infant feeding

Categories B3RD

PSA: There’s nothing wrong with serving your baby purees

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Half of you are shaking your heads and thinking “No duh”. You raised your children on little jars of Gerber and the kids turned out just fine.

But in the years since I was a tot, “Baby-Led Weaning” has taken off, and with it, a whole new set of food rules for babies. One that many crunchy types have latched onto is that purees are not just unnecessary (that one is true, folks – babies can learn to eat without purees) but are harmful. This, friends, is simply not true.

While my older three barely ate any purees as their first foods, Shiloh has eaten purees almost every day since she started eating solids two or three weeks ago. She’s had cream of peanut and butternut squash soup, homemade applesauce, and pureed pumpkin whenever the family has those food items – which, for right now, is almost every day. That’s what we eat in the fall when squash and apples are in season.

Shiloh with pumpkin on her face.

And she’ll be just fine.

What you do want to watch for is that your baby doesn’t ONLY get purees for months on end. The evidence suggests that there is an ideal window for the introduction of texture – babies who don’t get introduced to textured foods by about 9 months are much more likely to become pickier eaters and to develop texture aversions. (References: Delayed introduction of lumpy foods to children during the complementary feeding period affects child’s food acceptance and feeding at 7 years of age; The effect of age of introduction to lumpy solids on foods eaten and reported feeding difficulties at 6 and 15 months).

So don’t only serve your baby purees, but don’t stress if you find yourself picking up a little container of puree at the grocery store or blending some for your baby: There’s nothing wrong with serving your baby purees.

Categories B3RD, Book Reviews

Book Review: The Baby Food Bible by Eileen Behan

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Face it, feeding a baby is hard work. Whether at the breast, from a bottle, or at the table, infant feeding takes time, energy, and savvy. (And don’t even get me started on the cleanup!)

For the health savvy mom, feeding a baby can be even harder – there’s so much conflicting information, so much advice, so many different ways to go. Start at four months or six? Rice cereal or avocado as a first food? Wait 3-5 days between foods or introduce mixtures at will? Cut grapes into quarters or sixteenths? Jarred or homemade baby foods? Or maybe baby-led weaning is the way to go? Should I choose organic foods or are conventionally grown foods okay? Should my baby eat salt? Sugar? Dairy foods? Soy foods? Wheat? Peanuts? The list of potential questions goes on and on.

I wish there were a good quality book that addressed all these issues (and addressed them the way I do – because, of course, I know it all :-P), but unfortunately, to my knowledge, no such book exists.

Eileen Behan’s The Baby Food Bible does a pretty good job though as a basic resource for moms. Behan, a dietitian who works with families, does a decent job summarizing general infant feeding recommendations as of 2008 when The Baby Food Bible was published.

The largest section of the book is a list of healthy food items (from all the food groups), discussing how moms can make them into purees for their infants and how they can incorporate those foods into family meals. She gives easy “recipes” for the purees, including how much water to use per unit of food and both stovetop and microwave cooking times. For the mom who’s going the puree route (which you don’t have to, by the way – Tirzah Mae ate purees maybe twice), it’s a good resource. The next largest section is a collection of multi-ingredient recipes that can be pureed to be fed to babies, as well as to the rest of the family. Again, if you’re going the puree route, it’s a good resource.

Now, every so often, Behan says something about a specific food that reflects traditional infant feeding biases that I don’t agree with (and that don’t have research to back them up) – like when she says that cucumbers are “not recommended for infants”, but are “a good snack food for older toddlers.” It’s true that cucumbers do not puree well, but I don’t see any reason why an infant eating stage 3 or 4 foods shouldn’t have little chunks of the inner portion of a cucumber (Tirzah Mae does whenever we’re eating cucumbers). Likewise, Behan writes that “onions are not a baby food” and suggests only that they can be included in recipes for older children because they add flavor. I’ve never seen any reason to avoid onions with babies (except cultural biases against it) – and we eat sauteed onions (or sauteed onions and zucchini or onions and peppers or…) rather frequently.

Other recommendations Behan makes are outdated – the most notable being that she gives the (then current) recommendation to avoid potentially allergenic foods in the first year. Pediatricians and dietitians had been giving that advice for years based on a “better safe than sorry” principle while research was being conducted to determine whether it made a difference. Well, in the past 2 (maybe 3?) years, the research has come out and indicates that holding off on potentially allergy-causing food has the exact opposite effect than the one we’d hoped for. We now know that introducing potential allergens between the ages of 4 and 6 months has a protective effect against the development of food allergies.

And then there are the philosophical questions that don’t necessarily have scientific evidence on their side – organic foods, local foods, humane foods, etc. Behan generally jumps on the bandwagon with each of these, although she does acknowledge to some degree that parents may have different priorities.

So… now for the difficult part. Do I recommend The Baby Food Bible?

If you’re a mom with a baby younger than 8 months, you intend to go the puree route, and you want to learn how to make your own baby food, this is a great resource. If you’ve got a baby older than 8 months, you should be working on introducing textures (which Behan doesn’t talk a whole lot about but which I consider a very important step in ensuring healthy eating patterns into adulthood – something I believe the research supports). If you intend to skip purees – hey, I did too – wanna compare notes? If you intend to just buy staged baby food from the store, the bulk of this book won’t apply to you.

