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
- Wheat
- 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.
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.
A reaction can take different forms. If your baby demonstrates any of the following reactions please contact your doctor immediately- rash, swelling of the tongue, redness or swelling of the face or difficulty with breathing.
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.
If there is a strong family history of allergy to any one of the foods listed, please proceed with caution and ensure your doctor is aware of the allergy.
All allergy producing foods must be introduced in a similar fashion to what has been described for nuts and eggs.
Vitamins
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. 
VitaminsGetting started with solids
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. In diagram form the introduction to solids will look like this:
- Solids can be started with the introduction of a bland cereal eg, wholegrain rice cereal.
- The cereal is given one to two hours after the first milk feed of the day, around 8am
- Mix 2-3 teaspoons of dry cereal with cooled boiled water, formula or breastmilk to form a runny consistency.
- Cereal is given in the morning for three to four days. The milk feeds are given as usual for the rest of the day.
- Cereal can then begin in the evenings as well. This is given at around 5pm. Baby should then be bathed and given the last milk feed of the day.
- Cereal is given twice a day for about a week.
- Lunch is now introduced once your baby is tolerating the cereal. At this stage your baby should be on about four milk feeds per day. Lunch is given between 12 and 12.30pm.
- A new yellow vegetable is offered every four days until each of the yellow vegetables have been tried.
- The yellow vegetables include sweet potato, butternut, pumpkin and carrot. Be aware that carrots may make a vomity baby worse so this vegetable can be left for later.
- Vegetables are all low glucose index (GI) foods. They therefore maintain the glucose levels for a sustained period after their ingestion so baby is likely to feel satisfied for longer than on the cereal alone.
- You will begin with one teaspoon of vegetable and build this up to about five teaspoons.
- Freshly made vegetables are always preferable however there are a number of very good pre-prepared vegetables on the market.
- Fruit now replaces cereal in the morning. This is given at the same time as the cereal was given, around 8am.
- Cereal continues in the evening until such time as proteins are introduced.
- You will introduce a new fruit every four to five days
- The first fruits will include apple, pear, mashed banana (1/2) or mashed papino.
- Once each fruit has been tried a medley of fruit may be offered.
- Strained, fresh fruit is always best but again there are a number of pre-prepared fruits on the market for convenience.
- Green vegetables are introduced around six months of age if your baby started solids at four months of age. If solids are a new thing, then this will be slightly later.
- Remember that if you started the solids later than four months you will be able to move through the introduction phase a lot quicker.
- By now you and your baby are used to solids and the introduction of new foods will be easier.
- You will continue to test a vegetable for a few days before introducing something new.
- You are able to use the established yellow vegetables in addition to the green vegetables to make a more substantial meal.
- It is time to change things around a bit now as well. You are aiming to feed your baby in the same way that you would eat. You can begin giving the cereal in the morning, fruit for lunch and the vegetables for dinner.
- The green vegetables include baby marrow, gem squash, patty pans (yellow or green), spinach, peas and beans.
- Besides the beans and peas, other legumes including lentils, kidney beans, black beans and cannellini beans are highly nutritious and add fibre to the diet. They are also easy to add to the other vegetables if they are soaked, cooked and blended well.
- Please remember that legumes like peanuts and soyabeans are part of the allergens and need to be introduced with care. Take a look at how to introduce the allergy producing foods.
The following dairy products may be started between 6 and 8 months:
- Cottage cheese
- Plain yoghurt or any flavoured smooth yoghurt
- Kiri cheese
These products may be given together with the veg or fruit for example:
- ½ a block of kiri cheese in the vegetables
- Yoghurt added to the fruit for a dessert or lunch
- Small squares of lightly toasted bread with kiri cheese.
You and your baby are becoming accustomed to the world of food. New tastes and textures are so important if you want to avoid fussy eaters. Remember that food is an expression of who we are individually and culturally. Once you are able to introduce meats, meals become fulfilling and resemble the family diet.
By the time meat is introduced you will be giving your baby 3 meals a day. Breakfast will consist of cereal, lunch may be fruit and yogurt or vegetables and dinner meat and vegetables.
Please remember that your baby needs the protein and vitamins found in animal products for normal development.
Infants receiving a vegan or macrobiotic diet, with limited or no animal foods have a high risk of developing nutritional deficiencies. These babies run the risk of severe cognitive impairment unless they are given supplements containing animal foods like dairy or fish.
It is thus recommended that you introduce your baby to animal products but if this is completely contrary to your beliefs then supplements must be introduced.
- Strained meats
- Begin with chicken, beef, veal and lamb
- Liver and ostrich are high in iron and a very good source of lean protein.
- Again, these are added to vegetables to make meals interesting and nutritious.
Fish is a rich source of protein, Vitamin D, omega-3 fatty acids and other nutrients all of which are very important for neuro-development and strength in your baby. Fish is however, a food which may cause allergy. As with the other foods that may cause allergy, it is important that parents proceed slowly when introducing fish. (Please use the guidelines laid our previously on how to introduce foods which may cause allergies)
Mild white fish, light tuna, pilchards and salmon are all good choices. Fish may be steamed, baked or poached and then either mashed with a fork or pureed. Fish cakes or croquettes are also good preparation options and offers your baby a new texture as well.
Fish is easy for babies to chew if prepared correctly and goes well with vegetables to make a wholesome meal. By the time you introduce fish, your baby should be well established on all the vegetables so making a medley of foods like sweet potatoes, green beans or peas, carrots and even mashed avocado with the fish makes a great meal for your baby.
If you are preparing the fish yourself be very careful to check for bones. The fine bones found in fish are real choking hazards. The bones of tinned fish like pilchards are very soft so one can mash these with the fish into very fine bits.
Parents are often afraid to give their babies food that may require a little chewing. Be assured that those toothless gums can chew! Your baby will really enjoy picking up a tasty square of soft, toast and eating it.
Chewing is also a very important part of development. For this reason, we introduce babies to granular or lumpy food from 9 months of age. If you avoid lumpy or textured food you may run the risk of your child refusing such foods after this age. Even if your baby doesn’t have teeth the gums are strong enough for soft lumps and certain finger foods. Not only will this increase the variety you can offer your baby but your baby will enjoy the experience of feeding him or herself.
Your baby should be sitting at this stage and bringing his or her hands to their mouth. You can offer finger foods so that he or she learns to feed themselves. To avoid choking, make sure that the finger food is easy to swallow, cut into small pieces and soft. Some examples include:
- Small pieces of banana or panino
- Lightly toasted bread with a little kiri cheese, ricotta or Bovril
- Wafer biscuits
- Scrambled eggs (only if you are sure your baby is not allergic to eggs)
- Well-cooked chicken finely chopped
Well-cooked and cut up potatoes, squash or peas
Avoid foods that can cause choking for example:
- Hot dogs, meat sticks, biltong
- Whole nuts and seeds
- Whole grapes
- Chunks of raw vegetables or fruit
- Chunks of cheese
- Hard, sticky sweets
- Popcorn
Congratulations!!!! Not only have you and your baby survived the first year but your baby is now ready for a regular family style of eating.
This means that your baby should be having three meals a day with a healthy snack in-between breakfast and lunch and again in the afternoon.
An example of the meals for the day would be:
- Breakfast- cereal, porridge or egg and toast
- Mid-morning snack- fruit, unsalted biscuit and cheese
- Lunch-finger foods or yoghurt and fruit
- Mid-afternoon snack- similar to mid-morning
- Dinner-meat and vegies or fish and veggies
10. General
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.
Good luck!
