Introducing First Solid Foods

A few friends have asked if I could post on the subject of introducing solids: How, When, What to Expect. I wanted to write out a few of my thoughts on the subject. If you are the parent of an infant you can start right away by giving your little one oral stimulation by means of gum massage, tongue strokes and stimulation that help build oral awareness. Give your baby firm kisses around the mouth and playful taps with your finger while singing familiar songs. Although your baby may not be ready for solids you are creating positive oral experiences by doing these simple motions.

Allow your baby to explore orally with different teethers, Nuk brushes and textures. I love the vibrating teethers that are available in stores such as Target, Wal-Mart, and Toys R Us. Check your local pharmacy for the hummingbird vibrating flosser--I have so many patients that love this quiet steady vibration that can be added to spoons, nuks or just held by hand. I use a product called Z-vibe with several kids in therapy but it is not always necessary to buy expensive products when there are others readily available and more affordable. These nuk brushes and teethers will come in handy when it is time to introduce your baby's first cereal!

The general consensus in the medical field is to introduce solid foods no earlier than 6 months of age. I won't go into much detail regarding that statement but would like to attach a portion of the July 2006 issue of The American College of Asthma, Allergy, & Immunology. This organization developed a consensus document for introducing solid foods into an infant's diet to avoid development of food allergies, and they published the new guidelines in the July 2006 issue of the Annals of Allergy, Asthma, & Immunology.

Specific recommendations are as follows:

1. During the first 6 months of life, exclusive breast-feeding is recommended, with exclusion of cow's milk formulas and any supplemental foods. Exclusive breast-feeding protects against the onset of allergic symptoms extending far beyond the period of breast-feeding.
2. Complementary feeding of supplemental foods can be introduced starting at the sixth month of life. Introducing supplemental foods during the first 4 months of life has been associated with a higher risk for allergic diseases up to the age of 10 years, which confirms current WHO recommendations.
3. Exposure avoidance is an effective means of preventing cow's milk allergy. By extrapolation, delayed exposure to solid foods should prove to be similarly useful in preventing food allergies.
4. In the developed world, the main foods posing an allergy risk are bovine milk, egg, peanut, tree nuts, fish, and seafood. If introduced early, other foods can become clinically significant allergens. Therefore, it seems reasonable that foods should be introduced individually and gradually.
5. Mixed foods containing a variety of food allergens should not be given unless tolerance to every ingredient has been determined.
6. For processed foods, such as beef and kiwifruit, that are less allergenic when cooked, it is preferred to serve these foods cooked and homogenized.

In addition to this information the consensus statement recommends that "pediatricians and allergists should cautiously individualize the introduction of solids into the infants' diet. For infants at high risk for allergy, the optimal age for the introduction of selected supplemental foods should be 6 months; 12 months for dairy products; 24 months for hen's egg, and at least 36 months for peanut, tree nuts, fish, and seafood."

You are now ready to introduce your baby to solid foods and you ask yourself "How exactly should I do this?" This is where the nuks and teethers will have come in handy! We often think we need to do everything "by the book" but when it comes to parents of children who have had a very difficult time with feeding, this is not always the case. Place a small amount of the cereal and milk mixture on your baby's favorite teether for self exploration. The idea is to keep things familiar to him and to avoid a lot of suprises. It can also be helpful to pre-blend dry cereal so it results in a smooth puree when the liquid is added. Offer tastes on your finger, nuk brush, teethers and even your child's own fingers. Gradual exposure to the food can be very helpful in the long run! Use these opportunities to focus on the experience and not the volume. As he becomes comfortable with the tastes he will be more receptive to larger quantities on the spoon.

While we're on the topic of spoon feeding I'd like to point out that there is actually a 'better' way to spoon feed than to simply put the food anywhere in the mouth and scrape it on the roof of the mouth. Most people spoon feed that way so that is why I am mentioning it! Wait until your baby opens his mouth then place the spoon directly on the tongue (anterior-middle part) with a small amount of pressure to help elicit a central groove (the groove in the tongue helps with organized collection of the food bolus) This technique may not sound all that important..."Hey, he's opening his mouth and swallowing, what more do I need?" .... but since I am keeping babies with inefficient oral motor patterns in mind I wanted to give that brief description of typical tongue patterns for feeding. Wait for your baby to bring his top lip down to meet the spoon and clear. Good luck on your journey!!!

**For additional reading on the importance of coordination and feeding as well as suggested feeding tools/ products check out this fantastic post by Cheri Fraker over at cheriandlaura.blogspot.com entitled "Treatment Summary for the First Year of Life"