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A Report by
The American Council on Science and Health
This report was prepared for ACSH by Kathleen Meister, M.S., a freelance
medical writer and former ACSH associate. Some material on nutrition
was taken from an earlier ACSH report written by Linda Behre, M.S., and
other ACSH staff members. Complete Text Download in PDF: 90K
http://www.acsh.org/publications/booklets/feedingbaby.pdf
Feeding Baby Safely: Facts, Fads and Fallacies
Executive Summary
Both
commercial and homemade baby foods can be safe and nutritious if used
appropriately. To
provide their infants with a healthful diet, parents need to choose foods
wisely, introduce them correctly,
and follow appropriate safety precautions:
• To prevent burns, always check the temperature of heated foods before
serving.
• Use
safe food-handling procedures to prevent the introduction and growth of
disease-causing
bacteria.
• Never feed unpasteurized apple juice, juice blends containing
unpasteurized apple juice, or
unpasteurized apple cider to infants.
• Never feed infants foods that pose a high risk of choking, such as whole
hot dogs, hot dog
“coins,” peanuts, hard candies, or raw carrots.
• Because of the possibility of contamination with the microorganism that
causes infant botulism,
never feed honey or corn syrup to infants under the age of one year.
• Because of the possibility of excessively high levels of nitrate, it may
be best not to home-prepare
beets, carrots, collard greens, turnips, or spinach for infants under the
age of 6 months.
Parents who prepare their own baby food should consult with the infant’s
health-care provider
for individualized advice on this subject.
• Severe tooth decay can occur if an infant habitually drinks any
carbohydrate-containing liquid
(milk, formula, or juice) from a bottle at bedtime or sips from a bottle
continually during the
day. If an infant wants a bottle at bedtime or likes to carry one around,
the bottle should be
filled with plain water.
To minimize problems with food allergies and other types of food
sensitivity, parents should:
• wait until an infant is four to six months old before introducing solid
foods;
• introduce new foods or ingredients one at a time in order to detect
those that may cause allergic
reactions; and
• delay the introduction of foods that are particularly likely to provoke
allergic reactions.
For good nutrition, parents should:
• breast feed or use iron-fortified infant formula throughout the first
year of life;
• let the infant decide how much food to eat;
• make sure that infants over 4 to 6 months of age receive some
supplementary source of iron;
• not feed any fruit juice in greater than the recommended amount (water
can be given instead if
the infant is thirsty); and
• not apply adult dietary guidelines (such as the recommendation to limit
intakes of fat and cholesterol)
to infants.
Salt does not increase infants’ acceptance of foods; sugar does. Neither
of these substances is a
necessary baby-food ingredient. However, neither is known to be harmful
when consumed in small
amounts.
The flours and modified starches that are used to thicken some commercial
baby foods do not
harm an infant’s health.
The minute amounts of pesticide residues found in some baby foods are not
a cause for concern.
The amounts of pesticides found in commercial baby foods are usually lower
than those found in
regular produce. The nutrient content of commercial baby foods is
comparable to that of properly
prepared homemade baby foods.
On an ounce-for-ounce basis, commercial baby foods are more expensive than
regular products
intended for adults. However, parents should realize that they are paying
for the convenience of
avoiding the extensive labor involved in baby-food preparation and for the
security of having sanitary,
shelf-stable products that are easy to handle and store safely.
For individualized advice on all aspects of infant feeding, parents should
consult with their
infant’s health-care provider.
Introduction
When the time comes for an infant to start eating solid foods, parents
often find that they have
many questions. Would it be better to make homemade baby food or to buy
commercial products?
Are some brands of baby food really better than others? Are there some
foods or ingredients that the
baby would be better off without? And what about those recent news
reports: Are the modified
starches and pesticide residues in some baby-food products really a cause
for concern?
This report by the American Council on Science and Health is designed to
answer these and
other questions about baby foods. It provides tips on safety, nutrition,
and the prevention of food
allergies both for families who use commercial baby foods and those who
prepare baby foods at
home.
The Role of Baby Food in an Infant’s Diet
The term “baby food” refers to food prepared in special ways (usually
by pureeing or straining)
so that it can be eaten by infants. This category includes both “solid”
foods (cereals, fruits, vegetables,
meats, and mixed foods) and fruit juices; it does not include either human
milk or infant formula.
The process of introducing foods other than human milk or formula into an
infant’s diet is
usually called “starting solids.”
Baby foods may be purchased ready-made, or they may be prepared at home.
In general, homeprepared
foods are described as “baby food” only when special procedures (such as
pureeing) have
been used to make the food suitable for an infant. Adult foods that are
served to an infant with little
or no modification are referred to as “table foods.” A very few table
foods, such as applesauce and
fork-mashed raw bananas, are appropriate for infants who are in their
first few months of eating
solids. Most table foods, however, should not be given to infants until
near the end of the first year.
Baby foods should never be the mainstay of an infant’s diet. Throughout
the first year of life, the
principal food for an infant should be human milk, iron-fortified infant
formula,*1 or some combination
of the two.**2 Baby foods should be given as a supplement to human milk or
formula, not as a
substitute.
Over the years, recommendations on when to introduce solid foods have
varied greatly. Before
1920, solid foods were seldom recommended for infants under one year of
age. In the decades that
followed, however, solids were introduced earlier and earlier. Often,
infants started eating baby food
during the early weeks of life.
In 1980 the American Academy of Pediatrics recommended that solid foods
not be started until
infants reach the age of four to six months. At that age, their ability to
swallow and digest foods has
matured sufficiently to allow them truly to benefit from eating solids.
This recommendation remains
in effect today.
Most babies eat baby food for about six months. By the end of the first
year (roughly half a year
after the introduction of solids), most infants have progressed beyond the
need for pureed and
strained foods. For these children, the solid portion of their diets
consists largely of chopped or cutup
table foods.
Parents often wonder whether homemade baby foods are best for their
infants or whether it is
wiser to choose commercial products. In truth, both types of food are
safe, nutritious, and appropriate
for infants as long as parents choose foods wisely, introduce them
correctly, and follow appropriate
safety precautions. It takes more time and effort to prepare homemade
foods than to use commercial
products, however, and parents who prepare homemade baby foods have to be
especially
careful to use safe food-handling and storage procedures.
