Saturday, January 1, 2011

Feeding Your Baby

As a pediatrician and member of the American Academy of Pediatrics (AAP), I agree with and follow the vast majority of guidelines put forth by the AAP.  As a woman of science and a mom, I can see how some of the advice and policies are based less on researched evidence and more on tradition.

One of the BIG areas that I feel needs changing is that of starting baby on solid foods.

Why is this important to me, and why should it be important to all parents out there?
*  You may be restricting your children from a wide world of delicious foods.
*  This may cause them to grow up with a narrow selection of taste preferences.
*  This leads many parents to panic and give their child whatever they will eat, often resulting in too many starches and sweets.
*  This may contribute to unhealthy feeding habits, which could be a source for overweight and obesity issues.
*  This may also be a cause for our leading nutritional deficiency, iron.

Here are some of the steps TRADITIONALLY put forth: 
(see example here
- Wait until baby is 4-6 months of age, and watch for signs of readiness (sitting upright, lack of tongue thrust, watching you eat or grabbing food from your plate).
- Start with just rice cereal for a month or two.
- Next give one new food per week, so that you watch for signs of allergic reaction.  These should be cooked pureed fruits or vegetables.
- Next try meats (still only one new food per week).
- Give 100% fruit juice to drink, limiting to 4-6 oz per day.
- Delay eggs until after 1 year of age.  Delay peanut products until even later.

Do these sound familiar?  Many pediatricians are still offering this advice, even though MUCH of it is outdated and inconsistent with current scientific findings.

Here are the points with which I disagree:

- Wait until baby is 4-6 months of age, and watch for signs of readiness (sitting upright, lack of tongue thrust, watching you eat or grabbing food from your plate).  Yes, but don't wait past 6 months unless there is good medical cause (such as developmental delay, severe medical condition, or prematurity).  Your baby needs the added nutrition that comes from solid food starting around 6-9 months of age, and also needs to learn to love this important new part of his life.

- Start with just rice cereal for a month or two.  There is NO reason to restrict your infant to rice cereal.  It was historically thought to be an "easy food to digest" and that is why it is commonly recommended.  Thought there is nothing wrong with rice cereal, other foods work just as well or even better as first food introduction.  Don't be afraid to try mashed avocado, banana or sweet potato!

- Next give one new food per week, so that you watch for signs of allergic reaction.  These should be cooked pureed fruits or vegetables.  I have to go against even the AAP on this one.  They say to wait 3-4 days between new foods, which is better than a whole week, but still I believe this is excessively conservative and unnecessary.  See below for full discussion on this point.

- Next try meats (still only one new food per week).  No reason to delay meats!  They are extremely high in nutrition for your baby, loaded with iron, protein, zinc, fat (which at this age is a good thing, needed to grow and learn), and other goodies.

- Give 100% fruit juice to drink, limiting to 4-6 oz per day.  Babies need NO juice.  I recommend not giving juice at all.  It's basically sugar water, high in calories, low in nutrition, and absent any of the fiber that real fruit contains to help balance the sweetness and slow digestion in your stomach.  Give milk and water instead!

- Delay eggs until after 1 year of age.  Delay peanut products until even later.  See below for AAP revision of guidelines about when to introduce what foods.

Kudos to the AAP for releasing a change in policy in 2008 regarding introduction of allergenic foods.
Prior to that, it was recommended to delay introduction of known allergenic foods until after a certain age, in order to help decrease risk of developing allergy to those foods.  The culprits included fish, shellfish, eggs, and peanuts.  Over the years many good studies were done to see if delaying until the child is older to try these foods would decrease their rate of developing allergies.  Results were NOT at all in favor of this practice, and in fact some studies showed an increased risk of food allergy development for those who delay versus those who don't.  Thus, the AAP's revised statement says it matters not at all what order of foods you give to your child, or at what age (as long as they are old enough for solid foods of course).

