Nutrition for Kids – Q&A by Age
Every parent wants to know that their child is getting what they need to grow and thrive. We are here to help! Nutrition is such a huge topic, but I’d like to share my answers to some of the most frequently asked questions I get in the office. Enjoy!
Infants (Ages 0-12 months)
Does my baby need any vitamin supplements? Babies who are fed 100% formula do not need a supplement unless recommended by your provider. If breastfeeding, mothers should continue to take their prenatal vitamin. Additionally, the AAP recommends a Vitamin D supplement (400 IU per day) for exclusively and even partially breastfed infants until the age of 12 months. It’s best to start it in the first week of life. If using the one-drop formulation, you can apply it to the mother’s nipple right before a feed, or put it directly on baby’s tongue. The 1 mL formulation can be squirted directly in baby’s mouth, aiming for the side of the inner cheek. Mothers may also choose to take high levels of Vitamin D themselves, but this method is still being studied, so your provider can help you determine if it’s right for you. At 6 months of age, start giving your baby iron-rich solid foods to complement their milk (see below).
If breastfeeding, should there be any limits to the mother’s diet? You can continue with your normal diet. Alcohol should be limited to no more than 1 drink per day, ideally 2-3 hours before a feed. Caffeine is generally fine, in moderation. You can eat properly handled raw fish without concern. Most babies tolerate dairy in the mother’s diet, but some may have sensitivities. Talk to your provider about any concerns before removing things from your diet.
What type of formula should I feed my infant? Firstly, remember that “fed is best.” Choose whatever works best for your family, whether it be breastmilk, formula, or both. For babies who are formula-fed, choosing the right one may seem like a daunting task, as there are TONS of options out there. Fortunately, ALL formulas that are sold at stores in the US are strictly required by the FDA to contain ALL the nutrients your infant needs from the age of 0-6 months. (This is why homemade formulas are not recommended). Most babies do well with standard formulas, and there is generally not a need to trial different ones. If your child is having significant symptoms (extreme fussiness, projectile vomiting, or blood in their stool), then it’s time to talk with your provider about whether specialized formulas might be right for your baby.
When and how do I start feeding my infant solid foods? I usually recommend starting solids (ie, foods other than breastmilk/formula) around 5-6 months of age. You know your baby is ready when they have good head control, they show interest in what you’re eating, and they’ve lost the “extrusion reflex,” in which they push the spoon out with their tongue. Make sure they are always sitting up in the highchair, and that you are sitting directly across from them so you can respond to their cues, and watch for choking.
Every baby is different, so advance their diet as their development allows. Generally speaking, here is a brief guide by age:
- 6-8 months: Offer a variety of any pureed foods you’d like: cooked pureed meat, legumes, veggies, fruit, baby oatmeal, even yogurt – all fair game. (We no longer recommend postponing meat, especially because it’s a good source of iron).
- 8-10 months: lumpy foods (such as smashed avocado), small pieces of soft foods (eggs, cooked veggies such as carrots).
- 10-12 months: most soft/tender table food is appropriate, cut up into small chunks/pieces (pasta, soft raw fruits/veggies, ground beef, shredded chicken, fish)
*Make sure all fruits/veggies are peeled, seeded, and pitted. Remove bones, fat, and skin from meats/fish.
Generally try to only introduce one food at a time (every 1-2 days), especially the allergenic foods such as nut products, shellfish, eggs, and dairy. Under 12 months, avoid giving honey (which may contain toxins that are poisonous to babies) or cow’s milk (which babies can’t digest properly yet). Avoid the following choking hazards until at least 5 years old: whole nuts, seeds, grapes, hot dogs, popcorn, or other hard/slippery things.
How can I reduce the amount of toxic heavy metals in my baby food? In recent news, certain baby food products have been identified as containing higher than ideal levels of toxic heavy metals (such as lead, arsenic, cadmium). These metals are naturally found in soil, and plants absorb them. They are commonly found in low levels of many baby food products. Your child does not need testing other than the usual lead screenings we do at the age of 1 and 2 years. It is difficult to avoid these heavy metals completely, so just aim for a variety of different foods. Try to limit rice cereals, which may contain higher levels of arsenic. Organic foods do not necessarily have lower levels of these toxic metals.
What’s this new update about when to offer allergenic foods? Previously, guidelines recommended waiting until the 1st birthday to offer allergenic foods such as peanuts. But a recent, very large study, has shown that offering this food starting at 6 months can reduce the risk of developing a peanut allergy later, especially in infants with risk factors such as eczema or family history of allergy. Talk with your provider on whether you should trial these foods at home or under the supervision of an allergist, and remember to never give whole peanuts to children under the age of 5 years. (I recommend mixing a little peanut butter into another pureed food they’re already eating).
