Starting babies on food
Modern medicine, in a worthwhile desire to avoid problems associated with poor eating habits, has developed rules about the feeding of food to babies that have made eating food a complicated, frightening and a tiresome exercise. These rules are even more complicated when parents must choose the “right foods” for their children, especially those still too young to choose for themselves.
Most paediatric societies, including the Canadian Paediatric Society and the American Academy of Pediatrics, agree with the World Health Organization statement that babies be breastfed exclusively for the first 6 months and that solids be started when the babies are 6 months old. This seems simple enough, not at all complicated. But on closer inspection and when we are trying to deal with the real world, some issues come up.
It should be emphasized that the normal length of breastfeeding usually is about 3 – 5 years and longer because toddlers and young children need breastfeeding not only for nutrition but also as a relationship.
It is worthwhile remembering that these statements by the WHO, the Canadian Paediatric Society and the American Academy of Pediatrics, as well as other pediatric societies around the world, are public health statements, and are true for most babies, but not necessarily every single baby. Perhaps we can say that the statements are an “ideal” approach to starting babies on food, but that there are times or babies for whom the statement may not be appropriate.
Unfortunately, too often, mothers writing me with regard to their baby seeming hungry, their baby who will turn 6 months of age in one week, will state, in response to my suggestion (amongst others) that the baby be started on food: “We plan to start him on food next week”.
Is that what the WHO and other statements really suggest, that the baby be exactly 6 months old, 182.5 days, before starting food? I don’t think so.
Please see at the end of this article some unusual situations with regard to food, under the title of Late onset decreased milk supply and Ketosis.
Why would there be exceptions?
The obvious answer is that not all babies are the same; they reach developmental milestones at various times and parents watching for signs of the baby’s readiness to eat food is more important than looking strictly at the calendar. The beginning of their interest in food varies as well, as does the timing of a baby’s sitting up without support, saying words and independent walking.
It seems obvious that the baby should decide when he is ready to eat food and parents usually are quite aware that their baby starts to become interested in eating food. By about four months of age, many babies are becoming interested in what their parents are eating. The baby, sitting in a high chair (at four months usually supported by pillows) or on one of his parents’ lap while the parent is eating, may follow with fascinated interest the progress of the spoon or fork from the plate to the parent’s mouth. At about the same time, the baby is starting to develop the hand-eye coordination which will allow him to pick up food and other objects and put them into his mouth.
By about 6 months, many babies are trying to reach for food and many, if food is within reach, will try to take the food and put it into their mouth. This seems an appropriate time to start offering food to the baby.
However, some babies seem very anxious to start solids earlier than 6 months of age. Why should parents feel they must wait until the magical 6 months? So, starting earlier than 6 months, say, 5 months and 1 week, would be, in my opinion, perfectly appropriate, BUT, please see the paragraph on late onset decreased milk supply, below.
Starting at this age, however, depends on the baby’s desire to start food, not the parents’ desire to start “real food” as opposed to breastmilk (not “real food”), as not uncommonly described by grandparents, desirous of being able, finally, to take part in feeding the baby themselves. Or, too often, unfortunately, due to a lack of confidence in breastfeeding, even if the baby is happy and gaining weight well.
A comment, though, about the 5 month and 1 week old baby being very interested in solids. Besides the importance of making sure he is still breastfeeding well and that the mother has not had a decrease in her milk supply, it is true that the baby may be happier with eating food. But it is more important that the possible problem of the decrease in milk supply be addressed. Breastfeeding is still the most important food at this time.
And, in a world where formula companies keep clamouring for food and formula to be introduced to babies earlier and earlier and where public policy of 6 months of exclusive breastfeeding is being questioned more and more, what should be reinforced in people´s minds is that they keep breastfeeding exclusively for 6 months.
On the other hand, some babies may not show interest in food until, say, 7 months of age. Is it okay to wait? Sure. If all is going well with the baby’s breastfeeding, then it’s fine, no problem.
The baby shows signs of being ready; let’s start the baby eating food
Your baby is around six months old and seems ready to eat food. What foods should you start offering him? It’s not really complicated: basically, the same food that the parents eat with a very few exceptions (see below). There is no need at all for special foods for healthy, thriving babies of 6 months of age.
