Introducing Solid Food to Babies – PediaCast 585
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Show Notes
Description
Cinthia Scott and Dr. Krupa Playforth visit the studio as we consider introducing solid foods to young infants. Scientific evidence has led to a more straightforward approach, but essential strategies and safety concerns remain. We hope you can join us!
Topic
Introducing Solid Food to Babies
Guests
Cinthia Scott
The Baby Dietician
Author, Baby Leads the Way
Dr Krupa Playforth
The Pediatrician Mom
Author, Baby Leads the Way
Links
Baby Leads the Way: An Evidence-Based Guide to Introducing Solid Foods (Amazon | B&N)
101 Before One – Baby-Friendly Meals Your Whole Family Will Enjoy – Together
The Baby Dietitian (Instagram)
The Pediatrician Mom (Instagram)
Episode Transcript
[Dr Mike Patrick]
This episode of PediaCast is brought to you by Nationwide Children's Hospital.
Hello, everyone, and welcome once again to PediaCast. We are a pediatric podcast for moms and dads.
This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 585.
We're calling this one Introducing Solid Foods to Babies. I want to welcome all of you to the program. We have an important episode for you this week, especially if you have a young baby at home, or you are expecting a newborn, or if you know someone who has or is expecting an infant, this episode will be an important one to share.
Introducing solid foods to babies has changed considerably since today's grandparents had children. I think it's easier, to be honest, with fewer rules, but there are some important safety considerations that we have to keep in mind. This is one of those things where you might not want to get advice from your parents or other relatives or neighbors because we do have evidence-based approaches for introducing solid foods, which were not known or available for parents a couple of decades ago.
Back then, it was based on tradition and not so much science. However, even with the new approach being more straightforward, it can still be overwhelming, but also exciting. Today, we're going to explore the process of introducing solid foods to infants, including signs that they are ready for solid foods, the concept of baby-led feeding, how do we prevent food allergies, and strategies for stress-free family meals.
Of course, in our usual PediaCast fashion, we have a couple of terrific guests joining us in the studio. Cinthia Scott is the baby dietitian and co-author of the book, Baby Leads the Way. Dr. Krupta Playforth is a pediatrician in Virginia. She's also the pediatrician mom online and also co-author of the book. Before we get to them, I do want to remind you the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals.
If you're concerned about your child's health, be sure to call your healthcare provider. Also, your use of this audio program is subject to the PediaCast terms of use agreement, which you can find at pdcast.org. So, let's take a quick break. We'll get Cinthia Scott and Dr. Krupa Playforth settled into the studio, and then we will be back to talk about introducing solid foods to babies. It's coming up right after this.
Cinthia Scott is a registered dietitian and board-certified lactation consultant.
She is also an educational content creator with a website and Instagram called The Baby Dietitian. Dr. Krupa Playforth is a pediatrician in Vienna, Virginia. She also has a website and Instagram.
Hers is The Pediatrician Mom, and we will put links to both of those sites in the show notes over at pdcast.org. Together, they authored a book for the American Academy of Pediatrics called Baby Leads the Way, an evidence-based guide to introducing solid foods. That is what they are here to talk about, introducing solid foods to infants.
But before we dive into our topic, let's offer a warm PediaCast welcome to our guests, Cinthia Scott and Dr. Krupa Playforth. Thank you both for visiting us today.
[Dr Krupa Playforth]
Thanks for having us.
[Dr Mike Patrick]
Yeah, absolutely. We are very happy to have you. I think a good place to start, Cinthia, from a baby's point of view, what are the signs that they are ready to start solid foods?
[Cinthia Scott]
Yeah, that is a great question. There are four things we're typically looking for to determine if a baby is ready to start solids, and the first one is going to be, are they around the developmental age of six months? That's when we are starting to see the signs that they're developmentally ready for solids, but also that is when there's actually a nutritional need for complementary foods to be introduced.