The next few sections of this report describe the general procedures that
parents should follow to
ensure that their infant’s food is safe and nutritious, to protect their
infant’s teeth, and to minimize
the risk of food allergy problems. The information presented here is
general in nature; it is not
intended as specific medical advice. Decisions about when to start solids,
which foods to introduce,
how much food to offer, and how to deal with feeding problems should be
made by an infant’s
health-care provider.*3
Feeding Baby Safely
To ensure that their infant’s food is safe to eat, parents must pay
particular attention to four
aspects of the food:
• temperature;
• microorganisms;
• choking hazards; and
• ingredients.
Temperature
Obviously, food that is too hot can burn a baby. Fortunately, this
problem can be easily avoided.
There is no real need to warm up baby food. Adults may prefer that certain
foods be served warm,
but infants have no such preferences. Parents can serve their infant’s
food at room temperature or
even at refrigerator temperature. The only time it’s really necessary to
heat baby food is when frozen
food needs to be thawed in a hurry.**4
Parents who insist on warming baby food and those who must thaw frozen
products should use
extreme caution, especially if they use a microwave oven. Microwave
heating is very uneven; hot
spots can develop within a container of food. The food may become hot
enough to burn an infant
even if the container remains cool. Very thick baby foods, such as pureed
meats and egg yolks,
should never be microwaved because they can become superheated and spatter
or explode.
Accidents of this type are a common cause of visits to hospital emergency
departments.
When baby food has been heated, either in a microwave oven or by other
methods, the parent
should stir it thoroughly (to eliminate hot spots) and check the
temperature before serving by touching
or tasting a bit of the food—not by touching the container. Baby food
should never be served hot;
if heated at all, it should be warmed only to body temperature.
Microorganisms
If you ask people to list the most important health hazards associated
with food, they often mention
additives, pesticide residues, or nutritional problems. But in reality,
none of these is the highest
priority concern. According to the Food and Drug Administration and other
experts, the primary
cause of illness from food is microbial contamination.1 Foodborne
disease—what most people call
food poisoning—is the number-one food hazard in the United States.
The U.S. Department of Agriculture estimates that between 15 and 60
million cases of food poi-
soning occur in the U.S. each year.1 Most of these illnesses are
attributable to mishandling or
improper storage of food by the people who prepare it, either at home or
in a food-service establishment.
Very few cases are attributable to mistakes in the production or
commercial processing of
food.
Microbial contamination of foods is even more of a concern for infants
than it is for adults.
Infants tend to become more severely ill from foodborne diseases than
adults do, and they are at risk
for dangerous—even fatal—complications. Unlike many of the other
food-associated risks that parents
of infants worry about, bacterial contamination is a very real and
immediate threat.
For example, a case was recently reported in a medical journal in which a
five-month-old infant
developed a severe illness requiring prolonged hospitalization after
eating eggs fried sunny side
up.2 Why did the baby become ill? Sophisticated parents (or people who
have been reading this
booklet from back to front) might suspect that the illness was an allergic
reaction (eggs should not
be introduced until late in the first year because they are a potentially
allergenic food) or that it was
due to some type of chemical contaminant in the eggs or the frying fat.
Neither of these guesses
would be correct, however. The illness was a bacterial infection.
Raw eggs, like other raw foods of animal origin, are sometimes
contaminated with microorganisms
that can cause illness, and they should always be cooked thoroughly to
destroy all potentially
harmful bacteria. The traditional sunny-side-up method of cooking eggs
isn’t always thorough
enough to kill all the bacteria that may be present. Some bacteria
evidently survived in the eggs
given to that infant, and the bacteria caused the illness.
Bacteria in Unpasteurized Apple Juice
Practically any food can become contaminated with disease-causing
bacteria if appropriate safety
precautions are not taken. For example, in 1996 an outbreak of food
poisoning on the West Coast of
the U.S. was traced to an unexpected source—unpasteurized apple juice.
Apples can become contaminated with disease-causing bacteria at several
steps during their production
and handling. In several reported incidents, apples in the orchard became
contaminated
with microorganisms from animal droppings. In another reported incident,
apples were contaminated
when they were washed with contaminated water. If contaminated apples are
processed into
juice or cider without being pasteurized, some bacteria may survive in the
finished product.*5
All apple beverages sold in shelf-stable form—that is, in cans, bottles,
or juice boxes that can be
stored at room temperature—are pasteurized (the label may not indicate
this, however). Some
brands of apple juice and cider sold in perishable forms—that is, in
cartons found in a store’s refrigerator
case—are also pasteurized; but some other brands of perishable apple
beverages are not.
Some manufacturers choose not to pasteurize their apple beverages because
some consumers prefer
the flavor of the unpasteurized versions. Consumers should check the
labels of perishable apple
juice and cider to determine whether the products have been pasteurized.
Pasteurized apple beverages are safe for infants and children.
Unpasteurized apple beverages
may not be. The microbiological safety of unpasteurized apple beverages
cannot be guaranteed, and
the bacteria that these beverages may harbor can cause especially severe
illness in infants and young
children.
When buying fruit juices for infants and children, parents should choose
shelf-stable products
(from either the baby-food section or the regular juice aisle of the
supermarket) or should check the
labels of perishable beverages to make sure they have been pasteurized.
Keeping Commercial Foods Safe
For parents who use conventional commercial baby foods (i.e., dry
infant cereals and jarred
foods), making sure that baby food is microbiologically safe is relatively
simple. The food is safe
when purchased; parents merely have to keep it that way by heeding these
precautions:
• Store boxes of infant cereal in a clean, dry place.
• Once infant cereal has been mixed with liquid, serve it immediately.
Don’t save leftovers for
another meal.
• Store unopened jars of baby food at room temperature.
• If the tops of baby food jars become dusty or dirty, wipe them with a
clean cloth or rinse them
with water (and dry with a clean paper towel) before opening.
• Do not use a jar of baby food if its vacuum seal has been broken.
• Refrigerate opened jars of baby food immediately after opening. Fruits
and small bottles of juice
can be covered and stored for three days after opening; large bottles of
juice can be stored for
seven days. All other baby foods should be stored in the refrigerator for
no more than two days
after opening.
