childhood nutrition
BREAST MILK
The World Health Organisation recommends continued breastfeeding for up to 2 years or longer. This is because breast milk is a great nourishment for your child and its nutritional composition changes according to your child’s needs. You can breastfeed your baby for as long as you both are comfortable and at the 4–6 month mark, your baby can start weaning and discovering new food textures.
How it benefits your baby
Contains all essential vitamins, minerals and nutrients for your baby's growth and development, for the first 4—6 months
Is easier to digest so your baby is less likely to develop a tummy ache, constipation and diarrhoea
Contains antibodies that can boost your baby’s immunity and reduce risk of infections
Reduces the risk of Sudden Infant Death Syndrome (cot deaths), as well as obesity and diabetes in adulthood
How it benefits you
Early suckling helps your womb contract faster and reduces blood loss after childbirth.
It delays the return of your menstrual period, where exclusive breastfeeding is a natural (although imperfect) contraceptive.
The calories burnt while breastfeeding can help you shed some of the weight gained during pregnancy.
It lowers your risk of developing breast, ovarian and/or womb cancers, osteoporosis (brittle bones) and heart disease.
Close contact between your baby and you enhance mother-child bonding.
Key nutrients in breast milk
Provides energy for growth
Fat, carbohydrates, protein, growth factors, nucleotides
Ensures good brain and eye development
Omega-3, such as DHA, taurine
Contributes to good gut health
Oligosaccharides, taurine, enzymes
Develops a robust defense and immune system
Immunoglobulins, selenium, beta-carotene, nucleotides, oligosaccharides
Supports a healthy cardiovascular system and blood
Iron, lactoferrin, vitamin K
Helps build strong bones
Calcium, phosphorus, vitamin D
Risks of not breastfeeding
For mothers
Increased risk of:
Breast and ovarian cancers
- Osteoporosis
For babies
Increased risk of:
- Gastrointestinal infection
- Urinary tract infection
- Respiratory diseases
- Allergies
- Obesity and diabetes, later in life
WEANING
Introducing solid food to your baby’s diet
The process of switching your baby from a milk-only diet to one that includes portions of milk and solid/baby food, is called weaning or complementary feeding.When your baby is around 4—6 months of age, you can start to introduce solid foods into their diet gradually, to meet their increasing nutritional and developmental needs.
Benefits of weaning
Helps develop motor skillsSuch as chewing, biting, sucking and swallowing.
Provides various nutrientsWeaning foods provide a wide range of nutrients like calcium, protein and even DHA, which are great for your baby's growth and development.
Allows your baby to experience different textures and tastesYour baby will be less likely to be a picky eater if he/she is exposed to a variety of foods at an early age.
Signs of a weaning-ready baby
Your child may exhibit the following signs around 4–6 months of
age, indicating that he or she is ready to wean.
Able to sit up properly and hold head up when leaning against chair backrest, with some assistance
Shows interest in solid foods
Reaches hands out proactively to grasp objects
During feeding, baby moves food with tongue to back of mouth to swallow, with less pushing out of tongue
Seems hungry even after a milk feed
Tends to put objects in mouth and chew on them
Pacing the feeding of solids and milk
When your baby is around 4–6 months of age, he should start eating more solid foods. In the initial stages of weaning, you could start by feeding your baby pureed foods about 30–60 minutes before his usual milk feeding time. It is best to gradually allocate your baby’s milk feedings away from main meal times (e.g. morning, late afternoon, before bedtime), and feed him solid food at his main meal timings. This helps prevent his milk intake from interfering with his appetite for other solid foods
Weaning guidelines
Start your child on solids gradually by introducing one new type of food every 3–4 days. Be sure to keep a lookout for any allergic reactions such as skin rashes which can appear immediately or minutes to hours later.
Should your baby develop any allergies during weaning, take note of the food that most likely caused the reaction and see a paediatrician immediately.
If your baby constantly pushes the spoon out with his/her tongue or appears to have difficulty swallowing solids, wait for another week before trying again. Some babies need more time to get used to consuming solid foods.
It is normal for food to spill out from the sides of your baby’s mouth initially. He/she will develop better control of his/her facial and oral muscles over time. It does not mean that your child does not like the food. Repeated exposure will help your child to accept new flavours and textures.
