From Breastfeeding to Family Foods - when baby needs more than milk
Around the middle of your baby’s first year, that is at about six months, your baby will start showing signs that he is ready for family foods: he will be able to sit up in a high chair or on your lap; he will have lost the tongue thrust reflex (that protects him against choking in the early months, but also means food gets thrust out of his mouth, rather than swallowed); he will be watching you closely as you eat and probably reaching for your food - but being able to grab objects and put them into his mouth is an actual sign of readiness ( after all, even young babies will watch you and may reach for food). Your baby may seem to suddenly be more hungry but not satisfied by extra milk feeds over a period of several days.
Introducing new foods – baby led or parent feeding?
There are two main styles of introducing family foods to your baby’s diet : you can introduce foods on a spoon or your clean finger to your baby or you can simply offer him pieces of what you are eating from your own plate (as long as foods are soft and safe). Many parents choose a mixture of both baby led (letting baby feed himself pieces of suitable food placed on his high chair tray or shared from your plate ) and parent feeding (food offered to baby with a spoon).
When to start family foods
The World Health Organisation and the National Health and Medical Research Council (NHMRC) both recommend starting family foods at around six months when baby shows signs of readiness. Recent media headlines claimed that it was beneficial to start solid foods at 4 months. However, the Centre for Food & Allergy Research (CFAR) which examines evidence to improve the way we manage food allergies, and seek novel treatments for them recently recommended three changes to the Australian infant feeding guidelines.
These revised recommendations are based on a consensus agreement by participants in the Infant Feeding Summit hosted by the Centre for Food & Allergy Research (CFAR) in May 2016. The reasons for the continued rise in allergic diseases, such as food allergy, eczema, asthma and allergic rhinitis (hay fever) are complex and not well understood. Although infants with a family history of allergic disease are at higher risk of allergies, infants with no family history can also develop allergies. Therefore, these guidelines are relevant for all families, including those in which siblings or parents already have food allergies or other allergic conditions.
1) When your infant is ready, at around 6 months, but not before 4 months, start to introduce a variety of solid foods, starting with iron rich foods, while continuing breastfeeding.
2) All infants should be given allergenic solid foods including peanut butter, cooked egg and dairy and wheat products in the first year of life. This includes infants at high risk of allergy.
3) Hydrolysed (partially and extensively) infant formula are not recommended for prevention of allergic disease. If your infant already has an allergic disease (such as severe eczema or food allergy), you should discuss what specific measures might be useful with your doctor. Why six months?
According to a statement by the Australian Breastfeeding Association,The reasons the major health bodies in the world and in Australia recommending around 6 months take into account ALL factors around the safest time to start which include but are not limited to allergies.
There are risks to introducing solids at 4 months and these risks include:reducing the mother's breastmilk supply and baby's breastmilk intake; increasing the risk of infection (particularly gastroenteritis); increasing the risk of obesity; increased strain placed on the baby's digestive system and kidneys, particularly in relation to digestion of starches.
There is absolutely no advantage to starting solid foods earlier than around six months – there is no evidence that solid foods will help your baby sleep longer for instance and, in fact, a baby with an upset tummy is likely to be more wakeful. Starting solids earlier than at least four months (but preferably closer to six months) poses a number of risks such as premature weaning and malnutrition if your baby eats too many solids and these displace milk feeds (milk will be most of your baby’s diet for the first year).
Or you could increase the risk of allergies by exposing your baby to potential allergens that his tiny gut isn’t equipped to deal with: between four and seven months a baby’s intestinal lining goes through a developmental growth spurt called closure. This means that the intestinal lining becomes more selective about what to let through. This is due to increased secretion of IgA, a protein immunoglobulin that acts as a protective coating in the intestines, preventing harmful allergens from passing through the gut wall. In the early months, IgA secretion is low (although breast milk is high in IgA), allowing allergens to easily pass through the gut wall and enter the bloodstream. As these particles enter the bloodstream antibodies may be produced to them, causing an allergic reaction.
So of course, these are valid reasons to see introducing solid foods as just that –an ‘introduction’ rather than a meal, and to wait until your baby is developmentally ready. However you choose to introduce family foods, if you have a family history of allergies or your baby has been sensitive to foods passing through your milk, it is wise to introduce a single food at a time in increasing proportions so that you can see how it affects your baby. If he experiences any adverse reactions such as tummy discomfort, vomiting or rashes with a new food, it is best to stop that food. If you have concerns, please check with a dietician or paediatric allergist.
Ditch rice cereal
Common infant feeding advice suggests rice cereal as a first food because it is low protein and therefore low allergenic (allergic reactions are triggered by foreign proteins). This advice started when babies were generally introduced to foods other than milk early (at around 3 or 4 months) . At this age babies are not ready to manage anything other than runny mush, nor are their gut linings ‘closed’ to foreign molecules that may increase sensitisation and potential allergies.
