Nutrition and Breastfeeding Articles

I have spoken to many parents feeling a little concerned that Christmas & school holidays may throw their nutrition routine out the window. Whilst that is ok for a short time, it is absolutely possible to celebrate and have some balance too, hooray! . Try these tips for your family:

• Don’t restrict yourself or the kids. Feed yourself and children as usual leading up to social events. So for Christmas lunch, eat a normal breakfast and morning tea if late lunch. It is best not to attend events so hungry that it is difficult to think straight, as this often leads to eating beyond fullness and makes it difficult to listen to those body cues.
• Encourage and guide your children to learn their hunger and fullness cues, practice eating slowly and waiting 20-30 minutes after eating to decide if still hungry.
• At other times, stick to meal structure, try to choose foods from the five core food groups; fruit, vegetables, meat and meat alternatives, dairy and dairy alternatives and grains/cereals, as these foods provide best energy for growing and learning.
• Engage in active play as a family. Take a ball or Frisbee to a picnic.
• If you are taking a plate, why not try a balanced option, such as wholegrain crackers, chopped fruit, vegetables, cheese, dips such as hummus & tzatziki.

 
Healthy snacks at home:
Choose fresh, natural, unprocessed foods, where possible:
-        Cheese (tasty or cottage) on seeded crackers
-        Fresh fruit cut-up
-        Carrot, cucumber or tomato cut-up and served with hummus.
-        Yoghurt
-        Popcorn (for children over 3 years of age).
-        Healthy bliss balls
-        Boiled eggs
-        Nuts and seeds
-        Canned beans e.g. chickpeas
 
How do treat foods fit in?
There is no such thing as a ‘bad’ food, as balance is the key. Treat foods do fit into healthy eating, sometimes. Parties and special occasions are those time to include these foods, the rest of the time, offer healthy snacks and meals.
 
Is nutrition actually important over school holidays?
School holidays add up to 14 weeks of the year – that is over 3 months, or 25% of your child’s total diet! Keep a similar routine to school, with meals at similar times. Encourage eating at designated times rather than snacking throughout the day to promote hunger at meal times. Promote physical activity, encourage your kids to play outside and reduce time spent on screens. Hunger levels may be different to the school year, if activity levels are different too.

​By Emma McShane (Dietitian) & Nicole Bando (APD, IBCLC), December 2022

​Transitioning from breastfeeding or formula to family foods is a natural progression for a baby. A breastfed baby may continue to breastfeed beyond the first 12 months of life, whilst including dairy and family foods.
 
If your child is 12 months or older, it is safe to give your child whole cow’s milk (or fortified dairy milk alternatives) as a drink. Do not give cow’s milk as a drink 12 months of age, continue to breast or bottle feed. Beyond 12 months, formula is no longer required, this includes toddler formula, which is ultra-processed and creates a preference for sweet foods & takes up tummy space for core food groups, making fussy eating more likely.
 
Beyond 12 months:
 
By 12 months, a breastfed baby may include dairy in cereal, yoghurt and cheese as a snack. Continue breastfeeding as you wish, as breastmilk continues to provide ongoing benefits for health and immunity, and is a source of calcium and other nutrients.
 
A bottle fed baby may only be including a morning and night bottle of formula by 12 months. The morning feed can be replaced with a larger breakfast; add milk into cereal such as oats or Weet-bix, or try yoghurt and fruit or cottage cheese on toast. Incorporate dairy into snacks, e.g. small bowl of natural yoghurt with fruit, cheese and crackers or ½ cup of full cream milk, either after some meals or offered as a snack. . Offer dairy 3 times a day to ensure adequate calcium for growing bones.
 
What about the night time bottle?
 
Many parents report that their toddlers drink milk before bedtime and worry that stopping it will upset the bedtime routine. Parents are often concerned that their child isn’t eating enough during the day, especially if dealing with a fussy or selective eater.

There are many good reasons to change the evening milk routine. The evening bottle of milk may fill your child up and affect their appetites, which may contribute to fussy eating. Drinking milk out of a bottle or after teeth brushing can contribute to dental caries. Dairy contains 10 essential nutrients, including protein for growth, zinc for immunity and vitamin B12; essential to nerve cell function. However, it does not contain iron, so children who drink large quantities of milk are at risk of iron deficiency, as milk may replace other foods in their diet. Also other nutrients in milk can interfere with the absorption of iron, when consumed in excessive quantities.
 
Whilst your child adapts to the change, it may be a good time to alter the evening routine. Offer a small amount of milk at the end of the evening meal in a cup if concerned that dairy needs have not been met during the day. Perhaps a feeding chair can become the story chair, or moved out of the room if no longer needed.
 
