Feeding & Eating

Whether you’re a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are answers to some common queries that mothers — new and veteran — may have.

How can I increase my milk supply?

Your milk supply is determined by the stimulation that your baby provides while nursing. In other words, the more you breastfeed, the more milk your body produces. So, if you seem to be producing less milk than usual, try to feed your baby more often. You also can pump after nursing to help stimulate more milk production.

Stress, illness, and some medicines can temporarily decrease your supply. Drinking plenty of water and eating good, nutritious food can help. But also try to take some time for yourself each day, even if it’s only for 15-30 minutes.

If your baby is younger than 6 months old and you’re away from your little one for long stretches during the day (for instance, at work), pump or hand express every 3 hours to maintain your supply. Your freshly pumped breast milk can stay at room temperature for 6-8 hours, or in the refrigerator for up to 5 days. When keeping it in the refrigerator, never store it on the shelves in the door.

If the milk is not going to be used within 5 days, store it in the freezer. Pumped breast milk can be safely stored in the freezer compartment of a refrigerator that has a separate suction-sealed door for 3-6 months or in a deep freezer for 6-12 months.

If your milk supply still seems low and you’re concerned, you may want to talk to your doctor, your pediatrician, or a lactation consultant.

If I wait to nurse, will my milk supply increase?

Actually, no — it’s the opposite. Waiting too long to nurse or pump can slowly reduce your milk supply. The more you delay nursing or pumping, the less milk your body will produce because the overfilled breast sends the signal that you must need less milk.

Once babies are back to their birth weight, they can sleep for longer stretches at night and will gradually lengthen the time between nighttime feedings. Letting your baby sleep for longer periods during the night won’t hurt your breastfeeding efforts. Your baby is able to take more during feedings, and that, in turn, will have him or her sleeping longer between nighttime feedings. Your body will adjust to the longer spacing.

Some moms wake during the night with full breasts and a sleeping baby. If that happens, pump for comfort and to help your body adjust to your little one’s new schedule at night.

The interval for daytime feedings usually stays between 1-3 hours for the first few months and then may lengthen to 4 hours or so. Cutting back on feedings during the day can lead to a decreased milk supply over time.

If you follow your baby’s cues and spread out the feedings as he or she wishes, your milk supply should remain at what your baby needs.

I’m producing too much milk. What can I do?

Whereas some women may feel like they don’t have enough milk, others may feel like they’re making too much. Some mothers’ bodies just produce more milk than their babies need. Others overstimulate their breasts by pumping or expressing milk between feedings. If expressing or pumping to relieve discomfort, remove just enough to feel comfortable but don’t empty the breast.

Alternate the breast that you start each feeding with. Let the baby stay at the first breast until either the breast is very soft or the baby is full. If the baby is not satisfied with the first breast, then offer the second breast.

A mom may try nursing on only one breast during a feeding to help to lessen her milk supply. Over time, she should notice her milk supply and “let-down reflex” (the milk ejection reflex) become easier to handle.

Sometimes a woman’s let-down is really strong and causes the baby to gag and pull off of the breast. If your baby is staying on the breast and handling the flow of milk, you don’t need to do anything. If the baby is pulling off and coughing, sit your baby up in a seated burp position. Pat your baby’s back to help him or her regain composure. You can use a burp cloth pressed into the breast to help slow the flow, then latch your baby back onto your breast when ready to resume feeding.

Nursing your baby in a more upright position (head above the breast) also may decrease the force of the let-down. A side lying position also might help slow the flow of milk.

My baby favors just one breast. Is this OK?

Some babies might prefer one breast over the other. If this happens, to keep up your milk supply in both breasts (and prevent painful engorgement), alternate breasts and keep your baby on the first breast until it’s soft, then move your baby to the second breast. This ensures that your little one gets the hindmilk, which is creamier and contains more calories than the foremilk, which comes at the beginning of a feeding.

Some babies will always take the second breast and some will be satisfied with just the first breast. At the end of the feeding, if both breasts are comfortable, you don’t need to pump. But if either breast is still full and uncomfortable, pump or hand express to comfort.

Of course, if your baby won’t latch onto one of your breasts, pump or hand express that breast to maintain its milk supply until your little one is latching onto both breasts easily.

Whether you’re a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are answers to some common queries that mothers — new and veteran — may have.

What should I eat?

Just as when you were pregnant, it’s important to eat well while you’re breastfeeding, with plenty of wholesome fruits, vegetables, whole grains, protein, and calcium-rich foods. Follow the recommendations in the MyPlate food guide and you’ll be well on your way to giving both you and your baby a nutritious diet.

Your diet doesn’t have to be perfect. You need an estimated 300-500 extra calories per day as a breastfeeding mother. Breastfeeding might make you thirsty, so consider keeping a water bottle nearby so it’s there when you need it.

Also ask your doctor if you should still take your prenatal vitamins — many doctors have women continue them during breastfeeding. To prevent problems associated with iodine deficiency, the American Academy of Pediatrics (AAP) recommends that all lactating women take a supplement that contains 150 micrograms of iodine per day, use iodized salt in their cooking, and eat foods high in iodine, like seafood and dairy products. If you are vegan or don’t eat dairy or fish, talk to your doctor about getting checked for iodine deficiency.

Does my breastfed baby have an allergy?

A breastfed baby may have an allergy or sensitivity reaction after the mother consumes certain foods or drinks (such as common food allergens like cow’s milk, soy foods, wheat, corn, oats, eggs, nuts and peanuts, and fish or shellfish).

Signs of a baby having such a reaction to food can include:

• frequent spitting up or vomiting
• apparent belly pain (lots of gas and/or pulling up the knees in pain)
• bloody, mucousy stools (poop)
• hard stools
• rash and swelling

If you think your baby has had a reaction to food, call your doctor and avoid eating or drinking anything your little one can’t seem to tolerate. If your baby has difficulty with feeding, try to keep a journal of exactly what you eat and drink, along with any reactions your baby had, which could help both you and your doctor pinpoint what the problem food, or foods, might be.

Although such a reaction is extremely rare, if your child has trouble breathing or has swelling of the face, call 911.

Should I avoid certain foods?

Every baby is different. Some moms may find that if they eat beans, cauliflower, or broccoli, their little ones get gassy or fussy while other babies can tolerate these foods just fine. And some mothers can confirm that after they eat spicy foods, their babies don’t seem to like the taste of their breast milk. Again, other babies may not mind if mom just enjoyed a bunch of hot chili peppers.

Just like during pregnancy, nursing moms should avoid or limit their intake of fish high in mercury, since high mercury levels can damage the developing nervous system.

Also, if you notice a pattern (of fussiness, gassiness, colicky behavior, etc.), try to keep track of exactly what you eat and how your baby reacts to it each time, then talk to your doctor. He or she may suggest not eating the food (such as dairy products, a common allergen) for a few days to see if there’s any change.

Is alcohol still a “no-no”?

Drinking in moderation — one or two drinks within a 24-hour period — is fine, as long as you wait before feeding your baby.

When you drink alcohol, a small amount of it gets into your breast milk. The amount of alcohol in breast milk depends on the amount of alcohol in the blood. It takes about 2 hours after having one drink for the alcohol to be metabolized and no longer be a concern for nursing. So do not give your baby fresh breast milk, from your breast or pumped for a bottle, for at least 2 hours if you’ve had one drink, 4 hours if you’ve had two drinks, and so on.

