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Introducing Solids to Your Baby

Mamas Milk GazetteLa Leche League

of Bermuda NewsletterJuly 2012

Look Insides My Baby Ready forolid Foods?.............4

aby LedWeaning......6

oes My Breastfed Babyeed Water During the

ummer...8

MeetingScheduleMeetings are held in the

irst Floor ConferenceRoom at King Edward VIIMemorial Hospital on the

econd Saturday of themonth at 10:30am. All

regnant women, mothers

nd babies are welcome.

uly 14, 2012

atching and Attaching

August 11, 2012

The Scoop on Solids

Forbreastfeeding

assistance,

call 236-1120or [email protected]

Check us out onFacebook:

La Leche Leagueof Bermuda

Some mothers are confusedabout introducing solids asthey receive conflicting advicebetween friends and family,health authorities andindividual health professionals.

However, the followinginternational healthorganizations recommend that

healthy full-term babies beexclusively breastfed (nocereal, juice, water, or anysolids) for the first 6 months oflife (not the first 4-6 months oflife):

World Health Organization (WHO)

UNICEF

American Academy of Pediatrics (AAP)

Academy of Breastfeeding Medicine

Australian National Health and MedicalResearch Council

Health Canada

European Union project: Promotion ofBreastfeeding in Europe

Additionally, our own Bermuda BreastfeedingGuidelines for Healthy Infants recommenddelaying solids until six months of age.

Remember, ounce for ounce, breast milk hasmore calories than most baby-safe solid foodsand significantly more nutrients than any type ofsolid food that you can feed your baby.

Recently, some healthprofessionals have begunadvising the introduction ofsolids before six months of aThis may be due to a BritishMedical Journal (BMJ) articlpublished in January of lastyear which suggests that indeveloped countries babiesmay benefit from introducing

solids before the currentlyrecommended age of sixmonths.

Some initial comments on tharticle and its authors are:

The article published in the BMJ is a revieand is not based on new research. Theresearchers selected a few past researchstudies to come to their conclusions. Thestudies they selected were observationalstudies, which cannot prove causation. T

authors gave no methodological details ohow they chose the studies to include in treview.Three out of four authors of the articlereceived funding from the baby food indushave opposed the WHO recommendationthe past, and have even appeared as exp

witnesses in the defense of a baby foodcompany that was being prosecuted forillegal advertising.The baby food industry will likely use thisarticle as a marketing strategy to encouraparents to introduce purees and cerealsearlier than is recommended by the WHO

(Continued on pa

International health organizations recommend that healthyfull-term babies be exclusively breastfed (no cereal, juice,

water, or any solids) for the first six months of life

(not the first four to six months of life).
mailto:[email protected]:[email protected]://www.facebook.com/#!/pages/La-Leche-League-of-Bermuda/141273875928884https://www.facebook.com/#!/pages/La-Leche-League-of-Bermuda/141273875928884https://www.facebook.com/#!/pages/La-Leche-League-of-Bermuda/141273875928884http://www.who.int/topics/breastfeeding/en/http://www.who.int/topics/breastfeeding/en/http://www.unicef.org/nutrition/index_breastfeeding.htmlhttp://www.unicef.org/nutrition/index_breastfeeding.htmlhttp://pediatrics.aappublications.org/content/129/3/e827.full?sid=f3871353-09cc-4213-afd2-9669f920b44ahttp://pediatrics.aappublications.org/content/129/3/e827.full?sid=f3871353-09cc-4213-afd2-9669f920b44ahttp://www.bfmed.org/Media/Files/Documents/pdf/Statements/ABM_Position_on_Breastfeeding%20bfm.2008.9988.pdfhttp://www.bfmed.org/Media/Files/Documents/pdf/Statements/ABM_Position_on_Breastfeeding%20bfm.2008.9988.pdfhttp://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-brfeed-index.htmhttp://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-brfeed-index.htmhttp://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-brfeed-index.htmhttp://www.hc-sc.gc.ca/fn-an/consult/infant-nourrisson/recommendations/index-eng.phphttp://www.hc-sc.gc.ca/fn-an/consult/infant-nourrisson/recommendations/index-eng.phphttp://ec.europa.eu/health/ph_projects/2002/promotion/fp_promotion_2002_frep_18_en.pdfhttp://ec.europa.eu/health/ph_projects/2002/promotion/fp_promotion_2002_frep_18_en.pdfhttp://ec.europa.eu/health/ph_projects/2002/promotion/fp_promotion_2002_frep_18_en.pdfhttp://ec.europa.eu/health/ph_projects/2002/promotion/fp_promotion_2002_frep_18_en.pdfhttp://ec.europa.eu/health/ph_projects/2002/promotion/fp_promotion_2002_frep_18_en.pdfhttp://www.hc-sc.gc.ca/fn-an/consult/infant-nourrisson/recommendations/index-eng.phphttp://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-brfeed-index.htmhttp://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-brfeed-index.htmhttp://www.bfmed.org/Media/Files/Documents/pdf/Statements/ABM_Position_on_Breastfeeding%20bfm.2008.9988.pdfhttp://pediatrics.aappublications.org/content/129/3/e827.full?sid=f3871353-09cc-4213-afd2-9669f920b44ahttp://www.unicef.org/nutrition/index_breastfeeding.htmlhttp://www.who.int/topics/breastfeeding/en/https://www.facebook.com/#!/pages/La-Leche-League-of-Bermuda/141273875928884https://www.facebook.com/#!/pages/La-Leche-League-of-Bermuda/141273875928884mailto:[email protected]


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Healthcare experts, including the WHO, disagree withthe conclusions of this article.

Insufficient IronThe authors of the BMJ study questioned whether sixmonths of exclusive breastfeeding reliably meets aninfants iron requirements. They chose only three of many

studies on which to base their conclusion. Two of thestudies are not about breastfeeding at all, but about theeffects of severe anemia.

The other study from 2007 examines iron levels and infantfeeding, but only 6% of the infants involved wereexclusively breastfed. The age groupings of infants wasfour to six months and six months or more, with no definedupper limit of how long some ofthese infants had been breastfedwithout receiving solids.

This very small study contradicts

the findings of numerous otherstudies, including a 2008 studywhich found, Full-term babieswho are exclusively breastfed arenot at heightened risk of low ironstores by the age of six months,even if their mothers were iron-deficient during pregnancy.

Breast milk is low in iron, butinfants can absorb it much moreeasily than they absorb the iron infortified formula. Healthy full-term

infants are also born with enough iron stores to makedeficiency unlikely in the first six months.

The percentage of iron absorbed in breast milk is in the 50-70% range, meaning it is high in bioavailability. Theportion of iron absorbed from iron-fortified formula and iron-fortified cereals is below 10%.

Additionally, some starter foods are very low in iron, suchas carrots and apples, and the introduction of solidsreduces the bioavailability of iron from breast milk.Replacing breast milk with iron-fortified cereal or otherfoods can actually cause a decrease in the amount of ironabsorbed by a baby.Some babies are at more risk for iron-deficiency anemia:

Premature infants, since babies get the majority oftheir iron stores from their mother during the lasttrimester of pregnancy

Babies with birth weights less than 3000 grams(approx. 6.5 lbs) tend to have reduced iron stores

Babies born to mothers with poorly controlled diabetes

Babies fed cows milk during the first year of life

The timing of cord-clamping at birth can also influence anindividual babys iron stores.

When a birth is normal and a mothers nutrition is typical,there is no evidence to suggest that babies shouldroutinely need iron supplementation (either drops or iron-fortified foods) prior to around 6 months.

However, there is some discussion that giving ironsupplementation to infants younger than six months maybe harmful (slower growth and increased risk of diarrhea).

This suggests that ironlevels in infants thought tobe at risk for anemia shouldbe verified by a healthprofessional.

Only then should ironsupplementation in the formof iron-fortified cereal orother supplements beginprior to six months of age.

Allergic DiseaseThe BMJ authors note thatallergy and intolerance areon the increase amongstchildren despite therecommendation for later

introduction of solids at six months.

This has been noted in recent research and has not beendenied by the WHO. This is an area where furtherevidence-based research on exclusively breastfed infantsis needed.

The Policy Statement from the AAP, February 27, 2012says:

There are conflicting studies that examine the timing ofadding complementary foods after four months and therisk of allergy, including food allergies, atopic dermatitis,and asthma, in either the allergy-prone or nonatopicindividual.

Similarly, there are no convincing data that delayingintroduction of potentially allergenic foods after six monthshas any protective effect. One problem in analyzing this

(Continued from page 1) Introducing Solids to Your Baby

(Continued on page 3)

Replacing breast milk with iron-fortified cereal or other foods can actually

cause a decrease in the amount of iron absorbed by a baby.
http://pediatrics.aappublications.org/content/129/3/e827.fullhttp://pediatrics.aappublications.org/content/129/3/e827.fullhttp://pediatrics.aappublications.org/content/129/3/e827.full


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research is the low prevalence of exclusivebreastfeeding at six months in the study populations.

Thus, research outcomes in studies that examine thedevelopment of atopy and the timing of introducing solidfoods in partially breastfed infants may not be applicable

to exclusively breastfed infants.

Celiac DiseaseThe BMJ authors suggest there may be a critical timewindow between three to six months to introduce glutento avoid the risk of wheat allergy. Two of the threestudies they cite specifically focus on at risk infants.

None of the studies reviewed by the BMJ authorsmention differentiation between feeding methods; theinfants in the studies are not defined as breastfed infantsor not.

The feeding method of an infant is extremely significantas stated in a 2002 study, The risk of celiac disease

was reduced in children aged


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Follow your own babys cues so that you begin solid foodson a schedule that is developmentally and nutritionallyapplicable to him. Some infants may show signs ofreadiness prior to six months of age; others not until later.

Reasons to delay introducing solids include:

A babys intestines need to mature.The intestines are the body's filtering system, screeningout potentially harmful substances and letting in healthynutrients. In the early months, this filtering system isimmature and a baby has an open gut meaning spacesbetween the cells of the small intestines will readily allowmacromolecules to pass directly into the bloodstream.

This is great for a breastfed baby as it allows beneficialantibodies from breast milk to pass directly into thebloodstream. But, large proteins from otherfoods (whichmay predispose the baby to allergies) and disease-causing

pathogens can pass right through, too. Between four andseven months a baby's intestinal lining goes through adevelopmental growth spurt called closure, meaning theintestinal lining becomes more selective about what to letthrough.

Young babies have atongue-thrust reflex.In the first four months the tonguethrust reflex protects the infantagainst choking. When anyunusual substance is placed on thetongue, it automatically protrudes

outward rather than back. Betweenfour and six months this reflexgradually diminishes, giving solidfood the chance of making it fromthe tongue to the tummy.

A babys swallowingmechanism is immature.It takes time for a baby the tongueand the swallowing mechanism.Between four and six months of

age, most infants develop the ability to move the food fromthe front of the mouth to the back instead of letting itwallow around in the mouth and get spit out. Prior to fourmonths of age, a baby's swallowing mechanism isdesigned to work with sucking, but not with chewing.

Young infants are not equipped to chew.Teeth seldom appear until six or seven months, givingfurther evidence that the young infant is designed to suckrather than to chew. In the pre-teething stage, betweenfour and six months, babies tend to drool, and the droolthat you are always wiping off baby's face is rich inenzymes, which will help digest the solid foods that aresoon to come.

Readiness for solids depends on both the maturity of yourbabys digestive tract as well as his individualdevelopmental timetable. Developmental readiness cannotbe determined using a calendar; some babies may beready before others.

Sign that indicate that your baby isdevelopmentally ready for solids include:

Baby can sit up well withoutsupport.Baby has lost the tongue-thrust reflex and does notautomatically push solids out of his mouth with his

tongue.Baby is ready and willing to chew.Baby is developing a pincer grasp, where he picksup food or other objects between thumb andforefinger. Using the fingers and scraping the foodinto the palm of the hand (palmar grasp) does not

substitute for pincer graspdevelopment.

Baby is eager to participate inmealtime and may try to grab foodand put it in his mouth.Additionally, a sign of solidsreadiness is when a baby exhibits along-term increased demand tonurse (sometime around six monthsor later) that is unrelated to illness,teething pain, a change in routine ora growth spurt.


Is My Baby Ready for Solid Foods?

Readiness for solids depends on

both the maturity of your babys

digestive tract as well as his

individual developmental timetable.


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However, it can be hard to judge whether babys increasednursing is related to readiness for solids. Many, if not most,six-month-old babies are teething, growth spurting andexperiencing many developmental changes that can leadto increased nursing sometimes all at once!

Make sure you look at all the signs of solids readiness as a

whole, because increased nursing alone is not likely to bean accurate guide to babys readiness.

Four-to five-month old babies are sometimes very eager toparticipate at mealtimes, but it doesnt necessarily meanthey are ready to eat solids. Research tells us there arehealth advantages to delaying solids to around 6 months ofage, and risks to introducing solids early.

There are things you can do to let your baby participate inmealtimes without starting solids:

Let your baby sit with the family at mealtime in a

lap, booster seat or high chair.Give your baby a cup of water or expressed milk.Your baby can entertain himself at mealtime whilelearning to use a cup. 1-3 ounces of water in the cupshould be plenty (often for the entire day). Manymoms choose to use only water or a small amount ofbreastmilk to avoid wasting it while the baby learns touse the cup.Offer your baby spoons, cups, bowls and other baby-safe eating utensils to play with during mealtime.Give baby an ice cube (if its a baby-safe size &shape) or ice chips to play with.Offer baby a momsicle (popsicle made frombreastmilk) or slushy frozen breastmilk to eat with aspoon.

Should Solids Replace Breast Milk?You will notice in the policy statements from WHO andother health authorities that solids are referred to ascomplementary foods.

During the first year of a babys life, solids are meant tocomplement breast milk, not replace it. Starting solids ismore of a way to add textures to your babys diet, to allow

for new experiences, and to develop hand/eye coordinationthrough finger feeding.

Your baby should still be allowed to nurse on demand, asyour milk should be her primary source of nutrition untilcloser to the end of the first year. Continuing to allow on-demand feedings also better ensures your milk supply.

Introduce your baby gradually to solid foods. Once sheaccepts them (it might take some time), continuebreastfeeding as often as before and add solids as your

babys appetite increases. A few bites once a day isenough for a baby at the beginning, but gradually increasethe amount as your baby accepts it.

If your baby is younger than a year (and you are notweaning), make sure that you always nurse before offeringsolids. Babies who start solids early, and babies who eat a

lot of solids tend to wean earlier.

For the first year, it often works well to offer the solidsabout an hourafteryou nurse. If nursing has come beforethe solids you can continue feeding your baby the solidsuntil he shows signs of fullness; i.e. turning his head,closing his mouth, batting at the spoon, wanting down,spitting the food out, etc.

Trying to feed past this point is overfeeding. Most babieswill balance their milk intake with their solid food intake wellif you feed in this way.

If you have questions about how to get started withintroducing solids to your baby, are experiencingchallenges with feeding your baby solids, or have anyother breastfeeding inquiries, LLL Leaders are happy toassist you.


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Resources:Books from our free lending library:

The Womanly Art of Breastfeeding (section on Solids)

The Baby Book (section on Solids)

My Child Wont Eat

Whole Foods for Babies and Toddlers

Websites:LLL International: http://www.llli.org/nb/nbsolids.html

Kellymom: http://kellymom.com/nutrition/

Dr. Sears: http://www.askdrsears.com/topics/feeding-infants-toddlers/starting-solids

(Continued from page 5) Is My Baby Ready for Solids?

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Baby Led Weaning, quite simply, means letting your childfeed themselves from the very start of introducing solids.(Weaning in this sense means adding complementaryfoods.) At around six months of age most babies reach forfood and are developmentally capable of feedingthemselves. One of our moms shares her baby ledweaning experience with her son, Liam.

Our Baby-Led Weaning Experienceby Marisa Stones

In 2009 my husband and I were visiting with friends in theUK. Unlike past visits where we went to restaurants andtheatres with this particular couple, this time we wereinvited to their home to dinner as they now had a 10 monthold daughter. We had a lovely afternoon, and a mostmemorable dinner.

What was so special about the dinner? Well, our friendsdaughter sat at the table with us and ate everything that weate that evening. There were no purees, no bottles of babyfood, no odd combinations of foods just real food that shepicked up, chewed with her two teeth, sucked on andplayed with while we ate.

My husband and I were fascinated by this and asked aboutthis interesting way of introducing a child to food. It was thefirst time I heard the term baby-led weaning, and I kneweven then that it was a method that would fit into myfamilys life one day.

When I became pregnant, like many first time mothers Iread many, many books. I knew that I wanted to breastfeedfor as long as possible but I also wanted to have a smoothtransition into solid foods when the time was right.

I also spoke to many people about what they did whenintroducing solid foods, I learned about various pureemachines to make my own baby foods, and I also learnedabout the options out there for organic baby foods.

But I was still very interested in the concept of feedingregular food to my child at the table when we ate. I askedmany questions about baby-led weaning of my friends and

others who used this method in the time between that visitand the birth of my son in late 2010.

My friend in the UK recommended the book Baby-LedWeaning: The Essential Guide to Introducing Solid Foods -and Helping Your Baby to Grow Up a Happy and ConfidentEater by Gill Rapley and Tracey Murkett and I quicklyordered the related cookbook because I liked what I hadread.

The basic principles were simple:Our son would sit with us at mealtimes and wouldjoin in when he was ready (usually after, and not untilhe was at least 6 months of age). When he showed interest, he would be encouragedto explore food picking it up with his hands.

Baby Led Weaning
http://www.llli.org/nb/nbsolids.htmlhttp://www.llli.org/nb/nbsolids.htmlhttp://kellymom.com/nutrition/http://kellymom.com/nutrition/http://www.askdrsears.com/topics/feeding-infants-toddlers/starting-solidshttp://www.askdrsears.com/topics/feeding-infants-toddlers/starting-solidshttp://www.askdrsears.com/topics/feeding-infants-toddlers/starting-solidshttp://www.askdrsears.com/topics/feeding-infants-toddlers/starting-solidshttp://www.askdrsears.com/topics/feeding-infants-toddlers/starting-solidshttp://kellymom.com/nutrition/http://www.llli.org/nb/nbsolids.html


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Food would be offered in pieces that would be thesize and shape that he could easily handle.He would feed himself from the start we wouldjust put the food in front of him.It would be up to him how much he eats and howquickly he tries new foods.He would continue to be breastfedwhenever he wanted and hewould decide when he wasready to reduce his feedings.

So we invested in a highchair thatwould allow him to sit at the dinnertable with us. First he just joined usduring dinner, which we started toschedule for before we started hisbedtime routine.

He sat in our lap at mealtimes and then, at around five

months old, once he was sitting up on his own, he startedto sit in his chair. He watched us eat at home, inrestaurants, when we went on vacation.

And then, about a week after he went six months old, hebegan reaching for what was on our plates. He wasready to start experimenting.

His first food was a stalkof broccoli. He picked itup and it immediatelywent into his thentoothless mouth. Hegnawed on it andsucked it that first time.We watched entrancedand a little nervous.

We wanted him toexperiment but we werestill concerned about him choking. We knew from ourresearch that the risk was low but we were cautious andalways observed him when he was eating.

We have since learned over the last year about thedifference between gagging and choking and havethankfully never had a choking situation but due to his

own experimentation our son can easily move food fromthe back to the front of his mouth when necessary.

That first time, and many times thereafter was messy, butso much fun! It was great to watch him exploring food the textures, the tastes, gripping foods, chewing foods,the decisions he made in what he liked and didnt like.We introduced foods conservatively to ensure that therewere not any allergies. But it was easy and sometimes itseemed too easy.

What was also happening was that family meals wereplanned with our son in mind. In those first months itmeant really healthy meals for us with lots of broccoli,brussel sprouts, watermelon, corn and other fresh fruitsand vegetables that he loved.

Since he was still

breastfeeding, if he didnt eat (and swallow) much, itdidnt matter. As he got older the content of his diapersbegan to change as he began to swallow more of whathe ate. I found it easy to make his lunch for school, oftenincluding broccoli spears or whatever we had for dinnerthe night before. He has never had bottled baby food andexcept for cereal, yogurt and apple sauce, he has hadlimited spoon feeding.

And he truly did decide when he would transitionsolely to solid food. At first his milk intakeremained the same for many months. And then, abit after a year of breastfeeding he began toprefer food over milk, cutting his daily milk intakeby about half.

In our case, he self-weaned from breastfeedingby the time he was 15 months old. I was sad tosee that part of his life end, but I was also happythat it happened comfortably.

So our now 18-month old son is still an adventurer at thetable. He does not balk at textures or trying new foods.He can feed himself from a bowl or plate using a spoonor fork, which started with him trying to copy what wewere doing at the table. Meals are still messy and mydogs probably need to go on a diet due to the extras they

pick up off of the floor. And my husband and I lookforward to our family dinner every night

Resources:Book from our free lending library: The Baby-LedWeaning CookbookWebsite: www.babyledweaning.com

So our now 18-month old son is still anadventurer at the table. He does not balk at

textures or trying new foods. He can feed

himself from a bowl or plate using a spoon or

fork, which started with him trying to copy

what we were doing at the table.

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Breastfed babies do not needwater keep in mind thatbreast milk is 88% water. Even in the first few days afterbirth, before moms milk has come in, colostrum is all thatis needed to keep baby well hydrated (assuming baby isnursing effectively).

Per the American Academy of Pediatrics, Supplements(water, glucose water, formula, and other fluids) should notbe given to breastfeeding newborn infants unless orderedby a physician when a medical indication exists Duringthe first 6 months of age, even in hot climates, water andjuice areunnecessary forbreastfed infants andmay introducecontaminants orallergens.

In addition, breastfedbabies do notrequirewater when it is veryhot outside,assuming baby isallowed to nurse asneeded. Baby canget all the liquidsneeded via breastmilk.

A number of studieshave determined that an exclusively breastfed baby doesnot need extra water these studies have been done invarious locations (both humid and dry) at temperatures

ranging from 22-41C (71.6-105.8F) and 9-96% relativehumidity.

For newborns (especially under 4-5 weeks), watersupplements can be risky

Babies under two months should not be givensupplemental water.

Water supplements are associated with increased

bilirubin levels in jaundiced newborns.Too much water can lead to a serious condition calledoral water intoxication.

Water supplements fill baby up without adding calories,so water supplements can result in weight loss (orinsufficient weight gain) for the baby.

Babies who get water supplements are less interestedin nursing. If baby is not nursing as often as he should,it will take longer for moms milk to come in and candelay or prevent mom from establishing an optimummilk supply.

For babies past the newborn stageToo much water can interfere with breastfeedingbecause it fills baby up so that he nurses less. Babiesneed the nutrition and calories in breastmilk to growwater has none of these.

Breastmilk has all the water your baby needs, even invery hot weather.

When your 4-6 month old baby is learning to use a cup,giving him a few sips of water a couple of times a day(no more than 2 ounces per 24 hours) is fine and fun.

Once baby starts solids, you might want to give him a few

sips of expressed milk or water with his solids somebabies need this to prevent constipation.

Does My Breastfed Baby Need Water During the Hot, Summer Months?

Mamas Milk Gazette

is produced by

La Leche League

of Bermuda

Editor: Alex Hasselkuss

We welcome your

comments and sugges-tions.

Please contact us at

236-1120

[email protected]

or on Faceboook at

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