The introduction of complementary foods is something that sooner or later (or better – in a timely manner) any mother faces. And one of the questions that haunts her – where to start?

To date, there are no convincing data indicating significant advantages of choosing a particular product as a complementary food, as well as the sequence of product introduction.

Only a full-fledged intake of all the necessary nutrients, including vitamins, macro- and microelements, is recognized as necessary. Thus, when choosing products for the first complementary feeding, one should take into account the most acute needs of a growing organism in individual elements necessary to ensure normal life: iron, calcium, zinc, other minerals, as well as vitamins, proteins, carbohydrates, etc.

In connection with the above, opinions on the choice of a product for the first complementary feeding differ.

  1. Porridge should be introduced first

According to Borovik T.E., Skvortsova V.A., Ladodo K.S., Netrebenko OK and others, it is preferable to use dairy-free porridge as the first complementary food, and preferably industrial production, enriched with  calcium, iron, iodine,  zinc, vitamin D as well as other minerals and vitamins. 

At the first stages, the baby should be introduced monocomponent gluten – free dairy –  free cereals: buckwheat, rice, corn. Such cereals should be diluted with water, breast milk or a mixture to which the child is accustomed.  

It should be noted that even unfortified cereals provide 20-30% of the baby’s daily need for nutrients and slowly utilized energy (due to the high content of carbohydrates (mainly polysaccharides)), and are also a source of protein,  minerals, vitamins (especially group B) and dietary fiber. 

At the same time, buckwheat and oat groats have the  highest nutritional value (remember that oat groats contain gluten, so it should be introduced with caution and preferably after the introduction of gluten-free cereals). These cereals are rich in  dietary fiber,  vegetable protein, contain a sufficient amount of  iron,  potassium,  magnesium, phosphorus, zinc, B vitamins. Corn and rice cereals are characterized by a high starch content, but a low level of  protein,  fat,  mineral salts and  vitamins. 

The value of cereals also lies in the fact that later they can be combined with all other types of complementary foods (add milk, pieces of fruit, or use as a side dish), which contributes to the  formation of a variety of taste perceptions. 

Especially often, porridge as the first complementary food is recommended to be administered to children with insufficient weight gain,  signs of rickets, a  tendency to regurgitate,  iron deficiency,  unstable stools, atopic dermatitis, premature babies, as well as children who are introduced to complementary foods after 6 months of life. 

Further, as a rule, it is recommended to introduce vegetables, then meat or fruits (here opinions are divided).

2. Vegetables should be introduced first

Most pediatricians recommend starting complementary foods with vegetables, since vegetables are a source of carbohydrates, vitamins (A, C, group B,  folates,  carotenoids), organic acids,  trace elements and  minerals (including iron, sodium, potassium, etc.), and an important source of vegetable dietary fiber and pectins,  which normalize the intestinal microflora and prevent constipation .  

It is proposed to start the introduction of vegetable puree with one type of non-red vegetables (zucchini,  cauliflower, broccoli,  squash, pumpkin, then potatoes, carrots). In the future, vegetables can also be combined with meat, cereals, fruits.

It is believed that vegetable purees with the addition of green beans, green peas and other legumes should not be given to a baby earlier than 7 months old, since they have a high content of  plant fibers and special types of sugars – raffinose and stachyose trisaccharides, which can irritate the intestinal mucosa, and also lead to bloating and gas production. 

From 8-9 months, you can add herbs (parsley, dill,  spinach,  celery) to vegetable puree  . This will improve the taste of dishes due to the high content of essential oils in the greens, as well as additionally enrich them with vitamins.

As a first complementary food, vegetable puree is usually recommended for healthy children, as well as for children with excess weight gain, a tendency to constipation.

3. Juices, fruits and teas should be introduced first

For a long time in the countries of the USSR, complementary foods should have started with juices. Some pediatricians are still convinced of the correctness of this approach and continue to convince inexperienced mothers.

It is assumed that by using liquid juices, and then fruit puree, the child gradually gets used to thicker food, and this is necessary for the subsequent introduction of grain and vegetable complementary foods, i.e. fruit juices and purees are regarded as “training complementary foods”.

