Tag Archives: Introducing Solids

Smooth purees… now what?

Finally!  Back to feeding!!!

We’ve chatted about when to introduce foods, how to introduce it, and what  your first food options are.

What next? 

Your baby is eating many smooth purees by now.  Parents can be so relieved that their baby accepts a variety of tastes that they forget about introducing different textures.  All of the sudden there is a panic to move onto lumpy and table foods.  The baby is abruptly presented with a full meal of a brand new texture.  Gone is the smooth applesauce that he loved and in its place is some unknown lumpy mound of cooked apples, seemingly a totally different food.  Back to the scary zone for a lot of babies.

A 10/11 month old that only accepts fine purees and discerns the smallest piece of grit is very challenging.  We want to prevent this from happening.  The goal:  think about moving away from smooth purees as soon as you have a variety of accepted tastes.  It’s a progression that is easiest when you move at the speed your baby sets.  Some babies are much more sensitive to texture changes and need small changes with added time to adjust. Other babies can go from smooth puree to lumpy to table foods in quick succession.

I’d like for you to have tools to prevent challenges in the first place, or at least from minimize how big the challenges become.  Please keep in mind that these strategies are not  meant to be “therapy” for your child if he has been identified to have feeding challenges.   Make sure you see your physician or feeding therapist for assessment and individualized recommendations if you are concerned.

Always, always be working on increasing texture.  Don’t expect your baby to instantaneously accept the majority of a  meal in a new consistency (although I hear that these wonder babies do exist!).   Babies don’t have the luxury of knowing what food is coming at them based on visual recognition.  They don’t have enough experience for that.  The same applesauce of a different consistency seems like a brand new food.  As adults, the sight of applesauce allows us to predict the taste, even when it is a different consistency.  To your baby, it is just like being fed blindfolded.  Everything is a surprise.

At most meals you want to be offering at least one bite that is a new/more challenging consistency.  You’ll need to adjust your jumps in consistency based on your baby’s reactions. You don’t need to do every step listed below.  Pick and choose what works for you.

First, you want to increase the thickness of a familiar food.  You can even present a few thickness options of the same food, at the same meal.   Start by offering the familiar thin consistency, then offer a bite of the slightly thicker version.  Head back to the familiar thinner puree if the thicker one was more difficult for your child.  If not, offer a bite that is just a little thicker.  This seems like a lot of work but really you are only preparing a few tastes of the thicker consistency.  I’ll post some photos of how I do it soon.  You can increase the thickness of a food by adding baby cereal, wheat germ, tofu, greek yogurt, or ground oats.  Please let me know if you have a food that you’ve used to thicken.  I love discovering new things.

Once thicker purees are going well, try adding some lumps that will dissolve in your baby’s mouth.  Things like crushed up Mum Mums, crushed up rice puffs, crushed Farley’s biscuits will all dissolve in about 5 seconds in your baby’s mouth.  This provides an opportunity to feel a “lumpier” texture that changes to a more familiar consistency quickly.

Next move to soft lumps.  Think very mashed banana, mashed avocado, mashed very ripe pear, or anything else very soft and mash-able.  This can also be presented gradually.  When you are mashing the banana, take a spoonful out when you’ve just begun mashing, then continue mashing the majority of the volume until it is just a little lumpy. Offer both consistencies at the same meal.

Finally,  move to small, soft cubes/pieces (small cubes of ripe banana, pear).  You can introduce these just after the lumpy version or in tandem.  Move back and forth between a small piece of banana and the lumpy version within the same meal (if tolerated).  If a small piece of banana is spit out right away, try squishing the cube to soften it up a little bit.

I’ll post some food ideas within each categories soon… plus another tool to help develop tongue skills while you are working through the progression.

Until then!

Tagged , ,

A misnomer… starting solids

“Starting solids” is a ridiculous expression for teaching a baby to transition from breast milk/formula to table foods. The whole concept is misleading.  It makes you think of sitting a baby in a highchair and putting a spoon in his mouth.  In reality, babies can and should have many opportunities to learn about the whole process of eating long before their butts hit the highchair.  Please don’t misinterpret this to mean you should be spoon feeding your baby before they are safe to do so.

