Introducing Solid Foods

I’ve heard that I shouldn’t feed my baby honey. Is this true?
– Cait

Yes, babies younger than 1 year old should not be given honey. Clostridium bacteria that cause infant botulism usually thrive in soil and dust. However, they can also contaminate certain foods — honey in particular.

Infant botulism can cause muscle weakness, with signs like poor sucking, a weak cry, constipation, and decreased muscle tone (floppiness).

Parents can help prevent infant botulism by not giving their baby honey or any processed foods containing honey (like honey graham crackers) until after the child’s first birthday. Light and dark corn syrups are thought by some to also contain botulism-causing bacteria, but a link hasn’t been proved. Be sure to check with your doctor before giving these syrups to an infant.

As kids get older, they can have honey because their mature digestive systems move the Clostridium bacteria spores through the body before they can cause harm.

When a child is choking, it means that an object — usually food or a toy — is stuck in the trachea (the airway), keeping air from flowing normally into or out of the lungs, so the child can’t breathe properly.

The trachea is usually protected by a small flap of cartilage called the epiglottis . The trachea and the esophagus  share an opening at the back of the throat, and the epiglottis acts like a lid, snapping shut over the trachea each time a person swallows. It allows food to pass down the esophagus and prevents it from going down the trachea.

But every once in a while, the epiglottis doesn’t close fast enough and an object can slip into the trachea. This is what happens when something goes “down the wrong pipe.”

Most of the time, the food or object only partially blocks the trachea, is coughed up, and breathing returns to normal quickly. Kids who seem to be choking and coughing but still can breathe and talk usually recover without help. It can be uncomfortable and upsetting for them, but they’re generally fine after a few seconds.

Choking Can Be an Emergency

Sometimes, an object can get into the trachea and completely block the airway. If airflow into and out of the lungs is blocked and the brain is deprived of oxygen, choking can become a life-threatening emergency.

A child may be choking and need help right away if he or she:

• is unable to breathe
• is gasping or wheezing
• can’t talk, cry, or make noise
• turns blue
• grabs at his or her throat or waves arms
• appears panicked
• becomes limp or unconscious

In those cases, immediately start abdominal thrusts (also known as the Heimlich maneuver), the standard rescue procedure for choking, if you’ve been trained to do so.

Abdominal Thrusts (The Heimlich Maneuver)

If you have kids, it’s important to get trained in both cardiopulmonary resuscitation (CPR) and the technique of abdominal thrusts (the Heimlich maneuver). Even if you don’t have kids, knowing how to perform these first-aid procedures will let you help if you’re ever in a situation where someone is choking.

The idea of abdominal thrusts is that a sudden burst of air forced upward through the trachea from the diaphragm will dislodge a foreign object and send it flying up into (or even out of) the mouth.

Though the technique is pretty simple, abdominal thrusts must be done with caution, especially on young children. They are safest when done by someone trained to do them. If done the wrong way, the choking person — especially a baby or child — could be hurt. There’s a special version of abdominal thrusts just for infants that is designed to lower the risk of injury to their small bodies.

The technique of abdominal thrusts and CPR are usually taught as part of basic first-aid courses, which are offered by YMCAs, hospitals, and local chapters of the American Heart Association (AHA) and the American Red Cross.

What to Do

Call 911 for any critical choking situation.

Here are several possible situations you might face and tips on how to handle them:

• If a child is choking and coughing but can breathe and talk, this means the airway is not completely blocked. It’s best to do nothing but watch the child carefully and make sure he or she recovers completely. The child will likely be fine after a good coughing spell. Don’t reach into the mouth to grab the object or even pat the child on the back. Either of these steps could push the object farther down the airway and make the situation worse. Stay with the child and remain calm until the episode passes.
• If a child is conscious but can’t breathe, talk, or make noise, or is turning blue, the situation calls for abdominal thrusts. Call 911 or tell someone nearby to call 911 immediately. Begin the thrusts if you’ve been trained to do so. If you haven’t been trained, and no one else is available who has been, wait until help arrives.
• If the child was choking and is now unconscious and no longer breathing, shout for help and call 911, or tell someone nearby to call 911 immediately. Then proceed immediately to CPR, if you’ve been trained in it. If you have not been trained, and no one else is available who has been, wait until help arrives.

