Baby feeding recommendations changed
EDITOR’S NOTE: Laurel LeConte is a mother of two small children (ages 3 and 15 months), a local registered dietitian and a member of Dietitians of Canada.
by Laurel LeConte
MANITOULIN—What parents should feed their children, and any unsolicited parenting advice in general, is a very touchy subject. And yet recently Health Canada, Dietitians of Canada, the Canadian Pediatric Society and the Breastfeeding Committee for Canada together released updated guidelines intended to simplify the messages out there on feeding infants aged six to 24 months.
These revisions, including some that may be surprising, attempt to incorporate the latest scientific evident on how to feed babies. But as any parent or caregiver can tell you, endeavouring to feed your child well is as much an art as a science. Sometimes the textbook advice conflicts with the practical challenges of raising your baby in our busy, modern world.
Here’s my take on the latest guidelines. (The full guidelines are available on the Health Canada website www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/recom-6-24-months-6-24-mois-eng.php.)
Breastfeeding, exclusively for the first six months, and continued for up to two years or longer with appropriate complementary feeding, is important for the nutrition, immunologic protection, growth, and development of infants and toddlers.
This guideline actually isn’t new or one of the updated guidelines. However, I thought it was worth mentioning since many people don’t realize that the health authorities have long endorsed extended breastfeeding. Breastfeeding should be supported for up to two years or beyond, as long as mother and child want to continue. Many people are uncomfortable with the idea of a toddler nursing, especially in public. However, I think that’s just because in our society it’s not that common and we’re not used to the idea. I challenge you to re-think the judgment you might have once had when you find out someone is “still” nursing their toddler. The reality is complementary feeding, along with continued breastfeeding, confers many benefits to mother and child including nutritional advantages to the older baby.
That being said, extended breastfeeding is not practical or desirable for many mothers. For my own circumstances, I was happy to have my children drinking exclusively from a cup by the time I returned to work full time when they were one year of age. Other mothers I know have chosen to successfully manage to follow these guidelines and return to work full time.
The next updated guideline I wish to comment on concerns what foods should be offered at what age.
Parents should start babies off with iron-rich solid foods around six months of age. Parents can start with well-cooked minced, mashed or shredded meat or alternatives (such as cooked, mashed beans, lentils or eggs) and iron fortified cereal.
At six months, babies can handle a variety of soft textures and finger foods. The importance of iron-rich foods on infant brain development and growth has been known for some time, for this reason soft or finely minced meat and alternatives are perfectly acceptable first foods for babies.
This recommendation has been updated to emphasize that although parents should be delaying solid foods to around six months, textures should actually be introduced earlier. There is some evidence that keeping babies on pureed food too long is associated with feeding difficulties in older children.
Also updated are the recommendations that all other food groups can be introduced after the iron-rich foods with no specific order. After iron-rich foods have been introduced there are no longer strict orders on the sequence of types of foods to offer babies.
Indeed, in my own experience, as long as a baby is actually hungry, they are eager to try new foods and textures, especially if they see mom or dad eating those foods around the table on a regular basis. I distinctly remember the look of horror on an older relative’s face when I proudly announced my then six-month-old daughter’s first food was a taste of a Burt Farm pork chop. Times have clearly changed. As long as risk of choking is minimized by appropriate size of food pieces and there is proper supervision during eating, the new guidelines suggest parents can relax at what foods they offer to babies, and in what sequence.
Anecdotally, I have heard many parents complain that their children won’t eat certain foods, food groups or textures and I wonder if it is because they have kept their babies on pureed foods and bottles too long. Studies show that greatest influence on a child’s eating habits is observing their same sex parents eating habits and that it can take multiple exposures for a child to accept a new food. So if your just doesn’t seem to want to accept a food, I suggest you keep offering it and model the behaviour you would like to see yourself.
In the past, the advice has been to delay the introduction of potentially allergic foods. The new recommendations are for parents to actually introduce all of the “priority” or most common allergens as part of the first foods introduced to babies including egg, milk products such as cheese or yogurt, peanuts, seafood, sesame, soy, tree nuts and wheat. The reason for this change in recommendation is that they latest evidence shows that in order to reduce risk of developing allergies, babies should actually be exposed to these foods earlier and more often. Babies can start to try these foods around six months of age and parents are advised to wait at least 48 hours between trying new foods so that potential allergic reactions can be identified.
The last of the updated recommendations I will comment on is perhaps the most difficult to adhere to—I literally laughed out loud when I heard it.
Parents are recommended to start offering infants an open cup starting at six months of age.
Open cups support the development of mature feeding skills and babies are actually capable of learning to drink from open cups at an early age. The rationale behind this updated guideline is that there are some increased health risks with prolonged use of ‘sippy’ cups and bottles. Sippy cups and bottles require sucking action, which is thought to prolong contact of the teeth and gums with the liquid inside. If allowing a baby or toddler to sip milk, juice or formula from a bottle or sippy cup throughout the day, incidence of dental cavities may increase. There is also suggestion that babies using bottles for a prolonged amount of time may interfere with a baby regulating hunger and satiety, leading to the potential for overfeeding. The gold standard is to get a baby drinking from a cup at an early age, limit or avoid juice or other sugary drinks and offer water, homo milk, breast milk or formula depending on circumstances. It should be noted that babies should not be started on cows milk until 9 to 12 months of age and they should be offered 2-3 cups of full fat milk per day to allow them enough hunger to be willing to try sufficient solid foods. Additional thirst should be met with water.
I understand the rationale behind this sippy ban guideline, but I questioned if the authors actually had small children at the time of development. My three-and-a-half-year-old still drinks from a sippy cup at times since my kitchen is already covered in a thin film of spilled milk. Kids are messy. The convenient choice may not always be the best choice. Perhaps I need to employ a little more patience in my parenting stills for the greater good.
Although some are controversial, the guidelines do have merit. Personally and professionally, I support them. That being said, I think we can all agree that parenting and raising children is hard enough without being made to feel guilty about our choices. I think all parents and caregivers just need to do their best with the resources available to them and rest assured, and just like the generations before us, odds are in our favour that our kids will turn out okay. For more information on how to implement the guidelines in a practical way, visit this parent-friendly guide www.healthycanadians.gc.ca/kids-enfants/infant-care-soins-bebe/nutrition-alimentation-eng.php.
