Give your baby the very best

Finger foods are food pieces that your baby can pick up and eat herself.

At first, finger foods are mostly tools for practice in self-feeding, which will help your baby to develop manual dexterity and give her more control of her jaw muscles. Practice at finger feeding also promotes the skills necessary for later self-feeding with a spoon. It may take up to baby's 9-10th month until she aims accurately enough to get good amounts of finger foods inter her mouth.

Finger food ides

SOFT pieces or wedges of ripe, peeled and cored fruit: peaches, mango, papaya, watermelon, canteloupe, honeydew, banana, pears, cucumber with seeds removed.
SOFT pieces of cooked, diced veggies: broccoli florets, sweet potato sticks, or cooked white/sweet potato rolled into balls.
Raw carrot, grated finely (bigger pieces are choking hazards)
Small tofu chunks
Beans cooked until very soft with skins removed
Peas cooked until soft and smashed slightly with a fork
Oatios or another health food brand equivalent of Cheerios
Other whole grain and unsugared dry boxed cereal (without nuts or other hard pieces)
Crumbled egg yolk pieces, cooked solid
Pieces of scrambled egg yolk, cooked solid
Small pieces of soft cheese
Small lumps of cottage cheese
Cooked brown rice and other grains
Whole grain crackers
Well-cooked small pasta pieces
Whole grain bread, cut into small pieces

( Super Porridge )

Apples can be served as a sweet dessert that does not cause a quick rise in blood sugar levels as other sweet desserts do. Although apples do not have lots of vitamins and minerals, they do have modest amounts. They are abundant in pectin, a fiber found on the apple peel and just below, which is known for its cholesterol-lowering effects. Whenever possible, eat apples unpeeled. Unfortunately, apple peels are a choking hazard for babies and toddlers.

Note that apple juice does NOT lower cholesterol. How does juice differ from cider? Apple cider is freshed-crushed apples in season. Apple juice is pasteurized a bottled for a longer shelf life. "Clarified" apple juice is filtered to remove all pulp.

Equivalents: 3 medium apples = 1 pound = 2 &1/2 cups peeled and sliced
Baby must be at least: 8 months for peeled, raw, grated apple. At least 3 years old for unpeeled.
In season: Available year round; peak for Cortland, October to January; for Empire, October to April; for Granny Smith's, April to July; for Macintoch, Newton Pippin and Red Delicious, September to Juce; for Golden Delicious and Spartan, September to May; for Idared, Rome Beauty and Winesap, October to June.
Choosing: Choose apples that are smooth and not shriveled. Bruises seriously affect apples, so check carefully for small depressions in the skin. Apples should be very firm and not yield when pressed. Be especially careful to check large apples for firmness, because they age more quickly than small apples. Small brownish or tan freckles on the skin are OK. Try to buy unwaxed apples. Wax used on produce is supposedly safe, but may contain pesticide residue.
Ripening and storing: As apples ripen, they become sweeter. Some varieties, such as Granny Smith's, stay more sour or tart than others. If apples are too firm or sour, ripen at room temperature for a day or two and they will ripen quickly. Place ripened apples in a plastic bag in the refrigerator. Apples keep in the refrigerator very well, up to 2-4 weeks before they begin to soften. Apples will keep longer if they don't touch each other - but who has the room! Soft apples can be eaten raw, but they are better for baking or applesauce.
Freezing applesauce: Freeze unsweetened applesauce using the food cube method for up to 2 months.

Some experts recommend waiting until age three before introducing a baby to peanuts, peanut butter, peanut oil, or anything containing these foods. A peanut allergy is a dangerous one and is similar to bee-sting allergies in that the reaction can be quick and deadly. Peanut allergic children may suffer serious reactions and even death from eatnig peanut-containing foods. A serious reaction may result when a child leans on a counter smeared with with peanut butter or peanut oil, even if it has been wiped off.

Best first foods

Ripe avocado
Ripe banana
Cooked, pureed sweet potatoes
iron-fortified single-grain infant rice cereal

Best foods for the beginning eater

Mild fruits, cooked and strained: apricots, nectarines, peaches, pears, plums and prunes
Whole-milk yogurt (for babies older than 6 months)
Commercial, iron-fortified single-grain infant cereals: barley, millet, oatmeal

6 months or older

Homemade single-grain cereals: brown rice, millet, rolled oats/oatmeal
Winter squash
Raw mild fruits: papaya, mango, and pears

7 months or older

Tofu
Cottage cheese
Homemade mixed cereals
Hard-cooked egg yolk (not the egg white!)
Asparagus
Carrots
Green beans
Peas
Summer squash
White potatoes
Peaches
Mild fruit juices/nectars, strained and diluted: apple, apricot, grape, papaya, pear, peach, and prune

8 months or older

Apricot
Apple
Cantaloupe
Honeydew melon
Grapes (peeled and quartered, not whole grapes)
Kiwi fruit
Plums
Watermelon
Broccoli
Okra
Cooked parsley
Wheat germ (if family allergy, wait until after 1 year)
Tahini
Finely ground nuts
Finely ground seeds
Brewer's yeast
Powdered kelp
Natural cheeses
Desiccated liver

9 months or older

Brussels sprouts
Cauliflower
Spinach
Beets
Greens
Kale
Eggplant
Rhubarb
Rutabaga
Cooked onion
Turnips
Pineapple
Finely chopped raw parsley
Beans, split peas, lentils and other legumes ground to a powder and cooked or cooked whole and mashed with skins removed

10 months or older

Ground sprouts
Thinned nut butters (See PEANUT ALLERGIES)
Whole grain pasta
Homemade bulgur cereal
Cooked whole grain cornmeal with the germ
Raw and finely grated: carrots, greens, summer squash, and sweet peppers

Foods for babies one year or older

Cow's milk
Citrus fruits/juices
Hard-cooked egg white
Uncooked honey
Tomatoes/tomato juice
Strawberries, blueberries, and other berries (not whole, cut into small pieces)

A 4 to 7 day waiting period after the introduction of each new food

It is possible that your baby has one or more food allergies, especially if food allergies run in your family. When your baby eats a food that she is allergic to, a reaction can occur immediately, or a reaction can be delayed and occur several days later. Because of this, it is important to wait several days before introducing another new food.

