Do I have to put my chubby baby on a diet? If I collected a dime every time parents told me about someone’s advice to restrict calories in order to slim their child down, I would have been a rich woman by now. But it seems especially unfair when this counterproductive recommendation to interfere with child’s decision on how much to eat comes from their primary care provider, someone they entrust with their child’s health and well being.
Here is a story of a parent who came to one of my workshops on introduction of solids, where I promote trusting babies to self-regulate their intake, establishing structure in feeding and focusing on a variety of foods. Thanks to decades of research, I know that allowing babies to determine how much to eat works to ensure better eating habits and healthy relationship with food in the future. Besides, I feel it is especially important to help small children stay connected with their hunger-satiety signals since, without supportive environment, they tend to lose this connection by the age of 2.
By the way, the mom from this case study did an absolutely phenomenal job with feeding her baby in an attuned way and providing a wide variety of healthy foods. I was thrilled to see how following the Division of Responsibility in feeding (DOR) has helped her build a wonderful feeding relationship with her child. I could not help italicizing in her emails how she implemented the DOR principles in feeding her baby.
My doctor recommended restricting my baby.
Here is an excerpt of the mom’s email to me: “My daughter is now 8 months old and has done really well with introduction of solids, thanks to the wonderful guidance we received from your session. However, she is quite big. The doctor is a bit concerned with her weight and advised us to start decreasing her formula intake. Before solids, she was drinking 32 oz. And up until last week, she was drinking 23 ounces (in 4 bottles throughout the day). The pediatrician suggest we go down to 16 oz immediately, so she is now drinking 4 bottles that are 4 oz formula + 2 oz water. …. We have introduced all proteins – meats, fish, beans and cheese. And many veggies and fruits. We have also successfully introduced all nuts. So she pretty much eats everything these days. She’s also eating a lot of different textures and is doing some finger feeding. She’s on the verge of crawling and standing, which I know will help her burn more energy.
I have been following T’s cues from the time she was very little – letting her lead when it comes to food. She has always been allowed to eat as little or as much as she wants, so getting this direction from the pediatrician made me feel like I was doing something wrong or that I somehow had the “broken” baby who couldn’t self-regulate.
We’ve made the switch to the 16oz a day, but each bottle is 4 oz formula + 2 oz water, so she’s getting more fluid than 16 oz. And she drinks water from a straw cup a few times a day. This was based on the guidance from the pediatrician – but is this the right approach? I have noticed she is interested in eating more solid foods since we dropped the formula, which we have let her do. I’ll continue to allow her to eat as much or as little as she wants of the solids and will continue to offer her variety. I’m also trying to let her self-feed more since that way she has the most control.”
No need to put your baby on a diet.
Here is my response to the mom: “ If your daughter’s intake of solid foods is good, nutritionally there may be no problem with going down to 16oz of formula at 8 months, although this is typically the least amount recommended for a 1 year old baby. BTW, looks like she is doing a wonderful job with eating, congratulations!
However, the reason for cutting on her formula concerns me. Diluting formula with water definitely looks like tricking her into eating less. Putting babies on a diet/reducing their caloric intake does not work. Calorie restriction triggers very strong biological mechanisms that push kids to overeat when they are given a chance. Pushing skinny kids to eat more or restricting chubby kids results in the opposite effect – they start eating less or more than they need, respectively.
Since you are feeding her in a responsive way, i.e. not pushing her to finish her bottle or eating more solids than what she is hungry for, she is able to wonderfully regulate how much food she needs. That’s why she just increased the intake of solids to compensate for the missing formula calories. And your doctor will probably not see her slow her weight gain before she herself is ready for it. Many kids who can self-regulate and are trusted with their eating start naturally eating less after they turn 12 months and their growth slows down.
So you have two options, in my opinion:
1/ Keep giving her 24 ounces of formula but do not feel like she needs to finish the bottle. She will adjust her intake and will naturally drink less by 9-10 months when solids will become the main source of calories. Here is an article I wrote about it.
2/ Follow your doctor’s advice and reduce formula to 16oz but make sure she can eat as much of solid foods as she is hungry for at mealtimes.”
In a few weeks….
Mom’s follow up email: “Thanks for reaching out! Things have been great and I’m so glad we followed your advice. Just a few weeks after we went to the pediatrician where we were told she was a bit too heavy and we needed to put her on a diet, she started crawling and walking. So in my mind, she needed the energy to be able to do those things!
After we emailed, we followed your advice and offered 6 ounces (not diluted) following each of her 4 meals. That said, we noticed soon that she was only interested in drinking around 4-5 ounces following her meal. And now, she only wants 4 ounces. Sometimes, she’ll whine after she’s done and then we’ll offer her another 2 ounces. We also try to give her as much finger food as we can. That way, we know she’s regulating herself vs eating to please us.
She does sometimes get “tired” of eating with her hands but you can tell she’s still hungry, so we help her with the spoon at that point. We also offer water over the course of the entire meal and let her drink as much as she would like.
Her cues are pretty clear these days so we try to just listen to them as best we can – she closes her mouth when she doesn’t want a particular food; she tries to stand up in her highchair when she’s had enough; and she opens her arms wide when she’s still hungry. Some days she eats more and some days she eats less and that’s okay with me.
… And of course with all the movement now, her rate of weight gain appears to have slowed by itself (i’m guessing based on the way she looks and the way her clothes fit). So, as you said, self-regulation is a pretty wonderful thing and I’ve learned to trust and listen to her instincts even more than before.”
So it looks like following the Division of Responsibility in feeding and trusting the baby to decide how much she was hungry for paid off for this parent, as it did for many others. Now I only wish more health professionals were familiar with the feeding literature. This will allow them to be guided by a more holistic and research-based approach in their recommendations vs just a number on the growth chart.