Feeding Baby in the First Year

This post originally appeared on the blog, One Mother to Another.

I know first hand how being a mother with young children is – a juxtaposition of sheer exhilaration (first smile, first steps, first word), mixed with the overwhelming reality of trying to get showered, dressed, feed yourself and your kid, all in the same day.  I remember moments of sleepless stupor, doing ridiculous things like pouring breast milk into coffee (yep, I did that). I had two children under two. One was premature; the other was colicky. You do the math – it was like three years of utter exhaustion. Yet, despite what I might have told you back then, I would not trade it for anything. Now they are the coolest, smartest, most fun second and third graders on the planet (I’m not biased at all)!

In all seriousness, despite my personal challenges with early motherhood, I am a Registered Dietitian/Nutritionist specializing in pediatric and family feeding. I have worked with hundreds of families on everything from nutrition for kids with various diseases to picky eating, and healthy feeding for babies and toddlers all the way to teens. I am passionate about nutrition for the whole family.

Melissa asked me to write about feeding baby in the first year. This is not intended to be a substitute for medical care or advice from a doctor. Always talk to your pediatrician about how to feed your baby, as each baby is unique. Your pediatrician has specific information about your baby that may alter recommendations for him or her! (These are general guidelines).

4-6 Months:

Solid foods are typically introduced around 4-6 months of age. Look for signs of readiness to determine when (these include: baby can hold her head up, sit in a high chair, opens her mouth when spoon approaches, takes food from a spoon and transfers to throat, and is about double her birth weight).

In the past, babies typically started solid foods with rice cereal, but there is no medical evidence that introducing solid foods in a specific order is beneficial to baby. The American Academy of Pediatrics has recently emphasized earlier introduction of meats (single, strained meats) because of baby’s need for key nutrients such as iron, zinc, vitamin B12, and phosphorous. If your baby is exclusively breastfed, meat introduction can be beneficial, because breast milk may be low in these nutrients. Check with your doctor to see if this is appropriate for your baby. Introduce one, strained meat, or single grain cereal (no salt or sugar) at a time. It can be helpful to mix first foods to a soupy consistency with breast milk or formula. Try one food for two to three days before trying another food to ensure there are no signs of an allergic reaction.

  • Petite Nutrition Tip: Research has shown that rice cereal can have high levels of arsenic. Opt for another single grain infant cereal, such as oats, to avoid exposure.

  •  How much? Typically babies drink around 28-32 ounces of breast milk or formula per day (4-6 feedings) at this age and eat approximately 2 tablespoons – ½ cup of food total per day (divided up between 1-2 serving times per day). But remember all babies are different!
  • Example schedule:
    • 6am: 4-6oz breast milk/formula
    • 10am: 1-2 Tbsp infant oat cereal mixed with breast milk plus 4-6oz breast milk/formula
    • 2pm: 4-6oz breast milk/formula
    • 6pm: 1-2 Tbsp strained meat mixed with breast milk plus 4-6oz breast milk/ formula
    • 9pm: 4-6oz breast milk/formula

6-8 Months:

Depending on when you start solids, you should be gradually expanding your baby’s diet, introducing one food at a time without mixing flavors. You can start to mix flavors once you know your baby can tolerate each of them individually. After a few months, your baby’s diet should include breast milk and/or formula, fruits, vegetables, cereal, meat, boneless fish, eggs.  I’ve noticed in my practice, that many moms are hesitant to begin including protein foods: meat, fish and eggs. Some pediatricians advise against fish and eggs in the first year due to allergic concerns, but evidence does not show introducing these after 4 to 6 months increases allergy to them. So unless your family has a strong allergic history, there is no reason to avoid them. Talk to you pediatrician about this. A lot of moms feel more comfortable with fruits, vegetables and grains. But make sure you are exposing baby to protein foods too! And start practicing with a cup!

