Infant and baby nutrition

Early signs a newborn is hungry or ready to feed include:

• opening their mouth
• turning their head side-to-side
• stirring
• seeking out the breast or demonstrating the rooting reflex
• moving their hands to their mouth.

Mid-signs a newborn is hungry or is ready for a feed include:

• increased physical movement or restlessness
• bringing their hands to their mouth
• sucking their lips and hands
• making sucking or lip-smacking sounds.

Breastmilk composition changes as your baby grows. This provides the right make-up of nutrients for when your baby needs it.

From approximately 16 weeks of pregnancy until the first few days after birth, a type of breastmilk is produced. Generally, the first milk produced is in small amounts and is called colostrum. Colostrum is high in fat, protein and energy and contains nutrients which support a newborn's immune system.

After the first few days of birth, breastmilk changes from colostrum to foremilk and hindmilk. The baby gets foremilk at the start of each feed and, as that feed continues foremilk, changes to hindmilk. 

Foremilk is higher in water and lower in fat, providing hydration to the baby. Whereas hindmilk is high in fat and energy, which keeps the baby full and assists with growth.

Generally, the composition of fats, protein and carbohydrates in breastmilk are similar among women across the world. In most cases, breastmilk is not impacted by the mother’s diet. Based on an average Australian diet, there are only a few vitamins and minerals that some breastfeeding mothers may need to consume more of or supplement with:

• iodine
• vitamin B12
• vitamin D.

There are small amounts of vitamin D in breastmilk, however, if a breastfeeding mother has low vitamin D levels they may require a supplement to ensure their baby gets enough through breastmilk.

Vitamin D supplementation may be required if the infant:

• has very dark skin
• does not get much exposure to the sun
• has a condition which affects vitamin D levels
• is taking medication which affects vitamin D levels.

Talk to your paediatrician or paediatric dietitian if you think your infant has low vitamin D levels or is at risk of vitamin D deficiency.

Breastfeeding may be challenging, especially when you first start. Finding a method that works for you and your baby is important to help your baby feed well.

Babies have natural instincts to attach to your breast. Letting your baby use these instincts to find your breast is called baby-led attachment. This approach can help your baby attach well in the early weeks of feeding. Signs of these instincts include babies:

• opening their mouth and sticking out their tongue
• turning their head towards and away from your breast
• grasping the breast and attaching to the nipple
• suckling.

Mother-led attachment is when the baby is positioned and brought towards your breast to attach.

It is estimated that 1 in 20 women worldwide have difficulty and are unable to successfully breastfeed or provide enough nutrition through breastmilk alone. Despite having good knowledge, motivation, support and breastfeeding techniques some mothers may experience insufficient lactation. Conditions which may impact breastmilk supply include:

• infant tongue-ties
• incorrect attachment
• large blood loss or retained placenta
• maternal thyroid problems
• maternal Polycystic ovary syndrome (PCOS)
• maternal insufficient glandular tissue (IGT).

Some parents cannot feed their baby directly from the breast or choose not to. Reasons may include trauma, pain, difficulty or personal preference. 

Other ways to feed breastmilk are by:

• donated breastmilk
• expressing breast milk for bottle-feeding
• using a Supplement Nursing System (SNS) line with expressed breastmilk
• combination feeding using both breastmilk and infant formula.

Planned social events, returning to work, lifestyle flexibility or personal reasons may require mothers to express breastmilk. Expressing breastmilk can help preserve supply and will allow your baby to feed later. 

Breastmilk can be expressed manually by hand or with a pump. Manually expressed breastmilk generally contains slightly higher fat content than breastmilk expressed by an electric pump. It is thought that massaging the breast when manually expressing causes more hindmilk to be ejected.

Research has shown the nutritional composition of fresh breastmilk can change depending on how it is stored, thawed or heated.

It is important to know the correct methods of storage and preparation of breastmilk. See the Expressing, handling and storing breastmilk factsheet for more information.  

Some factors which can impact breastmilk include:

Storage

• the material of the container
• environmental temperature – room temperature, fridge or freezer 
• temperature fluctuations of refrigerators and freezers
• length of time stored.

