Solid Introduction Basics
A few basic concepts to remember:
1.
Two things have to occur for your doctor (Dr.Z) to approve moving forward with solids: number one, the neck is nice and sturdy and not slouched forward or backward. This usually occurs around 4-5 months of age. Very seldom 3-4 months of age. And second, the infant is drinking enormous amounts of milk and is not satisfied. At this point, grandma steps in and usually suggests putting cereal in the bottle. This may sound like a good idea and at times we do recommend this if the infant is too young to introduce the spoon (premature infants) or they have reflux, but we do it with some reserve. Remember chewing becomes important to strengthen the muscles that later on help us speak and communicate. Children that are kept on bottle feeding too long tend to be delayed in speech, more so if it's a boy.
2.
After 4 months of age, milk loses most of the nutritional properties an infant needs to continue the rate of growth that he/she is faced with.
3.
It behooves the parent to move forward with solids as swiftly and efficiently as possible. The goal is to give better nutrition and wean from the bottle. By 6 months, the infant is feeding 3 servings of solids and 3 servings of milk. By 9 months, 5 servings of solids and 2 servings of milk.
By 12 months, 5 servings of solids and 1 serving of milk. The 3 servings are: BF, lunch and dinner.
The 5 servings are: BF, snack, lunch, snack and dinner.
4.
By a year of age the infant should be on table food with the exclusion of nuts and peanuts. This type of food should be offered after 2 years of age, one at a time. The infant should be on whole milk. You may try eggs separating the yellow from the white. The yolk should be offered on four different occasions. If no problems, offer the whole egg, or if you're not sure, give the egg white alone. If there have been no allergic manifestations, the infant may have an egg a day. Seafood like shrimp, lobster, oysters, crabs and shellfish in general should be offered after 3 years of age.
5.
Allergic symptoms may present as a simple rash or may be more complex and present as: runny nose, congestion, sneezing fits, generalized rash, lip swelling, face swelling or generalized swelling. As you can see, there may be a garden variety of allergic symptoms. If you are in tune to them, you can avoid having an allergic child. Once you develop an allergy as an infant, it is very hard to outgrow it. It's possible but very difficult. These are the children or individuals that end up at the allergist's office for shots or medication.
EZ Pediatrics - Mario D. Zambrano, MD, FAAP | 10794 Pines Boulevard, Suite 102 | Pembroke Pines, FL 33026
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6.
When we introduce the solids, we slowly and progressively substitute bottle feedings with solid feedings. Again, we never put foods in the bottle except for certain circumstances which I will make clear in each individual case, at each visit.
7.
It will take 4-5 different offerings of a specific food before we can assume there will be no problem. Therefore, when we introduce cereals we do each individual cereal one at a time. The same with vegetables, meats, fruits and finally juices.
8.
Stage I foods we offer until the infant is at lest 6 months of age. Stage 2 foods, from 6-9 months of age, stage 3 foods, from 9 months on. Stage one' s are single foods, stage two's are a little thicker and combination of two foods that have probably already been offered. Stage three foods are larger portions and thicker than stage I & 2's.
9.
If you think there has been an allergic manifestation, stop the food in question and wait till the symptoms subside. You may want to wait to offer that food a little longer. Move on to the next scheduled food and then retry the food in question at a later time. If the symptoms recur, you know that there is an allergy to that food. In this case you communicate this to me or the physician in charge and they or I will tell you what to do.
10.
Always move forward with the solids, don't look back. Once you've done the cereals, continue the cereals for breakfast. Stick with cereals for breakfast for now. As the infant gets older and you have tried most of the foods out there, you can start being creative and mixing foods together.
11.
If the infant makes unhappy faces or spits out a food while feeding, please don't assume the infant dislikes that food. He/she needs to get acquainted with different tastes and textures. Keep trying that particular food, maybe not on the same attempt but don't give up with just 2-3 attempts. It may take more like 8-10 attempts before you make a determination that a particular food is not for your child. Eating habits and preferences are created; we are not born with a particular preference for a particular food. You can argue that sweet foods are preferred but this is a general statement.
12.
These are basic points that you should have in mind before you introduce solids to your infant.
There will be times when you will feel compelled to give table food. Remember, maybe nothing will happen, but if it does, you will be dealing with a food allergy for a long time.
EZ Pediatrics - Mario D. Zambrano, MD, FAAP | 10794 Pines Boulevard, Suite 102 | Pembroke Pines, FL 33026
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Solid Introduction per Se
You start off with the cereals for breakfast and you want to do the light cereals to the darker ones first.