Is toddler formula necessary?
Toddler formula is not required for healthy children. Formula may make your toddler too full to accept a variety of other solid foods. It is ultra-processed and creates a preference for sweet tasting foods. As it takes up tummy space for core food groups, fussy eating is more likely. Toddlers do not grow as much in their second year of life and will have variable appetites, which means some days they may eat more than others. Continue to offer a variety of foods across the core food groups to your toddler and trust their appetite, to meet individual growth needs. If you are feeling worried about your toddler’s intake, see a paediatric dietitian for support.
 
 

References:

1. Nicholas K. How to transition from formula to milk: 5 tips. Peanut app. 2022. Available at: https://www.peanut-app.io/blog/how-to-transition-from-formula-to-milk
2. Centers for disease control and prevention. Weaning. Nutrition. 2021. Available at: https://www.cdc.gov/nutrition/infantandtoddlernutrition/breastfeeding/weaning.html
3. Nicole Bando. Dairy & toddlers. Nicole Bando Paediatric & Family,  Dietitian & Lactation consultant. 2019. Available at: https://www.nicolebando.com/articles/previous/3

 
​By Emma McShane & Nicole Bando, November 2022
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Eczema is a disorder of the immune system caused by an abnormal skin barrier, dryness and inflammation.
30% of people with atopic dermatitis (eczema) also have an allergy.  A food allergy may trigger eczema, but it is not the cause of the eczema. Some foods such as dairy may exacerbate eczema.
 
Eczema can be normally well managed by maintaining, protecting and treating the skin by:
-         Applying moisturiser (at least twice/day)
-        Use non-soap based wash or oil in the bath or shower
-        Avoiding soap and washes that produce bubbles or foam (as these may cause the skin to dry out)
-        Using anti-inflammatory creams and ointments, such as topical steroids
-        Treating bacterial skin infections with antibiotics
-        Use immune modulating treatments if prescribed by your doctor or dermatologist.
 
Food exclusion diets are only recommended to be tried in children with eczema when the above treatments don’t work. Food exclusion diets should be guided by a clinical immunologist or allergy specialist and dietitian. Only short term food exclusion is needed to determine if the food allergy is causing the eczema.
 
Dairy is often a common trigger for eczema, even if they are not allergic to dairy but to something else. Research has shown that more often than not food exclusion diets can be short-term. This is because eczema is an immune response, and in children, their immune system is not fully developed. It is predicted that as a child’s immune system develops, they are likely less sensitive to dairy causing eczema and can slowly introduce these foods back into their diet. It is important that this is done under close guidance of a paediatric dietitian.

References:

1. Eczema and food allergy. Fast facts. ASCIA. 2020. Available at: https://www.allergy.org.au/patients/fast-facts/eczema-and-food-allergy

 

1. National eczema association. Everything you need to know about eczema and food allergies. 2018. Available at: https://nationaleczema.org/blog/eczema-food-allergies/

 

1. Nikolovski A, Rallis S (2020) The Impact of Dairy Elimination on Pediatric Atopic Dermatitis. J Nutri Med Diet Care 6:044. doi.org/10.23937/2572-3278.1510044

 
 

Dairy is a common allergy in babies. In Australia and New Zealand, more than 2% of infants are allergic to cow’s milk protein. Mild or moderate signs of a dairy allergy include:
-        Swelling of lips, face, eyes
-        Hives or welts on the skin
-        Stomach pain
-        Vomiting
-        Diarrhoea
 
Severe rapid onset allergic reaction (anaphylaxis): This reaction is life threatening, and immediate medical attention should be sought by calling 000.
-        Noisy breathing
-        Wheezing
-        Swelling or tightness in throat
-        Young children may be pale and floppy
 
Delayed reactions to cow’s milk and other dairy foods can occur, and reactions usually occur hours or days after consuming dairy.
Symptoms may include:
-        Eczema
-        Delayed vomiting
-        Diarrhoea
-        Blood in the stool
 
Lactose intolerance is caused by the lack of the enzyme, lactase, which helps to digest the milk sugar, lactose. It commonly occurs after the age of 5 years.
Symptoms of a lactose intolerance include:
-        Vomiting
-        Diarrhoea
-        Stomach pain
-        Gas (wind or bloating)
These symptoms are uncomfortable but are not life threatening. Lactose-free dairy is the best alternative. Very rare lactase insufficiency in babies can present as very poor growth, severe diarrhoea and is a medical emergency.
 
Secondary lactose intolerance: may occur due to conditions such as gastroenteritis, which damages the gut lining and will resolve once the virus passes. Lactose intolerance can also present with a new diagnosis of coeliac disease; once treated, it will resolve.
 
Functional lactose overload: may occur in breastfed babies who are receiving large amounts of lactose-rich milk, often in a case of over-supply. This can be managed with the right breastfeeding support, there no need to stop breastfeeding or switch to a lactose-free formula.
 
