Nutrition. To assess nutritional status, begin by inquiring how often the infant breastfeeds and the length of feeds. For formula-fed infants, ask how many ounces are consumed per feed and how many bottles per day. Caloric needs are around 90 to 100 kcal/kg/day. Many infants have started complementary solid foods before 6 months. Most infants between 4 and 6 months have developed appropriate head and neck control, can sit well with support, and have effective oral motor abilities. If solids have already been started, inquire about specific foods and amount and if there have been any adverse reactions. Solids are necessary at this age due to an increased iron requirement, and this should be explained if solid food has not been initiated. Single-grain infant cereals such as rice, barley, and oatmeal are the recommended initial food given their iron fortification, easy digestibility, and relatively low potential for allergic reaction. Additional foods, once the infant is easily taking cereal for a few weeks, include pureed or soft fruits, vegetables, and meat to offer a balanced diet. Review the importance of feeding solids twice a day, placing the infant in a high chair or infant seat, and offering pureed food with a spoon. Remind the parents that it often takes several attempts before the infant accepts spoon feeding and initial intake is often just a few spoonfuls. New foods should be introduced every 5 to 7 days to ensure time to watch for adverse reactions. Avoid adding spices, salt, and sugar. Juice is not a necessary part of the diet. Review the foods to avoid because of high allergic potential and choke hazard: peanut products, shellfish, eggs, popcorn, whole grapes, hot dogs, and dry foods that do not easily break apart.¹ Honey should be discouraged until age 2 years because of the increased risk for infant botulism. Infants should always be supervised at mealtimes. Continue supplemental vitamin D (400 international units daily) for breastfeeding babies, especially if they are dark skinned or have limited exposure to sunlight.²

Fluoride supplementation is started in breastfed infants and those who receive formula prepared with water that is low or deficient in fluoride (<0.3 ppm).² Initial tooth eruption may begin at any time between 6 and 12 months. Lower central incisors often erupt first. Oral health risk assessments should occur routinely with the first tooth eruption. Encourage parents to gently brush or wipe teeth with a soft cloth daily. Discourage supine bottle drinking and bottle propping because of the strong evidence of increased dental caries and otitis media.^3,4