Everyone probably has one of these pictures in their kid’s baby albums—their little one seated in a high chair, beaming chubby cheeks smeared in baby food. Feeding baby is a labor of love, but with new and increasing options, it can be one of the most complicated aspects of baby rearing. Here, Dr. Elizabeth Harris, a pediatrician with BayCare Medical Group, demystifies baby feeding for us.
Breast is (still) best
We can’t always improve on Mother Nature, and in this case, we may not need to. “Breastmilk is still the recommended nutritional option for all babies,” says Harris, who explains that the American Academy of Pediatrics suggests breastfeeding for at least one year, if possible. Proven benefits of breastmilk includes protection against diseases and conditions such as diarrhea, ear infections, diabetes, childhood obesity and leukemia. If exclusive breastfeeding is not an option, doctors recommend supplementing with formula as a second choice. “That doesn’t mean a mom should feel guilty [if they can’t breastfeed],” says Harris. “Moms need a break sometimes.”
Formula options may seem overwhelming, however. Harris notes that there are so many on the market today, and the AAP does not endorse any specific brand. All of them have the required dietary ingredients. Beyond the basics, parents can choose an option that best suits their baby—organic, soy-based, lactose-free and so on. They can also choose between pre-prepared and powdered ones that you have to mix yourself. If you’re going to mix it yourself, Harris recommends using regular fluoridated Hillsborough County tap water. Not all bottled waters contain the necessary fluoride to help with baby’s future teeth growth. If parents are leery of tap water, they can buy nursery water that is fluoridated.
At this age, baby should not drink water because they get plenty of hydration through breast milk.
4 to 6 months
As long as baby can sit up without support and spoon feed without difficulty, this is a good time to introduce first foods, which are usually rice cereal (fortified with iron) and oatmeal. Now, parents can also introduce Stage 1 fruits and vegetables: pureed sweet potatoes and pears, applesauce. Baby can dine on these meals once or twice a day to supplement the breastmilk (or formula if breastmilk is unavailable). During this stage, baby can occasionally have a couple of ounces of water to drink, but don’t overdo it: Too much water can be hazardous and cause a drop in sodium levels.
6 to 9 months
By now, your little gourmand is probably enjoying those meals and ready for something more adventurous. At this point, baby may still be eating pureed or mashed goodies, but can be introduced to cheerios or mashed up crackers, or other finger foods at around 8-9 months. They should be able to pick up and finger feed themselves before starting with more textured foods. As always, stay away from things that can choke baby—the worst hazards are grapes, hot dogs, baby carrots and other foods that can fit like a hand in a glove inside that tiny throat. Cook and mash the carrots and they’ll be just fine. This is also the time to begin to wean baby off that bottle and onto a sippy cup.
Although you may be in a hurry to introduce baby to “normal” food, keep in mind that whole milk is still not recommended until 12 months of age. Snacks like yoghurt may cause gas and discomfort to baby until he is at least 7-9 months old.
9 to 12 months
Breakfast, lunch and dinner—by now, baby should able to join the rest of the family at set mealtimes and eat soft table foods. This habit can have a lifetime of good consequences. Harris says it’s never too early to establish eating together at the table at home because children are more likely to make healthy choices if they see their parents doing so. If baby turns up her little nose at a particular offering, keep trying. It can take 10 to 15 times of offering a food to get a child to take it. By the time baby hits his first birthday, he should be drinking from a sippy cup. At 12 months of age, babies should transition from formula to whole milk. Goal intake is 16-24 ounces of whole milk per day.
One guideline that has changed for this group involves the introduction of allergens. Doctors used to frown upon exposing babies to potential allergens, especially peanut and egg, until they were a year old. However, due to new studies that showed an increased rate of allergies by age 5 for kids who had not been exposed before they were a year, the AAP no longer holds to this recommendation. Babies can be introduced to peanut products between 4-11 months. Those with severe eczema or a strong family history of allergies should do this under the guidance of an allergist. “It’s something to discuss with your pediatrician,” Harris says.
One yummy treat is off limits till baby is 1 year old: honey. Due to the potential harm of botulism, doctors are still recommending that babies only try their first spoonful of honey after their first birthday.
Baby food blues
Especially for first time parents, any sign of fussiness from a baby can be worrisome. Sometimes, it’s a minor issue that will go away by itself; other times, a visit to a pediatrician may be useful. Here are some common problems that Harris sees:
GERD: Gastroesophageal reflux disease is super common among babies, but don’t rush to assume that your baby has GERD if he’s distressed after a meal. “Some babies spit up every time, but as long as they’re gaining weight and not irritable or fussy,” it’s OK, says Harris. However, if baby is arching, fussy, crying or vomiting so much that he is not gaining weight, bring him in, pronto.
Milk Protein Allergy: Some babies can’t digest dairy and a constantly spitting up baby could have this problem, but usually when coupled with bloody stools or mucus in the stools. Breast feeding mothers in this case are advised to stop taking in any dairy, and formula-fed babies are switched to a nondairy or soy version.
Overfeeding: As tempting as it may be, don’t feed the baby every time she cries. For the first two months, it is fine to breastfeed on demand, says Harris, but after that, baby should be able to go two to three hours without being fed. Babies who feed every ten to 15 minutes are either just snacking between meals or using mom as a pacifier, and neither are good habits and could lead to an overweight baby.
No juice—ever: Seeing all those beautifully packaged baby juice bottles may lead some parents to think that juice is a great introduction to fruit for baby. Nope, says Harris. “The AAP does not recommend juice until toddlerhood,” says Harris, and even then, giving the baby an actual fruit is always better than offering juice. The only exception is giving a maximum of 2 to 4 ounces a day for a constipated baby.
Gripe water: While this is a popular home remedy that many mothers dose out to fussy babies, Harris says that doctors don’t recommend it and gripe water is not FDA-approved. “Families use this all the time, and while it’s probably harmless, there’s no proven benefit,” she says.
Baby is on the large side: If the toddler is falling off the upper end of the charts and parents complain that she seems to be hungry all the time, some solutions might be to eliminate juice, discourage snacking and cut down to 2 percent milk (usually, whole milk is fine until age 2). Social habits, such as families sitting down and eating healthy meals together rather than eating on the go, can also make a positive difference in baby’s weight and health, says Harris.
Baby is too small: If baby’s sliding off the bottom end of the scale—especially if he started in a much higher percentile but then dropped—then doctors will investigate whether there’s a problem with milk supply (if breastfeeding) or the way formula was mixed. If not, they’ll look into whether baby has signs of reflux, milk protein allergy or other conditions such as pyloric stenosis, which is caused in 6-week to 2-month-old babies for whom the top of the stomach gets tight, causing baby to vomit constantly.
Mommy’s diet: Breastfeeding mothers may need to stay away from some food temptations a few months longer as babies under 4 months may be quite sensitive to gas producing or spicy foods. From 6 months onwards, they don’t seem as sensitive to mom’s diet. If mom wants to have more than one glass of wine in a three-hour period, however, that breastmilk should be discarded.
Take your vitamins! Recent research suggests that exclusively breastfed babies may be low in Vitamin D, which is crucial for bone and immune system growth. Babies who don’t get at least 32 ounces of formula daily should supplement with 400 IU daily of Vitamin D, says Harris.