Newborn Care

Breast Milk and Introducing Complementary Foods

“For a baby who is healthy in every way, give your baby ONLY breast milk for THE FIRST 6 MONTHS”

Why Breast Milk?

Breast milk is the most suitable food for a baby’s normal growth and development. Its composition is not fixed; it changes to suit the child’s age and physiological needs. As a result, every mother’s milk is the ideal milk for her own baby. Because of these qualities, no formula can replace breast milk.

If there is no reason not to breastfeed, babies should be given only breast milk for the first 6 months. On its own, breast milk is a complete food for the first 6 months. After 6 months, breastfeeding can continue until 1–2 years of age, provided the baby is also given complementary foods.

What are the main benefits of breastfeeding?

• Breast milk has the ideal composition for a baby’s normal growth and development. No food can replace breast milk.
• Breast milk is clean and at the ideal temperature for the baby.
• Breast milk is easier to digest. Despite its very rich nutritional content, it suits babies’ delicate digestive systems.
• Breast milk protects against illness. Diarrhea, allergic diseases and respiratory infections are less common in breastfed babies. Breast milk contains immune factors and supports the development of the baby’s immune system. Breastfed babies have been shown to have a lower risk of chronic diseases such as diabetes, asthma, obesity and coronary heart disease.
• Thanks to the long-chain fatty acids it contains, breastfed babies have been shown to have better nervous system development and higher intelligence levels.
• Breastfeeding benefits the baby’s tooth and jaw health.
• Breastfed babies have a lower risk of intestinal diseases and ear infections.
• Breast milk is economical.
• Breast milk is a natural comforter for the baby.
• During the first 6 months, babies need no food or drink other than breast milk, not even water (unless your doctor advises otherwise).
• Breast milk contains growth factors that regulate the growth of all organs and systems.
• Suckling contributes to the child’s psychosocial development, fosters a positive emotional bond between mother and baby and helps meet the baby’s emotional needs.

Breast Milk and Breastfeeding Are as Important for the Mother as for the Baby.

• Starting to breastfeed immediately after birth reduces the mother’s postpartum bleeding.
• It is convenient for parents. It is always ready; there is no need to measure, mix or warm it. Breastfeeding, especially at night, relaxes the mother and helps her sleep more deeply.
• Breastfeeding helps the mother’s body return to its pre-pregnancy shape. It stimulates the uterus to contract and shrink back.
• Breastfeeding mothers lose the weight gained during pregnancy more easily.
• Breastfeeding protects the mother’s health by reducing her risk of breast cancer, ovarian cancer, uterine cancer and osteoporosis (bone loss).
• Breastfeeding is a natural way of giving babies ideal nutrition. To do it successfully, the mother needs to feel confident, be well informed about breastfeeding and have the support of her family.

Mixed Feeding
Nutrition is essential for growth, development and good health. Growth is fastest in the womb. Between the ages of 1 and 3, nutrition is the most important factor affecting growth.

Because children are constantly growing, their nutritional needs change with their growth rate and age.

The aim of moving to mixed feeding is, on the one hand, to meet the baby’s increasing nutritional needs and, on the other, to get the baby used to eating textured foods and to develop their sense of taste, so that by their first birthday they can sit at the table with the family and fully adapt to a mixed diet.

Your doctor will tell you when to start mixed feeding based on your baby’s needs. Breastfed babies can start mixed feeding at 6 months, while babies whose breast milk is insufficient may start earlier. Ideally, babies should be fed only breast milk for the first 6 months. The World Health Organization, the American Academy of Pediatrics and the Ministry of Health of the Republic of Türkiye recommend that every baby be fed exclusively breast milk for the first 6 months.

Mixed feeding is not superior to breast milk, so there should be no rush to start it. Even after mixed feeding has begun, half or more of the baby’s nutritional needs between 6 and 12 months should still come from breast milk.

At this age, children clearly show a desire to imitate adults’ eating and to taste the foods their parents eat. Many parents notice this and let their children taste what they are eating. The curiosity babies show in these months is linked to their urge to put everything in their mouths. Just because your baby puts something in their mouth, or you let them taste it, does not mean it is good for them. In fact, babies’ digestive systems are so delicate that you could even harm them.

WHY DON’T WE START COMPLEMENTARY FOODS EARLIER?

1. Complementary foods given too early will prevent the baby from getting the full benefit of breast milk.
2. For your baby’s growth, BREAST MILK IS MORE BENEFICIAL THAN ANY OTHER FOOD.
3. Because the tongue-thrust reflex is strong in the first months, breast milk is the form of feeding that suits this reflex.
4. The baby’s kidney function and digestive enzymes are not ready for foods other than breast milk.
5. Complementary foods can cause allergies.
6. There is a risk of infection and of picking up germs from food.

