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Infant Feeding Guidelines
 Introduction
Birth to Four Months
Four to Nine Months
Nine to Twelve Months
One to Two Years
Conclusion
Many new parents feel very confused and over-whelmed by questions
about feeding their baby. Advice from friends and family members may
be in conflict with the pediatrician's advice, and books and magazine
articles may provide a myriad of confusing recommendations. The
reasons for this are clear. No one knows the exact "right" way to
feed your baby. Babies are very much like adults in that they have
different metabolic rates, different caloric needs and different
biologic clocks. It is unrealistic to think that as pediatricians, we
can give you specific rules for how, what, when and how much to feed
your baby. However, we recognize your need for some timetables and
guidelines. Therefore, in this summary, we attempt to give you some
rough suggestions. We hope that you will individualize them to meet
the specific needs of your baby.
BIRTH TO FOUR MONTHS
Breast milk and/or formula are the best forms of nourishment for
your infant. They are easy to use, easy to digest, and nutritionally
complete. There is no reason for breastfeeding mothers to restrict
their diets or avoid any foods as recent studies have shown this will not
eliminate or delay the onset of food allergies in their infants.
It is not necessary to give your infant cereal or any other
solid food. Despite the popular belief that solid foods will improve
your infant's sleep pattern, innumerable studies have proven repeatedly
that there is no benefit to the early introduction of solid food. In
fact, there are many advantages to your waiting until your infant is at
least four months of age. Solid foods may decrease the baby's intake
of the nutritionally preferable breast milk or formula.
They may increase the risk for potentially serious allergic reactions.
They may cause problems with constipation, diarrhea or intestinal gas.
FOUR TO NINE MONTHS
Your infant should not receive anything other than breast milk or
formula for at least the first four months. When you choose to begin solids,
you should proceed slowly, with small quantities of a limited number of foods.
There is no nutritional need for solid foods until at least four months of age
because breast milk and formula are nutritionally complete.
In order to facilitate your ability to identify foods to which your
baby may be allergic, we suggest that you wait two to three days
between the introduction of new foods. Although allergic-type
reactions are very unusual in infants, you should be aware that your
baby could become gassy or constipated or develop diarrhea or a rash.
If these things occur, simply stop the suspected food, wait about two
weeks and try it again.
The first food you introduce should be a single-grain cereal such as
rice, oatmeal, or barley. Cereal should always be introduced with a
spoon, not mixed into bottle feedings. Rice cereal may be constipating; if so,
try using oatmeal cereal instead. Once your baby has been
tolerating cereal well for a couple of weeks, you may begin the yellow
vegetables such as sweet potatoes, squash, and carrots (not corn). If
this goes well, you may also try apples, bananas, peaches, and pears.
You may use commercially available baby foods or prepare your own.
Remember that if you introduce solids prior to six months of age,
breast milk and/or formula are still the preferable foods, so do not
allow the introduction of solid foods to drastically decrease the
baby's milk intake. Formula-fed babies should still be taking
approximately 24-36oz per day and breast-fed babies should still be
having 4-6 feedings. With any new food, start with one teaspoon
and work up to 1-3 Tbsp of each item per feeding. Wait two to three days before
starting a new food to ensure there is no allergic reaction such as rash,
vomiting or diarrhea. Most new eaters will prefer to have
their milk feeding (or part of it) first, then the solid food.
Initially, two meals a day should be sufficient. These meals can be
at whatever time of day is most convenient for you and your baby. As
your baby is introduced to an increasing variety of foods, and as
he/she demonstrates and increasing interest in solid food, you may want
to introduce the third meal. Although you can give whatever foods you
want at whatever meal, a sample menu might be cereal and fruit for
breakfast, cereal, fruit and vegetable for lunch and
dinner. It is also a good idea to introduce the cup into your mealtime
routine. Prior to six months of age, the cup should contain only
breast milk, formula, or water, but after six months of age, you can
also introduce juices. We do recommend that juice be given only in a
cup, and that it be diluted and in small quantities. Juices are not nutritionally
necessary and may interfere with your child's appetite if given frequently.
Once your baby has been introduced to cereals, yellow vegetables, and
fruits, a large number of new foods can be introduced in any order.
Try to relax and enjoy the process of introducing these new foods to your baby. Do not feel pressured to
feed specific foods or specific amounts. Look at your baby and use
your good judgement and it will be easy! These new foods include:
1. Green vegetables.
2. Other fruits and vegetables, including fruit and vegetable
combinations and "second stage" foods.
3. Dairy products such as yogurt and cottage cheese (but not
actual milk).
4. Strained meats or meat and vegetable or meat and fruit
combinations. Baby "dinners" often contain unnecessary fillers
and seasonings, so should probably be avoided until about nine
months of age.
5. "Finger foods" such as cooked or soft fruits and vegetables,
cheese, meats in small pieces, macaroni and pastina, etc. These
should only be given when your baby is seated and supervised.
Start these finger foods around 8 to 9 months of age so that
your baby can get used to more solid types of foods.
6. Infant pretzels, biscuits, etc.
In the past the following foods were withheld until at least nine to ten months of
age: citrus, corn, tomatoes, eggs, chocolate, strawberry, fish and cow's milk products because of fear of causing allergy.
