Feeding Baby Solids
By Dr. Tom Collins

It’s hard to believe, but by the time children reach 2 years of age, they are about 50% of their adult height, and about 15% of their adult weight. Obviously, there is a lot of growing going on during the first 24 months of life! With the national health focus more and more on obesity-related problems of in adolescence and adulthood, it’s probably a good time to review sound feeding practices for infants and toddlers.

I think that the one key concept we need to keep in mind when we are feeding babies is the simple question ‘Why am I feeding this child?’ The equally simple answer is, of course, ‘to meet her caloric and fluid needs, to keep her body functioning well, to keep her healthy, and to allow her body and mind to grow in an appropriate manner.’ What is not part of the answer is equally important: it is not to see their reaction to new foods, it is not to make them sleep through the night (although I confess to sharing this wish, both as a parent and as a pediatrician), and it is not because Grandma (or Grandpa or Great Aunt Gertrude) thinks that it is about time. Thus, as with most mysteries of infancy, we need to check with the expert: the baby.

Many years ago when I was first in training, the thought was to feed the infant much earlier, well before she was ready for solids. The scene went something like this: you held the infant on your lap, placed one of her arms behind your back, held her other arm with one of your arms, and then crammed a spoon into her mouth. That’s a rather barbaric approach, if you think about it, but it went along with us adults thinking that we were so much smarter than these know-nothing infants. (For any of you familiar with farm animals, we never thought it was especially wise for us to force-feed calves or colts, so I guess we thought baby animals were smarter than baby humans!) Fortunately or not, our understanding of infants has now progressed to the point where we understand that human infants are a lot more complex that we gave them credit for.

So what do I mean, the baby’s the expert? If we agree that it is not beneficial to force babies to eat something that (a) they don’t want, (b) they don’t need, and (c) they aren’t developmentally ready for, then how the heck do we know when we should offer solids? There are several developmental signs. First, she should be able to sit supported and hold her head fairly steady, so she can be an active, rather than a passive participant in the feeding process. Second, she should be able to turn her head away to let us know when she has had enough (and we parents should be developmentally sophisticated enough to believe her when her body language tells us ‘no more’). Third, she should be at the stage where she wants to be part of the meal, anticipation the spoon, giggling, and having a fine, messy time with this solid stuff. (Hint: if she wants to help too much with the spoon, give her one of her own, which she will wave about, thereby taking one grabbing hand out of the confusion of fingers.)

If you put these all together, you usually come to the age of 3½ to 4 months of age, which is when many pediatricians, as well as the American Academy of Pediatrics, recommend starting solids with your baby. Until that time, the universal recommendation is that the only food your baby should receive is breast milk and/or iron-fortified infant formula.

“So okay, when my baby’s 4 months old, I‘ll feed her steak and potatoes, right?” Well, not exactly…Please understand that there is much more harm to be done by going too fast than by taking a leisurely pace. It is generally recommended to offer one food group at a time, starting with the simpler foods and working up to the more complex. It is also a very good rule of thumb to offer only one new ingredient into the diet at a time, so that if vomiting or diarrhea or a rash follows the introduction of a given food, we’ll be better able to trace the offending foodstuff.

In my practice, and in keeping with generally-accepted nutrition guidelines, I’d recommend to my families:

4-6 months: introduce single cereals once a week, usually in the sequence of rice-oats-barley-wheat. (Since baby doesn’t know that there are sweets out there, we don’t need to hurry things up and start with cereals and fruits at this time-they’ll come soon enough.)

6-9 months: keep the cereals going, and add from the fruits and vegetables (and 100% fruit juices) category, again adding things slowly and one at a time. Now is a good time for some of those fruit-cereal combinations, but remember to add only one new ingredient at a time.

9-12 months: Add meats, fish, dairy, egg yolks (again slowly and one at a time). Some pediatricians may counsel their patients to leave shellfish until after 12 months, especially if there is a family history of allergy. Until 1 year of age, it is strongly recommended that breast milk or iron-fortified formula be given as the main beverage.

After the first birthday, things get much simpler. Whole cow’s milk is then adequate, since the rest of the diet can by now be providing the needed iron. Babies need the fats found in whole milk, and should stay on whole milk until their second birthday. It is also recommended that nuts (especially peanuts and peanut butter) be avoided until at least 24 months, and longer if there is a family history of nut allergies.

Dr. Tom, as he’s affectionately known by patients, has spent 20+ years in a top-notch and demanding pediatric practice outside of Boston, MA. Having in-depth training with Berry Brazelton on early childhood development, Dr. Tom is accessible, frank, and passionate about his work with children and their parents. Dr. Tom’s commitment to children has taken him to the third world, including recent trips to small villages in Honduras, bringing medical expertise and medicine to children in need. Dr. Tom was awarded the Children’s Hospital, Boston 2003 award “For Service to Pediatrics and the Community.” Dr. Tom is the father of six and a grandfather of one, lives in Concord, MA. and can be reached via www.AskDoctorTom.com.