The term “starting solids”  makes parents think that they have to wait until 6 months of age to venture into the process of eating.… NOT TRUE.  Let’s redefine starting solids.   I haven’t yet developed a more accurate and concise expression.  I have been toying with: transition to everyday foods, breast to table…. however, none of them are ideal.  I’ll keep working on it.  DSC01116

This transition is significant. Most healthy babies obtain approximately half of their energy needs from table foods by the end of their first year.  Breast milk or formula, initially the exclusive sources of a baby’s energy, gets downsized to 50% [1].  This change really occurs over the short course of  6 months.  In addition to the dramatic change in energy source, the table food transition also imposes abarrage of new textures: runny liquid, dissolvable food, lumpy puree, and soft food!  So many new sensory challenges…..talk about a lot of work!

Okay, so:  readiness signs.

Baby should have:

  • Interest!  (looking at you when you are eating and drinking, reaching for your food)
  • Trunk control (able to push up on arms when on their tummy, sitting with support, able to lean forward and open his mouth to indicate desire)
  • Head control (able to hold up his head in supported sitting, able to turn his head away to tell you he doesn’t want any more)
  • Decreased tongue thrust (pushing tongue straight out of their mouth when something is placed there) [2,3,4 ]

Previous recommendations have suggested that solids be introduced  between 4 and  6 months of age.  Newer recommendations suggest introducing solids at 6 months of age [5].  World Health Organization (WHO) and Canadian Pediatric Society recommend exclusive breastfeeding for the first 6 months of life.  Most babies are developmentally ready for solids around 6 months of age.  In addition,the 6 month mark is  the point at which a breast-milk exclusive diet is inadequate to support a baby’s nutritional demands; the volume of breast-milk required to meet his needs for energy, protein, iron, zinc and other vitamins is untenable [6].

Also, later solid introduction (i.e. much later than 6 months)  may put babe at risk for developing oral aversion (not wanting anything in the mouth).

So how we do set the stage for success?  We all dislike abrupt change.  Opportunities to learn about different shapes, textures, and temperatures will help your baby feel more comfortable with something other than breast-milk or formula in her mouth. This needs to happen before she is put into a high chair!

What if the interest is there but you are not sure if motor skills are?

What if the motor skills are there but the interest isn’t?

There is no reason you can’t teach your baby about the eating process before all of the readiness indicators are present.  If she is awake and you like babywearing, put her in a carrier as you prepare dinner so she can be exposed to the smells.  This might be a necessity anyways for those cranky babies during “witching hour”.  Someone is always needy when it’s time to make dinner at my house.  Always.  Since my kids were tiny, dinner hour has  been witching hour.   If it’s not the cranky one holding her little arms up, the older one is demanding to sit on the counter and help!DSC01236

Unless you just plain need a break from baby or you have your hands full with older kids,  hold baby in your lap as you eat dinner.  Give her intermittent kisses as you eat.  She will smell the food on your breath and maybe even get a taste if you give her a smacker00 right on the lips.  I recently attended a feeding conference and the presenter suggested the idea of “kiss therapy” for  kids who are ultra-sensitive.  I like the idea for all kids before they end up in a high chair for meals.

Once she has the ability to grasp an object and bring it to her mouth, be creative with the object you offer her to play with and mouth.  angelcare_toothbrush_blue Obviously make sure they are safe, but you don’t need to stick with baby toys.   Her hands and toes are wonderful things to shove in her cheek, lick and drool all over.  It teaches her about her tongue, jaw, lips and cheeks.  Your fingers are great too!  Think beyond hard plastic toys… she can hold one of your raw carrot sticks as she sits on your lap during dinner.  It’s safe if is is thick enough that she cannot bite through it.  Or a piece of beef jerky.  A lick of your apple as you eat it (you would control handling the actual apple).  Baby toothbrushes are usually textured and some even come with a guard that prevents baby from gagging herself over and over.  Try freezing teethers or links.  zoli-gummy

These ideas are not meant to replace therapy recommendations for babies who are identified as at-risk feeders.  Default to your physician or therapist if your baby has medical differences and has been deemed to be an unsafe swallower. 

References:

1. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. AUAgostoni C, Decsi T, Fewtrell M, Goulet O, Kolacek S, Koletzko B, Michaelsen KF, Moreno L, Puntis J, Rigo J, Shamir R, Szajewska H, Turck D, van Goudoever J, ESPGHAN Committee on Nutrition: J Pediatr Gastroenterol Nutr. 2008;46(1):99.

