Newborn: We highly recommend that mothers breastfeed their infants. Breast milk has many advantages over formula feeding, including optimal nutrition, enhanced cognitive ability of the child, enhanced intestinal health, establishment of strong emotional ties between the mother and infant, providing anti-infectious factors to the baby from the mother, cost savings, ease and convenience of food preparation, and many other advantages. For these reasons, our clinic enthusiastically recommends breastfeeding for all of our patients. For more information on breastfeeding please see our reading list on this website and our booklet entitled “Advice for newborn care”.
Sometimes however, breastfeeding is not chosen and an infant formula must be used. Two such formulas are Enfamil Lipil and Similac Advance. For milk allergic infants, Prosobee and Isomil are available. Please contact our office for the appropriate formula for your child. Infants who are bottle fed should be on formula which is fortified with iron by two months of age. The use of low iron containing formula for infants older than two months of age is discouraged because such infants are at high risk of developing anemia and require repeated blood count testing to rule this out.
We feel that breast feeding and/or formula feeding should be continued until the child is 9 – 12 months old. This will provide proper nutrition for your child during this very important period of growth. You should not start your child on cow’s milk during the first nine to twelve months of life because it won’t meet adequate nutritional needs. Cow’s milk has too much protein, too little iron, too much sodium and differences in vitamin, mineral, fat and calorie distribution from breast milk and infant formula.
Certain infants may require a certain formula for health reasons. In some circumstances, it may be dangerous to change from one formula to another. For these reasons, you should disregard infant formula advertisements, sample promotions, and coupon promotions which are directed at obtaining your business for their formula company. The choice and use of an infant formula should be under our direct supervision for the proper health and nutrition of your child. You should not change your baby’s formula without the advice of your doctor. We do not recommend “follow-up” formulas routinely.
A frequent question we are asked by parents relates to the need for vitamin and fluoride supplementation in their child. There is no question that breast feeding provides the best and most complete nutrition for your baby. However for vitamin D, which is needed for calcium deposition to make strong bones, breast feeding may not provide all the vitamin D that the baby requires. More precisely, breast milk is actually rich in pro-vitamin D, an inactive form of vitamin D that requires sunlight for activation. Vitamin D is called the “sunshine vitamin” because direct sunlight is needed to activate the pro-vitamin D to the active form. Because direct sunlight is not good for a baby’s skin and because of an increasing amount of Rickets (vitamin D deficiency) in the US among breast fed babies, the American Academy of Pediatrics recommends that vitamin D supplementation be done for all breast fed infants. For some breastfed infants, fluoride supplementation is also done if the water supply of fluoride is inadequte. Infants who require vitamins are generally started on these at the four week visit. The purpose of fluoride supplementation is to prevent tooth decay.
Formula fed infants usually do not require vitamin supplementation because the vitamins are contained in the infant formula. Fluoride supplementation is not necessary in bottle fed infants if the formula is mixed with water containing adequate amounts of fluoride. Most communities, including Little Rock and North Little Rock have adequate amounts of fluoride in their water supply. If you have questions concerning this, you should contact your local water official for information about fluoride levels in your water system.
Four to Six Months: During the first four months of life, breast feeding and infant formula feeding provide all of the calories, water and nutrients that your baby will need. We generally recommend starting solid foods at four to six months of age when your child is physically ready to swallow them. Solids have less calories per unit volume than both breast milk and formula. Because of these two considerations, it is best to wait until four to six months of age to start them. Rarely, some babies may need to begin solids earlier than this time as directed by your doctor (such as for reflux or spitting up).
The goal of introducing solid foods into your baby’s diet is to provide a starting place for a more mature diet. Your baby’s first solid food should be an iron fortified infant cereal. There are three cereals available: rice, barley and oatmeal. Any of these are fine to use. The first feeding should usually be one tablespoon mixed with either breast milk, formula or water. The eventual goal is four tablespoons per serving, two or three times per day. This should be increased gradually.
Vegetables can also be started at four to six months of age. We recommend trying carrots first, followed by squash, green beans, peas, and sweet potatoes in that order. We recommend this because of ease of digestion. Vegetables should be introduced before fruit so that your child will develop a taste for them.
After a new food is introduced into your child’s diet, you should wait three to four days before introducing another food because of the possibility of food allergy. Vomiting, diarrhea, rash, colic, runny nose, irritability and sleeplessness can be signs of food allergy. If these should occur after the introduction of a new food, you should discontinue it and report this to us during a regular office visit. Each feeding that your child receives should be followed by milk or water. The amount your child eats should depend upon her desire. Give as much as she wants, but do not be insistent when the child is no longer interested.
