From the Research
For extremely low birth weight (ELBW) and very low birth weight (VLBW) infants in later infancy, complementary feeding with non-milk semisolids should begin around 6 months corrected age, not chronological age, as supported by the most recent study 1 and consistent with other recent findings 2.
Key Considerations
- Start with single-ingredient, iron-fortified cereals mixed with breast milk or formula to a thin consistency, offering 1-2 teaspoons once daily and gradually increasing to 3-4 tablespoons twice daily as tolerated.
- After cereals are well-accepted, introduce pureed vegetables and fruits one at a time, waiting 3-5 days between new foods to monitor for allergic reactions, although the necessity of waiting 3 to 5 days between introducing new foods has been questioned by some practitioners 3.
- Protein-rich foods like pureed meats should be introduced early due to their high iron and zinc content, which is particularly important for these infants who often have depleted iron stores, as highlighted in a study on micronutrient intake during complementary feeding 1.
- Texture should progress gradually from thin purees to thicker consistencies as oral motor skills develop.
- These infants may need smaller, more frequent feedings and may demonstrate delayed oral motor skills requiring patience during feeding progression.
- Avoid honey until after 12 months of age and foods with high choking risk.
- Complementary foods should supplement, not replace, breast milk or formula, which remains the primary nutrition source until 12 months corrected age.
Nutritional Considerations
- The introduction of complementary foods should ensure adequate macronutrient intake, with recent studies suggesting that VLBW infants have adequate macronutrient intakes irrespective of the timing of solid introduction 2.
- However, there is a notable need to enhance dietary intakes of certain nutrients like docosahexaenoic acid (DHA) and arachidonic acid (AA) 2.
- Micronutrient intake is also crucial, with a study indicating that while total vitamin D, calcium, zinc, and phosphorus intake may meet recommendations, dietary iron intake may be insufficient 1.
Clinical Implications
- Pediatric practitioners should be aware of the latest recommendations and research findings to provide evidence-based guidance on complementary feeding for ELBW/VLBW infants.
- A need for additional training on complementary food introduction has been reported by practitioners 3, highlighting the importance of ongoing education and updates in this area.
- The approach to complementary feeding should be individualized, taking into account the infant's developmental stage, nutritional needs, and potential allergies or intolerances.