Tuesday, August 26, 2014

Introducing Solids to Baby - Why I Waited

Starting a baby on solids is a momentous occasion in any parent's life. Among Keralites, this is marked by a special ceremony where the baby is fed a few grains of rice with some salt and jaggery by every overzealous member of the family. A taste of foods to come, as it were.

Look at the moisture on Shobana's forehead.

While we have decided to forego this 'choroonu' ceremony, we still need to introduce solids to our exclusively breastfed baby. As E approaches the 6-month milestone, I've noticed that she now looks at me hungrily when I eat something, and sometimes, even mimics my chewing action.

Our relatives started inquiring about her solid intake when she was around 4-months old, which is when, traditionally, babies are fed a strained paste of ragi or millets. This was generally given to babies whose mothers had an insufficient or nonexistent milk supply American babies were fed donkey's milk. Imagine that! but over the years, it has now become a baby's first introduction to solids.

Strained Finger Millets. Image courtesy: yummytummyaarthi.com

Being promised a healthy, chubby baby, I too thought I would feed her 'ingru' (as we call it in Kerala) when she crossed the 90-day mark. Until I did a little bit of reading.

Why Delay Solids


Most health organisation, including the World Health Organisation and UNICEF, recommend that babies be given only breastmilk or formula until they are 6-months old.

E's paediatrician made the same recommendation and that was enough for me. Once E and I had overcome the initial hurdles of breastfeeding, I knew I wanted to continue for as long as she wanted to. I treasured our oneness and it felt counterintuitive to start her on anything else when she was only 4-months old. 

So I started doing a little bit of research on introducing solids to breastfed babies. The reasons given below assume that baby is fed breastmilk only (although experts generally recommend that solids be delayed for formula-fed infants as well).

Baby will have greater protection from illness
Breastmilk contains identified and unidentified immune factors 'germ killing cells' for us non science-y types. It also facilitates the development of the good bacteria that protect baby's intestines.

Baby's digestive system will have time to mature
From birth until somewhere between 4 and 6 months of age, babies possess, what is referred to as, an 'open gut.' This means that the spaces between the cells of the small intestines will readily allow intact macromolecules, including whole proteins and pathogens to pass directly into the bloodstream.

While this is great for the breastfed baby as it allows the beneficial antibodies in breastmilk to pass directly into baby's bloodstream, it also means that large, potentially allergy-causing proteins from other foods and disease-causing pathogens can pass right through, too. Baby starts producing antibodies on her own at 6-months while gut closure should have occurred by this time as well.

It's a bad idea to start cereals like millets too early because baby doesn't start producing pancreatic amylase (an enzyme essential to proper digestion of such cereals) until she is about 8 to 12-months old. This causes an unhealthy weight gain in baby just like a pre-diabetic who becomes chubby just before being diagnosed with the disease and unnecessary pressure on a still developing itty-bitty pancreas.

Further if solids are started before a baby is physiologically ready, it can result in poor digestion, causing problems like gas, constipation etc. Human milk contains enzymes that efficiently aid digestion. Hence the recommendation that babies are simultaneously fed breastmilk and solids till they are 1-years old.



Baby will be developmentally ready to eat foods that are not liquids
Clinical reports indicate that "the majority of normal full term infants are not developmentally ready for the transition from suckling to sucking or for managing semi-solids and solid foods in addition to liquids until between six and eight months of age."

Food will not need to be steamed and puréed to liquid form (resulting in the complete loss of essential nutrients). This means less work for mum and baby.

Starting solids will be easier
Babies who start solids later can feed themselves. No jabbing spoons into their mouths and forcing them to swallow.

Mom can maintain her milk supply
A study conducted by the WHO in 2003 indicated that for babies less than 6-months, solids tend to replace breastmilk in their diet. Thus, the more solids that baby eats, the less milk she takes from mom, which means less milk production by mom. This could result in premature weaning.

Mom can more quickly lose extra "baby weight"
Mothers who exclusively breastfeed their babies for 6 months (as opposed to 4 months) have more rapid postpartum weight loss. I had gained around 14 kilograms during my pregnance, all of which I lost within 8 weeks postpartum, all thanks to breastfeeding now to get my tummy area to stop feeling like dough.

In waiting to give E solids, I also gave myself time to read up on how to introduce solids. Like most mothers, I assumed that baby's first foods will need to be steamed and puréed. Until I learned about
Baby-led Weaning or BLW.