If you notice any of the above symptoms in your child, it is important to speak to your doctor, dietitian or lactation consultant, so the appropriate action may be taken.
 
For up-to-date, evidenced based information on allergies, check out the Australasian Society of Clinical Immunology and Allergy (ASCIA) website: https://www.allergy.org.au/ 

By Emma McShane, Dietitian, edited by Nicole Bando (APD, IBCLC), November 2022

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​Dairy products contain 10 essential nutrients; calcium, potassium, phosphorus, magnesium, carbohydrate, protein, vitamin A, riboflavin, vitamin B12 and zinc, important for healthy immune and blood systems, eyesight, muscle and nerve function, healthy bones, skin, energy, growth and repair of your body. If your child cannot have dairy, whether it be due to an allergy, intolerance or dislike, it is important to find alternatives that provide these nutrients.
 
Soy milk has the most similar nutritional profile to cow’s milk and is considered the best choice if your child cannot have dairy, unless they have a soy allergy. Soy milk is also high in protein. Look for soy milks with added calcium, Vitamin A, B1, B2, and B12. When opting for a milk alternative, always look for brands that contain 120mg/100mL of calcium.
 
If your child cannot have dairy and soy, other options are:
-        Oat; contains protein, fibre and is high in carbohydrates. Choose those fortified with calcium.
-        Almond milk; low in protein and carbohydrates. Again choose unsweetened brands with added calcium.
-        Coconut: High in saturated fat, and low in most nutrients e.g. protein, carbohydrates, vitamins and minerals.
-        Check out our article comparing plant vs dairy milks: https://www.nicolebando.com/articles/which-milk-a-review-of-plant-vs-dairy-milks
 
For dairy-free brands, see our article; https://www.nicolebando.com/articles/dairy-free-andor-soy-free-foods-supermarket-brands-to-look-for.
See here for information on how much dairy kids need.
 
Full cream or low fat milk?
The latest evidence suggests that full cream milk is recommended from the age of 12 months onwards, even into your adult years, unless you have high cholesterol, and then reduced fat is recommended.
 
Infants (0-12 months of age) should only be given breastmilk or infant formula. Cow’s milk as a drink is not suitable for infants under 12 months of age. Cow’s milk may be consumed as part of a meal, e.g. in cereal. 

By Emma McShane, Dietitian, November 2022 (Edited by Nicole Bando, APD, IBCLC)

Eggs: how many is too many?
Eggs are a great source of nutrition, including protein, iron, choline, Vitamin D, B12, and selenium. Eggs contain heart healthy monounsaturated fats and also some saturated fat (which can increase cholesterol in excess). Include up to seven eggs a week, this won’t increase risk of heart disease. Those at increased risk of heart disease can eat up to six eggs per week.
 
How often should I eat fish?
Research supports including 2-3 portions of fish per week.  Try to choose sustainably sourced fish and limit high mercury options, such as shark, swordfish, barramundi, orange roughy and ling. Low mercury fish include salmon, mackerel, tuna, sardines and shellfish.
Fish are a great source of omega-3 fatty acids (unsaturated fats – known as good fats!) which contributes to brain health and development and reduces risk of heart disease.
Protein, selenium, zinc, iodine, and vitamins A and D are other important nutrients in fish.
 
Vegetables: what’s 5 a day?
We may have all heard that adults need five serves of vegetables a day. To help figure this out, a serve of vegetables is ½ cup of cooked vegetables, canned or cooked legumes, or 1 cup of green leafy vegetables or chopped salad. To achieve this, aim to include half a plate of vegetables at lunch and dinner.
 
Did you know that toddlers need 2-3 serves per day, increasing to 5 serves by aged 9? A great way to increase vegetable intake, is to offer them 2-3 times per day, for important nutrients, including potassium, fibre, Vitamins C & A. Eat from the rainbow by choosing lots of different coloured vegetables. If 5 a day feels a bit tricky, start small and try to add some chopped carrot or cucumber to your morning snack. Frozen, canned and fresh are all great options.

By Emma McShane, Dietitian, edited by Nicole Bando (APD & IBCLC), October 2022
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Water is essential for our body’s vital functions; to maintain healthy cells, eliminate by-products and excess electrolytes (salts), regulate body temperature, aid digestion and more. In a child over 12 months, it is the first choice of fluid. Many drinks (other than milk and water) contain sugar (or artificial sweeteners), colourings and limited nutrients. These drinks can impact healthy growth and reinforce a preference for sweet foods. Why not try to flavour water with mint leaves, frozen fruit pieces, orange or lemon rind?
 
Are sugar free drinks ok?
Sugar free drinks contain large amounts of artificial sweeteners, colours and flavouring to substitute the sugar. They are not a great choice for children as can promote preference for sweet foods. Carbonated drinks are acidic and can erode tooth enamel.
 
