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Flavor Training, Healthcare Professionals, Food Parenting

Complementary Feeding vs. Flavor Training

By Diana K Rice, Nutrition, LLC, RD, LD, CLEC

In the medical community, there's a clear consensus on when infants should begin complementary feeding: at 6 months old. But despite the AAP, ACOG, AAFP and WHO recommendations being very clear about this timeline, parents often start much earlier.

The primary reason that official guidelines push for this 6 month mark is that very early introduction of complementary foods has been shown to reduce breastfeeding's overall duration. The medical community also holds concerns that introducing solids prior to the age of 6 months could increase the risk of choking and aspiration, lead to diarrhea and poor gut health and contribute to the onset of certain chronic diseases later in life, including diabetes and celiac disease.

So why is there so much confusion over this?

One reason is that up until as recently as 2013, organizations including the AAP supported beginning complementary feeding as early as 4 months old.2 Parents also hold beliefs that that starting early will help an infant sleep through the night or improve reflux, although there is very little evidence to support such claims.

To dispel these myths and make sure infants receive the benefits of exclusive milk feedings for their first 6 months of life, it's very important for healthcare providers to provide clear guidance on the right time to begin complementary feeding.

But does firmly standing behind the 6 month recommendation mean that infants should have no experiences with food whatsoever prior to the 6 month mark? Two emerging areas of research suggest otherwise.

In 2017, the AAAAI released recommendations that children who are at the highest risk of developing peanut allergies be introduced to peanut protein between 4 and 6 months old3 and research suggests that the same may hold true for egg introduction.

And while only a small number of children are in the highest-risk groups for potential peanut and egg allergy, we are also learning more about why all children may benefit from food experiences starting at around 4 or 5 months old: flavor training.

Flavor training is an early feeding practice that parents may use to help their infants learn to accept the wide variety of flavors found in vegetables, especially bitter and sour flavors. The current research shows that the flavor preferences that children develop in infancy track across their life spans and, of course, developing a preference for vegetables, which can have positive life-long health implications. 

The research also tells us that infants are most receptive to new flavors between the ages of 4 and 7 months. Given this fact, waiting until the child is 6 months old to introduce any food at all misses two-thirds of this critical window.

Complementary feeding is so named because it indicates the beginning of infants receiving nutrition from solid food sources as a compliment to their milk feedings. Infants benefit from receiving the calories, iron, zinc, omega-3 fats and other nutrients that these foods contain and the introduction of these foods signals the very beginning of the child weaning off of milk feedings altogether at 12 months old or later.

Flavor training, conversely, is not meant to deliver any nutrition to the infant. Between the 4 and 6 month age range, it can be done simply by smearing a bit of food on the child's lips or letting them lick an eighth of a teaspoon of food off of a parent's finger several times a week. Early allergen introduction can be done in the same way at this age.

The benefits of flavor training from as early as 4 months are numerous. Beyond helping children learn to consume healthy foods, the practice also has the potential to reduce feeding challenges and help children embrace the joys of eating. And when done in a way that does not interfere with the child's intake of milk feedings, there are no adverse effects. Moreover, by the time an infant is ready and needs essential nutrients from food, they have been given a head start of exposure and possible acceptance of a wide range of flavors and healthy vegetable-forward foods, making the transition easier. This may also take the pressure and anxiety away from mom as this is all about small flavor experiences and not about making sure food provides nutrition to baby.

And yet, with parents already so confused about the appropriate age to start solids, how can we communicate the importance of flavor training and give clear directions on how to introduce food flavors between 4 and 6 months without displacing the critical nutrition delivered from milk feedings?

We recommend being very clear with your patients that complementary feeding and flavor training are distinct practices with their own timelines. If parents don't bring up flavor training, it may help to do so yourself because they will likely encounter the idea elsewhere. And when discussing the practice, underscore the importance of offering the infant 'just a taste,' such as the amount an infant could lick off of a single adult finger. For parents seeking more guidance on how to do flavor training, which foods to offer and the research that supports the practice, we have a collection of free resources on goodfeeding.com that we encourage you to use.

Do you recommend flavor training to your patients? Do you have questions or concerns about the practice?
Click here to contact us, our ears are always open, and we welcome your thoughts.

Disclaimer: The information provided is the opinion of Good Feeding, it has not been evaluated by healthcare professionals, and is for educational purposes only. Before starting any new foods or feeding practices, please consult your baby's healthcare professional.

1 ‘Prevalence and Reasons for Introducing Infants Early to Solid Foods: Variations by Milk Feeding Type,’ H. B. Clayton, R. Li, C. G. Perrine, K. S. Scanlon, Pediatrics, Apr 2013, 131 (4) e1108-e1114; DOI: 10.1542/peds.2012-2265

2 ‘Infants Are Fed Solid Food Too Soon, C.D.C. Finds’ D. Quenqua, The New York Times, March 25, 2013. https://www.nytimes.com/2013/03/25/health/many-babies-fed-solid-food-too-soon-cdc-finds.html

3 ‘Addendum Guidelines for the Prevention of Peanut Allergy in the United States,’ A. Togias et al, National Institute of Allergy and Infectious Diseases, Oct. 18, 2016. https://www.niaid.nih.gov/sites/default/files/addendum-peanut-allergy-prevention-guidelines.pdf

4 ‘The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods’
F. R. Greer, S. H. Sicherer, A. W. Burks, Pediatrics Apr 2019, 143 (4) e20190281; DOI: 10.1542/peds.2019-0281

5 ‘Early Flavor Learning and Its Impact on Later Feeding Behavior,’ G. K. Beauchamp, J. A. Mennella, Journal of Pediatric Gastroenterology and Nutrition, March 2009 - Volume 48 - Issue - p S25-S30 DOI: 10.1097/MPG.0b013e31819774a5

6 ‘Managing weaning problems and complementary feeding,’ L. Cooke, Ú. McCrann, C. Higgins, Paedeatrics and Child Health, August 2013, Volume 23, Issue 8, pp 346–350, https://doi.org/10.1016/j.paed.2013.06.010

 

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Complementary Feeding vs. Flavor Training

By Diana K Rice, Nutrition, LLC, RD, LD, CLEC

In the medical community, there's a clear consensus on when infants should begin complementary feeding: at 6 months old. But despite the AAP, ACOG, AAFP and WHO recommendations being very clear about this timeline, parents often start much earlier.

The primary reason that official guidelines push for this 6 month mark is that very early introduction of complementary foods has been shown to reduce breastfeeding's overall duration. The medical community also holds concerns that introducing solids prior to the age of 6 months could increase the risk of choking and aspiration, lead to diarrhea and poor gut health and contribute to the onset of certain chronic diseases later in life, including diabetes and celiac disease.

So why is there so much confusion over this?

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Creating healthy and happy eaters

  • You provide, let baby decide. You provide what foods are on offer, and baby decides when they have had enough
  • Keep mealtimes happy and stress free
  • Remove unnecessary distractions such as TV or devices
  • Ensure baby is sitting comfortably and facing other family members
  • Role model healthy eating at every opportunity.
  • Respond to hunger and fullness cues and leave behind expectations of how much you want baby to eat. 
  • Feed slowly, encouraging baby to eat and never resorting to bribery
  • Avoid unhealthy foods you know baby will eat to ensure they ‘just eats something’
  • Only offer food for hunger and not for any other reason

Disclaimer: The information provided is the opinion of Good Feeding, it has not been evaluated by healthcare professionals, and is for educational purposes only. Before starting any new foods or feeding practices, please consult your baby's healthcare professional.

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