Expect at least 50% to end up on the floor: starting your baby on solid food
The Department of Health and the Department of Health of every other industrialised country in the world recommends the introduction of solid food at around six months.
You may hear ‘rumours’ that this will change.
You may hear people tell you that there’s something wrong with this recommendation and earlier is best.
Not true. The recommendation to wait until six months was the result of some careful deliberation and an examination of a wide range of evidence that looked at issues like disease and allergy prevention.
There are a few bits of infant physiology that are hard to argue with. Babies need the amylase enzyme to digest starch and it isn’t properly released until around six months. In the days when people would spoon rice cereal into their small babies like filling cracks in the wall with polyfilla, some of those nutrients weren’t going anywhere useful. Babies are born with what we call an ‘open gut’. This means the gut wall which separates the baby’s intestines from the blood stream is extremely permeable. Larger molecules that might cause disease and allergic reaction can pass through easily. Breastmilk does a clever thing as it forms a protective mesh over the gut wall that prevents various nasties passing into the baby’s bloodstream. However to get that mesh functional we need the baby’s gut flora to be the good stuff. Just as if we were going to end exclusive breastfeeding, adding in solids will change the gut Ph. and gut flora and some of that protection could be lost. However by around six months, gut closure has occurred in babies and introducing other food then appears to have less of an effect.
A baby who is six months can also participate much more in the feeding process. They can sit up and hold and bite and select and get that food is colourful and textured and wonderful. They can control the process, rather than simply be vehicles for beige mush. You’ll often hear people say, ‘But my four month old looks so longingly at us when we eat our bacon sandwiches. He looks so fascinated and he wants to reach out and grab my food. I don’t want to make him wait until six months’. Sure, but the same baby is probably going to look equally fascinated when you apply mascara and lipstick. Probably not the best argument for starting solids ahead of the recommendations.
“My baby is big. He’ll need solids sooner”. Nope. It’s really not the way it works. Our bodies are designed to make enough milk for twins. It can cope with your bigger-than-average baby.
“My baby is smaller. She’ll need solids sooner”. Nope. If you’re concerned about weight gain, there are more effective things we can do to increase calorie content.
“My baby doesn’t sleep well. He needs solids sooner”. This may well be the classic sleep phase we often see at around four months. Babies can wake more frequently for a variety of reasons including gross motor development ("I'm getting to a lighter phase of my sleep cycle and I CAN MOVE MY LEG. I HAVE LEGS. I'M MOVING THEM. And while I'm at it, where's that nice big mummy person gone? I'm fully awake now"). Or it could be teething. This waking phase is rarely connected to insufficient nutrition. We may even find that introducing solids causes more restless nights initially, not improved ones. Babies are experiencing new digestive sensations, pooing at different times and are more likely to be constipated.
This is one area where we may get a lot of pressure from friends and family. Many of them weaned at a time when the recommendations were different. If you’ve been breastfeeding, they are probably super keen to get the spoons out and literally get stuck in. You may hear this from your mother-in-law: “Well, Bob had baby cereal from six weeks and he’s just fine.” Bob now plays rugby, runs marathons, splits atoms – delete as appropriate. The anecdotal evidence argument is never a worthwhile one. Bob is probably a member of a generation with shocking levels of obesity, heart disease and diabetes. Perhaps if Bob hadn’t have been weaned at six weeks, he’d play better rugby and split more atoms.
The recommendations didn’t change because someone in government had a long lunch and was feeling cross with Heinz baby foods that day. Evidence looking at the health of babies breastfed for 3-4 months vs six months was reviewed. This evidence was relevant to babies living in all countries and in all conditions.
The recommendations may change again. More evidence is always needed. But right now ‘around six months’ seems right.
There are different ways to feed a baby solid food. Broccoli can be held by its convenient little handle and baby gums can mash down and take mouthfuls of stuff directly from the source. Or it can be steamed and pureed and spoon fed. Baby-led weaning is a method where spoon feeding doesn’t happen. Baby is in charge. Food is offered in pieces and chunks that can be held in a little baby fist and they just go for it. They sit and feed themselves while you sit and eat your own dinner.
Imagine two families with babies in a restaurant. On one table there is a baby sitting up and in front of him is a selection of finger foods: a bit of pitta bread, some vegetables from mum’s plate, some chicken. While his parents eat and talk themselves, he picks up pieces of food and self-feeds. At the other table there is a baby being fed pureed foods. While his parents eat, he sits and watches and perhaps is shown books or toys. When his parents are finished, they ask the restaurant to heat up some puree and then a parent sits and feeds him with a spoon.
Both babies are being fed and getting the nutrition they need. One baby is part of the social experience of the meal and is moving towards feeding independence and one baby isn’t quite.
The advantages of baby-led weaning are that baby is experiencing food as a full sensory world. They touch it, smell it and see its natural colours. They are part of the family meal. Food starts out ‘real’ and never changes. Some babies may gag when self-feeding finger food but the chances of choking are no more than if a baby was being puree fed. Plus you don’t have to worry about eventually transitioning to more solid food. If you are really nervous about choking, this can be a good time to do a course in baby first aid. They are often available cheaply in places like local children’s centres or even take some time to look at some videos online: http://www.redcross.org.uk/What-we-do/First-aid/Baby-and-Child-First-Aid/Choking-baby.
You can tell from my obviously biased description that I’m a fan of baby-led weaning. It’s been recently promoted by the work of Gill Rapley, a health visitor who has written some useful books on the process. I heard her speak at a food festival once and she got us to do an exercise. We got into pairs. Someone spoon fed me a puree. I couldn’t communicate when I was ready for the next mouthful or easily communicate when I was done. I couldn’t smell the food or easily see the colour. The spoons of beige mush kept on coming. It tasted fine but I couldn’t even put a hand up to slow the process down or ask for a smell or ask to take a breath. It felt overwhelming and the spoons kept coming. After a few minutes, I started to feel like a torture victim. Clearly I am being melodramatic here but imagine you are breastfed baby who up until now has been fairly in control of their own feeding. Wouldn’t it be nice if solid food was an extension of that experience?
Of course, you may feel purees are right for you and be particularly attached to your steamer. Like with most things in parenting, you must do what is right for you. Lots of people combine pureed foods and finger foods in a baby-led weaning style. However I would recommend you at least find out about ‘baby-led weaning’ as it can be enormous fun.
Food before twelve months is ‘just for fun’ people sometimes say. Not quite true because in many cases, we will need to give baby additional sources of iron and other micronutrients before twelve months. When babies are born they get stores of iron from you and then as they breastfeed, they receive easily absorbable iron from the breastmilk. There was a time when scientists looked at the iron in breastmilk and thought it looked a bit low but we now know that was misleading as it is absorbed incredibly efficiently and is very bioavailable. Studies have shown that when babies are exclusively breastfed for as long as eight or nine months, they still have sufficient levels of iron in their system. However the recommendation to start solids at around six months gives them plenty of time to get up and running before we need to worry about there being a problem. It simply isn’t true that because we are now starting a little later, we’re in a huge rush to get huge bowlfuls of food into our baby or the world will end. We have time. It’s really important to remember that milk remains the primary source of nutrition up until twelve months. It’s only at twelve months that solids starts to take equal status and then gradually becomes to primary source of nutrition. Some eighteen month olds are still happily breastfeeding several times a day (and at night) alongside solids and it’s a valuable part of their nutrition. These statistics are helpful: In the second year (12-23 months), 448 mL of breastmilk provides: 29% of energy requirements, 43% of protein requirements, 36% of calcium requirements, 75% of vitamin A requirements, 76% of folate requirements, 94% of vitamin B12 requirements, 60% of vitamin C requirements (Dewey 2001). That’s not me saying everyone should breastfeed for 23 months. That’s me saying breastmilk continues to have good stuff in it, the best stuff. It’s not going to turn into some useless white fluid when your baby reaches six months and now it’s all about the mashed banana.
What should we feed them? Well, what do you like eating? There's very little a baby over six months can't have (something else that's easier after six months). We don't give a baby under 12 months honey because of the risk of botulism poisoning. We want to be careful about whole nuts which could be a choking risk but nut butters are fine. If you are worried about a history of family allergies, you should talk to your doctor but automatically avoiding certain foods may not be the most sensible approach - certainly not for everyone. You don't have to wait a few days before introducing another new food. You need to be sensible with sugar (and that includes dried fruit) and salt can be dangerous so if you are cooking meals for the family, season your own food separately after cooking. Babies can enjoy herbs and spices and strong flavours. They can eat eggs and seafood and meat and fish. Though you need to pay attention to the quantities of oily fish as they contain pollutants. Did you know that boys can eat more oily fish than girls? There's some more information here: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/understanding-food-groups.aspx#close
Babies can eat dairy products and they can also be vegan or vegetarians. They can drink water. They don't need juice. The suggestion is to minimise the amount of wholegrain foods a child eats under two years old.
Some people are concerned about how they are going to time their solid food meals. They are also worried about how to go about ‘dropping’ a breastfeed and reduce breastmilk appropriately. This is one of the great things about breastfeeding and introducing solids - you don’t have to stress about any of that. It happens naturally and organically and your baby is in charge with very little assistance from us. You just continue to breastfeed to your baby’s cues. That’s it. Bottle feeding mums do have to plan things out more carefully. Breastfeeding mums just continue to response to their baby’s cues and just ensure that the solids intake doesn’t increase too quickly.
When you introduce their first solids, think ‘milk first’. That means we don’t feed a solid meal when a breastfeed is due and then find they aren’t that hungry for breastmilk. Better to offer solid food in between breastfeeds or not long after a breastfeed. Food is like a new activity. You’ve introduced this wonderful new toy that tastes a lot better than the plastic giraffe they’ve been chewing on for a while. When two meals start to happen, milk is still ‘first’. It doesn’t have to be first in the sense that you breastfeed and then run from the sofa and plunge them into their high chair - just not long after or a few hours after. We don’t want the quantities of breastmilk they receive to really change much for a while. As they start to take more solids, gradually over a 24 hour period, they will take less breastmilk. You may not even notice it happening. Feeds may become a little shorter and intervals between breastfeeds a little longer. It will happen very naturally.
Eat with your baby. Enjoy meals together.
Illustration by Estelle Morris