Wednesday, March 11, 2015

The Infant Cereal Question

Baby's First Food

With my first baby I was so excited to introduce solid foods. Watching his expressions as he tried new things was better than watching the A&E production of Pride and Prejudice...almost. As my others came along I developed a sense of how terribly fast it all goes. (I also had a better sense of the thirteen-month-mess with which I would be contending). So with each child I was less excited for that developmental milestone. It meant they were growing up, no longer infants. Like all milestones, it was exciting, but a little sad.

A few of our kids also had allergies- all kinds of allergies. Our poor first drew the genetic short straw inheriting my asthma and allergies as well as my husband's eczema and allergies. It was a rough few years for him. So we were careful with what we introduced and when. Some of the kids had allergic reactions to infant cereal so my husband and I worked with our pediatrician to come up with alternate plans. I was relieved to discover how simple and inexpensive it was to prepare our own foods instead of buying jars. This meant our babies were very soon eating the same foods that we were. If we had peas, carrots, spinach, squash, or whatever for dinner, so did the babe. Once a month I would shop for fruits and veggies and spend one Saturday morning steaming, pureeing, and freezing into ice cube trays all that our developing baby would need. Basically I did this three or four times per baby because by then, they had moved on from purees.

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The Cereal Shift

In our recent Welcome Baby home visitations, we have noticed an increasing trend toward not introducing infant cereal at all. We are curious as to why. We determined a post with some research about this subject might be welcomed as there seem to be so many with questions. As I pose questions and present research, I want to be upfront about the fact that my husband and I did not feed some of our babies cereal. This was a decision made child by child with careful thought, research, and guidance from our trusted pediatrician. Here are some of the reasons families have recently given for not wanting to feed their babies rice cereal:
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  • Concerns about empty calories
  • No nutritional value
  • Damaging or cancerous effects
  • Breast or formula milk is enough
  • There is no need to 
  • Friends or family didn't 

In addition to the online research I studied to find answers to these questions, I called my trusted pediatrician's office and spoke with our favorite pediatric nurse Cheri because I wanted a more personal response. I wanted to know what my pediatrician and staff had to say. 

Empty calories and no nutritional value?

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While rice cereal may not be as nutrient rich as breast milk, formula, or even many other food options, it is not empty calories. Cereal can be prepared with the breast milk and formula to enhance the intake of nutrient rich calories. Nurse Cheri described how around six months old infants' nutritional needs are changing. They develop a greater need for iron while at the same time, the supply of iron in breast milk and formula is depleting. According to Nurse Cheri, "there is more iron in formula, but the iron is more easily absorbed from breast milk." While there are other iron rich foods available (spinach, liver, red meat, and beans for example) these are not easily digested. Transitioning baby to solids from an exclusive milk diet ought to be a gentle, progressive process. Iron enriched cereals fit the bill. They provide the essentials for the developing child in a gentle, digestible way. "Juice is empty calories," Nurse Cheri went on to say, "there is no need for all of that sugar, no compensatory value. With cereal, they are getting the iron they really do need." WebMD said the following, “A common first baby food is a single-grain, iron-fortified cereal such as rice cereal or oatmeal. These baby cereals have the advantage of boosting your baby’s iron intake, and they’re easy to digest. Just mix with a little baby formula, breast milk, or even water on occasion.” Rice cereal is easily digested and hypoallergenic. These factors make it a natural choice as a first introduction and means to ensure enough iron is in your baby's diet. Once introduced, you can soon move on to more complex whole grains, fruits, and veggies. WebMD is also a good source for knowing how to determine when your baby is ready for solids.

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In addition, concern about the growing epidemic of obesity is understandable and warranted, but growing babies, beginning at six to eight months need more calories. Babies need to stock up for the incredible growth and development of the coming months. Consider the skills of crawling and walking and how much more energy they require than anything baby has previously expended. And if you have ever had an infant who was sick for a few days, you know how essential those stores can be. My four year old recently had the flu and didn't eat much for three days. He is now skin and bones. I wish he had had more fat to help him mange that short illness. I found an interesting story from Good Morning America which explores one pediatrician's claim that white rice cereal is a "gateway to obesity." He makes some interesting points, but has little evidence to support his theory.

Damaging, potentially cancerous effects?

A 2012 Consumer Report brought attention to the concern that arsenic had been found in many rice products. While a small degree of organic arsenic is to be expected and not so much of a concern, it is the inorganic arsenic residue from pesticides that has consumers concerned. published an article on this subject which included the following, “The U.S. Food and Drug Administration says this about what parents should do when it comes to infant rice cereal: 'Consider alternatives for an infant's first solid food. According to the American Academy of Pediatrics, there is no medical evidence that rice cereal has any advantage over other grains as a first solid food... .' However, “The American Academy of Pediatrics (AAP) has so far made no specific recommendation, saying additional research is needed. The AAP recommends serving children a variety of foods to reduce their exposure to arsenic in rice products. And your child's doctor may suggest feeding your baby other foods instead, such as pureed vegetables, fruit, and meat, and grain cereals such as oats and barley." My personal recommendation is to see for yourself what your pediatrician suggests. To read about the AAP's recommendations and the "Bright Futures" program (which my pediatrician uses), follow the link to Promoting Healthy Nutrition.

Isn't breast or formula milk enough? Is there a need?

Again, the issue is the changing nutritional needs of developing babies. At first, the primary concern is the iron. There is a need to supplement an exclusively milk based diet in order to meet that need for iron. Nurse Cheri explained, "As the intake of solids increases, the need for milk decreases over time." Eventually, as children incorporate more foods into their diet, their nutritional needs will be met primarily with the foods they eat rather than milk. According to the Mayo Clinic, "Breast milk or formula is the only food your newborn needs. However, by ages 4 months to 6 months, most babies are ready to begin eating solid foods as a complement to breast-feeding or formula-feeding." They recommend the following progression when it comes to introducing foods to infants:

Start with baby cereal. Mix 1 tablespoon of a single-grain, iron-fortified baby cereal with 4 tablespoons (60 milliliters) of breast milk or formula. Many parents start with rice cereal. Once your baby gets the hang of swallowing runny cereal, mix it with less liquid and gradually increase the amount you offer. For variety, you might offer single-grain oatmeal or barley cereals.
Add pureed fruits, vegetables, and meats. Add foods gradually, one at a time.
Offer finely chopped finger foods. As babies become accustomed to differences in texture and digestion, continue to expand their exposure and offer a balanced diet. Encourage them to eat on their own and to explore at mealtimes.

 Friends and family don't use cereal

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At Welcome Baby we support and encourage looking to your community of friends and family for ideas, guidance and even advice as you parent. We want parents to rely on the wealth of resources available to them. We also encourage parents to make educated, informed decisions. If you find your friends and family are not feeding cereal to their babies, ask them why. Perhaps their reasoned decisions will make sense for you. If they do not have a substantial reason, perhaps further research and inquiry are advisable. If the concerns are about how infant cereal is processed, make your own. If the concern is that you prefer whole grains, try oat or barley. Once again, the main objective is the iron with which infant cereals are fortified. We encourage all parents to decide intentionally and carefully as you talk with your pediatricians about how to ensure the healthy nutrition of your child. Happy feeding!

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