If you plan to drink more than a few (preferably after breastfeeding’s been established for about a month), you can “pump and dump” — pump your milk and then throw it away.

But drinking to excess when you’re nursing is not recommended. Even if you “pump and dump,” there are other risks to your baby. Drinking too much affects how you care for your baby and may prevent you from responding to your baby’s needs appropriately, since it alters your ability to be alert and think clearly. It’s also a risk factor for SIDS (sudden infant death syndrome).

Can I have caffeine?

As with alcohol, it’s best to limit the amount of caffeine you consume while breastfeeding. One or two cups of coffee a day are fine, but more than one or two servings of caffeine per day may affect your baby’s mood and/or sleep.

Choosing whether to breastfeed or formula feed their baby is one of the biggest decisions expectant and new parents will make.

A number of health organizations — including the American Academy of Pediatrics (AAP), the American Medical Association (AMA), and the World Health Organization (WHO) — recommend breastfeeding as the best choice for babies. Breastfeeding helps defend against infections, prevent allergies, and protect against a number of chronic conditions.

The AAP recommends that babies be breastfed exclusively for the first 6 months. Beyond that, breastfeeding is encouraged until at least 12 months, and longer if both the mother and baby are willing.

Although experts believe breast milk is the best nutritional choice for infants, breastfeeding may not be possible for all women. For many, the decision to breastfeed or formula feed is based on their comfort level, lifestyle, and specific medical situations.

For mothers who are unable to breastfeed or who decide not to, infant formula is a healthy alternative. Formula provides babies with the nutrients they need to grow and thrive.

Some mothers worry that if they don’t breastfeed, they won’t bond with their baby. But the truth is, loving mothers will always create a special bond with their children. And feeding — no matter how — is a great time to strengthen that bond.

The decision to breastfeed or formula feed your baby is a personal one. Weighing the pros and cons of each method can help you decide what is best for you and your baby.

All About Breastfeeding

Nursing can be a wonderful experience for both mother and baby. It provides ideal nourishment and a special bonding experience that many mothers cherish.

Here are some of the many benefits of breastfeeding:

Fighting infections and other conditions. Breastfed babies have fewer infections and hospitalizations than formula-fed infants. During breastfeeding, antibodies and other germ-fighting factors pass from a mother to her baby and strengthen the immune system. This helps lower a baby’s chances of getting many infections, including:

• ear infections
• diarrhea
• respiratory infections
• meningitis

Breastfeeding also may protect babies against:

• allergies
• asthma
• diabetes
• obesity
• sudden infant death syndrome (SIDS)

Breastfeeding is particularly beneficial for premature babies.

Nutrition and ease of digestion. Often called the “perfect food” for a human baby’s digestive system, breast milk’s components — lactose, protein (whey and casein), and fat — are easily digested by a newborn.

As a group, breastfed infants have less difficulty with digestion than do formula-fed infants. Breast milk tends to be more easily digested so that breastfed babies have fewer bouts of diarrhea or constipation.

Breast milk also naturally contains many of the vitamins and minerals that a newborn requires. One exception is vitamin D — the AAP recommends that all breastfed babies begin receiving vitamin D supplements during the first 2 months and continuing until a baby consumes enough vitamin D-fortified formula or milk (after 1 year of age).

The U.S. Food and Drug Administration (FDA) regulates formula companies to ensure they provide all the necessary nutrients (including vitamin D) in their formulas. Still, commercial formulas can’t completely match breast milk’s exact composition. Why? Because milk is a living substance made by each mother for her individual infant, a process that can’t be duplicated in a factory.

Free. Breast milk doesn’t cost a cent, while the cost of formula quickly adds up. And unless you’re pumping breast milk and giving it to your baby, there’s no need for bottles, nipples, and other supplies that can be costly. Since breastfed babies are less likely to be sick, that may mean they make fewer trips to the doctor’s office, so fewer co-pays and less money are paid for prescriptions and over-the-counter medicines.

Different tastes. Nursing mothers usually need 500 extra calories per day, which means they should eat a wide variety of well-balanced foods. This introduces breastfed babies to different tastes through their mothers’ breast milk, which has different flavors depending on what their mothers have eaten. By tasting the foods of their “culture,” breastfed infants more easily accept solid foods.

Convenience. With no last-minute runs to the store for more formula, breast milk is always fresh and available whether you’re home or out and about. And when women breastfeed, there’s no need to wash bottles and nipples or warm up bottles in the middle of the night.

Smarter babies. Some studies suggest that children who were exclusively breastfed have slightly higher IQs than children who were formula fed.

“Skin-to-skin” contact. Many nursing mothers really enjoy the experience of bonding so closely with their babies. And the skin-to-skin contact can enhance the emotional connection between mother and infant.

Beneficial for mom, too. The ability to totally nourish a baby can help a new mother feel confident in her ability to care for her baby. Breastfeeding also burns calories and helps shrink the uterus, so nursing moms may be able to return to their pre-pregnancy shape and weight quicker. Also, studies show that breastfeeding helps lower the risk of breast cancer, high blood pressure, diabetes, and cardiovascular disease, and also may help decrease the risk of uterine and ovarian cancer.

Breastfeeding Challenges

Breastfeeding can be easy from the get-go for some mothers, but take a while to get used to for others. Moms and babies need plenty of patience to get used to the routine of breastfeeding.

Common concerns of new moms, especially during the first few weeks and months, may include:

Personal comfort. Initially, many moms feel uncomfortable with breastfeeding. But with proper education, support, and practice, most moms overcome this.

Latch-on pain is normal for the first week to 10 days, and should last less than a minute with each feeding. But if breastfeeding hurts throughout feedings, or if their nipples and/or breasts are sore, it’s a good idea for breastfeeding mothers to get help from a lactation consultant or their doctor. Many times, it’s just a matter of using the proper technique, but sometimes pain can mean that something else is going on, like an infection.

Time and frequency of feedings. Breastfeeding requires a big time commitment from mothers, especially in the beginning, when babies feed often. A breastfeeding schedule or the need to pump breast milk during the day can make it harder for some moms to work, run errands, or travel.

And breastfed babies do need to eat more often than babies who take formula, because breast milk digests faster than formula. This means mom may find herself in demand every 2 or 3 hours (maybe more, maybe less) in the first few weeks.

Diet. Women who are breastfeeding need to be aware of what they eat and drink, since these can be passed to the baby through the breast milk. Just like during pregnancy, breastfeeding women should not eat fish that are high in mercury and limit consumption of lower mercury fish.

If a mom drinks alcohol, a small amount can pass to the baby through breast milk. She should wait at least 2 hours after a single alcoholic drink to breastfeed to avoid passing any alcohol to the baby. Caffeine intake should be kept to no more than 300 milligrams (about one to three cups of regular coffee) or less per day because it can cause problems like restlessness and irritability in some babies.

Maternal medical conditions, medicines, and breast surgery. Medical conditions such as HIV or AIDS or those that involve chemotherapy or treatment with certain medicines can make breastfeeding unsafe. A woman should check with her doctor or a lactation consultant if she’s unsure if she should breastfeed with a specific condition. Women should always check with the doctor about the safety of taking medicines while breastfeeding, including over-the-counter and herbal medicines.