When to Call the Doctor or Go to the ER

Take your child for emergency medical care after any major choking episode.

Also seek emergency medical care for a child if:

• there is a lasting cough, drooling, gagging, wheezing, difficulty swallowing, or difficulty breathing
• the child turned blue, became limp, or was unconscious during the episode, even if he or she seemed to recover
• you think the child has swallowed an object, such as a toy or battery

If your child had an episode that seemed like choking but fully recovered after a coughing spell, there is no need to seek immediate medical care but you should call your doctor.

Preventing Choking

All kids are at risk for choking, but those younger than 3 are especially vulnerable. Young children tend to put things in their mouths, have smaller airways that are easily blocked, and don’t have a lot of experience chewing so often swallow things whole.

You can help minimize the risks of choking:

• Avoid foods that pose choking risks (like hot dogs, grapes, raw carrots, nuts, raisins, hard or gummy candy, spoonfuls of peanut butter, chunks of meat or cheese, and popcorn), which are a similar size and shape as a child’s airway.
• At mealtime, be sure to serve a child’s food in small, manageable bites. That means cutting whole grapes into quarters, cutting hot dogs lengthwise and into pieces (and remove the tough skin), and cooking vegetables rather than serving them raw. Teach kids to sit down for all meals and snacks and not to talk or laugh with food in their mouths.
• Toys and household items also can be choking hazards — beware of deflated balloons, coins, beads, small toy parts, and batteries. Get down on the floor often to check for objects that kids who are learning to walk or crawl could put in their mouths and choke on. You’d be surprised by the things that routinely fall off counters or out of pockets and end up under furniture, behind curtains, etc.
• Choose safe, age-appropriate toys. Always follow the manufacturer’s age recommendations — some toys have small parts that can cause choking. To determine if a toy is too small, see if it passes easily through an empty cardboard toilet paper tube. If it does, it’s too small. Any object smaller than the size of a golf ball has the potential to enter the mouth and block the airway.

Take the time now to become prepared. CPR and first-aid courses are a must for parents, other caregivers, and babysitters. To find one in your area, contact your local American Red Cross, YMCA, or American Heart Association chapter, or check with hospitals and health departments in your community.

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.

By about 8 months old, most babies are pros at handling the iron-fortified infant cereals and the pureed foods that have been introduced as part of their diet along with breast milk or formula.

Over the next few months, they start to explore table foods.

Changing Eating Habits

As you expand your baby’s palate, continue to give new foods a trial run (a few days to a week) to look for any allergic reactions. But:

• 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.

You can buy baby foods that offer new tastes and textures (at this age, your baby might enjoy trying foods with coarser textures that require a little more chewing). Or you can fork-mash, cut up, or grind whatever foods the rest of the family eats. To prevent choking, cook it a little longer, until it’s very soft, and cut it into small pieces that your baby can handle safely.

By the time babies are around 9 months old, they usually have the dexterity and coordination to take food between forefinger and thumb so that they can try feeding themselves with their fingers. You may want to provide a safe baby spoon as well, though it might be some time before your baby gets the hang of it.

If you haven’t already, have your baby join the rest of the family at meals. At this age, they enjoy being at the table.

By the first birthday, babies usually are ready to go from formula to cow’s milk. If you’re breastfeeding, you can continue beyond your baby’s first birthday, if desired, or you may decide to stop.

You’ve probably already introduced your baby to a sippy cup, so let him or her keep working on it. (Juice should always be given in a cup, not a bottle.) After 12 months, you can serve whole milk in a cup, which will help with the transition from the bottle.