Toddler/School-age: (1-12 years)
Does my child need a multivitamin? If they are eating a couple of foods from each food group per day, then probably not. Be sure to offer foods containing iron, calcium, and Vitamin D – these are the most common nutrients that children tend to be deficient. If they are not able to consistently get these foods, speak with your provider about whether a multivitamin is needed. (Just be sure to limit cow’s milk to 16 ounces per day or less, as too much milk can cause iron deficiency and appetite issues)
When my child turns 12 months, how do I make the transition from infant formula/breastmilk to cow’s milk? Your child should continue breastfeeding until either child or mom or both decide it’s time to stop. When it comes to infant formula, you can gradually cut it out around the 1st birthday, while introducing cow’s milk. Some babies can ease into it by mixing a little prepared formula with some cow’s milk. Start off with whole milk for ages 1-2 years, and then low-fat after that. One important point is to limit cow’s milk to 16oz/day or less, to avoid iron-deficiency anemia. By 1 year of age, we should think of milk as a beverage, not a meal. I recommend mostly water and (a little) milk, and limit juice to 4oz/day, or ideally none.
My kid is picky; are they getting enough? Offer a variety of foods and allow your child to self-regulate their intake. There will be good days and bad; try not to get discouraged. It is common to offer a food multiple times (10+!) before a child will try it. Continue offering it without fanfare, and resist the urge to bribe/coerce. Excessive verbal pressuring can lead to unhealthy relationships with food. If your child is gaining weight appropriately, and they get at least 2-3 different types of fruits and veggies and some proteins/source of fat, they are most likely right on track.
What’s all this talk about protein? People often overestimate the amount of protein their child needs. Even if your toddler isn’t keen on meat, they can meet their protein needs with other foods such as yogurt/milk, cereals, or other protein alternatives. Aim for 2-3 servings of protein/day.
My child is not at the 50th% on the growth chart; should I be concerned? We use the growth chart to track your child’s weight, height, and head circumference (for babies). In general, we are less concerned with what “percentile” they are, and more interested in how they have been tracking over time. Many factors determine your child’s growth percentiles, including genetics. The goal is not that your child hits the 50th percentile, but that they are steadily following along their own curve. If you are concerned about your child’s growth, please let your provider know.
My child has eczema or asthma; does this mean they also have a food allergy? Not necessarily. Eczema and asthma increase the chance that your child may develop an allergy at some point, but without an immediate reaction/intolerance to certain foods, an eczema rash is not a tell-tale sign of an allergy. (If your child develops sudden-onset hives with respiratory distress, vomiting, or other severe symptoms, call 911 immediately)
How do I prevent or manage obesity? Childhood obesity is becoming more prevalent in recent years, and the reason is multifactorial (the pandemic, more screen time, processed foods, and less outdoor play). This can be a very challenging and sensitive topic for kids, so remember to avoid shaming or punitive talk. As kids get older, it is more difficult to control what they eat, but modeling healthy choices yourself can go a long way. Studies show that engaging in healthy lifestyles as a family, as opposed to targeting the child individually, can help prevent/manage obesity. Limit the junk food/sugary beverages that you keep in the house, and place healthy options out in the open (ex. fruit basket on kitchen table) and at eye-level in the fridge. Avoid fad diets such as low-fat (fat is good for developing brains!), meal replacement diets, etc. Focus on offering lots of whole foods (not processed). Keep it simple!
How do I make sure my vegetarian/vegan child is getting all the nutrients they need? There are lots of non-animal derived food options out there for your child. Make sure they’re getting foods that contain iron (leafy greens, legumes, tofu) and Vit B12 (some plant milks, soy products, and enriched cereals). Protein may be found in nuts, beans, oatmeal, and some vegetables, such as peas and broccoli.
What’s the scoop on dietary supplements for athletes, eg creatine, protein and others? They are usually not needed and may even be harmful, leading to organ damage. I generally recommend against them, even for athletes. Instead, aim for whole foods as your source of nutrients.
One more tip: try to eat meals as a family as much as you can. Benefits include family bonding, better school performance, and establishing healthy routines that result in less excessive snacking. Remember that food is meant to be shared and enjoyed together!
Watch Dr. Neidig's "Nutrition for Kids" Video HERE.