We're also wanting baby to be able to sit up unassisted and bring things to their mouth, whether that's a toy or food, but doing the motion of bringing hands and objects to their mouth and good head and neck support.
[Dr Mike Patrick]
Those are going to be the big ones. So, six months of age that they are sitting up well with little support needed, and they have an interest in foods and watching and seem to want to eat because they see you doing it and they want to do it too, right? Yes, absolutely.
And that's usually around six months of age? Yes. Okay.
Now, when I was training, it was like this format that everybody was supposed to follow, and you started cereal at four months, and then after that, you would do vegetables, and then you would introduce one thing at a time, and then fruits and introduce one thing at a time, and then by the time you got to six months, you're ready for the meat stuff. But you're saying really breast milk and or formula until six months of age and then start the solid food at six months rather than four months. Is that right?
[Cinthia Scott]
Yeah. So, breast milk or formula supplies all the nutrients a child needs in those zero to six months of age. So, there is not a necessary nutrient need at that time, and there also may be some benefits to waiting until your child's more developmentally ready for those solid foods.
Whether you're… I mean, some people will choose to start a little bit earlier than six months if they are seeing all those signs of readiness and their doctor has given them the A-okay for that, but we would want to wait until six months to provide any type of finger food just because that is when we're seeing the safety aspect. It's safer for a baby to do the finger foods and the more baby-led feeding style around that age.
[Dr Mike Patrick]
Okay. And then, Dr. Krupa, when is it safe then to let babies feed themselves, and what are some safety tips for making sure that that's done in a safe way and that kids aren't choking on their food?
[Dr Krupa Playforth]
I think this is a surprising idea behind baby-led feeding, which is that you can start giving babies finger food at six months of age as long as they are prepared safely and correctly and in a developmentally appropriate way. So, the book goes over this, but between six and nine months, they have that plantar grasp. Their oromotor skills are still developing.
They don't have mature oromotor skills yet. So, you can give finger foods, but you want to make sure that those foods—and this is the counterintuitive piece of it—those foods are long and bigger. We always think, oh, you're less likely to choke if a piece is smaller, but in fact, those babies are less likely to choke if the piece is long and thin and squishy, and we want it to follow something called the squish test or pass the squish test.
And then as they get older, 9 to 12 months, you can modify to smaller pieces. You still kind of want to make sure that you are avoiding choking hazards and things like that, but as long as you know that you are avoiding choking hazards and that you are presenting food safely, you can begin at six months.
[Dr Mike Patrick]
Yeah, and I love that you say that, and you're right. You think, oh, it's something that's too big. They could choke on it, but we really worry about those small things that could get in the airway and get stuck there.
So, we really want to avoid whole grapes and nuts and things that in their whole form are the perfect size to fit down in the trachea, correct?
[Dr Krupa Playforth]
Correct.
[Dr Mike Patrick]
Yeah, and then the squish test, I hadn't heard that before. I really do like that, though. So, you want it to be something that they're going to be able to take a piece off of it, and they may not have teeth at six months, and so you want it to be something that they could gum and still get a piece off of it to chew and swallow.
[Dr Krupa Playforth]
Exactly. Between six and nine months, they have a kind of a vertical munching pattern, and so the ability to munch on something that follows the squish test will make it safer.
[Dr Mike Patrick]
Yeah, and I would imagine you also want to be watching your kiddo. So especially when they're first learning how to do this, you don't necessarily want to turn your back on them and be fixing dinner for the family. You really want to be engaged and sort of watching and supervising them, because choking can be completely silent, correct?
[Dr Krupa Playforth]
Choking is completely silent, and it can happen so quickly. If your child is making that gagging noise, which many of us are familiar with if you've ever introduced solids to babies before, that is a sign that there is some air moving. That's why they're making the noise.
It can progress to choking, but as they're learning the skill, identifying gagging and when to intervene is part of the skill that we develop as parents. So, I think it is really important, and not just in those early months, but always, to be watching your child when they're eating.