The Four Day Wait Rule

Introduce only one new food at a time. After you introduce your baby to a new food, do not introduce another food for at least 4 days. During the 4 day waiting period, watch for signs of allergies.

NOTE: Some experts recommend a 3 day waiting period, while others say 5 days. Still others recommend a full week of waiting.

See also food allergies

Introduce these foods to your toddler

Cow's milk
Citrus fruits/juices
Hard-cooked egg white
Uncooked honey
Tomatoes/tomato juice
Strawberries, blueberries, and other berries (not whole, cut into small pieces)


How much should my toddler be eating

Between ages one and five, a child's growth is in a decelerated stage; that is, they have slowed down in growth. Since growth slows down, their need for calories subsequently decreases, which in turn leads to a smaller quantity of food ingested per day. Added to the decelerated growth is a burgeoning independence which limits the variety of foods your child is willing to eat ("finicky eater"). Rest assured that toddlers do not need as much food as you might expect because of this slowing down of the growth rate.

Your toddler is still eating small amounts of food frequently throughout the day, probably 3 means and 2 snacks. Snacks continue to be a big part of your child's diet, and will be until your child is 4-5 years old.

Some toddlers are eating very few solids, or even no solids, at 12 months. This is not unusual and really depends on your child - there is quite a big variation. We like to see breastmilk making up the majority (around 75%) of baby's diet at 12 months. Some babies will be taking more solids by 12 months, but others will still be exclusively or almost-exclusively breastfed at this point. It is normal for baby to keep breastmilk as the primary part of his diet up until 18 months or even longer. An example of a nice gradual increase in solids would be 25% solids at 12 months, 50% solids at 18 months, and 80% solids at 24 months.

Some children take a little longer to begin taking solids well. Some of them have food sensitivities and this may be their body's way of protecting them until their digestive system can handle more. Others are late teethers or have a lot of difficulty with teething pain. At this point there is NOTHING that your milk lacks that your child needs, with the possible exception of enough iron. As long as his iron levels are within acceptable levels and when he does eat you are offering him foods naturally rich in iron, then you have plenty of time before you need to worry about the amount of solids he's getting.

All you need to do is to continue to offer foods. Don't worry if he's not interested or takes very small amounts. Your only true responsibility is what you offer, when you offer it and how you offer it, not whether or not he eats it. That has to be up to him. Trying to force, coax, or cajole your child into eating is never recommended. Continue to nurse on demand, day and night, and trust your child to increase the solids when he's ready. As baby slowly moves into eating more solids, your milk will fill any nutritional gaps nicely.

24 ounces of milk per day

Her bones will increase in length and density as calcium and phosphorus are deposited inot them. Because of this bone mineralization, it is important to make sure that your toddler is getting enough minerals in her diet. She should continue eating or drinking 24 ounces or 3 cups of milk, yogurt, or other high-calcium and protein foods daily. It's best to limit the amount of cow's milk that your child receives to 2-3 cups (16-24 ounces) per day, since too much cow's milk in a child's diet can put him at risk for iron-deficiency anemia (because milk can interfere with the absorption of iron) and may decrease the child's desire for other foods.

Whole milk or low-fat?

Now that your baby is a toddler, she can begin drinking cow's milk, unless there is a milk allergy. Some experts suggest that you continue to feed her whole milk products, and no low-fat or skim milk products until she is two years old. This ensures that your child receives enough fat, which is essential to proper brain development. Others suggest 3 years old.

Breastfeeding and cow's milk

Many nursing moms are told that they must introduce cow's milk at a year. Your nursing toddler is already getting the best milk he can get - mother's milk! Breastmilk has a higher fat content than whole cow's milk (needed for baby's brain growth), and all the nutrients of human milk are significantly more bioavailable than those of cow's milk because it is species specific (not to mention all the components of mother's milk that are not present in cow's milk).

There is no need for additional milk or (or the equivalent nutrients from other foods) as long as your baby is nursing 3-4 times per day. Cow's milk is really just a convenient source of calcium, protein, fats, vitamin D, etc. - it's not required. There are many people in many parts of the world who do not drink milk and still manage to get all the calcium, protein, fats, vitamin D, etc. that they need.

-Good non-dairy sources of protein include meats, fish, peas & beans (chick peas, lentils, baked beans, etc.), tofu and other soy products, boiled eggs, peanut and other nut butters (if your child is not allergic).
-Good non-dairy sources of fats include soy and safflower oils, flax seed and flax seed oil, walnuts, fish and fish oils, avocado. Adding fats to cooking and baking can work well, for example, stir fry in safflower oil or make mini-muffins with soy or rice milk, oil or butter, and eggs.
-If your child is not nursing regularly and is not allergic to cow's milk products, but simply doesn't like cow's milk, you can incorporate milk into your child's diet in other ways. Many children like cheese, whole-fat yogurt or ice cream. You can also put milk into various food products: pancakes, waffles, muffins, French toast, scrambled eggs, mashed potatoes, and baked goods.
-Some moms wish to offer cow's milk to their toddler, but baby doesn't like it. Over the age of 12 months, milk becomes a more minor part of a child's diet. It is sometimes helpful to mix increasing amounts of cow's milk with your expressed milk to help baby get used to the taste. Many dietitians see nothing wrong with adding some flavor (such as strawberry or chocolate) to cow's milk.