Thawing and heating

• method of thawing – overnight in the fridge, placed in warm water, placed in hot water or microwaved.

It is not advised to use a microwave for heating breastmilk as it decreases the nutritional content.

Generally, mothers do not need to change their diets while breastfeeding and should aim for a healthy diet. Some breastfeeding mothers may need to change their lifestyle by avoiding or reducing certain foods, drinks, substances or smoking habits.

Caffeine

Caffeine can pass into breastmilk. Large amounts of tea, coffee and caffeinated beverages like soft drinks and energy drinks should be avoided. The recommendation of caffeine intake per day in Australia for breastfeeding women is 200mg or below.

Alcohol and other drugs

Alcohol and other drugs can pass through a mother’s blood and into breastmilk. The Australian Alcohol Guidelines recommend women who are breastfeeding should not drink alcohol.  The amount of alcohol in a mother’s blood is approximately the same amount that would be seen in breastmilk.

Only time will reduce the amount of alcohol in your blood and in your breastmilk. Expressing milk and throwing it away does not reduce the amount of alcohol in your breastmilk.

Expressing milk before having an alcoholic drink can ensure your baby can have expressed milk while you wait for any alcohol in your blood and breastmilk to fully pass through your system.

Allergen

Breastfeeding mothers are not advised to avoid allergen foods while breastfeeding unless their baby is reacting to trace foods from the maternal diet. Some allergic conditions like Food Protein-induced Allergic Proctocolitis (FPIAP) require removal and in time, re-introduction of the food allergens or triggers into the diet.

Common triggers for babies reacting to FPIAP can include cow’s milk and soy through breast milk. Less common triggers are eggs, wheat, fish and corn. Breastfeeding can continue with the maternal removal of the most likely triggers over two to four weeks when the baby's symptoms should improve. At 6-months old, 50% of babies tolerate the trigger foods when re-introduced into the mother's diet and 95% tolerate it at 9-months.

If a child has Food Protein-induced enterocolitis syndrome (FPIES) there is no need to restrict the mother's diet unless the baby is already reacting through the breast milk. This is rare.

Breastfeeding mothers can eat foods their baby may be allergic to. There are only rare situations where a mother may need to remove a certain food or drink from their diet for a short period of time.

Vaping and smoking

Chemicals like nicotine from cigarettes and vapes rapidly pass into the blood and into breastmilk. 

Cigarette smoking has been shown to reduce breastmilk supply and decrease the amount of fat, protein, energy and antioxidants in breastmilk. This can affect the nutrition supplied to the infant and may result in growth and development issues.

The safest option for an infant and a breastfeeding mother is to quit cigarettes and vapes. 

Research shows nicotine levels in breastmilk are only reduced by half for 97 minutes after smoking. If a mother does smoke or vape:

• a breastfeed should be done before smoking or vaping allowing more time before the next feed
• breastfeeding is encouraged and should continue as breastmilk contains protective factors against the harmful effects of cigarette smoke.

Medications

Most medications taken by a breastfeeding mother pass into the breastmilk. Generally, the amount of medication that passes into breastmilk is in small amounts. Only a small number of medications are not recommended while breastfeeding. 

It is important to let your doctor know you are breastfeeding if you are prescribed any medication for this reason.

In Australia, infant formula is available in powder or liquid forms and must comply with strict rules set by the Food Standards of Australia and New Zealand (FSANZ). In attempts to reflect the changes in breastmilk as a baby grows, infant formula (<6-months old) and follow-on formula (>6-months old) are available to parents and carers. Follow-on formula standards allow for higher amounts of energy and protein but have the same fat content requirements. 

Infant formula can be used up until 12-months of age instead of changing to a follow-on formula.

Generally, infant formulas are cow or soy milk-based. Other non-cow’s milk-based formulas, such as goat’s milk, are also available. 

Basic milk products, such as cow, soy and goat milk, are not the same as infant milk-based formulas. Infants are unable to digest or absorb basic milk products as the protein content is too high. These products also don’t have the right amount of vitamins, minerals or fats to meet an infant's nutritional needs.

