How do I go about introducing solid foods to my baby?

Government suggests that 6 months is the right time to start weaning, but my children were ready at four months and they thrived on it. What are your thoughts?

Although the World Health Organization and Department of Health suggest that weaning should not be started before six months (26 weeks), many parents still choose to offer solids to their babies before 6 months of age. As health care professionals we advise and encourage parents not to consider weaning before 4 months (17 weeks) and ideally with the support of a health care professional.

Each baby develops at their own pace and some reach key milestones before 6 months of age.  So your baby will let you know when they are developmentally ready for solids.

If your baby can sit up comfortably (and stable), maintain good head control and show an interest in your food your baby is ready for weaning.  Other signs that your baby is ready to be weaned include; still hungry after milk feeds, demand feeds more frequently and wakes at night for a feed having previously slept through the night.

It is also important to bear in mind that delaying weaning beyond six months of age can have negative consequences too. With delayed weaning there is a risk of developing multiple nutrient deficiencies, potential food allergies and it is likely that your baby can become a fussy eater.

With weaning it is important to start slowly and don’t expect your baby to have more than a few spoonfuls at first. The first step in weaning is to get your baby used to the new experience, moving from milk to solids.  Both the texture and flavour of food will be new to your baby.

When you start to introduce solids milk feeds remain vital to ensure your baby is getting all the nutrients required for growth. Babies are able to manage lumps from six months onwards, so be ready to move forward with textures. After the first 3-4 weeks of weaning you can get creative and as eating habits and tastes are formed in early childhood, it is important to introduce a variety of fresh flavours to help your baby establish a healthy eating pattern for life.

All children are different and various medical conditions often impact the timing of weaning. In some cases weaning might be suggested from as early as three months, where at other times it should be slightly delayed or slower progression is advised. Speak to your GP, paediatrician or dietitian if you have concerns regarding weaning.

When is the best time to encourage drinking from a cup?

Offer water from 6 months of age.  This should be cooled boiled water.  There is no need to give bottled water, mineral or soda water – lots of bought waters contain extra salt, minerals or sulphates.

The exception is when travelling abroad – then you shouldn’t offer tap water.  Opt for bottled water without added sodium or minerals.

A cup should be introduced from around 6 – 8 months to offer water after meals.  You can continue to offer a bottle at bedtime if you choose to, but aim to have your baby off the bottle by the age of 1 year.

When can I give my baby water, juice and squash?

Milk and water are the best drinks for your baby’s health and teeth.

In exceptional circumstances VERY well-diluted juice can also be offered roughly when your baby is on three solid meals per day.  To dilute juice add 1 part juice to a minimum of 3 parts water.  It is advisable to speak to your HCP if you are worried that your baby is not taking enough fluids.

Offering fluids at mealtimes can easily fill your baby up and reduce their appetite for food, so careful not to give too much fluid or displace milk intake.

Offer small amounts of water initially at the end of a meal – to allow your baby to learn the new skill of eating first.  Remember your baby will get lots of fluids from the food they eat e.g. 100g yogurt provided 80ml liquid.

Cow’s milk or suitable fortified alternatives can be offered as a drink once your baby is 1+ years old but are fine to use in food / cooking during weaning.

How do I ensure my daughter gets all the milk feeds she needs as well as eating solids?

Breast milk or formula milk should provide all the nutrients your baby needs for the first six months. As your baby’s intake of solid food gradually increases, milk intake will naturally decrease.

It is important that you continue to breastfeed or offer formula milk in adequate amounts when weaning is started. Between the ages of 4 – 6 months babies should still have 700 – 1000 ml of breast or formula milk each day.  From 6 months to 9 months, as weaning progresses babies should have between 500 – 900ml of breast, formula / follow-on milk each day and after 9 months aim to offer 400 – 600ml of milk per day. If less milk is consumed, ensure that your baby is having calcium rich foods in their diet such as yogurt and milk can also be added to cooking.

To use milk in baby purees it is important to remember food safety.  If using breast milk; you can keep it in the fridge for 2 days and it is suitable for freezing.  When using previously frozen breast milk it is not suitable for re-freezing or reheating.  For formula milk you can use freshly prepared formula in food and keep it in the fridge for 1 day.  It is also suitable to freeze foods with formula milk added.  Remember to cool foods completely within 2 hours of making.

Take care to never add any solid foods to the milk in your baby’s bottle.

What is baby-led weaning?

