Nutrition Guidelines: Birth To School Age

By Brianne Ozimok, Registered Dietitian

Feeding your child is no easy task. Knowing what to fed them, how much, what a good balance is and how intake changes over the years is difficult. On top of everything, it’s common for children to beg for something one day and then completely reject it the next. They can have a meltdown if an apple is cut wrong or there is a spot on their bread. As difficult as it is for parents to understand, we need to remember they are learning and exploring food. Not all blueberries taste the same and sometimes to them that apple just taste better cut in slices and not cubes.

Following recommendations from professional bodies can be helpful and help with stress that can be present around feeding children. Below are breakdowns of common food and nutrition recommendations from birth to school age.

0-6 months

  • In the first 6 months of life babies should be exclusively breastfed, offered formula or a combination of breastmilk and formula any time baby appears to be hungry. When babies are exclusively breastfed they should also be offered 400IU of liquid vitamin D

Introduction of solids starting at 6 months

  • Continue to offer breast milk until 2 years and beyond
  • Sometimes babies are ready for solids slightly before 6 months and for others it can be a little later. Looking for signs baby is ready is important. For example: Sitting up unassisted, good head control, tells parent they are full by turning head
  • It is important to offer high allergy foods (milk products, eggs, peanut, fish, wheat and soy) and to continue to offer these foods. Babies who have a personal history of eczema or a first-degree relative with an allergy may be at increased risk of food allergy. It is important to avoid honey until after 12 months.
  • Focus on iron rich foods first (meat, meat alternatives, iron-fortified infant cereals
  • Offer a variety of textures or food including finger foods (i.e., toast with thinly spread peanut butter, cut into thin strips)
  • Offer food (meals/snacks) in small amounts first, and then top up with breast milk or formula
  • Offer water from an open cup

At 12 months

  • Once baby is 12 months pasteurized homo milk (3.25%) can be offered or breast milk can continue to be offered. Homo milk should not exceed 500mL daily. Otherwise water should be offered.
    • Child who are breastfed or receiving breastmilk will continue to need 400IU of liquid vitamin D.
  • Continue to offer your child a variety of foods including different textures (pureed, minced, figure foods) and modify textures to reduce choking (cut grapes, avoid whole nuts and seeds)

24 months and beyond

  • Continue with breastfeeding or breastmilk or up to 500mL of skim or partly skimmed milk or fortified soy beverage daily to help meet vitamin D needs
  • Schedule 3 small meals and 2 nutrient-dense snacks/day
  • Avoid juice and sugar sweetened beverages
    • If given limit to at most 125mL/day of 100% fruit juice in an open cup as part of a meal or snack

Putting it all together!

Focus on structured Eating Pattern:

  • Work on incorporating 3 balanced meals and 2-3 balanced snacks daily.
    Allow 2-3 hours between meals and / or snacks without offering any food so that appetites can build
  • Avoid a “grazing” or nibbling pattern of eating and drinking which can interfere with a appetite at meals and willingness to try new foods.

Balance meals & snacks:

  • Include 3-4 food groups per meal
    • Meat or alternatives (protein) – i.e. meat, poultry, fish, eggs, nuts / seeds, nut butters, legumes, tofu)
    • Grains or starches (carbohydrates) – i.e. whole grain breads, cereal, rice, pasta, or starchy vegetables like potato
    • Fruit & vegetables
    • Dairy products (or alternatives)
  • Include 2-3 food groups with snacks (see examples)
    • Cheese, (shredded) crackers, and apple (shredded, pureed, thinly sliced)
    • Nuts/nut butter and sliced fruit
      o Yogurt (plain, Greek) and fruit
    • High fibre cereal & milk with berries
    • 1 slice of toast with peanut butter

Avoid Food battles:

  • Use Ellyn Satters division of responsibility (parents are responsible for what, where, and when they offer foods, child is responsible for what and how much they eat of what is offered).
  • Accommodate children’s feeding skills / abilities and preferences without catering to them (i.e. offer at least 1 food on the family meal that you know your child likes and is able to eat rather than preparing them a totally different meal).
  • Avoid short order cooking (this can impair children’s ability to learn to eat the foods provided at family meals and snacks).
  • Include children in the meal planning and prep (i.e. grocery shopping, unloading groceries, helping in the kitchen, contributing to their school lunches, cooking / food preparation, serving, cleaning up etc.). You can get input from children on parts of their meals and snacks (i.e. “would you prefer apple slices or carrots with your yogurt for your snack”).

Encourage kids to explore foods with their senses

  • How does it look, smell, feel, sound (i.e. when someone bites it or cuts it).
  • How does it taste (i.e., sweet, sour, is it a warm food or cold)
  • Start slowly allowing your child to become more familiar with new foods at their own pace. Encourage them to explore size and shape and assemble and deconstruct foods
  • The more “neutral” exposures children have with foods the more familiar those foods become and the more comfortable children will be interacting with and eventually eating them. A neutral exposure is one where there is no pressure (this can look like encouragement or praise) to eat it.
  • It can sometimes take up to 15 exposures for children to accept a new food. Changing how that food is prepared can help your child explore food and determine if they prefer something cooked vs raw, and / or with different seasonings / flavours.

Remember to model good eating behavior for your child. Allow them to see you eating meals, talking about food in a positive way, exploring and trying new things.

Ellyn Satter Division of Responsibility in feeding for Toddlers through adolescents:

  • Parent is responsible for what, when, where
  • Child is responsible for how much and whether

Parents Feeding jobs:

  • Choose & prepare the food
  • Provide regular meals & snacks
  • Make eating times pleasant
  • Show children what they have to learn about food and mealtime behaviour
  • Be considerate of children’s food inexperience without catering to likes and dislikes
  • Not let children have food or beverages (except for water) between meal and snack times
  • Let children grow up to et bodies that are right for them

Children’s eating jobs:

  • Children will eat
  • They will eat the amount they need
  • They will learn to eat the food their parents eat
  • They will grow predictably
  • They will learn to behave well at mealtime

Just remember feeding little ones can be exhausting but you are doing a good job!

Brianne Ozimok is a Registered Dietitian with the Brockton & Area Family Health Team.
Learn more about the Family Health Team at www.bafht.com or call to speak to one of the dietitians today.
This article was originally published in the Summer 2024 edition of Grey-Bruce Kids.

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