2. Food and Agriculture Organization of the United Nations (FAO), World Health Organization (WHO) and United Nations University (UNU): Human Energy Requirements. Chapter 2: Energy requirements of infants from birth to 12 months. Available at: http://www.fao.org/docrep/007/y5686e/y5686e05.htm (Accessed on January 21, 2013).

3. Committee on Nutrition American Academy of Pediatrics. Complementary feeding. In: Pediatric Nutrition Handbook, 6th ed, Kleinman RE (Ed), American Academy of Pediatrics, Elk Grove Village, IL 2009. p.113.

4. Eiger MS. Feeding of infants and children. In: Primary Pediatric Care, 4th ed, Mosby, St. Louis 2001. p.184.

5. Canadian Paediatric Society, Community Paediatrics Committee. Weaning from the breast. Paediatr Child Health 2004;9(4):249-53

6.Agostoni C, Decsi T, Fewtrell M, et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2008; 46:99.

Tagged , , , , , ,

Before starting solids…..

Starting solids can be OVERWHELMING.  It feels like you just have things under control and its time for change again!  Breast or bottle feeding is well established, nighttime sleep has grown into longer chunks and napping seems to be under some semblance of a routine.  Now you are supposed to sit your baby in a chair and teach him to eat from a spoon?!    And transition to offering these “meals” after a breast or bottle feed numerous times a day?!

There seems to be a lack of specific instructional information out there.   The medical community offers little concrete assistance, at least until difficulties arise.  The first and only formal reference to the solids transition for us was at my daughter’s 6 month immunization; the only investigation was a superficial, seemingly “check-box” question “are solids going well?”.  The feeding support was completed with the provision of a handout.

We are told when we should introduce solids, and to do it one food at a time.  To the “Introducing Solids” handout developers credit, the of pictures of textures for different stages and the menu suggestions are very useful. It is no wonder that many parents rely on friends, family members and Google as their trusted sources for feeding information. These people, often with good intentions, can offer some great information; they can also perpetuate myths such as babies sleep better with rice cereal in their bottles.

Beyond that, there aren’t many ideas readily available for what to do when things don’t go according to plan.  Not only that,  general handouts often do not explain the rationale supporting  recommendations. In the face of conflicting recommendations, an understanding of the rationale can be the compass.

Learning to eat is an incredibly sensory experience.  This sensory adventure can be stressful for parents and baby.  We often fail to appreciate the complexity of this task, expecting baby to instinctively open his mouth for the incoming food-laden spoon.

It is a disarming experience to have someone else to feed you.  You are vulnerable to the whims of the feeder; they control volume, temperature and rate of spoonfuls.  Imagine trying to coordinate your breathing, chewing and swallowing while an insensitive giant automatically shovels mountains of goo into your tiny mouth?!

You have to trust that she will know when to offer another bite, when its too hot, when its too cold and when you are full!  Not to mention that for the baby, every morsel loaded on that spoon is brand spanking new in look, smell, feel and taste!

Before introducing solids to your baby, I challenge you to have someone else feed you while you are blindfolded. The blindfold will prevent you from DSC_0149recognizing the food and subsequently preparing yourself for the sensory load.  This artificial novelty is meant to mimic a baby’s anxiety with new foods.  In this experiment, your feeder should prepare two very different dishes.  For example, warm chicken and cold applesauce; foods that differ in flavor, texture and temperature.  To create a realistic experience, ensure that you do not know what the foods are in advance.  Blind ingestion of varied foods in an unpredictable fashion will help to better approximate a baby’s experience.  For this same reason, you are not allowed to speak to your feeder – he must read your cues.  You laugh but I think deep down you know why you are laughing…..this is a scary task!   You will feel totally ridiculous.  Trust me,  it will help you empathize when your baby turns his head to an incoming spoon.  It will also help you problem solve different strategies to gently prepare your baby for an incoming spoonful or new food.

If you are interested in reading about developing a healthy feeding relationship with your child,  pick up the book “Feeding Your Child with Love and Good Sense”.  The feeding community widely embraces this dietician written book.  I have incorporated concepts into my work and home life.   Read excerpts of it before you start solids (yes I realize this is nearly an impossible request… hah! Reading… I just started reading again and my second daughter is 16 months old!).

Was introducing solids exciting for you?  Scary?  What do you wish you would have known?

More to come…..  ideas around when, why and the nitty gritty how to…..plus my favourite places to find new ideas for recipes and foods to try!

M

PS… I’ll take guesses on who is who in the photos!  One is F and one is E.

Tagged , , , ,