Feeding

The day is here.

Your pediatrician has said to begin feeding your baby cereal along with his formula or breast milk. What are you going to sit your baby in when you begin to feed? What things are you going to look for in a high chair for beginning feeding and then later when you want to move into self feeding? Is your baby ready to be fed? Can he sit and keep his head in an upright position? Can he bring his hands to his mouth even when he is facing straight ahead? Can your baby maintain his sitting in an upright position for 15 to 20 minutes or will he fatigue quickly? These are all questions that need to be answered by you, the expert on your baby. First of all, your baby should have good steady head control. He should be able to look up and look at your face. He should be able to bring both hands to midline and also to his mouth. His shoulders should remain against the seat back and he should be able to tolerate this position for 15 to 20 minutes. Drinking from a bottle or sucking at the breast should be well established. Most pediatricians do not recommend feeding solids until around six months of age and the necessary factors just listed, are not firmly established until about that time. If your baby is premature you should be going by an adjusted age not his chronological age.

Positioning is very important.

The baby should not be reclined for feeding. Holding the baby in your lap, sitting up in the crook of your arm is great if you are well coordinated and have five arms, otherwise it is better to be able to face the baby directly to see where the food is going and how he is reacting to it. The baby should be sitting up at about a ninety degree angle at the hips. You can use rolled hand towels on each side and one under the knees to keep the baby from sliding out. At this age, there is still a lot of extension going on and many babies arch or extend when they are tired of sitting. You may want to make your first feedings rather brief. Having all of the food ready to go will shorten the time you expect your baby to sit up and be ready to eat.

What should you feed the baby in? Lots of families haven’t yet invested in a high chair. An infant seat or car seat, as long as it isn’t reclined, can be used in the beginning. When looking for a high chair, take your baby along and try him in the different chairs. Most of today’s chairs are designed for a two-year-old. The tray height comes to the neck or chest of the child. The manufacturer seems to feel that a reclining seat back is a great feature but in reality, it is fairly dangerous. When feeding a new baby, be sure that the infant doesn’t throw his head back or is in a reclining position thus opening the trachea (windpipe). The food needs to go down the esophagus, not the trachea. When the food does go down the trachea, it is called aspiration and can result in pneumonia or death. By keeping the head level, the trachea is naturally closed off. It really isn’t as scary as it sounds but it is very important to begin a new baby in a safe correct position. Later, as the child develops greater muscle control and coordination of all the oral-motor mechanisms, it won’t even be a worry. What is really important in looking for a high chair is the seat and tray ratio. Can the baby comfortably rest his arms on the tray? Are the legs supported or do they dangle? If the baby is fairly small, a booster seat can be purchased that has a much lower tray and it can be used again when the child wants to sit at the table, for trips and for restaurants. See

For children with special needs, not being able to prop with the arms, can consume way too much energy and not leave enough cortical functioning for eating, let alone self-feeding. Some highchairs can be adapted by folding towels and placing them underneath the plastic seat upholstery to elevate the baby closer to the tray. A five point harness should also be on your list when looking for a high chair. Many toddlers have pulled to stand in their chairs and by using the tray they are able to either stand up in the chair or to crawl out on the tray. The harness eliminates the problem.

Feeding is a very social time.

You should be sitting at a level that enables you to have eye-to-eye contact. The baby will watch your mouth and you will not be able to avoid opening your mouth as if they needed a little help getting the food in. It is such a fun and intimate time, just as nursing has been only now dad can be equally involved. The baby is so alert and responsive, unlike early feedings when sleep followed feeding. What new things are you going to teach during feeding? Maybe some new vocalizations such as mmm, or taking turns-one bite for baby and one for daddy. Feeding should be at set times and maybe preceded with a song so that your baby will begin to anticipate meal times. Feeding is a time for new tastes and smells and lots of sounds and imitating. When first starting to feed, begin with small amounts and try not to wipe her mouth too much. Once most babies get the hang of eating, all the constant mouth wiping gets them aroused and upset. They just want the food to get into their mouths. Oral reflexes that are not quite integrated can be set off like alarm bells by scraping their mouth or using a cloth in an effort to be neat. Enjoyment of food is a top priority. It is also important to realize that this is the first area of power for your new baby. By allowing him to say when he has had enough and to express his likes and dislikes, will create a good partnership. Let the baby be your guide. Some babies scream all through the meal because you can’t get it in fast enough. Some babies tell you in no uncertain terms when they are through. Listen to them, don’t prolong mealtime after your baby has shown you he has had enough. There will be many more meals! An infant can’t sit through your dinner-time at first but eating with you near the table so he can observe what you are doing is important. Try to gradually increase the time spent eating together and don’t expect too much all at once. Some babies may refuse to eat or may need to be entertained because they were expected to stay at the table too long and mealtime became too laborious. But by all means avoid having the television on, begin to make this a family time where the baby focuses on you not on a commercial.

Allergies are something to definitely keep in mind, especially if other people in your family have food allergies or environmental allergies. Some babies seem at first to do well with certain foods but as certain times of the year come around, when pollen counts are high, they may experience an allergic reaction. Seasonal allergies can upset the delicate balance and affect how certain foods affect the baby. This is your first and only chance to control what your baby eats, so take advantage of it. Go slow, start with a rice cereal and use breast milk or formula to give a familiar transitional taste to the baby. Rice cereal with iron can constipate, so be fore-warned. There is rice cereal without iron and you can steam your own brown rice and put it into the blender with formula or breast milk until it is the right consistency. If you baby has any adverse reactions to this first food-call your doctor and you may need to wait until the baby’s system is a little more mature. Stay with one cereal for a week before you try another because if you have introduced too many new things you won’t know which one caused the problem. Most moms jump right into fruits but there are more allergies to fruits than to vegetables so you might want to discuss this with your doctor too and if he says it doesn’t matter, then do vegetables first. One new vegetable for 3-4 days. Yellow is usually before green. It isn’t advisable to mix the cereal and fruit and vegetables all together, because the baby is developing and trying new tastes and if you mix it all up, he just might not like anything. Fruits should come last for another reason. We all develop a liking for sweet things way too soon and look where we are.

There are quantities of great books and internet resources for parents who want to avoid canned baby food and there are all kinds of varieties of canned baby food including organic baby foods that are already prepared. Something for everyone. Whichever way you choose to go – happy eating!

Laurie Kasa, OTR
South County Staff