WEANING DIET
1) When to start?
When the infant is about 6 months completed the supplementary solids
are introduced to the child. Till then breast feeding and or formula feeding is
sufficient.
2) Why 6months, my mother and other elders in the family have said
they started when the child is about 3-4 months of age, can I start it
too?
The 6-month period is for the baby to be developmentally ready to handle
thick liquids or puree consistency. For taking solids consistently well the child
needs to have mastered below milestones-
*The infant needs to sit with support with good head control
*the infant should be able take from the spoon without thrusting the
tongue
*Chew with jaws and gums,
*Push it backwards with tongue
*Swallowing of thick liquids
Not all 3–4-Month-old infants are not developmentally ready to do the
above-mentioned milestones.
Also, breast milk or formula has good balance of proteins and fat and
other nutrients and immune protecting factors, so it is recommended to
exclusively breast feed till 6month of age.
Most of the time when anyone introduces solids at 3months, the infants
are made to lie down, and the food is put into the mouth and the baby swallows
automatically (because that is what babies do). It is not comfortable for the
babies (imagine us eating in a lying down position, are we comfortable?)
3) What are the starting foods during the supplemental feeds?
Grains - Rice and moong dal, Ragi flour, Oats (roasted or powdered), once these foods
are tolerated other items like idli, Rava kheer, upma, etc. can be given.
Fruits- Apple and pear – peeled, steamed and mash
Banana, papaya, sapota (Chikoo), muskmelon
Fruits such as juice – oranges, pomegranate, grapes, etc.
Vegetables: Potato, sweet potato, carrot, lauki (bottle gourd), peas, pumpkin, etc.
4) How to start the solids? - many parents are not sure how to give-
here is an example
Start one new item from each group every 3-4 days – for example
On D1- Rice with dal (moong)- 3part rice and 1 part moong Dal – cook well, mash well,
2-3 drops of ghee (Only) can be added for the taste.
D2 and D3- continue the above – observe the baby how he is taking, how much he can
take each mouth, consistency etc. And change accordingly as the baby’s need.
D4- Banana mash well. It can be given in the morning as breakfast
Lunch- rice and moong dal
D5-6 – same as day 4
D7- introduce vegetable- say pumpkin
E.g.- banana in the morning – mashed or can be mixed with breast milk or formula
Lunch – rice dal and vegetable mashed
Or
3-4 p.m. snack as mashed boiled vegetable
D8 & 9 – Breast fast as a fruit, lunch rice with dal or veg, evening snack fruit or veg
D10- 2nd grain for Oats, Lunch – rice and dal with or without veg
3-6 p.m.- fruit as snack
Likewise other food items can be introduced one by one
5)How to give fruits/ vegetables – all fruits need to be boiled?
Only apple and pear need to be boiled and mashed
Other fruits can be given mashed well
Certain fruits need to give only as juice till 3yrs – pomegranate, grapes etc.
Vegetables – Need to be boiled and mashed well.
6)What should be the thickness of the food?
Since eating a solid needs different ability and not all babies are ready to
handle solids initially. Make the food, thick liquid or puree form. Please observe
the baby while eating and change the thickness, amount of food per mouth etc.
according to the baby’s comfort
7) Why does my baby not like the solids?
If the child is not interested in taking solids or you may think the child is
not interested, it could be due to multiple reasons.
a) Tongue thrusting or pushing out with tongue- Initial days when solids
are introduced the baby sometimes pushes out the solids with tongue – that is
because the child does not know how to take with spoon- what to do- start
feeding with fingers, slowly the baby would know how to take from the spoon
b) Gagging with solids (vomiting sensation with solids)- few common
reasons:
Reasons what to do
Food is too thick to handle- make it little thin
Too much food is being fed each time- use small spoon to give less
Does not like the taste taste the food & make changes
Not hungry try next meal or snack early
c) Feeling sleepy so preferring not to eat
d) Sometimes the same food needs to be tried multiple times for the
child to start liking or accepting the food. So even if the child pushes or
seems not liking a healthy food, keep trying by changing the flavor or texture,
adding it with other food etc.
8) How much food is to be given for each meal?
