Transcript Introducton to

Introduction of Solid Foods
Milk – whether breastmilk or formula milk contains all the nutrients a baby needs until it is
around 6 months old. At that point, the stores of
iron the baby has will begin to be depleted and the
baby has begun to develop the skills and abilities –
sitting up unaided, chewing and swallowing for
example - that will enable it to move onto
combining milk feeds with solid foods. Learning to
eat, like other developmental stages, is a process
for a baby and takes time and patience.
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NHS Message on Introduction of Solid Foods
For some time, the NHS message was to introduce complimentary
foods from 4-6 months of age and signs of readiness were mainly
around behavioural signs – waking more frequently, seeming
interested in food etc.
In 2004 the guidance was changed to reflect research into the
impact of weaning at 4 months and further information around
readiness. It also reflects the Government’s recommendation of
exclusive breastfeeding until 6 months.
Current message: Introduction to solids should be done
at around 6 months. If a mum is planning to do it earlier,
they should consult a health professional and avoid a
number of foods (covered later).
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Not before 4 months
Solid foods should not be given to babies younger than 17
weeks as their bodies are not ready for foods other than
milk. Key reasons are:
 It reduces the absorption of nutrients from breast milk
(COMA 1994)
 Babies at this age have Insufficient development of
neuro-muscular co-ordination to eat safely
 Their gut and kidneys are not mature enough to process
foods and waste products
 It increases the risk of infections and allergies
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Why at 6 months?
One of the main reasons for the guidance changing was
research into the developmental readiness of a baby to
accept food. At 6 months the baby’s digestive system is
more developed and has begun to produce the enzymes
necessarily to break down more complex solid foods. The
baby has also lost the tongue thrust reflex – this is the
reflex that makes a baby poke its tongue out of the mouth –
it is used to prevent a baby swallowing things that are
‘foreign to it’. At 4 months, this reflex is still present in most
babies and for those weaning at this age, they will see the
baby’s tongue forcing most of the food back out of the
mouth.
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Signs of readiness
At 6 months of age, the baby is also better co-ordinated
and able to:
• Reach and grabs accurately by coordinating eyes, hands
and mouth – enabling them to be able to pick up and
hold pieces of food or spoons
• Sit up unaided with good control of their heads
• Move food around their mouths and swallow
Only when all three signs are demonstrated is a baby
ready to be offered solid foods.
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False Signs
Often mums describe a range of different factors
as suggesting a baby is ‘ready for solids’:
• Waking at night when previously slept through
• Baby requesting more milk feeds/drinking more
at each feed and being hungry afterwards
• Chewing fists/blankets/toys
• Watching parent’s eat
• Trying to grab spoons/food
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False Signs
Many of these signs indicate that a baby is
experiencing a ‘growth spurt’ – and can often be
solved with giving additional feeds for a few days.
It may be that the wakefulness or chewing are
signs of the baby teething – which also occurs at
around 4-6 months.
Grabbing spoons/watching parents are ways a
baby is demonstrating its interest in the world – not
necessarily an interest in the food because they
don’t actually understand what it is yet.
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Sleeping
Common belief that giving solids will help babies to
sleep longer at night
No evidence for this
Henig MJ, Nommsen LA, Peerson JM et al
Intake and growth of breast-fed and formula –
fed infants in relation to the timing of introduction
of complementary foods: the DARLING study
(1993)
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Other considerations
Although the recommendation is to wait until around 6
months, baby food manufacturers are still able to label food
as suitable from 4 months. This presents a message that 4
months is the ‘normal’ time to introduce solid foods. The
ingredients within the baby foods can be labelled in this
way because technically they are suitable although the
recommendation is to wait until 6 months.
There has been some research linking the early
introduction of solid foods with increased risks of obesity –
linked to the fact that early introduction of foods may result
in babies being overfed – or fed inappropriate foods.
Evidence in this area is limited.
