Feeding Fridays – Things to know before introducing solids – Part 1

Cindy Hooks Morrison, M.S., CCC-SLP, CLC

Introducing solids is a really exciting time for parents. Before getting out the cameras and setting up the food (homemade or store bought) with the bowl and the spoon…I have some very important information that I can’t wait to share with you all.

When it comes to feeding i’m a bit obsessed with the topic and the process, so much so, that i’ve continued to spend years after graduate school specializing, by advancing my education and staying up to date in all things pediatric feeding and swallowing (dysphagia). If you’ve ever wanted to know what things a pediatric feeding therapist is looking for when they are feeding their own child, then the next several Feeding Friday posts are going to be for you.

This first post is going to be a broad overview to introduce the series as I prepare for my own little boy to get ready for his transition into complimentary solids (purees). There’s A LOT to know and to do before i’ll even get the food into his mouth — so keep checking in. We are excited to have you join us on this sweet journey.

The typical way that children start solids (pureed foods) is by getting placed in a high chair in front of an excited parent. All good parents get the puree ready on the spoon and present it to the baby. The baby takes one taste, makes a classic, priceless expression and pushes the contents of the spoon right back out of their mouth with their tongue. We laugh and we snap a photo for the baby book. Right of passage complete. We’ve all seen the photos that i’m taking about it. I even have one of myself as a newborn doing exactly that.  It’s a part of how we’ve all learned.

The most common phrase that I hear after that takes place is, “He/she doesn’t like it” or “He/she doesn’t know what to think about that.” The second sentence is in the right direction. The first one is completely wrong.

If everything is going right, for the first six months of a newborn’s life, they are sucking solely from a nipple (breast or bottle) to gain nourishment. The mechanics of sucking from a breast and from the nipple of a bottle are different. It’s not exactly the same process going on inside those tiny mouths and that is why you often hear the term “nipple confusion”. I will go into the difference between the two in a later post. Today, I will point out the most important point of the suck and how understanding its role relates to starting solids.

In order to accomplish eating, newborns cup or curl their tongue around the nipple. They then elevate their tiny tongues to compress the nipple, suck and express the milk.

Hopefully, you are visualizing a nice curled tongue?  Perhaps, you can even try to curl your own right now. If you can do it, I want to let you know that you perfected this skill as a newborn when you curled it for 8 to 10 feedings per day.

So now that you understand that the baby’s tongue needs to be curled to gain nourishment from a nipple and that the baby has done this (over and over again) to eat since he or she was welcomed into your warm, loving arms…guess what their tongue needs to do to eat from a spoon?

It needs to be flat.

Now, let’s go back to the moment that I describe in the high chair above and think about some differences in feeding from a nipple versus a spoon. The sweet little one is now sitting upright in a high chair instead of being cradled in their loved ones arms. They are pretty excited and interested in what’s going on, because their parent or parents are full of smiles in front of them.

The spoon is presented.

This looks different from the bottle.

They accept the spoon into their mouth and instinctively go to curl their tongue. Instead of that working like it always has, the edges of the spoon causes some resistance to their tongues.

This feels different.  They stick out their tongue.  

An important reason their tongue may be coming out is that the spoon has triggered part of the sucking reflex called tongue protrusion. Tongue protrusion is one of several newborn reflexes that are in place to protect their airway from choking.  By design, the reflex causes the tongue to push out of the mouth taking the contents along with it. This reflex is triggered by gently tapping the tip of the tongue. The spoon brushing the tongue is enough to trigger the reflex.  Often this reflex being triggered confuses parents into thinking that their child does not like the food.  It simply may mean that they are not completely ready to begin solids.

The tongue protrusion reflex gradually disappears over time typically between 4 and 6 months of age.  This is part of the reason that the American Academy of Pediatric (AAP) recommends supplemental feedings to be introduced around this time. If you are introducing purees to a newborn prior to age six months, you can expect to run into the reflex. Please remember that it is there for a reason.  It’s a protective reflex.  

Did you notice that I didn’t even mention the other sensory differences of eating solids yet — the color, smell, taste, texture, temperature of the puree?

Eating is FAR more involved then simply offering food on a spoon. The more that you learn, the more fun it can be for you and your little one!

There IS evidence to support a specific sequence for how you are introducing food when you begin infant feeding. I am going to share the sequence with you next week.

Until then, try not to be in a rush to introduce purees too early. A few extra weeks can mean an easier, more enjoyable transition for your sweet little one. More and more, families are introducing purees at 4 months of age before their little ones can even sit up (and unfortunately, some are starting even earlier.) And I cringe to report that I have heard first-hand from some of my friends (that speed dial me to tell me) that their pediatricians have specifically suggested starting purees early to help their little one sleep through the night.

Please do not let sleeping through the night be a deciding factor of when you introduce your child to what will become a life long relationship with food.  They will sleep.  They all eventually sleep.  

So what does the American Academy of Pediatrics recommend?

The AAP recommends “breastfeeding as the sole source of nutrition for your baby for about 6 months. When you add solid foods to your baby’s diet, continue breastfeeding until at least 12 months. You can continue to breastfeed after 12 months if you and your baby desire. Check with your child’s doctor about vitamin D and iron supplements during the first year.” 

These recommendations are generalized and are a guide.  Every single child is different and has different needs.  Developmental milestones need to be met before you begin introducing solid (pureed) foods.  So it’s really important to talk with your pediatrician about the right time to start solids that is specific for your baby.  And prior to that time, tune into my new series to learn about the pre-stages to feeding. I’ll be here next Friday to start delving deeper.  It’s going to be fun!

What can you do over the next seven days?

I’d like to give you a Pre-Stages of Feeding Chew Chew Mama Challenge.  

The VERY best way to prepare for introducing solids to your child is to know how to handle the feeding when something goes wrong, such as choking or life-threatening allergic reactions.  We love to think about the fun of feeding so much that often the dangers get over looked. Tiny people have tiny airways.  So remember that anyone that is going to feed your baby  whether it be you, your husband, the grandparents or a caregiver should know basic CPR.

Contact your local hospital, church, community center or local chapter of the American Red Cross and American Heart Association to sign up for a CPR class. 

Can’t afford a live class?  Many classes are free and there are also several free, accredited videos posted online.  Please watch.  It only takes 20 minutes to learn what to do that could save a life.  

FIND A BASIC LIFE SUPPORT COURSE BY CLICKING HERE.

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