Eating and Nutrition
This is a hugely important topic at all ages and stages of life. Clearly, we in the United States can use some help here. The most important concepts to remember are moderation, variety, enjoyment, and discipline. Calories do count! The beauty of most all children is that if they given proper access to food, they very tightly control their calories to exactly what they need for proper growth. This does not mean that they will necessarily make the correct food choices; actually, they may very well not! As parents, it is our responsibility to provide our children with healthy food choices and let them decide how much to eat at any given time. There will always be exceptions to the rule, but in general, if these habits are started very early, there are very few problems.

It is important to understand that children’s nutritional needs vary and change as they develop and grow. We will go through, in a general way, the nutritional needs of kids from birth through adolescence. For more specific information, consult your pediatrician, pediatric nutritionist, and some of the internet resources like www.kidshealth.org and www.aap.org.

Foods to Aviod
Eating and Nutrition for a Child Birth to 4 Months Old
Eating and Nutrition for a Child 6 to 9 Months
Eating and Nutrition for a Child 9 to 12 Months
Eating and Nutrition for a Child 1 to 2 Years
Eating and Nutrition for a Child 2 to 4 Years
Eating and Nutrition for a Child 5 to 12 Years
Eating and Nutrition and Adolescence
Couple of my favorite recipes

Foods to Avoid

Foods to Avoid Before 9 Months Old (because of allergies)

Tropical fruits: mango, papaya, guava, and kiwi

Berries: strawberries, blueberries, raspberries, blackberries

Citrus Fruits: oranges, grapefruits, tangerines, lemons, limes, and tomatoes

Wheat or Mixed Cereals

Foods to Avoid Before 12 Months Old (because of allergies)

Eggs including the yolks

Dairy especially milk, cheese, cottage cheese, sour cream, and ice cream. If you want to try some yogurt at 9 months it’s probably ok but be sure to get whole milk yogurt not low fat.

Fish and Shellfish

Nuts of any kind including and especially peanut and peanut butter.

Raw or Uncooked Honey should be avoided because a baby under 12 months can become infected with botulism, a deadly infection that can contaminate raw honey. People over 1 year old are not at risk for this.

Foods to Avoid Before 2 Years

Peanut butter because of allergies. However, even at the age of 2 children should only have smooth peanut butter because of the risk of choking on the peanut fragments in chunky peanut butter.

Foods to Avoid Before 4 Years

Peanuts (whole or chunks) because of the choking risk

Popcorn because of the choking risk.

Please talk to your child’s pediatrician about more details on food recommendations.

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Eating and Nutrition for a Child Birth to 4 Months Old

This age group has rather straightforward needs. They ideally should be fed breast milk for at least the first 6 months. Some women have difficulty with breastfeeding or choose not to. Although we strongly encourage breastfeeding, it is not for everyone. Accept your choices and circumstances and be happy. Formulas are readily available and are a good substitute for breast milk.

Unless specifically instructed by your pediatrician, no baby under 4 months needs any plain water!

As far as breastfeeding goes, it is not always easy. Some babies have a hard time latching on and some women’s breasts are not easy to latch onto. Sometimes milk supply is an issue. For most women, their breast milk does not come in for between 3 and 5 days after the baby is born. This can be very frustrating and frightening especially with the influence of hospital nurses, family members, and mother’s own desire to make sure baby is getting enough to eat. First, understand that baby’s are born with extra water weight and generally lose it in the first 3-5 days of life. When a baby loses about 5-10% of its birth weight, the appetite generally kicks in and the baby will want to feed about every 2 hours. Once, this weight loss occurs, is exactly when mommy’s milk tends to come in. Sometimes, things are delayed or the weight loss in the baby occurs too quickly. The baby will usually become jaundiced (yellowing of the skin and eyes) and have less urine and stool out than expected under these circumstances. The pediatrician should be evaluating the baby every day while in the hospital and within 1-2 days of discharge from the hospital to monitor for these kinds of problems.