Is fizzy water ok?
Fizzy water is recommended in small amounts, as the bubbles can cause tummy upset. Research has also shown that excessive sparkling water can erode tooth enamel.
 
What about juice?
Consume in small amounts, for a child this may mean ½-1 glass occasionally. The sugar content of juices is high, as it can take 4 pieces of fruit to make 1 cup of juice! Juicing removes vital components of fruits and vegetables, such as fibre which is important for our bowels and stomach health. When making juice, use 1 piece of fruit and add vegetables such as carrot, celery, cucumber, spinach etc.
 
Are probiotic drinks ok?
Kefir is a great example of a healthy probiotic drink for children and adults. It’s a great source of Vitamins A, D, protein and calcium. Alternative, high sugar probiotic drinks on the market are not recommended for children.
 
Smoothie recipe:
 
Smoothies can be a good way and versatile way to use up fruit and vegetables in your fridge, and cook with your child. Try using this structure to make a smoothie for 1:

1. Liquid base -  e.g. 1 cup milk/alternatives (e.g. soy milk with added calcium)
2. Add 1 piece of fruit, try frozen for a creamy consistency.
3. Vegetables – add in 1-2 vegetables such as spinach
4. Flavour – add a teaspoon of nut butter, cinnamon or 1 tb of cacao.
5. Extras: 1 tb chia seeds, 2 tb of yoghurt or 2 tb of oats will boost the nutrition of the smoothie.
6. Add a handful of ice.
7. Blend and enjoy!!

By Emma McShane, Dietitian, edited by Nicole Bando (APD & IBCLC)

​Fruit contains vital nutrients including fibre, slow release carbohydrates, and myriad vitamins, minerals, plant nutrients & antioxidants (prevent damage to cells). The amount of fruit an individual needs depends on their age and stage. The type of sugar found in fruit is generally slow release energy and different to the free sugar added to processed foods, making it an excellent component of the daily diet. Leave the skin on for added fibre, to assist regular bowels and happy gut bacteria. Choose a variety of fresh, frozen or canned in juice. Watch out for products such as fruit straps, stringers & puffs as they tend to be high in fruit puree, concentrates & added ingredients, making them high sugar, low nutrient options.
 
What is a serve of fruit?
-          1 medium apple, banana, etc.
-          1 cup of canned fruit in juice
-          2 small stone fruit or kiwi
-          30g dried fruit = 4 dried apricots halves, 1 ½ tb of sultanas (include dried fruit occasionally, around once per week).
 
So how much does a child or adult need per day?
-          1-2 years: ½ serve = e.g. ½ medium apple, ½ cup canned fruit or 1 small apricot
-          2-3 years: 1 serve = e.g. 1 medium apple, 1 cup of canned fruit or 2 small apricots
-          4-8 years: 1 ½ serves = e.g. 1 apple & ½ cup strawberries,
-          9-18+ years: 2 = e.g. 2 medium apple/banana, etc. or 4 small apricots/kiwi/plums.
 
Aim to mix up the variety of fruit across the day and week. For example, a 4 year old may have 1 medium apple, and 1 small apricot to reach 1 ½ serves.
 
If your child loves fruit and is eating more than is recommended, it may mean they are missing out on other foods from the core food groups. Also, excessive fruit can lead to tummy upsets, due to the overload of fructose (this does not mean they are fructose intolerant). Try these alternative healthy snacks:

• Vegetable sticks e.g. carrot, cucumber and celery with dips

●       Corn on the cob
●       Boiled eggs
●       Cheese on crackers
●       Yoghurt
●       Nuts (if older than 5 years)
●       Snack size canned chickpeas and edamame
●       Popcorn (if older than 5 years)
 
See our article on Healthy Lunchboxes for other healthy snack ideas: https://www.nicolebando.com/articles/a-healthy-lunchbox
 
References:
Eat for Health. Recommended number of serves for children adolescents and toddlers. 2015. Available at https://www.eatforhealth.gov.au/food-essentials/how-much-do-we-need-each-day/recommended-number-serves-children-adolescents-and

​By Emma McShane, Dietitian, edited by Nicole Bando, APD

The planet's population is increasing, therefore meat intake continues to rise. Livestock production has negative effects on our environment as meat produces more energy emission per unit than plant-based foods, and livestock production produces methane, affecting the earth’s temperature and climate.
 
There is no need to cut out meat entirely, however reducing the amount of meat your family consumes is beneficial for the environment and overall health.
 
Try slowly reducing the amount of meat you eat by implementing one meat-free night per week and then slowly building this up, aiming for 3-4 meat free days per week.  You may be asking, what can I eat instead? 
 
