Table 1 BLISS recommendations developed to address low iron and energy intake, and the potential risk of choking

Increase the intake of high-iron foods

1). Encouraged to offer a high-iron food at each meal.

Nutritionist with expertise in iron nutrition (A-LH)

2). Provided with ideas for increasing the iron content of foods (e.g., including iron-fortified infant rice cereal in baking).

3). Provided with recipes and food ideas for iron-containing foods (including red meat which is high in total iron, haem iron, and the “meat/fish/poultry” factor that enhances non-haem iron absorption).

4). Advised to begin complementary feeding at 6 months of age (i.e., not to delay beyond 180 days).

Reduce the risk of growth faltering as a result of low energy from self-feeding

1). Encouraged to offer a variety of foods, including at least one high-energy food at each meal.

Paediatric health professionals

2). Provided with food ideas and recipes that were high in energy and could be easily self-fed by the infant.

3). Encouraged to practice responsive feeding, ensuring that: the feeding environment is pleasant with few distractions (e.g., no television), caregivers pay attention to the infant’s hunger and satiety cues, and that caregivers respond to the infant promptly and supportively.

4). Encouraged to offer ‘easy’ foods and more frequent milk feeds when their child was ill and during recovery.

Reduce the risk of choking

1). Advised to test foods before they are offered to the infant to make sure they are soft enough to mash with the tongue on the roof of the mouth.

Paediatric speech-language therapist

2). Provided with a list of specific foods to avoid (e.g., raw apple).

3). Advised to also avoid: foods that form a crumb in the mouth, hard foods, small foods, and circular (coin) shaped foods.

4). Educated on safety around eating including how to differentiate between gagging and choking, and what to do if choking occurs.