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There are many changes to a baby's diet in the first year.

While all these changes can be stressful, staying sensitive to your baby's needs will help make the transition to table food safe and enjoyable.

Breast Milk and Formula still Essential

According to the American Academy of Pediatrics (AAP), breast milk is the optimal source of nutrition during the first year. If breastfeeding isn't possible, formula is the next best choice. When solid foods are introduced around 6 months, they shouldn't replace breast milk or formula feedings.

Many nursing mothers worry that their babies will lose interest in breast milk once they begin solids. However, the AAP says that if breastfeeding is well established, then solid food introduction shouldn't interfere with breastfeeding. However, it is common for the frequency of breastfeeding to lessen slightly as your baby eats more solid food.

The combination of solids and breast milk is ideal during the second half of the first year, even if babies nurse less frequently. Babies need 750 to 900 calories during this time and at least 400 to 500 of these calories should be from breast milk or formula.

Starting Solids

Pediatricians recommend starting solid food at 6 months. However, the more your baby's gastrointestinal system is given time to develop, the less likely the risk of developing food allergies.

Your baby also needs to meet two development milestones before you begin solid food. The first is good head control so your baby can support him or herself while eating. Your child must have also grown out of the tongue-thrust reflex, which causes children push food out of their mouth.

Begin by finding a comfortable place for your baby to sit, such as a high chair. This helps babies remain upright and reduces the risk of choking.

The best first foods to introduce are single ingredient foods such as cereals, fruits and veggies. Cereal should be mixed with water, formula or breast milk. Begin with a thin consistency (about one tablespoon of cereal to four or five tablespoons of liquid) and gradually increase the thickness as your baby becomes better at swallowing.

Avoid adding fruit juice to infant cereal. While your baby may begin to prefer the sweet tastes of juice, breast milk is more nutritious at this age. Additionally, large amounts of fruit and fruit juice can make your baby’s stool acidic and irritate the skin, potentially leading to diaper rash.

Food Quantity

Babies grow and develop so quickly in their first year that their needs can change daily. Taking your baby for regular "well baby" check-ups will help you and your pediatrician chart your baby's development. Deciding how much your baby should eat depends on weight gain, readiness and attention span. Approximate weight gain indicates whether your baby is getting enough calories.

Paying attention to your baby's cues is the best way to decide how much to feed your baby. If your baby continues to accept your offer of healthy foods such as fruits, vegetables and cereals, then continue to feed your baby. If your baby shakes their head, pushes the spoon away or keeps their mouth shut, your baby may be communicating that they are done eating.

As babies grow older and begin to explore more, they may be more interested in exploring than eating. Limiting distractions and playing with your child before and after meals may help your baby to focus on food when it is mealtime.

Food Variety

It is best to introduce one new food at a time. Ask your pediatrician how many days to wait between introducing new foods. If your child develops an allergic reaction such as vomiting, diarrhea or a rash, this makes it easier to locate which food caused the reaction.

If your child dislikes a food or has a mild reaction such as stomachache or loose stool, take a break from that food and offer it again after a few days or weeks. It's best to keep a variety of foods on your baby's menu.

A reaction to food may not just be from the food itself, but also from the processing method, packaging or extra ingredients. If your family has a history of severe food allergies, it may be helpful to write down the brand of each new food source, along with the date and amount you fed your child. This documentation can help you and your child's pediatrician identify the source of problems should they arise.

Finger Foods

When your baby is able to sit up and swallow pureed food, he or she can be offered small fingers foods. This helps babies learn to feed themselves. Choose food that is soft, small and easy to swallow. This can include foods such as well-cooked, mashed vegetables such as peas, potatoes and green beans as well as bananas, crackers and wafer cookies.

Around 8 to 9 months, most babies eat three meals a day. Around this time, your baby may be ready to try foods with a thicker texture, including ground meat or combination meals. You can also introduce more finger foods such as diced cheese, turkey, pasta and Cheerios.

As always, paying attention to your child's development level will help you decide when to offer certain table foods to your child. Smaller pieces, no larger than the size of a pea, are best while your child is under a year old. Also, it is best to avoid foods with refined sugar, fried foods and any foods that may induce choking, such as raisins, whole grapes, hot dogs, nuts and raw vegetables. Honey, fast food and chocolate should be avoided until your child is older than one year.

Mealtime can become a wonderful time for your family to be together. Your child is always watching and imitating you. If you eat a nutritious diet, your child will grow to do the same.

Rosann Nichols, MD

Methodist Physicians Clinic Hawthorne Court (178 & Q)

Dr. Nichols answers your questions about child health and parenting. As a mom of three children, she tells her patients that she is in the parenting trenches with them and she can relate to what they are going through. She enjoys answering questions from her patients and their parents and helping parents adapt to the changes a growing family brings. She builds trust with parents and helps them understand that they are not alone and that they can call her office anytime if they have a quest ...

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