[Dr Mike Patrick]
Yeah, yeah, and that's really, really important. In terms of choking itself, and you make a good point. It's not really choking if you're making noise, because then the air is moving, and you just want to sort of let them be and see if they're going to continue to closely watch them and make sure that they maintain their airway.
But then if they really are choking and maybe turning color in the face and not making any noise, this is a really good reason for new parents to have CPR class and can practice what to do in terms of back blows and, you know, if your baby's choking. But it's best to sort of have some practice at that. So, you would probably recommend that all new parents have CPR training, yes?
[Dr Krupa Playforth]
We do. We recommend that all new parents have CPR training, regardless of the method that you are potentially going to choose to introduce solids, because you can choke on purees and you can choke on non-food items. So, knowing what to do, and not just parents, but anyone who's going to be taking care of your baby.
So even a nanny or a grandparent, everyone needs that refresher right before you start the solids.
[Dr Mike Patrick]
Yeah, yeah, absolutely. Cinthia, you know, the baby food that comes that you buy at the grocery store in a jar and it's already nice and soft is one way to go, but you can also make your own purees at home, is that right? And how do you know what to use and ingredients and all those things?
Or is it not complicated?
[Cinthia Scott]
Yeah, we really try to not complicate it. We really try to focus on family meals from the start. So, taking what you and your family are already enjoying and loving, especially if you have a lot of cultural dishes or tastes that you really prefer, because we want to go ahead and expose baby to the foods that we want them to eat when they're 12 months and two and all of that.
And so, of course, we're going to modify the family meal to make it safe. So, we're going to make sure that it's the appropriate consistency, that it's served in the appropriate size, and we're going to leave off extra salt or added sugar to baby's portions. But for the most part, our book really focuses on modifying meals to make them baby safe and not overly focusing on having to make individual homemade purees and do almost like you're making double meals.
That can be really overwhelming for parents and it just kind of makes the whole process a little bit more stressful than it needs to be. And then when we're trying to transition the child away from purees to more family meal style, we might run into some hiccups versus if we just kind of started that to begin with. So, we definitely, I think all of us that are moms that have written this book, we've relied on packaged purees to help when we're running out of time or short on time.
We've also probably dabbled a little bit in some homemade purees too. But I think majority, we just try to modify family meals whenever possible.
[Dr Mike Patrick]
What do you do when it's family mealtime and maybe your baby's not hungry or you mentioned baby-led feeding and so we want to honor baby's hunger cues and hopefully get an idea that if they're fussy and you feed them something and the fussiness goes away, they were maybe hungry or maybe they just wanted something in their mouth and they were bored. Like how do you tell if your child really needs to eat at a particular time?
[Cinthia Scott]
So, when we're just starting solids around six months, we're just starting with one meal a day and we're recommending that that one meal a day be when you have a lot of time for baby to explore and baby's in a good mood. So, they're not overly hungry, but they're also not overly full. So, it's a really sweet spot we're trying to aim for.
It can be kind of hard because our baby's moods fluctuate so quickly, but we really want to have a space and a time where they don't feel stressed or pressured and they're in a relatively good demeanor. And then as they get to eight, nine months is when we're going to start adding in two to three meals a day, two to three meals a day and then kind of get more on a consistent mealtime so that they know when to expect meals every day.
[Dr Mike Patrick]
Yeah, I would imagine that you want to introduce like lots of different things and as I think about a lot of toddlers and my own kids when they were toddlers, they can be such picky eaters. Is there something that you can do when you're beginning to feed them to encourage them to maybe accept more things rather than just a short list?
[Cinthia Scott]
Yeah, that's really why we promote variety in the beginning is because there is some studies that show there is a link to the more diet diversity given earlier on when our children are in the adventurous eating period per se, that if we expose them to all these flavors and textures earlier on, they're more receptive to consuming those foods later on as they're in the toddler age and older. I mean, research shows that the first 1,000 days of life, even the foods that mom is eating while pregnant and breastfeeding can shape taste preferences. And so, I think it's something really cool and modifiable that we can do early on.