Mothers who’ve had breast surgery, such as a reduction, may have difficulty with their milk supply if their milk ducts have been severed. In this situation, a woman should to talk to her doctor about her concerns and work with a lactation specialist.

All About Formula Feeding

Commercially prepared infant formulas are a nutritious alternative to breast milk, and even contain some vitamins and nutrients that breastfed babies need to get from supplements.

Manufactured under sterile conditions, commercial formulas attempt to duplicate mother’s milk using a complex combination of proteins, sugars, fats, and vitamins that aren’t possible to create at home. So if you don’t breastfeed your baby, it’s important to use only commercially prepared formula and not try to make your own.

Besides medical concerns that may prevent breastfeeding, for some women, breastfeeding may be too difficult or stressful. Here are other reasons women may choose to formula feed:

Convenience. Either parent (or another caregiver) can feed the baby a bottle at any time (although this is also true for women who pump their breast milk). This allows mom to share the feeding duties and helps her partner to feel more involved in the crucial feeding process and the bonding that often comes with it.

Flexibility. Once the bottles are made, a formula-feeding mother can leave her baby with a partner or caregiver and know that her little one’s feedings are taken care of. There’s no need to pump or to schedule work or other obligations and activities around the baby’s feeding schedule. And formula-feeding moms don’t need to find a private place to nurse in public.

Time and frequency of feedings. Because formula is less digestible than breast milk, formula-fed babies usually need to eat less often than breastfed babies.

Diet. Women who opt to formula feed don’t have to worry about the things they eat or drink that could affect their babies.

Formula Feeding Challenges

As with breastfeeding, there are some challenges to consider when deciding whether to formula feed.

Lack of antibodies. None of the antibodies found in breast milk are in manufactured formula. So formula can’t provide a baby with the added protection against infection and illness that breast milk does.

Can’t match the complexity of breast milk. Manufactured formulas have yet to duplicate the complexity of breast milk, which changes as the baby’s needs change.

Planning and organization. Unlike breast milk — which is always available, unlimited, and served at the right temperature — formula feeding your baby requires planning and organization to make sure that you have what you need when you need it. Parents must buy formula and make sure it’s always on hand to avoid late-night runs to the store.

And it’s important to always have the necessary supplies (like bottles and nipples) clean, easily accessible, and ready to go — otherwise, you will have a very hungry, very fussy baby to answer to. With 8-10 feedings in a 24-hour period, parents can quickly get overwhelmed if they’re not prepared and organized.

Expense. Formula can be costly. Powdered formula is the least expensive, followed by concentrated, with ready-to-feed being the most expensive. And specialty formulas (such as soy and hypoallergenic) cost more — sometimes far more — than the basic formulas. During the first year of life, the cost of basic formula can run about $1,500.

Possibility of producing gas and constipation. Formula-fed babies may have more gas and firmer bowel movements than breastfed babies.

Making a Choice

Deciding how you will feed your baby is not an easy decision to make. You’ll really only know the right choice for your family once your baby comes.

Many women decide on one method before the birth and then change their minds once their baby is born, or in the weeks or months after. And many women decide to breastfeed and supplement with formula because they find that is the best choice for their family and their lifestyle.

While you’re weighing the pros and cons, talk to your doctor or lactation consultant. These health care providers can give you more information about the options available and help you make the best decision for your family.

Most parents wouldn’t dream of giving their kids a mug of coffee, but might routinely serve soft drinks containing caffeine. Foods and drinks with caffeine are everywhere, but it’s wise to keep caffeine consumption to a minimum, especially in younger kids.

The United States hasn’t developed guidelines for caffeine intake and kids, but Canadian guidelines recommend that preschoolers get no more than 45 milligrams of caffeine a day. That’s equivalent to the average amount of caffeine found in a single 12-ounce (355-milliliter) can of soda.

How Caffeine Affects Kids

A stimulant that affects kids and adults similarly, caffeine is naturally produced in the leaves and seeds of many plants. Caffeine is also made artificially and added to certain foods. Caffeine is defined as a drug because it stimulates the central nervous system. At lower levels, it can make people feel more alert and energetic.

In both kids and adults, too much caffeine can cause:

• jitteriness and nervousness
• upset stomach
• headaches
• difficulty concentrating
• difficulty sleeping
• increased heart rate
• increased blood pressure

Especially in young kids, it doesn’t take a lot of caffeine to produce these effects.

Here are some other reasons to limit kids’ caffeine consumption:

• Kids often drink caffeine contained in regular soft drinks. Kids who consume one or more 12-ounce (355-milliliter) sweetened soft drink per day are 60% more likely to be obese.
• Caffeinated beverages often contain empty calories (calories that don’t provide any nutrients), and kids who fill up on them don’t get the vitamins and minerals they need from healthy sources, putting them at risk for nutritional deficiencies. In particular, kids who drink too much soda (usually starting between the third and eighth grades) may miss getting the calcium they need from milk to build strong bones and teeth.
• Drinking too many sweetened caffeinated drinks could lead to dental cavities (or caries) from the high sugar content and the erosion of tooth enamel from acidity. How can sodas cause that much damage to kids’ teeth? Consider this: One 12-ounce (355-milliliter) nondiet, carbonated soft drink contains the equivalent of 10 teaspoons of sugar (49 milliliters), as well as 150 calories.
• Caffeine is a diuretic that causes the body to eliminate water (through urinating), which may contribute to dehydration. Whether the amount of caffeine in beverages is enough to actually cause dehydration is not clear, however. It may depend on whether the person drinking the beverage is used to caffeine and how much caffeine was consumed that day. To be on the safe side, it’s wise to avoid excessive caffeine consumption in hot weather, when kids need to replace water lost through sweating.
• Abruptly stopping caffeine may cause withdrawal symptoms (headaches, muscle aches, temporary depression, and irritability), especially for those who are used to consuming a lot of it.
• Caffeine can make heart problems or nervous disorders worse, and some kids might not know that they’re at risk.

One thing that caffeine doesn’t do is stunt growth. Although scientists once worried that caffeine could hurt growth, this isn’t supported by research.

Foods and Beverages With Caffeine

Although kids get most of their caffeine from sodas, it’s also found in coffee, tea, chocolate, coffee ice cream or frozen yogurt, as well as pain relievers and other over-the-counter medicines. Some parents may give their kids iced tea in place of soda, thinking that it’s a better alternative. But iced tea can contain as much sugar and caffeine as soda.

Here’s how some sources of caffeine compare:

Sources: U.S. Food and Drug Administration and the National Soft Drink Association

What’s Caffeine Sensitivity?

Caffeine sensitivity refers to the amount of caffeine that will produce an effect in someone, which varies from person to person. On average, the smaller the person, the less caffeine necessary to produce side effects. However, caffeine sensitivity is most affected by daily caffeine intake.

People who regularly drink beverages containing caffeine soon develop a reduced sensitivity to it. This means they need higher doses of caffeine to achieve the same effects as someone who doesn’t drink caffeinated drinks often. So, the more caffeine kids take in, the more caffeine they’ll need to feel the same effects.

In addition to being more susceptible to the effects of caffeine based on size, younger kids are more sensitive because they haven’t been exposed to it as much as older kids or adults.