Food serving sizes for toddlers

A general rule of thumb is to make your toddler's portion sizes equal to 1-2 tablespoons of food for each year of age. For example, a two year old should get a 2-4 tablespoon portion.

( Sources )

Foods to introduce to your 11 month old

Continue to introduce foods that your baby hasn't had yet using the Four Day Wait Rule.

Food consistency

Although you are still feeding your baby her main meals mashed or coarsley pureed, she is probably enjoying quite a bit of finger foods by now. Sit with your baby while she finger feeds and watch carefully for choking or gagging. Never leave her alone while she is eating.

Daily amount of liquids

Breastmilk or formula is still the main food for your baby. She should be breastfeeding at least 3-4 times a day or drinking 26-32 ounces of formula. If she's drinking any less, decrease the amount of solids foods you are giving her. Also, to be sure that your baby is drinking enough breastmilk or formula, do not exceed 6-8 ounces per day of total water, juice, nut milks and other beverages.

Foods to introduce to your 10 month old

Ground sprouts
Thinned nut butters (See PEANUT ALLERGIES)
Whole grain pasta
Homemade bulgur cereal
Cooked whole grain cornmeal with the germ
Raw and finely grated: carrots, greens, summer squash, and sweet peppers

Food consistency

Food should still be fork-mashed or pureed, but continue to gradually increase its thickness and chunkiness. By 10 months, your baby may be eating finger foods very well. Finger foods are becoming a larger part of her diet. Small pieces of whole grain cooked pasta are a great finger food.

Daily amount of liquids

Breastmilk or formula is still the main food for your baby. She should be breastfeeding at least 3 times a day or drinking 24-32 ounces of formula. If she's drinking any less, decrease the amount of solids foods you are giving her. Also, to be sure that your baby is drinking enough breastmilk or formula, do not exceed 6-8 ounces per day of total water, juice, nut milks and other beverages.

Foods to introduce to your 9 month old

Brussels sprouts
Cauliflower
Spinach
Beets
Greens
Kale
Eggplant
Rhubarb
Rutabaga
Cooked onion
Turnips
Pineapple
Finely chopped raw parsley
Beans, split peas, lentils and other legumes ground to a powder and cooked or cooked whole and mashed with skins removed

Food consistency

As your baby's eating skills develop, gradually make the puree consistency a little thicker by adding less liquid. Also, gradually increase the chunkiness of pureed food by using your processor on a slower speed and/or for less time.

Besides increasing the chunkiness of your baby's food, another way to slowly accustom her to coarser food is to add a finely minced food to a smooth puree. Try adding finely grated cooked vegetable to yogurt. It is important that the chunkier food be very soft, so that your baby can chew them. If baby gags, chokes or spits our the food, you have made it too thick or chunky.

Daily amount of liquids

Breastmilk or formula is still the main food for your baby. She should be breastfeeding at least 3-4 times a day or drinking 26-32 ounces of formula. If she's drinking any less, decrease the amount of solids foods you are giving her. Also, to be sure that your baby is drinking enough breastmilk or formula, do not exceed 6-8 ounces per day of total water, juice, nut milks and other beverages.

Foods to introduce to your 8 month old

Apricot
Apple
Cantaloupe
Honeydew melon
Grapes (peeled and quartered, not whole grapes)
Kiwi fruit
Plums
Watermelon
Broccoli
Okra
Cooked parsley
Wheat germ (if family allergy, wait until after 1 year)
Tahini
Finely ground nuts
Finely ground seeds
Brewer's yeast
Powdered kelp
Natural cheeses
Desiccated liver

Continue using the 4 Day Wait Rule when introducing new foods

Wheat and other foods that contain gluten

The gluten contained in wheat, rye, and other foods is a common allergen. Some experts recommend waiting until baby is one year old before introducing it, especially it wheat/gluten allergy runs in your family.

Food consistency

Your baby's food should still be finely pureed. If your baby is easily eating this food, you can gradually decrease the added liquid for a thicker consistency. If she gags or chokes or spits out the food, you have made it too thick.

Daily amount of liquids

Breastmilk or formula is still the main food for your baby. She should be breastfeeding at least 5 times a day or drinking 29-32 ounces of formula. If she's drinking any less, decrease the amount of solids foods you are giving her.

Tahini

Tahini is a super healthy spread made from ground sesame seeds, and it is very easy to add into foods. It is high in calcium, protein and the healthy fat that your baby needs for proper development.

Brewer's yeast

Brewer's yeast, torula yeast, or nutritional yeast are nutrional supplement powders or flakes that are high in protein, the B vitamins, trace elements, and other nutrients. Brewer's yeast is very easy to add to other foods.

Foods to introduce to 7 month olds

Tofu
Cottage cheese
Homemade mixed cereals
Hard-cooked egg yolk (not the egg white!)
Asparagus
Carrots
Green beans
Peas
Summer squash
White potatoes
Peaches
Mild fruit juices/nectars, strained and diluted: apple, apricot, grape, papaya, pear, peach, and prune

There are over a dozen new foods in the list above to introduce to your 7 month old. Remember to always use the Four Day Wait Rule before introducing any new foods.

