Chapter 4: Nutrition and Food Service
4.3 Requirements for Special Groups or Ages of Children
4.3.1 Nutrition for Infants
18.104.22.168: Introduction of Age-Appropriate Solid Foods to Infants
A plan to introduce complementary, age-appropriate solid foods to infants should be made in consultation with the child’s parent/guardian and primary health care provider. Complementary foods are foods other than human (breast) milk or infant formula (liquids, semisolids, and solids) introduced to an infant to provide nutrients (1). Age-appropriate solid foods may be introduced at 6 months of age with the flexibility to introduce sooner or later based on the child’s developmental status (2). However, recommendations on the introduction of complementary foods provided to caregivers of infants should take into account:
- The infant’s developmental stage and nutritional status
- Coexisting medical conditions
- Social factors
- Cultural, ethnic, and religious food preferences of the family
- Financial considerations
- Other pertinent factors discovered through the nutrition assessment process (1)
For infants who are exclusively breastfed, the amount of certain nutrients in the body - such as iron and zinc - begins to decrease after 6 months of age. Therefore, pureed meats/meat substitutes and iron-fortified cereals should be gradually introduced first (3). Iron-fortified cereals, pureed meats, and pureed fruits/vegetables are all appropriate foods to introduce. The first food introduced should be a single-ingredient food that is served in a small portion for 2 to 7 days (3). Gradually increase variety and portion of foods, one at a time, as tolerated by the infant (4). There are several signs that caregivers/teachers should use when determining when the infant is ready for solid foods. These include sitting up with minimal support, proper head control, ability to chew well, or grabbing food from the plate. Additionally, infants will lose the tongue-thrusting reflex and begin acting hungry after formula feeding or breastfeeding (3). Caregivers/teachers should use or develop a take-home sheet for parents/guardians in which the caregiver/teacher records the food consumed, how much, and other important notes on the infant, each day. Caregivers/teachers should continue to consult with each infant’s parents/guardians concerning which foods they have introduced and are feeding. When appropriate, modification of basic food patterns should be provided in writing by the infant’s primary health care provider.
If nutritional supplements are to be given by caregivers/teachers, written orders from the prescribing health care provider should specify medical need, medication, dosage, and length of time to give medication.
Early introduction of age-appropriate solid food and fruit juice interferes with the intake of human milk or iron-fortified formula that the infant needs for growth. Age-appropriate solid foods given before an infant is developmentally ready may be associated with allergies and digestive problems (5). Age-appropriate solid foods, such as meat and fortified cereals, are needed beginning at 6 months of age to make up for any potential losses in zinc and iron during exclusive breastfeeding (3). Typically, low levels of vitamin D are transferred to infants via breast milk, warranting the recommendation that breastfed or partially breastfed infants receive a minimum daily intake of 400 IU of vitamin D supplementation beginning soon after birth (6). These supplements are given at home by the parents/guardians, unless otherwise specified by the primary health care provider.
Many caregivers/teachers and parents/guardians believe that infants sleep better when they start to eat age-appropriate solid foods; however, research shows that longer sleeping periods are developmentally (not nutritionally) determined in mid-infancy and, therefore, shouldn’t be the sole reason for deciding when to introduce solid foods to infants (7,8). Additionally, for infants who are exclusively formula fed or given a combination of formula and human milk, evidence for introducing complementary foods in a specific order has not been established.
Good communication between the caregiver/teacher and the parents/guardians cannot be overemphasized and is essential for successful feeding in general, including when and how to introduce age-appropriate solid foods.
Feeding Infants: A Guide for Use in the Child Nutrition Programs, US Department of Agriculture Food and Nutrition Service (https://wicworks.fns.usda.gov/wicworks/Topics/FG/CompleteIFG.pdf)
TYPE OF FACILITYCenter, Early Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS22.214.171.124 Medication Administration
126.96.36.199 100% Fruit Juice
188.8.131.52 Written Menus and Introduction of New Foods
184.108.40.206 Care for Children with Food Allergies
220.127.116.11 Vegetarian/Vegan Diets
18.104.22.168 Adult Supervision of Children Who Are Learning to Feed Themselves
22.214.171.124 Experience with Familiar and New Foods
US Department of Agriculture, Food and Nutrition Service. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Chapter 5: Complementary foods. In: Infant Nutrition and Feeding. Washington, DC: US Department of Agriculture; 2009:101–128 https://wicworks.fns.usda.gov/wicworks/Topics/FG/CompleteIFG.pdf. Accessed January 11, 2018
US Department of Agriculture, Food and Nutrition Service. Child and Adult Care Food Program: meal pattern revisions related to the Healthy, Hunger-Free Kids Act of 2010. Final rule. Fed Regist. 2016;81(79):24347–24383
American Academy of Pediatrics. Working together: breastfeeding and solid foods. HealthyChildren.org Web site. https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Working-Together-Breastfeeding-and-Solid-Foods.aspx. Updated November 21, 2015. Accessed January 11, 2018
World Health Organization. Infant and young child feeding. http://www.who.int/mediacentre/factsheets/fs342/en. Updated July 2017. Accessed January 11, 2018
Abrams EM, Becker AB. Introducing solid food: age of introduction and its effect on risk of food allergy and other atopic diseases. Can Fam Physician. 2013;59(7):721–722
Thiele DK, Ralph J, El-Masri M, Anderson CM. Vitamin D3 supplementation during pregnancy and lactation improves vitamin D status of the mother-infant dyad. J Obstet Gynecol Neonatal Nurs. 2017;46(1):135–147
Walsh A, Kearney L, Dennis N. Factors influencing first-time mothers’ introduction of complementary foods: a qualitative exploration. BMC Public Health. 2015;15:939
Robert Wood Johnson Foundation Healthy Eating Research. Feeding Guidelines for Infants and Young Toddlers: A Responsive Parenting Approach. Guidelines for Health Professionals. http://healthyeatingresearch.org/wp-content/uploads/2017/02/her_feeding_guidelines_brief_021416.pdf. Published February 2017. Accessed January 11, 2018
Content in the STANDARD was modified on 05/31/2018.