First Food

As I make my way through this holiday season, I have reflected on many things. I am extraordinarily grateful for my wonderful family, my friends, and the very special opportunity I have to provide care for children. I’ve thought about the things I have learned from those around me, especially those who selflessly and successfully advocate for the things they believe in. I’ve thought about what we could all do better for children and families.

But, I’ve also thought about lighter, perhaps more frivolous things. I’ve enjoyed the holiday decorations, the music, and, of course, the food (well, and some nice bottles of wine). In fact, after hosting a dinner party for two dozen people, I’ve been thinking a lot about food. Which leads me to the topic of this month’s article – baby food – and specifically, to a question I get all the time: Should you introduce fruits or vegetables first?

First, I should briefly comment on the timing of complementary food introduction. Of course, breastfeeding is recommended as the primary source of nutrition for the first 6 months of age, then adding in solid foods. Many of the families I take care of are very anxious to begin "baby foods" – I tell them there is no benefit (and some potential risks) to beginning complementary foods before age 4 months. Between 4-6 months of age, the evidence is a bit unclear for most children (there are, of course, exceptions), but according to the American Academy of Pediatrics Committee on Nutrition (Pediatric Nutrition Handbook, 6th ed., Elk Grove Village, Ill.: AAP, 2008, p. 128]), "there is no significant harm associated with introduction of complementary foods at 4 months of age." For families eager to start with solid food, I still encourage waiting until their infants are closer to (or at) 6 months of age, but don’t fuss much if they want to start a bit earlier.

The traditional recommendation has been to start with an iron-fortified infant cereal, and then progress to fruits and/or vegetables – with some recommending fruits first because of palatability and others recommending vegetables first so that babies don’t get too used to the sweet taste of fruit (and then reject the vegetables). Interestingly, the AAP’s Committee on Nutrition recommends pureed meats as a good first choice because of their high iron and zinc content – the two nutrients most likely to be deficient in an infant’s or toddler’s diet.

Despite this, a quick (nonscientific) review of some of the most visited parent websites suggests that this recommendation has not been popularly adopted among physicians or parents. So, back to the question: Which should be first – fruits or vegetables? The answer is: either. There is no evidence to suggest that there is any benefit in introducing one or the other first (and I looked). What is more important is that parents offer a "single-ingredient" pureed food (which as noted, is typically a fruit or vegetable, but could also be a meat), and that they be willing to offer it many times before their child decides it tastes good. No matter what the food is, it should be high in nutrients. It is also recommended that at least one food high in vitamin C be served each day to aid in the absorption of iron. Lastly, it is important to be sure not to add (or buy food with added) sugar or salt to any of baby’s food.

So, when parents ask me which should be first, I tell them whichever they prefer, and commend them for wanting to feed their child fruits and vegetables, and encourage that as a lifetime goal. I find that families today are so inundated with information about what they should and shouldn’t do, that most like hearing that the choice is up to them. I hope all of you are having a wonderful holiday season, and have much to be thankful for. I wish you a happy and healthy New Year, with lots of good food.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is a member of the Pediatric News editorial advisory board, chair of the American Academy of Pediatrics Committee on Residency Scholarships, and president of the District of Columbia chapter of the American Academy of Pediatrics. She said she had no relevant financial disclosures. E-mail Dr. Beers at pdnews@elsevier.com.

As I make my way through this holiday season, I have reflected on many things. I am extraordinarily grateful for my wonderful family, my friends, and the very special opportunity I have to provide care for children. I’ve thought about the things I have learned from those around me, especially those who selflessly and successfully advocate for the things they believe in. I’ve thought about what we could all do better for children and families.

But, I’ve also thought about lighter, perhaps more frivolous things. I’ve enjoyed the holiday decorations, the music, and, of course, the food (well, and some nice bottles of wine). In fact, after hosting a dinner party for two dozen people, I’ve been thinking a lot about food. Which leads me to the topic of this month’s article – baby food – and specifically, to a question I get all the time: Should you introduce fruits or vegetables first?

First, I should briefly comment on the timing of complementary food introduction. Of course, breastfeeding is recommended as the primary source of nutrition for the first 6 months of age, then adding in solid foods. Many of the families I take care of are very anxious to begin "baby foods" – I tell them there is no benefit (and some potential risks) to beginning complementary foods before age 4 months. Between 4-6 months of age, the evidence is a bit unclear for most children (there are, of course, exceptions), but according to the American Academy of Pediatrics Committee on Nutrition (Pediatric Nutrition Handbook, 6th ed., Elk Grove Village, Ill.: AAP, 2008, p. 128]), "there is no significant harm associated with introduction of complementary foods at 4 months of age." For families eager to start with solid food, I still encourage waiting until their infants are closer to (or at) 6 months of age, but don’t fuss much if they want to start a bit earlier.