By six months of age, babies are interested in eating the same food as the rest of the family. Why? Well, they have become social beings and they want to participate in the same activities as their parents and siblings. This is usually pretty obvious to parents. Babies are different at 6 months than they were at 2 months, say. Also, they mimic the adults’ behaviour. That’s how babies learn, by mimicking adult and older sibling behaviour.
The babies in the photos below are eating what the parents are eating, on the left, chewing a chicken bone and why not? On the right, the baby is eating a bit of meat.
And this photo below? Baby and mother eating the same food.
Eating has always been a social and family event until recently. “Give us this day our daily bread” with the family around the table is no longer the norm, it seems. But maybe, if we reinforce the social nature of eating by not feeding babies and children differently from the rest of the family, perhaps the family all eating together will return as a normal way of eating.
As you start offering food to your baby, you can also give him water to drink from an open cup; no need for special cups or sippy cups which are essentially modified bottles.
And you know what? The baby can and should be eating without help. Of course, somebody needs to be with him when he’s eating, but the baby does not need to be spoon fed. He can pick up the food and eat it without help, with his hands. If you don’t like messes, it’s time to get over that. Babies are anything but neat, as you know.
The photos below shows babies who don’t really care if they make a mess. Perhaps the parents should not care either. If you do care, put plastic around the high chair.
What about breastfeeding at this point?
Once a baby is six months old, all attention shifts to “food” and very little attention is paid to breastfeeding. And not infrequently people believe, wrongly, that breastmilk no longer contains the necessary nutrients the baby needs.
There is a widespread notion amongst physicians and nutritionists that there is “nothing in breastmilk” after about 6 months. This is patently false. See below in the section Late onset decreased milk supply and ketosis for more information.
Breastfeeding can and should continue after the first six months and food is added to breastfeeding. Food does not substitute for breastfeeding at this point and breastfeeding is not a supplement to food; breastfeeding is the main food. If problems with breastfeeding appear at this point, when your baby is 9 or 12 months or older, the problems can be overcome, and it is not a sign that your baby is “self-weaning”. A baby does not “self-wean” before the age of 2.5 or 3 years of age. The time between 6 months and 2 years serves to give the baby time to learn to eat the food adults eat and to establish breastfeeding and food as two important sides of normal eating.
A big deal has been made about babies needing to be exposed to gluten early in life, in order to prevent the development of coeliac disease. According to two fairly sketchy studies, babies have a decreased incidence of coeliac disease later in life if they are exposed to gluten containing foods between 4 and 7 months of age (not before 4 months and not after 7 months).
But these studies did not prove anything. And in fact, they didn´t find the children had a decreased incidence of coeliac disease. One US study found that babies started on food AFTER 4 months of age were better off than babies started on food BEFORE 4 months of age. One Swedish study did not include the question of whether babies were breastfed or not. And there have been many studies since then showing that there was no relationship between the timing of gluten and coeliac disease.
In any case, there is no need for cereals to expose the baby to gluten (see below).
First foods your baby really doesn’t need
Formula, “follow-on” formula (also called “follow-up” formula and “toddler” formula)
Your six month old breastfed baby who is learning to eat food does not need to start drinking any kind of formula or “special” formula. And definitely a six month old baby eating food does not need “follow-on” formula or “toddler formula”, no matter how convincing the advertising, even if he was receiving formula before he started on food. When the baby starts eating food, he can now do without formula supplements. There is no point at which your healthy breastfed baby who is also eating a variety of foods, would need formula after the age of six months.
This is also not a time to introduce bottles. Breastfed babies should be learning to eat normal food and to drink from the open cups they will also be using later on in life.
Where does the notion that babies need these products come from? Well, as mentioned above, from advertising. Formula companies know where the money is. As Willie Sutton, an American bank robber, said when he was captured and asked why he robbed banks “That’s where the money is”. Of course, formula companies do not rob banks because they have easier prey: parents worried by all sorts of tactics suggesting their babies are not getting “good nutrition”.
But also, there is the widespread idea in the minds of doctors that babies between 6 months and 2 years need 900 ml (30 oz) of milk in 24 hours. This is pure fantasy. Formulas are, essentially, liquefied solid foods. There is no advantage of follow-on formulas over normal food. If the parents want to give dairy products to the baby then cheese or yogurt are just fine and liquid milk is not necessary.
