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Dr. Saul Greenberg MD FRCP(C)
2401 Yonge St. #206
Toronto, Ontario M4P 3H1
Tel: 416-485-4419  Fax: 416-485-2936

Infant Feeding Guidelines

Introduction
Birth to Four Months
Four to Nine Months
Nine to Twelve Months
One to Two Years
Conclusion


                         
                         
  Many new parents feel very confused and over-whelmed by questions 
about feeding their baby. Advice from friends and family members may
be in conflict with the pediatrician's advice, and books and magazine
articles may provide a myriad of confusing recommendations.  The
reasons for this are clear.  No one knows the exact "right" way to
feed your baby.  Babies are very much like adults in that they have 
different metabolic rates, different caloric needs and different
biologic clocks. It is unrealistic to think that as pediatricians, we 
can give you specific rules for how, what, when and how much to feed 
your baby.  However, we recognize your need for some timetables and 
guidelines.  Therefore, in this summary, we attempt to give you some
rough suggestions.  We hope that you will individualize them to meet
the specific needs of your baby.
 
!!NEW RECOMMENDATIONS!!
 
  There has been a recent change in the recommendation as to when to start solid
foods for infants. New research suggests babies should start solid foods between 
four to 6 months in order to prevent allergies, instead of the old recommendation
of starting solid foods after 6 months of age. In addition it is now recommended that
all foods may be given after 6 months of age. No longer does one need to delay giving
potentially allergic foods such as eggs, fish, nut or berries til after 1 year of age. 
This also applies to infants with siblings who already have allergies to these foods.
Delaying the introduction of any of these foods does not reduce the risk of allergy and
there have been some suggestions that delaying introduction of foods my actually increase
(rather than decrease) allergy. There is also evidence that restricting potentially
allergic foods during pregnancy or while breastfeeding an infant has NO effect on 
decreasing the risk of food allergy, asthma or eczema in the infant.



BIRTH TO FOUR MONTHS

  Breast milk and/or formula are the best forms of nourishment for
your infant.  They are easy to use, easy to digest, and nutritionally
complete.  It is not necessary to give your infant cereal or any other
solid food.  Despite the popular belief that solid foods will improve 
your infant's sleep pattern, innumerable studies have proven repeatedly
that there is no benefit to the early introduction of solid food.  In 
fact, there are many advantages to your waiting until your infant is at
least four months of age.  Solid foods may decrease the baby's intake 
of the nutritionally preferable breast milk or formula. 
They may increase the risk for potentially serious allergic reactions. 
They may cause problems with constipation, diarrhea or intestinal gas. 