Weaning foods and textures
Baby’s first weaning foods
Breast milk and/or infant milk formula remains the primary food staple in the early stages of weaning. The calcium, protein and other essential fatty acids, vitamins and minerals present in milk would still contribute to most of your child’s energy and nutrition intake.
As your baby’s iron stores are almost depleted, iron-rich foods should be gradually introduced at the start of the weaning process. Good sources of iron include iron-fortified plain cereals, meat, and dark green vegetables like spinach and broccoli.
To help your baby’s body better absorb iron, combine iron-rich foods with good sources of vitamin C, like vegetables and fruits. Other suitable food choices include porridge blended with mashed or pureed vegetables such as pumpkin, sweet potato and carrot.
As your baby grows older, his/her ability to chew and bite will develop. You can then introduce other grains (fine oats, barley and wheat), cooked strained vegetables, soft mashed fruits and soft protein-rich foods like tofu, cooked mashed lentils or finely flaked fish at around 6 months.
At around 7–8 months, you may also start adding finely minced meat and shredded poultry, such as beef, chicken, pork and lamb, to his/her diet.
Examples of your baby’s first solid foods
Recommended foods and textures
At around 6 months, your baby’s food should be smooth, soft and fine in texture. As he/she grows older and his/her chewing abilities develop, the texture of their food can be thicker and coarser.
At around 10–12 months, your baby’s food only needs to be mashed, chopped or cut into small pieces.
Meal planning for your baby? Follow the guide below to determine the right texture for your baby’s food.
SOLID FOODS
Recommended foods and textures
At around 6 months, your baby’s food should be smooth, soft and fine in texture. As he/she grows older and his/her chewing abilities develop, the texture of their food can be thicker and coarser.
At around 10–12 months, your baby’s food only needs to be mashed, chopped or cut into small pieces.
Follow the visual guide below to determine the right texture for your baby’s food:
Portion sizing guide
In the early stages of weaning, start by giving your baby 1–2 teaspoons of solids once a day, and slowly increase it to 1–2 tablespoons of solids 2 or 3 times a day.
As your baby gets used to weaning, you can gradually increase the portion size, eventually reaching a full meal of solids that can replace one of their milk feeds.
Once your baby reaches around 10–12 months of age, he/she can be fed 3 meals of solids a day.
Do pay attention to bowel movements, height and weight to make sure he/she is
eating well. Familiarise yourself with the serving sizes across different food groups,
so you can plan a healthy diet for your child.
Follow the visual guide below to determine the right texture for
your baby’s food:
MILK
Benefits of plain full cream milk
Your toddler’s digestive system is now ready for a variety of solids to meet his increasing nutrient and caloric needs. Plain full cream milk is a rich source of protein and calcium, essential for growth and building healthy bones and teeth. If your child is above the age of 12 months, he/she can continue to breastfeed or consume plain full cream milk with a well-balanced diet.
Plain full cream milk is an easily accessible and convenient source of protein, calcium, vitamin D and riboflavin.
Riboflavin is an essential B vitamin that supports the growth and development of your toddler’s muscles, bones and nerves.
A healthy diet supplemented with plain full cream milk gives your toddler the nutrition he/she needs for healthy growth.
Types of plain full cream cow’s milk
There are 3 main types of plain full cream milk available in supermarkets:
Note: Powdered plain full cream milk is not to be confused with filled or formula milk. Filled milk is
unsuitable for toddlers as it is typically reconstituted with fat or oil of non-milk origins (e.g. palm oil).
How to introduce your toddler to plain full cream milk
Many first-time moms wonder how they should go about offering plain full cream milk to their toddlers. Here are some common ways:
Use plain full cream milk as
an ingredient in recipes
Does your toddler enjoy oatmeal? Cook oatmeal with milk instead of water. Does he/she love smoothies? Add milk. Find foods he/she already likes and add or mix with milk.
Mix plain full cream milk
with formula milk
Introduce plain full cream milk slowly to your toddler by mixing it with formula milk. Gradually increase the proportion of plain full cream milk in the mixture. You can start with a mix of one-quarter plain full cream milk to three-quarters formula milk.
Both ways will help your child slowly get used to the taste. This gives his/her digestive system more time to adjust to the higher concentrations of milk protein and minerals.
