Features of introducing complementary foods to a baby while breastfeeding

From the moment the baby is born, parents worry about its full development and health. And they, as you know, depend on diet and diet.

It is an indisputable fact that the most delicious, healthy and balanced food product for a child is breast milk. But no matter how valuable it is, the nutrients it contains are not enough for the baby. For the organic development of the digestive system, a growing organism needs vegetable protein, fiber and dietary fiber, so an urgent task is to introduce complementary foods to a breastfed child.

Complementary feeding is additional food of animal or plant origin, acting as a transitional step from mother's milk to the diet of an adult. Complementary feeding is usually introduced into a child’s diet between the ages of 6 months and up to one year.

How to understand that it is time to introduce complementary foods

The fundamental factor for determining the time to start complementary feeding during breastfeeding is the age of the child. There are a number of rules that allow you to accurately calculate the moment when a baby needs additional complementary feeding.

Among the basic rules, the following should be noted: • the child reaches 4 months of age. In cases of premature infants, calculations should be made by gestational age; • from the moment of birth, the baby’s weight has at least doubled; in those born prematurely, the weight gain should be at least 2.5 times; • the appearance of the baby’s first teeth indicates that, in addition to breast milk, the baby’s digestive system is ready to introduce additional food into the diet; • the child lacks a tongue thrust reflex, which is especially evident in the first months after birth. This reflex protects the baby from accidentally swallowing small objects; • if the child does not eat completely and asks for more; • the baby can confidently be in a half-sitting position, squeeze objects with his hands, consciously tilt his head, refusing to eat, or try to put everything in his hands into his mouth; • the first complementary foods can be introduced when the child has learned to protrude his lower lip and readily opens his mouth when presented with a spoon of food. Such skills greatly facilitate the process of additional spoon feeding; • the appearance of a chewing reflex, in which the child is able to push food deeper into the oral cavity with his tongue; • manifestation of increased interest in the food on the adult’s plate, while the baby strives to taste the contents. In order not to provoke digestive problems, you should not give your baby age-appropriate foods and delay the introduction of complementary foods. Therefore, every mother is recommended to study the basic rules and principles of introducing complementary foods during breastfeeding, follow them and monitor the development of the baby. Some doctors advise introducing the first complementary foods only after the appearance of the first teeth, others say that after 3-4 months you need to add vegetable purees or cereals to the baby’s diet.

IMPORTANT! According to the recommendations of the World Health Organization, complementary feeding can be introduced no earlier than 4–6 months after the baby is born. This allows the child to maintain the stability of the functioning of the digestive system and thus save the energy needed for development and growth that goes into digesting unusual food.

Russian pediatricians in the article “National Strategy for Feeding Children of the First Year of Life in the Russian Federation” in the journal “Pediatrician Practice” explain that up to 4 months of life, a child is not yet prepared to digest food other than human milk or adapted milk formula. By 4 months of age, the initially increased permeability of the mucous membrane of the small intestine decreases, the level of local immunity increases, the baby’s spoon-pushing reflex fades, and he is already able to swallow semi-liquid and thicker food.

If you start complementary feeding later - after 6 months - the child may experience a pronounced deficiency of iron, zinc and other important microelements, and there will be a delay in the formation of skills in chewing and swallowing thick food. And due to the need to quickly introduce an extensive list of products into the diet, the antigenic load will simultaneously increase.

Introduction to complementary feeding of fermented milk products

This is the most difficult question. I am sure that most of our grandparents demand that their stupid parents start feeding their grandchildren milk and kefir as soon as possible. In some cases, children really begin to assimilate fermented milk products well after 6 months, but before this age I treat even fermented milk Agusha with great caution, and introducing milk or kefir before 6 months is bad form, believe me, and can lead to very negative consequences for the child. I understand the Western European medical community, which has recently completely banned its pediatricians from recommending fermented milk products as complementary foods for children under 3 years of age, imagine!

They (Europeans) need to put their artificial milk formula somewhere. Even 20 years ago, we did not know any other formulas after the “two”, that is, the second formula for children from 6 to 12 months. Then formulas appeared for children from 1 to 2 years old, then from 2 to 3 years old, and now there are formulas for children up to 4 years old, and I think if this goes on, then until the age of sixteen there will be milk substitutes. Excuse me, I don't think this approach is correct. But the fact is that our grandparents had much better genetics than the generation of our children, alas. With the growing capabilities of medicine, genetically determined diseases are also growing, and in this case, cow’s milk protein intolerance, and with every 10th anniversary there are more and more such people among us. But if a child really suffers from an allergy to cow’s milk protein or is severely deficient in enzymes, then he will carry this peculiarity throughout his life, and most likely he will not drink either milk or kefir, and there is no need to force him if he won't want to!

But you were lucky with your genetics, and no one in the family ever had allergies (which is hard to imagine nowadays), and most importantly, if your child has always had perfectly clear skin, then you will begin to offer the first dairy product - cottage cheese - to your child with 7 months, kefir - from 10 months. Milk - after a year. It will be better this way.

But if your family does not have a very close and joyful relationship with milk, then it is better to postpone even the introduction of kefir and yogurt into the child’s complementary foods until after 18 months.

When is it better to postpone the introduction of complementary foods?

Not every child is ready to consume additional food other than mother's milk, even when reaching 6 months of age. Every baby has individual characteristics of development, weight gain and, most importantly, readiness to assimilate new foods through the gastrointestinal tract.

There is no need to rush into complementary feeding while breastfeeding in the following cases: • the child was born during a cesarean section, and not naturally; • during the vaccination period; • in the presence of allergic rashes; • during a cold; • with slow weight gain; • when pathologies are detected in the development of the central nervous system; • during the flowering period of allergenic grasses or trees, as well as in extreme summer heat.

You should also delay adding additional foods to your diet if you change your place of residence. The child must first get used to new conditions, and mother's milk will help him with this.

We follow the rules of complementary feeding

Now that we have found out what foods a child should eat in the first year of his life, all that remains is to make sure that complementary feeding is as comfortable as possible for the baby and according to all the rules that pediatricians have developed.

