The American Academy of Pediatrics recommends that no solid foods be given before four months of age. We have enclosed a feeding schedule as a general guideline for you to follow. New foods should be introduced one at a time and preferably in the morning. When a new food is introduced, no other new foods should be given for three to five days. If the food causes spitting up, really loose stools, constipation, or a mild rash, you may need to temporarily stop giving it. If your baby has worse symptoms such as vomiting, bloody or violent diarrhea, hives, extreme fussiness, or other more frightening symptoms, immediately stop giving the food and call us. By introducing new foods slowly, you give your baby’s system a chance to adjust, and it’s easier to trace problems back to the source. If a food doesn’t agree with your baby, we may recommend you try it again when the baby is older (talk to us if you have any questions).

Start feeding solid foods once a day. If your baby enjoys it, then increase the amount and maybe the thickness of the food every few days. Some baby food companies have different stages of solids. The main difference in the stages is the thickness and texture of the meal. As your child’s chewing ability improves, you can move up the different stages. Near her first birthday, your child should be eating three solid food meals a day (like you); with a snack in the morning and a snack in the afternoon (the snack may consist of just milk or formula).

h3. Feeding Guidelines

* No solids until four months old.
* Use breast milk or formula, not cow’s milk, until the baby turns one.
* Use a baby spoon to feed cereal. Do not put cereal in the bottle.
* Feed the baby food from a bowl and not the jar.
* Don’t add any sugar or salt to the baby’s food.
* Don’t offer the baby sweet desserts, candy, soft drinks, fruit-flavored drinks, or sugar-coated cereal.
* Introduce only one new food every three to five days.
* No wheat, citrus, or corn until six months of age.
* No honey, fish, eggs, or fresh berries until one year of age.
* No peanuts, peanut butter, or tree nut products until two years of age.
* No grazing (ex. snacking on drinks or foods such as cheerios throughout the day).
* No roaming. Keep food at the table once your child is old enough to sit with the family.

h3. Facts of Interest

* Solid foods have not been proven to help babies sleep through the night.
* Iron in formula has not been proven to cause stomach problems such as constipation.
* Foods initially “disliked” are usually accepted if repeatedly presented.
* True lactose intolerance is rare before school age.
* Bottle feeding in the bed after teeth (have come in) can lead to decay.

h3. Feeding Schedule
(This is a guideline. Each baby is unique and may require a different plan!)

h3. Vitamins

Most full-term babies taking breast milk or formula do not need any type of vitamin supplementation. If a mom is eating a healthy diet, the breast milk will provide all the vitamins and minerals that the child needs.

The American Academy of Pediatrics recommends that by two months old, breast-fed infants receiving less than 16oz of formula per day should be given vitamin D supplementation to prevent rickets (a disease of weak bones). Our patient population does not have many risk factors for rickets. Many of the breast feeders are adequately supplemented with formula, most get good amounts of sunlight to promote vitamin D production, most do not have enough melanin in their skin to block sunlight, and none of our patients live in the upper latitudes of the United States. If you have any questions about vitamin D supplementation, please talk to us about it in the office.

All formulas are made with added vitamins and minerals, so they provide all the vitamins and minerals necessary. Once solids are started, the variety of the diet provides all of the nutrients necessary for proper growth and development. We will check for iron deficiency at the one and two year visits as some children in these age groups are not getting enough iron.

The only supplementation that may be needed is fluoride. Houston�s tap water has added fluoride as does most bottled water. Therefore, fluoride supplementation in Houston is usually not necessary. If you are concerned about the amount of fluoride in your water supply, contact your utility company and let us know how much fluoride is in your water. We will let you know if supplementation is necessary.

h3. Changes in Feeding After the 1st Birthday

After the 1st birthday, we suggest you switch to regular whole cow’s milk (the fat is important for brain development). However, limit your child’s milk intake to no more than twenty four ounces in a single day. Too much cow’s milk can lead to anemia (“low blood count”) and picky eaters (they become full on milk and do not want solid food). We also recommend limiting juice to no more than eight ounces a day. Again, too much juice can lead to picky eaters. Juice, although it has some nutritional benefit, is mostly made up of fructose, which is a bunch of sugar. Finally, after turning one year old, try to wean all children off bottles, pacifiers, and sippy cups. A sippy cup is a hard nippled bottle. Sippy cups and bottles enable children to graze. They fill up on liquids at the expense of more nutritious solids. They bathe their teeth in sugar all day leading to cavities. Sippy cups are dropped or passed around and put back into their mouth leading to the spread of germs. They reinforce the habit of turning to food whenever sad, bored, angry, anxious, uncomfortable, or tired. Giving liquids in a parent controlled cup at the table eliminates most of these pitfalls. Sippy cups are great for convenience, but try not to elevate them to a lifestyle.