Introduction of complementary feeding to children of the first year of life

Breastfeeding is a natural process. There is nothing more healthy and nutritious for a newborn than breast milk. It contains all the vitamins, minerals, and antibodies to various viruses necessary for the health and development of the baby.

However, the baby is growing and he no longer has enough milk. It's time to start accustoming your child to adult food. As a rule, the start of complementary feeding occurs at 6-7 months. At first, children may refuse unusual food and spit it out, but over time they will get used to the new type of food.

General rules for introducing complementary foods

1. Give the new product to the baby a little at a time - half a teaspoon and gradually increase its amount.

2. First of all, the child is introduced to vegetable puree or porridge. The preferred vegetables are zucchini and cauliflower. These vegetables are least likely to cause allergies. When it comes to porridges, the child is first given gluten-free, dairy-free porridges – buckwheat or rice.

3. What is better to start with - with porridge or with vegetable puree, the pediatrician who is observing the baby will tell you. If a child is not gaining weight well or has unstable stools, it is recommended to start with porridge. If the baby is prone to constipation or is overweight, then it is better to first introduce vegetable puree.

3. Remember that at first the baby must be given pureed food, since he does not yet know how to chew.

4. Offer your baby a new food before breastfeeding, while the baby is still hungry.

5. Be sure to monitor the baby’s reaction: if digestive disorders (diarrhea, constipation) or skin rashes occur, then it is better to wait a few days with the new product, wait a few days and try to offer the child something else.

6. Introduce a new product into your child’s diet once every 3-5 days so that you have time to track your baby’s reaction.

Causes of functional constipation in children

The cause of impaired motility of the large intestine can be:

• introduction of complementary foods. With the arrival of complementary foods, enzymes that will break down nutrients should begin to be synthesized in large quantities. Until the body adapts to “adult” food, digestion will occur much more slowly, which will manifest itself in the form of constipation. It will take several days to restore stool frequency, so if constipation has just begun, then you need to wait and not interfere with the process;
• introducing complementary foods too early. Constipation when introducing complementary foods can occur as a result of morphofunctional immaturity of the digestive tract. For some children, it is early to expand the diet at 4 months, while for others it may be early at 6 months. In this case, the indicator is very individual, and parents need to focus on the baby’s nutritional interest and his well-being when consuming certain types of foods;
• introduction of certain foods into complementary feeding. Protein foods (milk, meat), which are introduced into the diet ahead of time, provoke the development of constipation, since the digestive system is not yet ready for it. If a child receives a lot of calcium from food, compounds are formed in the body that make stool more dense. Also, stool can become dehydrated if there is excess vitamin D;
• lack of fluid in the body. Breast milk is both water and food for a baby, but as the diet expands, the liquid becomes insufficient. Often parents themselves forget to give their baby a drink, or the baby is not accustomed to water, it tastes tasteless to him, and he refuses to drink. Fecal masses in the intestines quickly become dehydrated, and their movement becomes difficult. Hard stool can be like a plug blocking the intestines. A lack of fluid will be indicated by the release of first hard feces, followed by mushy or soft feces (moreover, bowel movements can occur in two bowel movements with a short time interval).

If parents introduced complementary foods early, it is better to return to formula and breastfeeding and postpone “adult” food for two weeks

Other reasons may be:

• food allergy. An allergic reaction can manifest itself in different ways, including a violation of stool frequency;
• non-compliance with diet. It is better to give complementary foods after a night's sleep. The baby will remain active after eating, which will improve intestinal motility, and in addition, the adult will notice possible changes associated with indigestion or undesirable reactions (rash on the body, redness);
• long-term drug therapy. Antibiotics, sorbents, iron supplements, antispasmodics, diuretics, and antacids can reduce intestinal motility. Medicines cause disruption of intestinal innervation or affect electrolyte metabolism;
• diseases of the digestive tract. Intestinal infection and dysbacteriosis provoke damage to the intramural ganglia, which leads to constipation during complementary feeding;
• psychological suppression of defecation. If your baby has ever experienced pain during bowel movements, he may be suppressing bowel movements. A similar reaction may occur if a child is scolded for not pooping in the potty;
• stressful situation. During stress, the functioning of the autonomic nervous system changes, which leads to a decrease in intestinal motor activity, a change in the concentration of digestive juices and, as a result, constipation. For a baby, stress can be physical illness, the absence of a mother nearby, weaning, or potty training.

