Omega-3 for babies and toddlers: DHA, fish and plant sources

What omega-3s are

Omega-3s are a family of fats the body uses to build cell membranes. The NIH describes three main ones:

• ALA (alpha-linolenic acid), found in plant foods like flaxseed, chia, walnuts and canola oil. It’s essential: the body can’t make it, so it has to come from food.
• EPA and DHA, found in fish and other seafood. They’re first made by tiny algae in the sea, and fish build them up by eating them.

The body can turn some ALA into EPA and DHA, but the NIH says the conversion is very limited (under 15%), so eating EPA and DHA directly is the only practical way to raise levels.

The AAP says DHA is important for a child’s developing nervous system and vision. The FDA lists omega-3s (DHA and EPA) among the key nutrients fish provide in early childhood, alongside iron, choline, protein, vitamin B12, vitamin D and selenium.

How much do babies need?

The NIH gives these adequate intakes:

• Birth to 12 months: 0.5 g of total omega-3s a day, based on what healthy breastfed babies take in
• 1 to 3 years: 0.7 g of ALA a day

No official amount has been set for EPA or DHA on their own (NIH).

Milk comes first. Breast milk contains ALA, EPA and DHA, and most infant formulas sold in the US have had DHA added since 2002 (NIH). You don’t need to do anything extra in the early months.

Oily fish: the best food source

The NIH says cold-water fatty fish, such as salmon, mackerel, herring and sardines, are high in EPA and DHA, while leaner fish like cod and tilapia, and shellfish, have less. Canned light tuna is a low-mercury Best choice (FDA), but it has much less DHA than salmon (NIH).

Good low-mercury oily fish from the FDA’s Best choices list:

• salmon
• sardines
• Atlantic mackerel (not king mackerel)
• herring and freshwater trout

Never give children king mackerel, shark, swordfish, marlin, orange roughy, bigeye tuna or tilefish from the Gulf of Mexico: the FDA lists them as the highest in mercury.

How much. For children aged 1 to 3, the FDA suggests 2 servings a week from the Best choices list, with a serving of about 1 oz (28 g). The AAP suggests small servings of a variety of fish and shellfish 1 to 2 times a week. In the UK, the NHS suggests at least 1 portion of oily fish a week for young children, and no more than 4 a week for boys or 2 a week for girls, because of pollutants that can build up in the body. It adds that the benefits of oily fish outweigh the risks within these limits.

For babies under 12 months, the FDA gives no serving size: start with a few flakes and let your baby decide. For cooking, bones and serving by age, see fish for babies.

Serving it safely:

• Cook fish and shellfish fully, until the fish is opaque and flakes easily. The NHS says to avoid raw shellfish for babies and children.
• Remove the skin and feel every flake for bones.
• Mash canned sardines and salmon completely flat after lifting out the backbone, or take the soft bones out.
• Choose canned fish packed in water with no added salt.

Plant sources of ALA

Plant foods give ALA, not DHA. They’re still worth offering, especially if your family eats little or no fish. Good sources (NIH, NHS):

• Ground flaxseed (linseed). Cook it into oatmeal or bake it into soft foods, as the flaxseed page shows. Never whole seeds.
• Ground chia seeds. Stirred into porridge or purée and left to soak and thicken: see chia seeds.
• Walnuts. Finely ground, or as a smooth walnut butter thinned into food: see walnuts.
• Hemp seeds, finely ground. USDA FoodData Central lists about 8.7 g of ALA per 100 g of hulled hemp seeds: see hemp seeds.
• Rapeseed (canola) or soybean oil in cooking.
• Soy foods like mashed edamame.
• Eggs enriched with omega-3 (NHS), well cooked: see egg.

The CDC lists whole or chopped nuts and seeds as choking hazards for young children, so offer them ground or as a thinly spread or thinned butter. Walnuts and other tree nuts are common allergens: introduce them one at a time (see how to introduce allergens).

For vegetarian and vegan families, see vegetarian and vegan babies and vegetarian and vegan toddlers.

Does my child need an omega-3 supplement?

Most don’t. The AAP says healthy children who eat a variety of foods usually get the nutrients they need, and that supplements aren’t approved by the FDA for safety or effectiveness before they’re sold. Talk to your pediatrician before giving any supplement.

Ask your doctor or health visitor whether a supplement makes sense if your child:

• eats no fish, for example on a vegetarian or vegan diet, or because of a fish allergy
• eats a very limited range of foods

If one is advised:

• Algal oil is a plant-based source of DHA (NIH), which suits vegetarian families.
• Cod liver oil also contains vitamins A and D (NIH). The NHS says not to give cod liver oil together with vitamin drops, because too much of some vitamins can be harmful. See vitamins for babies and toddlers.
• Use the dose your doctor gives, and store all supplements out of reach.

Fish as an allergen

Fish is one of the common allergens, and so is shellfish. Offer it from around 6 months, one new fish at a time, and keep it in the diet once your baby tolerates it. See how to introduce allergens.

Fish can also cause FPIES, a delayed reaction that causes repeated vomiting a few hours after eating, often with paleness or floppiness (ACAAI). If your baby vomits once or twice a few hours after fish and is alert and like themselves, call your pediatrician or GP. Call 911 or go to the emergency room if your baby is vomiting again and again, or is pale, floppy, very sleepy or hard to wake.Call 999 or go to A&E if your baby is vomiting again and again, or is pale, floppy, very sleepy or hard to wake.Call your local emergency number (such as 112 in Europe or 000 in Australia) or go to the emergency department if your baby is vomiting again and again, or is pale, floppy, very sleepy or hard to wake. For hives, swelling or trouble breathing, see signs of anaphylaxis.

Where US and UK advice differs

• How much fish. FDA: 2 servings a week of about 1 oz (28 g) from the Best choices list, for ages 1 to 3. NHS: at least 1 portion of oily fish a week, and no more than 4 for boys or 2 for girls.
• Girls and oily fish. The NHS gives girls a lower limit because pollutants in oily fish can build up and may affect a baby in a future pregnancy. US advice doesn’t separate boys and girls.
• Tuna. The FDA lists canned light tuna as a Best choice. The NHS says fresh and canned tuna don’t count as oily fish.
• Supplements. The NHS recommends daily vitamin drops with vitamins A, C and D for children from 6 months to 5 years (not for babies having more than 500 ml of infant formula a day), so check with your health visitor before adding cod liver oil. In the US, ask your pediatrician.