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Why Feeding Your Child With A Spoon Is Better For Her Development

Written by Jesse Hackell MD

messy face2

Growing up in the sixties, outer space was truly the final frontier. We greedily devoured all sorts of arcane facts about the nascent space program, from the rigors of pre-flight training to the seemingly more mundane details of how, exactly, one managed to eat and drink in the zero-gravity confines of outer space.

We knew that the astronauts drank Tang, which no self-respecting parent today would ever mistake for fresh-squeezed, locally sourced, organic and pesticide-free orange juice.

And astronaut foods were freeze-dried, and provided in pouches. When water was added to the pouches, the food was rehydrated and reconstituted, and the space explorers “ate” by sucking the resulting slurry out of the mouthpiece of the pouch.

Fast forward fifty years, and pouches aren’t just for astronauts any more. All sorts of fruits, vegetables and combinations thereof, in flavors which would certainly have thrilled early spacemen, are now seemingly the food deliver mechanism of choice for today’s on the move infants and toddlers.

No longer does feeding your baby on the go require a high chair, bib, bowl, spoon and yards of paper towels for clean-up.

Just pop off the top (don’t hand the top to the baby, although the caps are ingeniously designed to prevent choking should the little one happen to get hold of it and have it lodge in the airway), hand the pouch to your child, and–slurp–4 ounces of highest quality, organic produce goes down the hatch.

That’s progress, no? One prediction of the future made in the sixties actually coming true in the twenty-first century!

But I am not so sure that this new feeding mechanism actually represents progress for babies. They are born knowing how to suck nutrition out of a “container”–breast or bottle.

Progress in feeding, for an infant, comes not only in learning about new tastes and textures, but also in learning about new, more mature means of getting their comestibles out of the container and into their mouths.

These pouches (along with so called “sippy cups” with spouts) are really just bottles in disguise. (They are also a whole lot more expensive than either store-bought jars or homemade baby foods.) We do not generally recommend putting puréed foods in baby’s bottle, so why create a new bottle substitute?

Let me make a plea for a return to the older, admittedly messier, mealtime, with the baby sitting upright, wearing a bib, and being fed with a spoon. It will encourage the baby to learn new mouth movements and new positions for eating. And it will provide lots of opportunities for those adorable, messy face baby photographs!

Dr. Hackell is a founding member of Pomona Pediatrics PC, a division of Children’s and Women’s Physicians of Westchester. He practices in the lower Hudson River Valley just north of New York City.

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Starting Solids: The Old and the New and the Myths

Written by Kristen Stuppy MD

Many parents are excited yet apprehensive to start foods with their infants. So many questions, so many fears. So much food introduction guidance has changed in recent years, that what you did with your older kids might not be current. Change takes time, so not everyone agrees on the “new” rules. Talk to your own pediatrician to see their take on it all!

The older “rules” for starting foods were so confusing… different sources will vary on these rules.

  • don’t feed before 6 months is now ok to feed at 4 months if baby’s ready
  • don’t give nuts, eggs, and other “allergy” foods until ____ (2/3/5 years, varying by expert) is now it is okay to give allergy foods unless there is a family history of food allergy
  • don’t start more than one food every 3-5 days is now introducing multiple foods at one time is ok
  • start with rice, then add vegetables, then meat., wait until last for fruit is now begin with any foods, but try to make nutritious choices, such as meat which is high in iron and protein

Variations of this were plenty, depending on the provider’s preferences. No wonder there is so much confusion!!!!

New rules are much easier. I like easier.

  • Start new foods between 4 and 6 months, when your baby shows interest and is able to sit with minimal support and hold the head up.
  • Don’t give honey until 1 year of age.
  • Don’t give any textures your baby will choke on.

Done.

That’s it. Nothing fancy. Any foods in any order. Multiple new foods on the same day are okay. Common sense will hopefully guide types of foods. Nothing too salted. Try nutritious foods, not junk.

These minimal rules can make parents weary.

