Download Weaning Health Visiting Teams Huntingdon Area

Weaning
Health Visiting Teams
Huntingdon Area
Cambridgeshire Community Services NHS Trust: delivering excellence
in children and young people’s health services
What does Weaning mean?
There comes a time when a baby needs more nourishment than breast or
infant milk alone can provide. Weaning is the process of introducing a baby to
foods other than milk.
When is it best to start?
Most babies are ready to start solids when they are 6 months old. By this time
babies need more iron and nutrients than milk alone can provide. Food should
be increased gradually so that by one year it has become the main part of the
diet, with breast or infant milk to drink alongside.
Can I wean my baby earlier?
Do not be tempted to wean your baby before 4 months (17 weeks). His or her
body is not ready to cope with food other than breast or infant milk. Early
weaning can:
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Reduce the absorption of nutrients from breast milk or formula milk.
Lead to kidney damage.
Increase the risk of developing food intolerance.
Increase the risk of developing obesity
First Stage
The main aim at this stage is to get your baby used to the idea of eating from a
spoon. He or she will still be getting most of their nourishment from breast or
formula milk (at least 600ml per day).
Start slowly – offer one or two teaspoons of food, once a day. You can try this
after a milk feed or in the middle of one if this works better.
Start with:
• Cooked unsalted vegetable puree e.g. potato, carrots, swede, parsnip,
yam, courgette, cauliflower
• Fruit puree e.g. cooked apple, pear, peach, mango, apricot, mashed
banana
• Gluten free cereal mixed with breast or infant milk e.g. maize, baby rice,
pureed home cooked rice
Most babies take time to learn how to take food from a spoon. Be patient and
be prepared for some mess. Your baby may cry at first between mouthfuls.
Until now food has come in a continuous flow from the breast or bottle, but now
there are frustrating pauses.
If you start weaning near to six months, your baby will be developmentally
ready to move through the first stage quicker than if your baby starts just after
4 months (17 weeks).
During the next month:
• Gradually make the food a thicker consistency.
• Slowly increase the amount of solid food offered – try to match the portion
size to your baby’s appetite. Do not reduce milk intake initially.
• Gradually increase the number of solid food feeds from one, to two and
then to three a day.
• Go for variety - move onto pureed lean meat and poultry, pureed pulses
e.g. lentils, peas and beans.
• Introduce full fat natural yoghurt, fromage frais and custard – mix with fruit
purees.
• If using readymade baby food (in jars/cans), introduce first stage baby
foods initially. Use savoury meals in preference to sweet puddings. Look at
the ingredient label to check that it does not contain added sugar or salt (or
egg or gluten if your baby is less than 6 months old).
• If your baby rejects a particular food, offer it again several times before
deciding that he/she doesn’t like it.
Are there any foods to avoid?
• Salt. Do not add salt to your baby’s food because their kidneys can’t cope
with it. Avoid foods high in salt e.g. gravy.
• Sugar. Do not add sugar to your baby’s food or drinks. Try mashed banana
or breast or infant milk to sweeten food if necessary.
• Honey (until one year). Very occasionally it can contain spores, which can
cause very serious illness.
• Whole nuts until five years (to avoid choking)
Other foods to avoid up to six months
There are also certain foods that can cause an allergic reaction in some
babies. It is a good idea to avoid the following foods before he/she is six
months old:
• Eggs
• Gluten. Wheat–based foods and other foods containing gluten (before six
months) e.g. breakfast cereals such as Weetabix, Ready Brek, rusk, bread,
pasta.
• Fish and shellfish
• Citrus fruit and fruit juice e.g. oranges, satsumas, lemon and lime
What drinks are suitable?
Continue to give your baby breast or infant milk. You can start to give cooled,
boiled water from a cup with solids.
Second Stage:
The aim of this stage is to increase the amount of solids eaten and to introduce
a coarser texture with some soft lumps.
• Gradually increase the amount of food offered. You will find your baby’s
milk intake will reduce as they take more solids but continue to encourage
them to have approximately 500 – 600ml (1 pint) of milk a day in drinks
and in cooking.
• Offer solids first – savoury, then sweet and milk afterwards.
• Work towards three meals each day with one or two healthy snacks.
• Continue to avoid adding salt, sugar or honey to your baby’s food.
Aim to give:
2 – 3 servings a day of starchy foods such as:
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Potatoes
Yam
Rice
Bread
Unsweetened breakfast cereals such as Weetabix, Ready Brek, Rice
Krispies.
