Diet in the First Year

• Newborn through Four months

• Four Months to Six Months

• Six to Eight Months

• Foods to avoid until a year of age

• Eight Months to Twelve Months

• Danger foods

• Switching to milk

Newborn through Four months

This one's easy. Their diet should either be breastmilk or formula. They don't need any water or juice or cereal or anything else but breastmilk or formula. And it is my solemnly sworn duty to say that breastmilk is best. The daily intake should reach about 30 ounces by four months. (Warning:  that 30 ounces thing is an average.  That’s all.  If your child grows on less or seems to need more, then fine.  It’s a guideline and not a rule.) If you are told, as I was, that adding cereal to the feeding helps your child sleep through the night, ignore it. It's bunk.

Four Months to Six Months

The parents are responsible for the "what, where and when" food is offered, and the child is responsible for "whether" and "how much" to eat. 

 Ellyn Satter, author of Child of Mine: Feeding Your Child with Love and Good Sense.

Boy oh boy, what a can of worms feeding this age group has become. There are some very smart people from all parts of the world who are taking a stand on the addition of solid foods to the diet of this age group, and there is no consensus. The World Health Organization has said to start kids at 6 months, the Section on Breastfeeding of the AAP has agreed but the  nutrition committee for the AAP can't decide and will probably be debating this for ages. What we do know is that starting before 4 months is not recommended.  There is no rush to start solids, and that's different advice than when we were kids.  And at least one study has recently showed that early introduction of rice cereal (prior to 4 months of age) is a risk factor for the development of diabetes.  I would strongly recommend not starting anything but formula or breastmilk until after the kids are 4 months old.  

I guess the best summary of what all my resources tell me is that we should start kids on solids somewhere around the middle of the first year and that we should let the kids, not a calendar, decide.  It makes no sense to start a baby, to force them to eat if they aren't interested, nor does it make sense to make them wait if they are trying to grab food off your plate.

 There should be NO RUSH to start solids. 

So.. what's clear is that if you have made the commitment to breastfeed, the AAP Section on Breastfeeding (of which I am a member) says that exclusive breastfeeding for the first 6 months of life is beneficial and desirable. Complementary foods are not necessary, and may detract from the nutritional benefits of breastmilk.

Most breastfed kids have a “growth spurt”  at about this time, and start getting up in the night (if they hadn’t before).  Breastmilk is supply and demand, and then kids are “demanding” to increase mom’s supply.  It does not mean the kids need solids.  Solids don’t make kids sleep.  There is no sedative effect of rice cereal, carrots or peas.

We should NOT be making decisions about solids based of sleep schedules.  Four month olds may wake up and not be able to go back to sleep because they realize that there is a world out there.  It is about safety and not hunger.  We wake up and we are hungry but we don't wake up because we are hungry.

I also know that four month olds are eating more and may not seem "satisfied" with what we just fed them.  If they need more food, then it should be breastmilk or formula.  Breastfed kids may not be satisfied because they are trying to increase mom's milk supply and formula fed kids may not be satisfied, but they need more formula.  Giving cereal, or whatever, doesn't give them the nutrition they need at this age.  Similarly, there is no amount of formula that they are taking that should equal us giving solids. (I've heard often that they are at 32 ounces of formula...they must need solids.)

A child who is ready for solids should be trying to eat what's on your plate.  Not just watching, but trying to get it. And that's rarely occurring before 5 months.  The decision to start solids should have nothing, nothing, to do with sleep patterns.  Nothing! 

So when we decide that the kids are ready for food, what food do we start with?  The American tradition has always been rice cereal.  In Germany, many kids start with carrots or cooked pumpkin.  In Holland they start with bananas or apple mash.  There are no studies out there that tell us what the best foods to start with are.  Which means, that the insistence on cereal in our kids' diet is a tradition, not a necessity.  When you get right down to it, rice cereal is starch, and sometimes iron-fortified starch.  If we are giving it, and it decreases the amounts of breastmilk or formula the child takes, we aren’t doing them any favors nutritionally.  Click here for a lovely summary of initiating complementary foods in breastfed children written by the WHO.

Cereals started as an important part of a child's diet back when the infant formula companies couldn't get an absorbable form of iron into the formula.  They then fortified rice cereal with iron and introduced the rice cereal early into the diet as a way to make sure the kids got the iron.  Now, all the infant formulas are fortified with iron and of course, breastmilk has an abundant and easily absorbable supply of iron in it, so we really don't need an extra source.  If you take away the iron in rice cereal, it's just starch.  That's a long explanation to say that I don't really think rice cereal is necessary. And I love when the media agrees with me :)  The oatmeal cereal I think is great.  It packs some punch.  Rice?  Not so much.

Six to Eight Months

The parents are responsible for the "what, where and when" food is offered, and the child is responsible for "whether" and "how much" to eat. 

 Ellyn Satter, author of Child of Mine: Feeding Your Child with Love and Good Sense.

Your child should be exhibiting clues that they are ready to take solids, before you actually start them in the diet. Prior to four months of age, your child has a well-developed "tongue-thrust" reflex, which makes spoon feeding pretty difficult, and extremely messy. If your child turns away from the spoon, spits the food out at you, and in general, does not seem to be enjoying meals -- they aren't ready for the advancement in the diet.  This tongue thrust on non-interest in food can exist for longer than 6 months-- meaning, if you child is six months old and is not ready for solids, no worries.  It'll come.

If they are ready to eat, then we should start on food.  Real food, like fruits and vegetables.  It can be home prepared foods, or baby food.  Start on the Stage 1 foods and see what happens.  We all have a reflex in the back of our throat that doesn't let us swallow something that we have no business trying to swallow.  If we were to try to swallow a golf ball, for example, we would make a horrible face and try to throw up.

