PEDIATRICIAN EXPLAINS: How to Start Solids For Baby | Dr. Amna Husain
Dr. Amna Husain: Hi, everybody. I'm Dr. Amna Husain, board-certified pediatrician, board-certified lactation consultant, and mom. Today, we're going to be discussing a very popular topic, and that's introducing solid foods to your baby. This is often asked about, lots of questions out there, lots of opinions out there, so we're going to bust some myths. And before we do that, a lot of the common terms you're going to be hearing in this video are baby-led weaning, finger feeding, purees, spoonfeeding, maybe even a combination of all of those terms. We're going to debunk some myths, talk about pros and cons to each.
As I was trying to craft out this episode and think of what I wanted to say, I almost felt like I was overthinking it and getting confused about what made more sense. I'm just actually going to talk to you guys like I would one of my patients in my exam room and go through what we first start with.
First of all, I like to review developmental readiness signs. What we mean by developmental readiness is signs that the baby is showing that they are ready to start solid foods. Now, typically, we use the age range four to six months. That's a wide age range. And we use that because we look for a couple of things. Namely, we're looking at head control. Typically, I'd like to see baby's head being able to basically be controlled and upright by themselves. That typically happens after three months of age, but again, every baby is different. You'd also like them to be able to sit. Now, sitting unsupported may not develop until six months or later, so that's why sitting in a high chair with a five-point harness or somewhere where they're able to sit up straight and supported is very important.
Also, we expect to see loss of the tongue thrust reflex. What is the tongue thrust reflex? Well, it's basically that. Any time a spoon or something is brought to the mouth, actually, baby, to protect their airway, stick out their tongue. They don't really want something brought into their mouth, right? Usually, we see this disappear around the four-to-six-months age.
And now, lastly, some people also say that you should see interest, right? Baby should be interested in watching what you bring to your mouth or interested in watching what you eat. Now, I'm a little plus or minus on this one, because, really, if you've ever seen any four-to-six-month infant, they start to become very hypervigilant and aware of what their surroundings are, right? If you're nursing an infant, often these kids are the distractible children, right? Or if you're playing with your child, this is the age that they always go after things like cell phones, keys, TV remotes, things that they should not have their hands on. Well, children are just interested in their environment at this age naturally. Of course, if you're eating or they're sitting at the table watching you eat, they're going to be interested and want to grab that. That's pretty normal.
Now, depending on which approach you take, baby-led weaning or spoonfeeding, that also determines what age. Typically, I like to start baby-led weaning closer to six months at least. And we'll talk a little bit more about why that is later. Now, depending on which approach you take, baby-led weaning, purees, or spoonfeeding, it is a personal choice. Some of it's also influenced by our culture. Some cultures have and always recommend starting with pureed foods. Some cultures generally skip straight to table foods. No matter what, I usually recommend babies begin to be introduced to finger foods between eight to 10 months of age.
Why do we have to even start solid foods, right? Some people think, "Well, breast is best, right? The longer I continue to breastfeed my child, the better." Same with formula. "Maybe my child's just not ready. If I just want to continue to feed them with breast milk or formula, is there anything wrong with that?" Well, it really depends at the child we're looking at, right?
For example, we've used the age four to six months. A premature infant may not be ready at the four-month mark. We have to think about their developmental adjusted age. Again, your developmental readiness. Typically, why do we use the six-month mark? Well, oftentimes, depending on your nutritional requirements, it can become a little difficult to meet those solely from breast milk or formula alone. Namely, iron stores and zinc stores might start to become a little depleted, so a great way to replenish them is through the diet. Secondly, we do know that delaying introduction of solid foods, and definitely certain highly allergenic solid foods, can increase the risk of food allergies later in life.
All right. Now that we've talked a lot about the foundations of readiness and why we start solids when we do, let's actually get into what the methods are. First thing we'll start with is baby-led weaning. Baby-led weaning is an approach that lets you essentially skip purees and spoonfeeding and directly move on to baby controlling their first bite. This method is often thought to emphasize and encourage independence as the parent follows baby's cues and their interest and readiness to start solid food.
Babies are often brought to the table for family meals. They're encouraged to pick up food with their own fingers, and then they're actually entrusted to eat just as much as they'd like, not any more, and not any less. With baby-led weaning, there's often thoughts that there's more ease with dining out. Perhaps it's less expensive, because you're not buying baby jars or baby food pouches. And lastly, maybe even more successful in preventing a picky eater.
What are some of the cons? Well, just like you'd imagine, when babies feed themselves, it can get a little messy. Secondly, sometimes, it can be a little wasteful, right? When a baby is half chewing on a piece of a cucumber and then throws it on the floor, then you have to throw that food out. It wasn't consumed, and now you can't really eat it or make anything from it, so it can seem wasteful. Lastly, there's a concern for gagging, which can be a little alarming.