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Pediatricians advise introducing complementary foods to a baby from the age of six months, but if a child has constipation when drinking formula, then doctors recommend introducing vegetable purees into the diet of a 5-month-old baby or even a four-month-old baby. Moreover, you need to start feeding with zucchini, cauliflower, and beets.

During complementary feeding, do not forget to give the baby something to drink

Reaction to complementary foods

Unfortunately, the baby’s body often responds to the introduction of complementary foods with gastrointestinal disorders (abdominal pain, diarrhea, constipation). To avoid a negative reaction to new foods, complementary foods should be introduced while taking a probiotic, which will help the baby’s body cope with unusual foods.

The liquid probiotic Bifidum BAG is ideal for these purposes. It is approved for use from the first days of life. It tastes good and is usually liked by children.

If a child is on artificial or mixed feeding, then it is necessary to especially carefully monitor his health. In such cases, probiotics are especially necessary for the child to develop normal intestinal microflora.

For more information about the effects of probiotics on children's bodies, see here

Complementary feeding and stool formation

Norms of child development from the fetus in the stomach to the newborn year

In most cases, a baby's stool changes with complementary foods at 6 months. It acquires a consistency reminiscent of adult stool. If mistakes were made at the beginning with the introduction of a new type of food, then liquid or mushy stool may be observed.

In order to avoid negative developments, you should follow the rules for complementary feeding:

• Start giving it at six months;
• The first new dish is a vegetable, not an apple;
• The initial dose is half a teaspoon;
• First week – increase in volume to 50 g;
• By the first year of life – 250 g.

There are deviations from the norm. Changes depend on the baby’s weight and his individual characteristics. Minor changes in the color and consistency of stool are normal for a child’s body.

Porridge helps to change the usual bowel habits

If a child is naturally fat or is gaining weight quickly, then the following can be used as vegetable complementary foods:

• Broccoli;
• Cauliflower;
• Zucchini.

For those who are thin or have trouble gaining weight, porridges without gluten are recommended:

• Buckwheat;
• Rice;
• Corn.

To ensure that the baby does not refuse new food, it is recommended to dilute the composition with formula or breast milk. You should not rush and immediately add cottage cheese, kefir and other fermented milk products to the menu. It is better to give them from 8 months, from 10 months – meat and fish, finely chopped and removed from the bones. Another recommendation is that new food should be given to the baby in the morning for the first time. Until the evening, carefully monitor the baby’s health and the reaction of the gastrointestinal tract to unusual food.

Important! The child should be given a drink before and after eating complementary foods. The optimal interval is 30 minutes.

Difficulties in introducing complementary foods

The fact that the baby’s stool will change after complementary feeding is a normal reaction on the part of his body. Parents may face other problems:

• Prolonged constipation;
• Skin rashes;
• Intolerance;
• Allergic reactions;
• Too loose stools;
• Indigestion (bloating, pain in the abdomen).

The child's reaction to familiar foods may change. Formula or breast milk will no longer seem so tasty to your baby. Children often refuse to try new foods because they are afraid of the unknown. Often the period of introducing new products and dishes is accompanied by hysterics and rebellion on the part of the baby. Recommendation - you just need to wait out this period.

Important ! A product unknown to the baby should be given in small portions. It’s better to play up the process of introducing a new complementary food: put your favorite toy at the table and show her how she likes the food.

Why add more solder?

Regular breast milk or ready-made formula is given to the baby in liquid form. Complementary foods, even in the form of purees, have a thicker and denser structure. The baby needs water to replenish its usual fluid volume. It is necessary to supplement your diet so that water metabolism and salt balance are not disturbed.