The quantity of food consumed by a child varies from one baby to another. A
general recommendation is whatever quantity the child takes should be given. When
the child is hungry, she /he normally takes about 2-3 tablespoons ( 30-45ml)
9) Water – Usual questions:
a) Can water be given- yes, after each meal or snacks. In summer, when
ever you drink water, keep offering, if the child is hungry will drink water. (breast milk
and formula is mostly water)
b) Quantity? Is decided by the child. What ever the quantity child
demands can be given.
c) warm water or room temp water? The child or parents preference.
d) Water needs to be boiled? Yes. Even RO water needs to be boiled for 20
min, cool and give it.
e) How to give water- initially with spoon after each meal. Once the child
is about 8-9 months sipper cup can be introduced. Slowly the child learns to drink from
the sipper cup (i n about 2-3 weeks) then all types of fluid can be given through sipper
cup.
f) Can we add sugar or similar sweeting agent to the water? NO.
g) My Child does not drink water- drinking water in response to thirst is a
basic need for our body. All food, fruits and vegetables have some water. The water
need also depends on the external temp, activity, body size etc.
If the child does not drink water, keep offering and make the habit happen, but it
is not recommended to add sugar etc. to the water
10) When can we introduce other food items
Nuts – at 9months
How to give nuts?
Introduce one nut at a time, dry roast and powder it. It can be added to
the food. Avoid small bits and chunks – it can cause choking.
Milk products- Curd and paneer around 9month of age.
Fish and chicken around 9-12 months of age
11) Can ghee or oil be added, or can seasoning be given? 
Ghee or Oil can be added just for taste. Please don’t add multiple
spoons.
Seasoning- any hard items like chena dal, peanuts etc. need to be
removed
Because it can cause choking.
Jeera powder, Turmeric powder, etc. can be added for the flavor
12) Salt – No added salt till at least 1 yr. of age. But it is in Idli batter or upma
etc. It is ok.
It is also ok to add 1-2 spoons of Rasam or dal liquid to the baby’s food
to enhance the flavor
13) Sugar/ Jaggary/Honey or other sweetening agents;
NO added sugar till 1-2yrs of age. Try to add fresh fruits to improve the
taste and nutrition eg oats with fruits, ragi with banana,etc
14)Should breast milk and or formula need to be continued?
Yes, breast milk / formula needs to be continued. They are still main
component of babies' food because they are calorie rich, optimal
nutrition etc.
Solids are supplementary food.
Initial few days solid food intake is going to be minimal because the baby
is slowly getting used to taking from the spoon, etc.
Once they get comfortable taking from the spoon the solids are like
snacks – adding some calorie and other nutrients
By 12 to18 months (about 1 and a half years) when babies are
comfortable taking food, milk will become snacks
15) Can we add breast milk or formula to the baby food?
After the cooked food is cooled down a bit (room temp), expressed breast milk or
prepared formula can be added to the supplementary food in place of cow milk.
16) When can the child start taking 3 meals a day?
By 9 Months to 1 yr. most infants are ready for 3 meals a day – Breakfast, Lunch
and dinner.
Snacks 2times a day – milk or fruits and other snacks like bread, paneer, etc.
Some babies need not eat all major meals and snacks, but still it is
recommended to offer them every 2-4hrs, for few reasons, they can’t
communicate well if they are hungry, unpredictable eating habits, etc. If they are
full please don’t force feed or distract and feed.
It is recommended to give dinner by 7 p.m., milk 45-60 min before bedtime,
brushing and preparing for bedtime and sleep.
(brushing and bedtime preparation will be discussed later)
17) What are the signs of fullness?
*Turing the head away
*Refusing to open the mouth for another bite after the food is swallowed
*Keeping the food in the mouth
*Playing with the food or spoon instead of eating
18) What food items to be avoided
Safety reasons; Hard food items- due to choking risk e.g. Raw carrots, Raw
apple, grapes, pomegranate, nuts (peanuts, cashews, etc.), hard candies,
popcorn, etc.
Health reasons: Ultra processed food- cakes, bakery, cookies, biscuits, etc.
High sugary food- sweets, juices, etc.
High salt items like chips etc.
19) Can Cerelac (or other readymade food items)be given to babies?
It is not recommended because of the high sugar content, and other
added ingredients like preservatives etc.
