Rice Cereal/Rice Product: Yay or Nay ?

Since the Dartmouth college and consumer report published the research and article about arsenic in rice in 2012 and how infant exposure to the inorganic arsenic were among the highest had raised an alarm to the parent groups and pediatric health care providers. To this date, I still hear the same conversation between parents, doctors and dietitians.

As a pediatric dietitian, I’ve yet to see an infant with arsenic poisoning  came my way whether it be in the hospital or outpatient clinics. None the less, there’s some concern about inorganic arsenic in rice cereal/ rice products but since 2012, the infant cereal manufacturer has taken action to uses rice that has the least amount of inorganic arsenic for infant cereal and also provided other options of infant cereal such as Oats, Barley and Multi-grain.

BEWARE – brown rice cereal/brown rice has the highest amount of inorganic arsenic compared to regular rice cereal/ white rice. Same applies to organic baby formula which uses organic brown rice syrup -has also been tested with high level of arsenic content.

*So far, I only found Nature’s One Baby’s Only Toddler organic formula has a disclaimer that took action in filtering their brown rice syrup to an undetectable level of arsenic content.

What exactly is Arsenic ? Why does it matter ?

According to Food and Drug Administration (FDA): Arsenic is an element in the Earth’s crust, and is present in water, air, and soil. It occurs both naturally in the environment and as a result of human activity, including from erosion of arsenic-containing rocks, volcanic eruptions, contamination from mining and smelting ores and previous or current use of arsenic-containing pesticides. Long-term exposure to high levels of arsenic is associated with higher rates of skin, bladder and lung cancers, as well as heart disease. The FDA is currently examining these and other long-term effects.

So is it still safe to provide rice cereal/ rice products to my baby and children?

Short answer is YES.  The latest data analysis conducted by FDA in 2014 shows that majority of the rice cereal averaged about 103 parts per billion and the new proposal to limit the total arsenic content in rice cereal is set at 100 parts per billion (same as the European commission).  If you provide your infant/young children with variety of foods and rice is not the only source of grains, you shouldn’t be worried.

There’s also a few ways to help reduce the exposure to high amount of inorganic arsenic if rice is the main stable (such as Asian communities).

  • Rinse the rice in large quantities of water until the water is clear.  This has been the practice of Asian culture. (As per FDA, rinsing will reduced about 16% of the inorganic arsenic content, but it also rinses off other fortified vitamins and minerals such as iron, thiamine and folate)
  • Cook rice in large quantities of water (6:1 to 10:1 ratio) – as in making rice porridge for the infant. Which is also a practice in Asian culture when they first introduce solids. (This will reduce about 43% of the inorganic arsenic content).
  • Chooses rice that is lower in arsenic content, such as Basmati, Jasmine and Sushi Rice. Here’s a chart published by consumer report on all the rice that they examine:  consumer-reports-arsenic-in-food-november-2012_1

Bottom Line:

  • It is still safe to provide rice cereal to your infant as long as it’s not the only source of solids.  Meat, fruits, vegetables are also a good first food options as well. If you are still worried, then choose Oats, Barley, or Multi-grain infant cereal.
  • Provide a variety of grains for your toddler and rice shouldn’t be the only grain in his/her diet. VARIETY is the key !!
  • Rinse and cook your rice with lots of water.
  • Breastfeeding your baby as long as you can. Recommended exclusive for the first 6 months and then up until one years of age.

Is Probiotic Safe for Babies/Toddler?

You’ve probably heard all the good things about probiotic for adults and then you started wondering if it will benefit your babies and young children as well.  The short answer to this question is YES!  Although the research on safety on probiotics for infants are limited but of all the available research out there, side effects are rarely reported.

What are Probiotic exactly ? Probiotic are the “good bacteria” itself that’s helps with our digestive system and with consumption will enhance the health of the host (a.k.a -human). It may also improve outcome of pregnancy, certain intestinal problem such as irritable bowel problem or antibiotic associated diarrhea.  Probiotic often shows up on food as “live culture” such as yogurt, cheese, kefir, or probiotic drink (such as Yakult). Probiotic also presents in the non-dairy products such as fermented foods – Kimchi, tempeh, miso, natto beans, sauerkraut, Kombucha to name a few.