• Contrary to popular opinion, it is not dangerous to feed a baby directly
from a baby-food jar. If
this is done, however, any food that remains in the jar cannot be saved
for another meal. When
a baby is fed directly from the jar, enzymes and bacteria from the baby’s
saliva contaminate the
food and may cause spoilage. To avoid waste and save money, many parents
spoon the amount
of food they want to serve out of the jar into a bowl and then refrigerate
the rest for another
meal. When they’re away from home, however, they feed the baby directly
from the jar and
throw the leftovers away.
• Never put leftover baby food back in the jar, and never save leftovers
from the infant’s dish for
another meal.
Preparing Homemade Foods Safely
Preparing homemade baby foods safely takes considerable knowledge and
effort. The following
general guidelines may be helpful. More specific advice can be obtained
from baby-food cookbooks,
child-care manuals, and health-care providers.
• Clean all utensils and work surfaces thoroughly before preparing baby
food. Be especially careful
about cleaning blenders, food processors, and cutting boards. Any
equipment that’s used to
handle raw foods (especially meat, poultry, seafood, or eggs) should be
washed very thoroughly
with detergent and hot water and then rinsed before being used to handle
other foods.
• Food preparers should wash their hands before starting to prepare baby
food. Preparers should
also wash their hands after using the toilet, handling pets, coughing,
sneezing, changing baby’s
diaper, touching raw animal products (such as meat or eggs), or touching
their own or the
infant’s nose or mouth.
• Keep hot foods hot (140°F or hotter) and cold foods cold (40°F or
colder) so that bacteria can’t
grow. Don’t allow foods to sit at room temperature for more than one hour
during preparation.
(This may be easiest to accomplish if someone other than the food preparer
cares for the baby
during food preparation.)
• Cook all foods of animal origin (meat, poultry, seafood, eggs)
thoroughly. For a young baby,
vegetables and fruits (except bananas) must also be cooked. Check with the
infant’s health-care
provider to find out when raw fruits and vegetables can be introduced into
the diet.
• Leftover homemade baby food, like leftover commercial baby food, should
not be saved for
another meal.
• Never give unpasteurized juice or cider to an infant or young child.
• Remember that all homemade baby foods and all frozen commercial baby
foods are perishable.
They must be kept cold (refrigerated or frozen) at all times and should
not be stored in the
refrigerator for more than a day or two.
• If the baby is going to be fed away from home, all perishable baby foods
(homemade foods and
commercial frozen products) must be carried in an insulated bag or cooler
packed with ice or a
cold pack. If the food becomes warm, it should not be used. Because it is
difficult to keep perishable
foods at safe temperatures while traveling, some parents carry commercial
jarred or
dehydrated baby foods on outings, even if they rely primarily on homemade
or frozen baby
foods when they are at home.
• Thaw frozen baby food only in the refrigerator or in the microwave—never
on the kitchen
counter.
Choking Hazards
During the early stages of solid feeding, the most important step
parents can take to reduce the
risk of choking is to make sure the baby is in an upright position during
feedings. Later on, the
choice of foods becomes more important.
During the second half of the first year, infants progress from a diet
that consists entirely of
pureed and strained foods and liquids to a more adult-style diet that
includes chopped foods and
small pieces of “finger foods” that babies can feed to themselves. As a
general rule, finely chopped
homemade foods (or the slightly chunky “third-stage” products sold by
commercial baby-food companies)
are appropriate by the age of 8 to 12 months. Some finger foods (such as
well-cooked cut-up
soft vegetables; small chunks of raw banana or of canned peach or pear;
small pieces of crackers or
toast; and the ever-popular O-shaped oat cereals) can be introduced at
around the same time.
Parents should follow the specific instructions of the child’s health-care
provider concerning the
introduction of new textures and forms of food.
The food most frequently implicated in choking accidents in infants and
young children is the
frankfurter. Before giving hot dogs (or toddler “meat sticks”) to a young
child, the parent should cut
them first lengthwise and then crosswise into small pieces less than an
inch long. Hot dogs should
not be cut into coin shapes. Soft breads (such as white bread) are also a
hazard because they can
turn into a pasty glob in a child’s mouth; breads should be toasted and
cut up before being given to
an infant or toddler.
Foods that should not be given to an infant or toddler because they pose a
high risk of choking
include:
• nuts and peanuts;
• peanut butter, caramel candy, and other thick, sticky foods;
• whole grapes;
• large chunks of apple or underripe pear or peach;
• pieces of firm raw vegetables (such as carrot, celery, bell pepper, or
peas);
• chunks of meat or poultry;
• pieces of bacon;
• sunflower seeds;
• raisins;
• popcorn; and
• hard candies.
Ingredients
Certain foods and ingredients are not suitable for consumption by
infants. Foods that should be
avoided because of allergenicity or choking hazards are discussed
elsewhere in this report. This section
describes foods that should not be fed to babies for other safety reasons.
It also discusses some
ingredients and contaminants that have recently aroused public concern.
Honey and Corn Syrup
Honey should never be fed to infants under the age of one year because
it is sometimes contaminated
with spores of a bacterium called Clostridium botulinum. In an infant’s
digestive tract these
spores give rise to active bacteria. The bacteria then produce a toxin
that can cause a serious illness
called infant botulism.3 Older children and adults can eat honey safely
because their digestive tracts
are so well colonized with bacteria that newly arrived spores cannot
establish themselves.
(Clostridium botulinum can also cause a severe form of food poisoning if
it contaminates improperly
canned foods. In that case, however, the illness results from a toxin
produced by C. botulinum bacteria
growing in the food; the microorganisms do not colonize the digestive
tract.) Commercial baby
foods sold in the U.S. do not contain honey.
The consumption of corn syrup has also been associated with an increased
risk of infant botulism.