Caffeine moves through the body within a few hours and is then passed through the urine (pee). It’s not stored in the body, but kids may feel its effects for up to 6 hours if they’re sensitive to it.

Cutting Back On Caffeine

Can you keep kids caffeine-free? Absolutely! The best way to cut caffeine (and added sugar) is to eliminate soda. Instead, offer water, milk, or flavored seltzer; you also can serve 100% fruit juice in small amounts. For added convenience, serve water in squeeze bottles that kids can carry around. You can still serve the occasional soda or tea — just make it noncaffeinated. And watch for hidden caffeine by checking the ingredient list on foods and beverages.

If your teen has taken up coffee drinking, one cup a day can easily turn into several (as most adults know), especially if your teen drinks it to stay awake during late-night study sessions.

The best way to reduce coffee caffeine intake is to cut back slowly. Otherwise, kids (and adults) could get headaches and feel achy, depressed, or just downright lousy.

Try substituting noncaffeinated drinks for caffeinated sodas and coffee (water, caffeine-free sodas, and caffeine-free teas). Keep track of how many caffeinated drinks your child has each day, and substitute one drink per week with a caffeine-free alternative until he or she has gotten below the 100-milligram mark.

Someone cutting back on caffeine may feel tired. The best bet is to hit the sack, not the sodas: It’s just a body’s way of saying that more rest is needed. Don’t worry — energy levels will return to normal in a few days.

Feel free to let kids indulge in a sliver of chocolate cake at birthday parties or a cup of tasty hot cocoa on a cold day — these choices don’t pack enough caffeine punch to be harmful. As with everything, moderation is the key to keeping your kids’ caffeine consumption under control.

Carbohydrates are the body’s most important and readily available source of energy. Even though they’ve gotten a bad rap lately and are sometimes blamed for the obesity epidemic in America, carbs are a necessary part of a healthy diet for both kids and adults.

The two major forms of carbs are:

1. simple carbohydrates (or simple sugars): these include fructose, glucose, and lactose, which also are found in nutritious whole fruits
2. complex carbohydrates (or starches): found in foods such as starchy vegetables, grains, rice, and breads and cereals

So how, exactly, does the body process carbs and sugar? All carbohydrates are broken down into simple sugars, which are absorbed into the bloodstream. As the sugar level rises, the pancreas releases the hormone insulin, which is needed to move sugar from the blood into the cells, where the sugar can be used as energy.

The carbs in some foods (mostly those that contain simple sugars and highly refined grains, such as white flour and white rice) are easily broken down and cause blood sugar levels to rise quickly.

Complex carbs (found in whole grains), on the other hand, are broken down more slowly, allowing blood sugar to rise more gradually. A diet that’s high in foods that cause a rapid rise in blood sugar may increase a person’s risk of developing health problems like diabetes and heart disease, although these studies have been done mostly in adults.

Despite the recent craze to cut carbs, the bottom line is that not all foods containing carbohydrates are bad for kids, whether they’re complex (as in whole grains) or simple (such as those found in fruits). If carbs were such a no-no, we’d have a huge problem since most foods contain them.

Still, some carbohydrate-dense foods are healthier than others. Healthy sources of carbohydrates include:

• whole-grain cereals
• brown rice
• whole-grain breads
• fruits
• vegetables
• low-fat dairy

For kids over 2 years old, a healthy balanced diet should include 50% to 60% of calories consumed coming from carbohydrates. The key is to make sure that the majority of these carbs come from good sources and that added sugar in their diet is limited.

“Good” vs. “Bad” Carbs

Carbohydrates have taken a lot of heat in recent years. Medical experts think consuming too many refined carbs — such as the refined sugars in candy and soda, and refined grains like the white rice and white flour used in many pastas and breads — have contributed to the dramatic rise of obesity in the United States. (Of course, not exercising and eating overly large food portions are key parts of the obesity epidemic.)

How could one type of food cause such a big problem? The “bad” carbs (sugar and refined foods) are easy to get, come in large portions, taste good, and aren’t too filling. So people tend to eat more of them than needed. And some are not needed at all — foods like colas and candy provide no required nutrients; instead, they add only “empty calories.”

But this doesn’t mean that all simple sugars are bad. Simple carbs are also found in many nutritious foods — like fruits, vegetables, and dairy products, which provide a range of essential nutrients that support growth and overall health. Fresh fruits, for example, contain simple carbs but also have vitamins and fiber.

The 2010 dietary guidelines recommend that Americans eat more unrefined (“good”) carbs, saying that everyone — including kids and teens — should increase whole-grain consumption and avoid added sugar. In fact, at least half of grain intake should come from whole grains.

Whole grains certainly sound like the healthy way to go. But what makes them so different from simple carbs? Whole grains like brown rice, oatmeal, and whole-grain breads and cereals are complex carbohydrates.

Complex carbs:

• Break down more slowly in the body: Whole grains contain all three parts of the grain (the bran, germ, and endosperm), whereas refined grains are mainly just the endosperm — and that means more for your body to break down. More to break down means digestion is slower, the carbs enter the body slower, and it’s easier for your body to regulate them.
• Are high in fiber: Not just for the senior-citizen crowd, foods that are good sources of fiber are beneficial because they’re filling and, therefore, discourage overeating. Diets rich in whole grains protect against diabetes and heart disease. Plus, when combined with adequate fluid, they help move food through the digestive system to prevent constipation and may protect against gut cancers.
• Provide vitamins and minerals: In addition to fiber, whole grains contain other important vitamins and minerals, such as B vitamins, magnesium, and iron.

Some refined grain products are “enriched.” This means that nutrients like some B vitamins (such as thiamin, riboflavin, niacin, and folic acid) and iron are added back after processing. So these products might contain more of these nutrients than unrefined whole-grain foods that have not been fortified.

The actual amount of grain consumption needed depends on a person’s age, gender, and level of physical activity. Most school-age kids should eat four to six “ounce equivalents” from the grain group each day, at least half of which should come from whole grains. An “ounce equivalent” is like a serving — one slice of bread; 1 cup of ready-to-eat cereal; or a half cup of cooked rice, cooked pasta, or hot cereal can be considered a 1-ounce equivalent.

Sizing Up Sugar

Foods that are high in added sugar (soda, cookies, cake, candy, frozen desserts, and some fruit drinks) tend to also be high in calories and low in other valuable nutrients. As a result, a high-sugar diet is often linked with obesity. Eating too many sugary foods also can lead to tooth decay.

The key to keeping sugar consumption in check is moderation. Added sugar can enhance the taste of some foods, and a little sugar, particularly if it’s in a food that provides other important nutrients (such as cereal or yogurt), isn’t going to tip the scale or send your child to the dentist.

Instead of serving foods that are low in nutrients and high in added sugar, offer healthier choices, such as fruit — a naturally sweet carbohydrate-containing snack that also provides fiber and vitamins that kids need.

One way to cut down on added sugar is to eliminate soda and other sugar-sweetened beverages. Consider these facts:

• Each 12-ounce (355-milliliter) serving of a carbonated, sweetened soft drink contains the equivalent of 10 teaspoons (49 milliliters) of sugar and 150 calories. Sweetened drinks are the largest source of added sugar in the daily diets of U.S. children.
• Consuming one 12-ounce (355-milliliter) sweetened soft drink per day increases a child’s risk of obesity.
• Acidity from sweetened drinks can erode tooth enamel and their high sugar content can cause dental cavities.

