Eating for Healthy Babies and Toddlers/Ngā kai tōtika mō te hunga kōhungahunga - HE1521

A baby needs enough food to grow, develop, sleep, and be happy.

Caring for a baby is very rewarding, although there is always a lot to do. Your baby depends on you for a healthy start in life.

These guidelines will help you choose healthy food for your baby and toddler.

• Breast milk is best.
• If you are not breastfeeding, use an infant formula until baby is 12 months old.
• Give babies and toddlers plenty to drink.
• Start solid food when your baby is ready – at around 6 months old.
• Change the variety, texture and quantity of food as your baby grows.
• Healthy eating habits start early.
• Once your baby starts solids try to have some meals together as a family. Family mealtimes are important for the learning and development of your baby or toddler.

Breast milk is best

Breast milk is specially made for your baby and is all your baby needs until they are around 6 months old. Breast milk:

• is the perfect food for your baby
• changes with your baby’s needs
• helps protect your baby against infection
• is cheap, safe, environmentally friendly and ready to use!

Young babies need to be fed often and on demand (when they are hungry).

Baby’s appetite, weight gain and lots of wet nappies tell you how much milk your baby needs. If your baby is hungry after feeding from one breast, then offer the other breast. After feeding on both breasts, begin the next feed on the breast used last.

You can express breast milk. For babies under 6 months, sterilise all equipment and containers. For babies over 6 months, thoroughly wash and rinse all equipment and containers.

You can store expressed breast milk in an airtight container with a sealed lid for:

• 4 hours at room temperature 
• 72 hours (3 days) in the fridge
• 2 weeks in the freezer box in the fridge
• 3 - 6 months in the separate freezer part of a fridge-freezer
• 6 - 12 months in a separate chest freezer.

Always store breast milk in the bottom half of the fridge or freezer and towards the back. Remember to put the date on the container, and use the oldest milk first.

A breastfed baby’s bowel motions (poo) are soft, a bright yellow colour and often very frequent – but each baby is different. Most breastfed babies don’t get constipated (when it’s difficult for them to pass the bowel motion), but some will have a bowel motion only every few days. Formula-fed babies have firmer and darker bowel motions than breastfed babies do.

Formula feeding

Infant formula is made for babies up to 12 months old who are not breastfed. There are many reasons why some mothers don’t breastfeed. Try to maintain some breastfeeding if possible.

Before buying formula, check the formula label for baby’s age and the ‘use-by’ date. Find a formula that suits your baby and keep to the same one.

Choose a formula based on n cow's, goat's or sheep milk. Soy or other special infant formulas should only be used under the direction of a health professional. Do not give baby cow's milk, condensed, evaporated or plant-based milks.

Use breast milk or formula as the main drink until your baby is 12 months old. There is no need to change to a follow-on formula at 6 months, which is usually when baby will be ready to start solid food.

If baby is hungry and demands more, give more formula at each feed or add an extra feed. Do not make the formula stronger.

Preparing infant formula

• Always wash and dry your hands before preparing bottle feeds.
• You must wash and sterilise all feeding equipment until baby is at least 6 months old (including any items used with breast milk). After 6 months, thorough washing and rinsing is enough.
• Make a fresh bottle of formula just before each feed.
• Follow the instructions on the formula can. Use the scoop provided with each can, and make sure the powder is a level scoop that is not packed down.
• In the first 6 months, use boiled, cooled water to make up formula (see the next section).
• If you want to warm the formula, put the bottle of prepared formula in a bowl of hot water until it is warm enough.
• Microwaves are not recommended for warming formula because they can easily overheat the formula or heat it unevenly and burn your baby's mouth and throat.
• Before feeding baby, always check the formula’s temperature by putting some on the inside of your wrist. The formula should feel just warm.
• Use the formula within 2 hours.
• Throw out any remaining formula that your baby has not drunk.

Preparing water for formula

• From birth until baby is 6 months old, all water used for formula should be boiled and cooled to room temperature on the day it is used.
• From 6 months of age you can use the town supply water from the cold tap to make baby’s formula.
• Water from tanks or bore holes should be boiled until baby is 18 months old.
• If your water comes from a private supply (such as from a bore or
  tank), have it tested to ensure that is is safe for you and your baby.
• Bottled water is not recommended as it is not sterile. Like tap water, bottled water needs to be boiled then allowed to cool before it is used to prepare formula.
• When making up formula, pour the correct amount of water into the sterilised bottle before adding the powder. (Not all baby bottles have accurate volume lines on them. To check that your bottles do, look for the standard mark EN14350 on the bottle or packaging, or take your bottles to a pharmacy to check if the bottles are accurate.)