Here are the basic principles to consider when introducing complementary foods1,3,7:

1. Time. The baby eats the first complementary food during the second feeding in the morning. At the next feeding (after a new product), the baby is given breast milk.
2. Portions. Unfamiliar food is first introduced in small quantities (½ teaspoon of puree or porridge). Within a week, you need to increase the volume of the new product to the age norm and completely replace one of the breastfeedings or formula feedings with complementary foods.
3. Method of feeding. You need to feed from a spoon, not from a bottle with a pacifier.
4. Observation. It is necessary to monitor how the child tolerates new food.
5. Subsequence. Only after adaptation to one product can the next one be given.

Refusing an unfamiliar product is quite normal. New dishes should be offered to the child again. Sometimes he agrees to try what his parents offer only after 10-15 attempts1. It also happens that a baby willingly tastes a new dish, but after an unfamiliar food he develops signs of intolerance, for example, an allergic reaction9 or impaired intestinal function3 - diarrhea or constipation1. If signs of intolerance appear, you need to temporarily exclude the “undigested” product from the diet and try to introduce it again after 3 months3.

Don't worry if your baby's stools become less frequent. Changes in diet affect bowel function. It is quite normal if, after 4 months of life, a baby’s intestines will empty 1-3 times a day1.

Your pediatrician will be able to determine whether you actually have constipation. For constipation, he selects the right menu and gives recommendations, for example, on massage and special exercises that help normalize motility (motor function) of the digestive tract9. And to facilitate the passage of feces, a specialist may prescribe medications1, for example, MICROLAX® microenema. The drug has a laxative effect 5-15 minutes after rectal administration5.

Active components of MICROLAX® 5:

• displace bound water from feces;
• liquefy feces;
• stimulate the release of water into the intestinal lumen.

MICROLAX® is recommended by the Society of Pediatric Gastroenterologists11. As a result of the combined effect, the microenema softens stool and promotes bowel movements5. The drug does not irritate the intestines, does not affect other parts of the gastrointestinal tract and can be used in children from birth5.

The Union of Pediatricians of Russia notes that a baby’s nutrition in the first 2 years of life affects his health in older age1. But babies respond sensitively when new foods are added to their diet6. If introduced late or incorrectly, food intolerances1 or nutritional deficiencies3,4 may occur, and baby's growth may be slowed6. To avoid mistakes, you should consult a pediatrician before introducing complementary foods, especially if the child has irregular bowel movements. The specialist helps create a menu and schedule for introducing new dishes and makes sure that adaptation is easy, without constipation or diarrhea9.

The information in this article is for reference only and does not replace professional advice from a doctor. To make a diagnosis and prescribe treatment, consult a qualified specialist.

to come back to the beginning

Bibliography:

1. Program for optimizing feeding of children in the first year of life in the Russian Federation: methodological recommendations / Federal State Institution "National Medical Research Center for Children's Health" of the Ministry of Health of Russia. — M.: b. i., 2021. - 112 p. ISBN 978-5-6042256-5-3
2. Kozlovsky A.A. Modern approaches to nutrition of children in the first year of life. Health and environmental problems. 2013: 21-26 https://cyberleninka.ru/article/n/sovremennye-podhody-k-pitaniyu-detey-pervogo-goda-zhizni
3. Panasenko L.M., Kartseva T.V. et al. Proper nutrition at an early age is the key to future health. Russian Bulletin of Perinatology and Pediatrics. 2018; 63 (6): 115-120 https://cyberleninka.ru/article/n/pravilnoe-pitanie-v-rannem-vozraste-zalog-zdorovya-v-buduschem
4. Kamalova A.A. Updated European recommendations for the introduction of complementary feeding in children are a topic for thought. Russian Bulletin of Perinatology and Pediatrics. 2017; 62(6):92-98
5. Instructions for use of the drug MICROLAX ® solution for rectal administration // Registration number P N011146/01 // GRLS of the Russian Federation. — https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=f052fb31-5426-4bc1-958f-9fce793aa43f&t= (date accessed 03/20/2020)
6. World Health Organization: Infant and young child nutrition. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding
7. THEM. Lysenko, G.K. Barkun, L.N. Zhuravleva. Nutrition for a healthy child. Benefit /. - Vitebsk: VSMU, 2014. - 40 p.
8. Vasilyeva E.I., Savvateeva V.G. Nutrition of children in the first year of life in normal conditions and in some pathological conditions / textbook - 2011. - 56s
9. Zueva, O. S. Functional constipation in young children / O. S. Zueva, N. N. Zuev, T. M. Ryabova // Protection of motherhood and childhood. — 2021. — No. 2 (34). — P. 53-57.
10. Understanding constipation in Infants and Toddlers; Bladder and Bowel UK, Disabled living. 2021 www.bladderandbowel.co.uk
11. Khavkin A.I., Fayzullina R.A., Belmer S.V. and others. Diagnosis and tactics of managing children with functional constipation. Questions of practical pediatrics. 2014; 9(5):62-76.

Features of introducing complementary foods to infants

Each child needs an individual approach and this should be taken into account before starting complementary feeding while breastfeeding. If the mother eats well during breastfeeding, the baby develops normally and gains weight, and is absolutely healthy, then there is no particular need to change his diet before 6 months.

Video: 10 rules of complementary feeding Author: pediatrician, Ph.D. Komarovsky E.O.

When deviations in weight gain are observed and the baby’s hemoglobin level is below normal, it is advisable to introduce complementary foods before six months of age. You just need to do this correctly and step by step.

Educational complementary foods

To arouse the baby's interest in new foods is the main goal of educational complementary foods. About a month before introducing complementary foods while breastfeeding, you can let your baby taste different foods. For example, lick a banana or an apple, drop a drop of juice on your tongue, and put vegetable puree on the tip of a teaspoon. After this, be sure to monitor during the day whether the child has any allergic reactions or changes in stool and behavior. If everything is fine, then you can safely continue the preparatory period.

Where to start complementary feeding

Many pediatricians agree that it is best to start complementary feeding with porridge. It is ideal for children with normal and insufficient weight gain relative to age. The first row of cereals includes gluten-free cereals, which do not contain gluten. Rice porridge (especially useful for frequent loose stools), corn or buckwheat are excellent for complementary feeding. The latter is recommended for children with low hemoglobin levels. If the child is overweight, it is better to use vegetable puree as complementary foods. Carrots, cauliflower, potatoes or zucchini are great for this.