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Other considerations
SACN (Scientific Advisory Committee on Nutrition) are
currently looking at evidence for the recommendation for
introducing solid foods at 6 months. They are also looking
at whether specific foods such as wheat should be
introduced before 6 months. They will also undertake an
updated Infant Feeding Survey during 2010 which will
report in 2011/12.
This may result in a more broad statement around
introducing foods between 4 and 6 months – but as the
Committee has yet to report on this, the NHS
recommendation will remain the same for the foreseeable
future. Your role is to support current messages.
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Pressure to wean earlier
There are many factors at play which will influence a
family’s decision around when to introduce solid foods to
their baby – and what sort of foods they will introduce.
• Pressure from family
members or friends
• Baby waking at night
• Confusion over messages
• Wanting to move onto next
phase
• Cultural beliefs
• Marketing practices e.g.
“labels say it is ok from 4
months”
• Influence from health
professionals
• Previous experience of
feeding baby earlier
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Why should I wait?
Complete the activity “Why should I wait” and
share your thoughts with colleagues.
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Foods to avoid
If weaning before 6 months avoid:
• Wheat
• Eggs
• Shellfish
• Nuts
• Seeds
• Liver
• unpasteurised cheeses
These are linked with increased risk of allergies and food
safety – for example, choking and risk of listeria.
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Foods to avoid during weaning
• SALT – when cooking, salt shouldn’t be added. Babies cannot
process salt and high levels can damage baby’s kidneys. If you
must add salt, do it after taking they baby’s’ portion out.
• SUGAR – babies don’t need the empty calories in sugar and adding
sugar will encourage a sweet tooth later on
• HONEY – should be avoided until after the age of 1 year because
there is a risk of botulism in honey
• WHOLE NUTS – linked with a risk of choking under 5s
• LOW FAT FOODS - Under 2s need fats for development
• PROCESSED FOODS – contain too much salt for under 1s
• BONES of fish pose a risk of choking
• RAW EGGS or LIGHTLY COOKED EGGS – risk of salmonella
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Introduction of Solid Foods
There are several ways in which to begin to
introduce solid foods to the baby.
The more ‘traditional’ approach is that using
pureed foods and baby rice offered in small
quantities on a spoon.
Baby-led weaning is another approach which has
gained more popularity in recent years – that
approach builds on the principle of a baby learning
skills by trial and error and is about how they eat.
Both will be described in this session.
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Introduction of Solid Foods
At the beginning, the introduction of food is more
about introducing new tastes and textures and
learning new skills than the food providing the
nutrients for the baby. They will still rely on their
milk feeds for that for some time yet.
Each baby will take it at their own pace, will learn
and react differently. Patience and a relaxed
approach is the key to success.
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Introduction of Solid Foods
Key tips for mums:
• Expect mess
• It takes time
• Be patient - let the baby touch the food if they want to.
• Be prepared – have cloths and wipes available, cover
the floor – food can get everywhere!
• Make sure your baby is sitting up straight and is facing
forward. A highchair may be helpful.
• Remember its about learning – not eating - at first
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Getting Started
Small amounts of simple foods should be offered at first.
For example:
 mashed vegetable
 mashed fruit or puree fruit
 baby cereal eg rice or oats mixed with breast milk or
infant formula
Mums should pick a time of day when they are both relaxed
and offer tastes of food after a normal milk feed or half way
through a milk feed.
A plastic spoon is gentle on gums.
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First Foods
 Cereals eg baby rice or oats mixed with breast
milk/infant formula
 Mashed cooked vegetables eg potato and
carrot, sweet potato and parsnip, yam
 Mashed banana, cooked apple or pear, ripe
peaches or tinned fruit in fruit juice – drain off the
juice and mash
 Use a little of baby’s milk to mix food to
consistency
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Introducing more solids
Once the baby is comfortable eating a few teaspoons at one
meal a day, it can be gradually increased to a few
teaspoons 2 and then 3 times a day – to time with family
‘mealtimes’.
Mums should be encouraged to let the baby guide to how
much he/she wants.
New foods should be introduced one at a time to ensure the
mum can identify is anything upsets the baby’s stomach
They should also be encouraged to continue with their
normal milk feeds.