The experts don't agree on the ages to introduce these foods. Some recommend that you wait until 8 months before introducing egg yolks and cottage cheese, so you may want to introduce those later in the month and concentrate on introducing the new veggies first. Remember, the white part of the egg should not be introduced until after 1 year, because it is a common allergen. Be careful to cook the egg yolks thoroughly to kill any possible salmonella.

Tofu

Tofu is a great food for babies 7 months and older. Tofu is a cheese-like product made from soybeans. There are many nutritional and health benefits of soy products. Tofu does not have to be cooked, because it is made from cooked soybeans. Mashed or pureed tofu can be mixed with your baby's fruit of veggies. See TOFU for how to store and freeze it. Tofu is also a great finger food, and can be served in strips or small chunks.

Food consistency

Your baby's food should still be pureed or mashed to a smooth consistency, although it can be slightly thicker than it was for a beginning eater.

Daily amount of liquid

Breastmilk or formula is still the main food for your baby. She should be breastfeeding at least 5 times a day or drinking 30-32 ounces of formula. If she's drinking any less, decrease the amount of solids foods you are giving her.

Foods to introduce to 6 month olds

Homemade single-grain cereals: brown rice, millet, rolled oats/oatmeal
Winter squash
Raw mild fruits: papaya, mango, and pears

Food consistency

Foods for your baby at 6 months shold be made into a thing, very smooth, liquidy puree.

Daily amount of liquid

Breastmilk or formula is the top priority food. Your baby should be breastfeeding at least 5 times a day or drinking 32 ounces. If she is not, decrease the amount of solid foods you offer her.

You baby should be drinking a little water before and after meals. Limit baby's water intake to at most 4-8 ounces per day in order to assure she is drinking enough breastmilk or formula.

Foods to introduce to beginning eaters

Ripe avocado
Ripe banana
Sweet potatoes
Yogurt
Commercial, iron-fortified single-grain infant cereals: rice, barley, millet, oatmeal
Mild fruits, cooked and strained: apricots, nectarines, peaches, pears, plums and prunes

The first week of solid foods

For the first few days, each meal should be no more than a tablespoon before mixing with liquid.

The second week of solid foods

At the beginning of the second week of solids, introduce your baby to one new food from the list above. Wait 4-7 days (see the Four Day Wait Rule) and watch for allergy symptoms before introducing another new food.

Most fruits should be cooked for babies younger than 6 months

Before 6 months, it is best not to feed raw fruits to your baby (except for bananas and avocado). Cook fruits to make them soft and more digestible for your baby's immature system. If fruit contains little bits of peel, it is important to strain them out so your baby does not choke on them.

Food consistency for beginners

Food should be pureed to the smoothest consistency. Mash foods very well with a fork or puree in a blender until all lumps are completely gone. Mix finely pureed food with enough liquid (breastmilk, formula, or water) until the food is very thing and will pour off the spoon into your baby's mouth. Food should only be slightly thicker than breastmilk or formula.

Daily amount of liquids for beginners

Breastmilk or formula is the top priority food. Your baby should be breastfeeding at least 5 times a day or drinking 32 ounces of formula a day. If your baby is not drinking this amount, decrease the amount of solid foods. Your baby should be drinking a small amount of water after each meal (see Water).

Why delay solids?

Health experts and breastfeeding experts agree that it's best to wait until your baby is around six months old before offering solid foods. The American Academy of Pediatrics and the World Health Organization recommend that all babies be exclusively breastfed (no cereal, juice or other foods) for the first 6 months of life. Most babies will become developmentally and physiologically ready to eat solids by 6-9 months of age. For some babies, delaying solids longer than six months can be a good thing; for example, some doctors may recommend delaying solids for 12 months if there is a family history of allergies.

Reasons

Although some of the reasons listed here assume that your baby is breastfed or fed breastmilk only, experts recommend that solids be delayed for formula fed babies also.

Delaying solids gives baby greater protection from illness.

Although babies continue to receive many immunities from breastmilk for as long as they nurse, the greatest immunity occurs while a baby is exclusively breastfed. Breastmilk contains 50+ known immune factors, and probably many more that are still unknown. One study has shown that babies who were exclusively breastfed for 4+ months had 40% fewer ear infections than breastfed babies whose diets were supplemented with other foods. The probability of respiratory illness occurring at any time during childhood is significantly reduced if the child is fed exclusively breast milk for at least 15 weeks and no solid foods are introduced during this time. (Wilson, 1998) Many other studies have also linked the degree of exclusivity of breastfeeding to enhanced health benefits. (See Risks of artificial feeding.)

Delaying solids gives baby's digestive system time to mature.

If solids are started before a baby's system is ready to handle them, they are poorly digested and may cause unpleasant reactions (digestive upset, gas, constipation, etc.). Protein digestion is incomplete in infancy. Gastric acid and pepsin are secreted at birth and increase toward adult values over the following 3 to 4 months. The pancreatic enzyme amylase does not reach adequate levels for digestion of starches until around 6 months, and carbohydrate enzymes such as maltase, isomaltase, and sucrase do not reach adult levels until around 7 months. Young infants also have low levels of lipase and bile salts, so fat digestion does not reach adult levels until 6-9 months.

Delaying solids decreases the risk of food allergies.

