Go Ask Mom

Go Ask Mom

Infant Nutrition: First foods, allergies, more covered in WakeMed workshop

Posted March 21

Choosing baby foods used to be easier because there were just a few brand names, and they all came in jars. Now, store shelves offer more choices in different packages, making it tough to figure out the healthiest options.

For new moms, there's a lot of information out there about breastfeeding and bottle feeding, but once baby is ready to leave that very first stage, it can be tricky to figure out what's next.

Cheryl Patel, a registered nurse and lactation consultant at WakeMed, said it's a common question that she fields as she works with parents through birth and education classes and at one of WakeMed's pediatric offices.

When should a baby start solids? Does rice cereal have to be the very first thing? Should I mix cereal in my baby's bottle? When can my little one just start eating off my plate? Do I need to be worried about allergies?

"There's a lot of mixed information about when to start solids, when to start certain foods in the solids group," said Cheryl Patel, a mom who completely understands the struggle.

Patel will be leading a WakeMed program called Crawling & Above: Infant Nutrition, a free seminar for families of infants approaching four months and beyond. The program is scheduled for 10 a.m. to noon, March 26, at WakeMed Cary Hospital.

The goal for the program, said Patel, is to provide some guidance to new parents, who are excited and anxious about this next step in their child's life.

The American Academy of Pediatrics' recommendations for infant feeding will guide Saturday's conversation, Patel said. The group recommends that children be exclusively formula fed or breastfed for the first six months of life. After six months, breastfeeding and formula feeding should continue for another six months with the addition of foods that are appropriate for the child's age and stage.

But Patel also acknowledges that general rules sometimes don't apply to some cases.

"Each baby and family situation is different," she said. "This will present options for you and information so you can make the best informed decisions for you and your family. If a pediatrician has said, 'your baby needs to gain weight and we suggest adding rice cereal at three or four months,' that is a tailored feeding plan for your child and you should follow it."

I spoke with Patel to get some more tips on infant feeding in those early months.

What does "age and stage" mean? Age, obviously, refers to how old your child is. Stage refers to where they are developmentally - and that can vary widely depending on the child. If your child doesn't have a pincer grasp yet, it might frustrate him if you poured some Cheerios out on his tray. Does she still have the tongue thrust reflex? It helps with bottle feeding and breastfeeding, but not eating solid foods.

The appearance of teeth, however, are not a developmental milestone. Patel said there are plenty of 12-month-olds who can gum a small piece of steak. It's all about how strong the muscles are that a baby uses to eat, she said.

What first foods are best for my baby? It doesn't have to be rice cereal or oatmeal, though Patel said those are fine choices if that's what you want to go with. Mixed grain cereals have wheat products, which babies could be allergic to, and should be avoided in the beginning.

Because the taste of breast milk changes depending on what mom is eating, breastfed babies often will be less picky as they start eating solid foods. Avocado is a great first food, Patel said, because of the fat and essential oils. Because the taste of formula is pretty consistent, regardless of the brand, it can be trickier. Patel recommends starting with something sweet - like a banana.

She recommends mixing that avocado or banana with a little breast milk or formula to get it to a liquid consistency.

I gave my child some green beans and she refused them. Should I give up? No, says Patel.

Offer a food 10 times to a child up to preschool age before determining whether they like it or not, she said. "Try it in different ways and flavors once feeding is established."

So, if your child doesn't like canned green beans, for instance, try fresh, steamed green beans or roasted green beans. Give them to him raw, when he's ready, with a dip such as ranch dressing or hummus.

"If they want to dip their carrot in ketchup, OK," Patel said. "It’s very surprising what a child will refuse at one meal and what he’ll accept at another because it looks different."

What about peanuts? Patel's own child has a peanut allergy so she very much understands parents' concerns when it comes to nut allergies. Before you start giving your child any peanut product, talk to your pediatrician, she said. Generally, she says, it's best not to give any peanut product to a child under nine months. She'll discuss allergies more during the class.

I'm giving my baby food, but she just smears it all over her face. I'm not sure she's actually eating anything! That's fine and not at all unusual, Patel said. During the first year of life, the main source of nutrition is still going to be from breast milk or formula. If a child is teething or sick, for instance, they often revert back to their favorite method of feeding - breast or bottle. Some children may graze. Other kids may be more active one day and work up a big appetite. The next day they might just want to cuddle with mom.

"We are a society where we comfort with food," Patel said. "We [focus a lot] on how did they eat today, did they eat today. We can’t place such an importance during that first year of life on what actually went from plate to mouth." 

Patel will cover much more in the program this weekend. Registration is required. WakeMed's website has the details.

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