Complementary Feeding Matters: Optimal Nutrition 6 to 24 months


The infant and toddler months are arguably the most critical period in human nutrition so it’s important to know when and how to start complementary feeding. Not only are weight and height increasing at the fastest rate in life, but also the body’s organ systems continue their development during the early post-natal months. The growth and refinement of the body’s most metabolically active organs, such as the central nervous system, kidney, lungs, GI tract, and immune system, raise the baby’s basal metabolic rate (BMR) to 2.5 times higher than that of an adult.1 No organ develops more rapidly or more comprehensively than the brain during this time. Between birth and one year the brain will double, and by 3 years of age the brain will triple, in size.2 Brain activity alone accounts for nearly 60% of the baby’s BMR. 1 Many nutrients are crucial to build and maintain the infant’s rapidly developing brain, including iron, zinc, DHA and more.3-5 This is why the overall quality of complementary feeding is so crucial.

Exclusive breast milk is optimal for the first 4 to 6 months of life due to its nutritional balance and its many bioactive properties, which transition the baby’s growth and development from fetal to post-natal life. Foods other than breast milk or infant formula are inappropriate before 4 months, yet still are offered to 40% of American babies before that time. 6,7 The period from 6 months to one year provides a key opportunity to shape the infant’s future dietary preferences and feeding habits. Breast milk and infant formula supply a strong nutritional foundation, allowing the introduction of foods to help achieve several goals8-11:

  • Augment the energy and nutrients of breast milk or infant formula by 20% at 6 months up to 50% by one year
  • Introduce every taste, flavor, texture, and color from all 5 food groups — fruits, vegetables, (whole) grains, dairy (plain yogurt, cheese), and protein sources (fish, beans and peas, meats, eggs, nut butters)
  • Ensure food acceptance through repeated exposures and by allowing the infant to play with new foods to fully explore and accept them
  • Help establish a responsive parenting style, one that is attuned to the baby’s communication of wants and needs12
  • Establish a foundational dietary pattern; that is, a highly nutritious, diverse array of foods that, when rotated over several days, gives the baby nutrition needed for optimal growth and development.13

The period from one year to 24 months should build on the gains established during earlier feeding practices. During this time, a toddler will transition toward family foods.7,13-15 Food selection is critical. It makes the difference between a high-quality versus a lowquality diet and it also will be the basis for later food preferences and eating habits.11 In the second year of life, between-meal snacks are nearly universal.7,13,14,16 Snacks account for more daily kilocalories than are served at breakfast, lunch, or dinner meals.6 But snacks also supply many of the day’s nutrients.6, 13,16 So, nutrient-rich snack food choices are critical building blocks for the toddler’s overall dietary pattern.

Yogurt can help play a key role in complementary feeding – as an introductory food when children first explore nutrient-rich foods from all food groups – and also as a nutrient-rich snack or meal component for toddlers who are building a foundational dietary pattern. Yogurt is a source of key minerals, vitamins and quality protein and it also contains live active cultures that make lactose and protein easier to digest. Several expert organizations including the American Academy of Pediatrics recommend yogurt as a first complementary food starting at 6 months of age. The new USDA Child and Adult Care Feeding Program (CACFP) meal patterns also include yogurt at 6 months as a first foods option and continue to incorporate yogurt as a meal or snack option for toddlers and older children.

Meals should be a fun time for the infant and toddler, not only to learn self-feeding skills to get the fuel they need, but also to explore the diverse world of food using all their senses. Complementary feeding matters because the child’s future depends on it.5,17-21

For more information and discussion on complementary feeding, please join me and DanoneWave at the Academy of Nutrition and Dietetics Food & Nutrition Conference & Expo (FNCE) for Complementary Feeding Matters: Optimal Nutrition from 6 to 24 Months on Sunday, October 22, 2017, from 1:30 to 2:00 p.m. in the Expo Hall Learning Center.


