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Feeding Your Baby

There are thousands of different ways to feed a baby -- and the human race is still here in spite of them all.

I realise that you may be visiting this page for advice on the right way to feed your baby, not to be told that there is no right way to do it. However, there really is no one right way to do it. The best advice I can give you -- in my office or here on the Web -- is how I recommend that parents feed their babies, along with the very few hard-and-fast rules I give to parents.

Feeding a Newborn Baby

Although there are some differences between formulas, all milk-based formulas provide roughly the same nutritional benefit to a baby. Soy-based formulas are also roughly equal as far as basic nutritional content is concerned. (In the United States, formula composition is regulated by the Food and Drug Administration, which helps insure that formulas meet basic standards.) The main difference between milk-based and soy-based formulas is in the use of cows'-milk or soybeans as the protein source. (There are special formulas available which contain protein "pre-digested" into component amino acids; these are useful for a baby who is allergic to milk or soy proteins, but they smell awful and can be very expensive.)

Dr. Reddy's Rules for Feeding a Baby

If you are breast-feeding your baby, do not give a bottle as well, at least for the first few weeks.

Babies are smart. They will figure out pretty quickly that they have to work much less to drink from a bottle than from their mothers. If you spoil them with the bottle long enough -- and it may only take a few days -- they won't want to drink from your breast any more. (Some people feel that pacifiers can also affect babies' ability and desire to breast-feed. Whether this is or is not true, there are studies showing that giving a baby a pacifier when she's put to be actually reduces the risk of Sudden Infant Death Syndrome (SIDS) -- enough so that giving the pacifier is likely a good idea.)

If you are breast-feeding your baby, do not supplement with formula unless your doctor recommends supplements, or unless your baby has actual signs of dehydration.

The average breast-fed term (9 month pregnancy) baby drinks a bit more than 1 tablespoon of breast milk in the first 24 hours after birth. He isn't likely to be dehydrated in that time, either. In fact, we expect babies to lose up to 10% of their birth weight in the first few days after birth, as they get rid of the amniotic fluid that was in their lungs when they were born, and we worry about babies who do not lose that weight. Breast-fed babies lose a bit more weight, lose it faster, and gain it back more slowly than do formula-fed babies over the first two weeks, but by the end of that time breast-fed and formula-fed babies are pretty much even in weight and in the amount of milk they drink (usually a bit less than 2 ounces per pound of their current weight, or more).

Avoid playing Musical Formulas with your baby.

Babies are also smart enough to notice the difference in taste between different formulas -- and to complain when they do not get the formula they were expecting. Although sometimes your baby's doctor may recommend an immediate change in formula (for something like true formula intolerance), generally I recommend that when changing formulas you do it gradually:

• First week: 1/4 new formula and 3/4 old formula.
• Second week: 1/2 new formula, 1/2 old.
• Third week: 3/4 new formula, 1/4 old.
• Fourth week and beyond: new formula.

Sometimes I will shorten the time from one change to the next (to as little as 3-4 days), but I still do changes gradually. (Note that I find this gradual switching useful, but that many other pediatricians do not. As always, your baby's doctor is your best source of advice on your baby.)

Do not give low-iron formula to your baby.

Studies, including controlled trials, have shown again and again that regular iron-containing formulas do not cause constipation or other stomach or intestinal problems. If you feed your baby low-iron formula, your baby runs the risk of becoming anemic -- and the treatment for iron-deficiency anemia is iron supplements, which you would expect to produce worse symptoms of stomach upset.

Do NOT give plain cow's milk to your baby.

Cow's-milk-based formulas have been processed so that babies can digest the protein in the milk more easily. Plain cow's milk can irritate the intestinal wall, resulting in some cases in microscopic bleeding -- you won't see blood in your baby's stool, but it's there, and your baby will become anemic as the bleeding increases. Also, it's hard for a baby to absorb iron from cow's milk, even if extra iron is added. (Breast milk actually has less iron than formula does -- but a baby will absorb more iron from breast milk than from formula. The amount of iron doesn't matter nearly as much as how well the iron is absorbed.) Generally, babies' intestines aren't ready for cow's milk until they are about 1 year old.

Always follow the directions when preparing formula.

Formula that is too dilute or too concentrated can change a baby's mineral balances, especially those of sodium and potasssium. One of the most common cause of seizures in infants is sodium/potassium imbalance caused by formula mixed the wrong way. Occasionally a baby will need high-calorie formula, which can be made by mixing regular formula powder or concentrate according to different directions, but you should not do this unless your baby's doctor has given you those directions.

