PROTEINS IN A BABY’S DIET

NEW YORK TIMES COLUMN: FAMILIES TODAY:
PROTEINS IN A BABY’S DIET
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Is there any risk in not feeding beef or pork to our nearly 8-month-old son as he gets older? He is still on vegetables, fruits and oatmeal, but one of these days, we need to introduce proteins.

A. You started proteins almost eight months ago! Breast milk and formula, mainstays of a baby’s first-year diet, both contain lots of protein. Fish, dairy products and eggs will eventually also be good sources. Egg whites should not be given to children under age 1 since they may cause allergies.

Proteins come from plants, too. Important sources include soy foods, (for example, tofu and tempeh – staples of many Asian diets), soy milk, legumes (peas, beans, lentils, peanuts), nuts and seeds.

Cooked and strained peas and beans are early solids with protein. They can be mixed with blander-tasting foods like soupy corn or rice cereals for children who initially resist the taste.

To reduce allergy risk and to prevent choking, children under 2 should not be given peanut butter. In children or families with lots of allergies, it’s better to wait until 3. Whole peanuts, which can block small airways, should not be fed to children under 3.

As children grow, their nutritional needs change, varying with gender and activity level. Children also absorb, digest and metabolize nutrients differently.

All of us need certain amino acids – the building blocks of proteins – to survive and thrive. Essential amino acids are those that we can’t make on our own and that our diet must provide. Two additional amino acids – cystine and tyrosine – are essential for young babies, whose ability to make them doesn’t mature until later in the first year.

Breast milk contains the amino acids required in the first year. But when babies start eating solids and drinking less milk, the balance can be tricky.

Dairy products, eggs, fish, poultry and meat contain a wide range of essential amino acids, as do legumes and soy foods and milks. Other sources are foods made from quinoa, an ancient South American grain-like food, or from hemp seeds (hemp milk and even ice cream are now available).

Corn, rice, wheat and other grains also contain proteins but with fewer of the necessary amino acids. If animal protein is not part of a child’s diet, a variety of different plant-derived foods is important. With all these options, omitting red meat needn’t interfere with adequate protein intake.

The daily protein requirement should be spread out in feedings over the course of the day since babies’ bodies can’t store extra protein. They break down the proteins into amino acids that stimulate tissue growth. Spreading out protein across the day will stimulate growth several times daily.

Nutrients other than protein need special attention, too: iron and vitamin D and, for babies and children who are not given any milk or animal-based foods, vitamin B-12. Vitamin D supplements are recommended for all infants who are breast-fed (baby formula is fortified with vitamin D). Iron is found in plant foods as well as in meats, but is not as readily absorbed, so the daily requirements are higher for children and adults who eat no meat.

Check with your pediatrician about iron supplementation, since too much iron is not healthy. Vitamin B-12 is found only in animal-based foods and foods contaminated with B-12-producing microorganisms. Poultry, fish and eggs contain plenty of B-12 – so, again, red meat isn’t essential.


Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

IS MY BABY GETTING ENOUGH IRON?

NEW YORK TIMES COLUMN: FAMILIES TODAY:
IS MY BABY GETTING ENOUGH IRON?
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. How can I ensure that my breast-fed 7-month-old consumes adequate iron? I give her a daily serving of iron-fortified cereal, but I’m lucky if she eats one tablespoon (she’s also started pureed vegetables). My pediatrician has expressed concern about her intake since breast milk doesn’t contain much iron. So far she’s been growing well.

A. Breast milk is the best food for babies during the first year, with just the right balance of fats and amino acids as well as antibodies that protect against infection. Breast milk may not always provide adequate amounts of iron. But iron in breast milk is more easily absorbed than in iron-fortified baby formulas.

Iron is an essential mineral for hemoglobin, the molecule in red blood cells that allows the blood to absorb oxygen in the lungs and transfer it to the body’s tissues. Iron has other important roles, too. Iron deficiency in the first years can be related to learning disabilities.

Low iron levels can also increase the risk of lead poisoning in babies. A child with iron deficiency may absorb five times more lead than a well-nourished child. Pediatricians usually test a baby’s blood for lead levels at nine or 12 months and may repeat the test yearly until age 5. For mild cases of lead poisoning, pediatricians often prescribe iron supplementation.

During the first four months, babies generally can rely on the iron in the red blood cells acquired from their mother’s circulation before birth, unless maternal iron levels were too low during pregnancy. Nutrition during pregnancy, including adequate iron, affects a baby’s health and development long after birth.

For breast-feeding babies, the American Academy of Pediatrics (www.aap.org) recommends daily iron-drop supplementation between four months and the age at which you introduce iron-rich solids. Because too much iron can be as bad as too little, it is important to follow your baby’s doctor’s advice on dosage.

Babies can start on solids between four and six months. Some of the first solids – infant rice cereals, for example – are often iron-fortified. Iron that occurs naturally in food is better absorbed than the artificial kind.

Iron sources include soft, strained, pureed cooked meats such as beef, turkey and chicken. Cooked and strained peas and green beans are also good, although their iron is less readily absorbed than via meats.

Cooked, strained fruits are other early solids. Sometimes citrus fruits cause rashes in children under age 1. Apricots, peaches and prunes are worthy choices until then.

Pediatricians usually test a baby’s concentration of hemoglobin in red blood cells at nine or 12 months and again between 15 and 18 months. This test is not perfect, so an iron-rich diet is important even if the test result is normal. If iron levels are low at this time, iron drops may be prescribed, along with a recommendation for more iron in the diet.

Young children also need adequate supplies of calcium, but calcium interferes with iron absorption. Try serving high-iron foods at meals or in snacks, separate from breast-milk feedings. Cow’s milk should not be given to babies under age 1 because it can irritate their intestines and prevent iron absorption.


Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.