Chapter 1 Index

A. General Information about the well child examination

B. Nutrition Issues
--Breastfeeding – Advantages and Disadvantages
--Breastfeeding: Resources and Frequently Asked Questions
--Formulas – Which Gets Used When?
--Nipples, Bottles, Feeding

Solid Food Introduction – Questions Parents Might Ask

1. How should formula be mixed?
   1. Ready to use: most expensive; easiest to use when traveling
   2. Concentrate: half water, half concentrate
   3. Powder: 1 scoop (tablespoon) to 2 ounces of water
       

2. How much formula at different ages and weights? Depends on how many calories are desired (more in those with higher metabolic needs: children in congestive heart failure, long-term tachypnea, increased muscle tone, etc).  However for normal baby: 100 calories per kg – assume 20 calories per ounce formula:
    

*If give up night feedings, then go to 4-5 feedings a day and increase the amount of formula per feeding accordingly: always calculated total 24 hour amount and then calculate back

3. When should cereals and solid foods be started?
   1. Breast feeding: 6 months if possible; vitamins D/C’d once solids started
   2. Bottle feeding: 4-6 months
       

In general: in comparison with milk, vegetables and fruits have calorie contents similar to milk; however, cereals with tapioca, meats and puddings contain many more calories than milk.  Encourage the lower calorie solid foods.

4. How determine when it is time to start solid foods?

• If baby had been sleeping through the night and now is waking up, that is the most reliable sign of needing solids.
• Remind parents that though fun to give, the nutrition from solid foods is less important than the milk prior to 6 months of age.

5. Are there instructions I need to know when starting new foods?

Each new food should be given in small amounts for about three days before introducing another new food.  Never give foods in bottles unless cereal for GER.

6. Can I make up my own solid foods or do they need to come from the jars?  When can I start to introduce table foods?

• As long as no added sugar, salt parents can blend up foods to simulate what is found in the various staged baby food.
• Most parents find this a strenuous task and use jars.
• Table foods are fine: consistency should fit Stage guidelines.

7. Which foods should children avoid when starting table foods?
   1. Peanuts, popcorn, crunchy peanut butter, plain peanut butter
   2. Chocolate and eggs: high incidence of allergy
   3. Small pieces of food such as carrots, peas, pieces of sausage, hot dogs, anything cylindrical (Should also be careful about small toys, balloons, pins, etc.)
   4. Honey: association with botulism
   5. Spicy foods: trial and error
   6. Skim milk, whole milk, and lowfat milk: under 1 year of age, should stay on formula.  Whole milk should be taken until 2 years of age.
       
8. What about Apple Juice?  Is that good or bad for children?

Apple Juice intake can be associated with either a failure to thrive syndrome and an obesity syndrome because it is so sweet that children take it preferentially over other foods and can be associated with a malabsorption syndrome characterized by diarrhea, failure to gain weight, etc.  Obesity in those without this malabsorption syndrome is also described.

If parents feel that they must give juice your recommendations should include:

1. Apple juice is not healthy for your baby.
2. Apple juice should be given no more than once a day--if that.

    9. What other goals should I have for my baby in the first year of life?

Written 12/01

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© Medical College of Georgia
All rights reserved.

Department of Pediatrics  |  Medical College of Georgia
Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004