Sunday, March 7, 2010

Solid Food


It took me FOREVER to introduce solids to my baby boy. Now I believe what the pediatrician told me. He said it would be a natural transition. How natural? He REFUSES to eat baby food - I don't blame him. Before the 'natural' happened, I kept looking for reading material about introducing foods. Here's what a good friend sent me. Happy Sunday yall!


Introduction of Solid Food
There is no nutritional need to introduce solid food to infants during the first 6 months of age 
(1,2).  The infant’s individual growth and development pattern is the best indicator of when to introduce semisolid and solid foods.  Generally, an infant will double his birth weight and be able to sit upright without support by the time semisolid foods are introduced.  By 4 to 5 months, the infant has the ability to swallow nonliquid foods. If solids are introduced before this time, these foods may displace breast milk or formula and the infant may receive inadequate energy and nutrient needs.
    No specific schedule of introduction of food other than breast milk or formula must be followed, but certain recommendations exist:
  • Iron-fortified infant cereal is commonly suggested as the first food offered.  Start with a few spoonfuls of a single-grain, iron-fortified infant cereal such as rice, once or twice a day.
  • Introduce single-ingredient foods, one at a time, so that the offending food can be identified if an adverse reaction occurs.
  • Vegetables might be accepted more readily if introduced before fruits, since fruits taste sweeter.
  • Allow at least 3 days between the introduction of each new food.
  • Begin with small amounts of foods, offering seconds as necessary.
  • Avoid early introduction of the following common allergens: egg white, cow’s milk, citrus, wheat, chocolate, fish, shellfish, tree nuts, and nut butters (eg, no peanut butter until 18 to 24 months of age) because susceptible infants with a family history of allergies may experience allergic reactions.
  • Take care to avoid spoilage of home-prepared foods and jars of food once they are opened.  Do not feed infants directly from the jar, as saliva added to the jar causes faster spoilage.
  • Select appropriate solid foods that require minimal chewing.  Foods such as hot dogs, peanuts, grapes, berries, raw carrots and sliced apples, raisins, potato or corn chips, popcorn, seeds, round, hard candies, and gum may cause choking and aspiration in infants and children.
Table E-2: Infant Feeding Guidelines
Age (months)
Food
0-2
2-4
4-6
6-8
9-10
11-12
Human milk/ formula (oz)
18-28
25-32
27-45
24-32
24-32
24-32
Iron-fortified cereal (tbsp)


4-8
4-6
4-6
4-6
Zwieback, dry toast



1
1
1-2
Vegetable, plain, strained (tbsp)



3-4
6-8
7-8 (soft, cooked, chopped)
Fruit, plain strained (tbsp)



3-4
6-8
8  (soft, chopped)
Meat, plain, strained (tbsp)



1-2
4-6
4-5 (ground or chopped)
Egg yolk (tbsp)




1
1
Fruit juice (oz)



2-4
4
4
Potato, rice, noodles (tbsp)





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References
  1. Position of the American Dietetic Association: breaking the barriers to breast feeding. J Am Diet Assoc. 2001;101:1213-1220.
  2. American Academy of Pediatrics Committee on Nutrition.  Breast feeding and the use of human milk (policy statement). Pediatrics. 1997;100(6):1035-1039.
  3. Jorgensen MH, Hernell O, Lund P, Holmer G, Fleisher-Michaelsen K. Visual acuity and erythrocyte docosahexaenoic acid status in breast-fed and formula-fed infants during the first four months of life.  Lipids. 1996;31:99-105.
  4. Makrides M, Neumann MA, Byard RW, Simmer K, Gibson RA. Fatty acid composition of brain, retina, and erythrocytes in breast- and formula-fed infants. Am J Clin Nutr. 1994;60:189-194.
  5. Lawrence RA. Breastfeeding: A Guide for the Medical Profession. 4th ed. St Louis, Mo: Mosby-Year Book; 1994.
  6. Forsyth JS. The relationship between breast-feeding and infant health and development. Proc Nutr Soc. 1995;54:407-418.
  7. Bruno G. Prevention of atopic disease in high risk babies (long-term follow-up). Allergy Proc. 1993;14:181-186.
  8. Koletzko S. Role of infant feeding practices in the development of Crohn’s disease in childhood. Br Med J. 1989;298:1617-1618.
  9. American Academy of Pediatrics Work Group on Cow’s Milk Protein and Diabetes Mellitus. Infant feedings and their possible relationship to the etiology of diabetes mellitus. Pediatrics. 1994; 94:752-754.
  10. Darby ML, Loughead JL. Neonatal nutritional requirements and formula composition: a review. J Obstet Gynecol Neonatal Nurs. 1996;25:209-217.
  11. Anderson PO. Drug use during breast-feeding. Clin Pharm. 1991;10:594-624. (Cited in: Nutrition Management in the Full-Term Infant. Pediatric Manual of Clinical Dietetics. Chicago, Ill: The American Dietetic Association; 1997.)
  12. American Academy of Pediatrics Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics. 1994;93:137-150.
  13. Iyngkaran N, Yadav M, Looi LM. Effect of soy protein on the small bowel mucosa of young infants recovering from acute gastroenteritis. J Pediatr Gastroenterol Nutr. 1988;7:68-75.
  14. American Academy of Pediatrics Committee on Nutrition.  Iron supplementation for infant formulas (policy statement).  Pediatrics. 1999;104(1):119-123.
Manual of Clinical Nutrition Management                                                      
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