Weaning is the gradual introduction of semi-solid foods to the baby while still continue feeding breast milk or formula milk. It occurs over a period of months when newborns grow from breast milk or formula milk to pureed/mashed (and soft finger foods)/ minced, to cut up food, until they are able to enjoy conventional family meals.

Weaning onto solid food is important since the infant's fast expanding demands cannot be fulfilled only by breast milk or formula milk. From about six months of age, newborns have decreasing iron and vitamin D reserves and increased requirements for these and other nutrients.

The objective of introducing solid foods alongside newborn milk feeds is to provide additional energy and nutrients when milk alone is insufficient to support the baby's rapid growth, excellent health, and development. When the infant is responsive, give him or her the opportunity to sample various tastes and sensations based on family cuisine.

Weaning enables newborns to acquire new abilities necessary for progressing through critical developmental stages such as speech and self-feeding. It is critical to introduce a variety of tastes and textures during this time to assist baby learn to eat a varied and balanced diet and avoid later problems with fad eating.

Appropriate weaning is critical in preventing a variety of health and developmental problems in infants, children, and adults, including obesity, stunted growth, iron insufficiency, specific nutrient deficits, dental cavities, and developmental delay. It is critical to assist parents and caregivers in capitalizing on this critical opportunity to shape their child's future health and potential.

What is Complementary Feeding?

Around the age of six months, an infant's energy and nutrient requirements exceed those met by breast milk, necessitating the use of supplemental foods. Additionally, an infant of this age is developmentally ready for additional meals.  

Complementary feeding is the term used to describe this shift from breastmilk/formula milk in to the normal family diet.

If complementary foods are not offered around the age of six months, or are given in an incorrect manner, an infant's growth may be compromised.

To ensure that infants' nutritional needs are met, complementary foods must include the following:

timely – they are introduced when a child's need for energy and nutrients exceeds what can be met exclusively through breastfeeding; 

adequate – they provide enough energy, protein, and micronutrients to meet a growing child's nutritional needs; 

safe – they are stored and prepared hygienically, and fed with clean hands and utensils rather than bottles and teats; and 

properly fed – This means that they are supplied in accordance with a child's appetite and satiety signals, and that meal frequency and feeding are appropriate for the child's age.

Caregivers should take an active role in newborn feeding by responding to the kid's hunger cues and also by encouraging the kid to eat.

Recommendation by WHO Regarding Supplemental Foods:

The WHO recommends that newborns begin consuming supplementary foods in addition to breast milk at six months of age.

Frequency: Between 6–8 months, baby should eat supplemental foods two–three times a day, increasing to three–four times daily between 9–11 months and 12–24 months.  

Additional nutritious snacks should be served 1–2 times daily, as desired, to children ages 12–24 months.

Consistency: Increase food consistency and diversity gradually as the newborn grows older, adjusting to the infant's needs and skills.  

At six months, infants can begin eating pureed, mashed, and semi-solid meals. By the age of eight months, the majority of infants can also chew "finger foods" (snacks that can be eaten by children alone).

By 12 months, the majority of children can consume the same meals as the rest of the family, with the exception of nutrient-dense foods derived from animals, such as meat, poultry, fish, eggs, and dairy products.

Avoid foods that are in a choking-hazardous state, such as entire grapes or raw carrots. Avoid providing beverages that are deficient in nutrients, such as tea, coffee, and sugary soft drinks. Limit juice offerings to avoid displacing more nutrient-dense items.

Signs Your Baby is Ready for Solid Foods

There are a few distinct indicators that, when present together beginning about 6 months of age, indicate that your baby is ready for their first solid foods in addition to breast milk or infant formula.

Keep an eye out for:

• Head control

Your baby must be able to maintain an erect, steady head position.

• Sitting comfortably when properly supported.  

To swallow properly, your baby must be able to sit upright in an infant feeding seat or highchair.

• Impairment of the "extrusion reflex."

The mouth and tongue of your infant develop in lockstep with the digestive system. To begin solids, infants should be able to move food to the back of their mouth and swallow it, rather than pushing food out of their mouth with their tongue.

• Curiosity regarding eating.

If you offer your infant a teaspoon, they may begin looking or reaching for it, or they may open their lips.