Experts recommend using environmentally friendly industrially produced products for the first complementary feeding, which are crushed according to age to the required fractions, enriched with minerals and vitamins, prepared and packaged strictly under sterile conditions.

How to introduce complementary foods: basic rules

There are certain rules for complementary feeding when breastfeeding, the observance of which is extremely important at the initial stage of introducing other foods into the baby’s diet. These rules include: 1. Calendar dates. If the introduction of complementary foods is planned to begin in the winter season or early spring, then vegetable products should be used with extreme caution. The best period for vegetables will be summer or autumn. During the off-season, you should only use products in jars. 2. Diet. When introducing a child to new foods, you need to carefully plan the schedule. The intervals between feedings should be at least 4 hours. 3. Cooked food should be warm, but under no circumstances hot. It should be given to the baby on an empty stomach, and then supplemented with breast milk. 4. It is necessary to feed the child only with a silicone spoon. It will protect sensitive gums from damage and allow the baby to quickly get used to the spoon. The first portions should be alternated with the baby’s usual food – breast milk. 5. It is advisable to start complementary feeding in the morning, which will allow you to monitor the state of the child’s body and its reactions to new foods throughout the day. 6. A new product can be introduced into the menu only for those children who do not have any pathologies. If vaccination has been carried out, complementary feeding can be started no earlier than 3-4 days after the manipulation. 7. You should not try to force your baby to swallow a new dish. If the baby cries a lot and turns his head away, then you should just feed him breast milk. 8. If, after consuming a new product, severe dry skin, the appearance of a rash or upset bowel movements are observed, then it is necessary to temporarily exclude this product from the diet. 9. Only after two weeks have passed can you give the baby a second product after the body has accepted the first. 10. Initially, you should give the child only liquid food and gradually bring the consistency to a thicker state. 11. At the baby’s first request, he should be given a drink, but this should not be done during feeding. 12. The child should be fed new foods strictly according to the schedule.

IMPORTANT! The main task of the mother when supplementing the diet with new products is to monitor the condition of the stool and skin. If the first complementary feeding during breastfeeding causes even minor complications in the baby’s well-being, then you should immediately seek advice from a pediatrician.

How to choose complementary foods according to age?

In order to choose the right foods for complementary feeding, it is important to take into account the physiological characteristics of the child at a given age.

4-7 months

The child acquires chewing skills, along with them, the sucking reflex intensifies, the gag reflex moves from the middle to the back third of the tongue.
From this moment on, pureed foods can be introduced into the child’s diet: Vegetables.

You can spend 30 minutes or more preparing vegetable puree, using vegetables from the garden and following strict hygiene rules so as not to harm the baby. Or you can buy canned food, which differs from homemade food in its long shelf life, but not due to the addition of preservatives - there are none in baby food, but due to the sterile conditions at the enterprises producing food for babies. This broccoli puree produced by Babushkino Lukoshko is a low-allergenic one-component product. It contains no genetically modified ingredients or salt and can be stored for up to 24 months. You can also give your 4-month-old baby cauliflower from the same manufacturer to try. Broccoli puree from the Frutonyanya brand does not contain starch or flavorings: only flash-frozen vegetables and water. The shelf life of this product is 2 times less - 12 months. Polish Broccoli]Gerber[/anchor] consists of 80% vegetable and 20% water. Does not contain salt, artificial flavors, bone meal, palm oil and other unhealthy ingredients; stored for at least 2 years. In addition to this product for 4-month-old babies, Gerber produces cauliflower and carrot purees.

Fruity.

Apple/pear puree is available in the range of all manufacturers of this product. These are the first fruits that you can introduce your baby to. The Gerber and Frutonyanya assortment for 4-month-old babies includes peach and prune puree, and the Agusha brand has created apple, strawberry and raspberry puree for little delicacies. Starting from 5 months, the child can be fed with the following types of purees: - apple and pear; - apple and peach; - apple and blueberry; - apple and prunes; - apple and rosehip; - apple and cottage cheese; - pear and cottage cheese; - peach and cottage cheese; — fruit salad (apple, pear, peach); — vitamin salad (apple, cranberry, rosehip); — berry salad (blueberry, cherry, apple); — dessert with apple, cherry, rowan and black currant.

Choose the most delicious fruit purees for your baby on this page.

Grain (gluten-free).
A great idea for feeding a 4-month-old baby is Baby porridge. This is a dietary low-allergenic product based on powdered milk, which is designed for feeding children from 4 months. Porridge contains 12 vitamins and microelements necessary for the harmonious growth and development of infants. In the assortment of the FARMEKONOM online pharmacy you will find Baby brand instant rice porridge with apple pieces and without added fruit. Winnie's milk-based buckwheat and rice contain prebiotics that normalize the child's intestinal microflora. The manufacturer does not add salt, genetically modified ingredients or vegetable oils to the porridge, including palm oil, which is especially disliked by parents. The product is made from high quality raw materials and dissolves without lumps. If you want to diversify the diet of a little gourmet, then try giving him rice with buckwheat and apple, which is also suitable for feeding 4-month-old babies. Rice and buckwheat milk porridges from Malyutka have a delicate consistency and are easily absorbed by the body. They do not contain dyes, salt or preservatives.

Do not use dairy-free porridge to feed your baby unless indicated by a doctor: porridge diluted with water has a lower nutritional value compared to a product prepared with milk.

The Nestlé brand produces buckwheat and rice (with apple pieces) with a unique complex of minerals for growth and development. The products contain bifidobacteria, which help comfortable digestion. Along with dairy products, Nestlé offers hypoallergenic buckwheat and rice porridge. There is no milk in them, which means the risk of causing an allergy is almost zero. These are what the manufacturer recommends for first feeding. Rice and buckwheat from the Heinz company contain a probiotic that improves digestion and contain valuable minerals and vitamins that are especially important during periods of intensive growth and development. The product does not contain vegetable fats - only 100% natural grains. It also comes in an easy-to-use, reusable zip-lock packaging.