4 This link has not been established as clearly as the association with
honey, and the risk is
probably very small. Nevertheless, it is prudent to avoid giving corn
syrup to infants under the age
of one year. If it is necessary to sweeten homemade baby foods (for
example, if the fruit being prepared
for an infant is very tart), ordinary table sugar (sucrose) is a better
choice. The corn syrup
used in some infant formulas and jarred baby foods is not a cause for
concern because these products
are heated sufficiently during processing to destroy bacterial spores.*6
High-Nitrate Vegetables
The pureed vegetables sold by baby-food companies are safe for
infants. However, home-prepared
versions of certain vegetables—specifically, beets, carrots, collard
greens, spinach, and
turnips—may not be safe,5 especially if consumed in large amounts. These
vegetables sometimes
contain high levels of nitrate, derived from the soil and water in which
they were grown. Excessive
nitrate intake can cause a serious type of anemia, called
methemoglobinemia, in young infants. Older
children and adults are less susceptible to this problem because the
chemical composition of their
hemoglobin is different.
The commercial forms of these vegetables sold by baby-food companies are
safe for young
infants because baby-food processors take precautions that are not
available to home cooks. The
processors conduct chemical tests to detect nitrate in vegetables, and
they avoid buying vegetables
grown in areas where soil nitrate levels are high.6
There is disagreement among health professionals about the degree of risk
posed by high-nitrate
vegetables. Some experts say that home-prepared versions of potentially
high-nitrate vegetables
should never be offered during the first six months of life, while others
believe that the risk of
methemoglobinemia is so small that this restriction is not really
necessary. Parents who prepare their
own baby foods should consult with their infant’s health-care provider for
individualized guidance
on this topic.
Salt
The addition of salt to baby foods is unnecessary. Unsalted food
contains enough naturally
occurring sodium to meet an infant’s need for this mineral. And adding
salt to foods does not seem
to improve their acceptability to infants: In a recent study that
evaluated young infants’ acceptance
of various vegetables, no differences were found between salted and
unsalted peas or green beans.7
Scientists have speculated that high salt or sodium intake in infancy
might contribute to an
increased risk of high blood pressure in later life. This suggestion has
not been confirmed by scientific
studies, however. In one study, infants received either high-salt or
low-salt diets for five months,
and no effect was found on blood pressure in later childhood.8 There is no
conclusive evidence that
high sodium intakes during infancy and childhood are detrimental to
health, even for those children
who are genetically predisposed to develop high blood pressure later in
life.5
During the 1970s experts recommended that salt not be added to infant
foods, both because it
was unnecessary and because the possibility of harm had not been ruled
out. Today most baby
foods contain no added salt. (The “3rd Foods” dinners and vegetables
produced by Gerber are an
exception; some varieties do contain salt.) Because of the removal of salt
from most baby foods and
other changes that have taken place in infant feeding practices (the
delayed introduction of cows’
milk, for example), current infant sodium intakes are substantially lower
than those of several
decades ago. The American Academy of Pediatrics has stated that efforts to
reduce further the sodium
content of foods primarily intended for infants would be unwise.5
It is not necessary for parents scrupulously to avoid giving their infants
foods that contain salt
(in the way that they must scrupulously avoid feeding anything that
contains honey); but it is generally
recommended that salt not be added to commercial or homemade baby foods,
and that highly
salted products intended for adults (such as canned vegetables with added
salt) not be used in the
preparation of homemade baby food. When parents home-prepare foods for
both a baby and the
rest of the family, the food preparer should remove a portion for the baby
before adding salt or other
seasonings for the adults.
Sugar
Infants have an innate preference for sweetness.9 They may reject
foods that are too tart or bland
in flavor, but they are usually enthusiastic about sweet-tasting foods.
Some parents—and some
baby-food companies—add a little sugar to some foods in an effort to make
them more acceptable to
babies. This practice has both advantages and disadvantages. Sugar is not
harmful in itself, and its
use might even contribute to good nutrition if it encourages a baby to eat
a nutritious food that he or
she would otherwise reject. (Need we add that foods not eaten cannot
contribute to good nutrition?)
On the other hand, excessive use of sugar is undesirable, because sugar
does not provide the protein,
vitamins, or minerals found in other foods. Also, babies who are fed only
sweetened foods may
not learn to accept a variety of flavors, and this may hamper their
transition to a balanced, adultstyle
diet.
In recent years some parents have expressed a preference for baby foods
that contain no added
sugar. Baby-food companies have responded to this demand by increasing the
number of products
without added sugar. Instead, they sweeten tart fruits or bland cereals
(and in some recently developed
products, even meats) by mixing them with naturally sweet foods such as
applesauce or
pureed pears. Some parents do the same sort of thing at home.
From a nutritional standpoint, the mixing approach has some advantages,
since apples or pears
do contribute some nutrients (though not a lot; these fruits are not
particularly rich in vitamins and
minerals). However, in terms of teaching babies to accept a variety of
flavors, mixing everything
with applesauce is really no better than adding sugar.
Foods that consist mostly of sugar and that make little or no positive
nutritional contribution to
the diet—such as baby-food desserts and many family desserts—should, at
most, compose only a
very small part of an infant’s diet. Because infants’ nutritional needs
are high, there is little room in
their diets for foods that are low in nutrients.
Thickeners
Some foods do not puree well; they become excessively juicy or develop
unpleasant textures.
Baby-food cookbooks acknowledge this problem; they sometimes recommend
that parents deal with
it by mixing the troublesome food with something starchy, such as rice or
mashed potato, to create a
more acceptable texture. The companies that make commercial baby foods
have traditionally dealt
with texture problems in a very similar way, adding a starchy ingredient
(such as flour or modified
tapioca starch) to some foods. This long-standing practice does not
endanger infants’ health; nevertheless, the use of starchy thickeners has
come under fire in recent years.
Charges have been leveled that some companies “cheat babies” by including
starchy thickeners
in some of their baby-food products.10 Such foods have even been described
as “adulterated.” This
is a misuse of terms, however. Flours and starches are safe, officially
approved ingredients, and their
presence is clearly stated on the labels of the commercial baby foods that
contain them. The openly
declared use of acceptable ingredients is not “adulteration.”
It’s hard to see why anyone would object to the use of small amounts of
flours as thickening
agents in baby-food dinners or vegetable mixtures. Flours are acceptable
food ingredients for
infants. In fact, they are the main ingredients of the infant cereals that
most babies eat every day.
How can the same rice or oat flour that’s considered to be appropriate and
nutritious at breakfast
turn into a “filler” or “adulterant” by dinnertime?
