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Infant Feeding: Birth to 6 Months
Feeding your baby is the most important, and confusing, part of new parenthood. There is too much advice out there—from relatives, in-laws, friends and even mild acquaintances—and most of it is inconsistent information. Additionally, nutrition research keeps changing all the rules, so it becomes even more difficult to decide what is best for your baby. Still, there are some absolutes that never change: 

  • Use your instincts. If it doesn’t feel right or makes your baby miserable, it isn’t right for you.
  • Only listen to the recommendations of professionals in pediatric health. Things change, and professionals keep up with the research.
  • Be strong enough to stick to your plan but gracious to those who are trying to help you out. Remember, you will need a babysitter one day.
What follows is meant to be a guideline. Some babies advance sooner than others, while many are premature and should be held back until they reach their “corrected” age. Every baby is different, so guidelines are not absolute. If you have concerns, check with your pediatrician or call your local WIC (Women, Infants and Children) office and ask the advice of a WIC nutritionist who specializes in pediatric nutrition.

Starting out: Breast milk is the recommended and preferred first infant food for all babies and is encouraged by pediatricians, the American Academy of Pediatrics and the American Dietetics Association, as well as most other professional health organizations. Commercial infant formulas are the second choice and will allow most infants to grow well. Whichever method you choose, breast milk or formula is all your baby needs for the first 5 to 6 months of life.

A baby is born with a stomach the size of a marble, and at 10 days of age it’s only about the size of a pingpong ball! However, as your infant grows, his stomach becomes more elastic, allowing it to stretch as he eats. New babies are “pre-programmed” to eat eight to 12 times every 24 hours. Nursing babies will eat more frequently because breast milk is easier to digest, where formula fed babies will eat around every three hours. Regardless of which milk you use, you will know your baby is getting “enough” if he wets six to eight diapers and passes stool at least three times each 24 hours for the first four to six weeks. (Line the diaper with a tissue if his diapers are so absorbent that you cannot tell if he is wet.)

He should be satisfied after a feeding, and wake at regular intervals to be fed again. Spitting up formula at the end of the feed usually means the baby ate more than his stomach can hold, but if it persists, talk to your pediatrician.

The rule of thumb for formula at 1 month is 2.5 ounces per pound in 24 hours or 3 to 4 ounces per feed, increasing to 4 to 6 ounces per feed (up to 32 ounces a day) at 2 months and beyond. Larger babies may take slightly more. Once a bottle enters a baby’s mouth, any leftover formula in that bottle must be discarded after the feeding to prevent bacterial growth and breakdown of nutrients.

Solid food readiness: A baby’s immune system is immature during those first few months. Breast milk will provide most of the immunities your infant needs, but formula does not. Introducing any solid food too early can trigger sensitivities or allergies, and many of the enzymes needed to digest solids are not yet available in sufficient amounts to allow the food to be properly metabolized. Most importantly, an infant does not possess the ability to manipulate and swallow solid foods until around 5 months, so offering them can cause gagging or choking.

Solid foods also displace breast milk or formula, which contain the necessary nutrients needed for optimum growth in the first half-year of life. Breast milk and formula contain about 20 kilocalories per ounce, where a spoonful of cereal might contain only 16 kilocalories. Your baby will drink 4 to 6 ounces of milk at a feeding after 2 months, or 80 to 120 calories, but if filled up with cereal he will not take the needed amount of milk. So your baby may look healthy but actually be malnourished.

Some very large babies are ready for infant cereal before smaller infants. Your pediatrician will guide you on when to start. Pre-term babies must be given a little extra time before solid foods are offered. Even though your baby was released from the hospital at 36 weeks, she is still four weeks younger physically than the full-term baby. Give her time to let her body catch up.

Solid foods should be considered supplementary, not a replacement for breast milk or formula as the main source of nutrients from birth to 12 months.

Your baby is ready for solid foods when these things happen:
  • She has doubled her birth weight
  • She can sit in a high chair and support her head on her neck
  • She opens her mouth when she sees a spoon approaching
  • She can swallow some of the food that you put in her mouth
Cereal should not be fed in a bottle, and there is no truth to the rumor that cereal in a bottle will make your baby sleep through the night. If your baby wakes up hungry, feed her. She’ll go back to sleep.

Vitamins: Adequate vitamins and minerals, for the first six months, are found in both breast milk and formula. However, additional vitamin D might be recommended for some breastfeeding babies, and fluoride supplementation is necessary if you mix bottled or well water with your formula or live in a town that dues not put fluoride into the public water system. Your pediatrician will tell you if you need these additional vitamins.

Relax and enjoy the first six months of your baby’s life. If she is growing, content and happy, you can be assured you have done everything right!
Dr. Bettye M. Caldwell Ph.D. Professor of Pediatrics in Child Development and Education