What is a recommended complementary feeding diet chart for a six‑month‑old infant who is exclusively breastfed?

Complementary Feeding Diet Chart for Six-Month-Old Exclusively Breastfed Infants

Begin complementary feeding at 6 months of age with iron-rich foods as the priority, while continuing breastfeeding on demand, and introduce single-ingredient foods one at a time, waiting at least 4 days between new foods. 1, 2

Timing and Developmental Readiness

• Complementary feeding should begin at approximately 6 months (around 26 weeks) but not before 4 months (17 weeks) according to the American Academy of Pediatrics and World Health Organization. 1, 3
• Continue exclusive breastfeeding until this time, as breast milk alone meets all nutrient needs during the first 6 months. 4, 5
• Key developmental milestones indicating readiness include good head control, ability to sit with support, and showing interest in food. 2

Priority: Iron-Rich First Foods (6 Months)

Iron is the most critical nutrient at 6 months because infant iron stores from birth are now depleted. 1, 6 The following iron-rich foods should be prioritized:

Vegetables (Lower to Moderate Risk)

• Start with smooth, thin purees: squash, carrot, white potato, green beans 3, 2
• Moderate-risk vegetables: broccoli, cauliflower, parsnip, turnip, pumpkin 3
• Begin with 1-2 teaspoons per feeding, gradually increasing amounts 2

Iron-Fortified Cereals

• Two or more servings per day of iron-fortified infant cereal can meet iron requirements at this age 1
• These provide highly bioavailable iron and should be a staple 1, 4

Meats (Introduce Early)

• Pureed meats provide highly bioavailable iron: finely ground beef, lamb, chicken, or fish 2, 6
• Animal source foods should be eaten daily or as often as possible 3

Fruits (Vitamin C Enhances Iron Absorption)

• Offer vitamin C-rich fruits with meals to enhance iron absorption: apple, pear, orange (lower risk); blueberries, strawberries, plum, watermelon, peach, avocado (moderate risk) 3, 1, 6

Feeding Schedule at 6-8 Months

• Offer complementary foods 2-3 times per day 2
• Breast milk remains the primary nutrition source: offer breast milk first, then solids 2
• Continue breastfeeding on demand (typically 3-5 feedings per 24 hours) 2
• Introduce one new food at a time as a single ingredient 3, 2
• Wait at least 4 days before introducing another new food to observe for reactions 3, 2

Progression at 8-12 Months

Texture Advancement

• At 8 months, transition to soft-cooked and bite-and-dissolve textures 3
• Progress from smooth purees to thicker purees, then to mashed foods and finger foods 3, 2

High-Iron Foods to Add

• Lamb, fortified quinoa cereal, millet (moderate risk) 3
• Beef, fortified grits, fortified corn cereal, wheat, fortified barley cereal (higher risk) 3

Feeding Frequency

• Increase to 3-4 times per day at 9-11 months 2
• Continue breastfeeding alongside complementary foods 3, 2

Iron Supplementation

If the infant continues exclusive breastfeeding at 6 months and complementary foods are not yet providing adequate iron (less than 1 mg/kg/day), give iron drops at 1 mg/kg per day. 1, 6 This prevents iron deficiency anemia, which affects 15-25% of breastfed infants by 9-12 months without adequate dietary iron. 6

Introducing Allergenic Foods

• Introduce allergenic foods (peanut, egg, dairy, wheat) at the same time as other complementary foods, starting around 6 months 2
• For standard-risk infants, these can be introduced at home without specialist evaluation 2
• Follow the same single-ingredient, 4-day waiting period rule 3, 2

Foods to Avoid Before 12 Months

• No honey before 12 months (botulism risk) 2
• No whole cow's milk as a main drink before 12 months 1, 4
• Avoid added salt, sugar, and sugar-sweetened beverages including excessive juice 2, 4
• Ensure appropriate textures to prevent choking hazards 2

Continued Breastfeeding

• Continue breastfeeding for 2 years or beyond as mutually desired 3, 2
• Breast milk continues to provide substantial amounts of protein, fat, and most vitamins well beyond the first year 4, 7
• Breastfeeding should continue alongside the increasing variety of complementary foods 3, 7

Monitoring and Warning Signs

• Screen for anemia at 9-12 months if the infant has been breastfed with inadequate iron intake 6
• Normal responses include initial refusal (may require 8-10 exposures to accept new foods) and facial expressions of surprise 2
• Warning signs requiring medical attention: persistent vomiting, severe diarrhea, skin rashes, respiratory symptoms, or lethargy after eating 2

Critical Pitfall to Avoid

Delaying complementary feeding beyond 6 months significantly increases the risk of iron deficiency anemia, inadequate nutrient intake, and feeding problems. 2, 6 Introduction of solids before 6 months is associated with increased infection rates, reduced breast milk production, and disruption to the microbiome. 5