It is always recommended to give fresh homemade food rather than
store-brought food.
Another reason not recommended is – the goal of solids is to get the
infant ready for eating family food by 1 year, and cerelac is not a family food, so
why start in first place.
The scenario where cerelac plays a role in infant food is – when the family
is travelling- it may be used when it is difficult to get hygienic food.
20) Common myths; the below statements are wrong
X Fruits esp. banana and citrus fruits can increase cold and mucus -NO
X Store brought food like cerelac is healthier than homemade food -NO
X Vegetable and dal difficult for children to digest -NO
X Biscuits are healthy -NO
X Jaggery is not healthier than sugar – definitely not
X Fruit juices are healthy, and it can be substituted for fresh fruits -NO
21) Common step taken by parents which are not advisable- few steps
* Slow in starting solids- e.g. Giving only rice water or dal water till 8-9
months
* Giving limited food items- giving only 2-3 items e.g.- only uggu,
banana, or rava kheer and apple, etc
* Starting with readymade food- e.g. cerelac, etc.
* Giving calorie or nutrition restricted food.
* Introducing biscuits, juices etc.
* Adding sugar or (other sweetening ingredients) to water and food
* Distraction while feeding, lying down and feeding.
* Force feeding
* Expecting child to eat whatever is being fed
* Feeding the baby when the child is sleep
* Not doing responsive feeding (responsive feeding is paying attention
to the baby while feeding – looking for interest in taking solids, interacting
with the child, looking for fullness cues, etc.)
* Every crying is considered due to hunger- babies cry for other
reasons apart from hunger, too- tiredness, sleepiness, want to be held, etc.
The above steps are being done due to multiple reasons- lack of knowledge, busy
at work, etc.
22) Stool pattern when solids are introduced
Stool pattern can change after the introduction of solids. Some babies pass
stool 3-4 times a day, soft well-formed stool - that is normal if they are active, no
vomiting and growing well.
CONSTIPATION (passing hard stool) is relatively common when solids are
introduced. That is due to decreased intake of fiber food.
To avoid this, make sure the child is given daily
Adequate fruits and vegetables every day
Adequate water intake
NO toilet training till the child is ready for it.
Undigested food;
It is very normal to have undigested food in the stool of the baby. It does
not mean the food is not suiting the baby or any medicine to be given. WE can
continue to feed the child with the same and other solids
23) Can we give fruits juices?
Yes, it can be given with no added sugar. Some fruits can be given only as
juice, initially eg watermelon, orange, pomegranate, grapes, etc.
But if there is an option to give a fruit either as a mashed fruit or juice,
then go for mashed form rather than juice
24)How do I know if the child is allergic to certain food?
The child can develop symptoms like
repeated vomiting, eg in case of egg allergy,
rashes,
bloated stomach,
blood in the stool etc.
The symptoms will be similar each time, and one can predict or
anticipate the same response to the same food.
Please consult the pediatrician if one suspects a food allergy.
25) Can we give biscuits to babies?
Biscuits or other bakery items are not healthy. They have a
significant amount of added sugar and other items which are considered
unhealthy.
Many families eat biscuits routinely – that does not make the biscuit healthy, but
it is recommended that the whole family address the issue.
Dental hygiene practices
Dental caries is very common in infants and children.
25 % of children around 2 -5yrs of age have dental caries
50 % of children around 6-10 yrs. of age have dental caries
Fortunately, it is preventable if the right practices are followed.
Why dental care is important:
If the milk or food stays in the mouth more than 3-4 hrs. during the sleep
(because the saliva production is less,) it causes the overgrowth of bacteria
which affect the enamel--> caries and cavities
When does teething start?
As any development or maturation, teething process can vary from 4-5
month of age till 15month of age
Mouth care:
If formula fed -Clean the mouth after each feeding with soft cloth and
water. (if exclusive breast feeding it is not needed because the breast milk has
good bacteria)
When to brush: Once the tooth starts to erupt use toothpaste to clean
the mouth
What toothpaste-
any regular fluoride toothpaste Eg Kido dent, Colgate (0-3 yr. toothpaste)
or regular adult Colgate toothpaste
How much to put?