Instead of soda or juice drinks (which often contain as much added sugar as soft drinks), serve low-fat milk, water, or 100% fruit juice. A note: Although there’s no added sugar in 100% fruit juice, the calories from those natural sugars can add up. So limit juice intake to 4–6 ounces (118–177 milliliters) for kids under 7 years old, and to no more than 8–12 ounces (237–355 milliliters) for older kids and teens.

Figuring Out Carbs and Sugar

It isn’t always easy to tell which foods are good choices and which aren’t. To figure out carbohydrates, look under Nutrition Facts on food labels, where you’ll find three numbers for total carbohydrate: the total number of carbohydrates, the amount of dietary fiber, and sugars.

• Total Carbohydrate: This number, listed in grams, combines several types of carbohydrates: dietary fibers, sugars, and other carbs.
• Dietary Fiber: Listed under Total Carbohydrate, dietary fiber itself has no calories and is a necessary part of a healthy diet. A high-fiber diet promotes bowel regularity and can help reduce cholesterol levels.
• Sugars: Also listed under Total Carbohydrate on food labels, sugars are found in most foods. However, the Nutrition Facts label doesn’t make the distinction between natural sugars and added sugars. Natural sugars are found in many foods, including fruit and dairy products. Snack foods, candy, and soda often have large amounts of added sugars.

  To find out if a food has added sugar, you need to look at the ingredient list for sugar, corn syrup or sweetener, dextrose, fructose, honey, or molasses, to name just a few. Avoid products that have sugar or other sweeteners high on the ingredient list.

Although carbohydrates have just 4 calories per gram, the high sugar content in snack foods means the calories can add up quickly, and these “empty calories” usually contain few other nutrients.

Making Carbs Part of a Healthy Diet

Making sure that kids get a balanced, nutritious diet isn’t as hard as it may seem. Simply make good carbohydrate choices (whole grains, fruits, veggies, and low-fat milk and dairy products), stock your home with healthy choices, limit foods containing added sugar (especially those with little or no nutritional value), and encourage kids to be active every day.

Above all, be a good role model. Kids will see your wholesome habits and adopt them, leading to a healthier lifestyle throughout childhood and into adulthood.

Helping your child manage an egg allergy means being aware of what he or she eats and reading food labels carefully. It’s work, but it’s important.

About Egg Allergy

Eggs in themselves aren’t bad, but when someone is allergic to them, the body thinks they are. When a person is allergic to eggs, the body’s immune system overreacts to proteins in the egg. So every time something made with eggs enters the digestive system, the body thinks that these proteins are harmful invaders.

The immune system responds by creating specific antibodies to that food, which are designed to fight off the “invader.” These antibodies — called immunoglobulin E (IgE) — trigger the release of certain chemicals into the body, one of which is histamine.

So when a child with an egg allergy eats a food that contains eggs, the immune system unleashes an army of chemicals to protect the body. The release of these chemicals can affect the respiratory system, gastrointestinal tract, skin, and the cardiovascular system — causing allergy symptoms like wheezing, nausea, headache, stomachache, and itchy hives.

Most people who are allergic react to the proteins in egg whites, but some can’t tolerate proteins in the yolk. Egg allergy usually first appears when a child is very young, and most kids outgrow it by the time they’re 5 years old.

Egg allergy is like most food allergy reactions: It usually happens within minutes to hours after eating eggs. Most reactions last less than a day and may affect these three body systems:

1. the skin: in the form of red, bumpy rashes (hives), eczema, or redness and swelling around the mouth
2. the gastrointestinal tract: in the form of belly cramps, diarrhea, nausea, or vomiting
3. the respiratory tract: symptoms can range from a runny nose, itchy, watery eyes, and sneezing to the triggering of asthma with coughing and wheezing

Most kids with egg allergy have some of the reactions listed above, but a few may have a very strong reaction called anaphylaxis. This severe allergic reaction causes swelling of the mouth, throat, and airways leading to the lungs, resulting in breathing difficulty. In addition, there is a dangerous drop in blood pressure, which can make a child dizzy or pass out, and may quickly lead to shock.

Diagnosis

If your doctor thinks your child might have an egg allergy, he or she will probably refer you to an allergist or allergy specialist for further testing. The allergy specialist will ask things like how often your child has the reaction, the time between eating the food and the start of symptoms, and whether any other family members have allergies or conditions like eczema and asthma.

The allergy specialist may do a skin test. This involves placing liquid extracts of egg protein on a child’s forearm or back, pricking the skin a tiny bit, and waiting to see if a reddish, raised spot forms, indicating an allergic reaction.

Your child will need to stop taking anti-allergy medicines (such as over-the-counter antihistamines) 5 to 7 days before the skin test because they can affect the results. Most cold medicines and some antidepressants also may affect skin testing. Check with the allergist’s office if you’re unsure about what medicines need to be stopped and for how long.

The doctor also might take a blood sample and send it to a lab, where it will be mixed with some of the suspected allergen and checked for IgE antibodies.

In some cases, positive results of skin and blood tests aren’t enough to prove that symptoms are being caused by eggs. So doctors may use what’s called a food challenge to help diagnose the allergy. In a food challenge, the child will eat foods that contain eggs while being very closely watched by the doctor. If symptoms appear after eating egg products, it’s likely the child has an egg allergy.

Treatment

Treating egg allergy might seem simple — just make sure your child doesn’t eat eggs. But so many foods are made with eggs and egg products that it can be really hard to know what’s OK and not OK to eat. Consider working with a registered dietitian to develop an eating plan that has all the nutrients your child needs while avoiding things made with eggs.

If your child has a severe egg allergy — or any kind of serious allergy — your doctor may want you to carry a shot of epinephrine with you in case of an emergency. Epinephrine comes in an easy-to-carry container about the size of a large marker. It’s easy to use — the doctor will show you how to give a shot to your child should you ever need to.

If your child accidentally eats something with egg in it and starts having serious allergic symptoms, like swelling inside the mouth, chest pain, or difficulty breathing, give the shot right away while you wait for medical help. Always call for emergency help (911) if your child has needed to use epinephrine. Besides keeping epinephrine in your home, briefcase, or purse, also be sure it’s at relatives’ and other caregivers’ homes and at childcare or school.

Also carry an over-the-counter antihistamine as this can help ease allergy symptoms in some kids. Antihistamines should be used in addition to the epinephrine and not as a replacement for the shot.

If your child has had to have an epinephrine shot because of an allergic reaction, go immediately to a medical facility or hospital emergency room so they can provide additional treatment if needed. Up to one third of anaphylactic reactions can have a second wave of symptoms several hours following the initial attack. So your child might need to be watched in a clinic or hospital for 4 to 8 hours following the reaction.

Getting the Flu Vaccine

In the past, it was recommended that anyone with an egg allergy talk to a doctor about whether receiving the flu vaccine was safe because it is grown inside eggs. But health experts now say that the amount of egg allergen in the vaccine is so tiny that it (but not the nasal mist) is safe even for kids with a severe egg allergy. The flu vaccine is recommended for all kids older than 6 months of age during flu season.

