Expert Q&A: Meeting Your Baby's Nutrition Needs

An interview with pediatrician Stephen Parker, MD.

From the WebMD Archives

How can I tell when my baby’s ready for solid foods?

Even if the baby appears hungry and ready, we generally wait until at least four months to give solids. The best evidence right now is that the window for introducing solids is between 4 and 6 months of age. By then, we think babies are mature enough to deal with solid food -- meaning that they’re able to swallow it without risk of breathing it into the lungs, and to digest it.

If your baby is within that age range, the signs that he’s ready to get started include:

  • He’s interested in your food
  • He’s able to take food into his mouth and keep it there
  • He’s able to swallow without spitting or sputtering
  • He wants more and more milk and seems unsatisfied with milk alone

Why should babies start with single-grain cereals?

It’s rare for a baby to have an allergy to a single-grain cereal like rice cereal. These cereals are iron-fortified, and it’s also a bit of insurance to give a little more iron early on. Therefore, the first thing you give them is palatable, easy to digest, doesn’t cause allergies, and gets the show on the road. But if parents asked me why they couldn’t start with fruit, I’d say that there’s no reason why you can’t.

The key is that you just start with one new food at a time, no matter what it is, and watch for problems. Pureed pears or squash, or mashed bananas or avocados, are other examples of good options. Except for highly allergenic foods, the digestive system can pretty much handle what comes its way by 4 to 6 months.

How much should parents feed their baby?

Your baby tells you. People don’t have enough faith in their baby’s capacity to eat when they’re hungry and stop when they’re full. Occasionally a baby might stuff himself to discomfort when left to his own devices. But most babies, when you let them regulate their own intake, will take what they need and leave the rest. If they’re staying on the growth charts, and you think they’re not getting enough, you’re probably wrong and your baby’s right.

Continued

Does it matter if you give bottle or food first?

It doesn’t really matter. Many people give food first and then the milk as a chaser, especially before sleep, because the milk calms the baby down. Also, babies can regulate their milk intake based on what they’ve eaten. But it really doesn’t matter which comes first and which comes second.

What if your baby doesn’t like new foods?

That’s called “neophobia.” Many babies don’t like a food when it’s first introduced. It takes an average of three to four times trying a new food before they’ll take to it. That’s par for the course.

There are really picky babies, of course, but expect neophobia from most babies. Something they hate at 5 months, they may love at 8 months. Keep offering new foods gently and with good humor, and they’ll take to them eventually.

What if your baby is one of the really picky eaters?

The biggest rule is: Never to try to force them to eat. Make mealtime pleasant and fun -- they need to enjoy it or they’ll eat even less. Most babies, even if they’re very picky, will take enough of whatever it is they like to stay healthy. It’s very rare that a baby is so picky that they won’t grow if you let them eat what they want.

Perhaps give a supplemental vitamin if they’re sticking with one kind of food. Keep offering other foods regularly, put them away for a while if they don’t like it, and try again later. With a really picky eater, no games or tricks work except time. Parents make it worse by fighting with them and trying to force the things they don’t like.

What should parents do if their baby is overweight?

It’s certainly possible for babies to be overweight, and there definitely is a genetic component to that. Some babies put on weight more easily even with taking in the same amount of calories.

Do we need to worry about it? That’s a hard one. It can be a marker that this baby is susceptible to being overweight as a child. You don’t want to put a baby on a diet, but with some babies you might want to restrict the more fattening things -- maybe offering a little less milk and more fruits and vegetables to keep their weight at a reasonable level for their height. Talk to your pediatrician about this.

Continued

When is a baby ready to feed herself?

When she’s ready and when she wants to can be two different things! Babies always think they’re ready. At 8 or 9 months, they will want to push the food in and make a mess. There’s nothing wrong with that. The baby should be allowed independence and a chance to try it, even as you’re spooning the food that you want to get in her. It should be a collaborative effort.

Promote that independence and fun and joy in eating for the baby; never discourage it. Early on, some babies may be really stubborn and not want the parents to feed them, and you may have to use subterfuge -- make noise and distract them. They think they’re good at it, but they’re not and they don’t get that much in. But even if they don’t, they’ll make it up in the milk. It’s very rare that it causes nutritional problems, just a few bumps along the road.

What foods should you absolutely not feed a baby under 1 year old?

The big controversy is peanuts. There is some data that says you should hold off until they’re at least 3 years old because peanut allergies are really scary. But there is a competing theory that says that introducing small amounts of them early is what we need to do to prevent long-term peanut allergies.

I haven’t shifted my position yet. I’m still going with what the orthodoxy says -- to hold off peanuts as long as possible -- because these allergies are so bad. Peanut allergies can be so devastating, it’s important to keep abreast of the issue. Hopefully more research will help clarify this area. And I would hold off on feeding your child anything you are allergic to until they are age 3 or older.

You should also wait past a year on honey, because of concerns about infant botulism.

What about whole milk? I recommend a year, but I’m not ironclad on it. Most babies could probably tolerate it at 6 months. In our culture we’ve arbitrarily said, boom, you’re ready at a year. Maybe some kids do better digesting it if you wait a little longer, but most who get it at 9 months don’t blink an eye.

If a parent wants to start it earlier, I don’t tell them not to do it. Just introduce it the same as you would any other new food: Don’t give another new food at the same time and watch for distress.

WebMD Feature Reviewed by Louise Chang, MD on July 08, 2010

Sources

SOURCE:

Steven Parker, MD, director, division of behavioral and developmental pediatrics, Boston Medical Center, Mass.

© 2009 WebMD, LLC. All rights reserved.

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