Soy, coconut, almond or rice milk should not be given to an infant under 12-months old unless recommended by a paediatrician or paediatric dietitian.

Some infants may require specialty formulas. Specialty formulas include Special Medical Purpose Products for Infants (SMPPi), which are used if an infant has digestive conditions or allergies. 

Cow’s milk is a common food that causes an allergic reaction in infants. Infants with cow’s milk allergies may also have allergies to goat’s milk and soy milk and will require a specialty formula.  Specialty formulas include:

• partially hydrolysed formula (pHF)
• extensively hydrolysed formula (eHF)
• amino acid formula (AAF)
• rice-based or plant-based formula
• lactose-free
• anti-regurgitation (AR) or thickened formula.

See the Infant formula factsheet for more information on specific types of formulas and specialty formulas for regurgitation, intolerances and allergies.

Talk to your paediatrician or paediatric dietitian if you are thinking of using a non-cow’s milk formula or think your baby may have a digestive condition or allergy and require a SMPPi.

Visit Nutrition – Food allergies for more information on child allergies and allergic conditions.

Home-made ‘formula’ recipes are unregulated and do not meet the strict standards and regulations of the Food Standards of Australia and New Zealand (FSANZ). The standards are in place to ensure formulas are safe and provide adequate nutrition to babies and infants.

Generally, infants are more vulnerable to food safety risks as their immune systems have not fully developed. Some ingredients suggested for home-made ‘formula’ carry high food safety risks. High-risk ingredients include:

• raw milk
• raw chicken livers
• raw or partially cooked egg
• honey
• salt.

Only commercial infant formula should be used as an alternative to breastmilk until 12-months of age.

It is important to know the signs of when your infant is ready to eat solid foods.  

See Child Development for more information.

Certain foods should not be given to infants or toddlers until they are at an appropriate age.

Honey: Infants should not be given honey until they are 12-months or older. Raw honey has been shown to cause infant botulism. Infant botulism is a serious illness which causes paralysis.

Cow’s milk: Infants should not be given cow’s milk until they are 12-months or older. The protein and salt in cow’s milk are too harsh for an infant's digestive system and kidneys to process. 

Raw or runny eggs: Infants should not be given runny eggs until they are 12-months or older. Raw or runny eggs and homemade mayonnaise contain a risk of Salmonella bacteria causing Salmonella poisoning. 

Added salt or high-salt foods: Infants should not be given salt or consume foods with added salt until they are 12-months or older. Infant’s kidneys are very small and while they continue to develop, only small amounts of salt can be processed. High amounts of salt in an infant’s diet can cause a preference for salty foods resulting in a poorer quality diet over their lifetime.

Added sugar or high-sugar foods: Infants should not be given sugar and avoid added sugars until they are 12-months or older. Little to no added sugar is recommended for toddlers aged 12 to 24-months old. Added sugars cause a preference for sweet foods resulting in a poorer quality diet over the toddler's lifetime. No added sugar is also advised in children to develop healthier eating habits and to reduce its effects on dental health.

Raw or fresh milk: Raw or fresh milk is unpasteurised. Unpasteurised means the liquid has not been treated with heat. Unpasteurised liquids and food have a higher risk of containing harmful bacteria.  Raw, fresh or unpasteurised milk is not recommended for infants, toddlers or children. The sale of raw cow's milk for human consumption is also illegal in Australia.

Raw or fresh juice: Raw or fresh juice is unpasteurised. If produce has been contaminated or not stored properly, they can contain harmful bacteria that can make your child sick.

Caffeine and caffeinated drinks: Infants should not be given caffeine or caffeinated drinks such as tea, coffee, soft drinks or energy drinks. If caffeine is consumed by an infant half the amount of caffeine can still be in their bloodstream for up to 130 hours later. Infants' kidneys and liver cannot process caffeine as fast as adults. Caffeine can negatively affect an infant's sleep and behaviour.

Squeeze pouches (pouch-and-spout products): Squeeze pouches are an easy and convenient option for infant meals outside of the home or on the go. It is recommended content from squeeze pouches is given to an infant on a spoon. Infants should not be given squeeze pouches to suck food from. Sucking on the pouch spout can lead to tooth decay and affect speech development. Visit Child Development for more information on oral-motor skills.

Infants 6 to 9-months old primarily rely on breastmilk or formula for their nutrition. As a general rule breastmilk or formula should be provided before solid foods at this age. 

At this early stage of introducing solid foods, your baby will most likely only have a few mouthfuls of food. Exposing your baby to many different foods, flavours and textures, is just as important as transitioning your baby onto solid foods. It may take multiple tries before your baby will accept a new food. 

Important vitamins and minerals

Iron

Infants are born with enough of their iron stores to support their development for approximately the first 4 to 6-months of life. Breastmilk provides only small amounts of iron and from six months onward, iron-rich foods need to be included in the infant’s diet.

Iron is important for the child to development a blood protein called haemoglobin (Hb) and for preventing anaemia. Haemoglobin carries oxygen all around the body in red blood cells. 

Zinc

Infants are born with a large amount of zinc stores. These stores reduce by approximately 4-months old to a constant level in the body.  Excess zinc is not stored in the body and although breastmilk does contain zinc, zinc-rich foods are needed for healthy growth and development.

Vitamin D

Formula-fed infants generally get enough vitamin D from infant formulas as these products are fortified. Breastfed infants usually get enough vitamin D from breastmilk, unless the mother is vitamin D deficient. Vitamin D is found in small amounts of some fish, eggs, meat, mushrooms that have been exposed to ultraviolet (UV) light and fortified margarine. 

Most vitamin D is made by the skin when it is exposed to sunlight, only a small amount comes from food. Babies' skin is thinner and sensitive which can burn easily.  Sunscreen is not recommended for infants under 6-months old and it is not advised to expose an infant to direct sunlight under 12-months or older. See Hot weather and sun safety for more information.

Vitamin D is important for infants to develop strong bones. A supplement may be recommended by your doctor or paediatrician.

Vitamin B12

Infants have vitamin B12 stores that have been collected and stored during pregnancy. These stores, with additional vitamin B12 from breastmilk, are used for the first few months of life. If a mother has vitamin B12 deficiency through pregnancy, or while breastfeeding, the infant’s stores may be lower. 

Vitamin B12 is important for healthy brain and red blood cell development.

Amount of food

Start by offering a few teaspoons of solid food once a day to your infant in between breastfeeds of formula-feeds. At first, they may not eat much of the food offered but it is still important to offer. As your infant grows, different types of solid foods can be offered based on their hunger cues.

By 9-months old your infant can be fed approximately half a cup of food, two to three times a day depending on their appetite. Breastfeeds or formula-feeds should continue.

Types of food

Ensure the first foods given are a puree or soft-lumpy texture.

As your baby will only start by eating a few teaspoons of food, you can begin to introduce new foods in any order and any number of foods. 

It is recommended to choose iron-rich foods first. These can be mixed with other healthy foods to get different flavours and textures. 

It is recommended to introduce foods that may trigger an allergic reaction from 6-months old but no younger than 4-months old. See the section on Introducing allergens for more guidance.

Iron-rich foods include:

• iron-fortified infant cereals
• pureed, minced or stewed meat, fish (bones removed) or chicken
• cooked egg (no runny parts)
• cooked, mashed or pureed tofu, lentils, beans, edamame
• pureed dark green leafy vegetables; spinach.

Other foods that can be offered in age-appropriate textures:

• pureed or soft vegetables; pumpkin, spinach, carrot, taro
• pureed, stewed, mashed or soft fruit; pears, banana, apple, pawpaw, avocado
• full-fat dairy; yoghurt, a small amount of cow’s milk mixed with cereal
• nut pastes and nut flour; peanut butter, almond flour, hazelnut paste, tahini
• well-cooked rice, congee, sago
• bread, pasta, potato.

Infant food at this age can range from soft or firmer pieces of food to finger-foods and family meals. Transition through the textures will depend on your infant's ability to eat the different textures.

As a general rule, solid foods should be provided before breastmilk or formula at this age. 

