5 signs your baby is ready to start solids (not age based!)

Pretty much across the board pediatricians encourage parents to start solid foods at a certain age (some say 4-6 months, others suggest around 6 months, others 6 months and older.) Between 4 to 6 months is the most common time frame, but this is a HUGE spread in baby time.

Major skills and maturation occurs between 4 to 6 months, such as the ability to sit independently. While we can't see it as obviously, your baby's body is also maturing and growing on the inside (the stomach, reflex patterns, and immune system for example are all changing during this time.)

Age is a vaguely helpful guideline but each baby is SO different that age is an unreliable indicator and should actually be low on our list of check offs that help you decide if your baby is ready to transition to solid foods. The primary indicators of readiness are developmental skills and interest. That means, your baby should have the following skills/signs to show you that she or he is ready to start eating solid foods:

1. Head and neck control- not wobbly at all. Your baby should be able to hold his head up while sitting, by himself for at least 15-20 minutes. 

2. Trunk control/sitting independently- possibly a bit wobbly but at least sitting for a few minutes by herself if placed in a sitting position without toppling over. Even better if she can get into and out of a sitting position by herself. 

3. Fine motor coordination- to reach for and grab items and bring to the mouth. This can be toys, a spoon, or food. Your baby should have enough eye/hand coordination to at least reach towards objects and push them around the table while trying to pick them up. 

4. An emerging pincer grasp (picking a smaller item up with the pads of the thumb and index finger)- around the same time that your baby is ready to begin solid foods, she will also be starting to try to pick up smaller and smaller items that she comes across (lint on the floor, stray dog food, anything gross and small will probably catch your baby's attention.) 

5. An active interest in food, watching you eat, being a part of the meal, and touching/exploring food-the motor skills I mentioned above will generally coincide with your baby's overall interest in food and  eating. Your baby will go from being fairly content to sit in your lap or in a sling while you're at the table and maybe even nap through a meal, to wanting to be a part of it all. He will try to grab food from your hands and off your plate. He will intently watch you bring food to your mouth. If you let your baby be a part of your mealtimes, around the time he or she is ready to start solids you'll see a distinct interest as though your baby is asking for you to let him/her eat!

Baby Led Spoon Feeding

Babies are born learners and explorers. They find joy in exploring and mastering a skill. Babies are driven to do this and will learn and explore with food if we give them the opportunity to do so at their own pace. If we let this joy flourish and let them feel confident and successful, they will have a positive relationship with food that will last a lifetime. This is especially true for the more reticent feeder, who may never eat vigorously for the sheer love of it, but who will learn to eat what she or he needs and enjoy it. It holds true for all babies. Often the more we push them to eat or stop eating, the less likely they are to do so.

With this in mind, I'll offer my tips for baby led spoon feeding. Spoon feeding is primarily an adult let activity and can easily lead to a disconnect between patent and child's communication if we aren't  proactive about being "tuned-in". These tips are focused on making spoon feeding an interactive dance or a conversation. 

- Let your baby take the lead by giving him or her a spoon to hold from the very beginning. 

- Expect the activity to get messy and be ok with that. Mess is fun and it enriches the sensory experience. Your baby is learning a new skill and she can't do it perfectly from the start. If your baby isn't getting messy that means you're controlling the activity and doing it for them, which means your baby is not learning as much and probably not enjoying it as much. 

- Forget about quantity. Let the focus be on exploration and discovery, even if that means that zero amounts of food is actually swallowed or even tasted.

- Try loading the spoon for your baby at first, then just set it on the table, handle towards your baby. Let your baby pick it up and do whatever she or he wants with it!

- If your baby is struggling and appears interested, hold and offer the spoon directly to your baby. Keep the spoon near your baby's mouth and wait. Do not touch your baby's lips or try to put it in his or her mouth. Just wait until your baby opens his or her mouth or leans towards the food. If that never happens, eat the food yourself and let your baby just watch or touch the food if interested. 

- At all meals, try to have your own spoon and bowl of food to eat. Model eating and enjoy a meal with your baby. Babies and children learn best from watching you. They want to do what you're doing. If he is eating applesauce, you should eat applesauce. 

- If your baby is into the food and the activity, re-load the spoon and offer it again. 

- If not, let him or her enjoy time at the table, touching and playing with the food with his or her hands while you eat. Do not stress or worry. Offer a milk feed (breastmilk or formula) instead. 

Traditional Puree/Spoon-fed Approach VS Baby Led Weaning

"Why have an 'approach' at all?" you might ask.  This may seems silly to those who just "do it" and never even consider what their personal "approach" might be.  "We just fed you" my mother said when I asked her about what she did for me.  "We didn't stop to think about approaches." 

4 generations of daughters enjoying lunch together.  We all were fed in different ways and I'd say we all turned out fairly well!