It is well documented that prolonged exclusive breastfeeding results in a lower incidence of food allergies (see Allergy References and Risks of Artificial Feeding). From birth until somewhere between four and six months of age, babies possess what is often referred to as an "open gut." This means that the spaces between the cells of the small intestines will readily allow intact macromolecules, including whole proteins and pathogens, to pass directly into the bloodstream.This is great for your breastfed baby as it allows beneficial antibodies in breastmilk to pass more directly into baby's bloodstream, but it also means that large proteins from other foods (which may predispose baby to allergies) and disease-causing pathogens can pass right through, too.

Currently there is no conclusive evidence indicating that fluoride supplements in infancy improve a breastfed baby's dental health. Dr. Ruth Lawrence (author of "Breastfeeding: A Guide for the Medical Profession") states:

Evidence supports the contention that there is adequate fluoride in human milk, and fluorosis from excessive amounts is a concern.

The American Academy of Pediatrics has released an interim policy statement on fluoride supplementation: "Fluoride Supplementation for Children: Interim Policy Recommendations". Their stance is this:

Fluoride should not be administered to infants during the first 6 months after birth, whether they are breast- or formula-fed. During the period from 6 months to 3 years of age, breastfed infants (and formula-fed infants) require fluoride supplementation only if the water supply is severely deficient in fluoride (<0.3 ppm). [This particular statement is from the AAP's policy statement on breastfeeding.]

Many city water systems add fluoride to the water. If you use well water or bottled water, it's unlikely that fluoride has been added to your water, but it may still be there. Fluoride occurs naturally in most water, so you really need to know how much fluoride is in your water before you decide whether to supplement.

How do you find out how much fluoride is in your drinking water?

-If you use city water, call your local water department to find out.
-If you use bottled water, call the bottling company.
-If you use well water, you can ask your local water department about having your water tested for fluoride - fluoride analysis isn't very expensive (I've seen it advertised for $10).
-After you know how much fluoride is already in your drinking water, you can look at the AAP recommendations and decide whether fluoride supplementation might be beneficial.

Fluoride facts

-The benefits of fluoride were discovered in one of nature's own experiments -- the incidence of dental carries proved to be fifty percent less in areas with naturally fluoridated water, while the incidence of major diseases in these areas was the same as in the general population. Studies of large numbers of people over many generations have attested to the value of fluoride as a safe and effective nutritional supplement for the prevention of tooth decay.
-Fluoride has been added to drinking water for almost fifty years, and follow-up studies have validated the cavity-lowering effects of fluoride supplementation and failed to show any increase in diseases due to this public health measure.
-According to public health officials, fluoride supplementation ranks along with water purification and vaccines as one of the top public health measures of the 20th century.
-The American Academy of Pediatrics, the U.S. Public Health Department, and the American Dental Association have all recommended that from six months to sixteen years growing children with growing teeth should receive fluoride supplements either in their diet or in the water they drink.

How fluoride helps

Fluoride that your child ingests either in food or water enters the bloodstream and becomes incorporated in the tooth enamel even before the teeth erupt, making them strong and more resistant to decay. Fluoride applied topically through toothpaste or by your dentist also makes the teeth more resistant to decay and strengthens the enamel as it repairs itself from normal wear. Fluoride is a naturally-occurring trace mineral, and like calcium, iron and other minerals, it is often found naturally in water. Unlike other minerals, it has a narrow risk/benefit ratio. This means that just the right amount of fluoride helps the teeth and too much harms the teeth, causing a condition called fluorosis. While most cases of fluorosis are mild, causing a few white spots or patches on the teeth, more severe cases can cause a brownish mottling and weaken enamel. Because it's important to give infants and children just the right amount of fluoride, it is available only by prescription and should be given to your infant or children only in the exact dosage your doctor prescribes. There are many myths that persist about fluoride, but these have been disproven. Fluoride does not cause weaker bones or cancer.

Using fluoride supplements safely

To be sure your children get the right amount of fluoride -- not too much and not too little -- follow these recommendations:

-If your child drinks several glasses of water a day and the local water supply has a fluoride concentration of at least .3 parts per million, your child does not need fluoride supplements in the form of tablets or drops. Check with your family doctor or dentist as to your child's individual fluoride needs. You can check the fluoride content of your water by calling your local water department.
-Even if your local tapwater is fluoridated, your infant or child may not drink enough tapwater to receive sufficient fluoride. In this situation, consult your doctor about giving your child fluoride supplements. If you drink bottled water , it will not be fluoridated unless you specifically request it.
-Don't use fluoride-containing toothpastes and mouthwashes in children below the age of two, since toddlers tend to swallow toothpaste.
-If your child uses a fluoridated toothpaste, allow only a pea-sized dab a day. This will provide the daily dose of recommended fluoride without risking overdose. Don't allow your children to use the generous amounts of toothpaste they see in TV commercials.
-Ready-to-feed formulas are not made with fluoride- supplemented water.
-Breastfed babies do not need additional supplies of fluoride. The American Academy of Pediatrics recommends that fluoride supplements not be given to infants younger than six months of age because of the concern about fluorosis in this age group.

( Sources )

By Kelly Bonyata, IBCLC

A vegetarian or vegan mother does not need to take any special diet precautions as long as she is maintaining a diet with adequate amounts of vitamin B12, calcium and zinc. This is something that mom needs to do for herself, even if she is not breastfeeding.

If you are avoiding meat but eating any other type of animal protein (from eggs, milk or cheeses, fish, etc.) you will normally get enough vitamin B12.