An increasing number of parents are now opting for baby led weaning.  With baby led weaning (BLW) you are offering easy to grip, table foods instead of the traditional purees on a spoon to your baby.  No bowls or cutlery – the food is put directly onto the highchair tray.

The concept of BLW is that this allows babies to control their solid food intake by feeding themselves from their first encounter with food. Your baby decides the what, when and how of mealtimes.  Hunger might be frustrating for your baby when they are still figuring the feeding thing out.  As with traditional weaning, it is important to time meals between milk feeds and stick to the same times daily.

With baby-led weaning you are not feeding your baby directly but rather offering guidance during the meal. Your baby should be in control of what they put in their mouth, it is important that you never put any pieces of food directly into your baby’s mouth. First foods often include: steamed carrots, cucumber or mango pieces, toast finger etc. But can also be anything that you are having for your lunch or dinner (without the added salt and sugar).

This type of weaning does work wonderfully for some, whilst others struggle and revert back to traditional weaning and some parents follow a combination method.  Do remember that babies should be at least 6 months old when baby-led weaning is started; they should be able to sit up unassisted, grasp and hold onto foods.

Advocates for baby-led weaning often say that babies should eat what the rest of the family is eating and if they refuse the food, you should relax as your baby will be getting the calories from their milk.  As babies love their milk, this approach can easily lead to undesirable behaviour – babies learn fast and they will soon realise that if they refuse the solid food, mum will happily offer them some milk.

Parents must be warned that baby-led weaning is messy. You might want to do your homework and read up on this method before you decide to start. Forums are a good place to learn from parents who have followed this method. This will help ease your mind and somewhat prepare you for what to expect. Bear in mind that babies are all different and that they will eat at their own pace.

So is this the type of weaning for your baby?  Only you can decide if baby led weaning is right for your baby. Both traditional weaning and baby led weaning have pros and cons. If you are uncertain or have any questions, discuss this method with your health care professional.

Personally I usually recommend a combination approach (instead of traditional weaning or BLW alone) along with a responsive feeding approach – as it has many benefits; including supporting your baby’s long term feeding habits and development.

With weaning it is important to take time to respond to your baby’s cues and trusting your baby’s ability for self-regulation around intake.  Focus on nurturing a positive shared interaction between you and your baby and recognise that feeding is not only about nutrition – your baby is learning lots of new techniques and this learning curve requires love, reassurance, patience and trust.

Responsive feeding moves away from a focus on prescribed expectations (what is says on the formula milk tins / online) and will better support your baby’s ability to self-regulate their appetite and respond to mealtime cues. Each baby will have a different journey – try not to compare and go at your baby’s pace.  Be responsive to your baby’s cues

Hunger cues:

  • Fussing / crying
  • Leaning toward and opening mouth
  • Gazing at food
  • Expressive facial expressions and smiling or cooing
  • Gets excited about food
  • Reaches for or points at food

Fullness cues:

  • Closing mouth or clamping it shut
  • Crying or stress signals
  • Pushing the spoon away / turning body or head away / shaking head
  • Slowing pace of feeding
  • Holding food in their mouth
  • Vomiting

What foods should I avoid giving my baby and can I add salt and sugar to my baby’s food?

You’ve probably heard a lot of talk about introducing 100 foods to your baby’s diet before the age of 1.  This roughly translates to 1 new food every other day from 6months – 12 months which is not always feasible.  Variety and diversity is important for your baby’s overall health and microbiome, but I prefer to have a more balanced approach (offering foods from different food groups and focusing in flavour) instead of putting a number on the amount of foods to introduce before your little one turns one as this can add a lot of anxiety and pressure.

When starting solids the foods given should be

  • easy to digest and
  • unlikely to provoke an allergic reaction

The best foods to start with include:

FRUITS – Apple, pear, banana, prune, papaya (banana and papaya do not require any cooking, provided that they are ripe and can be pureed or mashed on their own or with a little milk).

VEGETABLES – Carrot, potato, swede, parsnip, pumpkin, butter squash and sweet potato. These vegetables tend to have a naturally sweet flavour and smooth texture, once pureed.

BABY RICE / GLUTEN FREE GRAINS – Mixed with water, breast or formula milk.  It is easily digested and the milky taste makes for an easy transition onto solids. There are varieties available which are sugar free and have added vitamins and minerals.  Baby rice also combines well with both fruit and vegetable purees, but can cause constipation in some babies.

It is always a good idea to taste any food that you’ve prepared, before giving it to your baby.