I get this.  Many people are too busy to consider the intricacies of a feeding style or they inherently trust their parenting skills and would never second guess themselves or confuse things by reading about someone's feeding philosophy.  But, many parents don't have this same sense of self-confidence or experience, and because we are more isolated than ever these days, we also don't have family or friends we can easily turn to for guidance. Additionally, if we look around at the incredibly high rates of picky eating childhood and adult obesity as well as the unbelievably high rates of funky childhood diseases, like autism, type II diabetes, asthma, and allergies, and digestive disorders (like Crohn's or Celiac), I think it becomes clear that whatever we have been doing--even when we are confident about it--has not really be working all that well.  We need guidance to find a better way.  Yes, I know that it's a leap to blame these ailments on the style a parent uses to introduce solids.  Of course that's not the full story, but I believe the way we start, often gives way to how we continue to interact with food, mealtimes, feeding and our children over the course of their childhood.  We all learn and improve as we go but we also build habits and routines that can be difficult to change. And when picky eating sets in, so does poor nutrition and unhealthy eating, which does contribute in a very real way to childhood and adult illnesses.

So, that being said, looking at theory and approaches can be helpful in terms of understanding what part of each approach works well and what doesn't.  It also helps the next person to learn from our mistakes and do it better from the start so that she doesn't have to undo bad feeding habits.

So, in the interest of making things easier and more sucessful, here is a chart that compares the two primary approaches to feeding an infant solid foods: Baby Led Weaning and Traditional Purees.

Baby Led Weaning Introduction to Solids

Benefits

Drawbacks

Not focused on quantity and intake, so milk remains primary nutrition source No need to prepare or buy “baby food” Consistent exploration of solid food builds new oral motor patterns early on Early and consistent practicing of new oral motor patterns helps to create a well coordinated skill set Coordinated oral motor skills are important for eventual eating of resistive foods, such as vegetables and meats Coordinated oral motor skills decrease a person's risk for choking May decrease mealtime battles because baby is feeding him/herself and will either choose to eat or not Self-feeding builds eye-hand coordination and fine motor skills Uses a baby's inherent motivation to explore, discover, and self-feed Use of frequent modeling because parents eat the same thing as baby Less focus on just baby at meals increases the focus on socialization and family time Self-motivation is valued and practiced at each meal

Very messy Gagging happens and looks scary Over stuffing mouth is common at first Increased risk of choking at first if done wrong (though physiologic protection from 5-8 months decreases this risk, as does supervision, always sitting baby upright in a supported seat and never putting food in the baby's mouth for him/her) Possibly difficult for nanny, daycare, or unfamiliar feeder to do Baby often is less likely to accept spoon feeding because she enjoys feeding herself Many parents worry they can't also give purees

Traditional (Puree) Introduction to Solids

Benefits

Drawbacks

No choking risk at first Baby uses very familiar oral motor patterns Can be less messy if parent controls the spoon Builds spoon skills quickly Potentially faster/more efficient mealtimes Gets larger volume of food in baby from the start Parent controls activity but can still be fun and “baby led” with a tuned-in parent Some babies enjoy because there is less challenge initially Some babies prefer bland flavors and textures

Less exploration by baby if parent spoon feeds Easy to over ride inherent hunger/satiety cues by giving “1 more bite” or stopping before baby is done if not tuned-in Quantity can easily become a focus with implications for decreased milk intake and mealtime battles Delayed building of important oral motor patterns (I.e.- for chewing) Increased risk of choking later, after natural physiologic protection against choking is gone and textures are introduced Purees are often bland Less modeling because adults don't often eat purees for our meals Uncertainty about when to progress to textured and finger-foods

What I do and why I LOVE it

This post is about me!  I want to explain my background and credentials, what an Occupational Therapist (OT) does to help babies, children, and families who have difficulty with feeding, as well as why I love the topic of feeding, eating, and mealtime.  

If you've found my site or my blog, I want you to feel confident that you've found someone who is not just passionate about feeding, eating, and mealtime, but also someone who is highly trained and educated on the topic as well.  Occasionally another medical professional will have a different opinion from me about how to approach a feeding issue and it is important to understand our backgrounds to know why we might have a different approach.

My credentials (aka, the letters behind my name): OTR/L, SWC, CLE

• OTR/L: These letters mean that I am an Occupational Therapist registered nationally and licensed through California.  
• SWC: This is an advanced practice designation from the California Board of Occupational Therapy indicating advanced training and expertise in the area of feeding and swallowing.
• CLE: Certified Lactation Educator.  This means I have completed additional training in the area of lactation to support breastfeeding. 