If, on the other hand, you are consuming no animal protein at all - no cheese, no eggs, no milk, no seafood, no poultry, etc. you will need to make sure you get enough vitamin B12 to prevent your baby (and you) from becoming deficient in this vitamin. Some moms take supplements. Other options would be to add fermented soybean foods and yeast to your diet. Supplementing your baby with vitamin B12 is an option if you are vitamin B12 deficient, but you would still need the vitamin B12 for yourself (and if you're getting enough, baby won't need the supplement).

If you don't eat dairy products, check to make sure you are getting sufficient calcium and zinc (this is for mom's sake - baby will get enough of these things even if mom is deficient).

( Sources )

Does my baby need vitamin B12 supplements?
By Kelly Bonyata, IBCLC

Infants of well-nourished mothers with adequate vitamin B12 intake do not need supplements. Mothers who are on strict vegan diets (that do not include fish, meat, and dairy products) may benefit from vitamin B12 supplements. Mothers who have had gastric bypass surgery are also at risk for vitamin B12 deficiency, and may also need small supplements of this vitamin. As long as mom is getting enough vitamin B12, then the breastfed baby is getting enough (since increasing mom's vitamin B12 intake increases the amount of the vitamin in her milk).

Vitamin B12 deficiency is rare, especially in North America. When a nursing mother has adequate vitamin B12 in her diet, her nursing baby will receive as much as he needs through breastmilk. Vitamin B12, or cobalamin, is present widely in foods from animal sources. Dietary deficiency is difficult to achieve, unless a person is eating a strict vegan diet. A simple blood test can diagnose current vitamin B12 deficiency.

Vitamin B12 is produced by the intestinal flora of animals. Most humans need to eat animal foods (liver, muscle flesh, eggs, and dairy products are sources, in order from richest to poorest sources) in order to supply enough B12, although some persons produce enough for their own use in their own digestive tracts.

The World Health Organization recommends 1 ?g per day of vitamin B12. In the US, the RDA for adults is 2.4 ?g of vitamin B12 per day, 2.6 ?g during pregnancy, 2.8 ?g during lactation, and proportionally less for children. Both have a significant margin of safety built into their recommendations. Unlike other B vitamins, B12 is stored in the liver so daily consumption is not necessary.

According to Nutrition During Lactation (Hamosh 1991, p. 157-58), a full-term infant is born with a store of vitamin B12 that should supply his needs for approximately 8 months. The amount of vitamin B12 usually provided by breastmilk to the exclusively breastfed baby is more than sufficient.

Vitamin B12 concentrations in breastmilk are dependent on the mother's B12 intake and stores. If mom eats a mixed diet that includes animal foods, then her milk will be a generous source of vitamin B12. The main nutritional concern with a vegetarian diet centers around whether a nursing mom is consuming animal protein, which can include dairy products, eggs, fish or meat. If these foods are not a regular part of your diet, then supplementation (for mom) with vitamin B12, and/or regular intake of foods such as fortified soy milk and fortified yeast is recommended.

An infant born to a mother who has been a total vegetarian for many years (and has a vitamin B12 deficiency herself) is at high risk for vitamin B12 deficiency. Even though the mother may not show signs of vitamin B12 deficiency, her fetus may not receive adequate intake of the vitamin since most of the infant's B12 stores comes from the mother's diet during pregnancy rather than from her stores. Exclusively breastfed babies of women who eat little or no animal foods (and who do not take supplements of B12) are also at risk for vitamin B12 deficiency. Vitamin B12 deficiency may develop in the breast-fed infant within 3-6 months of age. The B12 deficient child may have seizures, become apathetic, lethargic, anemic, and show signs of developmental delay and failure to thrive. This deficiency syndrome is not usually clinically apparent until the latter half of infancy, and breastfed infants may develop clinical signs of vitamin B12 deficiency before their mothers do.

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Does my baby need vitamin D supplements?

The American Academy of Pediatrics and the Canadian Paediatric Society recommend vitamin D supplementation for all infants and children to ensure that the small percentage of infants/children who need additional vitamin D (due to the below mentioned factors) do not become deficient.

Is your baby at risk for vitamin D deficiency?

First of all, babies rarely need vitamin D supplements. The babies who do need these supplements need them due to a lack of sufficient sunlight. Factors that put your breastfed baby at risk for vitamin D deficiency (rickets) are:

-Baby has very little exposure to sunlight. For example: if you live in a far northern latitude, if you live in an urban area where tall buildings and pollution block sunlight, if baby is always completely covered and kept out of the sun, if baby is always inside during the day, or if you always apply high-SPF sunscreen.
-Both mother and baby have darker skin and thus require more sun exposure to generate an adequate amount of vitamin D. Again, this is a "not enough sunlight" issue - the darker your skin pigmentation, the greater the amount of sun exposure needed. There is not much information available on how much more sunlight is needed if you have medium or darker toned skin. See the section below regarding amount of sunlight needed.
-Mother is deficient in vitamin D - this is rare in western countries. The amount of vitamin D in breastmilk depends upon mom's vitamin D status. If baby gets enough sunlight, mom's deficiency is unlikely to be a problem for baby. However, if baby is not producing enough vitamin D from sunlight exposure, then breastmilk will need to meet a larger percentage of baby's vitamin D needs. If mom has minimal exposure to sunlight (see above examples) and is not consuming enough foods or supplements containing vitamin D, then she may be vitamin D deficient. More below on supplementing mom with vitamin D.

