In this excerpt from the Jan/Feb 2012 edition of Journal of Family Health Care, Alison Fildes and Dr Lucy Cooke explain why introducing babies and toddlers to a wide variety of fruit and vegetable tastes and textures early on pays dividends. To read the article in full, subscribe here  

Balanced nutrition in infancy and early childhood is essential for both short-term and future health, as dietary habits established in childhood are likely to track into later life.

A substantial body of evidence indicates that a diet rich in fruits and vegetables is associated with multiple health benefits in childhood and beyond, including lower blood pressure, greater bone mass and protection against certain cancers

Despite these findings and the recent "Five-a-Day" campaign, children in the UK are consuming too few fruits and vegetables (FV). Less than a quarter of UK children are eating the recommended five daily portions of FV and a recent cohort study examining the diets of 18-month-olds found that 15.9 per cent of the toddlers ate no fruit and 8.4 per cent ate no vegetables over a three day period. We investigate the evidence for best weaning practice to help optimise acceptance of FV for the infant, toddler and beyond.

When to wean

The period of infancy when solid foods are first introduced provides an unparalleled opportunity to positively influence a child's diet. Complementary
feeding (CF) describes the transitional process that occurs between the period of exclusive breast or formula feeding and ultimately the consumption of family foods. This process often involves the introduction of purées and finger foods before moving onto "lumpier" foods.

Four key factors to consider before commencing CF:
i)   The capacity of an exclusively milk diet to meet an infant's nutritional requirements
ii)  The infant's motor development
iii)  The maturity of the infant's digestive system
iv)  Risk of allergies and food sensitisation.

The DH recommends that CF should ideally not begin before six months and advises parents to consult a health professional when considering introducing solids before this age. However the British Dietetic Association (BDA) place greater emphasis on an "individual" weaning age, driven by child specific developmental signs. Most researchers and health professionals do agree that CF should not begin before four months (17 weeks) or after six months because of an increased risk of nutrient and energy deficiencies.

A variety of flavours

Early exposure to a wide variety of foods and flavours has been shown to be predictive of later dietary intake. The acceptance of novel flavours is enhanced in younger infants and earlier introduction of FV during CF has been associated with greater intake in later childhood. There is some evidence of acritical period for flavour acceptance between four and seven months, when infants are particularly receptive to new tastes. It is important to capitalise on this window of opportunity by introducing a wide variety of FV during the period of CF.

Focus on fruit and vegetables

The main predictor of children's FV consumption is enjoyment of these foods and when listing their favourite foods, older children rate fatty and sugary foods the highest and vegetables the lowest.

Children generally prefer fruits to vegetables, reflecting an innate preference for sweet tastes and dislike of sour or bitter, but some studies have shown that before seven months, infants will consume more of an unfamiliar bitter taste. It may therefore, be beneficial for parents to offer vegetables before fruits uring CF to capitalise on this.

Whilst repeated exposure to a single vegetable flavour increases acceptance, a lack of variety risks "sensory specific satiety" -literally boredom with the taste. A study of infantsduring period of CF, found those who were offered a variety of different vegetables over nine days atemore of a novel food than those fed only potatoes or carrots.

There is also evidence to suggest that daily changes inthe vegetables offered to infants leads to immediateincreases in preference and intake and decreases in rejection of unfamiliar tastes.

Conclusions

Parents should be encouraged to introduce their infants to a wide variety of vegetables (and following that, fruits) as first foods. Infants' negative facial responses to novel foods should not automatically be interpreted as "dislike" and parents should continue to offer rejected foods on future occasions. Repeatedly exposing infants to the tastes and textures of these foods which are most commonly rejected by young children can having a lasting impact on vegetable acceptance with attendant health benefits both in the short and longer term.

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