About the size of a rice grain and brush and leave it off. Since the babies
don't know how to spit water, it is recommended to use only a very small amount
as mentioned above.
How often?
At least 2 times a day – morning and at bedtime.
Can silicon finger brush be used?
Yes. When there are top 4 teeth and bottom 4 teeth silicon finger brush
can be used.
When to use a toothbrush?
when there are more than 6-8 teeth (top and bottom) start using the
toddler brush.
My child does not know how to gargle. Can I use toothpaste?
Yes. Teeth need minimal fluoride, so a very small amount of fluoride
toothpaste- about rice grain amount is used for healthy teething.
My child is teething – can I use calcaria, etc.
Teething is a natural process. Most babies don’t have any symptoms or very mild
symptoms. NO extra care is needed.
Can I use teethers?
Yes, it can be used. Make sure it is washed periodically.
My baby is putting fingers in the mouth all the time. He /she is teething.
What to do?
Should I take the hand out?
Mouthing is very normal for the baby. Multiple reasons- hand exploration,
comforting, by mouthing the gag reflex is slowly reduced to make the child ready
for solids. It is part of growing up and no need to take the hand out.
Does teething cause fever, diarrhea or other illness
As teething is normal part of the growth, it does not make the child more prone
for infection
NIGHTTIME FEEDING
Many parents continue to feed at night for longer period
even though it is not needed.
It has few consequences
First of all, it is not needed
It affects the night sleep (both child and parents)
Dental caries and cavities
Improper day time food intake
Milk dependency leading to other health issues –
constipation, iron deficiency anaemia, behavioural issues,
etc.
Before we discuss night time feed, one need to know about
normal sleep. Many parents have inadequate knowledge
about sleep in babies and infants
Let us discuss sleep – the most essential aspect of life but unfortunately less
attention and importance being given to it.
Initial few weeks babies don’t have consistent sleep pattern.
The sleep pattern matures at about 2-4 months of age, around that time most
babies (7-8 out of 10 babies) can sleep for at least 6-8 hrs. without feed.
If the baby is sleeping well and growing well it is not advisable to wake up the
baby to give feed at night.
(if exclusive breast feeding and mother get painful breast swelling, it is ok to
breast feed to relive the pain or pump and store the milk for later use).
To help babies sleep well, practice few things
1) Aim or practice- Feed---> wake period ---> sleep
This ensures the babies are fed well to full tummy (sleepy baby may not feed to
full tummy)
wake period or active period – baby kicks and moves, (like our exercise) -->
baby gets tired and then feel sleepy --> now baby might cry or while a bit and go
to sleep
This also ensures that the baby does not go to sleep by feeding or rocking etc.,
which act as a “prop” to make the baby child sleep. This slowly becomes a
habit, and most babies may not know how to go to sleep without this “prop”.
2) All babies thrive well on routine – less anxious and stressed.
Consistent nighttime routine helps children to have good sleep habits.
How to do it?
Have a structured night routine or sleep hygiene – It means, parents
should do the same thing in the same order around the same time so that
babies know it is bedtime and slowly unwind to go to sleep. After 6-7
p.m., start dimming the lights, it helps infants to calm down, helps
secretion of melatonin (hormone to help sleep and day and night effect
on our body)
3) Brief awakening in-between the sleep is normal for all of us more so for
the babies. During that awakening period the child might cry or whine,
suck on the finger or fist and move a bit to get a comfortable position and
slowly go to sleep most of the time with no help or very minimal help from
adults (without feeding/rocking).
But unfortunately, many new parents don't know this, and every cry
(during day and night) is assumed to be hunger cry, hence is addressed
with feeding (either breast feed or bottle feed).
Slowly it becomes a learnt habit, and the baby would demand it to go to
sleep every time when sleepy. (Some babies don't feed but continue to cry and
parents start alternate methods like rocking, walking with the baby, etc. to put
them to sleep.
As any habit this demand would increase and at some point, most
parents are very tired and unsure as to what to do.
4) Have a consistent nap time – (remember having a routine.) A well-
rested baby is easy to handle and quick to pacify compared to a tired, sleepy,
jumpy, irritable child.
5) Early to bed-
Observe for sleep cues –
like infant appearing tired
blank eye, not playful
no consistent eye contact
rubbing eyes, yawning, etc.
