Friday, October 11, 2024

Dr Ted and Nurse Judy's Solid Food Guide

 As a pediatrician and advice nurse, we are familiar with many of the common questions that most parents have when it comes to starting food. The goal of this post is to answer those frequently asked questions as well as sharing tips and tricks (some from other parents) that you might not have thought about.

While we are not dietitians we have a lot of input about the ABCs of starting to feed your baby. 

We recognize that there are lots of opinions when it comes to solids. Our approach  tends to be on the more relaxed side of things. We hope this document offers information without adding stress to the equation.

Relax and have fun!


Timeline

Birth to 4 months

Why should babies start solids around 4 months (and not before)?

Feeding babies solids before 4 months isn't recommended for several reasons.

  • Young infant digestive systems aren't mature enough yet to handle anything other than breast milk or formula. Their tiny tummies are still developing the necessary stomach acids and enzymes needed to digest solid foods properly. Interestingly, these stomach acids are also a component of the body’s immune system that kills harmful bacteria in the gut. One of the reasons we are so careful keeping things sterile for the first couple of month is that infants produce less stomach acid than adults

  • Infants are also born with a “tongue thrust,” a reflex where they stick out their tongue. This helps them push out food that gets into their mouth by accident and is nature’s way to prevent choking. 

  • Introducing solids too early can increase the risk of digestive discomfort.

Once babies are around 4 to 6 months old, they are more physically ready and often start to show signs of being interested in trying new foods.


4 months: An Introduction

There are so many thoughts about all of this!  Some people believe not a morsel until 6 months, others are fervent that the benefits of starting early are not to be missed. At 4 months, parents have the option of starting solids. It’s by no means mandatory. There is no right or wrong. There are some advantages which we will discuss below.

Why start sooner? 

  • It can be fun.

  • Early feeding is more about exploration than it is about nutrition. This becomes important later on. Toddlers brains are very complex but in some ways they are very simple. When it comes to food they recognize that things are familiar or unfamiliar.  By exposing them to plenty of colors, textures and tastes early on, you may be avoiding picky eating later.

  • Recent research has proven that, for infants with eczema or a family history of food allergies, introducing allergens regularly between 4-6 months significantly reduces the likelihood that they will develop food allergies in the future. There are even companies that make products like allergy packets” to streamline this process. The most common food culprits are nuts, fish/shellfish, milk, eggs, wheat, and soy. There is a lot to say about introducing allergens to these kids safely, so we encourage you to read up here for how to do it.

How can you tell that your baby is ready for solids?

There are some basic signals that your baby is ready for solids:

  • Starts to lose the tongue-thrust reflex 

  • Has the ability to sit up with minimal support and reasonable head control (this can be on your lap)

  • Opens mouth for oncoming food

  • Keeps tongue flat and low so that spoon fits into mouth

  • Keeps most of the food in, although some is usually going to be dribbled back out

  • Likes to imitate you

  • Shows interest in food (this could be staring at you intently while you eat)

  • Reaches for the food in your hand

  • Turns their head away when they’re no longer interested

Remember: there is no “one-size fits all” with this. Some kids are very interested at 4 months, while other 7 month olds are driving their parents nuts by showing no interest whatsoever.

If you are offering food in this 4-6 month window, remember that they don’t technically need anything other than milk at this time, so it is no big deal if they don’t want it. 

How to start

There are a million ways to introduce solid foods. Below, we outline one approach to starting this journey. These is only one absolute rule! Aside from that, anything goes. You could follow some pieces but not others. After each suggestion, we provide an explanation for why we think you might consider it:

  • Here is the one firm rule: no honey for kids under 12 months.

    • Why: there’s a risk of botulism poisoning. This can be lethal (Dr. Ted has managed it with his patients twice).

  • Start with purees or cereals.

    • Why: There are definitely kids under 6 months who can handle soft foods like sweet potato and avocado, but many babies will do better if it’s fairly liquidy, while they’re just learning. You can mix a food with breast milk or formula to get that smooth consistency.

  • Time the solids mid way between milk feedings.

    • Why: A baby who’s already full from milk won’t want to try new things. A baby who is ravenous wants their milk now and won’t settle for anything else. Mid way between feedings is a good sweet spot to be open and curious.

  • Put one food “on trial” at a time if you’re doing whole foods or purees.

    • Why: this is to monitor allergens. If there’s a reaction, it’s easy to identify the culprit. Imagine you start with hummus and there’s a rash: was it the sesame? Or the chickpeas? If you opt to start with multiple foods at once, your life is just a little harder if there’s a reaction because it won’t be as obvious what caused it. In a family with no history of allergies, eczema, or asthma, the concern is very low for an allergic reaction and you can mostly do what you want. We will discuss allergen “packets” below.

  • Offer the ingredient at least three times before moving on to the next one.

    • Why: Allergic reactions almost never occur on the body’s first exposure (it happens, but it’s very rare). It takes multiple exposures for the body to develop an allergic reaction.

  • Introduce new foods on weekday mornings.

    • While anaphylaxis from a first food exposure is extremely rare, you don’t want to offer something and then put them right down to sleep. It is preferable to time it so that you can keep an eye on them for a bit. If you’re worried about allergies, Dr. Ted suggests trying foods on Tuesdays or Wednesdays: reactions are often worthy of being seen (without actually being an emergency), and it’s easier to get a call into the doctor’s office on those low-volume days.

