Newborn Care

Feeding Guide for 4 Month Olds

Introducing Solid Foods (Four Months)

     Your child is ready for solid foods.  The most important thing to remember about solid food is to start slowly.  This is done in order to detect any possible reactions your child may have.  Food reactions may include a rash, vomiting, and increased spitting up, diarrhea or fussiness.  If your child has any of these symptoms when starting a new food- stop the food and wait one month before trying that food again.  When starting to feed your baby, it is best to give the foods with a spoon before the breast or formula feeding.  Do not give your baby honey or karo syrup until he/ she is one year old.  If your child has eczema or egg allergy, please ask us for a referral to an allergist to determine the process to introduce peanut butter.  If your child does not have eczema or egg allergy, introducing peanut butter and eggs around 6 months of age may prevent the development of allergies.

The first food to start is rice cereal (a few tablespoons).  This should be mixed with enough breast milk or formula to make it thin- as your baby adjusts to spoon feeding you can gradually make the cereal mixture thicker.  Don’t be surprised if your baby doesn’t take cereal off a spoon right away.  They have to learn how to eat with a spoon.  Your baby may have as much cereal as he/she desires.  Once he/she has finished, wait 15-30 minutes before offering the breast or bottle.  Your child may take the same amount or less of breast milk/formula after a solid feeding- let your baby decide when he\she is finished.  Whenever you introduce a new food, give the new food daily for three days.  If there are no reactions, you can include that food in your child’s regular diet.  After five days of cereal your child is ready for other foods.   You can start a new food every five days.

Feed new foods when your infant is healthy, do not try new foods when your child has a cold, vomiting, diarrhea or other illness.

Fruits and Vegetables

     Your child is now ready to add fruits and vegetables to cereal (day 6).  Start one new fruit or vegetable every five days.  You may start fruits and vegetables in any order.  Applesauce, pears, bananas, green beans, peas, sweet potatoes are all good starters.  Place the fruit or vegetable in a bowl and add the dry cereal to the bowl to make it the right thickness.  You do not need to add any breast milk or formula.  Give the new food mixed with cereal once a day for three days in a row, using cereal alone at the other feeding (day 6-8).  On day 9 you can give mixture twice a day- breakfast and dinner.

Every five days you may try a new fruit or vegetable or cereal.  You do not need to stop the previous foods during this time.  First foods are not necessary for most babies.  Pick the jars that are single foods and most economical.  Once your child has had all the single ingredient jars, you can try the combination fruits (for example: once your child has had applesauce, he can try apples and blueberries).  Introduce cereal in the following order: 1st-rice, 2nd- barley, 3rd- oatmeal.  Alternate the green, yellow and orange vegetable types for variety and nutrition.

Day 1 Day 2 Day 3 Day 4 Day 5
AM Rice Rice Rice Rice Rice
PM Rice Rice
Day 6 Day 7 Day 8 Day 9 Day 10
AM Fruit/Veg & Rice Fruit/Veg & Rice Fruit/Veg & Rice Fruit/Veg & Rice Fruit/Veg & Rice
PM Rice Rice Rice Fruit/Veg & Rice Fruit/Veg & Rice

Juices

The AAP no longer recommends juice for infants under one year of age unless we have recommended it to treat constipation.

 

Five Months

One month after starting baby foods you can increase to three feedings a day.  Your child will now be on three meals a day and three to four breast or formula feedings a day.  You can also give second stage meat and vegetable dinners but do not give third stage dinners until seven months.

 

Breakfast:  Fruit mixed with cereal

            Lunch:  Vegetables and fruit (cereal optional)

            Dinner:  Fruit mixed with cereal and vegetables

 

You should offer the breast or formula after each meal and usually before bed.

 

Peanut Butter

     Peanut can be introduced by mixing 2 teaspoons of peanut butter with 2-3 tablespoons of pureed fruit or vegetable (without cereal).  For the first feeding, offer a small portion of the mixture and observe closely for 10 minutes.  If there is no allergic reaction after the small taste, give the remainder of the peanut containing mixture and continue to observe for two hours.  Watch for a new rash, hives around the mouth or face, lip swelling, vomiting, full body hives, face or tongue swelling, any difficulty breathing, wheeze, repeated coughing, change in skin color or sudden tiredness.  The peanut butter should be offered at least weekly.

 

Finger Foods

    At five months of age you can start to experiment with teething biscuits, Zwieback toast and “babies first cookies”.  Give these foods after spoon feeding and watch your baby carefully to prevent choking.  Stop the Zwieback toast when your baby can break off hard pieces.