Meat substitutes include:
-Legumes; lentils, chickpeas, butter beans
-Tofu & tempeh
-Vegetables e.g. mushrooms, eggplant
-Cheese e.g. paneer, ricotta
-Egg

Try this easy roast vegetable recipe, simply add a drained can of chickpeas for a balanced meal.
 
If reducing your meat consumption is not for you and/or your family at the moment, there are some meats that are considered more sustainable than others. Kangaroo is a high protein, lean meat that requires less feed and water during production than other meats, sustainably caught fish is also another good option. If choosing chicken, try buying free-range.  Grass fed beef isn’t necessarily better for the environment overall, given the demand for this has increased over the last few years. Or try adding a can of lentils to your bolognaise to boost plant intake and make the meal go further. 

By Emma McShane, Dietitian (edited by Nicole Bando, APD, IBCLC), September 2022

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Children attend multiple parties every year. If each party provides lolly bags (alongside party food), our kids are likely to consume excessive amounts of sugar, with minimal nutrients. These foods take the place of healthier options and can impact healthy growth, mood & concentration, not to mention the copious plastic packaging that ends up in landfill. We can have a positive impact on our children and planet by choosing healthier party food options & lolly bag alternatives. Why not give these ideas a try for your next children's party?
 
-          Craft to-do sets e.g. scrapbooking materials
-          Colouring in books
-          Play-Doh kits
-          Pencils and notebooks
-          Books
-          Seedlings to grow a garden
-          Frisbee or sporting equipment such as a ball
-          Recipe cards to healthy recipes to make at home
 
Try providing these in paper bags instead of plastic bags to make your party more environmentally friendly. 

​By Emma McShane, Dietitian. Edited by Nicole Bando, Dietitian & LC

By Emma McShane, Dietitian. Edited by Nicole Bando, Dietitian & IBCLC, August 2022

At a party, a small amount of sugary food is okay, though it is important to ensure the majority of the food includes healthy options for children to ensure they are being nourished for growth & their best health. Children may have many parties over a weekend, which means their opportunity to eat high sugar, processed foods is beyond their needs for growth.
 
For quick, easy packaged food options to include in your next kids’ party, check out this link:
https://www.nicolebando.com/blog/simple-packaged-snack-swaps
 
These colourful ideas also promote growth, mood, play & concentration:
 
-          Vegetable sausage rolls made with filo pastry
-          Assorted sandwiches using multigrain bread
-          Fruit skewers
-          Fruit and yoghurt cups
-          Wholemeal pita bread pizzas loaded with vegetables such as spinach, capsicum, tomato, mushrooms etc.
-          Healthy bliss balls
-          Popcorn for children over 3 years of age
-          Cheese and crackers
-          Rice crackers & dips
-          See our allergy friendly party food list 

Lolly bags have an excessive amount of sugar and minimal nutrients, and are generally not recommended. Try swapping out lollies for something else, such as colouring books and utensils, craft ideas or recipe cards for healthy foods to make at home. Or offer 1 small treat instead of a bag.

​If you are planning a party for children who have food allergies, it can seem overwhelming to know where to start. Follow these steps for safe and yummy party food. A food allergy is when a person’s immune system reacts to the protein in a food, causing symptoms such as hives, rashes or in more severe cases swelling of the mouth and throat (anaphylaxis).  Find out which allergens you need to exclude and take it from there. The key allergens are: peanuts, dairy, wheat, egg & fish.

1. Have a plan: Find out the symptoms of the child’s food allergy. Who will be supervising them? What is their allergy/anaphylaxis plan? Make sure they have their epi-pen & you or a supervising adult knows how to use it. Call an ambulance if the child demonstrates signs of an allergic reaction.
2. Know your key allergens and read the ingredients list. It is Australian law that processed foods must be clearly labelled to include allergens using their common names (e.g. egg or milk) so that they can be easily recognised. Allergens are often shown in bold in the ingredients list. There is also a ‘contains’ section that has a summary list of the allergens present in that food. Check food labels every time you buy the product, as ingredients and processes can change. 
3. What about ‘may contain traces of?’ This means that there is a potential cross-contamination risk.  It may be best to avoid these foods for safety reasons.
4. Food preparation and cross contamination: When the tiniest amount of an allergen comes into contact with another food (e.g. crumbs from wheat bread are on the bread board used to prepare gluten-free bread) it can be enough to cause an allergic reaction. Set up the food preparation area in a clean environment away from other foods being prepared. Use only clean (using hot, soapy water) equipment when preparing food. Make sure that your hands are cleaned prior to preparing and serving as well and that any products used haven’t been exposed to allergens (e.g. margarine previously used for wheat containing bread). 
5. So what party foods can I serve? Choose fresh over processed foods, it is easier to avoid multiple food allergens this way. Have fun with fruit, e.g. fruit skewers or try our simple allergy-friendly popsicle recipe: Blend 500ml of plant-based milk, 1 tb of maple syrup and your choice of 300g frozen fruit. Pour mixture into moulds, add an icy-pole stick & freeze until solid. Also try gluten-free pizza bases with vegetables (either without cheese or with vegan cheese), tofu and vegetable skewers, mini beef burgers with gluten free rolls, 100% corn chips & avocado dip, popcorn (over 3 years), rice crackers & dried fruit.  Consider party bags that are food free and perhaps involve craft, such as colouring.
6. What about the cake? Check out this allergy free birthday cake recipe! https://www.allergicprincess.com/egg-free-dairy-free-nut-free-cake/ - if looking for a wheat/gluten free option, swap out the plain flour for gluten-free flour.