A child with an egg allergy that affects the skin (with a rash, itchiness and/or swelling) should get the flu shot in a doctor’s office, not at a supermarket, drugstore, or other venue. If the allergy is severe (causing anaphylaxis), the child should get the flu vaccine in an allergist’s office.

The nasal mist is not recommended for people with an egg allergy because the risks are currently unknown. Doctors are studying its safety in people with egg allergies and until these studies are completed, it’s safest to get the flu shot.

Food Labels: What to Avoid

The best way to be sure a food is egg free is to read the label. Manufacturers of foods sold in the United States must list on their labels whether a food contains any of the most common allergens. So look for statements like these somewhere on the label: “contains egg ingredients,” “made using egg ingredients,” or “made in a facility that also processes eggs.”

This label requirement makes things a little easier than reading the ingredients list — instead of needing to know that the ingredient “ovoglobulin” comes from egg protein, you should be able to tell at a glance which foods to avoid.

Still, to make sure the foods your child eats are egg free, you’ll need to be on the lookout for any ingredients that might come from eggs. That means asking questions when eating out at restaurants or others’ homes and carefully reading food labels.

Here’s how eggs, in their many forms, are listed on food labels:

• dried egg
• egg white
• egg white solids
• egg yolk
• egg solids
• powdered egg
• whole egg

Also avoid these ingredients:

• albumin
• globulin
• livetin
• lysozyme
• ovalbumin
• ovoglobulin
• ovomucin
• ovomucoid
• ovotransferrin
• ovovitella
• ovovitellin
• silici albuminate
• Simplesse
• vitellin

Living With an Egg Allergy

Try to find out how foods are cooked and what’s in them. When you’re out and about or visiting friends, you may want to bring your child’s own food with you. When food shopping, look for egg-free alternatives to foods that usually contain eggs, such as pasta.

When preparing food, use one of these egg alternatives in recipes. Each of these replaces one egg (these substitutes may not work as well in recipes that call for more than three eggs):

• 1 teaspoon baking powder + 1 tablespoon liquid + 1 tablespoon vinegar
• 1 teaspoon yeast dissolved in ¼ cup warm water
• 1½ tablespoons water + 1½ tablespoons oil + 1 teaspoon baking powder
• 1 packet gelatin + 2 tablespoons warm water (don’t mix until ready to use)
• 1 tablespoon pureed fruit, such as apricots or bananas

When cooking at home, always carefully scrub the utensils you’re using in case they have been used on egg products.

Although the number of people in the United States with food allergies is low (just over 1% of the total population), there’s a growing awareness about food allergies. This means that everyone — from the waitstaff at a restaurant to food manufacturers — is more understanding and willing to accommodate a child’s food needs.

As with carbohydrates in recent years, fats have been wrongly accused of being “bad.” Too much fat can be a bad thing, but certain kinds of fat are actually good for us and are an important part of a healthy diet.

About Fat

Fats are nutrients in food that the body uses to build nerve tissue (including the brain and nerves) and hormones. The body also uses fat as fuel. If fats eaten aren’t burned as energy or used as building blocks, they’re stored by the body in fat cells. This is the body’s way of thinking ahead: By saving fat for future use, the body plans for times when food might be scarce.

Fat gives food flavor and texture, but it’s also high in calories and excess amounts of fatty foods can cause many health problems.

For kids and teens, desserts and snacks (including potato chips, chocolate, cakes, doughnuts, pastries, and cookies) are a significant source of fat. Kids also get fat from whole-milk products and high-fat meats, such as bacon, hot dogs, and fatter cuts of red meat.

Of course, fast-food and takeout meals tend to have more fat than home cooking; and in restaurants, fried dishes are the highest in fat content. Fat also often “hides” in foods in the form of creamy, cheesy, or buttery sauces or dressings.

However, fat is still an important part of a healthy diet if kids eat healthier types of fat at the recommended daily amounts.

Why Some Fats Are Healthy

Getting enough healthy fats is essential for growth and development. Young kids, in particular, need enough of them in their diet to help the brain and nervous system develop normally.

Besides supplying fuel for the body, fats:

• help the body absorb some vitamins (vitamins A, D, E, and K are fat soluble, meaning they can only be absorbed if there’s fat in a person’s diet)
• are the building blocks of hormones
• are needed to insulate all nervous system tissues in the body
• help people feel full, so they’re less likely to overeat

Fat is a great source of energy but has twice the amount of calories as carbohydrates or protein. For example, 1 gram of fat provides 9 calories, whereas 1 gram of carbohydrates or protein provide 4 calories.

Low-fat diets have been touted for years, but some experts think the low-fat/no-fat revolution may have gone too far, overlooking the complex nature of fats and how they work in the body.

Types of Fats

To help you figure out fats, here’s a look at the three major types:

1. Unsaturated fats: Found in plant foods and fish, these fats are seen as neutral or even beneficial to heart health. The types of unsaturated fats are:

• monounsaturated, found in avocados and olive, peanut, and canola oils
• polyunsaturated, found in most vegetable oils
• omega-3 fatty acids, a type of polyunsaturated fat found in oily fish like tuna and salmon

2. Saturated fats: Found in meat and other animal products, such as butter, shortening, lard, cheese, and milk (except skim or nonfat), saturated fats are also in palm and coconut oils, which are often used in commercial baked goods. Eating too much saturated fat can raise blood cholesterol levels and increase the risk of heart disease.

3. Trans fats: Found in margarine (especially the sticks), commercial snack foods and baked goods, and some commercially fried foods, trans fats (also called trans fatty acids) are created when vegetable oils are hydrogenated (meaning that hydrogen atoms are added to the fat molecule so they remain solid at room temperature).

Like saturated fats, trans fats can raise cholesterol and increase the risk of heart disease. Food manufacturers must list trans fats on food labels, but may also refer to them as “partially hydrogenated” oils on the ingredient list.

Looking at Labels

When shopping for food and reading labels, it’s important to understand that kids may eat a portion that is larger than the serving size on the label. For example, a bag of corn chips might list 12 chips as a serving size. But kids might easily eat two or three times that amount. So be sure to pay attention to serving sizes.

When it comes to fat, labels can say many things. Low-fat, reduced fat, light (or lite), and fat-free are common terms on food packages. The government has strict rules about the use of two of these phrases. By law:

• fat-free foods can contain no more than 0.5 grams of fat per serving
• low-fat foods may contain 3 grams of fat or less per serving

Reduced-fat and light (lite) foods are a little trickier and you may need to do some supermarket math. Light (lite) and reduced-fat foods may still be high in fat. The requirement for a food to be labeled light (lite) is that it must contain 50% less fat or one third fewer calories per serving than the regular version of that food.

Foods labeled reduced fat must contain 25% less fat per serving than the regular version. But if the regular version of a particular food was high in fat to begin with, a 25% to 50% reduction may not lower the fat content enough to make it a smart snacking choice. For example, the original version of a brand of peanut butter contains 16 grams of fat and the reduced fat version contains 12 grams. That’s still a lot of fat!

And don’t expect the label to tell all. The percentage of fat in a food isn’t always listed on the label. But it is easy to calculate. Divide the number of calories from fat by the number of total calories and multiply by 100. For example, if a 300-calorie food has 60 calories from fat, you divide 60 by 300 and then multiply by 100. The result shows that that food gets 20% of its calories from fat.