What about food allergies if foods are given too early?

Research does not support the thought that starting foods earlier lead to allergies. In fact, there is research to support that starting foods earlier might prevent food allergies. A full 180 degree change!

Pregnant women and breastfeeding mothers no longer have to avoid nuts or other allergy foods in most cases. If there is a close family member with a food allergy, it might still be beneficial to wait to introduce that food. Talk with your pediatrician in that case.

I admit that I was initially nervous about telling parents it was okay to give nut products in infancy. Not just the allergy aspect, but also choking risks. ~ Back to the no textures your baby will choke on… nuts are hard and round– two no-nos, peanut butter is thick and sticky– another choking risk.

Any of the more allergy prone foods should first be offered in small amounts at home. These foods include nuts, egg, and fish. Do this only if there is no one in your house who is allergic to that food.

Have diphenhydramine allergy syrup around just in case, but remember most kids are NOT allergic, and starting younger seems to prevent (not cause) allergy. In the case of nuts, since there is also a choking risk, you can try a food cooked with nuts or nut oil.

What about saving the fruit for last so they don’t get a sweet tooth?

Babies who have had breast milk have had sweet all along! Breast milk is very sweet, yet babies who are graduating to foods often love the new flavors and textures with foods.

Formula babies haven’t had the sweet milk, but they can still develop a healthy appreciation of flavors with addition of new foods. Saving fruit for last simply doesn’t seem to make a difference.

Adding fruits alone is not very nutritious though, so fruits should be added along with other more nutritious foods. The more colors on our plates, the healthier the meal probably is!

I thought they couldn’t have cow’s milk until after a year?

Cow’s milk is not a meal in itself (like breast milk or formula). It is missing many vitamins and minerals, so babies need to continue breast milk or formula until at least a year. Cow’s milk may lead to allergies or eczema, including formulas made with cow’s milk.

Milk products, such as cheese and yogurt can be given to babies as part of an otherwise well rounded diet as long as they don’t show any allergy risks to milk. Regardless of dairy intake, it is recommended for infants under 6 months to have 400 IU Vitamin D/day and those over 6 months to take 600 IU Vitamin D/day as a supplement.

I thought they should have cereal first…

Rice cereal has been the first food for generations, probably because grandma said so. There has never been any research supporting giving it first. With white rice and other “white” carbohydrates under attack now, it is no wonder the “rice first” rule is being debated. Despite being fortified with vitamins and iron, it is relatively nutrient poor, so choosing a meat or vegetable as first foods will offer more nutrition.

Shouldn’t we wait on meat?

Waiting on meat due to protein load was once recommended, but no longer felt to be needed. Pureed meats (preferably from your refrigerator… baby food meats are not very palatable!) are a great source of nutrition for baby! Some experts recommend meat as the first food due to its high nutritional value and low allergy risk.

How do we know what they’re allergic to if we start several new things at once?

First, most kids are not allergic.

Second, if they are allergic to a food, it is often days/weeks/months before the allergy is recognized. Waiting 3 days between food introduction simply doesn’t allow recognition unless it is hives or anaphylaxis, and there are a small number of foods that account for most of these reactions.

If your child has one of these reactions we can test to see what the offender was. This is recommended with severe allergies since people with one allergy might have other allergies, and identification for avoidance is important.

Allergy symptoms can be broad and often are not specific: dry skin (eczema), runny nose, hives, swelling of lips, difficulty breathing, vomiting, diarrhea, or blood in the stool. If you think your child is allergic to a food, discuss with your doctor. Severe symptoms (anaphylaxis) demand immediate attention!

How do we know when to start foods? I wanted to start to help baby sleep through the night, but I heard starting too soon increased obesity and diabetes.

When babies are able to sit with minimal support and hold their head up and when thye show interest in food by reaching for it they might be ready. They can wait until 6 months to start foods, but some studies show poor weight gain and nutritional balance as well as resistance to foods if started after 6 months.

