Infant Feeding – Recent Changes to the Health Canada Guidelines

How long (if at all) should I be breastfeeding my baby?

When is the right time to start introducing solid foods to my baby?

What foods should I be offering my baby?

Have you ever found yourself debating the answer to these questions with friends or family members? If so, you’re not alone. Infant feeding tends to be a hot topic, with everyone seeming to have their own opinions regarding the best approach and ways of “doing it right”.

In a joint effort, Health Canada, the Canadian Paediatric Society, Dietitians of Canada, and the Breastfeeding Committee for Canada came together to review and update the evidence-informed feeding recommendations. Of note are the revised guidelines for feeding the birth to six month old and the six to 24 month old.

Click HERE to be directed to the document. For your reference, the URL is http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/index-eng.php.

Key recommendations include:

• Support for continued breastfeeding after the introduction of solid foods.
• Supplemental vitamin D for infants and young children who are breastfed (10 µ each day).
• Beginning to introduce solid foods no earlier than 6 months of age.
• Emphasis on iron-rich foods such as meats, meat alternatives, and iron-fortified cereals, and offering them a few times each day.
• Encouragement of practices such as self-feeding, the early offering of finger foods, and drinking from an open cup.
• Feeding infants and young children nutritious foods from family meals.

I’d suggest that anyone who has a baby spend some time reviewing the document and become familiar with the updated recommendations.  Embedded within it is rationale on each point, including current and relevant research.  Although I could talk (or write) in length about each area, I have chosen three to provide my occupational therapist (OT) perspective on.

Why 6 Months?

As an OT who works in the area of infant feeding, I am often asked whether or not babies can begin solids earlier than 6 months. The truth is, although there is variability in the acquisition of oral-motor skills, with some babies being able to handle food earlier, before 6 months the mouth is simply not ready. In young babies, the tongue fills the oral cavity, facilitating the compression and suction required to retrieve milk from a nipple. Anatomical changes emerge around 6 months, with an elongation of the pharynx and more space for variations in tongue movements (i.e. tongue lateralization). Controlled thrusts (back and forth movements) of the tongue are initially used to move purees to the back of the mouth for the swallow. Think about eating pudding, for example. Could you successfully eat it without moving your tongue at all?

Family Meals

As I’m sure most people will agree, it’s usually quite unbelievable what habits babies will pick up by simply watching and observing others. That being said, including your child in the family meal early on is recommended. The idea initially is simply to expose your child to others eating. From the time you start putting your baby in a highchair, pull him/her up to the table. Timing is important; when feeding your baby, try making sure that someone else at the table is eating as well. The last thing that you want is for your baby to feel like all eyes are on him/her and for stage fright to kick in! Try and offer your baby foods that closely resemble what you are eating. However, do remain mindful of texture and size (more information about this will be included in an upcoming blog post). In addition, exaggerate your chewing patterns. Make vocalizations such as “num num” while moving your jaw up and down. If there’s any time to eat with your mouth open, it’s when your little one is learning to eat. Show them how the food moves from the front to the back and pair this with “I’m moving my food to the back of my mouth”.

Cup Drinking

When I read the piece about drinking from an open cup at 6 months I was initially quite taken back. My recommendation had always been 8 months, earliest. However, in giving it more thought, learning the “correct” technique for cup drinking early on is actually a good approach. In addition, the oral structure is set up for it, with the tongue large enough to elicit a suckle pattern. Parents tend to favor sippy cups as a transitional step (and to avoid a mess), yet drinking from one requires extension (bending back) of the neck. Think about trying to drink from a cup while tipping your head back – the liquid would be all over you! Why not assist your child in developing proper cup drinking skills from the onset. Below are some techniques and recommendations (Marcus & Brenton, 2013):

• Start with a spoon and purees, acting as a “small cup”. If closure of the top lip is not automatic, hold the spoon upwards while providing pressure on the lip. This should facilitate closure.
• Transition to medicine sized cups, filled quite high, where you can direct the flow by squeezing it. Use the same technique as with the spoon to facilitate lip closure; provide upward pressure on the top lip.
• During practice, continue to hold onto the cup for your baby. His/her fine motor skills will not be developed or controlled enough to do so independently. When providing less support, offer cups with handles on both sides that your baby can grasp onto.
• Note that transitioning from a bottle to a cup can be a shock to the mouth. During bottle feeding, only the taste buds at the back of the mouth/tongue are elicited, with the front of the mouth being ignored. To help prevent this shock, try cup drinking with just water (minimal flavor) to get your child used to the feeling of liquids at the front.

As with all other areas of development, acquiring the skills required to feed can be variable. That being said, please do remain mindful of the new guidelines when thinking about how, when and what to feed your baby.

Marcus, S. & Brenton, S. (2013). Infant and child feeding and swallowing: Occupational therapy assessment and intervention. Bethesda, MD: AOTA Press.