  • Petite Nutrition Tip: Hardboiled egg yolk mixes well into infant cereal and fruits. Eggs are a great source of choline – brain food for babies!
  • How much? Typically babies drink around 30-32 ounces of breast milk or formula (3-5 feedings) per day at this age and eat approximately ¾ - 1½ cups of food total per day, about 4oz per sitting (divided up between 2-3 serving times per day).
  • Example Schedule:
    • 7am: 6-8oz breast milk or formula plus 2 tablespoon infant oat cereal with 1 egg yolk mixed in plus 2 tablespoon applesauce
    • 11am: Lunch: 1 tablespoon strained chicken plus 2 tablespoons green beans, 1 tablespoon sweet potatoes, 1 cracker plus 6-8 oz breast milk or formula
    • 3pm: 6-8oz breast milk or formula
    • 6:30pm: Dinner: 2 tablespoons strained beef with 1-2 tablespoons well mashed avocado, 1-2 tablespoon well mashed banana, 1 cracker plus sips of water from practicing with cup
    • 9pm: 6-8oz breast milk or formula

8-12 Months:

At this time, cheese and yogurt can be introduced if there is not a dairy allergy. Choose whole fat yogurts because babies need fat for brain development. Keep practicing with the cup. Start “meltable” solids (foods that “melt” in mouth with saliva), such as teething biscuits, wafer-like crackers, bread. Increase offerings of finger foods/ “soft solids” (soft, small pieces of fruit and cooked vegetables that can be smashed easily when pressed with your finger) such as small pieces of avocado, banana, well-cooked yellow squash, scrambled eggs, etc.

  • Petite Nutrition Tip: You don’t need to buy baby yogurts. Buy whole fat plain yogurt and add fruit puree to them such as applesauce. This gives baby less refined sugar.
  • How much? Typically babies drink around 30-32 ounces of breast milk or formula (3-5 feedings) until 10 months. Then breast milk/ formula intake usually decreases to around 24-30 ounces in 2-3 feedings (as solid food intake increases). Solid food intake varies widely as babies age. Approximately ¼- ½ cup of each of the following throughout the day in 3-5 feedings per day: fruits, vegetables, protein foods (including cheese), cereal or other starches.
  • Example Schedule:
    • 7am: Breakfast: 3 tablespoons infant oat cereal with 3 tablespoons smashed banana and 2 tablespoons small pieces of scrambled egg plus 6-8oz breast milk/ formula
    • 10am: Snack: 2 crackers, 1-2 tablespoons small pieces of cheese
    • 12pm: Lunch: 3 tablespoons small pieces of chicken, 3 tablespoons small pieces of yellow squash, 3 tablespoons small pieces of blueberries, sips from cup of water
    • 3pm: Snack: ½ cup plain yogurt, 2 tablespoons unsweetened applesauce, 6oz breast milk or formula
    •  6pm: Dinner: ¼ cup baby Bolognese (pureed ground beef and tomato sauce) and 3 tablespoons pasta (finely chopped), 3 tablespoons pureed kale and mango*
    • 8:30pm: 6-8oz breast milk or formula

*Check out my baby food ideas (suitable for babies 8-12 months), recently featured in Kiwi Magazine.

Petite Nutrition General Feeding Tips:

  • Work with your pediatrician to develop an appropriate feeding plan for your baby.
  • Make meal times pleasant. This sets the stage for enjoying meals later.
  • Eat family meals together from the beginning. Baby watches you and learns how to eat.
  • Babies learn to eat by exploring. Exploring means big, giant messes. Embrace it – it will make them better eaters.
  • Start meal scheduling early. Babies should not graze all day long. There should be defined starts and stops to meals and snacks. All meals and snacks should take place in the high chair. Aim for about five to six total feedings per day – including breast milk/ formula and food. This will set you up for easier feeding in toddlerhood.
  • Do not use food for rewards. Period. It can teach baby to eat for reasons other than hunger.
  • Babies do not know what foods they like yet. Sometimes babies need to be offered a food many times before they learn to accept it. Be patient, don’t give up, and keep offering those foods.
  • Trust baby’s instincts on how much to eat. Babies are excellent self-regulators. Let them show you how much they need.

Sources: www.healthychildren.org

http://www.chop.edu/conditions-diseases/feeding-guide-first-year#.VIejTIe4mqA