Modified starches derived from tapioca or corn are used to thicken acidic
foods such as fruits
that do not thicken well with flour. Food manufacturers use modified
rather than unmodified
starches because the modified types are more effective thickeners—a
smaller amount can thicken a
larger quantity of food. Modified starches also prevent water from
separating out of the food;
unmodified starches do not. Scientists have reviewed the safety of
modified starches and concluded
that these ingredients are acceptable for use in foods intended for
infants.11 Very young infants
(under the age of three months) do not digest any type of starch well,
regardless of whether it’s
modified or unmodified. However, since infants of this age are not yet
eating solid foods, their limited
ability to digest starch is not an issue. (Human milk and formula do not
contain starch.)
Although modified starches are not harmful, baby-food manufacturers have
responded to consumers’
unease about these ingredients by reformulating many products to eliminate
their use.
Beech-Nut eliminated all modified starches from its products in the 1980s,
and Gerber removed
them from many of its products in 1996. (The newer Earth’s Best and
Growing Healthy product lines
do not contain modified starches.) Instead of using modified starches to
thicken fruit products, these
companies now deal with texture problems by mixing different kinds of
fruit together. For example,
Gerber has replaced its traditional “apricots with tapioca” product with
an apricot/apple/pear mixture.
Pesticide Residues
In 1995 data were published showing that some samples of fruits and
vegetables sold by the
three major baby-food companies (Gerber, Beech-Nut, and Heinz) contained
detectable amounts of
pesticides.12 The quantities of pesticides found in the baby foods were
substantially lower than the
maximum amounts allowed in food according to federal government standards,
and the findings of
the survey were very similar to those of previous tests on baby food
conducted by the Food and
Drug Administration. Nevertheless, the report unnecessarily led many
parents to be concerned
about the safety of baby food.
The presence of traces of pesticides in baby foods is not surprising. Most
crops grown in the U.S.
are produced with the aid of appropriate types and levels of pesticides.
And as long as pesticides are
used, there will inevitably be some pesticide residues in people’s diets.
The hypothetical hazards
posed by these minute traces of chemicals must be weighed against the very
real threat that would
accompany discontinuation of pesticide use: drastic reductions in the
quantity and quality of food
available to the public at reasonable prices.
Commercial baby food processors analyze their raw ingredients and finished
products for pesticide
residues, and they often set standards for pesticide residues that are
stricter than those of the
federal government. Home cooks cannot take similar precautions. For these
reasons, commercial
baby foods probably contain fewer pesticide residues than their homemade
equivalents. This does
not mean that homemade baby foods are unsafe; it simply means that home
preparation of baby
foods does not offer any special advantage when it comes to pesticide
residues.
Concerns about pesticide residues have prompted some parents to seek out
organically grown
foods for their infants. One company, Earth’s Best, is currently marketing
organic baby food in some
parts of the U.S. Parents can also purchase organically grown produce and
use it to prepare their
own baby foods at home. Organically grown foods, however, typically cost
much more than conventionally
grown foods, and they have no proven health advantage. In some instances,
they may not
even be free from pesticides; they can easily become contaminated by
chemicals used in neighboring
fields or those present in the general environment. Organic food producers
can claim only that their
products were produced without pesticides, not that they are totally free
from pesticide residues.
The current federal pesticide residue standards are appropriate for
protecting the public’s health.
However, questions have been raised about whether the standards for
infants and children should
be set differently from those for adults. As a 1993 report from the
National Research Council (NRC)
pointed out, infants consume fewer types of foods than adults do; and this
means that their exposure
to pesticides may not be the same as that of adults.13 Also, children may
be either more or less
sensitive to chemicals—both man-made and naturally occurring—than adults
are; this makes it difficult
to extrapolate scientific data from adults to children.
The NRC report recommended that the government take the special
characteristics of infants and
children into account when developing more sophisticated methods for
setting tolerance levels for
pesticides in foods. This is an important goal for future research.
Meanwhile, the best current scientific evidence indicates that the trace
levels of pesticides currently
found in the U.S. food supply are not a threat to the health of infants
and children.
Avoiding Allergies
Infants, particularly young infants, are more prone than adults to
food allergies and intolerances.
To minimize the risk of allergy problems, experts recommend that solid
foods not be fed before the
age of four to six months*7; that foods that are especially likely to
provoke reactions not be offered
during the first months of solid feeding; and that new foods be introduced
one at a time, so that any
problem foods can be identified. Rice cereal is often recommended as a
good first food because it is
very well tolerated and rarely causes any problems.
All the major commercial baby food companies have special lines of
single-ingredient
products**8 (and single-grain cereals) designed for young infants. Parents
who make their own baby
food should also start with single-ingredient foods. As a general rule,
parents are advised to choose
one food and offer it to the baby daily, for three to five days (some
experts say a week) before introducing another new food into the diet. If
any unusual symptoms develop while a new food is being
introduced, parents should consult with the baby’s health-care provider.
If a baby has shown an
allergic reaction to a food, that particular food should not be tried
again until the health-care
provider says that it is appropriate to do so.
Once an infant has eaten several single foods without difficulty, parents
can serve mixtures that
contain these ingredients. As the baby gets older, mixtures can become
increasingly complex. It is
still a good idea to try to introduce only one new ingredient at a time,
however. For example, if a
baby has already eaten applesauce and pears without problems, the parent
could introduce a commercial
or homemade apricot/apple/pear mixture. It would not be a good idea to
introduce a new
vegetable during the same few days when the baby is eating apricots for
the first time, however.
Foods that are particularly likely to cause reactions include dairy
products, eggs, wheat, corn, citrus
fruits, tomatoes, nuts, and seafood. In general, these foods should not be
offered to infants during
the first few months of feeding solids. Parents should check with the
infant’s health-care
provider for specific advice on when each of these foods can be started.
The timing may differ
depending on whether the baby (or the family) has a history of food
allergy.
Protecting Baby’s Teeth
Prolonged exposure to carbohydrates can contribute to severe tooth
decay in infants. This problem
is most likely to develop if an infant is allowed to go to bed with a
bottle of a carbohydrate-containing
liquid (milk, formula, or juice) or allowed to sip from a bottle
constantly throughout the day.
To help prevent tooth decay, parents should avoid these practices. If a
child insists on carrying
around a bottle or taking it to bed, the bottle should be filled with
plain water.