5-6 months

When the baby gets used to the new food and his body learns to assimilate it, diversify the menu with oatmeal with peach from the already familiar Baby brand, or wheat porridge with pumpkin (Vinny). Perhaps your baby's next dish will be Malyutka's corn porridge? A whole constellation of delicious cereals for 5-month-old babies is offered by the Heinz company as part of the “Delicious” series: - buckwheat with pear, apricot and currant; — corn with pumpkin, carrots and prunes; - oatmeal with apple, blueberry and black currant; — rice with apricot and prunes and other flavors. They contain milk, but if your baby can’t have it due to an allergy, pay attention to dairy-free porridges from Nestlé: corn and oatmeal.

You will find a huge selection of cereals on this page.

Complementary feeding schemes

Experts have developed special schemes according to which complementary feeding should be introduced during breastfeeding - traditional pediatric and pedagogical.

The first scheme involves the gradual introduction of different foods into the diet. You need to start with half a teaspoon, gradually increasing the daily volume of the product to 100 ml. If a particular product is well accepted by the baby’s body, then after about 10–14 days the next one can be introduced.

Over time, you can completely replace one breastfeeding with another food. When, after such a replacement, the child asks for the breast and is capricious, it means he is not yet ready for a complete replacement of mother's milk. In such cases, you need to combine breastfeeding with complementary feeding.

The principle of pedagogical complementary feeding is based on feeding the baby directly from the parent's plate. Portions should start minimal. The child gets the opportunity to get acquainted with the products consumed by adult family members. However, breast milk should remain the main food until the child reaches at least 12 months of age.

Rules for introducing complementary foods

Age is not the only guideline for reviewing a baby’s diet. Before introducing your son or daughter to new products, it is necessary to take into account the characteristics of psychomotor development :

• general activity of the child;
• interest in “adult” food;
• ability to swallow pieces of solid food;
• the ability to take new foods from a spoon rather than through a pacifier.

You should not focus on the appearance of teeth - some babies erupt their first teeth too late, and the need for a varied diet arises much earlier.

How to introduce complementary foods correctly:

• At the first stage, introduce your child to new food with a liquid consistency. The volume of the first portion is about 5 ml (g).
• Give the product from a clean teaspoon - at the very tip - to teach the baby to take food with his lips and move it in the mouth.
• Include the next product in your diet only after 1-2 weeks - this time is necessary to adapt to the new food.
• Plan complementary feeding for the first half of the day, so that in the second half you can monitor the body’s reaction (whether an allergy develops, how the stool changes). If there are no adverse reactions, every day you can gradually increase the volume of the product to the recommended amount.
• As you get used to liquid complementary feeding, offer your baby solid food - at about 9-10 months. If your baby refuses to eat food in pieces, try again a little later.
• Don't use too much sugar in your dishes. The baby should experience a variety of taste sensations, including sour and bitter.

Try to develop a positive perception of food in your child. Don't turn feeding into torture. You can offer the same dish 8 to 10 times. If a child refuses complementary feeding for the first time, this does not mean that he does not like the dish. Even those foods that the baby has repeatedly refused can later become favorites. Research shows that it can take up to 15 attempts to form such a habit [2].

Complementary feeding schedule: where to start

There is no exact time frame for when to start complementary feeding while breastfeeding. In this regard, you need to be guided only by the individual characteristics of the child.

Pediatricians also differ in their opinions on which products are best to use for first complementary feeding. Some recommend vegetable purees, others are sure that there is nothing better than porridge.

Along with the diversity of opinions, modern pediatrics, represented by the World Health Organization, has unquestioningly established the main rule - do not start complementary feeding with juices. They have an aggressive effect on the digestive system, so WHO does not recommend giving them to children under one year of age. It is also undesirable to use fruit purees as the first additional products due to the high content of various acids and sweetness in them, which the baby quickly gets used to.

Most pediatricians agree that the correct first complementary foods are vegetable purees, which are gradually replaced by gluten-free and dairy-free cereals.

According to the “Program for Optimizing the Feeding of Children in the First Year of Life in the Russian Federation,” approved in 2021, it is quite easy to make a choice between porridges and vegetable purees: if the child is underweight or has frequent stools, commercially produced porridge is preferable as the first complementary food; if the child is overweight and constipation - vegetable puree.

It is better to start vegetable feeding with one-component purees. In the first half of a child’s life, you can introduce fruit puree into the diet, and then meat puree, since it contains a lot of easily digestible iron. From 7 months of age, yolk is added to the diet, and from 8 months, fish puree is added. Kefir, yogurt, biolact are introduced into the diet no earlier than 8 months of age, at which time you can add baby cottage cheese.

Since the digestive system of a baby under one year of age is not ready to digest the coarse casein proteins contained in goat or whole cow's milk, porridge should be prepared in water. For example: human milk contains 18% casein, and in cow's milk this component reaches 82%.

Porridges should be gluten-free because gluten belongs to the group of potential allergens. The enzyme that breaks down gluten begins to be produced in the child’s body a little later. Gluten porridges include barley, semolina, pearl barley, and oatmeal.

The ideal choice for the first complementary feeding would be porridge made from buckwheat and rice. To do this, you can use ready-made baby food or carefully grind the grains to flour and cook the porridge with a liquid consistency. Such cereals are especially useful for children who do not gain weight well.

Rules for first feeding

Rules for first feeding

Rules for the first feeding
Babies grow and mature every day, and at a certain point there comes a period when milk nutrition is no longer enough for them and it is necessary to introduce complementary foods.

Lure

- this is food of animal or plant origin, which gradually replaces breast milk (infant formula) and helps transfer the child to an “adult type” diet. Complementary feeding satisfies the child's increased needs for food ingredients, energy, vitamins and minerals; in addition, timely complementary feeding contributes to the formation of the chewing apparatus and adequate taste habits.

It is optimal to start introducing complementary foods in the period of 4–6 months (recommendations of ESPGHAN (European Society of Specialists in the Field of Pediatric Gastroenterology, Hepatology and Nutrition), 2021, Federal State Institution "National Medical Research Center for Children's Health" of the Ministry of Health of Russia, 2019). Do not rush to introduce complementary foods too early, as the child’s body is not yet ready for a new type of food. At 4 months, the gastrointestinal tract becomes more mature, the child can swallow semi-liquid and thicker foods, and sufficient development of local immunity helps reduce the risk of allergies. If complementary foods are introduced after 6 months, this will provoke an increased risk of allergies, since it will be necessary to introduce new foods into the child’s diet more quickly. In addition, late introduction of complementary foods is fraught with the development of deficiency conditions, especially iron. The timing and order of introducing complementary foods are individual for each child, so they must be agreed upon with your pediatrician.