How Much Fat Should Kids Get?

Although some people may think it’s wise to try to cut fat altogether or excessively limit it, it’s crucial for fat to stay a part of a child’s diet.

For young kids, especially, fat and cholesterol play important roles in brain development. And for those under 2 years old, fat should not be restricted. Children ages 1 to 3 years should eat a varied diet with about 30% to 35% of calories coming from fat. For ages 4 to 18 years, the recommendations are about 25% to 35% of calories.

Fit Fats and Your Family

Although eating adequate amounts of fat is an important part of a healthy diet, it is true that many kids today do eat too much of it. And excess fat might lead to weight gain. Kids who carry excess weight into adulthood have greater risk of heart disease, high blood pressure, and diabetes.

Here are some ways to keep fat intake within the recommended ranges:

• Serve naturally low-fat foods, such as fruits and vegetables, whole grains, lean meats and fish, as well as low-fat dairy products.
• Choose healthier, unsaturated fats when cooking and reduce the amount you use.
• When cooking meat, fish, or poultry, opt for broiling, grilling, or roasting (on a rack). These methods allow the fat to drip away during cooking, which cuts down on calories, too. Frying, on the other hand, adds fat. Remove skin from poultry.
• Beware of reduced-fat and low-fat claims. These products often have more sugar added and just as many calories.
• Pack school lunches and meals for family outings instead of going to fast-food restaurants or relying on your kids to make healthy choices in the school cafeteria.
• When dining out, help kids make balanced choices that don’t include large amounts of fat. For example, make a green salad part of the order and use low-fat dressing on the side. Encourage choosing mustard instead of mayonnaise on sandwiches. Choose baked, grilled, or steamed dishes rather than fried. Limit visits to fast-food restaurants.

The most effective way to teach kids healthy eating habits is to set a good example yourself. Make nutritious food a priority in your life by teaching your kids how to prepare healthy meals and snacks. Making sensible eating a habit, choosing foods wisely, and exercising regularly are the keys to a healthy lifestyle.

Toddlers this age are moving from the eating habits they had as infants toward a diet more like your own.

Your job is to keep introducing new flavors and textures. Food preferences are set early in life, so help your child develop a taste for healthy foods now.

Toddlers have little tummies, so serve foods that are packed with the nutrients they need to grow healthy and strong, and limit the sweets and empty calories.

Your toddler will continue to explore self-feeding, first with fingers and then with utensils at around 15 to 18 months of age. Give your child many opportunities to practice these skills, but lend a hand when frustrations arise. As skills develop, step back and let your little one take over.

Toddlers also like to assert their independence, and the table is one place where you should give yours some sense of control. Allow your toddler to respond to internal cues for hunger and fullness but set the boundaries.

Remember: You decide what variety of healthy foods to offer at a meal and your child decides which of those foods to eat, how much to eat, and whether to eat at all.

A Word About Milk

Milk is an important part of a toddler’s diet because it provides calcium and vitamin D, which help build strong bones. Most kids under age 2 should drink whole milk for the dietary fats needed for normal growth and brain development. If a toddler is at risk for becoming overweight or there is a family history of obesity, high cholesterol, or heart problems, doctors recommend switching to reduced fat (2%) milk. Talk with your doctor before doing so.

When your child is 2, you can make the switch to low-fat or nonfat milk.

Between 12 and 18 months of age is a good time for transition to a cup. Instead of cutting out bottles all at once, you can gradually eliminate them from the feeding schedule, starting with mealtime. Offer whole milk in a cup after the child has begun the meal. If you are breastfeeding, only offer milk in a cup and avoid the bottle habit altogether.

Some kids don’t like cows milk at first because it’s different from the breast milk or formula they’re used to. If that’s the case, it’s OK to mix whole milk with formula or breast milk and gradually adjust the mixture so that it eventually becomes 100% cow’s milk.

Iron Intake

It’s important to watch out for iron deficiency after kids reaches 1 year of age. It can affect their physical, mental, and behavioral development, and also can lead to anemia.

To help prevent iron deficiency:

• Limit your child’s milk intake to 16-24 full ounces (480-720 milliliters) a day.
• Increase iron-rich foods in your child’s diet, like meat, poultry, fish, beans, and iron-fortified foods.
• Continue serving iron-fortified cereal until your child is 18 to 24 months old.

Talk with your doctor if you’re concerned that your child drinks a lot of cow’s milk or isn’t getting enough iron, or if you’re thinking of giving your child a vitamin supplement.

Foods to Avoid

By now your child should be eating a variety of foods. Continue to watch for allergic reactions when introducing new foods. Be aware that a child is at higher risk of developing food allergies if the child or one or more close family members have allergies or allergy-related conditions, like food allergies, eczema, or asthma. Talk to the doctor if you have any concerns.

Avoid foods that could present choking hazards, like popcorn, hard candies, hot dogs, raw vegetables and hard fruits, whole grapes, raisins, and nuts. Supervise your child at all times when eating.

How Much Should My Child Eat?

Offer your child three meals and two or three healthy snacks a day, but keep in mind that it’s common for toddlers to skip meals. Allowing kids to skip a meal is a difficult concept for many parents, but kids should be allowed to respond to their own internal cues for hunger and fullness. Don’t push food on a child who’s not hungry, but kids shouldn’t be allowed to eat on demand all day long either.

Maintain a regular schedule of meals and snacks so your kids will come to expect that food will be available at certain times of the day. If you have any questions about how much your child should eat, speak with your doctor.

During your baby’s first 3 months, breast milk or formula will provide all the nutrition needed.

As your infant grows, feeding will change. Babies move toward consuming more milk during each feeding, so they won’t need to feed as often and will sleep longer at night.

During the next year — and, especially, in the first 3 months — growth spurts will increase your baby’s appetite. Continue to feed on demand and increase the number of feedings as needed.

Your infant also will become more alert as the weeks go by, cooing and starting to develop a social smile. So there probably will be more interaction between you and your baby during feedings.

The following are general guidelines, and your baby may be hungrier more or less often than this. That’s why it’s important to pay attention to your baby’s signals of being hungry or full. A baby who is getting enough might slow down, stop, or turn away from the breast or bottle.

Breastfeeding: How Much and How Often?

After the first few weeks following birth, breastfed babies start to feed less often and sleep for longer periods at night. You can be reassured that your breastfed infant probably is eating enough if he or she:

• seems alert, content, and active
• is steadily gaining weight, growing, and developing
• feeds six to eight times per day
• is wetting and soiling diapers on a regular basis

Your baby might not be eating enough if he or she doesn’t appear satisfied, even after feeding, and cries constantly or is irritable. Call your baby’s doctor if you notice any of these signs.

Remember that after about a month, breastfed babies tend to have fewer bowel movements than they did before. When your baby is around 2 months old, he or she may not have a bowel movement after each feeding, or even every day. If your infant still hasn’t had a bowel movement after 3 days, call your doctor.

During periods of rapid growth, you may notice that your little one wants to feed more often. This frequent nursing prompts the mother’s body to increase her milk supply, and in a couple of days, supply and demand will get into balance.

Exclusively breastfed infants should get vitamin D supplements within the first few days of life, but additional supplements, water, juice, and solid foods aren’t usually necessary.

Formula Feeding: How Much and How Often?

