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A joint statement for the nutrition recommendations for infants, ages 6-24 months is being developed by Health Canada, Canadian Paediatric Society, Dietitians of Canada and the breastfeeding committee for Canada. These recommendations are outlined below.

The nutrition recommendation from birth to six months is for exclusive breastfeeding.  Breastfeeding is important not only for nutrition but also immunologic protection, growth and development of infants and toddlers.  Breastfeeding can be sustained for up to two years or longer with complementary feeding.

Supplemental Vitamin D (400 IU/day) is recommended for breastfed infants.

Complementary foods can be introduced at 6 months when the child shows signs of readiness (may be a few weeks before or after 6 months).  Iron stores at six months of age are depleted and breastmilk alone can no longer meet the nutrient requirements of the infant.  The first complementary foods introduced should be iron rich.  In the past we have always recommended iron fortified infant cereals as the first food and then the addition of fruit and vegetables.  Now the recommendations include meat (beef, lamb, game, poultry, fish) and meat alternatives (e.g. eggs, tofu and legumes), and iron fortified cereals as the infant’s first foods.

Foods offered at this age should be semi-solid in texture at first and gradually increasing.  Start by cooking these foods until tender and then mashing or mincing with a knife or grinder. Iron rich foods should be offered 2 or more times per day between the ages of 6-12 months and 3 or more times during the second year of life.

Grain products and cereals for infants and young children should be iron fortified.  The heme-iron in meats can increase the absorption of non-heme iron in plant foods.  Including foods rich in vitamin C will also enhance non-heme iron absorption.  For example adding mashed blueberries to iron fortified infant cereal at breakfast.

Previous recommendations also included delaying the introduction of whole eggs, fish and shellfish due to potential allergy.  However, the current recommendation is that the whole egg and fish without bones are good sources of iron and can be introduced at six months of age.  Introduce one new food at a time and wait 3 days before the introduction of the next new food in order to monitor tolerance. NOTE: If there is a strong family history of food allergy you should consult your doctor.

To reduce the risk of choking, avoid hard, small, round and sticky or smooth solid foods.  Introduction of all nuts, seeds, nut butters and fish with whole bones should be delayed.  Avoid: gum, hard candy, cough drops, marshmallows, popcorn, raisins, peanuts, other nuts and seeds, fish with bones and toothpicks.  Be sure to cut sausages or hotdogs lengthwise, grate carrots and hard fruit, remove pits, cut grapes and serve peanut butter spread thinly on a cracker or bread not on a spoon.

It is recommended to introduce cow milk at 9-12 months of age.  Earlier introduction can interfere in iron absorption and displace iron rich foods.  It may also cause gastrointestinal bleeding.  Excessive cow milk consumption (greater than 750ml) is associated with increased risk for iron deficiency anemia.  Offer cow milk in an open cup to avoid excessive consumption.

Be sure to offer children food that is prepared, served and stored safely.  Young children and infants should always be supervised when eating. Avoid raw or undercooked eggs, meat, poultry and fish. Foods should be prepared with little or no added sugar or salt.  High fat foods should not be restricted.  Limit fruit juice and avoid sweetened beverages, offer water instead.  To prevent infant botulism, avoid giving honey to a child under the age of one.

Encourage responsive eating from the start.  Pay attention to the child’s cues, allow them to  self-feed and offer finger foods.  The use of an open cup, with help initially, is also recommended.

Be a good role model and help instill lifelong healthy eating habits.

For more information or to find the whole report go to www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recommendations/index-eng.php#f