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All parents want to be assured that their child is healthy; the most tangible proof of this would be to see that his appetite is good and that he is growing before your eyes. But sometimes it is difficult for parents to judge how their child is eating and growing; especially when they have differing opinions of his appetite and growth from grandparents and relatives.

"Is my child eating enough?" is one of the most commonly asked questions at all health visits to pediatricians. The answer to that depends on the information you give your doctor about your child's foods and feeding habits. The pediatrician can evaluate your child's height and weight and compare them to prior measurements to see if his weight is appropriate for his height, and if he is growing along his growth curve.

Your child's diet varies greatly during the first few years of life. There are many recommendations on how to advance your child's diet from infancy to toddler hood. As first and second-generation immigrants to this country, we have many resources available to us, from grandparents and relatives to magazines to textbooks. Who's right? What's appropriate? Your child's diet should reflect his age, need for calories, and developmental stage. The following article will reflect some commonly asked questions about children's nutrition.

• Are the American formulas more nutritious for my baby?

  Some people have the misconception that breast-feeding is not as nutritious or filling as formula. If a woman is well nourished, breast milk is the best feeding available for your new baby. It has a combination of nutrients, minerals, vitamins, enzymes and antibodies for your child. Breast fed babies also has fewer infections and allergies during the first year of life than babies who are on formula. Breast feeding also contributes to a special bonding between mother and child. Because human milk takes less time to digest than formula, breast fed babies will have to be fed more than one that is formula fed. Another advantage is that breast-feeding is inexpensive, served at the perfect temperature, and easy to travel with!

• How often should my baby nurse?

  Until your milk supply is well established and your baby is gaining weight (at about 2 weeks), feed your baby whenever he seems hungry. After that, your baby can receive adequate milk when feeding every 2 to 3 hours. Nurse your baby 10 minutes on the first breast followed by burping and a shift to the other breast. Once your milk supply is well established, 20 minutes of breast-feeding will give your child 90% of the available milk. During the first few months, your baby shouldn't go more than 5 hours without nursing; if he's asleep, wake him up for a feeding. As your baby gets older, he can go longer between feedings because his stomach capacity enlarges and the mother's milk production increases. The best feeding schedule is one that your child designs himself.

• How do I know that my child is getting enough breasts milk?

  If your child's diet is adequate, he should have six to eight wet diapers a day and several small bowel movements a day. Later, he may have less frequent bowel movements and may skip some days. If your child is growing (proved by weight checks at the pediatrician's office), this is all normal. During the first week of life, your baby may lose up to 10% of his birth weight, but after that, he should be gaining. Your child should be back to birth weight by the second week. Once your milk supply is established, your baby should gain about 2/3 of an ounce a day during the first three months and 1/2 ounce a day between three and six months of age. After six months, this will drop off further, so don't be alarmed.

• Can I give my baby bottle feedings?

  Try not to offer your baby any bottles during the first four to six weeks after birth because this is when you establish your milk supply. Good lactation depends on the engorgement (swelling) of breasts. Severe engorgement leads to decreased milk production. Once your baby is nursing well, you may want to offer your baby a bottle of expressed breast milk or water. This will be convenient when you have to leave the baby with your mother or a baby-sitter.

• What if I go back to work?

  You can continue to give your baby breast milk by expressing your breasts or using a breast pump to save your milk. Breast milk can be saved in the refrigerator for up to 48 hours and up to 3 months in the freezer. The baby's grandmother or baby-sitter can warm up your milk by placing the milk container in some warm water to heat it up to room temperature. You can buy a hand pump from a medical supply company or rent an electric breast pump form your hospital instead of manually expressing your milk for storage.

• What if I want to give my baby formula?

  You shouldn't feel guilty if you decide not to breast-feed. Formulas mimic breast milk and provide all the nutrients an infant need, but without the antibodies that mother's milk provides. Some parents feel more comfortable with bottle feeding because they know exactly how much food the baby is getting, and there is no need to worry about the mother's diet or medications that might affect the milk.

  When selecting a formula, you should not give your baby regular cow's milk until he/she is at least 12 months old. Young infants cannot digest cow's milk as easy as breast milk and formula, and it contains high concentrations of protein and minerals that can stress your child's body.