• Swallow food.

Rather than regurgitate it.

Parents may mistake the following behaviors as indicators that their infant is ready for solid foods:

• chewing their fists 

• waking up at night (more frequently than normal) 

• requiring additional milk feeds

These are all typical infant behaviors and are not always indicative of hunger or readiness to begin solid meals.

Equipment checklist Before Starting Weaning

• Child's high chair. Your infant must be safely seated in an upright position (so they can swallow properly). Always utilize a high chair with a firmly attached safety harness. Never leave infants alone on elevated surfaces.

• Bibs made of plastic or pelican. At first, it's going to be a mess!

• Soft weaning spoons are kinder on the gums of your infant.

• A little bowl for weaning. You may want to invest in a special weaning bowl with a suction base to ensure the bowl stays in position.

• Initial cup. Introduce a cup around the age of six months and encourage sips of water during meals. Using an open cup or a free-flow cup without a valve can assist your infant in learning to drink and will be beneficial to their teeth.

• A soiled mat or newspaper sheets placed beneath the high chair to collect the majority of the filth.

• Plastic containers and ice cube trays are advantageous for batch cooking and portion control.

Foods To Avoid

Salt - At six months of age, infants' kidneys are not fully matured, and excessive salt/salty foods can be detrimental. Salt should not be added to foods until the infant reaches the age of one.

Processed foods such as stock cubes, gravy mixes, packet soups, instant mashed potatoes, sauces, and ready dinners should be avoided, as should salty snack foods such as crisps.

Sugar - feeds the sweet tooth and contributes to dental damage. Children shouldn’t be given with too much sugary product at the beginning of the weaning.  

Honey - honey may contain botulinum bacteria and should be avoided till one year of age.

Nuts - Children under the age of five should avoid entire nuts to avoid choking. After 7 months of age, peanut butter, pastes, and ground peanuts may be added.  

If a child has been diagnosed with an allergy (eczema or another food allergy) or if there is a family history of allergy, parents should see their GP, health visitor, or medical allergy specialist before introducing peanuts for the first time.

Sea fish: Avoid Sea fish owing to their mercury concentration. Avoid raw shellfish to evade contracting food illness. Boys should consume up to four meals of oily fish per week, but girls should consume no more than two portions. Apart from these restrictions, fish, particularly oily fish, are an important source of protein and necessary fatty acids in the diet and can be introduced during weaning.

High fibre/low fat diets - This are not suggested since they are quite bulky and may make it difficult for newborns and young children to consume adequate calories for growth. Fibre (for example, added bran) might decrease the amount of some nutrients (for example, iron) absorbed from diet.

Cow's milk - For a variety of reasons, cow's milk is not recommended for newborn babies. To begin, a baby's digestive system is not developed enough to process the high protein content (casein and whey) in cow's milk.

Second, early exposure to cow's milk can cause your infant's system to become intolerant to it.  

Thirdly, the salt content of cow's milk is significantly higher than that a baby's kidneys can manage.

Finally, cow's milk can deplete your newborn's iron stores by interfering with the body's iron absorption.

While it is not recommended to offer infants milk, milk-based products such as yoghurt and cheese are deemed suitable for infants under the age of one.  

Age: 4 to 6 months

Signs of readiness for solid food

Your child is likely ready to eat solids when they:

• Is able to sit straight in a highchair with their head held up;  

• Has gained substantial weight (doubled birth weight) and weighs at least 13 pounds;  

• Is able to move food from the front to the back of their mouth.

What to feed

• breast milk or formula, plus

• Pureed vegetables (peas, squash, sweet potato)
• Pureed fruit (apples, bananas, peaches)
• Cereal (avoid giving only rice cereal; instead choose a cereal made with oats or barley)
• Small amounts of unsweetened yogurt (no cow's milk until age 1)

Feeding tips

• If your infant initially refuses to eat what you offer, try again in a few days.

• Maintain a daily intake of 28 to 32 ounces of breast milk or formula.

• When beginning solids, begin with a very modest amount of a pureed food made from a single ingredient (about 1 to 2 teaspoons).

• Increase gradually to 1 to 2 tablespoons. If you're giving cereal, dilute it with breast milk or formula to avoid a too-thick consistency.