The World Health Organisation recommends continued breastfeeding for up to 2 years or longer. If your child is above the age of 12 months, and is no longer being breastfed, he/she can switch to plain full-cream milk with a well-balanced diet.
Dos and Dont’s
Many first-time moms wonder how they should go about offering plain full cream milk to their toddlers. Here are some common ways:
Do:
Consult a medical professional before opting for alternatives if your toddler is allergic to cow’s milk protein, on a vegan diet or has a medical condition. Options include unsweetened or reduced-sugar calcium-fortified milk alternatives like soy, almond or rice milk.
Do:
Include other energy-dense foods in your toddler’s diet if you are feeding your toddler soy-based or extensively hydrolysed formula, as soy-based milk typically contains only about half the energy content of full-fat animal milk.
Don’t:
Feed filled milk which is typically reconstituted with any fat or oil of non-milk origins (e.g. palm oil), and is unsuitable for babies or infants.
Don’t:
Substitute plain full cream milk with condensed or evaporated milk, as these types of milk are high in sugar and saturated fat.
Don’t:
Feed flavoured milk as it contains added sugar, which could lead to dental caries.
Under the Nutri-Grade grading system, plain full cream milk is graded C due to its higher saturated fat content compared to low fat milk. For 1-2 year olds, plain full cream still meets the dietary requirements of adequate fat, protein vitamins and minerals which are essential for their growth and development.
LATCHING & POSITIONS
- Your baby’s upper and lower lips flare out to form a good seal on the breast.
- Your baby’s chin is touching the breast and the nose is slightly away from the breast.
- The areola is drawn into your baby’s mouth.
- Your baby’s cheek is round.
- You may feel the initial tug on the nipple when your baby suckles but you should not have nipple pain or discomfort.
- You can observe your baby’s sucking rhythm to ensure good milk transfer.
How to position your baby for feeding
Cradle hold
Suitable when:
Your baby can latch on easily.
How:
- Support your baby’s head in the crook of your arm.
- Hold your baby’s buttocks, while his/her face and body are turned towards you.
Cross hold
Suitable when:
Your baby is a newborn, small or premature, and when your nipples are short.
How:
- Support the back of your baby’s head and shoulder at the nape of his/her neck using your palm.
- Rest your baby’s body and buttocks on your forearm.
Football hold
Suitable when:
Your baby is small and when you have large breasts or short nipples, or have undergone a caesarean section.
How:
- Support the back of your baby’s head and shoulder at the nape of his/her neck with your palm.
- Rest your baby’s body and buttock on your forearm.
- Tuck your baby under your arm so that his/her legs are behind you, and the head is at your breast.
Lying down
Suitable when:
You’ve had a caesarean section, forceps delivery or want to nurse at night.
How:
- Lie on your side with a pillow under your head and behind your back with the baby facing you.
FULL OR HUNGRY
When your baby is hungry
When your baby is hungry, he/she...
Increases his/her eye movements under closed eyelids or open eyes.
Opens his/her mouth, stretches out the tongue and turns his/her head to look for the breast.
Makes soft sucking sounds.
Shows a strong rooting reflex such as sucking or chewing on hands, fingers or other objects that come in contact with the mouth.
Moves towards your finger when you place it near the corner of his/her mouth.
How it benefits you
When your baby is full...
Your breasts will feel soft after nursing.
He/she appears contented and satisfied.
He/she passes clear urine and has bowel movements 2–5 times or more in a day.
BREAST MILK
You can express your breast milk manually by using your hands or with a manual/electric breast pump.
How to express breast milk with a breast pump
Wash hands thoroughly before expressing milk.
Ensure all the equipment is clean and sterilised.
Start your pump at low suction level and increase to a level you are comfortable with. Pump each breast for about 20 minutes.
Express your breast milk every 3 hours and store the breast milk in the refrigerator or freezer.
Storing and thawing breast milk
Thawing Guidelines
- Thaw frozen milk in the refrigerator or in a cup of warm water.
- Use the milk immediately or within one hour.
- Avoid boiling or heating breast milk in a microwave.
MILK SUPPLY
It is normal for mothers to worry about producing enough breast milk for their babies.As long as breast milk is expressed, your milk production will continue, no matter the mode of feeding. Frequent and effective milk removal is important to ensure a good supply. Hence, do:
Ensure that your baby latches on correctly.