 
References:

1. What is allergy? - Australasian Society of Clinical Immunology and Allergy (ASCIA) [Internet]. Allergy.org.au. 2022 [cited 9 July 2022]. Available from: https://www.allergy.org.au/patients/about-allergy/what-is-allergy
2. Avoiding Cross-Contact [Internet]. FoodAllergy.org. 2022 [cited 9 July 2022]. Available from: https://www.foodallergy.org/resources/avoiding-cross-contact
3.  [Internet]. Allergy.org.au. 2022 [cited 9 July 2022]. Available from: https://www.allergy.org.au/images/pcc/ASCIA_PCC_Dietary_avoidance_general_info_2019.pdf

 
 By Emma McShane, Dietitian, edited by Nicole Bando, Dietitian & LC, August 2022
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INTRODUCTION TO SOLID FOODS,
By Emma McShane, Dietitian
​
The World Health Organisation states ‘infants should be exclusively breastfed for six months and after this time continue breastfeeding with appropriate introduction to solids’ (2020).
When breastfeeding is not possible, bottle feeding is recommended.
How do you know if your baby is ready for solid foods?

• Your baby has good head and neck control and can sit upright when supported
• Your baby shows an interest in food e.g. looks at or reaches out for your food
• Your baby opens their mouth when offered food on a spoon
• Your baby has an increased appetite, is feeding more often, and wants more breast milk or formula at the end of their usual feed.

 
VARIETY OF FOODS:
It is important to include a variety of foods from the five core food groups in your baby’s diet.

CEREAL FOODS
Be sure to offer a variety of grains including wheat, rice, oats and corn.
Example of cereal foods: Bread, crackers, pasta, iron-fortified cereals e.g. Weet-bix, all bran

DAIRY FOODS
Yoghurt, cheese, and cow’s milk on cereal.
Cow’s milk should not be given as a drink (instead of breastmilk or formula), for babies under 12 months of age.

MEAT AND MEAT ALTERNATIVES
Beef, lamb, poultry, well-cooked egg, fish, other seafood, legumes (e.g. lentils and chickpeas)

VEGETABLES AND FRUITS
Can be grated, cooked, pureed or mashed.

Introducing Common allergy causing foods:

• Common allergy causing foods should be included in your baby’s diet before nine months of age, as research has shown that early introduction may reduce the chance of your baby developing a food allergy.
• These common allergy causing foods are: Eggs, Cow’s Milk, Wheat, Soy, Peanut, Tree nuts, Sesame     Fish, Shellfish
• It is important to introduce one new allergy causing food at a time, early in the day, and then wait a few days to try another new food, so that you can identify any foods that may cause an allergic reaction.
• An example of how to introduce an allergy causing food, is to mix a small amount (1/4 tsp) of an allergy causing food e.g. hard-boiled egg or smooth peanut butter into your baby’s usual food e.g. vegetable puree. If there are no signs of an allergic reaction (These signs include: hives, welts, swelling of the lips, vomiting, or change in behaviour), then gradually increase the amount next time (1/2 tsp). If your baby does show signs of an allergic reaction, stop offering the food and seek immediate medical attention.
• It is important that once you have introduced these foods, to include these foods in your baby’s meals at least twice a week.

The below is a guide of solids progression, showing texture, quantity and breast/bottle feeds; it may be highly variable for each baby. You may also choose a ‘Baby Led Weaning’ approach, this involves introducing solids through appropriately textured and sized finger foods and allows your baby to explore the food themselves. There is no set way to feed your baby, so do what feels best for your family.
The above is an approximate guide for food quantities and expected number of breast and bottle feeds, this is because there are no set guidelines, as each baby will progress differently. If you feel unsure about how to introduce solids to your baby, a Children's Dietitian (Paediatric Dietitian) can provide specialised feeding advice.
  
6 MONTHS

TEXTURES
Coarsely pureed/mashed

QUANTITIES
1-2 tablespoons, twice a day (start with 1 meal and progress to 2 over weeks).