In formula fed babies it has been shown to increase the risk of obesity at 3 years (6x!) if foods are started before 4 months of age. That risk is not seen in exclusively breast fed infants or those who begin foods after 4 months of age.

It is still an old wive’s tale that starting solids will help baby sleep through the night. Babies tend to sleep longer stretches at this age, so it is no wonder that this myth perpetuates. Start foods because you see signs that baby is ready, not because you want longer sleep patterns!

How do I know how much to feed my baby?

Babies will let you know when they are full by turning away, pursing their lips, spitting out food, or throwing foods. As they eat more food, they will need less breast milk or formula. In general a baby who is gaining weight normally will self regulate volumes.

What’s better: baby foods bought at the store or home made foods?

Marketing and ease of preparation has made pre-prepared foods for us all common place. It does not mean they are any better. They cost more than home made foods. I didn’t make baby foods when my kids were babies because I thought it would be too hard, but now I puree foods to put into recipes (my kids are like many who aren’t fans of veggies and I want to improve their nutrition). It really isn’t hard. You can take whatever you are cooking for your family and put it in a food processor or some blenders and with a little water to get it to a texture baby can eat: voila! Home made food. There are of course many baby food cook books and ideas of how to freeze meal-sized portions so you can make multiple meals at one sitting. There is help for parents who want to safely prepare baby food at home at the USDA website.

My baby only wants table foods. Is that okay? Don’t they need pureed foods first? He doesn’t have many teeth!

Pureed foods are what most babies start with due to the easy texture, but some babies quickly develop the ability to pick up small pieces of food with the pincher grasp (finger/thumb) and want to feed themselves. If they are able to get the food in their mouth, move it to the back safely with their tongue, and swallow without choking, they are ready to feed table foods… at least with some textures. Beware of chewy or hard foods as well as round foods ~ these all increase the risk of choking.

Most babies will be able to eat table foods between 9 and 12 months. They tend to not have molars until after 12 months, so they grind with their gums and use all their saliva to help break down food. They need foods broken into small enough pieces until they can bite off a safe bite themselves.

Don’t put the whole meal on their tray at once… they will shove it all in and choke! Put a few bites down at a time and let them swallow before putting more down. Rotate food groups to give them a balance, or feed the least favorite first when they are most hungry, saving the best for last!

This is a great time for parents, sitters, and other caregivers to take a refresher course on CPR in case baby does choke. Infants and young children are more likely to choke on foods and small objects, so it is always good to be prepared!

How much juice should my baby drink?

In general I think babies don’t need juice at all. They can practice drinking from a cup with water. Juice adds little nutritional value and a lot of sugar. Eating fruit and drinking water is preferable. If they do drink juice, it should be 100% fruit or vegetable juice, not a fruit flavored drink! No more than 4 ounces/day of fruit juice is recommended.

What about organic?

There is not enough evidence to recommend organic food, since the nutritional components of the foods are similar regardless of how they were farmed.

Organically grown foods do have lower pesticide residues than conventionally farmed produce, but it is debated if this is significant or not to overall health. Conventionally farmed produce have the pesticide levels monitored, and they fall within levels that are felt to be safe.

Organic farming rules also dictate no food additives or added hormones, which is also an area of study for health risks and benefits, but not enough data is available to give an educated opinion yet.

Organic farming is generally felt to be better for the environment, but the sustainability of that is questioned.

Many argue that the taste of organic foods is superior.

Organic farming might increase the risk of bacterial and fungal contamination or heavy metal content, so it is very important to wash fresh fruits and vegetables well prior to cutting or eating (as you should with all fresh foods).

For more information, see the USDA site.

A backyard garden can be inexpensive, organic, and a great way for your kids to learn about growing and preparing healthy foods!

 

Dr. Stuppy is a practicing pediatrician in Kansas. I feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.  

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Introduction to Solids – 6 Myths

Written by Natasha Burgert MD

 

At the 6-month check up, nearly all of my patient families want to talk about starting their babies on solid food. The conversations usually start like this…

“I go get all of Gerber stage 1 foods and then do all the greens, then the yellows, then the fruit. After she eats all of the stage 1 foods, then she goes on to stage 2, right?”