WHAT ARE THE DRAWBACKS OF STARTING COMPLEMENTARY FOODS LATE?

1. Continuing exclusive breastfeeding beyond the sixth month can lead to insufficient energy and nutrient intake and to growth delay.
2. Elements such as iron and zinc may be insufficient.
3. The development of eating skills such as chewing, and the baby’s acceptance of new tastes, flavors and textures, are delayed. This can lead to picky eating in childhood.

POINTS TO CONSIDER WHEN INTRODUCING COMPLEMENTARY FOODS

1. Before preparing food and feeding the baby, wash your hands thoroughly and, if possible, dry them with a paper towel. Following hygiene rules while preparing food and feeding is important to prevent diarrhea. The main cause of diarrhea in childhood is germs contaminating food.
2. New foods should be tried when the baby is hungry.
3. Complementary foods should be introduced as a single meal in very small amounts and increased gradually.
4. New foods can be introduced at intervals of at least 3 days to a week. Watch carefully for possible allergic reactions.
5. If an allergy to a food is detected, that food should be stopped and tried again 15–20 days later.
6. All foods should be given with a spoon.
7. Food for the baby should be prepared from natural, fresh ingredients, and prepared food should not be left at room temperature for long.
8. When your baby starts complementary foods, be sure to get a high chair, and give all complementary foods at the table with your baby seated in their chair. Let them sit with you while you eat, too. Sit down at the table together at mealtimes and leave the table together. From an early age, your child should feel that they are a member of the family who needs to follow table manners.
9. No salt should be added to a baby’s food until 1 year of age.
10. You are the one shaping your children’s sense of taste. Remember: even if you don’t find them tasty, your baby may happily eat foods without sugar or salt.

Babies who have started mixed feeding can be given water. After each feed, give your child a few dessert spoons of boiled and cooled drinking water.

Food Consistency:
Babies’ stomach capacity increases as they grow. When starting mixed feeding, puréed foods should be preferred. Puréed foods contain more calories than liquid foods. Babies easily refuse foods that are too thick, so the consistency of food should be increased gradually, without rushing.

Food Quantity:
Food is given in small amounts at first; a baby’s first encounter with food should be seen as “tasting”. Start with half a tea glass (30–35 ml) and gradually increase the amount. Like everyone, babies vary in how much they eat. A simple way to estimate the average amount a baby should eat is one tablespoon for each month of age. For example, 7 tablespoons of mixed food is enough for a 7-month-old baby.

4–6 months
If breast milk is not sufficient, mixed feeding can start as early as 4 months. Your doctor will tell you when to start mixed feeding.
Breast milk plus 2–3 complementary meals
Fruit and vegetable juices (apple, pear, carrot) – (do not use ready-made fruit juices)
Yogurt (homemade)
Milk pudding (made with rice flour and water)
Grape molasses (about 1 teaspoon)
Egg yolk (start with ¼ and gradually increase to a whole egg yolk within 1 month)

Preparation

Fruit purée: Choose seasonal fruit. You can start with apple in winter and peach in summer.
Preparation: Wash the fruit thoroughly, peel it and grate it on a glass grater. The first time, start with half a tea glass. Increase the amount gradually.
Vegetable purée: Wash and peel 1 dessert spoon of rice, 1/2 carrot and 1/2 medium potato and place them in a small pan. Add enough drinking water to cover them, bring to the boil and cook until very soft. Pass through a wire sieve with a little water to make a purée. Start by giving your child one or two dessert spoons. Gradually increase the amount, and add a new vegetable every 2 days. In the 2nd week, add 1 dessert spoon of olive oil to the purée, and in the 3rd week, 1 tablespoon of ground meat.
Yogurt: Because it is easy to digest, yogurt is a good food for babies. It also contains bacteria needed for the gut flora. Bring one litre of milk to the boil and let it cool to about 40 degrees, a temperature that does not burn your hand. Dilute 1 tablespoon of yogurt in 1–2 tablespoons of milk, add it to the milk as a starter and stir gently. Wrap the pan and leave it in a warm place for at least 4 hours. The yogurt can be given to your baby for 2–3 days. (It works better to use 1 heaped dessert spoon of yogurt for a 200 ml jar.)

7 months
From 7 months, when chewing movements begin, your baby can start eating textured foods and having breakfast.
Breast milk plus 2–3 complementary meals
Egg yolk (whole)
Fruit and vegetable juices (do not use ready-made fruit and vegetable juices)
Yogurt (homemade)
Milk pudding (made with rice flour and water)
Grape molasses (about 1 teaspoon)
Soft inside of bread
Meat (chicken, fish, ground meat)
Vegetable soups or purées (olive oil and ground meat can be used)
Breakfast
Breakfast can be started at 6–7 months. When preparing breakfast, you can use the soft inside of bread, grape molasses, unsalted cheese and egg yolk. It is best to add new foods to breakfast in gradually increasing number and quantity day by day. This way, the baby gets used to complementary foods slowly and one at a time, and if an allergic reaction occurs, you can tell which food caused it.