Another way to protect an infant’s dental health is to make sure that he
or she gets the appropriate
amount of fluoride. Parents who live in areas where the water is not
fluoridated should discuss
fluoride supplementation with their infant’s health-care provider.
Nutrition
Although good nutrition is important to an infant’s health and growth,
the exact nutritional composition
of the solid foods that a baby eats is not as crucial as many parents
believe. Human milk
and/or infant formula provide most of an infant’s nutrition, even after
the baby has started to eat
solids. Continuing to feed one of these types of milk throughout the first
year is far more important
than feeding any particular type or amount of solid food.
The transition from an all-milk or formula diet to a balanced, varied
adult-style diet is lengthy
and gradual. The first few months of eating solid foods (i.e., the months
during which baby foods
are used) are primarily a learning period. Although parents should make an
effort to choose nutritious
foods and to introduce a variety of foods into their infant’s diet, they
need not panic if the
baby takes a while to accept the idea of solid foods, wears more of his
meals than he eats, or spends
a few weeks spitting out all of his vegetables while gobbling up cereal
(or vice versa).
There are really only five crucial nutritional concerns that parents need
to pay attention to during
the months when an infant eats baby food:
• deciding which type of milk or formula to feed;
• letting the infant decide how much to eat;
• providing the infant with a reliable source of iron;
• preventing juice abuse (see below); and
• not applying adult dietary guidelines to infants.
Human Milk, Formula, and Cows’ Milk
Because milk in some form is the single most important component of
the diets of infants and
young children, the choice of the type of milk to feed to a baby or
toddler is crucial.
The American Academy of Pediatrics recommends that human milk,
iron-fortified infant formula,
or some combination of the two be the only types of milk given to infants
during the first year of
life.5 Low-iron formulas should not be used unless the infant’s
health-care provider specifically recommends their use.14 Cows’ milk of
any type—whole, low-fat, or skim—should not be offered during
the first year.15
During the second year of life, it is generally recommended that toddlers
drink whole cows’
milk. Those children who are still breast feeding, however, may continue
to do so. Both whole cows’
milk and human milk contain higher levels of fat than those present in the
reduced-fat milks that
older children and adults drink; toddlers need this fat to help meet their
nutritional needs. Reducedfat
milks should not be offered until after the second birthday.
Some babies do not tolerate cow’s-milk–based formulas well; they are given
soy-based or other
types of formulas during infancy. If these children are still intolerant
of cows’ milk when they reach
the age at which formula feeding is discontinued, special care is needed
in the planning of their
diets. This is one of the situations in which the expert advice of a
registered dietitian can be very
helpful.
How Much Should a Baby Eat?
Unless the infant’s health-care provider gives different instructions,
parents should let their
infants take the lead in deciding how much to eat. The parents’ role is to
choose the foods that are
offered; the infant chooses the amount.
Parents sometimes try to make an infant finish all of the food in a dish
or jar or all of the liquid
in a bottle or cup. This is not a good idea. Forcing an infant to eat more
than he or she wants can
lead to overfeeding and thus increase the risk of obesity.
It is also unwise to limit rigorously an infant’s food intake. Fear of
obesity has led some parents
to underfeed their infants, thus causing their infants to fail to thrive5
(failure to thrive is a condition
characterized by poor weight gain and growth failure in infants or
children).
Iron
Full-term babies are born with enough iron stored in their bodies to
last for four to six months.
After that, they need to get iron from an external source. Meat is a good
source of iron, but most
babies don’t eat enough of it to meet their need for this mineral. Most of
the other foods that babies
eat are not naturally rich in iron. For this reason, the American Academy
of Pediatrics and other
experts recommend that infants receive some supplemental source of
iron—either iron-fortified
infant formula, iron-fortified infant cereal, or vitamin drops that
contain iron—by the age of four
months.16
Because commercial precooked infant cereals are fortified with iron,
experts recommend that
these cereals be among the first foods given to infants. Further, the
experts recommend that these
cereals continue to be fed throughout the first year and possibly even
into the second year. All of the
major commercial brands of infant cereal are fortified with enough iron
that two servings per day
meet most of an infant’s daily iron needs. The use of iron-fortified
cereals is particularly important
for breast-fed infants, since human milk usually does not supply enough
iron to meet an infant’s
needs during the second half of the first year.
Parents who make their own baby foods need to realize that home-prepared
grain products are
low in iron in comparison to commercial infant cereals. Whether the use of
home-prepared grain
products is acceptable for a particular infant depends on the composition
of the rest of the infant’s
diet.
Parents who would prefer not to use commercial infant cereals should
discuss this issue with
their infant’s health-care provider. If the infant is not receiving
sufficient iron from other sources, the
health professional may prescribe iron-containing vitamin drops or advise
the parents to use a commercial product in this one instance, even if the
rest of the baby’s food is homemade.
Juice Abuse
Most people realize that nutritional imbalances can develop if an
individual overindulges in
foods of low nutritional quality (such as candy, cake, and soft drinks).
It is less obvious, however,
that similar problems can result if one type of nutritious food (such as
vegetables, fruit, or milk) is
overconsumed—consumed to the exclusion of other types of foods that are
needed for a balanced
diet.
In the case of infants, the product that tends to be abused is fruit
juice. Even if parents choose
100-percent-fruit-juice products rather than less expensive part-juice
fruit drinks, overconsumption
can lead to serious problems.
Fruit juice is natural, and it does provide some nutrients (such as
vitamin C), but it is far less
nutrient-dense than milk. If an infant or young child drinks too much
juice, the juice can displace
human milk, formula, or cows’ milk from the diet, leading to significant
nutritional problems.
Excessive fruit-juice consumption has been implicated as a contributing
factor in some cases of failure
to thrive in infants and young children.17
Overconsumption of fruit juice can also cause diarrhea in some infants and
young children.18 The
diarrhea results from malabsorption of carbohydrates in the juice, and
individual children vary in
their susceptibility to this problem.
Parents should follow the instructions of their infant’s health-care
provider about limiting the
intake of fruit juice. Often, health professionals recommend that an
infant consume no more than
four ounces of undiluted fruit juice (or eight ounces of half-strength
juice) daily. If a baby is thirsty
between meals, he or she should be offered water instead of juice.