  • It doesn’t really matter what foods come first with regards to vegetables versus fruits.

    • Why: there's no strong evidence that introducing vegetables before fruits will make a big difference in their long-term food preferences or prevent a sweet tooth. Babies have an innate preference for sweet flavors due to the naturally sweet taste of breast milk or formula, so introducing fruits isn't likely to create an issue. What matters is offering a variety of foods, including vegetables, can help them develop a diverse palate.

  • Don’t get discouraged if your baby rejects certain foods initially.

    • Why keep trying: Research shows that it takes between 8 to 15 introductions before a young baby will happily accept some new foods, even if they don’t seem to like them initially.

Things to Keep in Mind

Allergy Packets

There are a lot of potential allergens. Introducing them all in small amounts at the youngest age possible is intimidating. Some companies make packets of tiny amounts of these foods in powdered form (Ready, Set, Food! SpoonfulONE and Little Mixins are popular examples). You can sprinkle the powder into breast milk, formula, or onto cereals daily to ensure the body’s immune system learns about it. The idea here is that using very tiny amounts of these foods is safe to do just for this “teaching” phase. If there is an allergic reaction (like full-body hives, vomiting, or trouble breathing), you’d need to stop the packets and move forward with the supervision of your pediatrician.

Note: if your baby already has very sensitive skin or eczema, it’s possible the powders will make those rashes worse. If that happens, decrease the packets (to ¼ or ½ packets daily). 

Iron Supplements

At this stage, babies have lost their maternal iron stores. What does that mean? They’re born with iron from mom and the placenta, which remains in their blood for the first 3-ish months. If you’re mostly breastfeeding after 4 months, the American Academy of Pediatrics recommends supplementing with iron between 4 months of age and whenever iron-containing foods are introduced (including iron-fortified cereals), usually around 6 months. This is much more important for anemic mommies, because those babies started with lower iron levels. Read more here about how to make sure your kids are getting enough iron.

What about cereals?

As is typical with American parenting, there are strong opinions. We think that cereals, like oat or rice cereals, are an easy way to give your kids iron. Years ago when rice cereal was making headlines due to arsenic levels, Nurse Judy did a blog post titled ‘Food heroes and villains’. There is indeed more arsenic than we would like in some foods like organic rice. Balance is the key. Rice cereal is fine to offer several times a week, some of the other cereals like Oatmeal and Barley, don’t share the arsenic concerns.

Good starting foods

When doing single-ingredient solids introductions, there are lots of questions about which ingredients make good first foods. Below is a list of a couple easy ideas.

  • Applesauce

  • Oatmeal

  • Plums

  • Avocado

  • Peaches

  • Pumpkin

  • Banana

  • Pears

  • Rice

  • Barley

  • Peas

  • Squash

  • Green beans

  • Prunes

  • Sweet potato

Keep Things Relatively Clean

Because babies younger than 6 months are especially susceptible to food-borne illnesses, it is important to keep things as clean as possible. Once you introduce saliva to the food and they don’t finish up what’s in the bowl,  it might not be safe several hours later. To avoid waste, only put small amounts into a bowl at a time, and keep adding more using a clean spoon.


6 months

There is nothing wrong with waiting until your child is 6 months before starting to introduce anything. In fact until several years ago, that was the recommendation of many pediatricians.

Frequency

At 6 months, all kids should be starting some solids. It should happen at a minimum once per day. If you have a child who wants to eat more often, by all means go ahead and offer more frequent meals. If you have a child who has reflux, many gastroenterologists recommend solids at least twice a day.

Quantity

Many parents express concern that their child is eating either too much or not enough. It is normal for there to be some days when kids will eat just a spoonful of something and other days when they’ll pile it on – their appetites can be erratic. This is typical! You are NOT alone.

Here is the Nurse Judy magic equation:

X amounts milk + X amounts solids = A happy/growing/peeing/pooping/sleeping baby

You don’t need to ‘solve for X’ unless there is an issue with the right side of the equation.

In other words, if you have a child that is growing, peeping, pooping, sleeping, and happy, then you can feel pretty confident that  the amount of food and milk that they’re getting is sufficient. You can trust your baby. Your job is to offer what you think they should eat, but it is their job to accept what they actually need. They usually get it right. If you aren’t feeling confident, then go back up to that equation and see if something is off.

At about the 8 month mark, if you feel like you are not having any success with solids, and you’ve been diligently trying, it’s worth checking in with your pediatrician.

Form

At this stage, we can move from simple purees to a combination of purees and “baby-led weaning.” Baby-led weaning is an approach to giving solids that involves offering food to babies in a way that allows them to pick it up. The term can be confusing, but it has nothing to do with weaning milk. The broad philosophy of baby-led weaning is that there are no singular ingredients (except for honey) that can’t be prepared for babies safely at six months. 

It is not our intent to reinvent the wheel when there are other excellent resources that can hold your hand with some basics: The Solid Starts App gets a big thumbs up from us for how to introduce a variety of foods. With any app or programs that you find, remember that you can pick and choose to follow whatever parts feel helpful.