Ask your midwife, Well Child nurse or chemist for more information on formula feeding, including sterilising bottles and teats.

See the booklet Feeding Your Baby Infant Formula (code HE1306) for more information.

If you need advice and support with breastfeeding or formula feeding, ask for help from:

• your family doctor or practice nurse
• a Well Child nurse, Plunket Family Centre or Plunketline
• your midwife or a lactation (breastfeeding) consultant
• La Leche League (breastfeeding advice and support only)
• a community or private practice dietitian
• Parents’ Centre.

It is important to always hold your baby when feeding. Babies should not be left lying with a bottle to suck on because of the risk of choking and ear problems. Also, if they fall asleep with milk in their mouths, the milk can damage their teeth.

Babies and toddlers need plenty to drink

Formula-fed babies may also need boiled, cooled water. Toddlers should be offered drinks throughout the day. Healthy babies who are drinking enough will usually have 6 or more very wet nappies a day.

Best drinks for babies and toddlers are:

• from 0 to 6 months – breast milk (or formula if breast milk is unavailable)
• from 6 to 12 months – breast milk (or formula) and water
• from 1 to 2 years – breast milk, whole-fat cow's milk (dark blue lid) and water.

Your baby or toddler may need extra drinks:

• when the weather is very hot
• if they have a temperature and are feverish
• if they are vomiting or have diarrhoea

If your baby is unwell for 24 hours, continue to give breast milk or formula but see your doctor.

• Water from tanks or bore holes should be boiled until baby is 18 months old.
• Do not offer drinks containing natural or added sugar, such as fruit juice, cordial, fizzy drinks, or flavoured milks. These can damage teeth and cause the baby or toddler to develop a taste for sweetened foods.
• Never give babies and toddlers tea, coffee, alcohol, smart or energy drinks or other adult drinks.

Starting Solids

Offer solids when your baby is most relaxed and happy. Give the milk feed first (until 8–9 months old) and offer solids as a ‘top up’. Try 1⁄2–2 teaspoons first and gradually increase the amount until baby is having about 3–4 teaspoons at a meal.

Hold baby while you feed them or sit them in a baby high chair. Use a small teaspoon and put the food in the middle of their tongue. Throw out any uneaten food left on baby’s plate.

Offer your baby a variety of foods so they get to try lots of new tastes. You can mix
foods together or give them on their own. If they don’t like the food the first time, try again with a smaller amount or alongside a food the baby likes. It might take up to 15 tries!

Preparing baby's food

Always wash and dry your hands before preparing baby's food. Use a clean plate (or bowl) and spoon. Don’t share the spoon with your baby – you may pass germs to your baby if you do.

Remove the skins and seeds from fruit and vegetables before you cook or purée them. To pure baby’s food, use a blender or push food through a fine sieve.

Babies like the plain taste of milk, so first foods also need to be plain. Don’t add salt, sugar, honey, sweeteners, soy sauce, cream, butter or margarine to your baby’s food.

Use expressed milk or formula to make food runny enough for your baby to swallow. Home-made foods can be frozen in ice cube trays and used in the next 3–4 weeks.

Commercial baby foods can be a convenient alternative to home-made baby
food. When buying baby food, check that it is right for your baby's stage. Always follow the storage instructions on the jar, pouch or can. If using a pouch, empty the food into a bowl and spoon-feed the baby. This way the baby can see, smell and touch the food.

Do not give babies or toddlers honey to eat. Honey may contain bacteria that can make young babies sick. Children and adults have more developed digestive systems, which can kill the bacteria.

Teething

You can make rusks at home or buy teething biscuits or a teething ring to help your baby with teething and learning how to chew and bite.

Start brushing your baby’s teeth as soon as the first tooth comes through the gums. Buy a soft, small-headed brush and use a small smear of standard-strength fluoride toothpaste. Fluoride and regular brushing keep teeth healthy. Brush baby’s teeth twice a day – in the morning after breakfast and at night before bed. See your baby's Well Child Tamariki Ora Health Book for more information about teething.

Allergies

Delaying the introduction of solid food until your baby is ready for it and continuing to breastfeed while you introduce solids – may help prevent allergic reactions to some foods. At around 6 months, once baby is ready for solids, try new foods one at a time.  If you suspect an allergy or have a strong family history of allergies, talk to your doctor.

