10/01/2012 05:04 EDT | Updated 12/01/2012 05:12 EST

Where's the beef? Babies at 6 months need iron-rich foods like meat: guidelines

TORONTO - When Carli Sussman's son Oliver was five months old, she and her husband started giving him cooked meat to suck on as an adjunct to the breast milk he was getting as his primary diet.

"The first thing we gave him was a strip of rib-eye steak," recalls the Vancouver mom. "At that point, he wasn't actually eating any of it. We were just giving him pieces of food that we had. And he was just sort of putting them in his mouth, which is what five-month-olds do with everything."

So there were no surprises for Sussman in updated infant-feeding guidelines recently released by Health Canada, which advise that babies at six months old need to start ingesting iron-rich foods — including beef and poultry.

Those guidelines, aimed at health-care providers for dissemination to parents, say that babies at that age need to start eating meat, meat alternatives like tofu and legumes, and even eggs and fish.

The recommendations, posted without fanfare on Health Canada's website, seemed to take some parents by surprise.

"What probably really got the attention was the fact that some of these examples were new to people," says Jennifer McCrea, a nutrition adviser for Health Canada who helped prepare the guidelines.

But they would not necessarily be new to health professionals, she says. "Some would have been familiar with them. For some other people, this may be the first time that they've noticed that guidance."

McCrea, a member of the 14-person working group that drafted the slightly revised guidelines, says the document doesn't represent a change from the 2004-05 recommendations, but is a reaffirmation of advice stressing the importance of introducing solid foods containing iron.

"Meat can be one of those iron-rich first foods, but there are a whole range of options," she says.

"In this guidance, I think what we tried to do was just add more examples to add to the clarity ... that although (iron-fortified) infant cereals have been and really still are a popular choice, there are other options that are iron-rich as well."

The guidelines, penned by experts at Health Canada, the Canadian Paediatric Society (CPS), Dietitians of Canada and the Breastfeeding Committee for Canada, say: "Infants should be offered iron-containing foods two or more times each day ... Breastfeeding continues to provide the main source of nutrition as other foods are introduced."

Dr. Jeff Critch, a pediatrician in St. John's, N.L., who was also a member of the Infant Feeding Joint Working Group, says it's essential for babies to start getting more iron into their diet starting at about six months.

"Iron is very important for our blood. It's also important for child development" — especially neurological development, says Critch.

During the last trimester of pregnancy, the fetus builds up a store of iron from the mother, which carries the child through the first half-year of life.

And although breast milk contains iron, it's only in small amounts, says Critch. "After six months of age, (the baby's) iron stores are getting really depleted and we need to look for other sources because the breast milk at that point is not going to be sufficient to supply all the iron that's needed."

Without the addition of certain foods, a baby can become iron-deficient, he says.

McCrea says the recommendations don't focus on quantities of iron-providing foods — that detailed advice should be contained in updated guidelines for six- to 24-month-old children expected in 2013 or 2014.

Parents, she says, should be guided by an infant's appetite "and the cues back to you of when they want more and when they're full, because you're trying to nurture those natural hunger cues that they have that are really starting at that age.

"We are talking about family foods for sure, but with young children you want to avoid a lot of salt or sugar, again sticking to more plain foods. But all those family foods can be textured-modified and can begin to be introduced."

So along with continued breastfeeding, ideally, that means baby's first solids should be iron-fortified cereals as well as meat, tofu, eggs, fish or legumes that have been cooked until tender and mashed with a fork or minced finely with a knife or food grinder. Well-cooked, pureed or mashed-up vegetables and fruits would then be added to the diet.

Speaking of eggs and fish, parents were once advised to hold off giving them to their little ones because it was thought they might trigger allergies if started too early in life.

But scientific research has laid that theory to rest, says Critch. "We don't see any evidence to support delaying the introduction to prevent allergies."

It's recommended that an infant be exclusively breastfed for the first six months. Parents should then start introducing solids like meat based on an infant's signs of readiness. That could be a few weeks before or just after six months, he says.

"It doesn't mean 180 days plus one. There's certainly biological variation and individuality ... You have to look at each individual infant on his own merits and make a decision as to when that child needs to be started on solids.

"We look for signs of readiness. So is the child showing some interest in foods? Do they have the motor capacity to take foods?"

Sussman says Oliver showed he was ready to take on solid foods at five months old — at least the taste of them, anyway.

"In the very early months, from five months, we would give him really large pieces of the food, things he could hold in his hand and just suck on," she remembers. "He wasn't capable at that point of biting anything off. He was just sucking the juices out of a piece of meat or sucking a piece of broccoli or carrot or whatever we had.

"And then as he began to develop the ability to bite off pieces, which could then be potentially a choking hazard, we started to prepare the foods in a way that was good for him to swallow."

Now 13 months old, Oliver has grown molars that allow him to chew his food more, and he has graduated to larger pieces of meat and steamed vegetables like carrots on his plate.

While Sussman was well-versed in the guidelines — so introducing meat to her son was an easy idea to digest — they also fit in with the paleo, or "caveman," diet she and her husband had already adopted: meat, eggs, fish, vegetables, fruit, seeds and nuts — but no grains, dairy or legumes.

"We've been doing that and we found for our health it's really beneficial," she says. "When we looked at the (research) evidence ... we believed that was going to be the best way to raise our kid. So we decided to basically just put him on that diet from Day 1."