In every parent's life, there comes a moment when they are forced to address the transition to non-dairy foods for their child. The introduction of the first complementary foods is a significant change for both the child and parents, accompanied by a multitude of guidelines which unfortunately do not always align.
The term "complementary food" (complementary feeding) refers to all solid and liquid foods with the exception of breast milk or infant formula. Generally, complementary foods are introduced when:
A) Breast milk or infant formula alone can no longer meet the child's
nutritional needs (intake of
energy, macronutrients, and micronutrients),
B) The child usually exceeds a weight of 6 kg,
C) The child is hungry after 8-10 breastfeedings or drinking 900-1000 ml of milk per day.
For introducing complementary foods, the child's psychomotor development is also important. This means that the child must be able to sit alone or with support, hold their head in a stable position, open their mouth at the sight of a spoon, and upon being given food, not push it back with their tongue but swallow it.
In addition to the above conditions, the age of the child is also considered for introducing complementary foods, taking into account the duration of breastfeeding or feeding with infant formula. For exclusive breastfeeding, the consensus is to recommend at least until the end of the 4th month (17 weeks) of the child's age. If the child is thriving, breastfeeding is appropriate for 6 months (26 weeks). This period is followed by the introduction of the first complementary foods. In the opposite case, if the child is not thriving on exclusive breastfeeding, is fed with infant formula, or there is another reason for introducing complementary foods, it is recommended to begin with the first complementary foods between the 17th and 26th week of the child's age.
This timeframe has its reasons. Introducing complementary foods before the 17th week or delaying them past the 6th month of the child's age increases the risk of certain health complications—most often mentioned are eating disorders, malnutrition, anemia, or food allergies. The situation is somewhat complicated by the consensus of a significant segment of the expert community, which argues that non-dairy complementary foods should be introduced during the period known as the window of immunological tolerance ("immunological window"), between the 17th and 26th week of the child's life, meaning not earlier than after the completed 4th month of age and not later than at the end of the 6th month of age.
The transition to non-dairy foods should not be abrupt but gradual. During the introduction of complementary foods, breastfeeding or the provision of infant formula should continue according to the child's needs until 2 years of age or longer (the reason being the fact that milk is an important source of calcium, iron, and vitamin D).
In practice, the first complementary foods are often met with a child’s reluctance to consume the meals. This behavior is related, among other things, to the taste of the food. Children have an innate preference for sweet and salty foods but an innate aversion to bitter tastes. An infant is able to accept a new taste only after their 8th-10th trial; therefore, the parent should be patient and encourage the child despite their repeated displeasure.
The procedure for introducing various types of complementary foods is as follows:
- Initially, it is recommended to introduce single-ingredient vegetable purées.
Typically, this is carrot or potato, but peas, broccoli, cauliflower, and later spinach, zucchini, and kohlrabi are also suitable. It is essential to introduce each new food separately and repeatedly for 3-4 days to detect any potential allergic reaction.
- A multi-ingredient concept is adopted during the first month of complementary feeding, provided there is a good tolerance of individual components.
Combinations of several types of vegetables are used, and meat-vegetable purées are also served. The meat should be lean, preferably from organic sources, and processed meats should never appear on the menu. For better digestibility, white meat is preferred, but for its higher iron content, it is typically recommended to combine it with red meat (in a ratio of 1:1). General recommendations for the amount of meat per serving target values around 20 g, increasing to 35 g from the 7th month, with consumption frequency suggested at six times a week, with one occasion being replaced by a cooked hen's egg yolk. Eventually, one milk portion should be entirely replaced by this meat-vegetable meal. Until the child can consume at least 150 g of complementary food, they should be supplemented with breast milk or formula.
- The second complementary food, which replaces another milk portion after the meat-vegetable combination, is unsweetened fruit purée.
The same rules apply as for vegetable purées, i.e., new types of fruit are introduced 3-4 days apart. For homemade preparation, it is advisable to observe nutritional values, and 100 g of purée should not contain more than 20 g of carbohydrates. The purée can be gradually mixed with plain yogurt.
- The next introduced complementary food, which replaces the third milk portion, is milk cereal porridge.
Both gluten and gluten-free sources are used, always thoroughly cooked, non-whole grain. In commercially produced porridges, the type of grain from which they are made and the age of the child from which they can be served must be indicated.
At least until the child’s 1st year is completed, it is not advisable to salt or sweeten meals. A child should be fed with a spoon. Complementary foods should be smoothly puréed at first, later more coarsely mashed, and then chopped into pieces. Solid food should be included no later than the 8th-10th month. This is also the period when it is appropriate to offer the child food for self-feeding (known as finger food)—bread, fruit, and such.
One of the new trends is baby-led weaning, which bypasses spoon-feeding puréed food, allowing the child to choose what and how to eat on their own. However, there are doubts as to whether a child can receive sufficient nutrients this way.
Parents often face the dilemma of whether to purchase complementary foods or prepare them at home. Both approaches have their pros and cons:
Homemade complementary foods allow for a greater variety of flavors, but there is a risk of using inappropriate foods or methods of storage and preparation (cooking and baking are ideal, whereas grilling, frying, and sautéeing are unsuitable). For commercial production, consumers most often address concerns about the quality of the ingredients used and the price, but their undeniable advantage is the limited presence of certain harmful substances.
An important topic in infant nutrition is
allergens:
The incidence of allergic diseases in the population is continuously increasing. The most common manifestations of allergies in infancy include
food allergies (approximately 6-8% of infants), with a predominance of
cow's milk protein allergy (CMPA - 1-3%). Others include allergies to
egg proteins,
gluten, and
soy and
nuts. Thus, the significance of the
window of immunological tolerance between the 17th and 26th week of the child's life is considered, and within this period, allergologists recommend the first exposure to potentially allergenic foods (fish, egg white, cow's milk, gluten). It is important to introduce each new food separately for 3-4 days and monitor for any signs of an adverse reaction. Potential allergens are recommended to be introduced when the child is still at least
partially breastfed, and the doses should gradually be increased.
It is important to emphasize that this approach is primarily advocated by allergologists. On the nutritional platform, for fully breastfed children, it is usually recommended to begin with the first complementary foods after the sixth month of age, and to introduce each food, including potentially allergenic ones, progressively. This also applies to gluten sources, which some reputable sources recommend introducing only after the completed 12th month (the initial dose should be up to 7.5 g of food containing gluten per day, equivalent to two teaspoons of wheat flour in a vegetable purée or two biscuits in a fruit purée, and gradually increased until a full cereal portion is established).
In practice, one might encounter a "compromise" approach that merges the principles of both sides. By aiming to leverage the potential of the "immunological window," the child is given a small amount of individual foods, including potentially allergenic ones, to taste during exclusive breastfeeding. This can support the immunization process without suppressing the natural dietary approach for the infant.
