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October 25, 2012

Health Canada’s nutrition guidelines for healthy term infants

Health Canada recently released an updated version of their Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months. Some of the updates sparked media requests and questions about baby’s first foods. Changes to the guidelines include introducing meat, and meat-alternative as an infant’s first food, and not withholding certain foods to prevent allergies.    

With all the recent media coverage and questions about these guidelines, Daina Kalnins, Manager of Clinical Dietetics at The Hospital for Sick Children (SickKids) and co-author of Better Baby Food, provides her advice on infant nutrition.  

When should solid food be introduced?

It is recommended to introduce solid food around six months of age. For infants who are showing an interest in food prior to six months it is suggested that you consult with your family doctor or paediatrician for advice. It’s important to note,  the introduction of solids should not interfere with the continuation of breastfeeding.

The following is from Health Canada: Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months:

Exclusive breastfeeding for six months continues to be the target for the implementation of the WHO/UNICEF Baby-Friendly Initiative (BFI) and Global Strategy for Infant and Young Child Feeding (WHO, 2003). However, in individual practice, guidance on the appropriate time to introduce complementary foods should also be led by the infant's signs of readiness and may be a few weeks before or just after the sixth month. Beyond six months, further delay increases risk of iron deficiency. Introducing solid foods too early decreases the duration of exclusive breastfeeding.

By about six months of age, infants are developmentally ready for other foods (Naylor & Morrow, 2001). The signs of physiological and developmental readiness include (Grenier & Leduc, 2008):

  • Better head control
  • Ability to sit up and lean forward
  • Ability to let caregiver know when they are full (e.g. turns head away)
  • Ability to pick up food and try to put it in their mouth

What type of solid food should be introduced first?

Once solid foods have been introduced, parents should ensure their child is getting a balance of all the age appropriate nutrients. At six months, some children may not be receiving enough iron from breast milk alone. Iron is important for brain and cognitive development, so to prevent a deficiency the first food should be a good source of iron.

Common practice has been to give infants iron fortified cereal as a first food. However, there is no reason that at six months of age you can’t introduce soft meats, and/or meat alternatives, tofu and other iron-rich foods.

For more information on complementary feeding, please visit the World Health Organization or download Complementary feeding; family food for breastfed children

How does this iron rich food help a child develop?

If the mother was iron deficient during or at the end of the pregnancy, or the child was a smaller infant they are at higher risk for being iron deficient. Generally infants are able to maintain an adequate level of iron until the age of six months. At this point their natural iron storage begins to deplete and it needs to be supplemented for healthy development.  

The following is from Health Canada: Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months:

Most healthy term infants are born with sufficient stores of iron to meet their iron needs until they are about six months old (IOM, 2001; Butte, Lopez-Alarcon, & Garza, 2002; Dewey & Chaparro, 2007). At about six months of age, iron stores are depleted and breastmilk alone can no longer meet all of the infant’s nutrient requirements (Butte et al. 2002; Meinzen-Derr et al., 2006, Dewey & Chapparo, 2007). At this stage, iron-rich foods, such as meat, meat alternatives (e.g., eggs, tofu, and legumes), and iron-fortified infant cereals, are important to help meet the nutrient needs of the rapidly growing infant (ESPGHAN, 2008; Yang et al., 2009; Christogides, Schauer, & Zlotkin, 2005).

Why should an infant drink breast milk?

Breast milk is ideal for infants because it is a complete form of nutrition. It has the immune properties that none of the breast milk substitutes have.  Breast milk gives an infant the right nutrition, at the right age, at the right time.

There are benefits to the infant from a nutritional standpoint. It helps in the achievement of normal growth, the development of their immune system and the possible prevention of illness later on.  There are also health benefits to the mother, which can include cancer prevention or helping to get back to pre-pregnancy weight a little more quickly. The most incredible part of breastfeeding is the opportunity for mothers to bond with their child.

Premature infants should also receive breast milk as it has been shown to improve neurodevelopment, prevent infections and improve feeding tolerance.  However, because breast milk alone may not meet the nutritional requirements of most pre-term infants, special nutrient fortifiers or formula may be added to breast milk to support growth and development

The following is from Health Canada: Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months:

Breastfeeding – exclusively for the first six months, and sustained for up to two years of longer with appropriate complementary feeding – is important for the nutrition, immunologic protect, growth and development of infants and toddlers.

What are the options for mothers who are unable to breastfeed?

Ideally mothers should breastfeed their child for six months to two years if able. If they are unable to breastfeed they can substitute with formula but moms should be encouraged to provide breast milk even if they are unable to be with their child. Strategies like pumping and storing your breast milk allow for the child and mother to still access all the health benefits breastfeeding brings them both.

Are there concerns about allergies?

There is no evidence to say that avoiding certain food within the first year of life will prevent allergies from developing. If you don’t offer a child certain foods you can prevent observing an allergy, but not the development of one.  Right now the guideline is not to avoid foods, such as egg-white or fish, as a preventative measure.

The following is from Health Canada: Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months:

Delaying the introduction of priority food allergens is not currently recommended as a way to prevent food allergies, including for infants at risk for atopy (AAP, 2008, ESPGHAN, 2008, Alm et al., 2009; Koplin et al., 2010; Palmer & Prescott, 2012). Common food allergens that are a source of iron, such as fish and whole eggs, can be introduced at about six months of age.

Note: Health care providers should deal with cases where there is a family history of food allergy on an individual basis.

The guidelines were created by Health Canada with the Canadian Paediatric Society, Dietitians of Canada and the Breastfeeding Committee for Canada. The new principles and recommendations are supported by the World Health Organization. Revised recommendations for six months to two years are expected to be available in 2014.