Learning to eat is a gloriously messy rite of passage for parents and babies.
Babies grimace, dribble and rub as much of the starter fruits and veggies into their hair as they can.
Recommendations about what foods to start when have evolved over the past few years. There are fewer rules about which foods to introduce during the first year. Parents should be guided by developmental milestones and introducing babies to a wide variety of nutritious foods.
Starting solid foods is as much about development as it is about setting the foundation for good nutrition.
“It’s more about learning to eat,” said Dr. Shane Scott, a New Albany physician board certified in pediatrics and internal medicine.
For the first four months of life, breast milk and formula are what babies need to eat. There’s no truth that introducing solid foods earlier than four months helps babies stay full longer.
“Giving baby food early doesn’t help them sleep longer,” said Tupelo pediatrician Dr. Nikki Ivancic. “Babies are supposed to eat at night.”
Because the digestive tract hasn’t matured enough to handle solid food well, introducing cereal too early can backfire on parents looking for a little peace.
“Cereal can cause constipation, especially if it’s introduced too early,” Ivancic said. It can make them more fussy.”
If babies younger than four months seem like they are still hungry, it’s better for them to have more formula or breast milk, Ivancic said.
Pediatricians will sometimes recommend cereal in bottles for babies fighting reflux, but that’s more to help them keep food down as opposed to adding nutrition, said Tupelo pediatrian Dr. Eric Street.
When to start
Most babies are ready to start eating finely pureed Stage 1 foods after they reach 4 months and can hold their heads up and sit up when supported.
Traditionally, cereal mixed with breast milk or formula has been the first food, but it’s fine to start with finely pureed Stage 1 vegetables or fruits, too. Because cereal is fortified with iron, it can be a good choice for breast-fed infants who need to be supplemented.
“There’s no magic food,” Scott said.
Parents who want to put in the time and effort to prepare their own baby food from whole foods should be careful to prepare the fruits and vegetables without adding salt and seasonings and make sure they are pureed to the right consistency for the baby’s developmental stage, Street said.
The first feedings will be small, about a tablespoon of cereal with an ounce of breast milk, or a small jar of food once a day.
Babies have to learn how to take food from a spoon and move it to the back of their mouths. Some catch on more quickly than others. If the babies can’t seem to manage it, stop and try again in a few days.
Parents shouldn’t read too much into grimaces and spit ups, Scott said.
“They haven’t figured out how to get something that texture to the back of their throats,” Scott said. “They don’t know enough to know if they like it.”
New foods can be introduced one at a time every two to three days, to make it easier to identify the source of any possible allergic reactions.
Babies are really tuned into parents’ facial expressions, so parents need to make meal times fun and avoid letting their own bias toward certain foods influence the baby.
“You want to make sure they have happy associations,” Scott said.
Parents don’t need to worry about babies not eating enough baby food. Breast milk and formula will continue to provide the bulk of the nutrition they need.
It is important to introduce solid foods before nine months.
“There is a window where solid foods need to be introduced to avoid oral aversion,” Ivancic said.
As babies grow, they can handle food with more and more texture. Once they can pick an object up and bring it to their mouths, they can start soft finger foods. At this stage, parents should keep a sharp eye out for choking hazards.
“Even if they have teeth, they don’t really chew well,” Street said.
Allergenic foods like peanuts, eggs, fish and shellfish used to be off the menu for the first year because of concerns about early exposure setting children up for allergies. Those recommendations have been shelved.
“There’s not enough evidence to restrict them,” Street said.
Parents should still watch for choking hazards, introducing foods in forms babies can handle without choking.
“Now all these things can be introduced after six months when they are ready to start table food,” Ivancic said.
Peanut butter can be given in tiny dollops or stirred into yogurt.
“You don’t want to give them big globs,” Street said.
Scrambled eggs are a great choice for babies who are at the finger food stage, Ivancic said. Fish can be flaked into very small pieces. Both should be cooked without salt and seasonings for baby.
Babies with a history of eczema or an allergic reaction to food should be tested before introduction of peanut products, said Tupelo allergist Dr. Matt Oswalt. Those with strong family history of food allergies should talk with their pediatrician or allergist to see if testing is appropriate.
If high-risk babies test negative for peanuts, it’s recommended they begin early introduction of peanuts to reduce the risk of developing an allergy. Studies have shown a dramatic decrease in connection with early introduction of peanuts.
“Peanuts have been studied the most,” Oswalt said. “It isn’t clear if early introduction helps with other (allergenic) foods.
No use for juice
Last month, the American Academy of Pediatricians changed their recommendations, taking juice off the menu for infants.
“It has no real nutritional value, no benefit,” Street said. The juice just delivers extra calories that can compound problems with obesity and extra sugar that can contribute to cavities.
“We don’t need help in a negative direction,” Street said, noting that babies and toddlers don’t need soda or sweet tea either.
For toddlers and older children, juice should be treated more like a treat.
“Juice should be like dessert,” Street said. “They don’t have to have it every day.”