Q.) How do I start feeding my baby solid food?

The American Academy of Pediatrics recommends the introduction of solid food between 4 months and 6 months of age. It is very important for parents to know that there is not one single way to introduce baby food or advance baby food. With that being said, I am going to give you an example of how to introduce baby food to your infant that I have found to be successful.

First, start with rice cereal with iron for a couple of weeks. Rice is a good starter food and is generally well tolerated. It might take a little bit of time for your infant to get used to the spoon (you might notice your infant tongue thrusting). Once he or she masters the spoon, we are ready to start on the Stage I foods. Stage I foods are in the smallest jars and are the most liquid in consistency. If you would like to make your own baby food that is perfectly fine. My advice is to model the consistency after the consistency of baby food in the store. Normally, I tend to start with vegetables before fruits. My experience has been that starting with the sweet stuff makes eating vegetables more difficult. I also normally introduce a new food every two to three days. That way if your infant has a problem with a food you will be able to pinpoint the problem food. For the first two months, the goal is to get the infant on two meals a day. Rice cereal for breakfast and the Stage I foods for dinner. There are only a few Stage I foods and it doesn’t take long to go through all of the fruits and vegetables.

After two months, we are ready to move up to the Stage II foods and to three meals a day. The Stage II foods are in bigger jars and are thicker in consistency. At this time, we can branch out a little bit if you would like. Yo Baby yogurt is a good source of calcium and can help break up the monotony of rice cereal for breakfast. You can also try some of the different kinds of cereals. Stage II meats can also be introduced at this time. They make Stage I meat but I could never bring myself to feed my child liquid turkey.

At nine months of age, we can try some Stage III foods. Now, many of my patients cannot do Stage III foods because of their lumpiness. I remember watching my son throw up Stage III spaghetti, and I’m still scarred by the experience. Around nine months, you will notice that your child has developed a pincer grasp where he or she can grasp things between the thumb and forefinger. At this time, it is o.k. to introduce the Gerber fruit and veggie puffs which dissolve in the mouth. Once your child masters the puffs, you can try the cheerios which are gummed up and swallowed. The one food that I find that provides the biggest choking hazard is the Gerber Biter Biscuits. Infants gnaw on them until they get soggy and a large piece breaks off. I would stay away from them. If you need a teething food, I like the Gerber Zwieback toast. It is very messy but it doesn’t break off in large pieces as easily.

At one year of age, it is time to start transitioning to table food. It is also the time to be off the bottle and on a sippy cup. Keeping the child on a bottle promotes dental caries and dental malocclusions. I have always found taking the bottle away to be harder on the parents than on the child. Be strong! If your baby is formula fed, it is time to move over to whole milk or soy milk. If your baby is breastfed, keep breast feeding for as long as you want. At one year of age it is o.k. to diversify foods as long as we stay away from foods that are choking hazards like nuts, popcorn, etc.

Q.) When do I start my child on juice and how much per day?

Most of the studies now say that a lot of juice makes for short, fat kids. Juice is sugar water and children who drink a lot of it are not getting the nutrition that they need. I don’t see the need to start juice before nine months of age and no more than four ounces a day. My son generally only gets juice at Sunday School and birthday parties.

Q.) My mother says I should give my baby water, should I?

Keep in mind that babies grow a tremendous amount in the first year of life. They double their weight on average by four months of age and triple their weight by a year of age. If a baby fills up on water, they are not getting fat, protein, and carbohydrates they need to grow. Plus, breastmilk and formula are both composed largely of water and babies get the water plus the nutrients they need from breastmilk or formula. Thus, I tend to discourage giving babies water the first year of life.

Q.) What do you consider a fever in a newborn or infant?

For the first three months of life, I consider fever to be a rectal temperature greater than 100.4 or 38 degrees Celsius. Greater than three months of age, I consider a high fever to be greater than 102.9 or 39 degrees Celsius. For the first year of life, I always prefer a rectal temperature because it is the most accurate and the most representative of core body temperature.

Q.) What kind of bug spray should I use?

