Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Introducing solid foods and vitamin and mineral supplementation during infancy

Teresa K Duryea, MD
Section Editors
Jan E Drutz, MD
Kathleen J Motil, MD, PhD
Deputy Editor
Mary M Torchia, MD


The primary objective of feeding during the first year is the acquisition of nutrients for optimal growth [1]. The balance of energy intake to energy needs is of primary importance [2]. Secondary goals include the acquisition of oromotor skills and appropriate eating behaviors.

Feeding development is a "learned progression of behaviors" [1]. It is dependent upon structural integrity and neurologic maturation and compounded by individual temperament, interpersonal relationships, environmental influences, and culture. Feeding practices during the first two years of life help to establish lifelong eating habits, so it is important to develop healthy eating habits [2-4].

The introduction of complementary foods (sometimes called beikost, or "weaning foods") and the need for vitamin and mineral supplementation during the first year of life will be discussed here. Breastfeeding and dietary recommendations for toddlers and preschool children and issues related to the introduction of solid foods in infants at high risk for allergy are discussed separately.

(See "Infant benefits of breastfeeding".)

(See "Breastfeeding: Parental education and support".)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: May 2017. | This topic last updated: Jun 06, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Stevenson RD, Allaire JH. The development of normal feeding and swallowing. Pediatr Clin North Am 1991; 38:1439.
  2. Woodruff CW. The science of infant nutrition and the art of infant feeding. JAMA 1978; 240:657.
  3. Stang J. Improving the eating patterns of infants and toddlers. J Am Diet Assoc 2006; 106:S7.
  4. Skinner JD, Carruth BR, Bounds W, et al. Do food-related experiences in the first 2 years of life predict dietary variety in school-aged children? J Nutr Educ Behav 2002; 34:310.
  5. Food and Agriculture Organization of the United Nations (FAO), World Health Organization (WHO) and United Nations University (UNU): Human Energy Requirements. Chapter 3: Energy requirements of infants from birth to 12 months. Available at: www.fao.org/docrep/007/y5686e/y5686e05.htm (Accessed on January 21, 2013).
  6. Fox MK, Devaney B, Reidy K, et al. Relationship between portion size and energy intake among infants and toddlers: evidence of self-regulation. J Am Diet Assoc 2006; 106:S77.
  7. Fomon SJ. Taste acquisition and appetite control. Pediatrics 2000; 106:1278.
  8. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012; 129:e827.
  9. World Health Organization. Complementary feeding. www.who.int/nutrition/topics/complementary_feeding/en/index.html (Accessed on April 19, 2011).
  10. Boland M. Exclusive breastfeeding should continue to six months. Paediatr Child Health 2005; 10:148.
  11. Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev 2012; :CD003517.
  12. Jonsdottir OH, Thorsdottir I, Hibberd PL, et al. Timing of the introduction of complementary foods in infancy: a randomized controlled trial. Pediatrics 2012; 130:1038.
  13. Agostoni C, Decsi T, Fewtrell M, et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2008; 46:99.
  14. European Food, Safety Authority. Scientific opinion on the appropriate age for introduction of complementary feeding of infants. EFSA Journal 2009; 7:1423.
  15. Evans Morris S. Eating readiness cues: Introducing supplemental foods. Pediatric Basics 1992; 61:2.
  16. Zutavern A, Brockow I, Schaaf B, et al. Timing of solid food introduction in relation to atopic dermatitis and atopic sensitization: results from a prospective birth cohort study. Pediatrics 2006; 117:401.
  17. Kleinman RE. Learning about dietary variety: The first steps. Pediatric Basics 1994; 68:2.
  18. American Academy of Pediatrics Committee on Nutrition. Complementary feeding. In: Pediatric Nutrition, 7th ed, Kleinman RE, Greer FR (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2014. p.123.
  19. Eiger MS. Feeding of infants and children. In: Primary Pediatric Care, 4th ed, Mosby, St. Louis 2001. p.184.
  20. Macknin ML, Medendorp SV, Maier MC. Infant sleep and bedtime cereal. Am J Dis Child 1989; 143:1066.
  21. Hall RT, Carroll RE. Infant feeding. Pediatr Rev 2000; 21:191.
  22. Fomon SJ. Potential renal solute load: considerations relating to complementary feedings of breastfed infants. Pediatrics 2000; 106:1284.
