Infant 6 months+

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
Soups	None	All
Sandwiches	None	All
Salads, dressings	None	All
Breads, cereals	Iron-fortified infant cereals Strained porridge	All others
Spreads	None	All
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
Yoghurt	Smooth lump-free yoghurt	Fruit 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
Biscuits	Infant rusks	All others
Miscellaneous	Starch 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.