Baby
FEEDING 101: WHEN TO INTRODUCE SOLID FOODS
By Graciela Wetzler, M.D.
My advice to parents who want to start their young infant on solid
foods: Don't be in such a rush. Breast milk, supplemented by vitamin D
and iron, and iron-fortified baby formulas provide all the necessary
nutrients during the early months of life. So, despite advice from
friends or family to give solids to your two month old, remember that
there is no nutritional advantage to starting solids at that age. In
fact, there may be some risks associated with starting solid foods
prematurely.
Some infants may appear not to be satisfied by breast or
bottle-feeding, especially those who have accelerated growth. It is as
if they are always hungry and demanding, and this can be particularly
upsetting to parents who are exhausted by sleepless nights and infants
constantly sucking at the breast. For these infants, increase the
volume and frequency of milk feedings since they may not yet be
neurodevelopmentally prepared for the introduction of solid foods.
Young infants exhibit an "extrusion reflex" in which their
tongue pushes away something placed in the mouth, and it is impossible
to eat non-liquid foods until the infant loses this reflex. Parents who
try to force a spoon into an infant's mouth are fighting a losing
battle. When the child is able to sit in a receptive position for
spoon-feeding - that is, keep his head and neck upright - he is
considered neurodevelopmentally ready to "learn how to eat." Learning
how to eat entails leaning forward and opening the mouth when hungry,
swallowing the food, tasting the food and identifying flavors, and
closing the mouth and pulling away when full. The baby's
gastrointestinal system also needs time to develop the ability to
digest and metabolize food. The American Academy of Pediatrics
recommends the introduction of solid foods by four to six months, when
these processes should be adequately developed.
If you have a faster growing and demanding baby, you may want
to start solid foods at the earlier end of this range, and babies who
are content with milk may be started at the later end of the age range.
But just as there are dangers associated with starting solid foods too
early, there are also problems with postponing this developmental
milestone past six months of age. Some mothers, especially those who
breast-feed, find it so easy and enjoyable that they are reluctant to
start solid foods. Keep in mind that breast and bottle-feeding should
continue until at least age one, when cow's milk may be introduced, and
that solid foods should be considered a supplement to, not a substitute
for, human milk.
The two biggest risks of introducing solid foods are choking
and allergies. To prevent choking, parents need to make certain that
the texture of the solid food is soft. Babies should always be fed in
an upright position, and parents should be nearby in case of choking.
Although there is no way to prevent allergic reactions, I recommend
that new foods be introduced one at a time, at five to seven day
intervals. If an allergic reaction does occur (i.e., vomiting,
diarrhea, skin rashes), you will be able to identify which food is the
cause. Spitting up is not an allergic reaction, and may merely be an
indication that the baby does not like the flavor or texture. Babies'
preferences change quickly, so you should try the rejected food again
in a few weeks.
When introducing solid foods, start at once a day and build
gradually to three feedings per day. These feedings should be at family
meal times, when baby and parent will find it most convenient. Middle
of the night feedings won't help the baby learn that eating should
occur at meal times. Once this routine is established and enjoyable,
daytime snacks can be added. The introduction of solid foods will
change baby's stools. Don't be surprised when the color and texture of
the stool becomes darker and harder. Most babies do not become
constipated.
Iron-fortified infant cereals are ideal as the first solid
foods because they can be mixed with either breast milk or formula for
high caloric content. Unless the baby is being treated for
gastroesophageal reflux disease, it is not recommended to add cereal to
the bottle. Nor is it recommended to put other solid foods in a bottle
because this can cause choking, and babies do not learn how to eat. The
cereals I recommend are rice, barley, oat, and mixed cereals once all
of them have been introduced in the infant's diet. Try to avoid barley
and oat cereals until six months of age.
After cereals, introduce yellow vegetables (carrots, squash,
sweet potatoes) because they are sweet and less gassy. Then come green
vegetables (green beans, peas) and later fruits (apples, bananas,
pears). Once all these foods have been introduced, I encourage parents
to offer their baby a varied meal, including cereal, vegetables and
sweet fruits. Food should be warmed to body temperature since, if it is
too hot, it can burn a baby's soft palate. Parents should be wary of
microwave-heated food because it's heated unevenly, and so the food's
temperature should be tested throughout the container.
The risk of choking decreases with age, so parents can
introduce more complex and textured foods by eight months. This
includes well-cooked, chopped solid foods (e.g., tender carrots and
other vegetables, and different fruits), finger foods, and teething
biscuits, which babies can feed themselves. More dangerous foods, such
as hot dogs, raw carrots, peanuts, whole grapes, popcorn, and round
candies, should not be given until age three. By one year of age,
infants should be eating most of the same foods as the rest of the
family.
There are merits to both commercially prepared and homemade
foods. Commercially prepared foods have added vitamins, homogeneous
texture, and are hygienic, but certain canned foods may contain large
amounts of salt and sugar that are not suitable for infants. Homemade
foods are equivalent to commercially prepared foods, and in some cases
may be more nutritious and flavorful. If you serve homemade foods,
however, make sure that they have a soft texture, which can be achieved
by mashing with a fork or pureeing in a food processor with a little
water if necessary. Homemade foods do not need to be sweetened or
salted, and honey should not be given to babies until 12 months of age
because of the risk of botulism.
One of the biggest factors in the development of healthy eating
habits is limiting the amount of sweetened juices that the baby
receives. These juices contain fructose and sorbitol, and parents rely
too heavily on them as a substitute for nutritional feeding. They
suppress the baby's appetite for solid foods and can cause loose stools
and diarrhea. Juices should not be introduced until a baby is able to
drink from a sippy cup (sucking a bottle of juice for long periods of
time can cause tooth decay) and limited to no more than 10 ounces per
day. The amount of water in breast milk or infant formula is sufficient
for babies' needs, and there is no need to supplement these liquids
except when the weather is especially hot.
Feeding Tips:
- Make meal times pleasant and fun.
- Begin solid foods at four to six months of age.
- Introduce solid foods one at a time.
- Don't force babies to eat particular foods. If they do not like one food, try another.
- Don't force babies to keep eating after they turn away or keep their mouths shut. They may be full.
- Don't use food as a reward or punishment.
- Avoid junk foods. Good eating can become a habit.
- Toddlers need nutritious snacks, such as fresh fruits,
vegetables, bagels, unsalted pretzels, crackers, rice cakes, cheese,
and yogurt.
- Too much milk or juice can remove the appetite for nutritious foods.
Top
About The Author
Graciela Wetzler, M.D., is Pediatric Gastroenterologist, Maimonides Medical Center in Brooklyn, New York.
