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"

Reuben Cups

Ok, Now I know that there is nothing about a recipe involving sauerkraut that screams "Picky Tot Friendly" but I have a particular child in mind. He, like many others I have seen for therapy, is very receptive to foods with a tart taste, whether it be Italian dressing, vinegar based, garlic or lemon. I had seen a recipe in a South Beach cookbook for spinach cheese cups and I thought it would be fun to try with ham, sauerkraut, cheese and a small amount of shredded baby spinach. I made this for my own lunch and added a dab of dijon mustard to each cup. So yummy!

So many of the children I see like the taste of ham but they may be turned off with the contents in this recipe so you could try just melting cheese inside or puree the contents so the consistency is more uniform. I posted this for the adults as well, I think this would make a great appetizer for a party or a quick lunch or dinner at home!

1 serving = 6 slices in mini muffin pan

6 sices thin sliced honey ham (I used oscar meyer)
sauerkraut
1 string cheese (this is what I had on hand!)
dijon mustard
3-4 baby spinach leaves

Place 1 slice of ham in mini muffin tin, pinch sides to create a little bowl
Peel strips of cheese (or shredded cheese) and place a few in each 'ham bowl'
Chop (tear) spinach leaves into small pieces and place a pinch in each bowl on top of cheese
Place approximately 1 tsp of sauerkraut on top of mixture
Bake at 350 degrees for 10 minutes.

Add dijon mustard before eating! Here is the finished product:

The Bigger Picture—how Attitudes affect Mealtime experiences

I think the best practice for all of us, whether we have a child with food aversions or not, is to put ourselves in their little (or big) shoes. The Big Picture, always about the Big Picture. Our own anxieties and fears as parents feed directly into our children---how does this play out in a child with feeding complications? You want so badly for them to try a food, to eat a certain amount so they can reach a desired weight for their age, but sometimes ignore the fact that eating in itself is Not Enjoyable for them! Therefore the act of “trying a food” can be a really far-fetched idea in many instances. Not only that but it is often not one, but two or three people surrounding the dinner table coaxing the child to try the food and once again, our own anxieties set in and result in an overall stressful mealtime experience for everyone! There definitely needs to be a shift in the thinking here, and not only in the caregivers but also in many therapists treating children for feeding issues.

Here is a great example—last week we had family in town to celebrate our daughter’s 3^rd birthday. We went to a great little seafood place and had some delicious food! My husband was really wishing for Adalyn to try the grilled shrimp but everything on her face said “No!”…thus the coaxing begins, “Just try it, you’ll love it” “Just one bite and then you can__(fill in blank here)” We all know this scenario, right? I of course had to jump in and say “Hello? Do you not know anything about what I do for a LIVING, treating very selective eaters? Please don’t worry about her not trying the shrimp” ha! I said we’d just do a seafood or shrimp night one night. Which is exactly what we did! I started talking about it the night before and mentioned it a few more times the next day, took Adalyn with me to the store and started calling out for “Popcorn Shriiiimp, where are you?” We even got some hush puppies since that is always a nice addition to any seafood! We came across some yummy looking breaded butterfly shrimp in the frozen food section and went that route instead of popcorn shrimp. I showed her the tails (on the picture on box) and asked if I could take them off for her, she thought that was the most generous act and thanked me in advance right there in the store “Oh, thank you mommy!”

That night we had a great meal of baked tilapia with butter, lemon, mint from the garden and lots of parmesan cheese, a few new shrimp and some hush puppies! She immediately asked for her ranch—her favorite choice for dipping, especially with new foods, but I asked her if she would try some mango preserves for a sweet dip for our shrimp. She tried it, seemed to enjoy it, but politely declined any additional dips! Only 3 or so bites of the shrimp, but you know what? That’s ok! What a different reaction than the night in the restaurant! She was not prepared for trying shrimp, she shuddered at the thought and there was not much that was too familiar about it to her.

I do realize that different personality types make it easier or harder to come to grips with inconsistencies in life. Especially when dealing with the health and nutrition of our children. I am considered an “Idealist” (according to the Myers-Briggs personality test anyway), and I know my ability to really empathize with another person in combination with some other ‘weird’ qualities help me help others and I have a strange knack with the pickiest of picky eaters! It is a challenge but I do love it—at times I find it harder to relate these mealtime concepts and beliefs to the parents of these children, but I do believe a shift in attitudes toward mealtime is needed. This is why I am content with a "1 bite shrimp night" and the fact that she may have eaten a third of what she did the day before. With the children we, as therapists, work with however the details to caloric intake are much more important—I am a big believer in finding calorie packed foods that can be added to current accepted foods, I learned this from the beginning of my career and it is a perfect way to continue to allow a child to choose what they will eat and how much they will eat…it just so happens that some of their choices have more calories in them! The outlook I have in many situations is the same, “This too shall pass”, or many small steps toward the bigger picture. And like I said, it’s all about the Bigger Picture.

** I love you dear husband, just using you as a wonderful example!