Of course we don’t anticipate young infants (<6 months of age) to eat all this probiotic foods but guess what ?! Human milk is full of probiotic properties (specifically Bifidobacterium Infantis) that was discovered in the intestinal tract of babies, which is the reason why breastfeeding infant does not get sick as often compared to formula fed babies.

If you are formula feeding your babies, don’t feel guilty. You have done the best you could to provide what you can either first few days, weeks or months of available breast milk to help your baby kick start a better immune system.  There’s also probiotic formula available on the shelf these days, mostly labeled as “Formula for supplementing”.

Also, don’t get confused between prebiotic and probiotic. There’s a big differences.

What are Prebiotic? Prebiotic are non-digestible dietary fibers that fuel the good bacteria in our gut (a.k.a bacteria’s food). The more of prebiotics that we consume, the more gut flora will grow and stays to help keep us healthy.  Prebiotic also helps produces vitamin B, helps with calcium digestion and absorption as well. Good prebiotic sources includes: Artichoke/Jerusalem Artichoke, chicory roots, leeks, garlic, onions, asparagus, banana, whole wheat products, scallions, apples and legumes.

Therefore, once your babies reaches the age to introduce solids. Try to introduce as much prebiotic food sources in their diet to help colonize their little gut with the good bacteria and ward off illness as much as possible. When prebiotic and probiotic combined, they are a dynamic pair to keep the digestive system healthy.

I always recommend to get your probiotic sources from food before opting for the pill forms.

 

 

 

Homemade Infant Formula…What seems best may not be!

We all know breast milk is the best food a mother can provide for your precious newborn. But there’s time when you aren’t able to provide enough breast milk for your infant and formula automatically becomes the next best thing we turns to.  In the past 3 years, homemade infant formula has becoming more popular thanks to parenting website such as wellness mama and celebrity Kritin Cavallari sharing her recipes on magazine and blog post.

It really boggle my mind that 1.27 million hits on google search with homemade formula has come up in less than .5 seconds. This does concern me as a healthcare professional and a mother of a young toddler. I would steer away from making my own homemade formula at all cost. This is because there’s too much variation in homemade formula and the ingredients that they called for might not be the safest for your baby’s tiny body.  I’m certainly not “Pro commercial formula” but when it comes to infant’s health, I’ll stick to what I know is best 1) Breast milk and 2) Commercial Formula.  My recommendation is to stick with Organic or Non-GMO labeled commercially prepared formula if financially able to do so.

Parents often complaints that formula is so horrible because there’s sugar, corn syrup plus a long list of other ingredients that they are unable to pronounce. If they can’t pronounce and don’t know what that is, it must be bad, correct? Answer is no.  I think parents’ need to understand that corn syrup and high fructose corn syrup are two different things. One is a natural derivative of sugar from corn (mostly made of glucose), and the latter is a chemically altered to produce fructose from corn syrup.

You will only see corn syrup on the formula that is made for babies with sensitivity as it is easier for the digestive system. Babies need carbohydrate to grow, without it they simply wouldn’t thrive whether the sources is lactose, sugar or corn syrup.   And that the other ingredients listed (most of them are less than 2% of the formula content) are the vitamin and minerals scientific name carefully crafted to suites the needs for newborn to match the content similar to breast milk.

Commercially prepared formula is being monitored by the FDA, USDA and EPA and they have been subjected by thousand of research before to ensure their nutrient adequacy to be served to the most vulnerable populations.

Homemade formula on the other hand looks great in a glance but it carries a lot of hidden danger of food borne illness, nutrient imbalance and other potential health risk to your baby if you are not mixing it correctly.  Just one misstep can send your child into the emergency room.

Here’s the reason why homemade formula might not be the best after all:

Unpasteurized raw cow’s milk/ Raw goat’s milk

Any type of raw food products possess a certain type of risk for food safety. According to Center of Disease Control (CDC), unpasteurized dairy increases a staggering 150x of your baby’s risk of Campylobacter, Listeria, E.Coli infections.  Most dairy product related outbreaks are associated with consuming raw dairy products and children are the most affected populations.  You wouldn’t even drink raw milk when you are pregnant because it can increase your chances of food borne illness and affecting your unborn baby, now why would you want to feed your baby raw milk then? Seriously, think about it.

Here’s a link to the CDC hand out on raw milk statistics.

