Infant formula (Guideline 2)
HEALTHY EATING GUIDELINE 2
If an infant is not breastfed, is partially breastfed, or if breastfeeding is discontinued, use an infant formula until 12 months of age.
Infant formula is the only safe alternative to breastmilk in the first 12 months. Breastmilk is the best choice for babies, so it is important that mothers know about the benefits of breastfeeding before they make the decision to combine breastfeeding with formula-feeding or to offer formula instead.
If a baby is not breastfeeding, or is partially breastfed, infant formula should be the only other food they have until solids are introduced. Breastmilk or infant formula should be continued while introducing solids, with other drinks avoided until the infant is 12 months of age.
Many types of infant formulas are available. A formula that is appropriate for the age of the baby should be prepared safely in a clean environment, according to the manufacturer’s directions and using the scoop provided to measure the powder. Formula that is not made up correctly can cause babies to become dehydrated, constipated or even undernourished. It is important that nothing is added to infant formula. Adding infant cereal or other foods to formula can interfere with a baby’s feeding.
For babies in care, parents should provide the setting with sterilised bottles and teats, as well as premeasured powdered formula, each day. These should be clearly labelled with the date, the baby’s name and the amount of water to be mixed with the formula. Water for infant formula should be prepared by bringing a fresh kettle or jug of water to the boil and allowing it to boil for 30 seconds (or, for an automatic electric kettle, until the cut-off point). Water should then be cooled before use. Infant formula should always be prepared as close as possible to the time it is needed. It is safest to prepare feeds individually, and not in bulk.
It may be preferable for parents to bring bottles already filled with the correct amount of pre-boiled, cooled water, so that staff and carers do not have to boil and cool water before feeding babies. Water boiling units are not suitable for use when preparing formula for babies. Once made up, infant formula should be stored in the refrigerator until used, and discarded after 24 hours.
It is not safe for parents to bring preprepared infant formula for their child. This is because of the small risk of bacteria not killed during the formula preparation process growing in the bottle after it is prepared.
To ensure that formula is heated evenly and to reduce the risk of burning the baby, bottles should be warmed in a water bath for no longer than 10 minutes, and not in the microwave.
It is crucial to supervise babies while they are feeding – never leave them unattended with a bottle, or prop a bottle up for a baby. Propping a bottle is dangerous, as the baby risks choking or developing an ear infection. In addition to supervision, babies benefit from close interaction with a parent or carer while feeding.
Babies should be allowed to decide the amount of milk they wish to drink, and should never be urged to finish a bottle. Unfinished formula should be discarded and not stored, even in the refrigerator, for later use.
After use, all bottles and teats should be rinsed in cold water and sent home to be washed and sterilised.
Cow’s milk should not be given to babies as a main drink until they are
12 months of age. Small amounts of cow’s milk can be used in mixed
foods for babies prepared for the infant. Low-fat and reduced-fat milks
are not recommended for children under the age of two years.
Feeding babies infant formula is recommended in cases where breastfeeding is discontinued within the first 12 months.
Infant formula is prepared according to the manufacturer’s directions and offered in a clean, sterilised bottle.
Infant formula is prepared as close as possible to feeding time.
Correct procedures for preparing and handling infant formula are carried out.
Introducing solids (Guideline 3)
HEALTHY EATING GUIDELINE 3
Introduce solid foods at around six months.
Breastmilk or formula provides all of the necessary nutrients for babies from birth to six months. From around six months, babies need solid foods in addition to breastmilk or formula for adequate nutrients and energy.
Moving from breastmilk or formula to eating a variety of foods should be a positive experience. Experiences with eating early in life can affect attitudes and habits later on, as well as influence health. The skills that babies learn when starting on solid foods and their experiences with new tastes and textures are the foundations for future eating behaviours and preferences.
Showing interest in food and an increased appetite are signs that a baby is ready to be introduced to solid foods. It is also important that the baby can sit upright with limited support, and control the head and neck. Around six months of age, most babies show signs that they are ready to try new foods.
It is recommended that solids are not introduced until around six months of age.
As solids are introduced, there is often a reduction in breastfeeding. Early
introduction of solids increases the likelihood that a mother will be unable
to maintain lactation, and so breastfeeding will be unable to continue.
Breastfeeding or bottle-feeding should continue while solids are being introduced. Breastmilk (and/or an age-appropriate infant formula where breastmilk is not available) should continue to be the main milk drink until a baby is around 12 months of age.
Delaying the introduction of solids much beyond six months may result in the baby not getting enough nutrients, and may increase the possibility of allergies. Babies are usually willing to try new foods at around seven to eight months, making this a good time to introduce a variety of foods.
How to introduce solids
The introduction of solids aims to:
use babies’ existing capacities to help them learn the new skills needed for eating
maximise babies’ willingness to accept new tastes.
As long as iron rich foods are included in first foods, foods can be introduced in any order and at a rate that suits the infant. The order and number of foods being introduced is not important. Slow introduction of solid foods is not necessary.
The first food offered to young babies is often iron-fortified infant cereal, as it is smooth, easy to mix in small amounts and provides extra iron, which is the additional nutrient most needed by babies. Pre boiled, cooled water, or cow’s milk can be mixed with the cereal. Foods can be introduced in any order provided the texture is suitable for the infant’s stage of development. Smooth foods should be offered in the beginning. Foods of various textures and thickness can be gradually introduced after babies have taken well to eating. If food is provided by the setting, ensure that culturally and religiously appropriate foods are available.