In general, when breastfeeding in the first few days of life, mommy will produce colostrum (pre-milk) which is small in volume but packed with immunity boosters and some nutrition. The baby should be put to each breast for 7-10 minutes approximately every 2-4 hours. Count from the start of one breastfeeding to the next. In between breasts, attempt to burp the baby for 1 minute. If no burp occurs move on to the second breast anyway. After finishing nursing on both sides, attempt to burp the baby for up to 10 minutes. If the baby doesn’t burp in that time, it’s unlikely more time in that effort will produce a burp, and it will tire both mommy and baby to keep trying. Understand that the air the baby swallowed while feeding will eventually come out the baby’s bottom end as gas. It is not harmful, although it may be uncomfortable for the baby as it passes through the length of the intestinal tract. Either it comes up as a burp or out as a “toot”, either way it is coming out! Until a baby has reached back up to or beyond the birth weight, he or she should be fed every 2 to 4 hours. Although tempting to let or allow the baby to sleep for longer stretches, in those early days the baby’s blood sugar can dip low in between feedings and it can also result in poor weight gain, dehydration, and jaundice.

Most formula fed babies take the equivalent of 1 oz/ hour. In general, they eat 2-4 ounces every 2-4 hours. For smaller sized babies, their stomachs can maybe only hold 2 ounces at a time so they may have to eat more frequently than a larger baby does. Some larger babies still eat every 2 hours. Every baby is an individual. Try to respond to the needs of your baby within the boundaries I have explained. For babies getting enough to eat, they will usually have between 6 to 8 diapers/day and have soft yellow stools. Breast fed babies tend to have looser stools and more frequent stools than formula fed babies and may stool with and in between every feeding!!! That is a lot of stools. Yet, there are some breast-fed babies who don’t stool every day. Check with your doctor to be sure the stooling pattern is ok.

Understand that babies, especially newborn babies, cry. Initially, it is the only way they have to communicate. Not every time a baby cries does it mean that it is feeding time. Sometimes babies cry because they are tired or over stimulated or gassy or peeing or pooping or just because. If it has been less than 2 hours after a good feeding, the baby has been changed, swaddled, cuddled, and loved; it is unlikely that the baby is hungry.

Good eating habits start this early by good choices of milk for the baby, either breast milk or formula or some combination of both. No water, juice, or cow’s milk should be given at this time (unless instructed by the pediatrician). No solid foods of any kind before 4 months, again unless instructed by the pediatrician. Sometimes, for a baby who brings stomach contents up into the esophagus (ge reflux), the doctor will recommend medicine and/or thickening feedings with rice cereal. In general, this is not necessary and not recommended. Adding cereal to the bottle allows the baby to get a lot more calories from the formula with the same amount of effort as with plain formula. This can set up eating habits that promote obesity later and is discouraged. Babies should eat solids from a spoon and drink their milk from the breast or the bottle. Most babies have a strong reflex to thrust out their tongue when anything goes in their mouth, up to around 4 to 6 months. This reflex helps ensure proper feeding from a nipple and so before 4 months, a baby is unlikely to be able to eat from a spoon, and doesn’t need to anyway.
4 to 6 months.

Between 4 to 6 months, depending on baby and mommy’s interests in starting solids, now is the time to start having some new fun. Initially, we recommend starting out with baby rice cereal mixed with the baby’s primary milk source to make the taste familiar. Experiment with the consistency of the cereal to find what the baby likes. Once the baby has the hang of eating from the spoon once a day with the rice cereal, add a second feeding of rice cereal. Once the baby is tolerating the 2 feedings/day well with no bowel problems or other intolerances, start to add in single ingredient fruits and vegetables. If you want to make the baby food yourself, it is fine, just make sure to make a smooth puree. You can mix it in with the cereal or serve one separately from the other. Offer 1 new food every 5 to 7 days to make sure that there is no allergy. If you have offered 3 new things one week and the baby gets a rash or abnormal bowels, which one was the problem? If a baby has tolerated a food for 5 to 7 days with no problem, that food is no longer “new” and can be offered as much or as little as you like.