EXPECTED NUMBER OF BREASTFEEDS
Breastmilk is the main nutrition source. Continue breastfeeding on demand.

EXPECTED NUMBER OF BOTTLE FEEDS
If your baby is not breastfed, continue with bottle feeds, as this is still the baby’s main nutrition source. Slight decreases may be seen in the amounts taken.

EXAMPLE OF FOODS
Start with iron-rich foods; as your baby’s iron stores gained during pregnancy start to run low. These foods include fortified baby cereals, eggs, beans, lentils and soft cooked and pureed meat. Introducing allergy causing foods e.g. yoghurt added to pureed fruit and vegetables, Semolina porridge made with breast milk or infant formula.

6-8 MONTHS

TEXTURES
Lumpy, finely chopped, progressing to finger foods

QUANTITIES
Progressing 1-4 tablespoons of food 1-3 times/day by 8 months (slow progression) – up to ½ cup of food

EXPECTED NUMBER OF BREASTFEEDS
On demand

EXPECTED NUMBER OF BOTTLE FEEDS
3-5 times per day at 6-8 months

EXAMPLE OF FOODS
Peanut butter added to mashed foods or porridge, hummus mixed into mashed vegetables, finely shredded, soft meat added to puree vegetables.

8-10 MONTHS

TEXTURES
Grated, diced, chopped finger foods, progressing to regular menu
You’ll find your baby starts to play with their spoon. 

QUANTITIES
Up to 1 cup of food at each meal
At 9 months: 3 meals
At around 10 months: Introduce mid-meals, roughly ½ to ¾ cup of food (e.g. ½ cup full fat yoghurt with cut up banana).

EXPECTED NUMBER OF BREASTFEEDS
On demand; By 9 months: 4-5 breastfeeds

EXPECTED NUMBER OF BOTTLE FEEDS
3-4 formula feeds at 9-12 months

EXAMPLE OF FOODS
Well-cooked spiral pasta as finger food, hard-boiled egg with mashed avocado, soft grated cheese as finger food, pikelets.

10-12 MONTHS

TEXTURES
Chopped finger foods, Begins spoon feeding

QUANTITIES
Small balanced meals 3x/day e.g. 1 scrambled egg, chopped soft fruit, 1 Weetbix with cow’s milk, plus mid-meal snacks 1-2x/day.

EXPECTED NUMBER OF BREASTFEEDS
On demand; 3-4 breastfeeds per day

EXPECTED NUMBER OF BOTTLE FEEDS
600mL Bottle feed/day

EXAMPLE OF FOODS
Omelettes, cottage cheese and fruit mixed together, bread offered as toast fingers or sandwiches, homemade fish fingers, pesto sauce with pasta.

1-5 YEARS

Family foods (avoid small, hard pieces of food).  Can offer cow’s milk as a drink after 12 months.
Example foods: Scrambled eggs, Crumbed fish, vegetables dipped in hummus, pastas, cereals with cow’s milk
 
References:

1. Australian Breastfeeding Association. Breastfeeding and family foods.  ABA, 2020. (Available from: https://www.breastfeeding.asn.au/, accessed May 31st, 2021).
2. Australasian Society of Clinical Immunology and Allergy. Introducing foods and allergy prevention fast facts. ASCIA, 2019. (Available from https://www.allergy.org.au/images/pcc/ff/ASCIA_Introducing_Foods_Fast_Facts_2019.pdf, accessed  May 31st, 2021).
3. NIP Allergies in the Bub. Introducing solid foods. Prevent Allergies, 2018. (Available from https://preventallergies.org.au/introducing-solid-foods/, accessed 31st May 2021).
4. NIP Allergies in the Bub. Around 6 months (not before 4 months). Prevent Allergies, 2018). (Available from https://preventallergies.org.au/wp-content/uploads/2020/10/Food-Ideas-for-Babies-around-6-Months.pdf, accessed May 31st 2021).
5. NIP Allergies in the Bub. Around 7 to 9 months. Prevent Allergies, 2018. (Available from: https://preventallergies.org.au/wp-content/uploads/2020/06/RECIPE-IDEAS-FOR-BABIES-7-9-MONTHS.pdf, accessed May 31, 2021).
6. NIP Allergies in the Bub. Around 10 to 12 months. Prevent Allergies, 2018. (Available from: https://preventallergies.org.au/wp-content/uploads/2020/06/RECIPE-IDEAS-FOR-BABIES-10-12-MONTHS.pdf, accessed May 31, 2021).
7. Castle J., Jacobson M.  (2013). Fearless Feeding. Jossey Bass. pp 40-54. Accessed May 31, 2021.
8. Surwald, D. (2017). Baby-led weaning & introduction of solids. Peninsula Health. Accessed June 10th 2021. Available from: https://www.peninsulahealth.org.au/2017/08/25/baby-led-weaning-introduction-of-solids/

