Hold off on baby food until time is right
The parents of the 2-month-old looked at me hopefully. Their little guy was a big boy, way up at the top of the infant growth curves, and they were wearing out trying to keep up with his frequent feedings.
I knew they were hinting at starting their son on solid foods, but as much as I felt for them, I could not give them the OK. Just as when parents seek my approval to put their infant to sleep on his belly - "But doctor, he sleeps so much better on his stomach!" - some things, for sound medical reasons, are just not done.
When parents ask my advice on infant feedings, I outline a few of my own guidelines to help them decide when to start solids. By the 4-month visit, if the baby is still drinking every two hours, is taking more than 40 ounces of breast milk or formula per day or is not sleeping through the night, I tell parents that the time seems right for the introduction of solids. If the infant does not meet one of these critia, I suggest waiting until the fifth or sixth month to start these feedings.
Physicians may vary a bit in these specific feeding details, but the consensus of experts at the American Academy of Pediatrics (AAP) is that solid food meals should begin sometime between the fourth and sixth month of life. There is no evidence that waiting longer than six months is of any benefit to the baby.
The feeding age limit is based on the understanding that infants need to reach certain developmental milestones before solid feedings can be safe and successful. Babies should have good head control and be able to sit in a chair or maintain a seated position while propped up. Solid food feeders must also have the ability to allow a spoon to enter their mouths and to take and swallow food off the spoon in a smooth, coordinated manner. These motor skills usually develop sometime between the fourth and sixth month.
Parents sometimes ask if they should just start by adding cereal to the baby bottle. The answer, generally, is no. While thickening formula or breast milk bottles with cereal can be part of the treatment plan for infants with reflux, or GERD, this type of feeding is not indicated in otherwise healthy babies.
Infant feeding progresses in stages as parents help their little one move from a strict liquid diet to thin cereal feedings, then on to a more varied menu with a thicker consistency. The baby's job is to first learn to eat off a spoon, then later in infancy to finger feed and finally to manipulate utensils as a toddler. Bottle feeding cereal brings no developmental benefit, and when used for nonmedical reasons, may contribute to excess weight gain during infancy.
When you and your pediatrician feel your infant is ready, start feeding with an appropriately small baby spoon. There will be a learning curve for your baby, so don't be discouraged if he doesn't know what to do with his tongue and the spoon on the first attempt. Once your infant becomes a champion eater, watch for signs that he is full. If he clamps his lips shut, turns his face away, bats at the spoon or takes other evasive action, it's probably time to call it a meal.
The AAP suggests the introduction of rice cereal as the first solid food, followed by oatmeal, then barley cereals. Next, fruits and vegetables (or vegetables and fruits, the order does not really matter) can be added to the schedule. The basic idea is to layer foods in, giving each new food at least a two- to three-day trial before starting the next new item. This allows parents to recognize and pinpoint any allergic food reactions such as a rash, vomiting or diarrhea.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.