  23. Ong KK, Emmett PM, Noble S, et al. Dietary energy intake at the age of 4 months predicts postnatal weight gain and childhood body mass index. Pediatrics 2006; 117:e503.
  24. Wilson AC, Forsyth JS, Greene SA, et al. Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ 1998; 316:21.
  25. Huh SY, Rifas-Shiman SL, Taveras EM, et al. Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics 2011; 127:e544.
  26. Hawkins SS, Cole TJ, Law C, Millennium Cohort Study Child Health Group. An ecological systems approach to examining risk factors for early childhood overweight: findings from the UK Millennium Cohort Study. J Epidemiol Community Health 2009; 63:147.
  27. Weng SF, Redsell SA, Swift JA, et al. Systematic review and meta-analyses of risk factors for childhood overweight identifiable during infancy. Arch Dis Child 2012; 97:1019.
  28. Sun C, Foskey RJ, Allen KJ, et al. The Impact of Timing of Introduction of Solids on Infant Body Mass Index. J Pediatr 2016; 179:104.
  29. Burdette HL, Whitaker RC, Hall WC, Daniels SR. Breastfeeding, introduction of complementary foods, and adiposity at 5 y of age. Am J Clin Nutr 2006; 83:550.
  30. Yeung DL, Pennell MD, Leung M, Hall J. Infant fatness and feeding practices: a longitudinal assessment. J Am Diet Assoc 1981; 79:531.
  31. Lin SL, Leung GM, Lam TH, Schooling CM. Timing of solid food introduction and obesity: Hong Kong's "children of 1997" birth cohort. Pediatrics 2013; 131:e1459.
  32. Pearce J, Taylor MA, Langley-Evans SC. Timing of the introduction of complementary feeding and risk of childhood obesity: a systematic review. Int J Obes (Lond) 2013; 37:1295.
  33. Guthie HA. Introduction of solid foods - Part 2. Consequences of early and late timing. In-Touch 1998; 15:1.
  34. Underwood BA, Hofvander Y. Appropriate timing for complementary feeding of the breast-fed infant. A review. Acta Paediatr Scand Suppl 1982; 294:1.
  36. Northstone K, Emmett P, Nethersole F, ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood. The effect of age of introduction to lumpy solids on foods eaten and reported feeding difficulties at 6 and 15 months. J Hum Nutr Diet 2001; 14:43.
  37. Nwaru BI, Takkinen HM, Niemelä O, et al. Timing of infant feeding in relation to childhood asthma and allergic diseases. J Allergy Clin Immunol 2013; 131:78.
  38. Nwaru BI, Erkkola M, Ahonen S, et al. Age at the introduction of solid foods during the first year and allergic sensitization at age 5 years. Pediatrics 2010; 125:50.
  39. Mennella JA, Ziegler P, Briefel R, Novak T. Feeding Infants and Toddlers Study: the types of foods fed to Hispanic infants and toddlers. J Am Diet Assoc 2006; 106:S96.
  40. Park S, Pan L, Sherry B, Li R. The association of sugar-sweetened beverage intake during infancy with sugar-sweetened beverage intake at 6 years of age. Pediatrics 2014; 134 Suppl 1:S56.
  41. Grimm KA, Kim SA, Yaroch AL, Scanlon KS. Fruit and vegetable intake during infancy and early childhood. Pediatrics 2014; 134 Suppl 1:S63.
  42. Maier-Nöth A, Schaal B, Leathwood P, Issanchou S. The Lasting Influences of Early Food-Related Variety Experience: A Longitudinal Study of Vegetable Acceptance from 5 Months to 6 Years in Two Populations. PLoS One 2016; 11:e0151356.
  43. Heyman MB, Abrams SA, SECTION ON GASTROENTEROLOGY, HEPATOLOGY, AND NUTRITION, COMMITTEE ON NUTRITION. Fruit Juice in Infants, Children, and Adolescents: Current Recommendations. Pediatrics 2017.
  44. Krebs NF, Westcott JE, Butler N, et al. Meat as a first complementary food for breastfed infants: feasibility and impact on zinc intake and status. J Pediatr Gastroenterol Nutr 2006; 42:207.
  45. Briefel R, Ziegler P, Novak T, Ponza M. Feeding Infants and Toddlers Study: characteristics and usual nutrient intake of Hispanic and non-Hispanic infants and toddlers. J Am Diet Assoc 2006; 106:S84.