Complementary feeding table for up to one year

Introduction of complementary feeding to children of the first year of life

For a long time in our country there were legal provisions on the early introduction of complementary feeding from 3 weeks of a child’s life. The rationale for this was the statement about the need for early subsidies of vitamins, dietary fiber and fiber in order to improve digestion. This system of introducing complementary foods was determined by the very wide spread of artificial feeding, which was mainly not adapted to human milk (bifido-kefir, rice or buckwheat, from industrial mixtures - “Malyutka” or “Baby”). They included unchanged cow's milk protein, carbohydrates were mainly sucrose and glucose, and fats were a mixture of saturated and unsaturated mostly long-chain fatty acids. Against this background, children very often developed enzymopathies, disorders of intestinal microbiocenosis, allergic dermatitis, anemia and rickets. To reduce the negative impact, it was proposed to introduce products very slowly (starting with drops - as if “preparing” the intestines) and very early - to replace the main milk formula as quickly as possible.

The scheme for introducing complementary foods was as follows: starting from 3 weeks, it was proposed to introduce juices (drops), then vegetable broth, gradually adding one component at a time in order to “accustom” the child to these products. At 2 months, fruit puree was introduced, at 3 months, kefir, at 4 months, porridge, at 5 months, vegetable puree and cottage cheese, then an egg, and at 7 months, meat and cookies.

And if the alternation of complementary foods and the speed of their introduction in the second half of the year in children of the first year of life differed slightly in different countries, then such an early introduction of complementary foods in the first half of the year had no analogues in the world. Epidemiological studies conducted at the initiative of WHO in 1999–2002, aimed at identifying the causal factors in the prevalence of gastroenterological, allergic, and immunological diseases among children and adults, found that one of the leading causes of the development of these diseases is the early introduction of complementary foods.

Modern guidelines regarding the introduction of complementary foods are based on the study of the physiology of the development of the child’s organs and systems, his readiness to accept new food.

Timely introduction of properly selected complementary foods helps promote health, improve nutritional status and physical development of infants and young children during the period of accelerated growth and maturation.

During the entire period of introduction of complementary feeding, mother's milk or formula replacing it should remain the main product consumed by the infant.

The gradual expansion of the child’s diet and the addition of mother’s milk (or its substitutes) with complementary feeding products is due to:

• the need to replenish the deficit of energy and a number of nutrients (protein, iron, zinc, etc.) that occurs in the body of a growing child, the supply of which with breast milk or substitutes becomes insufficient after 4–6 months;
• the feasibility of expanding the diet with plant components, various types of carbohydrates, fatty acids of vegetable oils and microelements;
• the need to include in the diet denser food than milk for the development of the digestive system, chewing apparatus and stimulation of intestinal function.

Complementary feeding products can be divided into two categories. Transition foods are complementary feeding products specifically designed to meet the specific nutritional and physiological needs of the infant. Food from the family table, homemade food are complementary feeding products that are introduced into the diet of a young child and are similar in composition to those products consumed by the rest of the family.

The ability to consume solid foods requires maturation of the neuromuscular, digestive, urinary, and immune systems.

Up to 4 months, infants do not yet have the neuromuscular coordination necessary to form a bolus of food, move it into the oropharynx and swallow, so introducing semi-solid food before this time is not physiological. Further stages of development of neuromuscular coordination in infants and the relationship with the possibility of introducing various complementary foods are presented in the table.

Digestion and absorption. The introduction of complementary foods is advisable only after gastric, intestinal and pancreatic digestive enzymes have fully matured. In different children, depending on the degree of morpho-functional maturity and hereditary factors, enzymes begin to fully function at different times, but not earlier than 4 months. That is why the early introduction of complementary foods is associated with the appearance of intestinal dysfunction.

Renal function. Renal solute load refers to the total amount of solutes that must be excreted by the kidneys. These are food components that are not transformed during metabolism - mainly electrolytes: sodium, potassium, chlorine, phosphorus, which were absorbed in excess of the body's needs - and the final products of metabolism, in particular nitrogen compounds. The potential solute load on the kidney is endogenous and dietary solutes that must be excreted in the urine. It is defined as the sum of four electrolytes (sodium, chloride, potassium, phosphorus) plus solutes derived from protein metabolism, which typically account for over 50% of the potential load on the kidneys.

Breast milk has the lowest potential load of “osmotically active substances” on the kidneys - 93 mOsmol/l, infant formula - 135 mOsmol/l. When complementary foods are introduced, the load increases two or more times. The formation of renal function occurs at approximately 4 months, and in children who have suffered chronic intrauterine or postnatal hypoxia, at a later date (approximately 6 months). Thus, from this point of view, introducing complementary foods after 4–6 months is safe.