Concerns about overconsumption of fruit juice do not stop after a child’s
first birthday. While
this report was in preparation, researchers published a study showing that
excessive intake of fruit
juice (12 fluid ounces or more daily) is associated with increased risks
of both short stature and obesity
in two- and five-year-old children.19 In some of the children who
participated in the study,
excess fruit juice may have displaced other, more nutritious foods from
the diet, leading to a slowing
of growth. In other children, fruit juice may have been consumed in
addition to an already-adequate
diet, leading to excessive caloric intake. This study should serve as a
reminder that the excessive
intake of fruit juice—or of any single food—can interfere with good
nutrition at any age.
Babies Are Not Little Adults
Many aspects of the dietary guidelines recommended for adults are not
appropriate for infants
and children under the age of two years.20 The types of dietary
restrictions that may help prevent
chronic diseases in adults (limiting calories, fat, saturated fat and
cholesterol; choosing high-fiber
diets) are actually counterproductive in infants and toddlers because they
may interfere with the
baby’s ability to consume enough food for proper growth. Even the most
basic of the adult dietary
guidelines—the recommended consumption of a variety of foods—isn’t
applicable to young infants,
who thrive on diets that contain only a single food: human milk or
formula.
The main goal of feeding during infancy is to provide enough calories and
nutrients for normal
growth and development. Since infants have small stomachs, they may not be
able to get enough
food if they are placed on low-fat, high-fiber diets. Such diets are not
appropriate during the first
two years of life. Parents should not attempt to limit an infant’s total
fat intake unless specifically
advised to do so by the health-care provider.
The format of the Nutrition Facts label on baby foods reflects the unique
nutritional priorities of
infancy. Unlike the labels on adult products, it focuses on the nutrients
that a baby needs—such as
protein, vitamins, and minerals—rather than on such food components as
cholesterol and saturated
fat. Appendix A contains more specific information on the nutrition
labeling of baby foods as well as
some samples of typical baby-food nutrition labels.
Are Homemade Foods More Nutritious than Commercial Foods?
One reason why some parents prefer to make homemade baby foods for
their infants is that they
believe that much of the nutritional value in commercial baby foods is
destroyed during processing.
This view is not correct, however. The retention of nutrients in
commercial baby foods is very good.
Commercial processors usually cook and pack foods quite soon after they
are harvested, and they
cook foods in minimal water in order to preserve nutrients. The only
nutrient that suffers substantial
losses during the production of baby foods is vitamin C, which is very
sensitive to heat. To compensate
for these losses, baby-food manufacturers add extra vitamin C to many
fruit, vegetable, and
juice products.
Homemade baby foods are comparable in nutritional value to commercial
foods if home cooks
use preparation techniques that preserve the food’s nutrient content.
Boiling is not a good method of
cooking because many nutrients leach out into the cooking water; and
frying is not recommended
because it adds large amounts of fat and calories—but few other
nutrients—to food. Instead, foods
should be steamed, microwaved, baked, or broiled before being pureed and
strained for an infant.
Comparing Costs
It is
often claimed that commercial baby foods are inordinately expensive in
comparison with
“regular” foods intended for adult consumption. However, when people
compare the prices of baby
foods and “regular” foods, they often fail to take into account the value
of the parents’ time, the cost
of fuel used for cooking and dish-washing, and the cost of wasted or
inedible portions of the original
ingredients.
For
example, the price per pound of jarred baby-food meats is usually higher
than the price of
the fresh meat sold at a supermarket’s regular meat counter. The two types
of meat products are not
really equivalent, however. The baby-food meat is ready to serve; the
fresh meat would have to be
trimmed, cooked, cut up, pureed, and strained before it could be fed to a
baby. Moreover, the homeprepared meat would have to be stored under
refrigeration at all times, making it less convenient
than the commercial product for away-from-home use. As indicated above,
for a truly meaningful
comparison between the two products, the parents’ time, the cost of fuel,
the money spent on discarded
trimmings, and the convenience of having a shelf-stable product would all
have to be taken
into consideration.
For many families, the parents’ time is the most important factor—and not
just because of its economic
value. Adults employed outside the home may have limited amounts of time
to spend with
their children. Many parents would prefer to spend as much of that time as
possible interacting with
their children—not preparing food.
In a few instances, though, parents may be able to save money without
doing any extra work in
the kitchen by choosing “regular” food products that are equivalent to
baby-food products. For
example:
• Baby-food applesauce is essentially equivalent to unsweetened regular
applesauce.
• Baby-food fruit juices are equivalent to regular vitamin C–fortified,
unsweetened, pasteurized,
100-percent-juice products.
• Toddler diced fruits are very similar to regular canned fruits packed in
juice.
• Toddler diced vegetables are essentially identical to no-salt-added
canned vegetables.
In these instances, consumers will usually find that the cost per pound of
the “regular” products
is lower than that of the baby-food or toddler products. The “regular”
foods may therefore offer substantial savings, provided the family uses
all of the food in the container. If the family does not eat
the leftovers, the larger containers of “regular” food may not be a
bargain at all. The tables in
Appendix B illustrate this point.
For applesauce and fruit juice, the easiest way to get a real bargain with
no loss of convenience is
to choose multipacks of small containers of adult brands (juice boxes and
snack packs). These products
typically cost less than baby food in packages of similar size, can be
used with little or no
wastage, and don’t have to be kept cold. Parents who choose these products
should realize, however,
that not all of them are equivalent in quality to baby-food products. For
example, some of the
drinks sold in “juice” boxes contain little fruit juice. Parents who wish
to choose regular products
that are truly comparable to baby foods need to read product labels
carefully.
Conclusions
Both commercial and homemade baby foods can be safe and nutritious if
parents choose appropriate
foods and handle them correctly. Preparing homemade baby food is
time-consuming, and it
requires a thorough understanding of the principles of safe food handling.
If these principles are
observed, most homemade foods are just as healthful as their commercial
equivalents. The major
exception is infant cereal; homemade varieties are not iron fortified and
may not be as easily digested
as commercial products.
Safety should be a parent’s top priority when it comes to baby food.