As an occupational therapist I have to maintain my licensure by completing continuing education courses yearly.  I have to utilize evidenced-based treatment strategies and I have to stay current on applicable research in my field.  I challenge myself to do this by speaking at conferences and writing journal articles.  (Most recently I spoke at the American Occupational Therapy Association national conference and I was published in the May 2013 issue of the Journal of Infant, Child, and Adolescent Nutrition).  As someone who loves infant development, neuro-anatomy and function, feeding, and nutrition, I am an avid reader on these topics.  As a mother and someone surrounded by many families with babies, I try to stay current on what parents need, want, and love.  

As an occupational therapist, my primary role is to "help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations)." -American Occupational Therapy Association  My chosen focus is the "occupation" of feeding and mealtime and my target audience is infants and children.

Occupational therapist are holistic and we have been trained to look at the whole person in the context of their environment, as well as every aspect of an occupation.  When it comes to feeding and mealtime, this is so important because it is one of the most complex and multi-faceted "occupations" that a person will participate in.  

• Feeding engages every one of our sensory systems (site, smell, taste, hearing, touch, vestibular, and proprioceptive- all of them in one way or another!) 
• It requires adept gross motor, fine motor, and oral motor skill coordination.  
• Feeding also is a deeply social and behavioral activity, which is made up of routines, habits and cultural norms, and is affected by temperment.  
• When working in the area of feeding, you must understand the deep ties between health and wellness of the body and digestive tract and how this plays a roll in determining hunger and interest in eating.  
• And let's not forget nutrition! 

There are really so many pieces to think about when talking about feeding and mealtime.  As a therapist, I have to combine all those pieces with the individual child's strengths, weaknesses and environment.  As if that wasn't enough, when working with children, I have to also take into account the strengths, weaknesses, temperment, and daily schedule of the parents and siblings to make every recommendation functional for the family.  

          

-So many of life's most joyful moments happen around a meal-

There are many other very complex activites out there, but another reason that I love feeding and mealtime is that every single person has to participate in this "occupation" every single day, multiple times a day, without fail, for the duration of their lifetime.  Success and joy in feeding, eating, and mealtime can have a pervasive impact on our daily happiness.  

This sounds excessive and dramatic, but it's true!  This is why I LOVE working as an occupational therapist in the area of pediatric feeding, eating, and mealtime.  I am constantly kept on my toes, engaged, and challenged.  When I hear people say that they know it shouldn't be "that difficult" I get so excited to let them know that, in fact, it is super complex and though it all sort of falls into place most of the time, it can very easily be put off track and so difficult to get working smoothly if it does go wrong.  This is also why I have become so so passionate about working with families of typically developing babies and children.  I know that with a little bit of guidance, the feeding relationship can get off on the right foot and be successful for life.  So much of our health and wellness stems from our diets and our intestinal health.  Small changes to how we as a society approach feeding, eating, and mealtime can make HUGE differences in our overall health, our body image, our socialization and our joy.  Small successes in my work can bring big satisfaction and health to a family.  Yes, this is a lot to swallow.  But I get excited when I'm passionate, and this topic makes me passionate!

Best First Foods

I know that what you want is a simple list of foods and maybe some recipes.  Instead I am giving you an essay. I am sorry. I am, truly. But I think part of the problem with health care for infants these days is that we're giving one-size-fits-all recommendations. And when it comes to first foods that is definitely the case. Whether or not the recommendation is rice cereal, vegetables, fruits, or even meats, our healthcare providers are emphatic about it being one of these options across the board for all babies. But with millions of babies out there, each with a different genetic make up, temperament, and home environment, there is no possible way that one idea will work for all. 

Often parents are surprised to hear that there may be more than one right choice for first foods. We assumed there is one right way and that's what has been recommended to us. Not so! Rather than a mediocre one-size-fits-all recommendation, parents need tools to make the best decision possible for their family and individual baby. 

That's what I want to offer in this post- guidance. Rather than 2 or 3 foods, which might be best for me and my child, but totally off for your baby, I'm going to give you ideas to consider in order to get at what will work best for you when choosing the best first foods. 

1. Consider what you and your partner's favorite foods are. 

2. Think about which foods are important to your culture and family. 

3. Take into consideration which foods are local and seasonal. 

4. Of course take into account your baby's nutritional needs (is she exclusively breastfeeding or is she taking formula? Iron needs may be higher in the baby who is fed formula, as an example. Or maybe intense allergies run in your family. Discuss your baby's unique needs with the pediatrician or a dietician.)

5. Consider your baby's temperament. For example, if your baby is spirited and likes to do things for herself, a "finger foods" approach, such as baby led weaning might be a good option. If your baby is content to be fed or is a really hungry baby that likes to eat quickly, a puréed and spoon-fed approach might be the more ideal way. Pick foods that lend themselves to the approach your child prefers. 

