Welcome to Play On Pediatric Therapy
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By: Jacqueline Agnew, Occupational Therapist (Pediatrics)
For the first 6 months of life, breast milk and/or infant formula is the only food that your baby needs to grow and be healthy. After 4-6 months, you can start to offer solid food if your baby is showing signs of readiness, but continue to breastfeed and/or formula feed as the baby’s main source of nutrients until their first birthday. Breastmilk and/or infant formula can be continued after your baby turns one year old for as long as you and your baby wish, as it will continue to offer vital nutrients and a sense of comfort and bonding between the parent/caregiver and baby.
Able to sit unsupported
Good control of neck muscles – holds head steady
Shows interest in food when others are eating
Opens mouth and leans body toward offered food
Baby will pick up food and try to put it in mouth
Baby may close lips over a spoon
Baby will hold food in mouth without pushing it out with tongue right away
Baby will make gnawing and chewing movements
Baby will let you know he/she doesn’t want any more food by closing mouth, leaning back, or turning head away.
*Your baby does not need teeth to start eating solid food
Ensure you and your baby are truly ready! If you start too early, it can be overwhelming and turn into a negative experience, but if you start too late, your baby may be so used to only breastmilk or formula that he/she rejects other textures and tastes.
∗Be confident! Your baby can pick up on your mood. If your little one sees your confidence, they will be more confident in exploring different tastes and textures.
∗ Offer solid food after your baby has had breast milk or formula. Continue to breastfeed or formula feed throughout the day as your baby needs it.
∗ Be consistent! Once you begin, try not to skip days. Your baby needs consistent practice with new textures and flavours.
∗ Start by offering solid food once per day, then twice per day, increasing to 5 times per day as your baby reaches 12 months of age.
∗ Extra iron is needed at 6 months so it is a good plan to start with iron-rich foods, such as iron-fortified baby cereal, meat, eggs, tofu, and well-cooked legumes (e.g. beans, lentils, and chickpeas).
∗ After iron-rich foods, your baby will need other foods such as vegetables and fruit. Start with mild tasting foods such as squash, peas, sweet potatoes, apple sauce, mango, peaches, pears, avocados, and bananas.
∗ Your baby gets enough to drink from breast milk or formula. You can offer your baby small sips of water if you wish.
∗ Start a new food when your baby is happy and hungry.
∗ Include your baby at family mealtimes.
∗ Ensure your baby well supported and in a seated position, such as in a high chair.
∗ Encourage your baby to start finger feeding or holding a spoon.
∗ Keep mealtimes pleasant. Never force your baby to eat. Remember, you are responsible for what your baby is given to eat. You also decide where and when to feed your baby. Your baby is responsible for how much (or even if) he or she eats.
∗ Expect a mess! Babies and toddlers learn about food through play.
∗ Remove distractions such as toys or screens during feeding.
∗ As your baby gets older, you can increase the variety of foods and textures that you offer.
Baby-Led Weaning (BLW) is a method of transitioning from breastmilk/formula in which the baby is in charge of feeding themselves foods instead of being spoon-fed pureed food from a caregiver. Babies are thus introduced to a wider variety of textures from an early age. BLW can
provide earlier opportunities for oral-motor skill development, as well as more sensory exploration of their food (basically making a mess of their food tray, their face and body, the floor, the walls…), which is important because babies learn by touching and exploring their food!
On the other hand, a concern with BLW is the potential for choking. This is a valid concern but unlikely to happen if you follow BLW guidelines: Offer foods that are shaped like a finger, about 2 inches in length and a half inch wide. This shape makes the food manageable for little hands
to hold for self-feeding while leaving a little bit out above their grasp so that they control how much they put into their mouth. The texture of these foods should be either naturally soft (like ripe avocado or banana) or cooked in a way that allows for safe eating (like steamed well-cooked carrots and broccoli). Thin sticks of firmer foods like cheese, bread, or meat may also be given eventually. Research shows that babies who do
BLW are not more likely to choke than those who do not do BLW. (1) Nonetheless, if gagging and the potential for choking has you very nervous and increases your anxiety around mealtime, this may in turn increase the baby’s anxiety. If your baby is anxious around food, they may start to refuse food at mealtime. It’s important to stick with what feels comfortable for you and your baby.