Or this…

“I have gone to the farmer’s market and bought all organic produce to make his baby food. I am following the [insert name here] recipe book that I got from a friend, and their baby is such a great eater. Do you think bulgar wheat or quinoa is better?”

Or this…

“I have already given some rice porridge with scrambled egg, and some broth with root vegetables. Can I start tofu now?”

As these real-life conversations demonstrate, the plan and expectation for introducing solid food to babies is different for every family. The food items that parents first feed children is influenced more by culture and generational upbringing, than by any scientific research or product marketing plan.

And, that’s OK! In fact, it’s wonderfully liberating news for parents who are really stressed out about first foods.

So, what are my general guidelines when it comes to starting infants on solid foods?

  • I encourage the families of healthy, normally-developing children* to start solids near or after 6 months of age.
  • I want parents to give babies a great variety of real food, in a safe way.
  • I think of pureed foods as practice and play to develop the skill of eating; nutrition is still from breast milk or formula.
  • I try to challenge my families to think outside of the Gerber-defined box and give babies interesting tastes, but no raw honey until after the first birthday.
  • That’s it. Go. Eat.

Wait a minute…. There has to be more. What about the rule about veggies first? Babies can’t have dairy, right? What about spicy stuff? They aren’t supposed to have strawberries or oranges, either!? My mom wanted to give her yogurt, and I told her “no.” Please don’t tell me she is right!?! And you have said nothing about rice cereal.

OK, so maybe there is a little bit more. But, likely not what you expect. When continuing the food conversation with families, some common myths creep to the surface.

It’s tIme to bust some common “starting solid food myths” … for good!

Myth #1: Rice cereal must be first.

Rice cereal has traditionally been the first food for babies in the United States for generations. But, why rice cereal? It is convenient – easy to obtain and easy to feed. Baby cereal is also fortified with iron and other nutrients. This promoted as a benefit for those infants who need some supplemental vitamins and minerals in their diet. Click here for information about iron recommendations for infants.

Giving rice cereal as a first food is under active debate. Specifically, Dr. Alan Greene is noted for starting a “White Out Now” movement. He encourages families to feed infants whole, natural first foods instead of rice cereal.

Dr. Greene discusses how the food industry has marketed and advertised to parents so heavily, the industry has created doubts in our minds regarding what is best to feed babies. We, as parents, start to believe that the healthy foods that we eat are not “good enough” for our babies.

Dr. Greene’s is also concerned that rice cereal primes infants to crave only carbohydrate-rich foods, contributing to the obesity epidemic. Other physicians have debated his theory,but I think his general concern for the quality of first foods is worth notice.

For the first few months of eating solids, an infant’s nutrition is still based upon the healthy calories given by breast milk and formula. That allows pureed foods of all forms to be first foods, as they have for centuries.

Expand beyond the rice cereal “default”. What about some pureed red meat as a first food? What about whole grain cereal, oatmeal, or a pureed fruit or veggie? Maybe, something you have in the fridge? (see #2)

Myth #2: Making baby food is hard (A.K.A. I don’t have time to make baby food.)

I hear this a lot; mainly from parents whose only experience with baby food making is observing a few moms with fancy baby-food makers, complicated recipe books, and bags of locally-sourced organic ingredients. This “all-in” approach to pureed food making can seem overwhelming and unreachable.

But, let me offer a suggestion…

In my clinical experience and personal experience, the earlier you get your baby eating the healthy meals that you provide your family (in a safe, modified way), the better they will eat as toddlers. So, I challenge all my families to try to make some first food… simply.

I do not talk about making baby food with the claims that it is of greater superiority to jarred baby food. There are some great commercial baby foods on the shelves today. But, babies have survived for many years before infant food was available in aisle 4B of the grocery store; and I think only offering what a food company can put in a jar is actually quite limiting to a baby’s early taste experiences.