Rest, eat well and drink plenty of fluids.
Express and store breast milk if your baby is not feeding well or is away from you.
Feed your baby on demand. Allow him to suckle for as long as possible.
Reduce caffeine. Avoid alcohol and tobacco smoking.
Breastfeed regularly every 2–3 hours according to your baby's demand and avoid supplementary feeding with formula milk.
Avoid supplementary feeds as far as possible because your baby will have no desire to suckle to maintain the milk production and flow.
Avoid feeding from a bottle or using a pacifier in the first few weeks until breastfeeding is established, as it may cause “nipple confusion”.
CHALLENGES & TIPS
Do not worry or be discouraged if you encounter some difficulties when you first breastfeed.By being aware of the possible problems, understanding their solutions and asking for help, your breastfeeding journey can be a smoother one.Here are some examples of the common problems encountered and their solutions.
Sore or cracked nippes
Cause:
Your baby is not positioned or latched on properly.
Solution:
- Gently take your baby off your breast, then re-attach and re-position him.
- Reduce the nursing duration but increase the number of feeds.
- Initiate breastfeeding on the unaffected breast.
- Express a few drops of breast milk on the nipples to soothe them.
- Apply nipple cream or balm that is safe for babies.
Thrush
Engorgement
Nipple confusion
Plugged ducts
Breast infections (mastitis)
Breastfeeding premature babies
RESUME WORK
FORMULA MILK
Picking the right infant formula
While breast milk is recommended for newborn babies, you can consider switching to infant formula milk as an alternative or supplementary source of nutrition when breastfeeding is insufficient or not possible.
Rest assured that all infant formula sold in Singapore is safe and adequate for your baby to consume thanks to the stringent regulations and nutritional requirements set in place by the Singapore Food Agency (SFA).
Although the amount of nutrients may vary, the nutrient composition of formula milk is similar among major brands (all contain the required level of macronutrients, vitamins and minerals essential for a baby’s growth and development). Some, for example, contain higher levels of omega-3 fatty acids. However, the evidence for its added benefit(s) is inconclusive.
How much to feed your baby
Feeding your baby the right portion of milk is essential for their growth and health. The amount of milk your baby requires will vary according to their growth and body weight. For infants who are 6–12 months old, HPB recommends consuming about 500–700ml of milk per day, complemented by appropriate weaning foods.
Do not force your baby to finish the bottle if he/she appears to be full. If your baby has a specially-prescribed formula to follow, do consult with your paediatrician on the correct amount to feed every day.
Types of formula milk
Stages of formula feeding
Common concerns
ALLERGIES
- Plain full cream milk should not be given to infants younger than 12 months as it is low in iron and high in solutes which can damage your baby’s developing kidneys.
- Honey (on its own or in other products like cakes); your baby should not eat honey in any form until he is at least 12 months old. As infants cannot digest the bacteria found in honey, eating honey can cause infant botulism.
- Any food high in salt content like canned foods, sausages, preserved foods, and foods seasoned with salt, soy sauce or chicken seasoning powder; your baby’s kidneys cannot handle one gram of salt or more per day until he/she is 12 months old.
- If your baby gets too used to salty flavours, he/she may be more likely to reject unseasoned food. This could encourage him/her to consume more salty foods and raise future risk of high blood pressure. Instead, use ginger, garlic, spring onion or spices such as turmeric as alternatives for seasoning.
- Any uncooked foods and unpasteurized milk products
- Fish with high levels of mercury — such as shark, swordfish, marlin, tuna (includes bluefin, big eyes, albacore yellowfin varieties), king mackerel, orange roughy, yellowback seabream and dash-and-dot goatfish.
- Any food that can easily be a choking hazard, such as: Small and hard pieces of food (e.g. nuts, and grapes); crunchy or hard foods (e.g. uncooked vegetables); fish and meat with bones; fruits with seeds, and sticky rice (e.g. glutinous rice).
- Commercial snacks that are high in sugar and high in sodium are a big no-no.
- Sugared drinks, soft drinks or fruit juice.
- Caffeinated drinks such as energy drinks, coffee or tea.
