By Sara Dumond, MD
Wouldn't it be nice if babies came with an instruction manual? One of the most helpful chapters would be the "What to Feed Me" chapter. First, there are the nagging questions, such as: "Is she getting enough to eat?" or "Is she getting too much?"
Plus, you have so many choices, and that brings the added stress of making the right decisions for your child's nutrition. Here's an easy-to-understand, user-friendly guide to help make feeding time more fun for you and your baby.
Drink Up! (0 to 6 months)
For the first 4 to 6 months of your baby's life, the only nutrition she needs is breast milk or formula. During the first month or so, a baby will need to eat "on demand." This means that instead of trying to force a set feeding schedule, it's better to feed her whenever she gets hungry. It may be an hour after the last feeding began, or three hours, but during these early days and weeks her tummy isn't on any set schedule. Look for hunger cues such as tongue thrusting, lip smacking, head turning and "rooting," and sucking on fingers or fists. Feedings go much more smoothly if you recognize the signs of hunger before the hunger cries begin.
Formula-fed babies will need an average of 16 to 28 ounces of formula per day during the first month. Breastfeeding is obviously more difficult to quantify, but in general, babies will nurse at least 15 to 20 minutes per feeding, receiving 6 to 8 ounces of breast milk. By the time your baby is celebrating her 4-month birthday, she'll be taking up to 24 to 40 ounces a day. No wonder babies grow faster during these months than at any other time in their life!
Open Wide (4 to 6 months)
Although the American Academy of Pediatrics' section on breastfeeding supports exclusive breastfeeding for the first 6 months, its committee on nutrition says that solids can be introduced between 4 and 6 months. Don't introduce solids before this age, however, because that can put your baby at increased risk for developing food allergies. Your doctor will help you determine exactly when your child is ready for food. He should be able to control his head and neck well, show signs when he's full (e.g., turning his head away from you or the bottle), and show interest in grownup food. Every baby is different, so don't worry if your 4-month-old only wants breast milk or formula. Start with an iron-fortified, single-grain cereal such as rice or oatmeal. Mix 2 to 3 tablespoonfuls of cereal with breast milk or formula to make a soupy-oatmeal consistency. Place your baby in an upright or semi-upright feeding chair or high chair and feed him the cereal twice a day using a baby spoon. Although you may have heard about parents putting cereal in a bottle, we want babies to eat their food, not drink it. It's a developmental accomplishment for a baby to learn to control his oral motor muscles to eat off a spoon. Don't worry if it all runs down his chin the first ten times. He'll get the hang of it eventually, and in the meantime it makes for some great photo opportunities.
It's often helpful to feed baby solids between nursing sessions or bottle feedings, just so he can start and finish with something familiar. Breastfeed for a few minutes or give baby a few ounces from a bottle. This way he isn't starving but still has an appetite for solids. Then top off his meal by nursing or bottlefeeding again until he seems full. Once he gets used to spoonfeeding, he probably won't need to warm up with that familiar "appetizer." At this point, it's best to nurse or bottlefeed after solids or cereal.
By 6 months, you've got the green light to introduce strained baby food vegetables and fruit. He'll need two to three servings (2 to 4 tablespoonfuls) of each per day. (Same goes for a 6- to 9-month-old, although at this age he'll be meeting the upper end of the portion range.) There's no specific order to introducing each food. Just wait two to three days in between new foods. This way, if your baby develops a rash or a little upset stomach, you'll be able to pinpoint the cause. These symptoms may indicate an allergy or temporary intolerance, which you'll need to discuss with his doctor before giving the food again.
Don't be surprised if your baby has definite preferences or dislikes initially. It's very normal, but to create a healthy eater, continue to offer even those foods that he seems to turn his nose up to at first. You'll find that you have to offer some foods 15 to 20 times before your baby will begin to like it or even try it. The take-home message? Be patient! Even after they start solids, babies between 4 and 6 months will still need 24 to 40 ounces of formula (this amount includes what you're mixing with baby's cereal) or 5 to 6 servings of breast milk per day (this doesn't include the expressed breast milk that's added to cereal).
Moving on Up (6 to 9 months)
Between 6 and 9 months, once your little one has mastered strained baby foods, you can move on to more lumpy and textured baby foods, including pureed meats - a great source of dietary protein and iron. One recent study even suggested the introduction of meats as early as 5 months to exclusively breastfed infants might be an even better iron source than baby cereal. This is certainly food for thought, but it's not necessarily reason to insist that your child gets pureed turkey for breakfast. Start with 2 to 4 tablespoonfuls of meats per serving and aim for 1 to 2 servings per day. The same rules apply as you advance to new foods. Introduce slowly and one at a time.