Babies naturally prefer sweet tastes and some experts recommend giving vegetables before fruits. Whatever feels right to you is fine. One new food every 5-7 days is the most important rule of thumb. There are some specific foods to avoid before certain times and they are listed in the section below. Sometimes in the baby food section even in the stage 1 foods, you will find these “foods to avoid” so just avoid those jars, especially if there is a strong family history of food allergies on either side of the family.

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Eating and Nutrition for a Child 6 to 9 Months

Between 6 to 9 months, babies should be starting to take in 3 solid meals/ day like adults do plus their milk. They should be fed breakfast, lunch, dinner, and eat something in between the meals as well, even if that is their milk from the breast or bottle. By this time, they should also be starting to eat meat-based solids too, like chicken, turkey, lamb, beef, and pork. Remember, no fish or shellfish until 12 months! You can make your own meat based baby foods by grinding up what you eat or buy the jars. It is perfectly fine to mix meats with vegetables or fruits like the baby food companies do, most babies like that anyway. Babies should be fed meat 1 to 2 times/day. Some babies by this time are also ready to progress beyond a smooth puree to some texture. Every baby is different. Choking is always a risk and babies should not be left unattended at this age while eating. Some babies do well with stage 3 texture which is chunks in puree and others get confused by the combination and will do well with chunks alone or puree alone. Be patient with and respectful of your baby. Every baby eventually figures out how to eat textures and yours will too! Some babies are more motivated than others toward eating, this is natural. If you feel there is a problem with your baby’s eating discuss it with the pediatrician. Some babies love to eat with their fingers; others really prefer being fed from a spoon. Again, work with your baby and stop worrying about what other babies do or even what your other babies did. Everyone is an individual. Part of raising a healthy child, is respecting that child…even this early!

Cheerios are a great finger food at this age because they are oat based, not presweetened, and melt quickly in all the saliva the baby is producing at this time. They are very portable and make a nice snack or pre-meal distraction until the real food comes. Since most kids are teething at this age, biter biscuits are ok, but never leave the baby alone with them.

What about JUICE? Juice is one of the most misrepresented foods I know of. It is, unless you juiced it yourself, nothing more than sugar in a glass. It is the nutritional equivalent of candy bars. When they make juice, they take the fruit, process out the fiber and most of the nutrition from it leaving sugar water, and then add back some vitamins. We would be far better off to get those vitamins from real fruits and we would certainly get all the fiber and other nutritional elements the juice is missing if we ate the actual fruit. SO, avoid juice as long as you can (unless specifically instructed by the pediatrician). If you never had something, you don’t miss it. Babies at this age should drink water and their milk (breast or formula). Offering a sippy cup at this time is a great thing to do. Some babies like it some don’t. Keep trying and one day your baby will get it.

Get your baby used to eating meals in the highchair and in the same place all the time, except when you go out. Babies this young should not have any fast food or soda ever. Consistent mealtime routines are best started now and continued as the child grows.

For some very physically mobile babies at 9 months, they may start to reject baby food. This is especially true of babies with older siblings who are eating table food. They just want to do what everyone else is doing. Let them! As long as there are no FOODS TO AVOID and the texture is something they can handle, go for it.

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Eating and Nutrition for a Child 9 to 12 Months

The first thing to remember about this age group is that their growth rate is slowing down compared to the previous months. Therefore, there is usually a relative decrease in appetite starting around this time and continuing into and through age 2-3 years. This can be confusing and upsetting to parents if you didn’t know about this. Remember that kids are excellent at controlling their calories. Just continue to provide healthy food choices and consistent eating routines and let the child determine how much is enough. Most all babies stop eating when they are not hungry anymore. They have excellent connections between their stomachs and brains and stop when they are satisfied unless they are consistently pushed or encouraged to go beyond that. Babies give clues that they have had enough, like turning their head away, pushing back and away from the food, knocking the spoon out of your hand, and starting to “play” with their food. When you see these things happening, make one or two more gentle efforts to feed the baby and then QUIT! Do it with a smile and a tone of approval at how well the baby ate, even if it wasn’t so well. You don’t want to show your disappointment, even though you might naturally feel it, because the baby will notice those cues and it may set up dysfunctional relationships with food and eating in the future. Eating experiences should be enjoyable and pleasant for babies and continue that way into childhood, adolescence, and adulthood. You can avoid lots of eating problems if you start with these good habits early.

