Introduction
Implementing a baby-led approach to the introduction of solid food requires an understanding of what makes this approach logical and safe. The first section below explains the rationale and underlying principles which support this method of introducing solids and the last section, DOs and DON'Ts, provides a quick reference list of the key points. Adherence to these guidelines will maximise the chance that both the baby and his parents will enjoy the transition to solid feeding, and will help to ensure the baby's wellbeing.
Normal, healthy, breastfed babies appear to be quite capable, with the right sort of support from their parents, of managing their own introduction to solid food. However, parents of babies who were born preterm (i.e. before 37 weeks of pregnancy) or who have any medical condition that might affect their ability to handle food safely or to digest a range of food should seek advice from their health advisers before embarking on this method of introducing solids. Parents who are bottle feeding their baby should also consult with their health advisers, for the reasons outlined below.
by Gill Rapley, adapted by Stefan Kleintjes, dietician
These guidelines have been adapted from the original, which were developed as a result of a small piece of research carried out by Gill Rapley as part of a Master's degree. Gill's interest in the introduction of solid foods is independent of her work for the UNICEF UK Baby Friendly Initiative.
The baby is referred to as 'he' throughout these guidelines.
Joshua, born on the 4th of June 2004, trying his first pear when he is six months. Two months later he wanted to eat a toy giraffe and a big big piece of bread
Breastfeeding as the basis for self-feeding
Exclusive breastfeeding is recommended for the first six months of life. Breastfeeding is the ideal preparation for self-feeding with solid food. Breastfeeding babies feed at their own pace – indeed, it is impossible to force them to do anything else! They also balance their own intake of food and fluid by choosing how long each feed should last. Breastfeeding is essentially self-feeding, with the baby in control of the process. And, because breast milk changes in flavour according to the mother's diet, breastfeeding prepares the baby for other tastes.
It is not clear whether a baby-led approach to the introduction of solids is appropriate for babies who are bottle fed; more research is needed to establish this, since bottle-feeding seems to be more mother-led. It is difficult to predict how bottle-fed babies will manage solids, so we need to be careful. However, as long as care is taken to ensure adequate fluid intake (see below), there would be nothing inherently wrong in adopting this approach. It is recommended that parents of babies who are being bottle (formula) fed discuss the matter fully with their health advisers if they wish to use this method.
Understanding the babies motivation
This approach to introducing solids offers a baby the opportunity to discover what other food has to offer as part of finding out about the world around him. It utilises his desire to explore and experiment, and to mimic the activities of others. Allowing the baby to set the pace of each meal, and maintaining an emphasis on play and exploration rather than on eating, enables the transition to solid food to take place as naturally as possible. This is because it appears that what motivates babies to make this transition is curiosity, not hunger.
There is no reason for mealtimes to coincide with the babies milk feeds. Indeed, thinking of (milk) feeding and the introduction to solid food as two separate activities will allow a more relaxed approach and make the experience more enjoyable for both parents and child.
Won't he choke?
Many parents worry about babies choking. However, there is good reason to believe that babies are at less risk of choking if they are in control of what goes into their mouth than if they are spoon fed. This is because babies are not capable of intentionally moving food to the back of their throats until after they have learnt to chew. And they do not develop the ability to chew until after they have developed the ability to reach out and grab things. Thus, a very young baby cannot easily put himself at risk because he cannot get the food into his mouth in the first place. On the other hand, the action used to suck food off a spoon tends to take the food straight to the back of the mouth, causing the baby to gag. This means that spoon feeding has its own potential to lead to choking – and makes one wonder about the safety of giving lumpy foods off a spoon.
It appears that a baby's general development keeps pace with the development of his ability to manage food in his mouth, and to digest it. A baby who is struggling to get food into his mouth is probably not quite ready to eat it. It is important to resist the temptation to 'help' the baby in these circumstances since his own developmental abilities are what ensure that weaning takes place at the right pace for him. This process is also what helps to keep him safe from choking on small pieces of food, since, if he is not yet able to pick up small objects using his finger and thumb, he will not be able to get, for example, a pea or a raisin into his mouth. Once he is able to do this, he will almost certainly have developed the necessary oral skills to deal with it. Putting foods into a baby's mouth for him overrides this natural protection and may increase the risk of choking.