There are certain signs that a child is ready to introduce complementary foods:

• extinction of the reflex to “pushing out” with the tongue with a well-coordinated reflex of swallowing food;

• the child's readiness to chew;

• completed or current teething;

• sitting independently or with little support;

• the ability to express attitudes towards food with emotions and gestures;

• maturity of the gastrointestinal tract functions.

Basic rules for introducing complementary foods:

• the child must be healthy. Complementary feeding should not be introduced in case of acute illnesses, during travel, moving, on the eve of vaccination or immediately after it for 3–5 days;

• complementary foods are given at the beginning of feeding, and then the baby is supplemented with milk;

• start with small volumes (1-2 teaspoons), gradually increasing the volume over 5-7 to the age norm and, accordingly, reducing the volume of milk feed during this feeding;

• a one-component, low-allergenic and homogeneous in consistency dish as the first complementary food, and then gradually complicating the composition (two-component, multi-component) and expanding the range;

• introduce new foods into the child’s diet in the first half of the day, so that you can monitor the child’s initial reaction (condition of the skin, digestion, appetite, etc.) until the evening;

• complementary foods are given warm, from a spoon. Initial refusal to accept a new taste is a common occurrence; it is necessary to patiently accustom the child to the new taste. For most children, it takes at least 8-10, and sometimes 15, tries to accept a new taste. Children also have the right to their opinion in this matter. If the baby is not in the mood today, do not force-feed him, maybe he will like this product tomorrow or in a week;

• a new type of complementary food can be introduced after complete adaptation to the previous one. Two new products cannot be introduced at the same time (including simultaneously introducing a new milk formula and introducing new complementary foods);

• Babies who are introduced to complementary foods need extra fluids. It is better to use specialized baby water (150–200 ml per day).

Homemade complementary foods or commercially produced baby food?

Leading pediatricians around the world recommend industrially produced food, because... it has a number of undeniable advantages:

• tested high quality raw materials and safe for the baby. Use of varieties suitable for baby food (for example, fruits with low acidity to prevent irritation of the immature mucous membrane of the baby's gastrointestinal tract);

• guaranteed chemical and microbiological safety (compliance with SanPiN, GOST);

• guaranteed and stable chemical composition corresponding to age-related characteristics of metabolism and digestion;

• consistency and degree of grinding, corresponding to the age characteristics of the child’s chewing apparatus and digestive system;

• a diverse and seasonally independent range of raw materials used in the production of complementary foods (hard-to-cook vegetables, fruits, meats, difficult-to-cook cereals - corn, rye, barley and mixtures of several cereals, etc.);

• additional enrichment with vitamins, minerals, pre- and probiotics, etc.

Now let's talk about what complementary foods you should start with.

What complementary foods should I start with?

Currently, leading pediatricians recommend so-called energy-dense complementary foods as the first complementary foods. This is due to the small volume of the stomach, so that with a small amount of food it satisfies the child’s needs for nutrients and energy. Therefore, complementary feeding products must have a high energy value (density) (more than 70 kcal/100 ml) and a high nutrient content, since they are given to the child in a limited volume. First, 3 main types of complementary foods are introduced: cereals, vegetables, meat.

An energy-dense product recommended as the first complementary food is porridge, preferably industrially produced instant porridges that do not require cooking. Porridges can be fortified with vitamins, iron, calcium, zinc, iodine, or have a naturally high content of vitamins and minerals if they are organically grown products (Hipp, Fleur Alpin Organic). The advantages of industrially produced cereals are also the safety of raw materials and the final product; stability of the composition, providing 20–30% of children’s daily needs for nutrients and energy. Porridge replaces milk feeding, usually the second after morning feeding with breast milk or formula. Dairy-free cereals can be diluted with breast milk or the formula that the child receives. Porridge is introduced into the diet no earlier than 4 months and no later than 6 months of life.

Porridge is recommended as the first complementary food for children who do not have excess weight gain. If your baby is overweight and prone to constipation, it is better to start with vegetable puree, which we will discuss below.

Which porridge should you choose first?

Historically, our mothers and grandmothers widely used affordable and quick-to-prepare semolina porridge. However, gluten-containing cereals (semolina, oatmeal, wheat) can provoke food allergies and intestinal disorders. In addition, semolina is poor in vitamins, minerals, and also contributes to excess weight gain.

Gluten-free cereals are currently recommended as the first cereal - buckwheat, rice, corn. For children with unstable stool, rice porridge may be recommended first. On the contrary, a child with a tendency to constipation should be given buckwheat porridge, rich in dietary fiber.

Start with dairy-free, low-allergenic recipes for these cereals,

containing one type of cereal and vitamins.

Usually porridge replaces the morning feeding at 10 am. First, you give the child 1-2 teaspoons of porridge, then supplement with milk. If the porridge is well tolerated, the next day increase its volume by another 1–2 teaspoons. And so every day you will increase the volume of porridge, and the volume of milk food that the child eats will correspondingly decrease until you completely replace this feeding with porridge, bringing the volume to 140 - 150g. While introducing a new type of product, stay with one type of cereal. When the child adapts to the first type of cereal, for example buckwheat, you can try another type - rice, and then corn. Once you are sure that your baby tolerates these cereals well, you can use milk porridges made from these types of grains and their combinations, as well as with the addition of fruit. By 6.5–7 months, the child can be given porridges made from gluten-containing cereals (oatmeal, wheat, millet) - both from one type of cereal and multigrain.

The introduction of complementary foods is accompanied by an increased risk of intestinal infections. Therefore, complementary foods enriched with components that help maintain the growth of friendly intestinal microflora are relevant.

I would also like to highlight whole grain porridges, for example Fleur Alpin Organic, as well as the Nutrilak Premium PROCEREALS line, the production of which uses flour in which all parts of the grain (shell, endosperm and germ) are preserved during processing. This makes it possible to retain all the beneficial natural nutrients, vitamins, minerals and dietary fiber. Also, natural dietary fiber from the grain shell contributes to the proper functioning of the child’s digestive system and the growth of beneficial bacteria in the intestines.

