#TipsForNewPeds The baby aisle

This will be the first in a series of brief posts in honor of all the trainees starting their pediatric residencies in the next few weeks #TipsForNewPeds.

My goal is to give you some familiarity with the world of products marketed for kids, a primer on what’s out there so you can feel comfortable as you start to have discussions with parents in the hospital and clinic.

First up, a walk down the baby aisle at your local grocery store (please note, while I have my own thoughts, this is not meant to be an endorsement nor a warning about any brand or particular product, except baby hot dogs).

Formula deserves its own post (or novel), for a pretty good overview, check out this post by Dr. Chad Hayes. One thing worth mentioning – many parents get samples of the ready-to-feed (aka premixed) newborn formula. There is really little difference between newborn and infant formulas. If not breastfeeding (or supplementing), infants under 12 months should get regular, stage 1 infant formula. At 12 months, infants can transition to whole milk, full stop. There is no need for stage 2 formulas or “toddler formula” for 99.99% of all healthy children.

The problem with toddler formulas like Pediasure are:
– they provide calories without the satiety feedback of solid foods
– they are often sweetened (chocolate, strawberry, etc)
– they may provide a short term bolus of nutrients, but miss the opportunity to teach kids healthy eating through role modeling
– most kids are gaining weight fine, parents just worry because infants gain weight at breakneck speeds and toddlers slow waaaaaaaay down, sometimes abruptly.

Next up is baby food, the choices are nausea inducing… They come in jars, plastic tubs, and “pouches.”

Once infants show signs of readiness around 4-6 months, you can start feeding purees. Commercially, these are often labeled as “stages”. In my head they go something like:
Stage 1 – loose puree
Stage 2 – thicker
Stage 3 – chunky (needs some chewing, or gumming)
Stage 4 – solids

Many parents start with rice or oat “baby cereal”. This is neither rice nor oat, nor cereal. It is basically cream-of-wheat. Due to concerns of possible arsenic contamination in certain rice crops, many people recommend other grains. It is good for mixing with breast milk or formula as an initial food (always from a bowl with a spoon, not in the bottle) and for thickening up loose purees. It is fortified so can be a useful supplement for exclusively breastfed infants. Otherwise it is pretty bland. For both of my kids we bought one can of this stuff and never finished the whole thing.

If you have a blender or an immersion blender, you can make most any baby food from fresh, canned (unsweetened), or frozen fruits and veggies for a little bit less money. Freezing batches in ice cube trays allows you to thaw out just enough for each feeding and not be making food every day.

A caveat for pouches – parents should still feed the puree with a spoon and not allow kids to constantly suck the stuff out like a straw. Learning to use a spoon and managing more solid textures are important steps in oral-motor development.

I don’t recommend a particular order, nor does the AAP, check out their recs – most families have some sort of tradition and as long as it isn’t harmful, I try not to micromanage.

Last come the puffs, wafers, cookies, crackers, melts, cookies, biscuits, and bars. These are basically crunchy things of various shapes and sizes, many of which dissolve rapidly to reduce the chance a baby can choke on them.

Around 9 months, when infants are working on their pincer grasp skills, these are great practice. Infants put everything in their mouth, so you can’t exactly practice fine motor skills with little pebbles…

You can also offer things like canned red or black beans or soft cooked corn and peas. Often you can find cereal (like regular adult cereal) that serves the same purpose as long as it is not sweetened.

Infants still need close supervision because as soon as a cracker is small enough to get in their mouth, they will immediately jam it in there. Speaking of supervision – just because a food is labeled for babies and sold in a jar, doesn’t make it safe. For example, you can find small hot dogs marketed for >1 year olds.

I would only offer these little choking hazards under one of two circumstances:
1. Cut into tiny pieces about the size of a pea
2. In the presence of a pediatric ENT outside of a fully staffed OR

Remember eating is a social activity. Encourage families to always sit and eat with their infants as often as they can, even from an early age – it teaches healthy habits and many infants and toddlers like to ham it up in the highchair, waving, clapping, and generally making a mess.

Stay tuned for more #TipsForNewPediatricians

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