Before we bust the myths on whether these are actually pros and cons, let's talk about the difference between choking and gagging. True choking is when your baby's airway is obstructed and they're having trouble breathing. Signs of a baby choking are an inability to cry, high-pitched sounds, even color change to maybe blue or purple. If you suspect that your child is choking, immediately call 911 and start performing CPR.
Gagging is actually a protective reflex and natural function that can prevent choking. When your baby is gagging, many baby-led weaning experts recommend that it's important for your child to work through the gag. Try not to stick fingers into your child's mouth, which can further dislodge a piece of food down into the airway. Most baby-led weaning experts recommend trying to coach your child into spitting that food out or expelling it by really sticking out your own tongue and trying to demonstrate to them what you'd like them to do.
Speaking of, this is one reason why I recommend waiting until at least six months of age to begin baby-led weaning. There's just a much higher risk of choking if you start at a younger age, because they may not developmentally be ready to swallow and move that food into the back of their mouth, or if they are gagging, to be able to expel that food. You want that child to not only have the head control that we've mentioned, loss of the tongue thrust reflex, but also be able to really sit unsupported and have good truncal control, which for some babies at six months of age, they may still require a little bit of support with sitting.
Now, we have all these pros and cons of baby-led weaning. Let's actually talk about, in my opinion, if they are valid or not. First, let's start off with independence. Definitely, baby-led weaning can help to promote independence, right? The child is responsible entirely for what they put in their mouth. When they reach out their hand and getting that coordinated motion of getting the food into their mouth, it's promoting an independent skill. It's also promoting some development as well.
Appetite control, I could be convinced of otherwise. Some children may just not be developmentally coordinated enough, but still be interested to want to continue to eat. I really think that could be argued both ways.
Now, let's talk about success, right? A lot of people think with baby-led weaning, you can have a less picky eater. I would call false on this. I have definitely seen many infants who have done baby-led weaning, and then go on to become picky toddlers. It's hard to really predict this. Yes, in theory, it does sound like it would promote less picky eating, but at the end of the day, children do have changing taste buds and preferences, and they also go through phases. They may not want to eat a specific vegetable that initially they loved at eight months of age, but now at 13 months of age, they're just not really enjoying it.
In regards to family meals, I also feel like this can be false. For many parents, when they choose to go to baby-led weaning, they may specifically create a meal or cut up vegetables or fruits or solid foods for their child and then eat their own meal later. It's just practical parenting life. Sometimes, it's easier to feed your child first and then eat yourself, or the vice versa. Maybe your breakfast very early and then feed your child. You can still absolutely have family meals no matter which method you choose. It's not a gung-ho thing that you're always going to have family meals if you choose to go the baby-led weaning route.
And now, dining out. Definitely. I think it can be a lot easier when you're dining out and you're choosing to do baby-led weaning, for sure, because we can't really take what's on our plate and puree it. But there are methods around this, which we'll definitely discuss later. There are pureed foods that we as adults eat and consume normally, and they can definitely be fed to baby if you're eating out.
Now, in terms of the expense, this is true. Definitely. When you prepare foods at home, it'll definitely be the less expensive option than jars or baby food pouches. That's something to consider.
Now, in terms of the cons, is it messy? Totally. It is. But what I recommend is parents embrace it. You can set up a mat underneath your high chair, you can get them a special bid that protects their clothes, or just know that you're going to hose down your baby and give them a shower right after they eat. Just embrace the mess. It's totally true.
In terms of food waste, this is definitely also something to consider. And for some families, maybe baby-led weaning is not an option, because you might be giving up an expense one way from baby foods, but the other hand, you might feel like you're wasting food and that's just not practical for your family.
In general, success rates can be pretty high with baby-led weaning, but I do think that you have to realize your child will have changing taste buds and preferences. Even if you do go the baby-led weaning route, just know that they may eat what you eat right now, they might go through a picky phase later, and that's not necessarily your fault.
We talked a lot about baby-led weaning. Now, let's talk about spoonfeeding or puree feeding. We'll do the same thing where we discuss what's important, what it emphasizes, the pros and cons, and then bust any myths about whether I think, personally, these are actually true pros or true cons.
Puree feeding or spoonfeeding is the traditional approach perhaps your parents chose when introducing you to solid foods. Foods are typically served mashed or pureed, and then babies are spoonfed those foods, later given the opportunity to have some finger foods as well. Definitely, if you go this route, I recommend that you still introduce finger foods to babies between eight to 10 months of age.