Start solid food when your baby is ready – at around 6 months old

Breast milk (or infant formula) gives babies all the nutrients they need up to around 6 months old. From 6 months babies start to need food as it provides extra sources of nutrients, such as iron. Also, babies have usually grown and developed enough to start eating solid food. Breast milk (or infant formula) is still very important.

Discuss starting solids with your Well Child provider or family doctor or nurse. Use the following information as a guide.

Your baby is ready to start solids if they:

• can hold their head up
• sit with less help
• often put their hands in their mouth
• easily open their mouth when the spoon touches their lip or as food
• approaches
• can keep food in their mouth and then swallow it, instead of spitting the food out
• show signs of chewing movements.

Fluids

Offer milk (breast milk or formula) before solids.

Foods – plain, soft, smooth

The best foods when your baby is starting on solids are:

• cooked and puréed beef, lamb,
  pork, chicken or fish, or vegetarian
  alternatives such as puréed legumes*
• cooked and puréed vegetables
  without skins − kūmara,
  kamokamo, pumpkin, potato,
  cassava, tapioca
• puréed fruit without skins, pips or
  seeds - apple, pear. Cook to soften
  if needed
• puréed or mashed ripe fruit
  without skins, pips or seeds -
  banana, mango, avocado
• iron-fortified infant cereal/baby rice
• puréed, plain cooked rice or congee
• bought baby food, which is at the
  right stage for your baby
  

* Legumes include cooked dried peas, beans or lentils.

From 7 to 8 months

Change the type of food offered, how much you give and the texture.

Give more variety as baby grows older.

Your baby is ready for mashed foods, finger foods and new flavours if they:

• can sit without support
• can pick up and bring food to the mouth
• probably have some teeth
• are learning to bite and chew
• can keep thick purées in their mouth.

Fluids

• Offer milk (breast milk or formula) before solids.
• Offer water if needed.

Foods

• Continue to purée cooked meat, fish and chicken.
• Introduce mashed well-cooked fruit and vegetables, mashed cooked legumes*, mashed cooked egg, soft cheese (such as cottage cheese), custard and plain yoghurt (without added sugar).
• Remove stalks and ‘stringy bits’ from foods like silverbeet, pūha and bok choy.
• Offer finger food in pieces that can be easily picked up by baby – very soft fruit and vegetables (eg, ripe banana, well- cooked pumpkin), toast fingers and thin slices of cheese.

* Legumes include cooked dried peas, beans or lentils.

Between 8 and 12 months

Start introducing more textures and ‘lumpy’ foods.

Your baby is ready for more textures and lumpy foods if they:

• are learning to crawl and may pull
• themselves up to stand
• can bite well and can chew soft lumps
• are interested in a range of foods and textures
• need some help to eat.

Fluids

• Offer solids before milk (breast milk or formula).
• Offer water if needed.

Foods

• Try mashed vegetables mixed with minced or finely chopped tender cooked meat, chicken, kai moana, egg or slightly mashed cooked legumes*. You could also add chopped up noodles or pasta or whole rice.
• Add chopped soft fruit to yoghurt or custard.
• Offer breakfast cereal – porridge, wheat biscuits and infant muesli.
• Introduce slightly firmer finger foods such as:
  • soft ripe fruit or soft cooked vegetables such as kiwifruit or kūmara
  • finely grated raw carrot and apple
  • toast fingers
  • puffed crispbread.

* Legumes include cooked dried peas, beans or lentils.

From 12 months

If your toddler shows the signs listed below, start giving them small amounts of the same food the rest of your family eats. Your toddler is ready to try many different spoon and finger foods.

Milk is still important in your toddler’s diet, but needs to be balanced with the amount of solid food that your toddler eats. See the Fluids section below.

Your toddler is ready for many different spoon and finger foods if they:

• can easily use their hands and fingers to feed themselves
• can hold a cup with two hands and drink from it
• has molar teeth starting to appear (the larger teeth at the back of the mouth, which are used to chew and grind food)
• can bite through a variety of different foods and chew well.

Fluids

Offer milk or water between meals. You may choose to continue breastfeeding and/or offer up to 350 ml of whole-fat cow's milk (dark blue lid) a day. The more breast milk your toddler has, the less cow's milk they need.

Foods

• Breads – pita, rēwena, chapatti, buns, rolls – cut to a size that your toddler can easily hold and eat.
• Small sandwiches with thinly sliced fillings or a thin layer of easy-to-spread ingredients (eg, smooth peanut butter).
• Soft pieces of vegetables and fruit, including new ones (cook or finely grate if raw).
• Finely chopped salad vegetables – lettuce, cucumber.
• Yoghurt and slices of cheese.
• Tender, finely chopped lean meat, chicken, seafood and egg.
• Soft, slightly mashed, cooked dried peas, beans or lentils.
• A variety of cereals (remove very hard foods like whole nuts or hard dried fruit).

