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Author: All Pediatrics

Feeding through the ages Part 1 – 3

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Part one – newborns

I will start the discussion with infants.  Breast feeding is clearly best for numerous reasons, and we are strong advocates.  That having been said, if breast feeding is not for you, for whatever reason, in America today you will not be harming your child if you use formula. If you are unsure whether you want to breast feed or not, start off doing it, as you can always switch to a bottle later, while it is hard to do this the other way around.

To establish breast feeding, frequency is probably the most important factor.  Feeding for shorter periods every 2 hours is more helpful at getting milk flowing than marathon feeds every 4.  We recommend trying to feed 10-12 times per day (every 2-2.5 hours), 10 minutes per breast, and then ‘topping off’ for a few more minutes if the baby is still hungry.

Breast milk does not come in for a few days, during which time your baby will lose weight, up to 10 % or so in many cases.  This is normal, and not a cause for concern.  Well-meaning family and friends may suggest giving a bottle to the baby ‘just in case’. This is not necessary, and can interfere with breast feeding.  There are some medical indications for supplementing, but let us help decide that.

If you choose formula, there are a wide variety from which to choose, for gas/fussy/spit up and so forth.  All of the formulae nowadays are nutritionally complete (low-iron ones are no longer out there), and I am not convinced that there is much more than marketing, rather than science, that goes into these.   I therefore do not recommend any particular brand.  Along those lines, I have no problem with generic formula, which is often made by the company that produces brand names, and can be the same, except for the label.

Lastly, a word about gas and spitting up.  Just about all babies spit up some.   We may suggest changing formula, or the maternal diet, to see if that helps, as this is simple enough, and safe to do.  However, it will usually not work.  Most spitting up is due to the baby themselves, not the diet, and one waits for it to be outgrown.  As long as the baby is comfortable and gaining weight (a ‘happy spitter’), this is a laundry problem and not a medical one.

Part two- starting solids (4 months to one year)

When to start solids has varied over the years, but current thinking is as follows.  First, a healthy breastfed baby can be exclusively breast fed until six months of age, and a bottle-fed baby does not need solids until they are consistently taking 32 ounces of formula a day.  Second, however, a baby is developmentally ready for solids at around four months of age, in that they have the tongue and lip movement skills and co-ordination to safely take pureed foods.  Therefore, you may start solids at this age, if you wish.

Traditionally, rice cereal was the first food given to babies in this country. However, it is perfectly okay to start with whole grains, fruits, or vegetables.  We actually prefer not to begin with rice cereal nowadays, as there have been reports of arsenic in baby rice cereal; there is no evidence that this causes harm, but with other options out there, it seems prudent to start elsewhere (barley and oatmeal are other cereal options).

Whether to begin with fruits or vegetables first is not a question for which science has an answer.  Either is fine in my opinion, just be sensible – creamed spinach is not a good starting choice.  With a new food, it should be introduced in pure form, not mixed with other foods (you want the baby to learn that bananas taste like bananas, and not like oatmeal).  Your baby will let you know how thick to make it (they will spit it out or sputter if it is too thick), and how much they want; when they are full, they will get bored and stop eating.  Do not make them finish a meal.  Introduce only one new food at a time, for two reasons:  one, if they are allergic, I only want to have to worry about one possible food, and two, they do not always like a food right away.  If a food is rejected, offer it for several days in a row (but do not force it), and they will usually come around.

The most important point about early feeding is that it be fun:  it is for the experience, not the nutrition. Feed the baby in a relaxed manner, at a time when you are not rushed, and when you can fully engage with them – no TV in the background, no texting, etc.

The major change in infant feeding over the last years is when to introduce ‘allergic’ foods.  The recommendation had been to postpone this for years, but evidence shows, that, with peanuts at least, delay actually predisposes to allergies.  There is no reason to think that this will not be true with other foods.  Therefore, starting at six months of age, you can start to introduce your baby to a wide range of foods:  meats, eggs, peanuts, dairy products, etc.   Exceptions would be if there is a child or strong family history of eczema, in which case you should talk with us first about this.  The only foods we do not recommend before one year of age are pure cow’s milk, and pure honey (foods with cooked honey are acceptable).

You can advance the texture as your baby is able to tolerate it.  From experience, I know that most babies go from stage 2 to chewable table foods and often skip stage 3. If a food is soft/crumbly and not a choking hazard, the baby can have it regardless of teeth.  Major chewing is done by molars (front teeth are for ripping), which do not come in until after one year.

Lastly, you can start to introduce a sippy cup at around six months of age, as your baby will need to come off the bottle at around one year.  For breast fed babies, water is a fine choice for the cup.

Part 3:  ages 1 and up

After one year of age, a child can eat pretty much any food (as long as it is not a choking hazard), except that we still prefer whole milk until two years of age, after which one can switch to low-fat (preferably skim) milk.  Juices, even pure ones, are not good beverages as a rule, and should be limited to at most one per day (my preferred number is zero).

At around 18 months or so, children become picky eaters.  They may only eat one meal a day with the rest snacks, and will eat a balanced diet from week to week, not day to day. If you try and force them to eat a food, they will reject it now, and also when older. If there are doubts as to the variety of foods they are eating, you can give a multivitamin with minerals.  While on the subject of vitamins, getting enough vitamin D in is often a problem, especially for teenagers.  Our main natural source of vitamin D is sunlight, but we spend much more time indoors nowadays.  Milk is a good source of vitamin D, because the vitamin has been artificially added.  Other dairy products are good for calcium, but generally not for vitamin D. If your teenager is not much of a milk drinker, they will need a supplement.

There was an old advertising slogan that ‘breakfast is the most important meal of the day.’  I would not go that far, but it is in the top three.  Breakfast is often skipped because people are in a rush in the morning.  As such, it is useful to have easy-to-fix breakfasts good to go.  Examples include cereal (preferably unsweetened) with fruit, bagels/bread with cream cheese, hard boiled eggs (easy to prepare for the week), and instant oatmeal.

Lunch is often the least nutritious meal of the day; children make bad choices here.  For example, teenagers will happily go off campus for fast foods if allowed.  Preparing lunch the night before can insure that it is of high quality (e.g. low-salt meats with whole grain breads, fruit, pretzels), and will save quite a bit of money over time.

On the subject of poor food choices, I come down hard on the three “S” foods:  soda, salt and sugar.  Soda is a rare treat, not for every day use. It has no nutritional value.  Sugar free soda may be better than the alternative, but that does not make it healthy, just less horrible.  Salt is ubiquitous in the American diet, present in high amounts in nearly every prepared food you can come up with.  Read labels, and aim for lower salt content.  Try not to salt food during preparation, and there is essentially no reason why a salt shaker should be on the dining room table.  As for sugar, it is indeed a natural substance found in many foods (e.g. fruits), but, again, the American diet is loaded with artificially added sugars.  This is not to say that an occasional cookie, or scoop of ice cream, is bad, but this should not be the norm. Some products now list added sugar content on the label, but this is not yet a requirement.  On a label, look to see if a sugar product is one of the early ones listed in the ingredients (sugars end in ‘ose’, such as fructose, glucose, and dextrose).

Lastly, a word about dinner.  Studies have shown that family dinners promote better eating habits, can increase academic performance, and enhance family bonding. Make times for family dinners at least several times a week (even with your teenagers). All electronics must be off during this time, including phones and TV, and you should talk as a family; find a topic to share.  For example, in our household everyone had to report one good thing that happened to them that day.