Grandparents, nannies and sitters: a feeding plan

Why write it down

Grandparents, nannies, babysitters and friends all feed babies differently. The AAP says parents should give caregivers specific instructions about feeding: not only what to serve, but when, where and how. New and teenage sitters need more detail. The AAP also notes that you may need to be tactful with older family members, because the practices they’re used to don’t always suit a new generation.

A one-page plan on the fridge does most of the work. If you can, ask a new caregiver to come over during a meal first, to watch and help (AAP). For a nursery or child care center, see daycare and solid foods.

What to put in the plan

1. How your child eats now. Purées, mashed food, finger foods or family food, and how much milk and when. Spell out which finger foods are fine and which your child is still too young for (AAP). See safe food sizes and shapes.

2. Allergens already eaten. List the common allergens your child already eats without problems, such as egg, peanut, milk, wheat, fish or sesame, and the form you use (for example, “smooth peanut butter thinned into porridge”). Ask caregivers not to give a common allergen for the first time: do first tastes at home, when you can watch for a couple of hours afterward. See how to introduce allergens. The AAP tells sitters never to give a child any food unless the parents have said they can.

3. Foods to skip.

• No honey before 12 months, in any form: not in food, water or formula, and not on a pacifier (CDC). It can cause infant botulism. See honey and botulism.
• Choking hazards (CDC): whole or chopped nuts and seeds (not before age 4, AAP, and no whole nuts before 5, NHS); chunks or spoonfuls of nut butter; uncut grapes, berries and cherry tomatoes (quarter them lengthwise); hot dogs and sausages (thin lengthwise strips only, never coins); hard raw vegetables or fruit like raw carrot or apple; popcorn, chips, hard or gummy candy, marshmallows and chewing gum.
• Juice before 12 months (CDC). After that, it isn’t needed.
• Added sugar, including sweets, cookies and sugary drinks. The NHS says to avoid it up to age 4, and US advice now agrees: see salt and sugar for babies. The AAP suggests telling caregivers your rules on sweet foods and leaving them other treats to offer instead.

4. Milk. How to warm and store breast milk or make up formula. The AAP says never to heat bottles in the microwave, and to test a few drops on the wrist. Ask caregivers to hold the baby for bottle feeds: never prop a bottle, which the CDC says raises the risk of choking, ear infections and tooth decay.

5. Contacts. The AAP suggests leaving your phone numbers, a neighbor’s number, your pediatrician’s number, your home address, and your child’s date of birth and approximate weight. In the US, add the Poison Help line (1-800-222-1222) and 911.In the UK, add 999 for emergencies and NHS 111 for urgent advice (NHS).Add your local emergency number (such as 112 in Europe or 000 in Australia) and your local poison information line.

Things that have changed

Advice has moved on since many grandparents raised babies. Points worth saying out loud:

• No cereal in the bottle. The CDC says never to give cereal or other food from a bottle.
• Back to sleep, in their own sleep space. If your baby falls asleep during or after a feed, lay them on their back on a firm, flat surface in their own cot or crib, never in an adult bed or on a sofa or armchair (AAP, NHS). The AAP tells grandparents not to let a grandchild sleep in their bed. Never put a baby to bed with a bottle: the CDC says milk can pool around the teeth and cause tooth decay.
• Allergens early, not late. Peanut and egg are now offered from around 6 months, not held back: see how to introduce allergens.
• Sit up to eat. The CDC says children should sit up in a high chair or other safe place, not lie down, crawl, walk, or eat in the car or stroller.
• Microwaved food can have hot spots. The AAP says microwaves heat unevenly, so food can feel warm outside but be very hot inside. Stir it and test it.
• Let the child decide how much. No pressure to finish, and no food as a reward. See hunger and fullness cues.

At the table

The CDC says to watch children at all times while they eat and to pay close attention to what they put in their mouths. The AAP tells grandparents never to leave a child alone in a high chair. Phones down, and stay with a baby for the whole meal. See gagging vs. choking so caregivers know that noisy gagging is normal.

Choking first aid course

The AAP says to make sure any sitter has had first aid training and knows CPR, and that every caregiver knows what to do for a choking baby and a choking older child. Ask grandparents and nannies to take a baby and child first aid course: see choking first aid for what it covers.

If your child can’t breathe, cough or cry, they may be choking: Shout for help and have someone call 911 straight away. If you’re alone and your phone is with you, put it on speaker, call, and start back blows at once. Don’t leave your child to find a phone.Shout for help and start back blows and thrusts straight away. If someone is with you, ask them to call 999 now. If you’re alone, call 999 (on speaker) if the blockage hasn’t cleared after one round of back blows and thrusts, and keep going until help arrives.Shout for help and have someone call your local emergency number (such as 112 in Europe or 000 in Australia) straight away. If you’re alone and your phone is with you, put it on speaker, call, and start back blows at once.

If your child has a food allergy: an emergency plan

Give caregivers a written allergy plan from your child’s doctor, a list of foods to avoid (including hidden forms, AAP), and the medicine. The AAP says anyone who has had an allergic reaction to food should have two doses of epinephrine available at all times. Show caregivers where it is and how to use it, ideally with a trainer device. The AAP also suggests writing down signs that may be food-related, such as vomiting, diarrhea, wheezing, rash, hives, swelling and trouble breathing, next to the emergency numbers.

Mild signs, like a few hives or mild puffiness around the eyes: stop the food, stay with your child, and call you or the pediatrician.

Severe signs (anaphylaxis): trouble breathing or wheezing, lips, mouth, tongue or throat that suddenly swell, turning pale or floppy, or signs in more than one part of the body at once. Then:

1. Give epinephrine first, if your child has been prescribed it.
2. Then call for an ambulance: call 911, even if your child seems better after the epinephrine.call 999 and say it’s anaphylaxis.call your local emergency number (such as 112 in Europe or 000 in Australia) and say it’s anaphylaxis. If there’s no auto-injector, call straight away. If you’re alone with the child, give the auto-injector first if they have one, then call on speaker straight away. Don’t leave the child to find a phone.
3. Keep your child lying down, never standing or walking. Turn them on their side if they’re vomiting, and raise their head and shoulders a little if breathing is hard (NHS).
4. Call the parents once help is on the way.

Vomiting again and again a few hours after a food, or being pale, floppy, very sleepy or hard to wake, is also an emergency: call 911 or go to the emergency room.call 999 or go to A&E.call your local emergency number (such as 112 in Europe or 000 in Australia) or go to the emergency department. See FPIES.

See signs of anaphylaxis.

Where US and UK advice differs

• Whole nuts. The AAP says not to give nuts and other high-risk foods until at least 4 years, depending on the child. The NHS says no whole nuts for children under 5.
• Epinephrine. In the UK it’s called adrenaline. The steps are the same: adrenaline first, then the ambulance call.
• Emergency and advice lines. US: 911 and Poison Help. UK: 999, or NHS 111 when it’s urgent but not an emergency.