Silver Spring, MD January 26, 2011 - One day it will happen: your baby will reach for your spoon, launching whatever you were attempting to eat across the room or painting it all across your face. If this sounds familiar, your baby may be ready to take the big step of starting solid foods.
When a baby starts solid foods, it’s a momentous occasion worthy of documentation with a camera or with a video of those first tastes and first reactions. But taking that next step can also be bittersweet. It is often the first big signal that your baby is turning into an independent person.
However, while this is often more exciting for parents than it is for babies, you should not rush to introduce solids to your baby. While both the American Academy of Pediatrics (AAP) and the World Health Organizations say breast milk is an adequate source of nutrition until 6 months, they also agree that introduction of solids any time between 4 and 6 months is appropriate. Don’t introduce solids under 4 months unless specifically instructed to by your doctor. A 2011 article published in Pediatrics showed a six-fold increase in obesity by age 3 in formula fed babies introduced to solids prior to 4 months of age. Both organizations go on to specify that if you wait past 6 months, an infant may not receive enough nutrition and could experience growth and developmental delays.
Photo by Eliabeth/Table4Five. Click to enlarge.
That doesn’t mean you should break out the rubber tipped spoons just because your little one has hit 4 months and passed his check-up with flying colors. There are a few key signs to determine when your baby is ready for his first meal requiring a spoon. The first sign is good head and neck control. Without it, choking is a hazard, even with runny infant cereals. Second is the ability to sit upright with minimal support. This also goes back to choking, but the baby needs to be able to sit in her high chair so you can have your hands free to feed her. The third is the loss of the tongue extrusion reflex. Babies will automatically push their tongue forward, thus pushing any solid food out of their mouth, until they lose this reflex.
These are the three key things to determine if she’s ready for solids. If you haven’t been looking for these signs or even missed them, there are a few more noticeable signs that might indicate she’s ready. If she tries to grab your food or drink and pull it towards her mouth, chances are she’s telling you she wants to try some. Also, if she seems more hungry than normal, especially after feedings, this might be a sign you can supplement with solids rather than just a sign that of a coming growth spurt.
Once you do introduce solids, the AAP says you can do so in any order you choose. While they say research has show that it doesn’t matter the order you introduce, they do suggest starting with an infant cereal that is thinly mixed for the initial food introduction. They also recommend buying pre-made infant specific, single-ingredient cereals due to the iron fortification that such cereals provide. These iron supplements through food are important because around 6 months, baby’s iron stores have become depleted.
Another common food introduction myth the AAP addresses is the need to introduce vegetables first. They say that while it is common practice to introduce these after cereals, and parents are often advised as such by pediatricians, babies are born to prefer sweets. They say because of this preference, babies are no more likely to prefer vegetables if you introduce them before fruits. However, don’t give up on vegetables just because your baby spits them out.
Research published in Pediatrics in November of 1992 shows it can take up to 10 exposures to a single food before babies adjust to the taste. Vegetables are an important part of a complete diet and you should not omit them just because baby doesn’t like them. If after several introductions your infant still refuses to take them, mixing vegetables with fruit or cereal often makes them more palatable.
Keeping vegetables as part of a baby's diet is important. Research shows that it can take up to 10 times before a baby will take a new food. Photo by Brighid Moret. Click to enlarge.
The recommended number of servings by the AAP and WHO once you have established solid foods in your baby’s diet is 2-3 meals a day. Around 8-9 months, they are able to start eating finger foods and meals should increase to 3-4, with snacks as appropriate. These meals are in addition to breast milk or formula meals, with your baby still requiring at least 24 ounces a day.
Once you start introducing solids, don’t get carried away in the desire to introduce baby to all of your favorites. Introduce one food at a time. The AAP recommends a 2-3 day wait period, versus the “4-day rule” that is commonly espoused elsewhere. The distance between each food allows you to observe your baby to determine if she is allergic to anything you give her.
Look for signs of allergic reactions such as a rash, diarrhea, vomiting, or wheezing. Remove the food immediately from her diet and call your doctor if you notice any symptoms of allergies. In the case of a severe allergic reaction that involves swelling and breathing difficulty, seek emergency medical treatment.
A common practice is to avoid giving your baby highly allergic foods like peanut butter, eggs or shellfish until after the first year. However, research published in Pediatrics in December of 2009 overturned this idea. The study actually found that delaying the introduction of highly allergenic foods can increase the risk for an allergy. There are other studies that have had similar results, prompting the AAP to reverse their old advice of waiting to introduce things like eggs and wheat to your baby.
While many of the common guidelines you may have heard for introducing solids to your child have been altered or altogether changed, there are still a few things you should restrict from a child’s diet once you’ve introduced solids.
Never give honey to children under the age of 1. Honey can contain the spores for the botulism toxin which is very hazardous to children, and particularly in children less than a year old. While you can introduce cow’s milk in the form of yogurt or cheese, do not offer it as a replacement for formula or breast milk until 1 year of age. Cow’s milk does not have the nutritional value that formula and breast milk provide and that baby needs. After 1 year, make sure you use whole milk once you decide to introduce cow’s milk into her diet.
While parents can introduce juice once she starts using a sippy cup, the general advice it to use it sparingly. The AAP has found that children who drink too much juice can become malnourished because the juice can fill the child and inadvertently replace more nutritious formula or breast milk meals. They also state that too much juice can lead to obesity because of the increased sugar in juices.
The AAP recommends that if you are going to introduces juice, limit the amount in a day to 2-4 ounces. It also recommends using a half juice half water mix, and says that white grape juice is the easiest for young children to digest. The American Dental Association urges never to put a baby to bed with a bottle of juice as it can lead to tooth decay rapidly in baby teeth.
Embarking down the path towards self-feeding is a fun and exciting time for parents and babies alike. By following the guidelines set forth by the AAP and WHO you can ensure that your baby is getting proper nutrition that will allow her to continue thriving as well as protect her from potential threats to her health, both now and down the road.
Follow Brighid on Twitter at @BrighidMoret and receive updates on when new columns post on Facebook. Read more about first time parenting issues in Parenting the First Time Through at The Communities at The Washington Times.
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