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May 23rd, 2006, 02:49 AM
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Q: My four-month-old son has been eating cereal for a month, but he is now refusing to eat any strained fruit. How can I make sure he is getting the balanced diet he needs?

A: Your baby’s rapid growth can be sustained for about six months on breastmilk or formula alone.

I cannot tell you how many babies are started on solids at three or four months old because of some misconception that the baby is hungry or not fat enough. Babies, like adults, have variable levels of hunger. However, in these early months, this hunger should be satisfied by increased milk feedings. Starting solids too early may actually interfere with growth.

So don’t worry about your baby refusing fruit at four months of age. He doesn’t need it. At this age, breastmilk or iron-fortified infant formula already provides your son with a complete diet.
– Diane Sacks

Q: When do I stop puréeing and start giving my child cut-up table food?

A: Generally children can manage increasingly chunky foods near the end of their first year.

Try experimenting with less puréed foods and see how he manages. An older baby’s gums are very strong and having teeth is not a prerequisite for chunky foods. Start with soft cut-up foods, such as small banana pieces, mashed potatoes and other table food. As his fine motor skills improve, including his eye-hand coordination, he will likely start to enjoy finger foods like small cereals, rice, pasta, soft vegetables and fruits which he can feed himself. Children often want to try using their own spoon and cup as well around this time.
– Sarah Liddell

Q: At what age can you give your child meat and dairy products? My baby is six months old.

A: At about six months, iron needs increase and cereal is introduced for that purpose. After your baby is doing well with cereal (this takes about a month), I would introduce vegetables. Start the new food in small amounts and watch for any bad reaction, such as rashes around the mouth or diaper area. Over six to eight weeks, introduce three or four vegetables. Once these first few vegetables are in place, try a meat, such as chicken, veal or lamb, or tofu. After meats, introduce fruits before dairy products. You can introduce your baby to whole milk at around 10 months of age. Whole milk products can also be introduced to a breastfed baby around this time.
– Diane Sacks

Q: My seven-month-old is not eating solids well. Should I be worried?

A: At his age, most needed nutrients can be obtained from breastmilk with vitamin D supplementation or formula. The exception is iron. If your baby continues to refuse iron-fortified solids after a few months of trying, consult with your doctor about iron supplementation. The other reason to introduce food at about six months is to ensure that they become comfortable with different textures of food, so that they can obtain enough nutrients and calories when solids become more important in the second year.

That said, don’t force your baby to take solids, but take a few days off and retry the same food or try something new. Stay calm and don’t turn this into a power struggle because you want your baby to have positive associations with eating. Remember that you have a fair amount of time to ease your baby into solids.
– Diane Sacks
Q: How much cereal should my 10-month-old daughter be eating? Are four to six tablespoons per meal OK?

A: Iron-fortified cereal is important during your child’s first two years because few foods provide as much of this important nutrient. More than 30 percent of infants and toddlers in Canada are iron deficient.

Depending on the type of milk your baby drinks, iron needs vary. That said, if your baby is eating four to six tablespoons of cereal three times a day, she’s probably getting plenty of iron. But the composition of infant cereals varies, so check the labels; look for a cereal that meets 100 percent of your baby’s needs. Usually 100 millilitres or six tablespoons provide adequate iron for one day.

Also look for:
• no hydrogenated oil to avoid any trace of trans fats, which are the bad fats;
• organic whole grains such as brown rice, oatmeal, barley or a mix of organic whole grains.
– Louise Lambert-Lagacé

Q: Is 18 ounces of homo milk too much for my 12-month-old? He also drinks apple juice once or twice a day.

A: Your 12-month-old baby is doing just fine with 18 ounces of pasteurized whole milk a day. This is both the right type of milk for his age and the appropriate amount. Partly skim and skim milk, are not recommended before age two because they are short of essential fatty acids and provide insufficient energy.

The role of fruit juice in your infant’s diet is another matter. Too much juice can displace the intake of milk and more nutritious foods. It can also cause diarrhea in some babies. Some studies have even linked juice intake to excessive weight gain as well as dental caries.

Your baby can drink four to six ounces per day of 100 percent juice. A good idea is to dilute it with water for extra fluid and reduced sweetness.
– Lousie Lambert-Lagacé

Q: My 13-month-old suddenly seems less hungry than he used to be. Should I be worried?

A: Parents are often surprised and worried when they notice their one-year-old seems suddenly less interested in food. The transition to new textured table foods and the marked decrease in physical growth that occurs at this age result in an unpredictable appetite and fussy eating. Remember that your child is now growing slowly and in spurts compared with the intensive growth of his first 12 months. Never force your child to eat. The most effective attitude is one of respect and indifference — hard to apply, but efficient in the long run. Continue to offer your child healthy food choices — that’s your job. His job is to eat according to his own appetite.
– Louise Lambert-Lagacé
Q: My two-year-old refuses to eat meat and vegetables. He eats macaroni, cheese sandwiches and some fruit. What should I do?

A: Feeding a two-year-old is a challenge. Food refusal is common, with meat and vegetables at the top of the list. Meat is most often refused because it takes more chewing. Meat mainly provides protein and iron, two important nutrients for a child’s normal development. Cheese and cheese dishes provide protein, but are very low in iron. Try minced meats in pasta sauces, meat loaves, minced chicken, tofu or mashed chickpeas, which are easier to chew. To increase his iron intake, make sure your child eats iron-fortified cereal (dry or cooked) every day.

Vegetables add vitamins, minerals and fibre, and help prevent constipation. Raw vegetables are often more acceptable than cooked ones especially when served with a dip. Try partially cooked carrots and zucchini with a yogurt dip. Finely shredded cabbage or carrot salads are likeable items. You can also offer vegetable juices or soups, but remember that they are low in fibre. If the vegetable route becomes a dead end, compensate by offering vitamin-rich fruit, such as oranges, melons, kiwis, mangoes, and papayas, instead of apples and pears. Offer small servings and never insist. And never give up.
– Louise Lambert-Lagacé

Q: My 2½-year-old barely touches his meals, but likes to eat snacks constantly. How can I get him to eat his meals?

A: Children have small stomachs and generally do need more frequent meals and snacks than adults. This can lead to lots of grazing. Try instead to keep to a regular meal-and-snack schedule to help your child establish good eating routines. Offering a healthy variety of snacks can help your child establish good eating habits and might make you feel better if he doesn’t eat his meal.
– Sarah Liddell

Panel of Experts
Louise Lambert-Lagacé is a consulting dietitian and author of Feeding Your Baby the Healthiest Foods (Fitzhenry & Whiteside 2000).

Sarah Liddell is the program manager of Toronto’s Mothercraft Parent-Infant Program.

Paediatrician Diane Sacks is on staff at North York General Hospital and past president of the Canadian Paediatric Society.
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