Re: feeding a 6 month old

June 4, 2007

I'm responding as a mother to a soon to be 6-month old, not as a RD with ANY

experience in this.

Try looking up Dr. Sears website (www.askdrsears.com) on starting solids.

I have attended a feeding solids class given by a RN and lactation

consultant who I find very reliable and she got lots of her info from his

websites and books. My pediatrician also told me to follow his advice per

his website.

What's so confusing is that everybody has got different things to say on

this. My sister who has a 1 year old was told to start giving her 3 month

(at the time) rice cereal in the bottle and to start giving solids at 4

months. I was told NEVER to give cereal in the bottle (unless reflux was an

issue - which it was not) and to not start solids until 6 months. Then I

was also told to look for cues from the baby (is he sitting up?, is his

tongue protruding reflex gone?, etc.). It's all just sooo confusing. I

have also looked up Ellyn Satter's website, but I found that I really need

to buy her book to get a better understanding.

I would love to hear what a RD has to say about this that actually have

experience.

Lawson, RD, LD

_____

From: rd-usa [mailto:rd-usa ] On Behalf Of

Digna Cassens

Sent: Sunday, June 03, 2007 11:45 PM

To: rd-usa

Cc: RD Forum

Subject: feeding a 6 month old

So many of you were so very helpful when my grandson was born 6 months ago

that here I am again for some of your excellent advice. To summarize, he

wasn't able to nurse well, lost over a pound before leaving the hospital,

and it took a couple of months before he started to regain the lost weight

or put on much needed weight.

He is now a chubby, dimpled and happy 6 month old weighing about 17 lbs

trying to grow into his very large hands and feet, and very interested in

solid food. My daughter started feeding him solids following her

pediatrician's advice, and preparing all of the food herself consisting of

organic produce and whole grains mostly at this time. She insists that the

guidelines given to her indicate that the best foods are legumes and brown

rice. She also gives him fruits such as apricots and bananas.

My questions are my concern as a worried g/ma and a frustrated RD who

doesn't do infant and child nutrition:

#1, is she introducing the foods too fast? (not one at a time for 3 - 4

days) The father has some food intolerances, as does my daughter and most of

the family, including me (mine is a frank allergy w anaphylactic shock w/in

10 min).

#2, beans and brown rice???? They're pureed but not strained. How is that

inmature gut handling all that fiber? Well, for one, his stools are more

than firm, and he's a bit cranky these days. For another, the evening I was

there he regurgitated almost every bite, indicating to me the food was

either too thick and pasty and he could now swallow it, or he was full, or

he hated it.I also have never read to introduce beans and rice for the first

solids.

#3, everything is mixed together in one bowl, instead of letting him taste

each food separately.

#4, how much to feed in one feeding? She gives at least 1/2 cup of the meal

and another of the fruit. I believe he still needs to drink more formula

than eat solids, but he must be full bc he only takes about 18 - 20 oz per

day as best as I could count the bottles during one day. She does give him

water, especially when he's eating the solid foods.

I thank you in advance for your opinion.

Digna Cassens, MHA, RD

http://groups. <http://groups.msn.com/RDForum> msn.com/RDForum

Start by doing what's necessary, then what's possible, and suddenly you are

doing the impossible. St. Francis Assis

June 4, 2007

I have 10 month old twins that were born prematurely. I started them on cereal

at 6 mo. I tried at 5 mo, at the advice of a GI specialist, but neither baby was

ready. I am a big fan of Ellyn Satters book, " Child of Mine " and follow most of

the advice in it. I also go with my parenting gut. It is recommended to start

one food at a time, no mixed foods, until the baby has tried and tolerated a

wide variety of foods. It is advised to avoid wheat, milk and nuts for some

time if you have sensitivity issues in your family. Once the baby has

established quite a few foods that they tolerate, then you can mix foods if you

wish. I have also read that in order for the child to develop a taste for

different food, foods should be offered separate, but sometimes this isnt

practical. Beans are OK, but made my babies gassy and now I only serve in small

quantities. I give my twins tofu, mixed with something, as well as avocados. I

avoid a lot of dairy because I know one twin doesnt

tolerate it well. Go with textures that are safe for the babies age. If the

baby will eat slight textures with out choking or spitting it out, go for it. I

cant get my kids to eat rice in baby food just yet, but they will eat lumps and

bumps in food. I bought myself a nice food processor and make most of their own

foods, so nothing is totally smooth, but it does pretty good. I have found that

my kids let me know when the texture is unacceptable. I dont know about the

formula question because I am breastfeeding. I like to remember that feeding

your baby should be like a nice conversation, with lots of give and take. If

the baby doesnt like a food, dont force it, watch for cues that he/she is full

and stop feeding and likewise dont stop a feeding if they are still opening

their mouths for you. I remember this confusing and overwhelming time very

well. I just try to remember that safety is first, then the rest is just trying

a food and observing the baby's response.

I hope this helps

Staci Freeworth MS RD LD CDE

feeding a 6 month old

So many of you were so very helpful when my grandson was born 6 months ago

that here I am again for some of your excellent advice. To summarize, he

wasn't able to nurse well, lost over a pound before leaving the hospital,

and it took a couple of months before he started to regain the lost weight

or put on much needed weight.

He is now a chubby, dimpled and happy 6 month old weighing about 17 lbs

trying to grow into his very large hands and feet, and very interested in

solid food. My daughter started feeding him solids following her

pediatrician' s advice, and preparing all of the food herself consisting of

organic produce and whole grains mostly at this time. She insists that the

guidelines given to her indicate that the best foods are legumes and brown

rice. She also gives him fruits such as apricots and bananas.

My questions are my concern as a worried g/ma and a frustrated RD who

doesn't do infant and child nutrition:

#1, is she introducing the foods too fast? (not one at a time for 3 - 4

days) The father has some food intolerances, as does my daughter and most of

the family, including me (mine is a frank allergy w anaphylactic shock w/in

10 min).

#2, beans and brown rice???? They're pureed but not strained. How is that

inmature gut handling all that fiber? Well, for one, his stools are more

than firm, and he's a bit cranky these days. For another, the evening I was

there he regurgitated almost every bite, indicating to me the food was

either too thick and pasty and he could now swallow it, or he was full, or

he hated it.I also have never read to introduce beans and rice for the first

solids.

#3, everything is mixed together in one bowl, instead of letting him taste

each food separately.

#4, how much to feed in one feeding? She gives at least 1/2 cup of the meal

and another of the fruit. I believe he still needs to drink more formula

than eat solids, but he must be full bc he only takes about 18 - 20 oz per

day as best as I could count the bottles during one day. She does give him

water, especially when he's eating the solid foods.

I thank you in advance for your opinion.

Digna Cassens, MHA, RD

http://groups. <http://groups. msn.com/RDForum> msn.com/RDForum

Start by doing what's necessary, then what's possible, and suddenly you are

doing the impossible. St. Francis Assis

June 4, 2007

Digna,

I am mom to a 3 mo. preemie (now 10 years old) and daughter now 8 y.o. One

combination breast/formula fed, one breast fed-both different feeding schedules.

I think you are on the right track and following what are considered the

safest guidelines for feeding an infant. When she says that she is following

the guidelines, do you know to what guidelines she is referring? Perhaps you

could read along with her.

Tread carefully though. Emotions run high when a mother feels she is

questioned as to doing something that may not be in the best interest of her

baby. If the baby is showing distress with feedings, you will have to find a

way to suggest modifying her approach while being supportive and on the same

team. If this is her first baby, help her learn to read her baby's signals.

Maybe some " I remember when... " stories. Be really in tune with the signs of

interest and cues of hunger and being done. Help her to take plenty of time for

feedings and patience and interest during them. Focusing less on how much

should be eaten and more on finding out what the baby's pattern of the day might

be.

Yes, foods are best introduced one at a time with a few days in between. Rice

cereal is generally the standard, increasing variety, barley, oat, as it is

typically fortified with iron; I don't think brown rice and legumes are

comparable, unless you are talking about a brown rice infant cereal.

