HYANNIS – Until a baby can sit up and hold its head up – usually around 6 months of age – breast milk or formula should satisfy all of its nutritional needs, according to Sonia Chaudhry, MD.
“Both provide protein, carbohydrates and fat – fat is essential for brain development” said Chaudhry, a pediatric hospitalist with Tufts Floating Hospital for Children’s program at Cape Cod Hospital. “And also water for hydration. It’s basically a complete meal – the ideal shake!”
Solid foods begin to enter the picture at 6 months, but breast milk or formula should continue to be part of the diet for the baby’s first 12 months, she said. Babies must be able to switch from sucking and swallowing to swallowing solids, before they can handle a spoonful of food.
“They need to know how to use their tongue to push the bolus (mouthful of food) back,” Dr. Chaudhry said. “If you give a baby a spoonful of cereal, and they stick their tongue out and it just dribbles down – they may not be ready. You have to give them time to get used to the texture.”
In addition to being physically able to eat without choking, watch for cues that they’re ready for other foods, she said.
“Make sure they’re interested,” Dr. Chaudhry said. “One of the ways to do that is if they’re watching you when your eat. Grabbing things, grabbing for your spoon, things outside of their reach.”
Some babies are physically ready between 4 and 6 months, but feeding solids too early poses risks beyond choking.
“People are adding cereal to their bottles (before 6 months), thinking they’re still hungry or to pacify them, but it’s more disservice,” Dr. Chaudhry said. “It’s putting them at risk of obesity and overfeeding.”
The exception would be if the baby had a medical condition, such as reflux, and a specialist ordered adding cereal to their bottle, she said.
Cereal, whether oat, rice or wheat, is typically the first food to introduce to a baby. At first, a little should be mixed with breast milk or formula to keep the consistency similar to the fluid diet they’ve had. Then it can be gradually thickened.
Because of concerns that rice cereal contains trace amounts of inorganic arsenic, the U.S. Food and Drug Administration recommends it not necessarily be the first or only cereal, and that parents provide cereals that are iron-fortified.
“Rice products are known to have arsenic,” Dr. Chaudhry said. “Arsenic is naturally occurring in the environment. The FDA came out with proposal to limit the amount of inorganic arsenic – limit and add variety. Apples also have arsenic in their seeds. The question then is pressed juices. We don’t really recommend juice, even if it’s 100 percent juice. We recommend whole fruit. They’re getting more from whole fruit.”
There’s no real reason to start with cereal rather than any other food, she said.
”There’s no literature or data that says you can’t start with pureed fruit or pureed vegetables or pureed meat. It’s very cultural. If you were living in India, you would probably start your first meal with lentils; like lentil soup. I’m Indian, and that’s the first meal you get as a baby. A little dal (an Indian dish of cooked lentils or other legumes). So long as it’s pureed or mush.”
All first foods should be prepared specifically for babies, and be iron-fortified, Dr. Chaudhry said.
“You don’t want to give adult canned fruit or veggies because of the amount of sodium and preservatives,” she said.
Families that are vegetarian or prefer to make their own baby food need to ensure they replace the protein, zinc and iron that meat provides, Dr. Chaudhry said. Legumes and soy products provide good sources of protein, and pescetarians can introduce fish.
“You don’t have to use jarred,” she added, saying that homemade baby food can be wholesome and less expensive. “But there’s nothing wrong with jarred baby food.”
New foods should be introduced one at time, over a period of a few days, with parents watching for any signs of an allergic reaction: vomiting, rash or diarrhea. This rule applies to all foods, not just possible allergens, such as peanuts or eggs.
“Previously – and some pediatricians still feel – hold off on introducing eggs and fish and peanut butter or peanut products until after 12 months of life, because of the potential for allergic reaction,” Dr. Chaudhry said. “There’s no evidence to support that, so now we’re sort of proposing, introducing these items at 4 to 6 months of life.”
Parents can gradually increase the amount of solid food from a few spoonfuls per serving to about 4 ounces, she said. At around 9 months, finger foods can be started, according the American Association of Pediatrics.
“They need to be able to sit up and they need to be able to bring their hand up to their mouth. Foods need to be soft and mushy or break down easily. They need to be small,” Dr. Chaudhry said.
She singled out grapes as a food that needs to be cut into slivers, not just halves, and perhaps more appropriate for children 11-12 months-old.
To encourage healthy habits, Dr. Chaudhry said parents should feed their children at the same time they eat meals.
“When introducing solids, when sitting down for a meal, your baby is sitting down with you. … A lot of studies out there say teaching mealtime reduces obesity and helps them develop healthy eating habits,” she said.
Dr. Chaudhry offered these other nutritional tips for baby’s first year:
- “A bottle is just for formula or breast milk. Prior to 4-6 months, they don’t need anything beyond.”
- “Don’t fill up baby’s bottle with juice. No more than 4 ounces in a day. If you’re going to give juice, wait till they’re 12 months old and dilute it with water.”
- “If you’re going to do juice, you need to put in a cup or sippy. Because if you put juice in a bottle, it’s high sugar concentration, it sits in their mouth… puts them at risk of caries (cavities).”
- “At six months, if you don’t have fluorinated water, add fluoride drops to protect their teeth enamel.”
- “We really want food to be the main source of nutrients. If they have a properly mixed diet, they should not need any supplementation (other than Vitamin D, which is prescribed at about 6 weeks of age to help build bones).”
- “I would say confer with your pediatrician before making any changes to your child’s diet.”