Age-appropriate diet for children
An age-appropriate diet is one that provides adequate nutrition, is appropriate for a child's state of development, and can help prevent childhood obesity.
Diet - age appropriate
Rice cereal and other foods with rice have long been recommended as first or early foods for infants and children. Recent concerns have been raised regarding arsenic content in rice. Key points about this issue are:
- Further research continues.
- Neither the FDA or The American Academy of Pediatrics recommend avoiding or placing specific limits on the amount of rice in a child’s diet.
Parents should also offer children a wide variety of age-appropriate foods to their children. These include:
- Cereals from other grains such as oats, wheat, and barley
- Vegetable purees
- Finely chopped meat (good source of iron)
BIRTH TO 4 MONTHS OF AGE
During the first 4 - 6 months of life, infants need only breast milk or formula to meet all their nutritional needs.
If breastfeeding, a newborn may need to nurse 8 - 12 times per day (every 2 - 4 hours), or on demand. By 4 months, the baby is likely to cut back to 4 - 6 times per day, however, the quantity of breast milk consumed at each feeding will increase.
Formula-fed babies may need to eat about 6 - 8 times per day, starting newborns with 2 - 3 ounces of formula per feeding (for a total of 16 - 24 ounces per day). As with breastfeeding, the number of feedings will decrease as the baby gets older, but the amount of formula will increase to approximately 6 - 8 ounces per feeding.
Never give honey to an infant, as it may contain the spores that cause botulism. An infant's immune system is not fully developed to fight off this disease.
Although an infant may sleep through the night, waking to feed may be necessary if the infant is not eating enough during the day or if they are underweight. Routine check-ups with your physician to monitor your child's growth will ensure they are eating adequately during the day. Your doctor or dietitian will inform you if waking to feed is recommended.
4 - 6 MONTHS OF AGE
At 4 - 6 months of age an infant should be consuming 28 - 45 ounces of formula, and is often ready to start the transition to solid foods. Starting solids too soon may cause the infant to choke if they are not physically ready.
There are several developmental milestones to indicate an infant is ready to eat solid foods:
- The birth weight has doubled
- The baby has good control of head and neck
- The baby can sit up with some support
- The baby can show fullness by turning the head away or by not opening the mouth
- The baby begins showing interest in food when others are eating.
Start solid feedings with iron-fortified baby rice cereal mixed with breast milk or formula to a thin consistency. The cereal may be mixed to a thicker consistency as the baby learns to control it in his mouth.
- Initially, offer cereal 2 times per day in servings of 1 or 2 tablespoons (dry amount, before mixing with formula or breast milk).
- Gradually increase to 3 or 4 tablespoons of cereal.
- Cereal should not be given in a bottle unless a doctor or dietitian recommends it, for example, for reflux.
Once the baby is eating rice cereal routinely, you may introduce other iron-fortified instant cereals. Only introduce one new cereal per week so you can watch for an intolerance or allergy.
Never put a child to bed with a bottle as this can cause bottle mouth, resulting in tooth decay. Use plain water if a bottle is necessary. Discuss use of water with your physician. (In some cases, use of excess water can lead to seizures in children.)
6 - 8 MONTHS
Continue to offer breast milk or formula 3 - 5 times per day. Cow's milk is not recommended by the American Academy of Pediatrics for children under 1 year old.
The baby will begin drinking less formula or breast milk once solid foods become a source of nutrition.
After a baby has tried a variety of different baby cereals, try strained fruits and vegetables.
- For strained fruits and vegetables, introduce one at a time, waiting 2 - 3 days in between to check for any allergic reaction.
- Start with plain vegetables such as green peas, potatoes, carrots, sweet potatoes, squash, beans, beets; and plain fruits such as bananas, applesauce, apricots, pears, peaches, and melon.
- Some dietitians recommend introducing a few vegetables before fruits, as the fruit's sweetness may make a less-sweet food such as vegetables less appealing.
- Give fruits and vegetables in 2 - 3 tablespoon servings and offer about 4 servings per day.
Amounts of fruits and vegetables eaten per day will vary between 2 tablespoons and 2 cups depending on the size of your child and how well the child eats fruits and vegetables. The consistency of foods offered may be gradually increased as your child tolerates.
Finger foods may be offered in small amounts, but avoid foods such as apple chunks or slices, grapes, hot dogs, sausages, peanut butter, popcorn, nuts, seeds, round candies, and hard chunks of uncooked vegetables that may cause choking.
Soft cooked vegetables, washed and peeled fruits, graham crackers, melba toast, noodles are good finger foods. Salty or sugary foods are not recommended. Teething foods, such as toast strips, unsalted crackers, bagels, and teething biscuits may also be introduced at this time.