For example:

• 100 ml breast milk or formula
• 1 slice of the soft inside of fortified bread
• A matchbox-sized piece of unsalted pasteurized white cheese or 1 dessert spoon of labneh
• 1 dessert spoon of grape molasses or additive-free jam

Once the baby is used to this mixture, a quarter of an egg yolk is added. The egg yolk and cheese can also be prepared as a separate mixture. The egg yolk can be increased gradually until a whole yolk is given. It is best to give half an egg yolk a day, or one every other day.

YAYLA SOUP (YOGHURT AND RICE SOUP)
INGREDIENTS:

• 3/4 cup of yogurt
• 1/2 cup of water
• 1 tablespoon of rice
• 1 teaspoon of vegetable oil
• 1 teaspoon of flour

Method: Sort and wash the rice, boil it in the water and leave it to cool slightly. Then mix the yogurt with the flour and add it to the boiled rice. Cook while stirring and add the oil on top.

TARHANA SOUP
INGREDIENTS:

• 1 cup of water
• 1 tablespoon of tarhana (dried fermented soup mix)
• 1 dessert spoon of oil

Method: Mash the tarhana with cold water and cook while stirring. Add the oil. The tarhana should not be spicy.
WARNING: The baby’s teeth should be wiped with a muslin cloth at least once a day. If the food you have prepared contains green leafy vegetables, do not reheat it. Repeated reheating increases the nitrite content of the food.

8 months
Breast milk plus 3–4 complementary meals
Whole egg yolk
Fruit and vegetable juices (do not use ready-made fruit and vegetable juices)
Yogurt (homemade)
Milk pudding (made with rice flour and water)
Grape molasses (about 1 teaspoon)
Meat (chicken, fish, veal)
Oily fish such as salmon, tuna, sardines, mackerel and herring are rich in omega-3 polyunsaturated fatty acids, which are important for neuromotor development.
Vegetable soups or purées (olive oil and ground meat can be used)
Well-mashed home-cooked dishes (with ground meat and vegetables)
Mashed grains and pulses

You can now start giving your child meatballs and chicken. Meatballs made with ground meat and the soft inside of bread should be grilled without drying them out and given in small bites. Chicken can be given minced, or the breast can be boiled and shredded. Take great care that fish is boneless; it can be steamed or grilled. Instead of puréeing food, simply mashing it with a fork is now enough. (Although fish can be given at this age, the World Health Organization recommends starting it after 1 year of age because of mercury contamination.)

Pulses are a very valuable source of plant protein.

They can be introduced by mixing them into vegetable soup. Rice, potatoes, carrots and lentils make a wonderful soup.

WARNING: Puréed foods should be continued until the baby has learned to chew, after which the consistency should be increased gradually. If the consistency of food does not suit the baby’s development, the baby cannot eat enough or eats far more than needed. In addition, children who do not get used to textured foods at the right time will want to keep eating puréed food later on.

Don’t turn your baby into a “blender baby”!

WARNING: Meat broth or the liquid from cooked dishes is not as nutritious as people think. The meat itself and the solid part of the dish should be given.

LENTIL SOUP
INGREDIENTS:

• 1 tablespoon of red lentils
• 1 cup of water
• 1 teaspoon of vegetable oil

Method: Sort and wash the lentils and add them to boiling water. Turn down the heat, cook until the lentils are soft and add the oil.

RICE AND LENTIL SOUP
INGREDIENTS:

• 1/2 tablespoon of red lentils
• 1/2 tablespoon of rice
• 1 cup of water
• 1 teaspoon of vegetable oil

Method: Sort and wash the lentils and add them to boiling water. Cook until soft and add the oil. The soup can also be made with bulgur instead of rice.

MASHED CHICKPEAS OR WHITE BEANS
INGREDIENTS:

• 2 tablespoons of chickpeas or dried white beans
• 1 teaspoon of oil
• 2 cups of water

Method: Sort and wash the chickpeas or beans and soak them for 8–10 hours. Pour away the soaking water. Peel the skins off the softened chickpeas or beans. Add enough water to cover them by 1–2 finger widths and cook until soft. Mash the cooked chickpeas or beans in their own cooking liquid and serve.

Sample menu for an 8-month-old baby
Breakfast:

• Breast milk or formula (100 ml)
• 1 egg yolk
• 1 teaspoon of butter
• 1 dessert spoon of jam or grape molasses
• 3–4 biscuits or 1 slice of bread
• A matchbox-sized piece of cheese.