And what not to offer or take care with offering your baby include:

GLUTEN – to be introduced from 6 months onwards into your baby’s diet.

NUTS – in a nut butter of grounded form should be introduced early where possible, especially where there is a history of food allergy or eczema.  Chopped and whole nuts are not recommended before the age of 5 due to the high risk of choking.

RAW, LIGHTLY COOKED or SOFT EGGS – should be introduced from 6 months of age (or earlier when your baby is in a high risk allergy group).  Due to the risk of salmonella infection, eggs should be fully cooked until both the yolk and white is solid. Eggs are also a great source of iodine.

SALT – Babies under a 1 year should not have any salt added to their foods as this can strain their immature kidneys and cause dehydration.   A preference for salt can be established at an early age and eating too much salt may lead to high blood pressure later in life.   Also avoid any smoked foods.

SUGAR – Try to avoid foods with added sugar. Adding sugar to your baby’s food increases the risk of tooth decay and may be habit-forming.

UNPASTURISED CHEESES and PATE – Avoid Brie, Camembert or Danish Blue cheese before 12 months due to the risk of listeria infection.

SHELLFISH – Should not be given until at least 1 year.  If there is a family history of a shellfish allergy, avoid feeding your baby shellfish.

HONEY – Should not be given before 1 year.  Very occasionally honey can contain a type of bacteria that can result in a potentially serious illness to your baby called infant botulism

ARTIFICIAL ADDITIVES – Avoid giving foods or drinks that contain artificial additives for example sweeteners and colourings.  These are banned by law from baby foods and drinks.

COFFEE & TEA – Compounds in tea and coffee interfere with your child’s nutrient absorption, thus it is best to avoid these.

My baby is 9 months old – can I give my baby cow’s milk to drink?

You should continue to give breast or formula milk to your baby as their main drink for their entire first year of life. Cow’s milk does not contain enough iron or other nutrients to ensure adequate growth. However you can use full fat cows’ milk with cereal and in cooking from 6 months onwards.

Many parents opt for follow-on or growing up milks as these are enriched with added vitamins and minerals. If your child is a fussy eater it might be a good idea to rather offer one of these milks to ensure they will be getting adequate amounts of these nutrients.

Below is an indication of how much calcium your child requires at a certain age. Calcium does not only come from milk but also from calcium rich “desserts”, cheese and other dietary sources.  If your baby is on a dairy free diet, speak to your Dietitian to provide you with dairy free calcium rich alternatives.

AGE

  • 0 – 12 months – Calcium 520mg
  • 1 – 3 years – Calcium 350mg
  • 4 – 6 years – Calcium 450mg

My baby is not a good eater and weaning has been difficult. I’m worried – what can I do?

When you start weaning, your baby will only take a small amount of food, approximately 1 – 2 teaspoons once daily. Aim to get your timings right, avoid offering solids when your baby is tired or hungry and also not shortly after a milk feed.

Be responsive to your baby’s cues and gradually increase the quantity and number of times that you offer solids to your baby in a day. Do not worry if your baby refuses the food on the first introduction, this is often the case, stay positive and try again later.  Continue to offer the same food on another day and remember repeated exposure is often needed.

When you’ve tried everything to get your baby weaned, without success, it is possible that the timing might not be right. I know it’s easier said than done, but try to relax; your baby might be picking up on your tension and frustration.  Your baby might be feeling unwell or adjusting to the fact that you’ve gone back to work. Do not compare your baby with other babies.  Babies clearly indicate when they’ve had enough by turning their heads away.

If your baby is refusing a meal do not offer milk directly after that, let your baby wait until the next snack or meal and offer some food again. But be careful as snacks between meals can often spoil your baby’s appetite.

If your baby is losing or not gaining weight, their appetite has been poor for quite some time or they are also refusing milk feeds, speak to your HCP.

At what age can I stop sterilising her feeding equipment?

Milk is a good breading base for bacteria and babies are quite vulnerable to germs that cause diarrhoea and vomiting, thus it is best to continue to sterilise your baby’s feeding equipment until they are 1 year old.

If you are using a cup or beaker for your baby (advised from 6 month’s onwards) no sterilisation is required.  Cups and beakers are easier to clean than bottles or teats and they can be washed in warm, soapy water together with your baby’s plates and cutlery.  But do remember to wash your baby’s things separate from the rest of the dishes.

When is a good time to stop my child’s daytime bottle feeds?