Around this time, your baby will also be ready to begin trying some finger foods. Start with baby biscuits and crackers. You may have to show her how to put each in her mouth before she learns what to do with it, but over time she'll grow to love her newfound skill of self-feeding. Although most finger foods are designed to dissolve easily, always keep a close eye on your child when you give her finger foods to make sure pieces don't break off and put her at risk for choking. Teeth are not a requirement for finger foods. Babies generate force by "chewing" with their gums and jaws.
Still breastfeeding? If you are, that's great. You should nurse 3 to 5 times a day. If you're bottlefeeding, continue to give 24 to 36 ounces of formula per day. Want a tip for making life a little easier down the road? Let your baby try drinking from a sippy cup. Start with about 2 to 3 ounces of water. If you let her explore the use of a sippy cup now, she'll have six months to get the hang of it, because she should be off the bottle by 12 months.
Table for Three? (9 to 12 months)
By the time your baby is 9 months, strained baby foods have become such a part of your life that you'd win first place in one of those blindfolded baby food taste-testing games that are so popular at baby showers. Your baby is approaching his first birthday, and with that comes the task of learning how to eat like a big kid. Between 9 and 12 months, table foods become an exciting addition to the feeding regimen. So if your mother-in-law has been dying to feed her grandchild her famous sweet potato casserole, she can have her moment.
Beginning at 9 months, as long as your baby has tolerated the thicker, chunkier baby foods and has learned to mash finger foods between his gums, you can go ahead and introduce finely chopped, diced, or mashed table foods. Try diced bananas, peaches, or chopped, cooked carrots, which are some favorite firsts. They're soft and easy for baby to gum. There are a few foods that shouldn't be introduced until later (see "Choking Hazards," right), but for the most part you can have fun now letting your child join in dinner right along with you. Just don't over-season food for babies. While it's true that added salt isn't good for any of us, heavy amounts of seasoning can overwhelm a baby - even if you've been eating spicy foods while nursing. Let your child decide if he likes plain carrots before you reach for the salt shaker. You can still feed him jarred foods until he becomes better at feeding himself grown-up foods, but many babies begin to refuse strained foods once they realize they can eat the real thing.
That's fine as long as you aim for this recommended daily intake:
Happy Birthday, Baby! (12 to 15 months)
You've helped her blow out her candle, watched her shove cake in her face, and reminisced that the past year has gone by so quickly. Once babies reach a year, I tell parents to think of their child's eating the same way they would think of their own. Aim for a basic structure of breakfast, lunch, and dinner, with a mid-morning snack and a mid-afternoon snack. By now, they should be eating, not drinking, their way through the day. Solid foods should be the bulk of what they're consuming, and drinks should be viewed the same way adults view them--as a thirst-quencher with a meal, not as a meal itself. At the 12-month mark, we recommend that parents switch babies from formula to whole milk. If you're still breastfeeding, that's great, too, but we still recommend introducing whole milk into their diets at this age. Your new toddler needs between 16 and 20 ounces of milk a day. In this instance, more isn't necessarily better. I've had many moms bring their kids in for their 18-month checkup, ready to pull their hair out because they can't get them to eat anything anymore. The first question I ask: how much whole milk is the child drinking per day? If she's getting more than the recommended daily amount, it's likely that she's filling up on milk and therefore isn't hungry for food. If she's thirsty but already had enough milk for the day, offer water. There's no need for juice in a toddler's diet; however, if you choose to give it to your child, make sure that you offer 100 percent juice that is watered down by half. Total daily juice intake shouldn't exceed 4 to 6 ounces.
Overall, offer balanced meals and healthy snacks and shoot for the following from the food groups:
Children younger than 2 years shouldn't be on a low-fat diet because they need the extra fat - from healthy sources such as milk, cheese, and eggs - for brain development. Do you feel better equipped to forge ahead with your baby's eating adventures? You now know how much to feed your young child, but remember that those numbers are loose guidelines. And don't concern yourself with feeding schedules; babies will ultimately decide on their own when they're done eating, and it's going to vary from feeding to feeding. On the flip side, if they're still hungry, they'll open their mouth wide. So don't get caught up in exact serving sizes and minimum and maximum recommendations. Your baby will give you clear signals for what to do. As your baby matures into a toddler, it's important to set good examples for healthy eating. If you commonly snack on doughnuts and cookies, what do you think your child will want? Teaching the importance of a balanced diet is as important as showing children how to read or ride a bike. These lessons will stay with them forever, shaping their taste preferences and creating a lifelong appreciation for food.
Sara DuMond, MD, is a pediatrician in Mooresville, Carolina, and the mother of two young children.
Reprinted with permission from American Baby. Copyright Meredith Corporation 2008. All rights reserved.