Feeding

Babies should always be off the bottle completely by their 1st birthday. There are two reasons for this:

First, developmentally this is the appropriate time. A baby between 9 and 12 months will happily take the cup and won’t miss the bottle much. If you continue to give a bottle beyond 12 months, however, the toddler becomes more and more attached to it emotionally, and it becomes harder and harder to wean.

Second, after 12 months bottles – in any amount, even only once per day, even containing only water – have been shown to cause increased rates of 5 separate health problems:

  • Ear Infections
  • Dental Cavities
  • Speech Delay
  • Obesity (even into adulthood)
  • Anemia

None of the above risks apply to breastfeeding or pacifiers, only bottles. From a health standpoint it is fine to continue breastfeeding and/or pacifiers as long as you like – although the 9-12m age is a relatively easy time to wean most babies from these things as well (compared to earlier or later ages) if you want to.

Start by introducing a cup at around 9 months age. Put whole cows milk in the cup if you have been using Enfamil, Similac or another milk-based formula (or if you have been breastfeeding and the mother takes dairy in her diet) – the baby will have no trouble digesting it. Keep using the formula in the bottle. Gradually between 9 and 12 months give the cup more and more, the bottle less and less. This means the baby will get more and more milk, less and less formula. Shortly before 12 months the bottle disappears, and the formula disappears with it.

If your baby has been on Soy formula (Isomil, Prosobee) or another non-milk based formula (or if you have been breastfeeding with mother on a dairy-free diet) you can still introduce the cup at 9 months and gradually increase it’s use as above, and you still want the goal of making the bottle disappear by 12 months – but put the same formula in the cup as you’ve used in the bottle until you consult with us about when and how to introduce dairy.

9-12 months is not just a cognitive, formula, and bottle transition time, it is a solid feeding transition time as well. A child in this range should be doing more and more of it himself. Feeding independence is something most emerging toddlers want and can handle, and it’s important to gradually give it to them. It is important for the toddler not to psychically connect feeding or being fed with their parents love for them (a connection only a toddler, not a baby, can make) as this will set them up later in life to use food for comfort when they are sad or stressed. After 12 months it is best for your child to think that you really don’t care much about whether or how much they eat.

Self feeding will be messy. At 9 months you feed your baby. By 12 months you mostly clean up after your toddler instead. Don’t get mad and don’t worry about how much they are getting. Kids this age are usually very good about knowing when they are hungry and when they are full, and they learn things by watching the food go “splat” on the floor, too. Think of it as their first physics lesson.

It does not matter whether the baby is self feeding table foods or baby foods, or some mixture. While most toddlers can eat most table foods by 12 months, some may not be so good at chewing & swallowing yet and for them baby foods may be more appropriate for a while longer. While messy, table or strained, it is still most developmentally appropriate to let them feed themselves by 12 months of age.

“Stage 3” foods are just a plot by the baby-food makers to keep you buying their products longer than you have to. If a baby can handle stage 3, he or she can handle table foods as well.

If you have not weaned the bottle before 12 months and you want to wean your 15 or 18 month old, the technique described above for 9-12 months will not work. The only way to wean a “full fledged” toddler (over 13 months) is to go “cold turkey”… and endure the few days of temper tantrums that will ensue when he or she doesn’t get the bottle they want. Soon enough the bottle will fade into memory and become “ancient history”, and the tantrums will subside. To get you through this ordeal, remember this: if your toddler wants the bottle, you offer the cup, and they refuse it and/or throw a tantrum, it means that they weren’t thirsty – they wanted the bottle for some other reason.

Avoid foods that the toddler could choke on. These include nuts, hard candies, raw carrots, steak, and hot dogs.

At each well-child physical we will measure your child’s height, weight, and head circumference and plot them out on a “growth curve”. This is the ultimate measure of whether your toddler is “getting enough”. Too much is made by some people of percentiles. Percentiles reflect genetic traits more than health. What’s most important is the growth rate and trajectory, and you can be sure we’ll let you know if that doesn’t look healthy or normal.

Citrus fruits/juices, eggs, fish, nuts, and wheat are the most common sources of food allergy and some experts recommend avoiding giving these foods until 12 or even 24 months of age. This probably most important in families with allergic histories, much less so in non-allergic families. Wheat can be hard to avoid – it “hides” in “mixed” cereal, baby cookies and toasts, and many other baked goods. Eggs are also commonly “hidden” ingredients you must be on the lookout for.

Babies under one year of age should not consume honey

Toddlers over 11-12m should be given utensils with their meals – spoons and perhaps forks (that aren’t too sharp). Prior to 15 months expect them to use these mostly as toys, not tools for eating. They will use their hands for that. But between 15 and 18 months most toddlers start using them more and more for feeding, and by 18 months should be pretty good at it.

Most Massachusetts communities have fluoride in their water supply. We no longer recommend routine fluoride supplementation. Instead a smear of fluoridated toothpaste should be used for children less than 2 years of age & a pea-sized for children greater than 2 years of age. For further questions discuss with your pediatric dentist. All toddlers should take a daily Multi-vitamin with Iron.