This "golf ball" reflex is what stops us from going to more textured foods.  I'm not going to say that a child has crossed some magic starting line and therefore can have stage 2 or stage 3 foods.  It'll be the ability to handle texture that lets us go forward.  I take care of kids I swear can eat steak at 6 months and some kids who can't handle anything but pureed food at 14 months.  It's up to your child how we move through these textures.  And that goes for finger foods too.  Whatever texture they can handle is OK to give-- if you're not comfortable trying a new texture, don't!  Your child never has to eat Cheerios, ever, and they can go to college on stage 1 foods.  We aren't in a hurry.  We can get iron now from many sources, the easiest of which is meat.  And meat can be pureed if need be, and is found in the second stage foods. 

You can start at whichever feeding you want to-- whichever feeding your child seems most interested in trying the new food. (One wise friend told me that starting in the morning makes sense because if they get sick from the solids, you have daylight hours to deal with it!) Start with a teaspoon and work up from there. And most of the feeding will wind up on them, not in them. So be prepared.  Breastfeeding mothers may find that the kids won't eat from them, so daddy may be the better person to be feeding solids.

After each new food, you can wait two or three days to see if signs of an allergic reaction, such as diarrhea, rash or vomiting occur. If they do, don't give that food for awhile.  Or you can live on the edge, like Ryan and I did (Ethan ate whatever we did), and try one new food a day.

I like holding off on starting juice until about 9 months or later (if at all), when you can bribe your child off the bottle by putting the juice in a cup. Plus, juice can cause diarrhea and diaper rash by making the stool very acidic to the skin.

There's nothing special about store-purchased baby foods: meaning, if you want to make them yourself, go ahead (see the included exceptions, below). All the food should be cleaned, soft, unsalted and unseasoned. Bananas are fine raw, but all other fruits should be cooked.

Do not home prepare these foods:

·         beets

·         turnips

·         carrots

·         collard greens

Here's why you shouldn't prepare these at home. This information from the AAP.

Kids in this age group don't have a taste for salt or for unsaturated fat. They don't even know that they want them. Start good eating habits early and don't give salt or unsaturated fat to your child in this age group.

Foods to avoid until a year of age:

·         honey (risk of botulism)

·         eggs (especially the whites, which are very allergenic)

·         cow's milk

·         peanut protein

Now is a perfect time to start getting your child off the bottle and on to a sippy cup. There is nothing that says that children need formula out of a bottle.  Negotiating with a 12 month old, trying to get them to give up their bottles is hard to do.  Try to get them off of it now, while it’s only a source of nutrition and not a source of comfort!  

But remember, the sippy cup was designed for parents, not kids, so the kids may have a hard time using them.  I personally feel that the "spill-proof" ones are also "drink-proof" and that they shouldn't be used.  Most kids can do fine with a cup without a lid.  I can even get newborns to drink from cups.

Eight Months to Twelve Months

The growth rate of a child in this age group slows a bit, so it's not surprising that their appetites slow down a bit now too. They can usually tolerate food with a little more texture. You can even try to let them use a spoon now if you are brave.    Sample Menu

There is no minimum amount of breastmilk that they should be getting. There is no minimum of solid food.  There is no minimum of formula.  Kids in this age group are really, really good at taking enough calories to grow.  They will eat when they are hungry, drink when they are thirsty and if you guess wrong, you will wear what you chose.  If you do this wrong, and they are hungry, they will squawk at you until you get it right.  I have never met a kid who will let their parents starve them, at least without a fight.  But they are not growing as fast as they were, so they don't need that many calories.  We are trying to teach this generation to respond to hunger cues, not eat simply because the Packers are on or because it's noon.  If they are not hungry, they are really not hungry.

Danger foods -- have risk of choking

·         Spoonfuls of peanut butter ( and no peanut butter until after 1 year)

·         popcorn

·         nuts

·         raisins

·         grapes

·         uncooked peas

·         celery

·         hard candy

·         whole hot dog

Switching to cow's milk

There really isn't any magic to this.  Just switch over, without worrying about weaning or a slow transition. Even kids who were on soy or other formulas usually do OK with the switch to cow's milk.  And if you are nursing (good for you!) there is still plenty of benefits of breastmilk in this age group- there is no cow out there making better milk for your child than you are.

Cow's milk is not the perfect food, despite all that we learn, especially in Wisconsin.  And I see more problems with kids getting too much milk rather than too little.  Too much cow's milk (which is more than 20-24 ounces a day) can lead to severe iron deficiency and iron deficiency in a growing brain is not a good idea, in fact, childhood iron deficiency can cause developmental problems that the kids may not overcome. See, cow's milk has no iron in it, can interfere with iron absorption and can cause a low grade blood loss in some kids by creating an inflammation in the gut.  Meat is the best source of iron.  Other foods that are fortified with iron have a form that is a little harder to absorb.

The kind of milk you transition to makes little difference to me. The idea is that the kids need a source of fat in their diet for the first two years of life because the fat helps with brain maturation and development. The AAP has always said to use whole milk as a way to provide that fat, but there isn't anything special in the fat of whole cow's milk that helps human brains grow. I personally think the recommendation comes from the belief that we, as  parents,  are giving our kids only fruits, veggies, whole grains and lean meats and therefore we would never get fat into our kids any other way than whole milk.  I guess I just don't think it's hard to find sources of fat in a normal American diet and in this time of increasing childhood obesity, I think the fat in whole milk is just excessive and unnecessary (unless you are only giving your kids the good stuff I mentioned above).   So... make sure that your child gets about 30% of their calories from fat every day,  just like we, as adults,  are supposed to do.