Raw Liver

This is another food source that can foster bacteria Campylobacter jejuni especially when using it raw. Campylobacter food poisoning can cause damages to your baby’s intestine and can easily leads to bacteremia (bacteria in bloodstream), a serious condition which requires hospitalization and heavy dose of antibiotics.  In rare cases, it can cause Guillian-Bairre syndrome, an autoimmune disorder that the body defense mechanism start attacking the healthy cells.

Nutrient Imbalance

I carefully read through some of the most promising homemade formula out there, there’s no nutrient analysis of them anywhere. Only one I read was all the nutrients gathered according to the ingredients from the food database. Please be reminded, data gathered from food database is not a detail nutrient analysis of the formula, nutrient displacement can occur during mixing process.

Another scary discovery was whether it is cow milk based or goat’s milk based homemade formula, both contain excessive calories and protein per serving. To adults, a little higher calories or protein here and there doesn’t hurt but in tiny infant, every single one matters. If the infant doesn’t require extra calories and protein, it will make them gain too much weight too quickly. Excess calories will lead to extra fat accumulation which in turns link to adult obesity later on in life.  Liver based formula on the hand has the right amount of calories, but protein still slighter higher and what was lacking is sodium and calcium, two key nutrients that needed for bone and cell formations.  The extra protein in the homemade formula will put extra stress on their tiny kidney to process and can easily leads to dehydration.

So, if you think you are doing your child a favor, think twice before you jump into the homemade formula bandwagon. Just be aware of the potential risk of giving homemade infant formula, every baby’s body digestive system is different. Homemade formula is definitely not recommended for infant younger than 6 months of age.

Always consult with your child’s pediatrician or meet with a pediatric nutrition specialist to discuss your formula choice/decision. They can help you analyze the formula and let you know if it is safe.

 

Nutrition for Infant 10-12 Months

This is the time when your infant can safely  transition to soft table food if you haven’t already done so. No more making separate meals for your little one and welcome them to dine together with the entire family and start modeling good eating behavior from a young age.  They might not interest in new foods in particular but keep offering and let them explore, it usually takes 8-10 tries of introducing same food item before they start accepting it.

Persistent and interactive fun is the key to coaching healthy eating behavior among children. Don’t skim on the flavor as well.  Children doesn’t have to eat bland or mild tasting food, introduce interesting natural flavor such as  strong vegetables (broccoli, asparagus, onion, garlic, ginger, cabbages), spices (not spicy) and herbs to stimulate their taste bud. They don’t have to like it but by offering and expose them to the flavor profile will do.

10 – 11 Months old 

Baby at this age still requires roughly about 4 feedings (6-8 ounces) of breast milk or formula on a daily basis. The breast milk and formula consist of 50-60% of their daily intake and the remaining is from food.  You can start offering combination meals and doesn’t have to be a single food item by this age anymore.  Peanut butter, fish, eggs are safe to introduce at this time as well if there’s no history of allergies in you or your partner medical history. A schedule 3 meals 2 snacks should be offered daily.

Make sure to keep offering 2-4 ounces of water in a cup during the day as well. If you live in an area that the water is not fluoridated, then make sure to add 0.5 ml drop of fluoride in the water he/she is drinking starting after 6 months of age. Always check with the pediatrician and pediatric dentist to see if your baby need it. Formula fed baby might not require additional fluoridation.

*There has been some controversies regarding the safety of giving fluoride to infant and young children. At this time, American Academy of Pediatric and American Dental Association still recommend fluoride to be given to children in none fluoridated communities. It will be up to individual parent decision whether they would like to use it for their infant.

12 Months old

They can start eating table food without any problem. Still cut round foods into quarters to avoid choking. Cut other foods into small strips for easy holding. Do not serve whole nuts and hard to to chew item as well. By about one year of age, your baby should be able to  self feed themselves (will be messy) with their finger or using spoon/fork. This is part of their development milestone to be able to pick up food and put in their mouth.

Breast milk/ formula still consist about 40-50% of their daily intake (3-4 servings of 6-8 oz milk) and the rest from solid foods. They should be eating 3 meals and 2 snacks daily.  A easy rule of thumb to remember how much solid food they should be eating is one tablespoon of each food groups (grains, fruits, vegetables, meat/meat substitute) per year of a child’s age at each meal. Refer to this How_To_Feed_Baby-English step by step guide if you wanted a more specific serving size.

If you still have ample breast milk supply, please continue to breast feed your baby as long as you desire. And, if you are formula feeding, you can also start switching to whole cow’s milk/ full fat (original) fortified soy milk.  There is now toddler transitioning formula available from Similac (R), and Enfamil (R) if this is something you are interested in. Your child is also supposed to triple his/her birth weight by the time they turn one.

Note: Let your baby be their own guide as to how much they can eat.  Forcing baby to eat the amount of food you think they should can easily back fire and cause food aversion. There’s going to be weeks they don’t have much appetite for food such as teething period. Sometimes they will eat more than the recommended servings and don’t be alarm as well, baby tends to go through short period of growth spurts. As long as they grow accordingly along their growth curve without excessive weight gain or weight loss, there’s nothing much to worry about.

9 FAQ From First Time Parent about Nutrition

It is exiting yet nerve wrecking when your precious little one finally arrive in your arms. You can read all the parenting guide book to get yourself prepared as much as you can but the real deal awaits you when you bring your baby home. That’s when the true test of parenthood begins.

Here’s a few frequently asked question by my patients’ parent as to what to expect regarding their newborn/infant first year of nutrition problem/needs.

1. How do I know my baby is getting enough ? 

Well, the first few days your baby’s stomach really can hold 5-15 ml of breast milk or formula. Slowly it will stretch out and increasing the volume they can tolerate. One way to know is adequate wet diaper and soiled diaper. Breastfeeding babies should have at least 2-3 soiled (yellow seedy poop) and 8-10 wet diapers daily.  Another sign of baby is getting enough is good weight gain, if your baby is gaining 1.5-2.0 pounds per month, that’s a good sign he/she is receiving enough from breast feeding or formula. If you have a premature babies, his/her nutrition requirement will be higher than a normal healthy term baby and are expecting to grow a minimum of 2.2-2.5 pounds per month.

If you are still worried, go to the doctor’s office in between well baby visit for weight check. There’s also birth center that does weight check for infant as well.

If you have time, read nutrition for infant 0-6 months article I’ve written earlier.

Every parent should familiarize themselves with an age appropriate growth chart. This can help you keep track of how their growth is overtime. You can go to infant chart website to monitor growth for infants and children ages 0 to 2 years and 2-20 years of age in the U.S. The website also included preterm baby’s growth chart, and a Chinese babies growth chart as well (Historically, Asian babies tend to be smaller in size).

2. My baby has bloody diarrhea ! What do I do ?

This could means several things, intestinal irritation, intolerance of breast milk/formula, and/or allergies. Please call your child’s pediatrician office right away.  In the meantime while waiting for your doctor’s call back, continue to offer breast milk to prevent dehydration. Pedialyte also is appropriate at this time. You can try switching to a hypoallergenic formula (Nutramigen(R), Alimentum (R), Pregestimil (R), Gerber(R) Extensive HA) and consult a doctor for next step.

3. My baby is constipated, HELP !

Most breastfed infant seldom get constipated before solids food are introduced. But, that doesn’t mean it won’t happen. When babies goes 3 days without a bowel movement, you can start some prune juice (15 ml juice mix with 15 ml water) and give it to your baby twice daily. You can also do warm bath and gentle belly massage to stimulate the bowel movement. If constipation doesn’t resolve in 1-2 days, call the doctor !

4. When should I stop feeding baby during the night? 

Breast milk is easily digested therefore your baby will get hungry much faster compared to formula fed babies. It is best to continue feeding your baby on demand until adequate solids intake is achieved, usually between 8-10 months of age when sleeping through the night is possible.  However, breastfed babies might still wake up in the middle of the night craving for comfort nursing, it will be your decision, whether you wanted to continue offer a bottle or breast. One thing to remember is that they are able to consume enough solids food during the day to meet their energy needs and doesn’t need the 1-2 feedings at night as it was before.

5. Can I drink coffee or alcohol when I’m breastfeeding ?

Moderate amount of coffee (1-2 cups) is usually acceptable while you are breastfeeding.  If you are expecting to go to a social events and would like to have more than a few sips of wine/beer. Feed your baby before hand or pump and completely empty both breast before drinking alcohol. Wait for 3 hours after before the next feeding after alcohol consumption. Only one serving is recommended (5 ounce of wine, 12 oz beer, 1.5 oz of spirits).

6. When should I introduce solids ?

Technically by 6 months of age or 6 months of corrected age if you have a premature babies. Babies have to be able to sit up without neck support, showing signs of interest in food, open mouth wide when seeing a spoon.

7. What is an ideal first food ?

There’s none. You can choose infant cereal (rice, oatmeal, barley), puree vegetables (avocado, peas, carrots, green beans, sweet potato, squash), puree fruits (peaches, pears, prunes, banana, applesauce),puree meats/beans. It is your choice and what your family prefers. Just remember to introduce one food at a time, wait for 2-3 days before the next new food is being introduced. The key is to continue introduce different variety and flavors and will be more adventurous in trying new foods later on.

8. Homemade purees vs Commercially prepared

All of us know what home made food is the best. But there’s a large majority of parents that didn’t have the time or luxury to obtain fresh/ organic produce to make home made foods for their little one. Just be careful that fresh produce and some roots vegetables such as spinach, green beans, squash, beets and carrots may contains large amount of nitrates, which can leads to anemia. So, it is best to buy commercially prepared ones for those food items as food manufacturer does test of nitrates in baby’s food.

9. Is eggs, nuts, dairy, soy, fish safe to introduce during first year? 

The latest research published by the American Academy of Pediatrics in 2013 have indicated early introduction to allergenic foods are actually beneficial to prevent food allergies later on. Unless your family has a history of food allergies, then it is unnecessary to avoid introducing eggs and/or peanut butter containing foods to infant starting at 6 months of age given appropriate texture is provided. It is still not safe to provide large chunks, hard to chew food during the early introduction of solids food.

 

 

 

 

 

Baby’s Poop 101… What parents should know!

“Did they poop? How much they poop? What’s the poop look like ? Is this normal ? ” Those are the thoughts process always going through new parents’ mind on a daily basis when taking care of their babies.

Well, what does nutrition has to do with it ?? The answer is EVERYTHING ! Food consumption, digestion and defecation is an important indicator for healthy gut, digestion and food tolerance. A healthy gut and healthy poop means your baby will be absorbing the nutrients he/she is needing and grow without major problem.

Baby’s stool frequency,  color, and consistency tells me a lot about their diet and whether if there’s something the parent should be concerned about. Whether it be allergies, intolerance, dehydration, constipation, malabsorptions, irritable bowel etc – poops are usually the first tell tale signs of something has gone awry or it is completely normal.

FREQUENCY:
What’s normal?? There really isn’t a concrete answer. Some baby goes everyday with 2-3 soiled diapers  or more and some only goes once per day. As long as they don’t look uncomfortable with harden belly or straining too hard when they have to go, there’s nothing to worry about. Exclusive breastfeeding baby sometimes can go several days and up to 7 days without having a bowel movement and this is completely normal as well.

COLOR & CONSISTENCY

NORMAL POOP WHAT IT MEANS
Black, Sticky, Tarry (First  1-3 days of life) Meconium (the first poop from the intestine of newborn)
 
Yellow, Seedy, Curds like Breast feeding poop (Breast milk is very easily digested and move through the intestine quickly. Therefore, it’s yellow/mustard yellow color most of the time).
 
Darker Yellow/brown Combination of breast milk and formula feeding
 
Dark brown/Tan/Light Tan Formula feeding or sometimes when your baby is on goat’s formula or goat’s milk.
 
Yellow  with Mucus Sometimes this is normal, usually when baby is teething and is swallowing more of their saliva. But it can also means some intolerance to milk (check the frequency and when in doubt-call the doctor)
 
Green frothy Imbalance of foremilk (watery clear)and hindmilk (rich creamy milk) Note: Just make sure to feed baby long enough on one breast to empty the rich creamy hindmilk before switching to the other breast.
 
Darker Yellow/ Dark brown soft solid with undigested food–It could be orange, dark blue, dark green Transition between milk to solids, and when they start eating more solids food, undigested food chunks will be identified in their soft formed poop. Colored poop as long as is not black and dark red is normal based on the type of foods they are eating. If it is darker red (make sure baby hasn’t been eating beets or cherries the day prior).

NOTE: Remember the faster the food goes through the intestine tract, it will be yellow, when it’s a slower digestion, it will change to green, brown then dark brown to black (which will lead to constipation)

Green If your baby are those select few that were solely on amino-acid based formula such as Elecare® or Neocate® or Alfamino®. Don’t be alarmed if their poop is green.
ABNORMAL POOP WHAT IT MEANS
Diarrhea Food/milk intolerance, malabsorption, or it could be viral illness as well.  Note: Make sure baby is well hydrated. If it lasted more than 2 days, contact your baby’s pediatrician.
 
Very dark brown/black, hard small pellets, marbles like size Constipation.  This could mean they have extra iron in their diet, not enough fiber or not getting enough liquids. Note:  Offer prunes, peaches, pears and massage their belly gently if they are older than 6 months old. Making sure baby (6 months and older) getting enough liquids (breastmilk or formula and 1-2 oz water daily). You can also look into probiotic drops or formula that contains probiotics for your baby if he/she is prone to constipation.
 
Bloody tint/streak in yellow stool Sign of food allergies. Usually milk protein allergies. Note: Remove cow’s milk formula and use an semi-elemental formula (Alimentum®, Nutramigen®Gerber® Extensive HA®
or Pregestimil®). If you are breastfeeding, you’ll need to eliminate all dairy from your diet.  Check with your baby’s pediatrician to complete a milk protein allergy testing to get a better picture.
 
Bloody stool Milk, allergies, intestinal infections, or gastrointestinal bleeding.  Call the pediatrician right away!
 
Chalky White Liver or gallbladder problem because of bile malabsorption. Call pediatrician right away!

There’s several parenting sites that has visual I like that decipher the baby’s poop mystery for mothers (and fathers) to look at.  First one is from Parents: Baby Poop Guide they also have a very nice pdf file to download and keep it handy at home. All you have to do is simply becoming a member with no fees or obligations. Here’s their PDF Parents_Baby_Poop_Guide to save you a trip to sign up if you don’t want to subscribe.  Second site is  Baby poop: A complete guide | BabyCenter and the third one is from Similac Diaper Decoder. I quite like the Similac decoder page because it tells you the reason why the poop is the way it is and if you should be worried.

Again, this is all just a guidance for the first time parents. A proper diagnosis from your child’s pediatrician is highly recommended if your child is experiencing any abnormal signs and symptoms of their bowel movement!

 

 

Nutrition for Infant 6-9 Months

If you are a first time mom (FTM), surviving the first 6 months after your baby is born is definitely worth celebrating. If you are an experienced mom, then kudos to you for your bravery to take on the second or third kids challenge.

Being a mother is a 24/7 job and  not counting the sleep deprivation, trying to establish breast milk supply, constant worrying and the emotional roller coaster post-partum and the list goes on. None the less, you have made it past the most difficult months but there’s still a lot more ahead we have to know about your baby’s nutritional well being when they are ready to embark on the solid foods journey.

Now that you’ve mastered their schedule down to a tee, let’s talk food 🙂

6 -7 Months

Starting solids is a big step for your baby. But where do you start ? Answer is start simple, one food at a time and there’s no right or wrong on whether you start rice cereal, fruits, vegetables or meat first. There’s no research to support whether the starting order of vegetables first will make your infant to be more incline to eating vegetables later. Nope, no such things. Breast milk and infant formula are sweet to begin with, so most babies will have a tendency to like fruits much better than others.

Offer a wide variety of foods (cereal, fruits (no juice at this time), vegetables, meats), but only single food at a time. Start with one food, offer for 2-3 days and then introduce the next to rule out any potential allergies. But do remember, do not add salt at this time as baby’s kidney are still developing. This will go on for about two months time to let them try as much food as possible. By the end of 7 months, the list of food they can consume will grow to about 30-35 foods.

You can also lightly seasoned the foods with spices, herbs as well at about 7 months. Introducing purees doesn’t equate to eating bland foods for your children. Expose them with different flavors which in turn will help them be more of a adventurous eater later on. They don’t have to like it, by just exposing them with variety of flavors profile will do.

How much to offer ? About 1/2-1 Tablespoon is a good start at each meal. Let your baby be the guide on how much they wanted to eat. Baby will turn their head or spitting out food when they are done with eating.

Key Point:  At 6-7 months of age, solids foods are consider a “complimentary” foods. As in it is just supposed to be letting the infant to experience the different taste of food and continue to work on their oral motor development. Food at this point are not suppose to replace their major source of nutrition (breast milk or infant formula. 90% of their caloric intake should still be breast milk or infant formula at this time (approximately 26-32 ounces daily).

8-9 Months

After your baby has time to master the oral motor skills for 1-2 months. Now is time to introduce some chunky purees now. If you are interested and aren’t afraid of baby led weaning (BLW) techniques, you can also try giving your baby well cooked vegetables, soft ripen fruits (cut in stripe or small cubes), soft/ground meats (fish/meat balls) with careful supervision at dining table. At this time, most baby has the capability to chew with or without teeth and swallow without much difficulty.

You can start introduce cheese, yogurt (not cow’s milk or goat’s milk yet), egg yolk and egg whites if you like. The American Academy of Pediatrics and the World Allergy organization have released reports that early introduction of high allergenic food such as egg whites, wheat, nuts can reduces even high risk infants of developing egg/nuts allergies later on.

How much to feed ? Making sure to offer about 1-2 Tablespoons of each food groups (Grains/bread, fruit, vegetables, meat/meat substitute) at meal time if possible. They can have more if desire. Can start offering snacks in between feeding such as cheese, yogurt, teething biscuit, cut up fruits.

Don’t let anyone (family, friends or co-workers) to put you down whichever methods you choose and how you feed your children.  As long as your baby is growing well and eating nutritious meals within the recommended guidelines, do what works for your family! One size doesn’t fit all.

However, do remember that at this time. Baby still need their main source of nutrition from breast milk and infant formula. About 70-80% of caloric intake from breast milk/infant formula (~24 ounces per day) and the rest from solids. Continue with no to minimal salt with cooking for the foods that will be served to your baby at this time frame.

Once they started to eat more solids, their poop will change to more of a darker solids form and sometimes even becoming less frequent with their bowel movement. Offer 1/2-1 ounce of water during meal time and also feed your baby fruits that helps to relieve constipation such as prunes/pears/peaches/plums. If your baby hasn’t poop in 3 days, you can offer 1 oz prune juice / apple juice mix with 1 oz of water and massage their belly to help stimulate bowel movement. Always call the pediatrician for advice when you are worried.

Ready to feed: Purees vs Baby Led Weaning ?

banana-meh-2277

Puree foods has always been the go to texture when we first introducing solids to our baby at about 6 months of age. Some may start earlier at 5+ months if your baby is showing signs that they are ready. Either store bought or homemade puree foods, this traditions has been going on for centuries and babies across the globe has been thriving and doing just fine on it. It is really convenient to have some ready made puree baby foods handy when time is scarce during the work week.

In most recent years, baby led weaning (BLW) has been gaining more popularity as mom doesn’t need to make a separate puree meal for their baby. Family meal is offered to young baby in softer texture. This approach encouraged young infant to self feed soft finger foods (still no hard to chew texture foods such as nuts, seeds, raw vegetables and hard textured fruits), teaching infant to recognizing their own hunger cues and promoting stronger oral motor skills as it’s require more biting and chewing coordination during meal time (surprisingly baby doesn’t really need teeth to chew). Which in turn, reducing the frequency of over feeding as compared to spoon-fed babies. It is believed that BLW also foster a more positive eating and interactive meal environment at the family table.

Bottom line: There’s no one method that is superior than the other. Both has its pros and cons. Just follow your instinct and do what you feel most comfortable with and what your baby prefers.

* It is also recommended that at least one family member should be trained in infant CPR whether you are introducing purees or whole foods.*

After much trial and tribulations with my own daughter. I find that using both methods suites our family lifestyles and that’s what she prefers. There’s no rules that says you have to use one or the other, why not just mix it up? Although, I would recommend all mother to start the first month with puree when introducing solids. As the baby become stronger with their oral motor skills, then slowly introduce whole foods in softer textures later.

I really enjoyed making some puree foods (savory congee/porridge) feeding her via spoon, and also find it fascinating watching her able to gum through whole banana, ripe pears, orange slices, and sliced cooked vegetables at 8 months. To this date, I still have those puree fruit/veggies pouches handy to use as snacks when we are traveling and she still enjoys it. She’s a great eater and always have been, so I’m very thankful for that.

Though one thing to keep in mind that not all babies are all up for BLW even though research has indicated that most healthy term baby is developmentally ready for BLW approach between 6-7 months of age. Premature infant, infants with feeding and swallowing difficulties are not recommended to use the BLW method when first introducing complimentary foods. Rule of thumb is to always check in with your baby pediatrician when you first introducing solids so they can give you guidance on where to start.