  Most formulas are derived from cow's milk. Soy formula contains different proteins and carbohydrates. Healthy, full term infants are given soy formula only when medically indicated. Choose a formula that is iron fortified; low-iron formulas do not provide adequate iron supplements. If you use concentrate or powdered formula, be sure to follow the mixing instructions carefully.

  Your newborn will take 2 to 3 ounces a day every 3 to 4 hours. By the end of the first month, your child will be up to 4 ounces per feeding and have a predictable schedule. By six months your child will eat 6 to 8 ounces per feeding 4 to 5 times a day. By two months most babies do not need a middle-of-the-night feeding because they are eating more during the day and have developed a more regular sleeping schedule.

• What if my child wants to eat more than this?

  A common mistakes some parents make is to feed a child when he becomes fussy or cries. If your child is growing well, and you just fed him 1 or 2 hours ago, find out if he is upset because of a wet diaper or something else irritating him; try to comfort the child (use a pacifier/hold him...). If only a bottle can comfort your baby, then try to distract him with a bottle of water until the next feeding. This should make him hungrier for the next feeding so that he will eat more at that time and be satisfied for a longer period of time. If you continue to feed your child when he is fussy and not hungry, this can lead to over feeding and obesity.

  We (Vietnamese) tend to continue bottle feeding our children longer than the American standard. There are several reasons to advance to solids, and this is done through stages.

• When can I start solid foods?

  The best time to start solids is when your baby has lost his tongue thrust reflex (which pushes food out of the mouth when you attempt to introduce a spoon), has adequate head control and can sit with some support. This happens at 4 to 6 months.

  Start with cereals as your child's first solid food. Rice cereal is less likely to cause allergies than other cereals. You can try barley and oat cereal 1 to 2 weeks later. Wheat and mixed cereals should be introduced last since they may cause allergic reactions in some very young babies.

  Strained or pureed fruits and vegetables are the next solid foods to introduce. It is important to give your baby only one new food at a time, give about 3 days to assess for any allergic or adverse reactions. Within 2 to 3 months (6 to 9 months of age), your baby's diet should consist of fruits, vegetables, meats, cereal and formula or breast milk distributed among 3 meals. Small snacks may be required to tide him over until the next meal. The midmorning and midday snack should be a nutritious non-milk food. You don't need to buy the jarred foods; you can prepare these meals at home if you have a blender or food processor. Just remember to add enough water to get a consistency that your baby can easily swallow. You do not need to add spices or sugar to these home made foods; your child does not need the added salts and sweets.

  (Some grandparents may want to only prepare pureed foods at home; they have the misconception that jarred foods have too many chemicals and are not nutritious for the child. Don't feel guilty if you want to buy the jarred foods for convenience, they are adequately prepared and have the proper vitamins and minerals for your baby if he has a well balanced diet. Some grandparents advise us to chew up the child's food and re-feed it to him; this was done frequently in Vietnam when blenders and food processors were not available to the general public, but this method should not be used now because re-feeding food that has been in someone else's mouth is not sanitary and a way for germs to spread.)

  Between 8 and 12 months, introduce your child to mashed table foods or junior foods. You can also introduce finger foods to your child between 9 to 10 months. Good finger foods are dry cereal, slices of cheese, slices of canned or soft fresh fruits, crackers, and breads. This will be a messy process, but most babies like to feed themselves.

  Your child should be eating the same meals as you do by approximately 1 year of age. This assumes that your diet is well balanced (breads, grains, and rice; fruits and vegetables; meats, chicken and eggs; milk, cheese and yogurts) and that you carefully dice any foods that would be difficult for your baby to chew. Avoid foods that can be choked on such as raw carrots, grapes, hot dog pieces and peanuts.

  Some foods to not introduce until at least 12 months of age are eggs, fish, shellfish, peanut butter, and oranges. They may produce allergies and should be avoided until 1 year of age. Honey also should not be fed to children under 1 year old. It may contain spores of bacteria that can cause botulism. Infant botulism is a disease that can weaken the baby's nerves and muscles and in extreme cases the baby may not be able to move and may stop breathing. After 1 year of age, the child's intestines and immune system are able to eliminate the bacteria and their spores.

