FROM LIQUIDS TO SOLIDS
When infants start to eat what are they supposed to be eating and how should they eat it?
Parents talk to me about their fears of how to feed their children when it’s time to introduce solid foods into their diets. There are real fears of the development of allergies and diseases that are linked to nutrition in early life.
How can you tell that baby is ready for food? Look for some of these signs.
- Looks interested in your food and might even grab at it eagerly.
- Can pinch food between their tiny fingers.
- Sitting up with the ability to support their head and neck without bobbling over ie ( in a seat or high chair holding their head up).
- Do a push up from the ground.
- Stops pushing food out of mouth as infants tend to do.
- Starts putting hands and toys into their own mouth.
- Leaning forward to food with open mouth when hungry and turning away from food when not hungry.
- Teething as shown by drooling, biting and the appearance of teeth.
Why do we wait for readiness?
If too early infants are too uncoordinated and unskilled to swallow without choking.
The reflex that pushes objects out of mouth goes away after four months. Babies literally can’t eat this early.
At four months, birth weight doubles to 6 kilos when babies would not be able to effectively consume enough nutrients.
May increase food allergies to start food too early.
Isn’t 4 months too early?
Infants who are introduced to solids at 4 months are more likely to discontinue breastfeeding by 6 months and are more likely to eat fatty sugary foods by 1 year. Continuing to breastfeed for another two months reduces future risk of obesity and diabetes by big numbers about 40%. Parents often say if they knew about the reduction in obesity they would have maintained breastfeeding if they were able to.
We used to say leave the allergenic foods like eggs, peanuts, tree nuts, and fish until last. After years of observing allergy trends that contradicted this advice, the guidelines changed in support of allergy at risk infants to have solids introduced between four and six months. Continuing to breastfeed until six months reduces rates of eczema, asthma, and cow milk allergy.
1, 2, 3 Rule
The branches of our immune system will let us know when we are allergic or sensitive to a food either right away or within a three day period. The food allergy branch alerts us within a 30 minute period of exposure. The food sensitivity branch can take up to 3 days.
Parents can introduce 1 teaspoon, 2 times per day for 3 days to identify if an allergy or sensitivity occurs. Symptoms are:
- hives, rashes, eczema
- behaviour changes,
- trouble breathing,
- indigestion, gas and bloating, vomiting, coughing,
- runny nose and watery eyes, ear infections, pale skin, and dark circles around eyes.
Parents ask “what if the food will cause anaphylaxis when I give it to them?”
Most allergic reactions will occur on first exposure to the food and fatal reactions are extremely unlikely on first exposure to a food. There is no reason to think you need to introduce even highly allergy prone foods in the presence of a health professional unless there is a severe allergy already in the family.
If a symptom occurs stop feeding that food and resume breastmilk or formula until the symptoms resolve before moving onto the next food. While solids are introduced formula should not be more than 32 ounces per day. Breastmilk has no limit.
Normal Changes with solid foods
Solid food means solid poops. The additional sugars and fats will increase the odour and change the colour too. Green foods like peas make the poop green and red foods like beets and berries make poop and pee look almost bloody. When you don’t know this it can be alarming.
Unstrained foods like corn hulls and the vegetable skins can normally cause undigested food to show up in the diaper. Over time with maturity our digestion is able to break these foods down better. Diarrhea and mucous are not normal and signal a need to slow down food introduction.
How do I give food to my baby?
Make a sandwich! Give your baby a little breast milk/formula first, then switch to very small spoonfuls of food, and finish with more breast milk/formula. If she’s very hungry she’ll get irritated less this way because she’ll have been fed something she is used to. The food should be of thin consistency and should be gradually increased until baby is eating 2-3 tablespoons of food at each meal. Spoonfeeding is important because it helps coordinate mouth touch and swallowing and helps speech development.
It’s not uncommon for babies to smear, spit, food fight or flat out rejecting food while they are learning to swallow and eat. If your baby cries don’t force the food because this will make it harder in the long run. Skip the 1, 2, 3 Rule here and go at your baby’s pace.
How do I know if my child is at risk for a food allergy?
They are if at least 1 person in your immediate family who has food allergy, asthma, allergic rhinitis, or eczema.
Babies often need to be exposed to food multiple times (10 times over the course of months) before accepting them and it helps if you eat them too. Babies love to parrot. The goal of food introduction is to expose infants to new flavours and textures of foods. The order of food is less important than the consistency and texture of the foods. The consistency at first should be similar to breast milk because babies aren’t used to anything else.
Start with single ingredients that have no preservatives, including no sugar and salt. Once you’ve gone through and determined no allergy to individual ingredients then food combine. Eventually the consistency can get thicker with chunks of food for chewing. This is usually achieved at 8 months.
With these ideas in mind, you may choose from the following food list focusing on iron and vitamin C rich foods at first because their needs for iron are high at this age.
- Steamed prunes: fiber, iron, vitamin C, fluid, calcium
- Oat, rice or wheat cereal.
- It is becoming popular to delay wheat and other cereals given growing number of people with wheat allergy/sensitivity, but this has actually been shown to increase the incidence of wheat allergy in children. That may be where some of the increased allergy comes from in our current adult population.