Feeding Safety

Never leave your baby unattended while eating in case he or she chokes. Don’t serve foods that could present a choking hazard, such as whole grapes, raw vegetables, hard fruits, raisins, white bread, pieces of hard cheese, hot dogs, popcorn, and hard candies.

If you’re unsure about whether a finger food is safe, ask yourself:

• Does it melt in the mouth? Some dry cereals will melt in the mouth, and so will light and flaky crackers.
• Is it cooked enough so that it mashes easily? Well-cooked vegetables and fruits will mash easily. So will canned fruits and vegetables. (Make sure to choose canned foods that don’t have added sugar or salt.)
• Is it naturally soft? Cottage cheese, shredded cheese, and small pieces of tofu are soft.
• Can it be gummed? Pieces of ripe banana and well-cooked pasta can be gummed.

Making Meals Work

Keep your baby’s personality in mind when introducing new foods. If your baby balks at new textures, serve them in small portions and mix them with food you know your child likes.

A child who likes a lot of stimulation may enjoy it when you “play airplane” with the spoon to get the food into his or her mouth. A more sensitive tot, however, may need the focus kept on eating with minimum distractions.

How Much Should My Baby Eat?

Infant formula and breast milk continue to provide important nutrients for growing infants, but babies will start to drink less as they approach the first birthday. They’re getting more nutrients now from the variety of foods they’ve learned to eat and enjoy.

You may be concerned that you’re feeding your child too much or not enough. Pay attention to your child’s cues of hunger and fullness. A child who is full may suck with less enthusiasm, stop, or turn away from the breast or the bottle. With solid foods, your baby may turn away, refuse to open his or her mouth, or spit the food out.

Let your baby finger feed or hold a spoon while you do the actual feeding. This is good preparation for the toddler years when kids take charge of self-feeding. And if you haven’t already, consider setting regular mealtimes.

Until now, feeding your baby has been your job. But as your baby gets older, your little one will want to do this more and more on his or her own.

When babies begin feeding themselves — a new task most really enjoy — they’ll find that they like trying new tastes and textures. No longer are baby purees and mushy cereals the only things on the menu.

By the time they’re 9 months old, most babies have developed the fine motor skills — the small, precise movements — needed to pick up small pieces of food and feed themselves. You may notice that yours can take hold of food (and other small objects) between forefinger and thumb in a pincer grasp. The pincer grasp starts out a little clumsy, but with practice soon evolves into a masterful and efficient skill.

Allow your child to self-feed as much as possible, though you’ll still be helping out by spoon-feeding cereal and other important dietary elements. Encouraging finger feeding helps your child develop independent, healthy eating habits.

Finger feeding — and using utensils a little later — gives babies a measure of control over what they eat and how much. Sometimes they’ll eat the food, sometimes not, and that’s all part of the process of learning self-regulation. Even little kids can tell when they’re hungry or full, so let them learn to recognize and respond to these cues.

What Should a Baby Eat?

Now that they’re joining the rest of the family for meals, older babies are ready — and often willing — to try more table foods.

This means more work for whoever is preparing the meals for the family, but dishes often can be adapted for the baby. For instance, your little one can have some of the zucchini you’re making for dinner as long as you cook that portion just a bit longer — until it’s soft — and cut it into pieces that are small enough for the baby to handle. Pieces of ripe banana, well-cooked pasta, and small pieces of chicken are other good choices.

Before presenting your child with a finger food, try a bite first and ask yourself:

• Does it melt in the mouth? Some dry cereals and crackers that are light and flaky will melt in the mouth.
• Is it cooked enough so that it mushes easily? Well-cooked veggies and fruits will mush easily, as will canned fruit and vegetables (choose ones without added sugar or salt).
• Is it naturally soft? Cottage cheese, shredded cheese, and small pieces of tofu are good examples.
• Can it be gummed? Pieces of ripe banana and well-cooked pasta can be gummed.
• Is it small enough? Food should be cut into small pieces. The sizes will vary depending on the food’s texture. A piece of chicken, for instance, needs to be smaller than a piece of watermelon, which even a pair of baby gums will quickly smash.

