In my Tips for When Your Baby Resists Solid Food, I made the remark that “there is no rush to get the baby to eat solids because breast milk provides complete nutrition through the first year.” I’ve since revised that statement to “there is no rush to get the baby to eat much solid food because breast milk provides the bulk of nutrition through the first year (and in fact some babies thrive on breast milk alone)” based on the following comment that that post received:

http://www.who.int/nutrition/publications/infantfeeding/WHO_NHD_00.1/en/index.html - see page 10 + 11

Breastmilk does not provide complete nutrition for the second six months of life. I am all for full term breastfeeding (I am still feeding my 18 month old), but I think it is fair to point out that the energy gap between what a baby needs and what breastmilk can provide gets wider from about 6 months.

There are other important nutrients which are also needed - iron stores from birth run out at around six months, so it’s important for babies to get some iron from other foods.

While I think that many doctors are ill informed and try to bully us into pushing solids before the baby is really ready, it’s important for parents to be informed of the facts, so they can make an informed decision.

Baby who resisted rice cereal (Photo by LizaWasHere)

As I replied in the comments section:

“In general I agree that it’s a good idea to start solids around 6 months of age and I certainly believe every mother should do her own research and consult a doctor for medical advice.

When a baby resists solid food and/or has a family history of allergies or shows signs of severe and numerous food allergies, some mothers choose to rely on breast milk for the baby’s sole (if not “complete”) source of nutrition. Kellymom.com says: “Some babies are exclusively breastfed for a year (and occasionally up to two years) with no problems at all. In addition, some doctors recommend that babies with a high risk for allergies be exclusively breastfed for a year.”

Kellymom also notes: “The current research indicates that a baby’s iron stores should last between six and twelve months, depending upon the baby.” Your comment implies that there is no iron in breast milk, although perhaps that is not what you intended. The good news on iron is that “up to 50% of the iron in human milk can be absorbed by the infant, as compared to 10% in cow’s milk, and 4% in iron-fortified formulas.” (LLL fact list). Some (many?) babies might need an additional source of iron (from solid food or vitamin supplements) at some point after 6 months, but not all babies will.

The points I hope to make are that parents need not worry quite as much as some seem to about getting solids into a baby, that breast milk continues to provide the bulk of nutrition, that it’s not always a good idea to push solid food when the baby resists or has allergies, and that there is anecdotal evidence (and perhaps more) that some babies thrive on breast milk alone for up to one year and even beyond.”

Your Thoughts?

Did anyone reading this delay (or stop feeding) solid foods after six months of age? What was your experience and reasoning?

So far in this three-part series I have offered ten tips for helping your baby enjoy solid food. In this last installment, I make some suggestions for what to do when your baby resists eating solids.

Helping my baby feed herself some yogurt

Five More Tips for Helping Your Baby with Solid Food Feedings

11. Don’t starve the baby of breast milk in the hope of encouraging solid food intake. I hope that sentence speaks for itself, but in case not, let me explain what I mean. Don’t give in to the unhelpful suggestion or thought that you are feeding the baby too much breast milk and that is the reason the baby shows little interest in solids. People who think that are misguided on a few levels: (1) it’s nearly impossible to feed a baby too much breast milk (you cannot force a baby to nurse when the baby is not interested, and babies self-regulate at the breast whereas milk from a bottle flows freely and it is harder for a bottle-fed baby to control the amount consumed), (2) depriving the baby of milk does not encourage solids but does encourage a cranky, potentially malnourished baby, and (3) there is no rush to get the baby to eat much solid food because breast milk provides the bulk of nutrition through the first year (and in fact some babies thrive on breast milk alone — see the comments section for more discussion on that assertion).

A baby who is resisting solid foods simply might not be ready for any number of reasons. Maybe the gag reflex has not completely gone away. Perhaps your baby is teething or ill and needs some time off from or a delay in starting solids. It’s even possible that your baby knows what is best. I have heard anecdotes about babies who resisted solid food or certain foods in particular and those babies turned out to have one or more food allergies. If you suspect a food allergy, read “A” Is for Allergy Prevention and Reduction.