For the first year of life I prefer an all natural products like those that contain citronella. DEBT is a toxin and I would rather stay away from DEBT containing products if possible. After the first year of life, children spend more time outdoors and parents find that the all natural products don’t work as well. At this time we can use a DEBT containing product but I would recommend a 10% DEBT or less. A good example would be Kid’s Off. Spray the outside of your child’s clothing. Then, spray your hands with the bug spray and then apply it to your child’s exposed areas.

Q.) What kind of sunscreen do you recommend?

I like Water Babies by Coppertone. The bottle says “down to six months of age.” I’ve found it to be well tolerated down to four months of age. Younger than four months and they really shouldn’t be in the sun in the first place.

Q.) When can I take my newborn out in public?

Most people would probably say six weeks. However, I would prefer if you kept outside contact to a minimum for the first twelve weeks. There are a lot of nasty germs out there and I would like to keep them away from your baby.

Q.) How do I go about getting my baby to sleep through the night?

The best way to get a baby to sleep through the night is to have them in their own crib in their own room.  If you want to use a bassinet, it is alright to do so for the first month of life. Remember, a baby should always sleep on his BACK. Crib death or SIDS is eight times more likely if a baby sleeps on his stomach and twice as likely if a baby sleeps on his side.

Between one month and six weeks, it is time to get the baby into his own room. A baby that sleeps next to the parents in a bassinet will never sleep all night because at the slightest whimper mom will race over to tend to the baby. Once the baby is in his own room, you can start to push him a little bit to get him to sleep longer. Pediatricians differ on how aggressive to be to get a baby to sleep through the night.

By two months of age, a baby should be able to give you a minimum of a 5 hour stretch at night and by four months a baby should sleep all night. Generally, when a baby weighs about twelve pounds, he should really start sleeping well.

A bigger problem that I see is the nine month old or one year old that does not sleep through the night.  Yikes! This child has developed a bad habit and all bad habits are hard to break. The biggest mistake that I see parents make is that they finally get fed up with the situation and they let the child cry for an hour or two with no change in behavior. This approach never works because the child has been trained that if he cries the parent will come. So that child will cry for eight hours if need be. You have to tackle this problem over one to two weeks. First, you have to get the young child to soothe himself and put himself to sleep. Put him in bed awake at bedtime and give him five minutes to cry before going into the room. The next night make it ten minutes. Each night make it five minutes longer than the previous night. After a week, the baby will put himself to sleep. Now, if the child wakes up in the middle of the night, the parent needs to take the same approach. Let the child cry five minutes the first night, ten minutes the second, etc. After a week or two, the parent should have successfully modified the child’s behavior.

Q.) What is normal pooping for my newborn?

When a baby is first born they pass black stools known as meconium. As mother’s milk supply is established or as she starts to feed formula, the baby’s bowel movements change from black to green to yellow. Yellow, seedy, and very loose is just perfect for a newborn. Don’t be surprised if your newborn has a bowel movement after every feeding.  As your newborn gets older, bowel movements may change color, get a little firmer, and may occur less commonly. All of this is normal. Some infants will only have a bowel movement every three to four days. As long as the movements are soft and not rock hard pebbles, this is o.k. Babies also tend to strain with bowel movements. This is generally normal as well. Babies spend most of their time on their backs and so it makes sense to have to work a little bit harder to have a bowel movement.

Q.) What do I do if your office is closed?

Monday through Friday after 5 pm we do have after hours services in our office until 8:30 pm, Saturday 10 am to 4 pm and Sunday 12 pm to 4 pm. There are times during our after hours that we may close early so please make sure you call about coming into after hours. Our office number is 478-741-7337. After our regular business hours if you have questions or concerns about your child you may call the Children’s Call Center at 478-741-3007 and speak with a nurse but if you need a physican they will be able to page the on call physician. If our after hours is closed then Primary Pediatrics After hours is open 5 pm to 11 pm Monday through Friday and 10 am to 10 pm Saturday and Sunday. Their office is located at 5300 Bowman Road, Macon, Ga.