It is recommended that high-risk allergen foods, in an age-appropriate texture, are introduced by 12-months old to prevent allergies. See the section on Introducing allergens for guidance.

Amount of food

By 12-months old your infant can be fed approximately half a cup of food two to three times a day, plus a small snack, depending on their appetite. Breastfeeds or formula-feeds should continue.

Types of food

Continue to increase the variety of foods and flavours given to your infant.

Mixed food and texture meals can be provided.  Examples include homemade:

• mince and vegetable pasta
• flaky fish with mashed vegetables
• omelette with vegetables
• mixed tofu, udon and vegetables
• stewed spinach with ground meat and rice.

At 12-months old a baby no longer needs infant, follow-on or toddler formula. Solid foods should make up most of an infant’s nutrition and energy needs. Breastfeeds can continue beyond 2-years-old for as long as the breastfeeding mother and baby desire. 

Amount of food

A toddler will begin to eat approximately three small meals or between three-quarters to one cup of food a day, with two or three healthy snacks, depending on appetite. 

It is normal for toddlers to eat more on some days and eat less or skip meals or snacks on other days. It is also normal for toddlers to be resistant to trying new foods or be fussy with what they choose to eat. See Nutrition - Fussy Eating for more strategies to help.

Types of food

From 12-months old, a toddler should be eating family meals. Some foods may need to be cooked until they are softer and chopped into smaller pieces to reduce the risk of choking. Children under 5-years-old should only be given nuts as a smooth nut paste, flour or powder. 

Milk

Full-fat pasteurised cow’s milk can be given as a drink, but water should be the main drink consumed. Cow’s milk should be limited to two cups, or 500mls, in a 24 hour period. 

If a baby cannot consume cow’s milk, a fortified non-cow’s milk drink can be given if directed by your paediatrician or paediatric dietitian. Other non-cow’s milk drinks like soy, oat, rice, coconut or almond, may not be fortified and contain less protein. Lower protein content can result in your baby not feeling as full and may be hungrier.

After 2-years-old a toddler can start to have reduced-fat or fat-free milk.

When an infant transitions to solid foods, it is normal for a gagging reflex to occur. Choking is different to gagging, it should be taken seriously as it can be fatal. An infant’s windpipe is approximately the width of a drinking straw. Anything small, round or hard that could block or get stuck in a straw can be a choking risk. 

See the Choking first aid factsheet for advice on what to do if your child is choking.  

Texture progression is important to keep your infant safe. Solid foods and different textures should only be given to your infant when they are developmentally ready. See Child Development for information on infant reflexes and developmental stages.

High-risk foods that infants can choke on include:

• hard raw vegetables or fruit; pieces of apple, carrot
• round fruit and vegetables; grapes, tomatoes, blueberries, pomegranate arils, peas, corn kernels
• nuts, legumes and seeds; peanuts, hazelnuts, chickpeas
• fish bones
• frankfurt sausages, “twiggy” sticks
• popcorn and hard small lollies.

Some high-risk choking foods do not need to be avoided. Through safe preparation, these foods can be given to your infant when they are age-appropriate and developmentally ready.

• Hard raw vegetables and fruit can be cooked until very soft, then mashed or cut into thin slices.
• Round fruits and vegetables can be cut into quarters lengthwise, smashed, mashed or pureed depending on the age-appropriate stage.
• Hard, round and small foods like nuts and seeds can be ground as flour or powder and mixed with soft foods, or nut and seed pastes can be given.  Children under 5-years-old should not be given whole nuts. 
• Firm and round foods like legumes, lentils and chickpeas can be cooked until they are very soft or can be smashed or pureed.
• Ensure raw and cooked fish is deboned properly. Some tinned salmon contains bones. These bones are soft and are high in calcium. Tinned salmon bones can be removed, or can be pureed with the flesh of the fish. 
• Frankfurt sausages and twiggy sticks are processed meats and can contain high amounts of sodium. Processed meats are not recommended for infants or toddlers. Sausages must be cut into quarters lengthways. 
• Popcorn and hard small lollies are not recommended for infants or toddlers because they can be high in salt and sugar and are a high choking risk.

