Feeding Guide: Infants

(Bottles/BF 1/2 to 1 hour after solids)

There are many factors which need to be considered by a mother when she decides whether to breast or bottle feed. Whichever method you choose, we will support your decision.

Breast feeding is recommended as the initial method of infant feeding. In addition to best meeting the nutritional needs of your baby, breast milk contains important factors which will make your baby less susceptible to infection. Formula also provides balanced nutrients that your baby needs for optimal growth and development and is formulated to imitate the nutritional constituents of breast milk as closely as possible. Whether breast or bottle feeding, allow your baby to feed on a modified demand schedule. When feeding your baby, choose a position which is most comfortable for you and your baby. However, keep in mind that he or she should be in a semi-upright position during feedings.

Most breast fed babies feed every 2-3 hours during the day and night. It is occasionally acceptable for your baby to want to eat in less than two hours. Do not let your baby go longer than 3-4 hours at night until you are advised by the doctor that it is ok to do so.

A breast fed baby will have approximately 10-12 feedings (every 2-3 hours) per 24 hours in the 1st month, and 8-10 feedings (every 2-4 hours) per 24 hours in the 2nd and 3rd months. The baby may nurse 15-30 minutes on one breast and 15 minutes or more on the other breast.

Some babies become efficient nursers and can spend 5-10 minutes per breast once breast feeding is well established. Alternate the starting breast at each feeding. If you wish to supplement breast feeding, it is best to supplement once a day at a fixed time. You may give a bottle of expressed breast milk or formula as a supplement.

If you are bottle feeding, start by putting 2-4 ounces of formula in every bottle. Let the baby take as much as he or she wants. Always try to have at least ó ounce of formula left in the bottle when your baby is finished eating. This will prevent air swallowing and let you know when the baby is ready to take a larger quantity. As your baby grows, gradually increase the amount of formula in each bottle to stay ahead of his demand. Always use an iron-fortified infant formula.

Formula fed babies usually go 3-4 hours between feedings. If your baby sleeps longer than 4 hours during the day, we suggest that you wake and feed him or her. If your baby sleeps longer than four hours at night, depending on his weight and age, consider yourself lucky and do not wake the baby for a feeding. Between 2-4 months your baby will start to go longer stretches at night. By 4 months your baby should be sleeping a 6-8 hour nighttime stretch. Propping the bottle is not recommended. Never give a bottle in the crib.

Solid foods are not necessary for the first four to six months of life. Rarely an infant may need to start solid foods earlier. Indications for this may include consistently increased frequency of breast feeding or consistently taking more than 40 ounces of formula a day. Even if your baby seems hungry, solid foods should not replace breast or bottle feedings, but should act as a supplement during the first 6 months. Whenever starting a new food, introduce it early in the day (before 2PM). Do not introduce more than one new food at a time, and use the new food for a minimum of four to five days before introducing a different food. Whenever starting any new food, there may be a change in the child’s bowel habits.

Iron fortified cereal can be started between 4-6 months. Start with 2-4 tablespoons oatmeal, mixed with breast milk or formula twice a day, in the morning (6AM-10AM) and in the evening (4PM–8PM). Initially mix to a thin consistency and then thicken as your baby adjusts to spoon feeding. Never put cereal in a bottle. Bottles are for breast milk, formula, or water only. After at least 4 to 5 days of oatmeal you may then switch to barley or mixed grain cereal.

Begin the introduction of fruit with bananas (unless constipated) and then progress to: applesauce, pears, peaches and prunes. You may then introduce other fruits. Start with yellow vegetables (carrots, squash, or sweet potatoes), then progress to green vegetables (peas, green beans). Fruits and vegetables can be freshly prepared at home or may be served from store bought containers. Babies who enjoy yellow vegetables can develop a harmless yellow coloring of the skin called (carotenemia).

Use live culture whole milk yogurt, such as, “Yo-Baby”. Do not use yogurt with large pieces of fruit. You can use fruit flavored whole milk yogurt or add your own pureed/mashed fruit to plain or vanilla flavored yogurt. Soft cheeses such as cottage cheese, ricotta cheese or cream cheese can also be introduced at this time. Feed your baby yogurt or soft cheeses once a day either during a meal or as a snack.

REMINDER: Do not give your baby any milk products other than formula prior to 6 months.

Peanut butter is a great source of protein, magnesium, and healthy fats. Peanut butter is the best way to expose your child to nuts when you are ready. Peanuts and tree nuts used to be restricted in babies’ and toddlers’ diets until 2 years of age. New studies indicate that this is an unnecessary precaution and may actually contribute to developing a nut allergy. In a baby who has exhibited and allergic propensity with significant eczema or other allergic signs or symptoms, we may elect to send your baby to an allergist prior to beginning nuts. We also may elect to send to an allergist if there is a strong family history of food allergies.
 
