Pediatric Nutrition in Practice

318 Koletzko  Dokoupil

require additional nutrients, such as the trace ele-
ments iron and zinc, after the age of 6 months. The
introduction of solid foods over time should grad-
ually get the child used to an increasing variety of
foods and, around the age of about 1 year, to regu-
lar family foods. The first complementary foods
should be given no later than at 6 months of life
but not before the age of 4 months. As the first
solid food, a mixture of pulpy vegetables, potatoes
and meat can be recommended, which provides
iron and zinc with high bioavailability ( fig. 1 ). In
about monthly intervals, additional meals consist-
ing of cereals with milk and a fruit-grain pap may
be introduced. From the age of about 10 months,
(initially soft) bread may be offered. Gluten-con-
taining cereals (wheat, rye, and barley e.g. in por-
ridge, bread, biscuits, and rusks) should initially
be given only in small quantities to reduce the risk
of developing intolerances (celiac disease). No
benefits of a generally low-allergen diet in infancy
have been shown. Therefore, the exclusion or de-
layed introduction of complementary food prod-
ucts considered allergenic is not recommended.

Beverages

When 3 meals per day of complementary feeding

are given, children should be offered water; avoid

providing sugary drinks or adding sugar to the

water. Prior to reaching 3 solid food meals per

day, no liquid in addition to breast milk or infant

formula is needed, except in cases of fever, vomit-

ing, or diarrhea. Cow’s milk should regularly be

offered as a drink only after the first year of life to

avoid potential adverse effects, for example on

iron absorption.

Further Advice and Information

Do not hesitate to ask your pediatrician if you

have any further questions on the feeding of your

infant.

123456789101112

Vitamin

Breast milk

or infant formula

(follow-on formula) Milk cereal pap

Age (months)

Bread

+ milk

Bread

+ milk

Snack

Snack

Vegetable potatoe meat pap

Cereal fruit

pap

Vitamin D, fluoride

Fig. 1. Recommended feeding concept in the first year of life. Modified from Ernährungskommis-

sion der Deutschen Gesellschaft für Kinder und Jugendmedizin (DGKJ) [1].

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 316–319

DOI: 10.1159/000375275