Feeding Guide for the First Year

Making appropriate food choices for your baby during the first year of life is very important. More growth occurs during the first year than at any other time in your child's life. It is important to feed your baby a variety of healthy foods at the proper time. Starting good eating habits at this early stage will help set healthy eating patterns for life.

Recommended feeding guide for the first year:

Do not give solid foods unless your child's physician advises you to do so. Solid foods should not be started before 4 months of age because:

breast milk or formula provides your baby all the nutrients that are needed to grow. your baby is not physically developed enough to eat solid food from a spoon. starting your baby on solid food too early increases the chance that he/she may develop a food allergy. feeding your baby solid food too early may lead to overfeeding and being overweight.

The American Academy of Pediatrics recommends that all infants, children, and adolescents take in enough vitamin D through supplements, formula, or cow's milk to prevent complications from deficiency of this vitamin. Your baby's physician can recommend the proper type and amount of vitamin D supplement for your baby.

Consider the following feeding tips for your child:

When starting solid foods, give your baby one new food at a time - not mixtures (such as cereal and fruit or meat dinners). Give the new food for five to seven days before adding another new food. This way you can tell what foods your baby may be allergic to or cannot tolerate. Egg whites are more likely than egg yolks to cause an allergic reaction. Most physicians recommend that you wait until after one year to introduce whole eggs. Begin with small amounts of new solid foods - a teaspoon at first and slowly increase to a tablespoon. Begin with dry infant rice cereal first, mixed as directed, followed by vegetables, fruits, and then meats.

Do not use salt or sugar when making homemade infant foods. Canned foods may contain large amounts of salt and sugar and should not be used for baby food. Always wash and peel fruits and vegetables and remove seeds or pits. Take special care with fruits and vegetables that come into contact with the ground. They may contain botulism spores that cause food poisoning. Infant cereals with iron should be given to your infant until your infant is 18 months old. Cow's milk should not be added to the diet until your infant is 1-year-old. Cow's milk does not provide the proper nutrients for your baby. Fruit juice (100 percent juice, without added sugar) can be given when your baby is able to drink from a cup (around 6 months or older). Feed all food with a spoon. Your baby needs to learn to eat from a spoon. Do not use an infant feeder. Only formula and water should go into the bottle. Avoid honey in any form for your child's first year, as it can cause food poisoning. Do not put your baby in bed with a bottle propped in his/her mouth. Propping a bottle has been linked to an increased risk of ear infections. Once your baby's teeth are present, propping the bottle can also cause tooth decay. There is also a risk of choking. Help your baby to give up the bottle by his/her first birthday. Avoid the "clean plate syndrome." Forcing your child to eat all the food on his/her plate even when he/she is not hungry is not a good habit. It teaches your child to eat just because the food is there, not because he/she is hungry. Expect a smaller and pickier appetite as the baby's growth rate slows around 1 year of age. Infants and young children should not eat hot dogs, nuts, seeds, round candies, popcorn, hard, raw fruits and vegetables, grapes, or peanut butter. These foods are not safe and may cause your child to choke. Most physicians suggest these foods be saved until after your child is 3 or 4 years of age. Always watch a young child while he/she is eating. Insist that the child sit down to eat or drink. Healthy infants usually require little or no extra water, except in very hot weather. When solid food is first fed to your baby, extra water is often needed. Do not limit your baby's food choices to the ones you like. Offering a wide variety of foods early will pave the way for good eating habits later. Fat and cholesterol should not be restricted in the diets of very young children, unless advised to by your child's physician. Children need calories, fat, and

cholesterol for the development of their brains and nervous systems, and for general growth.

Feeding Guide for the First Year (4 to 8 Months)

Item 4 to 6 Months 7 Months 8 Months 3 to 5 feedings per day or 30 to 32 ounces per day 5 to 8tbs. single grain cereal mixed with formula 2 to 3tbs., strained or soft mashed/2 times per day 2 to 3tbs., strained, mashed, soft/2 times per day

3 to 5 feedings per Breastfeeding or 4 to 6 feedings per day or day or 30 to 32 Formula 28 to 32 ounces per day ounces per day Gradually from 1 tbs. to 3 Dry Infant to 5 tbs. single grain iron Cereal with Iron fortified cereal mixed with formula Fruits At 6 months, 1 to 2 tbs., plain, strained/1 to 2 times per day At 6 months, 1 to 2 tbs., plain, strained/1 to 2 times per day 3 to 5 tbs. single grain iron fortified cereal mixed with formula 2 to 3 tbs., plain, strained/2 times per day 2 to 3tbs., plain, strained/2 times per day

Vegetables

Meats and Protein Foods Juices, Vitamin C Fortified Snacks

1 to 2 tbs., 1 to 2 tbs., strained/2 strained/2 times per times per day day 2 to 4 oz. from a cup arrowroot cookies, toast, crackers Make first cereal feedings Start finger foods very soupy and thicken and cup. slowly. 2 to 4 oz. from a cup arrowroot cookies, toast, crackers, plain yogurt Formula intake decreases; solid foods in diet increase.