Baby-led Weaning


Weaning is the gradual change that a baby makes by replacing breastmilk or formula as her only food with foods that adults consume. While this transition takes at least 6 months, the weaning process starts with baby's very first mouthful of solid food. These first solids or complementary foods are not meant to replace a baby's main diet of breastmilk or formula but rather to 'complement' baby's diet, such that it gradually becomes more varied.

More like an intense feeling of loss.

In most families, weaning is led by the parents. When we start to spoon-feed baby, we decide when and how she starts solids; when we stop offering the breast or bottle; and when to end all milk feeds.

Baby-led weaning shifts control to the baby, relying on her instincts and abilities. Thus, the spoon-wielding adult steps out of the picture, along with their puréed apple; games of 'here comes the airplane,' and scooping up food that baby spits out and sticking it back into her mouth.

Instead, with BLW, baby is encouraged to explore food by picking it up with her hands - it doesn't matter whether or not she manages to eat any at first. Food is offered in pieces that are the size and shape that baby can handle easily, rather than as purées or mashed food.

Thus, baby goes from suckling to gnawing and chewing. By sidestepping learning how to suck from a spoon, baby learns the important skill of chewing and swallowing her food. BLW also helps baby decide how much she eats, and how quickly she widens the range of food she enjoys. She continues to have milk feeds whenever she wants them, and then, she decides when she is ready to begin reducing them.

To educate myself further on this subject, I bought the book Baby-led Weaning by Gill Rapley and Tracey Murkett. Ms. Rapley is a British health visitor with over twenty years of experience while Ms. Murkett is a writer who tried BLW with her children. I'm still reading the book, which reads like one giant advert for BLW I'm instinctively suspicious of anyone who tries that hard to sell something.

Thus far, my feelings on the subject are as follows:

BLW seems like a nice way to introduce solids to a baby - especially since I'm petrified of sticking a spoon into my baby's mouth. A baby's gag reflex isn't at the back of her tongue like it is for adults be quiet my memories of helping out drunk girls at college, it's somewhere at the middle of the tongue. Therefore, it's entirely possible for a spoon controlled by an inexperienced parent to trigger it. 

If a baby is allowed to feed herself, she probably will gag; this is to prevent choking and the bolus will come out in its entirety. However, when sucking food off a spoon, some part of it could go directly to her throat, circumventing the gag reflex, thereby causing her to choke necessitating back slaps and performing the Heimlich Manoeuvre.

Mama would be happier if your gagging isn't caused by the spoon mama's sticking in your mouth.

BLW isn't a brand new idea. Even my parents' Dr. Spock book from the 1970s talks about the importance of giving babies 'finger foods.' But back then, baby was first spoon-fed puréed foods, and later offered finger foods as a sort of developmental exercise - to encourage her pincer grasp, which develops by month 9.

I'd like E to be comfortable being fed by spoon and by hand. Rather than follow the Dr. Spock solids progression sounds like the title of an episode of The Big Bang Theory, E's first foods will be little bits of apple and banana, mashed between my fingers and dabbed on her lips. This way, I'll know food is at the right temperature and consistence for her.
She may or may not eat that fingertipful my guess is that she'll spit it back out. But then I'll offer her little slices of both (at least 5 cms long so she can grasp and gnaw) and then just watch her. Once we're both comfortable with food going into her mouth, I'll introduce The Spoon.

I'd like to watch E eat her food rather than worry about her eating. I don't want to worry about how much she's eating, when she's eating or even whether she's eating. Instead, I'd like to see how she handles the various bits of food - watch her face change when she manages to get some in her mouth and taste it. I like that BLW assumes breastmilk or formula to be baby's main source of sustenance, making food about fun and exploration.

Rapley and Murkett warn us that BLW can be messy - they suggest placing baby's highchair on a large oilcloth or even shower curtain to catch dropped food. I plan on keeping her as close to the ground as possible until she's comfortable sitting unassisted. To this end, I've bought this booster seat by Fisher Price I bought it at INR 2495 as a stopgap till I get my dream booster seat on our next trip to Dubai. Yes I have a dream booster seat. I'm a nerd.

To get her used to sitting in her little seat, E currently spends around 5 minutes at a stretch, three times a day in there, mouthing her various toys. When she starts eating solids next week, I'll place the chair on some newspapers while she plays with her first morsels of food. Sure, it'll be messy but I'm counting on my scavenger of a dog to help out with that.

That's my baby! (firstborn and actual born)

More updates on our adventures in food next month!

Stay tuned for Headbather's FavTV coming up later this week.

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