Feeding – Introduction to solids
The introduction of solids often causes parents a huge amount of anxiety and confusion. Please remember that food is a vital part of our lives. It is part of the way we socialise and is very often steeped in culture. Your baby should learn this from an early age and to do so you need to embrace this new stage.
Breastfeeding is highly recommended for the first four months of age and should be continued for as long as possible. There does come a time however when your baby’s nutritional needs are not completely met by breast milk or formula and it is time to graduate to solid food.
Solids are not started before the age of four months of age since the intestinal system cannot adequately digest the solids.
Solids must be started no later than six months of age otherwise the baby will not learn to accept the textures of solids and will not be receiving adequate nutrition for development. By the age of 6 months the baby needs to learn to chew and swallow.
The recommendation for solids is thus not before 17 weeks and not after 26 weeks.
If your baby is between the ages of 4 months and 6 months but you are unsure on exactly when to start your baby on solids, please discuss it with your doctor or nurse.
FOODS THAT CAN INDUCE AN ALLERGIC RESPONSE:
- Cow’s milk protein, soya protein
- Egg white
- Salmon, shellfish, shrimps, crustaceans, codfish
- Tomatoes, legumes, peanuts
- Oranges, strawberries, kiwi fruit
New data regarding the introduction of allergic foodstuffs has resulted in alterations to the guidelines of when to introduce these foods. This data suggests that early introduction to these foodstuffs may in fact reduce the likelihood of allergies. One is thus encouraged to introduce these foodstuffs but it is very important that this is done slowly and cautiously to limit a reaction should your child be sensitive.
The American Academy of Asthma, Allergy and Immunology (AAAAI) recommends that a baby who is older than 4 months of age and has tolerated foods which are considered non-allergenic like rice-cereal, sweet potatoes, carrots, bananas, pears and apples, can begin to have foods that may cause allergy. The recommendation is that all these foods should be given at home when first being introduced rather than at a restaurant or at day care. In the home environment parents are able to watch their baby carefully for any sign of reaction and are able to respond quickly.
The data also shows that exclusive breastfeeding for at least 4 months protects against cow’s milk allergy in babies. It is also interesting to note that if a mother avoids allergenic foods like dairy, egg and peanuts during pregnancy or breastfeeding, it has NO significant protective benefit for the baby. In other words, a mother avoiding these foods is not preventing her baby from getting food allergies.
How should foods which may cause allergy be introduced?
The introduction of nuts, in the form of nut butters, between the age of 4 and 11 months of age has resulted in a decreased sensitivity of infants to nuts. An infant who eats nut products during this time has been shown to have less likelihood of allergy to nuts than infants who avoided nuts at this age.
To begin, first dip the tip of a teaspoon into peanut butter and this can be touched on the tip of the baby’s tongue. This should be repeated on at least three different days. If there is no adverse reaction, then the amount of peanut butter can be increased. First the tip of the teaspoon, then a quarter and only after some time a half. If you are certain that no reaction has occurred, then you may progress to a full teaspoon.
In a similar way, cooked egg white can also be introduced into the diet between the ages of 4 months and 11 months. The egg is introduced to the infant in the form of scrambled egg. To test if your baby will react to the egg, simply wet a teaspoon on scrambled egg and touch your baby’s lips and tongue. Observe whether there is any reaction. This may include a rash, swelling of the tongue, lips or face or difficulty with breathing. This process should be repeated three times in a week. If this exposure is tolerated, you can give a granule of scrambled egg three times in a week and watch for the same reactions. If your baby does not react you will then move onto a ¼ of a teaspoon, a ½ a teaspoon and a full teaspoon. If your baby tolerates this, you are able to give scrambled egg to your baby as part of the diet. Should a reaction occur at any of the stages during the introduction you must contact your doctor for advice.
All allergy producing foods must be introduced in a similar fashion to what has been described for nuts and eggs.
Vitamins can be introduced in breastfed babies from four months of age. Infant formulas are fortified with vitamins so formula fed babies do not need vitamin supplementation.
Babies that are kept indoors can become vitamin D deficient. Breastfed babies can also become iron deficient. A multivitamin with iron can be introduced at four months of age in breastfed babies.
Getting started with solids
(Please weigh your baby regularly while solids are being introduced.)