Things to keep in mind

Drinking Water

It’s technically not necessary to offer water if your child is pooping lots and peeing clear, but instinctively, now that we’re adding solids consistently, adding at least an ounce or two of water into your child’s diet seems like a good habit to incorporate. Water can be in a straw cup, a sippy cup, or a bottle. Pay attention to their pee and poop and adjust the amount accordingly. The honey bear cup is an easy way to introduce the concept of drinking from a straw. Scroll down for more info about cup choices

Pouches and Rusks

Another form of food that parents find very easy to serve are pouches. Kids love pouches. The unfortunate thing is that most pouches are akin to bags of sugar water. No wonder they love them! Rusks are dried teether crackers for babies that share a similar problem. If a pouch or rusk advertises itself as kale and apples, it’s often mostly concentrated apples with smaller amounts of kale. It’s wise to read labels closely here. The order of the ingredients is related to their relative amount. You want to see that the healthy ingredients, like kale or other low-sugar vegetables, are listed before the apples, pears, and sweet potatoes. Remember, something can be labeled as organic, but that alone does not make it a healthy food. Think of pouches and rusks as tools: they’re convenient if you’re stuck in the car or can’t get out of the stroller and need something to eat (and you need your sanity). But try not to overuse them.

Changes to Poop

Poops can be SO strange once you start solids. Before you became a parent, you might not have imagined that you would take a photo of your kids poops and send it to someone. Think again. It is more common than you might think. One of the biggest culprits is bananas. When those are consumed, the poop sometimes contains little darkish threads that can freak people out.

Beets? red. Blueberries? Yes….blue poop. It happens.

Not only does it look different, but spoiler alert, the poop is also going to get much stinkier. 

It is very important to make sure that your kids don’t get constipated as their systems figure out how to handle real food. Hard, pellet, formed stools are a sign that you need to intervene. It could be as simple as adding more water, but being aware of which foods are binding and which ones keep things moving is important.

Please check out this article for some guidance.

Brushing Teeth

The guidelines will tell you to use fluoridated toothpaste as soon as the teeth erupt, but many parents will simply wipe down those early teeth, and that seems adequate. Do a more thorough job of brushing if your child has something sticky and sweet.

https://nursejudynvp.blogspot.com/2023/03/dental-health-2023when-to-see.html

Eating With (or Without) Teeth

While we are on the subject of teeth, it might be worth mentioning that there is a wide range of normal when it comes to tooth eruption. Some late teethers can manage to eat a wide variety of textures by gumming things. 

Do this simple experiment. Put a soft piece of food in your own mouth and try to eat it without using your teeth. You might be surprised what you can manage. If you are curious about the timing of your child’s tooth timing, this teething post has a useful tooth eruption chart.

Shifting away from eating at night

This is a gentle reminder that most babies who weigh more than 12 pounds are physiologically permitted to try sleeping through the night without feeding. 

  • Their bodies need the long stretch of sleep for growing (not digesting)

  • Families who get a good night’s sleep function better in almost every way

  • When babies wake at 1am, they always accept food, which can make it confusing to parents who feel like their child is still hungry overnight. If someone offered you a warm chocolate chip cookie in the middle of the night you would probably say thank you and eat it. I know I would. The hard truth is that no one actually needs the midnight cookie. 

  • We think that it is time to train babies not to expect food between midnight and 6 AM. This does not mean you are not available to offer other types of comfort measures as needed.

Choking

The risk of choking is something that many parents have nightmares about. But regardless of how nervous you are, take a deep breath.  Kids need to learn how to eat.  When babies learn to walk, there are lots of tumbles along the way. When they are learning to eat, you can expect some gagging as they’re learning this new skill.  There is a big difference between gagging and choking.

Gagging is loud. It can involve coughing, gurgling or sputtering. The skin might look red.

Choking is often silent. They aren’t able to give a full cry. Kids look distressed.

It is worth doing more of a review on choking rescue than what we include here. But briefly:

If your baby seems like they are struggling: If you can’t see the food, tilt your child forwards and let gravity do the work. If you can visualize a piece of food and want to do a “finger sweep,” remember to stick your finger into the cheek and side of the mouth, not straight back (which might push food further). Never blindly stick your finger in their mouth.

When the meal is finished, do an “all done” mouth check, making sure there are no pockets of food squirreled away in their cheeks. The solid starts app has an excellent guide on this https://solidstarts.com/gagging/

It is also worth doing a drill where you practice removing your child from their buckled up highchair so you can see how quickly you can do it.

Avoid round hard pieces of food, such as hotdogs, popcorn etc (I am a grape cutter until they go to college). Safe beginning on instagram is a great account that addresses this (along with other general baby safety stuff)

Scroll down for more ‘safe eating’  tips.


9 months

Frequency

At 9 months, kids are ideally doing solids at least twice a day. If life is hectic and you skip a meal here and there, don’t stress about it. If you are generally increasing the frequency and amount from the previous month, then you are on the right track. 

Quantity

The amount that your child takes in may shift at this stage, but the job descriptions remain the same. Your job is to offer what you deem a reasonable amount, and their job is to accept what they want. Ideally, at this age, kids can use the “all done” sign – see below for more on signing. (see link below) This can help them to regulate quantity.

On average, between 6 months to 12 months, there is a steady transition as solids edge out milk for importance, with 9 months representing the inflection point.

Form

It is fine to continue to offer some purees if your baby likes those, but perhaps more baby-led weaning should be encouraged for those who are interested. Mesh bags filled with a piece of fruit are welcome for kids who are actively teething.

Things to keep in mind

Nutrition

Protein becomes more relevant, especially if a large quantity of solids is starting to replace the milk. Milk is very high in protein, so it cannot be replaced with just a bag of peas without missing a lot of macronutrients.

Continue to make sure your kids are getting enough iron. See the link above

Teaching basic signs

Teaching your kids some basic signs can get a jump on their communication and lead to less tantrums. Start with more, all done, milk, and food. Here is a video teaching these signs. 

Pay attention to attention.

Kids crave attention – doesn’t matter if it’s positive or negative. If they are getting more attention from not eating, they will continue with that pattern. It’s good to give them positive attention when they’re eating safely, eating well, etc. If they throw a cup on the floor and you either make a game out of it, or get annoyed..guess what? You have now engaged in the universal favorite activity that drives parents nuts.

Throwing Food
If they throw something, I suggest that you just pick it up and don’t give it back without looking at them. 

When they are old enough, consider the concept of a ‘no thank you bowl’ where they can deposit food that they don’t want. More on attention here.

Are they getting enough?

This is also a phase where some kids slow down on their growth curve. It makes sense when you see some of these little athletes rolling, scooting and crawling all over the place…they’re doing cardio.  When you look at the growth chart it is common for some kids to bounce along the curve, ignoring the rules. As long as the length and the weight seem to be in agreement, we are content to have you do a re-check in a month or so. If your child is not eating anything with texture, now is a time to bring it up at your 9 month check up.  At this age we want to see kids doing more finger foods.


12 months and up

Frequency

At 12 months, eating should be with the family, although young kids will often need more snacks. 3 meals and 2 snacks is an oft-cited frequency, but more is ok if they want it. Pay attention to tantrums: a lot of times they can be headed off with a well-timed snack.

Quantity 

Truly, whatever they want. If they want less, that can be okay. Dinner being the biggest meal of the day is more of a Western invention. The rest of the world, and toddlers, tend to eat bigger lunches and smaller dinners, and that’s fine. If they’re growing and happy, we aren’t worried. Note: growth has slowed at this age, and that’s normal. They’re no longer growing at the rapid rate of young infancy.

Form

It’s ok to give almost everything that parents are eating at this time, with a few choking-centric exceptions. Still avoid whole nuts, hot dog rounds, whole grapes, etc. Popcorn also isn't a great snack for a 1-year-old, mainly because little kids don’t have the molars or the chewing skills to safely break down those hard, uneven pieces, which can easily get lodged in their throat. One thing that is now ok: honey. The threat of botulism is now gone.

Things to Keep in Mind

The Milk Transition

Many questions about the transition to other kinds of milk are addressed in this post.

If you are breastfeeding, congratulations for making it this far. Of course, kids' complete nutritional needs haven’t been satisfied by milk alone for several months now, but there remain lots of health benefits from breast milk. Continue to nurse as long as it feels right to you.

Do we have to do full fat cow’s milk?

Many parents think they *have* to switch to whole-fat cow's milk, but that's not exactly the case. Kids do need to have healthy fats in their diet, but there's no biological reason we need to be dependent on bovine milk. The real goal is making sure your toddler is getting enough fats, proteins, vitamin D, and calcium, and cow’s milk happens to be a convenient way to get these. But there are plenty of other options! For instance, three servings of yogurt and cheese, along with plenty of water, will do the trick just as well. You can also explore milk alternatives like oat or pea protein milk, which are often fortified with calcium and vitamin D. If you do decide to go with whole-fat cow's milk, 24 oz per day (about three 8 oz bottles) is enough to cover all your toddler’s calcium and vitamin D needs.

Why not do more than 24oz?

It’s important not to overdo it with milk in the absence of other high-iron foods. Drinking too much, especially more than 30 oz a day, can block iron absorption due to certain proteins in cow's milk, specifically A1 proteins, and even lead to intestinal bleeding (sounds scarier than it is…we all bleed into our intestines, cow’s milk can just increase it). That’s why it’s important to focus on iron-rich foods too. Heme iron, found in meats like beef, duck, and liver, is absorbed most easily by the body. Non-heme iron, which is in plant-based foods like beans, lentils, and tofu, is trickier for the body to absorb, but pairing it with vitamin C (like orange slices or bell peppers) helps boost absorption. Getting that balance between healthy fats, iron, and nutrients like vitamin D and calcium is what matters most, whether that’s through cow's milk or other food.

How can you get enough iron without eating red meat? How do vegetarian kids thrive?

It’s totally possible for a 12-month-old to get enough iron without eating red meat—you just have to be smart about combining non-heme iron sources with vitamin C to boost absorption. Think of how they eat in India: lentils, beans, nuts, and legumes are staples, and they’re often paired with tomatoes, which are high in vitamin C. The vitamin C helps the body absorb the plant-based (non-heme) iron much more efficiently. So, at almost every meal, you'd want to include something like lentils or chickpeas with a little citrus, tomato, or bell pepper on the side. Cow’s milk should be limited since it can block iron absorption, so sticking to alternatives or reducing milk intake is key. While it takes a little planning, vegetarian kids can absolutely thrive if meals are balanced like this. If you want more specific food ideas or meal plans, follow up with your pediatrician. (if that is Dr Ted, then you are in luck)!

What about the bottle and transitioning to a cup?