If choosing to spoon feed and start with purees, you want to move through the process quickly in order to expose your baby to new tastes and textures, yet still introducing your baby to one food at a time for about 3 days per food. By 9-10 months, your baby should be able to eat soft foods. Also by this time, your baby is picking up pieces of food and holding larger strips of food, and bringing them to his/her mouth. By 12 months, your baby should be eating a variety of textures and tastes 3-5 times per day. (2)
Gagging is NORMAL! When babies first transition to solid food, they WILL gag and cough. This is to be expected, as a 6 month old baby is using their tongue and mouth for sucking food back. If the baby is given a piece of solid food, such as a slice of avocado, they will suck it back and this
will elicit a gag reflex (in order to protect the airway). Babies gag and cough because their gag reflex is more forward in the mouth. The gag reflex will move back around 6-8 months and mature around 12 months of age. 3 It is important to stay calm and confident, and know the difference between gagging and choking. Gagging is noisy – the baby will cough in an attempt to prevent the food from going down the airway. Choking is often silent because the baby cannot breathe. The baby’s nails, lips and skin may turn blue. Although uncommon, choking is very serious and it is a good idea to take an infant CPR and first aid course so you are prepared and know what to do if it happens.
♦Added sugars and artificial sweeteners, including pop, sports drinks and fruit cocktails/punches.
♦ Honey before the age of 1 years old. Honey has been linked to infant botulism, caused by Clostridium botulinum spores, which are sometimes found in both pasteurized and unpasteurized honey. (4)
♦ Deli meats – these are high in fat and salt.
♦ Fish with high levels of mercury, such as swordfish, shark, tuna steak or albacore tuna, marlin, orange roughy and escolar.
♦ Foods that may cause choking, such as raw vegetables and hard fruits, nuts, hard candy, gum, marshmallows, dried fruit, seeds, popcorn, grapes and hot dogs (must be cut length-wise or in small bite-sized pieces), stringy foods (e.g. celery), and nut butters spread thickly or served on a spoon.
→ The current guidance from the Canadian Paediatric Society (CPS) and the Canadian Society of Allergy and Clinical Immunology (CSACI) is to actively offer non-choking forms of foods containing common allergens (e.g., peanut, egg) around 6 months of age, but not before 4 months, as this can be effective in preventing food allergy in some high-risk babies. Babies who are not considered high risk for allergies should start food containing common allergens around 6 months of age if they show signs of developmental readiness. (5)
→ Introduce one new food at a time. If your baby shows signs of allergy, this makes it easier to know which food is causing the problem. Give the same food for 3-5 days before you try a new food.
→ Make sure you feed the potential allergen at a time when your baby will be awake for two hours afterwards in case allergy symptoms develop.
→ Offer your baby a small amount of the allergen on the tip of a spoon. Wait 10 minutes. If no symptoms develop, continue to offer the rest of the food at your baby’s pace and preference.
→ If a cow’s milk-based formula has been introduced, feed it regularly (as little as 2 teaspoons daily) to help maintain tolerance.
→ Once your baby has eaten the food, and if there is no allergic reaction, it’s very important to keep feeding that food to your baby about 2-3 times/week to help prevent the development of a food allergy.
→ Mild symptoms of allergy may include: Flushed face, hives, itchy red rash on tongue, mouth or around the eyes. If you notice any of these symptoms, stop feeding the food and call your doctor.
→ More severe symptoms of an allergy may include: swelling of your baby’s mouth, tongue, and throat, hives that are spreading, difficulty breathing, difficulty swallowing or a hoarse voice, and a pale or blue colour of your baby’s face or lips. If you notice these symptoms, call 911 immediately.
This information is geared towards providing some general advice for parents and caregivers as they begin their child’s journey into the exciting world of eating solid food. If you have further questions or concerns about your child’s ability to eat solid foods safely, please contact your health care provider and/or get in touch with us at Play On Pediatric Therapy in
order to determine if an occupational therapist can assist you and your baby in their feeding goals. Our pediatric therapy clinic is located here in Barrhaven (West Ottawa), Ontario. We offer various pediatric services like physiotherapy, Occupational therapy, Chiropractic care & osteopathy.
References
1. Fangupo, L. J., Heath, A. M., Williams, S., Williams, L. W. E., Morison, B., Fleming, E., Taylor, B., Wheeler, B. J., & Taylor, R. W. (2016). A Baby-Led approach to eating solids and risk of choking. Pediatrics, 138(4). https://doi.org/10.1542/peds.2016-0772
2. Pure Pediatric Therapy (2019-12-21). Introducing solids to baby. Retrieved 2024-02-05 from https://purepeds.com/2019/12/21/introducingsolidstobaby/
3. Smith, A. (2021-09-27). Veggies and Virtue – How to Prevent Choking with BLW. Retrieved 2024-02-05 from https://veggiesandvirtue.com/blog/safe-feeding-practices#:~:text=Although%20one%20study%20did%20find,of%20food%20(like%20apple).
4. Health Canada (2023-02-16). Infant botulism. Retrieved 2024-02-05 from https://www.canada.ca/en/health-canada/services/food-safety-vulnerable-populations/infant-botulism.html
5. Food Allergy Canada (2024). Early Introduction. Retrieved 2024-02-05 from https://foodallergycanada.ca/living-with-allergies/ongoing-allergy-management/parents-and-caregivers/early-introduction/
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