Darcy Lesniak, MD Pediatrics Columbia St. Mary’s Germantown

September 06, 2011

Birth to 4-6 Months:

The very best source of nutrition in the newborn period is breastmilk. The benefits of breastfeeding are extensive, including immune protection, ideal nutrition and growth, positive maternal health, economic advantages and more. The American Academy of Pediatrics and the Department of Health and Human Services highly recommend breastfeeding as the optimal source of nutrition for infants. To see most of these benefits, it is recommended that exclusive breastfeeding occur for at least 6 months and encouraged throughout the rest of the first year. But, the value of breastfeeding for any amount of time is great. If your newborn does not breastfeed, iron fortified infant formula should be given. 

Breastmilk or formula has essential nutrients your baby needs for the first 6 months of life. Extra water or added cereal is unnecessary and will not help your child sleep through the night. Adding solids too soon may increase the risk of diabetes and celiac disease later in life. Vitamin D is essential for all infants, but has been measured in lower levels, especially in the Midwest. Exclusively breastfed infants and some formula-fed infants will need a Vitamin D supplement.

4 Months – 12 Months:

4-6 months is a great age to start solids since your baby is sitting up, no longer has a “tongue thrust” reflex and is usually interested in trying new foods by now. There is no particular guideline for introducing solids. The order of foods introduced and how to proceed should be directed by you and your baby. It is your job to decide what your baby eats, and it is up to the baby to decide how much to eat.

Continue offering breastmilk or formula. Start offering baby foods (cereals, fruits, veggies) in small spoonfuls. Most meals will start out being about 3-4 tablespoons and increase from there. If your baby seems to reject certain food, try it again later. It may take up to 6-8 exposures to a new food for your baby to accept it. Your baby needs to adjust to new textures and flavors, but don’t force-feed. Around 6 months, your baby should receive a source of iron such as meats or iron fortified cereals. Fluoride should also be added to the diet either through fluoridation of water or vitamin drops.

Advancing your baby’s diet with the introduction of solids does not need to happen at a set time schedule. Add a new food every few days to watch for a potential allergic reaction. The difference between “first foods,” “second foods,” and “third foods” is texture. See what your baby can handle with texture and advance from there. The main difference between prepared jar baby food and table food is usually related to added salt, sugar, spices and preservatives. As long as table food is mashed, blenderized or ground up enough, it is just as good if not better than jarred baby food. These foods don’t need additional salt or seasonings.

Some foods can cause choking and should be avoided such as nuts, popcorn, raisins, whole grapes, hot dog pieces, hard candy and peanut butter. Avoid honey prior to a year of age since it is related to infant botulism. Pick nutritious foods rather than fatty or sugary foods so that good habits can begin early.

Introduce a sippy cup, then a regular cup as early as possible. Bottle feeding for a prolonged period increases the risk of dental cavities and may perpetuate excess intake of milk. Besides, it is very hard to talk a toddler out of his precious bottle. Fruit juice is not essential, and if offered, should be less than 4-6 ounces per day. Your baby can get much better nutrition from real fruit. Additional water can be given as desired.

Once your baby is sitting up on his own and has tolerated his first solids well, try introducing soft finger foods. Breastfeeding or formula feeding will often decrease as babies become more independent and mobile. Also, the rate of growth slows down compared to the first several months of life. Let your baby try using a spoon, but be prepared for messes. Continue offering a cup instead of a bottle. Make the feeding experience positive and follow your baby’s cues. Remember that you are in charge of what and when your baby eats, and allow him to determine how much to eat.