Infant Feeding:  What’s In, What’s Out

Infant Feeding

Early solids.  Late solids.  Give allergens.  Don’t give allergens.  Whole milk.  Skim milk.  Probiotics.  DHA.  There are so many recommendations out there as to when to feed what to babies that at times it makes picking your 401K investments at work look easy.

Come to think of it, choosing a diet for your little one does have some similarities to investing.  Not only are you nutritionally “investing” in your child’s future good health, but like, say, picking a stock, the recommendations change with the times.

Happily, there have been some constants in the last few decades.  We encourage Moms to breastfeed for the first year.  And we know the importance of making sure babies get enough iron.  (Yes, babies need lots of nutrients, but iron seems to be the tough one to get in.)  Then again, a lot of advice has changed over the years, and as more studies are done, it’s likely to change some more.  Let’s look a little at what was, what is, and what’s a work in progress.

Don’t Grow Up Too Fast

One of the major changes we’ve seen is the standard with which we measure whether an infant is getting enough:  the infant growth chart.  In order to examine a baby’s growth, pediatric providers will plot weight, height and head circumference on a growth chart.  Historically, providers have used growth charts provided by the Center for Disease Control (CDC).  However, in 2006, experts came up with recommendations for a different growth chart:  that provided by the World Health Organization (WHO).

Why the change?  What’s the difference?  It lies in the difference between breastfeeding and bottle feeding.  Breastfed infants actually grow more slowly than bottle-fed babies.  The CDC growth charts were based on a largely bottle-fed American population, making breastfed babies look underweight.  The WHO charts are based on an international, 100% (for at least the first 4 months) breastfed group, and plotting growth on these charts makes breastfed babies appear less underweight.  It also helps providers pick up whether a baby, especially a bottle-fed one, is on track for becoming overweight.

Your pediatric provider wants to make sure you understand everything about your baby’s growth.  Understanding what the term “growth percentile” means is tricky enough (and here is an excellent article explaining the concept).  It’s worth asking your provider what growth chart—WHO or CDC—the office is using.

Regular Milk:  What and When

30 years ago, it was thought to be OK to switch babies from breast milk or formula to regular milk as soon as they were taking a good amount of solid food.  This switch could take place as early as six months of age.  How times have changed!  It’s now recommended that infants stay on breast milk or iron-fortified formula through at least a year of age.  One of the difficulties with early milk has to do with that hard-to-get iron:  regular milk doesn’t have any, and drinking excessive amounts can lead to iron-deficiency anemia.  And infants—even if they’re taking solids well—do benefit from other nutrients present in breast milk and formula.

When it’s time to start regular milk, which one—whole or low-fat?  It seems as if the recommendations here are evolving.  Historically, pediatricians have have told parents to give their toddler whole milk for one main reason: toddlers were thought to need the fat in the milk for brain development.

A lot of the effects of nutrition on child development are subtle, and the recommendation has stood largely for that reason.  However, in 2008 the American Academy of Pediatrics Committee on Nutrition began to recommend low-fat milk even down to the age of 1 in certain situations, such as a family history of obesity or heart disease, or if the toddler is overweight.  What lies behind this change is the increasing incidence of childhood obesity, which poses a risk for a host of issues such as type 2 diabetes, high blood pressure and heart disease.

What’s New with Food Allergies

One of the most interesting recent developments in infant feeding recommendations has to do with food allergies.  It long been advised to delay solids to 4 to 6 months, largely to avoid the development of allergies.  (There are other good reasons not to start before this age, but the allergy issue was certainly thought to be one of them.)  Also, and particularly for infants and young children that were already showing allergic-type symptoms, pediatric experts were recommending that foods that tended to cause frequent allergic symptoms, such as nuts and seafood, be introduced later—as late as 3 years of age for seafood.

These recommendations were withdrawn in 2008 after noting that kids who delayed having these potential offenders actually exhibited more allergic symptoms.  More recently, a study was done on infants that already were showing signs of severe allergic symptoms (such as eczema, which is an allergic skin rash).  Researchers found that when the infants were introduced to peanuts between 4 and 11 months of age, they actually showed less peanut allergy.

Infants who show up early with a true peanut allergy shouldn’t be fed peanuts.  But for those who don’t have an allergy specifically to peanuts, but who show general “allergic-type symptoms” (such as eczema) early on,  the feeding recommendations have changed.  These young ones are now recommended to have foods that contain peanuts introduced between 4 and 11 months of age.  (This, of course, should only be done after consulting with your provider!  Many providers may want to do more definitive testing for peanut allergy before proceeding to feed peanut products.  And there are other precautions such as making sure the baby is ready for solids to begin with!)

When you consider how issues facing kids change, it’s not surprising that advice on their treatment has to evolve as well.  We can be grateful to researchers in child health for keeping us up to date on the latest studies and what they mean for infants and young children.  And your baby’s provider will continue to be the best resource for interpreting these studies.

Stan Sack
Dr. Stan Sack has 29 years’ experience as a primary care pediatrician in Massachusetts and Florida. A medical writer since 2015, he enjoys blogging on topics that are on parents’ minds but are covered less often in books and on websites. He lives in the Florida Keys with his family and enjoys healthy cooking, fitness activities and singing in his spare time.

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