Introducing Solid Foods

This is an exciting event in a new parent’s life, but it can feel overwhelming and produce anxiety.  There are different ways to introduce solid foods, and each method has ardent supporters and vehement detractors.  Five different sources may give you five different “best” or “only” ways to do it.  My goal is to provide clear information based on the latest scientific research.  Evidence regarding solid food introduction is evolving as new research takes place.  Some information you find is based on old research.  The guidance I give is based on my understanding of the most current research in this field.  If I am stating an opinion that is not based on solid current research, I will make that clear. 

First and most importantly, you MUST discuss solid food introduction with your child’s health care provider.  Every child and every family has unique characteristics and circumstances that must be accommodated.  What I present here is an explanation of various approaches and basic logistics.  What you need from your child’s provider is agreement on when your child is ready, and which approach to use.  If a biological parent has food allergies, your child is much more likely to have them as well, so be sure to discuss this in detail with your child’s provider.  Remember, if your child has a reaction to a food, your provider is the one you will call, so he or she must be on board from the start and throughout the process. 

Photo credit LB1860; downloaded from Flickr without amendment

Next, if you feel overwhelmed or anxious, don’t.  Take a deep breath and remember that all children learn to eat, regardless of what you do, or don’t do.  My hope for you is that you will introduce solids in such a way as to foster a love for healthy eating in your children.  This is difficult to do when you are feeling anxious.  (This is my opinion; find more opinions on this subject in “Growing Healthy Eaters”).

Finally, don’t forget about nursing (if your baby is formula fed, skip this paragraph).  I’ve seen it countless times.  We moms go from obsessing about breastfeeding to obsessing about solid foods.  This may result in a decline in breastfeeding.  Breastfeeding provides baby’s primary nutrition until at least 9 months; after 9 months, it continues to be a very important source of nutrition.  Also, breast milk contributes important immune support for as long as it’s offered.   The goal is to continue breastfeeding until at least 12 months.  Continuing to breastfeed as solid foods are introduced may decrease the chances of developing food allergies (evidence is conflicting on this subject).  So be sure to keep some focus on breastfeeding while you’re putting your energy into the introduction of solids.

Photo credit Raphael Goetter; downloaded from Flickr without amendment

Let’s cover some basic logistics now. 

·       Infant CPR:  If do not already know infant CPR, now is a great time to take a class (see below for resources).  Your baby may never choke on food, but it’s best to know what to do just in case.  It can be quite easy to save a life, if you’ve been properly trained.

·       How do you know when baby is ready?  Be sure to discuss this with your child’s provider; this discussion is usually brought up at the 4 or 6 month well child check.  Your baby will be around 6 months of age, but don’t go by age alone - it’s more important to check the signs of readiness.  Once you see the signs, offer baby some food and see what happens. 

o   Here are the signs:

§  Doubled birth weight

§  Sitting up and holding head steady

§  Possibly cutting teeth

§  Eating more frequently and still seeming hungry

§  Showing great interest in food (babies at this age show interest in everything you do, but this is a more intense level of attention)

o   Here are the signs that your baby is NOT ready:

§  When food goes in the mouth they spit it out

§  Baby keeps mouth closed when presented with food

§  Baby doesn’t look at you when you’re offering food

·       How often should I offer food?

o   Start with once a day.  Eventually, your child will eat 3 meals and 1 to 2 snacks a day. 

o   You know baby is ready for an additional meal when:

§  Baby reliably eats the meal(s) you are already offering

§  Baby seems hungrier

§  Baby has great interest in the meal you are eating

·       When is a meal over?

o   When baby spits the food out, or

o   Stops looking at you, or

o   Turns head away when you present food, or

o   Does not open mouth when you present food, or

o   Pushes food away

o   If you get these clear signals from your baby, you know the meal is over.

Photo credit Dean Wissing; downloaded from Flickr without amendment

·       Jars vs pouches vs homemade vs Baby Led Weaning:  How are you going to feed your baby?  Hint: it may be a combination of these options

o   Jars

§  Read labels – make sure you know exactly what you’re giving baby.  Jars typically come in 1^st, 2^nd, and 3^rd foods options, which is primarily an indication of how liquefied the food is.

§  Don’t double dip your spoon.  If baby is not going to finish the jar, dump some out into a bowl and spoon feed from there.  Double dipping the spoon introduces bacteria that can cause the contents of the jar to spoil.

§  Keep open jars refrigerated.  Discard open jars after 2 to 3 days.

o   Pouches

§  May be lined with BPA, although some claim to be BPA free (for information on BPA and pthalates, see "Don't Drink the Water").  The packaging materials that are used may or may not, in my opinion, be healthy for growing bodies.