• Some physicians recommend introducing new meals one at a time. If possible, wait three to five days before introducing another new food.

Age: 6 to 8 months

Signs of readiness for solid food

• Same as 4 to 6 months

What to feed

breast milk or formula, in addition

• Fruits pureed or strained (banana, pears, applesauce, peaches, avocado)  
• Vegetables pureed or strained (well-cooked carrots, squash, sweet potato)
• Meat pureed or mashed (chicken)
• The yolk of an egg
• Small portions of pureed or soft pasteurized cheese, or plain yogurt (no cow's milk before age 1)

• Lentils pureed or mashed (black beans, chickpeas, fava beans, black-eyed peas, lentils, kidney beans)
• cereal (oats, barley, sago); small pieces of bread and crackers

Feeding tips

• 2 to 3 tablespoons fruit, gradually increasing to 4 to 8 tablespoons
• 1 to 2 tbsp grain products, increasing gradually to 2 to 4 tbsp

• 1–2 tbsp. protein-dense foods, progressively increasing to 2–4 tbsp.
• 28 to 32 ounces of breast milk or formula per day
• As your baby becomes more accustomed to eating, you can begin introducing new foods and increasing the frequency of meals. By 8 months, your baby should be eating one to two meals each day.

Age: 8 to 12 months

Signs of readiness for solid and soft finger foods

• Identical to 6 to 8 months, plus

• Uses thumb and fingers to pick up items.

• Capable of transferring objects between hands  

• Moves jaw in a chewing motion • Swallows food more easily  

• No longer pushes food out of mouth with tongue

What to feed

• breast milk or formula, in addition

• Unsweetened yogurt, soft pasteurized cheese, and cottage cheese

• Vegetables prepared in bite-size pieces (carrots, squash, potatoes, sweet potatoes)

• Fruit that has been crushed or chopped into small cubes or strips (bananas, peaches, pears, avocados)

• Snack foods (O-shaped cereal, small bits of scrambled eggs, well-cooked pieces of potato, well-cooked spiral pasta, teething crackers, small pieces of bagel)

• Foods high in protein (small bits of meat, poultry, boneless fish, and well-cooked beans, like lentils, pea or black beans)

• grains, cereals, and others (barley, wheat, oats, mixed cereals)

Feeding tips

• 30 to 32 ounces of breast milk or formula (8-10 months) or 24 to 30 ounces (10-12 months)

• 1/2 to 3/4 cup fruit
• 1/2 to 3/4 cup vegetables
• 1/4 to 1/2 cup grain products
• 1/4 to 1/2 cup protein-rich foods
• By 8 months or so, babies often have three meals and start adding snacks.

• Continue to offer a wide variety of fruits, vegetables, grains, and protein-rich foods. As your baby's eating skills improve, gradually introduce more textures and soft finger foods.
• It's fine to serve your baby what the rest of the family is eating – just watch out for added sugars and salt, which aren't recommended for children under 1.  

Baby Food Feeding Tips

Offer fruits or vegetables in any order

Some parents may advise you to begin with veggies rather than fruits to avoid your newborn developing an appetite for sweets. However, because newborns are born with a taste for sweets, there is no need to introduce sweet or savory foods in any particular order.

Feed cereal with a spoon only. 

Unless your baby's doctor specifically requests it, avoid adding cereal to a bottle — your baby may choke or acquire too much weight.

Encourage variation of food

Don’t keep food limited to bland and dull. Discover how to use spices and seasonings to enhance the flavor of your baby's meal.

Allow new foods time

If your infant refuses to eat a certain meal, resist the urge to push. Retry in a few days.

Know the choking hazards

Give your infant no foods that could cause them to choke.

Watch carefully for constipation

When a baby's diet changes, their stool may vary as well. Although constipation is usually transient, your baby may experience constipation following the introduction of food.  

Notify their doctor if you find your kid is having fewer bowel motions or if their feces have grown firm or dry and appear difficult to pass. Certain doctors advocate supplementing a baby's diet with high-fiber fruits such as pears, prunes, and banana, and vegetables until bowel movements return to normal.

