Helping infant/toddler staff support parents in delaying the feeding of early solids.
Authors: Linda Kimura, M.A. & Lisa Gartin, R.N.
We continue to receive questions from new parents (and infant/toddler caregivers) who want to feed cereal and other solid foods to babies at very early ages. Caregivers often remember feeding rice cereal in bottles when their babies were small and assume they can use the same process for children in their care. Many parents are strongly encouraged toward early feeding by their own parents. They view the introduction of solids as a positive developmental milestone that they are anxious for their babies to achieve. However, like all developmental milestones, each baby reaches it at her or his own individual pace. There is no absolutely correct age to introduce solids; and feeding solids too early can actually cause more harm than good. In most areas of child development, our mantra is “Babies Can’t Wait!”, but in the case of early solids, Baby can! Caregivers can use the following information to help parents understand about early feedings and solid foods. Let’s look at seven reasons why Baby CAN wait for solid foods:
ONE: IMMATURE INTESTINES.
The human digestive process is a wonderfully complex system. Like a baby’s brain, it is still growing and fine-tuning itself! Baby’s intestines act as a filter, screening out harmful substances while allowing in healthy nutrients. To prevent foods that are possible allergens from entering Baby’s bloodstream, the maturing intestines secrete a protein called immunoglobulin (IgA). In the first few months after birth, Baby’s IgA production is low (even though human breast milk contains IgA). Also, during the early months it is easy for potentially allergy-producing food molecules like cow milk protein and large molecules to enter Baby’s digestive system. This ease of entry, plus the low level of IgA makes Baby more vulnerable. Once those potentially allergy-producing food molecules enter the blood stream, Baby’s immune system may produce antibodies that create a food allergy.
At birth, Baby’s intestines can be thought of as similar to Swiss cheese. Baby’s first feedings with colostrum (human milk produced shortly after birth) acts like a protective shield to seal the gut. Between four and seven months, Baby’s intestinal linings begin to secrete more IgA which causes the intestines to become more selective about what is allowed through – this is called “closure”. The initial protective shield becomes a stronger coat on the intestines to prevent potential allergens from seeping through. At about seven months, Baby’s intestines have matured enough to be able to filter out more of the possible allergens. When solid food is delayed until this point, the chances of early allergies are much less. It is especially important to delay the introduction of foods to which Baby’s family members are allergic.
TWO: TONGUE THRUST REFLEX
Have you ever watched a baby imitate an adult by pushing her or his tongue out in response to the adult’s stuck-out tongue? It’s an amazing thing to see tiny newborns watch and act in response to adult interactions! One reason Baby is able to physically complete this response is because of a complicated muscle response called “tongue thrust reflex”. In the first four months of life, tongue thrust reflex prevents Baby from choking. When something (such as cereal) is placed on Baby’s tongue, the tongue automatically pushes it back out rather than pulling it in toward the throat like an adult tongue. Between four and six months, tongue thrust reflex gradually lessens, which means that a spoonful of cereal has a better chance of being swallowed than being pushed back out of Baby’s mouth.
THREE: IMMATURE SWALLOWING MECHANISM
At birth, Baby’s tongue and swallowing mechanism are not mature enough to work together smoothly. The newborn swallowing mechanism is designed to work with sucking, not with chewing. If you watch a baby less than four months of age “eating” a spoonful of cereal, you may see that baby moving the food around in her/his mouth. Some food may end up in the spaces between the cheeks and gums, some will be pushed back out the mouth and dribble down the chin, and some may actually move back into the pharynx to be swallowed. Between four and six months of age, the swallowing mechanism in most babies develops the ability to move food from the front of the mouth to the back.
FOUR: ABILITY TO SIT UP INSTEAD OF BEING CRADLED IN ARMS
From Baby’s point of view, feeding in the early months is closely associated with trust and touch. Feeding newborns is a very intimate activity and is closely associated with falling asleep at the breast or in a parent’s arms. Feeding solid foods is a much less intimate interaction. Baby may not be thrilled about changing from a soft, warm breast to a cold, hard spoon! Feeding solids requires Baby to sit up – skill most typically-developing babies develop between five and seven months. Holding a breastfed baby in the breastfeeding position is not the best way to begin introducing solids. Food rejection can occur when Baby expects to receive breast milk through sucking and receives a spoon in the mouth instead. Note: Cereal should always be fed with a spoon, not added to a bottle unless specifically instructed by a pediatrician.
FIVE: ABILITY TO CHEW
Newborn babies are not ready to chew. Teeth in most typically-developing babies don’t erupt until six or seven months. This supports the fact that young babies are prepared to suck, not to chew. Between about four and six months, Baby produces an enzyme-rich drool designed to digest food when solids are introduced. This is a hint that teething and first solid foods will be appropriate in the near future.
SIX: DEEP SLEEP
Some parents add rice cereal to a bottle to help their babies sleep longer. However, the idea that all babies will sleep through the night during the early months is unrealistic. It is also connected to the issue of Sudden Infant Death Syndrome (SIDS). There are many known and suspected reasons for increased SIDS risk in babies. Promoting deeper sleep patterns has been shown to increase babies’ risk for SIDS. If Baby wakes frequently, parents and caregivers can realistically feel reassured rather than upset.
Children learn through imitation and exploration in the context of close, caring relationships. At about six months of age, most typically-developing babies become strongly interested in imitating what they see. When Baby sees adults eating solids with a spoon, she will be more excited about being able to perform the same action as the adult.
In conclusion, each baby is an individual and will show signs of developmental readiness for solids somewhere along the spectrum of normal limits. There is no perfect age for this – some babies will be ready around 6 months, while others may not be developmentally ready until closer to 12 months. There is no need to push the introduction of solid foods. Feeding/eating is a relationship that should develop slowly and with respect between Baby and parents/caregivers. When parents and caregivers let Baby lead the way, successful feeding is more likely to follow. For further guidance, encourage parents to consult their pediatricians and caregivers to consult the health professionals at their place of work or at their local public health department. They can also explore the resources below.
American Academy of Pediatrics, Breastfeeding and the Use of Human Milk, Pediatrics vol 100, no 6, Dec 1997 pp 1035-1039
Bright Futures, Promoting Healthy Nutrition brightfutures.aap.org./pdfs/Guidelines_PDF/6-Promoting_Healhty_Nutrition.pdf-2008-04-17
Joneja JM. Babies, Children and Food Allergy. Optimum Nutrition. Journal of the Institute for Optimum Nutrition 2000 13(2):22-28
La Leche League International, The Womanly Art of Breastfeeding, sixth edition, La Leche League International, Schaumburg, IL 1997
Naylor, Audrey J. MD, & A. Morrow, PhD, co-editors, Developmental Readiness of Normal Full Term Infants to Progress from Exclusive Breastfeeding to the Introduction of Complementary Foods Reviews of the Relevant Literature Concerning Infant Gastrointestinal, Immunologic, Oral Motor and Maternal Reproductive and Lactational Development,www.idpas.org/pdf/757DevReadiness.pdf, April 2001
Satter, Ellyn, Child of Mine; Feeding with Love and Good Sense, Bull Publishing, Boulder Colorado 2000
WebMD, Introducing Solid Food Too Early, webm.com/parenting/news…/allergy-risk-early-solid-foods.acaai.org/public/linkpages/Introducing+Solid+Food+Too+Early