Between 9 and 12 months, you can start to introduce more of the formerly forbidden foods, much to the excitement of baby and parents. In addition, at 12 months, or just before, you can start to transition baby from breast milk or formula to whole cow’s milk. We discourage having regular cow’s milk be the baby’s primary milk source before 12 months because it is very low in iron (which babies really need before 12 months) and cow’s milk is a highly allergenic food. When a baby does go onto whole milk, the amount taken per day should be no more than 24 oz./day. More than this can contribute to iron deficiency anemia and may also cause constipation as well as decrease a child’s appetite for other healthy foods. Whole milk, unlike formula, is not a complete nutrition source, but it has almost as many calories per ounce as formula does. For a child who is excellent at total calorie control, too much milk results in intake of fewer calories from other food sources. Also, between the ages of 1 and 2 years, children should consume only whole milk because their brain needs the extra fat for its development.

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Eating and Nutrition for a Child 1 to 2 Years

As discussed above, these kids should be on whole milk only. If you continue breastfeeding beyond 1 year that is ok, but there is no reason to spend money on formula, even the newer follow up formulas at this point. Kids this age are usually very physically active and getting to be quite mobile. They use more calories during the day than ever before, can’t, and shouldn’t take in the calories each day to keep up the same growth rate they had been doing before. Review the growth curves with your pediatrician to see this clearly. Also, sometime in this age range, most all kids start to get picky if they weren’t already. This can be difficult to deal with. First, take your emotions out of it as much as possible. Realize that it is no offense to you if your child doesn’t want to eat much or even anything at any one given meal. Sometimes this “lack of appetite” can appear to go on for days. The secret is that at this age kids get their calories in over a week rather than on a daily basis. If you are gauging the eating habits of a child over any one day in time, you are probably going to get it wrong. Many reasons underlie this phenomenon. Among them are the fact that kids at this age are very distracted by playing and exploring their world. Sometimes those activities take precedence over eating. Also, they are starting to test boundaries with everything in their life and especially with parents. Eating and food are no exceptions. Sometimes there are teething issues and sometimes kids are sick and their appetite is decreased. It is during these times that a parent’s patience and will really be tested. Kids often would prefer to eat and run and eat and play and carry food around with them as they go. Be careful not to indulge too much of this. Kids need to have consistent eating routines and that includes sitting for meals. Sometimes you have to strap the child into the highchair or booster chair because they won’t stay in a regular chair. Negotiate on the play issue by allowing some toys to come to the table with the child. Let the child play and eat at the same time, at least he/she is sitting right? Talk to your child while you are feeding him/her. If your child is good at self-feeding, sit, eat, and talk together. Sing songs while eating. Pretend to feed the toys, your child will copy you. Pretend to feed other objects around the room which engages your child, reviews/teaches vocabulary while at the same time incorporates eating at the same time. Avoid making numerous different things at each meal to try to get the child to eat something. This will become a major pain in the future if you don’t avoid it now. You can offer 1 or 2 things and if the child doesn’t want it, say “Ok I guess you aren’t that hungry.” Do it with a smile and no hint of disapproval or anger. The child is not rejecting you, he’s rejecting the food! Remember that. As long as the child has spent a reasonable time at the table, approximately 10 minutes, let him go and play. Quietly and happily clean up the table and proceed to the next non-food related activity. Avoid the impulse to then chase after the child offering this or that, which he may just take and eat. The reason is that then you have undermined your whole plan and goals. The child gets the message that he can call all the shots and that he can use food and eating as a power tool over you. This is exactly not what you want. Kids need consistent boundaries. Eventually the child will learn that if he/she is hungry, the time and the place to eat is at the table at mealtime. In between meal snacks are both necessary and encouraged, but DO NOT replace meals.

