ASK THE DOCTOR: Start feeding solids to infants between 4 and 6 months
By DR. JIM MITTERANDO
The Patriot LedgerQ My son is four months old and I don’t know what to do regarding feeding. My mother wants me to feed him solid foods. I read that I should wait to start solid foods until six months. He has no teeth yet, does that make a difference? Do you start with yellow or green vegetables first? What should I do?
A Parents often are uncertain about what foods their infant should eat or avoid and when can he eat different foods. Food allergies cause concern. Grandparents can add to the confusion by recommending solid foods too early.
Solid foods are commonly introduced sometime between four and six months of age. There is no rush to introduce solid foods. Up to six months of age, infants gets all their necessary nutrients from breast milk or formula. After 6 months, your child requires solid foods to provide extra nutrients.
Delaying solid foods until at least four months and possibly six months may decrease the risk of food allergies. Infants’ intestines are more porous than adults’ and may absorb undigested proteins that can cause an allergic reaction. As a result, different foods are introduced at different ages during the first year. The more allergenic foods are added later as your baby’s digestive system matures.
Before four months of age, infants have not developed enough to handle the complex task of chewing and swallowing solids. Some children are not ready to eats solids until five or six months.
You don’t have to wait until your baby gets his first teeth to introduce solids. Their hard gums are ready to deal with most solid foods. Teeth will be necessary later to tackle the hard vegetables and fruits as well as tougher meats.
The fortified infant rice cereal you find at the supermarket is a good place to start. Rice cereal has the lowest risk of causing an allergic reaction. Mix it with breast milk or formula to a fairly liquid consistency for the first feedings. The amount can be determined by his interest, ranging from less than a teaspoon per meal to two teaspoons. Your goal is to let your child enjoy solid foods rather than try to get a certain amount eaten. Pick one meal a day when your baby is hungry but not ravenous and irritable. Try cereal for a week. If he hasn’t gotten the hang of swallowing it, or seems uninterested, stop for two or three weeks, then try again.
If he wants more, increase the portion and try two daily meals. You can also try barley or oatmeal baby cereal, leaving three to five days between each new food so that any problems such as a rash or diarrhea can be traced to a particular food. Avoid wheat and mixed cereals until eight months of age to avoid allergies since wheat is more allergenic than other cereals. Cheerios contain wheat and should be avoided until eight months.
After several weeks, introduce cooked apple and pear purees or jars of sweet potatoes. Wait until six months of age to try other foods when the baby’s immune system and gastrointestinal tract will be ready for greater diversity.
At six months you can diversify with a variety of cooked fruits. Raw, mashed banana is usually popular. Low nitrate, cooked vegetables such as potatoes, peas, broccoli and yams are safe to home prepare starting at six months. For vegetables containing more nitrates, such as spinach, carrots, squash, string beans and beets, use only commercial baby food before eight months.
There is no reason to introduce yellow and orange vegetables before green as is commonly believed.
At eight months you can serve any home-cooked vegetable. Home-cooked vegetables tend to taste better than jarred foods. They can be frozen and rapidly thawed in the microwave. Raw avocado is a quick and easy food to mash and serve at this age. At eight months, kids can have unsweetened cereals such as Cheerios as well as rice, pasta and breads. They can also eat pureed meats and egg yolks.
Choking is always a concern but especially during the first year of life. Watch your baby at all times when he is eating because even ‘‘safe’’ foods can cause choking. Whole grapes and hot dogs should be cut into halves or quarters. Hard vegetables and fruits as well as meats should be cut into thin pieces and not served until nine months of age. Avoid popcorn and nuts at this age.
At nine months, he can have yogurt, beans, soy products and cheese and the harder raw fruits.
By the time he is nine to 12 months old, he will most likely be eating three meals and several snacks daily.
Avoid certain foods until one year including egg whites, cow’s milk, citrus fruits (oranges, grapefruits), strawberries, tomatoes, chocolate, nuts, peanut butter, fish and honey.
Most babies can eat a complete family diet without any exclusion by 12 to 15 months.
Food allergies that develop during infancy, unlike pollen and dust allergies that develop later, often don’t last a lifetime. Milk, soy and egg allergies, in particular, usually disappear during the toddler years. In contrast, peanut and nut allergies usually persist and do not disappear. If your child develops a rash to a food, he can try that food again several months later to see if the allergy has gone away.
Food intolerances such as diarrhea or vomiting are not allergic reactions. During the first year of life, dietary additions often will cause stool changes. If diarrhea persists, you may want to avoid the suspected food for several weeks and reintroduce it. If diarrhea recurs, then wait several months and reintroduce it. The same is true for foods that may cause vomiting.
Avoid fruit juices that tend to contain sugar and few nutrients. These ‘‘empty calories’’ fill up a child so that they eat less nutritious foods. Fruit juices also help to promote a sweet tooth. Water is a much better fluid to drink. Breast milk or formula are the only liquids needed during the first six months. A sippy cup of water can be added later, around 9 months. If you really want to give your child juice, then dilute it, and limit it to three or four ounces. Choose a juice with some nutritional value such as red grape or pineapple (apple juice is mostly sugar, and citrus fruits should not be given until 12 months).
It is good to establish healthy eating habits at a young age. Take advantage of an infant’s willingness to try a variety of foods and avoid getting into the habit of processed, highly salted foods. By doing this, the toddler years will be less of a struggle.
My favorite book for childhood nutrition, ‘‘Feeding Your Child For Lifelong Health,’’ by Susan Roberts is temporarily out of print but is available at some internet sites (Amazon.com) or you can send a $15 check to Dr. Susan Roberts, USDA Nutrition Center, Tufts University, 711Washington St, Boston 02111 to receive a copy. I highly recommend this book, many of my recommendations come from it. Another popular book is ‘‘Child of Mine: Feeding With Love and Good Sense,’’ by Ellyn Satter.
Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.
Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com
Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.
Copyright 2002 The Patriot Ledger
Transmitted Tuesday, December 17, 2002