Ask the experts

At six months old, babies’ diets change to become less reliant on milk. So how do the experts advise health visitors and community practitioners help parents at this transitional phase?

Why is it best to start the weaning process with vegetables?

“Vegetables are great sources of nutrients and are easy, safe foods to offer to babies as their first foods. They are cheap, easy to prepare and also very versatile as they can be mashed, puréed or offered as soft finger foods,” says registered nutritionist Charlotte Stirling-Reed, BSc (Hons) MSc. “As babies are born with a preference for sweet foods, they don’t often need encouragement to enjoy eating fruit. However, vegetables have a variety of different tastes – some bitter, some sour – so it is a good idea to start getting baby used to these different flavours right away. Familiarity is key to babies’ acceptance of new foods, so it’s important to encourage parents to continue offering a variety of different tastes, textures and flavours to baby during complementary feeding.”

How much cows’ milk should a toddler be drinking?

Registered nutritionist Charlotte Stirling-Reed BSc (Hons) MSc, says: “Cows’ milk is not recommended to be offered as a drink to babies under one year of age; however, after six months, it can be added to foods. Once babies get to one year of age they no longer need formula milk, and can start drinking full fat cows’ milk, but they also need less milk every day. The NHS recommends that between one and three years of age children only need to have around 350mg of calcium a day. About 300ml of milk (just over half a pint) would provide this.”

Tanya Thomas, BSc (Hons) RD freelance paediatric dietitian, adds: “Toddlers should have no more than 600ml of milk a day, which is roughly a pint. Toddlers who drink more than a pint of milk tend to be too full to eat an adequate toddler diet and may miss out on the essential nutrients that are not present in milk.”

When a baby starts eating solids, how will his bowel movements change? What are the signs that something might be wrong?

“The stools tend to get firmer and darker and may become less frequent. The appearance of the stools will depend on what has been eaten,” explains freelance paediatric dietitian Tanya Thomas, BSc (Hons) RD. “Signs that something is wrong may be straining, pain, infrequency or difficulty passing a stool. These may indicate constipation, which can occur at weaning with the change in solid intake. If stools are very loose or frequent, this may indicate an intolerance to some part of the weaning diet.”

What is the best way to persuade a baby to start drinking from a cup?

Tanya Thomas, BSc (Hons) RD freelance paediatric dietitian, says: “Introduce a cup from around six months of age onwards. Encourage an open cup or a free-flow cup without a valve so that baby learns to sip rather than suck – this is better for their teeth. It is sometimes a good idea to try using the cup in the day rather than the night time at first. It may take several attempts to introduce a cup. Parents and carers need to persevere and may need support. They should also be prepared for some mess!”

What foods should not be given to a baby during the weaning process?

Boots UK nutritionist Vicky Pennington says that babies should not be given: 

  • Before six months: cows’ milk, eggs, wheat, gluten, nuts, peanuts, seeds, fish, shellfish, liver, soft or unpasteurised cheese
  • Added sugar, salt or stock cubes 
  • Honey before one year of age 
  • Whole nuts until the age of five 
  • Raw or undercooked eggs 
  • Low fat or low calorie foods 
  • Too many high fibre foods, or foods with added bran, which fill a baby up. Also, too much fibre interferes with absorption of important minerals such as iron 
  • Shark, swordfish, marlin (the mercury in them can affect the nervous system) or raw shellfish
  • Tea, coffee, fizzy drinks or squash.

Toddlers who drink more than a pint of milk tend to be too full to eat an adequate toddler diet

What are the signs that a baby is not getting the right diet or enough to eat while they are weaning?

”If a baby is not getting enough to eat, he/she will start to fall below their normal growth line (centile) on the growth chart,” says Geraldine Goodman, community dietitian, Dietetic Department, Cumberland Infirmary. “Babies not getting the right balance of foods in their diet are unlikely to show obvious signs for a while and so it is important to make sure that babies are having foods from each of the main food groups, including: meat, fish, pulses and eggs; potato, rice, pasta, yam, bread and cereals; fruit and vegetables; milk, yoghurt, cheese and custard. If a parent is concerned that their baby is not growing properly, they should discuss this with their health visitor or GP.”

If a nine-month-old baby is eating three meals a day, how much milk should he be drinking?

Dr Emma Derbyshire, independent nutrition consultant and founder of Nutritional Insight Ltd, says: “Three bottles of about 150-200ml each time, in the morning, before or after their nap, and before bed.”

Registered nutritionist Charlotte Stirling-Reed BSc (Hons) MSc, adds: “This will vary from baby to baby. Once a baby is established with solid foods and feeding well, parents will find that their baby doesn’t need so much milk and will normally start taking less milk at each feed or even drop a milk feed altogether. It’s important that parents look for signs that their baby has had enough milk during a feed such as turning their head away, clamping their mouth shut or stopping before the end of a feed. Responsive feeding is important for parents to try and recognise their baby’s signs of fullness and to ensure they don’t overfeed. The best way to check that a baby is getting enough in the way of energy is to get them weighed fairly regularly with the health visitors.”

What feeding problems might a baby have at 12 months plus?

Geraldine Goodman, community dietitian, Dietetic Department, Cumberland Infirmary, says: “As they get older it is perfectly normal for babies/toddlers to start to refuse to eat or even taste new foods. Providing they eat foods from the four main food groups, even if it is always the same favourites, parents don’t need to worry. They should gradually introduce other foods or go back to the foods their child didn’t like before and try them again. They should also try to eat meals together, if possible. Never force a baby to eat – if a food is rejected it should be taken away without comment. Parents should try to stay calm, however frustrating.”

When can parents stop using sterilising equipment?

Charlotte says: “It is generally recommended that a baby’s bottle and teats need to be sterilised until 12 months of age, when they then no longer need to use a bottle. From six months of age, all other feeding equipment, such as spoons, bowls and knives, can simply be washed using hot soapy water.””

 

 



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