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.

At what age is a baby ready for complementary feeding?

WHO recommends that a baby be introduced to new foods from around the 6th month if he is healthy and born at term4,6. According to the recommendations of ESPGHAN (European Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists), both breastfed and bottle-fed children are allowed to introduce complementary foods between 17 and 26 weeks of life, that is, between 4 and 6.5 months1. Domestic pediatricians also designate such terms1.

But age is not the only criterion for a baby’s readiness to change their usual menu. It is important that his digestive system matures and can absorb thick food without expressing “protest” in the form of an allergic reaction1,3. Therefore, doctors believe that the timing of introducing complementary foods should be determined individually1,3,7.

The best way to find out if your baby is ready for complementary feeding is to consult with your pediatrician. Parents can pay attention to the “tips.”

A child’s body is ready for new food if3:

• the baby's body weight increased 2 times compared to what it was at birth;
• The baby is teething;
• he can sit with support and hold his head;
• the baby “recognizes” the spoon - does not push it out and begins to chew when it enters the mouth;
• the child already expresses an opinion about food - he opens his mouth and leans forward if he likes it, or purses his lips and turns away when he doesn’t like the food.

Parents should also be aware that if they switch their baby from breastfeeding to bottle feeding early or start introducing complementary foods untimely, he may develop a tendency to constipation9.

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.

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.

Mistake 4: Too much

Mom takes her time and does everything right, but there is another extreme: if the baby likes it, then they give him more and more, because it’s so touching when the baby happily eats porridge or meat with vegetables!

Stop! Never exceed the amount of product prescribed for your child’s age. And if it is written that 60 grams of fruit puree per day is enough for a 6-month-old baby, then it is so.

One of the goals of complementary feeding is to teach a child to distinguish between the feeling of hunger and the feeling of fullness, which allows healthy eating habits to be established in early childhood. By overfeeding your baby, you form an incorrect perception of food in him. A child who is overfed is at risk of obesity, metabolic disorders and increased load on the excretory system, and there are other pitfalls. If you increase the portion too quickly when introducing complementary foods, this can result in indigestion and stool upset, regurgitation and even an allergic reaction for the baby. Experts note that some products provoke delayed allergies, which manifest themselves when a critical mass of a particular allergen accumulates in the body.

It is important to start complementary feeding with 1/2 teaspoon of the product and each time increase the portion by half a spoon, maximum by one. Yes, it's tedious, but it's simply necessary.

Introduce a new product in the first half of the day so that you can track your baby's reaction to it.

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.

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.

What should you not give to infants?

There are a number of foods that children under one year old should completely avoid eating. Such products include primarily sugar, salt, foods that can be choked on - nuts, grapes, raw carrots, raisins, peas, etc., soda, juices, fruit drinks, compotes, whole milk, honey and semolina porridge. These products will bring absolutely no benefit to the child’s body, but can, on the contrary, cause harm.

We tried to fully cover the question of when it is possible to introduce complementary foods to a child and how to make this process so that as a result the child receives good health, pleasure from the learning process and correct eating behavior.

Let your children be healthy and happy!

• Manual with recommendations for introducing complementary foods from the World Health Organization
• Website of the Union of Pediatricians of Russia

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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.

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

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.

Negative reaction to complementary feeding

Each new product is introduced into complementary foods separately, and it is necessary to carefully monitor the baby’s reaction and if any signs of intolerance, digestive disorders, allergic reactions, etc. appear, it is necessary to exclude the product that caused them from complementary foods and replace it with another.[1] If your child does not like a certain complementary food product, you should not force-feed him, as this may cause the baby to refuse to eat complementary foods in principle.[1] You can offer your baby a product of a different taste or consistency, and try offering the product you didn’t like again later. Only fresh foods can be used in complementary feeding.[1] A child's first complementary feeding, as well as his food up to 2 years of age, should not contain salt, sugar, [3] spices, smoked meats, sausages and sausages. Also, you should not give children of this age tea (black, green, herbal) or coffee, as well as distilled, carbonated and mineral water.[1,2]

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.

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.

Mistake 5: Not on time

You can often hear from mothers that the baby does not want to try new foods, and they simply postpone the introduction of complementary foods until later. However, behind this behavior of a naughty toddler is most often the mother’s mistake. It consists in the fact that the baby is first given breast milk to eat, and only then is offered to try delicious vegetable or fruit puree. Naturally, a well-fed child does not show the slightest interest in food. First, you need to invite your baby to eat 1-2 spoons of a new product for him, and only then supplement him with milk. And you don’t have to worry that he will remain hungry: he will eat as much milk as he needs.

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.

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.

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.

How to introduce fruit puree and dairy products?

Fruit puree can be added to the menu only after meat1,3.

Delicious fruit purees are recommended for children with decreased appetite or a tendency to constipation, especially if vegetable purees with vegetable oil did not help regulate stool frequency1,3.

At 8-9 months, one feeding with breast milk or formula should be replaced with yogurt or kefir, adding cookies3. The optimal amount of fermented milk product is no more than 200 ml per day1,3.

But drinking milk (cow, goat or other) in the first year of life is not recommended1,2. If a child is prone to allergies, cow's milk can disrupt intestinal function and make it difficult to absorb certain micronutrients, such as copper and zinc3. In addition, whole cow's milk is a high-calorie product that should not be abused4. Animal milk up to 12 months can only be used in milk porridges3.