Monday, February 2, 2015

Baby 101: Starting Solids

Disclaimer: I am not a health or medical professional; this is strictly based on my own research, experience, and mommy intuition. :)
The first several months of feeding a baby are straightforward: breastmilk or formula, and that's it.  The only questions are how much and how often, which your baby is usually pretty good about communicating (ha!)  I found introducing solids to be slightly overwhelming, in no small part due to the vast amounts of conflicting research that's out there.  No matter your position on solid foods, there is a study that both supports and contradicts it, so you really have to go with your pediatrician's advice and your gut.



There is a ton of conflicting information about when to start solids; most health professionals agree that 4 months is the absolute earliest you should start any kind of solids (unless directed by a pediatrician earlier for a medical condition like reflux).  However, many sources will advise waiting until around or after 6 months before beginning solids, including the American Academy of Pediatrics and the La Leche League.  The rationale behind this theory is that prior to 6 months, babies have a "virgin" or "open" gut, which allows particles from anything they consume to pass directly into the bloodstream; this can (in theory) contribute to food allergies. 
Due to all the opinions out there, we decided to follow our pediatrician's advice; she instructed us to start solids NO EARLIER than 5 months but said that we could wait until after 6 months if we wanted.  We had planned to wait until 6 months, but slightly after 5 1/2 months, C was showing signs of being ready for solids, so we started about a week and a half before he turned 6 months old.  (To me, this is "around" 6 months, which is what the AAP and LLL recommend). Different babies are ready at different times, though, so there's no universal "right time".  If you try to start solids and your child can't figure out how to swallow (instead spitting it out), wait a while and try again; they may just not be ready yet.  C was instantly able to eat off a spoon and swallow the food, so I feel like our timing was about right for him.


There is also a lot of confusing advice about WHAT to feed your baby first.  Conventionally, rice cereal has been a baby's first "solid".  Now, there are other options like oatmeal and barley cereal.  There are also a lot of people who discourage starting with baby cereal and instead recommend starting directly with fruits and vegetables, since baby cereals are essentially empty calories.  Again, due to all the conflicting information, we consulted our pediatrician.  Based on everything I had read, I was planning to skip the cereals and go straight to pureed vegetables.  

However, our pediatrician strongly encouraged feeding C cereal first, since he is exclusively breastfed; baby cereals are iron-fortified, and breastfed babies begin to have declining iron levels after 6 months old, since breastmilk doesn't contain a lot of iron.  (For the first 6 months, babies survive off the iron they got from your placenta in utero).  Formula is iron-fortified, so this is less of an issue for formula-fed babies.  She agreed that cereal is "empty calories" but said that it was necessary for the iron content, so we complied. 

I did choose to feed C organic, whole-grain baby cereal (instead of the standard Gerber product), and also decided to do oatmeal in lieu of rice cereal, due to the arsenic levels in rice.  We're using Earth's Best Organic Whole Grain Oatmeal, which you can buy at any grocery store.  It is recommended to start with single-grain cereals while you monitor for any food allergies.  We started with 1 tablespoon of dry oatmeal cereal mixed with breastmilk; we experimented with the consistency until we figured out where C was in terms of swallowing (we started with it very runny and gradually made it thicker as long as it appeared he could handle swallowing it).  We've been using the Gerber Graduates soft-tipped spoons, which are the perfect size and soft on baby's mouth (which is good because C likes to "chew" the spoon with each bite with his gums, which seems painful with a metal or hard plastic spoon).

After the introduction of oatmeal, we gradually started introducing pureed vegetables.  Our pediatrician advised waiting 4 days between each new food introduced so you can monitor diapers and skin for food allergies.  4 days after introducing oatmeal, we gave C avocado, which I mashed well with a fork and mixed with a tiny bit of water to make it runnier.  I plan to introduce several vegetables before we try fruit so that he doesn't develop a preference for sweet foods (I'm not sure if this is scientific, but it seems logical to me).  Similar to the cereals, the first foods should be single-fruit or single-vegetable so you can monitor for food allergies; later, vegetables and fruits can be mixed together if desired.  So far, C has happily eaten everything we've fed him, but some babies appear to dislike certain fruits or vegetables, so their parents stop feeding it to them.  I've read that it can take 3-4 times for a baby to adjust to the taste of a fruit or vegetable, so don't give up if baby spits it out on the first try - it may just take a few more tries before they like it.

Baby-led weaning is a popular subject in the mommy world right now, and I don't have strong opinions about it.  If you're not familiar with it, in a nutshell, this approach involves feeding your baby very small pieces of soft, cooked food but NOT pureeing it.  We personally chose not to use this approach since C eats half of his solids at daycare, and we don't feel comfortable with the increased choking risk without one of us present.  It may have been a different decision if I were a stay-at-home-mom who was going to directly supervise every meal he ate, but that's neither here nor there.

How much?

Right now, at 6 months, C eats 1.5 tablespoons (dry measurement) of oatmeal, mixed with water or breastmilk, for "lunch" everyday, and 2 tablespoons (1 ounce) of pureed vegetables + 1 tablespoon (dry) of oatmeal cereal mixed with water or breastmilk for dinner.  He has his bottle (pumped breastmilk) or nurses first, though, to ensure that he doesn't get too full on solids to drink his milk; formula or breastmilk should continue to be baby's primary source of nutrition for the first year of life.  Contrary to logic, babies should not decrease their formula or breastmilk intake after they start solids; it should stay the same (25-35 ounces per day).  If your baby begins consuming less milk, you should cut back on the amount of solids or change the timing of when you serve them, since milk/formula is more nutritional.  (Hence the phrase, "food before one is just for fun.")  Some babies do well with a bottle/nursing immediately followed by solids, while some babies need to space it out (say, a bottle/nursing and then solids an hour later). 

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