Introduction 
Birth to Six Months 
Six to Nine Months 
Nine to Twelve Months 
Conclusion 
                       
INFANT FEEDING GUIDELINES  
 


  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.

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BIRTH TO SIX 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 six months of age.  Solid foods may decrease the baby's intake of the nutritionally preferable
breast milk or formula.  They may alter the absorption of nutrients such as iron from the intestinal tract.  They may increase the risk for potentially
serious allergic reactions. They may cause problems with constipation, diarrhea or intestinal gas.  They are messy, increase your laundry volume, and
are inconvenient to purchase, drag home and store, so give yourselves abreak and hold off until six months! We recognize that some babies may be ready
for solid food before six months, just as some may not be ready until  later. If you decide to institute feeding earlier please follow the guidlines in
the next section. Under no circumstances should you begin before four months.

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SIX TO NINE MONTHS

  Your infant should not receive anything other than breast milk or formula for at least the first six months.  Most experts agree that it is in your baby's best
interest to wait until that time because breast milk and/or formula are nutritionally superior for the  first six months of life.  If you choose to begin solids
prior to six months of age, you should proceed slowly, with small quantities of a  limited number of foods. There is no nutritional need for solid foods until at
least six 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.  Stay away from "mixed" cereals as they
generally contain wheat.  Cereal should always be introduced with a spoon, not mixed into bottle feedings. 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, fruit and vegetable for lunch, and cereal and vegetable for 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. In general we do not recommend juice at
all at any age but if you decide to give it we recommend that it be given only in a cup, and that it be diluted and in small quantities. 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 about 7 or 8 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:     


  Green vegetables.     
  Other fruits and vegetables, including fruit and vegetable combinations and "second stage" foods.     
  Dairy products such as yogurt and cottage cheese (but not actual milk). 
  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. 
  "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. 
  Infant pretzels, biscuits, etc.  Be careful because these often contain milk products, eggs, and wheat, all of which are potentially allergenic. 
  
The following foods should be avoided until at least nine months of age: citrus, strawberries, corn, tomatoes, peanutbutter, eggs, chocolate, and cow's milk.  
Honey should be avoided until twelve months of age because of the danger of botulism.   Please let your baby guide you in determining quantities.  As long as
you are giving the types of foods outlined above (and not puddings,  desserts, etc.), it is really impossible for you to overfeed your baby. Try to give solid
foods first and then follow with breast-milk or a  bottle.  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. Peanut products, nuts, and 
shellfish should be avoided entirely for at least the first two years.   

 
              
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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.  It is perfectly acceptable for them to continue on baby foods well into the second year of life if they so desire.

  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 nine months of age, but it should not replace formula or breast milk.  Cow's milk is not 
adequate nutrition for an infant under twelve 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.

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. 

RELAX AND ENJOY YOUR BABY!!!!

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