Watch out for symptoms of food allergies
Symptoms usually occur within several hours or several days after eating the trigger food. Hence, it is best to observe your baby’s reaction(s) closely – especially after introducing a new food. Look for:
- Hives and worsening eczema
- Swollen eyes, tongue, face, mouth and lips
- Water stools
- Vomiting
- Breathing difficulties
- Fainting
Some babies may develop an allergic reaction 1 or 2 days later so do keep a lookout for
symptoms like eczema, wheezing, persistent vomiting, constipation and/or stomach pain. See a
paediatrician immediately if your baby displays any of these reactions.
YUMMY RECIPE IDEAS
Sample daily meal plan for babies 6-9 months
Here’s a sample daily meal plan to give you a rough idea of the types of food you can prepare for your baby. Note: This is just a guide. Now that your baby is able to regulate their own milk or food intake, let them decide how much to eat and whether they want to eat.
Sample daily meal plan for babies 10-12 months
Here’s a sample daily meal plan to give you a rough idea of the types of food you can prepare for your baby. Note: This is just a guide. Now that your baby is able to regulate their own milk or food intake, let them decide how much to eat and whether they want to eat.
q&as
ALLERGIES
- Plain full cream milk should not be given to infants younger than 12 months as it is low in iron and high in solutes which can damage your baby’s developing kidneys.
- Honey (on its own or in other products like cakes); your baby should not eat honey in any form until he is at least 12 months old. As infants cannot digest the bacteria found in honey, eating honey can cause infant botulism.
- Any food high in salt content like canned foods, sausages, preserved foods, and foods seasoned with salt, soy sauce or chicken seasoning powder; your baby’s kidneys cannot handle one gram of salt or more per day until he/she is 12 months old.
- If your baby gets too used to salty flavours, he/she may be more likely to reject unseasoned food. This could encourage him/her to consume more salty foods and raise future risk of high blood pressure. Instead, use ginger, garlic, spring onion or spices such as turmeric as alternatives for seasoning.
- Any uncooked foods and unpasteurized milk products
- Fish with high levels of mercury — such as shark, swordfish, marlin, tuna (includes bluefin, big eyes, albacore yellowfin varieties), king mackerel, orange roughy, yellowback seabream and dash-and-dot goatfish.
- Any food that can easily be a choking hazard, such as: Small and hard pieces of food (e.g. nuts, and grapes); crunchy or hard foods (e.g. uncooked vegetables); fish and meat with bones; fruits with seeds, and sticky rice (e.g. glutinous rice).
- Commercial snacks that are high in sugar and high in sodium are a big no-no.
- Sugared drinks, soft drinks or fruit juice.
- Caffeinated drinks such as energy drinks, coffee or tea.
Watch out for symptoms of food allergies
Symptoms usually occur within several hours or several days after eating the trigger food. Hence, it is best to observe your baby’s reaction(s) closely – especially after introducing a new food. Look for:
- Hives and worsening eczema
- Swollen eyes, tongue, face, mouth and lips
- Water stools
- Vomiting
- Breathing difficulties
- Fainting
Some babies may develop an allergic reaction 1 or 2 days later so do keep a lookout for
symptoms like eczema, wheezing, persistent vomiting, constipation and/or stomach pain. See a
paediatrician immediately if your baby displays any of these reactions.
MEAL TIMES
Food portion guide for toddlers
You can use My Healthy Plate as a rough guide to ensure that your toddler gets a variety of food from the four main food groups, in the right portions.
The guide below shows you the recommended portion sizes and servings per day, for each food group.
Sample daily meal plan for babies 12-24 months
Here’s a sample daily meal plan to give you a rough idea of the types of food you can prepare for your toddler.
Note: This is just a guide. Now that your baby is able to regulate their own milk
or foodintake, let them decide how much to eat and whether they want to eat.
Mealtime tips for toddlers
While milk remains a key source of nutrients at this stage, your toddler should also eat a variety of nutrient-rich solid foods.This ensures that he/she receives quality nutrition, even if he/she doesn’t eat much.
Follow these tips for healthy meals!
TIP 1
Prepare food with little salt, sugar or seasoning.
TIP 2
Make sure your child drinks enough water and gets enough fibre from fruits, vegetables and wholegrains.
TIP 3
When a child is faced with a new food, it may take at least 10 exposures before it is accepted. The more frequent the exposure, the more likely he/she will accept the food.