If these sleep cues are missed, the child gets very tired, and it takes
longer to put them to sleep, and the sleep is not restful (unlike what most
parents think)
6) Have a consistent place to sleep -e.g. bedroom, room should be dark,
comfortable.
Babies start to associate bedroom with sleeping and would cooperate.
7) Last but not least- it is important to have well rested parents to take
care of the child. If parents want their children to sleep well and on
schedule, parents (the whole household) should wind down at an
appropriate time and should have good sleep or bedtime hygiene.
Common questions;
1) @ 4-6 WEEKS- most parents ask my child sleeps for 4-6 hrs. in the
night, should I wake up to feed
Or my child does not wake up at night for feed, but I am still waking
her or him up to feed. Is it ok?
As mentioned about, it is good that your babies sleep cycle has
matured and started to consolidate at night. If the baby is growing well,
there is no medical reason to wake up the baby to feed. Enjoy the well rested
night.
2) Usually at 6-9 months (sometimes later at 12-24 months too –
many parents say my child keep waking up every 3hrs at night,
how can I make them sleep?
Follow the above mentioned recommendations
Most likely reason is the child is going to sleep due to “props”-
please read above about “ props”
The usual “props” are – feeding (either breast feed or bottle
feed)
Rocking to put to sleep
Walking or holding the baby to put to sleep
Because of the help of these props babies are going to sleep.
When the brief normal night time arousals happen ( when we
transition from one sleep pattern to another sleep pattern), the
child does not know how to go to sleep without these props.
Please understand that the child also wants to sleep ( like you do)
but he or she does not know how to do it and they cry ( demanding
to put to sleep). At 2 a.m. the helpless, sleep deprived parents do
what the only method they know to put the child to sleep. The
habit slowly gets well established till the child know how to go to
sleep by themselves.
3) Ss, dr. what can I do to stop this cry?
First of all, to know the normal sleep pattern for that age group
Know your child’s “props”
Once you know your child’s “props”- have a realistic
expectation to stop this behavior.
How soon we can train the child to sleep is based on few things
Age of the child
Props – duration and times at night
Personality of the child and or parents
Having a realistic expectation from parent’s side
How consistent they are in following sleep training (if
they believe in one and parents are willing to try one)
4) One way to do it
After following a bedtime routine- for example
Feeding →cleaning the mouth -→ light massage-→ going to the
bedroom with lights dim-→ change to the diaper, night dress etc. -
→ quite play with the child or lullaby or story or humming etc.→
the child slowly becomes drowsy -→ put the baby to the bed (
drowsy but awake the most important phase) and pat the child or
be next to the baby ( what ever one is comfortable) and the baby
learns to go to sleep slowly
5) Dr. I am doing the same but my child always wakes up when I put
her or him to sleep?
Yes, she would initially few days, but be consistent, please
don’t pick her up. Keep patting or rubbing her back or humming,
shhh etc. Some babies go to sleep but some stubborn babies
might keep crying.
If the baby continues to cry and the intensity increases, hold
the baby again till drowsy but awake and put the baby down….
Initial few nights it may have to be done multiple times for
several minutes (esp. initial 3-5 nights). But if one is consistent the
cry would definitely start to improve from 5-7 days, the crying
duration and frequency will come down and by 2-3 weeks, most
babies would sleep well.
AGAIN- The Key message is consistency.
This is just an example what to do and you can use other
similar techniques to calm down (whatever you and the child and
the family are comfortable with).
All members of the family need to be on the same
understanding and should be willing to tolerate some cry and
should be willing to help.
(please understand that most of the previous generation may
not agree with this, please discuss with them and the husband or
wife before doing this)
It is better to do this when not other stress at home or before
the holiday plans (because during the holiday the schedule is
bound to change)
If a new baby is expected soon or other stress at home, please
wait till things settle.
Plan it ahead and be prepared mentally (e.g. long week end
etc.)
6) Dr. I can tolerate my child crying, what should I do?
As mentioned earlier, it involves some crying
If one is not ready it is difficult to do it.
Then the parent should re attempt when they are ready or wait
till the child out grows it – which will happen sometime around 4-6
years of age.
