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Starting Solid Foods

 

Rice, oatmeal, or barley? What infant cereal or other food will be on the menu for your baby's first solid meal? Have you set a date?

At this point, you may have a plan or are confused because you have received too much advice from family and friends with different opinions.

Here is information from the American Academy of Pediatrics (AAP) to help you prepare for your baby's transition to solid foods.

 

When can my baby begin solid foods?

Here are some helpful tips from AAP Pediatrician David Hill, MD, FAAP on starting your baby on solid foods. Remember that each child's readiness depends on baby's own rate of development.


Other things to keep in mind:

  • Can your baby hold his/her head up? Your baby should be able to sit in a high chair, a feeding seat, or an infant seat with good head control.

  • Does baby open his/her mouth when food comes baby's way? Babies may be ready if they watch you eating, reach for your food, and seem eager to be fed.

  • Can baby move food from a spoon into his/her throat? If when you offer a spoon of rice cereal, baby pushes it out of his/her mouth, and it dribbles onto the chin, baby may not have the ability to move it to the back of the mouth to swallow it. That's normal. Remember, baby's never had anything thicker than breast milk or formula before, and this may take some getting used to. Try diluting it the first few times; then, gradually thicken the texture. You may also want to wait a week or two and try again.

  • Is baby big enough? Generally, when infants double their birth weight (typically at about 4 months of age) and weigh about 13 pounds or more, they may be ready for solid foods.

NOTE: The AAP recommends breastfeeding as the sole source of nutrition for your baby for about 6 months. When you add solid foods to your baby's diet, continue breastfeeding until at least 12 months. You can continue to breastfeed after 12 months if you and your baby desire. Dr. T does recommend supplementing solely breast fed infants with vitamin D and iron supplements during the first year.

How do I feed my baby?

Start with half a spoonful or less and talk to your baby through the process ("Mmm, see how good this is?"). Your baby may not know what to do at first. Baby may look confused, wrinkle the nose, roll the food around inside the mouth, or reject it altogether.

One way to make eating solids for the first time easier is to give your baby a little breast milk, formula, or both first; then switch to very small half-spoonfuls of food; and finish with more breast milk or formula. This will prevent your baby from getting frustrated when he/she is very hungry.

Do not be surprised if most of the first few solid-food feedings wind up on your baby's face, hands, and bib. Increase the amount of food gradually, with just a teaspoonful or two to start. This allows your baby time to learn how to swallow solids.

Do not make your baby eat if she/he cries or turns away when you feed baby. Go back to breastfeeding or bottle-feeding exclusively for a time before trying again. Remember that starting solid foods is a gradual process; at first, your baby will still be getting most of baby's nutrition from breast milk, formula, or both. Also, each baby is different, so readiness to start solid foods will vary.

NOTE: Do not put baby cereal in a bottle because your baby could choke. It may also increase the amount of food & calories your baby eats and can cause your baby to gain too much weight. However, cereal in a bottle may be recommended if your baby has reflux. Check with your child's doctor if you suspect baby needs cereal.

Which food should I give my baby first?

For most babies, it does not matter what the first solid foods are. By tradition over past generations, single-grain iron-fortified cereals have been usually introduced first. However, there is no medical evidence that introducing solid foods in any particular order has an advantage for your baby. Although many pediatricians will recommend starting vegetables before fruits, there is no evidence that your baby will develop a dislike for vegetables if fruit is given first. Babies are born with a preference for sweets, and the order of introducing foods does not change this. If your baby has been mostly breastfeeding, your baby may benefit from 1st baby foods made with meat, which contains more easily absorbed sources of iron and zinc that are needed by 4 to 6 months of age (beef, veal, lamb, pork, chicken, turkey, fish, etc). Check with your child's doctor.

Baby iron-fortified cereals are available premixed in individual containers or dry, to which you can add breast milk, formula, or water. Whichever type of cereal you use, make sure that it is made for babies and iron fortified.

When can my baby try other food?

Once your baby learns to eat one food, gradually give baby other foods. Give your baby one new food at a time every few days. Generally, meats and vegetables contain more nutrients per serving than fruits or cereals. Please continue foods already given as part of your baby's daily variety.

There is no evidence that waiting to introduce baby-safe (soft), potentially allergy-causing foods, such as eggs, dairy, soy, peanuts, or fish, beyond 4 to 6 months of age prevents food allergy. There is scientific evidence for just the opposite_giving these foods between 6 & 10 months of age appears to reduce a baby's chances of food allergy bby allowing baby's immune system to develp tolerance to foods. If you believe your baby has an allergic reaction to a food, such as diarrhea, rash, or vomiting, talk with your child's doctor about the best choices for the diet.