12. Offer a choice. As I’ve said before, I believe most food issues are about control. If you limit food choices and try to force your baby to eat a particular food, that can backfire to the point that your child severely limits the foods he or she will eat. Give your baby the control by offering a choice at any given meal. “Squash or applesauce?” “Pears or kiwi or both?” Even a six-month-old can indicate a preference for food through facial expressions, sounds, or grabbing for a particular food. The idea is not to prepare two separate meals or to waste food, but to show the baby what’s on offer and to provide the food the baby will actually eat!

Of course, the choice is not “veggies or fast food chicken nuggets.” All of the options you offer should be nutritious. This will become more and more important as the baby becomes older. At my house, a child can choose whether to eat any or all of the fruit, vegetable, grain, and/or meat offered at that particular meal. If the child chooses not to eat any of the items on offer (this has happened two or three times with my four-year-old), then she gets to wait until I finish my meal before I will prepare one other healthful option (usually something unexciting like whole grain cereal and milk). I look at my child’s nutrition over the course of a week and do not worry about any isolated meal.

13. Ease up if it is not going well. Hindsight will often reveal why a baby was refusing a particular food or solids in general. Let your baby rely on the nutrition from breast milk as you slow down the process. Your baby will sense if you become tense or anxious about food. Don’t let your anxiety become contagious! The goal is for your baby to enjoy solid food, not any particular amount of food or any one certain food. Success breeds success, and a baby who has a good experience at meal time will look forward to the next meal. A child who refuses vegetables at one meal just might eat them at the next, and in the end the child quite possibly will eat better if you do not engage in a battle of wills over a certain food. It all comes back to the issue of control.

14. Invite over a peer. If your older baby still does not show much interest in solids or does not eat many different types of food, it can be very helpful to invite over a little friend you know is a good eater! Go on a picnic or have a play date. Talk to the other parent in advance about serving a food the other child will readily eat. When your child sees the other child eating that food, your child might very well want some too!

15. Read up on the subject. If you missed parts one and two of this series, see 5 Tips for Helping Your Baby Enjoy Solid Food and More Tips for Your Baby and Solid Food. If your baby is just starting solid food, check out Starting Your Baby on Solid Foods: When, What and How. For more detailed reading, you might enjoy the following books:

Super Baby Food by Ruth Yaron
Child of Mine: Feeding with Love and Good Sense by Ellyn Satter
My Child Won’t Eat!: How to Prevent and Solve the Problem by Carlos González

What are your thoughts? Do you agree or disagree with my tips? Have you read any of the books I mentioned? Do you have any other books you recommend?

The list of tips for helping your baby enjoy solid food continues today with five more ideas. Stay tuned for the last five tomorrow when I will share some thoughts for what to do when solid food feeding is not going as well as you might hope! Feel free to add your thoughts in the comments section — what have you done and do you agree or disagree with this set of tips so far?

Strawberry yogurt face!

Five More Tips for Helping Your Baby Enjoy Solid Food

6. Set a good example with what you eat. One of the signs of readiness for solid food is that your baby shows interest in what you are eating. The baby’s urge to lunge for your food works in a positive way! At meal time, sit next to your baby or have your baby sit in your lap, and be prepared to share your food (modified as appropriate and safe for the baby). If you are having red beans and rice, squish some beans and let your baby grab them and work on self-feeding, or load a mashed bean onto a baby spoon and help your baby guide the spoon.

Of course, this interest in your food means that if you’re eating a chocolate chip cookie, your baby will want that cookie too. So save the treats for when your baby is napping or has gone to bed.

7. Consider the texture of the food. You are the expert on your baby! Pay close attention and experiment to see whether your child prefers sweet potatoes diluted with a little breast milk, mashed up plain, or cut into tiny bits. At the same time, consider whether your child likes to use a spoon or prefers to pick up the mash or cubes of food with his or her hands. Mix up the routine and have fun with it!

8. Let your baby be in the driver’s seat. Babies have a way of making their preferences and desires quite clear. Let your baby tell you whether meal time is over or it’s time for seconds. Don’t force the issue if your baby simply isn’t interested in solids one day. Teething, an upset tummy, a belly full of milk (not a bad thing!) — all those can suppress your baby’s interest in food at any given meal.

If your baby is clamoring for more food though, then it’s okay to let your baby take the lead, within reason. For example, an entire banana probably isn’t a good idea or you risk constipation. You also want to keep in mind that breast milk is still the baby’s primary source of nutrition and if your baby seems particularly hungry, it could be a growth spurt. Offer more nursing sessions throughout the day, and keep an eye on your milk supply so that the amount of solid foods you are offering does not interfere with your milk supply.

