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What To Feed Your Baby

Tanya Altmann, MD and Mizuho Morrison, DO
00:00
18:05

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Miz and Tanya discuss the introduction of solid foods into an infant’s diet including grains and peanuts.

 

Pearls:

  • When an infant is ready to start solid foods, classically allergenic foods, such as eggs and fish, can be introduced in a manner the infant can texturally handle.

  • Peanut containing products can and should be introduced to infants in form of melted peanut butter for younger infants and peanut puffs for older infants.

 

  • What are the AAP recommendations for starting solids and advancing diets? In 2008, the AAP guidelines changed in terms of waiting until 1 year old to introduce traditionally allergenic foods. For example, peanut products, egg whites, fish, shellfish, if prepared properly, can be introduced to infants starting solid foods. It is important to start nutritious healthy food and stay away from processed foods and juices.

    • As per the LEAP (Learning Early About Peanut Allergy) study, released in 2015, infants introduced to peanut produces at a younger age have decreased changes for peanut allergies later in life.

    • Some healthy foods to start with include avocados, green vegetables, and fish. Salmon is one of the healthiest things babies can get use to eating early. Altmann likes this because infants are exposed to the healthy omegas and develop a taste for fish. Infants can really be fed anything except for honey and choking hazards.

Du Toit, G et al. Randomized trial of peanut consumption in infants at risk for peanut allergy.

N Engl J Med. 2015 Feb 26;372(9):803-13. PMID: 25705822

  • What about rice cereal?   Altmann does not usually recommend rice cereal as a first food because white rice, especially, is a plain carbohydrate with little taste and little nutritional value, other than added iron. Meats, for example, are much better sources of iron and zinc for infants. There have been recent reports of high arsenic levels in rice cereals.

    • The AAP recommends varying the grains given to babies. Altmann suggests oatmeal as a fabulous first food for babies.

Karagas MR, et al. Association of Rice and Rice-Product Consumption with Arsenic Exposure Early in Life. JAMA Pediatr. 2016 Apr. Epub.  PMID: 27111102

  • How should these foods be prepared?  Infants should be fed food in a consistency they can handle. Some babies can handle fork mashed and others need to start with completely pureed foods. The families can toss in almost any foods they are eating into a blending, add a little breastmilk or water, so it is a liquid consistency, and feed that to the baby. At restaurants, families can ask for foods on the side and fork mash them for the babies at the table.

    • The nice thing about homemade baby food is that it tastes a little different and has a little different consistency everyday. This way, babies get used to different flavors and textures.

    • The goal is to slowly increase the texture and size so that around 1 year old, children are eating regular table food with the rest of the family.    

  • What about baby food pouches?  While convenient, pouches may teach babies and toddlers to slurp and inhale their food. One technique is to squirt the food onto a spoon and have the child eat with the spoon. This also helps the child learn portion control. As with jarred baby food, it is important to read the labels on jars and pouches to see how many and what ingredients are actually in the jar or pouch.    

  • What are the differences between the different milk products available? Dairy products provide nutrients such as calcium, Vitamin D, proteins and potassium. If families are sensitive to dairy and/or do not want to feed dairy products to their children, education is important. For example, almond milk has less than half the amount of protein per serving than cow’s milk. Almonds as a nut are very healthy. Soy milk has an equivalent amount of protein as cow’s milk. Rice milk and almond milk, especially, are fine as beverages, but should not be used as a substitute for nutrition.    

  • What are the AAP recommendations on Vitamin D and Iron supplementation?  The AAP recommends 400 IU of Vitamin D for all exclusively breastfed babies, babies receiving breast milk and formula, and babies receiving less than 32 ounces of formula per day. Most teenagers and adults also do not receive enough Vitamin D and would probably benefit from 1000 IU of Vitamin D per day. The AAP recommends  iron supplementation for all premature babies. For full term, breastfed babies, the recommendation is to start iron supplementation at 1 mg/kg/day at 4 months of age, until iron-rich solid foods are introduced. Hemoglobin levels should be checked at 9 months of age.

First AAP recommendations on iron supplementation include directive on universal screening.  2010 October, AAP News.

  • How should peanut products be introduced? Nuts are a choking hazard and should not be given to children under 3-4 years of age. They should never be given to kids while riding in a car and/or “on the go”. One can melt 1-2 teaspoons of peanut butter and mix in with oatmeal and add a little breastmilk or water to thin the mixture. As the infant ages, peanut puff snacks are available. Two brand examples are Bamba and Cheeky Monkey.

    • For children with nut allergies, an allergist should be involved and there should be a food allergy plan in place. For siblings of children with severe nut allergies, allergists should also be consulted prior to the introduction of nut products.  

  • How should eggs be introduced?  Eggs can be baked, hard boiled, scrambled, and/or pureed and given to the child small bits at a time. Children with true egg allergies, may be able to tolerate baked egg products; an allergist, again, would be involved. There is a chance that children with egg and dairy products will outgrow these allergies, especially if introduced to small amounts every day, under the consultation of an allergist.    

Dr. Altman has a new book out called “What to Feed Your Baby”.  She has more information on her website, drtanya.com.

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Near Hits and Direct Misses Full episode audio for MD edition 195:00 min - 91 MB - M4AHippo Peds RAP July 2016 Summary 582 KB - PDF