Dr. Greene's Answer
Msfho, I speak with parents all over the world who express concern that their babies are eating too little – or too much. Some parents think that 90th percentile is an ‘A’ and 80th is a ‘B’. If their baby is at the 50th percentile, they are concerned that something is wrong. But healthy babies come in many shapes and sizes. The 50th percentile is a wonderful weight, sometimes called the target weight. Half of the healthy baby boys at that age weight more, half weigh less.
If he is taller than average, a more useful measure of his growth is the weight-for-length percentile (or for older children, the BMI percentile). Whatever you look at, keep in mind that (if he is in the healthy range) most of us would rather be on the slim side of healthy.
I understand that feeding our babies is a core part of our role as parents that we deeply want to know that we are doing it right.
Comments by friends, relatives, or strangers can heighten our concern: “He barely eats a thing. You need to feed him more.” “What a chubby baby!” “He looks so skinny. Are you feeding him enough?”
This preoccupation led to “scientific” guidelines of how many teaspoons of what type of food to offer, and how often. We now understand, though, that babies’ needs differ, and that the same baby may have different needs depending on what is happening on a particular day. Rigid guidelines can be counterproductive.
Children need ever-changing amounts of food, influenced by their activity level and developmental phase, the air temperature and relative humidity, and perhaps by a virus they might have.
How is a parent supposed to decide how much to feed?
At 5 ½ months, most of the nutrition still comes from breast milk or formula. The solids provide wonderful experience with flavors, textures, and the mechanics of eating.
A baby can breastfeed as much as he wants, or have about 20 to 32 ounces of formula per day. In addition, he can have as much or as little in the way of healthy solids he wants to supplement this.
Thankfully, babies are born with a sophisticated internal mechanism for determining just how much they need to thrive. Healthy babies given the right selection of healthy foods will tend to eat just the right amount (as long as we don’t short circuit this with empty calories in what they eat or drink).
Our role as parents is to offer healthy foods and to learn to recognize their signals and not to short-circuit our babies’ own sense of how much they need.
Independent toddlers might make it easy for us by saying “all done” or using hand signals to indicate, “I’m finished!” Before they have those skills, babies will use their whole bodies to get the message across, fidgeting in the high chair, or even standing up.
The signals of younger babies are quieter. A newborn may push the nipple out of the mouth, or just fall asleep. A baby who has entered the delightful stage of first solids will lean forward or open the mouth when hungry, and clench the mouth shut, turn aside, or lean back when satisfied. When babies get better at using their hands, they might push the spoon away.
There are several ways to tell if our dance of communication is working well. A bright, happy child is a good sign. Babies who aren’t getting enough to eat tend to be irritable or droopy (of course many other things can make them unhappy). Babies should make urine regularly. If they don’t urinate in 8 hours, it bears looking into. And throughout childhood, their growth will be plotted at each regular check-up to be sure that they are growing on target for themselves.
Too much food creates a bloated feeling. Too little leaves craving. But just right – the baby feels deeply satisfied. What joy to be able to give this pleasure to our babies and to watch them grow! After all, growth is what childhood is all about.