Nutrition and Weaning
Weaning can bring a number of questions to mind, especially if you’re a first-time parent. Pediatric nutritionist, Dr. Tanisa Kwanbunbumpen, shares some helpful information on introducing the right types of foods and how to identify any nutritional deficiencies.
By Dr. Tanisa Kwanbunbumpen
Nutrition deficiency occurs when a child has an inadequate intake of the required amount of nutrients. It can also result from the body not absorbing a particular nutrient properly. However, it is not just about the type of food they eat. The amount they eat and when also plays a significant role.
One of the most widely known deficiencies in weaning children is iron deficiency, with late weaning found to be one of the most significant risk factors for iron-deficiency anemia (Sultan, 2003). Other key nutrients for growth that parents should be aware of are zinc and vitamin D. Making a plan to introduce the right solid foods at the right time, and in the appropriate amount, can help to minimize the risk of your child experiencing an insufficient intake of the nutrients they need.
When to wean
Complementary feeding should start when your baby is around six months old (NHS, 2019). After six months of age, nutrition from milk alone, whether breast milk or infant formula, is insufficient for your baby’s nutritional needs. Hence, adding complementary foods to your baby’s diet will provide them with the nutrients they need for optimal growth and development. There are physical signs of readiness that can help parents determine whether their baby is ready for solids. These include:
• Able to sit up with support and has good head control
• Has good eye-hand-mouth coordination
• Has the oral motor skills for solids and can swallow food
• Shows an interest in the food you are eating
Nutritional deficiencies
Common deficiencies can be detected with a health check up and a blood test, and if needed, supplementation may be recommended by your pediatrician. You may also notice some signs that may indicate a deficiency in your child. These are given in more detail below.
According to the WHO (2021), iron deficiency is found in 20–30% of children aged six months to three years. This is mostly because after the age of six months, the amount of iron accumulated in the body diminishes. A 7–12 month-old baby needs 11 mg and 1–3 year olds require 7 mg of iron in their daily diet (Kids Health, 2021). Paleness, fatigue, moodiness, dizziness and a fast heart rate are all possible indicators of iron deficiency (Cedars Sinai, 2022). A blood test for anemia may further be recommended, especially in children aged nine months to one year, if the child’s diet is found not to include iron-rich foods such as liver, pork, beef, or some beans.
Zinc deficiency is another silent threat in infants who do not eat a balanced diet and can impair growth and immune function. An insufficient intake of zinc can present as redness and peeling of the skin around the mouth and anus, the appearance of rashes on the hands, feet, mouth, and buttocks, or with changes in the nails, hair loss and even loss of appetite (Health Direct, 2021). About 3 mg of zinc should be included in a 7-month to 3-year-old child’s diet (Stanford Children’s Health, 2022). Parents can include zinc-rich foods like red meat, liver and/or seafood (if there is no allergy) in their cooking. Vitamin D deficiency, which can compromise immune response and cause brittle bones, is also seen in children of this age. Exposure to the morning sun and eating foods such as eggs and oily fish can help keep vitamin D levels in check (NHS, 2021). A vitamin D supplement is usually recommended if a blood test reveals that there is a deficiency. In extreme cases, physical examination by a doctor may help confirm rickets, a condition that impacts bone development in children.
What to feed
Table 1 suggests nutritionally balanced meals and suitable amounts for young children as they grow to ensure they receive a nutritious diet.
| Age of child | 6–8 months | 8–10 months | 10–12 months |
|---|---|---|---|
| Number of meals in a day | One Tip: Limit mealtime to 30 minutes or less to reduce stress for both child and parent | Two Tip: offer soft, easy-to-hold finger foods along with the meal suggested below | Three Tip: allow your child to share some of the foods cooked for the whole family |
| Suggested foods and amounts per meal | Finely blended: - 2-3 tablespoons of rice or potatoes - 1-2 tablespoons of meat - 1-2 tablespoons of vegetables - 2.5 ml of rice bran oil per meal | Coarsely blended: - 2-3 tablespoons of rice or potatoes - 1-2 tablespoons of meat - 1-2 tablespoons of vegetables - 2.5 ml of rice bran oil per meal | Finger food: - Starchy foods, such as 5 tablespoons of rice or a slice of bread or 5-7 tablespoons of potatoes per meal - 2-3 tablespoons of meat or 1 egg per meal - Use fats such as rice bran oil or butter for cooking or include cheese in their diet. One gram of fat provides 9 Kcal of energy. |
Disclaimer: The content of this article is intended only for information purposes, not as medical advice. As with all health matters pertaining to children, please consult with your pediatrician.
Photos from Canva.
References
Sultan, AN & Zuberi, RW. (2003) Late weaning: the most significant risk factor in the development of iron deficiency anaemia at 1–2 years of age. J Ayub Med Coll Abbottabad. 15(2):3-7. Available online at: pubmed.ncbi.nlm.nih.gov/14552238/
NHS (2019) Your baby’s first solid foods. nhs.uk/conditions/baby/weaning-and-feeding/babys-first-solid-foods/
WHO (2021) Anemia in women and children. who.int/data/gho/data/themes/topics/anaemia_in_women_and_children
Kids Health (2021) Iron. kidshealth.org/en/parents/iron.html
Cedars Sinai (2022) Iron-Deficiency Anemia in Children. cedars-sinai.org/health-library/diseases-and-conditions---pediatrics/i/iron-deficiency-anemia-in-children.html
Health Direct (2021) Zinc Deficiency. https://www.healthdirect.gov.au/zinc-deficiency
Stanford Children’s Health (2022) Zinc. stanfordchildrens.org/en/topic/default?id=zinc-19-Zinc
NHS (2021) Rickets and osteomalacia. nhs.uk/conditions/rickets-and-osteomalacia/
About the Author
Dr. Tanisa Kwanbunbumpen is a pediatrician at Samitivej Children’s Hospital. She graduated with a First Class Honors from Srinakharinwirot University, and did her Pediatric Internship at HRH Princess Maha Chakri Sirindhorn Medical Centre from 2009 to 2012. From 2012 to 2015 she was a Pediatric Resident at King Chulalongkorn Memorial Hospital, and from 2018 to 2019, she was a Pediatric Fellow at the Division of Nutrition, at Chulalongkorn University.
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