The next food to introduce in your child’s diet is fruit. You can introduce a new fruit every three to four days. You should initially use individual fruits and not mixed fruits because of the need to identify which food your child might react to. We recommend starting vegetables first, then fruits. Fruits are much sweeter and your child will prefer these over vegetables if you start them first.
Meats are the last foods that you should introduce into your baby’s diet. They have the highest protein content and are the most difficult for the infant to digest. We generally recommend delaying meats until the child is approximately seven to nine months old. Because of ease of digestion, we have an order of introducing meats that we would like to suggest to you. First, try lamb, then chicken, veal, turkey, beef, liver, pork and fish, in that order. Of course, our food lists are a bit arbitrary in the order of introduction of foods into the diet, but many mothers appreciate these. These lists are merely presented as suggestions and are certainly not hard, fast rules. After your child has tried all of the individual foods above, you can try food mixtures for the sake of variety and convenience.
Juices such as apple juice, white grape juice, pear juice, etc., can be added to the diet at the time the fruits are added. These are not essential to the diet, but are a good source of extra fluid and calories, and may be given at any time during the day. Try to not give your child more than about 6 ounces of juice per day so that more of the nutritious milk and solids foods will be taken.
One Year and Older: The first year of life is your child’s period of most rapid growth. After about 12 months, the rate of growth decelerates and parents notice that the child’s appetite decreases. Many times, parents become very concerned that their one-year-old child seems to be eating less. Part of your health supervision visits is to actually plot the height, weight and head circumference of your child on a growth chart. As long as his/her growth percentiles are within the normal range and the blood count is normal, you can be assured that your child is receiving adequate nutrition.
After the age of 9 – 12 months, usually breast feeding and/or formula feeding is discontinued and cow’s milk is introduced into the diet, although it is fine for breast feeding to be continued after 12 months. We generally recommend whole milk until two years of age and then 2% milk thereafter. It is a good idea for young children to have mealtimes at a regular hour each day. Between meal feedings are usually not a good idea, although there are exceptions. We like for children to eat a balanced diet from all food groups. However, you should never force your child to eat food he does not want. Simply make foods available to your child. At 12 to 18 months of age, we also like to encourage parents to discontinue the use of a bottle and offer their children beverages in a cup.
Vitamin supplementation after the first year of life is usually not needed as long as the child is eating a well balanced diet from all of the food groups. If this is not the case, then a multivitamin with iron is probably a good idea. Fluoride supplementation for the older child is needed only if the water supply contains inadequate amounts of fluoride.
The Picky Eater: We find in our practice many parents who are exasperated with their toddlers and young children because of their picky eating habits. Some children eat only a very limited diet which is actually unhealthy for them and parents instinctively know this. Most of the time, a picky eating child will graze on snack foods such as crackers, Cherios and cookies all day long. In addition, most picky eaters will consume a lot of fruit juice as well. As we don’t have to tell you, this is not a healthy pattern because nutritional deficiencies may result. Also, patterns of unhealthy eating develop this way. These patterns may well last a lifetime if not checked. You must change your child’s eating habits.
To help your child overcome this bad habit, there is a wonderful, natural remedy for this situation. It is called “hunger”. Simply wait out your child’s picky eating habits and refuse to give them unhealthy foods. At three meals times per day, provide your child with a healthy, nutritious meal from all the food groups in appropriate proportions. If your child eats a good meal, then a snack and some fruit juice is fine between the next meal. However, if that child refuses to eat the nutritious meal, there is nothing offered except water until the next meal. This pattern is repeated until the child eats a good diet. Most children will throw a temper tantrum with the loss of their first snack of crackers or cup of juice as their expectations are not met. Appropriate punishment needs to be applied at this time, and no food or fruit juice is given until the next meal, only water. After missing one to three meals, most children will miraculously develop healthy eating habits. Missing a whole day’s food supply will not hurt normal children, just make sure that your child drinks adequate water. The point of this exercise is discipline. Discipline is healthy and needed in our kid’s diets.
In regards to fruit juice, please know that a large consumption of fruit juice has been shown to be associated with poor weight gain and poor eating habits. You should limit the amount of fruit juice your child gets each day. In addition, fruit juice can cause cavities.
For more information check out child nutrition at: www.bcm.edu/cnrc