What should babies eat

and what is the reality?

Dr Ada Garcia
Lecturer in Public Health Nutrition
School of Medicine, Nursing and Dentistry
College of Medical, Veterinary and Life Sciences
 Why is necessary to start solids?

WHO, Complementary feeding. Family foods for breastfed children. Geneva. World Health Organisation, 2000
 Nutrient gaps to be filled by
complementary foods

WHO, Complementary feeding. Family foods for breastfed children. Geneva. World Health Organisation, 2000
 Which micronutrients matter?

Most vulnerable micronutrients worldwide at

this age are
• Iron
• Vitamin D
• Vitamin A
• Zinc
Current recommendations and infant
feeding advice – UK

• Complementary solids ~ 6 months (not below 17 weeks!).

• Continue breastfeeding
• Start with cereals, vegetables/fruits, iron rich foods
• Avoid added salt and sugar
• Encourage home-made
• Cows’ milk until 12 months
• Vitamin drops unless 500mL formula/day
• At 12 months suitable family meals
How to feed?

Responsive feeding
following principles of psycho-social care
(Engle et al., 2000; Pelto et al., 2002)

- feed infants directly

- sensitive to hunger/satiety cues
- feed slowly
- encourage children to eat/ do not force feed
- minimize distractions
- talk to children/eye to eye contact
What about “Baby led weaning”?
• Parent / web based movement
http://www.babyledweaning.com/
• Less coercive
• Energy intake regulation?

From: Effect of a Baby-Led Approach to Complementary Feeding on Infant Growth and Overweight: A
Randomized Clinical Trial
Rachael W. Taylor; Sheila M. Williams; Louise J. Fangupo et al
JAMA Pediatr. Published online July 10, 2017. doi:10.1001/jamapediatrics.2017.1284

Age n Control n BLISS Intervention effect

Mean BMI z Mean BMI z Adjusted difference

score (SD) score (SD) (95% CI)
12 84 0.20 (0.89) 93 0.44 (1.13) 0.21 (-0.07 to 0.48)

24 78 0.24 (1.01) 88 0.39 (1.04) 0.16 (-0.13 to 0.45)

What texture?
6 – 7 months
puréed

7 – 8 months
mashed and
“Finger” foods

8 – 12 months
chopped
Which foods?

OR

OR
 Nutritional content and
fruit and vegetable content in
commercial baby foods
in the UK market
Commercial baby foods in the UK
Food Types (n=479)

44% of pureed
foods were aimed
at infants
4+ months

Data from all baby foods available from 6 UK

major manufacturers, Oct 2010-Feb 2011.

García AL, et al. Arch Dis Child 2013

Suggested Taste of Spoonable
(pureed) Foods (n=365)

40% of all
pureed foods
were sweet
but 60% of
those for the
younger
infants

García AL, et al. Arch Dis Child 2013

Nutritional content of commercial baby
foods and selected home-made foods

N=410, values are means per 100 g food . Pastas, sauces, powdered foods and breakfast
cereals excluded (n=69)

García AL, et al. Arch Dis Child 2013

Types of F&V in commercial baby foods
(n=329)

18% 7%

10% 5%

6% 5%

4% 4%
Fruit juice in commercial baby foods
(n=126,38%)

A median of
15g/100g fruit juice
was added to 59
(18%) products.

Garcia AL et al Matern Child Nutr. 2016

 Sugar content in commercial baby
foods (n=311)
45
Mean sugar content ± SD

40
35
30
(g/100g)

25
20
15
10
5
0
Sweet (n=128) Savoury Sweet (n=39) Savoury
(n=133) (n=11)
Spoonable Dry finger foods

Garcia AL et al Matern Child Nutr. 2016

What are babies eating
in reality ?
What are babies eating
in reality ?
 What are babies eating?

First foods
•Baby rice (57%)
•Mashed or pureed food (94%)
•Finger food (4%)

Complementary foods received on previous day (4-6 months)

•F&V (46%)
•Ready made foods (38%)
•Baby rice (31%)
•Home made foods (28%)
SIFS
2017
 Commercial baby
foods, does it matter?
 Complementary feeding practices &
healthy eating

• F&V in home cooked meals weaning  higher F&V

intake in childhood (Coulthard et al 2009)
• Commercial baby food weaning  lower F&V intake at
school age (Foretek et al 2015)
• Commercial baby foods in infancy  added sugar intake
in childhood (Foretek et al 2016)
What are babies eating
in reality ?
 What are babies eating in the UK?

First foods
•Baby rice (57%)
•Mashed or pureed food (94%)
•Finger food (4%)

Complementary foods received on previous day (4-6 months)

•F&V (46%)
•Ready made foods (38%)
•Baby rice (31%)
•Home made foods (28%)
In Scotland, frequency of consumption, 2017
Types of commercial baby foods (CBFs) used in
low and middle income economies

Swailes C and Garcia AL (in prep)

 Commercial baby
foods, does it matter?
 Complementary feeding practices &
healthy eating

• F&V in home cooked meals weaning  higher F&V

intake in childhood (Coulthard et al 2009)
• Commercial baby food weaning  lower F&V intake at
school age (Foretek et al 2015)
• Commercial baby foods in infancy  added sugar intake
in childhood (Foretek et al 2016)
 Conclusions
• Labels recommend 4+ months contradicting WHO
recommendations
• Nutritional value of spoonable commercial baby foods is
similar to that of breast milk.
• Sweet commercial baby finger foods have high sugar
content.
• Vegetables used in baby foods are predominantly
sweet.
• In LMIC CBF are expensive and not a good value for
money