Development

Feeding Guide for the First Year (9 to 12 Months)

Item 9 Months 10 to 12 Months 3 to 4 feedings per day or 24 to 30 ounces per day

Breastfeeding or 3 to 5 feedings per day or 30 Formula to 32 ounces per day

Dry Infant 5 to 8tbs. any variety mixed Cereal with Iron with formula Fruits Vegetables Meats and Protein Foods 2 to 4 tbs., strained or soft mashed/2 times per day

5 to 8 tbs. any variety mixed with formula per day 2 to 4 tbs., mashed or strained, cooked/2 times per day

2 to 4 tbs., mashed, soft, bite- 2 to 4 tbs., mashed, soft, bite-sized sized pieces/2 times per day pieces/2 times per day 2 to 3 tbs. of tender, chopped/2 times per day 2 to 3 tbs., finely chopped, table meats, fish without bones, mild cheese/2 times per day 2 to 6 oz. from a cup 1/4 - 1/2 cup mashed potatoes, macaroni, spaghetti, bread/2 times per day arrowroot cookies, assorted finger foods, cookies, toast, crackers, plain yogurt, cooked green beans Eating more table foods. Make sure diet has good variety. arrowroot cookies, assorted finger foods, cookies, toast, crackers, plain yogurt, cooked green beans, cottage cheese, ice cream, pudding, dry cereal Baby may change to table food. Baby will feed himself/ herself and use a spoon and cup.

Juices, Vitamin 2 to 6 oz. from a cup C Fortified Starches

Snacks

Development

Introducing Solid Foods to Infants

by J. Anderson 1 (8/08)

Quick Facts...

Mother's milk or an iron-fortified formula supplies all the nutrients a baby needs during the first six months. An infant's developmental readiness should determine when to feed solid foods. Introduce single-ingredient foods one at a time at weekly intervals. Avoid sweetened foods because they can promote tooth decay and may cause a preference for sweets.

The introduction of semisolid and solid foods to an infant's diet has changed since 1920, when these foods were seldom offered before 12 months. During the 1960s and 1970s, solid foods often were fed to infants in the first three months and viewed as a milestone achievement. Many people also believe that feeding solid foods (such as cereal) before four months will make an infant sleep through the night. This is not true.

Many pediatric health care professionals were concerned that an early introduction of solid foods increases the risk of overfeeding and food allergies. An infant's developmental readiness should determine when to feed semisolid foods. In fact, breast milk or iron-fortified formula supplies all the nutrition an infant needs in the first few months.

When to Start
The child's age, appetite and growth rate are factors that help determine when to feed solid foods. Before feeding solid foods, the baby should be able to:

swallow and digest solid foods, sit with support and have neck and head control, and close their lips over a spoon.

Semisolid foods and juices are a significant change and should not be started until four to six months. This age usually coincides with the neuro-muscular development necessary to eat solid foods. Introduce single-ingredient foods one at a time at weekly intervals. This process helps identify any food sensitivities the child might have. The sequence of new foods is not critical, but rice cereal mixed with breastmilk or formula is a good first choice. Add vegetables, fruits and meats to the infant's diet one at a time. Serving mixed foods is not recommended in the beginning. (See Table 1.) Food can be homemade or commercially prepared, depending on the mother's needs. Choose plain, strained fruit such as applesauce, peaches or mashed ripe bananas. Do not offer fruit desserts that contain unnecessary sugar. They provide unneeded calories and may cause a preference for sweets as the child gets older. Introduce juices when your baby learns to drink from a cup, around six to nine months. Dilute adult juices half and half with water or strain them before giving to a baby. Avoid sweet drinks; they can promote tooth decay. To make baby food, boil the vegetables and fruits until tender. Cool. Blend until there are no lumps. If it is too thick, add breast milk, baby formula or a little water. Remember:

Begin with single-ingredient foods (such as rice cereal). Wait five days between new foods. Feed the baby when he or she is hungry, but do not overfeed. Make meal time a happy time. Never force your child to finish bottles or food. This can cause the baby to ignore what his or her body says and may lead to poor eating habits later. Watch for cues from your baby.

Starting Solids

Offer new food when your baby is in a good mood, not too tired and not too hungry. Serve solids after the baby has had a little breast milk or formula. Hold the baby on your lap or use an infant seat or feeding chair if the baby can sit. Use a baby spoon and place a small amount (about 1/2 teaspoon) of food on the baby's tongue. Give the baby time to learn to swallow these foods and get used to the new tastes. Never use a bottle or other feeding device for semisolid food. Do not feed baby directly from the jar; use a clean dish. Heat only the amount baby will eat and throw leftovers away. Make meal time fun for your infant.

Table 1: Calendar for feeding your baby for the first year of life.
Foods Birth 1 2 3 4 5 6 7 8 9 10 11 12 months Start whole cow's milk from cup. Mixed grain cereals. Noodles, rice. Bread and toast strips. Breast milk or Breast milk iron-fortified or formula formula Cereals and grain products Continue breast milk or iron fortified formula Iron-fortified plain Teething infant cereal (no fruit biscuits. flavor or mixed grains). Start with rice, then oatmeal or barley. Strained, single vegetables

Vegetables

Cooked vegetables, mashed or chopped.