Once your baby is having 3 solid meals per day with calcium-rich foods and the age-appropriate volume of milk, you can stop offering daytime bottle feeds. Aim to start using a cup or beaker from 6 months onwards.

Once my baby starts on solids, will his bowel movements change? What can I include in my baby’s diet to avoid/cure constipation?
Most definitely, constipation is common in the early stages of weaning as their digestive system is adapting to something other than milk.  It is normal to see changes in your baby’s nappies once solid food is introduced and the nappies will differ from day to day, depending on what you are feeding your baby.

Constipation can make some babies uncomfortable, reluctant to eat and impact their sleep or even aggravate their reflux.

Constipation is defined as:

  • Having less than 3 stools a week
  • Dry / hard / pellet-like stools
  • Larger than usual stools
  • Straining or discomfort
  • A firm tummy
  • A reduction in appetite

Babies and toddlers’ needs are different from adults – a low fat, high fibre diet is not appropriate as babies and young children require more fat and concentrated sources of calories and nutrients to fuel their rapid growth.

They should not be given too much fibre as excess fibre may remove valuable vitamins and minerals or can cause diarrhoea.   Fibre is also quite bulky and can easily fill your little one up before they get all the nutrients they need for proper growth and development.

Instead opt for a gradual introduction of fibre rich foods e.g. oats/pulses and beans, nuts, and cereals.  And offer fibre and sorbitol rich foods – prunes, pears, plums, peaches, apricots and apples

Sorbitol acts as a natural laxative bringing water to the bowel to help soften the stool.  Also, ensure to offer extra fluid (water and milk) and increase your little one’s movement e.g. pumping your baby’s legs or opting for tummy massage

If your baby remains constipated, speak to your health care professional.

When is the earliest I can start my baby on cows’ milk and how much does he need? Is full-fat best?

Breast or formula milk should be your baby’s main drink until they reach 1 year. Cows’ milk can be used in cooking or with cereal from 6 months onwards.

As cows’ milk does not contain enough iron or other nutrients to ensure proper growth, it is not recommended before the age of one. Once your baby has reached 12 months, you can change from formula or breast milk to full-fat cows’ milk.  I often advise parents to gradually wean their baby onto the full-fat cows’ milk to avoid your baby refusing the milk.

All children younger than 2, should be on full-fat cows milk or a growing-up milk with added vitamins and minerals. A growing-up milk would usually be recommended if your child is a fussy eater.

How can I make sure my baby gets a varied diet on a small budget?

Even on a shoestring budget, you can still ensure that your baby will have a balanced, varied diet. If money is limited it’s best to rather opt for homemade foods instead of ready-to-serve baby food in supermarkets. These baby food jars and pouches are very convenient and have come a long way over the past few years, but can be quite expensive.  It is always a good idea to have a couple of jars just as a backup in your house (buy these when your supermarket has a special deal).

The bonus of making food at home is that you know exactly what you are adding to your baby’s meals and you can freeze any leftovers or prepare food in advance – this way our baby will also get used to your family diet and flavours.

When working with a tight budget it is advisable to plan your meals ahead with weekly or monthly menus and stick to the menu. The menu planning can be done for the whole family. As babies can eat the same food as the rest of the family; you do not have to buy special foods for your baby, just avoid adding sugar, salt or too many spices to your baby’s food.

Babies and toddlers should eat a wide variety of fruit and vegetables to ensure they get plenty of vitamins, minerals and adequate fibre from their diet. When you do the shopping, buy fruit and vegetables that are in season and frozen vegetables are also a good option as they are slightly cheaper than fresh vegetables.

Stick to appropriate portion sizes, do not dish up too much food, this will just end up in the bin.

Experiment with plant-based proteins and aim to have a meat-free meal two – 3 times per week, but ensure that your baby has some protein at every meal.

Nutrients that are particularly important in the early years include:

IRON

Iron is very important for your baby’s physical and mental development. Babies are born with limited iron stores that will last for about 6 months. Iron deficiency is the most common nutrient deficiency in young children and can cause your child to feel tired, run down and more prone to infection.

Iron foods of animal origin like red meat or poultry are better absorbed than the iron in plant foods like green vegetables or cereal. Vitamin C helps with the absorption of iron so give your baby vitamin C rich fruits or vegetables like sweet pepper, broccoli, berry fruits or citrus.

Animal sources of iron are; red meat, particularly liver, chicken or turkey – especially the dark meat, well cooked egg yolk and oily fish such as canned sardines, salmon, mackerel and tuna.  Non-animal iron sources include; lentils, beans and pulses, wholemeal bread, spinach and broccoli and dried apricots. Follow-on formula is also a good source of iron.

