Why should my baby stop eating solids?

From milk to porridge to family meals

In the first year of life, every child goes through a number of decisive developmental steps. Diet is also subject to very strong changes in this phase of life. The energy requirement more than doubles and most of the nutrients are also required in larger quantities [1] (Tab. 1). Many functions of the digestive, metabolic and immune systems are still in development in the first months of life, so that nutrition already has long-term metabolic and functional effects on the organism at this age [2]. Neuromotor development is critical to a child's eating skills. From a food law perspective, babies and toddlers up to the age of 3 belong to the groups of people with special nutritional requirements that are taken into account in the German Diet Ordinance and in EC guidelines [3].

The nutrition plan for the first year of life

The nutrition plan for the first year of life was developed by the Dortmund Research Institute for Child Nutrition (www.fke-do.de) on the basis of current scientific data on the energy and nutrient requirements of this age group. The plan translates the findings into food and meal-related recommendations. Eating habits and the food supply in Germany are also taken into account.

The first year of life is divided into three nutritional and developmental age groups. In the first four to six months, infants should only be fed milk, between the fifth and seventh months of life complementary foods are introduced and family meals can be started from the tenth month of life. The specified time periods take into account the considerable interindividual variability in children's development [3; 4]. The nutrition plan is not only suitable for the normal nutrition of infants, but also - with a few modifications - for those with an increased allergy risk and existing food allergies [5].

Tab. 1: Recommendations for the intake of food energy and selected nutrients for infants between the ages of 5 and 12 months (DACH reference values)
* m = male; w = female

Definition and legal classification of complementary foods

Complementary food refers to all dietetic foods specially prepared for babies (and toddlers) that should supplement the diet with breast milk or breast milk substitute products from the age of 5 months at the earliest and from the 7th month at the latest. It is advisable to select complementary foods that correspond to the nutrition plan of the Research Institute for Child Nutrition in Dortmund and to use them gradually in the specified order.

Particularly strict legal rules apply to both baby formula and complementary food products with regard to the composition, the use of additives (coloring, flavoring, preservatives are prohibited), the bacteriological requirements and limit values ​​for residues and pollutants, which are standardized in the European Union are.

Introducing complementary foods does not mean weaning!

There are several reasons in favor of introducing complementary foods between the ages of five and seven months. On the one hand, from the age of four months, children gradually tolerate foods other than breast milk or infant formula. On the other hand, the need for energy and nutrients increases due to the growing mobility [6], so that milk alone is no longer sufficient to meet the needs from the seventh month at the latest. The neurophysiological development of the infant is so advanced in the fourth to fifth month of life that the sucking reflex gradually disappears and spoon feeding is accepted [3]. Last but not least, the first teeth erupt during this time, so that the introduction of solid food can begin [6].

If the introduction of complementary foods is started before the age of five months or if an excessive variety of foods is offered immediately, there is an increased risk of developing an allergy.

Carrots have proven to be a good starting point for complementary foods. If - as has been observed occasionally - an allergic reaction to carrots is found, other nutrient-rich vegetables such as broccoli, kohlrabi or parsnips can be used. The latter is also commercially available as a single product. Due to the critical iron supply at this age, meat-containing complementary foods are recommended as the first porridge, as heme iron is easily absorbable. In addition, meat and the vitamin C available through the addition of juice promote iron absorption from plant-based foods [3].

With the complementary food, one milk meal should gradually be replaced by a porridge until you have reached three complementary meals [3]. Towards the end of the first year of life, these porridge meals are then replaced by family meals [5].

The transition from milk to complementary foods is fluid. Feeding mash does not mean that breastfeeding should be stopped completely immediately. Rather, the complementary meals should initially be supplemented by breastfeeding. Partial breastfeeding should also continue once the child has developed the ability to drink from a mug or cup. Only towards the end of the first or in the course of the second year of life does the importance of breast milk as a food decrease.

Since complementary foods in reasonable form are available everywhere in Germany, breast-feeding towards the end of the first year of life is mostly determined by the need for closeness and affection rather than hunger. The National Breastfeeding Commission currently does not give an explicit recommendation as to when to finally wean, because no scientifically justified basis can be found for Germany on this topic [7].

The modular system of meals

As the overview of the foods in the various complementary meals shows, only a few, but nutrient-rich foods are required in meals that are coordinated with one another (Table 2). The different nutrient profiles of the complementary meals complement each other together with the remaining milk meals as in a modular system, so that overall a nutrient supply is guaranteed that meets the requirements of the growing child.

Tab. 2: Overview of the foods in the various meals of the complementary foods for self-preparation.
Vegetable, potato and meat porridge
200 ml of milk
(Whole milk or baby milk)
20 g whole grain
Cereal flakes
20 g fruit juice or fruit puree
20 g whole grain cereal flakes

The vegetable-potato-meat porridge is rich in fat (due to the addition of oil), protein (meat) as well as iron, zinc and vitamins. The whole milk and cereal porridge provides protein and calcium. Finally, the relatively low-protein grain and fruit mash prevents an undesirably high protein intake and thus renal overload.

Do it yourself or buy a glass

Complementary food can in principle be prepared by yourself or offered in the form of industrially produced food. Both forms have advantages and disadvantages. One of the advantages of industrially produced food is the extremely low content of pollutants. Food for infants and young children are dietetic foods and are therefore subject to higher quality requirements than foods for general consumption. This is why the use of pesticides, pest control agents and stored product preservatives is generally not used for dietetic foods. On the other hand, foods for general consumption, which are the basis for self-preparation of complementary foods, can be more or less contaminated with harmful substances depending on their origin. However, these foods are also checked in Germany, so that self-preparation of complementary foods in the household is sufficiently safe and harmless.

Another advantage of the jar food is the simple and time-saving preparation. The effort involved in preparing complementary foods is significantly higher. When making your own, you can determine which ingredients the child receives in which quantities and, in particular, consciously refrain from adding salt and sugar. The taste of self-made porridges is often better than that of jar food [8].

The iodine intake can be problematic when preparing complementary foods: only 50% of the recommendation (80 µg / d) is achieved on average. This is because the whole grain flakes usually used in cereal meals do not currently have iodine added. In contrast, industrially manufactured products contain iodine additives, so that up to 150% of the recommended intake can be achieved with food in glasses [3].

Vitamin D and fluoride supplementation is generally recommended for healthy infants at the age of complementary feeding [3].

Tab. 3: Nutrient supplements for healthy, mature infants from the 5th month of life
Vitamin D (rickets prophylaxis)
from the 2nd week of life during the 1st year of life and the
Winter months of the 2nd year of life
Fluoride (caries prophylaxis)
0.25 mg F / d (for drinking water / mineral water <0.3 mg F / l) in the first 3 years of life
Source: [3], modified: K. Aue

Food in a jar: Often too little fat and too much sugar

It was shown in the Dortmund Nutritional and Anthropometric Longitudinally Designed Study (DONALD). that today almost all infants are fed some form of commercial complementary food. As already mentioned, this form of nutrition is subject to diet regulations and therefore strict quality standards. As a rule, the nutrition plans of the baby food manufacturers are based on the presented "nutrition plan for the first year of life", which makes it easier to choose from the wide range on offer. However, an earlier age is often indicated on ready-made meals than the nutrition plan provides. The composition is also not always optimal. The ready-made meals often contain fat contents that are well below the recommended

lungs (e.g. pure carrot mash). Then it makes sense to add about a teaspoon (approx. 4 g) of oil per meal. Of the common edible oils, rapeseed oil, with its high proportion of oleic acid and the balanced ratio of omega-6 and omega-3 fatty acids, comes closest to current preventive medical recommendations [3]. For safety reasons, however, unrefined oils should be avoided, because the refining removes undesirable substances such as heavy metals, pesticide residues and mycotoxins. In contrast, nutrient losses due to refining are only minor, so that the nutritional quality is not impaired.

Some commercial complementary foods contain sweeteners. This applies in particular to the group of milk and cereal porridges. In addition to sucrose, maltodexrin, glucose or fructose are also added. Alternative sweeteners such as honey, maple syrup, apple syrup or raw cane sugar also have no advantages over conventional sweeteners. Overall, the "nutrition plan" does not include any sweeteners at all, as added sugar not only promote the child's innate preference for sweets, but also the risk of tooth decay with the first teeth [8]. Practice has shown that most mothers today choose to use commercial complementary foods. For this reason, the FKE has formulated detailed instructions for both home-made and jar food, which can be found in brochures and on the FKE website. The DONALD study was able to show that it is above all important to know that commercial complementary meals in practice often correspond less to the "nutrition plan" than self-made meals. The distribution of macronutrients is still in need of improvement, such as the insufficient intake of fat, the amount of added sugar and the sometimes excessive protein intake. With regard to vitamins and minerals, the supply situation can be regarded as satisfactory with a few exceptions due to fortifications [5].

Now drinks are becoming important

A healthy child does not need any additional fluids during the exclusive milk diet in the first four to six months of life. Exceptions are borderline situations with fever, loss of appetite and profuse sweating. When more solid foods are introduced, the relative water content of the food decreases. From the tenth month onwards, according to the "nutrition plan", regular additional fluid intake of around 200 ml / day is recommended. Tap water (drinking water) is best for this, also in the form of unsweetened herbal or fruit tea. According to the Drinking Water Ordinance, the nitrate content should be a maximum of 50 mg / l. In addition, the lead content in the household should be checked in old water pipes, mainly from the time before 1970. Mineral water labeled "Suitable for the preparation of baby food" can also be used [3].

Advice on the selection of industrially produced complementary foods

So that the infant is nourished in a balanced way even when using industrially produced complementary food, the selection of finished products should be based on the porridges of self-preparation.