Our only real rule is not to give a bottle to your baby in the crib. 

The AAP recommends transitioning from bottles around 12 months because using bottles long-term can lead to cavities and affect how a child’s teeth and jaw develop. The constant sucking on a bottle can keep sugary liquids like milk in contact with their teeth, which increases the risk of tooth decay. Orthodontic issues can also come up if bottle use continues for too long. That said, the impact isn’t huge if the transition is done gradually, and there’s no need to rush. You can start introducing a cup slowly and aim for a full transition by 18 months. Try replacing one bottle a day with a cup, and as they get more comfortable, swap out more over time. It's a slow and steady process, so feel free to take it at a pace that works for your child.

They grow too fast not to savor the occasional calming, ‘snuggle bottle’

And because nothing is simple, Parents can get absolutely overwhelmed by their cup choices.

Another deep breath, see if this post can help make sense of that.


A few extra topics

Drinking Juice 

Water is almost always preferable to juice.  If your child simply won’t drink plain water, see about flavoring it with a slice of fruit, such as an orange. If that doesn’t work, then it is fine to add a little splash of apple or white grape juice to add a little flavor.  Adding some pedialyte powder is another option. Kids tend to like the flavors and as a bonus the added electrolytes are helpful if it is hot out.

There are times when juice does become a tool. If your child is sick and you are really focused on getting them hydrated, at that point you can offer whatever you need to get them drinking, but that added pedialyte might be especially helpful.

 Another time when juice comes into play is if they are constipated. I am a big fan of diluted prune juice to get things moving along.

Picky Eaters

Picky eating after 12 months is super common and totally normal. At this age, kids are starting to develop independence and become more aware of their preferences, which can lead to them rejecting certain foods. Evolutionary-wise, this pickiness actually helped kids avoid harmful foods—our ancestors didn’t have food labels, so being cautious with new or bitter foods kept them safe. But it can be frustrating for parents! One way to encourage trying new foods is to keep offering them without pressure. Kids often need to see a food multiple times before they’ll try it, so don’t give up if they turn something down at first. Also, try pairing new foods with things they already like to make the experience more familiar. We often feel like the “healthy food” needs to be served healthfully (i.e. cheese over here, broccoli steamed over there). But if the cheese is eaten anyway, just melt it on the broccoli! That will incorporate the flavors and adjust the palate.

Mama Jen shared that frozen veggies are her favorite tip.

 The nutrient content of frozen veggies is actually generally at or better than fresh, because the nutrients are preserved at their peak, and they last longer, and can be prepared in just a few minutes with a microwave. All of our kids LOVE peas and broccoli, without any added seasoning. But if we want to boost the calorie content, we can add cheese or butter and they gobble that up just the same.

It's also important to remember that kids at this age might just seem picky at dinner because they’ve eaten a lot earlier in the day. Many toddlers are big breakfast and lunch eaters, and by dinner, they’re simply not that hungry. If they’re growing and hitting their developmental milestones, it’s totally fine if they have a small or even skipped dinner. The idea that dinner needs to be the biggest meal is a Western thing and not how people eat in many parts of the world. So, if your kid is thriving, don’t stress too much about how big their dinner plate is.

Remember attention? Notice it when they try something new! Feel their muscles when they eat some good ‘growing food’.

There are some more picky eating tips here.

Safe Eating

Safety is key since they're still learning how to eat properly. Make sure you're sitting with them during meals and model good habits—chewing slowly, taking small bites, and not talking with your mouth full. Toddlers love copying what they see, so if you're practicing good habits, they'll pick them up. They will pick up your bad habits even faster.

It's also important to prevent them from running around with food, since it can be a choking hazard. Encourage them to sit calmly during meals and remind them not to shove too much food in their mouths at once.

Salt and Spices

Babies are generally content to eat fairly bland food, They don’t know any differently! The minute they are exposed to the wonders of salt, that acceptance phase is behind you. I am fine with most spices, but if you can avoid adding salt, your child will be better off. If you are cooking for the family, consider holding the salt for everyone and just adding it at the table (in secret)

Most other seasonings are actually a bonus and can expand their palate.

Sweets

Added sugar is actually an inflammatory food that can lead to health issues later on in life if you eat too much of it, but it is VERY hard to avoid it completely.

When kids are old enough to grasp the concept, I divide foods into ‘growing food’ or “Not growing food.” If kids have had enough of the growing food, then you can make a choice as a family how you want to handle the occasional dessert. I would counsel you that if you elevate it to a rare or forbidden treat, that will add to its allure. I would also suggest that sugar ‘treats’ are not to be used for rewards (good luck with that). I prefer a reward to be a special activity.

Vitamins/Supplements?

If kids are eating a good variety of food (eat the rainbow), then it is probable that they are getting all of the vitamins they need from their diet.

Vitamin D is the exception. It is tough to get adequate amounts from food alone.

For that reason we think that kids should continue taking Vitamin D supplements.

If your family is vegetarian, then a B12 supplement is needed

If your little one has severe allergies and can’t eat all of the standard food groups,  it is worth meeting with nutritionist  ensure they are getting a balanced diet

Microplastics

Microplastics is one of these emerging areas of medical research that are still poorly understood and absolutely terrifying. The idea is that flexible plastics (think plastic bags, plastic tupperware, disposable water bottles) leach microplastic particles into our foods and bodies, where they might increase the risk of hormonal disruptions and unknown impacts. Microplastics are literally everywhere, and they’re almost impossible to avoid. It’s worth noting that we have lived with microplastics for generations and have managed to get by. But as our awareness grows about them and their possible health impacts, there are a couple of ways that one could easily decrease their microplastic burden: cold over hot, firm over flexible, and water over grease.