So for the record, there is no reason to delay or deny your baby of the flavors of the world (if you know there is high occurrence of food allergies in your family, you may choose to be careful with certain high risk foods).  You are free to have fun with food!  Don't be bound by bland, low nutritious rice cereal!  Give your little one peanut butter, eggs, or soft/mashed fish at whatever age you like (again, assuming he is ready for solids).

This tradition has to go.  It is so embedded in the US practice among doctors and families, and really has very little redeeming value.

Here's the ONLY argument for waiting between foods:
1.  You can catch what food(s) your baby has allergy or intolerance to much more easily and quickly.

Here's my argument against this policy:
1.  Giving foods slowly will NOT prevent food allergy, it may only help in detecting it.
2.  If your baby has an allergic reaction, you will be playing the food elimination game no matter what.  You will become an investigator of your baby's diet to find for certain what was the offending food so that you can avoid it.  If the problem persists, you will likely see an allergist who will test your baby for common food allergies (skin test is best, blood test distant second-  but that's a whole other discussion).
3.  There is a fairly narrow window of opportunity when your baby is willing to try whatever food you put in front of him.  Why not take advantage of this and give as many foods as possible?  Later when your little one becomes a picky two-year old, you will have a wider variety of foods to choose from that you would otherwise (one per week is very slow and limited!).
4.  The chances of having an allergic reaction to food is very small (about 4%).  And even for those who are food allergic, the vast majority will be to the high risk culprits:  milk, wheat, soy, egg, fish, shellfish, peanut, tree nut, strawberry.  So if you do want to be cautious and aware, introduce just those foods with a watchful eye.  But don't worry so much about peas, carrots, apples, bananas, etc.

for more info:
food allergy prevalence in the US:
general resource on food allergy:

If you're looking for a great online site with family friendly and science based advice on feeding baby, here is my favorite:
They offer step-by-step guidance that follows what the AAP recommends (don't get me wrong, I AGREE with AAP on most things!), have great food and recipe ideas, and tackle many of the common questions and problems parents may run into.  Here is their section on starting solid foods:

When did it get in people's minds that babies need to eat processed food from a jar?  This is the most backward thing I can think of for a new eater!  Babies need to taste the foods that we eat, experience the aromas and textures and flavors that CANNOT be preserved in a jar.  Have you ever tasted jarred baby food yourself?  If it doesn't taste good to you, you better believe it won't be a treat for your baby.

That doesn't mean your infant won't eat it (he most likely will), but he won't enjoy a processed/stored jar of peaches the same way as if you picked a ripe one, steamed and mashed it yourself.  As your baby graduates to table foods, he will enjoy the same delicious foods that your family enjoys more readily if he's been having tastes of it all along.

Making your own baby food is very very simple, earth friendly, and saves money!  Here's a nice guide to help you get started.  It's what our family used and gave us great results (just ignore the places where they insist you give only certain foods at certain ages, since we already know this advice is outdated).

Babies need to practice feeding themselves at a young age, again for the enjoyment and texture, but also to develop the all important finger-pince grasp.  By prolonging spoon feeding your baby mashed foods you deprive him of the opportunity to learn this new skill (everything in an infant's environment is large, so as not to be choking hazard.  small pieces of finger foods is a novel thing to a new feeder).  As soon as your baby is old enough to scoop food off a tray and aim toward his mouth (around 7 months of age), you should be offering finger foods.  Everybody knows and loves Cheerios, which are perfect size and shape and even nutritional.  But don't forget pasta, cooked veggies, and pieces of soft meats and fish.  Basically just look at the foods you eat and figure out which ones are soft enough for "gumming."

Here is an example plate of food we would feed our happy hungry healthy 11 month old (who only has 2 teeth), who by the way LOVES to eat all varieties of food.
(water from a cup, slow-cooked pork, broccoli, tofu with tomato sauce, cranberry sauce, and squash)

I'm happy to answer any questions or clarifications I can.

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