In between meal snacks should be as healthy as possible. We, in the United States, seem to equate snacks with junk food. This is unfortunate, and it leads to overweight and obesity and the medical problems that follow from there. Why can’t a snack be fruits or vegetables or cheese and crackers or yogurt or any number of creative ideas you can come up with? Snack can be leftovers from the last uneaten meal too.

Remember to offer your child plenty of fluids during the day. Especially during the summer months and especially in desert climates like Las Vegas, this is really important. Be prepared to have several different cups for your child to drink from, kids get bored easily. If your child still takes a bottle, try to reserve its use to critical times, like before naps and nighttime. Most kids who still use a bottle beyond age 15 months need the sucking for comfort. There is nothing wrong with that. However, the goal should be to get rid of the bottle by or before age 2. The child should not be allowed to run around with the bottle all the time. This sets up poor eating habits and may result in excess milk intake. Additionally, the child should never have the bottle in bed. Most all children have teeth by the age of 12 months and sugary liquids bathing the teeth at night sets them up for serious dental disease. The child should be given up to 24 oz of whole milk per day and no more than 4-6 total ounces of juice per day. If you put 4 ounces of juice in a cup with 4 ounces of water, even though the child may drink 8 ounces of fluid, only 4 ounces of juice have been consumed. This not only saves on calories and dental cavities, it saves money as well. The rest of the fluids the child drinks during the day should be water. Some children don’t seem to like water that much and they can be a challenge. First of all, practice what you preach. If your child sees you drinking anything but water, chances are that what he’ll want too. Children love to drink from mommy’s cup. If you’re drinking soda, you’re either going to have to say no to your child or give soda. I recommend you drink water too so that when your child asks to drink from your cup, you can have no hesitation to hand it over. This may require some sacrifices on your part. Make them because your child deserves it and your health deserves it too. Do not give soda to your child especially between ages 1-2 years.

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Eating and Nutrition for a Child 2 to 4 Years

This age group is really cementing habits learned up till now. Tastes are developing, and a lot of finicky behaviors can persist during this time. Kids are also maturing and are often being exposed to other kids and their eating habits. This can make for some fun and challenging times. Kids at this age are also much more verbal than before which can be used to advantage. They also have a strong curiosity and are receptive to learning new things. It is very important to keep consistent eating routines going at this time and to continue to practice the good habits you have been working on thus far. Even, if your habits have been less than great up till now, kids in this age group are very malleable and with a little consistent persistence, you can make any changes needed.

Children in this age group should be fed breakfast, lunch, and dinner as well as at 1-2 snacks/day. They need still to be given access to healthy food choices and to be allowed to determine how much they are going to eat. They must not be allowed to substitute junk for good food. Some meals go very well, others don’t. Accept this as normal. If a child in this age group asks to eat the same thing every day for 5 days, as long as it is a healthy food choice, let him have it. Even though you might be bored eating that way, it’s ok for kids. Do not give in to the whining and begging that can go on when a child doesn’t get the food he wants at that moment. Don’t take rejections of food as a rejection of you. It really isn’t.

Please check out the following link to see the food pyramid for kids at www.usda.gov/cnpp/KidsPyra/LittlePyr.pdf.

At age 2 years, the child should be switched to all low fat dairy products. This means either 2%, 1% or skim milk. Nobody over the age of 2 needs all the fat from whole milk. Cheese can be found in low fat options and still be pretty tasty. Low fat yogurt is easy to find. I recommend avoiding the yogurts that contain aspartame or NutraSweet unless your pediatrician specifically recommends using them. Kids should have between 2-3 servings of dairy/day. This can be between 18-24 oz of milk per day, or less milk combined with yogurt and or cheese. Yogurt is an excellent source of calcium, and there are many fun kinds of yogurts for kids on the market. Ice cream is not a significant source of calcium, but it is a fun desert and should be enjoyed in moderation.

