Paediatrician: babies and food

Q:  Starting a baby on solids

I have a five and half month old son - I have started him on rice cereal. He has 2 t/spoons cereal at about 9am. He is fine during the day, however at night he wakes up often to feed. Do I move his solid meal to the evening rather than the morning? When do I start introducing more than 1 solid meal a day? Also when do I start increasing the amount of cereal he has?

A:  You can certainly offer your baby the cereal in the mornings and evenings now. He is getting a bit hungry in the evenings. Look up information on feeding your baby solids on: www.purity.co.za.

Q:  Next food step

Hi Dr,

When do we start with foods like yoghurt, pap and gravy, cheese etc? My baby is 8 months old. What about onion and tomato gravy (grated onion, fried in a little olive oil with tomato and a bit of salt), will it be okay?

A:  You can start with yoghurt now and the pap. No gravy now and no cheese until your baby is about 10 months old.  No, you must not give your baby of 8 months any onions or tomatoes. Also do not add salt to any food you give to your baby.

Q:  Son doesn't like food

My 18-month-old baby boy doesn't want food.  He drinks Nido, his rooibos tea and sometimes juice.  He'll only eat few spoonfuls when we feed him. He still eats Nestum because he won't eat other food.  What can I feed him?  I'm worried about his weight as well, his weight was 10kg when he was 16 months. Please help.

A:  The average weight for a baby boy of 16 months is 10.5 kg, so your son's weight was a bit below the average at 16 months. This has probably continued to 18 months. He is obviously satisfied to drink his Nido and feels full on this formula. The rooibos will not make him feel full. He still seems to want to eat only soft foods which is common at this age. Always offer him his food before he is given Nido. He actually neeeds very little Nido now, about 700ml a day is enough.Always introduce one solid at a time and let him get used to eating that food before going onto the next one.

Q:  Poor eater

My 13-month-old daughter is a poor eater. She barely eats anything all day and survives on breastmilk. I've tried to cut down on the breastfeeding so she can start eating better, but to no avail. She's not interested in drinking pediasure. I recently put her on Vi-daylin drops. Please advise me on what to do as I'm really stressed out. What am I doing wrong? I've seen many babies with great appetites. At13 months she weighs 7.5kg. I'm not sure of her height. My husband and I are petite in stature. I'm 1.55m and he is 1.65m.

A:  The average weight for a baby girl of 13 months is just over 9kg. Your baby girl's weight is far below this average and she is in the lowest 10% for babies of her age. Even coming from a petite family her weight is still of concern. She should definitely be eating better than she does. I see that you have been given some good advice from one of our forum members already about how to try to feed her. If her appetite does not improve she will need to be seen by a doctor to make sure that there is no medical cause for her low weight and poor appetite.

Q:  Eating disorder?

My 8-year-old girl hasn't been eating her food for weeks now.  What could the problem be? Help.

A:  This sounds like a serious problem. You have given very little information about your daughter. There are many reasons why a child of this age will not eat from possibly having TB to psychological causes. Your daughter must be seen by a doctor so that a definite diagnosis can be made of the cause of her eating problem.

Q:  Hungry boy

I'm a first-time mom and I need advice please. My baby is 1 month old and drinks 150ml Formula every 3-4 hours, but given his way, he would drink 2 such bottles in one go. If I try to give him water he goes mad - he wants to drink milk. He cries and if I do put a milk bottle in his mouth, he drinks non-stop. Please, I don't know what to do.

A:  Your baby is indeed hungry despite giving him more than an adequate amount of milk per day. Do not give him water at his young age, in any case it will not make him feel full.Change his formula to a casein rich formula which will make him feel full such as Lactogen1.

Q:  Child not eating

My son is now 13 months old and he does not want to eat finger foods etc. He usually eats very well, but as of late he has lost his appetite. He is currently on antibiotics because he has ear and throat infection. Can the antibiotics be the cause?  He is much better now, but still doesn't want to eat.

A:  Make sure that your baby's nose is open as he will not eat well if his nose is blocked.Use saline nose drops such as Salex twice a day if his nose is blocked. Otherwise he may still have a bit of a 'scratchy' throat after his recent throat infection which will soon settle down. Give him a good probiotic for 10 days to counter the effects of the recent antibiotic.

Q: Finger food

My twin boys are now 10 months old and doing well. They weigh just over 10kg each. They eat 3 meals a day and drink about 800ml of NAN 2 each day. My question is, when can I start giving them finger foods, and what would be best to start with? They both have their first 4 teeth. I have given them toasted bread fingers and some grated cheese, but they still seem to take very large bites and tend to gag easily. What would you suggest? Thanks for your advice.

A:  Your babies are now old enough to start on finger foods. You are correct - the main thing to be careful about is any food that may cause choking or may be difficult to swallow. Cut the food into small finger-shaped pieces. Cheese and toast are good choices. Bananas are good too and are the correct shape for babies and toddlers to eat easily.

Q:  2 1/2 year old - how much liquid is enough?

I have come to you in the past for advice and you have been most helpful - my child was tube weaned in October last year and I'm looking for some more advice here....

He now weighs 11.8kg and 84cm, having only put on 100gm and not having grown in height since November last year. Is he very tiny and should I be concerned?

Also, I'm very worried about his lack of drinking. He was admitted over the weekend for dehydration and put back on a drip of 40ml per hour and the little monster-munch still didn't drink. We were discharged yesterday morning and told to give our paed a call if he needs to be rehydrated again. It is now Tuesday 2.30pm and I haven't changed one wee nappy yet today. He has had a whopping 50ml to drink today - that's it. I have tried ice cream, jelly, water, ice, sloppy cereal - you name it.

I am at my wits' end and don't know what to do. How much fluid does he need to take in before I can start stressing that he is not having enough? I don't want to call my paed for nonsense, but I really don't know the minimum quantity.  He was never a big drinker, but at least when I have the feeding peg I could get liquids into him. I got maybe 200ml max into him yesterday, including some of it via a drip, and today we are at 50ml.  Do you have ANY advice for me?

A:  You really are having a difficult time. The average weight for a boy of  2 and a half is 13.3kg. Your son's weight is on the 10th percentile line of the children's growth chart; the lowest 10% for boys of his age. I don't have to tell you that he should be drinking much more than he does. Your son needs at least 1litre plus 50ml for every kilogram he weighs above 10 kg. This means that he needs 1000ml+ 50ml +40ml [for the .8kg] =1090ml per day. The only advice I can give you is to contact the gastroenterologist who saw your son originally so that a decision can be taken about helping your son.

More info:

Are you facing a feeding challenge? Write to the Paediatrician for advice.

Visit the First Year section for more about weaning and solids.

(Joanne Hart, Health24, April 2011)

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