9. Remember that these first feedings are more for learning and less for nutrition. As I mentioned in tip #8, you do not need to worry about getting a certain amount of food into the baby at any given meal. While you want the food you offer to be nutritious, your baby’s nutrition continues to come from your milk. That’s one of the great things about breastfeeding in that for the first year or so, you have the security of knowing your baby is getting a well-balanced meal at your breast! (The nutritional benefits of breastfeeding also continue well beyond the first year. Toddler milk supplies protein, fat, vitamins and antibodies, some in even greater quantities during the second year and beyond!)

10. Eat a wide variety of foods while you are breastfeeding. Believe it or not, the foods you eat flavor the breast milk and help your baby learn to appreciate a wide variety of foods. There is no reason for you to limit yourself to a bland diet while you are breastfeeding. It’s perfectly fine — and beneficial — for you to enjoy spicy and flavorful foods!

If you missed tips 1-5, see 5 Tips to Help Your Baby Enjoy Solid Food.

You have determined that your baby is ready for solids (see Starting Your Baby on Solid Foods: When, What and How). You are determined to make it a good experience for both of you! Here are some tips to get the adventure off to a good start. Over the next couple of days I will post more tips in this series. While I don’t claim to be an expert, I apparently have a lot to say on the subject!

My 10-month-old with tomato sauce all over her face!

1. Tell your baby the name of each food you are offering. This simple step goes a long way to establishing a healthy relationship with food. Your baby deserves to know what each food is. You might not think a six-month-old baby could understand what you mean when you say “peas,” but say it often enough and the baby will start to associate that delicious green food with the word “peas” and might even get excited with anticipation when you say it! As silly as it might sound to your ears, it’s helpful to say at various points throughout the meal, “These are peas.” When your baby shows approval, “Oh, you like peas!” And when your baby opens wide for more, you affirm, “Peas are yummy.” Telling your baby what each food is shows respect and builds trust. Speaking positively about a food — “Peas are yummy” — becomes a self-fulfilling prophecy. It teaches the child, “My parent just told me this is a good food, and I can believe it!” It can be helpful to use the term “yummy” for objects (food) your child is allowed to put in his or her mouth, and “yucky” for objects (inedible items) your baby is not allowed to put in his or her mouth. My 10-month-old daughter knows to spit out anything I declare “yucky.”

2. Serve whole foods. Boxed baby cereals and jarred baby foods are conveniences, not necessities. Factor in the additional cost and the potential reduction in flavor and nutrients, and such foods are not really all that “convenient.” It does not get much easier than mashing a banana or an avocado. Serve your family foods that can be easily modified for the baby, and you’ve made feeding your baby simple and fun. Having oatmeal for breakfast? Baby can have that too! How about baked sweet potatoes as a side at dinner for your family? Just mash up the potato or break it into bits for the baby to pick up and eat.

3. Allow your baby to self-feed. Babies love to learn how to pick up tiny steamed broccoli “trees” they can feed to themselves! When babies feed themselves, they control how much or how little they eat. Even when babies do not yet have much hand control, you can pre-load a spoon for them and help them guide the spoon to their mouths. Remember, it’s a learning opportunity and not something that needs to be forced by you. These early solid food feedings are far more for experimentation and socialization than for nutrition.

4. Allow your child to make a gigantic mess. I can’t say it any more plainly. Babies need to be able to make a mess at the table. I believe that the root of many food issues is control. If you start trying to control the mess, that can lead to the baby trying to control what he or she will consume. Invest in a big bib (try my free instructions for big bibs with extra long ties or crew neck over-the-head pullover bibs), or strip the baby down naked in a warm room. Babies can get a lot of joy out of playing with their food — and that’s exactly what you want. Yes, playing with food, because ultimately the goal is for your child to enjoy meal times. The first experiences should be fun and relaxed, not anxious and controlled. Food washes off skin and out of clothing, and any time that you spend cleaning your baby, the table, and the floor (and the walls!) will be made up for later when your child eats a nice variety of foods. The time for teaching table manners comes when your child is no longer a baby.