For those kids who really seem to dislike milk, cheese, and yogurt, I have couple of suggestions. Add chocolate or strawberry powder to the milk to flavor it. It is a little bit more calories, but it’s worth it for the calcium benefits. Sometimes you can disguise the milk/yogurt in a fruit shake. You don’t have to go to Jamba Juice, which is expensive and gives huge portions, but you can make similar things at home. You can use frozen fruit, fresh fruit, combinations of them, honey, vanilla, cinnamon, chocolate, whatever your creative minds can think up. You just need a blender and some ice if you are not using any frozen fruit and the fun begins. These shakes can be for breakfast, snack, or any meal, really, although not for every meal. I recommend avoiding the use of high protein powder shakes in children.

Children in this age group should, as should all older children and adults, have fast food no more than 2 times each week. If you can have it less than that, great! As far as sodas go, they should be avoided as much as possible. DO NOT keep sodas in your house! People will drink them if they are there. It is really that simple. Try to avoid giving kids sodas with caffeine and NutraSweet. Limit the portions of soda to 4-6 ounces and don’t allow it more than 2 times each week. Try also to limit intake of juices, unless you are juicing yourself, to 6-8 oz each day.

Print out a copy of the food pyramid at www.usda.gov/cnpp/KidsPyra/LittlePyr.pdf and hang it in the kitchen where the kids can see it. Let them explore it, ask questions, and try to keep track of what they are eating to see if they have a healthy pyramid. Take them shopping with you and let them pick out healthy foods to buy. Take the food pyramid with you to the store to make sure you are buying the foods they need to eat. ,Also, read the handbook on how to use the food pyramid at www.usda.gov/cnpp/KidsPyra/PyrBook.pdf.

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Eating and Nutrition for a Child 5 to 12 Years

This age group is really starting to learn become set in the habits that have been established, but of course, as kids, are still open for changes. Keep trying to stick to those good healthy habits and routines. As kids’ schedules get busier and with school thrown into the mix, it can be hard to stick to your routines and your guns. Make it a priority and remember to be flexible. Kids are learning life coping skills from you at this time, so be a good role model. Hopefully kids in this age group have structured physical activity as well so remember that snacks and portable food are very important. Also, remember to have plenty of water available for drinking, especially when it is hot.

For more specific information on the food pyramid guide for kids older than 6 years check out http://www.usda.gov/cnpp/pyrabklt.pdf. Portion sizes for kids this age group are generally what can fit in the palm of the child’s hand. This is a good rough estimate of portion size. You can always talk to the pediatrician or a nutritionist for further guidance.

Since this age group cannot drive to the store, they are still dependent upon you to provide food choices. This is fortunate because they are not reliable to make healthy or proper food choices at this time.

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Eating and Nutrition and Adolescence

This can be a very challenging time as we all know, and not just with respect to eating habits. However, eating habits can be pretty awful among teenagers. If their foundation was solid, chances are things are going pretty well and a moderate amount of reminding and keeping the patterns going will be required. However, if things have already gotten off track, this can be an incredibly difficult battle. It’s one you really have to fight though because it only gets harder once a person becomes an adult. The statistics show that if a child is obese/overweight by age 13, there is a greater than 75% they will remain that way as an adult!!

Be sure to take you teen to the pediatrician once a year for a complete physical exam. This should include a measurement of weight, height, calculation of BMI (body mass index) all to be plotted on the growth curve. Also, they should take your teen’s blood pressure and perform a complete examination of his/her body including the spine and genitals. Eating habits and exercise habits should be discussed at this visit. This can help to reinforce what you have been saying and hopefully doing already at home.

Some specific eating issues that can come up during adolescence are meal skipping, substituting sodas, and junk food for meals, excess fast food, and eating disorders (see http://www.kidshealth.org/parent/emotions/feelings/eating_disorders_p2.html). It is important to address these issues head on, although it may be difficult or impossible to do it alone. Ask your pediatrician for help or a referral. You and your teen should check out www.kidshealth.org for more information on these subjects.