[Dr Mike Patrick]
Yeah. You know, as I think about the ways that medicine has changed just even since I've been in practice, it was thought that if we avoid foods that are typically thought of as high allergic foods, so things like peanut for example, that if we wait until they're 12 months old, that that might help to prevent allergies. And then what we discovered is actually waiting may make it more likely that you'll have an allergic reaction to a particular food.
So, Dr. Krupa, how do parents know what to do in terms of these, you know, foods that are typically seen with food allergies and how do you introduce those?
[Dr Krupa Playforth]
I love that you brought that up because that is such a shift in the way that we introduce solids. Even when I trained in pediatric residency, we were still in this phase of, oh, you should put off these allergenic foods and introducing them. And I think the thought was partly that if they did have a reaction and they're older, maybe they have more reserve, which is probably true.
With that said, the LEAP trial, which was the first fundamental trial on peanuts, showed that early introduction has the potential of decreasing risk for developing an allergy later on. But I think it's really important to keep that in context because allergies are a result—they're multifactorial. There are so many reasons that a child might have an allergic reaction or be allergic to a certain food, and I don't want anyone who's listening to this to take away from it, oh, because I did not do that, it is my fault that my child has a food allergy.
But we know that this is something that can help. The book goes over exactly how to introduce the allergens, what are the top nine allergens to introduce. We have data on some of them, but we're extrapolating to all the top nine allergens.
And we want, once we've introduced them and we know that the child will tolerate them, we want to keep up the frequency three times a week for each of those allergenic foods just to maintain that exposure. Because even longitudinal data has shown us that maintaining that exposure leads to a sustained protective response to developing that allergy.
[Dr Mike Patrick]
Yeah. If you have a baby who has severe eczema or atopic dermatitis even before six months of age, those babies may be at a little higher risk for food allergies. And so maybe really collaborating with your pediatrician, and depending on the clinical situation and the family history and such, they may even want to bring an allergist in to kind of supervise the introduction of some of these foods, right?
[Dr Krupa Playforth]
Right. So for babies who are considered high risk, and that definition is narrower than I think most of us assume, but having severe pre-existing eczema, so severe eczema that is not responding to normal measures, and having a pre-existing food allergy, which obviously as your child is just starting out, you wouldn't know anyway, having those two risk factors or even one of them puts you into a category where you are higher risk for developing subsequent additional food allergies. For those babies, there may be a benefit to introducing allergens between four and six months. But we're not saying, oh, you start giving them these foods.
These are just minor exposures. But that is something that a parent should do with close guidance from their pediatrician and their allergist if they have one, because they need to know what to do if there is an allergic reaction.
[Dr Mike Patrick]
Yeah, yeah. And we still have to pay attention to all those safety rules. So, you know, whole peanuts are definitely something that's small enough to get stuck in the airway.
And there aren't really peanuts that are naturally long and mushy. So, we do want to use products that introduce peanut protein without necessarily being dangerous.
[Dr Krupa Playforth]
Exactly. Even peanut butter, which is obviously a thinner consistency than peanuts themselves, can be a choking hazard. So, it needs to be thinned out appropriately.
And the book goes over the specific ratios for how to do that. So, for peanut, for example, the perfect ratio of thinning peanut butter is mixing two leveled teaspoons of peanut butter with half an ounce of breast milk and or formula or water. And that is the consistency that is considered safe.
[Dr Mike Patrick]
And then what are some signs of a food allergy, especially if you if you're a new parent, this is your first baby, maybe you've never had food allergies before? What should they be looking out for in terms of signs that their baby may be allergic to a particular food?
[Dr Krupa Playforth]
So, signs of a mild food allergy include the one that most parents are familiar with as the hives. So, a few hives, maybe an itchy mouth or itchy skin, which obviously in an infant you're not going to know. Sometimes they sneeze a little bit, they develop a little nausea or kind of a stomach upset, but it's very limited to one organ system.