  • The composition should be similar to that of home-made porridge. The list of ingredients for the products provides information about the approximate recipe. It lists ingredients in descending order of their proportions in the product.
  • It is generally recommended to prefer complementary meals with recipes that are as simple as possible, i.e. products that are made with as few different ingredients as possible and with common foods.
  • Grains should always be included as whole grains.
  • Ready-to-use milk porridge, fresh milk porridge and pure grain products should have an added iodine (potassium iodide or potassium iodate).
  • Cereal pulps should be free from dairy and dairy products to increase the availability of iron from the cereal.
  • The porridges should not contain any salt or sugar. Flavoring ingredients such as nuts, cocoa, chocolate, flavors and spices are also not necessary. Under no circumstances should you add salt. The baby should like the porridge, not the adult.
  • The finished products should be used at the times that are specified in the nutrition plan, regardless of the usage time printed on the respective product.

From porridge to family food

Towards the end of the first year of life, porridge and milk meals gradually become main meals and snacks in the family diet. But there are a few things to keep in mind during the transition: At first the child should not be given any small, solid foods such as nuts, berries or pieces of carrots that can be swallowed. We also advise against very fatty foods or preparations. Finally, the child should be introduced to foods that are difficult to digest, such as legumes, very slowly. Furthermore, there is no need for special children's foods, as these are of no nutritional benefit. From the point of view of nutrition education, too, they do not make sense, as this makes it difficult for children to participate in family meals. The prevention concept of the optimized mixed diet, which seamlessly replaces the "nutrition plan", is more suitable [3]. This nutritional concept will be the content of the next part of our series "Basic knowledge of child nutrition".

questions and answers

Finally, some current questions about nutrition in the second half of life will be examined.

1. Are carrots at the beginning of the complementary diet an increased risk of allergies?

With regard to the prevention of allergies, it is discussed whether carrots, which are recommended as an ingredient in the vegetable-potato-meat porridge, can sensitize infants. Overall, it can be said that allergies to carrots are rare. Older children or adults who also react to herbs and birch pollen are often affected. Cooked carrots as used in complementary foods also have a lower allergenic potential than raw carrots. Carrots are therefore recommended for complementary feeding at the beginning and later. The slightly sweet taste, which most infants accept well, is an advantage. This vegetable is also rich in nutrients, especially β-carotene. In the form of mono vegetables in jars, next to carrots, pumpkin and parsnip are also offered today. If you cook yourself, you can also use other vegetables, such as fennel, kohlrabi, zucchini, cauliflower, broccoli or spinach [5].

2. How are the new milk-based complementary foods to be assessed?

Furthermore, the question arises as to how milk-based complementary foods, e.g. B. with yogurt, quark, or cream cheese are to be assessed. According to the FKE, these products are not included in the "nutrition plan" and are not desired. The reason for this is the high protein content of quark and cream cheese.On average, infants receive more of this nutrient than is recommended. This is problematic because high protein intake puts stress on the kidneys and stimulates insulin production. There is also evidence that a high protein intake in infancy is associated with an increased risk of obesity later on. It is also disadvantageous that these meals displace other wholesome complementary meals in the "nutritional plan" and thus the balance of the diet is impaired [5].

3. From what age can children receive whole milk?

The administration of cow's milk in the first year of life is discussed in many ways. Cow's milk is the food that most frequently triggers allergies in infancy. For this reason, babies at risk of allergies should only be breastfed or given suitable hydrolyzate food in the first six months of life. All other infants who are not breastfed should receive infant formula with adapted cow's milk protein. All in all, commercially available drinking milk is not suitable as a breast milk substitute at any age. The reason for this is that unmodified cow's milk has significant nutritional deficiencies. Examples are a high protein content, lack of fat modification and the lack of iron and iodine. Milk also reduces the bioavailability of iron from meals. If the child drinks milk from a cup as part of the family diet, conventional drinking milk with 3.5% fat is suitable. 150 g of conventional drinking milk are added to a bread and milk meal. In return, this is much less than a milk meal for infants: 250 g of baby milk are required for this. However, there are no concerns if small amounts of whole milk are included in complementary foods [5].

literature[1] German Nutrition Society (DGE); Austrian Nutrition Society (ÖGE); Swiss Society for Nutrition Research (SGE) (Ed.) (2000): Reference values ​​for nutrient intake. Frankfurt / Main 1st edition. [2] Koletzko, B et al. (1998): Growth, development and differentiation: a functional food science approach. Brit J Nutr 80 [suppl 1]: S5 - S45. [3] Kersting, M. (2001): Nutrition of healthy infants - food and meal-related recommendations. Monthly Pediatric Medicine, 149: 4 - 10, Springer-Verlag. [4] Research Institute for Child Nutrition: www.fke-do.de [5] Kersting, M; Alexy, U .; Rothmann, N. (2003): Facts on Child Nutrition. Hans Marseille Verlag GmbH Munich. [6] Elmadfa, I, Leitzmann, C (2004): Human nutrition. Verlag Eugen Ulmer, Stuttgart, 4th, corrected and updated edition. [7] National Breastfeeding Commission: www.bfr.bund.de [8] Alexy, U. & Kersting, M. (1999): What children eat - and what they should eat. Hans Marseille Verlag GmbH Munich.
Author's addressKatja Aue [email protected]