A dietary recommendation that has been considered good for a long time can become completely obsolete in a few years. And, as new research is published, the advice that health professionals convey in their consultations changes. Also those related to the diet of the little ones.
“Today we know that the first 1000 days of life, which include the fetal period, the first year and the second year, are a window of opportunity for metabolic programming and disease prevention in children, adolescents and adults. Nutrition during these periods is going to be essential for this,” explains Rosaura Leis, Professor of Pediatrics at the University of Santiago de Compostela and coordinator of the Nutrition and Breastfeeding Committee of the Spanish Association of Pediatrics (AEP).
How long should they breastfeed, what is the best time to introduce other foods - and, specifically, those that cause more allergies such as milk and eggs - or what margin of freedom should be offered during meals are some of the questions. most common doubts among parents. We talk to pediatricians so they can solve them for us:
In the first six months of life, babies should be fed exclusively with breast milk. This means that, in general terms, it is not advisable to give them other foods until they reach this age, a recommendation that is agreed upon not only by pediatricians, but also by international organizations such as the WHO and UNICEF. "We must value what is natural and insist on the benefits of breastfeeding from the prepartum talks," says Dr. Marcelo Andrade, pediatrician at the Sant Joan de Déu Hospital in Barcelona.
In addition to being a good source of energy and nutrients, mother's milk promotes the development of the immune system and reduces the prevalence of infectious diseases during the first year of life. For this reason, it should continue to play a major role in the infant's diet after six months, which is when other foods begin to be added. "Until the child turns one year old, it should be the main support," Andrade insists.
Other advantages of breast milk are related to its content of probiotics and prebiotics, "which will help the development of a balanced, eubiotic, and healthy intestinal microbiota," adds Leis. The coordinator of the AEP Nutrition and Breastfeeding Committee adds that some studies have also observed a lower risk of being overweight and/or obese at later ages in children fed with breast milk.
It has also been proven that these children obtain better results in intelligence tests and that they achieve higher incomes in adult life. The benefits are also numerous for mothers, since breastfeeding reduces the risk of ovarian cancer and protects against diabetes and blood pressure; in addition to improving the relationship with the baby.
For years, most professionals have recommended delaying the introduction of potentially allergenic foods, such as cow's milk or eggs. It was believed to be a way to prevent allergies in children, but this has changed. Now, professionals advise that babies begin to become familiar with them from six months, which is when the complementary feeding phase usually begins. “Recent studies, specifically with peanuts and eggs, have observed that introducing them earlier reduces the development of allergies to these foods, that is, increases tolerance,” says Leis. This is explained because the baby's immune system is more moldable and has more capacity to adapt. On the contrary, there is no evidence that delaying this step is beneficial for the child.
When the time comes to add these foods with allergenic potential to the diet of children, it should be taken into consideration whether the baby already has a diagnosed allergy or has a family history. In these cases, it is best to decide how to proceed with the help of a health professional. If not, they should be offered to the child one at a time and in small quantities to detect any reaction. Andrade advises applying the three-day rule, that is, trying a food during this period of time, especially in small quantities, and observing how the child tolerates it before moving on to the next.
"They must be introduced without pause, but without haste," says Dr. Susana Domínguez, from the pediatric service of the MútuaTerrassa University Hospital. As for what signs should worry us, she says the following: "There is no mother who does not know how to perceive that something is not right. Skin rashes or small gastrointestinal disorders are some of the reactions that tell us that she is not tolerating the food well." And Andrade adds another, vomiting.
The child should also start trying these ingredients "in a quiet moment when he is not distracted by other stimuli and when the mother and father can observe how he responds," adds Domínguez.
Less and less importance is also given to the order in which foods are introduced, since meals will vary according to the family's gastronomic and culinary tradition. But that does not mean that there is free rein. Ingredients that pose a choking risk, such as grapes, cherries, olives, sausages, whole nuts, popcorn, or raw carrots, should be avoided.
"The first foods we introduce must be safe," emphasizes Domínguez, who also remembers that at these ages we should avoid game meats due to their high levels of lead, fish with a lot of mercury (such as swordfish, bluefin tuna, shark and pike), or green leaves, because they are rich in nitrates and nitrites. Infusions must also be avoided, which can be toxic in the first months/years of the child's life, such as honey, which often appears responsible in cases of infant botulism.
Another key point is to ensure that the food is healthy. "It is very important to educate from the first moments of life on a healthy diet, avoiding adding simple sugars and salt to preparations, in addition to products rich in saturated and trans fats, sugars and salt, such as pastries and sausages," Leis points out. On the other hand, you should not resort too much to the famous ready-to-eat baby food and purees made at home should take priority.
Ultra-processed foods are not recommended either, since their intake is related to ailments such as obesity, cardiovascular diseases, type 2 diabetes or even cancer, says Andrade, who insists that the menu at these ages should be composed of "genuine foods."
In relation to how to administer these foods, whether in the form of porridge or whole foods, there is not enough evidence as to whether the traditional technique, spoon or porridge, or offering whole pieces of food to the infant is better, says Leis.
With the rise of plant-based diets, one of the increasingly recurring doubts is whether babies can be vegetarians or vegans. Pediatricians affirm that it is possible to offer 100% vegetable menus to children, but some considerations must be taken into account.
The American Academy of Pediatrics and the Academy of Nutrition and Dietetics agree that to be nutritionally adequate during infancy, childhood, and adolescence, they must be well planned. "Especially in the case of vegan diets, close supervision by a professional may be necessary to ensure that the proportions the child is receiving are appropriate," says Domínguez. On the other hand, Leis points out that the pediatrician must also assess the need for dietary supplements.
In these cases, it must be clear that breast milk continues to be the main sustenance of the creatures, Andrade insists again, who reminds that vegetable drinks are not even close to a valid substitute.
Another increasingly common recommendation is to give the baby more freedom while eating, especially after six months, which is when complementary feeding usually begins. Proof of this is the great popularity that baby-led weaning is gaining, a method that encourages the child's self-feeding. Basically, food is offered in pieces to the infant and he chooses and ingests.
"This was thought to pose a greater risk of nutritional deficiencies or suffocation or choking. Therefore, modified baby-led weaning began to emerge, where parents select the foods they offer, as well as their hardness," explains Leis. The pediatricians consulted for this report agree that extremes are never good, but that promoting self-regulation is a positive thing.
"When the child is given a passive role, he is not allowed to adequately develop the sensations of hunger and satiety. But in order to give him that freedom, it is necessary to remember the emotional-social aspects. That is, practice perceptive eating," he points out. Dominguez. This means feeding him slowly and patiently, and encouraging him to eat, but without forcing him; Or if he rejects a food, try it again and experiment with other combinations. "We can try that food up to 10-15 times. One day's rejection should not be interpreted as something definitive," insists the expert.
In addition, we must remember that meals are moments of learning and love in which it is essential to talk to children and maintain eye contact. "For this reason, we must avoid mobile, tablet or television screens at all costs, and sit them at the table so that they feel like one more," concludes Domínguez.