1 + serving a day of protein foods such as:
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Soft cooked meat e.g. chicken, turkey, lamb, beef, pork, liver
Fish – boneless e.g. plaice, cod, haddock, tuna
Egg – well cooked e.g. mashed hard boiled egg, scrambled egg
Tofu · Pulses - beans, peas, lentils, dahl
2 + servings of fruit and vegetables
What About Finger Foods?
Encourage your baby to chew, even if there are no teeth, by giving finger
foods. Finger foods provide chewing practice and encourage children to feed
themselves. Suitable finger foods include:
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Toast or bread fingers
Breadsticks
Pitta bread or chapattis
Cubes of cheese
Softened vegetables e.g. carrot sticks, green beans
Fruit – banana, peeled apple or pear
What About Lumpy Food?
It is not unusual for babies to cough when eating lumps at first but try to
persevere. Babies often cope better when food is the same texture throughout.
Avoid mixtures such as puree with lumps in. Go for thicker purees and
gradually increase the coarseness; progress to rough mash then to mince and
then to finely chopped food. Keep calm and always remain with your baby
whilst he/she is eating or drinking.
What Drinks Are Suitable?
Continue to give your baby their usual milk, either breastmilk or infant milk.
Give milk at waking and at bedtime.
Cow’s milk should not be given as a drink until your baby is one year old.
However, it can be used for:
• Mixing with foods such as cereal
• Adding to mashed potato
• Making cheese sauce, custard, milk puddings
Other suitable drinks are water and diluted fruit juice. Fruit juices, such as
orange juice, are a good source of vitamin C. However, fruit juice contains
sugars, which are present naturally, and these can cause tooth decay. Fruit
juice is also acidic. For this reason, fruit juice should be given very diluted (1
part fruit juice with 10 parts tap water). Tap water does not need to be boiled
after six months.
Try to encourage drinking from a cup rather than a bottle.
Third Stage:
The aim of this stage is to move towards family foods and mealtimes. Try to
establish a regular meal pattern of three meals plus 2 – 3 healthy snacks each
day.
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Try to eat with your baby as much as possible.
Do not force feed.
Offer small portions on small plates. You can always offer seconds.
Allow your baby to feed herself/himself.
Offer a variety of tastes and textures. Go back to foods that your baby
didn’t like earlier and try them again.
• Offer food at different temperatures from fridge cold to room temperature to
warm.
• Continue to avoid adding salt, sugar or honey to your baby’s food.
Aim to give:
3 – 4 servings a day of starchy foods such as:
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Potatoes
Pasta – small pasta shapes or finely chopped
Yam
Rice
Unsweetened breakfast cereals such as Weetabix, Ready Brek, Rice
Krispies, Shreddies, Cheerios
• Bread
1 + serving a day of animal protein foods such as:
• Soft cooked meat e.g. chicken, turkey, lamb, beef, pork, liver
• Fish – boneless e.g. plaice, cod, haddock, tuna, salmon
• Egg – well cooked e.g. mashed hard boiled egg, scrambled egg, omelette
Or
2 + servings a day of vegetable protein foods such as:
• Pulses – kidney beans, chick peas, beans, peas, lentils, dhal
• Tofu
3 - 4 servings of fruit and vegetables
What Drinks Are Suitable?
Continue to breastfeed or offer 500 – 600ml (1 pint) infant milk each day to
drink or with foods. Give milk on waking or at bedtime.
If your baby does not like to drink much milk, offer at least two servings of full
fat yoghurt, cheese or milk based dishes e.g. rice pudding, vegetables with a
cheese sauce each day.
Give milk, water or diluted fruit juice at mealtimes
What Are Suitable Snacks?
• Fresh fruit – banana, wedges of apple, orange, pear, satsuma, melon,
grapes, strawberries
• Cubes of cheese
• Fingers of toast, breadsticks, rice cakes, small triangle sandwiches
• Yoghurt or fromage frais
• Plain biscuit
Do I Need To Give Extra Vitamins?
You will need to give vitamin drops containing vitamins A, C and D if:
You are still breastfeeding after your baby is 6 months old
or
Your baby is drinking less than 500ml infant formula each day.
Talk to your health visitor about how to obtain them. Vitamin C helps the body
to absorb iron. Offer a good source of vitamin C e.g. citrus fruit, kiwi,
strawberries, tomatoes, peppers, small amount of diluted fruit juice with meals.
First Stage
General Aim:
Gradually introduce solid food. Introduce a variety of tastes. Feeds are still
mainly breast milk or baby formula.
Suggested Breast/ Formula Intake:
Minimum 600ml (1 pint) daily achieved by 5 – 6 feeds. Start to introduce drinks
from a cup/beaker.
Food Consistency:
Thin, smooth and semi-solid. Babies who are developmentally ready may be
able to miss out the runny stage and will cope with a thicker texture sooner.
Types Of Food To Introduce:
Start with: Unsalted vegetables, mashed potato, pureed fruits, natural yoghurt,
and gluten free cereal.
Move on to: A wider variety of pureed foods including meat, liver and poultry,
pulses e.g. lentils, split peas.
Suggested Quantities
Start with: 1 – 2 teaspoons once or twice daily and gradually increase.
Move on to: 6 – 12 teaspoons of baby food three times daily and continue to
increase.
Key Messages
No gluten before 6 months.
Second Stage (7- 8 Months)
General Aim:
Increase the amount of solids eaten. Encourage savoury rather than sweet
foods.
Suggested Breast/ Formula Intake:
500 – 600ml (1 pint) daily achieved by 3 – 4 feeds.
Food Consistency:
Minced or mashed food; soft finger food.
Types Of Food To Introduce:
Coarsely pureed meat, soft cooked fish or pulses, cereals, well-cooked egg,
fromage frais, finger foods like soft fruit and softened vegetables, cheese, toast
fingers, chapattis and breadsticks, meat, cooked vegetables, small shaped
pasta, mild curry, finger foods and other family foods.
Suggested Quantities:
Meat, fish or other protein sources :
1+ serving per day
Bread, potatoes and cereals:
2 – 3 servings daily
Fruit and vegetables:
2 + servings daily
Key Messages:
Encourage iron rich weaning foods.
Third Stage (9 – 12 Months)
General Aim:
Aim for 3 small meals plus healthy snacks each day.
Suggested Breast/ Formula Intake:
500 – 600ml (1 pint) daily
Food Consistency:
Minced and chopped food
Types Of Food To Introduce:
Coarsely pureed meat, soft cooked fish or pulses, cereals, well-cooked egg,
fromage frais, finger foods like soft fruit and softened vegetables, cheese, toast
fingers, chapattis and breadsticks, meat, cooked vegetables, small shaped
pasta, mild curry, finger foods and other family foods.
Suggested Quantities:
Meat, fish or other protein sources:
1 - 2 servings per day
...continued...
Bread, potatoes and cereals:
3 - 4 servings daily
Fruit and vegetables:
3 - 4 servings daily
Key Messages:
Encourage iron rich weaning foods
Do not add salt, sugar or honey to food or drinks
What about Nuts?
Some people are allergic to nuts or seeds. Babies are more likely to develop
allergies if there is a family history of allergies such as eczema, asthma,
hayfever or food allergy.
The following guidelines may help to reduce the risk of developing a nut
allergy:
• Peanuts and foods containing peanuts such as peanut butter or unrefined
or cold pressed groundnut oil should not be given to infants from allergic
families until they are at least 3 years old
old.
• Refined peanut oil, vegetable oils and creams containing refined peanut,
arachis or groundnut oil are considered safe.
• Read ingredient labels carefully, and if you are in doubt avoid the product.
If there is no allergy in the immediate family there is no need to avoid peanuts
after weaning. These can be given from 6 months but should always be
crushed or flaked.
Do not give whole nuts to children under 5 years in case of choking.
What about Iron?
Iron is a very important nutrient. It is needed to make blood and to keep the
body healthy. All of the iron needed has to come from food, as the body cannot
make it. Some foods provide more iron than others.
Babies are born with a store of iron that will last about six months. After that
they need to get iron from their food. Foods rich in iron include:
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Red meat e.g. minced beef or corned beef, lamb, pork
Eggs – well cooked
Pulse vegetables e.g. beans, lentils, peas, chick peas, dhal
Oily fish e.g. salmon, mackerel
Fortified breakfast cereals e.g. Weetabix, Ready Brek
Green vegetables e.g. broccoli, spinach
For further information about this service contact:
Health Visiting Teams
Oak Tree Centre
1 Oak Drive
Huntingdon
Cambs
Tel: 01480 418653 or 01480 418600
If you require this information in a different format such as in large print or on audio
tape, or in a different language please contact the service on the details above.
If you have any concerns about this service or suggestions for improvements,
contact our Patient Advice and Liaison Service on Freephone 0800 013 2511 or
email: [email protected].
For free, confidential health advice and information 24 hours a day, 365 days a
year please contact NHS 111.
©Cambridgeshire Community Services NHS Trust
Website: www.cambscommunityservices.nhs.uk
0214 - April 2015 (V1)
Code No:
Date of Production: April 2015
Date of Review:
April 2018