You can allow for cultural differences when introducing foodstuffs as long as all the food groups are ultimately introduced. By this we mean cereals, vegetables, fruit and proteins.
At first the taste and texture of the solid food may come as a surprise to your baby. Most babies will pull a face and spit it out. This does not necessarily mean that the baby doesn’t like the food. It is just a new experience, so don’t get discouraged. Placing the food on the back of the tongue helps to reduce the amount that is spat out.
Your baby’s solid first feed will always be given in addition to his/her milk feeds. Milk intake should still be between 600 and 800mls per day.
Offer baby’s solid feed about an hour after a milk feed. To minimise the risk of food allergy, start small portions ( 1 teaspoon) of new food at a time. Initially offer one solid feed per day and build this up to three feeds per day. Gradually increase the amount of each feed by one teaspoon up to about five teaspoons.
When introducing a second foodstuff, add one teaspoon of new foodstuff to the already established foodstuff.
Try a new foodstuff for 4 to 5 days before introducing another one to ensure that your baby is tolerating this food.
If you start solids at six months of age you will move through the introduction period quicker so as to have all food groups established by nine months of age.
In diagram form the introduction to solids will look like this:
When considering a cereal for your baby it is important to consider the fibre, protein and sugar content of the cereal . Wholegrain cereals have a low Glycemic Index (GI). In other words they are more slowly digested, absorbed and metabolised than highly refined cereals. As a result your baby will feel fuller for longer and the blood glucose levels in your baby’s blood stream will rise slower. It has been shown that whole grain cereals help prevent obesity in later life. The fibre will assist with constipation and the protein is also important.
Cereals that are suitable for small babies include:
- plain rice cereal
- organic wholegrain cereals
- millet and rice cereal
- Mealiemeal or yellow polenta.
The texture of the cereals should be refined for babies when you first introduce cereal. This is achieved by passing the cooked cereal through a sieve or putting it in your food processor.
As your baby gets older there will be no need to stain the cereal as various textures are important in infant feeding.
If at any stage, you are uncertain about what to feed your baby don’t be afraid to ask your paediatrician or clinic sister. Another very good guide is to check what foods are available commercially for your particular age group. Here you will find ideas for different combinations of food and quantities.
Be aware of food labels. It is highly recommended that you avoid foods containing sugar, excessive salt and preservatives. A tip is to look at the list of ingredients. Whatever is listed first is the ingredient that is found in the highest percentage, so while you believe you are giving your baby a pure product the label may indicate that this is in fact not the case.
Home cooked food is made with love and is also much cheaper than commercially produced food. In some literature, however it is suggested that home-cooked green beans, carrots, squash, beetroot and spinach may contain high levels of nitrites. These are harmful as they can cause an unusual form of anaemia. Manufacturers are able to test for nitrates making these particular vegetables safer if commercially produced. This is only relevant during early infancy. Peas, mealies and sweet potatoes are very safe vegetables to make yourself.
At all times avoid forcing your baby to eat. One sure way of causing stress around food is to force feed. If you are having difficulty with feeding your baby it may just be a phase. Babies cannot distinguish between you being upset about them not eating or the food making you upset. If mealtimes are causing stress to the parents the baby often interprets the food and not the behaviour to be the problem. This in turn causes the baby to avoid food for fear of the parent getting upset. For this reason, mealtimes, should be fun, relaxed and offer a variety of tastes and textures to be explored and enjoyed.
Toddlers often become fussy eaters and this is just a way of them showing independence. There are a number of ways to overcome these issues. Food play such as baking or icing biscuits, helping to make a salad or adding chopped vegetables to a dish you are preparing helps children develop a healthy interest in food and encourages them to try new flavours. If your child feels part of the family at mealtimes with his or her own plate, cup, spoon or fork, food will become more appealing. It is important that you stick to the mealtimes and avoid “grazing “throughout the day. This way your child will look forward to mealtimes and will have an appetite. Allow 30 minutes for a meal time. If your child does not finish, then remove the food (not in anger or frustration) and don’t offer an alternative such as milk or yoghurt. When mealtime comes around again the child is likely to be hungry.
At all times remember that you want your baby to fit into your family with ease. For this to happen you should ensure that your baby eats what you as a family eat. This you should aim to achieve by the age of a year.