Complementary food - additional porridge food after the 4th-5th month of life - as well as 6th - 8th month and 7th - 9th month

Complementary food* must be introduced earliest at the beginning of the 5th month - and at the latest at the beginning of the 7th month. Even after that, mothers should continue to breastfeed as much as they can. 

* Complementary food refers to all food that the baby receives in addition to breast milk or infant formula (e.g. porridge od mash food from vegetables, potatoes, meat/fish, and cereals and fruit)

Porridge meals in the form of drinking porridge (drinking meal or e.g. goodnight porridge bottles) are not recommended, as they can easily lead to overfeeding and can then promote tooth caries in the first teeth.  Sweet teas are also not suitable.

From the 5th month of life, solid food (porridge or mash food)is suitable and necessary for the baby, since only breast milk alone cannot be supplied with sufficient energy and sewing substances. With the months, the breast milk composition changes, but above all the child has a changed need for nutrients (especially iron and proteins).

From the 5th month of life, solid food (porridge or mash food)is suitable and necessary for the baby, since only breast milk alone cannot be supplied with sufficient energy and sewing substances.

With the months, the breast milk composition changes, but above all the child has a changed need for nutrients (especially iron and proteins).

From the 5th month of life, solid food (porridge or mash food) is suitable and necessary for the baby, since sufficient energy and nutrients can no longer be supplied through breast milk alone. The composition of breast milk changes over the months, but quite all children need more nutrients (especially iron and proteins).

The insufficient iron content in breast milk becomes relevant at the beginning of the 5th month of life when the blood change (conversion of the fetal hemoglobin) requiring more iron. Then the feeding of porridges (cereals, vegetables, and meat) should take place. Meat and fish provide the best bioavailability for iron. Moreover, with a balanced diet, you can also get enough iron without meat, but it is safer to feed fish or meat – you can get by with small amounts.

From this point on, the baby will also need secondary plant substances (phytochemicals) from fruit and vegetables that are not sufficiently transported through breast milk.

ß-carotene as a precursor to vitamin A is also only slightly present in breast milk, which is why carrot-mash from the 5th up to 6th month should be fed. The ß-carotene has many important functions – e.g. in the development of vision (healthy eyesight). 

Many other secondary plant substances (there are over 700 different ones in the carotenoid group alone) play key roles in the healthy development of the child.

There are no known disadvantages due to long, partial breastfeeding. As long as the mother and child wish, the infant can be breastfed, but over time most nutrients are to be obtained from the other food.

Theme Nutrient supplementation:

Infants can benefit from the supplementation of some micronutrients that are low in breast milk.

Vitamin K is low in breast milk. It has important functions in blood clotting. For safety reasons, 3 times 2mg of vitamin K are given orally in the first days after birth (at U1 – 1st day; at U2 – 3-10th day; at U3 in the 4th-6th week of life) – in the case of absorption disorder, it is injected intravenously (0.1-0.2mg i.v.).

There is also little vitamin D in breast milk; it serves for tooth and bone development. For the prevention of rickets, it is given orally from the 2nd week of life (in Germany often together with fluoride for a lower incidence of caries *).

The formation of vitamin D in the body is mainly stimulated through contact with the sun on the skin, which is lower in the infants in our culture. In the first year of life, 400 - 500 IU of vitamin D are given orally. If the child was born in the winter months, or if it was a premature baby, supplementation is also needed in the second year of life until after the winter period (until the beginning of the second summer for the child. Therefore, those born in winter receive vitamin D orally for 1 ½ years). Premature babies under a birth weight of 1500g receive 800-1000 IU of vitamin D daily.

* Depending on the region, fluoride (0.25mg) is also given - usually together with vitamin D (D-Fluorette). The daily amount of fluoride of about 0.05 mg/kg body weight is appropriate for the infant (with infants in Germany because it's a fluoride deficiency area).

It could not be sufficiently clarified whether caries prophylaxis is promoted by the early administration of fluoride or, above all, only due to good dental care (with toothpaste appropriately adapted for children). In any case, the benefit is particularly evident in the permanent teeth following the milk teeth and, on top of that, in the fluoridation via the toothpaste with good regular tooth brushing, as well as avoidance of the particularly cariogenic factors.

From the beginning of the 5th month, a vegetable-potato-meat/fish-mash is fed as the first spoon food (mash). One month later, between the 6th and 8th month, a milk-cereal porridge follows, and between the 7th and 9th month a cereal-fruit-pulp. 

After a month of porridge introduction, a whole milk meal at noon should be replaced by this porridge.

* Start with a few spoons of porridge (e.g.finely pureed vegetables) and then give it breast milk; slowly increase the amount to about 100g of vegetables, which you supplement with further additions, step by step (small amounts of pureed lean meat – e.g. 30g – should be added after getting used to - after about 1-2 weeks). Examples of the composition and the quantity of the porridge food follow in the chapter Baby Nutrition Part 7 -see Table BZgA Children's Health below.

The Theporridge ingredients should be varied from the list of recommended foods (see table below). 

Overall, attention should always be paid to the quality of food. Organic products according to stricter control standards are recommended.

Other recommendations of the specialist societies and BZgA (issue child’s health)are:

Additional liquid requirements:

 Infants do not need additional liquid until the beginning of the 7th month when the third complementary-food porridge (cereal-fruit porridge) is introduced. 