In all other babies, we recommend feeding a small “dab” of peanut butter daily for 2 weeks. If there is no reaction, you may continue feeding it to your baby on bread or a cracker. Once started, you should not go longer periods without reintroducing it. The same procedure can be done with other nut butters, but not at the same time as doing peanut butter.

Make sure any meat you feed your baby is strained, shredded or ground. Start with chicken and turkey first and then veal, beef and pork. Feed your baby meat once a day.

Use a hard boiled or well done scrambled egg. Your baby may have eggs 3-4 times per week.

Includes 3-4 breast/bottle feedings per day; lunch and dinner menus are interchangeable

The consistency of the fruits and vegetables can increase as the baby gets older. Between eight to ten months your baby should be starting to eat soft, bite sized pieces of table foods; such as fruits, vegetables, meats, crackers, cereal, pasta, rice, cheeses, bread, waffles, etc. Stay away from choking foods. Formula and breast milk should be offered at meals in a sippy cup at 6-7 months. The sippy cup should have a valve mechanism that can be removed, so that the fluid flows freely upon tipping. Straw cups can also be used. It is very important to introduce your child to the sippy cup early and often. At 9 months your baby will begin to pick up objects with the thumb and forefinger (pincer grasp). He/She will also start to have a “do it myself” attitude. This should be encouraged! These are all signs that your baby is ready to start feeding himself. Between 9-12 months, your child should move toward a more toddler schedule of eating. We do not recommend juice as it consists of mostly sugar and has no nutritional value. If you do decide to offer juice, you should give no more than 4 ounces per day, and it should be diluted with water. Never give in a bottle.

DO NOT USE LOW-FAT OR SKIM DAIRY PRODUCTS UNTIL 2YRS OF AGE!

We usually switch your child from formula or breast to whole milk at 9-12 months of age. Timing will depend on your doctor’s assessment of your baby’s growth and nutritional intake. Occasionally, if your child has poor nutritional intake, was premature, or has other medical problems, we may extend formula feedings beyond 1 year of age.

To introduce milk, mix your baby’s cereal with milk for two to three days. If the baby tolerates the milk without a problem, substitute one bottle or one cup of milk for a bottle of formula (or one breast feeding). Gradually increase the number of bottles or cups of milk per day, until the child is taking only milk and no formula (or breast milk). Some mothers may wish to breastfeed until 1 year of age or longer. If you wish to continue breastfeeding longer than 1 year of age, do not nurse more than twice per day. More than this will impair your child’s intake of other nutrients. We do not recommend breastfeeding or bottles during the night as this leads to dental caries.

After 1 year of age, you should limit your child’s intake of milk to 12-24 ounces per day. Weaning from the bottle should begin at 12 months and be completed by 15 months. We do not recommend the use of “dripless” cups, as this will not help your child to learn to drink from a cup. This type of cup is based on the sucking mechanism, like a bottle. Instead your child should use a sippy cup that spills when tilted. Often the “dripless” attachment can be removed from the sippy cup. Bottles and “dripless” cups encourage drinking at the expense of nutritionally rich foods and when used for too long causes dental problems.

• NO HONEY DURING THE FIRST YEAR!
• Do not add sugar, corn syrup, or Karo syrup to foods.
• We do not recommend the use of any nutritional supplements unless prescribed by physician. A prescription fluoride multivitamin is given to all children 6 months to 13 years of age. Do not give fluoride 30 minutes before or after any products with calcium (eg. Breast milk, formula, whole milk, yogurt, cheese, calcium fortified orange juice).

Foods that contain high levels of fat and/or sugar:

• Bacon, lunch meats, hot dogs
• French fries
• Creamed vegetables
• Puddings
• Cookies, candy, cakes
• Sweetened drinks (iced tea, soda)

Foods that can cause choking in small children (do not give until 3 years of age):

• Whole Hot dogs
• Whole grapes
• Whole Nuts
• Hard candies or chewing gum (we don’t recommend for any young child)
• Popcorn
• Thick, hard, raw vegetables or fruits
• Chunky pretzels
• Large pieces of meat

Foods to avoid until 9 months:

• Citrus fruits and juices. (Citrus is very acidic and infants may experience digestive upset)
• Food high in cholesterol helps build brain and nerve tissue. Do not try to limit your child’s intake of cholesterol under 2 years of age.
• Your child’s appetite may start to wane around 12 months of age. This behavior may continue until the child is well over 2 years of age. Your child may eat only 2 good meals per day rather than 3.
• Avoid giving fluids prior to mealtime or at the beginning of a meal as this may decrease your child’s appetite for food.
• Avoid fish that are high in mercury including, tilefish, swordfish, seabass, mackerel, shark and tuna (ahi, yellowfin, canned (white albacore). Children can have two (2-3oz) servings per week of low mercury fish like salmon, tilapia, canned light tuna, pollock, halibut and catfish.

• Breastfeed: 7-9 feedings 24 hours
• Formula: 25-40 oz

• Breastfeed: 4-6 feedings 24 hours
• Formula: 24-32 oz. Start to offer sippy cup with formula or breast milk