Feeding Guide for 6-9 Months

Six Month Feeding Guide

Your child is now six months old and will be making the transition from baby food to table food.  Your child should be on three meals a day taking cereal, fruit and vegetables.  You may now introduce cereals like: Cheerios, Rice Chex, Corn Chex and Crispix.  Cheerios will dissolve quickly in your baby’s mouth.  Crispix, Rice Chex and Corn Chex can be easily crunched into little pieces with your baby’s gum.  Spoon feed your baby first, then put the cereal on the tray letting your baby feed him/her.  As always, watch your baby carefully when eating.  After this cereal, your baby will be ready for the breast or bottle.
At seven months you may introduce the third stage dinners with meats.  If your child has not had meat before, introduce one new one every five days.    Also between seven and nine months you may try table foods like mashed potatoes, French style green beans, slices of American cheese, toast, graham crackers, yogurt, cottage cheese, etc.
Do not give milk products yet if your child has been on a soy or other specialized formula.  Do not give honey or Karo syrup in the first year (baked honey is okay- Honey-Nut Cheerios, Honey Grahams, etc.)  We do not recommend “follow- up” formulas.  Keep your baby on breast milk or infant formula until he/she is one year old.

Nine Month Feeding Guide

The next three months will continue to mark the transition from baby food to table food.  You can continue to introduce table foods over the next three months.  During this time your child may start to resist spoon feeding and prefer to feed him/herself with his/her fingers.  This is a sign of your baby’s increasing independence and is good.  Try foods like toast, pop tarts, macaroni and cheese, cottage cheese, yogurt, children’s cereals, pancakes, waffles, jelly sandwiches, grilled cheese sandwiches, hamburger, baked chicken and fish, ham and casseroles.  Most cooked vegetables are also okay if they are soft and you can also try cut up fruits.  Make sure the food is in bite size pieces before giving it to your baby.  You can now start milk products if your baby has been on Isomil or Prosobee.  Keep your baby on breast milk or infant formula until the end of his/her first year.  We do not recommend the “follow- up” formulas.
In the next three months, you should work your child over to the cup and off the bottle.  Introduce the cup with meals, using formula or breast milk.  Once your baby can drink from the cup, try going without the bottle after one of the feedings.  Slowly (every few days) add more cups while eliminating bottles.  Your baby will drink less from a cup then from a bottle- this is normal and desired in the transition from baby to toddler.

Twelve Month Feeding Guide

Twelve Month Feeding Guide

     At twelve months your child is now a toddler.  Your toddler should be off the bottle and drinking solely from a cup.  You can now put your child on whole milk or 2% milk.  Mix the cow’s milk with an equal amount of formula in each cup for five days.  If your child has no reaction you can stop formula completely.  If your child has been on Prosobee or Isomil add one ounce of milk to three ounces of formula in each cup for five days, then two ounces of milk to two ounces of formula for five days, then three ounces of milk to one ounce of formula for five days.  If no reactions, then you can stop formula completely.  If your child reacts to milk, go back to just formula until 15 months of age.  Breast feeding can be stopped when you and your child are ready to stop- there is no magic age.

Your toddler may have any food now, including honey and juice.  However the risk of choking remains.  Do not give your child peanuts, popcorn, raw carrots or celery and other hard foods.  Your child will not be able to take these hard foods for quite awhile.  Hot dogs are okay if they are cut into little pieces.

The new AAP guidelines for juice recommend no more than 4 oz. of 100% fruit juice for 1-3 year olds, 4-6 oz. of 100% fruit juice for 4-6 year olds and 8oz a day for children 7 and older.

Your toddler will gain half as much weight this year as the last year and so will not eat as much.  Your child needs no more than 20-24 oz. a day of milk and milk products.  Your child can drink as much water as he/she wants.  Water does not interfere with your child’s appetite like too much milk or juice can.  As long as your child’s appetite is good, vitamins are not needed.  If your child does not eat from all four food groups a once a day vitamin can be given (liquid: poly-vi-sol, chewable: Sesame street, bugs bunny, flintstones, generic for kids).  If you do not have city water and your well water does not have fluoride (your local health dept. will test water) your child will need a fluoride supplement.

How Feet Develop

Children’s feet are not miniature replicas of adult feet.  Unlike our own, a baby’s feet are pliable, almost like putty.  Consequently, they can change shape quite easily.  In fact, up until the ages of 12 to 14, children’s feet  continually grow and change positions.  They go through phases of development that cause a younger child to appear flat-footed, bowlegged, or knock-kneed.

Some of these stages can worry parents, but there is no need for concern.  “At birth the average child toes-in, has flat feet, and is bow-legged,” says Vincent Mosca, MD, FAAP, a pediatric orthopedic surgeon and director of the Department of Orthopedics at Children’s Hospital and Medical Center, in Seattle.

“Children are born flat-footed because of baby fat,” explains Lynn T. Staheli, MD, FAAP, a pediatric orthopedist at the University of Washington, in Seattle.  A pad of protective baby fat- nearly an inch thick- lines the soles of the feet and gradually disappears by the time the child is three, revealing the arch underneath.

Between 10 and 15 percent of children and adults remain flat-footed, but only a small percentage of flat-footed people experience pain while walking.  Children who are flat-footed and have pain may shy away from walking  or running activities that last  longer than 20 minutes.  If you notice this tendency in your child, you can ask your pediatrician to examine your child’s feet.

As babies and children naturally exercise their foot muscles, especially by walking barefoot, they build up a strong arch.  While there’s no need to exercise your baby’s feet, he may simply enjoy the workout.