  46. Engelmann MD, Davidsson L, Sandström B, et al. The influence of meat on nonheme iron absorption in infants. Pediatr Res 1998; 43:768.
  47. Fomon SJ, Filer LJ Jr, Anderson TA, Ziegler EE. Recommendations for feeding normal infants. Pediatrics 1979; 63:52.
  48. Beauchamp GK, Moran M. Dietary experience and sweet taste preference in human infants. Appetite 1982; 3:139.
  49. Fomon SJ, Ziegler EE, Nelson SE, Edwards BB. Sweetness of diet and food consumption by infants. Proc Soc Exp Biol Med 1983; 173:190.
  50. Baird J, Fisher D, Lucas P, et al. Being big or growing fast: systematic review of size and growth in infancy and later obesity. BMJ 2005; 331:929.
  51. Monteiro PO, Victora CG. Rapid growth in infancy and childhood and obesity in later life--a systematic review. Obes Rev 2005; 6:143.
  52. Ong KK, Loos RJ. Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions. Acta Paediatr 2006; 95:904.
  53. Ziegler P, Hanson C, Ponza M, et al. Feeding Infants and Toddlers Study: meal and snack intakes of Hispanic and non-Hispanic infants and toddlers. J Am Diet Assoc 2006; 106:S107.
  54. Karagas MR, Punshon T, Sayarath V, et al. Association of Rice and Rice-Product Consumption With Arsenic Exposure Early in Life. JAMA Pediatr 2016; 170:609.
  55. American Academy of Pediatrics. Arsenic in food products. www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Arsenic-in-Food-Products.aspx (Accessed on October 29, 2014).
  56. US Food and Drug Administration. Questions & Answers: Arsenic in rice and rice products. www.fda.gov/Food/FoodborneIllnessContaminants/Metals/ucm319948.htm (Accessed on October 29, 2014).
  57. US Food and Drug Administration. FDA proposes limit for inorganic arsenic in infant rice cereal. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm493740.htm (Accessed on April 06, 2016).
  58. Cooke LJ, Wardle J, Gibson EL, et al. Demographic, familial and trait predictors of fruit and vegetable consumption by pre-school children. Public Health Nutr 2004; 7:295.
  59. Jones LR, Steer CD, Rogers IS, Emmett PM. Influences on child fruit and vegetable intake: sociodemographic, parental and child factors in a longitudinal cohort study. Public Health Nutr 2010; 13:1122.
  60. De Bourdeaudhuij I, te Velde S, Brug J, et al. Personal, social and environmental predictors of daily fruit and vegetable intake in 11-year-old children in nine European countries. Eur J Clin Nutr 2008; 62:834.
  61. Sullivan SA, Birch LL. Infant dietary experience and acceptance of solid foods. Pediatrics 1994; 93:271.
  62. Forestell CA, Mennella JA. Early determinants of fruit and vegetable acceptance. Pediatrics 2007; 120:1247.
  63. Benton D. Role of parents in the determination of the food preferences of children and the development of obesity. Int J Obes Relat Metab Disord 2004; 28:858.
  64. Hendricks K, Briefel R, Novak T, Ziegler P. Maternal and child characteristics associated with infant and toddler feeding practices. J Am Diet Assoc 2006; 106:S135.
  65. Stordy BJ, Redfern AM, Morgan JB. Healthy eating for infants--mothers' actions. Acta Paediatr 1995; 84:733.
  66. van den Boom S, Kimber AC, Morgan JB. Nutritional composition of home-prepared baby meals in Madrid. Comparison with commercial products in Spain and home-made meals in England. Acta Paediatr 1997; 86:57.
  67. Melø R, Gellein K, Evje L, Syversen T. Minerals and trace elements in commercial infant food. Food Chem Toxicol 2008; 46:3339.
  68. Savino F, Maccario S, Guidi C, et al. Methemoglobinemia caused by the ingestion of courgette soup given in order to resolve constipation in two formula-fed infants. Ann Nutr Metab 2006; 50:368.
  69. Greer FR, Shannon M, American Academy of Pediatrics Committee on Nutrition, American Academy of Pediatrics Committee on Environmental Health. Infant methemoglobinemia: the role of dietary nitrate in food and water. Pediatrics 2005; 116:784.
  70. American Academy of Pediatrics Committee on Nutrition. Appendix E-1. Dietary Reference Intakes: Recommended Intakes for Individuals, Food and Nutrition Board, Institute of Medicine. In: Pediatric Nutrition, 7th ed, Kleinman RE, Greer FR (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2014. p.1355.