The second complementary food, after 5–5.5 months and, as a rule, 2 weeks after the introduction of porridge, is usually vegetable puree. Vegetables can also be the first complementary food for children who are gaining weight. At first, it is better to use puree made from one type of vegetable, for example, zucchini, cauliflower, broccoli, gradually moving on to expanding the range (carrots, pumpkin, potatoes, Brussels sprouts, etc.). Pumpkin, various varieties of cabbage (white cabbage, cauliflower, broccoli), zucchini contain less carbohydrates than other vegetables, so they can be used in the diet of overweight children. When preparing puree at home, vegetables are steamed or in a small amount of water until tender, without salt (for the correct formation of taste habits), vegetable oil is added in an amount of 3%.

White carrots, which come from wild carrots, are also suitable as a first food. There is a puree of such carrots, for example, from the Hipp company. White carrots have a very mild and slightly sweet taste, which makes it easier to introduce a new product into a child’s diet. The nutritional composition is very close to regular carrots, but it does not contain ß-carotene, which significantly reduces the risk of allergies.

It is preferable to use ready-made baby food in a jar. According to the degree of grinding, industrial purees can be homogenized for children 4–6 months old

;
pureed for children from 6 to 9 months;
coarsely ground for children
from 9 to 12 months.
Introduce your child to vegetables gradually - on the first day, give 1-2 teaspoons of vegetables, then supplement your baby with milk. It is advisable to start with one-component purees based on dietary varieties of cabbage (cauliflower, broccoli) or zucchini. If tolerated well, increase the amount of vegetable puree every day, and reduce the amount of dairy food accordingly. This way, you will increase the volume of vegetable puree to 130-140 g. Give vegetables to your baby at lunchtime, from a spoon, warm - heated to 37ºC. When your baby adapts to these types of vegetables, you can add a small amount of mashed potatoes to them. Thus, the child will receive a two-component puree. You can give pumpkin - it is well absorbed and tolerated by small children, and its dietary fiber gently regulates intestinal activity.

Meat, starting with meat puree, is introduced at 6–7 months.

This is
the third
complementary food. According to the individual recommendation of a pediatrician, premature babies, children with anemia, insufficient weight gain, as well as those with a tendency to allergies, meat can be prescribed as early as 5 months. Meat is essential. It is a source of complete protein and many minerals and trace elements necessary for harmonious development, especially highly digestible heme iron. Dietary types of meat are suitable for baby food - turkey, rabbit, lean pork, which are the first of the recommended types of meat. Then you can use horse meat purees. All these varieties are also recommended for children with allergies. In this case, of course, the individual tolerance of the product is also taken into account. Beef, veal, chicken can also be used for baby food, provided they are tolerated. Puree with the addition of offal (liver, heart, tongue) is used in the diet of children over 7 months of age no more than 2 times a week.

To introduce meat, add a small amount of puree containing meat (meat-vegetable or meat) to the vegetable puree already familiar to the baby, for example, to 135g of cauliflower puree, add a few teaspoons of “Turkey” or “Rabbit” meat puree. You can also use Semper's meatballs, which have a high meat content and, when combined with vegetable purees, serve as a complete lunch for your baby. Provided that it is well tolerated, increase the volume of meat and vegetable puree every day, and reduce the volume of vegetables. Thus, you will combine vegetables and a meat and vegetable dish for several days until you completely switch the child to meat and vegetable puree. Now meat and vegetable puree will be included in the child’s diet every day at lunchtime in a total amount of 160 - 180 g, and by 8 months - up to 190 - 200 g. You can also use ready-made vegetable cream soups with meat as lunch, for example “Hipp Vegetable Cream -soup with tender veal.”

Ready-made canned meat for baby food is more preferable:

they are better absorbed, have optimal safety parameters and correspond to the capabilities of the baby’s immature digestive tract.
Meat, meat-vegetable (or they are also called meat-vegetable) and vegetable-meat canned food differ in the content of meat in them and in the degree of grinding. Meat makes up at least 50%
in canned meat, at least
30%
in canned meat and vegetables, and no more than 10–15% in canned vegetable and meat products. Based on the degree of grinding, these canned foods are differentiated depending on the age of the child and are divided into canned food for three stages (stages) of development:

· I stage

— for children 6–8 months (homogenized),

· II stage

– 8–12 months (puree),

· III stage

- for children over one year old (coarsely ground).

Using increasingly coarsely ground types of purees as the child grows and teething is very important for the proper development of the child’s jaw and bite.

And in conclusion, we repeat once again that all children are individual, so the scheme for introducing complementary foods should be flexible and take this into account:

• - if you are underweight or have frequent stools, porridge is the optimal first complementary food;
• - if you are overweight, constipated, or have signs of rickets, vegetable puree is recommended as the first complementary food.
• — for children with a hemoglobin level below 115 g/l, meat is introduced as a second complementary food 10–14 days after porridge, and then vegetable puree is introduced;
• — the time of introduction and type of complementary foods for children at risk of developing allergies are determined on an individual basis.

Authors of the article: pediatricians Babanova Zhanna Iosifovna, Nebesny Evgeniy Anatolyevich.

• Publication date: 12/01/2021
• Nutrition issues

Complementary feeding during breastfeeding: input table

Pediatricians and WHO specialists have developed special schedules regulating the list of foods introduced into the diet and complementary foods by day. This table of complementary feeding during breastfeeding by month is one of the schemes approved by leading Russian pediatricians and WHO.

CHOOSING THE TYPE OF COMPLETE FEEDING: PEDAGOGICAL OR PEDIATRIC

— How does pedagogical complementary feeding differ from the pediatric regimen?

— In pedagogical complementary feeding, food is given from the adult table only for familiarization. Milk feeding remains the main type of nutrition. You can try new foods before, after, or while breastfeeding or formula.

Pedagogical educational complementary feeding

- This is the introduction into the children's diet of food that adults eat, that is, not processed specifically for the child. The goal is to introduce him to a variety of foods.

The baby sits at the adult table and tries in microdoses - up to one teaspoon - any product from his mother’s plate.

Pediatric traditional complementary foods

- these are, in fact, the first, second and third complementary foods with a nutritional function.

