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    Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.

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  • Nov. 5, 2008

    Infant feedings: Don't rush the transition

    By Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.

20 comments posted

In the span of the first 12 months of life, the changes an infant experiences in growth and development are extraordinary. It is exciting for everyone — infant, parents, grandparents, and extended family and friends.

Parents guide infants through the feeding transitions from exclusively breast milk and/or formula feedings to a diet of complementary foods. And feedings, like any other developmental milestone, invite advice, some in line with current recommendations, some not.

If it worked 10, 20 or 40 years ago, and we turned out OK, it is still good advice, right?

A large survey of mothers of infants was conducted recently to assess the feeding practices during the first year of life. I was surprised at some of the results — early solid food feedings were associated with decreased length of breast-feeding (both unfavorable), delay of nutrient dense foods and introduction of high sugar, fat, and low nutrient dense foods sooner.

As a parent, there is not a month that goes by that I don't receive a mailing or link to a Web site with infant feeding information. Beyond the colorful advertisements, product endorsements, and coupons, the information is generally appropriate. Does the "good information" get lost in packaging? Are parents getting the information but deferring to family and friends for "tried and true" advice (well intended but not necessarily ideal)?

Are parents too sleep-deprived or overwhelmed to retain the appropriate information? Are they so anxious to get through the first year that breast-feeding is dropped and feeding transition is sped up?

Glossy advertisements aside, here are highlights of appropriate feeding practices in an infant's first year:

  • Breast-feed.
  • If you unable to provide breast milk, use an iron-fortified formula for the full first year of life.
  • Do not provide solid foods before 4 months of life. No need to rush, they do not require another source of iron and zinc until 6 months.
  • First food — single grain, iron and zinc fortified cereal.
  • Second food — consider meat over vegetables and fruit. Meat is a better source of protein, iron, and zinc.
  • Feed single ingredient foods.
  • Feed your child every 2-4 hours; frequent, nutritious meals ensure varied and adequate nutrient intake.
  • Babies don't need juice.
  • A starting portion for solids, 1 tablespoon. Feed this and offer more until the baby turns its head away, pushes away, or gives a cue that the meal is complete.
  • Transition textures gradually after 8 months.
  • Avoid foods that are a choking risk.

While in the midst of parenting, you may be tired, anxious, and missing details. Feeding/meal time is a perfect time to sit, relax, enjoy, and reflect on all the remarkable moments that you and your baby are experiencing. Don't rush; it will go faster than you'd like it on its own.

20 comments posted

blog index

  • October 27, 2009 1:08 p.m.

    Monica, hopefully your pediatrician has already pointed out to you the frequency of vitamin D deficiency in premature babies, and has also advised you of the importance of substantial vitamin D supplementation for the nursing mother as well as her baby.

    - Russ

  • October 7, 2009 8:48 a.m.

    Monica, This is an excellent question and your thinking with starting solids somewhere between her actual and adjusted age is on track. Her developmental readiness for solids should be your 1st cue that she is ready. Is she sitting up independently or with some support? Are her neck muscles strong enough to hold her head up and does she watch you eat and drink? In other words, if she is on your lap or at the kitchen table with you, is she interested in the meal you are eating? If and when she does that, she is likely ready for solids. If her developmental readiness is after the 6 month mark, talk to your doctor about the need for additional iron, if she is not already on a multivitamin with iron supplement.

    - Katherine, your blog host

  • September 25, 2009 2:59 p.m.

    My daughter is 5 1/2 months old actual, and 3 months old adjusted (she was born at 29 weeks, 4 days). She is doing great and her weight is at the 50% mark for her adjusted age, and is 5% for her actual age, and her Ped is pleased. But should when should we feed her solids? (she only gets pumped breastmilk now). Yes, developmentally she is 3 months, but her gut and the enzymes in it have been breaking down breastmilk for well over 5 months. We were going to split the difference and feed her solids at 7+ months actual, 5 months adjusted, but I don't want to feed her solids too late either. Any RD's out there that would like to comment? It would be greatly appreciated! TIA!

    - Monica

  • July 16, 2009 10:35 a.m.

    my baby is 2 months old she was 3 1/2 weeks early and weighed 7lbs 9oz. she was growing quickly and i couldn't keep up with feeding her. she was taking a 6oz bottle then 2-3 hrs later another. i am a firm believer that if a child is hungry feed them. however, she was having major intestinal issues with so much formula. so i spoke with her dr and he said start her on sindle grain cereal. she went for her 2 month check up weighed 13lbs 13 oz grew 3 inches and was in the 76th percentile. he was very happy with her, so every child is different.

    - Jamie

  • July 8, 2009 1:54 p.m.

    My daughter is 11 mo old and she has an aversion to solid food. Even a slightly coarse spoonful induces a gag reflex and she ends up throwing it all up. She also resists drinking milk. She has been gaining weight okay, but still on the petite side. Any advice??

    - Kaveri

  • July 2, 2009 4:44 a.m.

    Confused - Nurse your baby for as long as you want. When people tell you to stop remind them that the World Health Organization recommends breastfeeding for at least two years. If it is working for you and your family why stop? I am going to nurse my son until he is at least 18 months old, hopefully we will make it to two years.

