Month 12 Worry: What Does My Baby Need to Eat Now?Dr. Greg Germain, MD
Feeding our third child solids went something like this in my house: “Honey, shouldn’t we have started solid foods with Rosie yet? She’s already three weeks past her six month birthday.” Poor Rosie—destined to slip through the cracks her entire childhood! But when she could barely tolerate thinned cereal by her eleventh month, I started to worry. Was something wrong? Why was she so different from our other two kids? Turns out she did just fine in the next month, but even a veteran parent like me can worry during this important transition time.
By 12 months, my patients’ most common concerns are, “You want us to stop formula and the bottle at one year of age?! Then what do we do?” Well, here’s the scoop.
What’s the Issue?
The transition from a mainly liquid diet at 11 months of age to a mainly solid diet at a year is a big step forward for many parents. Infant formula and breast milk are a wonderful safety net. They contain all the fat, protein, minerals, and calories a rapidly growing infant needs. At one year, we are told to pack up the bottles and the formula and move on to an adult-type diet with supplemental whole milk. Yikes! Parents ask me, “How do I make sure I am meeting my toddler’s nutritional needs?”
Consider the Numbers
If you are one of the 20 percent of moms still breastfeeding at your child’s one year birthday, keep it up. There are multiple studies which show benefits to both a mom (lower risk of breast cancer in one study) and baby (fewer viral infections) when breastfeeding continues into a baby’s second year. And the nutritional safety net can’t be beat.
But if you’re not breastfeeding, you have to worry about meeting the caloric needs of your toddler. Every day, he requires:
- 1000 calories
- 500 mg of calcium
- 19 grams of fiber per day
- 1 gram per kilogram body weight of protein per day. (So, a 23-pound child needs about 10 grams of protein daily.
Yikes is right!
“Well, shouldn’t we just follow the food pyramid?” parents ask. A look at the USDA food pyramid will tell you that there are no pyramid plans for 1-year-olds. And without one, the idea of serving size for toddlers is hard to get a grip on.
What Parents Should Know
At ages 6 to 12 months, the calories that a baby gets from breast milk or formula are decreasing and being replaced by a wider variety of nutrients in solid foods. For example, two servings (2 tablespoons) of iron-fortified infant cereal a day meets your child’s iron requirements. Meats and table foods provide protein and necessary fats. Fruits and vegetables provide a wide range of vitamins and nutrients and calcium needs are fulfilled with formula, breast milk as well as cheeses and yogurt.
When to eat? At 1 year of age, toddlers start on the five-meal-a-day plan. Typical toddler meal offerings are:
- Morning snack
- Afternoon snack
Note that no evening or night feedings are physiologically necessary. These meals are notoriously variable. The big meal of the day may be the morning snack, and toddlers may not be very hungry for lunch or dinner like we’d expect them to be. I tell parents that one good meal per day is the expectation, and their job is to balance out the diet as best as they can over time.
What to eat? The most common mistake I see here is too few fresh fruits and (more commonly) veggies. Catering to a toddler’s tastes or whims is usually a bad idea, as well. I’ll occasionally hear, “All he wants to eat is macaroni and cheese, so that’s what I end up giving him.” Going back to the infant pureed veggies is a nice trick that works for many parents. Pureed carrots as a dip with unsalted bread sticks is a fun toddler hors d’oeuvre. Pouring a jar of pureed veggies into pasta sauce is another way to hide them in the diet.
How much to offer? Toddler portion sizes should be about one-third of an adult serving. Tricks to estimate are to divide a child size plate into four quadrants. Each one should hold the right amount of vegetables, starches, and meats. The fourth quadrant can be reserved for a second vegetable or a special treat at the end of the meal. Another trick is to aim for the size of your toddler’s palm.
What about milk? It’s time to recalibrate your serving size expectations again! Where your infant was recently taking 20 to 24 ounces of formula daily before her first birthday, now we should expect half that volume per day of whole milk. Interestingly, whole milk has more than twice the calcium content as infant formula. So two 6-ounce servings of milk per day will do the trick, even if your child takes in no other calcium source—which is unlikely.
Keep in mind this measurement conversion chart:
- 1 tsp = 5 ml
- 1 tbsp = 3 tsp
- 1 ounce = 2 tbsp
- 8 oz = 1 cup
- Typical stage one infant food jar = 4 ounces
What the Docs May Do
Your pediatrician will watch your child’s growth and development carefully at each well visit. Growth, it turns out, is the gold standard for adequate caloric intake. Unfortunately, your child can grow adequately, but still be nutritionally deficient (see the above-mentioned parent serving macaroni and cheese five meals per day). Your vigilance as a parent in structuring a balanced, well-rounded diet is so important!
This is also why some pediatricians are not big fans of multivitamins. Not only are they scientifically shown to do very little in the toddler age group and they are one of the most common poisoning agents of toddlers in America, but they also give parents a false sense of security. “Oh, I don’t have to worry about getting the green veggies into him today, he took his vitamin this morning.”
There is no lab work which tells if your child is “nutritionally balanced,” but lab work may be sent if your toddler is either significantly overweight or underweight, or if her growth curve is concerning.
Most pediatricians recommend a diet for toddlers that does not restrict fat or cholesterol. This is because extra fat and cholesterol are thought to be necessary for proper brain growth and development.
More 12th Month Health Help
Even the most confident parent has concerns about her child’s health and wellness from time to time. Learn more about which medical issues are most common at each baby age, here. (If you have any pressing concerns or questions about your baby’s health, please check with her healthcare provider.)