What is the usual feeding schedule for infants and toddlers?

Food is important for your baby's healthy growth and development. This information is designed to answer questions you may have about feeding your baby.

Remember: these are general guidelines. Every baby will progress at his or her own rate. If you have questions about your infant's feeding or nutrition, please let us know.

During the first 4-6 months, the only food your baby needs is breast milk or iron-fortified formula. The baby doesn't need any extra water, juice, rice cereal, baby foods or table foods until 4 months.

Although many people used to advocate earlier feeding, we know now it's not a good idea because:

• Babies grow and gain weight just fine on breast milk or formula.
• Breast milk and formulas are complete nutrition in themselves, and contain enough protein, fat, vitamins, and minerals for babies.
• Babies fed solid foods this early (before their head and neck muscles are coordinated) can choke and gag on the strange textures.
• Babies fed solid foods this early can develop allergies and asthma.
• Babies who drink too much water or juice instead of formula have trouble gaining weight, and can have a sodium imbalance in their blood.
• Cow's milk is too concentrated for a baby's kidneys to handle.

Rarely, we will recommend using a small amount of water or juice for a severely constipated baby, or thickening bottle feedings with rice cereal for severe reflux (spitting up.) We'll tell you if your baby needs these changes. Otherwise, just stick with formula or breast milk until age 4 months.

Tips on feeding a very young infant:

• Hold and talk to your baby during feeding. A pleasant feeding time makes your baby feel happy and secure.
• To prevent baby bottle tooth decay and ear infections, don't prop a bottle or put the baby to sleep with a bottle.
• There is no need to force a baby to finish a bottle. If you are concerned your baby is not eating enough, let us know.

• Sit with a little help and turn their heads.
• Open their mouths and lean forward.
• Lean back and turn their heads away.
• Accept a small amount off a spoon without thrusting out their tongues.

Some babies may be ready by 4 months and others need to wait until 6 months. Don't rush - your baby is the best guide. Nutritionally, your baby's milk still provides his complete needs. Spoon feedings are to practice developmental skills - and for fun. Don't get stressed, keep feeding time calm, and enjoy this time of discovery together.

Tips for starting spoon feedings:

• Begin with baby rice cereal. Thin the cereal with breast milk or formula. The consistency should be like Cream-of-Wheat. Do not add sugar or honey.
• After your baby has tried cereal, offer mild-tasting vegetables until 6 months of age. Carrots, peas, or squash are good choices to start. You can use the "step 1" baby foods, or you can puree your own vegetables at home.
• Start with just a little bit of food at a time, 1-2 teaspoons. Use a child-size spoon to feed.
• Remember: go slowly with new foods. Try one at a time. Allow 3 days to pass before trying another new food.
• First foods should have only one ingredient; don't use mixtures or "dinners." (If the baby is sensitive to one of the ingredients, you won't know which one.)
• Be prepared for initial refusal of the new flavors and textures. If your baby refuses food - stop feeding. Try another food and re-introduce the refused food in another week or two.
• Do not add foods to the bottle. This confuses the baby as to what taste and texture to expect from the bottle.
• Don't use infant feeders. These syringe-like gadgets basically force-feed solids into infants. A normal baby will never need this. Either he is too young to take food from a spoon (and thus doesn't need the solids yet anyway) or he can take some off a spoon, even if it doesn't seem like ''enough." Please talk to us about your concerns before resorting to this method.

How do you know if your baby is food sensitive?

Severe diarrhea or vomiting, a rash, or wheezing may be symptoms of sensitivity to a specific food. On the other hand, they may just be coincidence. If you think your baby reacts to a food, stop feeding that food. Try it again in a few weeks. If the problem continues, let us know.

Sample meal plan: 5-6 month old infants

• Breakfast: 4-6 tablespoons baby cereal, 6-8 oz milk feeding
• Mid-morning: 2-4 oz milk feeding
• Lunch: 2-4 tablespoons cooked strained vegetables, 6-8 oz milk feeding
• Mid-afternoon: 4-6 oz milk feeding
• Dinner: 2-4 tablespoons cooked strained vegetables, 6-8 oz milk feeding

This is a good time to add fruits. You can also offer a little juice in a sippy cup. Be sure to continue offering cereal and vegetables.