CALCIUM

Calcium is essential for building strong, healthy bones and teeth. It is also important for the smooth functioning of muscles, including the heart. Dairy products like milk, cheese and yoghurt are excellent sources of calcium and protein. Other sources include salmon, broccoli and dried fruit. Always choose full fat dairy products for children under the age of two.

ZINC

Zinc is important for normal growth, it helps boost the immune system and speeds the healing of wounds. Red meat, eggs, wholegrain and fortified cereals as well as pulses are all rich in zinc. Vitamin C also works with zinc so ensure that plenty of vitamin C rich foods are included in your baby’s diet.

VITAMIN C

Vitamin C is needed for growth, healthy tissue and healing of wounds. It also helps with the absorption of iron and zinc. Vitamin C is abundantly found in strawberries, apples, pears, peaches and other summer tropical fruits and also in broccoli, cauliflower, spinach, potatoes and sweet peppers.

VITAMIN A

Vitamin A is essential for growth, healthy skin, teeth, bones and good vision. Best vitamin A foods include; liver, butter, cheese, eggs, oily fish, carrots, sweet potato, tomatoes, dark green vegetables such as broccoli and orange-coloured fruits such as mangoes.

IODINE

Iodine is an essential micronutrient that is required in tiny quantities to help the body make thyroid hormones.  It is just as important for little ones as it is for adults (including pregnant and breastfeeding women).  Special care should be taken for children on a dairy free or other allergy diet as sources of iodine include; white fish, shellfish, dairy and eggs.

ESSENTIAL FATTY ACIDS

Essential fatty acids (EFAs) are important for your baby’s brain and visual development especially in early life.  There are two essential fatty acids – linoleic acid (omega 6) and linolenic acid (omega 3). In general we get enough omega 6 fats from seed oils – sunflower and corn and omega 3 fats from oily fish such as salmon, trout, fresh tuna and sardines.

You can opt to make your own baby rusks and biscuits at home, there are various recipes online.  Making a homemade baby custard or rice pudding is a good alternative to yoghurts.

How To Make Custard (egg-based) For Your Baby

Ingredients:

  • 2 beaten egg yolks
  • 250ml full fat milk (custard will NOT set well with formula)
  • 1 tsp vanilla extract
  • 1 small, sweet apple, peeled, cored and diced (optional and can be substituted for pears, peaches etc.)

Method:

1.  Simmer the apple in a very little water until tender, then mash thoroughly or puree.

2. Put the apple into the bottom of a small oven-proof dish.  Preheat oven to 180° C

3. Stir the beaten egg yolk and the vanilla into the milk, and then pour the mixture over the cooked apple.

4. Sit the dish in the middle of a baking pan and pour in hot water until it comes about halfway up the side of the dish (this creates a simple bain-marie).

5. Bake for 30 minutes until the custard has set.

6. Cool and serve chilled.

How To Make Egg-free Custard For Your Baby (1 serving)

Ingredients:

  • 150ml full fat milk
  • 3 teaspoons corn or maize flour
  • ½ tsp vanilla essence

Method:

1. Add the maize or corn flour into a saucepan

2. Gradually add the milk to form a smooth paste.

3. Add the remaining milk.

4. Heat over medium heat, stirring constantly to prevent lumps forming.

5. Custard will thicken after 1 – 2 minutes.]

6. Serve with fruit

How To Make Your Baby Rice Pudding (2 servings)

Ingredients:

  • 3 tbsp baby rice
  • 100ml full fat or formula milk
  • 1-2 drops vanilla essence

Method:

1. Heat the milk in a pan until hot.

2. Add the baby rice and whisk until the mixture is smooth and lump-free.

3. Remove from the heat. Add the vanilla and sugar and stir well.

4. Serve warm or cold.

Does my baby need a vitamin supplement?

Breastfed babies should be given a daily supplement of 8.5 – 10ug of vitamin D  from birth and are recommended to move onto a combined supplement that contains vitamin A, C and D from around 6 months of age and continue until school age. Mothers should have a daily vitamin D supplement (10ug).

Formula-fed or combination fed babies are recommended to have vitamin A, C and D daily once their formula milk intake drops below 500ml per day and continue to give until school age.

Article by Bianca Parau, Specialist Paediatric Dietitian
www.lavie-nutrition.com
M: 075 003 88108

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