There is now evidence that these so called allergic foods including nuts should not be delayed
and should be given by six to seven months of age. In fact, there is some evidence that delaying foods beyond seven months
may actually increase the risk of allergy. Honey (because of the danger of botulism) should be avoided
until twelve months of age.
Let your baby guide you in determining quantities. Breast-fed
babies are generally down to 3-4 feedings per day by 9 months
and formula intake should be down to the 24-32 oz range on
average, but depending on your baby's size and metabolic rate, he or
she may vary from this range.
NINE TO TWELVE MONTHS
As your baby reaches nine to twelve months of age, you may find that
he/she becomes more independent in his/her food preferences. In
addition, appetite is significantly decreased compared to younger
infants and developmentally, babies in this age group are much more
interested in the mastery of their gross and fine motor skills than in
eating. Your baby may not consider it fun to sit in a highchair long
enough to eat a meal. Very few, if any, one-year olds eat three good
meals per day. They tend to eat occasional good meals and pick the
rest of the time. Therefore, parents are often concerned that their
older infants are not eating enough or not eating a balanced diet.
Remember that their current nutritional needs are less than they were
at six to nine months of age. If your baby is eating small quantities
of food, but is gaining adequate weight and has a good energy level
during the day, try not to be concerned. Offer frequent (3-5 times per
day) small meals of healthy foods, minimize snacking (including breast
milk and formula) between meals, and do not try to force your baby to
eat what he or she does not want.
Some babies dislike any type of food texture and insist that all
foods be pureed and smooth. These infants will eventually tolerate
table foods, so don't panic.
Other babies may refuse all baby foods and prefer to self-feed,
with their fingers, of course. This independence should not be
discouraged. Although it may appear that they are only playing with
their food, toddlers can easily meet their nutritional needs in this
manner.
It is acceptable to introduce cow's milk at ten months of age. Most
breast-fed babies in this age group are taking about three feedings
per day. Formula-fed babies are generally taking 16-24 ounces per day.
We strongly recommend that you discontinue the bottle completely by
15-18 months of age. Prolonged use of the bottle is associated with
serious dental problems as well as nutritional deficiencies and even
ear infections. To this end, it is important that you introduce the
cup by six months of age and strongly encourage cup feedings by nine
months of age. We are aware that an infant with a cup can be a hazard
to your house and car, but there are many spill-proof cups on the
market. Do not, under any circumstances, allow your infant to take the
bottle to bed. The bottle should be given well before bedtime so that
teeth can be cleaned. Your baby can and should learn to fall asleep
without the aid of a bottle. You will thank us for this!
Remember that future eating habits begin to be established in this
age group. Frequent or unhealthy snacking should be discouraged.
Children should be encouraged to sit while eating. Distractions such
as toys and television should be minimized. Eating should not be made
into a power struggle between child and parents. It is the wise parent
who maintains a positive and relaxed attitude about eating.
ONE TO TWO YEARS
As your child enters the second year of life he/she will begin to eat regular meals,
and formula-fed babies will most likely switch to regular cow's milk. Since babies
need fat in their diets for development, they should drink whole milk until their
second birthdays. Then, if growth is steady, you can switch to low-fat or nonfat milk.
When introducing table foods, don't worry too much about the amount or variety your baby
accepts, or how much gets into her mouth. At this stage you need to remember that your
baby's growth is slowing down, and three small meals and two snacks a day will probably
be enough for most toddlers. Watch for cues that your baby is finished: if she's disinterested,
turning her head away, or pushing food away, don't force her to eat more.
Serve the most healthful foods possible, but don't expect your toddler to eat
a "square" meal at each sitting. Don't let your child fill up on empty-calorie
snacks, but don't force her to eat when she doesn't want to. Although you should be
offering solid food, you still must supervise your toddler's meals in case of choking,
and you still have to avoid foods that can cause choking including popcorn,
hard candies, hot dogs, jelly beans, chunks of carrots, grapes, raisins, and nuts.
Cut or finely chop such foods, or simply wait until your baby gets older.
Expect your toddler to go through periods when she wants only a favourite food.
It's not uncommon for a child this age to want the same breakfast for a month.
Remain relaxed, continue to offer other healthful choices, and remember that
these behaviors will one day come to an end. Again, your toddler might not eat what
you would call a balanced meal at each sitting, but over the course of time she should
get what she needs for good health.
Most doctors suggest doing away with the bottle by 1 to 2 years of age.
When you and your baby are ready, you may choose to wean your baby from the
breast or bottle directly to a toddler cup. She may be hesitant at first, but
if you hide the bottle permanently and only supply the cup, your child should
get the message pretty quickly. Do not let your baby go to sleep with a bottle;
this increases the risk for dental cavities and ear infections
CONCLUSION
We must remind you again that these recommendations are only intended
to be guidelines. You must look at your individual baby and follow his
lead. He or she will not necessarily require solid food, drink from a
cup, tolerate textured foods, or enjoy finger foods at the same age as
your friends' children. If you have questions about these guidelines,
please call the office. Consider making an appointment to check the
baby's weight if you are concerned that weight gain is not adequate.
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The information contained on this web site is not
a substitute for direct examination and treatment by a physician. If any
of this material is unclear or confusing, or if you have additional
questions or concerns, please call the office at
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