Signs of a severe food allergy, in other words, where we're thinking anaphylaxis, we have severe hives, vomiting, coughing, wheezing, shortness of breath, swelling of the lips and the tongue, even sort of altered mental status where they're starting to become less alert, confused, that kind of thing. Those are signs of a severe allergic reaction. And the real question that parents want to know the answer to is, what do you do?
So, when I see patients in the office clinically, we always talk about having an oral antihistamine in the house when you're introducing allergens. And then the book goes through additional safety things, like if you're going to introduce a new allergen, do it earlier in the day so that if they have a severe allergic reaction, that's most likely to happen in the two hours after the exposure, so you're still watching them ideally. Knowing when to give an oral antihistamine versus calling 911 and getting your child to emergency care is a good conversation that every parent should have with their pediatrician.
[Dr Mike Patrick]
Yeah, yeah, very important to talk about that. And I love that you mentioned it's usually pretty quick, so a couple of hours, oftentimes even within a half an hour, eating something, if there's going to be a severe reaction, that's when it's most likely to happen. And so again, just supervising your kids, watching for symptoms and signs, especially within the first hour after eating.
Could be up to two hours, but it's usually quick, is the take-home. So, Cinthia, what are some easy nutrient-packed first foods that we can give to our babies? You mentioned starting out with just one meal a day, but they do have this need.
How can we get the most bang for our buck when we're first starting to feed them?
[Cinthia Scott]
Okay, so the foods we want to focus on introducing are ones that are super nutrient dense, like you said, so really high calorie, high in fat, and iron-rich, because those are some of the most important things we need for baby at this time. We also know that they're only going to consume small volumes, so packing in a lot in like a small portion size, one or two spoonfuls is really important. So, some of the foods that we really love are avocados, eggs, sweet potatoes, meats, salmon, lentils, beans, bananas, things like that.
Anything that packs a lot of nutrition in just a couple bites is really important.
[Dr Mike Patrick]
And then I want to focus in on the family meal once again. So, Dr. Krupa, what can parents do if their one meal for their baby is going to be the family meal? How do you modify that for the baby?
We talked about pureeing things. Are there other things that we ought to think about?
[Dr Krupa Playforth]
The idea behind the book is that we want to modify what the rest of the family is eating in a safe way so that the parent does not have the pressure of cooking an additional meal or an additional puree. So, we kind of went over some of the ways to do that earlier, you know, considering choking hazards, making sure things are prepared in a developmentally appropriate way, making sure that things are not overly salted, there's not too much added sugar. But I think the other piece to remember is that mealtime is a social event.
It is more than just the food that you're eating. And parents need to kind of get into this mindset of let the baby participate in the meal, even if they're not really consuming a whole lot. Sitting down and participating in the ritual of a meal has a lot of benefit, and it sets the foundation for hopefully long-term great family mealtimes.
[Dr Mike Patrick]
Yeah, which we know is sometimes a struggle and a challenge, especially with busy schedules, but definitely an important social thing to do. And it's a great opportunity to communicate and sort of share what everyone's day has been like and the challenges. And we can learn from each other as well as just communicating as a family.
[Dr Krupa Playforth]
I think the other piece of this, though, is lifestyle-wise, not everybody can do it at, say, the big meal, which is often dinnertime. If you're, you know, working, if your kids have activities, especially as they get older, even if you do it two or three times a week, and even if the family meal is not dinner, if the easiest one for everybody to sit down and do together is breakfast, then make that the family meal. You can take the pressure off or modify these recommendations for what works for your family realistically, and that might change over time as well.