Babies digest formula more slowly, so if you’re bottle-feeding, your baby may have fewer feedings than a breastfed infant.

As your baby grows, he or she will be able to eat more and may go for longer stretches between feedings. You’ll also notice that your baby is starting to sleep longer at night.

During the second month, infants may take about 4 or 5 ounces at each feeding. By the end of 3 months, your baby will probably need an additional ounce at each feeding.

One note about formula feeding: It’s easier to overfeed when using formula because it takes less effort to drink from a bottle than from a breast. So make sure that the hole on the bottle’s nipple is the right size. The liquid should drip slowly from the hole and not pour out. Also, resist the urge to finish feeding the bottle when your baby shows those signs of being full.

Never prop a bottle prop. Propping a bottle might cause choking and it increases the chances of getting ear infections and tooth decay.

A Word About Spitting Up

Many infants “spit up” small amounts after eating or during burping. Over time, this will happen less often, and be nearly gone by about 10 months. Spitting up a small amount — less than 1 ounce (30 ml) — shouldn’t be a concern as long as it happens within an hour of feeding and doesn’t bother your baby.

You can reduce spitting up in these early months by:

• feeding before your baby gets very hungry
• keeping your baby in a semi-upright position during the feeding and for an hour after
• burping your baby regularly
• avoiding overfeeding
• not jostling or playing vigorously with your baby right after a feeding

If your baby seems to be spitting up large amounts, is spitting up forcefully, is irritable during or after feedings, or seems to be losing weight or is not gaining weight as expected, call your doctor. And if your child has a fever or shows any signs of dehydration (such as not wetting diapers), call the doctor right away.

Contact your doctor if you have any questions or concerns about feeding your infant.

Most babies this age are introduced to solid foods. Experts recommend gradually starting solid foods when a baby is about 6 months old, depending on the baby’s readiness and nutritional needs.

Be sure to check with your doctor before giving any solid foods.

Is My Baby Ready to Eat Solids?

How can you tell if your baby is ready for solids? Here are a few hints:

• Is your baby’s tongue-thrust reflex gone or diminished? This reflex, which prevents infants from choking, also causes them to push food out of their mouths.
• Can your baby support his or her own head? To eat solid food, an infant needs good head and neck control and should be able to sit up.
• Is your baby interested in food? A 6-month-old baby who stares and grabs at your food at dinnertime is clearly ready for some variety in the food department.

If your doctor gives the go-ahead but your baby seems frustrated or uninterested as you’re introducing solid foods, try waiting a few days or even weeks before trying again. Solids are only a supplement at this point — breast milk and formula will still meet your baby’s basic nutritional needs.

How to Start Feeding Solids

When your baby is ready and the doctor has given you the OK to try solid foods, pick a time of day when your baby is not tired or cranky. You want your baby to be a little hungry, but not so hungry that he or she is upset. So you might want to let your baby breastfeed a while, or provide part of the usual bottle.

Have your baby sit supported in your lap or in an upright infant seat. Infants who sit well, usually around 6 months, can be placed in a high chair with a safety strap.

Most babies’ first food is a little iron-fortified infant single-grain cereal mixed with breast milk or formula. Place the spoon near your baby’s lips, and let the baby smell and taste. Don’t be surprised if this first spoonful is rejected. Wait a minute and try again. Most food offered to your baby at this age will end up on the baby’s chin, bib, or high-chair tray. Again, this is just an introduction.

Do not add cereal to your baby’s bottle unless your doctor instructs you to do so, as this can cause babies to become overweight and doesn’t help the baby learn how to eat solid foods.

Once your little one gets the hang of eating cereal off a spoon, it may be time to introduce single-ingredient puréed vegetables, fruit, or meat. The order in which foods are introduced doesn’t matter, but go slow. Introduce one food at a time and wait several days before trying something else new. This will let you identify any foods that your baby may be allergic to.

Your baby might take a little while to “learn” how to eat solids. During these months, you’ll still be providing the usual feedings of breast milk or formula, so don’t be concerned if your baby refuses certain foods at first or doesn’t seem interested. It can just take some time.

Foods to Avoid

Kids are at higher risk of developing food allergies if one or more close family members have allergies or allergy-related conditions, like food allergies, eczema, or asthma. Talk to your doctor about any family history of food allergies.

In some kids, their chance of developing an allergy to peanuts may be related to when they start eating peanut products. Talk to your doctor about how and when to introduce these foods to your child.

Possible signs of food allergy or allergic reactions include:

• rash
• bloating or an increase in gassiness
• diarrhea
• vomiting

For more severe allergic reactions, like hives or breathing difficulty, get medical attention right away. If your child has any type of reaction to a food, don’t offer that food again until you talk with your doctor.

Also, do not give honey until after a baby’s first birthday. Honey may contain certain spores that, while harmless to adults, can cause botulism in babies. And do not give regular cow’s milk until your baby is older than 12 months because it does not have the nutrition that infants need.

Tips for Introducing Solids

With the hectic pace of family life, most parents opt for commercially prepared baby foods at first. They come in small, convenient containers, and manufacturers must meet strict safety and nutrition guidelines. Avoid brands with added fillers and sugars.

If you do plan to prepare your own baby foods at home, puréeing them with a food processor or blender, here are some things to keep in mind:

• Protect your baby and the rest of your family from foodborne illness by following the rules for food safety (including washing hands well and often).
• Try to preserve the nutrients in your baby’s food by using cooking methods that retain the most vitamins and minerals. Try steaming or baking fruits and vegetables instead of boiling, which washes away the nutrients.
• Freeze portions that you aren’t going to use right away rather than canning them.
• Don’t serve home-prepared beets, spinach, green beans, squash, or carrots to infants younger than 4 months old. These can contain high levels of nitrates, which can cause anemia in babies. Use jarred varieties of these vegetables instead.

Whether you buy the baby food or make it yourself, remember that texture and consistency are important. At first, babies should have finely puréed single-ingredient foods. (Just applesauce, for example, not apples and pears mixed together.)

After you’ve successfully tried individual foods, it’s OK to offer a puréed mix of two foods. When your child is about 9 months old, coarser, chunkier textures will be OK as he or she starts moving to a diet that includes more table foods.

If you use commercially prepared baby food in jars, spoon some of the food into a bowl to feed your baby. Do not feed your baby directly from the jar because bacteria from the baby’s mouth can contaminate the remaining food. If you refrigerate opened jars of baby food, it’s best to throw away anything not eaten within a day or two.

Around 6 months of age is a good time to introduce your baby to a cup. Buy one with large handles and a lid (a “sippy cup”), and teach your baby how to hold and drink from it. You might need to try a few different cups to find one that works for your child. Use water at first to avoid messy clean-ups.

You can give your 6-month-old juice, but serve only 100% fruit juice, not juice drinks or powdered drink mixes. Do not give juice in a bottle and remember to limit the amount of juice your baby drinks to less than 4 total ounces (120 ml) a day. Too much juice adds extra calories without the nutrition of breast milk or formula. Drinking too much juice can contribute to excessive weight gain and can cause diarrhea.

Your goal over the next few months is to introduce a wide variety of foods, including iron-fortified cereals, fruits, vegetables, and puréed meats. If your baby doesn’t seem to like a particular food, try again at later meals. It can take quite a few tries before kids warm up to certain foods.