In early infancy, nutrition choices are relatively simple (though not necessarily easy!). When the baby is hungry, it’s time to breastfeed or prepare a bottle. But in later infancy and toddlerhood, the child’s food horizons expand. This is an exciting period of learning about foods and how to eat with the rest of the family.

Introducing Solid Foods

The World Health Organization recommends that babies begin eating foods at about 6 months while continuing to breastfeed. Other health organizations offer more flexible advice, recommending that solid foods be introduced sometime between 4 and 6 months. Most babies aren’t ready to eat solid foods before 4 months, and starting too soon may displace breast milk or formula without a clear benefit. It’s also important not to start solids too much later than 6 months, since breast milk alone may no longer meet the infant’s needs for certain nutrients like iron and zinc.^[1]

As babies begin to eat solids, breast milk or formula continue to be the nutritional foundation of the diet. This period is also called complementary feeding because solid foods are meant to complement the nutrients provided by breast milk or formula rather than replace. Between 6 and 12 months, babies gradually eat more solid foods and less milk so that by 12 months, formula is no longer required. Breastfeeding mothers may choose to continue for as long as parent and child desire.

Babies should be developmentally ready to eat solids before trying their first foods. A baby ready for solids should be able to do the following:^[2]

• Sit upright with minimal support and good head and neck control
• Open mouth for a spoonful of food and swallow without excessive gagging or pushing it back out with the tongue
• Reach for and grasp food or toys and bring them to his or her mouth

The American Academy of Pediatrics recommends beginning complimentary feeding with iron-rich foods such as pureed meats or iron-fortified cereals, as iron is usually the most limiting nutrient at this age, particularly for exclusively breastfed babies. For many years, rice cereal was recommended as the first cereal; however, because rice might contain arsenic, current guidance encourages offering a variety of iron-fortified cereals, not just rice. After iron-rich foods are introduced, others can gradually be added to the diet, introducing individually to observe tolerance. Over time, infants should be offered a wide variety of foods from all of the food groups to support nutrient adequacy and flavor acceptance. Parents can gradually increase texture from pureed to mashed food, then lumpy foods to soft finger foods. By 12 months, most babies can eat most of the foods at the family table, with some modifications to avoid choking hazards.^[3]

When choosing good complementary foods, there are three main goals: (1) to meet nutrient requirements; (2) to introduce potentially allergenic foods; and (3) to support your baby in learning to eat many different flavors and textures. Caregivers should be sure to include the following:^[4]

• Good sources of iron and zinc, as both minerals can be limiting for breastfed infants. Good sources include meat, poultry, fish, and iron-fortified cereal. Beans, whole grains, and green vegetables add smaller amounts of iron.
• Adequate fat to support babies’ rapid growth and brain development. Good sources include whole-milk yogurt, avocado, nut butters, and olive oil for cooking vegetables. Fish is also a great food for babies, because it provides both iron and fat, and it’s a good source of omega-3 fatty acids like DHA and EPA, which support brain development.
• A variety of vegetables, fruits, and whole grains, so that your baby learns to like many different tastes and textures. It can take babies and toddlers 8 to 10 exposures of a new food before they learn to like it.

There is no need to delay the introduction of common food allergens, such as peanut, eggs, dairy, fish, shellfish, wheat, soy, or tree nuts in age-appropriate forms. Studies indicate that introducing at least some of these foods during the first year can reduce the risk of developing food allergies. The evidence is strongest for peanut allergy. A randomized controlled trial called the Learning Early About Peanut Allergy (LEAP) study showed that for high-risk infants, introducing peanut products beginning between 4 and 11 months reduced peanut allergy by 81 percent, compared with delayed introduction.^[5] Early introduction of egg has also been shown to reduce risk of egg allergy.^[6][7] With any new food, parents should keep an eye out for symptoms of an allergic reaction, such as hives, vomiting, wheezing, and difficulty breathing.^[8]

Responsive Feeding and Infant Growth

Regardless of whether infants are fed breast milk or formula, or start solids at 4 months or 8 months, it’s important that caregivers use a responsive feeding approach. Responsive feeding is grounded in 3 steps:^[10]

• The child signals hunger and satiety, which may occur through vocalizations (crying, babbling), actions (reaching for food, turning away), or facial expressions.
• The caregiver recognizes the cues and responds promptly and appropriately. For example, if the baby seems hungry, he or she is offered food promptly. If the baby turns his or her head or pushes away the breast, bottle, or an offered bite of food, the caregiver does not pressure the baby to eat more.
• The child experiences a predictable response to his or her signals, which builds trust.

With breastfeeding, responsive feeding simply means feeding the baby when he or she signals hunger. The baby will usually turn away, release the nipple, or fall asleep when full. With bottle-feeding (breast milk or formula), it’s a little trickier. It’s human nature to want the baby to finish the bottle that you’ve prepared, but a responsive feeding approach means that you let the baby decide when he or she has had enough. Pressure to eat more can cause the baby to experience more rapid weight gain in infancy, which is correlated with overweight or obesity later in childhood. When feeding solid foods, the same responsive feeding principles apply, although solids should be offered at predictable meal- and snack-times to avoid constant grazing throughout the day. If babies are offered appropriate, nutrient-dense foods, and fed responsively, parents generally don’t need to worry about serving sizes or amounts eaten. They can trust that their babies will eat what they need.^[11]

growth monitoring

The best way to determine if babies and children are getting enough food to eat is to track their growth over time. Healthcare providers do this by measuring a child’s weight, length or height, and head circumference at routine check-ups and plotting their measurements on standardized growth charts. In the U.S., growth charts from the World Health Organization are typically used from birth through age 2. CDC growth charts are typically used after age 2. Growth charts compare a child’s growth to a reference population of other healthy children. Children come in different shapes and sizes, and some grow faster than others. A child in the 15th percentile for weight may be a bit smaller than average, but when it comes to body size, the goal is not to be average or above average. The goal is to grow steadily and predictably in a way that is healthy for that individual child. If a child who was previously in the 15th percentile was suddenly measured at the 5th percentile or 50th percentile, that might indicate a health or nutrition problem that warrants further evaluation.^[12]

Feeding Toddlers

Toddlerhood (ages 1 to 3 years) represents a stage of growing independence. They gain the physical abilities to feed themselves confidently, and their expanding vocabulary means they can verbalize food preferences more clearly. Gradually, through exposure and experience, they learn to eat the same foods as the rest of the family.^[13]

In the toddler years, it’s important to shift from a mindset of feeding “on demand,” which is appropriate for infants, to one of predictable structure, with sit-down meals and snacks – usually three meals and two to three snacks each day. This prevents constant grazing and means that children come to the table hungry, ready to enjoy a nourishing meal. Parents should sit down to meals together so that toddlers learn that part of the joy of eating is enjoying time with the family.^[14]

NUTRIENT NEEDS

The Acceptable Macronutrient Distribution Ranges (AMDRs) for children ages 1 to 3 recommend that 45 to 65 percent of calories come from carbohydrate, 30 to 40 percent from fat, and 5 to 20 percent from protein. Compared with older children and adults, this balance of macronutrients includes a higher level of fat to support young children’s energy demands for growth and development. Fat or cholesterol generally should not be restricted in toddlers, although the focus should be on nutrient-dense sources of fat. Pediatricians usually recommend that toddlers ages 1 to 2 years drink 2 to 3 cups of whole cow’s milk per day to provide fat, protein, and micronutrients, including calcium and vitamin D. At age 2, parents can switch to low-fat or nonfat milk to reduce fat intake. For toddlers with a family history or other risk factors for obesity, pediatricians may recommend switching to low-fat milk sooner. It is important for toddlers to not over-consume cow’s milk, as filling up on milk will reduce the consumption of other healthful foods. In particular, toddlers who drink too much cow’s milk have a greater risk of iron deficiency and iron deficiency anemia, which is a common nutrient for this age group and can cause deficits in brain development.^[15]

Just as for adults, MyPlate can be helpful for planning balanced meals for children 2 and up, with appropriate serving sizes. A ballpark recommendation for serving sizes for children ages 2 to 6 is about 1 tablespoon per year of age for each food, with additional food provided based on appetite.^[16]

attributions

This section is an adaptation of “Nutrition in Later Infancy and Toddlerhood” in Nutrition: Science and Everyday Application, v. 1.0 by Alice Callahan, PhD; Heather Leonard, MEd, RDN; and Tamberly Powell, MS, RDN licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.