FEEDING GUIDELINES
AGES 4 TO 6 MONTHS

STARTING SOLIDS: FULL-TERM INFANTS
Solids are begun at 4-6 months of age. Most infants are ready by age 4 months, but some parents choose to wait until age 6 months. Although some experts recommend starting solids at age 6 months for all infants, there is controversy as to the validity of claims that starting solids earlier causes increased incidence of allergies or other health problems. Again, most infants are ready and interested in solids by age 4 months. Only in rare circumstances are solids such as cereals begun earlier than 4 months. Please call our office to discuss this if you feel that your infant should start solids earlier than 4 months.

STARTING SOLIDS: PREMATURE INFANTS
Infants who are very premature(Less than 35 weeks) may not be ready for solids at age 4 months and may be more ready at 5 or 6 months of age depending on their degree of prematurity and other circumstances. We will normally discuss this with you at the well child routine visits.

PROCESS OF STARTING SOLIDS AND FEEDING PRACTICES DURING THE FIRST YEAR OF LIFE:

1. Begin with rice cereal on days 1,2 and 3, offering it twice daily at breakfast and dinnertime. Rice cereal can be mixed with water or milk(breast or formula) to make a thin oatmeal like consistency. The infant should be offered a rubberized spoon. During these first three days, offer 3-4 tablespoons at a time but be flexible. Some infants will be very hungry and want more- that's OK. Offer as much as the infant wants until he/she loses interest or spits the food out or pushes the spoon away. Parents should learn to use the infant's own cues of hunger and satiety to guide the amount of food that is offered. Never force feed a stubborn infant; just wait for the next mealtime. If the infant only wants 2 tablespoons- that's OK too.

2. Add a single fruit on days 4,5, and 6. Continue twice a day feeds. The fruit can be mixed in with the cereal in one big bowl of mush and offered that way or given separately. Offer 2-4 ounces at each sitting. (Again, some infants will take more and some will take less, some may not want any-that's OK too,). Common starter fruits include apple sauce, pears, bananas, and peaches. Prunes are especially helpful for constipated infants.

3. On day 7, add a single vegetable and change to three meals a day. Some of the popular starter vegetables include carrots, peas, squash, green beans, and sweet potatoes. One popular feeding schedule at this time is cereal and fruit for breakfast, fruit and vegetable for lunch, and fruit and vegetable again for dinner. Notice that we usually drop cereal down to once per day at this time. Some parents may elect to continue to offer cereal twice a day at either lunch, dinner, or bedtime "snack", but we prefer to emphasize fruits and vegetables.

4. Every 3 days, add a new food- alternate between fruits and vegetables so the infant learns to appreciate the tastes of both right from the start. You can offer multiple foods on any given day, but only offer one new food every 3 days. This helps to identify a food allergy or intolerance by not offering two new foods at the same time.

5. STAGED FOOD JARS- What To Do?
With this schedule, it takes roughly 3-4 weeks to work through all the common starter fruits and vegetables. Therefore, at 3-4 weeks after starting solids, you can move from single stage 1 food jars to stage 2 jars of fruits and vegetables, mixed fruits, mixed vegetables or mixed cereal with fruit jars. Usually, the only difference between stage 1 and 2 is that the jars are bigger, the consistency is a little thicker and there are combination items. Stage 2 jars remains pureed and easy for infants to handle with the rubberized spoon by age 5-6 months . Animal foods like meats and chicken are usually begun at 6-7 months of age. Stage 3 jars are also deferred until after 6 months of age.

6. How Much To Feed?
We prefer parents to use the infant's hunger cues as a guide to how much to feed, since the infant's appetite will vary from meal to meal. A rough estimate is as follows: Age 4 mon-offer 2-4 total ounces per feed, Age 5 mon-offer 4-8 ounces total per meal, Age 6 mon-offer 6-12 ounces total per meal.

7. Remember To Be Flexible!
Don't get caught up in rigid feeding practices. Mealtimes may change once in a while and the infant may not be hungry from time to time. A good method is to start with a vegetable at a meal, then when the infant gets bored of the vegetable, move on to some fruit. On the other hand, if he is enjoying the vegetable and eats 6 ounces, he/she may not be interested in the fruit, so then you can start at the next meal by offering a fruit first.

8. How do I Schedule Milk Feedings and Solids Throughout the Day?
Breast milk or formula intake remains quite high even after solids are begun. We prefer to offer the breast milk or formula  either roughly 1 hour before the solid meal or 1 hour after the solid meal so the infant's stomach has time to empty. This means that you might be spending a lot more time feeding your infant. Again, be flexible and create a schedule that works best for you. Here is an example of a typical schedule:

Early AM (6-7AM):   Milk feeding
Breakfast (8-9 AM):  Solids
Mid-Morning (10-11 AM):  Milk feeding
Lunch (12-1 PM):  Solids
Early Afternoon (1-2 PM):   Milk Feeding (optional)
Late Afternoon (4-5 PM):  Milk Feeding
Dinner (6-7 PM):    Solids
Evening (9-10 PM):      Milk Feeding

The above schedule provides for 4-5 milk feedings and 3 solid feedings per day all between 6 AM and 10 PM. Notice the optional early afternoon milk feeding allows for 5 milk feedings per day. Some infants may do well with milk and solid feedings right after one another which may allow for more of a time break between feeding times. By 4 months of age, parents should stop middle of the night milk feedings and encourage the infant to sleep a good 8 hours without any food or drink. Good Luck!

9. Are There Any Brand Preferences?
We do not have strong brand preferences for infant foods. We prefer brands that have the least amount of preservatives and additives, including salt or sugar. The major brands are usually fine. Frozen infant solids are probably better since the food is preserved better, but there is the inconvenience of thawing the food before feeding time. Beware that microwaves may cause the food to be very hot in some places and not in others. Many parents make their own infant pureed solids by storing portions in ice cube trays for individual servings.

10. What About Juices?
Try to avoid juices for both infants and older children. The reason is that juices contain mostly sugar and water, but lack the quality aspects of the fruit such as complex carbohydrate, active vitamins, antioxidants and fiber that can be obtained only by eating the whole fruit. Also, the vitamin quality in juice may be less active due to processing  when compared to eating the fresh whole fruit.

11.When Are Other Cereals Started, Such As Barley Or Oatmeal?
We usually begin first with rice cereal because it is very well tolerated, mixes well with other foods, and has very minimal adverse effects. After going through all the single ingredient fruits and vegetables(usually by 3-4 weeks of starting solids), then you can offer the infant oatmeal cereals followed by barley and wheat cereals. Remember to add only one new food every 3 days. Some infants may get constipated on rice cereal and may do better with oatmeal cereal earlier on.

12. What About Water And Flouride Needs?
Infants do not need additional water prior to 4 months of age. After 4 months, it is OK to offer infants water once in a while but it does not need to be a regular item. Infants can drink faucet water starting at age 2 to 3 months if your water supply is clean and reliable. Generally, if it is good enough for adults to drink, it should be good enough for infants after age 2 to 3 months. Most infants will get flouride in their drinking water once they begin taking water if your water is flouridated. Even if your infant is not getting much water to drink or your water is not flouridated, we do not recommend flouride supplements prior to age 6 months. If you do not have flouride in your water supply, please discuss possible flouride supplementation with us at the 6 month routine exam.

13. What Feeding Practices Are Recommended After Age 6 Months?
Excellent question. Please see our feeding guideline handout for infants age 6 to 12 months!!