8 - 12 MONTHS OF AGE
Breast milk or formula should be offered three to four times per day at this age. Cow's milk is not recommended by the American Academy of Pediatrics for children under 1 year old.
At 8 - 12 months of age, a baby will be ready to try strained or finely chopped meats. For breastfed infants, start meats at 8 months of age (breast milk is not a rich source of iron, but infants have adequate iron stores to last until 8 months of age when iron-rich foods such as meats can be given).
As with other foods, offer only 1 new meat per week in 3 - 4 tablespoon servings -- use strained and finely ground meats, frankfurters, or meat sticks. Serving sizes for fruits and vegetables increases to 3 - 4 tablespoons, four times per day. Eggs may be given 3 - 4 times per week, but only the yolk until the baby is 1 year old, as some babies are sensitive to egg whites.
By the age of 1, most children are off the bottle. If the child still uses a bottle, it should contain water only.
1 YEAR OF AGE
After a baby is 1-year old, whole milk may replace breast milk or formula. Children under the age of 2 should not be given low-fat milk (2%, 1%, or skim) as they need the additional calories from fat to ensure proper growth and development.
Children under the age of 1 should not be given whole milk as it has been shown to cause low blood counts. Cheese, cottage cheese, and yogurt, however, may be given in small amounts.
The 1-year-old child should be getting much of their nutrition from meats, fruits and vegetables, breads and grains, and the dairy group, especially whole milk.
Providing a variety of foods will help to ensure enough vitamins and minerals. Toddlers do not grow as rapidly as babies do, so their nutritional needs relative to their size decrease during the second year of life. Although they continue to gain weight, they no longer double their weight as infants do.
Keep in mind, however, that toddlers are becoming more and more active as they learn to crawl and walk. Toddlers and small children will usually eat only small amounts at one time, but will eat frequently (4 - 6 times) throughout the day, so snacking is strongly encouraged.
- Feeding solids too early is not recommended and can result in overfeeding.
- Offer only one new food at a time. Offer the new foods for a few days. Watch for allergic reactions (hives, vomiting, diarrhea).
- Do not feed solids in a bottle.
- If your child dislikes the new food, try giving it again later.
SAFETY DURING MEALTIMES
- Feed the baby directly from the jar only if you use the entire jar contents, otherwise use a dish to prevent contamination with food-borne illness.
- Opened containers of baby's food should be covered and stored in a refrigerator for no longer than 2 days.
- Use a small spoon to feed the baby.
- A baby put to bed with a bottle (milk, fruit juice, or sweetened beverage) can develop bottle mouth, resulting in tooth decay. Use plain water if a bottle is necessary.
- Avoid foods that may cause the baby to choke -- popcorn, nuts, potato chips, whole kernel corn, berries, grapes, hot dogs, raw vegetables, raisins, dry flake cereals.
- Water can be offered between feedings.
- Feeding sweets or sweetened beverages is not recommended, because they will spoil the appetite and contribute to tooth decay.
- Salt, sugar, and strong spices are not recommended.
- Caffeine products are not recommended (soft drinks, coffee, tea, chocolate).
- A fussy baby may need attention, rather than food.
Throughout childhood and adolescence, it is important that the diet include a variety of foods for proper development. The principles of the food guide plate apply to a child's diet as well as an adult's, although portions and number of servings per day are obviously less for children.
After the age of 2, it is recommended that the diet be moderately low in fat, as diets high in fat may contribute to heart disease, obesity, and other health problems later in life.
In areas where water is not fluoridated, fluoride supplementation is recommended. A diet that contains a variety of foods from each of the food groups (breads and grains, meats, fruits and vegetables, and dairy) will help prevent nutrient deficiencies.
Both the American Medical Association and the American Dietetic Association recommend that healthy children should get all their nutrients from foods rather than vitamin supplements.
The nutrients that are most likely to be deficient in a child's diet are calcium, iron, vitamin C, vitamin A, folic acid, and vitamin B6. The American Academy of Pediatrics does not support routine supplementation for normal, healthy children. However, there is no significant risk if a parent wishes to give their child a standard pediatric multivitamin.
Children who consume little or no dairy products are at particular risk for calcium deficiency that can interfere with bone growth and development. Foods that are good sources of calcium include low-fat or nonfat milk, yogurt, and cheeses. Other foods such as broccoli, cooked greens, and canned salmon (with bones) will also provide a source of calcium in the diet; however, it is often difficult to get children to consume adequate quantities of these foods.
Iron requirements vary by age, rate of growth, iron stores, increasing blood volume, and rate of absorption from food sources. Adolescent girls will have increased iron needs due to menstrual losses. Food sources of iron include meat, fish, poultry, iron-fortified cereals, spinach greens, and dried beans and peas.
Stettler N, Bhatia J, Parish A, Stallings VA. Feeding healthy infants, children, and adolescents. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 42.
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc; Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine.