Feeding our children is as much an art as it is a science. There may be many different methods, books, or suggestions that you will encounter, but ultimately each child is an individual who may not go “by the book”. The following bullet points can serve as a foundation upon which to build your food introduction routine as they are derived from the body of scientific evidence we currently have.
These recommendations can serve as guidelines, not hard and fast rules, to support you and help you avoid common pitfalls.
- Honey, whole milk, and foods that are choking hazards are the only foods to be avoided prior to one year old. Honey can be poisonous. Whole milk in large quantities can lead to anemia. Foods that cannot be mashed easily with your fingers or that are round or cylindrical are unsafe even after one year of age.
- Food should be introduced between four and six months of age. However, babies do not need anything but breast milk or formula until they are six months old. Waiting until six months avoids unnecessary work and allows babies time to become more receptive to foods with less gagging and tongue thrusting. Some six-month-old babies can even skip purees and begin with soft finger foods if they can sit upright, hold their head up well, and bring pieces of food to their mouth.
- It is not necessary to wait three days between food introductions to detect a food allergy. Allergic reactions can occur unpredictably even after many exposures to a certain food. Also, most allergic reactions will manifest within a few hours of ingestion. In addition, allergy tests can usually confirm any suspicion of food allergy.
- Early exposure to foods may reduce the risk of food allergies. The old recommendation to delay egg, fish, and foods containing peanut protein until after 1 year of age is not based on good science. In babies with severe eczema, allergy testing may be recommended before attempting certain foods such as peanuts; however, in most children preemptive testing is not necessary. Ask your doctor if you would like further guidance on this.
- The order of food introduction is not critical. Traditionally in the USA, many parents start with rice cereal and then other grains. However, there is no medical reason to proceed in a certain order. For example, in some cultures babies eat meat as a first food. Many experts support this idea as meat provides nutritional elements that cereal cannot.
- Consider ignoring your baby’s food preferences. They are quite fickle and sometimes need to taste a food more than 40 times before suddenly liking it. Similarly, they will suddenly reject a favorite food for several months only to like it again later on. Repeated introductions of varied, nutritious foods will yield better nutrition and eventually a broader palate.
- Do not soothe with food or drink. Consider using something else such as a toy, lovey, or an interactive distraction. Teaching a child that food is for comfort could lead to long-term bad habits and unhealthy ideas about food.
- After one year old, monitor for liquids intruding on solid food intake. If your baby is having five wet diaper per day, they are adequately hydrated. If they are thirsty, offer sips of water between meals from a cup. Limit juices to less than five total ounces per day diluted to 50% with water, juices are best regarded as a desert-like food.
- Eat together. Doing so will foster making your baby even more a part of the family routine. Babies are more likely to eat foods they see their family members eating. These are the foods already deliberately chosen to optimize the health and enjoyment of the entire family long term. Let’s bring the babies on board as soon as they are ready. Also, the regular family eating intervals help to foster self-regulation and reduce overeating.
The goals of solid food introduction are:
- Overall, to transition a baby from formula or breast milk to a predominantly solid food diet.
- By nine months, to have your baby consuming foods from all of the food groups at three-four meals per day with the rest of the family.
- By one year of age, to have them eating varied and nutritious solid foods from the family table at regular intervals and drinking no more than 24 ounces of whole milk per day.
Because infants begin their life on breast milk, parents often think that milk is essential for their child’s diet even beyond the first year of life. While milk is absolutely important for the first few months of life, once babies can start eating solids, the value of milk (breast, formula, or cow’s) quickly diminishes. Milk’s main purpose is to serve as an easy source of nutrition for our babies until they are ready for solid foods that offer a far greater diversity of nutrition.
By one year of age, the bulk of a child’s nutrition should come from solid foods. Ideally, babies should eat a well-balanced diet from all of the food groups. A one year old should be taking no more than 20 ounces of milk per day (transitioning from formula, if applicable). As long as they are eating an adequate diet of animal-source foods (such as meat, poultry, fish, eggs, and milk), a minimum of only seven ounces per day is recommended. Most organizations do not even specify a recommended lower limit of milk intake. Although milk does offer vitamin D and calcium, you can get plenty of vitamin D from the sun and all the calcium you need from meat, certain vegetables, soy, nuts, beans and other solid foods.