The traditional recommendation has been to start with an iron-fortified infant cereal, and then progress to fruits and/or vegetables – with some recommending fruits first because of palatability and others recommending vegetables first so that babies don’t get too used to the sweet taste of fruit (and then reject the vegetables). Interestingly, the AAP’s Committee on Nutrition recommends pureed meats as a good first choice because of their high iron and zinc content – the two nutrients most likely to be deficient in an infant’s or toddler’s diet.

Despite this, a quick (nonscientific) review of some of the most visited parent websites suggests that this recommendation has not been popularly adopted among physicians or parents. So, back to the question: Which should be first – fruits or vegetables? The answer is: either. There is no evidence to suggest that there is any benefit in introducing one or the other first (and I looked). What is more important is that parents offer a "single-ingredient" pureed food (which as noted, is typically a fruit or vegetable, but could also be a meat), and that they be willing to offer it many times before their child decides it tastes good. No matter what the food is, it should be high in nutrients. It is also recommended that at least one food high in vitamin C be served each day to aid in the absorption of iron. Lastly, it is important to be sure not to add (or buy food with added) sugar or salt to any of baby’s food.

So, when parents ask me which should be first, I tell them whichever they prefer, and commend them for wanting to feed their child fruits and vegetables, and encourage that as a lifetime goal. I find that families today are so inundated with information about what they should and shouldn’t do, that most like hearing that the choice is up to them. I hope all of you are having a wonderful holiday season, and have much to be thankful for. I wish you a happy and healthy New Year, with lots of good food.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is a member of the Pediatric News editorial advisory board, chair of the American Academy of Pediatrics Committee on Residency Scholarships, and president of the District of Columbia chapter of the American Academy of Pediatrics. She said she had no relevant financial disclosures. E-mail Dr. Beers at pdnews@elsevier.com.

As I make my way through this holiday season, I have reflected on many things. I am extraordinarily grateful for my wonderful family, my friends, and the very special opportunity I have to provide care for children. I’ve thought about the things I have learned from those around me, especially those who selflessly and successfully advocate for the things they believe in. I’ve thought about what we could all do better for children and families.

But, I’ve also thought about lighter, perhaps more frivolous things. I’ve enjoyed the holiday decorations, the music, and, of course, the food (well, and some nice bottles of wine). In fact, after hosting a dinner party for two dozen people, I’ve been thinking a lot about food. Which leads me to the topic of this month’s article – baby food – and specifically, to a question I get all the time: Should you introduce fruits or vegetables first?

First, I should briefly comment on the timing of complementary food introduction. Of course, breastfeeding is recommended as the primary source of nutrition for the first 6 months of age, then adding in solid foods. Many of the families I take care of are very anxious to begin "baby foods" – I tell them there is no benefit (and some potential risks) to beginning complementary foods before age 4 months. Between 4-6 months of age, the evidence is a bit unclear for most children (there are, of course, exceptions), but according to the American Academy of Pediatrics Committee on Nutrition (Pediatric Nutrition Handbook, 6th ed., Elk Grove Village, Ill.: AAP, 2008, p. 128]), "there is no significant harm associated with introduction of complementary foods at 4 months of age." For families eager to start with solid food, I still encourage waiting until their infants are closer to (or at) 6 months of age, but don’t fuss much if they want to start a bit earlier.

The traditional recommendation has been to start with an iron-fortified infant cereal, and then progress to fruits and/or vegetables – with some recommending fruits first because of palatability and others recommending vegetables first so that babies don’t get too used to the sweet taste of fruit (and then reject the vegetables). Interestingly, the AAP’s Committee on Nutrition recommends pureed meats as a good first choice because of their high iron and zinc content – the two nutrients most likely to be deficient in an infant’s or toddler’s diet.

Despite this, a quick (nonscientific) review of some of the most visited parent websites suggests that this recommendation has not been popularly adopted among physicians or parents. So, back to the question: Which should be first – fruits or vegetables? The answer is: either. There is no evidence to suggest that there is any benefit in introducing one or the other first (and I looked). What is more important is that parents offer a "single-ingredient" pureed food (which as noted, is typically a fruit or vegetable, but could also be a meat), and that they be willing to offer it many times before their child decides it tastes good. No matter what the food is, it should be high in nutrients. It is also recommended that at least one food high in vitamin C be served each day to aid in the absorption of iron. Lastly, it is important to be sure not to add (or buy food with added) sugar or salt to any of baby’s food.

So, when parents ask me which should be first, I tell them whichever they prefer, and commend them for wanting to feed their child fruits and vegetables, and encourage that as a lifetime goal. I find that families today are so inundated with information about what they should and shouldn’t do, that most like hearing that the choice is up to them. I hope all of you are having a wonderful holiday season, and have much to be thankful for. I wish you a happy and healthy New Year, with lots of good food.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is a member of the Pediatric News editorial advisory board, chair of the American Academy of Pediatrics Committee on Residency Scholarships, and president of the District of Columbia chapter of the American Academy of Pediatrics. She said she had no relevant financial disclosures. E-mail Dr. Beers at pdnews@elsevier.com.