March is National Nutrition Month, when the Academy of Nutrition and Dietetics reminds everyone to return to the basics of healthy eating. It is also the time of year when the Academy celebrates expertise of registered dietitian nutritionists as the food and nutrition experts.
During the first two years, children move from exclusive breast or bottle feeding to eating table foods with the rest of the family. There are two important parts of this process:
- What specific foods and textures to introduce at each age
- How best to feed babies so they develop a healthy relationship with food.
Types of Foods
The order in which you introduce solid foods doesn't matter for most babies. The traditional progression has been single-grain cereals followed by vegetables, fruits and meats. While there is nothing wrong with this pattern, pureed meat or poultry actually may be the best first food to provide sources of iron and zinc.
Introduce one new food at a time and wait three to five days before starting another. If you notice diarrhea, vomiting or rashes, stop the new food and contact your baby's health care provider. These symptoms may indicate a food allergy.
In 2008, the American Academy of Pediatrics published the following guidelines for infants "at risk" of developing an allergy based on evidence from current research. Infants are considered at risk if they have one first-degree relative with an allergic disorder (such as asthma, atopic dermatitis, allergic rhinitis or food allergy).
- Exclusive breastfeeding for at least 4 months decreases the incidence of atopic dermatitis, cow's milk allergy and wheezing in early life when compared with feeding infants cow's milk-based formula.
- The use of soy-based infant formula does not appear to play a role in allergy prevention.
- Solid foods should not be introduced before 4 to 6 months of age. Delaying the introduction of solid foods beyond 4 to 6 months of age does not appear to provide significant protective effect from developing food allergies.
- At this time there is insufficient evidence to recommend further dietary interventions such as avoiding specific foods (including fish, eggs or peanuts) during pregnancy, breastfeeding or beyond 4 to 6 months of age to protect against the development of food allergies.
Textures are very important for introducing foods. Most babies prefer to start with softer, smoother textures and gradually move toward thicker foods. Firm foods, especially round foods, slippery foods and sticky foods are choking hazards. To avoid choking, don’t offer the following foods to children under 4 years of age:
- Nuts and seeds
- Whole grapes, cherry tomatoes
- Whole kernel corn
- Hot dogs
- Hard, raw fruits or vegetables such as apples, celery and carrots
- Chunks of meat or poultry
- Sticky foods, such as peanut butter, which can get stuck in the back of the mouth
- Hard candy, gum drops and jelly beans
For toddlers and preschoolers, chop grapes, meat, poultry, hot dogs, and raw vegetables and fruits into small pieces (about ½ inch or smaller).
Nurturing Healthy Relationships with Food
Establishing a positive feeding relationship during infancy can have lifetime benefits. According to registered dietitian and child feeding expert Ellyn Satter, the key to a healthy feeding relationship is the appropriate division of responsibility.
Adults are responsible for what food is present and how it is presented.
- Choose foods that are the right texture so your baby's tongue and mouth can control it and swallow easily.
- Hold your baby on your lap when you first introduce solid foods. Then move your baby to a safe high chair.
- Support your baby well in an upright position so he or she can easily explore the food as much as desired.
- Have your baby sit up straight and face forward. This makes swallowing easier and choking less likely.
- Talk in a quiet, encouraging voice while you feed. There’s no need to be entertaining. Babies are easily overwhelmed and distracted with games.
Children are responsible for how much and whether they eat.
- Wait for your baby to pay attention to each spoonful before you feed it.
- Let your baby touch the food in the dish and on the spoon. You wouldn't want to eat something if you didn't know anything about it, would you?
- Feed at your baby's tempo. Don't make your baby eat faster or slower than he or she wants.
- Allow your baby to self-feed with finger foods as soon as he or she shows an interest in touching or holding them.
- Stop feeding when your baby shows you cues that he or she is done. Often, your baby will do this by turning his or her head away from you.