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In continuation with my previous Blog on what is Inborn Errors of Metabolism (IEM), today I will discuss on the kind of foods the infant can have with the available set of restrictions.

To do a recap, IEM is a condition where an infant is unable to convert the natural form of protein/ carbohydrate/ fat to energy. This happens due to a defective gene responsible to digest the nutrient.

So…what can the child consume…

Infant with IEM needs specialized nutrition solutions. This avoids any accumulation of the toxic element in the vital organs due to the defect in the gene that produces the enzyme required for the metabolism of the nutrient.

Eg: An infant having Phenylketonuria (PKU) need to restrict consumption of phenylalanine, which leads to hyperammonemia due to the absence of the enzyme required to process phenylalanine. Thus, specialized nutrition supplement which is phenylalanine free is recommended

During weaning stage, the infant should be provided high carbohydrate, low protein and moderate amount of fat in the diet. Following this regime becomes difficult for parents. The following dietary guidelines will make the transition to solid foods along with Specialized Nutrition Supplement easy.


  • High protein foods like Diary products, meat, chicken, fish, egg, soya products, nuts, beans and lentils should be avoided.
  • Include mainly fruits and vegetables: incorporate it in stewed or smoothie form to provide texture and flavour in the diet.
  • Include Low protein bread, flour and pasta.
  • Use cornflour/arrow root flour or low protein flour instead of multipurpose flour in the child’s diet.
  • Incorporate Oil/fat(EFA’s & LCPUFA’s) in regular food to increase the nutrient density such as in sunflower oil, Olive oil & Groundnut oil which has a better absorption & utilization to provide energy
  • Honey & fruit juices can be used to increase sweetness rather than adding sugar or glucose alone.
  • 2- 4 tbsp of semolina as upma (salty) or suji halwa (sweet) could be given as a snack
  • Tapioca flour, wheat flour or arrowroot flour could be roasted and made into a laddoo or as halwa, as chappati, nippattu, etc.
  • Cauliflower or Broccoli can be boiled and left to dry. You could cut them into small pieces, garnish with oil & salt+pepper, as finger foods. Similarly, you could run it in the grinder, it becomes like rice grains (called cauliflower rice), which you could use as an alternative to rice.


  • Weaning an infant has three stages of feed to be given
  • Lump free: strained (pureed) vegetables such as pumpkin, carrot and green beans.
  • Strained fruits like apples, sweet lime, oranges.
  • There is no need to add any fat, sugar, salt or spice to their food, as they will enjoy the natural flavour of food.
  • Soft lumps (>8months): vegetables should be mashed grated or diced.
  • Finger foods: low protein rusk, strips of pieces of cooked vegetables, low protein crackers.
  • Avoid food containing protein from animal sources, legumes or nuts.
  • Healthy eating guidelines recommend at least 2 serves of fruit a day


IEM is a debilitating, lifelong disorder, when managed well with specialized nutrition supplement, appropriate dietary management and medical care, improves the quality of life of the child with low mortality rate.




-Senior Nutritionist


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