Does Your Baby's Bottle Make Her Thighs Look Fat?

A study just published in the respected journal Pediatrics suggested that when babies gain a lot of weight in their first six months, they would be obese at 3 years old.

For so long, the main nutrition concern regarding infants has been that they obtain enough nutrients and calories to support good growth and development. Well, America got the memo, at least about the calories.

Now there's an epidemic of obesity, and it seems to appear earlier and earlier in life. This study found that 7.5 percent of 3-year-olds were obese. That's about one in 13 toddlers, and that's 50 percent more than the one in 20 you'd otherwise expect. Of course, there really shouldn't be any obese 3-year-olds.

The cause: Nature? Nurture? Not enough recess?

OK, disregard the recess comment. Actually, this study didn't look at reasons for the obesity, only that it happened.

The researchers do pose some possible explanations, however, and I can concur, based on 25 years of clinical practice with parents and children:

Overfeeding. Think about it. You have 6 ounces of formula in the bottle, and your baby wants only 4 ounces. You pester him into taking the other 2 ounces so that you don't have to throw it away. All fine and well, but you're also overriding his internal cues that have told him he's had enough.

Not sensing when your baby has had enough. Feeding babies is one of the most enjoyable things parents can do. You feel as if you're doing your job when your baby takes his bottle and you like feeding him, but when he starts refusing the bottle, you need to learn when to reel it in and not push the issue.

Reinforcing oral fixations. The study didn't look at this, but I see it all the time. Too many parents stick a bottle, a snack or a pacifier into a baby's mouth every time he opens his mouth. It stops him from crying or fidgeting, but it also reinforces the idea that all comfort comes from eating, suckling and anything oral.

Early introduction of solids. The study didn't find an association here, but the researchers didn't probe too deeply either. Babies aren't little adults, and giving solids too early can add unnecessary calories to their diet. Even if your baby can tolerate solids, that doesn't mean he's ready for them.

Low-Carb, or Low-Fat Formula?

Whoa! Neither. I'm a little concerned that a hypervigilant parent who may have the best of intentions starts getting obsessed about his baby's weight. Here's a starting point for figuring your baby's formula needs:

Take your baby's weight in pounds;

Multiply that weight by 2.5 to 2.7;

The result is the number of ounces your baby will probably need in a day.

So, if your baby is 10 pounds, she'll need about 25 to 27 ounces of formula per day. Some babies can grow nicely on a little less, but others will need a little more.

What do you do if your baby is chunky? There's a reason there is no low-calorie baby formula -- babies shouldn't need it. Babies and toddlers have a higher need for fat until they're about 2 years old.

If your infant is overweight, don't put her on a diet; just feed her like her age. Use the math above as a starting point. Definitely check with your pediatrician however, before doing anything. Don't even consider adding extra water to the full-strength formula without clear instructions from your pediatrician, and no fat-free or low-fat milk for toddlers.

When it comes to obesity in infants, it's all about prevention. Here are some tips to get things started:

Ask your baby's pediatrician if his weight is good and if it's correct for his height. It's all about proportion here, not just the pounds.

Give the right amount of formula for your baby's weight.

Hold pacifier use to a bare minimum -- like when it's 2 a.m. and you're ready to scream. Other than that, it's not a good thing. Just ask a speech pathologist -- too much pacifier use can interfere with making sounds and forming words. Keep that cork out of their mouths

Wait until your baby is at least 4 months before considering introducing solids. Wait until he's 5 or even 6 months if you can. Babies have a lifetime of eating ahead, and it will be worth the wait.

Learn to recognize when your baby has had enough, and then honor that. It's the beginning of great communication.

Keith-Thomas Ayoob is an associate professor in the department of pediatrics at the Albert Einstein College of Medicine in New York City.