Tuesday, August 26, 2014

Introduction of Solid Food to a Breastfed Baby

    Introducing solids to a baby seems simple enough. However, if it was that clear then there wouldn't be a plethora of sources all differing in their suggestions of how much to offer, how frequently to offer and what food to offer when. Furthermore, introducing solids to a formula-fed baby and an exclusively breast-fed baby can be a different experience.
     I began offering my son solid food at each meal. What I didn't know then but do know now is that solid food three times a day is a shock to the gut of a breastfed baby. He responded with a steady state of constipation. His gut's ability to process foods was not quite up to speed with his tastebuds! We then decided to back off a bit on the frequency at which we were offering him solid foods to give his little belly some time to adjust slowly. When it appears that he's handling fewer meals a day better, then we'll proceed to offering him more etc.

     This post is to share what I've learned about introducing solids to an exclusively breastfed baby. This information only applies to an exclusively breastfed baby, as that's my experience. Also, I'm a Mama not a medical professional. The following information is just my opinion. Please seek professional medical advice for any questions you may have or any actions you may take.

Breastfed Baby Characteristics
     As an exclusively breastfed baby grows older, he may not poo frequently. That's perfectly okay. Because breastmilk can be 100% utilized by his little body he may not produce waste (ie., poo). Digesting solid foods, however, will produce waste. However, the gut hasn't been working that hard and dealing with a daily lot of waste product. So, it needs time to adjust to the process. Therefore, an exclusively breastfed baby needs a very gradual introduction to solid foods.

When to Begin
     The current recommendation is to begin offering solid foods (in the form of cereals or purees) to a baby at least six months of age. I feel rather strongly about the need to wait until this time. The stomach and intestines need time to mature! A young baby is biologically meant to digest milk, not solids. There's something to be said about the fact that a baby will become interested in food at the same time he becomes able to digest solid foods.

     Furthermore, breastmilk is highly nutritious! It's a superfood to which solid foods can't equate.

First Foods and Baby Cereals
     Traditionally, fortified baby cereals were recommended as a first food for a baby. This product can be mixed to be as thin as milk, which permitted it to be added to a bottle or otherwise given at a very young age. In fact, the recommended start age for solids used to be as early as three months old. We now know that a baby's isn't mature enough to handle anything but milk until at least six months old. 

     The purpose of using baby cereals as a first food is that they are very mild in taste and are fortified with vitamins and minerals, particularly iron. However, some babies actually prefer bold tastes. My son would much rather have a spoonful of bold tasting green beans than mild tasting squashes or potatoes. Homemade grain cereals (oatmeal, barley, rice) are probably his least favorite, unless mixed with a fruit or veggie. 

     In regard to the concern for iron, supplementation isn't absolutely necessary for healthy babies. Towards the end of pregnancy the baby creates nutrient stores and one of those is iron. That store is sufficient up to six months when it begins to decline. Note that it doesn't just suddenly drop. The levels are okay up to the point at which a baby can begin to take in iron from foods like meats. Like I said, this is applied to healthy, term babies. Babies in which the pregnancy experienced some sort of nutritional problem (including diabetes), the baby was born premature or any other circumstance which could compromise him building up those nutrient stores may need the supplementation. Because my son was born nearly two months premature he didn't have an opportunity to build up that lovely fat layer or nutrient stores. So, we add a little fortified cereal to his meals (it also helps thicken foods that puree really thin like fruits).  (The disclaimer yet again- please question and/or verify all information with your physician first and foremost. I'm not a medical professional, just a Mama. If you have any questions as to whether your child may or may not need iron supplementation your physician is a much better source than the internet. What I've shared is just my opinion (and again, as a Mama not a medical professional)).

Frequency At Which To Start Offering Solids
     The role of the solids then is to complement the milk. Offering solids and then nursing would lead to the baby filling up on solids and then taking in less milk. It's best to nurse at least an hour before a mealtime involving solids. This allows the baby to take in as much milk as he wants which ought to be his primary nutrition.

     Introducing too much solids too soon can have negative consequences. As mentioned above, the gut that's used to fully utilizing breastmilk now has to work through a substance that requires work and waste. When it's not quite ready the result may be a steady state of constipation. Also, having his fill on solid foods the baby may wean early, despite nutritionally needing the milk still.

     The following chart is a way to gradually introduce solids to an exclusively breastfed baby: (Source: http://kellymom.com/nutrition/starting-solids/solids-how/)

0 – 4 monthsBreastmilk onlyBreastmilk only
4 – 6 monthsBreastmilk onlySee also: What if my 4-5 month old seems developmentally ready for solids?Continue nursing on cue.When your 4 – 6 month old baby is learning to use a cup, giving him a few sips of expressed breastmilk or water (no more than 2 ounces per 24 hours) a couple of times a day is fine and fun.
6 – 7 monthsOffer solids once a day, at most. Many start out offering solids every few days or even less often.Continue nursing on cue. Solid foods should not replace nursing sessions unless you’re actively weaning.Limit water to SIPS from a cup with meals.
Juice is not necessary for baby’s nutrition. If you offer juice, limit to sips from a cup with meals and introduce it gradually just like any other new food. It’s best to dilute juice with water and limit total juice intake to no more than 3-4 ounces a day.

7 – 9 monthsWatch baby’s cues – this is particularly easy if baby nurses beforehand and most/all of the solids are offered to baby to self-feed. Increase solids gradually if baby is interested, with a maximum of 2 meals per day.
9 – 12 monthsWatch baby’s cues – this is particularly easy if baby nurses beforehand and most/all of the solids are offered to baby to self-feed. Increase solids gradually if baby is interested. Aim for baby getting no more than 25% of her calories from solids by the age of 12 months (some babies eat less than this at 12 months and that’s also normal).
A Note About Constipation
      If you find yourself in a battle with the stubborn poos, there are a few things you can do to help remedy the situation. First, if you began introducing solids too much too soon, then you can back off on frequency. We mistakenly began by offering solids at all three meals each day. We then decided that until we feel his bowel habits are easier and more frequent, then we'd back off to only two meals a day. This hopefully will allow his belly a bit more time to mature. In the meanwhile, we were recommended to offer him juice to help clear his system. The nurse at our pediatrician's office advised us to offer him 1 oz. pear or prune juice mixed with 1 oz. water once or twice a day. (Again, check with your physician before starting any "treatment." I'm only a Mama, not a medical professional).

       From a dietary standpoint, it's helpful to be aware of the foods that can ease a bowel movement and those that can trouble one. Fortunately, these each have an easy little memory device. Foods that help things to move along can be remembered as the "4Ps" : peaches, pears, prunes, plums. Conversely, foods that can constipate can be remembered as the "ABCs": apples, bananas, (rice) cereal. If your baby is in a state of constipation or is prone to constipation (like breastfed babies are as mentioned above), then it may be helpful to cut back on the "ABCs" or pair them with the "4Ps" to keep things balanced. In other words, serve prunes with rice or apples with pears etc.

    In another post, I'll share our experience in making our own baby foods! So far, Tennyson is loving them!

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