Is it normal for a toddler to be a fussy eater?
By Melbourne Dietitian, Nicole Bando
As a children's dietitian, this is a commonly asked question. Many parents feel concerned about the variety and quantity of food their toddler eats. A fussy eater is defined as a child who refuses to try a new food at least 50% of the time. Fussy eating behaviours in the second year of life are normal and part of how your child expresses their new found independence whilst exploring the world around them. It is normal for children to be uncertain of new tastes and textures; an evolutionary mechanism designed to keep us safe from danger! We have a natural preference for sweeter foods as they are higher in calories, another survival mechanism which no longer serves us.
Establishing healthy habits early in life is important for a child’s optimal growth and development, and reduces the risk of obesity and chronic disease later in life. When a child develops fussy eating behaviours, meal times can become stressful for the whole family. There are many strategies to prevent and manage selective eating habits, making meal times enjoyable once again.

2) When should I worry about my toddler's eating?
Growth slows during a child’s second year, and so their intake reduces. Many parents worry that their child isn’t eating enough, however may have unrealistic expectations of how much their child needs each day. Toddlers have a small stomach capacity and need to graze frequently throughout the day. Remember that a healthy child will never go hungry, and if energetic and thriving, they are likely eating enough. Seek help from your GP, Maternal Health Nurse or Paediatric Dietitian, if your child is:

• exhibiting extreme fussy eating behaviours and mealtimes are very difficult
• lethargic and lacks energy for daily activities
• appears unwell

• gagging or vomiting often, or has problems with chewing or swallowing
• eating a very limited variety of foods and missing out on entire food groups
• unable to drink from a cup from around 16 months
• rejecting whole food groups or groups of foods of a similar texture
• not growing or developing as expected

 
3) How can I encourage my toddler to eat what I offer them?
Are you or any other adults in the house fussy eaters? Research shows that eating meals (as often as possible) demonstrates positive role modelling. If children see their parents eating a variety of foods, they are more likely to learn and copy that behaviour. These times give opportunity to chat, as well as share a meal. Try to cook 1 family meal, so that everyone is eating the same food (may need slight modification for texture), together as often as possible. It doesn’t matter if your child doesn’t want to eat or try everything on the plate. Repeated and exposure of a variety of new foods will help your child to develop healthy habits. 
The below strategies can help manage fussy eating behaviours:
     Parents use a consistent approach with all strategies
     Keep calm, avoid a fuss as this gives issue more attention which can lead to a power struggle
     Avoid using punishment or bribes e.g. dessert as reward for eating vegetables
     Minimise distractions: eat at table, away from television, devices or toys.
     The Division of Responsibility: it is the parent’s job to offer a variety of healthy foods at the right times and the child’s role to decide what, and how much to eat.
     Offer foods in different ways e.g. broccoli with melted cheese, or stir-fried to promote enjoyment and acceptance
     Keep meal times to a reasonable time limit and develop a routine around meals.
     A new food may need to be offered up to 15 times before it is accepted. Many parents give up after a few times.
     Harness your toddler’s independence and encourage self-feeding, with a mixture of finger foods and mixed textured foods, requiring a spoon or fork
     Children love helping and can assist with shopping for the family’s food and simple meal preparation.
     Your child’s appetite can vary considerably day-to-day depending on activity and growth. If your child rejects the food offered, avoid offering an alternative, instead reoffer the food at a later stage, perhaps they are just not hungry.
     Sometimes children can be filling up on milk and this takes away their appetite for other foods. They may not be fussy, just full.
     Toddler formula is not necessary in a child’s diet. It displaces food gives preference to sweet tasting drinks. After 12 months, cow’s milk or a suitable dairy alternative can be provided as a drink. Breastfeeding may continue for as long as mother and child are enjoying it.
     Keep high sugar and high fat treat foods to a minimum. These can take place of foods from the other food groups, which means your child does not have the appetite for nutritious foods.
4) Should I force my toddler to eat?
Forcing a child to eat will create a negative association with food, which can have long-lasting effects, such as poor relationship with food, food aversions and worsening fussy eating behaviours, a high level of stress at mealtimes and reinforcing an idea that healthy foods are bad. It also overrides your child’s own hunger and fullness cues, and this can contribute to weight gain and obesity in later life. Forceful behaviour includes coercion, ‘have one more mouthful’ and negotiation, ‘eat this and you can have dessert’. If your child does not want to eat at a particular time, it can be for a whole range of reasons, so if you feel concerned, see your health professional to discuss. Children are excellent at regulating their own appetites and by using the above strategies, you can help your child to create a healthy relationship with food.