Babies and toddlers need three small meals a day and small healthy snacks between meals. They have small stomachs and use lots of energy.

Healthy snacks

Some healthy snacks are:

• carrot, apple or celery – finely grated or cooked until soft
• crackers with a thin scrape of smooth peanut butter
• half a banana
• thinly sliced or grated cheese
• yoghurt.

Babies and toddlers can choke on food quite easily

This is mainly because they have small air and food passages and are still learning to move food around in their mouths and how to bite, chew and grind food. To reduce their risk of choking:

• always make sure babies and toddlers sit down while they eat and that an adult is with them while they are eating or drinking
• offer food that matches their chewing and grinding ability

Be aware of foods that are more likely to cause choking – for example:

• small hard foods that are difficult for children to bite or chew (eg, nuts, large seeds, popcorn husks, raw apple, carrot and celery)
• small round foods that can get stuck in children’s throats (eg, grapes, berries, raisins/sultanas, peas, watermelon seeds, lollies)
• foods with skins or leaves that are difficult to chew (eg, sausages, chicken, lettuce, nectarines)
• compressible* food that can get stuck in children’s throats (eg, hot dogs, sausages, pieces of cooked meat, popcorn)
• thick pastes that can get stuck in children’s throats (eg, chocolate spreads, peanut butter)
• fibrous or stringy foods that are difficult for children to chew (eg, celery, raw pineapple).

To reduce the risk of choking on these foods, you can:

• alter the food texture – grate, cook, finely chop or mash the food
• remove the high-risk parts of the food – peel off the skin or remove the strong fibres
• avoid giving small hard foods, such as whole nuts and large seeds until children are at least 5 years old.

* Compressible foods are those that can squash down into the shape of the child’s throat and get stuck there.

Parents and caregivers need to learn choking first aid and CPR.

For information on choking first aid and cardiopulmonary resuscitation (CPR), see your Well Child Tamariki Ora Health Book or the Ministry of Health website.

Start healthy eating habits from an early age

How much food should I offer my baby?

All babies are different. Watch for signs of being full – some babies turn their heads away. As your baby becomes more active, you will need to offer small amounts of food often.

My toddler seems to eat less than she did as a baby. Is that usual?

Yes. In their first year, babies grow very quickly and they need a lot of food. They don’t grow quite so quickly in the second year, so some days they may eat a bit less.

We use low-fat milk. Is that OK for my toddler?

Toddlers should have whole-fat milk (dark blue lid) until they are 2 years old. Then you can gradually replace it with reduced-fat milk. Toddlers may still be having breastmilk as well.

My children won’t eat vegetables.

Don’t worry – it’s very common, especially as toddlers get older. Keep offering a variety of vegetables so they can get used to a range of tastes. Try presenting the food differently by using different cooking methods or textures. For example, try offering raw, grated vegetables as an alternative.

Is it true that toddlers should not have breads with whole grains or large seeds?

Wholemeal bread is a healthy choice for toddlers. Bread with whole grains is better for older toddlers who can chew and grind their food well. Avoid bread with large seeds.

Can my baby eat the vegetables cooked for the family dinner?

Babies and toddlers do not need salt added to their their food. If you use salt when you cook the family's vegetables, cook all of the vegetables without salt, remove your baby's meal and then add salt to the vegetables for the rest of the family.

My baby seems to like sweet foods best.

Healthy habits begin early, and we can encourage children to like fresh plain foods. Offer water instead of sweet drinks and don’t add sugar or honey to fruit or cereals.

Why does my toddler need to eat iron-rich foods?

Iron is especially important to keep blood and brain cells healthy. Iron helps children to learn. Lean meat, chicken and fish contain lots of iron, and vegetables and fruit help the body to absorb the iron. Don’t give children tea to drink, as it contains substances that stop iron from being absorbed.

Give toddlers three small meals a day using lots of different foods. They also need small healthy snacks between meals, and milk – around 350 ml of cow's milk a day is plenty for toddlers.

Should babies and toddlers have extra vitamins?

With the exception of vitamin D, babies and toddlers can get all the vitamins they need from food. Each day, toddlers should be offered a variety of foods from each of these groups:

• vegetables and fruit
• breads and cereals
• milk and milk products
• lean meat, chicken, eggs, and cooked dried peas, beans and lentils.