5. Make meals a social event. Babies enjoy being with the rest of the family at the table. They learn from watching you eat, and they benefit from the social interaction. When you share a meal with your baby you have the opportunity to model the behavior you want to see from your child. Take turns with the other adults at the table when it comes to helping the baby eat (these feedings that are not at the breast are perfect for dads to get in on feeding the baby!) Soon enough your baby will become quite good at self-feeding and you will all get to enjoy your meal at the same time!

What are your tips for helping a baby to enjoy solid food? Do you agree or disagree with the tips I have shared so far?

Last fall my family purchased a share in a Community Supported Agriculture farm (CSA). It’s been a wonderful thing. The kids like to have a “feast” from the organic fruits and vegetables we get in the basket delivered from the farm to our pick-up site. They enjoy old favorites like apples and pears, and make new favorites like kohlrabi (in lemon, olive oil, and salt).

Photo by Piovasco

Today we got the opportunity to visit the farm to pick strawberries out in the field. The field trip (forgive the pun) showed the kids exactly where their food grows. The experience was educational and tons of fun! There’s nothing quite like setting loose a 10-month-old in a row of strawberries and watching her pick her own berry and pop it in her mouth! When she tired of that activity and needed to reconnect with me, I didn’t have to head back to the car, I just sat right down in the field and nursed her. It felt great to be cuddling my baby in the sunshine. As far as I know, no one paid us any mind, they were all so busy picking strawberries.

We came home with over 10 pounds of organic strawberries for $10.75! I nursed my little one to sleep for her nap and had a chance to process all the strawberries. The perfect ones went into the refrigerator, the ones that got a little bruised in transit got frozen whole, and the ones on their last legs got pureed and frozen.

Our u-pick adventure was unique and memorable, and I credit nursing for making it easy and enjoyable too!

Test your knowledge of how alcohol affects breast milk with these 8 questions! The trivia was derived from studies compiled on the LactMed database as of April 2009. For information about drinking and breastfeeding, see this article on alcohol and the controversial Milkscreen test. For current information on drugs and lactation, visit the LactMed database.

Photo by Steve Woods

1. Nursing after 1 or 2 drinks (including beer) causes the infant to:
a) increase milk intake.
b) decrease milk intake.
c) Milk intake remains unaffected.

2. Nursing or pumping within one hour before ingesting alcohol:
a) does not affect the level of alcohol in the milk.
b) increases the level of alcohol in the milk.
c) decreases the level of alcohol in the milk.

3. Breastmilk alcohol levels are:
a) the same as blood alcohol levels.
b) higher than blood alcohol levels.
c) lower than blood alcohol levels.

4. While food consumption can delay the peak of breastmilk alcohol levels, the peak generally occurs:
a) one hour after ingestion of alcohol.
b) two hours after ingestion of alcohol.
c) three hours after ingestion of alcohol.

5. When a baby nurses after a mother consumes alcohol, the baby sleeps:
a) better.
b) worse.
c) the same.

6. True or false: The American Academy of Pediatrics rates alcohol as “usually compatible with breastfeeding.”
a) True.
b) False.

7. What minimum level of alcohol consumption affects infants negatively and is associated with shortened duration of breastfeeding?
a) Any alcohol consumption.
b) Casual alcohol consumption (1 drink per day).
c) Daily heavy use (more than 2 drinks daily).

8. One study estimated that a breastfed infant received a certain percentage of the mother’s weight-adjusted dosage of alcohol when she consumed 1.5 drinks. That percentage was:
a) between 0.5 to 3.3% of the mother’s weight-adjusted dosage.
b) between 3.3% to 5.0% of the mother’s weight-adjusted dosage.
c) between 5.0% to 8.3% of the mother’s weight-adjusted dosage.

The Answers

1. b. Nursing after 1 or 2 drinks can decrease the infant’s milk intake by 20 to 23% in the 3-4 hours after ingestion of alcohol. However, the infants increase the number of feedings over the next several hours and total milk consumption over 20 hours is the same. Smart babies!
2. c. Nursing or pumping within one hour before drinking alcohol may slightly decrease the amount of alcohol in the milk.
3. a. Breastmilk alcohol levels closely parallel blood alcohol levels.
4. a. Breastmilk alcohol levels peak approximately one hour after ingestion of alcohol, although food consumption can delay the peak.
5. b. Babies slept more frequently for shorter periods of time during the 3.5 to 4 hours after alcohol intake.
6. a. True, the AAP category is “usually compatible with breastfeeding.”
7. c. Heavy drinking is dangerous. Casual drinking is unlikely to cause short- or long-term effects particularly if the mother waits 2 to 2.5 hours per drink before nursing.
8. a. The study showed the breastfed infant received between 0.5 to 3.3% of the adjusted dose.