Additionally, do not be shocked if the color and odor of your baby's faeces alter as you introduce solids into their diet. If your kid has been exclusively breastfed up to this point, you're likely to notice a significant odor in their previously mild-smelling faeces after they begin eating even small amounts of solids. This is entirely typical.

Feeding During and After Illness of baby

During illness, fluid intake should be increased, including more frequent breastfeeding, and the child should be encouraged to consume soft, varied, pleasant, and preferred foods. Give food more frequently than usual during illness and urge the youngster to eat more.

Common Feeding Problems in Bangladesh

Many mother are unaware of the nutritional requirements for baby and young child feeding. There are some frequent feeding difficulties that mothers encounter.

• Despite moms' understanding, children are not often breastfed exclusively for the first six months.

• Providing children with plain rice or sago porridge as supplemental foods is insufficient to meet their nutritional requirements, support growth, and development, contributing to high rates of malnutrition.

• Mothers occasionally prepare complementary foods in bulk, i.e. three daily meals once a day, resulting in leftovers for lunch and dinner. If food is not properly stored and heated prior to feeding, it becomes unsafe—particularly during the warm and hot months—and can make children ill. Mothers have a misperception that hinders them from incorporating vegetables, fish, meat, and hard-boiled or soft-cooked eggs into their child's diet.

• Mothers delay the introduction of certain foods until after one year, claiming that they are difficult to chew or swallow, which is not the case. These are nutrient-dense foods that should be introduced at a much younger age.

Increasing Energy Density of Food

Energy density of foods given to infants and young children can be increased in different ways.

• By supplementing each feed with a tea spoon of oil, ghee, or butter. Fat is a concentrated source of energy that significantly boosts the energy content of food without adding bulk.
• Increasing the food's thickness. Consumed foods should become thicker and more energy dense in consistency and composition.  

• Porridge and other semi-solid foods are appropriate first foods for infants since they are physiologically prepared to take them. You can add different ingredients like date, nut powder, formula milk into the solid to make it nutrient dense.  
• After determining your infant's digestive capability, you can introduce multicomponent solids such as khichuri, egg suji, and so on. By including additional components such as date power, you may improve both the taste and energy density.

Idea of Feeding to the Fussy Eater

It is very natural for a baby to periodically refuse meals. The recommendations below will assist you in dealing with a picky eater.

• Avoid frequent snacks in between meals and monitor your baby's drinking throughout the day — both of these factors can diminish your baby's desire for main meals.
• Maintain consistent mealtimes - infant requires predictability.
• Portion sizes should be small because infants cannot consume big quantities of food at one time.
• Do not panic if your baby refuses eating - simply clear away the food calmly and discard it. Offer no substitutes – simply wait until the following meal or snack.
• If your baby refuses a food, reintroduce it a few days later - it may take several efforts before your baby accepts it.

• Ascertain that no distractions, like as toys or television, are present.
• Never make your infant eat via pressure. This phase will pass for the majority of children, so avoid becoming overly concerned.  
• Continue to experiment by introducing different methods of cooking and food ingredients. Additionally, never stop feeding solid after starting baby's solid journey.

However, if you are truly concerned about your child's eating habits, such as if they are losing weight, speak to your doctor or health visitor or request an appointment with a certified dietician.

Potential Dangers While Introducing New Food Items

Food allergies when starting solid food

• Experts recommend introducing one item at a time to your infant and waiting three to five days before introducing another, in order to monitor for allergic responses. Additionally, it's a good idea to keep track of the foods your infant samples. If they experience an unpleasant reaction, keeping a food journal will assist in determining the cause.
• It is not needed to withhold allergic foods such as eggs or soy. There is no proof that delaying the introduction of particular foods can aid in your baby's allergy avoidance. Indeed, there is evidence to the contrary.
• According to the American Academy of Allergy Asthma and Immunology (AAAAI), beginning at 4 to 6 months of age (and continuing throughout childhood), including typically allergenic foods into your baby's diet may actually help avoid the development of food allergies.  

Indeed, multiple observational studies have discovered that exposing children to a variety of foods prior to the age of six months may help avoid food allergies – particularly in higher-risk children. ‍

Rules: Begin with typical first foods such as infant cereals, pureed vegetables, fruits, and meats. After introducing a couple of these items and ensuring that your infant tolerates them well, you can begin introducing more typically allergenic foods such as eggs yolk, wheat, fish, and peanut products.

