Wondering how to start off your precious little one with solid foods? It’s a fun but sometimes nerve-wrecking process — even for me, a registered dietitian who specializes in children’s nutrition. I have practised in infant feeding and feeding disorders for 10 years, but I had my first child, Aiden, just over a year ago. It’s been an interesting experience of finally practising what I preach and I have included some of my own experiences with Aiden in this article. Infant feeding through the first year is a fast-paced process — just like your little one’s growth — and many families may face some common issues. Dr. Sean Murray, a Sudbury-based pediatrician, says “failure to thrive and feeding aversion are the most common nutrition related issues” he sees in his office. Dr. Murray says a lack of education on this topic is the biggest challenge for parents.
When to feed solids: the first four to six months
The current guidelines by Health Canada and the Canadian Paediatric Society recommend getting baby started with foods at six months of age.1,2 However, your baby’s doctor or pediatrician may actually suggest a slightly earlier time to introduce food: between four and six months of age, because there is evidence to show that starting solids a bit earlier can actually provide protection against certain allergies and celiac disease. The amount of solids most children are consuming at this time are tiny and don’t take away from the benefits of breast milk and/or formula. But given that every baby is unique, how do you know when your child is ready for solid food?
Look for these signs:
- ability to hold up their head (good head and neck control)
- ability to sit with minimal support
- demonstrated interest in food: opening their mouth wide when food is offered or turning their face away if not hungry
- not pushing foods or the spoon back out with the tongue.
Once you have decided your baby is ready, get a high chair, a bib, a baby spoon and the first puréed food. Baby-led weaning, which involves infants feeding themselves handheld foods (instead of being spoon-fed by a parent) and being offered breast milk or formula on demand until they self-wean, may also be an option. Be sure, however, to consult with your child’s doctor first.
What should be baby’s first food?
The common recommended first food is iron-fortified baby cereal, since breast milk has no iron, and your baby will run out of their supplies by six months of age. Iron is essential for growth, brain development and much more. It also plays a role in dental health, as it may lower the risk of cavities, while iron deficiency anemia has been associated with cavities in children. While homemade foods are encouraged, incorporating iron-fortified cereal is important for this reason.
Parents have a choice of using prepared puréed baby foods, making their own or both. Dr. Edina Heder, a Toronto based pediatric dentist, says she finds people start using processed foods early. “At my practice, we stress the importance of home cooking and preparing the baby foods yourself, so you know the ingredients.” She says the concern is that many processed foods have a lot of hidden sugars or simple carbs that turn into sugar quickly, serving as fuel for bacteria in baby’s mouth. I echo Dr. Heder’s words in my practice and encourage parents to use homemade purées or a combination. If you decide to use homemade baby food, make sure to offer them before the commercial versions, so your child doesn’t get used to that perfect texture right away.
Other first foods to introduce to baby
Aside from iron-fortified cereals, fruits and vegetables are the other typical first foods. But, don’t be afraid to introduce protein-rich foods. One of the most common reasons for a low weight in the infants I see is they’ve been given mostly grains, fruits and vegetables, which aren’t the best for infant growth. Remember: proteins are made up of amino acids, and these amino acids make up everything in our bodies: genetic material, hormones, muscles and teeth. So protein equals growth. Don’t shy away from good sources of protein such as puréed dark chicken meat, eggs, fish, lentils and other beans, along with fats such as avocado, almond butter and olive oil. Protein- and fat-rich foods are the ones to aid in weight gain, not carbohydrates such as crackers, cereal and toast.
Also, protein-rich foods such as turkey, beef, peanut butter and chickpeas contain the trace mineral zinc, which is one of the most important and versatile micronutrients. High amounts of zinc are present in bones and teeth, and so it is also essential for children’s growth and development. Magnesium also plays a role in dental health, as it helps absorb calcium, build strong enamel and prevent dental caries by holding calcium in the tooth enamel.11 Good sources of magnesium include pinto beans, tuna, navy beans, pumpkin seeds, cashews and cooked dark leafy greens such as spinach.
