Next to diaper changes, feeding your baby is the activity that you will do most for him or her during the first year of life. Providing proper nutrition is obviously of utmost importance for an infant, but feeding can serve as a barometer for wellness. When babies are ill, changes in feeding patterns are often one of their first symptoms. Parents also should be aware of what, when, and how much to feed their baby. This article will provide some basic principles on feeding infants during their first year.
Breastmilk or infant formula should be at the center of your baby’s diet during their first year of life. In fact, for at least the first 4 months, it should be their sole source of nutrition. The quantity that infants ingest can vary from baby to baby, but there are some general guidelines that are helpful. An infant’s stomach size changes over the first month of life. On the first day, the stomach is the size of a cherry and can only hold 5-7 ml of volume. By day 3, it is the size of a walnut and can hold up to 27 ml, which is nearly one ounce. At the end of the first week, the stomach is the size of an apricot and has a capacity of 45 to 60 ml, up to 2 ounces. By one month of age, the stomach is the size of a jumbo chicken egg and can hold a volume of 4 ounces. With these volumes in mind, parents can expect their new baby to consume slightly increasing volumes over the first month of life. More important than the specific volume is the infant’s growth. For the first several months, the rate of weight gain should be about one ounce per day, but that rate slows to half an ounce per day around 4 months.
There are also some general guidelines for the interval between feedings. Formula fed newborns typically eat every 3 to 4 hours, while nursing infants eat more frequently. It is important to note that all babies, whether eating breastmilk or formula, should not go more than 4-5 hours without being fed. For most babies, until they reach approximately 12 pounds (between 2 and 4 months for most), they still require feedings during the night.
Many parents inquire about adding cereal to the bedtime bottle to help the baby sleep through the night. The American Academy of Pediatrics (AAP) recommends against starting solids until at least 4 to 6 months of age. Research has shown that infants who eat rice cereal prior to 4 months old have a higher risk of developing diabetes later in life. In addition, an infant is not ready to digest solid food before 4 months and their immature kidneys should not be exposed to the level of salt contained in cereal.
Side note: Parents should refrain from giving young infants water as well. Again, their kidneys are too immature to maintain the proper salt balance and in severe cases, it can lead to seizures.
Although many babies have the oral-motor skills to start solid foods at 4 months of age, the AAP urges breastfeeding as the sole source of nutrition for the first 6 months. Rice cereal has traditionally been suggested as the first solid food for infants even though there is no specific research to back this recommendation. I usually recommend this for practical reasons. Parents can prepare cereal with breastmilk or formula which allows them to adjust the consistency to their baby’s needs and it is also a familiar flavor on the baby’s palate. Likewise, there is no medical evidence to support starting vegetables prior to fruits, but this has been the traditional recommendation by pediatricians for decades. The conventional wisdom is that babies will prefer sweeter foods so those should be reserved for later. Regardless of the order, there should be an interval of 2 to 3 days between the start of each new food so if there are any sensitivities or allergies, it is easier to identify which food is the culprit. Finally, newer research suggests that there is no need to wait to introduce foods that commonly cause allergies such as eggs, dairy, fish, or peanuts.
Another side note: When I discuss “solid” foods for infants, I am referring to pureed foods.
There is lots more to say about feeding your baby than I can fit into this article. You will have lots of discussions with your doctor during the first year regarding what and how to feed your infant. If you notice any changes in your baby’s typical feeding pattern, let your doctor know as this could be a sign of illness. Feeding your baby, particularly during the night, can seem like a chore at times, but try to enjoy it. It is a great time to nurture and bond with your little one. Before you know it, they will be feeding themselves!