There remains the historical knowledge in older physicians’ minds that too much cow’s milk would result in bleeding from the intestines and anemia in the older baby. The picture of the fat, pale baby remains deep in their memories. So, no cow’s milk; only formula. And breastfeeding? What happened to breastfeeding in this picture? Breastmilk does not cause bleeding from the intestines. Except, rarely, when there has been late onset decreased milk supply, and it’s not breastmilk that causes the bleeding, but a decrease in the baby’s intake of breastmilk. And the problem is corrected by increasing the intake of breastmilk by the baby.
An frequently made argument is that if the family cannot afford “good, nutritious food”, the baby would do well with the follow on formula. But in fact, the cost of follow on formula is greater than most good nutritious food. Moreover, the baby can and should continue to be breastfed, thus ensuring “good nutrition”.
Commercial infant cereals
If the baby is eating commercial infant cereals, it is clear to him that he is not eating what the rest of the family is eating, so why give them this food?
Infant cereals are touted as good first foods for babies, but they really aren’t. They are not even okay, in my opinion, partly because the rest of the family is not eating that stuff and partly because they are basically introducing “instant fast food” to the baby.
Commercial infant cereals were introduced into the mass market in North America in the 1920s and 1930s. Parents were encouraged to give these foods from very early on, from the baby’s age of 2 or 3 months and sometimes even earlier. Besides making money for the manufacturer, they were promoted as providing the baby with “easily digestible” food, containing important elements the manufacturer claimed were not easily available in other foods babies were first given. And this worry about the baby missing out on “not easily available nutrients” has been with the parents ever since.
Back in the 1920s and 1930s, with more and more pediatricians pushing formula feeding as “scientific infant feeding”, often to the exclusion of breastfeeding, infant cereals were “nutritional insurance” against nutrients missing in formulas at the time. Especially home-made formulas (1 part cow’s milk, 2 parts water, 1 tablespoon of corn syrup and less water and more corn syrup as the baby gets bigger).
These cereals, even the modern versions, tend to taste bland, at best, and bad, at worst. And they are expensive for what you get from a nutritional point of view. Indeed, the nutritional value of most commercial cereals is rather lacking. The only nutrient thought to be of possible potential value, but in truth serves only to market the product, is the iron that has been added. But, most of the iron, which is poorly absorbed, ends up in the baby’s diaper. And because of the high levels of iron in the cereals, commercial cereals tend to be constipating.
Another brilliant marketing stratagem? Let’s add formula to infant cereal! Brilliant indeed, trying to convince parents that the cereals are “better than ever” and selling more formula at the same time. Win-win for the formula companies.
In fact, the “need” for iron has been overly exaggerated, based on the knowledge that breastmilk does not contain a lot of iron. Did nature mess up? What could possibly be the reason for “insufficient” amounts of iron in breastmilk.
It was assumed, on the basis of “nutritional theory”, that because the concentration of iron in breastmilk was low, this was a bad thing. Exclusively breastfed, thriving babies are, it needs to be remembered and too often forgotten, the physiological norm. They are meant to get iron from three sources – during the pregnancy, from cord blood at birth and breastmilk which contains iron in a very absorbable form. And it is quite possible that the decrease in iron stores that occurs in the exclusively breastfed baby around 6 months of age actually has a beneficial effect in preventing infection in the baby when he starts food.
High levels of iron in the intestinal tract of a baby encourage the growth of pathogenic bacteria that need iron in order to multiply, thus increasing the risk of serious infection. Once the baby is six months old, he will start to eat food, but at an age where his immunity has developed to the point that he could fight off these infections, especially if he is still breastfeeding.
In any case, iron can be naturally found in foods other than infant cereals (to which it is added artificially), and often the absorption of the iron is more complete than from infant cereals.
The latest in selling parents useless foods for their babies
The infant food industry loses no opportunity to make money on the backs of parents who really want to do the best for their children. There is now available, a whole array of “special baby food” in “food pouches”, and parents are being convinced that babies are to be started on “special food” first – blended vegetables, fruit and even whole meals. This includes special “teas” for babies, special baby cookies (with “vitamins”) and even special pasta, ham and yogurt. So instead of being taught to eat normal food, babies are frequently transferred from one bottle to another sort of bottle (the pouch) and from one formula to another version of “formula”. Popular in Europe is special “baby water”. Coming to your local grocery store soon! And how much do they cost? 1.5 litres in Europe cost 1.75 euros ($2.60 Canadian, $2.09 US). For water!