What type of complementary feeding to choose, pedagogical or pediatric, or a combination of both options, is decided by the mother:

• pedagogical - introductory, forms food interest;
• pediatric - full feeding of the child.

Tips for preparing complementary foods

A rather responsible process is the introduction of complementary foods during breastfeeding. Only freshly prepared meals can be given to the child using special dishes. It is extremely undesirable to feed your baby with your own spoon and from your own plate.

To avoid possible problems with the absorption of foods, you should be guided by several simple principles: • select only young vegetables and organic products for complementary feeding; • it is best to feed a new dish in the morning during breakfast and always before breastfeeding; • products should be introduced one at a time, starting with minimal doses. In this case, you need to observe the reaction of the body that has not yet become stronger for 12 hours; • if negative reactions occur, the unsuitable product must be discontinued immediately; • increase the volume gradually and smoothly, taking into account age; • you should not stop breastfeeding even in cases where the baby likes “adult” food.

After the child gets used to the porridge, you can add a little butter to it. It is strictly forbidden to give your baby exotic fruits, mushrooms, nuts, honey and regular tea before one year of age.

Water, juices and other drinks

In addition to complementary foods, children need to be given drinks. Thick meals, which make up the bulk of their diet, contain about 30% water. This is less than in breast milk1, which the baby is accustomed to. If he does not get enough fluids from food, he may become constipated1,10. Therefore, between feedings, you can offer the baby water - boiled or specialized baby water1.

Regardless of the type of feeding, you need to give your baby water in the amount of one feeding1. You can calculate the required amount based on body weight - for every kilogram of weight 15-20 ml of water8.

When the baby gets used to the main products, he can be given fruit and vegetable juices (the optimal amount is 100-150 ml per day)2,3,8. Juices contain glucose and fructose, as well as organic acids that stimulate digestion. But if your baby drinks a lot of juices, especially between meals, this can lead to tooth decay and excess weight in the future3.

Black or green tea is not recommended for children under 2 years of age because they interfere with the secretion of gastric juice and the absorption of iron.
Children's teas, for example, with chamomile and fennel, can be prescribed by a doctor for medical reasons3. Approximate scheme for introducing complementary feeding products to a child in the first year of life1

Types of cereals for complementary feeding

Porridge is a necessary and very important dish in children's nutrition. Their benefits are great and consist of the following: • cereals contain a large number of useful elements, the porridge itself has a beneficial effect on the baby’s digestive system; • the porridge contains the amount of proteins necessary for a child, as well as vitamins belonging to group B; • cereals are a powerful source of healthy carbohydrates necessary to saturate a small body with energy. Porridges also have high nutritional value.

When complementary feeding begins while breastfeeding, it is better to use store-bought cereals for this. They come in several types: • dairy and dairy-free; • gluten-free and gluten-containing; • fermented milk; • hypoallergenic; • single-component and multi-component.

IMPORTANT! There are also special therapeutic and preventive porridges on sale, which contain pro- and prebiotics and well restore the balance of intestinal microflora.

Products for first feeding

The first vegetable puree should be monocomponent, that is, consist of one vegetable. As a rule, this is a puree of zucchini or cauliflower with delicate dietary fiber, to which vegetable oil is added1,3.

If the doctor recommended starting with porridge, it should be dairy-free, from one type of cereal - rice, buckwheat or corn. These grains are preferred because they do not contain gluten, a grain protein that can cause food intolerances. You should dilute the porridge with breast milk or formula, add butter1.3.

For the first course, you can choose one of the products presented in table 2,3.

The procedure for introducing cereals into a child’s diet

Before introducing complementary foods while breastfeeding, you need to make sure that the baby is completely healthy and does not have any hidden pathologies. Vegetables or cereals can be given to a child from 5-6 months before breastfeeding. The diet should be planned so that one feeding is subsequently completely replaced with additional products.

Porridge should be introduced into the baby's diet in the following order: • feed the child freshly prepared porridge every day for breakfast. Cook without sugar or salt. At first the consistency should be slightly thicker than breast milk, later you can prepare thicker mixtures; • during the first week, give your baby buckwheat porridge. Start with one teaspoon. If there are no negative reactions on the second day, the amount of porridge can be increased to 2-3 spoons. On day 4, you can make the consistency thicker and let the child eat 5 spoons. By the end of the week, the daily portion should be 100 g, the consistency should resemble a creamy porridge; • during the second week, prepare rice porridge and feed the child according to a similar scheme as with buckwheat. It is also possible to alternate rice and buckwheat every day; • in the third week, corn flour porridge is prepared for complementary feeding, following the schedule described above; • starting from the fourth week, you can include oatmeal in the menu. But here it is necessary to carefully monitor the baby’s reaction, since oatmeal contains gluten.

Corn grits porridge is considered a valuable product. It contains a lot of protein, microelements and fiber. It is best to introduce it after buckwheat and rice. There is no need to rush with semolina; some experts advise giving it to a child only after a year.

At what age should a child try meat?

Meat is rich in protein and essential amino acids, which are necessary for the normal growth and development of the child's body. Meat products are important for babies with iron deficiency - a microelement that is much better absorbed from meat than from plant foods. Meat is best introduced into a child’s diet at the age of 6 months. For the first complementary feeding, pureed meat from beef, veal, rabbit, turkey and chicken is suitable. After becoming familiar with single-ingredient products, you can introduce variations of dishes with meat into your child’s menu, for example: - beef with buckwheat or beef with zucchini from the manufacturer Babushkino Lukoshko; — chicken with spaghetti, vegetables with rabbit (rabbit, cauliflower and potatoes) or stewed vegetables with veal (as well as potatoes, carrots and pumpkin) from Gerber; — chicken with buckwheat, beef with chicken, beef with rice and zucchini of the Tema brand. For 7-month-old babies, the baby food manufacturer Babushkino Lukoshko, already known to us, offers vegetable stew with beef (beef, potatoes, zucchini, carrots) and its variation with chicken meat - with the same vegetable composition.

Check out the full range of canned meat on this page - read detailed information about the products, select them by age and create a complete menu.

