If I were to add up all the minutes I spend talking with patients' parents about different topics, there's no doubt which one would win: feeding. Every relative and her neighbor has advice, much of it contradictory (start with vegetables versus start with fruits, babies need teeth for table food versus no, they don't). And everyone seems certain she's right. Plus, the news is so full of nutritional directives that it can be dizzying. We feel judged as parents based on the eating habits of our children, and we want so much for them to eat well and grow well; it's hard not to feel overwhelmed trying to figure out how best to feed them.
Thirteen years of parenting and doctoring have taught me a lot about feeding kids --enough to help parents relax and even enjoy the process. Here, answers to some of the questions I'm asked most:
Claire McCarthy, M.D., a pediatrician at the Martha Eliot Health Center, in Boston, is on the faculty of Harvard Medical School. She is the author of Learning How the Heart Beats: The Making of a Pediatrician (Penguin).
When to start solids
Q. When should I start my baby on solids?
A. The most common mistake is to start too early. Which I can understand --getting out the spoon and watching your child do the baby-bird thing with her mouth can be lots of fun. My husband and I looked forward to it with each of our children (now 13, 11, 6, and 3). Many moms and dads are told by friends and family that their baby will sleep better when she's on solids too, and, of course, what new parent isn't dying for more shut-eye?
But babies aren't ready for solids until 4 to 6 months. They aren't ready developmentally and could choke on the simplest of foods. And their intestines can't handle anything more complicated than breast milk or formula. Introducing solids too early may also be linked to later food allergies and eczema.
Your baby's ready for her first taste of solid food when she can hold her head up easily and sit well with support --by that I mean she shouldn't slump down into a ball if you put her in an infant seat. She should also have some clue as to what to do with a spoon and its contents. If she doesn't seem much interested, sticks out her tongue a lot while you feed her, doesn't swallow the food, or gets fussy, she may need a little more time. Don't mix the food in the bottle; wait until she's ready to take it from a spoon.
If there's a strong family history of food allergies --at least one parent has or had them, and perhaps a sibling as well --it's best to wait until 6 months and to talk to your doctor about which foods to avoid.
When you do begin, keep it simple; that's the other common mistake people make. Once, I saw a mother giving her 4-month-old part of a hamburger! While going that fast is rare, it's easy to get excited and move beyond what's good for your baby. Rice cereal mixed with breast milk or formula is a good place to begin because you can easily adjust the consistency to what your baby can handle. After that, go ahead and introduce single-ingredient foods (you can make your own --just don't add salt, sugar, or spices, and be sure to strain out any lumps). Allow a few days between each new food while you watch for such reactions as rashes, diarrhea, vomiting, and fussiness.
Why is my toddler so picky?
Q. My 2-year-old could eat Cheerios for all three meals --in fact, he sometimes does-and he refuses to eat vegetables. What should I do?
A. My second child, Zachary, was exactly the same way starting around age 2. It caught me off guard, since his older sister, Michaela, loved vegetables and was open to new foods. I thought I had this whole teaching-kids-to-eat-well thing down, and was feeling proud of myself, until Zack came along and reminded me to be more humble.
Food jags and flat-out refusing certain foods are quite common in older toddlers and preschoolers. Fighting them head-on is likely to lead to frustration --for you and your child --and some incredibly unpleasant mealtimes. Creativity and patience are better tactics.
Creativity can mean playfulness --broccoli forests, sandwiches cut with cookie cutters, or making silly faces with food on the plate. It can also mean being a little sneaky, doing things such as pureeing vegetables and putting them into sauces or soup. Kids like dipping, so setting out some ranch dressing or other dips may help the vegetable cause. Involving your children in cooking --they can help pick recipes, stir, and get ingredients for you --may make them more interested in eating as well.
If nothing works, just keep offering vegetables and other foods. One day your child may surprise you (Zack did in elementary school, when he suddenly started to eat salad). In the meantime, speak with your pediatrician about giving your son a chewable multivitamin with iron.
Is it okay to give my baby "grownup" foods?"
Q. My 7-month-old wants to eat what we're eating at dinnertime. Is it okay to give her some?
A It depends --on her eating, development, and what you're having for supper. Most babies become ready for table foods between 6 and 9 months. If she's been eating baby foods well and hasn't had any reactions, it's okay to begin broadening her horizons. If she's shown any signs of a food allergy (such as rashes and vomiting), consult your doctor before making forays into table foods.
Start with things that are soft and easy for her to gum, such as mashed potatoes (or other cooked veggies --mashing them with the back of a fork usually works well), finely shredded chicken, and rice. (By the way, babies don't actually need teeth to eat these --they can do remarkably well without them.) If she gags or chokes, wait a month before trying again. Once she can manage the table foods you give her, she may be ready to try feeding herself. She should be able to sit well enough to graduate from an infant seat to a high chair and have at least a beginning ability to pick up small things with her fingers.