There is no need to add salt, sugar or other flavours to infant foods. Plain water can be added to pureed foods if liquid is needed. Where food is being prepared separately for each child, either in home or family day care, pre boiled, cooled water, or cow’s milk provided by the parents can be added to the child’s meal.
Some families will choose to offer pre-prepared baby food from cans or jars, or frozen infant foods. These can be useful for convenience occasionally. To ensure children eat a variety of foods and experience different textures, mashed, minced and shredded foods as well as finger foods can be introduced as babies’ eating skills develop.
Working with parents to introduce solids
Work with parents around introducing solids. A baby’s first solids are an important milestone for parents as well as for babies. Discuss family views and offer current information on introducing solids. Some parents may be eager to start solids very early and others may need advice about when to start solids. Some parents will have strong views that come from their cultural or religious backgrounds. Always let parents know where they can get further information.
Examples of foods that can be consumed
First foods (from around six months)
Iron rich foods, including fortified cereals
(e.g. rice), vegetables (e.g. legumes, soy beans, lentils), fish, liver, meat and poultry, cooked plain tofu
Other nutritious foods to be introduced before 12 months
Cooked or raw vegetables (e.g. carrot, potato, tomato), fruit (e.g. apple, banana, melon), whole egg, cereals (e.g. wheat, oats), bread, pasta, nut pastes, toast fingers and rusks, dairy foods such as full-fat cheese, custards and yoghurt
From 12 to 24 months
Full-cream pasteurised milk
Note 1: Hard, small, round and/or sticky solid foods are not recommended because they can cause choking.
Note 2: To prevent botulism, do not feed honey to infants aged under 12 months.
Nuts and other hard foods
Foods with a high risk of choking such as whole nuts, seeds, raw carrot, celery sticks and chunks of apple should be avoided for the first three years as their size and/or consistency increases the risk of inhalation and choking. However nut pastes and nut spreads can be offered to infants from around six months of age.
Progressing to feeding from a cup
Babies can learn to use a cup from an early age, and are usually ready to try from around seven months. For some babies, this will be a progression from bottle-feeding to cup-feeding, while breastfed babies may skip using a bottle completely and start using a cup, often while continuing to breastfeed.
Breastmilk can be offered to babies from a cup if the mother has expressed milk and has chosen not to bottle-feed. Cooled boiled water can be offered as an additional drink in a bottle or cup after
six months of age.
Although water is sometimes offered in a bottle after six months, it is best to use a cup. By around 12 to 15 months of age most babies can manage a cup well enough to satisfy their own thirst, and the bottle can be stopped. Babies who continue to drink from the bottle well into the second year may drink a lot of milk and have a reduced appetite for other foods – which increases the likelihood of a baby becoming iron-deficient. Stopping the bottle is often difficult for parents, so discuss this with them and offer some suggestions for further advice.
Babies do not need sweet drinks such as cordial, soft drink and fruit juice, or other drinks such as tea or coffee. These are not necessary or recommended for infants under 12 months. Sweet drinks can reduce a baby’s appetite for nutritious foods and increase the risk of dental decay. Breastmilk and infant formula are appropriate drinks for babies.
Choking risks for babies
It is important for staff and carers to be alert when it comes to the risk of babies choking. Babies are still mastering the skills of feeding, and have no or few teeth, no molars (back teeth) for chewing harder foods and a smaller trachea (windpipe), which can become more easily blocked at this age. It is important that babies sit to eat and that they are supervised while eating.
It is common for young children to ‘gag’, with coughing or spluttering, while they are learning to eat. This is different to choking and is not a cause for concern. However, choking that prevents breathing is a medical emergency.
To reduce the risk of choking:
Supervise babies whenever they are feeding.
Avoid putting babies in a cot or bed with a bottle.
Never prop a bottle up for a baby.
Make sure babies are developmentally ready to eat before offering solids.
Ensure that babies are awake and alert when fed.
Never force a child to eat.
Offer foods that are a suitable texture, starting with smooth and soft foods and then progressing on to a wider variety of tastes and textures.
Grate, cook or mash hard fruits and vegetables, such as apples or carrots.
Never give babies pieces of hard, raw fruits and vegetables, nuts, popcorn or other hard, small, round and/or sticky solid foods.
Special feeding needs
Disabilities, early illnesses and invasive procedures that may affect feeding will impact on the age at which solids should be introduced. Additionally, a baby’s acceptance of solids and progress toward increasing the variety of foods may be slower. Working closely with parents is particularly important in these situations. Finding out about any specific plans they may have developed with specialists or other health professionals is critical. Getting additional information and advice from a family’s doctor or an Accredited Practising Dietitian may be useful.
Introducing solids is discussed and decided on collaboratively with parents, taking into consideration the baby’s signs of readiness and any special needs the child has.
Choking risks for babies are minimised through supervision – babies are never left unattended with a bottle, and always offered foods of the appropriate texture.
Staff or carers and parents are reminded that the progression from breastfeeding or formula to a variety of foods is a positive experience for children, and is likely to influence long term eating patterns.