Solid Foods: Frequently Asked Questions

Expert answers to questions about feeding your baby solids.
By Bryan Vartabedian, MD

When it comes to feeding solids, just as soon as you've figured out what foods to start with, you're wondering "What's next on the menu?" and "What should my baby be eating?" Late infancy brings your child from pureed baby feed closer to the table. He'll advance from two feedings a day to three and begin to eat with the rest of the family. Although each new step comes pretty naturally, here are some questions that may arise along the way:

How much cereal should my 6-month-old be eating?

While there's nothing magical about cereal, it does provide a valuable source of iron during the second half of a baby's first year. How much cereal a baby needs depends on the child's intake of formula or breast milk. A 6-month-old needs about 10 milligrams of iron per day, which can be met with 27 ounces of regular infant formula (avoid low-iron varieties). The amount of breast milk is harder to quantify, because the number of daily feedings and the amount of iron that a woman's milk contains will vary. Since your child may not consistently take in adequate formula or breast milk, to round things out, give her at least 4 tablespoons a day of dry cereal mixed with formula. This provides about half of her daily iron requirement. Once your child is 7 or 8 months old, you can introduce meat, which will make cereal less important.

My baby doesn't seem to like meat. Does he really need it?

While babies don't necessarily need meat, it offers a terrific source of iron, especially since cereal intake often decreases late in the first year. In addition, the type of iron found in meat is absorbed more efficiently than the iron in cereals or fortified foods. So give your baby some more time to get used to meat before counting it out.

My baby eats a lot of squash and carrots, and I've noticed that her skin in a slight shade of yellow. Is this jaundice?

This is a condition called carotenemia, which results from the intake of a lot of carotene, a pigment abundant in the orange and yellow vegetables your baby appears to enjoy. The resulting slight skin discoloration is harmless, and it will fade with the addition of other foods to your baby's diet. One of the ways you can distinguish carotenemia from jaundice -- an excess of bilirubin (a liver by-product) in the blood -- is that in children with jaundice the whites of the eyes are also yellow. Carotenemia doesn't affect the eyes.

When is it okay to switch from stage 1 to stage 2 foods?

Some parents place a lot of stock in the label on the baby-food jar. But these stages are created by the baby-food manufacturers and are somewhat arbitrary. The main difference between stage 1 and stage 2 is that stage 2 foods are more diverse, mixing foods such as chicken and rice. The jar may also be bigger to satisfy the larger appetites of older infants. But the texture of stage 2 foods isn't any more advanced, or lumpier, than stage 1 foods -- they're both purees. So if your child is polishing off his stage 1 foods and eating a small variety of four to six baby-food fruits and vegetables, feel free to take the leap. Just be aware of the new fruits, veggies, or other foods introduced in stage 2, in case your baby has an allergic reaction. Chunkier baby food (stage 3) can be offered at around 7 or 8 months.

What foods are most likely to cause an allergic reaction?

Fortunately, the fruits and vegetables that babies start with infrequently cause true allergic reactions, which usually means just a rash or stomach problems. The most common allergies experienced by children are to milk (from exposure to cow's milk protein in formula or breast milk), wheat, eggs, fish, and peanuts. Bread and egg yolks should be withheld until your baby is 8 months old, egg whites and fish until age 2; shellfish should not be given until age 3. Peanut exposure, through nuts, oils, or peanut butter, should certainly be avoided during the first year of life. (Allergic reactions to peanuts are often serious, and the nuts themselves are a choking hazard until a child is 4.) If you have a family history of allergies, you may want to talk to your doctor about holding off on these foods for even longer.

My son was diagnosed with a food allergy at 4 weeks. He's 5 months old now and we'd like to start him on solids, but we're nervous about it. What should we do?

This is a very common concern among parents of children with milk protein sensitivity. The fear is that if he's allergic to milk protein, he'll also be at risk for a number of other allergies. As it turns out, most babies who react to milk in the first weeks of life do just as well advancing on solids as any other baby would. However, if your baby has had a severe milk protein allergy with symptoms that included blood in the stool, rash, or breathing difficulties, you should proceed with caution. He's at risk for reactions to other baby-food components, such as soy. Discuss this with your baby's physician.

My son is 7 months old and we haven't yet offered him solids. Is there any danger in waiting?

