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. 

First Foods

People keep asking me what I’m going to give Birdie for her first foods.  This seems like a loaded question to me- I get the feeling people want me to answer either “rice cereal” or “apple sauce” or maybe even “avocado.”  I just keep thinking, “I have no idea what I’ll be having for lunch or dinner the day that Birdie chooses to reach out and grab some foods off the table” and “I don’t really know which of those first foods I give her that she’ll actually swallow.”  

I’m a big believer in the phrase “food is for fun until age one” and utilizing the oral motor skills that are inherent to a 6 months old (tongue thrust, phasic bite, tongue lateralization) to taste and explore solid foods without actually swallowing them.  When you give purees, the goal is generally to get them swallowed, vs just letting your baby taste and explore, then spit out.  That can be very difficult on babies at first (though of course some do phenomenally with this from the get go!)  But since time allows the gut to keep maturing and also allows practice to build well coordinated oral motor skills, I like the idea of letting her mouth foods before asking her to swallow them in any quantity.  

So I will most likely stick with foods that are easily held and easily mouthed: long "sticks" of food or big pieces of mashable foods. She can taste, suck, and gnaw on them until she eventually drops them, pushes them back out or even gag them out of her mouth.  I will definitely edit what I let her put in her mouth- avoiding things that are true choking hazards (small, hard, round food items) as well as things that are heavily salted or sugary, but I don’t plan on choosing a specific food right now.  I think I will just pull whatever is most appropriate from my plate and give her the chance to pick it up and feed herself if she can. At the suggestion of a nutritionist I met, I might try to steer her towards green and yellow veggies, the seasonal ones I get in my CSA delivery and am preparing anyways for my husband and I, because green and yellow veggies do not spike your blood sugar and are low on the glycemic index.  Maybe green beans or roasted squash?  But possibly not- maybe lentils or humus?  Maybe scrambled eggs? Possibly a carrot stick or zucchini slice that she can mouth? (I don’t have any history of allergies, nor does my husband and since Birdie will be 6 months, I am not terribly worried about allergic reactions.)  We’ll see if my mind changes over the next few weeks.  

What were your baby’s “first foods?”  Any thoughts on purees vs “table foods” as your baby’s firsts? This is my nephew enjoying some of his firsts: spinach and crackers.  This boy can eat!