How did you do? What surprised you the most?

The results of the poll on allergies and breastfeeding were quite telling and the comments were helpful and insightful, especially for all those dealing with allergies in the breastfed baby. Frankly I was surprised at the number of nurslings with known or suspected allergies and the number of mothers coping with an elimination diet. An even 1/3 of respondents said that yes, their nurslings have food allergies. These pyramids (in honor of the USDA food pyramid LOL) illustrate the distribution of the 148 votes.

Let’s be clear though — breastfeeding is wonderful for babies with food allergies. Do not interpret these results to mean that breastfed babies are more likely to have food allergies, because in fact the opposite is true! To learn more about the protective effects of breastfeeding, read “‘A’ is for Food Allergy Prevention and Reduction.”

I thought I would update how Nicole is doing at six months of age.

Solid Foods

Nicole continues to enjoy trying new solid foods. As you can see, mashed ripe avocado is one of her favorites! Just as with breastfeeding, I believe in baby-led solid food feeding. She feeds herself with her fingers or with a spoon that I have pre-loaded for her with food. She controls how much she gets, and I make sure to take her out of the high chair before she ever gets upset. I want that feeding chair to be a happy place! It must be working because she certainly is an enthusiastic eater so far!

Measurements

At six and a half months I took her in for her six-month well baby visit with the pediatrician. I would have taken her in earlier, but we both had rotavirus and I completely forgot about the appointment! So, at 6.5 months she weighed 17 pounds, 11.5 ounces, and was 27 inches in length. That puts her in the 75th and 90th percentiles on the CDC growth charts. I have yet to translate it to the WHO charts because that requires me to convert from pounds to kilograms and inches to centimeters, and that’s just too much math at the moment, even with on-line conversion calculators. I just look at Nicole and know that she’s doing fine — that’s all I need to know!

Sleep

When Nicole was getting her two bottom teeth in she woke up more often at night, every hour or two. Now that they are in and she’s not yet working on her top teeth, she is thankfully back to sleeping in four hour stretches or more.

She’s started crawling, and that could have contributed to the extra night-waking too. She wants to practice her abilities to roll around, push up on all fours, and crawl right off the mattress (which is on the floor for that very reason).

Reflux

For the record, and for all those mothers out there wondering when the spit-up will stop, please oh please make it stop, at six months Nicole only spits up occasionally rather than after every feeding. There was significant improvement some time after she turned five months old, both in the frequency and volume of spit up. She never had a problem to the point that I was concerned, especially in light of the fact that she was certainly growing well, not projectile vomiting, and not showing any worrying signs of food allergies. Still, I am not sorry to see the spit-up lessen!

And you?

Anyone else out there just starting to introduce solid foods? How is it going?

n

Please leave a comment to explain your answer. Whether or not your child has known food allergies, do you restrict your diet in any way? How easy or difficult is it to eliminate particular foods from your diet? Is there a history of food allergies in your family? If your nursling has food allergies, to which foods? Did your nursling or other children outgrow any food allergies?

As I researched the local agricultural fairs in which my daughters might like to participate, I learned that January is National Oatmeal Month! Somehow for a breastfeeding blogger, everything relates to breastfeeding, and National Oatmeal Month is no exception. It begged the question, does oatmeal increase milk supply? I knew that the answer could be found in the new book The Breastfeeding Mother’s Guide to Making More Milk by Diana West, IBCLC, and Lisa Marasco, M.A., IBCLC. The authors note that oat straw and its grain, oats, have long enjoyed a reputation as a galactagogue. In a section on lactogenic foods, they say:

Oatmeal is popular with North American mothers. Steel-cut or rolled oats are more nutritious and likely to be more effective than instant. Oats are also high in fiber, as is brown rice and most other whole grains and dried beans.

p. 173. So, given that oatmeal is nutritious and easy to incorporate into a healthful diet, it looks like we file this one under “Can’t hurt and might help.”