In addition, fruit juices and purees are a source of mineral salts ( iron,  potassium),  sugars, dietary fiber, some vitamins (vitamins C, P,  β-carotene,  folic acid, etc.), organic acids. The presence of dietary fiber ( pectin,  cellulose, hemicellulose) has a positive effect on intestinal peristalsis, and also promotes the binding of toxins and their subsequent elimination from the intestines with feces. 

However, to get the baby used to thicker food, you can just as well begin to introduce a thinner porridge (as for a bottle). As for vitamins and minerals, their content in fruit juices is relatively small (approximately 0.3-0.5% of the  nutritional value of the diet for vitamins and minerals), and, accordingly,  cannot satisfy the needs of a growing organism.

Thus, from the standpoint of replenishing the deficiency of vitamins and minerals, there is no indication for the introduction of fruit juices and puree in the form of the first complementary food product. In addition, the osmolarity (concentration of dissolved particles in 1 liter of liquid) of fruit juices is 2 times higher than in breast milk or in an adapted milk formula. Some juices (including apple juice, which is often recommended as a first meal)  contain sorbitol and high fructose / glucose ratios, which can lead to fermentation, increased gas production, and cause colic in infants.

If the rationale for the introduction of fruit juices and mashed potatoes is considered the receipt of new types of tastes and aromas with complementary foods, then it is probably safer and no less effective in this regard to introduce a small amount of fruit additives as an addition to the already introduced cereals or vegetables.

Also, some mothers give their babies herbal teas almost from birth. In Chapter 5 of the National Program for Optimizing Feeding of Infants in the First Year of Life in the Russian Federation (hereinafter referred to as the Program), children’s herbal teas are recommended for introduction no earlier than 4 months of age.

However, according to the World Health Organization (hereinafter – WHO), as well as some of our authors (in particular, Shamanskaya T.V., Kachanova D.Yu.), all types of tea (herbal / black / green), as well as coffee should be avoided at least 24 months of age, as they interfere with the absorption of iron by the body (iron absorption is reduced by about 75%). After this age, you should avoid drinking
tea with meals.

Chapter 6 of the program discusses nutrition for iron deficiency. In particular, for the prevention of anemia, the development of which is promoted by teas, the authors of the Program recommend the inclusion in the diet of industrial products fortified with iron, including fruit juices and purees. In this regard, WHO experts note “But this will only be the elimination of the consequences of a problem that did not exist at the beginning.”

Thus, the introduction of fruit juices is preferable at a later date, especially in case of dysfunction of the gastrointestinal tract and food intolerance. It makes sense to introduce fruit purees as an addition to an existing diet in order to expand the flavor palette. As for tea and coffee, they should not be complementary foods at all.

4. Meat should be introduced first

The Guidelines  for the WHO European Region,  with a particular focus on the republics of the former Soviet Union, “Feeding and Nutrition of
Infants and Young Children” (hereinafter – the WHO Guidelines) contains the phrase: “ When introducing complementary foods at about 6 months of age,  it is important that the diet included iron-rich foods such as liver, meat, fish and legumes, or iron-fortified complementary foods. ”

Thus, WHO considers it possible to introduce meat, if not as the first complementary food, then one of the first.

The general trend  towards an earlier introduction of meat products is reflected in the domestic recommendations. The program provides for the introduction of meat complementary foods from 6 months of age.

Some works indicate the possibility of introducing meat products into complementary foods  in the presence of iron deficiency anemia or its risk  from 5–5.5 months of a baby’s life, including as the first complementary food.

This approach is considered as a measure for the prevention of iron deficiency, since iron deficiency in infants and young
children is widespread and can cause  irreversible changes (decreased learning ability, memorization,  cognitive impairment, decreased intellectual and psychomotor development), and prevention and timely correction can improve cognitive functions, as well as minimize long-term consequences. 

Why is meat considered the best way to prevent iron deficiency? Meat is a source of complete animal protein with a balanced set of amino acids (20-21%), “heme” iron (that which is part of hemoglobin, ie, contained in animal products),  vitamins of group B, PP,  minerals and trace elements ( potassium, magnesium,  phosphorus,  zinc). “Heme” iron is assimilated by the body regardless of the influence of other food components by 17-22%, while the absorption of “non-heme” iron (which is contained in plant foods) is only 3-5%. Moreover, the degree of assimilation of “non-heme” iron depends on many factors (a set of food products, the  concentration of iron salts,  pH, medications, etc.), which can either promote or interfere with iron absorption. 

