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Dr. Greene

Feeding Guide for Baby’s First Year

One of the most common types of questions I receive as a pediatrician and on my site, DrGreene.com, is whether a baby is eating too much or too little. Comments by friends, relatives, or strangers can heighten our concern: “He barely eats a thing. You need to feed him more.” “What a chubby baby!” “He looks so skinny. Are you feeding him enough?”

This preoccupation led to “scientific” guidelines of how many teaspoons of what type of food to offer, and how often. We now understand, though, that babies’ needs differ, and that the same baby may have different needs depending on what is happening on a particular day. Rigid guidelines can be counterproductive.

Children need ever-changing amounts of food, influenced by their activity level and developmental phase, the air temperature and relative humidity, and perhaps by a virus they might have.

Thankfully, babies are born with a sophisticated internal mechanism for determining just how much they need to thrive. Healthy babies given the right selection of healthy foods will tend to eat just the right amount (as long as we don’t short circuit this with empty calories in what they eat or drink).

Our role as parents is to offer healthy foods and to learn to recognize their signals and not to short-circuit our babies’ own sense of how much they need. Still, it is nice to have a basic understanding of their nutritional needs, so here are some very general guidelines for baby’s first year.

The First Feeding:
I recommend breastfeeding if possible within the first hour after birth. Hold off on bathing and post-natal testing or shots until your baby’s natural instincts for feeding take hold. Rather than rushing baby to the nipple, watch for signs like lip-smacking or salivation and then lay him on your stomach to allow him to find his way to food. Have patience! He’ll get there! And, babies who rely on instinct and reflex and work to get there on their own are more likely to take the whole areola into the mouth, nursing more effectively and hurting the nipple less.
 
The First Few Days:
For the first few days, it’s normal for babies to lose weight. Whenever possible, I urge breastfeeding at least until the baby has regained their birth weight - even for women who have decided to bottle-feed later.
 
Whatever your method of feeding, the first 8 days appear to be a critical window as babies are setting their internal sense of how much is “normal” for them to eat. Too much, or too little can lead to lifelong impacts. Thankfully, breastfeeding typically leads to the right amount and pacing during that first week. You are designed to provide just what your baby needs! With formula-fed babies, you’ll need to be more attentive to not over- or underfeed.
 
How can you tell if a baby is getting the right amount? Your baby will let you know! The first cue is satisfaction after eating. And, she should make a wet diaper at least once on the first day, twice on the second day, and three times every day after. The first baby poops are the sticky meconium, but by the end of the first week, they may average 8-10 soft stools a day.
 
The first months (about 2 weeks to 4 months):
During these first months, schedules can vary widely.
 
  • Bottle-Fed Scheduling - Most bottle-fed babies start out taking 2-3 ounces every 3-4 hours. Over the first 4 weeks or so, they usually increase to about 4 ounces every 4 hours. By 2 months, the feedings stretch out to every 5 hours or so. And, by 6 months, usually they are up to 6-8 ounces about 4-5 times a day. My rule of thumb is that most bottle-fed babies need about 2-3 ounces per pound of body weight per day (up to a maximum of 32 ounces per day). Though, needs will vary from day to day.
 
  • Breastfed Scheduling - The feeding schedule for breastfed babies varies even more than for formula-fed babies. When mother’s milk first comes in, babies often nurse 8-12 times a day. As they grow, most mothers and babies will develop a unique routine. Some prefer large feedings fewer times a day; others prefer small, frequent feedings. You don’t need to worry about the amount - that usually takes care of itself.
 
Starting Solids (about 4 to 9 months)
Babies have unique digestive systems and mature at different rates, so there’s no single best answer for when every baby should start solids. Usually, the best time to start is when babies are asking for it with their body language - either by leaning forward or straining and fussing and staring longingly at your food. Another indication is if you notice your baby still seems hungry after getting plenty of milk (32 ounces of formula, or nursing at least 8 times).
 
For breastfed babies, I prefer waiting for solids until the babies are pretty adamant about starting; there is value in exclusively breastfeeding for the first 6 months. For formula-fed babies, I am more apt to recommend starting as soon as they express interest after 4 months.
 
Most kids who take solids between 4 and 6 months do well having “meals” of solids once or twice a day. Increase to 2-3 times daily after 6 months - usually at the same meal as breast milk or formula.
 
For breastfed babies, nurse first and then offer solids. For formula-fed babies, do the reverse (to get the biggest taste variety and finish with formula when they get bored).
 
Again, there is no preset amount. Watch for your baby’s cues. If he turns his head away from the spoon, scrunches his lips shut, or just looks bored, it’s time to stop.
 
What should those first solid foods be? For the last several decades, the first bite of solid food for 98% of babies in the US has been processed white rice flour baby cereal. It’s the consistency of processed white flour.  And it has a similar same impact on a baby’s metabolism. It starts turning to sugar before it even leaves a baby's mouth and is all glucose very quickly. If you want to start with a grain, try this easy recipe for ground brown rice, barley, quinoa or millet as a healthy, whole grain. Or you can start with produce if you’d like. Avocado or sweet potatoes are great first foods, too. I like this because babies can see that food comes from the produce aisle or farmers' market. Whatever you choose, puree or mash with a fork until the food is nice and smooth. Mix in a little breast milk or formula to thin out the mash if need be.

The first few days most kids will tend to push food right back out with his tongue. This is because babies have a thrust reflex causing their tongue to thrust back out anything that is put in their mouths. Within several days your baby will begin to get the idea of closing his lips and swallowing.

Contrary to popular opinion, there is no good reason to wait between introducing new foods to your baby.  Many doctors still recommended waiting 3 to 5 days because of food allergies. Waiting between new foods doesn’t decrease food allergies; it only makes it a bit easier to figure out which food was responsible. But it also trains kids to be pickier eaters. Only a small percentage of babies ever have food allergies, and it’s pretty easy to determine the possible offending foods, should food allergies arise. I vote for variety!

Finishing Up the First Year (about 9 to 12 months) Breast milk or formula will continue to be the primary source of calories for the first year, but as your child moves from infancy to toddlerhood, he’ll begin to look for more adventure in food choices. Take advantage of this window of opportunity by offering a wide variety of flavors!

It’s especially important to be in charge of your baby’s eating during this crucial developmental period. No matter how careful you’ve been up to now, as she nears the end of her first year, your child can fall out of the habit of eating good food so fast you won’t know how it happened!
Bear in mind:
  • Being too overbearing and pushy with healthy foods will decrease your child’s desire for them.
  • Restricting unhealthy foods that you are eating or are in plain sight will increase your child’s desire for them.
Lead by example and eat a wide variety of healthy foods.
Also, pick up a copy of “Feeding Baby Green” for a practical 33-month road map for giving your child the best start possible and for establishing a foundation for enjoying a lifetime of healthy eating habits.

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Dr. Greene

Dr. Greene is a practicing pediatrician, author, speaker, children’s health advocate, and father of four.

Dr. Levine

Dr. Alanna Levine is a New York based pediatrician and a mom of two children.