Oh, baby, it’s time to eat
Until a baby can sit up and hold its head up – usually around 6 months of age – breast milk or formula should satisfy all of its nutritional needs, according to Sonia Chaudhry, MD.
“Both provide protein, carbohydrates and fat – fat is essential for brain development” said Chaudhry, a pediatric hospitalist with Tufts Floating Hospital for Children’s program at Cape Cod Hospital. “And also water for hydration. It’s basically a complete meal – the ideal shake!”
Solid foods begin to enter the picture at 6 months, but breast milk or formula should continue to be part of the diet for the baby’s first 12 months, she said. Babies must be able to switch from sucking and swallowing to swallowing solids, before they can handle a spoonful of food.
“They need to know how to use their tongue to push the bolus (mouthful of food) back,” Dr. Chaudhry said. “If you give a baby a spoonful of cereal, and they stick their tongue out and it just dribbles down – they may not be ready. You have to give them time to get used to the texture.”
In addition to being physically able to eat without choking, watch for cues that they’re ready for other foods, she said.
“Make sure they’re interested,” Dr. Chaudhry said. “One of the ways to do that is if they’re watching you when your eat. Grabbing things, grabbing for your spoon, things outside of their reach.”
Some babies are physically ready between 4 and 6 months, but feeding solids too early poses risks beyond choking.
“People are adding cereal to their bottles (before 6 months), thinking they’re still hungry or to pacify them, but it’s more disservice,” Dr. Chaudhry said. “It’s putting them at risk of obesity and overfeeding.”
The exception would be if the baby had a medical condition, such as reflux, and a specialist ordered adding cereal to their bottle, she said.
Cereal, whether oat, rice or wheat, is typically the first food to introduce to a baby. At first, a little should be mixed with breast milk or formula to keep the consistency similar to the fluid diet they’ve had. Then it can be gradually thickened.
Because of concerns that rice cereal contains trace amounts of inorganic arsenic, the U.S. Food and Drug Administration recommends it not necessarily be the first or only cereal, and that parents provide cereals that are iron-fortified.
“Rice products are known to have arsenic,” Dr. Chaudhry said. “Arsenic is naturally occurring in the environment. The FDA came out with proposal to limit the amount of inorganic arsenic – limit and add variety. Apples also have arsenic in their seeds. The question then is pressed juices. We don’t really recommend juice, even if it’s 100 percent juice. We recommend whole fruit. They’re getting more from whole fruit.”
There’s no real reason to start with cereal rather than any other food, she said.
”There’s no literature or data that says you can’t start with pureed fruit or pureed vegetables or pureed meat. It’s very cultural. If you were living in India, you would probably start your first meal with lentils; like lentil soup. I’m Indian, and that’s the first meal you get as a baby. A little dal (an Indian dish of cooked lentils or other legumes). So long as it’s pureed or mush.”