Tipping a baby backwards or lying him down to feed him solid food is dangerous. A baby who is handling food should always be supported in an upright position. In this way, food which he is not yet able to swallow, or does not wish to swallow, will fall forward out of his mouth, not backwards into his throat.
Adopting a baby-led approach doesn't mean abandoning all the common sense rules of safety. While it is very unlikely that a young baby would succeed in picking up a peanut, for example, accidents can and will happen on rare occasions – however the baby is fed. Rules of safety which apply in other play situations should therefore be adhered to when eating is in progress.
Won't he start eating solids too early?
The babies who participated in the research were allowed to begin at four months. But they were not able to feed themselves before six months. Some of the younger babies picked food up and took it to their mouths; some even chewed it, but none swallowed it. Their own development decided for them when the time was right. Part of the reason for this study was to show (based on a theory of self-feeding) that babies are not ready for solid food before six months. It seems that we have spent all these years working out that six months is the right age and babies have known it all along!
It seems reasonable to predict that if parents choose to provide babies with the opportunity to pick up and eat solid food from birth they will still not be able to do it until around six months. The principle is the same as putting a newborn baby on the floor to play: he is being provided with the opportunity to walk but will not do so until about one year – because his own development stops him. But: everything depends on the baby being in control. Food must not be put into his mouth for him. Since it is very tempting to do this, it is probably safer to recommend that babies should not be given the opportunity to eat solid food before six months.
Ensuring good nutrition
Babies who are allowed to feed themselves tend to accept a wide range of food. This is probably because they have more than just the flavour of the food to focus on – they are experiencing texture, colour, size and shape as well. In addition, giving babies food separately, or in a way which enables them to separate them for themselves, enables them to learn about a range of different flavours and textures. And allowing them to leave anything they appear not to like will encourage them to be prepared to try new things.
The opposite appears to be true for a baby who is spoon fed, especially if food are presented as purees containing more than one flavour. In this situation the baby has no way of isolating any flavour he doesn’t like and will tend to reject the whole meal. Since his parents can only guess which food is causing the problem, they risk more food rejection until they track it down. In the meantime, the baby learns not to trust food and the range of food he will accept can become severely limited. This can lead to his overall nutrition being compromised. Offering food separately, but together on the same plate, allows the baby to make his own decisions about mixing flavours.
General principles of good nutrition for children apply equally to young babies who are managing their own introduction to solid food. Thus, 'fast food' and food with added sugar and salt should be avoided. However, once a baby is over six months old there is no need, unless there is a family history of allergy or a known or suspected digestive disorder, to otherwise restrict the food that the baby can be offered. Fruit and vegetables are ideal, with harder food cooked lightly so that they are soft enough to be chewed. At first, meat is best offered as a large piece, to be explored and sucked. Once the baby can manage to pick up and release fistfuls of food, minced meat works well. Note: babies do not need teeth to bite and chew – gums do very well!
There is no need to cut food into mouth-sized pieces. Indeed, this will make it difficult for a young baby to handle. A good guide to the size and shape needed is the size of the babies fist, with one important extra factor to bear in mind: Young babies cannot open their fist on purpose to release things. This means that they do best with food that is chip-shaped or has a built-in 'handle' (like the stalk of a piece of broccoli). They can then chew the bit that is sticking out of their fist and drop the rest later – usually while reaching for the next interesting-looking piece. As their skills improve, less food will be dropped.
What about drinks?
The fat content of breast milk increases during a feed. A breastfed baby recognises this change and uses it to control his fluid intake. If he wants a drink, he will tend to feed for a short time, perhaps from both breasts, whereas if he is hungry he will feed for longer. This is why breastfed babies who are allowed to feed whenever they want for as long as they want do not need any other drinks, even in hot weather.