Within a few months of starting solid foods, your baby's daily diet should include a variety of foods, such as breast milk, formula, or both; meats; cereal; vegetables; fruits; eggs; pureed nut butters; soft cheeses; yogurts; soft biscuit pieces and fish. Please delay cow's milk until age one year and offer no honey in the first year of life.

When can I give my baby finger foods?

Once your baby can sit up and bring his/her hands or other objects to the mouth, and pick up small pieces with forefinger and thumb, you can give baby finger foods to help her/him learn to feed her/himself. To prevent choking, make sure anything you give your baby is soft (easily crushable between parent fingers), easy to swallow, and cut into small pieces the size of baby's thumb tip. Some examples include small pieces of banana, wafer-type cookies, or crackers; scrambled eggs; well-cooked pasta, rice and legumes; well-cooked, finely chopped chicken; and well-cooked, cut-up potatoes or peas.

At each of your baby's daily meals, baby should be eating about 4 ounces, or the amount in one small jar of strained baby food. Limit giving your baby processed foods that are made for adults and older children. These foods often contain more salt and other preservatives.

If you want to give your baby fresh food, use a blender or food processor, or just mash softer foods with a fork. All fresh foods should be cooked with no added salt or seasoning. Although you can feed your baby raw bananas (mashed), most other fruits and vegetables should be cooked until they are soft and then cooled, then refrigerated or frozen and dated until needed. Refrigerate any food you do not use, and look for any signs of spoilage before giving it to your baby. Fresh foods are not bacteria-free, so they will spoil more quickly than food from a can or jar.

NOTE: Do not give your baby any food that requires chewing at this age. Do not give your baby any food that can be a choking hazard, including hot dogs (including meat sticks, or baby food "hot dogs"); nuts and seeds; chunks of meat or cheese; whole grapes; popcorn; chunks of peanut butter; raw vegetables; fruit chunks, such as apple chunks; and hard, gooey, or sticky candy.

What changes can I expect after my baby starts solids?

When your baby starts eating solid foods, baby's stools will become more solid and variable in color. Because of the added sugars and fats, they will have a much stronger odor too. Peas and other green vegetables may turn the stool a deep-green color; beets may make it red. (Beets sometimes make urine red as well.) If your baby's meals are not strained, baby's stools may contain undigested pieces of food, especially hulls of peas or corn, and the skin of tomatoes or other vegetables. All of this is normal. Your baby's digestive system is still immature and needs time before it can fully process these new foods. If the stools are extremely loose, watery, or full of mucus, however, it may mean the digestive tract is irritated. In this case, reduce the amount of solids and introduce them more slowly. If the stools continue to be loose, watery, or full of mucus, consult your child's doctor to find the reason.

Should I give my baby juice?

Babies do not need juice. Babies younger than 12 months should not be given juice. After 12 months of age (up to 3 years of age), give only 100% fruit juice and no more than 4 to 6 ounces a day. Offer it only in a cup, not in a bottle. To help prevent tooth decay, do not put your child to bed with a bottle. If you do, make sure it contains only water. Juice reduces the appetite for other, more nutritious, foods, including breast milk, formula, or both. Too much juice can also cause diaper rash, diarrhea, or excessive weight gain.

Does my baby need water?

Healthy babies do not need extra water. Breast milk, formula, or both provide all the fluids they need. However, with the introduction of solid foods, water can be added to your baby's diet. Also, a small amount of water may be needed in very hot weather. If you live in an area where the water is fluoridated, drinking water will also help prevent future tooth decay. Generally Metropolitan water is fluoridated and helps build strong teeth. Commercial bottled water is generally not fluoridated and does not build strong teeth, nor prevent tooth decay.

Good eating habits start early!

It is important for your baby to get used to the process of eating—sitting up, taking food from a spoon, resting between bites, and stopping when full. These early experiences will help your child learn good eating habits throughout life.

Encourage family meals from the first feeding. When you can, the whole family should eat together. Research suggests that having dinner together, as a family, on a regular basis has positive effects on the development of children. TV, cell phones and other electronics should be off and elsewhere during family meal times.

Remember to offer a good variety of healthy foods that are rich in the nutrients your child needs. Watch your child for cues that he/she has had enough to eat. Do not overfeed! Babies will not eat the same amount every meal, nor even every day, but research shows babies will consume what they need from a healthy variety of foods offered them over a number of days. Babies feel hunger and they feel satisfied when full and need no encouragement to eat more than they want.

If you have any questions about your child's nutrition, including concerns about your child eating too much or too little, talk with your child's doctor.

Additional Information from HealthyChildren.org:

By contactus@priority-pediatrics.com
January 28, 2017
Category: Breast Feeding

This information on Coping with Engorgement comes from Breastfeeding Medicine of Northeast Ohio.

