Baby weight gain in the first year

How much should you feed your baby? Watch for your child's signs that she's full

When it comes to baby weight gain, “bigger is better” has long been the conventional wisdom. But now research is showing that a baby who gains too much weight too quickly may be at risk of health problems.

Robert Bertolo, research chair in human nutrition at Memorial University of Newfoundland in St. John’s, says his studies, and work by others, are showing that what and how much an infant is fed can determine how healthy that baby is as an adult. “We’ve known for some time that babies who are born smaller than normal are at a greater risk of problems like obesity, diabetes, high blood pressure and Alzheimer’s. What we’re finding now is that it’s not just being born small, it’s the combination of being small and gaining quickly during the first year that is the most risky,” explains Bertolo.

And it’s not just small babies who may be at risk if they gain weight too fast, says Sheila Evans, dean of research in the faculty of nursing at the University of Calgary. Any baby who is overfed during the first year will be more prone to later health problems. The World Health Organization released new growth standards last year, which are intended to show how babies should grow. These are based on measurements of babies fed according to current recommendations: exclusive breastfeeding for six months, followed by a gradual introduction of solid foods while breastfeeding continues. The new charts call for leaner babies than the previous growth charts used in Canada and the US. (These can be seen at who.int and are expected to be approved for use by physicians soon.)
What do these developments mean for parents? How much should you feed your baby? How do you know that he’s not getting too much or too little? Evans and Bertolo say that the best strategy is to follow your baby’s cues. “Babies are excellent self-regulators,” Evan says. Here’s how to take advantage of your baby’s natural ability to regulate his food intake:

Avoid scheduling. “You want your baby to attend to her own feelings of hunger, not the clock,” says Evans. That means you feed on demand, even if your baby is growing quickly. Evans explains that trying to get the baby to wait a longer time between feedings or to stick to a schedule can lead to overeating; the overly hungry baby will eat more than she really needs and, over time, this suppresses the natural appetite controls.

Watch for the “all done” signs. Breastfeeding produces leaner, healthier babies, and this may be partly because of the milk and partly because of the feeding method. When the breastfed baby is full, he simply stops sucking. Bertolo points out that bottle-feeding parents frequently try to get the baby to finish whatever is left in the bottle. An extra half-ounce at each feeding may not seem like a lot, but in proportion to the baby’s size it can be significant. Especially with a very young baby, you need to watch closely for his cues that he’s done — or at least wants a break. The baby may try to turn his head away from the bottle, stop sucking or fall asleep. If you see any of these behaviours, Evans recommends removing the nipple from the baby’s mouth and perhaps trying to burp him. Then offer the bottle nipple again by touching it to the baby’s lips. If he seems uninterested, don’t try to get him to take more. “Forcefully encouraging the baby to take more when he’s full will eventually turn off the appetite control mechanism,” Evans explains.

Start solids slowly. Many parents think a baby-sized portion is much bigger than it really should be. “If you’re making your own baby food, you can freeze the puréed food in ice cube trays. One ice-cube-sized piece of food is a good serving for a baby under a year,” says Evans. Begin with one serving a day for a week or two and work up gradually to three, and then to small meals that include more than one type of food.

Serve finger foods. Introduce soft fruits, cooked vegetables and whole-grain cereals as soon as your baby has the coordination to get food from the tray to his mouth. It gives him more opportunities to self-regulate. (When he stops eating and just throws the food on the floor, he’s done.)

Think nutrient dense. Bertolo says parents should look for colourful food (like bright orange carrots and deep green spinach). Foods that are close to nature — fresh fruits, steamed vegetables, whole grains — provide more nutrients per calorie.

Note that breastfed babies sometimes grow quickly in the first months, then slim down. If you’re concerned your baby’s too chubby, discuss it with your doctor — but don’t expect baby to be put on a diet. Instead, the focus will be on nutritious food and responding to baby’s hunger.

The active baby

It might seem strange to be thinking about exercise for your three-month-old, but Sheila Evans, dean of research in the faculty of nursing at the University of Calgary, says it’s important for baby to have time to play on the floor or on your lap every day. “This is how she develops strong muscles and coordination, and burns off some of those calories,” she explains. “I see too many babies who spend all their time in a car seat.”

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