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More foods to try
Once baby is used to eating vegetables and fruit add meat
and alternatives group and bread and alternatives group eg
 Pureed or mashed up meat, fish and chicken
 Mashed rice, noodles or pasta
 Lentils (dhal) or pulses
 Full fat dairy foods eg yogurt, fromage frais, custard
 Mashed family meals
 Vegetarian babies should eat a range of pulses and
beans and sources of protein such a soya/quorn
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Happy Weaning
Other hints and tips:
• Mums should offer a range of different tastes and
textures – even foods they don’t like – to encourage the
baby to have a wide range of foods
• If baby doesn’t like the food the first time, try again over a
few meal times.
• Be relaxed.
• Ensure that baby eats with family.
• Use spices and herbs
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Finger Foods
Encourage baby to chew
Encourage as early as baby is ready: usually around 7
months
 Cooked carrots, cauliflower and broccoli
 Toast, breadsticks
 Chapatti
 Banana, slice of ripe pear, peaches
 Cooked pasta shapes
 Sticks of cheese, mini baby bel
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7 – 9 months
Once the baby has become used to eating a range of
different foods and become confident in eating, the baby
should be encouraged to eat normal family meal. Some
parts may need to be mashed or chopped into small
pieces.
Milk will become less important to the baby – they should
breastfeed on demand or, if formula fed, be drinking around
500mls per day.
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From about Nine Months
Ideally baby is having 3 solid meals a day with the
rest of family having –
 chopped or mashed family meals
 3 - 4 servings of bread and alternatives
 3 - 4 servings fruit and vegetables
 2 servings meat and alternatives
 Breast milk on demand or 500mls infant formula
milk
 Snacks – fruit, bread, toast
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At one year
3 family meals and snacks –
Eat with family
No more than 500mls/1 pint cows milk a day
Breast milk on demand
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Baby-led Weaning
The adult-led approach described before is the most
common approach to introducing solids. Baby-led weaning
is an approach advocated by Gill Rapley, whose
background in Health Visiting and work with UNICEF led
her to undertake research into the way babies learn to eat.
As a result of the research, she published a book “Baby –
Led Weaning”, and a complimentary DVD and has now
launched a website – www.babyled.com to promote this
approach to introducing solid foods. Clips from the DVD are
available via youtube.
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Baby-led Weaning
The principles behind baby-led weaning – are exactly as
they suggest – the process is led by the baby. Babies
learn most of their key skills by watching and copying –
moving, rolling, crawling, walking, talking – and learn with
support from adults, rather than being taught directly.
Eating is one of the few skills we feel that we have to teach
them.
For some babies, the adult-led approach seems to suit
them. But on the flip side, you may have already
experienced the sight of a mother frantically forcing a
spoon into a reluctant baby’s mouth. It often results in a
frustrated mother and frustrated baby.
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Baby-led Weaning
For some babies, the adult-led
approach seems to suit them. But
on the flip side, you may have
already experienced the sight of a
mother frantically forcing a spoon
into a reluctant baby’s mouth. It
often results in a frustrated mother
and frustrated baby.
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What is Baby Led Weaning?
 Infant controls his/her own solid food by self
feeding from the start of the weaning process.
 Given a variety of finger food in a high chair ie
soft fruit, baton shaped pieces of natural shapes
that have a handle eg broccoli.
 Not bite size bits
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Baby Led Weaning
Advantages
• Babies learn to cope with lumps better
• Babies learn to chew earlier
• Controls what, how and how much they want
• It is more fun for the baby (and therefore, for the parent)
• It is natural
• Learn more about individual foods – rather than pureed
tastes all mushed up together
• No mealtime battles
• Less fussy
• Cheaper – baby eats what parents do
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Baby Led Weaning
How is it ‘done’?
• Make sure baby has already been ‘fed’ (a milk feed)
• Allow baby to touch, feel and experiment with foods
• Let baby join in normal mealtimes/snack times
• Make sure baby is sitting upright and safely – in a
highchair or on a lap
• Offer finger foods that are easy to hold in their hand –
sticks of finger food like broccoli, carrots, parsnips etc
(soft but not soggy)
• Offer food – don’t be tempted to put it in the baby’s
mouth – and less is more.
