Helping children eat for
a healthy life
Rosemary Brown
CPHVA conference
June 2013
What are we aiming for?
 Healthy, active child able to enjoy life –
now & later
What are we aiming for?
Happy, secure child through good
What are we aiming for?
 Child who enjoys food…
… without feeding
becoming a battleground
What are we aiming for?
 Child who eats enough for their needs
…but not too much
How can we achieve that?
 Encourage what will build positive
relationships from the beginning
Harness a child’s inbuilt ability to regulate
his/her own intake
Enhance parents’ knowledge, skills and
confidence in enabling development of
healthy eating habits
Government recommendations:
exclusively for 6
months, then
Continue to
breastfeed until at
least 1 year, whilst
offering solid foods
from around 6
How does breastfeeding help?
 Custom-made food and drink for baby,
adapting to meet changing needs of
How does breastfeeding help?
Contains many
ingredients not
present or active
in formula
Bifidus factors
Growth factors
Viral fragments
White blood cells
Transfer factors
How does breastfeeding help?
Breastmilk contains many protective
factors, lowering the risk of infection &
other diseases for babies and mothers:
reducing all common childhood infections
1/3 risk of SIDS
reduced risk of breast and ovarian cancer for mum
15% fewer GP visits in first 6 months
decreased hospital admissions
(McConnachie et al
(DH quarterly figures)
How does breastfeeding help?
The hormones of breastfeeding (prolactin &
oxytocin) and physical closeness facilitate:
connecting up helpful pathways in brain
good bonding & protective instincts in mum
stabilise baby’s heartrate,
breathing, temperature,
blood sugar
calm the baby & help the
mum relax & rest
How does breastfeeding help?
Facilitates baby regulating intake to meet
hunger cues enable responsive feeding
more control over flow and how much they take
leptin: hormone regulates appetite and energy
learn to recognise when they are full – need
several weeks of breastfeeding before this begins
(Brown & Lee 2012)
lower protein and energy in breastmilk reduces fat
deposition -> lower risk of obesity (McCrory et al 2012)
Enabling breastfeeding
Skin to skin contact at and after birth
Help to ensure effective attachment:
C close to mum, chin indenting breast
H head able to tip back – nipple protected, big
mouthful more from underneath of breast
I in line – head & body in line helps swallowing
N nose to nipple – stimulates wide gape
S sustainable & comfortable for mum
Recognising effective feeding
Use breastfeeding assessment ourselves
Empower mum to look for signs of effective
 deep suckles AND swallows
baby calm at breast
baby content after most feeds
at least 6+ wet and 2+ dirty nappies a day
pain-free for mum
baby alert, when awake, with good colour and tone
How can we achieve that?
 Bottle feeding: intake depends on:
 teat stimulating baby to suck, whether hungry
or not
size of teat
expectations of mum/tin/society as to
quantity and frequency
 tends to be more mother-led
can involve less interaction &
closeness & more people
How can we achieve that?
 Bottle feeding : important to encourage
responsive feeding
watch out for and follow hunger cues
let baby decide quantity
allow baby to draw teat into mouth
take bottle out from time to time
hold baby close with eye contact, smiles, talking
limit caregivers
use first stage milk
How can we achieve that?
 Start offering solids when:
 they are developmentally ready to cope well &
eagerly with solids
 nutritional needs no longer met completely in
breastmilk or formula
 usually around 6 months – not too early or too
early or too late
 Allows baby to continue to
control own intake
 Baby develops skills & good eating lifestyle
So why from around 6 months?
 Breastmilk,
or formula,
has all they need till then:
- energy for growth
(Nielsen et al 2011; Wells et al 2012)
for adequate iron stores
(Jonsdottir et al 2013)
Giving anything else
displaces breastmilk
(Wells et al 2012)
So why from around 6 months?
 Their
body systems
are mature enough
Needed enzymes are
Breastfeeding whilst
whilst starting solids
seems to reduce risk of
allergies (Akobeng et al 2006)
So why from around 6 months?
 Can
sit up
 Safer
 More
able to
reach out
for food
So why from around 6 months?
 Interested
in food – no
 Start by
people eat
from 4-5
So why from around 6 months?
 Then
reach out and grab objects, take
to mouth & chew on them
So why from around 6 months?
 Eager
to eat and feed themselves
 Encourages baby-led feeding & may
reduce parental anxiety
So why from around 6 months?
 Good
& hand
& motor skills
(Wright et al 2011)
 Feeding
develops skills
So why from around 6 months?
 Tongue
to move
 Munching
So why from around 6 months?
Able to swallow solid
foods – learn to gum and
gnaw before learning to
swallow (Naylor & Morrow 2001)
Can cope with lumpier
foods from beginning, so
no need for purees &
less work for mum
 Breastfed babies accept
new tastes more easily
So why from around 6 months?
 Able
to take food
off spoon without
constantly pushing
it out with tongue
 Able to eat almost
everything (e.g.
fish, eggs, dairy
So why from around 6 months?
 Reflex
baby to gag
but still
is safety
So why from around 6 months?
 Great
sense of achievement!
Look for 3 signs together:
Can sit and hold head steady
Picks up food & puts it in mouth
Swallows some – not pushing it
all out again
How to start
Start with 1 meal a day, after or between milk
feeds – time when baby not too hungry or
Build up to 3 meals & 2 healthy snacks by 1 yr –
baby’s stomach small
Give baby finger foods to pick up in fists to
eat – finger-shaped pieces (Baby-led weaning cookbook)
Offer softly cooked or mashed foods on a
spoon – can add a little breastmilk or formula
to mix.
How to start
Offer wide variety of food from all the
food groups from the beginning
Increase lumpiness of foods quickly
Be prepared to offer new food many
times (up to 20) – babies show they
recognise new food by spitting it out!
 Baby’s
tummy about the size of baby’s
fist – use this as guide to portion sizes
Encourage good eating lifestyle
Sit baby up to eat and stay with him/her
Let baby participate in
family meals - and
preparation when older
Avoid distractions during
Be prepared for messy eating – bib, food on clean
highchair surface, plastic sheet on floor
Follow baby’s pace & cues
 Wait
for baby to open mouth for spoon
Follow babies’ cues
showing they have had
enough – turning head
away, pushing food away
Learning to drink from a cup
 Use
open cup (or one with
free flow spout) to give
fluids – water, milk
 Wean
off any bottles &
dummies by 1 year
Encourage a relaxed approach
Praise good eating
Don’t use food as
Look at what baby
eats over a week
rather than a day
If they are not
interested, wait till
next mealtime
So what do they need?
Milk still major source of
nutrients until 2 years - and
protection, if breastfeeding
Food from all food groups:
raw or softly cooked vegetables and fruits –
starting once day, 4 times a day by 1 year
starchy foods – potatoes, rice, pasta, plantain
protein foods – soft well-cooked meat and
chicken, fish, eggs, meat, pulses and beans, dairy
foods - 1-2 a day by 1 year
Just a few guidelines:
Use whole milk – wait till 2 yrs to use semi-skimmed &
5 yrs for skimmed milk – young children need the fat
content for calories without bulk and to carry vitamins
Cut up any small round or coin-shaped food
 Make sure egg is well-cooked – yolk & white firm
 Avoid:
salt & sugar or salty/sugary snacks, including juices
and squash.
 honey, in 1st year – rare danger of botulism
 reduced calorie or low fat food
 very high fibre food – fills stomach too quickly
 tea/coffee – reduce absorption of vitamins
 whole nuts till 5 years – danger of inhaling
 rice or soya “milk” or goat’s milk – not suitable
Vitamin supplements
Vitamin drops A, C & D are
recommended :
From 6 months, if:
- breastfed
- taking less than 500ml
formula per day
For all children 1-5 years
From 1 month if mother has not
taken vitamin D in pregnancy
Help parents know where & how to
obtain them
Mums to take Vit D and folate while
pregnant and breastfeeding
Why is Vitamin D needed?
Healthy diet is not enough: 90% of
our vitamin D comes from sunlight
 Sunlight not enough Oct-March
 1 in 4 people in UK have low vitamin D
 Darker skins take longer to
absorb enough from sunlight
 Hijabs etc -> less sunlight exposure
 Safe sun messages – only a short time
of exposure needed
 Increased indoor pursuits
 Obesity: affects production & use
 Deficiency -> rickets, seizures in
babies, smaller pelvis, lower immunity
Make mealtimes fun…
& eat together!
Many thanks to Maya Tammam & the Goodinge support group for being wonderful
visual aids! (Maya photos ©Jonathan Tammam)
• Leaflets (Start4Life - DH):
‘Introducing Solid Foods’
‘Building blocks for a better life’
‘Off to the best start’ (breastfeeding)
‘Guide to bottle feeding’
Islington (PDF in English & 7 other languages):
‘Milk & More: starting your baby on solid foods’
‘ Drinks for children up to 5’
‘ Snacking for children under 5’
‘ Vitamins and minerals for children 1-5 years old’
• ‘Milk and More’ training pack and recipe book
• Websites:
 ‘Infant Milks in the UK’: independent info re
formula milks
 Eating well in the first years of life’ – for
parents and carers – coming in 2013
 Breastfeeding and starting on solids:
 – research & resources
• The Baby-led weaning cookbook (Rapley & Murkett)
Akobeng A.K et al (2006) Effect of breastfeeding on risk of coeliac disease: a systematic review and meta-analysis
of observational studies, Archives of Disease in Childhood, 2006(91), 39-43
Brown, A. & Lee, M. (2012) Breastfeeding during the first year promotes satiety responsiveness in children aged 1824 months. Pediatric Obesity.2012, 7, 382-390
Cameron, S., Heath, A-LM.., & Taylor, R.W (2012) How feasible is baby-led weaning as an approach to infant
feeding? A Review of the evidence, Nutrients 2012, 4, 1575-1609
Cameron, S, Heath, A-L.M. & Taylor, R.W (2012) Healthcare professionals’ and mothers’ knowledge of, attitudes to
and experiences with, Baby-led Weaning: a content analysis study, BMJ Open 2010:2:e001542
DH quarterly figures, including comparison between breastfeeding prevalence and prevalence of hospital
DH (2013) Diet and Nutrition Survey of Infants and Young Children, 2011 (available on DH website)
Jonsdottir O.H. et al (2012) Timing of the introduction of complementary foods: a randomized trial, Pediatrics,
McConnachie A. et al (2004) Modelling consultation rates in infancy: influence of maternal and infant
characteristics, feeding type and consultation history, British Journal of General Practice, 2004, 54, 598-603
McCrory C. & Layte, R.(2012) Breastfeeding and the risk of overweight and obesity at nine-years of age, Social
Science and Mediecine 2012:Jul:75(2):323-30
Naylor, A.J. & Morrow, A.J (2001) Devclopmental readiness of normal full term infants to progress from exclusive
breastfeeding to the introduction of complementary foods, Wellstart International and the LINKAGES project
Nielsen S.B. et al (2011) Adequacy of milk intake during exclusive breastfeeding: a longtitudinal study, Pediatrics
Rapley G. & Murkett T. ( 2011) The Baby-led Weaning Cookbook
UNICEF (2012) Preventing disease and saving resources: the potential contribution of increasing breastfeeding
Wells, J.C.K et al (2012) Randomized controlled trial of 4 compared with 6 mo of exclusive breastfeeding in Iceland:
differences in breast-milk intake by stable-isotope probe, American Journal of Clinical Nutrition, May 16, 2012
WHO (1998) Complementary feeding of young children in developing countries: a review of current scientific
knowledge, WHO
Wright, C.M. et al (2010) Is baby-led weaning feasible? When do babies first reach out for and eat finger foods?
Maternal and Child Nutrition
• For more information:
Rosemary Brown
Infant Feeding Coordinator, Islington
0203 316 8441