Vitamin D supplementation is often recommended particularly in Canada and other northern latitudes, since these areas don't receive much sunlight during certain parts of the year. If you live in the far north and don't receive much sunlight, you might consider a vitamin D supplement. However, Dr. Jack Newman, a Canadian pediatrician and breastfeeding expert, indicates that Vitamin D supplements are rarely needed - even in Canada. The 2002 results of the Canadian Paediatric Surveillance Program confirmed 20 cases of nutritional rickets in Canada during 6 months of study. The researchers noted that:

"Intermediate- and dark-skinned children who were breast-fed without vitamin D supplementation were at risk for the disease. Among identified cases, the mothers were frequently veiled, did not receive vitamin D supplementation following delivery, and infrequently ingested milk (thus eliminating a potential dietary source of vitamin D)... A subset of residents in Canada are particularly at risk for nutritional rickets, including darker-skinned, breast-fed infants whose mothers adhere to a diet that is low in vitamin D and have limited sun exposure." [p. 43-44]

Per [Hamosh 1991, p. 156],

"In summary, exclusive breastfeeding results in normal infant bone mineral content when maternal vitamin D status is adequate and the infant is regularly exposed to sunlight. If the infant or mother is not exposed regularly to sunlight, or if the mother's intake of vitamin D is low, supplements for the infant may be indicated."

World Health Organization information [Butte 2002, p. 29 ] states,

"...although there is abundant evidence suggesting that breastfed infants often receive less vitamin D than is required, most studies fail to find rickets in breastfed infants less than 6 months of age... infants who are exclusively or predominantly breastfed for 6 months or longer can be at an increased risk of rickets if their mothers are at risk of vitamin D deficiency, and the infants receive limited sun exposure and no vitamin D supplements."

If you are in doubt as to whether vitamin D supplements are needed and prefer not to give supplements "just in case" -- getting a blood test to determine the vitamin D status of you or your child is always an option.

Recommended vitamin D intake

In the US, the recommended intake of vitamin D for babies and lactating mothers is 200 IU (5 micrograms) per day, the same as for anyone else under the age of 50.

Infants 0-12 months should not exceed 1,000 IU (25 ?g) per day. Anyone aged 1-50 years should not exceed 2,000 IU (50 ?g) per day.

The amount of vitamin D in human milk is small: 0.5-3.4 ?g/liter (20-136 IU/liter) [Hamosh 1991, Good Mojab 2002] in mothers who are not vitamin D deficient. However, the vitamin D in human milk is in a form that is very easily used by the baby and therefore adequate for most infants, when combined with a small amount of sun exposure.

How much sunlight is needed to generate adequate vitamin D?

The best way to get vitamin D, the way that our bodies were designed to get the vast majority of our vitamin D, is from modest sun exposure. Going outside regularly is generally all that is required for you or your baby to generate adequate amounts of vitamin D. (Keep in mind that there is a concern of sunburn and increased risk of skin cancer with too much sun exposure, however.)

Per "Infant feeding: the physiological basis" [WHO, 1991] by James Akre,

"...it is now understood that the optimal route for vitamin D ingestion in humans is not the gastrointestinal tract, which may permit toxic amounts to be absorbed. Rather, the skin is the human organ designed, in the presence of sunlight, both to manufacture vitamin D in potentially vast quantities and to prevent the absorption of more than the body can safely use and store."

World Health Organization information states, "Two hours is the required minimum weekly amount of sunlight for infants if only the face is exposed, or 30 minutes if the upper and lower extremities are exposed." This guideline is from a study [Specker 1985] of exclusively breastfed Caucasian infants under six months old at latitude 39?N (Cincinnati, Ohio, USA). Darker skinned infants may require a longer time outside (three to six times the sunlight exposure) to generate the same amount of vitamin D.

It is not necessary to get sun exposure every single day, as the body stores vitamin D for future use. "Studies have shown that children can store enough vitamin D to avoid deficiency for several months when they are exposed to only a few hours of summer sunlight."

Food sources for vitamin D

Vitamin D is available in fortified foods (where vitamin D has been added) such as milk, cereals, or margarine. There is also a new vitamin D fortified orange juice available (fortified with the same amount of vitamin D as used in milk). Vitamin D is found naturally in a few foods including fatty fishes & fish oils (salmon, mackeral, sardines, herring, cod liver oil), liver and egg yolk.

Can we supplement the mother instead of the baby?

During pregnancy: The primary source of vitamin D for babies, other than sunlight, is the stores that were laid down in baby's body prior to birth. Per [Hamosh 1991, p. 155], several studies "suggest that infants born to mothers with inadequate vitamin D status are highly dependent on a regular supply of vitamin D through diet, supplements or exposure to ultraviolet light." Because mom's vitamin D status during pregnancy directly affects baby's vitamin D stores at birth and particularly during the first 2-3 months, it would be very helpful for pregnant women to make sure they are getting enough vitamin D. It is easy to determine if mom is vitamin D deficient by using a simple blood test to check parathyroid hormones. If these hormones are elevated, it can indicate a deficiency in vitamin D. Baby's fetal stores of vitamin D are sufficient for around 3 months if baby gets very little sunlight, but will last much longer if baby is exposed to sunlight regularly.

