A baby’s first solid food is a big event—not only for the baby but also for the parents. It seems, at the time, as significant a forward step as graduation from high school or even college.
My mother told me that when I was a baby ninety years ago, we babies didn’t get any solids until one year of age. That rule, like others, was established by Dr. Emmett Holt’s book, The Care and Feeding of Children, which my mother followed religiously, at least with her first child or two. I didn’t think of being the first as an advantage. When I got into a quarrel with a younger sibling my mother always put the blame on me, saying, “Benny, you should have known better; you are the oldest.” And she was always stricter in applying the rules with me, it seemed to me. For example, I wasn’t allowed to eat even half a banana until I was twelve years old, because Dr. Holt said they were too indigestible. But I remember that rule being relaxed progressively with each of my subsequent sisters and brother.
When I started pediatric practice in New York City in 1933, the most usual age for starting first solids was five months. When Baby and Child Care was published in 1946 the most common age was three months.
A few years later, some physicians suggested starting cereal at one month and adding vegetables, fruit, and beef by three months. Why the rush? Beginning mothers were eager to have their babies keep up with—or even excel—their relative’s or neighbor’s babies. Some doctors were eager to compete with others, in being “advanced.”
Then gradually it was realized that much of the very early solids were not being digested, and that they sometimes interfered with the success of breast-feeding, which was beginning to be popular. So now we are back to five or six months as the time to begin solid food. I am strongly in favor of delaying solids until five or six months.
Cereal has generally remained the traditional first solid food, probably because it is bland and it rarely causes indigestion or allergy (except in the occasional case of a wheat allergy). The commercial rice cereal made for babies is fortified with iron, a necessary nutrient after six months of life for nursing babies and those not getting enough iron in formula.
I deviated from tradition in my practice and suggested apple sauce or raw, ripe banana as a first solid, because some babies are unenthusiastic about cereal for a while, and I was very reluctant to get them prejudiced or antagonistic toward any food.
Speaking of lack of enthusiasm for solids reminds me of how puzzled babies behave toward any first solid. They wrinkle up their noses. They block the food with their tongues, they push it around, and they make clacking noises. All of this pushes most of the food out of the mouth and onto the chin. The mother shaves as much as she can with the spoon and tries to get it back into the mouth by scooping it off the spoon against the upper lip. Most of it oozes out again onto the chin but a little gets swallowed on each try.
It’s not surprising that this skill takes time to learn. The spoon is a strange object! The muscles of the mouth are accustomed to squeezing milk between the nipple and the roof of the mouth and then it is pushed down the throat. The baby must learn to catch the food with the tip of the tongue, move it back over the top of the tongue and start it down the throat with a “milking” motion of the tongue and throat. Fortunately, for most babies this remarkably complex set of movements takes only a few days or weeks to learn.
Up to a few years ago, almost all doctors recommended starting with cooked cereal, then adding strained, boiled, or steamed vegetables, strained stewed fruit, scraped beef, and hard-boiled egg white. Egg yolk is postponed to the last quarter of the first year because it may cause allergy in some children. Later introduction of other foods also lessens the chance of allergies in susceptible families. Chicken and white fish such as sole, haddock, and halibut are commonly introduced early in the second year.
Baby foods in cans or jars are convenient to store and to warm up, and can be as nutritious as fresh cooked foods. But some manufacturers mix the fruit, vegetables, and meats with cereals. I think it is wiser to buy such foods separately so that you will know what you are serving and you will know if vegetables, fruits, and meats are diluted with cereals. For if a baby is getting plain cereals or puddings from some jars, cereals mixed with vegetables, fruits, and meats from others, the diet may be lopsidedly starchy. Read the fine print to learn what your baby is eating.
It is wise not to add salt to a baby’s or child’s foods. The desire for salt can easily become a lifelong habit that favors high blood pressure, heart disease, and stroke.
It is often convenient to give the baby the same cooked vegetables and fruits, fresh or canned, that the rest of the family are eating. These foods should be strained so that prior to one year your baby can swallow the food with comfort and safety. You can shift gradually to lumpy vegetables and fruits after a year, whether fresh or canned or in “junior food” jars. Canned fruit for adults is often full of syrup which is not advisable and should be poured off.
In recent years there have been small but increasing numbers of nutritionists and physicians (including myself) who recommend a vegetarian diet with not only no meat, chicken, or fish, but no animal fats, no dairy (cream, butter, cow’s milk, or cheese), and little vegetable fat. Their reasoning has been as follows:
I advise withholding cow’s milk (“pasteurized milk” and prepared formula) until after the age of two or three years. I also recommend withholding meat, chicken, fish, eggs, cheese not only in infancy but at any age. I have been on such a diet for several years, with good results. This is not a reason for others to do the same, but it shows I’ll take my own medicines.
But there are still many nutritionists and physicians who are doubtful whether a child over the age of two years on a vegetarian diet (without meats, chicken, cheese, eggs, and particularly milk, which is in a special category that I’ll discuss next) can get enough calories, calcium, and high quality protein to thrive. I am not a researcher or expert on this question; but I have been convinced by nutritionists and physicians who have studied it carefully and at length. They believe that a variety of vegetables, fruits, whole grains, and beans will cover all of a young child’s needs after the age of two years.
Up to the age of two years, I am strongly in favor of breast-feeding if the mother is willing and able. Second best is the prepared formula, liquid or powdered, based on cow’s milk. The proportions of protein and fat in the formulas have been reduced and the sugar has been increased to make it closer to human milk in composition.
Breast milk confers partial immunity to some intestinal and respiratory infections. It is less likely to cause allergy and perhaps less likely to favor diabetes. Babies who breast-feed have fewer ear infections than those who take formula. However, if a mother chooses not to breast-feed or is unable to breast-feed (because of insufficient milk—this is rare—or a medical reason), prepared formula is better than pasteurized or evaporated milk formulas made at home.
The idea of eliminating cow’s milk after the age of two or three years, and not introducing such dairy products as cheese and yogurt, is shocking to many people who have been accustomed to hearing it advertised as the best all-around food for children and recommended in amounts from a pint to a quart a day. In my childhood the milkman delivered six quarts for six children!
It’s important to realize that for most of the world’s children, the feeding of milk does not go beyond weaning from the mother’s breast, typically at two years.
The Physician’s Committee for Responsible Medicine concluded that children can get sufficient calories, calcium, and high grade protein from a diet of vegetables, whole grains, and beans. Animal feeding experiments that have looked at various diets show that extra rapid growth and development from extra rich diets may be thought of as atypical and may lead to death from “old age” earlier than the average. The children who are given a diet without meats and dairy products may avoid arteriosclerotic heart disease, certain cancers, and stroke when on such a diet for life. More information about preparing this type of diet for young children is available in Baby and Child Care (7th edition).