  • Cold over hot: Microplastics shed more when hot. Try not to microwave plastics. This includes tupperware and frozen bags of food. 

  • Firm over flexible: Thin and flexible plastics are worse than firm, re-usable containers. Pouches and rusks may be significant carriers due to their processing and delivery (pouches are often plastic bags).Try to avoid thin disposable water bottles.

  • Water over grease: Research has suggested that oils assist in leaching microplastics from plastic containers. Dry things and less greasy things are better for plastic than oily leftovers. 

Pet Safety: Which foods are toxic?

Now that your little one is eating, no one is more excited than the family pet. They are no doubt circling the area like little sharks, waiting to see what food is dropped.

Sawyer’s mama Becca warns that letting your pup lick up the spilled prunes may have unfortunate consequences.

It is important to be aware that some human foods can be toxic to animals.

Be especially careful of anything that contains Xylitol (also known as birch sugar).


In case you missed these links

Eating together as a family can have significant benefits

Introducing your child to allergens

Iron

Vitamin D

Picky Eating

Attention

Poop and Solid foods

Teething

Sippy cups

The milk Transition

Dental Health


Other Resources

https://nursejudynvp.blogspot.com/2020/07/2020-2025-dietary-guidelineshighlights.html 

Food Worksheet

Super Baby Food

Note: Parents do not  need to make homework out of feeding your child. You don’t need to monitor every pea that they eat. But for the parents who really want a worksheet, the above are useful resources.

Food Safety Websites

Breast milk storage guidelines

Worthy books to scope out

  • Super Baby Food by Ruth Yaron

  • Baby Led Weaning by Gill Rapley and Tracey Murket

  • River Cottage Baby and Toddler Cookbook. 

    • This has recipes that are super yummy, and it gives suggestions on how to vary for babies, toddlers, older kids, and adults, in a way that we all eat the same food but it doesn't taste plain or boring, so the whole family is happy. (from Mama Paula)

Useful Apps

  • Solid Starts

  • Safe Beginnings


A giant shout out to the incomparable designer Nancy Elle, who acted as a sounding board as well as offering her expert eye on our formatting.

Thank you to the models

Elliot, Coby, Sawyer, Bowie and Waffles

Friday, October 4, 2024

A message from Beyond/ But perhaps, useful only if you are trying to learn to sound a shofar

 This week, I had some folks over to help celebrate the Jewish New Year. One friend brought his collection of Shofars. A shofar is typically made of a ram’s horn and making the sound is a ritual during the high holidays. Some describe it as a spiritual ‘wake-up’ call. The pure sound from someone who is skilled can be tremendously moving. Unsuccessful attempts fall into the nails on on a chalkboard, or someone just learning to play the violin, category.

As I was holding a shofar, an old anecdote came to mind.

As some of you are aware, I have collection of odd but true stories that I am going to compile into a book one of these days. This is one of those.

Back in 2014, Lauren was home for a short but glorious visit. While she was here she took the opportunity to poke through long buried piles of papers that had been tucked away in the bottom of her closet.

Not surprisingly, she unearthed some treasures.

There were several shoe boxes stuffed full of letters. At one point she called me in to take a look at an one old letter that she had randomly selected out of the hundreds. It was a correspondence from my parents dated September 1993. 

My father's segment of the letter was “vintage Grandpa”

He loved to problem solve and loved to teach. He had just figured out the best way to teach someone to sound a shofar and he was eager to share it.

Dear Lauren,

The best way to learn how to do something better and better is to teach other people how to do it. By teaching your cousins how to blow the shofar, I discovered that if I can pfubpfupfub my lips, I get a good sound. I cant wait to teach you…….

The very next day after Lauren had found that note from her grandparents, I called my nephew Asher to wish him a happy birthday. I told him about the letter. What I didn’t know was that when Asher had been in Pittsburgh a month earlier, he had found my dad’s shofar and had been encouraged to take it with him back to Utah; he had been working on learning how to blow it in time for the Jewish holidays.

My dad passed away in 2007. I imagine my father’s spirit watching Asher trying to perfect the sounds, and trying his hardest to get this pfubpfpf message across.

I am glad he found a way.

So, last night, I took hold of a shofar, I channeled my dad….did the pfubpffub and was able to make a sound. The coyotes who live in the woods across the street responded in kind.

This is a ‘truah’ story. For all of you who understand that little play on words, Shana Tova!

The weeks model is 7 month old Coby; the shofar temporarily distracted him from his mission, which is to pull himself up to a standing position on anything in his path.


Friday, September 27, 2024

Family Dinners

 So many parents already have a full to-do list and are not really in the market for ‘one more thing’ that they are ‘supposed to do’.

I hear you, but bear with me for a moment.

There is more and more research out there that eating together as a family can have a real impact.

The benefits include:

  • lower rates of overweight and obesity, substance abuse, teen pregnancy, depression, and eating disorders

  • Higher self esteem and better academic performance. Those who have family meals are shown to have a better vocabulary

Kids who eat together with the family also tend to eat a wider variety of foods.