The immune system. The immature intestinal mucosa of infants is extremely susceptible to the action of enteropathogenic microorganisms and is sensitive to antigens contained in food. In the first months of life, when the intestinal immune system is not yet developed, nonspecific protective factors, which include breast milk, play a decisive role in maintaining the health of the child. In addition, during this period of a child’s life, the intestinal wall is highly permeable to macromolecules, primarily food allergens. Under the influence of lymphocytes and partially hydrolyzed immunoglobulin G of breast milk, the intestinal lymphoid system (GALT - Gut associated lymphoid tissue) matures, which is not only the main protective factor, but also reduces the permeability of the intestinal wall. Potential antigens include soy proteins, gluten, cow's milk proteins, eggs, fish, etc. Thus, the earlier these products are introduced, the higher the risk of antigenic exposure.

Particular attention should be paid to the fact that such an antigen may be soy protein, mixtures based on which are now often prescribed when skin changes appear, regardless of their genesis. Soy-based formulas should be prescribed only if there is intolerance to cow's milk protein and with mandatory monitoring of the child's individual reaction.

Introduction of complementary feeding in children of the first year of life

When introducing complementary foods to children in the first year of life, a number of provisions should be taken into account.

• Each child may have an individual tolerance reaction.
• The timing of each introduction of complementary foods may vary for each child within 1–2 months.
• During the period when a child is sick, he experiences severe “intestinal colic”, i.e., before 4 months, the introduction of complementary foods is extremely fraught with “breakdown”.
• With natural feeding, the timing of introducing complementary foods can be shifted by 2 months and new foods can be introduced after 6 months.

The timing of the introduction of complementary feeding in our country is still somewhat different from global norms and WHO recommendations. Thus, WHO recommends not introducing complementary foods until 6 months, and after 6 months adding new foods to the diet fairly quickly. Domestic experts (I. Ya. Kon et al., 2000) recommend introducing the first complementary foods from 4 months and at a slower pace. Apparently, it is inappropriate to consider the timing of the introduction of complementary foods as a kind of dogma. The individual characteristics of the child should be taken into account. Thus, if breastfeeding, the mother has a desire for long-term lactation, and the child has good physical and psychomotor development, complementary foods can be introduced from 6 months. With artificial feeding, it may be advisable to maintain the introduction of new foods from 4 months. If there is an allergic predisposition in the family or manifestations of dermatitis in the child, the introduction of complementary foods can be slightly delayed, as, for example, with long-term unstable stools or a late start of enzymes.

The first complementary foods are fruit juice and puree. In Russia, this is traditionally applesauce, preferably from a slightly “poached” apple: it contains less extractive substances. It is desirable that the apple is green or yellow. You can also use “industrial” purees, especially in the winter and spring. They are no less healthy and contain essential vitamins and dietary fiber. Juices contain extractive substances that have a more active effect on the intestines. The question of what to introduce at the beginning - juice or puree - can be decided individually. The next fruit could be a banana, then apricot, prunes (all in the form of puree). It is very good to use combinations - apple-zucchini or pumpkin. At 4 months these products are almost safe, but at 1–1.5 months they are very likely to cause allergic reactions, skin manifestations or increased abdominal pain.

Fruit, fruit-vegetable and vegetable purees and juices can be prepared from one or two types of fruit, or from a mixture of fruits and vegetables. Juices can be clarified and with pulp. Juices with pulp are introduced later than clarified ones, although they contain plant fibers that stimulate intestinal motility and can be used as a way to treat constipation.

Basic rules when using juices.

• The label should indicate the minimum age at which the juice can be given, but older children can start giving it.
• You should always start with juices containing one fruit or vegetable. It is not recommended to start with grape, carrot, or exotic fruit juice.
• It is impossible to simultaneously introduce several types of juices, since in this case it is difficult to determine which juice the child developed a particular reaction to. You should start introducing juice with minimal volumes, while carefully monitoring the child. It is necessary to monitor whether there are any changes in stool, increased abdominal pain, or redness of the skin. If these symptoms appear, this type of juice should be discontinued. The reaction to juice may appear delayed, as its volume increases. The next type of juice can be given to the child only after the previous one has been completely mastered. The later you start introducing juices (no earlier than 4 months), the fewer negative reactions.
• After introducing single-component juices, you can begin to include multi-component juices in the diet, but it is better to do this after 6–7 months. Tomato and grape juices most often cause negative reactions, so it is better to start giving them to your baby by the age of one year. Juices from wild berries and oranges are also useful. It is better to use apricot, pear, and plum juices.