§  Often have a mix of vegetables and fruit.  The fruit content is often somewhat high, meaning the sugar content is high.  Pouches bypass our normal eating mechanism – eating becomes slurping and swallowing rather than chewing or gumming and swallowing.  Slurping food that is high in fruit allows the sugar to bathe the teeth and gums, thereby increasing the odds of dental decay.  Here’s a good article on this.

§  Are expensive

§  Can be handy to keep in the diaper bag for emergency snacks

o   Homemade

§  First foods are runnier than you might expect.  Before making your own, I recommend you buy one jar of 1^st foods to see the consistency.

§  Add water or pumped breast milk to the food to make it runny enough.  Consider water safety:  Are you using water bottled in plastic (for information on BPA and pthalates, see "Don't Drink the Water")?  Do your pipes have lead in them?  How safe and clean is your tap water?  If you are using well water, discuss this with your child’s provider.

§  Once you know baby likes a food, make a large batch and freeze in small portions.

Photo credit Jan; downloaded from Flickr without amendment

o   Baby Led Weaning

§  “Weaning” is used here with the British meaning of introducing solid foods

§  You provide baby with appropriate sized pieces of the food you are eating.  For example, a whole carrot cooked thoroughly enough that it’s easy to smash between your fingers.  Baby gnaws on the food with the idea that he won’t be able to dislodge a piece large enough to choke on.

§  The theory is that babies learn how to eat like an adult, bypassing the puree phase.

§  Can be very empowering for babies.

§  Is fairly easy, but messy.

§  Can be a problem with choking babies, or with babies who don’t master the skills quickly enough to keep up with their nutritional needs.

§  See http://www.babyledweaning.com/ for more information

Now let’s discuss the million dollar question – what foods and when?  You have 3 main options to consider:  table food, the 3 day wait, and a delayed food schedule.  Choose your approach after discussing your options with your child’s provider.  Remember, if a biological parent has food allergies, your child is much more likely to have them as well; you must provide this family history to your child’s provider.  Also consider family dynamics when making your choice; most importantly, who will be feeding the baby?

·       Table food:  Whatever the family is eating gets pureed and fed to baby.  Likely the easiest option.

·       The 3 day wait:  Give one food at a time and wait 3 days to see if baby has a reaction to the food.  (Reactions are described below.)   If there is no reaction, give a new food on day 4.  Wait 3 days, and so on.  If there is a reaction, it will be clear what food caused it.  Take that food out of baby’s diet.  Wait for the reaction to clear completely before introducing any new foods.  While you are waiting for the reaction to clear, continue to breastfeed (or give formula if that’s what you were doing before) and give foods that baby has not reacted to.  If the reaction was mild, reintroduce the food in 6 months, and it will likely not reoccur.  If the reaction was severe, discuss it with your child’s provider.  The 3 day wait plan can be continued for as long as you feel it’s necessary.  Just know that once you go to table food, if your child has a food reaction, it will be harder to determine which food was the culprit.

·       The food schedule:  Until recently, most parents were advised to follow a strict food schedule that delayed allergenic foods like shellfish, strawberries, nuts, etc until a certain age.  The logic for the delay was that babies have immature gastrointestinal tracts, and allowing them to mature before introducing the allergenic food would decrease the chances of an allergic reaction.  The idea did not pan out in research.  Not only does the delay not decrease the chances of an allergic reaction - it might even increase them.

Photo credit miheco; downloaded from Flickr without amendment

Why follow a food schedule now that we have this research?  Some practitioners, especially Naturopathic Doctors, still advise a delayed schedule as a way to prevent food intolerances.  Foods that are commonly delayed are gluten, soy, dairy and corn.  Additional foods may also be delayed.  Food intolerances are similar to food allergies, but there are important differences.  Food allergies are scientifically proven immune mediated reactions to a food that the body believes to be an invader.  Food intolerances are not scientifically proven, and the mechanism for them is not well understood.  They may include but are not limited to: constipation, gas, bloating, increased mucus or phlegm, changes in personality, and changes in energy level.  The idea is the same as it was for food allergies: allow the gastrointestinal tract to mature before introducing potentially problematic foods to decrease the odds of intolerances.  The problem is this: by following the delayed schedule, you are not doing everything you can (based on the research we have) to decrease your child’s chances of developing food allergies.  This option should only be chosen after careful consideration by you and your doctor. 

See my upcoming post on food quality for more information on first food choices.

Photo credit ConstructionDealMkting; downloaded without amendment

Food Reactions

Some babies react to many foods, some react to nothing, and some react to a few foods in a minor way, or one food in a bigger way.  You won’t know which baby you have until you start introducing foods.  If you are giving table food and baby starts exhibiting signs of a food reaction, it will be harder to determine what food might be causing the reaction.  If you are using the 3 day wait plan, eventually you will decide to abandon it – either because everything has been introduced, or because you realize that your child doesn’t tend to react to foods.