The introduction of meat should begin with a monocomponent meat puree from hypoallergenic meats ( turkey,  rabbit, horse meat), followed by an expansion of the diet with lamb, pork, beef, chicken. The use of modern production technologies allows you to adapt the degree of grinding meat puree according to the functional capabilities at different stages of the baby’s development, and the guaranteed composition (no  GMOs, dyes, preservatives,  starch, salt) gives them hypoallergenic properties.  

5. Fermented milk products should be introduced first.

Undoubtedly, vegetable purees, cereals and meat benefit from the amount of iron, vitamins and mineral salts. However, some authors (including Komarovsky E.O.) believe that you need to start with fermented milk products, since they are closer in composition to breast milk (or to an adapted mixture), which is very important when choosing the first complementary food, because babies are  very bad endure a sharp change in the composition of food. 

Thus, it is assumed that complementary foods, started with kefir and cottage cheese, reduce the likelihood of intestinal disorders. In addition, fermented milk products contain lactic acid bacteria, which, firstly, help a small body to cope with pathogenic flora that can cause intestinal infections; secondly, they participate in the formation of enzymes, respectively, improve digestion;  thirdly, they reduce the load on the child’s weakest and immature organ – the liver.

However, other authors generally doubt the need to include milk and fermented milk products in the nutrition of children of the first year of life, since this can lead to protein overfeeding (especially for babies receiving adapted formulas), which may be accompanied by an increase in body mass index, a higher level of blood pressure and a decrease in glucose tolerance at the age of 4–7 years, respectively, is a risk factor for the development of obesity, hypertension, and insulin resistance. When consuming proteins of whole cow’s milk (including when cooking porridge on it) kefir (400 ml), the possibility of diapedetic intestinal blood loss, presumably of an allergic nature, and a decrease in the serum ferritin level have been proved. In addition, the low content of the metabolite in milk and kefir, the high content of protein and calcium in them, impair the absorption of iron in the intestine.

WHO has nothing against fermented milk products in the second half of the first year of life. On the contrary, the WHO Methodological Recommendations indicate a number of useful properties of lactic acid products (including accelerating the absorption of “non-haem” iron due to low pH, preventing a wide range of diseases (atherosclerosis, allergies, gastrointestinal diseases, cancer)).

But the WHO recommends abstaining from the introduction of whole cow’s milk as a  milk component of the diet until 12 months of age (at least up to 9 months).

There is no doubt that early nutrition is one of the leading factors in determining the health of a child. Organization of complementary foods in accordance with modern ideas and recommendations, namely, an individual approach in terms of timing (I wrote about the “pluses” and “cons” of different terms of introducing complementary foods here ), the sequence of introduction and the choice of products depending on the child’s health and nutritional status (complex various indicators characterizing the quantitative ratio of muscle and fat mass of the body), allows not only to provide it with the necessary nutrients, but also to prevent or correct (if necessary) functional disorders of the gastrointestinal tract, deficiency conditions, food allergies.

The ambiguity of the recommendations on the timing and sequence of the introduction of complementary foods should be perceived as an opportunity for the local doctor to choose an individual approach for each child. However, many doctors, unfortunately, do not take advantage of this opportunity,  because it is much easier to prescribe the assortment of foods and complementary foods offered in the Program within the time recommended in it (and “just in case” at the earliest) and in the sequence that is provided for in it. as a general recommendation.

In connection with the above, the mother should remember that the recommended period indicated on the jars and boxes with industrial foods of complementary foods only means the age from which the use of this product is safe for most children in the population, and in no way means the need introduce this product to your child during this period.

Conclusion: the choice of the first product for complementary feeding requires an individual approach, in which one should start with those products that are necessary for a particular child at the time of the beginning of complementary feeding, focusing on the condition of the baby and the properties of the product.

You may be interested in the following entries:

When to introduce complementary foods for breastfeeding and bottle feeding?

First food: cook or buy?

How to cook porridge for feeding babies at home

How to cook vegetables and fruits for feeding babies. Part 1 (general rules)

How to introduce complementary foods for atopic dermatitis: mom’s experience