Fruit and vegetable purees can contain only fruits and vegetables, or their combinations with formative components - starch, flour, thickeners. Fruit purees can be single- or multi-component. The principles for introducing purees are the same as for introducing juices.

Fruit purees can be of varying degrees of homogenization - completely crushed, finely and coarsely ground. This division corresponds to the stages of introducing foods and preparing the child to eat solid food. In addition to pure fruit or vegetable purees, there are currently combination products on the market, for example with the addition of yogurt or cereals. You need to start giving them at a time corresponding to the period of introduction of the second component, i.e. during the period of inclusion of fermented milk products in the diet - in the first case, and porridge - in the second.

Fruit and vegetable dishes are always tastier, sweeter and are introduced as fruit puree.

Later, less tasty vegetable purees are introduced, to which the child must be introduced more gradually. When introducing them, it is necessary to take into account the composition, as well as the child’s individual reaction to the composition of the puree. When introducing vegetable purees, you should start with those that consist of a minimum amount of vegetables; gradually introduce purees with a more complex and coarsely crushed composition. We are talking about puree from zucchini, pumpkin, sweet potatoes, then puree from carrots, peas and other legumes, cabbage is added to them. Lastly, after 9–10 months, purees containing tomatoes, onions, and spices are introduced. Usually the puree contains vegetable oil, so it should not be added additionally.

Porridge is an important complementary food that should be added to the diet after fruit purees and juices. All cereals are divided into dairy and non-dairy, and also containing one grain or several grains; it is possible to include fruit and vegetable additives. In the presence of these additives, complementary feeding refers to cereals, and not fruit purees.

Industrially produced milk porridges are mostly instant, that is, they do not require cooking. When diluted with water in the ratio indicated on the box, the result is a porridge containing a milk component in the form of an appropriate mixture produced by this company, or less often - in the form of cow's milk powder.

The packaging of some cereals states that they are “gluten free.” Gluten, or gluten protein, is found primarily in grains. It can cause damage to the lining of the small intestine, leading to decreased absorption, increased bowel movements, wasting, and anemia. This condition is called celiac enteropathy or gluten-sensitive celiac disease. Gluten is a mixture of proteins found in grain products. The gliadin fraction of gluten is toxic to the intestinal epithelium. The largest amount of gliadin is found in wheat.

True celiac disease is a fairly rare disease. However, a late start of small intestinal enzymes may also affect gluten-digesting enzymes. In this case, not only clinical intestinal manifestations occur, but physical and psychomotor development may also be delayed. A direct connection has been established between the time of introduction of complementary foods and the clinical manifestations of celiac disease. At the same time, in most children, the introduction of gluten-containing products after 6 months no longer causes these changes. Moreover, even in children with primary celiac disease, late introduction of gluten-containing products causes a delayed development of the clinical picture. The latter is quite important, since during a particularly vulnerable period of accelerated physical development there are no obstacles to the child’s nutrition and growth. Therefore, it is better to start the first introduction of cereals with gluten-free products; you should also not start giving whole cereals after the 6th month of life.

Traditionally, Western companies use rice, wheat flour, less often - oatmeal, semolina and very rarely - buckwheat. This is explained by the fact that in the West these cereals are considered the most important for babies, and the purpose of porridges begins with them.

In Russia, it is customary to begin introducing this type of complementary food into the diet with porridge made from buckwheat and oatmeal. The production of porridges from these cereals is a tribute to the traditions of our country, and they are produced mainly for sale in the CIS.

It is known that corn flour causes allergic reactions less often than others, and rice flour contains the largest amount of essential vitamins. Rice flour for baby food is usually prepared from uncrushed rice, so these cereals do not have the property of slowing down peristalsis and do not provoke the development of constipation in children. Therefore, industrially produced porridges made from rice flour can be recommended to all children, even those with a tendency to slow down the evacuation of feces, while homemade rice porridge from ground crushed purified rice can provoke a slowdown in peristalsis. Oatmeal, on the contrary, enhances peristalsis and promotes better evacuation of bile.

