Guide to Weaning

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The UK government recommends that solids are not introduced before four months of age. However we know from the government’s own Infant Feeding Survey that 51% of infants were reported to have received solid foods before 4 months of age. This figure is consistent with the average age of introduction of solids in the Millennium Cohort Study (a study in the UK of 15,980 infants) which was 3.8 months.

One reason put forward for not introducing solids before six months is concern about an increased risk of gastrointestinal infections. However, the Millennium cohort has recently reported (Quigley, 2008) that the age of introduction of solids had no effect on risk of hospitalization for diarrhoea or lower respiratory tract infection.

In 2003, the World Health Organisation (WHO) published advice in partnership with the children’s charity UNICEF recommending exclusive breastfeeding for six months and that weaning or complementary feeding should be delayed until six months of age.  The UK’s Department of Health adopted this recommendation and so have some EU States but the majority have not.

Nearly ten years on, the evidence behind the recommendation has been reviewed in some detail and many scientists recommend that since each baby is unique, a single recommendation to wean at six months may not be appropriate.

This recent change in viewpoint caters to your ‘average’ baby. However, there will be babies above and below this average line who have special circumstances, which need specific nutritional care; including weaning early.

Traditionally, first solid-food introductions are veggie based with some baby rice. For babies with reflux, this still applies but certain vegetables and fruit should be avoided, as they may cause a flare up:
  • Most fruits and citrus fruits, fruit juice, especially orange, apple, blackberry, pineapple, raspberry, and strawberry.
  • Tomatoes and tomato sauce
  • Onion
  • Chocolate
  • Spicy Foods (even brand prepared baby food)

Starting early…
There are a set of signs that your baby will be demonstrating to you, which indicate that they are ready to cope with solid foods.

  • can hold their head up
  • sit with less help
  • often put their hands in their mouth
  • easily open their mouth when the spoon touches their lip or as food approaches
  • can keep food in their mouth and then swallow it, instead of spitting the food out
  • show signs of chewing movements
  • increased saliva production
  • sucking and mouthing toys or their hands
  • putting everything into the mouth and also teeth making an appearance.

These signs usually arrive when your baby is around 16-18 weeks old. Furthermore, it is documented that between the ages of 3-5 months, there is a window of acceptance for a baby to accept new tastes and smells.

Using solids to help keep your baby’s milk feed down is fast becoming an acceptable ‘tool’ to help manage reflux. You know your baby best and unless your paediatric doctors consider other circumstances that would go against early weaning, then the decision is yours to make.

Puree the foods very smooth. Go very slowly, perhaps start with half a teaspoon to 2 teaspoonfuls per meal in the beginning and keep a note of the quantities your baby is consuming. If your baby turns the solid food away, leave it a few days and then try again. It may take several attempts with certain foods.

It is important to remember that at the weaning stage; baby is still getting all their nutrition from their milk, so the solid food is a taste, smell and texture exercise, so don’t get too hung up on it, if baby turns it away. Ensure that you offer the milk feed first at least until the baby is 8-9 months old. One way of aiding the transition between the teat and the spoon is to introduce the Flowspoon. This ingenious device will prevent your little one from taking in too much air, as they learn how to eat from the spoon.

Hydration – If your baby is very young, perhaps 4 months old, then there are some considerations to take into account. Hydration is very important because as soon as you being to thicken up food, the levels of liquid are changed with the introduction of bulk. Ensure you are offering cooled boiled water a few times a day for a baby who is weaning early. This will help them to process the solid food, and hopefully avoid constipation

Veggies – Root vegetables are an old favourite with weaning and can be mixed with baby rice. Good vegetables to start with are courgette and butternut squash. The taste is not too strong and the texture of the vegetable is lovely a smooth. Following this, you could look at trying swede and carrot, which are both good options which are sweet to taste and breakdown very smoothly. These veggies are not complex to digest and should not cause stomach acids to flare up.
If in the early days of early weaning your baby they show signs of wanting more solids very quickly, try not to feed more quantity – instead slow the feeding down and offer them their milk feed. This is important so that they don’t get full up with vegetables and leave no room for milk. Once your baby has established a good routine of eating solids and dirty nappies, without any problems (like constipation) then you can slowly increase quantities and new tastes.

Gradually introduce avocado, broccoli, parsnip, swede, pumpkin, leek, butternut squash as smooth pastes. Think about taste – a parsnip for example is a strong-tasting veggie, so consider this when you introduce it. These vegetables are less likely to cause problems with reflux.

Avoid putting more than three veggies together in the early days, as the tastes can be quite confusing when mixed together. Try to introduce new tastes one at a time, every 3-4 days.

Bulky foods need to be watered down with formula or breast milk to a very thin texture. When building up your combinations, think about taste, smell and texture. If you would eat a combination, then the chances your baby will!

Rice – has always been part of the first foods, but it’s more relevant with reflux babies as it adds weight to a meal and is a pretty inoffensive. Many parents report that rice added to a small amount of veg works very well in the early stages too. It’s easy to digest and can be mixed quickly and to differing thicknesses.

Rice or cereals can also be added to babies milk too and this may be suggested by your GP. Be aware of possible effects – In many cases when this is suggested, the reflux babies are younger than their non-reflux peers and the possibilities of a reaction may be greater. Essentially all the rice is doing is weighing down the milk a little to help it stay down. Note: also if you are using a normal teat and adding thickeners to a feed, you will need to upgrade to a larger teat. We used 6 month size teat with our daughter at only 5 weeks old, just to get the thickened milk flowing!

Fruit – Pear is probably the only fruit with can be tolerated at a very young age.

If you think about fruit in terms of your own eating – putting an apple on top of milky food usually causes us some indigestion. Imagine what it might do to a baby with reflux who has bubbling stomach acid – think about this when working out a meal plan for your baby with reflux. Banana’s are great for thickening a meal, but can also be acidic and hard to digest. The following fruits are less likely to cause a flare up, but should be used with caution: Banana, blueberry, peach, mango.

Avoid: citrus, strawberry, raspberry, blackberry, apple, orange, tomato.

Timing – If you think about the timing of introducing solids in terms of a baby’s ‘good’ time, you’ll stand a good chance of observing a positive reaction. Try to avoid times when baby is tired & fractious (late afternoons usually) or times when you are tired after a sleepless night – early morning. Pick a time when you are both calm perhaps lunchtime or early afternoon. Don’t rush the solid food, let baby move it around their mouth exploring it. More will come out than stay in, at the beginning, but don’t worry keep putting it back in and watch baby’s reaction.
Start off with one solid feed  a day and stick to this for about a week. We suggest from our own experiences that an early afternoon feed is the best one to start with. If your baby has a flare up to the foods given, you can deal with it during your waking hours. Once you have established this and you feel ready to move on to two or more solids meals, move next to breakfast time. If baby has taken solids in the afternoon consistently, they may start to become more hungry by breakfast time. Eventually you will begin to form your *three meals a day* structure with a milk-feed at bedtime.

There are no rules about weaning, just lots of great advice – remember you are the best judge! If in doubt about introducing solid foods at 4, 5 or 6 months, always discuss with your health professional.

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About Author

Rachel

Mum of three and co-founder of reflux sites - refluxSUPPORT, babyREFLUX and littleREFLUXERS.Gathered loads of experience and wisdom talking to thousands of mums and dads who have little refluxers. Campaigning to reduce the number of infants given prescribed drugs for reflux.Superb at parallel parking and eating biscuits.