Having a new baby creates an abundance of decisions for parents, with providing the best nutrition at the top of the list.

Both the American Academy of Pediatrics and the American Dietetic Association affirm that exclusive breastfeeding for the first six months of life, and breastfeeding with complementary foods for at least twelve months is the ideal feeding pattern for infants, whenever possible.*

There are health benefits associated with breastfeeding for both mother and baby. For babies there is a reduced risk of ear infections, gastroenteritis, respiratory illness, sudden infant death syndrome, and obesity and hypertension later on in life. For moms, improved outcomes include a reduced risk of breast and ovarian cancer, Type-2 diabetes and postpartum depression. Breast milk is nature’s ideal nourishment for baby, containing the right amount of fat, sugar, water, protein and other nutrients for optimal growth and development.

Let’s answer a few questions about providing for your infant’s nutritional needs:

1. If I can’t breastfeed or decide not to, how do I pick a formula that will meet my baby’s needs?
   Be assured that modern science has enabled manufacturers to create formulas that closely resemble breast milk as far as protein to carbohydrate and fat ratio, and vitamin and mineral content. The decision of what kind (brand) and how much should be the decision of the physician who is caring for your child.** The one thing missing from formulas is the immune-quality of breast milk.***
   
   
2. If my baby doesn’t tolerate a milk-based formula, what are my options?

   If your baby has digestive issues with a milk-based formula, consider switching to a soy-based formula. Sometimes it is the lactose in cow’s milk that challenges digestion. Remember that regular soy milk from the dairy section or shelf does not have the necessary nutrients to support growth and development. Infant formulas are the only option for early feeding besides breast milk.
3. What about formula fortification?

   When babies are breastfed, they usually don’t require extra iron because the iron in mother’s milk is easily absorbed. Iron fortification is essential for bottle-fed babies. Formulas with a cow or soy milk base require added iron to cover baby’s needs. As your baby progresses to the cereal stage, you will find that baby cereals come fortified with iron.
   
   
4. What else does my baby need that is not in a standard formula?

   Human breast milk is a natural source of the omega-3 fatty acids, DHA (docosahexaenoic acid) and ARA (arachidonic acid). DHA and ARA are essential fatty acids, which means that human bodies can’t make them from other molecules so we need to eat foods that contain these omega-3 fatty acids. DHA and ARA are found throughout the body – they are responsible for proper growth and development, especially for eye and brain development.
   
   

   Before baby is able to eat foods, it is important to provide for DHA and ARA in breast milk or formula. Later in life, organ meats and fatty/oily fish will provide a source. These omega-3 fatty acids are added through fortification to an increasing number of foods that are available in the grocery store.
   
   
5. How much and how often to feed baby?

   Plan to feed on demand – when a baby signals hunger. A formula-fed baby may not eat as often because formula digests more slowly than breast milk. ****
   
   

   Let baby decide how much to drink. Babies will self-regulate. This is the perfect opportunity for baby to learn hunger and fullness cues.
   
   
   You’ll know if baby is getting enough by observing if there are 6 or more wet diapers a day, if baby seems content between feedings and if baby’s weight is steadily increasing. ****
   
   
6. When do we start spoon feeding?

   Age is just a reference point but most babies are ready to start spoon feeding at about six months of age or before. What is most important are developmental readiness signs – so look for these signs:
   
   

   • Has baby doubled his/her birth weight, or weighs at least 13 pounds?
     
   • Head control is important – if baby can lift up his or her chest, shoulders and head when lying tummy-down, then he will be able to signal that he’s had enough food.
     
   • Does baby still seem hungry after eight to ten breast-feedings, or 32 ounces of formula?
     
   • If you can answer yes to all of the above, you can start spoon feeding. Use a small spoon with a long handle and put just a little bit of food on the tip of the spoon. For successful swallowing, baby should be able to push his/her tongue back and forth, and after a few tries, down it goes!
     
   • Start with just a teaspoon or two and work up to one to two tablespoons, two to three times a day.
     
     
7. What type of baby food should we start with?
   
   

   • Iron-fortified infant cereal digests easiest. Mix with breast milk or infant formula.
     
   • Try infant cereals in this order: rice, oats, barley and after baby is 6–12 months old, introduce wheat
     
   • Use single-ingredient cereals first – leave the jars of cereal and fruit until you have tried each single ingredient.
     
   • Introduce new foods one at a time, with 3 to 5 days between new foods. Be alert of baby’s appearance and behavior for any signs of allergic reaction: rash, hives, runny nose, diarrhea, gas, vomiting and irritability.
     
     
8. Any other tips for first foods?
   

   • Babies are especially vulnerable to food-borne illness, so keep these safe practices in mind:
     
     • Put baby food in a separate dish to feed, instead of spooning from the jar. Enzymes and bacteria from baby’s saliva can spoil food in the jar.
       
     • Refrigerate baby’s food promptly.
       
   • Humans are hard-wired to prefer “sweet” taste, so baby may naturally reject tart or less-sweet foods. Keep offering food like carrots, squash and green beans. Research shows it can take up to 10 exposures for baby to decide if he likes a food!
     
   • Exposure to fruits and vegetables early sets the stage for more variety later! Help to prevent a finicky eater at age 2 – 3 years.
     
     
9. What about making homemade baby food?
   
   Making your own baby food can be cost-effective and rewarding. You have control over ingredients and additives. Soft fruits can be mashed or pureed in a blender.
   
   

   • No added salt or sugar
     
   • Little or no added fat

How to make homemade baby food:

1. Cook food (steam vegetables until tender, poach meats in a small amount of water). When preparing cooked foods for baby, keep in mind:
   • No added salt or sugar
   • Little or no added fat
   
2. Mash, add liquid and process into smooth, appropriate textures
   
3. Spoon into ice cube trays and cover
   
4. Freeze 8 – 10 hours, remove cubes and place in freezer bag.
   
5. Keeps for about 6 weeks, frozen solid.
   

Apple Carrot Casserole (A Step-2 Food)

• 2 Tablespoons fresh apple puree (or baby food)
  
• 2 Tablespoons fresh carrot puree (or baby food)
  
• 1 Tablespoon cooked pastina or finely chopped spaghetti

Directions: Mix all ingredients together. Warm slightly (optional) and serve.

* American Dietetic Association, Position paper: “Promoting and Supporting Breast Feeding , Vol. 109, Issue 11, Pgs 1926-1942.
** http://aapnews.aapublications.org.
*** www.earthsbest.com/content/infant-choosing formula
**** Roberta Larson Duyff, American Dietetic Association, Complete food and Nutrition Guide 3rd Edition, John Wiley & Sons, Inc. 2006.