Infant first foods

Aim

To provide developmentally appropriate foods of a manageable consistency for first introduction of solids for infants.

Characteristics

A diet that conforms to the Nutrition standards for paediatric inpatients in NSW hospitals for infants from 0-6 months. First foods supplement breast milk and/or infant formula. Developmentally appropriate foods include iron-fortified infant cereal, vegetables and fruits.

Foods are given individually i.e. 1 ingredient only, with no combination foods given, to keep flavours separate and to allow the digestive system to adapt. Food is prepared without salt or sugar and with minimal fats.

Texture of food is smooth, uniform in consistency, and contains no lumps. Pureed food is finely strained.

Indications

For the introduction of solids.

Suitable for infants from around 6 months of age, when developmentally appropriate and at parent/carer discretion.

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

Used in conjunction with continued breast and/or infant formula feeding.

May be combined with other therapeutic diets for children who have special or high nutritional needs.

This diet may be combined with thickened fluids/texture modifications.

Nutritional adequacy

Nutritionally adequate when first foods are used to complement breast milk and/or infant formula.

Solids at this stage make minimal contribution to nutrient requirements. Breast milk and/or infant formula meets the majority of nutrient requirements if age appropriate.

½ serve size is appropriate to ensure sufficient food variety and manageable serve size.

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 throughout the early stages of introduction of solids. Introduction of complementary solids is not advised before 17 weeks and should not be delayed beyond 26 weeks. Introductory solids need to be offered after breast milk or formula feed or at a separate time so they do not detract from feed volume taken.

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: this diet is only for first introduction of solids; once solids are established the infant progresses to a more advanced solid diet as is developmentally-appropriate. Requires regular monitoring to ensure solids are tolerated, and that adequate amounts are provided in keeping with the child’s nutritional and experiential needs.

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	None	All Meats, eggs, combination foods
Sauces, gravies	None	All
Starchy vegetables/pasta/rice	½ serve size Potato pureed to a smooth texture and finely strained	Pasta/rice, combination dishes
Vegetables	½ serve size Cooked. All pureed to a smooth texture and finely strained (e.g. beans, broccoli, carrot, cauliflower, pumpkin, squash, sweet potato, zucchini)	Salad, uncooked vegetables, hard or stringy vegetables Nuts
Soups	None	All
Sandwiches	None	All
Salads, dressings	None	All
Breads, cereals	Iron-fortified infant cereals, strained porridge All cereals to be pureed to a smooth texture and finely strained	Bread, crunchy cereals, cereals with nuts or hard pieces, or that cannot be finely strained Unprocessed bran
Spreads	None	All
Hot breakfast choices	None	All
Fruit	Soft cooked or canned fruit – all pureed to a smooth texture and finely strained (e.g. canned/cooked pear, apple, apricot, peach)	Raw fruit Cooked fruit whole or in large pieces
Yoghurt	None	All
Desserts	None	All
Milk and cheese	None	All cow's, goat's milk
Beverages	Breastmilk and/or infant formula as the primary source of nutrition while solids are being established Water	All milks Soy beverage Juice, soft drinks, tea or coffee
Biscuits	None	All
Miscellaneous	Starch based, locust bean (carob bean) gum and guar gum thickeners for thickening EBM or formula	Xanthan gum based thickeners for thickening EBM or formula Salt, sugar or fat in food preparation Salt, pepper, sugar sachet Honey, 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. National Health and Medical Research Council. Infant Feeding Guidelines for Health Workers.
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. WHO. 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. NSW Ministry of Health. Breastfeeding in NSW: Promotion, protection and support. 2011.
13. Australasian Society for Clinical Immunology and Allergy, 2008. Infant feeding advice.
14. 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 Pediatric Gastroenterology and Nutrition 46:99-110.
15. Food Standards Code FSANZ.
16. Abrams S.A. American Academy of Pediatrics Jun 3, 2011; DOI: 10.1542/aapnews.20110603-1. Be cautious in using thickening agents for preemies.