Starting complimentary foods is an exciting journey for your baby. Let them explore and exposed to a wide variety of foods as long as eating and food safety practices are being followed.

Nutrition for Newborn 0-6 Months

I often get inquiry from new mothers about how much to feed their babies.

So, I’ve decided to compile a simple guidance for all you first time mother about what the baby really needs in a series of article dedicated to infant nutrition.

TAKE HOME MESSAGE: If you have a healthy term baby, breast milk or formula is all your baby need for the first 6 months of life. No additional water or other food is necessary at this period.

First Month of Life
Baby’s stomach is pretty tiny for the first few weeks of life, they only need a few drops of milk at each feeding during the first few day and then slowly increase about one ounce per week to about 3-5 ounces at about one month of life. If you are breastfeeding, you probably will be feeding the baby on demand (usually 10-12 feedings during this first month).

Don’t worry if your milk supply hasn’t come in yet, just continue to practice good feeding techniques to help stimulates supply. Many elders may get worried and urge you to supplement early but always check in with lactation consultant and a maternal health dietitian as to what to do. Remember, each baby is different as well, if you have a premature baby, their stomach capacity is even smaller and vice versa if you have a large baby, then they probably will need more.

This photo below illustrated the baby’s stomach size and the approximate milk content you should be feeding the baby if you are using a bottle.  If you are breastfeeding, the baby usually will release their latch when they are satisfied and full.

The perfect latch

If you are exclusively breastfeeding, your baby pediatrician will recommend a Vitamin D supplementation about 1 ml drop per day (400 IU) given orally to your baby as our human milk is lacking in Vitamin D to help support bone development. Increasing mother’s Vitamin D intake may increase the Vitamin D in the milk content but mother’s daily intake has to be consistent at about 4,000-5,000 IU daily.  Breastfeeding women’s who lives in Africa or in tropical countries usually able to obtain adequate sunlight daily (full body 15-20 minutes sun exposure), may not require to supplement their infant with Vitamin D.

One Month to 3 Months of Age
During this 2-3 months time frame, your baby needs for milk remains the same. Most baby is now able to tolerate between 3-5 ounces of milk at each feeding and usually eat at a 3 hours interval (average about 8 feedings/day). Don’t be surprise if you are still feeding your baby about 10-12 feeds if you are breastfeeding, again, it is on demand and we can’t really measure how much milk baby is taking in.

If your breast is full and firm at the beginning of the feed and then becoming soft and empty at the end of the feed, this is a good sign that baby is effectively removing milk from your breast. Always feed on one breast until it is empty and then offer the other side when the baby still wants more.

Four Months to 6 Months of Age
Your baby now can tolerate between 6-8 ounces of milk at each feeding with a total of 4-6 feedings per day (about 4-5 hours between feed). Yay ! That means, you can get some longer naps in between feeding together with your munchkin. It is also normal to feed baby 4-6 oz at each feeding but more frequently at 3-4 hours interval each. There really is no golden rule here as long as your baby is getting a minimal of 32-36 ounces of breast milk or formula in one day.

Your baby also should doubled their birth weight by 4-5 months old. Don’t try to introduce solids food to baby too early.  Each baby development milestone is different and it is solely depending on how ready they are. How do we know when he/she is ready ? Here’s a few checklist to determine:

  • Can he/she sit up and hold his neck without support ?
  • Does he/she open their mouth when seeing a spoon approaching their way?
  • Can he/she move the solids food from tongue to throat? (If you try to feed the baby and the cereal tends to drip down their chin as baby pushes the content out instead of swallowing, that means they are not ready)

If you answer yes to all of the above, congratulations !! Your baby maybe ready to start complimentary solids food.  Just as I said “complimentary” foods, this should not replace the breast milk and formula the baby still needs at this time. Most common first food to start at around 6 months is rice/oatmeal/barley cereal as they are enriched with iron as baby’s iron store is beginning to diminished at about 6 months of age. When starting solid foods, make sure you only introduce one new food at a time so that you can trace back if any intolerance or allergies were to happen.  A few teaspoon is always a good start then slowly increase to 1 tablespoon a few days later.

This How_To_Feed_Baby-English guidelines obtained from Oregon Dairy Council is a good resource that I often give to new parent at the nutrition clinic to re-assure them how much is enough to feed the baby.