Question

Question: What is the single most important change that should be made in Kevin’s diet now? Why is this important?

Kevin comes into your clinic for his 9-month check-up. Kevin’s mother stopped breastfeeding when he was 2 months old. He was constipated after he started infant formula so his mother switched to a low-iron formula. When Kevin reached 6 months of age, his grandmother insisted that he was old enough to start drinking cow’s milk instead of infant formula. Kevin’s parents decided to feed him 2% fat milk because his father has high cholesterol and they are worried Kevin will also develop high cholesterol if he eats high-fat foods. His hemoglobin is 9.0 g/dL.

At 9 months he is drinking milk and apple juice, but does not have much appetite for his baby food.

Foods were introduced into Kevin’s diet on the following schedule:

0-2 months	Breast milk
2 months	Low iron Enfamil infant formula (provides about 4mg iron per day) Juice (in a bottle) to help with constipation. Infant cereal (added to the evening bottle to help him sleep through the night)
3 months	Strained fruits and vegetables (but he kept spitting them back out when a spoon was used)
6 months	2% fat cow’s milk (discontinued Enfamil) strained infant foods (chicken) infant rice cereal with a spoon
9 months	Biter (teething) biscuits dry Cheerios (finger food)

Kevin’s daily typical intake at 9 months of age is as follows:

24 oz 2% cow’s milk

2 oz strained green beans (baby food)

2 oz strained applesauce (baby food)

1 oz strained chicken (baby food)

3 Tbsp infant rice cereal made with cow’s milk

4 oz juice in a bottle, 2x per day

Teething Biscuits or cheerios as snacks