If your child doesn’t like a food, don’t let that stop you from offering it at future meals. Kids are naturally slow to accept new tastes and textures. For example, some are more sensitive to texture and may reject coarse foods, such as meat. When introducing meat, it’s helpful to start with well-cooked ground meats or shreds of thinly sliced deli meats, such as turkey.

Present your baby with a variety of foods, even some that he or she didn’t seem to like the week before. Don’t force your baby to eat, but realize that it can take 10 or more tries before a child will accept a new food.

Finger Foods to Avoid

Finger feeding is fun and rewarding for older babies, but it’s important to avoid foods that can cause choking and those with little nutritional value.

Choking Hazards

Parents and caregivers can help prevent choking by supervising the baby during eating. Foods that are choking hazards include:

• pieces of raw vegetables or hard fruits
• whole grapes, berries, cherry or grape tomatoes (instead, peel and slice or cut in quarters)
• raisins and other dried fruit
• peanuts, nuts, and seeds
• peanut butter and other nut or seed butters
• whole hot dogs and kiddie sausages (peel and cut these in very small pieces)
• untoasted bread, especially white bread that sticks together
• chunks of cheese or meat
• candy (hard candy, jelly beans, gummies, chewing gum)
• popcorn, pretzels, corn chips, and other snack foods
• marshmallows

Hold the Sweets

At first bite, your baby probably will love the taste of cookies, cake, and other sweets, but do not introduce them now. Your little one needs to eat nutrient-rich foods instead of consuming empty calories found in desserts and high-fat snacks, such as potato chips.

It’s tempting to want to see the baby’s reactions to some of these foods, but now is not the time. Grandparents and others may want to rush your baby into trying triple-chocolate cake or some other family favorite. Politely and firmly explain that the baby isn’t ready for those foods. If grandma persists and says you had your first bite when you were an infant, blame this tough stance on your child’s doctor — the doctor won’t mind.

Keeping kids’ teeth healthy means more than just daily brushing. During a routine well-child exam, you may be surprised to find the doctor examining your child’s teeth and asking you about your water supply. That’s because fluoride, a substance found naturally in water, plays an important role in healthy tooth development and cavity prevention.

About Fluoride

Fluoride, which exists naturally in water sources, is derived from fluorine, a common element in the Earth’s crust. It is well known that fluoride helps prevent and even reverse the early stages of tooth decay.

Tooth decay happens when plaque — that sticky film of bacteria that builds up on teeth — breaks down sugars in food. The bacteria produce damaging acids that dissolve the hard enamel surfaces of teeth.

If the damage is not stopped or treated, the bacteria can penetrate through the enamel and cause tooth decay (also called cavities or caries). Cavities weaken teeth and can lead to pain, tooth loss, or even widespread infection in the most severe cases.

Fluoride combats tooth decay in two ways:

1. It is incorporated into the structure of developing teeth when it is ingested.
2. It protects teeth when it comes in contact with the surface of the teeth.

Fluoride prevents the acid produced by the bacteria in plaque from dissolving, or demineralizing, tooth enamel, the hard and shiny substance that protects the teeth. Fluoride also allows teeth damaged by acid to repair, or remineralize, themselves. Fluoride cannot repair cavities, but it can reverse low levels of tooth decay and thus prevent new cavities from forming.

Despite the good news about dental health, tooth decay remains one of the most common diseases of childhood. According to the Centers for Disease Control and Prevention (CDC):

• more than 25% of 2- to 5-year-olds have one or more cavities
• half of kids 12 to 15 years old have one or more cavities
• tooth decay affects two thirds of 16- to 19-year-olds

Fluoride and the Water Supply

For more than 60 years, water fluoridation has proved to be a safe and cost-effective way to reduce dental caries. Today, water fluoridation is estimated to reduce tooth decay by 20%-40%.