Infants only need breastmilk or infant formula from birth up to 6-months old. No other fluid should be given to an infant under 6-months old, even in hot weather. 

An infant’s developing stomach and kidneys are very small, putting them at risk of water intoxication if consumed. Offering an infant water at this age may also cause them to drink less breastmilk or infant formula and can affect growth.

Formula is required to be mixed with boiled and cooled water. Breastmilk is approximately 87% water, providing enough hydration for an infant. The recommended intake of fluid from breastmilk or infant formula for this age is approximately 700mls per day. 

From 6-months old, small amounts of boiled and cooled water can be offered to an infant using a cup. Offering water in a cup allows your infant to practice holding and drinking from a cup. At this age, most of an infant’s fluid needs still come from breastmilk, infant formula and food. 

The recommended intake of fluid at this age is approximately 800mls per day, with at least 600mls as actual fluid, not water content from food. 

From 12-months old, toddlers can consume water sourced straight from the tap. If a clean water supply is available, tap water does not need to be boiled and cooled before drinking. Full-fat cow’s milk can also be introduced as a drink from 12-months old.

The recommended intake of fluid for this age is approximately 1.4 litres per day, with at least 1 litre as actual fluid from plain water, full-fat cow's milk, or breastmilk.

Concerns about BLW are seemingly related to poor adherence to instructional guides and include:

• Choking: Choking is a concern for all weaning methods. Your infant must be developmentally ready before introducing solids. Ensure all foods are either prepared safely to reduce the risk of choking or avoid foods at risk of choking completely until the baby is older.
• Nutritional inadequacy: As an infant self-feeds what and how much they eat, there is a risk of the infant becoming underweight or not getting enough nutrients like iron, zinc and Vitamin B12. Even if BLW infants are supplemented with breastmilk, from six months onwards nutrients from breastmilk, including iron, will not be adequate to meet infant requirements.
• Excess salt or sugar: If infants are eating family meals, the amount of sugar and salt in the meal may be too high. Seasonings, added salts or sugar in pre-prepared meals or processed meals can cause nutritional imbalances in infants.

Self-reported benefits from parents included in research claim:

• more family meals are eaten together
• mealtimes are calmer and less stressful
• breastfeeding mothers experience less pressure around weaning.

Infants with developmental delays, neurological issues or who are born prematurely are advised to follow traditional weaning methods. If you have concerns discuss this with your paediatrician or paediatric dietitian.

Introduce one allergen food at a time, with consideration of the other recommended dot points. This will help identify which food may be allergy causing if the infant develops an allergic reaction. If they do not have an allergic reaction continue to give the allergen food at least twice a week until 5-years of age. 

If your infant has an allergic reaction, stop giving the allergen and seek medical advice from your doctor. If your infant has an anaphylactic reaction call Triple Zero (000). See the Allergy and allergy test Factsheet for signs and symptoms of an allergic reaction or anaphylaxis.

Most severe allergic reactions can occur within minutes of exposure. Milder reactions can occur within a few hours. Some symptoms of allergic conditions can take days to weeks to appear. 

There is no specific order or time of day to introduce allergy causing foods. Single foods like pureed hard-boiled egg, smooth peanut butter or tree nut paste, are age-appropriate textures that can be introduced. It is best to introduce allergen foods during the day or after waking, so the infant can be watched for signs of an allergic reaction or anaphylaxis. 

Start by mixing approximately ¼ teaspoon of the allergen food into your infant’s usual food. If there are no signs of an allergic reaction this amount can be increased to ½ a teaspoon next time. Increase the amount and texture as your infant grows and develops.

If you are worried about introducing allergen foods, you can rub a small amount of the food on the inside of your infant’s lip. If your infant does not have an allergic reaction you can offer more of the allergen by mixing into your infant’s food.

If a family member has a food allergy, it is still important to introduce that food allergen to your infant in a way that keeps the other family member safe.   

It is advised to continue feeding a food allergen to your infant once it has been introduced. If your family does not eat a certain allergen food or your infant is not likely to continue eating the allergen, you may wish to speak to your doctor or allergy dietitian for options or further advice.

Visit Food allergies for more information.