Sliced cooked vegetables for finger-feeding.

Fruit & fruit juices

Strained, single fruits.

Unsweetened Cooked, canned, Sliced soft fruit for fruit juices or soft fresh finger feeding. fruits, mashed or chopped. Same foods, chopped or mashed. Cottage cheese, mashed egg yolk. Same foods, bitesized pieces for finger feeding. Creamy peanut butter. Egg white. Tender, flaked boneless fish.

Meat and other protein foods

Strained single meats. Pureed dried beans, peas. Plain yogurt.

Egg white and fish

SPECIAL NOTE: Some foods may cause choking. Because of this, avoid raw carrots, nuts, seeds, raisins, grapes, popcorn and pieces of hot dogs during baby's first year.

Solid foods: How to get your baby started

Solid foods are a big step for a baby. Find out when and how to make the transition from breast milk or formula to solid foods.
By Mayo Clinic staff Does your baby suddenly seem interested in what you're eating? Does your baby open his or her mouth if you offer a spoon? It might be time to start introducing solid foods.

Is your baby ready for solid foods?

Breast milk or formula is the only food your newborn needs. Within four to six months, however, your baby will begin to develop the coordination to move solid food from the front of the mouth to the back for swallowing. At the same time, your baby's head control will improve and he or she will learn to sit with support essential skills for eating solid foods. Most babies are ready to begin eating solid foods as a complement to breast-feeding or formula-feeding between ages 4 months and 6 months. If you're not sure whether your baby is ready, ask yourself these questions:

Can your baby hold his or her head in a steady, upright position? Can your baby sit with support? Is your baby interested in what you're eating?

If you answer yes to these questions and you have the OK from your baby's doctor or dietitian, you can begin supplementing your baby's liquid diet.

What to serve when

Continue feeding your baby breast milk or formula as usual. Then:

Start with baby cereal. Mix 1 tablespoon (15 milliliters) of a single-grain, ironfortified baby cereal with 4 to 5 tablespoons (60 to 75 milliliters) of breast milk or formula. Many parents start with rice cereal. Even if the cereal barely thickens the liquid, resist the temptation to serve it from a bottle. Instead, help your baby sit upright and offer the cereal with a small spoon once or twice a day. Once your baby gets the hang of swallowing runny cereal, mix it with less liquid. For variety, you might offer single-grain oatmeal or barley cereals. Keep in mind that some babies eat cereal with gusto right from the start. Others are less enthusiastic. Be patient and keep trying. Add pureed meat, vegetables and fruits. Once your baby masters cereal, gradually introduce pureed meat, vegetables and fruits. Offer single-ingredient foods at first, and wait three to five days between each new food. If your baby has a reaction to a particular food such as diarrhea, rash or vomiting you'll know the culprit.

Offer finely chopped finger foods. By ages 8 months to 10 months, most babies can handle small portions of finely chopped finger foods, such as soft fruits, wellcooked pasta, cheese, graham crackers and ground meat. As your baby approaches his or her first birthday, mashed or chopped versions of whatever the rest of the family is eating will become your baby's main fare. Continue to offer breast milk or formula with and between meals.

To help prevent food allergies, parents were once told to avoid feeding young children eggs, fish and peanut butter. Today, however, researchers say there's no convincing evidence that avoiding these foods during early childhood will help prevent food allergies. Still, it's a good idea to check with your baby's doctor or dietitian if any close relatives have a food allergy. You may consider giving your child his or her first taste of a highly allergenic food at home rather than at a restaurant with an oral antihistamine available, just in case.

A Typical Immunization Schedule

What is a typical immunization schedule? Do all doctors follow the same schedule? The schedule is simply an indication of the kinds of immunization that your child will be getting and roughly around what age. To know more about it, read on. What is a typical immunization schedule

Age Birth 1 to 2 months 2 months 3 months 4 months 6 to 18 months 12 to 18 months 3 to 5 years 11 to 12 years 14 to 16 years

DTP

Td

OPV or TOPV

TB test X*

MMR

HIB

HBV X* X**

X X X

X X X*

X X X X** X X X***

X X****

*Only in high-risk areas **Infants must be vaccinated at birth, 1 month, and at 6 months, if their

mothers test positive for HBV ***In cases where the first dose is not given at birth ****If the child is vaccinated against measles at the time of school admission, it is not normally repeated Key to Table: DTP - Diphtheria, Tetanus, Pertussis HBV - Hepatitis B vaccine HIB - Haemophilus Influenzae B MMR - Measles, Mumps, Rubella OPV - Oral Polio Vaccine TB - Tuberculosis

Do all doctors follow the same schedule Absolutely not. The schedule provided above is simply an indication of the kinds of immunization that your child will be getting and roughly around what age. Most doctors follow their own schedules, so you should consult your doctor on his preferred schedule of immunization. You will be surprised to know that doctors even in the same hospital sometimes follow different schedules.