For example, you take rice cereal and before you give the infant the first bottle of the day, you make porridge. The first day or occasion, you give one flat tablespoon of rice cereal and you mix it with the same amount infant’s breast milk or formula. After giving him this portion, you top him/her off with the rest of the bottle of BM or formula. The second day or occasion, you do two flat tablespoons mixed with the same amount of BM or formula. Do the same on day/occasion three and four. If the infant has no problems, do the same steps with oatmeal and barley. If you can't find barley alone, you may use the mixed cereal but this you can do if you've already tried rice and oatmeal alone and you are sure there has not been a reaction.
Remember to always move forward and don't go back to the bottle for breakfast. Infants and children need routines. If you deviate, it will become difficult for them and you to move forward. After the cereal introduction, continue the cereal for BF. If the infant drinks 6 or 7 oz of milk after giving him his portion of cereal, increase the amount of cereal to 5 or even 6 tablespoons of cereal. Again, the goal is to depend more on the solids versus the BM or formula.
Now we are going to work with the vegetables. You will need to get two jars of stage I veggies: that means 2 jars of squash, 2 jars of potatoes, 2 jars of carrots and sweet potatoes, 2 jars of green beans, peas and spinach and so on. The first 2 days you are going to give a y" of the jar. The jar has 2 oz so what you will be offering is approximately a tablespoon. On day 3, give 2 tablespoons which is and once and that will finish the first jar. On the 4th day you give the whole jar. If you are sure there has been no reaction to that food, do the same with each single veggie until you are done with them all. Once you've finished with all the veggies, you can give a veggie for lunch topped off with BM or formula and a veggie for dinner topped off with BM or formula. Again, if the infant drinks 6-7 oz of milk after the serving of solids, increase the serving to 1-112 or 2 jars. Our goal is to depend on the solids and not the milk.
By now you are giving 3 servings of solids including the cereal for BF, the veggie for lunch and dinner.
Usually by this stage the milk intake decreases from 32-34 oz per day to 24-26 oz per day. Now you are going to work on the meats. You will find stage 1 meat that is single. You will also find stage 2 meats but you would want to wait to see how the infant does with the meat alone. Buy 2 jars of chicken, 2 jars of turkey, 2 jars of ham and 2 jars of veal or beef. You're going to give the meat jar first for lunch before the veggie. Just as you did for the cereals and veggies, do y" jar on day 1 & 2, Yz jars on day 3, and full jar on day 4. Do the same for each new meat. Once you've tried all the meats and you are sure there will not be a problem, you may offer a meat for lunch with the veggie and a meat for dinner plus the veggie. By now you can probably move to the stage two veggies and meats.
EZ Pediatrics - Mario D. Zambrano, MD, FAAP | 10794 Pines Boulevard, Suite 102 | Pembroke Pines, FL 33026
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Remember to offer the solid before any liquid is offered. Now you are ready for the fruits. I would prefer that you leave the sweets for last because we all naturally like sweet things. The fruits are going to be for snacks for now. You are now ready to add the midmorning meal and the midafternoon meal. You're going to start with the midmorning. Again, buy 2 jars of each fruit and you will be starting the light fruits to the darker ones last. Buy 2 jars of apple sauce, 2 jars of pear sauce, 2 jars of bananas, 2 jars of peaches, 2 jars of mangos, 2 jars of plums & prunes, 2 jars of guava etc. Once again if there was no problem, you may offer a fruit as a midafternoon snack.
By now, you have your infant eating 3 main meals and 2 snacks. The milk intake will drop to 18-20 oz per day. You may now start the juices and as you did with the other foods; you introduce light juices to darker juices. You can use the juice as a snack or as a compliment to a meal substituting for the milk.
By a year of age the infant is eating his 3 meals and 2 snacks. Hopefully he/she is off the bottle and pacifier and takes one sippy cup of milk and 3-4 oz of juice per day. You may now introduce water if the child seems thirsty or after they've had their portion of milk or Juice.
These instructions are in a perfect world. We do not live in a perfect world. There will be contingencies and setbacks. The important thing is that you have a guideline that helps guide you through a topic that is highly controversial and parents will get different opinions even from different physicians. My goal is that you understand the rationale for having a system of solid introduction.
Godspeed!
EZ Pediatrics - Mario D. Zambrano, MD, FAAP | 10794 Pines Boulevard, Suite 102 | Pembroke Pines, FL 33026
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