Childhood nutrition: the basis for good health

In the first months of life, diet is crucial for children’s health. Children grow faster in their first year of life than at any other time and need calories as well as protein, vitamins and minerals. A good and varied diet will provide everything they need. It is very important to know that, although the adult diet should be low in fat and rich in fiber, it is not suitable for young children.

Eating habits and tastes (good or bad) are formed in the first years of life, so giving the child a wide variety of fresh and stimulating tastes will help to create a correct eating pattern. For example, commercial purees always taste the same, but with homemade purees, children become accustomed to the natural variations in the taste of home-prepared meals, which helps them get used to family meals as they get older.

Starting to feed

Breastfeeding is the best food for that newborn or infant. In addition to the emotional benefits, breast milk contains antibodies that protect them from infections. In the early months they are very vulnerable, and colostrum is a very important source of antibodies that help strengthen the baby’s immune system. If the mother has plenty of milk or has to be away, she can express it manually or with a breast pump. It can be given immediately or stored in a sterile container in the refrigerator, for consumption in less than 48 hours, or in the freezer, for consumption in up to 3 months or more.

Artificial infant formulas, mostly based on modified cow’s milk, guarantee adequate nutrition for the infant, although always inferior to breast milk. You should use drinking water from the public water supply heated to the first boil (approximately one minute) or mineral water (non-carbonated, weakly mineralized or specific for bottles) hot enough to dissolve the powdered milk. It is important to know that you should not use water that has been boiled several times as it can be dangerous due to the concentration of mineral salts. Temper the bottles by placing them in hot water and be very careful with the microwave, as the milk may become too hot, even if the glass is cool to the touch. During the 4-6 months of life, infants should drink between 600-800 ml of milk per day (breast milk or artificial milk).

In recent years, there is a lot of pressure on parents to start very early with the administration of solid foods. In the first months the digestive system of an infant is not capable of absorbing more complex foods than milk, that is why at the Instituto Valenciano de Pediatría we do not start complementary feeding until 5-6 months. After 6 months of age, breastfeeding is not enough to satisfy the infant’s nutritional requirements and supplementary feeding with other foods must be administered.

How is feeding introduced to a baby?

Individually, according to each child and his or her environment. There are no rigid or established rules as to the order in which foods are introduced. And as we do in the Valencian Institute of Pediatrics (IVP) in the review of each month the different foods are introduced progressively depending on the evolution of weight and height, as well as the response of the child after the intake of some of them.

The size of the porridges is very variable. At the beginning it is usually 90-120 g, to be of up to 250 g in the most foodies of one year of age.

The first porridges offered to an infant should be easy to digest and have little chance of provoking an allergic reaction, so we will start their feeding either with gluten-free cereals prepared with milk (maternal or artificial) or with fresh fruits. At first they should eat cooked fruit purees such as apple, pear or banana (the latter does not require cooking if it is ripe). After 15 days and if there is good tolerance, you can gradually give the same fruits crushed or pureed, adding others such as peach, grape, etc. Natural juices are not a substitute for whole fruit. Only occasionally and with a spoon or glass and always diluted 50% with water, giving it after its preparation to avoid the loss of vitamins.

The next food to introduce could be vegetables, especially potatoes, carrots, turnips, parsnips, pumpkin, sweet potatoes. Do not include green leafy vegetables (spinach, lettuce or chard), as well as artichoke, borage and beet, before the age of two due to their high nitrate content. Once the puree has been prepared, it should be kept in the refrigerator if it is to be eaten within 24 hours, or frozen immediately. Add one or two teaspoons of olive oil, preferably extra virgin, to the puree.

  • Meat: Introduce meat early (6-7 months), especially in breastfed children. It is customary to start with chicken, later introducing other meats (turkey, beef, lamb and pork, the most common).
  • Fish: Due to tradition and because blue fish, which is more fatty, is less digestible, white fish is usually started first and then blue fish. We start at 6-7 months of age with white fish (hake or whiting) and then monkfish, sole, megrim and then continue with small blue fish (red mullet, sardines, horse mackerel, mackerel, anchovies, herring, white tuna…).
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Both fish and meat are added to the vegetable puree, (initially 20-30 g and around the year 30-40 g). They are offered cooked in the form of puree, crumbled or in small pieces for older children. The Nutrition Committee of the AEP recommends eating fish 3-4 times a week, one of them oily fish.

Be careful to remove any bones that may be present. Frozen fish has the same nutritional value as fresh fish.

After introducing meat and fish, we will do it with the cooked and crushed egg (usually the yolk first), added to the vegetable puree instead of the meat or fish. Later we will also give the egg white, in the form of scrambled eggs or omelet. Do not offer meringues or raw eggs.

The legumes we usually give them later added to the vegetable puree in small quantities 2-3 times per week. The most commonly used: chickpeas, lentils, beans and peas. During the first year it would be convenient to prepare them peeled or to pass them through a potato masher, to reduce the excess of fiber, from 12-14 months they can be given whole.

Yogurts and cheeses will help to complete the recommended daily milk intake (400-500 ml in total), but should not replace fruit or other foods. Other dairy products, such as flan or custard, can be eaten occasionally, but are less healthy.

In recent years, new trends have emerged, such as baby led weaning. This offers uncrushed solid foods from the sixth month, to be eaten with the hands. This form of feeding has its advantages. However, in its extreme form, which discourages the administration of any mashed food, it can have certain disadvantages, such as insufficient supply of some nutrients and/or total energy. Not all infants will be ready for this technique by the sixth month and there is a theoretical risk of increased choking episodes.

Common mistakes

Do not be tempted to add salt or sugar to your child’s food during the first two years of life. Salt can damage your kidneys and sugar will make you greedy and give a false sense of satiety. For this reason, very salty foods such as canned vegetables, cured meats, broth tablets and powdered soups should be avoided.

Avoid unmodified cow’s milk as the main dairy product until 12 months of age and if your pediatrician advises it, the ideal is to continue with a follow-on milk until 18 or 24 months of age. Yogurt, made with adapted milk or natural unsweetened whole cow’s milk, or low-fat cottage cheese can be given from 8-10 months.

Honey should also be avoided because it may contain Clostridium Botulinum spores, which, together with the infant’s gastric acid deficit, would facilitate the development of botulism and also because of the high sugar content of honey.

In children under 10 years of age and in pregnant women, women planning to be pregnant and nursing mothers, the consumption of large blue fish, such as swordfish/emperer, bluefin tuna, shark (dogfish, blue shark…) and pike, should be avoided due to their high mercury content.

And remember that poor nutrition can cause problems that our children will carry with them for the rest of their lives.