  When you start your child on rice cereal, remember to feed your child with a spoon instead of placing it in his bottle (putting solids in bottles can lead to over eating by giving your child too much food in a short period of time). By 15 to 18 months, most children can feed themselves with a spoon (although somewhat messy) and a parent is no longer needed in the feeding process.

  We tend to assist our children in feeding until much later because we are concerned that they will not eat enough if they feed themselves. However, when you allow them to feed themselves, it will foster a sense of independence; your child will not starve, he will eat enough to satisfy his hunger, just remember to offer him a variety of foods. Some children do not eat well at meal times because they are given high calorie foods such as milk or formula in between meals; this fills them up and they will not be hungry during mealtime.

• When should my child start drinking from a cup?

  Many Asian children still drink from a bottle much later than their American counterparts.

  It is important to introduce the cup at 6 months of age, because the longer an infant goes without using a cup, the less willing he will be to try it later. At 5 to 6 months, start with once cup a day with formula or breast milk and advance to all feedings. Total weaning to a cup should occur between 9 to 18 months.

  Don't let your child carry a bottle around during the day. This can interfere with normal development that requires speech or two-handed play.

  Remember not to start bad habits by putting your child to bed with a bottle; this can cause tooth decay. If you already put your child to sleep with a bottle, wean it as soon as possible; if he needs the bottle, replace formula or milk with water.

  At 12 months, your child no longer needs formulas or breast milk and can be changed to whole cow's milk. Don't buy the low fat or nonfat milks.

• My child is more active, shouldn't he be eating more?

  After 12 months, it is normal for the toddler's appetite to decline. His growth rate has slowed, so he doesn't require as much food. His eating habits may be more erratic, eating a lot one day, and refusing most foods another day. Let your child feed himself with a spoon (he should be able to do this well by 15 to 18 months). Don't struggle to get your child to eat. The more you push him, the less likely he will to comply. Force feeding your child may lead to overeating and obesity. Don't allow him to fill up on cookies or sweets in between meals, a nutritious non-milk snack should tide him over until mealtime.

  Some families make the mistake of give their child milk if he has a poor appetite. "My cousin's child drank milk and is healthy and fat." Drinking too much milk can fill kids up and they won't be hungry for mealtime. Drinking more than 24 to 32 ounces of milk a day may also decrease your child's iron absorption and cause anemia. You don't need to eliminate milk completely, it is still important for the added calcium and Vitamin D that your child needs (16 to 32 ounces will provide the needed nutrients).

  By age two, your child should be eating 3 meals a day plus one or two snacks. By three, his independent feeding will be less messy. He should be drinking all liquids from a cup. Milk is still important but not more than 16 to 32 ounces. You should try to arrange regular times for the three main meals; they should be eaten with the family instead of when your child is hungry.

• What about vitamins?

  When a baby is breast-feeding, the mother needs Vitamin D and calcium. A quart of milk (or its equivalent in cheese or yogurt) is adequate. When you are breast-feeding and on medication, remember to ask your doctor if the medication can affect your breast milk.

  In Santa Clara County, the water is not fluorinated and your child will need fluoride supplementation. Fluoride requires a prescription from your doctor. It is needed for your child's growing teeth. Some pediatricians start at two weeks, others prefer to wait until 6 months; nonetheless, this is continued until your child is 12 years old. Some counties have fluorinated water and you do not need this supplement unless you do not use the tap water for cooking and drinking. Your pediatrician will know if the water supply in your county has fluoride.

  Commercial formulas and breast milk contain all the vitamins and iron your child needs. After 1 year, if your child eats a balanced diet, he does not need vitamins unless he is a particularly picky eater. Iron supplements may be required if your child drinks excessive milk and has anemia.

  Remember that feeding your child does not have to be a struggle. Ask to see your child's growth chart; if he is following a curve, he is growing appropriately. Don't be alarmed if he adjusts himself slightly on the growth curve in the first 3 years, his body is adjusting to his own growth rate. Your pediatrician will be happy to answer any questions you have.