Health Canada infant feeding recommendations improved
Health Canada’s revision of
the 1998 Nutrition for Healthy Term Infants (posted on its website January
2006) is a greatly improved document over its 1998 predecessor. Now less
bogged-down by its previous need to balance breastfeeding and formula
feeding (although the attempt to balance the two is still evident), the
revision is more evidence- based and in greater conformity with World Health
Organization recommendations.
Of particular interest are the revised recommendations on complementary feeding. Some interesting improvements:
(i) Age of introduction. As a global public health recommendation, the World Health Organization recommends that infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond (WHO, 2003).
Because iron absorption from human milk is depressed when the milk is in contact with other foods in the proximal small bowel, early use of complementary foods may increase the risk of iron depletion and anemia.
(ii) First foods. During the transition to solid foods, it is vital that infants continue to ingest an adequate volume of
breast milk or formula (our emphasis). In Canada, the most commonly used first food is iron-fortified infant cereal. Meat and alternatives are iron-containing foods that can also be introduced at this stage. The foods in this group include meats, fish, poultry, cooked egg yolks, and alternatives such as well-cooked legumes and tofu. Iron from meat sources is better absorbed than iron from non-meat sources.
There is little nutritional or developmental benefit associated with the practice of adding infant cereals or other puréed foods to bottles containing formula or milk. In fact, an important reason for the introduction of solids is the developmental readiness of the infant to progress from sucking to spoon-feeding and from ingesting liquids to more textured foods.
Vegetables and fruits are added next to the infant’s diet; they add colour, flavour, texture and variety to infants’ diets. The introduction of milk products such as cottage cheese, other cheeses and yogurt usually follows. Egg white which contains at least 23 different glycoproteins is not traditionally given to infants until one year of age to minimize any possible allergic reactions (Anet et al., 1985; Langland, 1982).
(iii) Table foods. The transition to other solid foods, such as more textured purées, finger foods and table foods eaten by the rest of the family, takes place in the latter part of the second six months of life because infants are ready to chew and need more texture in their foods. Safe finger foods include bread crusts, dry toast, pieces of soft cooked vegetables and fruits, soft ripe fruit such as banana, cooked meat and poultry, and cheese cubes. At this time, most infants are developmentally ready to feed themselves and should be encouraged to do so (Hahn, 1993; Satter, 1990; Illingworth and Lister, 1964). Important feeding behaviours at this time include taking food from a spoon, chewing, self-feeding with fingers or a spoon, and independent drinking from a cup or bottle (our emphasis) (Pridham, 1990; Satter, 1990). By one year of age, the ingestion of a variety of foods from the different food groups of Canada’s Food Guide to Healthy Eating is desirable.
(iv) Home-prepared foods. Parents and caregivers may prepare their infant’s solid foods by puréeing cooked fresh or frozen foods. Current infant feeding practices (later introduction of solid foods) are not likely to result in an infant consuming sufficient plant nitrate to cause methaemoglobinaemia even in susceptible infants (AAP, 1970).