- Bananas: potassium, iron, easy to chew
- Carrots: fiber, carotenes
- Cauliflower: iron, fiber
- Pear sauce: vitamin C, fiber, fruit sugar
- Papaya: Vitamin C
- Cherries: fiber, iron, vitamin C, fluid
- Blackberries: fiber, iron, vitamin C
- Applesauce: pectin, fluid, fruit sugar
- Sweet potatoes: carbohydrates, carotenes, potassium
- Green peas: iron, fiber, chlorophyll, calcium
- Steamed, dried apricots: iron
- Fresh apricots
- It is important because of how it’s changed from a food to leave until last, to now being recommended to introduce early. Peanut can be introduced as a diluted butter between six and twelve months in order to significantly reduce future peanut allergy incidence with the exception of infants who have an immediate family member with peanut allergy. Please consult my article on peanut introduction for further details. Probiotics exposure therapy are key to resolving peanut allergies
- 100% juice with no added sugars are ok at six months when infants can drink from a cup, not a bottle or sippy cup.
At some point baby will be able to sit up and put foods into her mouth to chew on. This is when finger foods can be introduced when she can learn to feed herself. Anything you give baby should be soft, easy to swallow and cut into small pieces like banana, wafers, crackers, eggs, pasta done well, finely chopped well-cooked chicken, squash, peas and potatoes.
To nine months and beyond
By now, baby is eating 2 meals a day composed of 2 or 3 foods each. At this point, you can expect your baby to be growing and maturing substantially. To help maintain this process, choose fiber-rich foods for you child that are also high in iron and zinc. These purees can be slightly chunkier.
- Lima beans: zinc, protein
- Split pea soup: zinc, protein
- Mashed potatoes: complex carbohydrates
- Ground brown rice: complex carbohydrates, protein
- String beans: fiber, magnesium
- Nectarines: vitamin A, potassium
- Blueberries: fiber, vitamin C
- Acidic foods like berries, citrus fruits, tomatoes, and some vegetables can cause skin reactions like a rash or hives around the baby’s mouth due to high histamine and the acid irritant. This is a common and not an allergic reaction.
- Chard: magnesium, chlorophyll, fiber
- Grapes (pureed): vitamin C, fluid, fruit sugar
- Cow dairy in small amounts that is contained in other foods including yogurt and cheeses.
- Small amounts in baked goods or cooked eggs (scrambled, hard boiled, poached, or fried) has been shown to decrease future incidence of egg allergy if introduced before 10 months of age. The reduction is even greater if eggs were introduced around 6 months of age.
- Fish introduction before 9 months can reduce the risk of eczema in children.
- Acorn squash: carbohydrates, fiber
- Blackstrap molasses: iron
- Barley: carbohydrates, phosphorus, magnesium, protein
- Asparagus: fiber, protein, vitamin A, niacin, potassium, manganese
- Brown rice: carbohydrates, protein, fiber, vitamin B complex, phosphorus
- Avocado: fats and oils
- Swiss chard: magnesium, fiber
- Parsnips: fiber, vitamin A, B complex, potassium, calcium, zinc
- Goat’s milk: protein, vitamin A, B complex, potassium, calcium, zinc
- Yogurt: calcium, protein, some B vitamins, zinc
- Hubbard squash: carbohydrates, protein, vitamin A, potassium
- Kiwi: vitamin C, fluid, fiber
- Lamb: protein, iron
- Chicken: protein, B vitamins
- Organic whole cow’s milk
- Caveat – I’m not a supporter of cow’s milk in a child’s diet because of the risk of ovarian and prostate cancer as well as allergies. It is not necessary for the healthy development of children. Although, if you were going to introduce it now would be the time. Before one year of age, whole cow’s milk is not a desirable food staple because of increased kidney load and low iron content in place of healthier foods.
- Whole goat’s milk
- Tahini: oils, protein, calcium, iron
- Beets/beet greens: chlorophyll, fiber, iron
- Spaghetti squash: carbohydrates
- Various greens: magnesium, fiber
- Rye: carbohydrates, fiber, sodium
- Mushrooms: fiber, copper, zinc
- Rutabaga: carbohydrates, carotene, fiber
- Buckwheat: carbohydrates, fiber, B vitamins
- Eggs: B12, protein, carbohydrates
- Beef liver: B12, iron, protein, B vitamins
- Cashew butter: protein, essential fatty acids
- Almond butter: protein, essential fatty acids
- Game hen: protein
- Oranges: vitamin C, bioflavonoids
- Turkey: protein
- Pineapple: vitamin C
- Brewer’s yeast: B complex
- Crushed walnuts: oils, protein
- Organic cheese
- Organic fortified soy beverages
- Sunflower seeds
- Cottage cheese
- Lamb liver
Food to Avoid
Refined added sugar. That’s never healthy.
Honey isn’t a suitable alternative, because it carries a toxin to infants younger than 1.
Water only after solids are begun. Water fills their little tummies and doesn’t leave room for food with needed nutrition. A few sips a day is good enough. This included diluted natural fruit juices.
Choking hazards – Do not introduce before 4 years of age hot dogs, whole peanuts, whole tree nuts, whole grapes, whole raisins, whole raw carrots, popcorn, round candies.
DIY Baby Food
Organic fruits and veggies.
Steam them rather than boiling.
Pour into an ice cube tray, cover and freeze in freezer bags. This should be good for three months.
Thaw the food in the fridge or warm in saucepan of water with gentle heat.
Process the food into a puree. You can use steamed water and breast milk to dilute pureed foods to get the best consistency.
Home prepared spinach, beets, green beans, squash, and carrots, should not be given to infants younger than 4 months because of increased nitrates, which can cause a kind of anemia. These foods are best used in commercially available products that have nitrates tested.
Eating shouldn’t be scary. Even in our current climate of heightened allergies, we don’t need to keep foods at a distance. A variety of food should be encouraged to support healthy children and prevent allergies. For special circumstances, especially highly allergic children, consult a qualified healthcare professional.
References include Dr Pat Rennie and Dr Cathy Carlson Rink as well as the links attached.
Infant Feeding Guide PI
Dr. Bobby Parmar