Beyond Breast and Bottle

by Daniel Neuspiel, MD and Steven Schwartz, MD

Research shows early feeding can have long-term effects on your child's health. How can you make sure your child is eating the right foods once he or she is off the bottle? Dr. Daniel Neuspiel, associate chairman of pediatrics at Beth Israel Medical center, and Dr. Steven Schwartz, professor of pediatrics at SUNY Brooklyn, will be helping us ready to begin solids.

When do you start giving your child solid food?
The answer is not "as early as possible," which is sometimes what I see. There are no hard and fast rules, but I can tell you what I do. Typically, when an infant is taking an appropriate amount of formula and they're consuming greater than 32 ounces per day, that usually signals the time to start some form of solids. It's harder to measure intake with breastfed infants, but developmental readiness is a good sign. And for infants that are breast-fed or bottle-fed typically that's around four to five months.

What's the best time to stop breast-feeding?
I really recommend breast-feeding for as long as it's comfortable and possible for the mother and child, given their own preferences and lifestyle. Certainly, six months of breast-feeding is recommended as the optimal early nutrition for babies.

How is it best to introduce solids?
It's important to take a couple of things into consideration. In addition to the time you're introducing solids, the way they're introduced is also important. Giving solids only by spoon and not putting them in the bottle is an important rule. Many parents start putting cereal and other solids in the bottle. And while they're well-meaning in doing that, that can often cause some digestive problems.

There are clinical conditions in which we recommend rice cereal in the bottle, but that's specifically on a physician's recommendation. I'm reminded of an advertisement I received several years ago. I'm not even going to mention what it was called, but it was a bottle with a spring-loaded plunger in it that was for the administration of solids in the bottle. And clearly that is not the way to go.

It's advisable to start with one solid at one time to give the baby an opportunity adjust to that new taste, new food and perhaps more importantly to watch for any potential allergic reactions, difficulties the baby may have.

There are no good tests for food allergies that are reliable. The most reliable is give a single food and see if there is a reaction. And use withdrawal and rechallenge. So it's very important to only start one food at a time.

What do you think of solid food in a baby bottle?
In general it's not recommended. There are certain medical conditions where there may be some recommendation for thickening a formula. But unless a pediatrician recommends it, parents should stay away from putting any solids into bottles.

Giving a child solid food in a bottle, increases the risk of obesity. Solids are very calorically dense substances. And you're in fact overfeeding a child. If you're going to put solid food in a bottle, you're going to have to open up the nipple because it's very hard to get solids through that nipple. So again, it is really, I think, a symptom of overfeeding. We're not going to see digestive problems; you may see allergies, particularly if you start the solids very, very early. And indeed, if solids are going in the bottle, my assumption is that the child is not physiologically ready to take the solids on the spoon, so that's why we're giving it in the bottle. Again, it's just not correct. It's not a good idea.

What about a six-week-old who doesn't sleep well?
First of all, they're not going to be able to digest it. Second of all, a six-week-old or a two-month-old is not going to be able to coordinate getting the cereal from the front of the mouth to the back of the mouth and then swallowing it. And if they're unable to do that, you may find them gagging or choking -- sometimes with bad consequences. So again, they're not ready for it so don't give it.