Last month, I marked the twentieth year of my career in medicine. In 1998, I moved to Richmond to enroll at what was then known as the Medical College of Virginia. In addition to the name of Virginia’s renowned medical school, many other things have changed.
Topics that hardly received a mention in medical school and residency years ago are now bread and butter for parents and pediatricians. Feeding infants is one of those areas in which both recent research and changes in our society have informed pediatricians about what is best for parents and their new babies.
Support Women Who Want to Breastfeed
Breastfeeding still remains the gold standard for infant nutrition. This best first food has become more supported and more accessible in many ways. Nursing bras at your favorite superstore? Yes! Lactation pods at airports? Yes! Breastfeeding lounges at sports venues? Yes! Despite these advances, many mothers still struggle with work or family demands, modesty concerns, or community and family opinions. In the end, supporting mothers with whatever choice they feel is best for themselves and their baby is the most respectful and kind thing we can do to help parents starting off on their feeding journey with their babies.
Update on Food Allergy and Safety for Children
Perhaps the biggest area of change with infant feeding has been with food allergy prevention. In my childhood, it was almost unheard of to have a friend with food allergies. Now, it is part of the routine that other parents and I go through as we are dropping off our children for play dates. Guidelines released in 2017 turned what we thought we knew about food allergy prevention upside-down. Rather than holding off on highly allergenic foods like peanuts, we should be working to introduce those ingredients into our infant’s diets around four to six months of age for infants at risk. Parents of infants with eczema or with a strong family history of allergies should talk with their pediatrician about allergy testing first, but for other infants, introducing these and other allergenic foods early has been shown to help decrease food allergies later in life.
Historically, a staple of infant feeding has been cereal because of the beneficial iron fortification. Many parents use this as the first solid to feed their infants. Warnings from the FDA indicate that arsenic found in rice baby cereals mean that we should all be cautious about feeding our babies rice cereal regularly. Fortified wheat, oatmeal, and multigrain cereals are good choices for parents looking for cereal alternatives.
Families Can Head Off Picky Eating
Many families are worried about picky eating, which develops in infants around nine to twelve months of age, though some parents feel food preferences start as soon as food is introduced. Often, babies will need to try the same food many times before they like it – the normal response to a new texture or taste often causes them to push the food right back out. Also, around this 9- to 12-month mark, a baby’s weight gain is slowing down. This age infant is still gaining weight, but the speed of weight gain has decreased, and much like how a car driving more slowly needs less gas, the volume of solids a baby needs can decrease or vary drastically from day to day. If parents worry, they will often offer foods they know their child loves and will eat regardless. In this case, we’re encouraging a baby to eat when he is not hungry and filling him up on foods he already enjoys, further limiting any interest in trying new foods.
Eating Meals Together is Smart for Families
The best answer seems to be serving family-style meals and trusting that your babies, toddlers, and children will eat enough to grow as they should. Remember, continuing to offer foods in a low-stress environment is one of the best ways to ensure children of any age will like those foods at some point – yes, even if that’s not until after college! This long-term perspective is one reason why looking at growth curves with parents is one of my favorite parts of an office visit. It is reassuring to know children are growing well, despite our meal-to-meal struggles. The growth curves help keep us focused on the long view.
Family Lifestyle Choices Impact Long-term Health
Parents should be aware their behaviors and approaches to eating are important factors in setting up their child for a healthy weight over an entire lifetime. Although weight is a complicated topic and we have a long way to go before we fully understand what causes some children and adults to struggle with being overweight or obese, helping children to think of food as fuel for healthy living can help. From the beginning, encourage treats to be reserved for truly social and celebratory occasions like parties. Avoid using food as a reward. Keep only water and milk in the home to drink and treat any sugary beverages – including juice and sports drinks – like dessert. Structure snacks and mealtimes so our children know we are looking out for their good health. Help them to understand that routines around sleep and exercise are part of staying fit as well. These gentle restrictions – part of family life from the start – can be offered in a no-nonsense way that helps convey to children we’re not going to let them harm themselves by eating or drinking in unhealthy ways.
The depth and breadth of new discoveries in pediatrics are such that I still feel very much in the spring of my time as a pediatrician. With all of the changes we’ve seen over the past few years, I’m looking forward to another twenty years with my patients.