As of 2012, CDC statistics show that more than 60% of the U.S. population receives fluoridated water through the taps in their homes. Some communities have naturally occurring fluoride in their water; others add it at water-processing plants.

Your doctor or dentist may know whether local water supplies contain optimal levels of fluoride, which is 0.7 milligrams per liter of water (previously it was a range of 0.7 to 1.2 milligrams). If your water comes from a public system, you also can call your local water authority or public health department, or check online at the Environmental Protection Agency’s (EPA) database of local water safety reports.

If you use well water or water from a private source, fluoride levels should be checked by a laboratory or public health department.

Some parents buy bottled water for their kids to drink instead of tap water. Most bottled waters lack fluoride, but fluoridated bottled water is now available. If fluoride is added, the manufacturer is required to list the amount. If fluoride concentration is greater than 0.6 ppm (parts per million), you might see the health claim “Drinking fluoridated water may reduce the risk of tooth decay” on the label.

The Controversy Over Fluoride

Opponents of water fluoridation have questioned its safety and effectiveness; however, there has been little evidence to support these concerns.

Scientific research continues to show the benefits of fluoride when it comes to prevention of tooth decay and its safety. Dramatic reductions in tooth decay in the past 30 years is attributed to fluoridation of the water supply, and parents and health professionals should continue to ensure that kids receive enough fluoride to prevent cavities.

The American Dental Association (ADA), the United States Public Health Service (USPHS), the American Academy of Pediatric (AAP), and the World Health Organization (WHO), among many other national and international organizations, endorse community water fluoridation. In fact, the CDC recognized fluoridation of water as one of the 10 greatest public health achievements of the 20th century.

Kids’ Fluoride Needs

So how much fluoride do kids need? In general, kids under the age of 6 months do not need fluoride supplements. Your child’s 6-month checkup offers a great chance to discuss fluoride supplementation with your doctor.

If you live in a nonfluoridated area, your doctor or dentist may prescribe fluoride drops, tablets, or vitamins after your baby is 6 months old. The dosage depends on how much fluoride naturally occurs in the water and your child’s age. Only kids living in nonfluoridated areas or those who drink only nonfluoridated bottled water should receive supplements.

Here are some other tips:

• Use a fluoride-containing toothpaste that carries the ADA’s seal of acceptance.
• Brush babies’ teeth as they come in with an infant toothbrush. Use water and a tiny bit of fluoride toothpaste (about the size of a grain of rice). If you are using baby toothpaste without the fluoride, keep it to the same amount because you still want to minimize any toothpaste that is swallowed.
• Kids ages 3 and up should use only a pea-sized amount of fluoride toothpaste.
• Kids younger than 6 may swallow too much toothpaste while brushing. Supervise them when brushing and teach them to spit, not swallow, the toothpaste.
• Kids under age 6 should never use fluoride-containing mouth rinses. But older kids at high risk for tooth decay may benefit from them. Your dentist can talk with you about risk factors such as a family history of dental disease, recent periodontal surgery or disease, or a physical impediment to brushing regularly and thoroughly.

Your family dentist or pediatric dentist (one who specializes in the care of children’s teeth) is a great resource for information about dental care and fluoride needs. A dentist can help you understand more about how fluoride affects the teeth, and may even recommend applying a topical fluoride varnish during routine dental visits.

Overexposure to Fluoride

If some fluoride is good, why isn’t more fluoride better? As with most medications, including vitamins and mineral supplements, too much can be harmful. Most kids get the right amount of fluoride through a combination of fluoridated toothpaste and fluoridated water or supplements.

