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Growing Healthy podcast

Oct 22, 2017

MK - Alicia, we both get to field alot of questions about babies.  Let's do a listener question:

AP - Dr. Kang and Dr. Power, my baby just turned 4 months old and my mom is telling me to start rice cereal already.  This seems really young to me.  When should I start trying out solids, and what should I start with.  I am really worried my baby will choke. 

MK - that's a common one.

AP -  The WHO and CPS suggest starting solids between 4-6 months of age.  General readiness signs include: 1) able to sit in chair that the infant will eat with good head control  2) interest in what family is eating and ability to take food from the front of the mouth and pull it to the back with their tongue.  

MK - What do you think about holding babies in your lap and feeding solids?

AP - If they're able to hold their head up themselves that seems reasonable, but it can also get awkward to hold your baby in your lap and feed at the same time.

AP - what should parents start with?

MK - Because breast fed babies tend to run out of their iron stores by about 6 months of age, we generally recommend starting with an iron fortified cereal while your baby is learning how to process the food in their mouth.  You can play around with how liquid you make the cereal as well.  I like to remind parents that starting solids is practice.  It's not about calorie intake.  Most of that will come from breastmilk or formula, in the beginning.

 You can then add in vegetables, meats and fruits slowly over time as your child get used to different substances.  

MK - I get a lot of questions about food allergies and family history of allergies.  What do you think parents should do in that case?

AP - If starting prior to 6 months of age we generally recommend adding one new food every three days, while continuing on with all the others they have already eaten.  If starting after 6 months of age you can just add on as you like.  If you have a high risk of allergies in your family, you may want to get the advice of your health care professional before you start solid foods.   

We know earlier exposure to foods decreases allergies, so the only food you should avoid prior to one year of age is unpasteurized foods, such as honey and cheese.   

We generally get you to start Cow's milk products such as cheese and yougurt after 9 months of age, and milk after one year of age, but other than that you can add on as you like.  Please do not feed your child sugar or fruit juices, as these have no benefit and increase the risk of childhood obesity.  

MK - That's a really important tip.  Toddler obesity is associated with adult obesity and all the complications that are related.  If you and your family don't have the best dietary habits, what a great time to start fresh.  Remove those fruit juices and excessive treats from your home.  

And what about water?

AP - water is great for your child, and we highly encourage starting to introduce it to your child at meals around 6-9 months of age.  Using a sippy cup is great as it will also help enable your child to learn the skill of drinking from a cup.  

MK - Just a word of caution here.  Baby kidneys are still maturing, so too much free water (as we say) can actually be harmful.  So I usually tell parents to limit their baby's daily intake of free water to 1 cup.  But after 18 months or so, when your baby is more active and eating much more, you can consider increasing that.

I'm gonna bring us back to our listener questions.  It sounds like they were worried about choking specifically.  I know you've had experience with choking episodes.  It can be a really scary thing.

AP - choking is always a concern with starting solids.  Infant's choking reflex is much farther forward than adults, and so your child will at some point seem like they are choking. 

It is a protective mechanism while they are learning to manage solid foods.  For this reason we recommend all parents take an infant first CPR course...but the chances are you will not need to use it!  Because their choking reflex is so much more forward they will probably just sputter and spit out the offending food...but always stay close by to your infant and child while they are eating, and 

do not let them walk around with food, or eat in the car!  You need to be able to react in a moment's notice on the rare occasion that they might need help!

MK - I've done back blows to my kids.  It's so important to do an infant CPR course.  You can access infant cpr courses at a variety places locally, like Mothering Touch.

So after being equipped with good knowledge on choking, you can move through the different tastes and textures as our baby tolerates them.  You can experiment with more soft chunks, first larger chunks, then smaller ones, then more firm chunks as well.

AP - Family dinners are so important, to show your children how to eat, what to eat, how to act and most importantly to connect with each other at the end of the day!  This is a great time to teach your children the art of communication.  A great way of learning about your childs day is by the rose, the thorn and the bud!  

MK - What a great reminder for parents.  It's amazing to watch babies watch you! 

Stay tuned, folks as we keep on....Growing Healthy.

Canadian Pediatric Society - starting solids:

World Health Organization:

Starting solids in allergic families: