Today’s blog post is written by Carly Noe, Registered Dietitian Nutritionist at Complete Balance Nutrition. Some of you may know Carly since the feeding therapy team at High Hopes often refers families to her. We are so grateful for Carly’s partnership and her willingness to share her expertise on our blog!
With so much information at our fingertips about how to properly nourish our children, how do we determine what is essential to the growth and development of our precious little ones? In honor of National Nutrition Month, I am going to give five tips regarding the building blocks of good nutrition for infants and children. From when to introduce new foods to how to overcome or avoid picky eating habits, we will cover some of the most essential points of infant and childhood nutrition.
Tip #1: When is it appropriate to introduce certain foods, and how do we introduce new foods? Most infants are developmentally ready to start puree foods when they are four to six months old. Puree foods will compliment either breast milk or formula intake, which should remain their main source of calories and nutrition during introduction of new puree foods. Begin by offering fortified baby cereal once or twice daily using a small infant spoon or teaspoon while helping your baby sit upright. Initially, you may offer one to two teaspoons after baby finishes breast feeding or a bottle. Once your infant is tolerating runny baby cereal, you can slowly increase the thickness of it by adding less breast milk or formula until it is a thick puree similar to stage 1 baby foods consistency. Be sure to offer a variety of fortified baby cereals including barley, oats, rice, and multigrain.
Next, trial offering puree vegetables without sugar or salt in them, it is important for infants to get used to the taste of foods without added flavors first. Offer one new vegetable every 3-5 days, this will allow you to monitor for any allergies or intolerances such as rash, diarrhea, vomiting. Once your infant is tolerating a variety of vegetables, begin adding puree fruits, one new fruit every 3-5 days. If your baby turns away from a new food or spits it out, this does not necessarily mean they “don’t like it”. Babies are naturally afraid of new flavors and textures, often times it takes them several tries to realize they like a food, be patient, do not force or pressure your infant to try a new food. If your infant turns away from a new food, simply wait and try it again in a week.
Around 6 -8 months you may start introducing puree meats. Again, trial one new meat every 3-5 days, and monitor for allergies or intolerances. Once your infant is tolerating a variety of meats, he or she is ready to move to combination foods, or foods with meat, grain and fruit or vegetable mixed together. At 8-10 months, infants are ready to trial small portions of very finely chopped foods, soft fruits or vegetables, pastas, and soft cheeses. As your infant reaches 12 months of age, begin offering 3 meals per day, and 2-3 snacks per day, include chopped or mashed foods in their meals.
Tip #2: What foods should I avoid giving my infant, and why? Certain foods are not appropriate for infants or children under 12 months of age. These foods include honey, juices (especially any unpasteurized juices), or foods that may be a choking hazard. Honey contains something called spores, because infants have a weaker immune system, if spores are ingested, they can cause an illness called infant botulism which can be serious enough to cause hospitalization. Infants under 12 months do not need juice, it is more important they receive breast milk or formula for their liquids, as this provides more nutritional value than juice. Juice can also cause tooth decay in the soft and fragile teeth infants may be developing. Unpasteurized juices can contain certain bacteria that can cause a baby to become ill due to their limited immune system.
Finally, avoid giving foods that tend to be choking hazards such as hotdogs, grapes, large chunks of meats, cheeses, or fruits, raw vegetables. Be sure to cut these foods up into very small pieces if you are giving them to your infant, and wait until they are 8-10 months of age. Avoid giving infants nuts, seeds, popcorn, or hard candies as these foods typically cannot be cut into small pieces or changed to be safe options.
Tip #3: When should we transition from breast milk or formula to whole milk or milk substitute? After your baby turns 1 year of age it is appropriate to transition to whole milk or an appropriate milk substitute. Prior to a year, it is important for your infant to have breast milk or formula as their main liquid intake because breast milk and formula provide good sources of iron, where as whole milk or other milk substitutes do not, transitioning to whole milk or other milk substitute too early can cause anemia (low iron).
When transitioning to whole milk or milk substitute, some children will transition quickly and will enjoy the taste of milk. However, if your child does not transition quickly, or refuses a bottle or cup of milk, do not be afraid to transition slowly. One way to transition slowly is to mix breast milk or formula with equal parts of whole milk or milk substitute, slowly increasing the amount of whole milk or milk substitute in the bottle or cup until your child is fully transitioned. Transitioning slowly can take a week or several weeks, each child is different, be patient and do not pressure or force the child to transition too quickly.
Tip #4: What are appropriate portion sizes and number of servings for toddlers and children? Portion sizes are the amount of food you serve your child, for example ½ of a banana is one portion. The number of servings refers to how many portions of a type of food you should provide your child throughout the day, for example 2-3 servings of fruits per day. It is important to know that children have much smaller portion sizes than adults. It is also important to note that portion sizes and number of servings are an estimate; your child’s stage of growth and development, age, energy level and appetite will all affect his or her intake.
Here is a quick reference chart for appropriate portion sizes and number of servings per day for toddlers and children ages 1-6 years old:
Tip #5: How do I prevent my toddler or child from becoming a “picky eater”? Toddlers and children appreciate having a routine, and this is true for snack and meal times too! It is important to avoid getting in power struggles with your child. A general rule of thumb is “it’s the parent’s job to determine what foods are on the child’s plate, and it’s the child’s job to decide how much food he or she will eat”. Do not force your child to clean his or her plate; try to respect your child’s appetite. If your child chooses not to eat the foods you put on their plate that is ok, you can wrap their plate up and offer it to them at the next designated snack or meal time, but make sure they do not get any additional or alternate foods until that designated snack or meal time. For example, if lunch time is at 12pm and the next scheduled snack time is at 3pm, and your child chooses to eat 2 bites of a sandwich, that is fine, if you choose, you can save the sandwich in the refrigerator for the next snack or meal time. If your child complains of hunger or asks for food at 2pm, tell him or her that snack time will be in one hour and stick to the scheduled meal and snack time. At 3pm, when snack time occurs, offer the child their left over sandwich or another food if you choose, and allow him or her to decide how much of that snack they will eat. Sticking to a schedule, and preventing snacking between scheduled meal or snack times, will help your child learn a routine, and will also help them learn how to eat enough to be satisfied until the next meal or snack time. Maintaining meal and snack routines will be implemented once your child enters preschool, so this will also help with transitioning to places where established routines are important.
Remember to be patient with new foods, as discussed earlier, children are often scared to try new foods and it may even take several times seeing and touching the food before they taste it, and several more times before they determine they like the taste of a new food. Once your child is old enough, you can encourage them to help you prepare a meal or snack, this often gets children more interested in eating the food they have prepared, and interested in trying new foods if they have prepared or helped prepare them. Lastly, minimize distractions at the meal/snack table; turn off the television, Ipad, radio, make sure pets are not around, and establish that the whole family sits at the table for 20-30 minutes before getting up to do other things. This will help your child focus on the meal and the task of eating, rather than getting distracted and then realizing they are hungry an hour later when meal time is over.
Implementing these few tips throughout infancy and childhood will help your children develop healthy eating patterns now which will continue to help their relationship with food and nutrition later in life. Remember that eating habits are not developed over night and they cannot be changed overnight, however, taking small steps each day will help children establish routine and continue to grow and develop to their full potential!