Signs of a food reaction include but are not limited to:

Diarrhea / mucous in stool / green stool
Constipation	Runny or stuffy nose
Vomiting	Ear infections
Skin reactions	Allergic shiners (dark circles under eyes)
Hyperactivity or lethargy	Cough / Sneezing
Change in personality	Watery eyes

Note that these signs may mimic a virus, so it might not be initially clear.

Lip or tongue swelling, hives, wheezing or difficulty breathing or swallowing indicate anaphylaxis – seek medical attention immediately and avoid repeating that food.

Miscellaneous Information

·       AVOID

o   Honey until 1 year of age due to risk of botulism

o   Choking foods

§  babies under 9 months of age tend to choke easily

§  finger foods should be introduced around 9 months of age, but these can be choking hazards so use caution

o   Raw meat, fish, eggs, dairy

o   Sugar substitute (stevia ok) 

o   Limit salt

o   Caffeine, preservatives

o   Artificial colors and flavors, caution with natural flavors

o   Be careful with dried fruit – it’s high in sugar and sticks to the teeth, thereby increasing the chances for tooth decay

o   Juice, soda, high sugar / carb drinks (rice milk)

·       Offer water from a cup often (throughout day).  As above, consider water safety.

·       Dairy products should be whole until 2 years of age.

·       Strive for organic as much as possible:  babies have immature detoxification systems, and their brains and nervous systems are still developing, so they may be particularly susceptible to toxins.  Animal products especially should be organic as the toxins they eat bio-accumulate into the flesh that we eat.  Fish should be low in mercury.  “Dirty dozen” produce should be organic.  (See resources for more information.)

Resources:

Infant CPR classes:

http://www.redcross.org/take-a-class

The Dirty Dozen produce list: 

http://www.ewg.org/foodnews/summary.php

Mercury levels in fish:  http://www.nrdc.org/health/effects/mercury/guide.asp

More on food allergies:

http://www.healthychildren.org/English/healthy-living/nutrition/Pages/Food-Allergies-in-Children.aspx

Welcome To My Blog

I have been a mother for just over two years, and a Naturopathic Physician for almost six.  My blog will address the world of Naturopathic Medicine, raising healthy children, being a healthy woman, and mothering.  My practice is focused on pediatrics, adolescent care, and women’s health.

Naturopathic Physicians embrace the following principles:

First do no harm

Nature and the body have an innate healing power

Seek the cause of illness

Heal the whole person using individualized treatments

Teach the principles of healthy living and preventative medicine

In a nutshell, I treat each patient as an individual, and as a whole person rather than a set of symptoms or any given disease.  I address what I believe to be the cause of illness, and I seek to empower my patients to live healthful lives.  My primary tools include herbal medicine, nutrition (diet changes and nutritional supplements), exercise, hydrotherapy, physical medicine (Craniosacral Therapy and Visceral Manipulation) and homeopathy.  I am licensed to prescribe pharmaceuticals, and I use them when necessary.

Licensed as a primary care provider, I offer well child exams, well woman exams, sports physicals, lab studies, vaccines and vaccine education. 

My goal is to empower my patients and their parents to lead healthy lifestyles and prevent illness, or manage it as healthfully as possible if necessary. 

I graduated from Bastyr University, and then completed a two year residency at The Kids Clinic in North Seattle.  At the Kids Clinic, I became comfortable managing urgent acute matters as well as chronic health concerns.  Since graduation, I have completed the New England School of Homeopathy, and earned the Simkin Center's Certified Lactation Educator certificate.

I am starting a blog with the goal of educating and empowering more people than I can reach in my office.  Not everyone has access to Naturopathic Medicine, and not everyone can communicate with a Naturopathic Doctor every time they have a question or concern.  My hope is to increase awareness around healthier choices. 

The internet can be your best resource, and your worst enemy.  Chock full of misinformation and terrifying stories, it’s not the easiest place to find an accurate answer.  Your best bet is to stick to trusted sources whose writers are well qualified and experienced in their subject matter, and who stay up to date on research.  I hope to be one of those sources for you.


DISCLAIMER:  This blog should not be construed as medical advice.  I am looking to share knowledge that I have gained as a doctor, as a mother, and through life experience.  I hope to provide you information that you can use as a basis to ask questions of your or your child's doctor.  I am not looking to help you diagnose or treat on your own.  If you or your child are ill, please schedule a visit with your doctor.

Look for new blog posts every few weeks.  Welcome to my blog!