It certainly doesn’t need to be daily. Even 3 or 4 nights a week can make a difference. It also doesn’t even have to be dinner! Maybe your family work schedule can only manage a 10 minute breakfast! The point is that you set your intention that at least several times a week, you will have a family meal. If the thought of this is stressing you out, start small. Even one meal together is better than nothing.

One of the best things about this family time is simply an opportunity for connection.

Try to put the phones and screens away. This means no television playing in the background!

If the phone rings:

Hey if this isn’t urgent, I will call you back in an hour. We are having our family meal.

Don’t underestimate the message that your kids are hearing from this. The time with them matters and you are making it a priority.

Make it understood that this is a time when the family is sitting together.  It is about more than eating. Even if one person is just moving the food around their plate, their presence is important. 

Although I am aware that there are social media posts warning you against asking the very basic How was your day? Sometimes that might be the only question that you have the energy for.

But if you want to get beyond one word answer of Fine, then here are some potential talking points…

What was something you did today that was kind?

Did you learn anything new? 

Did something surprise you?

Did anything interesting happen?

Did anything funny happen?

Or focus on the senses.

Did you smell something especially good or yucky?

Did you notice something beautiful?

Did you notice any interesting textures?

There should be no obligation to participate if they don’t want to, but they can still listen to everyone else.

With any new thing, trying to get everyone to gather at one time may feel like you are herding cats. Offer a transition time to dinner so that you are not yanking them away from whatever they are doing.

10 minutes until dinner...etc

Maybe have a collection of fun placemats (you can make some as art projects) and let one kid be in charge of which ones you will use and then have everyone help set the table. 

In general, knowing how to set a table is a good skill that many people lack.

You will likely find that once the ritual is established, it is easier to get everyone to the table.

Have them help pick out the menu, or help cook.

If you want your kid to be able to make an omelet when they go off to college, having them start young will help them become much more self-sufficient.

To keep the drama to a minimum, have a ‘no thank you’ bowl, where they can deposit food that they don’t want to eat, rather than whining or tossing it.

Give positive attention when they are eating what everyone else is eating, but have a safe food at the ready if they are having ‘that kind of day’

If you can get the family meal ritual set when the kids are young, you have a better chance of keeping it going as your kids get older. Having these opportunities for connection and communication can be invaluable

Thanks to my mom, I did grow up with nightly family meals. But full disclosure, I was not at all consistent with it with my own kids (and they are stellar human beings none the less!)

Looking back, that is one thing I would have done differently.

Even beyond the research, instinctively it feels like a really positive and worthwhile effort.


Friday, September 13, 2024

Picky Eating 2024

 As some of you know, Dr. Ted and I are working on a document addressing the ins and outs of starting solid foods. We are not trying to reinvent the wheel. There will be plenty of links to topics where there is already an existing post. One of those topics is dealing with picky eaters. 

But, when I reviewed my old picky eating post, it felt a bit outdated. Hence this fresher edition. 

I asked my daughter Lauren to weigh in with her wisdom. She is clearly doing something right (okay, perhaps we can add a dollop of luck since every child is so different) but so far I marvel at what an adventurous eater my oldest grandson EJ is. Sushi, Ethiopian, Burmese…. Bring it on! He tries just about anything. Hopefully Coby will follow in his big brother’s footsteps. So far so good.

Picky eating 2024

There are plenty of parents out there who swear that their toddlers simply don't eat. Amazingly enough, these same kids are growing and developing just fine.

It is more common than you might think for young kids to be erratic eaters. There are days when they eat whatever is in front of them and others where parents celebrate if they eat two bites.

It doesn’t matter that it is normal, it stresses parents out!

There are things you can do to start off on the right track.

Offer a variety

Some experts say that toddlers and preschool kids identify foods as either "familiar" or unfamiliar. If they haven't tried it before, this is not the age when they are apt to become adventurous eaters. For this reason I strongly encourage you to offer an assortment of foods to your children their first year of life. Make sure you are giving them a variety of colors, shapes and consistencies. Although I really advise about adding any extra salt, other spices are fair game. Add as many foods as possible to the list of things that they are comfortable with before they move into that stubborn toddler phase. 

If your nine month old seems to be having trouble with the mechanics of eating, it is worth having a conversation with your pediatrician so see about getting a referral to an appropriate resource.

Be aware of the power of attention

The "quest for attention" is something that has its own blog post, but for our purposes here, trust me, kids love attention of any sort. If they find that they can get a big rise out of mom or dad when they don't eat, well you guessed it, they will ignore the food and sit back to watch "the make my parents nuts" show. Avoid that trap if you can.

It is NOT the intent to be making mealtimes all about how much kids are actually eating, but little appropriate bits of positive attention can go a long way.

Make sure you are noticing behaviors that you want to see more of. 

Hey, let's feel your muscles because you just did such a good job eating that nice 'growing food. 

Did you eat carrots? That is so good for your sparkly eyes! 

I see you taking small bites, chewing and swallowing. That is nice safe eating! (and give a nice thumbs up signal)

 Making sure that they overhear you tell someone about what you saw, also counts

Grandma, I am so proud that ____ tried something new

If there is another child nearby, take full advantage of the opportunity and praise good eating observations; chances are your child won't want to be left out. If they see you making a fuss over someone else it usually doesn't take long before they are modeling the same behavior 

Look, I ate my broccoli too, feel MY muscles.