Common pros that are thrown around with this. It's tidy. A lot of people think there's less fuss and less mess compared to baby-led weaning. It's less wasteful, perhaps, because you're able to buy a jar of food or create an ounce or two ounces of baby food at a serving, and then know that that's how much might get consumed or discarded if it's not eaten. Many people also think that this is a more efficient method, because you're able to create a batch of food and then possibly puree it and then serve as multiple meals for the baby later down the line.
Let's talk about the cons. Some experts claim that this could make your baby dependent on you for meals and less in control of their appetite and regulating whether they're full or not. Others claim that with one texture, babies are not going to have the appropriate oral development, which can then lead to some picky eating behaviors later in life. There's claim that it's more expensive, especially if you're buying baby jars or baby pouches, and perhaps not as conducive to family meals, because baby has to really eat their meal that's separate from what the parent might be eating. All of these things being aside, we also know that sometimes, babies just won't open their mouth. What do you do then?
Now, let's bust the pros and cons of these and see if they're actually true. In regards to being clean and tidy, false. Babies can actually be incredibly messy when they eat purees, and that's totally okay. Certainly, in the beginning, they don't quite understand the textures that are going into their mouth. Some of it might even dribble out. They may not like the taste of something as well, so they might spit it out. That's totally fine. But I don't think you can always expect a feeding is cleaner or tidier.
Now, is it more efficient? Well, that really depends. For some parents, if you choose to make foods at home and you're great at bulk cooking and cooking in batches... Well, that really depends. For some parents, if you're choosing to make baby food at home in bulk and you're batch cooking, then you can definitely be efficient. But for others, if you prefer to make baby food in smaller batches, you might find that this is actually causing you more time and more stress at home if you're making baby food.
Definitely, I do think that there might be less waste here, because you can definitely determine how much you want to get out for the baby, whether initially baby's only taking a teaspoon or two and then working their way up to one tablespoon, or maybe your baby's doing really well with solid pureed food and eating three to four ounces at a time. You're able to understand better how much that you can really allocate for your baby and how much is being wasted.
Let's talk about dependency. I actually think this is false. Your baby is going to become interested in what you're doing. They're going to want to grab the spoon from you, so be spoon ready. Have a few spoons. Let your baby try to actually feed themselves and stick the spoon into the jar. Your baby doesn't have to be dependent on what you eat.
Same with appetite control. I think this is actually false. Your baby can still control their appetite very well when they're puree feeding. You just have to watch their cues. If they're turning away from the food or they're not interested, then don't keep making them try to open their mouth or force a spoon of food into their mouth.
What about oral development and picky eating? Well, I call false again, because as your baby begins to grow, you're going to actually increase the thickness of the puree and add different textures in. Don't forget, we still want to add in finger feeding between eight to 10 months of age. Your baby won't necessarily lag behind in development if you continue to introduce and appropriately thicken feeds and add different textures as they get older. Same with picky eating. As you continue to add textures and introduce more foods, your baby's going to be exposed to just as diverse of a palate of foods as if you were to have done baby-led weaning.
Now, in terms of family meals, this really depends, again, just like baby-led weaning, how you choose to feed your baby. If you choose to feed your child before you sit down to eat your own lunch or dinner, then yes, your baby will not be eating with you. But if you choose to bring baby to the table and feed them alongside you, then I think there's absolutely no harm in doing puree feeding and still feeling like it's a family meal.
Now, when it comes to expense, this is definitely true. Pouches and jars can add up. It is actually less costly to make baby food at home. However, that is something that can take up quite a bit of time for parents, or something that they may just not be interested in. It's really a parental choice. In fact, all of this, again, is a parental choice. It's your personal decision, which you'll hear me say over and over again.
All right, let's do some troubleshooting. What happens if your baby just doesn't open their mouth? Not a big deal. Some babies will take one bite, clamp their mouths, and then turn away. And if that happens, don't force the spoon into their mouth. Instead, you can do a few other things. You can either take the puree and put it on your finger and allow them to taste off your finger. Again, please, a clean finger. You could also put a little bit of the puree on their highchair and let them try it with their own fingers. Use their cues. See how interested they are.
I know what you're thinking. Isn't sticking your finger in a baby's mouth completely against baby-led weaning? Isn't putting food on the tray more like baby-led weaning? Well, you're right. It doesn't have to be a complete delineation, in my opinion. I think many parents have become camp baby-led weaning or camp puree, and they really don't go and stray from either direction. Well, in my personal opinion, I think you can actually do a combination of both and still get the best of both worlds if you choose to go that route. Even as adults, we eat smooth, pureed foods. Hummus, yogurt. It's okay to introduce those types of textures into your baby without feeling like you're going to compromise their oral development.