Foods should be cut into bite-size pieces and be as mushy as possible. Try overcooked pasta, Cheerios, pieces of baked or boiled potato, bits of banana, and well-cooked beans. Avoid the following, which are high on the most-choked-upon list: sliced cooked carrots (they can block little windpipes if cut horizontally --dice them small instead), raw carrots, nuts, popcorn, hot dogs, grapes, raisins, and round candies.
Be wary of teething biscuits; chunks that are big enough for a child to choke on can break off when mixed with saliva. The same goes for bagels and big pretzels. I once had to do a Heimlich maneuver in the grocery store when Michaela choked on a piece of a big pretzel she was sucking on. It's no fun learning lessons that way!
Are vitamins necessary?
Q. Should I give my preschooler vitamins?
A. Probably not, maybe yes. The vast majority of kids older than a year who eat at least a little bit of most foods, including meat, don't really need vitamins. (Younger children should take vitamins or iron only if prescribed by their doctor.) However, kids aren't always so obliging, and some diets may need to be supplemented.
As I said earlier, if you've got a picky eater who's living off Cheerios, plain pasta, and not much else, a multivitamin with iron may be a good idea. Children on a vegetarian diet may have trouble getting enough iron, B vitamins, and zinc, so they, too, are likely candidates for a multi with iron.
If you give your child vitamins, read the package carefully, as kids' formulations are generally geared for a certain age (usually not under 2) and the dose varies by brand-your child's dose might be half a tablet of one brand and a full one of another. Liquid preparations are available for kids under 2.Look for a multivitamin with calcium, since many kids these days don't get enough of that in their diet. It's always a good idea to read labels because the amount of different vitamins and minerals can vary significantly from one brand to another.
Infants and toddlers who nurse a lot (so that the bulk of the milk they get is breast milk) and older children who drink less than 16 ounces of milk each day should take vitamin D. Some children may also need fluoride (after 6 months of age), depending on your water supply. Check with your pediatrician for recommendations based on your child's diet.
A cautionary note on vitamins: Some of them taste as good as candy. Always keep them out of reach --taking too many can be dangerous.
Should I try to "fatten" my child up?
Q. My mother says that my 18-month-old daughter is too thin. Should I try to get her to eat more?
A. I hear this one a lot. Many grandmothers like chubby grandbabies; there's something about those rolls of fat that spells health to them. Unfortunately, rolls of fat aren't healthy and can lead to trouble down the road.
Of course, if you also think that your child looks too thin, or if she's been having any symptoms of illness (like fever, loss of appetite, vomiting, diarrhea, and stomachache), take her to the doctor to be weighed and measured. But if she's healthy, her appetite is good, her clothes are getting steadily too small, and she's got plenty of energy, you simply may need to tune out your mother (easier said than done, I realize).
As a pediatrician, I see the unnerving trend of childhood obesity played out in my office day after day, and I've learned that healthy eating habits need to start very early. Breastfeeding can help. Experts think breastfed babies regulate their food intake to their hunger better than bottle-fed babies; there's no "Come on, baby, finish your bottle" phenomenon. Keep the same thing in mind for toddlers and older kids. If they don't want to clean their plate, fine. Let your child listen to her body. It can make a big difference in the prevention of overeating later on.
As the one who introduces food to your child, you have a never-again opportunity to put your own "spin" on healthy foods. If you present fruits and vegetables as treats, your child will grow up thinking they are. If you don't have soda or potato chips in the house, your child won't get a taste for them. If you introduce skim milk early (but not before age 2 --growing brains need the fat until then), your child will think that skim is how milk should taste. My husband and I did that, and whenever Michaela was offered whole milk, she'd ask to have it watered down!
Remember, too, that no matter what we say, it's what we do that our kids really watch. If you have a healthy diet, chances are much better that your child will too.
Feeding himself --minus the mess?
Q. My 15-month-old won't let me feed him --but when he feeds himself most of it ends up all over the place. What can I do?
A. There's only one solution: Get a dropcloth! An old shower curtain or vinyl tablecloth, or even a large towel, will do the trick. (Dogs work well too.) What your son is doing is developmentally appropriate; he should be congratulated for his initiative.
This stage is messy (I have a stash of photos I plan to whip out at four wedding-rehearsal dinners), but it's fun. My kids were hilarious as they dove into their food --sometimes literally --and it was great to see the pride on their faces when they actually managed to spear that pesky bit of pasta with a fork or get that spoon to their mouth while it still had corn in it. Keep your child in a high chair rather than at the table --finger painting with tomato sauce is better done there, since you can hose it down later. There's something about bowls and plates, too, that invites throwing them to the floor. Putting food right on the tray may be best until the Gravity Game becomes less interesting. Don't give your child a lot at once. And don't worry about him eating enough. He'll let you know if he's still hungry.
There will indeed come a day when you aren't down on the floor wondering if anything at all got into your child's mouth.