This advice was (and still is), heavily promoted by baby food companies. However, evidence based advice from the WHO recommends: ‘As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health.’
In a 2011 White Paper: Why White Rice Cereal for Babies Must Go’ Paediatrician, Dr Alan Greene, Clinical Professor at Stanford University School of Medicine warns of a potential connection between feeding babies refined cereals and obesity. He says, “I have been studying nutrition very carefully for more than a decade now and one of the things that I have become convinced of is that white rice cereal can predispose to childhood obesity. In fact I think it is the tap root of the child obesity epidemic.”
Dr Greene advises that white rice cereal is high in calories and made of processed white flour. “The problem is that it is basically like feeding kids a spoonful of sugar.”
He also explains that first food experiences can set babies on a path of food preferences. He says, “We know in animals that the first bite of solid food can be particularly influential. For human babies the moment of the first bite is laden with positive associations. The child has often been staring at the parents’ food choices, eager to learn what eating is all about. The child is the centre of attention at an emotionally charged moment, often with a camera capturing the event. The processed white rice flour is often mixed with breast milk or formula, giving it an even stronger positive association.
Conversion of the white rice flour to glucose begins while the cereal is still in the baby’s mouth, lighting up the hard-wired preference for sweets (and the cereal is nearly 100% glucose by the time it is absorbed in the intestines). Dr Greene says, “given this “perfect storm” of extrinsic and intrinsic factors, both initially and throughout the formative months, it is easy to see how a preference for processed refined grain products could become firmly established, and later in life, challenging to change.”
Rice cereal is very bland, so often parents mix it with stewed fruit such as apple or pears but why not simply offer your baby the fruit which is more nutritious? Or, your breastfed baby may enjoy a small amount of ripe mashed banana as this will be sweet like the milk he is used to. However, by the time your baby is truly ready for family food (around 6 months), he will be ready to explore a variety of tastes and textures - there are brown(unrefined) rice cereals for babies or you can offer oat porridge or congee (normal rice - not rice flour- cooked in bone broth, so it's highly nutritious).
Consider, if you are breastfeeding, your baby has already experienced a range of flavours passing through your breast milk so is more likely to enjoy foods that you eat as a family - a very good reason for eating a range of healthy foods as you breastfeed.
Baby led weaning
This style of introducing family foods is simply offering your baby whole pieces of food from your own menu and allowing him to choose how much to eat, rather than pureeing or mashing ‘baby’ foods and spooning them into your baby’s mouth (and often ‘encouraging’ him to ‘eat it all up’). This has now been labelled ‘Baby Led Weaning’ because your baby will naturally set the pace at which he is ready to proceed with eating.
The main principle with baby led weaning is that you offer your baby food by either allowing her to take it from your hand (or not, as she chooses), or you simply place food such as soft fruits or cooked vegetables on her highchair and allow her to feed herself. There are no purees and no spoon feeding. The baby leads.
Proponents of baby led weaning claim the advantages of this style of baby feeding include: babies get to explore taste, texture, colour and smell of foods naturally it encourages independent eating helps develop hand-eye coordination makes fussy eating and food fights less likely because you avoid stress around meal times and pressure to ‘eat it all up’ or encouraging your child to eat when she may not want to.
For a more comprehensive look at baby led weaning, download and listen to Pinky’s audio interview with with Gil Rapley, UK Infant Feeding Specialist, author and proponent of Baby Led Weaning.
Baby won’t eat yet?
Please don’t worry if your baby seems disinterested in eating with gusto for several months after you introduce his first tastes of solid foods. It is important to be respectful and trust that your child knows his own body signals for food.
A good rule to consider is: ‘it is your responsibility to provide healthy food and it is your baby’s choice whether he eats or not.’
And remember ‘food is fun until they are one!’ Your little one will never starve himself as long as he has access to healthy nutritious foods and at this stage milk will form the majority of his diet anyway.
If your baby is a ‘late starter’ and still seems disinterested in eating family foods at eight to ten months and you feel concerned, you can ask your doctor for a blood test to check his iron levels. Chances are, if he received all his cord blood at birth, you are breastfeeding and eat a healthy diet yourself, he is active (a baby with low iron levels will probably be lethargic) and his growth and development is on track, you can relax. Just expose him to family mealtimes so he can join in socially and model your enjoyment of food when he is ready.
Wondering about weaning?
For more tips on moving beyond exclusively breastfeeding, check out the Ebook Weaning With Love by IBCLC Lactation Consultant, Pinky McKay. Whether you are choosing to introduce family foods, wean from breast to bottle or you are happy to breastfeed until your nursing baby becomes a walking, talking toddler and initiates weaning by him or herself, or something in between, you will find tips to make this process as easy on you and your little one as possible.