The volume of formula will vary day to day-but generally around 32 oz should

be offered daily. Expect variations of what is taken in from 20 to 36 oz day

to day.

I would think the fiber foods may fill up the baby too quickly.

The feeding guidelines are just that. The feeding should match the baby' s

developmental stages. Variety will help the baby meet their nutrient

needs...formula/breast milk, iron fortified cereal, strained vegetables and

fruits, and the beginning finger foods of unsweetened dry cereals and crackers.

1 -2 tablespoons of each, but only one new item every 3 or so days.

All the best,

Sharon

Sharon Staier, MS, RD

Family and Sports Nutrition

Cape Cod, MA

Digna Cassens wrote:

So many of you were so very helpful when my grandson was born 6 months

ago that here I am again for some of your excellent advice. To summarize, he

wasn't able to nurse well, lost over a pound before leaving the hospital, and it

took a couple of months before he started to regain the lost weight or put on

much needed weight.

He is now a chubby, dimpled and happy 6 month old weighing about 17 lbs trying

to grow into his very large hands and feet, and very interested in solid food.

My daughter started feeding him solids following her pediatrician's advice, and

preparing all of the food herself consisting of organic produce and whole grains

mostly at this time. She insists that the guidelines given to her indicate that

the best foods are legumes and brown rice. She also gives him fruits such as

apricots and bananas.

My questions are my concern as a worried g/ma and a frustrated RD who doesn't do

infant and child nutrition:

#1, is she introducing the foods too fast? (not one at a time for 3 - 4 days)

The father has some food intolerances, as does my daughter and most of the

family, including me (mine is a frank allergy w anaphylactic shock w/in 10 min).

#2, beans and brown rice???? They're pureed but not strained. How is that

inmature gut handling all that fiber? Well, for one, his stools are more than

firm, and he's a bit cranky these days. For another, the evening I was there he

regurgitated almost every bite, indicating to me the food was either too thick

and pasty and he could now swallow it, or he was full, or he hated it.I also

have never read to introduce beans and rice for the first solids.

#3, everything is mixed together in one bowl, instead of letting him taste each

food separately.

#4, how much to feed in one feeding? She gives at least 1/2 cup of the meal and

another of the fruit. I believe he still needs to drink more formula than eat

solids, but he must be full bc he only takes about 18 - 20 oz per day as best as

I could count the bottles during one day. She does give him water, especially

when he's eating the solid foods.

I thank you in advance for your opinion.

Digna Cassens, MHA, RD

http://groups.msn.com/RDForum

Start by doing what's necessary, then what's possible, and suddenly you are

doing the impossible. St. Francis Assis

June 4, 2007

Digna, & colleagues,

As it is almost impossible to write when my three kids (ages 10

months - 4 1/2) are awake, I hope my response does not create more

confusion than clarification.

About the fiber question: I also recall learning that too much fiber

would not be good for the infant's immature gut. I went back to the

texts I have (they're not very good and I don't have Satter's -- I've

got to add that to my wishlist) and all but one of them addressed

fiber in the infant. The only text that had any warning against fiber

was ADA's Complete Food & Nutrition Guide (1st edition), where it

says:

" A word of caution with high-fiber foods: Some high fiber cereal,

such as bran, and raw vegetables are low in calories yet high

in 'bulk.' Avoid offering large amounts of these foods to infants;

they fill an infant's small stomach withough providing many nutrients

of calories. " (p. 407)

I then went to pubmed and searched for articles on fiber intake

recommendations in infants. I found one review (Proc Nutr Soc. 2003

Feb;62(1):17-23) that states:

" There are little data on the impact of dietary fibre in children

<2 years of age. With the rapid growth of infants it is thought that

dietary fibre would have a major effect on growth by reducing energy

intake. However this potential effect has yet to be established "

(p.20)

Here are my thoughts:

How much fiber is really high fiber? Is there too much fiber in whole

grain cereal, or are we talking about offering bran as being harmful?

I personally do not think that the fiber in rice and oats would be

too much. Also, in my experience with my daughter, rice can be

constipating (including brown rice), so I avoid it as much as I can

and give her oats instead.

As for the immature gut belief. I could not find (though obviously

that doesn't mean it doesn't exist) anything to support that belief.

My thinking is that it could be true for an infant younger than 4

months, but now that more recommendations are to start solids after 6

months, does the immature gut belief still stand?

Most of all, I back up Sharon's advice of treading with caution. But

from a young mother's perspective, we can be quite convinced about

the right way of doing things, but we really need the advice and

wisdom from those who are older than us. I think that this whole

confusion about how to feed infants stems from the almost extinction

of the mother to daughter passing on of knowledge. So, walk alongside

your daughter and let her know how proud you are that she is trying

to provide nourishing and healthful foods to your grandchild, then

admit that it is different than what you had learned and you'd like

to learn more about the recommendations she is using. The whole

foods/organic emphasis (but not the intruducing a bunch of foods at

the same time) reminds me of the recommendations from Super Baby

Foods by Ruth Yaron. That may be a good place to start.

Take care,

Renata Mangrum, MPH, RD.

June 4, 2007

Sharon, Thank you for such a thoughtful email. I've received such many wonderful

responses, and appreciate them all. I particularly appreciate those that help me

not to be overbearing, dogmatic and opinionated (hard for me to avoid).

Excellent advice. Digna

Re: feeding a 6 month old

Digna,

I am mom to a 3 mo. preemie (now 10 years old) and daughter now 8 y.o. One

combination breast/formula fed, one breast fed-both different feeding schedules.

I think you are on the right track and following what are considered the

safest guidelines for feeding an infant. When she says that she is following the

guidelines, do you know to what guidelines she is referring? Perhaps you could

read along with her.

Tread carefully though. Emotions run high when a mother feels she is

questioned as to doing something that may not be in the best interest of her

baby. If the baby is showing distress with feedings, you will have to find a way

to suggest modifying her approach while being supportive and on the same team.

If this is her first baby, help her learn to read her baby's signals. Maybe some

" I remember when... " stories. Be really in tune with the signs of interest and

cues of hunger and being done. Help her to take plenty of time for feedings and

patience and interest during them. Focusing less on how much should be eaten and

more on finding out what the baby's pattern of the day might be.

Yes, foods are best introduced one at a time with a few days in between. Rice

cereal is generally the standard, increasing variety, barley, oat, as it is

typically fortified with iron; I don't think brown rice and legumes are

comparable, unless you are talking about a brown rice infant cereal.

The volume of formula will vary day to day-but generally around 32 oz should

be offered daily. Expect variations of what is taken in from 20 to 36 oz day to

day.

I would think the fiber foods may fill up the baby too quickly.

The feeding guidelines are just that. The feeding should match the baby' s

developmental stages. Variety will help the baby meet their nutrient

needs...formula/breast milk, iron fortified cereal, strained vegetables and

fruits, and the beginning finger foods of unsweetened dry cereals and crackers.

1 -2 tablespoons of each, but only one new item every 3 or so days.

All the best,

Sharon

Sharon Staier, MS, RD

Family and Sports Nutrition

Cape Cod, MA

Digna Cassens wrote:

So many of you were so very helpful when my grandson was born 6 months ago

that here I am again for some of your excellent advice. To summarize, he wasn't

able to nurse well, lost over a pound before leaving the hospital, and it took a

couple of months before he started to regain the lost weight or put on much

needed weight.

He is now a chubby, dimpled and happy 6 month old weighing about 17 lbs trying

to grow into his very large hands and feet, and very interested in solid food.

My daughter started feeding him solids following her pediatrician's advice, and

preparing all of the food herself consisting of organic produce and whole grains

mostly at this time. She insists that the guidelines given to her indicate that

the best foods are legumes and brown rice. She also gives him fruits such as

apricots and bananas.

My questions are my concern as a worried g/ma and a frustrated RD who doesn't

do infant and child nutrition: