3.3: Complementary Foods

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Todd LaMarr

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Foods to Supplement Breast milk and Formula

At about six months of age, infants should be introduced to nutrient-dense, developmentally appropriate foods to complement breast milk or infant formula. Some infants may show developmental signs of readiness before the age of six months, but introducing complementary foods before age four months is not recommended. Waiting until after six months to introduce foods is also not recommended because starting around six months, complementary foods are necessary to ensure adequate nutrition and exposure to flavors, textures, and different types of foods. Infants should be given developmentally appropriate foods to help prevent choking. It is also important to introduce potentially allergenic foods along with other complementary foods. ^{^[1]}

For infants fed breast milk, it is particularly important to include complementary foods that are rich in iron as breast milk is not a good source of these nutrients.About one-third (32%) of infants in the United States are introduced to complementary foods and beverages before four months of age, highlighting the importance of providing guidance and support to caregivers on the timing of complementary foods. Early introduction of complementary foods and beverages is higher among infants receiving infant formula (42%) or a combination of infant formula and breast milk (32%) than among infants exclusively fed breast milk (19%). ^{^[2]}

Food Allergies

Food allergies are a growing food safety and public health concern that affect an estimated 8% of children in the United States (Gupta et al., 2018). That’s 1 in 13 children, or about 2 students per classroom. A food allergy occurs when the body has a specific and reproducible immune response to certain foods (Boyce et al., 2011). The body’s immune response can be severe and life-threatening, such as anaphylaxis. Eight foods or food groups account for most serious allergic reactions in the United States: milk, eggs, fish, crustacean shellfish, wheat, soy, peanuts, and tree nuts (Boyce et al., 2011). ^{^[3]}

There is no cure for food allergies. Strict avoidance of the food allergen is the only way to prevent a reaction. However, because it is not always easy or possible to avoid certain foods, staff in early care and education programs should develop plans for preventing an allergic reaction and responding to a food allergy emergency, including anaphylaxis. Early and quick recognition and treatment can prevent serious health problems or death. The symptoms and severity of allergic reactions to food can be different between individuals and can also be different for one person over time. Anaphylaxis is a sudden and severe allergic reaction that may cause death, but not all allergic reactions will develop into anaphylaxis (Sampson et al., 2006). ^{^[4]}

Developmental Readiness for Beginning To Eat Solid Foods

The age at which infants reach different developmental stages will vary. Typically between 4 to 6 months of age, infants develop the gross motor, oral, and fine motor skills necessary to begin to eat complementary foods. As an infant’s oral skills develop, the thickness and texture of foods can gradually be varied. Signs that an infant is ready for complementary foods include: ^{^[5]}

Being able to control their head and neck.
Sitting up alone or with support.
Bringing objects to the mouth.
Trying to grasp small objects, such as toys or food.
Swallowing food rather than pushing it back out onto the chin.

Infant eating complementary foods with caregiver — Figure \(\PageIndex{1}\): Enjoying food. (^{^[6]})

Infants and young children should be given developmentally appropriate foods to help prevent choking. Foods such as hot dogs, candy, nuts and seeds, raw carrots, grapes, popcorn, and chunks of peanut butter are some of the foods that can be a choking risk for young children. Caregivers can take steps to decrease choking risks, including ^{^[7]}

Offering foods in the appropriate size, consistency, and shape will allow an infant or toddler child to eat and swallow easily.
Making sure the infant or young child is sitting up in a chair or other safe, supervised place.
Ensuring an adult is supervising feeding during mealtimes.
Not putting infant cereal or other solid foods in an infant’s bottle. This could increase the risk of choking and will not make the infant sleep longer.

^{^[1]} “Dietary Guidelines for Americans, 2020-2025” by U.S. Department of Agriculture and U.S. Department of Health and Human Services is in the public domain.

^{^[2]} “Dietary Guidelines for Americans, 2020-2025” by U.S. Department of Agriculture and U.S. Department of Health and Human Services is in the public domain.

^{^[1]} “Food Allergies” from the CDC is in the public domain.

^{^[4]} “Food Allergies” from the CDC is in the public domain.

^{^[5]} “Dietary Guidelines for Americans, 2020-2025” by U.S. Department of Agriculture and U.S. Department of Health and Human Services is in the public domain.

^{^[6]} Image by Derek Owens on Unsplash

^{^[7]} “Dietary Guidelines for Americans, 2020-2025” by U.S. Department of Agriculture and U.S. Department of Health and Human Services is in the public domain.