Another key nutrient for dental health is calcium: it makes up most of our teeth, jaw and bones. I am not typically as concerned with calcium early in a baby’s life because breast milk is a good source of it, and fullfat yogurt and cheese can also be added to your baby’s diet when they’re six to seven months old. Caution: cow or goat’s milk is to be avoided until nine months of age, and other milks (soy, almond, etc.) are not appropriate for babies. Too much dairy can lower iron absorption, so it is all about balance.
Don’t forget about calcium’s partner, vitamin D, which mineralizes and strengthens the teeth and is needed for calcium absorption. It is present in very few foods, and breast milk is also not a source. If you are breastfeeding partially or exclusively, ensure that your baby gets vitamin D drops daily.
Last, but not least, is the mineral fluoride. The Canadian Dental Association recommends that children from birth to three years of age should have their teeth and gums brushed by an adult. The use of fluoridated toothpaste in this age group is determined by the level of risk. Parents should consult a health professional to determine whether a child up to three years of age is at risk of developing tooth decay. If such a risk exists, the child’s teeth should be brushed by an adult using a portion the size of a grain of rice of fluoridated toothpaste. If the child is not considered to be at risk, the teeth should be brushed by an adult using a toothbrush moistened only with water.
Water is also fluoridated in some Ontario communities and can be offered to infants in small amounts starting at six months of age (so it does not displace milk or formula). However, if the water in your community is not fluoridated, the risk of tooth decay may be higher, so the use fluoridated toothpaste early on may be essential.
By the time your baby is seven months old, you should be offering solids more frequently, about two to three times per day, and each meal should contain two or three choices. Give your baby as much or as little food as they want. Remember: we have no portion sizes set for children under two years of age. Unless there is a medical issue, your child has a well-built-in hunger and fullness gauge, so trust them to decide how much they need. There is a wonderful concept called “division of responsibilities,” where a child decides what and how much to eat, while parents decide on the when, where and how, providing a balanced meal at appropriate times in a positive environment free of distractions.
Words of caution
Remember: you no longer need to avoid allergenic foods like peanut butter and eggs in the first year of your baby’s life even if you (as the parent) or your baby’s siblings have an allergy. In fact, delaying introduction may increase the risk of allergy.6 You do have to avoid honey until 12 months of age and dairy milk until your baby is nine to 12 months old. Lastly, Dr. Heder and I strongly agree on a common myth. As she points out: “One of the biggest nutrition myths we encounter is that consumption of juice is healthy. Parents believe they are giving their children something nutritious. A lot of them even make juice themselves, and when I tell them it is pretty much sugar water, even if freshly squeezed, it is hard for them to believe,” she says. “In May 2017, the American Academy of Pediatrics confirmed that 100 per cent fruit juice and juice drinks have no essential role in children’s diets. Children under one year should get no juice at all, and beyond that, not more than once a day, preferably with a meal,” says Dr. Heder. In addition to a significant negative impact on oral health, juice also takes up a lot of room in the tiny belly, decreasing the appetite and taking away space from nutritious foods. The other big myth is that if it’s organic, it’s healthy, she says. “A lot of organic food is processed food, and just like any other, it contains high amounts of sugar and sodium. So we tell parents to read the label and list of ingredients. This is probably the most important part of our dietary instruction we give.” Once your baby is eight or nine months old, some major changes will occur: food will start taking priority over breast milk and formula, finger foods will begin replacing purées and your child may want to start self-feeding, all while more teeth are likely to be showing.
Find out what’s next for baby’s nutritional and oral health care needs in a future issue of YourOralHealth.ca.
Sample first meals
Here are some examples of what I have done for some of my son’s first meals: I started with oatmeal and blueberries blended together, and each day I would add a new food to the mix such as hemp hearts, olive oil and pumpkin seed butter or peanut butter. Then I tried puréed zucchini, adding dark chicken meat or salmon or boiled eggs with a bit of olive oil to make up the second meal. You will need to add breast milk or formula (or water if your baby is older than six months) to get the right texture. Freeze these as little cubes and have a couple of options on hand. Alternatively, you can use the store-bought purées with no added salt, sugar or juices. However, one challenge I had was finding protein-rich purées in the store, so you can always combine them with your own protein source such as black beans or turkey.