If You Are What You Eat, 
I'm a Chicken Pot Pie: 
What to Feed Your Baby and When
by E. Noel Preston, MD

   A grandmother listened skeptically as I explained to her adult daughter when she could add solid foods to her baby's diet. "That's not the way I fed my daughter when she was a baby, doctor," she said. "You're absolutely right," I replied. "That's not the way I fed mine, either -- but times have changed."

   A long time ago when my eldest daughter was a baby, her pediatrician started her on rice cereal when she was just two weeks old. We used to feed babies goat milk, or evaporated milk with some water and Karo syrup, and we started them on fruits and juices when they were only a few months old.

   Not any more. Admittedly, babies are tougher than most people think, and can tolerate a great deal of well-intentioned, but unknowing abuse. But we still don't want to do anything that might make a baby uncomfortable from gas or constipation. We don't want to give a baby anything that might cause allergies or diarrhea or contribute to the development of allergic problems like eczema or asthma. And we don't want to teach the baby to crave sugar and start the child down the path to diabetes and/or obesity.

   Solid foods act as a sponge that soaks up all the beneficial ingredients in breast milk that protect the baby from allergies, viral infections and iron deficiency, and so most pediatricians don't want breast-fed babies to have ANY solid foods at all until the baby is at least six months old. Formula-fed babies can start on cereals a little bit earlier. Some pediatricians say the formula-fed baby can start on cereals when he or she a) doubles the baby's birth weight, b) weighs 12 pounds, or c) is four months old. Usually, these all occur at about the same time. The safest solid to start the baby feeding at this time is rice cereal, usually a tablespoon in the morning and another about 12 hours later. After a week the cereal can be given three times a day instead of only twice. The dry cereal can be mixed either with water or formula, but not with applesauce, as I'll explain later.

   Some time ago a new mother called me a few days after her baby's 4-month-old checkup to ask if she had to give him a whole tablespoon of the rice cereal. I said no, the baby would do well just staying on formula feedings. She called back the next day to say she really wanted him to have solids so he would sleep through the night. I said fine, then give him the rice cereal as we had said earlier. And then she burst into tears. "But doctor," she sobbed. "The spoon is so big and his mouth is so small!" Sleep well, America -- the future of the country is secure.

   About a month after starting rice cereals the baby can start having green vegetables -- again, starting with a tablespoon twice a day and then, after about a week, increasing to three times a day. Pediatricians used to start babies on orange/yellow vegetables first, and then introduce the green vegetables later -- but I don't. I noticed when I checked babies' hemoglobins at the 9-month-old checkup and again at the 2-year-old checkup, that many young children were anemic. I would suggest the child eat red meats, green vegetables, egg yolks, peanut butter and enriched grain cereals, and the mothers would almost always say their children wouldn't eat anything but carrots, corn, sweet potato, and macaroni.

   That's when I realized children like orange/yellow vegetables better, and wouldn't eat the green ones. SO, I don't let them have the orange/yellow veggies until they are 9 months old. By that time, they're so accustomed to the green vegetables they're not so likely to be picky eaters.

   How are you going to keep 'em down on the farm after they've seen Paree? How could anyone expect a child to eat green beans after he's tasted applesauce, or banana, or honeydew, or cantaloupe? How, indeed! Fruits and juices taste sweeter than vegetables because they have more sugar. Children like them better and will reject everything else. If you start a child on fruits/juices before you start him on vegetables, you're doomed! The child will crave sweets all his life and may very well become obese or develop diabetes. Infants who drink more than a few cups of juice (or even just plain water) every day will have watery diarrhea. They will gain weight (as infants) slowly, if at all. They will be part of a pediatric syndrome called "Failure to Thrive." DON'T introduce fruits/juices until the child is 15 months old.

   The baby can start on eggs (yolks first, and after a month, the whole egg), meats, tomatoes, and pasta at six months. Honey (because of pasteurization-resistant botulism spores) and fish (because of mercury poisoning and allergic potential) should not be given until the child is two years old. (DON'T put honey on a pacifier!)

   And so, here is the schedule I recommend for feeding babies:

   Breast-fed babies should have breast only until 6 months of age. 
Whether the baby remains on the breast or not, at 6 months the 
baby can have cereals, green vegetables, egg, tomato, meat,
and pasta -- usually introducing a new food at two week intervals.

   Bon Apetit! May your children be slender, and thrive. 

E. Noel Preston, M.D. is a pediatrician in solo practice in Peachtree Corners. 6063 Peachtree Parkway, Suite 202-A, Norcross. (770) 448-1553. More information can be found at www.PeachtreeCornersPediatrics.com

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