Important safety concerns
include the temperature at which food is served, the use of safe handling
procedures to minimize
the risk of bacterial contamination, the avoidance of foods that pose a
high risk of choking, and the
avoidance of honey and corn syrup, which have been associated with an
increased risk of infant botulism.
Because of the risk of contamination with disease-causing bacteria,
parents should not feed
unpasteurized juice or cider to infants or children.
Salt and sugar, in moderate amounts, are not harmful to babies. However,
their use in baby foods
should be limited. Modified starches are safe, acceptable baby food
ingredients. The pesticide
residues occasionally detected in some commercial baby foods are well
below federal standards and
are not a cause for concern.
To minimize problems with food allergies and other types of food
sensitivity, parents should wait
until an infant is four to six months old before starting solids, should
introduce new foods or ingredients
individually, and should delay the introduction of foods that are
particularly likely to provoke
reactions.
Human milk and/or infant formula, rather than baby foods, are the main
sources of nutrition
during the first year of life. Cows’ milk should not be fed until the
second year. The exact types and
amounts of solid food fed to an infant are not crucial in terms of
nutrition. However, to ensure good
nutrition, parents should follow expert recommendations on the type of
milk to feed, should allow
the infant to decide how much to eat, should make sure that older infants
receive some supplementary
source of iron, should avoid excessive use of fruit juice, and should
avoid applying adult
dietary guidelines to infants.
1*Although the American Academy of Pediatrics recommends that all formulas
fed to infants be fortified with iron, some health-care providers consider
the use of low-iron formula to be acceptable during the second half of the
first year if the baby is eating sufficient iron-fortified cereal or
taking an iron supplement. Health-care providers may also recommend the
use of low-iron formula in other situations —in infants with persistent “colic,”for
example. Parents should discuss these situations with the infant’s
health-care provider and should not switch their infant to a low-iron
formula without the provider’s approval.
2**The issues involved in parents’ decisions about breast feeding versus
formula feeding are beyond the scope of this report. However, it is worth
noting here that the American Academy of Pediatrics and other experts
strongly recommend breast feeding.
3*In most instances, this will be a pediatrician or family physician. In
some health-care settings, however, advice on routine aspects of infant
feeding may be given by a nurse practitioner, nurse midwife, or
physician’s assistant. In other instances, and especially when special
considerations (such as allergy or vegetarianism) limit the choice of
foods, a registered dietitian may be involved in planning an infant’s
diet.
4**The companies that sell conventional baby foods in glass jars recommend
that their products not be frozen because the freezing process alters
their texture. However, one company, Growing Healthy, sells frozen baby
foods that are designed to be thawed in the microwave oven. Homemade baby
foods can also be frozen and thawed. Many parents who make homemade baby
food deliberately cook more than they can use in a single day and freeze
the extra food in ice-cube trays, thawing individual cubes as needed.
5*The term “pasteurization” refers to a heat treatment that destroys
disease-causing microorganisms. Most Americans are familiar with
pasteurization primarily as a treatment applied to milk. The same type of
process can also be used to ensure the microbiological safety of other
foods, such as fruit juices. 6*If honey were used as an ingredient in
commercial infant formulas or baby foods, any spores it contained could be
killed by the same process. Ordinary cooking does not ensure the
destruction of Clostridium botulinum spores, however.
7*Parents sometimes wonder whether it would be advisable to start cereal
at an earlier age if the infant does not seem satisfied after breast or
formula feedings. This situation should be discussed with the infant’s
health-care provider. Although the introduction of solids before the age
of four months is not generally recommended, some health-care providers do
approve the early feeding of solids in selected cases.
8**In
addition to their “single” ingredient, many of these foods contain water,
which is used to create an appropriate consistency. Some also contain
vitamin C, which is added to offset losses of this nutrient during
processing. Water and vitamin C do not provoke allergic reactions, so
parents need not be concerned about their presence in “single-ingredient”
foods.
Appendix A: Nutrition Labeling of Baby-Food
Products
Commercial baby foods carry Nutrition Facts labeling, just as
adult foods do. However, the
infant food label differs from the adult label in these ways21:
• The serving sizes are those customarily eaten by infants rather than
adults.
• The Daily Values referred to on the label are those for infants rather
than adults.
• The label lists percentages of Daily Values only for protein, vitamins,
and minerals. No percentages
of Daily Values are listed for fat, saturated fat, or cholesterol because
Daily Values for these
nutrients have not been established for infants or children under the age
of four years.
• Information about saturated fat and cholesterol and about the percentage
of calories from fat is
not included on the label. Parents should not attempt to limit the amounts
of these food components
in the diets of infants and toddlers under the age of two years.
Sample Labels
Sweet Potatoes (jarred baby food)
Amount per Serving
Nutrition Total Fat 0 g Total Carb. 17 g
Facts Sodium 10 mg Fiber 0 g
Serv. Size 1 jar Potassium 230 mg Sugars 8 g
Calories 80 Protein 0 g
% Daily Value
Protein 2% • Vitamin A 380%
Vitamin C 0% • Calcium 2% • Iron 2%
Infant Oatmeal Cereal (calcium and iron fortified)
Nutrition Facts
Serving Size 1/4 cup (14 g)
Servings per box 16
Amount Per Serving
Calories 60
Total Fat 2 g
Sodium 15 mg
Potassium 45 mg
Total Carbohydrate 11 g
Dietary Fiber 1 g
Sugars 1 g
Protein 1 g
% Daily Value
Protein 8%
Vitamin A 0%
Vitamin C 0%
Calcium 15%
Iron 45%
Thiamine 45%
Riboflavin 45%
Niacin 45%
Turkey with Broth (jarred baby food)
Amount per Serving
Nutrition Total Fat 6 g Total Carb. 0 g
Facts Sodium 40 mg Fiber 0 g
Serv. Size 1 jar Potassium 90 mg Sugars 0 g
Calories 90 Protein 8 g
% Daily Value
Protein 50% • Vitamin A 0%
Vitamin C 0% • Calcium 2% • Iron 4%
Appendix B: Cost Comparisons
See downloadable version for cost comparisons.
Complete Text Download in PDF: 90K
http://www.acsh.org/publications/booklets/feedingbaby.pdf
References
See downloadable version for references. Complete Text
Download in PDF: 90K
http://www.acsh.org/publications/booklets/feedingbaby.pdf
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