KK Women's and Children's Hospital shares more on why breast milk is best nutritional start and on weaning
Making a decision between breastfeeding and formula feeding, or a combination of both, is a very personal one. Sometimes, you may find yourself unable to breastfeed, or you’re not sure if supplementing breast milk with formula is good for your baby.
What you feed your baby during his first few months determines how well his immune system and body will develop.
Ms Grace Quek, Senior Dietitian,
Nutrition and Dietetics Department,
KK Women’s and Children’s Hospital (KKH), a member of the
SingHealth group will help you make an informed decision by sharing some information on breast milk and formula.
Breast milk offers the best nutritional start for your baby
For the first six months of your baby’s life, breast milk offers him the best nutritional start as it is tailor-made to his needs.
Breast milk contains all the nutrients your baby needs, and in the right proportions. It also contains valuable antibodies to help him fight infections and build immunity during his initial days.
As he grows, the breast milk you provide will continue to adapt to his changing nutritional needs.
Infant formula
If breast milk is unavailable, or if you’d like to supplement your baby’s diet, then you may feed your baby an age-appropriate milk formula.
The American Academy of Pediatrics (AAP) recommends iron-fortified cow’s milk infant formula, as it is most appropriate for babies 0 to 12 months who are not breastfed or who are partially breastfed.
What are the essential ingredients in infant formula and what role do they play in your baby’s development?
Most milk formulas are formulated to resemble the nutritional composition of breast milk.
Generally, the essential ingredients of infant formula include carbohydrate, protein, fat as well as vitamins and minerals to meet the needs of a growing full-term infant. Other important components, which should be present, include choline, inositol and long chain polyunsaturated fatty acids (AA and DHA).
The nutritional content of all infant formulas sold in Singapore are in accordance with the recommendations made by the World Health Organization (WHO) and can meet the nutritional requirements of your baby.
3 Things your baby doesn’t need when you’re breast- or formula-feeding
1. Water
Your baby doesn’t require additional water in the first six months of his life or before you introduce solid foods to him. Breast milk or formula alone would provide the fluids that his body needs daily.
2. Fish oil supplements
It is not necessary to give fish oil supplements to your baby, as breast milk and fortified formula milk are good sources of omega-3 fatty acids.
3. Vitamins
A balanced diet is vital to providing all the essential nutrients that the baby needs. However, your baby, whether breast-fed and bottle-fed, does not require any additional supplements until about six months of age.
When to start weaning your child
"Weaning describes the period when an infant gradually becomes accustomed to other food than milk," say doctors from the Department of Neonatal and Developmental Medicine, Singapore General Hospital, a member of the SingHealth group.
According to the World Health Organization (WHO), you can introduce solid food when your baby is about 6 months old, but no sooner than about 4 months.
“Introducing solid food earlier than four months old is not recommended as your baby’s digestive system is not mature enough. Furthermore, he may not be developmentally ready yet,” says Ms Quek.
Delaying weaning later than six months of age is discouraged, as it offers no advantage to your baby and may even lead to difficulties accepting solid food later on. He or she may also not get enough nutrition and this may lead to growth retardation.
How to know if your baby is ready for solid food?
To determine if your baby is ready for solid food, you first have to look out for signs that he’s developmentally ready. This means that:
He’s able to sit well with support and has adequate head-neck control – important for spoon-feeding.
He doesn't move his tongue forward and upwards to push food out of his mouth (extrulsion reflex)
He drools more and constantly puts things into mouth.
He shows a keen interest in food and/or people eating
What's the best food for your baby?
Your baby’s first food can be one of these:
Any single-grain cereal (for e.g. rice cereal, as it’s bland and least likely to cause any allergic reaction). This can be mixed with breast or formula milk.
Single vegetable purees that are prepared to a runny and lump-free consistency, slightly thicker than milk. A ‘vegetables first’ approach, i.e. introducing variety of different vegetables early is an acceptable approach to encourage vegetable acceptance early with potential benefits for later taste preferences.
Milk remains the main source of nutrition for your baby in the early stages of weaning.
When the baby is older, you can feed him or her other cereals like wheat and mixed cereals. Some need water to be added; others need to be mixed with milk. You should check the labels carefully before preparation.