• Introduce fruit after your baby tries a variety of vegetables. (Babies who get fruits before vegetables tend to refuse the less-sweet vegetables.) Again, use single ingredients first.
• At about the same time you start fruits, you can try juice too. Offer juice in a sippy-cup rather than a bottle - again, a bottle should contain only formula or breast milk. Juice in a bottle can lead to tooth decay, so don't offer juice at bedtime.
• At first, your baby will probably need lots of help with the cup, but with some practice he will get the hang of it. Cups have a faster flow than nipples, which require active sucking.

Now is a good time to add meats. (If you are raising your child as a vegetarian, we can suggest alternative sources of protein.) You can use commercially prepared baby food meats, or you can make your own as follows:

• Boil, bake, poach, stew, or braise meat until tender. (Avoid frying.)
• Remove all fat, bone, and skin from meat after cooking.
• Puree in blender until smooth, using cooking liquid, breast milk, or formula.
• Other sources of protein include ricotta cheese, mashed cottage cheese, and plain yogurt.

When your baby can sit alone without support, pick up little things with the thumb and forefinger, and has a few teeth, you can start to offer table foods:

• Offer your baby a spoon or give finger foods with more texture like unsweetened dry cereals, toast, cooked grains, mashed vegetables, soft fruit, ground or mashed meat, beans, and strips of cheese.
• Let your baby feed himself as soon as he is interested. This is messier than you doing it, but it's important to allow the child feeding independence for his development.
• Offer foods with different colors, textures, and tastes. Offer food without added sugar or salt.
• Hot dogs, nuts, chips, raisins, popcorn, seeds, granola, and hard vegetables (like raw carrots) can be dangerous for babies and toddlers - they can cause choking.

Sample meal plan: 8-12 month old infants

• Breakfast: 6-8 tablespoons baby cereal or cooked iron-enriched adult cereal, 2 tablespoons soft fruit, 6-8 oz milk feeding
• Mid-morning: 2-4 oz unsweetened juice (in a cup) and toast, 1/2 to 1 slice
• Lunch: 2-4 tablespoons soft vegetables, 1-3 tablespoons pureed or chopped meat or mashed beans, 6-8 oz milk feeding
• Mid-afternoon: 2-4 tablespoons soft fruit or toast, 2-4 oz water
• Dinner: 3-4 tablespoons soft yellow or green vegetable, 3-4 tablespoons soft vegetable or fruit

Tips on feeding young toddlers:

• After your baby reaches 1 year of age and eats enough food from all four food groups, your baby is ready for whole cow's milk from a cup.
• In general, children who are younger than 2 years old should not get lowfat milk because lower-fat milk does not provide the calories and essential fatty acids they need.
• Because your child may eat little at mealtime, children need snacks to balance the diet. Offer three regular meals and 3 small nutritious snacks.
• Remember sweet foods or beverages like cookies, candies, gelatin, soft drinks, fruit drinks, or oily salty foods like chips need to be controlled. These foods add pleasure to a diet, but if offered too often, they can decrease your infant's appetite for necessary foods.
• Juice is a good treat, but too much can be just like drinking too much soda: empty calories. Limit juice to 6 ounces a day.
• If your child is drinking from a cup now, great! If not, it is time to encourage cup drinking. Children should be completely off the bottle by 15 months.
• Toddlers continue to thrive on some routine. Mealtimes should be as calm and predictable as you can make them.
• Self-feeding is one of your toddler's first big steps toward independence. It can be messy. Be patient and encourage it. (You might want to cover your floor with plastic or newspaper to make cleanup easier.)

By this time, toddlers should be eating smaller portions of whatever everyone else is eating (except for potentially dangerous foods like popcorn, peanuts, raisins, granola, etc - wait until age 4 to introduce these.)

Tips for feeding older toddlers:

• Set a good example. Your toddler will usually eat the same foods you do.
• It may seem like toddlers eat next to nothing, but they do need much less food than adults (who tend to overeat anyway.) Easy guide to minimum servings: 1/4 to 1/2 cup of any food.
• Encourage children to try at least one bite of a new food. If the child rejects the food, reintroduce the food again later.
• Feed children before guests arrive. Children require lots of attention at mealtime and it may be impossible to give it to them while entertaining.
• Remember to offer your children water to drink. Toddlers should not get more than 16 oz of milk and 8 oz of juice daily. If they are truly thirsty, they will accept water. If they refuse water and will only take juice or milk, they want a "calorie fix."