While there are many baby foods available at the supermarket, feel free to offer bite size portions of soft foods that the rest of the family is eating. Foods such as pastas, baked potatoes, soft meats, and steamed vegetables are all safe, nutritious, and tasty for babies to consume as soon as they can chew well.
The more flavors and textures children encounter early on, the less picky they will be later! So go ahead and give them a bite of your dinner. They are probably eyeing you as you eat it and wondering where their portion is! As long as you can mash a food between your pointer finger and thumb, a baby’s gums, even with no teeth, are powerful and can handle it. The sooner they are eating real foods, the sooner you can cook one meal and make your life easier. Ultimately, if it is nutritious for you, it is nutritious for them.
So how should you incorporate the solid foods into your current feeding schedule? The truth is there is no singular best way, but here is one method. Pick one meal to begin with such as the feeding closest to breakfast time. Before giving formula or breast milk, start by allowing your baby to eat as much solid food as they will take. When they will no longer take any more solids, top them off with formula or breast milk until they are full. Once they seem to have the hang of one meal, add a second around lunchtime, and soon thereafter a third around dinnertime. Some babies will need an afternoon or morning snack, which you can make like a fourth small meal if necessary. It is that simple!
It is true that technology and junk foods are playing their role in these problems. However, bad eating habits, some of which start at a very young age are as much if not more to blame. Only families can teach children the best way to eat. There are several pitfall scenarios that we frequently see working against families.
- picky eaters
- portable food
- poor transitions
- poor shopping
You are in charge of quality, they are in charge of quantity. Almost all children at some point could be characterized as a “picky eater”. What governs the consequences of this phenomenon is parent dependent. With good intentions, some parents become afraid that their child will not eat enough calories and start giving their “favorite” foods, which typically are not the healthiest ones on the menu. Two dynamics naturally ensue. First, the quality of the diet deteriorates as the child “holds out” for their favorites. Second, the child becomes a tyrant of the table using food demands and refusals to control the adults in their life. The consequences are poor quality of nutrition without any improvement in calorie quantity.
Our recommendations will hopefully keep you out of this “trap”:
- Trust your child to determine calorie quantity. Their “calorie counter” is extremely accurate and reliable. Children keep count on a weekly basis, sometimes eating hardly anything at all for several days then making up the deficit a few days later. If you doubt their “counter” is working, then come in for a weight check. A child’s growth controls their appetite, not the other way around. Your kids will grow in spurts controlled by their hormones and appetite will follow accordingly.
- Maintain diet quality by continually and repeatedly presenting a wide variety of nutritious foods. Their brains are not wired like ours. Research has shown that they may decide a hated food is suddenly their favorite food as late as the 41st serving! We see parents compromising on quality more than we see kids falling short on quantity.
- Do not let your child perceive that you know what their favorite foods are. Offer such foods as you would offer any other.
- Try not to let your child “order off the menu” or turn you into a “short order cook”. Just say simply, “what’s for dinner is what’s for dinner.”
Portable food is food or drink that is consumed away from the table. Portable food has several consequences. First, children fill up on food or liquid between meals if they are allowed to tote a bottle, sippy cup, or bag of chips around the house. Second, such food or drink is usually not nutritious and edges out better foods. Third, we give children food when they are restless, scared, bored, upset, or crying to get them to behave or let them carry a sippy cup like a “lovie”. If we teach our children to use food for comfort, that addiction can possibly persist through a lifetime leading to obesity and poor nutrition. Portable foods, especially bottles, sippy cups, and food used to induce sleep can cause cavities.
Our recommendations will hopefully keep you out of this “trap”:
- Introduce an open faced cup at 6-8 months old. This act alone will force liquids to be kept at the table because no one will allow a child to toddle through the house with an open cup in their hand.