Robert Murray, MD, FAAP, FAND

Nutrition Advisor to Dannon

1.Son’kin V, Tambovtseva R. Energy metabolism in children and adolescents. In, Bioenergetics. Ed, Dr. Kevin Clark. Intech Press. Chapter 5: 121-142

2.Holland D, Chang L, et al. Structural growth trajectories and rates of change in the first 3 months of infant brain development. JAMA Neurol 2014;7:1266-74

3. Bourre JM. Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: Micronutrients. J Nutr Health Aging, 2006;10(5):377-85

4.Nyaradi A, et al. The role of nutrition in children’s neurocognitive development, from pregnancy through childhood. Frontiers in Human Neruosci, 2013; 7 (article 97): 1-15

5. Gould J. Complementary feeding, micronutrients, and developmental outcomes of children. Nestle Nutr Inst Workshop Ser, 2017;87:13-28

6. Miles F, Siega-Riz AM. Trends in Food and Beverage Consumption Among Infants and Toddlers: 2005-2012. Pediatr 2017;139:e20163290

7. Siega-Riz et al. New findings from the Feeding Infants and Toddlers Study 2008 Nestle Nutr Workshop Ser 2011;68:83-100

8.AAP Committee on Nutrition. Complementary feeding. In: Kleinman RE, Greer F, eds. Pediatric nutrition. 7th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2013.

9.World Health Organization. Report of the Commission on Ending Childhood Obesity. Geneva, Switzerland: World Health Organization; 2016.

10.Perreault M, et al. New Health Canada Nutrition Recommendations for Infants Birth to 24 Months Address the Importance of Early Nutrition. Nutr Today. 2016;51(4):186-190

11.Fewtrell M, ESPGHAN Committee on Nutrition. Complementary Feeding: A Position Paper. JPGN 2017;64: 119–132)

12.Black MM, Hurley KM. Responsive Feeding: Strategies to promote healthy mealtime interactions. Nestle Nutr Inst Workshop Series, 2017;87:153-165

13.Deming et al. Cross-sectional analysis of eating patterns and snacking in the US Feeding Infants and Toddlers Study 2008. Pub Health Nutr 2017; doi: 10.1017/S136898001700043X

14.Moshfegh A, NHANES Analysis, 2016. Food and Nutrition Service, USDA. Personal Communication.

15.Grimes CA, et al. Food Sources of Total Energy and Nutrients among U.S. Infants and Toddlers: National Health and Nutrition Examination Survey 2005-12. Nutrients 2015;17:6797-6836

16. Welsh JA, Fiuerosa Intake of added sugars during the early toddler period. J. Nutr Today 20.2017; 52:s60

17. Lioret et al. Dietary patterns track from infancy to preschool age: cross-sectional and longitudinal perspectives J Nutr. 2015; 145:775-82

18.Nyaradi et al. Good-quality diet in the early years may have a positive effect on academic achievement. Acta Paediatr 2016; 105:e209

19.Northstone et al. Are dietary patterns in childhood associated with IQ at 8 years of age? A population-based cohort study. J Epi Comm Health 2011; 66:624

20.Smithers et al. Do dietary trajectories between infancy and toddlerhood influence IQ in childhood and adolescence? Results from a prospective birth cohort study. PLoS One, 2013; 8:e58904

21.Smithers et al. Dietary patterns at 6, 15 and 24 months of age are associated with IQ at 8 years of age. Euro J Epi 2012; 27:525

This October, Celebrate National Health Education Week

National Health Education Week (NHEW) has been celebrated during the third week in October since 1995. The goal of the initiative of the Society for Public Health Education (SOPHE) and the Department of Health and Human Services is to increase national awareness on major public health issues such as diabetes, heart disease and obesity. NHEW also promotes a better understanding of the role of health education in the community and schools. Participate in NHEW from October 16 to October 20 by using SOPHE’s resources.

Bone and Joint Action Week

Bone and Joint Action Week, an annual global event with activities focused on disorders including arthritis, back pain, osteoporosis and trauma, runs October 12 through October 20. Individuals and organizations worldwide hold events and initiate projects to raise awareness of prevention, management and treatments that help support bone and joint health. The United States Bone and Joint Initiative has resourceful facts and activities to help you get involved.

OYED has some terrific resources that can help those who are looking to eat a more balanced and heart-healthy diet. Check out our fact sheet on the components of a healthy eating pattern. Another excellent resource is the MyPlate Daily Checklist, which shows people their daily targets for each food group.