Essential Guide to Feeding Your Baby: Ages 0-3 Years

[Updated on November 6 at 12:47 PM]. The French High Council for Public Health (HCSP) has issued a new report, updated in June 2020, on infant nutrition from birth up to 36 months. It emphasizes that from birth, “feeding serves multiple functions: nutritional, pleasure, socialization, identity“.

From 0 to 4-6 months: milk-based diet and breastfeeding

Experts agree that up to the age of 4 to 6 months, an exclusively milk-based diet is appropriate, without introducing solid foods. While exclusive breastfeeding is recommended, the HCSP acknowledges that mixed feeding (combining breastfeeding and special infant formula) is also suitable. The report cites WHO recommendations which endorse breastfeeding in all cases, but advise breastfeeding for at least the first four months for health benefits, and ideally up to six months.

Breast milk offers several benefits, including meeting nutritional needs and providing immunity benefits, obesity prevention, and better future acceptance of different foods and textures. Encouraging mothers to breastfeed is significant. However, the HCSP also stresses the importance of respecting a mother’s decision not to breastfeed and avoiding guilt-tripping.

Regarding infant formulas, the HCSP specifies that these should be labelled as “first age” or “stage one” formulas because their composition is closest to breast milk. Yet, it notes that feeding with a bottle has its drawbacks: “it might alter the infant’s ability to self-regulate food intake in the short term and doesn’t allow as easy identification of hunger and fullness signals“. To help parents recognize these cues, the report lists signs of hunger in infants, including crying, excited movements of arms and legs, and mouth opening when the bottle is near. Signs of fullness include falling asleep with the bottle, slower sucking, stopping feeding, or spitting out the pacifier.

From 4-6 to 12 months: introducing solid foods

Introducing solid foods does not mean stopping breastfeeding (or its substitute if the mother is not breastfeeding). Milk should remain the foundation of a child’s diet until at least 1 year old, the HCSP states, with a minimum daily amount of 500 ml. However, introducing a variety of foods is crucial as it helps transition from infant food to family meals.

• Until 4 months, breast milk alone meets all the nutritional needs of a baby.
• Parents are advised to wait until the child is at least 4 months old to start this second phase of feeding.
• After 6 months, milk alone is no longer sufficient.
• The preferred option is to start introducing solids between 4 and 6 months.

It’s essential to vary the foods and change them daily. There’s no specific order recommended, and these foods can be homemade or commercially purchased, although the former is preferable. Introducing a wide range of foods helps prevent food neophobia. The HCSP report also notes that food allergens should be introduced early to detect any sensitivities as soon as possible. Before one year, plant-based drinks (even those fortified with calcium) should not replace infant formulas or follow-on formulas.

Variety of essential foods:

• Dairy products (food allergen) without added sugars and low-salt cheeses
• Fruits, vegetables, legumes, potatoes, and grain products (including peanuts, an allergen)
• Meats and fish
• Cooked eggs (food allergen)
• Fats, which are essential (though often forgotten before 3 years of age)

Why are fats important?

Children under three years of age need more fats than adults. Fats play a crucial role in their development. They are found in breast milk and in “stage two” formulas. As these sources decrease in proportion in a child’s diet, solid fats must compensate. It’s important to add fats in homemade preparations, and they can also be included in commercial baby foods.

Can I give cow’s milk or other animal milk to my baby?

Before 12 months, no animal milk (cow, sheep, goat, or mare) can replace breast milk or its first or second stage substitutes. The HCSP emphasizes that these milks do not meet the minimum and maximum nutrient levels recommended for this specific age group. They contain, for example, two to three times the protein recommended, and two to three times less iron than advised.

Between 8 and 10 months: introducing more complex textures

“It is important to gradually introduce the child to a variety of textures by adjusting the size and hardness of the pieces to the child’s capabilities“, the report states. Foods with different textures should be introduced between 8 and 10 months to prepare the child for chewing. It is advisable to start with soft solid foods at 8 months, and if all goes well, move to harder foods at 10 months. However, before offering hard foods to a child, check:

• That they can maintain their head and back upright in the chair
• That they swallow smooth and thick purées without difficulty
• That they make chewing movements when bringing items to their mouth
• That they naturally bring food to their mouth on their own (indicating they are attempting to feed themselves)
• That they show interest in meals (for example, trying to grab food from another plate)

If a baby initially refuses a food during diversification, it should be offered at least 8 times subsequently to eventually be accepted by the child.

From 12 to 36 months: the diet evolves but remains different from adults’

Before age 3, children are introduced to a wide variety of foods but do not eat like adults. Certain products are not recommended, such as sugary foods (candies, dessert creams, ice cream, sugary drinks, etc.) or salty foods (snack crackers). The same goes for processed meats and fried foods.

After 1 year, babies can continue to drink breast milk, or alternatively “toddler milk”. This latter type is preferred until 3 years old because it is a source of iron. However, considering its cost, the HCSP suggests alternating with whole cow’s milk (not skimmed or raw), being mindful of potential iron deficiencies in the child. Iron can also be provided through a diet rich in legumes, meats, or vitamin C-rich foods to enhance iron absorption. Gradually, the amount of milk should decrease in favor of solid foods to avoid excessive protein intake. It should not exceed 800ml/day. After 1 year, the child begins to have snacks. It is important to avoid overly sugary products. Opt instead for a grain product, and/or a fruit puree or a dairy product.

What foods should be avoided or limited for babies?

To provide clear guidance to new parents on foods that are not recommended, Anses (French Agency for Food, Environmental and Occupational Health & Safety) established two lists in a 2017 report, confirmed by the recent HCSP report.

In terms of sugar intake, a significant public health issue, Anses relies on a recent European Commission study on baby foods available in the European market and criticizes several food categories, particularly biscuits and rusks, which may “contribute to excessive amounts of total sugars in children“. Beyond the need for public authorities to establish “sugar content criteria so that these products are suitable for young children“, parents can reduce their children’s sugar intake by carefully reading labels, making homemade snacks, and choosing healthy snacks.

Mealtime context

The mealtime schedule for children aged 12 to 36 months is similar to that of adults: breakfast, lunch, snack, and dinner. However, knowing what foods to give and how to introduce them into a baby’s diet isn’t enough. The context of the meal is also critically important. Therefore, mealtime should be a moment of conviviality, ideally shared with the family and without the television on! Anses points out the importance of avoiding any distractions that might “divert the child’s attention from their plate, from their sensations and from satiety signals and may also limit the opportunity for the child to observe other diners and their eating behavior“. Much of the learning about “eating well” comes from observation, so the baby should be in a warm and calm environment conducive to exchanges. Other diners are also there to encourage tasting without forcing the child to eat!