    - Cat

  • June 25, 2009 1:19 p.m.

    i am still breast feeding and my son is 16 months everyone says i should stop. Should i stop? they say he is to big now. He eats really good he loves pasta and cherrois. nOt to big on milk from a gallon. I work full time and have a husban, 11-and a 22 year old. and take care of a 3 story home , run my kids to practice or wher ever they need to go. I do not feel it gets in my way.

    - confused

  • June 24, 2009 11:06 p.m.

    Great advice, now I wish someone would relay this information to my mother and mother-in-law. They are putting pressure on me to start feeding my 2 month old solids so she doesn't get "too skinny". She's been breastfeeding and growing in the 50th percentile and my pediatrician is fine with her growth rate(we've only had one visit so far!)

    - Toni

  • June 21, 2009 11:55 p.m.

    Thank you soo much for this article! Everything I needed to know, My now 3 year old was given rice cereal at about 1 week and now has meny allergies to food...At the time I did not know any better. I now have a 5 month old and wanted to know exactly what you explained. Thank you ! P.S Hanna well said!

    - Amber

  • February 13, 2009 6:44 a.m.

    My daughter is nearing the end of her 6th month. I feed her breast milk, cereal, veggies and fruit. Expressing milk at work is a pain so that is why I only work 20 hours a week. This way I only disapear for about 15-20 minutes to express milk. I was hoping to start ramping my hours back up. At the meal that we feed her meat (I was considering lunch time), do we need to also feed her breast milk. If not, I'll increase my work time and leave her with my parents for lunch. If I do still need to give her milk when she eats meat, then I think I'll continue to only work 20 hours a week.

    - Ann P.

  • January 24, 2009 10:10 a.m.

    I think it's more important to follow your babys' cues then other peoples' advice... when your baby is ready for solids, she wil let you know. Every baby is different and every mother is different.

    - m

  • December 4, 2008 3:52 a.m.

    I started feeding my son solids at 6months and am still breastfeeding him at 9months. for solids he gets mostly vegitables and some fruits. Im confused about feeding meats b/c of the protein and his kidneys being able to process the complex amimal proteins. one of the reasons to delay cows milk is due to the proteins. why is it ok to give meat and not cows milk?

    - Stacy

  • November 17, 2008 8:13 a.m.

    I saw a talk show recently that said childhood food allergies might be caused (at least in some cases) by the early introduction of certain foods. For example, one guest's child had severe peanut allergies, and the parents said they had first given the child peanut butter at the age of 6 months. Would appreciate hearing your thoughts on this.

    - Janet

  • November 16, 2008 10:04 p.m.

    I am currently a mother of a 2 year old and a 5 month old. They both started rice cereal first, after 5 1/2 months. I believe that if your child is 'yelling' at you when you are eating it is a good indication that you should try cereals. However, milk (breast or bottle) should be their main staple of food for the first year. Everything else is just for introduction purposes.

    - Joni

  • November 15, 2008 11:10 a.m.

    I work in the infant room at a child care center. This article's suggestions are very similar to the state nutrition program that I have to follow, with the exception of introducing meats at 6 months. (We have to wait until 8 months.) I have read several articles relating to the introduction of cereals before 4 mo. and after 6 mo. and developing type 2 diabetes as an adult. Because I work with low income parents and children,(who have to really stretch their food dollar), I stress this part.

    - Julie

  • November 14, 2008 10:51 a.m.

    Thanks for this article! I agree whole-heartedly. Interesting about introducing meat before fruit/vegetables. Definitely makes sense though. I surely will not be introducing any foods before 4 months and not likely before 6 months either. The health of my baby is more valuable to me than simple convenience or more sleep for myself...Sure, many babies turn out "fine" w/foods introduced early. Keep in mind, "formula" in the 50s and earlier was home-made and was simply cow's milk, Karo syrup and water...Now just because those children turned out "fine" does not mean it was a healthy practice...Same with introducing foods early.

    - Hannah - Fellow RD and new mom.

  • November 11, 2008 2:03 p.m.

    Having had two 10 lb. babies (out of four) I strongly believe that feeding rules should always have the primary emphasis on the individual. Those two were voraciously hungry and fed differently - the first did not have early solid food and was always screaming with hunger. The last child got meat at five days and rice cereal at seven. All additions were carefully selected. Extreme perhaps but he was a happy baby and very healthy adult.

    - Great grandmother

  • November 11, 2008 1:33 p.m.

    It is so sad seeing a very young child (almost a baby) sitting in a high chair in a restaurant eating nothing but french fries. It's bad enough that school age kids & adults live on fast food, but babies. What a shame - to start a baby off in like with those kind of eating habits..

    - No name

  • November 10, 2008 11:36 a.m.

    My four month old nurses when she wants, not on schedule. I don't think any is good before 6 months.

    - christine

  • November 5, 2008 12:49 p.m.

    Feeding ecery 2-4 hours may put a mother in the hospital after a yr. In the world that we live in mothers work and have to manage everything. My daughter in law tried this waking my grandson up every 3 hrs to feed him. Now he is on the schedule and both mom and Dad are so tired I worry about their health. Really needed??

    - Sandy

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