After birth, your baby receives colostrum when breastfeeding. Colostrum is a early breast milk concentrate which is packed with antibodies to boost your baby's normal immature immune system and is often called nature's first immunization. Colostrum is high in protein and low in volume. This normal small volume allows your baby to practice early feeding on a soft breast. These tiny amounts are easy for your baby's 1-2 tsp size stomach to handle.

Breast fullness occurs when the milk comes in. It is a normal part of lactation that usually happens 3 to 5 days after birth. You might experience fullness, warmth, and tenderness as the blood supply to your breasts increases along with your milk supply. Usually this normal fullness is not a big problem. The worst of the discomfort and heaviness is usually gone in 24-48 hours. To help, it's important to feed your baby frequently during the period. Be sure to take advantage of normal cluster feeding to keep your breasts comfortable and your nipples soft and graspable.

When does engorgement occur? Engorgement typically peaks at postpartum day 5. On average it lasts about 4 days. It can be more severe if your baby does not nurse very frequently or is having trouble removing milk. Engorged breasts may be very firm, hard, hot and painful. The swelling may extend into your underarm area. Engorgement is caused by milk and fluid build-up. The breast skin can become taut and shiny, and the breast swelling can flatten the nipple making it difficult for the baby to latch on.

How can I lessen engorgement? You can avoid severe engorgement with some of these simple steps:

  • The best way to prevent engorgement is to nurse frequently.
  • If latching difficulty occurs, soften the areola with hand expression and massage before the baby latches.
  • Prior to latching, massage the breast toward the arm pit (this decreases swelling) and sofen the areola with reverse pressure softening and/or hand expression.
  • Check out the video link below for a hand expression and massage demonstration.
  • Express milk only for comfort (not to drain the breasts, but only for a few minutes to relieve pain or pressure).
  • Apply cold compresses to your breasts between feedings (ice packs, bags of frozen vegetables, etc) for no longer than minutes at a time to prevent frost-bite.
  • Apply moist heat before feedings (warm shower, warm wet wash cloth, diaper with warm water in it) to help blood flow and milk let down.
  • Ask your OB or Pediatrician about using an anti-inflammatory medication such as Ibuprofen for pain relief.
  • Call your OB immediately if you develop a fever over 101, flu-like symptoms (muscle aches, weakness, congestion) or redness and pain in the breast.
  • If your symptoms are not improving within 2 days, consider seeing a lactation consultant. 

This video demonstrates hand expression as well as basic massage techniques for breast engorgement:

There is a variety videos on this website by Canadian pediatrician and lactation consultant Jack Newmann, MD, including latching, milk transfer, supplementing at the breast and cup feeding.

http://www.breastfeedinginc.ca/content.php?pagename=videos

This collection of videos primarily includes positioning and frequently asked questions.

https://www.youtube.com/channel/UC9gWohP43VRtTfDzjv50Oyw

These Standford University resources offer useful informatin on Early Initiation of Breastfeeding, Maximizing Milk ProductionBreastmilk Storage and ShippingABC's of Breastfeeding, The Well Fed Baby Checklist, A Perfect Latch, Hand Expressing Milk, etc.

 

 

 

By contactus@priority-pediatrics.com
August 15, 2016
Category: Uncategorized

Hello from Dr. T,

 

I hope you have had a wonderful summer and are looking forward to the start of school and the coming colors of autumn.

 

Priority Pediatrics News:

 

We are off to Portland, Oregon, to enjoy the wedding of our nephew. We leave this Thursday, 8/18/2016, and return in one week on 8/25. Although I will be out of town, I will return phone calls and reply to texts and emails except when in the air and when the bride comes down the aisle. My voice mail will announce my circumstances.

 

The influenza vaccine has arrived. Unfortunately the vaccine nasal spray, Flumist, is not being offered this year. It was only 3% effective last year and the experts do not yet know why. The flu shot is 60-70% effective and is recommended for everyone, 6 months of age and older. Influenza is a serious disease... Make sure your child is protected! Influenza (Flu) Vaccine (the Flu shot): What you need to know.  What to do if your child has discomfort.

 

The best time to immunize against the flu is in September and October of every year. Children age 7 and older only need one vaccine. Under age 7 years, a child may need two shots one month apart if the child has never had a previous vaccine against the flu.

 

If you would like me to immunize your child(ren), please contact me by text or email to schedule the vaccine visit. I am happy to offer this vaccine to all healthy adults in your family and friends network after completing a Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination.


 

Other News items:

 

August is National Immunization Awareness Month.  Find out what shots you need (adults & teenagers).  If your child is under 7 years of age, find out what vaccines your child needs to be fully protected.  


 

August is Kids Eat Right Month™. Enjoy these links to articles, videos and recipes that help support Kids Eat Right initiatives every August and all year long.


August is Breastfeeding Awareness Month.  The CDC celebrates National Breastfeeding month.