Performance Art v. Science: Starting Infants On Solids

Performance Art v. Science: Starting Infants On Solids

Two truths follow. Food is love. People love feeding babies.

Usually at an infant’s four month visit, I’ll get a question parents have been thinking about for some time: “When can we start feeding our child solid foods?”  And, you can be sure that if there is a grandparent present, this will be followed by an echoic, “Yeah, when?”

This is a great question. In some small but important ways, there has been a shift in the thinking of when is best to introduce babies to the so-called “solid foods.” These ‘first feeds’ are pretty mushy actually–there isn’t much that is solid about them– and customarily begin with varieties of cereals, followed by compotes and purees of veggies and proteins.

Historically and until the last couple of years, 4 months of age was considered the go time to begin cereal feeds for full term infants. More recently research suggests infants seem to do better over in their long term appetite regulation and have lower rates of obesity if they begin solids closer to six months.  Lest ye grandparents protest:  the WHO and American Academy of Pediatrics (and a huge body of research) reassure us that  all of a healthy infant’s nutritional needs can be  met by exclusive fluid intake: breastfeeding (ideally) or formula feeding (second best but still ok) for the first six months. Really.

A child who is ready to feed must have achieved certain milestones of strength and coordination and interest  that prepare them to to manipulate thicker, textured stuff in their mouth.   By four months, babies have more strength in their trunk and better head control, allowing them to sit for increasing spells during meals. Some babies, such as premature infants, may have poor head control and may do that bobble -head newborn thing when upright, or they may lack trunk strength. They may need to wait a little longer. A check in with your baby’s primary care provider can help suss out when that time is right.

Around 3-4 months, infants lose a protective newborn reflex to push out substances thicker than breastmilk or formula, presumably as a defense against choking.  Three month olds who are fed baby food, for example, may simply spit back out spoonfuls placed on their tongue. Eager but potentially uninformed parents describe their younger babies as “not liking it.” Not likely. Lastly, babies need to be interested in food.  These babies are hard to miss. Food excites them, and they watch family members with obsessive curiosity as they feed themselves during mealtimes.  Mealtime, people!

And so, how to proceed? As a rule, there aren’t many rules. However, there are a few good ideas to keep in mind.

For starters, keep first feedings short and sweet.  When your nearly/just 6 month old infant appears ready, willing and able to sit up for several minutes, pick  a time of day when he is of a good mood, and customarily hungry (i.e. not naptime). Place the feeding chair in an area without too many distractions (read that as TV, tablet and phone, off). For these first meals, plan on rather short duration–10 or 15 minutes max, and/or until the child’s body language says “all done.” To cultivate long term good feeding behaviors, meals are best kept stress and boredom free. Babies tend to shut down when rushed or forced. And, seriously, you don’t have to stay til the food is all gone. Save that for when they are 12.

Bottomline: the first few meals are more of a dress rehearsal of eating–getting down the steps of the dance, as it were. Food will more be worn than swallowed, at first. That is ok, just don’t wear nice clothes.

More by custom than by necessity, most parents begin with a single ingredient cereal. As I tell folks, pick a grain and go with it: rice, barley, wheat. The order doesn’t matter. Prepare the first feeds as being mostly a small amount of cereal (a teaspoon or two) in one to two ounces of breastmilk or infant formula. It is pretty watery and that is ok, for at this point, it is more about the child mastering the art of eating off a spoon. For tentative babies or nervous parents, it is even fine and dandy to make the first meal or three a session of just spoonfeeding breastmilk or formula. Again, don’t be surprised if most of these calories go down the child’s chin. That is all right.

And, sure enough, if you find yourself speaking in musical and absurdly enthusiastic tones as you scoop up another bit of yumminess, all the better. See? Feeding babies is a hoot, albeit a messy hoot, after all.  After a dozen minutes or when baby pulls away, it is fair and proper to dab the child and top her off by nursing or bottle feeding til she is sated.

Some younger/beginner babies may not yet be ready or willing to try spoonfeeding at first, or they may react with a grimace to certain tastes later (they may in fact, not like it, too).  In such instance, it is fair to back off solid feeding altogether if the child is giving negative signals from the getgo and to try again in a week or two. For the child who has solidly begun, so to speak, but who is reacting with some dislike to a certain item, take it off the menu for a few weeks and reintroduce it later.

Once a child has spent a few days on her first cereal, say rice, it is advisable to add a new/different food to her repertoire every 4-5 days or so, then barley or wheat. In this way, parents can watch for signs of allergy or hypersensitivity to different foods. By adding two new foods at once, or by introducing new foods within 48 hours of each other, makes it hard to tell which was the offending foodstuff in a baby who breaks out in a rash, or who has vomiting or diarrhea.  If you aren’t sure, take an item off the menu for a few weeks and try again. If baby breaks out or has GI upset within minutes to ours, put that on the Do Not Feed list for a couple of months. Sometimes, there is a method to the madness.

After a week or two of cereals, parents customarily begin with purees of the orange-yellow veggies, like carrots, squash and sweet potato.  These are usually well tolerated by babies and go down well. By this time, parents can comfortably add in a second meal.

Feeding your baby can be a true bonding experience, with all that is good and challenging about that. When it goes well, life is good. If there are struggles or difficulty, it can be very stressful. As a pediatrician and as a dad, I appreciate that profoundly.  For any parent concerned their child is struggling or not doing well with feeding, I recommend a prompt consultation with their child’s health care provider.  Best to be reassured, or to identify a problem early.

How much do babies eat? Does the order of first foods matter? Can I give my baby juice or water or sushi(um, no)?  Stay tuned, as my next installment will involve the next steps–and some tasty morsels of wisdom–in advancing the infant’s diet.

Photo above by MandyMarie1201 (http://media.photobucket.com/image/baby%20food/MandyMarie1201/Baby%20Haydn/food.jpg?o=11)

Cartoon below by me

Performance Art v. Science: Starting Infants On Solids

All done, evidently.

Jack Maypole, MD has plenty of material to work from. He is director of Pediatrics at the South End Community Health Center and he is director of the Comprehensive Care Program at Boston Medical Cent ...read more

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