Too much fluoride before 8 years of age, a time when teeth are developing, can cause enamel fluorosis, a discoloration or mottling of the permanent teeth. For most, the changes are subtle. In one study, 94% of identified fluorosis cases were very mild to mild. Most cases are due to accidental swallowing of fluoride-containing dental products, including toothpaste and mouth rinses. Sometimes kids take daily fluoride supplements but may be getting adequate fluoride from other sources, which also puts them at risk.

Recently, the National Research Council found that some naturally occurring fluoride levels exceeded the optimal levels used in community fluoridation programs, putting kids under 8 years old at risk for severe enamel fluorosis. The CDC recommends that in communities where natural fluoride levels are high, parents should give kids water from other sources.

The ADA also recognizes that infants need less fluoride than older kids and adults. Some infants may be getting too much fluoride in the water used to reconstitute infant formula. If you’re concerned that your infant may be getting too much fluoride, talk with your doctor or dentist, who may recommend ready-to-feed formula or formula reconstituted with fluoride-free or low-fluoride water.

Very rarely, fluoride poisoning can happen if large amounts of fluoride are ingested during a short period of time. Kids under age 6 account for more than 80% of reports of suspected overingestion. Although this is generally not serious, fluoride poisoning sends several hundred children to emergency rooms each year.

Symptoms of fluoride poisoning may include nausea, diarrhea, vomiting, abdominal pain, increased salivation, or increased thirst. Symptoms begin 30 minutes after ingestion and can last up to 24 hours. If you suspect your child may have eaten a substantial amount of a fluoridated product or supplement, call the poison control center (1-800-222-1222) or 911.

Be sure to keep toothpaste, supplements, mouth rinses, and other fluoride-containing products out of kids’ reach or in a locked cabinet. Also, supervise young kids when they brush their teeth to prevent swallowing of toothpaste or other fluoridated products.

If you have any questions about your water’s fluoride content, the fluoridated products your child uses, or whether your child is receiving too much or too little fluoride, talk to your doctor or dentist.

Many toddlers become attached to their bottles. Besides providing nourishment, bottles also mean comfort and security.

It’s important for parents to start weaning babies from bottles around the end of the first year and start getting them comfortable drinking from cups. The longer parents wait to start the transition, the more attached kids become to their bottles and the more difficult it can be to break the bottle habit. Longer bottle use may lead to cavities or cause your child to drink more milk than he or she needs.

Switching from bottle to cup can be challenging, but these tips can make the change easier for parents and kids.

Timing the Transition

Most doctors recommend introducing a cup around the time a baby is 6 months old. In the beginning, much of what you serve in a cup will end up on the floor or on your baby. But by 12 months of age, most babies have the coordination and hand skills needed to hold a cup and drink from it.

Age 1 is also when doctors recommend switching from formula to cow’s milk. It can be a natural transition to offer milk in a cup rather than a bottle.

If you’re still breastfeeding, you can continue feeding your baby breast milk, but you may want to do so by offering it in a cup.

Tips to Try

Instead of cutting out bottles all at once, try eliminating them gradually from the feeding schedule, starting at mealtimes.

For example, if your baby usually drinks three bottles each day, start by eliminating the morning bottle. Instead of giving a bottle right away, bring your baby to the table and after the feeding has started, offer milk from a cup. You might need to offer some encouragement and explanation, saying something like “you’re a big boy now and can use a cup like mommy.”

As you try to eliminate the morning bottle, keep offering the afternoon and evening bottles for about a week. That way, if your child asks for the bottle you can provide assurance that one is coming later.

The next week, eliminate another bottle feeding and provide milk in a cup instead. Try to do this when your baby is sitting at the table in a high chair.

Generally, the last bottle to stop should be the nighttime bottle. That bottle tends to be a part of the bedtime routine and is the one that most provides comfort to babies. Instead of the bottle, try offering a cup of milk with your child’s dinner and continue with the rest of your nighttime tasks, like a bath, bedtime story, or teeth brushing.