During lactation: Adding a vitamin D supplement to mom's diet and/or exposure to ultraviolet light will increase the amount of vitamin D in her breastmilk. As long as mom is not vitamin D deficient, her breastmilk will have the right amount of vitamin D. However, babies were "designed" to get only part of their vitamin D from breastmilk and the remainder from sun exposure - what if baby does not get a minimum amount of sun? A 2004 study [Hollis & Wagner 2004] determined that supplementing the mother with 2000-4000 IU vitamin D per day safely increased mother's and baby's vitamin D status: the 2000 IU/d dose resulted in a limited improvement, and "A maternal intake of 4000 IU/d could achieve substantial progress toward improving both maternal and neonatal nutritional vitamin D status." A Finnish study [Ala-Houhala 1986] showed that supplementing the mother with 50 ?g (2000 IU) vitamin D per day was as effective for maintaining baby's vitamin D levels as supplementing the baby with 10 ?g (400 IU) per day. However, some feel that higher levels of maternal supplementation (greater than the "safe" level of 2000 IU) would be needed to maintain adequate infant vitamin D levels.

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Does my baby need vitamins?

Vitamin and mineral supplements are not necessary for the average healthy, full-term breastfed baby during the first year. Breastmilk is all that your baby needs for at least the first six months of life. Studies have shown that vitamins, fluoride, iron, water, juice, formula and solid foods are rarely beneficial to healthy breastfed babies during the first six months, and some can even be harmful. There are certain cases where a vitamin supplement may be needed for a breastfed baby during the first year, but these cases are the exception, not the rule (see below for specifics).

The American Academy of Pediatrics states:

No supplements (water, glucose water, formula, and so forth) should be given to breastfeeding newborns unless a medical indication exists... Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first 6 months after birth.

AAP recommendations on specific vitamins are noted below.


Vitamin A

Breastmilk is a natural, excellent source of vitamin A. Promoting breastfeeding is the best way to protect babies from Vitamin A deficiency. Vitamin A deficiency is rare in breastfed babies even in areas of the world where vitamin A deficiency is widespread.

Vitamin B1 (thiamine)

If mom is getting enough thiamine, then her milk has enough for baby and supplements are not needed. If mom is thiamine-deficient, then adding additional thiamine to mom's diet should increase the amount of thiamine in her milk (since this vitamin is water-soluble) to the necessary levels. Thiamine deficiency (beriberi) is rare in the United States.

Vitamin B2 (riboflavin)

Supplements are not recommended for breastfed babies, as riboflavin deficiency is rare in developed countries. The levels of riboflavin in human milk are quite constant and are usually affected only by large maternal supplements (3x the maternal RDA).

Vitamin B6

If mom gets adequate amounts of vitamin B6, then additional supplements are not necessary for a healthy baby. If mom is not getting enough vitamin B6, then adding additional vitamin B6 to mom's diet will increase the levels in her milk to the required levels.

Vitamin B12

See Vitamin B12

Vitamin C

Breastfed babies should not be routinely supplemented with vitamin C except in cases of obvious scurvy (vitamin C deficiency). FDA requirements for nursing mothers for this vitamin are 100 mg per day. Supplements of vitamin C for the mother do not alter the amounts in breastmilk, as they remain fairly constant no matter what mother's intake levels (assuming the mother does not have scurvy).

How much vitamin C in breastmilk? by Debbie Donovan, IBCLC

Calcium

Breastfed babies do not need additional calcium over that which they get from breastmilk and (during the second 6 months) complementary foods. According to the American Academy of Pediatrics Policy Statement on Calcium Requirements of Infants, Children, and Adolescents:

No available evidence shows that exceeding the amount of calcium retained by the exclusively breastfed term infant during the first 6 months of life or the amount retained by the human milk-fed infant supplemented with solid foods during the second 6 months of life is beneficial to achieving long-term increases in bone mineralization.

Vitamin D

See Vitamin D

Vitamin E

No known deficiencies of vitamin E have been described in healthy term infants fed human milk. Vitamin E supplements for mothers and their breastfed babies are not indicated.

Fluoride

See Fluoride

Folic acid (folate)

Folic acid deficiency has not been reported in breastfed, full-term infants, and supplements are not recommended.

Iron

See Iron

Vitamin K

Baby's vitamin K stores at birth are very low. Vitamin K is needed for proper blood clotting, and a deficiency of this vitamin causes a syndrome called hemorrhagic disease of the newborn. Increasing mom's vitamin K intake increases the amount of vitamin K in her milk. The review article "Do breastfed infants need supplemental vitamins?" (Greer 2001) recommends:

Other than the intramuscular injection of 1 mg of vitamin K at birth, there are no further recommendations for vitamin K supplements to breastfed infants with well-nourished mothers. If parents refuse the intramuscular injection, then 2 mg of the parenteral solution should be given orally. Because this is variably absorbed and there is no well-absorbed liquid product available in the United States for infants, it seems best to repeat the oral dose at 7 and 28 days after birth, as is done in northern Europe when oral vitamin K is used in newborns.

Vitamin K: Inject or Not, by Linda Folden Palmer, DC

Niacin

Niacin deficiency in breastfed infants in developed countries is extremely rare, and no supplementation is recommended.

Zinc

Healthy full-term breastfed babies do not need additional zinc past what they get from breastmilk and (after 6-8 months) from complementary foods. Good sources of zinc include meat (especially red meat) and yogurt. Signs of a mild zinc deficiency include: lessened appetite, lowered immune function, limited activity, growth faltering. Low birth weight, small for gestational age and premature infants are at risk for zinc deficiency.

If you're worried that your baby will need vitamins because your diet is not ideal

Studies have shown that when a mother is deficient in a certain nutrient, improving the mother's nutrition and/or supplementing her diet (multivitamins, etc.) may be as effective or more effective than giving her baby vitamin supplements.


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