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Baby Led Weaning
Using the link below have a look at the information
on BLW and watch the clips from Gill Rapley’s
Baby Led Weaning DVD to understand the
approach in more detail.
www.rapleyweaning.com
www.baby-led.com
Discuss what you see with your colleagues in the
forum.
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Premature Baby
Wean in same way as term baby
Start 5 – 7 months chronological age not
corrected age (Bliss - premature baby
charity)
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Commercial Baby Foods
There is a huge commercial market for baby foods – with
associated advertising campaigns and promotions. Indeed, a
recent Celebrity diet craze promoted the “Baby Food diet” as a
way to lose weight.
Commercial baby foods are prepared to nutritional standards but
still contain added sweeteners and preservatives that home
cooked foods do not. In addition, despite ranges offering a vast
variety of meals and tastes, many are bland and tastes startlingly
similar.
These are also much more expensive than home cooked foods
and lull parents into a routine of thinking their babies are better
with commercially prepared – rather than home cooked foods
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Commercial Baby Foods
Commercially prepared baby foods are ok for convenience
on odd occasions, but shouldn’t form the basis for a baby’s
introduction to solid foods for several reasons:
• Uniform texture, don’t offer challenge to babies
• Ingredients heated to high temperatures possibly
destroying key nutrients
• Not exactly fresh if it can last on a shelf for up to 2 years
• Doesn’t encourage wide range of tastes
• Contain more water, sugar and starch than homemade
foods
• Costs much more than equivalent home cooked versions
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Try it yourself
Complete the “Try it yourself” activity.
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Home cooked meals
Mums should be encouraged to cook for their own babies –
even if they don’t have great cooking skills. In the first few
weeks, cooked vegetable sticks or mashed vegetables will
be more than enough.
Think about some easy recipes to explore together – base
around current family meals.
Use it as an opportunity for the whole family to eat healthily
and share meals.
Babies will always eat the leftovers the rest of the family
won’t.
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Making baby food
Cool food as quickly as possible (ideally within 1 or 2
hours) and place it in the fridge or freezer. Food placed in
the fridge should be eaten within 2 days.
Make sure frozen food is thoroughly defrosted before
reheating. Safest: overnight in fridge or defrost in
microwave.
Always wash hands before food preparation and check
baby’s hands are clean before feeding
Keep surfaces and chopping boards clean. Prevent pets
from coming near food or food preparation surfaces
Cook all food thoroughly and cool it to a lukewarm
temperature before giving to baby.
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Different Cultures
Key messages:
 Traditional home cooked foods are healthier
than commercial foods or “western foods”
 The marketing of baby foods makes everyone
want to buy them but home cooked foods are
cheaper and more nourishing for baby
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Cerelac
Nestle product marketed for babies older than 8
months. It is mixed with water and contains wheat,
oats, rice, skimmed milk powder oils and some
vitamins.
It is used by many families from Asian or AfricanCaribbean backgrounds.
It is a high calorie food (211 cals per 50g serving)
and is marketed to fatten babies.
It is not necessary in the UK as a supply of protein
foods and calories.
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Drinks and Cups
• Cooled boiled water best for teeth
• Pure fruit juice only at mealtimes diluted one part juice to
10 parts water
• Squashes, fizzy drinks, undiluted pure fruit juice are not
recommended because they are acidic and cause dental
erosion
• Drinking tea interferes with iron absorption so should be
avoided
• Drinks should be given in lidded cups or beakers –
bottles should be replaced as soon as baby can use a
cup
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More Information
Many parents lack of confidence with introducing
solid foods. Ensure you are aware of services
available locally in Children’s centres, weaning
parties or groups eg baby massage, breastfeeding
groups, or via the family’s Health Visitor.
Other sources of information include:
www.nhs.uk/start4life and www.nhs.uk
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