- Wean straight to the cup by one year old. Skip the sippy cup all together. A sippy cup is a hard-nippled bottle and is just as portable. It also can become a “lovie”.
- Eat and drink only at the table on the family schedule. This prevents grazing between meals or snack times and keeps food at the table.
- Try to use other distractions such as toys instead of a baggie of Goldfish when children are fussing to help them calm down.
- Do not feed your child to sleep and definitely do not let them sleep with food or drink. They will continue to “need” food to go to sleep every time they wake up instead of just rolling over and going back to sleep. Also, they might get cavities.
Poor transitions from milk to baby food, to finger foods, to table foods are sometimes to blame for a poor diet. First, children sometimes refuse to give up liquids. They may drink well over 30 ounces of milk a day and refuse solids. Second, babies keep eating baby foods and are missing out on the more varied textures, flavors, and nutrition of the family meals causing added expense, inconvenience, and delay of diet advancement.
Here are some recommendations that will hopefully keep you out of this “trap”:
- Begin mealtime by first offering what you are trying to transition to until your baby is full of it before you offer what you are trying to transition from. For example, if your child fills up on table foods, they are not likely to take as much formula.
- Use the open faced cup to help decrease the amount of milk consumed. Most babies will take less from the cup than from a bottle or sippy cup at a sitting.
- Offer foods at the table on the family schedule without grazing between meals so that your baby will actually be hungry when sitting down to eat and therefore more likely to receive the new food.
- Let us know if you think your child has particular difficulty with certain textures. We might be able to help move things along.
Poor shopping involves bringing things into the house that lead to trouble. If the food is in the house, your baby will find a way to get you to give it to them. If it is not good for them, then it is likely that it is not good for Mom and Dad either.
Our recommendations will hopefully keep you out of this “trap”:
- Go “out” for junk food. It is an important part of our eating experience to eat delicious junk food. Eating out for junk food will keep the food out of your home where moderation is more likely to go the way of the dinosaurs. In addition, eating out is expensive and therefore less likely to become frequent. Furthermore, eating out is a great excuse for the family to have fun together.
- Avoid purchasing foods packaged for portability.
- Purchase a wide variety of nutritious foods from all food groups.
Risk factors for children developing a peanut allergy include:
- a history of eczema
- a history of peanut allergies in the family
- the presence of a known egg allergy
- severe eczema as a baby
New recommendations for first exposure to peanuts
The timing of first exposure to peanuts probably influences whether an allergy will develop or not. In countries where peanuts were recommended to be delayed until three years of age, the rate of peanut allergies was double compared to other countries where no such recommendation existed. Further, the Learning Early about Peanut Allergy (LEAP) trial showed a benefit to introducing peanuts between 4 to 11 months of age.
In 2000, the American Academy of Pediatrics (AAP) had previously recommended to delay high-risk foods such as peanuts until certain ages — three years of age in the case of peanuts, tree nuts and fish. However, evidence to the contrary has now led the AAP to reverse this recommendation.
In the majority of the population, early introduction to certain foods is helpful to reduce the risk of developing an allergy to them. However, in children with severe eczema or having a known egg allergy, it is prudent to consult an allergy specialist prior to introducing high-risk foods such as peanuts and tree nuts.
How to introduce your child to peanuts
There are a number of commonly used methods to introduce peanuts to babies who are tolerating solid foods.
- Mix 2 teaspoons of peanut butter with hot water until an easy-to-swallow mixture is created. Allow the puree to cool before serving.
- Mix 2 teaspoons of peanut butter powder with infant cereal, yogurt, or applesauce.
- If your child is able to eat puffed foods, introduce a peanut-containing snack.
The very first time you serve peanuts, allow your baby to eat a small spoonful of food and then wait ten minutes. If no reaction occurs, proceed to feed the rest of the meal and observe the baby for two hours after the meal. If at any point a reaction such as vomiting, a rash, or breathing issues occur, call your pediatrician for advice or seek emergency medical care.
It’s important to note that whole peanuts and undiluted peanut butter can pose choking hazards to infants and should be avoided.