Porridges made from several grains in combination with fruit fillings are best introduced closer to the year. This primarily applies to porridges with honey, chocolate, cocoa, nuts and wild berries.

Meat and fish are introduced at 7–8 months, usually in combination with vegetables. The child begins to give the meat in chopped, beaten form, gradually moving to larger pieces turned through a meat grinder or finely chopped - taking into account the child’s capabilities. The child should not choke on food so that a negative reflex to food does not develop. It is better to start with low-component meat and vegetable purees or pure meat purees, which are added to the vegetables familiar to the child. In Russia, potatoes, cabbage, zucchini, pumpkin, and turnips are traditionally used. Carrots must be administered very carefully. Particular attention should be paid to the use of tomatoes - children under 1 year of age tolerate them quite poorly: they can provoke eating “breakdowns”. The addition of onions and spices should also be treated with caution.

You can use any meat - beef, veal, turkey, rabbit, lean pork, chicken. It is necessary to introduce different types of meat gradually, taking into account the child’s food preferences and monitoring his condition.

At 6–8 months, cottage cheese and fermented milk mixtures are introduced. Children with rickets and anemia can start giving these products earlier - from 5 months.

At 8 months, bread or cookies are introduced, which are usually added to cottage cheese and mixed with fruit puree.

If family members are not allergic to it, it is better to include yolk in the diet starting from 10–11 months; during the same period, you can start giving weak broths.

Thus, in the first 6 months the child is almost not “loaded” with unfamiliar food, while in the second half of the year all the necessary ingredients can be introduced quite quickly.

All new food must be included in the diet gradually, one component at a time. If a negative reaction occurs, this type of complementary food or its constituent product is “removed” from the diet for at least 1 month.

The child’s diet should be structured in such a way as to form a reflex in him: breakfast (usually porridge), lunch (vegetable puree, then puree with the addition of meat and broth), afternoon snack (cottage cheese with cookies and fruit puree), dinner (yogurt, milk or porridge). It is advisable not to give the baby anything between feedings. If the baby is breastfed or is accustomed to some kind of formula, then perhaps after any type of complementary feeding he will need a little of his favorite product.

So, the following sequence of introducing complementary foods is recommended:

4–6 months - fruit purees and juices;

5–6 months - vegetable puree;

6–7 months - porridge;

7–8 months - meat; fish - after 10 months;

8–9 months - cookies, cottage cheese, kefir;

10-11 months - yolk, broth.

You can initially introduce porridge, and then vegetable puree. Cottage cheese for medical reasons (rickets, anemia, malnutrition) begins to be administered at 5–6 months. For persistent constipation, from 4 months you can include fermented fermented milk mixtures or kefir in your diet.

E. S. Keshishyan , Doctor of Medical Sciences, Professor of the Moscow Research Institute of Pediatrics and Pediatric Surgery, Moscow

Stomach upset

In everyday life this disease is called diarrhea. This reaction is common in infants who have tried new foods. If the food is not suitable for your baby, diarrhea may occur several hours after eating.

If an upset stomach occurs, the first thing to do is to postpone eating new foods for a while. It is important to control the amount of fluid you drink to avoid the risk of dehydration. In this case, mother's milk will be the best medicine for your child; if he is artificially fed, offer him a formula. It is worth seeking medical help if your six-month-old baby poops more than 5 times a day.

We open up the question: Symptoms and causes of green stool in a bottle-fed baby

Allergic reactions

They may arise due to the immaturity of the gastrointestinal tract of children; in addition, hereditary factors may influence the occurrence of allergies. The allergy manifests itself as redness or pinpoint rash on the cheeks. In addition, the baby may suffer from increased gas formation and inflammation of the mucous membranes.

The introduction of new food should be suspended to determine which product the body reacted to. If there are difficulties in identifying the allergen, then all complementary foods are completely excluded until the allergy symptoms disappear. It is better to introduce complementary foods carefully, in small portions and no more than one product per week. Many parents keep a food diary. The records will help you find out which foods are well absorbed by the child’s body, changes in the child’s behavior when eating new foods, and create a menu based on them.