiled egg

Baked beans pureed

All others
Fruit

Mashed soft fresh fruits (e.g. bananas, kiwifruit, watermelon)

Finely diced or pureed canned or stewed fruit

Hard uncooked fruits (e.g. apple)

Dried fruit

YoghurtSmooth lump-free yoghurtFruit yoghurts with visible pieces or seeds
Desserts

Plain vanilla or egg custard

Creamy rice

All other desserts (e.g. ice-cream, jelly, cakes)
Milk and cheese

Full fat cows’ milk with cereal

Full fat cows’ milk not preferred as main beverage for infant under 12 months of age

Cheese – grated, sliced or melted

Cows’ milk as main beverage for infants under 12 months of age
Beverages

Breast milk

Infant formula

Water

Full fat cows' milk if over 12 months of age

Juice, cordial, soft drinks, tea or coffee

Cows’ milk as main beverage for infants under 12 months of age

Reduced fat milks

BiscuitsInfant rusksAll others
MiscellaneousStarch based, locust bean (carob bean) gum and guar gum thickeners for thickening EBM or formula or other fluids

Xanthan gum based thickeners for thickening EBM or formula or other fluids

Salt, sugar in meal preparation

Salt, pepper, sugar sachet

Nuts, popcorn, alcohol

References

  1. Agency for Clinical Innovation. Nutrition standards for paediatric inpatients in NSW hospitals. Sydney 2011.
  2. Agency for Clinical Innovation. Nutrition standards for adult inpatients in NSW hospitals. Sydney 2011.
  3. Dietitians Association of Australia. 2009. Nutrition Manual 8th ed. Canberra: DAA.
  4. American Dietetic Association. Paediatric Nutrition Care Manual. Chicago: ADA.
  5. NHMRC 2003 Dietary Guidelines for Children and Adolescents in Australia.
  6. Sydney Children’s Hospital Network factsheets on Breastfeeding, Breastfeeding – Is it for me?, Baby's first foods and Preparation of Infant Formula.
  7. Australian Breastfeeding Association.
  8. Infant Feeding Guidelines for Health Workers. NHMRC 1996.
  9. WHO/UNICEF. Protecting, Promoting and Supporting Breastfeeding: The special role of maternity services. A joint World Health Organisation/UNICEF statement. 1989. Geneva, Switzerland.
  10. World Health Organisaton. International Code of Marketing of Breastmilk Substitutes. 1981. Geneva, Switzerland.
  11. Shaw V and Lawson M. Clinical Paediatric Dietetics. 3rd Edition. 2007. Blackwell Publishing.
  12. Australasian Society for Clinical Immunology and Allergy. 2008. Infant feeding advice.
  13. Agostoni C, Decsi T, Fewtrell M, Goulet O, Kolacek S, Koletzko B, Fleischer Michaelsen K, Moreno L, Puntis J, Rigo J, Shamir R, Szajewska S, Turck D, van Goudoever J. 2008. Medical Position Paper – Complementary Feeding: A Commentary by the ESPGHAN Committee on Nutrition. Journal of Paediatric Gastroenterology and Nutrition 46:99-110.
  14. NSW Ministry of Health. Breastfeeding in NSW: Promotion, protection and support. 2011.
  15. Food Standards Code FSANZ.
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