Introducing Solids
Once I help families get their baby to sleep through the night, the most common questions I get asked relate to when and how to introduce solid food to babies. Many moms are eager to have their baby join them at the table and eat what the rest of the family is eating. In some ways, it does make life easier when the baby is on the same eating schedule as the rest of the family. But getting to that point is sometimes confusing and needs to be done with care and planning. When and how it is done does make a difference, both to the health of your baby and the ease with which it occurs. Hopefully, this newsletter can get you off to a good start and provide you with some resources to do it with ease!
Any parent who has worked with me knows that I am a huge fan of a Madison Wisconsin nutritionist, Ellen Satter, MS, RD, CICSW, BCD. Her books Child of Mine, Feeding with Love and Good Sense, and Secrets of Feeding a Healthy Family, are two of my favorites and I recommend them to every new parent I work with. The main premise of all her advice is that parents are "responsible for the what, when and where of feeding. Children are responsible for how much and whether they eat." This "division of responsibility," as she calls it, is her guide to how to handle all feeding situations with children. Is it especially important when introducing solids and can really set the stage for a pleasant feeding relationship.
The American Academy of Pediatrics recommends that babies be exclusively breastfed for the first 6 months of life. This means that your baby needs no additional foods or fluids unless medically indicated. Babies should continue to breastfeed for a year or longer as long as is mutually desired by the mother and baby. So how do solid foods fit into that recommendation?
Satter recommends that you start solid foods "based on what your baby can do, not based on how old your baby is." There is no magic button that switches on at 6 months that all of the sudden makes your baby's stomach tolerate food. In order to begin solid food, Satter advises that your baby really should have achieved the following development milestones.
· Sit up, alone or with support
· Use the muscle of his neck to hold his head up straight
· Mouth his fingers and toys
· Open his mouth when he sees something coming
· Turn his head away is he doesn't want it
· Keep his mouth opened up if he does want it
· Keep his tongue flat and low so you can insert a spoon
· Close his lips over the spoon
· Scrape food from the spoon with his lips
· Keep the food in his mouth rather than spitting it out
Once you observe these milestones in your baby, you can begin solid food. Keep in mind that this is a process, with the end result being a baby that is eating table food. There are lots of things you can start with and many families use cereal. Try iron fortified rice, oat or barley cereal, mixed with breast milk. Initially, make it thin and then thicken it up as your baby is able to tolerate it. Nutritionally, your baby needs about a quarter of a cup of prepared cereal, twice a day. So that is your goal, and it can take as much as a month to get to that point.
When your baby has mastered that, you may move onto other foods. My advice is to give the vegetables first, as a child who starts with fruits, usually doesn't like his vegetables! The important thing to remember here is that you take your time. Ideally, you should introduce one new item at a time and feed your baby that for about 4 days, watching carefully for any signs of an allergic reaction to anything eaten. This link offers some great advice regarding food allergies and intolerances and how to spot them.
Once you make it through the vegetables, you can start the fruits. At the same time, you are offering increased textures, colors and consistencies so that your baby learns to eat foods that more closely resemble what the family is eating and can do so somewhere between 9 and 12 months.
Where does breastfeeding fit into all of this? Basically, it still comes first. Always nurse your baby first, and then offer solids. At some point, your baby will be eating so well that you will drop the nursing and offer the food first. What you will find is that somewhere around 9 months, your baby will be eating 3 meals a day. These meals replace nursing, so that typically, what your baby evolves into is a routine of breakfast, lunch and dinner, just like the rest of the family. However, he will also nurse 3-4 times a day, before naps and bedtime. In addition, you can offer a cup with each meal. Start with water, and only a little of it, as most will be lost to the highchair tray. Offer a sip in between bits of food. When your baby has mastered drinking from a cup, you can add breast milk to it instead.
Some other tidbits of advice from Satter that have guided me are never to give juice in a bottle, or a bottle in bed. Both of these practices result in children who consume too many unnecessary calories and have many cavities as well. In addition, children under a year only need 2 ounces of juice a day, and this is considered a serving of fruit. You really need to think of juice as a food and not a drink. She advises that juice always be diluted with an equal amount of water. This prevents your baby from developing a preference for really sweet beverages and gets some extra water in them as they age and need it.
Please pick up a copy of Satter's Child of mine: Feeding with Love and Good Sense if you get a chance. It is something you will refer to often and she has so much more great advice that I can't fit in this newsletter. In addition, I recently learned of a great nutritionist who has tons of free information regarding baby led weaning (BLW). Her link and some others below offer alternatives to store bought baby food and other ideas to make meals healthy and interesting. Lastly, we are excited to have Registered Dietitian and Nutritionist Stephanie O’Donnell teaching an interactive workshop about this topic in our office monthly starting in January. She is an excellent local resource and can help you through this process. Good luck and happy eating!