[Dr Mike Patrick]
Yeah, yeah, great points. We're going to have a resource in the show notes for folks called 101 Before 1, and it is baby-friendly meals that your whole family will enjoy together, and we'll put a link to that just to give you some ideas about what sort of things that we're talking about that are safe meals for the whole family, but also safe for your baby too. You know, we talked about introducing lots of different things and hopefully being able to prevent some of the pickiness down the road, although that may not be preventable.
That's just the nature of toddlers. But are there other things that we can do to encourage them to eat those diverse foods? So, like, if there's a particular food that a baby always is like, no, do you just stop trying, or do you keep trying to do the same ones that you know they don't necessarily like?
Will they eventually learn to like it?
[Dr Krupa Playforth]
It's important to keep a little context. Like you said, all toddlers are picky. The neophobia is developmentally appropriate, and so when they become 12 months and they're starting to have those phases of eating where they go through food jags or, you know, they don't want to try something, it's very tempting for parents to just stop offering those foods and to get into this routine where all you're offering is, you know, butter pasta and mac and cheese and grilled cheese or whatever it is. Keep exposing them and keep modeling eating those meals because they may surprise you. And I always tell parents in clinic; you have to remember that you are playing the long game here.
Most of the time, by the time that they are four or five, that they are starting to get over that neophobia and they may be willing to try something. This actually happened for us with my four-year-old this week, where for ages I've been trying to get him to have sweet potato, and this week he liked it so much he ate four sweet potatoes in like a single sitting. Admittedly, they were small, they were small, but still it was kind of out of nowhere.
But when you come from a culture of not wanting to waste food, it can feel really hard to do that. So just keep encouraging it and don't lose hope because just because your child is picky now does not mean that they are not destined to become a foodie, for example.
[Dr Mike Patrick]
Yeah. I would imagine, Cinthia, one of the challenges that families face is advice from well-meaning relatives, and that may be your own parents, so the baby's grandparents, it could be aunts and uncles, it could be neighbors. Everybody has an opinion.
What are some strategies for really helping relatives understand that things have changed and that this baby-led feeding is an important thing and things have changed so much that that may be difficult for people who did it a different way and just say, oh well, you turned out all right.
[Cinthia Scott]
Oh man, yeah, that's a good one. I think my main strategy when I have dealt with that with my family or friends or whatnot is sharing the evidence with them, and this may work with some people and some people might not really care, but that's the whole premise behind our book is that it's evidence based. We have research to support the things we recommend.
We're not just recommending it to be trendy or to make more work for parents or anything like that. We're recommending it because these are evidence-based tips that can support optimal nutrition, optimal growth, and help foster a healthier relationship with food.
[Dr Mike Patrick]
Yeah, very important. So, you could actually send them a copy of your book, and that might be a little passive aggressive. Maybe hand it to them in person or maybe show them some things and point out this is based on evidence, that this is a really good way to do it.
We are going to put a link to the book, Baby Leads the Way, an evidence-based guide to introducing solid foods, published by the American Academy of Pediatrics, and we'll put links to it so folks can find it easily in the show notes over at pdacast.org. This is episode 585, so you'll be able to find that easily. I will also put a link to that resource I told you about, the 101 Before 1, baby-friendly meals your whole family will love together.
And the baby dietician and the pediatrician mom on Instagram, we'll put links to both of those as well. So, Cinthia Scott, author of Baby Leads the Way and an infant dietician, and Dr. Krupa Playforth, the pediatrician mom and also author of the book. Thank you both so much for stopping by today.
[Dr Krupa Playforth]
Thanks for having us.
[Cinthia Scott]
Thank you so much.
[Dr Mike Patrick]
We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that. Also, thanks again to our guests this week, Cinthia Scott, the baby dietician, and Dr. Krupa Playforth, the pediatrician mom, and both of them authors of the book, Baby Leads the Way. Don't forget, you can find PediaCast wherever podcasts are found. We're in the Apple Podcast app, Spotify, iHeartRadio, Amazon Music, Audible, YouTube, and most other podcast apps for iOS and Android. Our landing site is pdacast.org.
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