What are the recommendations for complementary feeding in infants starting after 6 months of age?

Complementary Feeding Recommendations After 6 Months of Age

Complementary feeding should begin no later than 6 months of age, with foods offered 2-3 times daily at 6-8 months and increasing to 3-4 times daily at 9-11 months, prioritizing iron-rich foods first. 1, 2

Timing and Frequency

• Complementary foods should be introduced between 4-6 months, not before 4 months and not delayed beyond 6 months 2
• At 6-8 months: Offer complementary foods 2-3 times per day 1
• At 9-11 months: Increase to 3-4 times per day 1
• By 8-9 months: Diet should include breast milk/formula plus a variety of foods distributed among 3 meals 1

First Foods and Progression

Initial Foods (Starting at 6 months)

• Iron-rich foods should be introduced first to prevent iron deficiency 2, 1
  • Iron-fortified infant cereals
  • Pureed meats (especially important for exclusively breastfed infants)
  • Iron-fortified foods

Food Introduction Strategy

• Introduce one new food at a time 1
• For high-risk foods, wait at least 4 days between introducing new foods to observe for reactions 1
• By 8-9 months, diet should include:
  • Breast milk or infant formula
  • Whole grain cereals
  • Vegetables
  • Meats (including fish and poultry)
  • Eggs
  • Fruits
  • Nut butters 1

Food Selection by Risk Category

Lower-Risk Foods

• Vegetables: Broccoli, cauliflower, parsnip, turnip, pumpkin
• Fruits: Blueberries, strawberries, plum, watermelon, peach, avocado
• Proteins: Lamb, fortified quinoa cereal, millet 1

Moderate-Risk Foods

• Vegetables: Squash, carrot, white potato
• Fruits: Apple, pear, orange
• Proteins: Beef, fortified grits, corn cereal, wheat, fortified barley cereal 1

Higher-Risk Foods

• Green beans (legume)
• Peanut and other legumes (except green pea)
• Tree nuts and seed butters (appropriately prepared to prevent choking) 1

Texture Progression

• Begin with smooth, thin purees and progress to thicker purees 1
• Around 8 months: Offer soft-cooked and bite-and-dissolve textures 1
• By 12 months: Offer modified table foods (chopped meats, soft cooked vegetables, grains, fruits) 1

Foods to Avoid

• Foods high in sodium
• Foods with added sugars or artificial sweeteners
• 100% juice before 12 months
• Cow's milk as a main drink before 12 months
• Plant-based milk alternatives before 12 months
• Honey before 12 months (risk of infant botulism)
• Unpasteurized foods and beverages 1

Special Considerations

Allergenic Foods

• Potentially allergenic foods (peanut, egg, dairy, wheat) may be introduced during the 4-6 month window 2
• For infants with severe eczema or egg allergy, consult with an allergist before introducing peanut 2
• For infants with mild to moderate eczema, introduce peanut-containing foods around 6 months 2

Iron Supplementation

• For exclusively breastfed infants who receive insufficient iron from complementary foods by 6 months, consider 1 mg/kg/day of iron drops 1
• For preterm or low birthweight breastfed infants, provide 2-4 mg/kg/day of iron drops (maximum 15 mg/day) starting at 1 month until 12 months 1

Monitoring and Support

• Regular growth monitoring is essential to ensure adequate nutrition 2
• Watch for signs of readiness for texture progression:
  • Ability to sit with support
  • Bringing objects to mouth
  • Showing interest in food 2

Common Pitfalls to Avoid

1. Delaying introduction beyond 6 months - Can lead to inadequate nutrient intake, growth deficits, feeding problems, and potentially increased risk of food allergies 2

2. Introducing cow's milk too early - Should not be used as the main drink before 12 months of age 3

3. Excessive juice consumption - Avoid fruit juices or sugar-sweetened beverages 3

4. Neglecting iron-rich foods - All infants should receive iron-rich complementary foods including meat products and/or iron-fortified foods 3

5. Adding salt or sugar - No sugar or salt should be added to complementary foods 3