Vitamin D

Vitamin D is important for bone health. A lack of vitamin D can lead to seizures, soft bones (rickets), and arm and leg pain. In New Zealand, we make most of our vitamin D from exposing skin to sunlight. A small amount comes from foods such as oily fish (eg, sardines, salmon and trout), fortified foods (eg, some margarines, milk, and yoghurts), eggs, and liver.

Babies can’t safely get the vitamin D they need from the sun. Their skin is very sensitive and they should not be left in direct sunlight.

Toddlers need some time in the sun to get enough vitamin D. The amount of time depends on many factors, including season, time of day and skin colour.

Some babies and toddlers are more likely to have low vitamin D levels. This includes breastfed babies who are naturally dark skinned, or who have mothers who are vitamin D deficient, or have other family members who have had rickets. Some premature babies are also at risk. Toddlers who are naturally dark skinned are more at risk. If you are concerned, talk to your doctor or Well Child nurse. They may recommend vitamin D supplements for your baby or toddler.

Sun safety

While outdoors, babies and toddlers need to wear a wide- brimmed hat and loose-fitting clothing that covers as much of the skin as possible. Sunglasses are a good idea. Sunburn should always be prevented. Use sunscreen (SPF 30) with babies only if their skin cannot be covered with clothing.

September to April (including the daylight saving months)

• Keep babies out of direct sun.
• Toddlers are likely to receive enough vitamin D from sunlight if they are outdoors for short periods before 10 am and after 4 pm.

May to August (the cooler months)

• In winter, it is generally safe and advisable for babies and toddlers to spend some time in the sun.

Meal ideas for babies 8–12 months

Breakfast

• Porridge (with breast milk or formula), and stewed apple or
• Yoghurt with soft chopped fruit or
• Toast fingers with a little butter or margarine and mashed banana or
• A serving of bought baby food

Lunch

• Toast fingers with grilled grated cheese and yeast-based spread or
• Mashed potato with minced or finely chopped meat, chicken or grated cheese or
• Chopped well-cooked pasta with mashed vegetables and mashed cooked legumes* or
• A serving of bought baby food

Dinner

• Minced or finely chopped beef, lamb or chicken, or mashed cooked legumes*, with
• mashed kūmara, potato, pumpkin, taro or yam or
• rice and mashed vegetables

or

• A serving of bought baby food

Drinks and snacks

Between meals, offer milk (breast or formula) and small healthy snacks

• Pieces of soft ripe fruit (eg, kiwifruit, orange, apricot)
• Toast fingers with mashed avocado or cooked grated cheese
• Grated raw carrot or apple
• Puffed crispbread

* Legumes include dried peas, beans or lentils.

Meal ideas for toddlers 1–2 years

Breakfast

• Breakfast cereal with milk and chopped ripe banana, or
• Wholemeal toast with a little margarine and peanut butter or yeast- based spread

Lunch

• Wholemeal sandwich quarters with finely chopped lettuce and mashed boiled egg (or grated cheese) or
• Baked beans on toast or
• Macaroni cheese or
• Scrambled egg with toast

After lunch, serve pieces of soft ripe fruit and a drink of milk

Dinner

• Finely chopped lean meat, chicken or fish, and soft cooked vegetables with
• mashed potato, kūmara or taro, or
• rice or pasta

If needed, serve yoghurt, custard, or fresh stewed or canned chopped fruit for dessert.

Drinks and snacks

Between meals, offer water, milk and healthy snacks

• Puffed crispbread with a thin scrape of smooth peanut butter
• Half a banana
• Grated or thin slices of cheese
• Yoghurt
• Carrot, apple or celery – grated or cooked until soft

For more information

Talk to:

• the doctor or nurse who sees your baby
• Well Child nurse
• family doctor and practice nurse
• midwife
• child health nurse at community clinic or Tipu Ora
• paediatrician
• lactation consultant

Other groups in the community

• Plunket Family Centres
• marae-based health services
• Tipu Ora
• La Leche League
• kōhanga reo
• Parents’ Centres NZ Inc
• Multiple Birth Association

Community health workers

• community health services or your local public health service
• dietitian in community or private practice
• Māori or Pacific health workers

You can also get telephone help from:

• Healthline 0800 611 116
• PlunketLine 0800 933 922

Visit these websites:

• Ministry of Health
• Health education resources 

The Ministry of Health acknowledges the contribution of Loraine Hamm, Speech Language Therapist, in the development of this resource.

 

ISBN 978-0-478-41115-7 (print) 978-0-478-41116-4 (online)