It has been well established that breast-feeding is the ideal way to feed young infants. The nutritional value of breast milk is perfect for the growing baby – with the exception of Vitamin D, that needs to be supplemented as long as breast-feeding continues. Babies should be started on 400 IU Vitamin D daily, either in the form of highly concentrated drops (1 drop contains 400 IU and care must be taken to not overdose or have older children have access to the drops) or in the from of Di-Vi-Sol or Tri-Vi-Sol (1 ml contains 400 IU).
Mothers should take between 1000 and 2000 IU Vitamin D daily as long as they breastfeed their baby. Many mothers take maternity multi-vitamins like Materna® that contain 400 IU and should take an additional 1000 IU of Vitamin D daily as long as breastfeeding continues.
Difficulties with breastfeeding are not uncommon and are often significantly decreased with expert professional help. Mothers in our office have been helped for decades by the excellent assistance given to them and their babies by Anne-Marie Desjardins (Pager: 416-295-8441). Anne-Marie can be contacted in advance or whenever problems arise. She visits babies and their mothers in the convenience of their home.
Sometimes – despite the best intentions, efforts, and assistance, breast-feeding does not work. Fortunately, formulas today are excellent and babies raised on formula do extremely well. If breast-feeding does not work, there is no need to worry. All will be well!
In order to prevent iron deficiency, foods with iron (such as iron-fortified cereals) are recommended as the baby’s first solids. While we do recommend that you follow the Infant Feeding recommendations of the CPS (Canadian Pediatric Society) for the introduction of solids into the baby’s diet, we feel comfortable to suggest that solids may be introduced between four and six months rather than only after six months. Babies are ready for the introduction of solids once they are able to sit up in their infant chair without much support and have good control of their neck muscles.
Please note that the amount of food varies greatly from infant to infant and it does not make sense to provide guidelines how much a baby “should” eat. Use common sense and your intuition to interpret the cues the baby will give with regards to satiation and hunger.
Some babies eat a lot and gain weight rapidly. It does not make any sense to put babies on a diet or to worry about their weight gain in the first year of life. This is not the basis for being over-weight later but a sign of a healthy thriving infant.
Similarly, following infants and children on growth charts is very helpful when it comes to making sure that they grow parallel to their own percentile, but it makes little sense to compare today’s children to the comparison groups used to construct these charts or to compare different children with each other.
Infants, as a general rule, should double their birth-weight by 6 months, triple a at a year, quadruple by two years (and at seven years, they should weigh about seven times their birth-weight).
We generally recommend starting with the least allergenic foods (rice cereal), followed by pureed vegetables and fruits (carrots, bananas, squash, sweet potatoes, peaches, pears), mixed cereals and meat (veal, lamb, beef, poultry). If babies suffer from constipation, increasing fruit in the diet is helpful. It is best to start with small amounts and to gradually increase the volume as tolerated and communicated by the baby. Traditionally children were started on vegetables before fruit, and yellow vegetables before green ones. The order in which foods are introduced is not of importance and you should feel comfortable with being flexible. You may introduce one new kind of food every two to four days. Small amounts of fruit juice can be offered in a cup – avoid juice in a bottle. In Europe, infants are started on meets and vegetables at four months as their first solids.
Concerns about inducing allergies by introducing food early have led to recommendations to defer the introduction of highly allergenic foods until later. Recent research and experience suggest that this approach is futile and might even increase the frequency and severity of allergies in children. Hence, older recommendations to defer the introduction of foods do not reduce problems with allergies but increase the incidence of allergies.
- Babies may have whole eggs (egg yolk and egg whites) at 6 months.
- Babies may be switched from breast/formula to Homo milk at 9-12 months and to 2% milk at 2 years.
- Peanut butter can be introduced earlier than the AAP recommendation of 3 years suggests. We recommend first contact with peanut protein at around 7-8 months. Apply a small amount to the skin the first day and observe for a reaction. If this is tolerated, apply a small amount around the lips. The next day a small amount may be given by mouth. If this is tolerated, a small amount can be ingested. Be careful about choking – peanut butter has a consistency that makes it into a choking risk when given in a larger amount.
- Avoid easily inhaled items such as raisins, hot-dogs, pieces of fruit (grapes, oranges) or candy.
Once the baby is one year old, you can begin to feed a variety of foods of age appropriate consistency and texture according to the different food groups of Canada’s Food Guide to Healthy Eating.