While the word "danger" may be a bit strong, it isn't a good idea to keep your child away from solids much longer, because you risk the development of what's known as oral aversion -- a hypersensitivity to solids usually characterized by choking or gagging. It can occur when a child is fearful of certain food textures or tastes because he's never encountered them before. Oral aversion can also occur when swallowing is painful. Babies with recurrent heartburn, or reflux, often learn to avoid solids because of their fear of pain. While I normally don't push parents to start their children on solid food until they feel comfortable, the potential for aversion illustrates the importance of getting things underway by 6 months of age.

When should my child begin eating three solid meals a day?

When you start your infant on solid food, you'll typically offer baby food twice a day. As soon as your child is used to solids -- at around 7 months -- you can transition him to three meals a day, just like the rest of the family.

How much formula should an 8-month-old be taking? My son takes three 6-ounce bottles a day, in addition to three hearty meals of baby and table food. But I'm concerned that this isn't enough.

Most babies between the ages of 6 and 9 months will take anywhere from 25 to 35 ounces of formula a day. This varies depending on how often a bottle (or breast) is offered, what other liquids are being given, and how interested the baby is in solids, among other things. At 1 year of age, formula intake should drop to about 20 to 28 ounces a day. In your case, 18 ounces a day in addition to healthy solid feedings is a little less than what the average 8-month-old consumes. This shouldn't necessarily be a cause of concern, since plenty of healthy, thriving babies get by on this amount of formula. And growth -- monitored by your pediatrician at well-baby visits -- should be the bottom line when judging whether your baby is eating enough. However, be sure that your child isn't filling up on juice or other beverages instead of milk. Breast milk or formula is the preferred beverage during the first year.

How do I know when my baby is ready for table food?

Once your child is 8 months old, if she seems curious about what's on your plate or bored with her same old baby foods, you can try offering some unseasoned mashed potatoes or squash. Some babies will actually begin to refuse their silky-textured baby food as a sign that they're ready for something more advanced. If giving your fickle feeder table food arouses a new attitude, you may be on to something.

How early can I begin giving zwieback toast or teething biscuits to my child?

While most teething biscuits are designed to soften and melt upon chewing, larger pieces can break off and present a choking hazard to young children. Because of this remote but possible risk, teething biscuits should not be introduced until your baby is 10 to 12 months old, and then only under close supervision. And if your child seems more interested in breaking the biscuit into pieces with his teeth than sucking on it, biscuits may not be a good idea, even if he's at the right age. Instead, offer unsalted crackers that have a melt-away consistency and present much less of a choking risk.

I understand that children aren't supposed to drink regular milk until age 1. Can I give my baby cooked table foods prepared with whole milk?

You're right that your baby's digestive system is unable to process the proteins in regular cow's milk until she's a year old. But table foods that a child eats toward the end of the first year can contain whole milk, because the amount in these foods is not enough to cause harm.

What about yogurt?

Yogurt contains cow's milk protein, but the quantities are fairly limited and thus not usually a concern. You can give your baby yogurt after 8 months of age, but limit it to 2 to 4 ounces a day. Stick with plain, unsweetened yogurt and add your own minced fruit to keep things interesting. Yogurt can be a good addition to a baby's diet, as it appears to offer health benefits: Studies have shown that its active cultures may help prevent and treat diarrhea in infants and protect against eczema. However, yogurt should not be given to babies who have a documented milk allergy.

My 9-month-old has started crying in the middle of the night. We offer her a bottle and it seems to help. Does this mean she isn't getting enough to eat during the day?

Most 9-month-olds are able to get enough to eat during the day and don't need to be fed at night. Yet babies at this age will experience nighttime awakenings, perhaps as the result of a dream. Some parents interpret these episodes as a sign of hunger, and the eager acceptance of a bottle reinforces that notion. After several nights of this, though, a baby will come to understand that her wailing leads not only to a midnight social break but also to a warm bottle. Instead of giving your child milk, be sure she has some familiar objects in her crib to reassure her she's in a safe place. Don't reinforce her awakenings with food unless you're prepared to make middle-of-the-night snacks a permanent habit.

Adapted from the book First Foods, Copyright 2001 by Bryan Vartabedian, MD. Reprinted by arrangement with St. Martin's Press, LLC, New York, NY

Too Much Juice

Is juice squeezing important nutrients out of your child's diet?