In cases of illnesses with fever and/or diarrhea as well as in extreme heat (from the outside temperature), there is an earlier increased need for fluids, which must be compensated absolutely. Best is to give water (tap water if the quality is good for infants), alternatively unsweetened herbal and fruit teas to infants. In the case of illnesses with vomiting and diarrhea, electrolyte powder from the pharmacy must be added according to the instructions for use (the pediatrician will advise you on this).

Caution with water quality

Tap water but also bottled drinking water should be suitable for infants and should not exceed the permissible limits for nitrate and sodium chloride- and of course, it should meet the highest hygienic requirements.  

For baby food or teas, drinking water must not contain more than 10mg of nitrate per liter - and it should be low in sodium (below 20mg sodium per liter). It is best to only use water that has been labeled as "suitable for the preparation of baby food".

The nitrate content should also be considered in the type of vegetable used for the vegetable pulp. Especially with green leafy vegetables, higher nitrate levels may be present. It is also important for the infant not to eat too much spinach at this age.

Buy suitable drinking water for the babies and find out information about your tap water. The water from the house well may be used only after a suitability test and must be checked regularly if necessary. In the case of houses where lead pipes may still be present, this must not be used for drinking or cooking – overall not for anyone in the house.

Whole milk (cow's milk) is not recommended as bottled milk throughout the first year of life because nutrients such as iodine, iron, and copper are not sufficiently present in cow's milk.

Cow's milk should only be used in the amount of up to 200 ml per day for the preparation of milk-cereal-porridge in the first year of life. 

For drinking, cow's milk should only be given from a cup towards the end of the 1st year of life and only as part of the meal (e.g. bread meal). 

Other dairy products, such as quark, or fruit yogurt as a snack or dessert, should also not be fed in the first year of life. 

Composition and quantity of foods (Children's Health BZgA)

From 5th to 7th month: vegetable-potato-meat-mash

The introduction of complementary food usually starts between the 5th and 7th month with the vegetable-potato-meat-mash.

• As a lunch, first give your child a few teaspoons of finely pureed vegetables, such as carrots. It then receives breast milk (or formula milk) as usual until it is satisfied.
• If your child does not tolerate carrots, other vegetables (such as pumpkin, cauliflower, broccoli, kohlrabi, fennel, parsnip*, zucchini) can be used. You can also use frozen vegetables (but without sauce). *not too much parsnip

·         The amount of vegetables is slowly increased to 100 g. Then the other ingredients are added step by step.

·         If your child has got used to the vegetables after about a week, you can first add a cooked potato and 1 tbsp rapeseed oil to the vegetable-potato-mash. As a final step, 30 g of lean meat and 1.5 tbsp of fruit juice are added.

From 6th to 8th month: whole-milk-cereal-porridge

About one month after the introduction of the first porridge, another milk meal is replaced in the evening or afternoon by a whole-milk-cereal-porridge*, to which vitamin-rich fruit juice or fruit puree is added. * remember cow's milk only as an additive for the porridge, not single.

·         When self-preparing milk pulp, you can use pasteurized and ultra-highly heated whole milk, longer fresh (ESL), or H-milk with 3.5 percent fat or infant milk. Raw milk should not be used because it poses significant risks to your child's health. 

·         If you buy ready-made milk porridge, you should prefer products whose composition is as similar as possible to the home-cooked porridge. They should therefore contain few ingredients and no unnecessary additives such as cocoa, chocolate, flavorings, and larger amounts of sweeteners. The addition of vitamins and minerals and lactic acid bacteria is not necessary.

From 7th to 9th month: Cereal-fruit-mash

The dairy-free cereal-fruit combination is preferred in the afternoon, about a month after the introduction of the second porridge.

• Whole grain flakes for babies (preferred without added sugar) are mixed with a little water, boiled, and left to swell. Semolina is stirred into boiling water.
• Fruit of the season and rapeseed oil are added to the warm (not hot) porridge. The fruit types can be varied.

Ready-made milk-free wholemeal fruit porridge is available in a glass. Make sure that the composition is as similar as possible to the home-prepared porridge and that the porridge does not contain dairy products. If there is no fat in the jars, add it. Also, make sure that it has a good amount of whole grains.

Summary

·         From the complementary-food age (after the 4th-5th month of life), at least one complementary mash meal should be fed per day. It starts with a vegetable porridge, and after acclimatization, vegetable-potato-meat-porridge is added to the breastfeeding.

·         From 6th to 8th month: additional whole milk cereal porridge

·         From 7th to 9th month: additional cereal-fruit meals

·         From the 10th month of life, participation in family food is recommended (if it meets the balanced nutritional recommendations!)*

* except whole nuts posing a risk of aspiration; finely ground nuts, which are mixed e.g. in porridge, are possible. In case of allergies or intolerances, exclusions must always be observed. However, these should be supported by appropriate diagnostics and not merely based on parental assumptions.

Theme vegan diet

A vegan diet in infancy is discouraged by the specialist societies. Moreover, is also discouraged in the breastfeeding mother, as both she and the infant have the risk of a lack of different nutrients (in any case, there is a need for supplementation for vitamin B12 with an absolute vegan diet). 

A  vegetarian diet of mother and child is possible if the composition is balanced: in addition to dairy products, egg products should also be included, and a varied combination of vegetables, fruits, potatoes, cereals enriched by appropriate oils (linseed oil, rapeseed oil, olive oil, nut oils) should be consumed.