To make baby food, you need soft foods (fruits, veggies, whole grains, meats), a little water, and a machine to puree. The machine could be a food mill, a blender/food processor, or a strong arm with a fork. Voila! Simple as that. I bet there is something in your kitchen right now that you could whip up for baby. Last night’s grilled chicken breast? Leftover green beans? Melon? Avocado?

As a working parent, I certainly bought prepared baby food. But, I made a lot of food for my infant, too. For me, it was easy, cheap, quick, and just part of the routine.

So, I challenge you to try to make some of your baby’s first tastes. Experiment and have fun! Decrease your family’s food cost, decrease shipping and packaging waste, and increase the palatable options for your baby to try.

Myth #3: Starting solids will help my baby sleep through the night.

Nope. It doesn’t.

Starting foods too early may actually have some negative consequence including obesity, food allergy, and decreased sleep!

Yikes!

Currently, it is recommended that first foods should be started around 6 months of age. This age is preferred for both the developmental ability of an infant to take food off a spoon, in addition to decreasing the risk of food-associated allergies and obesity.

Eating solid foods is a developmental skill, not a way to “fill baby up” to sleep longer. So don’t let this myth determine when you start solid food.

Myth #4: Greens, then yellows, then oranges.

There is no evidence to suggest that if you offer baby fruits first, she will never eat veggies. Regardless of what order food is introduced, kids (and adults!) will always prefer sweeter-tasting food items. Offer your baby foods of all colors of the rainbow, in no specific order.

Myth #5: My baby can’t really have the food that I am eating.

I think the origin of this myth/concern stems from parents knowing the kind of diet they have. Feeding our children is often an examination of what we, as parents, feed ourselves.

If a parent’s diet consists of fast food, takeout, and late-night snacks then the thought of feeding baby exactly what you eat is ridiculous. Agreed. But, if you are not willing to feed what you eat to your baby, maybe it’s time to think about the nutrition and healthy eating choices for the entire family.

If a family eats a healthy, well-rounded diet then the concept of offering baby what you eat is not such a scary idea. Make healthy, positive food choices, include your baby, and see the long-term benefits for the whole family.

Myth #6: Oh, no.. baby can’t have that.

Currently, for healthy babies who are not in a family with significant food intolerance and allergies, the only thing babies under the age of 12 months cannot have is raw honey. Honey may contain harmful botulism spores that could make small babies very ill.

That’s it.

The research regarding introducing solid foods is actively changing. This means the foods that have been traditionally restricted until later in toddlerhood (eggs, shellfish, peanut butter) are no longer on the “Do Not Have” list. In fact, some recent data suggests that delaying the introduction of high-allergy foods (shell fish, nuts, eggs) actually increases the risk of developing a food allergy.

Other studies do not show an increase in allergic disease by starting allergenic foods early. In addition, adding dairy sources (cheeses, yogurt) and animal proteins (meat, chicken, pork, fish) can be added at any time.

Expand the box. Think about your own diet, and what you want your kids to eat. What is acceptable for your family, your culture? Don’t let Gerber or Earth’s Best or [insert baby food company here] make those definitions for you.

Your baby just might surprise you… mine certainly did. Within a very short period of time, my 8-month old son’s favorite food was my husband’s recipe for chili (pureed) – extra spicy!

Have fun!

Dr. Burgert is a pediatrician. She works at Pediatrics Associates in Kansas City, MO .  She is a distance runner and enjoys road races around the city. She also has a passion for travel that will certainly lead to many memorable family vacations with her husband and two children. And, of course, she bleeds Husker red. Dr. Burgert regularly blogs at kckidsdoc.com

* Starting solid foods may be very different for children with a significant personal or family history of allergies, milk intolerance, or skin issues. It may be very different if a sibling had challenges with foods. It certainly will be unique if a child is not growing correctly. If your child has any of these issues, or you have specific concerns about your child, please ask your pediatrician for guidance.