Behaviors that you want to see less of should be ignored within reason.

Oh, you are tossing your food on the floor, that means you aren't hungry. That shows me that you are finished eating, I am going to take the food away now.

Make sure you are quiet and matter of fact. Don't make a huge fuss. You can give them another chance in a bit. With many behavior challenges, consistency is key. It might take a dozen times until they realize you mean what you say.

Give them a better option. Offer  a ‘no thank you’ bowl. This is a place where they can deposit food that they don’t want to eat rather than throwing it on the floor.

Eating with the family is a bonus. Try to make mealtimes a positive experience. Talk about everyone’s day. Focus should be on being together rather than how many peas someone eats.

Below are some tried and true tips that may help you along.

Give your kids very small amounts that they can actually finish. You can always add more. Many kids will get overwhelmed by too much on their plate and won't even have any of it.

Not every meal has to be a performance, but there are things you can do to encourage kids to try new things. 

Make a face out of the food, 2 peas for the eyes, a piece of chicken for the nose,... etc. Make it a game, and laugh when they eat part of your design. 

There are plates that you can buy that have pictures or faces that can get uncovered when they eat.

 You can also consider making your own place mats. Blow up some photos of your family, laminate them and use them accordingly. 

Let's see if we can eat the tofu and find mommy's face.

Use cookie cutters to make your sandwiches into interesting shapes. 

Make a meal with a theme. One meal can be things that are orange, another day you can do things that are curly. 

Make smoothies with all sorts of wonderful ingredients. See if your toddler wants to help drop things into the blender and help turn on the power. Pour the smoothie into a special super hero cup that is used only for the super hero drink.

 Many kids like to dip things. Little sticks of assorted veggies that they can dip into some hummus or yogurt dip makes a nice healthy snack. 

Some kids like adding grated cheese to food. They can sprinkle it or get a safe grater and let them do it themselves

Muffin tins make great little food trays, especially for those kids that don't want their different foods to touch, heaven forbid.

Kids like to eat things that they have helped with. 

Get in the habit of good handwashing before handling food.

Kids with long hair should have it tied back.

Make sure you have a safe stool that allows them to easily reach the counter

Invest in some safe kids cooking tools, so that they can be even more hands on.

Allow them to sprinkle spices (again, try to minimize the use of salt).

Put the desired amount in small separate bowls so that you don’t need to worry about them dumping an absurd amount of something directly from the jars.

 Stirring the food is another helpful job.

When your children are old enough (this is especially useful if you have more than one) let them take turns being on the "make the meal team". No one else is allowed in the kitchen except the chefs. Make an event out of it. Put on your matching aprons.

They can even decorate a menu.

Not everything you try is going to be a complete success.

I did a little experiment with Elliot. I brought out some food coloring to see if we could make a meal a little exciting.

Here are some of the things I learned

  • Trying to get a 3 year old to limit anything to 1 or 2 drops is a challenge

  • Mixing 2 colors is great (and a fun way to learn about primary colors) but it is so hard to stop at two or even 3..more often than not we ended up with various shades of brown

  • Drinking rainbow milk is fun

  • Let other caregivers know what you were up to so that they aren’t surprised by the fascinating poops that come from drinking that rainbow milk

  • The color will come off your hands with a good scrub of soap and water. If it is stubborn, you can rub a little toothpaste on it and then rewash with soap. Talking about that process in advance would have been wise.

Mealtimes should not be 24/7

Some experts suggest that kids who have the option of grazing all day may not do as well at meal times and this can contribute to picky eating.

Toddlers and preschoolers tend to accept the concept that there are times when the ‘The kitchen is open’ and other times when ‘The kitchen is closed’. It is fine to create new rules. They will get used to it.

They don’t really have a clear concept of time, but this is more like a red light green/light concept.

Drinking water is always an option if they want something in between meal or snack times.

You can also add a “last call” ; This can get rid of the bedtime delay tactic of I’m still hungry.

A note about bedtime snacks

A nice snack before bed can become part of the nightly routine. This would be right before toothbrushing.

 It can fill in any nutritional needs they might have missed during the day. 

Try to avoid anything high in sugar, but a high protein snack can actually help with a good night’s sleep. 

A cup of warm milk contains tryptophan, which also might help with sleep.

You can ‘hide’ food (but don’t lie about it)

You can sneak ground up veggies into pancakes, breads, muffins or meatballs

If your little one is genuinely having a hard time getting enough calories, consider adding some pediasure.com 

Sugar and Dessert

I like to refer to food as “growing food” or not. If your child eats a reasonable amount of growing food, it is fine to offer an occasional dessert. Please don’t associate it with a reward or “being good”. It's a delicate balance. I have found that If you completely make sweets unattainable, they become much more interesting.

Nothing but Noodles

If you have one of those kids that is set on only one or two food groups that they accept willingly, be prepared to have one of their ‘safe’ foods as a backup.

Family rule might be that they try one bite of what the rest of the family is eating (applause for trying).

If they don’t like it, calmly offer the noodles (or whatever it is they like to eat). Try to avoid turning it into a power struggle.

The ultimate goal?

Helping your child have a healthy relationship with food!

I hope some of these tips are helpful.

Thanks to my models, EJ, Coby and Sawyer