With these food pouches babies can suck and feed themselves any time they want to eat, even when being pushed along in a stroller. Even at the dinner table, these pouches result in “different food for the baby”, partly overcome, perhaps, by having the rest of the children eating from these pouches.
But these pouches have babies and young children sucking on a bottle, essentially. Lactation consultants have noted that babies who suck on these pouches more than occasionally actually breastfeed less well. And lactation consultants have seen several mothers develop late onset sore nipples which got better once they stopped the pouches.
And although individual pouches seem inexpensive, in fact they are not. A child eating food that comes from the family’s plates, would eat for much less money than the cost of one of these pouches. And think about all these unrecyclable containers. Who is paying for them? Not the company, that’s on the parents’ bill.
Many of these pouches contain elevated quantities of sugar, which, finally, we are beginning to understand can contribute to childhood and adult overweight and obesity and diabetes type 2.
Even Health Canada states that babies older than 6 months should be drinking from an open cup, not a bottle and not sucking on a sippy cup. What is the difference between a food pouch and a sippy cup, or a bottle for that matter?
What foods should be avoided for a young baby?
The one group of foods that should be avoided are those that are called “choking hazards”. The most notorious type of food going down “the wrong way” (into the lungs) was popcorn, though one wonders who would feed an 8 month old popcorn.
Health Canada recommends cutting up any food that is slippery and could potentially block the trachea (whole grapes, for example). Okay, makes sense. But Health Canada also recommends cutting blueberries in half. Really? Who is going to do that? “I just cut 5 blueberries in half and I think part of my finger is mixed in”.
Late onset decreased milk supply, a significant problem for some mothers whose milk supply started off abundant and later decreased
In some cases of late onset decreased milk supply, the parents have reported that the baby was very interested in eating food well before the baby turned 6 months of age. This observation, in itself, may or may not be of significance because we tend to see late onset decreased milk supply around the same time that babies become interested, normally, in eating food. However, if we combine early interest in food plus the fact that the baby spends a lot of time sucking his fingers, or pulling at the breast, as well as other symptoms mentioned in the article, I think that, yes, in some cases the parents’ observation does indeed go along with late onset decreased milk supply.
In other cases, when the mother’s milk supply has decreased significantly, the baby may stay on the breast much of the day or have a pacifier in his mouth much of the day. The baby on the breast much of the day without gaining weight is often interpreted by those who do not know how to know the baby is drinking or not drinking at the breast, as: “there is no nutritional value to breastmilk after a certain age” often stated as after 6 months of age or after 1 year of age.
The real problem is that the baby is not getting much milk from the breast. What so many health professionals do not understand is that a baby is not drinking milk simply because the baby is latched on to the breast and making sucking motions with his mouth.
And yet, logically, it seems to make no sense that a baby not receiving enough milk to gain weight would refuse to eat solids. This is taken as proof positive by many pediatricians and nutritionists that there “is nothing in breastmilk after the first few months”. But they can only say this because they do not watch the baby on the breast, and even if they did, they would not know what to watch for.
On the other hand, the mother is told that the baby is using too much energy sucking all day long and using up the calories he gets from the breast. But this too is a misconception, based on the notion that babies “transfer milk”. Babies don’t transfer milk; mothers transfer milk. Babies, of course, do their part in the breastfeeding process, their sucking stimulates the milk to flow from the breast. The baby is not a passive vessel, after all.
But why would the baby refuse solids if he’s gaining little or no weight? It is true that the baby is not getting a lot of nutrients and calories, not because there is nothing in breastmilk after the first few months but rather because the baby is not getting much milk, period. And this makes the baby ketotic, just as dieters on some fad diets the purpose of which is to induce ketosis in the dieter. When you are ketotic, you lose your appetite. Thus, the baby has no interest in eating solids but continues on the breast because he gets comfort and security from the breast, another concept many health professionals still do not understand.
The other illogical deduction often made in such situations is that the baby is on the breast all the time, and thus filling up so much with the breastmilk that he’s not hungry. But if that were the case, the baby would be gaining weigh just fine because there are a lot of calories and nutrients in breastmilk, enough to make a baby double his birth weight in 3 to 4 months breastfeeding only. A baby is not getting milk from the breast just because he is latched on and making sucking motions.
Having problems with breastfeeding? Make an appointment at our clinic.
Photos courtesy of Grazia de Fiore
Copyright: Jack Newman, MD, FRCPC and Andrea Polokova. 2018