6. Gear your food choices and approach towards your baby's developmental readiness. If your baby is not sitting up independently yet but you have started introducing solids, purees are probably your safest bet, not finger foods. If your baby is just discovering his fingers and is loving to pick up small objects, finger feeding small bites might offer maximal enjoyment and motivation for feeding. Again, pick foods  that lend themselves to the approach that best fits your baby.

Once you've taken all this into account, it should be easier to pick certain first foods that will best suit your baby and your family. Run those ideas by your child's pediatrician and then bon appetit!

Rice cereal

There is generally very little research regarding best "first foods."  What guides first food recommendations are tradition and culture, a bit of science, as well as ideas that "sound good in theory." Here in the US, this has led to the recommendation of rice cereal as the doctor-recommended first food. The reasons behind the rice cereal:

1. Rice cereal is fortified with iron and iron stores from birth start to dwindle over time and may need food sources to be replenished by six-ish months.

2. Rice cereal has low risk of causing allergy. 

3. Rice cereal is easily mixed with breast milk (or formula) into a runny and easily accepted consistency which will taste sweet and familiar. 

4. Runny foods are not a choking risk (actually they can cause choking--aspiration is the better term-- and liquids and runny foods are the most commonly aspirated foods. However, they do not cause full airway obstruction choking which doctors are primarily concerned with because even though it is significantly more rare, it can be deadly.)

5. Although the AAP recommends starting solids "around 6 months" many people start solids even before 4 months. Rice cereal and other purée is easily ingested by a very immature baby. 

6. Rice cereal is manufactured on a large scale, readily available, and purchased in a standard box with simple mixing instructions, which makes it the same for just about everyone. This allows for consistency between doctors' recommendations. High and low income families alike educated or not, all will give pretty much the same thing with little concern of misinterpretation. This makes it an easy go-to recommendation for doctors. 

Liver from grass fed, well cared for cows is very high in iron and used to be a staple in babies' diets. 

While many of these reasons make sense, there are a few points to consider that might steer you away from rice cereal as a first food:
1. Rice cereal is a simple carbohydrate and as such it spikes your baby's blood sugar, without offering much by way of nutrition.

2. It is a processed food and in general, almost every doctor out there recommends NOT to give babies processed foods, especially at first. Processed foods are not as healthy as whole foods, like fruits, vegetables, and well sourced meats.

3. While babies will accept almost any food you give them at first, toddlers and school age children are significnatly more likely to be picky eaters.  If you have a picky eater on your hands, you can confirm that picky eating children almost across the board love carbohydrates (cookies, crackers, pasta, rice) but generally refuse veggies and protiens.  Since we don't really need to worry about kids learning to eat carb, why start with a simple carb as the very first solid food they ever eat? This may lay down a foundation for a lifetime love of simple, processed carbohydrates. 

4. Breast milk and formula are high in protein and fat so this is what your baby's stomach is used to processing. Some argue that your baby's body doesn't even produce the enzyme necessary to properly breakdown carbohydrates at 4-6 months. This causes foods like rice cereal to be hard on your baby's stomach. 

5. There are other foods besides rice cereal that naturally offer iron in higher amounts and in a more easily absorbable form.

6. Arsenic (a known carcinogen and poison) has been reportedly found in commercially available rice cereal in 2012. 

7.  If you follow the AAP recommendation to start solids at or around 6 months, your baby most likely has mature enough gross motor and oral motor skills to eat a wide variety of foods. 

8. Ask any pediatrician or infant feeding specialist: the whole point of those first few months of transitioning to solids is oral exploration and play with motor pattern learning. Rice cereal offers very little in terms of sensory input and doesn't challenge developing oral motor skills. It is so easily ingested it hijacks the focus from play and exploration and puts it on intake and quantity. 

9. Looking again towards toddlerhood- It takes very minimal oral motor coordination to eat things like crackers, cookies, and processed meats (I.E. chicken nuggets). It takes mature and strong oral motor skills to eat resistive foods such as raw and even partially cooked veggies and fruits, nuts, and baked or grilled meats. Building strong oral motor patterns in a safe way, from a young age (before food refusal sets in- around toddlerhood) is crucial to your child accepting these foods when he or she is older. Once he or she hits those toddler years, there is almost always less interest in exploring new foods and practicing how to eat them. If your child doesn't know how to safely eat resistive foods by toddlerhood, she or he will most likely refuse them completely for years to come- until they grow out of their resistant phase. I'm not suggesting you give choking hazards to your baby, but I am suggesting again that rice cereal does almost nothing to advance oral motor patterns.  There are other first food choices that do provide safe opportunities for oral motor skill advancement.  

If any of these points ring true to you or concern you, I suggest doing your own research and discussing with your baby's pediatrician before deciding what to give your baby for his/her first solid foods.