NEVER give plain water or sugar water to a baby without asking your doctor first.

Plain water (and sugar water) are even worse than too-dilute formula -- babies' kidneys cannot get rid of extra plain water the way our kidneys can, and so giving plain water can produce mineral imbalance and seizures even faster than too-dilute formula. Sugar water (and clear fruit juices and other children's drinks) are generally just as bad as far as mineral content is concerned. In fact...

NEVER give ANYTHING except breast milk or formula to a baby without asking your doctor first.

Most of us recommend that, when you start feeding your baby, you start with cereal. The three cereals we suggest are rice, barley, and oat; all three are easily digested by most babies. Rice cereal is the traditional first food for babies: it is more digestible and less allergenic than other cereals. However, rice is also the most constipating of grains. I occasionally suggest starting with barley or oat cereals; I usually suggest that a baby be fed all three cereals within 3 weeks of starting cereals.

Dr. Reddy's Rules for Feeding a Baby (continued)

Do not give wheat or corn cereals to your baby before 1 year of age.

Wheat and corn cereals tend to be allergenic in some babies.

After starting a new food, WAIT SEVEN DAYS BEFORE STARTING THE NEXT NEW FOOD.

This is the most hard-and-fast rule I give to my patients' parents. Lots of babies have problems with a particular food. Waiting one week between new foods will help you and your baby's doctor sort things out if your baby has a problem with a particular food.

After your baby has been through the three basic cereals, it's a good time to start her on other solid foods.

Dr. Reddy's Rules for Feeding a Baby (continued)

Start with vegetables; after you have gone through vegetables, start on meats. Leave fruits until last.

The theory behind this rule is that if you start fruits first, your baby may acquire a sweet tooth -- and then he won't want anything that's not sweet. (I haven't seen studies to confirm this one, but it does make sense, kind of...)

You can feed a baby vegetables, meats, and fruits that you have cooked and mashed (by hand or in a blender or food processor).

There is nothing sacred about jars of baby food -- in fact, about the only thing a jar of baby food has that home-cooked-and-mashed food doesn't have is extra salt (which your baby doesn't need anyway...).

Avoid corn, citrus fruits, and nuts.

Like corn, citrus fruits and nuts tend to induce allergies if given too early. (I usually recommend waiting until age 1 year to give wheat cereal, corn or corn cereal, or citrus fruits; some pediatricians I know suggest waiting until age 2 years before giving peanuts (including peanut butter) or other nuts. However, there is new evidence suggesting that exposure through the mother's diet during pregnancy may be enough to sensitize the baby. As always, ask your baby's doctor for the real lowdown.)

If you give clear fruit juices, don't give a lot -- and make sure that your baby isn't taking so much juice that she isn't drinking enough breast milk or formula.

Clear fruit juices are usually no more than flavoured sugar water -- sometimes with a vitamin or two, but they haven't nearly the nutritional content of breast milk or formula. Although a baby older than about 6-9 months has kidneys capable of getting rid of the excess water and keeping minerals balanced in the body, if she fills herself up with juices she won't want to eat and drink things with more and better-balanced nutritional content.

Feeding a Toddler

Once your child is walking and talking, it's sometimes hard to keep him still long enough to eat properly. By this time most children are eating table foods, and (should be) eating a good variety of foods. Most children's rate of growth drops off once they learn to walk, because they're often too busy to eat -- this is quite normal, and not a big concern unless they're actually losing weight.

Dr. Reddy's Rules for Feeding a Baby (continued)

After age 1 year, children should be drinking whole milk. Not 2%, not 1/2%, not skim -- whole milk.

We all know about saturated fats and how bad they are for adults in excess. This isn't true for children. To take one important example: your baby's body needs saturated fat to produce myelin (the material that "coats" nerve fibres so that they can carry signals to and from the brain properly). Among other things, without proper myelin coats your muscles won't work properly (you learn to walk only after the nerves to your leg muscles are myelinated, and you can't toilet train until the nerves that control your bowels and bladder have their myelin sheaths). Therefore, your baby must have saturated fat, like butterfat, while she's a toddler.

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Copyright © 2000, 2007 Vinay N. Reddy, M.D. All rights reserved.
Written 10/11/00; major revision 05/07/07