Consult your pediatrician if you have any concerns regarding food allergies.

Certain infants require special protection. If your kid falls into any of the following categories, see your baby's doctor or an allergist to develop a specific feeding plan before introducing solids:

• Your kid has a sibling who is allergic to peanuts;  

• Your infant continues to have moderate to severe eczema despite following a doctor's treatment plan.

• Previously, your baby had an immediate allergic reaction to a new meal or was diagnosed with a food allergy.

• Your baby's blood test revealed an allergy to a certain food.

If your infant is allergic to a new meal, you will notice symptoms within minutes or hours. The majority of children with food allergies exhibit just moderate symptoms. Consult your baby's doctor if you experience hives, vomiting, or diarrhea.

Choking

Choking can be a serious issue when introducing solid meals to a baby.

However, it's critical to understand that gagging is a perfectly natural part of the process of learning to eat. It serves as a protective reaction, preventing infants from choking.

Opening the mouth and forcing the tongue forward are all signs of gagging, as is spluttering and/or coughing. Your infant's face may appear red.

When a baby gags, it is critical not to worry or become extremely worried.

Choking, on the other hand, is a considerably more serious situation. It occurs when food obstructs the airways, preventing your baby from breathing normally.

Blueness, quietness, and an inability to create noise are all symptoms. Additionally, your infant may begin coughing or, in severe circumstances, lose consciousness.

Here are some helpful hints to assist you avoid choking:

• While feeding, keep your infant upright.

• Never leave your baby alone while he or she is eating.

• Avoid risky foods such as whole nuts, grapes, popcorn, blueberries, and bone-in meat and fish.

• Avoid giving too much food at once or forcing your kid to eat.

If your child does choke, you should know what to do next. A first aid course may be beneficial.

If you believe your child is choking and is unable to cough up the food, immediately contact emergency services.

Food Safety Measures

Parents/caregivers should be urged to adhere to stringent cleanliness standards when purchasing, storing, and preparing food for newborns to minimize the risk of food poisoning/ food intoxication.

• This involves hand-washing, maintaining clean surfaces and chopping boards, and overall food preparation areas.

• Never put solid food to the bottle, as this increases the danger of choking.
• If weaning from 6 months, plates, bowls, cups, and utensils do not need to be sterilized but should be washed in hot soapy water and rinsed with hot water.
• Reheating food more than once is not recommended. When cooking any commercial baby food, the manufacturer's recommendations should be followed.
• If parents choose to heat items in the microwave, they should be informed that the food will continue to heat up even after it is withdrawn from the microwave. Extra caution should be exercised in keeping food away from baby until it has been stirred and cooled sufficiently to avoid burning from 'hot spots.'
• Foods that have been partially consumed by the baby should be discarded.

• Frozen food should be defrosted in the refrigerator and not refrozen. To minimize the danger of food poisoning, eggs, meat, fish, and shellfish should be thoroughly cooked.
• Honey should not be given to infants under the age of one year due to the possibility of botulism spores;  
• Whole nuts should not be given to infants under the age of five due to the danger of choking.

Weaning at a glance

At six months, it is time to begin weaning

• Begin with a small portion of well mashed or finger foods.

• Continue to administer breastmilk or baby formula in the usual amount.

After a few weeks, begin introducing more foods to expose your infant to a variety of tastes and textures.

• You can begin by including a few soft lumps in any spoon feeding you provide.

• Increase to two or three meals daily.

• Continue to advocate the use of a cup for water during meal/snack times.

Around seven months

• Simply mash meals with a fork.

• By this stage, you should be feeding your baby two to three times a day and increasing the size of each feed.

• Once your baby is eating three meals a day, he or she will naturally desire less breastmilk; continue breastfeeding on demand. Reduce the amount of formula milk you give to at least 500-600ml (16-20fl oz) per day if you are using it.

From 9 months on, continue to provide three meals and snacks per day

• Gradually progress from mashed to chopped foods.

• Provide a variety of foods for your infant.

• Breastfeed exclusively or provide at least 500-600ml (16-20 fl oz) of formula milk.

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