Speaking of, what are the pros of really combination feeding? Well, family meals can still occur. You can still absolutely promote independence. You can still promote, like I mentioned, development of oral motor control, and babies can still get accustomed to a large variety of foods.
Now, some of the cons that people think about combination feeding is perhaps that it elicits confusion in children. One minute, they're getting purees, and the next, they're getting the opportunity to feed themselves. Personally, I think this overthinks the whole situation. Babies are not really going to get confused by feeding. Of course, you're always going to allow them to put the food in their mouth and get a taste no matter what texture it is, so I really don't buy this as a con.
Secondly, people seem to think that this is contributing to the worst of both worlds, the mess of puree feeding and the time spent with baby-led weaning. I disagree here. I think it's really what you make it. For example, I've just posted a TikTok video recently of making a veggie-heavy red sauce for my daughter. I cooked this on the weekend and I threw a lot of vegetables in it. Onions, garlic, tomatoes, zucchini, red bell peppers, you name it. And then I was able to cook it down with a little bit of chicken stock. I pulled aside some of it before I actually pureed it for the red sauce purposes and allowed my daughter to eat it. She almost ate it like a soup, basically, because there was some chicken stock in it as well. Then, I just used however much I wanted and pureed it and froze it for the sauce that she could eat with pasta later. Wasn't very much extra work at all. It was a step I already wanted to do, and I just took a little shortcut and provided her lunch for that day as well, something that she could pick up with her fingers. Now, of course, she's three years old right now, so she's actually able to self-feed herself with a fork or with a spoon, but it doesn't have to be complicated at all.
The most important thing is to know that, around eight to 10 months of age, you should be trying to introduce more finger foods and then slowly continue working on self-feeding. There's a couple of ways to do this. If you're doing purees, for example, you can start slightly thickening the purees as your child becomes more accustomed with what the puree does when it's in their mouth, how to swallow it, and get used to really their own oral motor control. Now, once you've slightly thickened your purees, you can actually move on to other textures and offer small chunks of soft, mushy food, similar to what you saw of the steamed and softened vegetables from my daughter's veggie-heavy red sauce before it was pureed.
The second method is to really go just straight from purees to offering them solid foods, but the solid food you would offer them would be more steamed, mushy, easier for them to put into their mouth. It's definitely possible for them to continue to be able to gum things and swallow them down, even if they don't have all their teeth.
Lastly, let's bring it all back to baby. Which is more fun for your baby? Baby-led weaning experts claim that exploration and the ability to enjoy food is more closely attuned to baby-led weaning. Again, I'm going to play devil's advocate here and say that's not necessarily true. You can absolutely have fun with both methods of feeding. Even with purees, I highly recommend letting your child touch, inspect, play, and taste different foods that they're going to be exposed to.
Speaking of, let's talk about what environment you can set as the parent. This is really crucial. Whether you do baby-led weaning or pureed foods or a combination, try to keep it a low-stress, distraction-free environment. Now, considering that I'm about to become a mom of two, and the second time that I do purees or baby-led weaning and begin to introduce solid foods, I'm going to have another toddler running around and screaming in the background. I realize that having a completely distraction-free setting and environment can be very difficult for moms and dads and multiples. But certainly, this is something that we know can be very helpful.
Always make sure you're keeping your baby upright in a high chair so they have good trunk control and are in a good position, upright to be able to swallow the foods down successfully. Make sure you're offering small amounts initially, right? Whether you do baby-led weaning or pureed foods, trying to offer small amounts initially is a good way to start off.
Lastly, check your emotions. If you find that your baby is not interested or just not really having it, would rather play that day with their foods, don't become frustrated and don't force them to eat. I definitely don't think that this is going to be conducive for either one of you. Just understand that babies can have varying emotions. Sometimes, we're not in the mood to eat, and we can expect the same from them. If this happens, my advice is to go ahead and remove the food, clean up baby, make sure you have them removed from the eating environment, and let them go play. I wouldn't let them snack unnecessarily during the day, but the next time you try again, hopefully they'll be hungry.
Speaking of, what is a good time to start trying to introduce solids during the day? Well, typically, we recommend waiting about one hour or so after they've had either their nursing session or their bottle of breast milk or formula. That way, they're not so hungry that they're hangry, but they do have some room in their stomach to try to explore and try something new.
All right. We talked about a lot of things here. Baby-led weaning, pureed foods, how to find out if your baby's developmentally ready to even start solids, debunking myths about all these types of feeding methods, and even discussing combination feeding. I hope this video was helpful for you. Give it a thumbs up, drop any questions that you have below, and make sure you share it with a parent who might be looking to start solid foods. Remember, new videos every Monday.