TIP 4
For variety, plain yoghurt or cheese can be offered in place of milk. Do not substitute plain full cream milk with condensed or evaporated milk as these are high in sugar.
TIP 5
You can continue giving your child breast milk or plain full cream milk. Low-fat milk is not suitable for a child under 2 years of age.
TIP 6
Other foods that have the same amount of calcium found in 250ml of plain full cream milk include:
- About 1 slice of cheese
- ¾ cup high calcium yoghurt
- 4 tbsp crushed ikan bilis
Dealing with picky eating
As a parent, you model food preferences and play an important role in setting a good foundation for your child’s dietary habits.
Be a role model
Your eating habits play an important role in shaping your toddler’s dietary habits and can determine if he/she becomes a fussy eater.
Provide smaller portions
Start slow and give your child smaller portions, refilling the plate as he/she requests.
Be patient if your toddler refuses to eat certain foods
Try alternatives, like spinach instead of broccoli. If your child is still resistant, take a break from that food and try again after a week. It can take up to 8–10 tries before your child accepts new foods.
Create a positive and supportive environment during meal times
A child should not be forced to eat. Let him/her explore food in his/her own way. Give praise by describing what was done well. Children need encouragement to recognise the right behaviour.
Involve your child in preparing their meals
For instance, shop with your child and let him/her choose foods and ingredients, allowing him/her to participate in the preparation (for simple recipes, eg: sandwiches). By doing so, it can evoke interest and anticipation towards the meal.
Be creative when preparing and presenting food
Make sure the food is not a choking hazard. Do not allow him/her to run around with food in his/her mouth.
Reward your child with non-food treats like stickers or toys
Do not reward him/her with desserts or processed food. You can create your own reward system that your toddler can look forward to. E.g. one gold star sticker for each new food accepted. And with enough stickers collected, they can be exchanged for a new toy.
Encourage self-feeding with supervision
Make sure the food is not a choking hazard. Do not allow him/her to run around with food in his/her mouth.
Introduce different food types and textures
Let your child have varied interesting experiences with food, such as presenting eggs as egg custard instead of hard boiled eggs.
ALLERGIES
- Plain full cream milk should not be given to infants younger than 12 months as it is low in iron and high in solutes which can damage your baby’s developing kidneys.
- Honey (on its own or in other products like cakes); your baby should not eat honey in any form until he is at least 12 months old. As infants cannot digest the bacteria found in honey, eating honey can cause infant botulism.
- Any food high in salt content like canned foods, sausages, preserved foods, and foods seasoned with salt, soy sauce or chicken seasoning powder; your baby’s kidneys cannot handle one gram of salt or more per day until he/she is 12 months old.
- If your baby gets too used to salty flavours, he/she may be more likely to reject unseasoned food. This could encourage him/her to consume more salty foods and raise future risk of high blood pressure. Instead, use ginger, garlic, spring onion or spices such as turmeric as alternatives for seasoning.
- Any uncooked foods and unpasteurized milk products
- Fish with high levels of mercury — such as shark, swordfish, marlin, tuna (includes bluefin, big eyes, albacore yellowfin varieties), king mackerel, orange roughy, yellowback seabream and dash-and-dot goatfish.
- Any food that can easily be a choking hazard, such as: Small and hard pieces of food (e.g. nuts, and grapes); crunchy or hard foods (e.g. uncooked vegetables); fish and meat with bones; fruits with seeds, and sticky rice (e.g. glutinous rice).
- Commercial snacks that are high in sugar and high in sodium are a big no-no.
- Sugared drinks, soft drinks or fruit juice.
- Caffeinated drinks such as energy drinks, coffee or tea.
Watch out for symptoms of food allergies
Symptoms usually occur within several hours or several days after eating the trigger food. Hence, it is best to observe your baby’s reaction(s) closely – especially after introducing a new food. Look for:
- Hives and worsening eczema
- Swollen eyes, tongue, face, mouth and lips
- Water stools
- Vomiting
- Breathing difficulties
- Fainting
Some babies may develop an allergic reaction 1 or 2 days later so do keep a lookout for
symptoms like eczema, wheezing, persistent vomiting, constipation and/or stomach pain. See a
paediatrician immediately if your baby displays any of these reactions.
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