Natalie Lambajian-Drummond, M.D.

Pediatrician at Dreyer Medical Clinic - West Aurora

Concerns about nutrition are prompting trips to the doctor in an age when we face a worldwide obesity epidemic. Parents want to teach their children healthy eating habits at an early age.

Experts believe food preferences are generally shaped between the ages of 2 and 3. Since many guidelines about when to start on solids or how to handle a picky eater have changed in the last 25 years, new parents can no longer rely on what their parents may have done.

The decision to start solids is based on the disappearance of the tongue thrust reflex that is present at birth to facilitate nursing – not when a parent wants to prolong night-time sleep. This reflex usually disappears between 4 to 6 months of age. If still present, food introduced into the mouth is forced out by the tongue.

Rice cereal is usually a baby’s first solid because of its hypoallergenic nature. It is best introduced on a spoon, not in a bottle, as a thickened formula through a nipple increases choking risks and can be linked with a higher rate of obesity later in childhood.

Once a child masters rice cereal, fruits and vegetables can be introduced. Some recommendations suggest vegetables first, but fruits are just as easy and once mastered, fruits can help the transition to vegetables. Mixing a little fruit with a new vegetable takes advantage of a baby’s innate “sweet tooth.”

New foods should not be introduced any sooner than every 3 days so there’s time to watch for any intolerance or allergy. A reaction can vary from diaper rash to stomach upset or hives.

By 9 months, most infants are ready for finger foods. The ability to pick up objects with thumb and forefinger is the developmental milestone an infant must master to start finger foods. Cheerios are often used to start because they dissolve quickly in the mouth and supply iron. A total of 20-24 ounces of formula should still be consumed in a 24-hour period to meet basic metabolic needs. Solids can be gradually increased to create a 3-meal-a-day feeding schedule, with most babies consuming ½ to 1 small jar of a fruit or vegetable with cereal at each meal.

Once a child has mastered baby food, they can be transitioned to table food, usually between 9 to 12 months. Soft foods or purees are best but many parents feel frustrated trying to maintain nutritional balance. Many baby food companies and formula makers have played on parents’ fear that their child is not getting enough nutrition and started marketing “follow up” formulas and “toddler meals.”

A toddler’s diet should be looked at in terms of weekly overviews. Important to consider is a toddler’s developmental stage of growing independence, which sometimes translates into single-mindedness about what they want to eat, wear, or do.

Parents should not become short-order cooks. Most toddlers have at least a few foods that they will consistently eat. Parents should try serving one of those preferred foods with a new one at every meal to help widen their baby’s food horizons. Remember that toddlers want whatever their parents are eating, so when parents model good eating habits, the child responds with a balanced diet.

When a child enters school, they discover foods that have been easy to avoid because parents never brought them into the house. This is an optimal time to teach one of the most important nutritional lessons – moderation.

Children can metabolically afford higher calorie foods than adults, but with limits. In this “super-size” age, children are simply eating too much. (Today’s “Happy Meal” is equivalent to what an adult meal was in the 1950s.) Parents do not need to limit what foods they allow, only how much they allow their children to eat. Parents should also limit snacking and combat boredom in their kids, as each are major triggers for overeating.

Once a child is overweight, it is important to talk to their doctor about medically and developmentally sound weight loss. No child should feel deprived, so moderation is the best focus. Severe calorie restriction is dangerous in a growing child, so using this adult method to force weight loss is inappropriate for children.

A better approach is multi-faceted and takes into account familial factors, cultural factors, activity level, and environment. Other siblings, who may be of normal weight, should be included in the plan adopted by the whole family to help a child regain a normal weight.