More Strategies

Here are some other tips to keep in mind:

• Spill-proof cups that have spouts designed just for babies (often referred to as “sippy cups”) can help ease the transition from the bottle. Dentists recommend sippy cups with a hard spout or a straw, rather than ones with soft spouts.
• When your child does use the cup, offer plenty of praise and positive reinforcement. If grandma is around, for example, you might say, “See, Emma is such a big girl she drinks milk in a cup!”
• If you keep getting asked for a bottle, find out what your child really needs or wants and offer that instead. If your child is thirsty or hungry, provide nourishment in a cup or on a plate. If it’s comfort, offer hugs, and if your child is bored, sit down and play!
• As you’re weaning your baby from the bottle, try diluting the milk in the bottle with water. For the first few days, fill half of it with water and half of it with milk. Then gradually add more water until the entire bottle is water. By that time, it’s likely that your child will lose interest and be asking for the yummy milk that comes in a cup!
• Get rid of the bottles or put them out of sight.

If you continue to have problems or concerns about stopping the bottle, talk with your doctor.

Weaning is when a baby transitions from breast milk to other sources of nourishment. When to wean is a personal decision. A mom might be influenced by a return to work, her health or the baby’s, or simply a feeling that the time is right.

Weaning a baby is a gradual process that calls for patience and understanding from both you and your child.

When Is the Right Time?

The American Academy of Pediatrics (AAP) recommends feeding babies only breast milk for the first 6 months of life. After that, the AAP recommends that a combination of solid foods and breast milk be given until a baby is at least 1 year old. At a year, babies may begin drinking whole cow’s milk.

Most experts agree that breastfeeding should continue for as long as mutually desired by mother and baby. Many women choose to wean after their baby’s first birthday. At this age, babies are starting to walk, talk, and eat more solid foods so they may just naturally lose interest in nursing.

Other moms choose to breastfeed longer than a year (this is called extended breastfeeding). Extended breastfeeding is a healthy and reasonable option for mothers and children who aren’t ready to wean. In fact, the World Health Organization (WHO) recommends that moms breastfeed for the first 2 years of a child’s life.

Weaning does not have to be an all-or-nothing proposition. Some women choose to wean during the day and breastfeed at night, depending on their work situation and their schedules.

Whenever you decide to wean, your child may have another time in mind. Some children wean themselves earlier than the mother intended and others are resistant to weaning when the mother is ready. Those who are weaned later in life tend to be more resistant. For example, a 2-year-old toddler may be more attached and less flexible about giving up breastfeeding than a 12-month-old baby. At times like these, it’s important to take it slow and be sensitive to each other’s needs.

Signs Your Baby May Be Weaning

Some kids are content to nurse indefinitely. But others will give moms clues that they’re ready to begin the process of weaning, such as:

• seeming disinterested or fussy when nursing
• nursing in shorter sessions than before
• being easily distracted while nursing
• “playing” at the breast, like constantly pulling on and off or biting (babies who bite during nursing should immediately be taken off the breast and told, calmly but firmly, “No biting. Biting hurts.”)
• nursing for comfort (sucking at the breast but not drawing out the milk)

Approaches to Weaning

To allow both mom and baby to adjust physically and emotionally to the change, weaning should be a gradual process.

One approach is to drop one feeding session a week until the child is taking all of the feeds from a bottle or cup. If you are planning to continue to give your child pumped breast milk, you will need to pump in order to keep up your milk supply. If you are weaning your child off breast milk, slowly dropping feeds can help avoid engorgement.

You might begin by stopping the midday feeding because it’s usually the smallest and most inconvenient — especially for working moms. Many mothers let go of the bedtime feeding last because it’s still a special part of bonding.