These cereals are usually fortified with iron to help meet the baby's increased need for dietary iron at this time.
Another option is blended home-cooked rice porridge using white or brown rice.
Vegetables such as cauliflower, carrots and potatoes can be boiled, mashed or pureed and added to the cereal or rice porridge, or served on their own. If necessary, they can be moistened with some milk. Offer a variety of different vegetables to expose the baby to different tastes and to help increase acceptance of vegetables later on.
Fruit such as banana, papaya, pear or other soft and ripe fruit can be blended or mashed and added to the cereal or scraped and fed to the baby directly.
Meat, chicken, fish, tofu, eggs and legumes are all protein-rich which can be introduced as part of the weaning diet. These foods are also important dietary sources of iron. Whole eggs can be introduced as early as 6 months of age, but it should be prepared in well-cooked form. Therefore, eggs can be hard-boiled and blended with cereals or porridge, or it can be steamed as egg custard. Similarly, meat and chicken can be introduced from 6 months of age. It should not just be boiled for stock only, so the meat can be blended or finely-minced in the porridge.
6 Tips for how to introduce solid foods to your baby
1. Start small
The importance of weaning is to introduce new tastes, different food consistencies and learning to be fed through a different mode of feeding using a spoon.
Start with small amounts, e.g. one to two teaspoons, and respond to your baby’s appetite and cues, then increase gradually as indicated by your baby’s interest.
As milk still provides the main source of nutrition during the early stages of weaning, the portion is not so critical. Focus on the positive feeding experience to help your baby build a good relationship with food.
2. Time it right
Choose a time when your baby is not too tired or hungry to introduce the new experience and tastes.
3. Watch for signs of food allergies for a few days
When introducing a new food to your baby, you may wait for a period of three to four days before the introducing the next item. Observe for any signs of allergies or intolerance such as rashes, swollen eyes and lip, vomiting and diarrhoea. Stop giving the food if there is any adverse reactions, otherwise if accepted, you can continue to include the food alongside with the other foods before.
4. When introducing purees, go easy on orange and yellow foods
If you’re giving your baby single-strength purees, please note that foods such as carrots, sweet potatoes, pumpkin and papaya are rich in carotenoid, a pigment that gives them the yellow or orange colour.
If your baby eats too much of these foods over a long period, he may have “yellow or orange-coloured” skin and increased levels of beta-carotene in his blood – symptoms of hyper-betacarotenemia.
Fortunately, hyper-betacarotenemia is harmless. Your baby’s natural skin tone will be restored if you feed him lesser or no foods of high beta-carotene content.
5. Offer small sips of water when introducing foods
When you start to introduce foods other than milk to your baby, you can start by offering a few spoonfuls of cool, boiled water during the feeding of solid foods or small sips between milk feeds.
There is no need to give more water as long as your baby has six to eight wet diapers a day and is not constipated, i.e. has no change in bowel movement and consistency.
6. Important! Introduce foods with iron to boost your baby's iron at the six-month mark
It is important to note that your baby’s iron stores will be depleted at about six months, so it is recommended to introduce weaning foods that contain iron such as infant rice cereal fortified with iron and meats.
Meats can be steamed and pureed to a smooth consistency, to be given as a meal or added to cereals.
3 Stages of weaning
At 6 months (babies who are totally breastfed)
Food should be slightly thicker than milk so that your baby can lick it off the spoon easily. Start with liquid paste and progress to semi-solids. Your baby should be fed milk first and then the food. At this stage, you are giving solids only to expose your child to different kinds of food and to get your baby used to spoon-feeding. Milk should remain the main source of nourishment.
At 7-9 months
As your baby gets older, he or she will be ready for food of different texture and taste. Your baby's food does not have to be liquid anymore – you may leave it thick. Milk should not be your baby’s only source of nourishment now. Since you want your baby to accept solids from now on, you will have to prioritise giving the food first followed by the milk. Aim for two solid meals per day, progressing to three if the baby is keen.
From 9 months onwards
Food does not need to be blended and mushy anymore. Roughly chopped soft food can now be given. Finger foods like teething rusks or biscuits can start earlier. This encourages your child to eat on his own, however messy the result may be! When your baby is one year old, you can adapt his or her food based on your family meals. There is no need to cook separately for him.
Ref: P16