This principle can work throughout the period of changeover to family meals if the baby continues to be allowed to breastfeed 'on demand'. A cup of water can be offered with meals as part of the opportunity for exploration but there is no need to be concerned if he doesn’t want to drink any.
Continuing to feed 'on demand' will have the added advantage of allowing the baby to decide how and when to cut down his breast milk intake. As he eats more at shared mealtimes, so he will 'forget' to ask for some of his breastfeeds, or will feed for less long at a time. There is no need for his mother to make these decisions.
Formula milk has the same consistency throughout the feed. If the formula-fed baby were to be given milk as his only fluid he would be at risk either of not getting enough fluid, or of consuming too many calories, or both. Parents who are implementing this method of introducing solids with a bottle-fed baby should therefore offer their baby water at regular intervals once he is seen to be eating small quantities of food.
DOs and DON'Ts for baby-led introduction of solids
- DO offer your baby the chance to participate whenever anyone else in the family is eating. You can begin to do this towards the end of the sixth month. Around this time most babies start showing an interest in watching you.
- DO ensure that your baby is supported in an upright position while he is experimenting with food. In the early days you can sit him on your lap, facing the table. Once he is beginning to show skill at picking food up he will almost certainly be mature enough to sit, with minimal support, in a high chair.
- DO start by offering food that is baby-fist-sized, preferably chip-shaped. As far as possible, and provided they are suitable, offer him the same food that you are eating, so that he feels part of what is going on.
- DO offer a variety of food. There is no need to limit your babies experience with food any more than you do with toys.
- DON'T hurry your baby. Allow him to direct the pace of what he is doing. In particular, don't be tempted to 'help' him by putting things in his mouth for him.
- DON'T expect your baby to eat any food on the first few occasions. Once he has discovered that these new toys taste nice, he will begin to chew and, later, swallow.
- DON'T expect a young baby to eat all of each piece of food – remember that he won't yet have developed the ability to get at food inside his fist.
- DO try rejected food again later – babies often change their minds and later accept food they originally turned down.
- DON'T leave your baby on his own with food.
- DON'T offer food that presents an obvious danger, such as peanuts.
- DON'T offer 'fast' food, ready meals or food that has added salt or sugar.
- DO offer water from a cup but don't worry if your baby shows no interest in it. A breastfed baby is likely to continue for some time to get all the drink he needs from the breast.
- DO be prepared for the mess! A clean plastic sheet on the floor under the high chair will protect your carpet and make cleaning up easier. It will also enable you to give back food that has been dropped, so that less is wasted. (You will be pleasantly surprised at how quickly your baby learns to eat with very little mess!)
- DO continue to allow your baby to breastfeed whenever he wants, for as long as he wants. Expect his feeding pattern to change as he starts to eat more of the other food.
- DO discuss this method of weaning with your health advisers before embarking on it, especially if you are bottle feeding, or have a family history of food intolerance, allergy or digestive problems.
- DO enjoy watching your baby learn about food – and develop his skills with his hands and mouth in the process!
- Finally, join us on the
Dutch Bijvoedingsforum if you have queries and if you wish to deal your experiences with other moms and the nutritionist en lactationconsultant
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Toen Thijs een dagje oud was, kregen we van de kinderarts te horen dat'ie onder de lamp moest. Ik heb bloedgroep O en m'n kleine manneke heeft A, dus ik was zijn bloed beginnen af te breken toen'ie in mijn buik zat.
Gelukkig was hij een flinke drinker, want hij lapte alle raad van de verpleging daar aan z'n laars… hij eiste iedere drie uur z'n voeding, ook al zeiden ze soms dat het teveel was. Ja mama wist wel beter. Dus ik ging dapper om de zoveel uur naar de neonatologie om te voeden. Soms wilden ze hem wat water bijgeven (ja door die lampen verlies je veel vocht) maar dat kan mama bespreken met de arts… zolang hij vlot dronk mocht ik 't zelf regelen! Oef!!
Eindelijk mocht Thijsje mee naar huis, grote broer Robin en kleine zus Hanne waren suuuper blij! En mama genoot eindelijk van het contact met dat kleintje… daar kwam de blauwe wolk.