Newborns also tend to turn their toes inward, a condition called in-toeing.  Once they start to stand, however, babies often turn their toes outward to help them maintain their balance.  As they gain confidence in standing and walking , and as their bones grow in length, children lose their tendency to toe-in or toe-out.  About ten percent of adults- including a number of professional athletes- continue  to toe-in, but the condition is painless and doesn’t pose any problems.

Another condition  that can exist in newborns is called overlapping toes-one toe sticks up higher than the rest or lays  on top of another toe.  This condition usually corrects itself when the child begins to walk, and his toes flatten out naturally.  But if overlapping persists, and interferes with a child’s ability to walk, surgery may be required.

Babies and toddlers will also look bowlegged until they’re about one-and-a-half years old.  “It’s a packaging problem: The children sit in the uterus in a yoga position,” explains Michael Goldberg, MD, FAAP, chairman of orthopedics at Tufts University, in Boston.  “As they grow and develop, they unwind.”

Between ages two-and-a-half and five, some children will naturally develop knock-knees (the legs curve inward at the knees).  This condition usually improves as the child grows, so that somewhere between the ages of five and seven, a child’s feet and legs will start to resemble those of an adult.

Proper Foot Care

Happy feet mean happy faces, an old saying goes.  So to keep your child smiling, follow these tips for proper foot care:

Finding the Right Shoe

To shoe or not to shoe?  That’s a question that often baffles the parents of  prewalking  babies.  But most experts agree that  babies don’t need to wear shoes until they are walking outdoors.  When your child is ready for shoes, be sure to keep these pointers in mind:

In addition to a good fit, the material and shape of a shoe are important too.  For instance:

Healthy Kids June/July 95 by Colleen Davis Gardephe copyright @ 1995 Reed Elsevier, Inc.

Nutrition and Your Child

 Is my child eating too little or too much?
 Does s/he get enough of the “right” foods?
 Is my child too fat/thin?

Have you ever asked yourself these questions? If so, you are not alone. Nutrition and body image are hot topics in America today. The media tells us that health, happiness, and success depend on a thin fit body. Parents want their children to get off to a healthy start when it comes to eating. But, excessive worry and some common eating rules can actually create bad habits. Making children clean their plates, defining foods as “good or “bad”, and restricting calories lead to food obsession and eventual over eating. The following explains why using these steps in nutrition management are not appropriate. Some healthier alternatives will be presented.

Nutritional need varies daily and are based on several factors including activity level, rate of growth, age, height, weight, and genetics. Unless you calculate your child’s needs before each meal and match that need with the correct amount of calories and nutrients, insisting that your child “clean that plate” is not helpful. In fact, it may be teaching your child to ignore internal signals and regularly over eat.

All foods contain calories and nutrients. Some have more nutrients per calorie than others. But, labeling foods as “good” or “bad” leads to trouble. It is human nature to want what we cannot have. While a cookie to a healthy eater is just a cookie (a sweet food to eat on occasion), a cookie to a chronic dieter is a COOKIE (a treasured treat to be had at all costs). A better approach is to regularly offer a wide variety of foods while modeling healthy eating habits.

Dieting, especially in children is not safe or effective. Calorie restriction leads to temporary weight loss, but most dieters regain any lost weight within five years and one-third become heavier than when they started. Dieting can slow metabolism and end in eating disorders. When offered a wide variety of nutritious foods children use internal cues for hunger and satisfaction. They eat when hungry, stop when full, and choose foods with varying amounts of nutrients per calorie. The best plan for raising a healthy eater is to offer a balanced diet while allowing your child to choose the amount that is eaten.

The following suggestions may help your child develop healthy eating habits while avoiding some of the more common feeding errors discussed above. Provide food from each food group (protein, fruits/vegetables, grains, and dairy) at each meal and let your child decide how much to eat. If he or she refuses what is offered do not provide additional choices and do not allow snacking prior to the next meal. Offer a wide variety of foods, but use those foods with the least nutritional value infrequently. Defining foods as “good” or “bad” only leads to power struggles and unhealthy attitudes about food. Regularly offer new foods, but remember to provide some old favorites at the same time. Offer new foods without comment and let your child experiment. Most preschoolers tend to be fearful of new things and may need to see a food several times before trying it. Also remember that children are often picky eaters, liking today what was hated yesterday. Do not allow your child to fill up on liquids. Providing milk only with meals is sufficient, but provide 20-24 ounces of milk and milk products daily to ensure an adequate intake of Calcium and Vitamin D. If your child is thirsty between meals water is perfectly appropriate. Juice is fine with meals or snacks, but offer no more than 12 ounces per day. Children become healthy eaters when allowed to identify and respond to their own cues for hunger and satisfaction. Using the tips above can avoid power struggles and aid in the development of excellent eating habits.

In addition to good nutrition, healthy individuals need regular physical activity. This does not mean regimented exercise! Regular enjoyable physical activity in the form of play is essential for good emotional and physical health. A balance between sedentary activities and active play is a must. Moving the body in fun ways leads to happy experiences and memories that will foster an active life-style.