By Madeleine Greey

There was a time when my son seemed to have only two words in his vocabulary: "No!" and "Juice!" Both words tumbled out of his two-year-old mouth with the same sense of dire urgency. When Nicholas awoke, it was "Juice!" Mid-morning, it was "Juice!" And so on throughout each busy day. I found myself pouring little plastic cups of juice like a mindless robot, until one day I stopped to take stock. My cute little juice-aholic was knocking back more than 24 ounces of the sweet stuff a day. No wonder his other favourite word came my way every time I asked him to sit down and eat.

Juice, like many good things, is best in moderation. Too much of it can lead to a surprising array of problems. The wake-up call for many health-care professionals was a study, published in a 1994 issue of Pediatrics, revealing that excessive juice consumption in toddlers could actually lead to failure to thrive, or growth deficiencies.

Less extreme, but still worrisome to many parents, is the relationship between juice drinking and picky eating. This phenomenon has been witnessed in detail by William Wilkoff, author of Coping with a Picky Eater, who points to a problem he calls "the juice deception."

"Juice is better than soft drinks," writes Wilkoff, "but it is easy to get too much, particularly in a bottle, and it displaces important nutritious components of the child's diet.... In my pediatric nutrition clinic days, more often than not, I would find toddlers were drinking way too much juice - sometimes as much as 24 ounces a day."

That amount far exceeds the Canadian Paediatric Society (CPS) recommendation that children from six to 24 months drink no more than four to six ounces (125 to 200 mL) a day, and children two to 12 years old drink no more than eight to 12 ounces (250 to 375 mL) a day. In other words, parents should limit juice intake to two servings daily.

"Parents have a tendency to offer juice more often than not," says Toronto dietitian Lorry Chen. "Kids love juice and will ask for it, again and again. Most parents aren't even aware that overconsumption is an issue. They think it's nutritious... so why not offer it all the time?"

That's the catch: Juice is nutritious. Most varieties are excellent sources of vitamin C. Depending on the type, juice can also supply folate, potassium - even vitamin A and calcium. It's fat-free, easy to digest, has no additives and is all natural.

Yet despite all of its attributes, juice is high in calories and does fill up tiny tummies quickly. If your little guy is feeling satiated from a juice bottle, chances are he won't want his Pablum. If babies and toddlers are filling up on the sweet liquid, they might routinely refuse solid foods, which may lead to anemia.

There's another concern. Too much juice - especially apple or pear juice - can sometimes lead to watery stools or toddler's diarrhea. Different than infectious diarrhea, toddler's diarrhea occurs when too much sorbitol and fructose enter the digestive tract. "These sugars are not broken down easily in a young child's digestive system," explains Doris Yuen, chairperson of the CPS Nutrition Committee, "and as a result, water actually leaks into the gut, causing diarrhea."

The other type of diarrhea - caused by gastrointestinal infections - can be compounded, warns Yuen, if a child drinks juice. While the old school of medical thought was to prescribe "clear fluids" for gastrointestinal infections and flu-related diarrhea, doctors now recommend that children take electrolyte rehydration solutions, such as Pedialyte, and avoid apple juice.

Another place to avoid juice is in a bottle. When children drink juice from a bottle, teeth are in constant contact with sugary liquids, wreaking havoc with dental health. According to Burton Conrod, a Sydney, N.S. dentist and president-elect of the Canadian Dental Association, children who spend a lot of time with a bottle in their mouth - whether lying down or walking around - are at risk of suffering from severe tooth decay (unless, of course, that bottle is filled with water). Thus it is better to drink juice from a bottle, cup, sippy cup or juice box in a single sitting rather than throughout the day, to limit the contact time between teeth and sweet fluids.

The best place for babies to get their first taste of juice is from a cup. That's what Darlynn Harmison of Bourget, Ontario chose to do with her six-month-old daughter. "Courtney was still nursing exclusively and I figured, `Why introduce a bottle, then take it away?' " she says. "Besides, I had read about the risk of dental caries with a juice bottle."

Harmison started Courtney with diluted apple juice since she didn't want her daughter's palate to become accustomed to the sweetness of full-strength juice. (The CPS says it's fine to offer pure, undiluted fruit juice to babies, but does not recommend introducing diluted or undiluted juice until a baby is six months old.)