Guidelines FOUR TO NINE MONTHS   Your infant should not receive anything other than breast milk or  formula for at least the first four months.  When you choose to begin solids, you should proceed slowly, with small quantities of a limited number of foods. There is no nutritional need for solid foods until at least four months of age because breast milk and formula are nutritionally complete.   In order to facilitate your ability to identify foods to which your baby may be allergic, we suggest that you wait two to three days  between the introduction of new foods.  Although allergic-type  reactions are very unusual in infants, you should be aware that your  baby could become gassy or constipated or develop diarrhea or a rash. If these things occur, simply stop the suspected food, wait about two  weeks and try it again.    The first food you introduce should be a single-grain cereal such as rice, oatmeal, or barley.  Cereal should always be introduced with a  spoon, not mixed into bottle feedings. Rice cereal may be constipating; if so, try using oatmeal cereal instead. Once your baby has been tolerating cereal well for a couple of weeks, you may begin the yellow vegetables such as sweet potatoes, squash, and carrots (not corn).  If this goes well, you may also try apples, bananas, peaches, and pears. You may use commercially available baby foods or prepare your own.    Remember that if you introduce solids prior to six months of age,  breast milk and/or formula are still the preferable foods, so do not  allow the introduction of solid foods to drastically decrease the  baby's milk intake.  Formula-fed babies should still be taking approximately 24-36oz per day and breast-fed babies should still be having 4-6 feedings.  A rough guideline is to give your baby about  1-3 Tbsp of each item per feeding. Most new eaters will prefer to have  their milk feeding (or part of it) first, then the solid food.   Initially, two meals a day should be sufficient. These meals can be at whatever time of day is most convenient for you and your baby. As  your baby is introduced to an increasing variety of foods, and as he/she demonstrates and increasing interest in solid food, you may want to introduce the third meal.   Although you can give whatever foods you want at whatever meal, a sample menu might be cereal and fruit for  breakfast, cereal, fruit and vegetable for lunch and dinner.  It is also a good idea to introduce the cup into your mealtime routine.  Prior to six months of age, the cup should contain only  breast milk, formula, or water, but after six months of age, you can  also introduce juices.  We do recommend that juice be given only in a cup, and that it be diluted and in small quantities. Juices are not nutritionally necessary and may interfere with your child's appetite if given frequently.   Once your baby has been introduced to cereals, yellow vegetables, and fruits, a large number of new foods can be introduced in any order  after 6 months of age. Try to relax and enjoy the process of introducing these new foods to your baby.  Do not feel pressured to  feed specific foods or specific amounts.  Look at your baby and use your good judgement and it will be easy!  These new foods include:     1.  Green vegetables.     2.  Other fruits and vegetables, including fruit and vegetable                   combinations and "second stage" foods.     3.  Dairy products such as yogurt and cottage cheese (but not          actual milk).               4.  Strained meats or meat and vegetable or meat and fruit                       combinations.  Baby "dinners" often contain unnecessary fillers         and seasonings, so should probably be avoided until about nine               months of age.     5.  "Finger foods" such as cooked or soft fruits and vegetables,                 cheese, meats in small pieces, macaroni and pastina, etc. These              should only be given when your baby is seated and supervised.
        Start these finger foods around 8 to 9 months of age so that          your baby can get used to more solid types of foods. 6.    Infant pretzels, biscuits, etc.  All of the following foods may be given after six months of   age: citrus, corn, tomatoes, eggs, chocolate, strawberries, peanutbutter,
shellfish, yoghurt, and cheese. 
Honey (because of the danger of botulism), should be avoided until twelve months of age.  Let your baby guide you in determining quantities. Breast-fed
babies are  generally down to 3-4 feedings per day by 9 months and formula intake should be down to the 24-32 oz range on average, but depending on your baby's size and metabolic rate, he or  she may vary from this range.                    NINE TO TWELVE MONTHS   As your baby reaches nine to twelve months of age, you may find that he/she becomes more independent in his/her food preferences.  In  addition, appetite is significantly decreased compared to younger  infants and developmentally, babies in this age group are much more interested in the mastery of their gross and fine motor skills than in eating.  Your baby may not consider it fun to sit in a highchair long enough to eat a meal.  Very few, if any, one-year olds eat three good  meals per day.  They tend to eat occasional good meals and pick the  rest of the time.  Therefore, parents are often concerned that their  older infants are not eating enough or not eating a balanced diet.  Remember that their current nutritional needs are less than they were  at six to nine months of age.  If your baby is eating small quantities of food, but is gaining adequate weight and has a good energy level during the day, try not to be concerned.  Offer frequent (3-5 times per day) small meals of healthy foods, minimize snacking (including breast  milk and formula) between meals, and do not try to force your baby to  eat what he or she does not want.   Some babies dislike any type of food texture and insist that all  foods be pureed and smooth.  These infants will eventually tolerate  table foods, so don't panic.    Other babies may refuse all baby foods and prefer to self-feed, with their fingers, of course.  This independence should not be discouraged.  Although it may appear that they are only playing with their food, toddlers can easily meet their nutritional needs in this  manner.   It is acceptable to introduce cow's milk at ten months of age. Most breast-fed babies in this age group are taking about three feedings per day.  Formula-fed babies are generally taking 16-24 ounces per day.   We strongly recommend that you discontinue the bottle completely by  12 - 15 months of age.  Prolonged use of the bottle is associated with serious dental problems as well as nutritional deficiencies and even  ear infections.  To this end, it is important that you introduce the  cup by six months of age and strongly encourage cup feedings by nine  months of age.  We are aware that an infant with a cup can be a hazard  to your house and car, but there are many spill-proof cups on the market.  Do not, under any circumstances, allow your infant to take the bottle to bed.  The bottle should be given well before bedtime so that  teeth can be cleaned. Your baby can and should learn to fall asleep  without the aid of a bottle.  You will thank us for this!   Remember that future eating habits begin to be established in this  age group.  Frequent or unhealthy snacking should be discouraged.   Children should be encouraged to sit while eating.  Distractions such as toys and television should be minimized. Eating should not be made into a power struggle between child and parents.  It is the wise parent who maintains a positive and relaxed attitude about eating. ONE TO TWO YEARS    As your child enters the second year of life he/she will begin to eat regular meals, and formula-fed babies will most likely switch to regular cow's milk. Since babies need fat in their diets for development, they should drink whole milk until their second birthdays. Then, if growth is steady, you can switch to low-fat or nonfat milk.   When introducing table foods, don't worry too much about the amount or variety your baby accepts, or how much gets into her mouth. At this stage you need to remember that your baby's growth is slowing down, and three small meals and two snacks a day will probably be enough for most toddlers. Watch for cues that your baby is finished: if she's disinterested, turning her head away, or pushing food away, don't force her to eat more. Serve the most healthful foods possible, but don't expect your toddler to eat a "square" meal at each sitting. Don't let your child fill up on empty-calorie snacks, but don't force her to eat when she doesn't want to. Although you should be offering solid food, you still must supervise your toddler's meals in case of choking, and you still have to avoid foods that can cause choking including popcorn, hard candies, hot dogs, jelly beans, chunks of carrots, grapes, raisins, and nuts. Cut or finely chop such foods, or simply wait until your baby gets older.   Expect your toddler to go through periods when she wants only a favourite food. It's not uncommon for a child this age to want the same breakfast for a month. Remain relaxed, continue to offer other healthful choices, and remember that these behaviors will one day come to an end. Again, your toddler might not eat what you would call a balanced meal at each sitting, but over the course of time she should get what she needs for good health.   Most doctors suggest doing away with the bottle by 1 to 2 years of age. When you and your baby are ready, you may choose to wean your baby from the breast or bottle directly to a toddler cup. She may be hesitant at first, but if you hide the bottle permanently and only supply the cup, your child should get the message pretty quickly. Do not let your baby go to sleep with a bottle; this increases the risk for dental cavities and ear infections CONCLUSION

  We must remind you again that these recommendations are only intended
to be guidelines.  You must look at your individual baby and follow his
lead.  He or she will not necessarily require solid food, drink from a
cup, tolerate textured foods, or enjoy finger foods at the same age as 
your friends' children.  If you have questions about these guidelines,
please call the office.  Consider making an appointment to check the
baby's weight if you are concerned that weight gain is not adequate. 



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The information contained on this web site is not a substitute for direct examination and treatment by a physician. If any of this material is unclear or confusing, or if you have additional questions or concerns, please call the office at (416)485-4419.