  71. Arnon SS, Midura TF, Damus K, et al. Honey and other environmental risk factors for infant botulism. J Pediatr 1979; 94:331.
  72. Hopkins D, Emmett P, Steer C, et al. Infant feeding in the second 6 months of life related to iron status: an observational study. Arch Dis Child 2007; 92:850.
  73. American Academy of Pediatrics Committee on Nutrition: The use of whole cow's milk in infancy. Pediatrics 1992; 89:1105.
  74. Ziegler EE, Fomon SJ. Potential renal solute load of infant formulas. J Nutr 1989; 119:1785.
  75. Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention. MMWR Recomm Rep 1998; 47:1.
  76. Vitoria I, López B, Gómez J, et al. Improper Use of a Plant-Based Vitamin C-Deficient Beverage Causes Scurvy in an Infant. Pediatrics 2016; 137:e20152781.
  77. Hyams JS, Etienne NL, Leichtner AM, Theuer RC. Carbohydrate malabsorption following fruit juice ingestion in young children. Pediatrics 1988; 82:64.
  78. Dennison BA. Fruit juice consumption by infants and children: a review. J Am Coll Nutr 1996; 15:4S.
  79. Lifschitz CH. Carbohydrate absorption from fruit juices in infants. Pediatrics 2000; 105:e4.
  80. Smith MM, Lifshitz F. Excess fruit juice consumption as a contributing factor in nonorganic failure to thrive. Pediatrics 1994; 93:438.
  81. König KG, Navia JM. Nutritional role of sugars in oral health. Am J Clin Nutr 1995; 62:275S.
  82. Gibson SA. Non-milk extrinsic sugars in the diets of pre-school children: association with intakes of micronutrients, energy, fat and NSP. Br J Nutr 1997; 78:367.
  83. Hale KJ, American Academy of Pediatrics Section on Pediatric Dentistry. Oral health risk assessment timing and establishment of the dental home. Pediatrics 2003; 111:1113.
  84. Pan L, Li R, Park S, et al. A longitudinal analysis of sugar-sweetened beverage intake in infancy and obesity at 6 years. Pediatrics 2014; 134 Suppl 1:S29.
  85. Armfield JM, Spencer AJ, Roberts-Thomson KF, Plastow K. Water fluoridation and the association of sugar-sweetened beverage consumption and dental caries in Australian children. Am J Public Health 2013; 103:494.
  86. Fomon SJ. Feeding normal infants: rationale for recommendations. J Am Diet Assoc 2001; 101:1002.
  87. Hodges EA, Hughes SO, Hopkinson J, Fisher JO. Maternal decisions about the initiation and termination of infant feeding. Appetite 2008; 50:333.
  88. Promoting healthy nutrition. In: right Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed, Hagan JF, Shaw JS, Duncan PM (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2008. p.121.
  89. Baker RD, Greer FR, Committee on Nutrition American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics 2010; 126:1040.
  90. Calvo EB, Galindo AC, Aspres NB. Iron status in exclusively breast-fed infants. Pediatrics 1992; 90:375.
  91. Walter T, Dallman PR, Pizarro F, et al. Effectiveness of iron-fortified infant cereal in prevention of iron deficiency anemia. Pediatrics 1993; 91:976.
  92. American Academy of Pediatrics Committee on Nutrition. Nutritional needs of the preterm infant. In: Pediatric Nutrition, 7th ed, Kleinman RE, Greer FR (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2014. p.83.
  93. Clark MB, Slayton RL, Section on Oral Health. Fluoride use in caries prevention in the primary care setting. Pediatrics 2014; 134:626.
  94. Recommendations for using fluoride to prevent and control dental caries in the United States. Centers for Disease Control and Prevention. MMWR Recomm Rep 2001; 50:1.
  95. COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE, BRIGHT FUTURES PERIODICITY SCHEDULE WORKGROUP. 2017 Recommendations for Preventive Pediatric Health Care. Pediatrics 2017.
  96. American Academy of Pediatrics Committee on Nutrition. Water-soluble vitamins. In: Pediatric Nutrition, 7th ed, Kleinman RE, Greer FR (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2014. p.517.
  97. American Academy of Pediatrics Committee on Nutrition. Fat-soluble vitamins. In: Pediatric Nutrition, 7th ed, Kleinman RE, Greer FR (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2014. p.495.