Lunch

• 2 tablespoons of vegetable purée with ground meat
• Half or 1 slice of bread

Afternoon

• 1 small bowl of yogurt (150 ml) or breast milk
• 1 small bowl of fruit purée

Dinner

• 1 bowl of milk pudding or 1 bowl of soup

Night

• Breast milk or formula

On Waking

• Breast milk

9–12 months
By this age, babies’ chewing and swallowing skills are well developed. Give your baby foods they enjoy, and do not force them to eat foods they dislike. Your baby can now gradually eat all kinds of food. You can give your child home-cooked meals as long as you add no salt and only a little fat.

Many dishes in Turkish cuisine are nutritious for children. Vegetables cooked in olive oil, soups, rice dishes and pasta are good choices.

Sample menu for a 9–12-month-old baby

Breakfast

• 1 tea glass of formula or breast milk
• ½ matchbox-sized piece of cheese
• 1 egg
• 1 dessert spoon of grape molasses or jam
• ½ thin slice of bread or 2–3 biscuits (on some days, a milky mixture with cereals and dried fruit can be given)

Snack

• 1 tea glass of fruit purée

Lunch

• 5–6 level tablespoons of vegetable purée with ground meat (or vegetables with chicken or fish), or mashed potato (pasta, rice)
• 1 tea glass of a drink (water, ayran, fresh fruit juice)

Afternoon

• 1 bowl of yogurt
• 1 slice of bread or cake, or 2–3 biscuits
• ½–1 bowl of fruit purée

Dinner

• 1 bowl of milk pudding or the same as the midday meal
• Breast milk or formula

WHICH FOODS SHOULD INFANTS AVOID?

Tea: Tea is not recommended for infants and young children. Because it contains tannins, which bind iron and other minerals, it causes iron deficiency. The sugar added to it causes loss of appetite and tooth decay.

Herbal tea: Herbal teas such as chamomile and green tea also reduce iron absorption. In addition, there is not enough scientific research on the safety of herbal teas, some of which contain pharmacologically active agents, for infants and young children.

Honey: Because honey can contain Clostridium botulinum spores, it carries a risk of botulism poisoning. Infants have low levels of stomach acid and cannot kill these spores, so honey is not recommended for children under one year of age.

Broad beans: They are not recommended during infancy because they can cause the breakdown of red blood cells in children with certain enzyme deficiencies.

Eggplant: Apart from small amounts of vitamins B1 and B2, it has no nutritional value.

Nuts and dried fruit: Children develop adult-like swallowing at the age of 5. Until then, nuts can pose a choking hazard.

Shellfish: They are not given because of their heavy metal content.

Very high-fiber foods: Not given until 12 months of age.

Foods high in sugar or containing sweeteners, and unpasteurized cheeses: These can cause food poisoning.

Undercooked eggs: These can cause food poisoning (salmonella infection). Because of the risk of allergy, egg white can be given after 1 year of age.

All foods and drinks containing additives, instant soups, ready-made puddings, etc.

Feeding children aged 1–2 years
At this age, it is important for children to sit at the family table and eat the same foods.
Every day, they should eat a balanced range of foods from the meat, dairy, grain, fruit, vegetable, carbohydrate and fat groups. Breastfed babies can be breastfed until the age of 2.

Care should be taken with foods newly added to the diet. Added sugar and salt should be avoided. A small amount of iodized salt can be added to meals. Children aged 1–3 are not advised to have more than 2 g of salt (or 0.8 g of sodium) a day.

At this age, children need 350 mg of calcium a day. 250–300 g of milk or yogurt and a matchbox-sized piece of cheese meet this need. Unlike in the first year, cow’s milk can now be given as a drink. 1–2 glasses of milk a day is enough. Drinking too much reduces the child’s appetite and can cause anemia and constipation. Skimmed or diet milk should not be used before the age of 2. Yogurt, kefir and cheese are fermented dairy products. Fermented milk products have the same nutritional content as liquid milk.
Egg white and honey are also gradually added to the diet.

The need for iron continues during this period. Make sure your child eats red meat.

Fish is a source of high-quality protein and omega-3. It is also rich in iron and zinc. Saltwater fish are a good source of iodine. Fish is recommended twice a week. Children who do not eat fish can be given fish oil.

Fruit juice is a good source of vitamin C. Drinking too much makes children feel full, causing a loss of appetite for other foods. It also causes tooth decay. For this reason, it is better to give whole fruit instead of fruit juice.

Watch out for preservatives in ready-made foods such as biscuits and crackers, and for allergens such as hazelnut and peanut spreads. Junk food such as chocolate, candy, chips and sodas should not be given.

Let us remember that children learn everything, including their eating habits, from the adults who raise them. If we do not adopt and practice the healthy eating habits we expect from our children ourselves, our children’s nutrition education will fall short.
Pediatrics Specialist