Now Courtney is 18 months old, and her mother limits her juice intake to four ounces (125 mL) a day. "I fill her sippy cup every day, and if she doesn't finish it when it's served, she can finish it later," explains Harmison. "But I'll always offer her water or milk first. I know that there's vitamin C in her juice, but I'd rather she got more nutrients from whole fruit."

The only time Harmison will break down and offer extra juice to her daughter is during a heat wave. "When it's really hot out and the temperature is up in the 30s, I do get concerned about dehydration," she says. "If juice is all she'll take, that's what I'll give her."

Since most juice hounds complain loudly when parents try to cut back, it's wise to do so gradually, perhaps over a month. Reduce the actual serving size, too, or consider diluting it. Juice from concentrate is easier to water down (without kids noticing) than juice from a can. When a dedicated juice-drinker witnesses his beverage getting a shot of water from a faucet, the success rate is sure to plummet. But if you dilute canned juice and store it in a pitcher, who's to know? Another trick for children over three is to serve one or two frozen-juice ice cubes in a glass of water. You can jazz up the cubes by adding a slice of strawberry or a few blueberries.

Of course, it makes better sense to serve juice judiciously, right from the get-go. If kids under two get a cup in a high chair, then wandering with bottles is prevented. If you instill some structure, such as, "We only serve it at breakfast" or "Here's your daily juice snack," then the all-day habit never starts.

Donna Green of Toronto remembers when her daughter, Stella, was two and a confirmed juice-aholic. "When she was hungry, Stella would much rather drink something sweet than eat food. So I started a no-juice policy during mealtimes to ensure a balanced meal."

It worked. Stella, now nine, is still an avid drinker. "The difference nowadays is that if she's hungry, she'll take a steamy bowl of soup over a glass of juice, hands down. She's kicked the habit, so to speak."

Month-by-Month Guide to Baby's Emotional Development

What to expect each month of your child's first year.
By Kristen Finello

Your baby's emotional development will grow by leaps and bounds during this remarkable first year. She'll go from quiet observation to active participation. Here's what she's likely to do as she grows.

Month 1
- Makes eye contact
- Cries for help
- Responds to parents' smiles and voices

Month 2
- Begins to develop a social smile
- Enjoys playing with other people and may cry when play stops
- Prefers looking at people rather than objects
- Studies faces
- Gurgles and coos in response to sounds around her
- First begins to express anger

Month 3
- Starts a "conversation" by smiling at you and gurgling to get your attention
- Smiles back when you smile at him. The big smile involves his whole body -- hands open wide, arms lift up, legs move
- Can imitate some movements and facial expressions

Month 4
- Is intrigued by children. Will turn toward children's voices in person or on TV
- Laughs when tickled and when interacting with others
- Cries if play is disrupted

Month 5
- Becomes increasingly assertive
- Can differentiate between family members (parents and siblings) and strangers
- Likes to play during meals

Month 6
- May quickly tire of a toy but will never tire of your attention
- Temperament becomes increasingly apparent. You'll see whether she tends to be easygoing or easily upset; gentle or active
- Recognizes his own name
- Coos for pleasure and cries with displeasure
- Can make noises like grunts and squeals; clicks his tongue

Month 7
- Starts to understand the meaning of "no"
- Enjoys social interaction
- Expresses anger more strongly
- Tries to mimic adult sounds

Month 8
- Can differentiate between familiar and unfamiliar
- May become shy or anxious with strangers
- Cries in frustration when he can't reach a toy or do something he wants to do

Month 9
- Imitates gestures that other people make
- Looks at correct picture when an image is named
- Smiles and kisses own image in the mirror
- Likes to play near parent (i.e., in kitchen while Mom is cooking)
- May be more sensitive to the presence of other children

Month 10
- Separation anxiety may begin
- Self-esteem begins to develop
- Responds to positive recognition such as clapping
- Becomes cautious of heights
- Shows moods such as sad, happy, and angry

Month 11
- Tries to gain approval and avoid disapproval
- Can be uncooperative

Month 12
- May have temper tantrums
- Can fluctuate between being cooperative and uncooperative
- Shows a developing sense of humor
- May cling to parents or one parent in particular