8-12 months

At this age, the baby is able to eat from a spoon, bite and chew, using the tongue to move food to the teeth.
It copes with mashed or chopped dishes, as well as with foods that can be eaten with your hands, these are: - well-cooked meat and liver, minced in a meat grinder; - chopped raw fruits and vegetables; — grains (wheat, oats); - bread. At the age of 12-24 months, the child's jaws begin to work stably and can make rotational chewing movements. From now on, the small family member can eat food from the family table. The assortment of the FARMEKONOM online pharmacy and the network pharmacies includes all the baby food products listed in the article. To buy them for sure, fill out an application on the website and wait for an invitation to purchase. Be healthy! There are contraindications. Before use, consult a specialist and read the instructions for use.

What criteria should porridge meet?

For the first feeding, it is important to choose the right foods. Porridge should not cause discomfort. To do this, you need to know what criteria it must meet.

Composition of cereals.

At the initial stage, you need to prepare porridge from one grain. This will allow you to control how the child’s body reacts to the new product. Only if there are no side effects can you start preparing porridge from several different grains.

Presence of gluten.

These include wheat, oatmeal, barley and semolina porridge. It is important to be aware of the possible risks here, since such dishes can provoke allergic reactions at an early age.

Milk content.

When can you start complementary feeding while breastfeeding cereals? No faster than from the age of 5–6 months. And you need to start with dairy-free cereals. Cow's milk is still an undesirable product because it belongs to the group of strong allergens.

Some mothers prepare porridge using their own breast milk or using special milk formulas. This solution is optimal.

What foods cause allergies

There can be an allergic reaction to any product, so complementary foods are introduced gradually. Of those offered from 4 to 6 months, butter and beef (veal) are the most likely to cause allergies.

One percent of people are intolerant to gluten, which is found in cereals made from wheat, rye, millet, barley and oats2. The admixture of these grains in food also causes a reaction, if gluten is not allowed.

Prepare porridge yourself or buy it

We have figured out when to introduce complementary foods during breastfeeding, but many mothers ask themselves another question: whether to prepare their own porridge or whether it is better to use store-bought ones. Certain advantages are characteristic of both options and you should be guided in this direction only by your own preferences.

If we talk about finished products, then among the advantages we should note: • saving time. Mom doesn't need to waste time standing at the stove. Just add water to the mixture, stir and the dish is ready to eat; • quality. Very high demands are placed on baby food manufacturers. Before products enter the market, they are carefully checked and certified. At the same time, mixtures for preparing porridges are completely tailored to the age and needs of the baby; • variety of choice. A variety of types of cereals are offered for sale today. This allows you to choose the most suitable product for each child.

In addition to choosing one type of porridge or another, you also need to prepare it correctly. For the first complementary feeding, it is prepared as follows: • diluted with water or milk formula, depending on whether milk is present in the composition or not; • you need to pour 5 g of cereal into a container, add 0.5 cups of water, stir thoroughly until the mixture has a liquid consistency (unless otherwise specified in the instructions); • subsequently the amount of cereal gradually increases to 10 g; • to prevent lumps from forming in the porridge, it must be mixed well immediately after adding water; • water for dilution should be boiled, but not too hot. If you add boiling water, then along with the formation of lumps in the finished dish, beneficial elements and vitamins will be disrupted.

When buying porridge in a store, you need to carefully study the packaging. It must be intact and hermetically sealed. Be sure to check the expiration date. Do not buy products that contain potentially hazardous substances. The packaging should also have a mark indicating the age at which you can start giving this product.

Second feeding. Porridge or meat?

Even 5 - 6 years ago, we taught students at the medical institute that from 5 - 5.5 months, an infant should start giving grain porridge as complementary foods. This is rice, buckwheat, corn. For the first week, you can cook 5% porridge: 5 grams of ground cereal per 100 ml of water. Then the porridge is cooked more dense: 10 grams of cereal per 100 ml of water. But now, mostly everyone uses instant (soluble) cereals, which are diluted with water according to the instructions on the package. In addition, ready-to-eat liquid porridges are available for sale: for example, Bellakt, Frutonyanya, etc.

Why meat? You ask. According to modern recommendations (they really began to change quite often), but in this case I support: if a child by the age of 5 months has a pronounced decrease in hemoglobin in the blood below 100 g/l, it makes sense to start introducing fruit or vegetable purees as a second type of complementary feeding, meat purees as a source of the most easily absorbed heme iron. You need to choose from varieties such as turkey, rabbit, lamb. Beef and veal can only be offered to children who do not have red cheeks or diathesis.

If there are no problems with low hemoglobin, feel free to introduce porridge as the second course of complementary feeding, especially if the child is a “little one” and is not gaining weight very well. In this case, we can recommend diluting cereals with the addition of breast milk or formula (Nan, Nutrilon, Celia, Nanny). Parents of children with a predisposition to allergies should be very careful with goat milk-based formulas. Goat milk formulas are not the best choice for children suffering from allergies or intolerance to cow's milk protein, no matter what they write on the Internet. Believe me, there are serious scientific articles by foreign authors that provided data on a very high incidence of cross-allergy between cow's and goat's milk proteins in children who were transferred to goat's milk formulas. And I saw this myself in my practice, when a child with dermatitis was switched to goat’s milk formula, there was a clear improvement for a month or two, and then everything started again and with a doubled degree of allergic skin damage.

How to offer your baby his first meal

The first feeding should be gradual. We must not forget that breast milk remains the main product in a baby’s diet. This is also noted by the famous TV doctor E. O. Komarovsky. The new dishes introduced to the menu are only a small addition to breastfeeding.

You should also prepare in advance for complementary feeding. To do this, you need to buy a special baby spoon made of silicone or safe plastic. Spoons with temperature indicators will be very convenient for feeding. When the temperature of the dish exceeds 40 °C, the spoon changes color.

The main purpose of complementary feeding is not to simply feed the baby. First of all, you introduce your child to new tastes. After each new meal, be sure to put the baby to the breast.

Why should you not introduce complementary foods before 4 months?

If complementary foods are introduced before 4 months, the following violations are possible3:

• allergies and digestive disorders;
• changes in the composition of intestinal microflora (dysbiosis);
• regurgitation;
• entry of food into the respiratory tract.

In addition, if a new food partially replaces breast milk from the baby’s diet, the nursing mother’s milk production will decrease3.