Another approach is to leave the decision of when to wean completely up to a child. Once they’re eating three meals of solid food a day (plus snacks in between), kids often breastfeed less and less. In this situation, you may find that your milk will dry up from lack of demand, and pumping may be necessary if you want to keep the milk flowing. If your child is breastfeeding less, make sure he or she is getting enough iron-fortified formula or milk. Check with the doctor about how much your child get.

If your baby weans before 1 year of age, or you find that you’re not making enough milk, you will need to give your baby formula. Check with the doctor to see what formula is right for your child.

Easing the Transition

Weaning is easier if a child has also taken milk from another source. So try giving an occasional bottle of breast milk to your little one once breastfeeding is well-established. Even if you plan to continue breastfeeding, this can ease weaning later. It also lets other family members feed the baby and makes it possible to leave your child with a caregiver.

It’s important to remember that infants over 6 months should have solid foods as well as breast milk. After 1 year, breast milk alone does not provide all the nutrients a growing child needs; solid foods must become a regular part of the diet.

As you start to wean, remember that your child needs time to adjust to drinking from cups. So be patient as your little one begins exploring the world of food. Here’s some more ways to make this change easier:

• Engage your child in a fun play activity or an outing during times when you would usually nurse.
• Avoid sitting in your usual nursing spots or wearing your usual nursing clothes.
• Delay weaning if your child is trying to adapt to some other change. Trying to wean when your little one is just beginning childcare or during teething might not be a good idea.
• If your baby is younger than 1 year, try to introduce a bottle or cup when you would typically be nursing. For an older child, try a healthy snack, offering a cup, or maybe even just a cuddle.
• Try changing your daily routine so that you’re otherwise engaged during breastfeeding times.
• Enlist your partner’s help to provide a distraction at a typical nursing time.
• If your child begins to pick up a comforting habit (such as thumbsucking) or becomes attached to a security blanket, don’t discourage it. Your child might be trying to adjust to the emotional changes of weaning.

How You Might Feel

Many moms make the decision to wean with mixed emotions. On the one hand, weaning brings with it more freedom and flexibility, as well as the proud realization that her child is reaching a major milestone. On the other hand, nursing is an intimate activity that fosters a strong bond between mother and child — and some women find it difficult to let that go.

As you go through this process, expect a wide range of emotions and understand that your child may have them, too. But also remember that there will be countless other ways to nurture your child in the days ahead.

At what age can babies switch from breast milk or formula to cow’s milk?
– Tamika

Infants younger than 1 year old need the nutrients in breast milk or formula. Breastfed babies over 1 year may continue to nurse, if desired, but at that point you can begin offering your little one whole milk. Why not low-fat or skim milk? Because most babies need the fat in whole milk to support normal growth and brain development during the busy early toddler period.

You can transition your baby from breast milk or formula to whole milk by beginning to replace bottles of formula with bottles — or sippy cups — of milk. By age 1, your baby should be eating a variety of other foods as well as drinking about 2-3 cups (480-720 milliliters) of milk per day.

If your baby was put on a soy or hypoallergenic formula for a milk allergy, talk to the doctor before introducing milk.

My 5-month-old seems to be interested in trying new foods. I’d like to offer him juice, but I’m not sure if he’s ready and, if he is, what type of juice drinks to give him. Any suggestions?
– Michelle

It’s best to wait until after a baby is 6 months old before offering juice. But even then, pediatricians don’t recommend giving babies juice often, since it adds extra calories without the balanced nutrition found in formula and breast milk. Drinking too much juice also may contribute to excess weight and tooth decay, or cause diarrhea in infants and toddlers.

Instead of juice, serve puréed whole fruits and vegetables. They contain important nutrients not found in juice. If your baby seems thirsty, offer a small amount water between feedings.

If you give your baby juice, follow these tips:

• Serve only 100% fruit juice, not juice drinks or powdered drink mixes (which are sweetened).
• Limit the juice to no more than 2–4 fl. oz. (60–120 ml.) per day.
• Offer juice in a cup, not in a bottle. Serve juice only at meal times.