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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
February 28, 2018
Category: Healthy Kids

8 Simple Rules for Raising a Healthy Kid

A doctor mom reveals the easiest ways to keep your little ones as healthy as possible. 

 

1. Offer lots of fruits and vegetables. Eating five servings every day is good for your heart and helps protect against cancer and prevent obesity. Unfortunately, kids facing, say, broccoli won't be particularly persuaded by a reference to the scientific literature. They often need to be taught to like fruits and veggies. When kids reject a food, it's often due to unfamiliarity, not true dislike. So offer the same food many times. While babies eagerly try new foods, older kids may need as many as 15 tries before they'll like or tolerate them.

 

2. Teach hand-washing. When I became a pediatrician, I was always sick. I assumed that exposure to kids' illnesses was part of the job. Although I washed my hands frequently, I eventually realized that I was inadvertently transferring germs from my computer keyboard to my mouth when I snacked between seeing patients. I stopped eating at my computer and I haven't had a stomach virus since! A group of researchers in London called the International Scientific Forum on Home Hygiene (IFH) tracked germ transmission through homes and found that people's hands are the number-one source for spreading infection. We may blame our pets, sneezing kids, and dirty shoes, but they're not the real cause. We transfer germs from our hands into our body when we touch our eyes, mouth, or nose. And young kids touch their face a lot: One study found that it's as often as 50 times an hour. The goal, then, is to reduce the number of germs on their hands. Certainly, door handles and toys are germ reservoirs, so wipe those down frequently. Other hot spots are the bathroom and the kitchen, which the IFH found to contain some of the most contaminated surfaces in the home.

3. Vaccinate on time. Children get up to 24 shots by age 2. With that number, it's no wonder some parents may be tempted to delay certain vaccines. I actually postponed my daughter's HPV (human papillomavirus) vaccine because we were too busy to schedule visits for all three shots, and protecting her from an adult disease when she was in 7th grade just didn't seem that critical. But after researching my decision, I was reminded that the vaccine schedule is meticulously designed to give immunizations when they are most effective. Babies and toddlers need to get their vaccines in the critical window that begins when their immune system is developed enough to respond but before they are at highest risk from the most dangerous diseases. Deviating from the schedule won't guarantee effectiveness, and delays may also contribute to more side effects. For example, measles-containing vaccines are twice as likely to cause a febrile seizure when given late, shows research from University of Washington in Seattle. Needless to say, we got my daughter back on schedule, and she finished her HPV series before she turned 13.

4. Brush teeth with fluoride. Even mild tooth decay can affect kids' health by causing pain, poor eating, and interrupted sleep. In one extreme case, I had an 11-year-old patient who spent a week in the hospital for a dental infection. Fortunately, simply brushing protects teeth—if you use f luoride. That's what builds and maintains the protective enamel on teeth. They need to "bathe" in fluoride for its magic to work. So as soon as your child has teeth, brush them with fluoride toothpaste at least twice a day. So-called "training" toothpaste doesn't contain fluoride. 

5. Enforce a regular bedtime (starting in toddlerhood). I have to confess, I've often delayed my kids' bedtime just to spend a little more time with them. But I'm not doing them any favors. Children who don't get enough sleep can become hyperactive, and their school performance suffers, according to a Pediatrics study. Sleep deprivation in kids may also impact the hormone leptin, which signals us to stop eating, and kids who don't get enough zzz's may be more likely to be overweight or obese than those who do. Make sure your child is going to bed early enough too. Research found that kids who regularly turned in after 9 p.m. also displayed more behavior problems. The good news is that the behavioral consequences of poor sleep are reversible once a kid switches to a regular, appropriate bedtime, no matter how old he is. Kids need far more sleep than many parents realize. Toddlers need 11 to 14 hours (including naps), preschoolers need ten to 13 hours, and after kindergarten, kids need nine to 11 hours. So set a regular bedtime routine and stick to it. If you read a book, cuddle, and tuck them in at roughly the same time each night (before 9 p.m.!), kids will find their natural rhythm and sleep the right number of hours. 

 

6. Insist on a helmet. We keep a dented helmet on a shelf in our pediatric E.R. with a note from a 13-year-old bike rider that reads, "This helmet saved my life when my head dented the hood of a car." It's a reminder that wearing a helmet can prevent serious injuries—yet less than half of kids wear one, and more than a third wear them incorrectly, according to Safe Kids Worldwide. Your attitude has the greatest influence on your kids' helmet use. So insist that your children wear helmets when they ride anything with wheels—and always wear one yourself. Kids often complain that a helmet is uncomfortable. Here's how to know it fits properly: It should rest two-fingers' width above the eyebrows and not slide around. Tighten the chin strap until it's snug; no more than one finger should fit under the strap. When your child opens her mouth wide, the helmet should pull down on her head. Adjust it so that the left and right straps form a Y below her ears.

7. Apply sunscreen, all year long. While sun exposure wreaks havoc on skin at any age, sunburn during childhood is particularly risky. The earlier in a child's life that skin cells become damaged, the greater his chance of developing skin cancer over his lifetime. Kids are especially sensitive to the harmful effects of ultraviolet radiationbecause their skin has a thinner outer protective layer than an adult's does. For kids over 6 months, apply sunscreen any time they're exposed to the sun. (Keep younger babies out of direct sunlight altogether.) In addition to sunscreen, protect kids with clothes that minimize exposure, a wide-brimmed hat, UV-protective sunglasses, and by keeping them in the shade as much as possible.

 

8. Use safety straps. The National Highway Traffic Safety Administration reports that three out of four kids aren't restrained properly in vehicles. Make sure you carefully follow the instructions on your child's car seat, booster seat, or seat belt so he is safe.