Rating: 3 stars
Category: Infant feeding
Synopsis: Behan discusses then-current recommendations for infant feeding and gives a giant list of foods and how to prepare and puree them for your baby.
Recommendation: Worthwhile if your baby is under 8 months, you intend to feed your baby purees, and you want to learn how to make your own baby food.

Categories B3RD

My Child “Choked”

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Little scares a mother more than hearing that half-retching, half-coughing noise that she almost universally describes as “choking”.

But just because it scares a mother doesn’t mean it should scare a mother.

You see, that little cough/retch? That’s not choking. Generally, it’s gagging.

According to the Mayo Clinic, choking is “when a foreign object becomes lodged in the throat or windpipe, blocking the flow of air”. By definition, choking makes no sound, since no air is able to flow through a blocked windpipe.

Gagging, on the other hand, is a function of the gag reflex, defined by Merriam-Webster as “the reflex contraction of the muscles of the throat caused especially by stimulation (as by touch) of the pharynx”. Gagging is an involuntary reaction in which the the throat contracts to prevent choking.

Did you catch that?

Gagging prevents choking.

While the sound of gagging can make a mother’s heart jump into her throat, it isn’t a sign that something is going wrong with your child. It’s a sign that something’s going right. Your child’s body is working as it’s supposed to, protecting your child from choking.

What does this mean for the mother?

For one, it means you can breathe a sigh of relief. When I’m feeding Tirzah Mae and she gags on a bite, my heart leaps just like other moms’ hearts do – but since I know what gagging means, I can then relax and thank God that He created her body to help keep her safe.

For two, it means you need to be vigilant when feeding your child. A choking child isn’t going to give a cough to let you know to rush to her side. A choking child can’t breathe, can’t make noise. Which is why young children should sit down to eat and why mom should be right there beside them while they’re eating. Letting a child wander with snack in hand ups the choking risk in two ways: a child distracted by walking is more likely to chew insufficiently or to send something down the wrong pipe (I find this to be the case when I’m walking and eating) and a child who is wandering about while eating is not necessarily being supervised in such a way that a caretaker can quickly intervene were true choking to occur. (There are social and nutritional benefits of sitting down to eat as well, but I won’t go into those here.)

When I was working as a WIC dietitian, mothers mentioned choking often in reference to introducing solids to their babies. Often, mothers insisted that their eight to nine month old babies couldn’t eat anything but pureed baby foods because they choked on them. Of course, these moms didn’t realize that their children were gagging rather than choking. But what about their response? Is mom right to say that her child can’t eat a certain food or a certain texture because she gags on it?

Yes and no.

Gagging is an interesting thing. While the gag reflex is classically induced by touching the pharynx (that is, the soft tissue at the back of the throat), it can also be induced by smells (as of rotten food), by sight (as with seeing maggots), or even by a thought (such as the thought of eating rotten food or finding maggots in the bottom of your lunch pail). Additionally, some people have more or less sensitive gag reflexes – such that different textures, different smells, and different tastes cause them to gag.

For most children, gagging when introduced to a new texture is simply the body doing what it’s supposed to do, keeping foreign bodies from entering the airway. As a child becomes more adept with and used to the new texture, gagging should decrease. However, in certain circumstances, children with hypersensitive gag reflexes will have severe sensory issues with food which can be exacerbated by forcing a child to eat foods that stimulate their gag reflexes.

So what should mom do?

In general, if your child gags at the first taste of a new food (or first try with a new texture), I recommend waiting until your child is calm (which may be two seconds or may be much longer) before trying another bite.

If your child eats several bites of that new food, gagging two or three times throughout the feeding, this represents a normal response and there is no reason to stop feeding your child that food or texture. Gagging will become less frequent as the child becomes more familiar with the taste and/or texture of that food.

If, on the other hand, your child gags on three successive bites of the same food (or if your child turns away or clenches his/her teeth when you offer a bite), I recommend that you call it quits for the meal. This ensures that you aren’t creating unpleasant associations with that food in your child’s mind – those unpleasant associations can actually condition your child’s gag reflex to always respond to that particular food, a situation you definitely want to avoid.

Then, you’ll want to do a little Sherlock-style sleuthing. What do you think it was that triggered your child’s gag reflex? Was this a brand new flavor for your child or has he tasted it before? Was this a new texture for your child or has he had a similar texture before? If this was a brand new flavor, try mixing that food with another accepted food the next time you try it. If it was a brand new texture, try modifying the texture just a little bit the next time you try it (if baby has only had watery purees and baby gagged on a lumpy mix, offer a thicker puree before introducing a lumpy mix; if baby has only had purees with some lumps and gagged on chunks, try getting your child used to minced textures before introducing chunks; etc.) The goal is to ease a child’s transition into the next texture “level” or novel flavor.

It is valuable to continue working at introducing novel flavors and textures, despite the gag reflex (while being respectful of a child’s cues – remember to stop and try again later if a child gags on every bite or if the child turns away or clenches his teeth). Children who do not learn to eat textured foods by 8-9 months are more prone to persistent sensory food issues lasting into adulthood.

But what if your child does persist in gagging at every bite? This may be a sign of a hypersensitive gag reflex, in which case it would be worthwhile to ask your doctor about a referral to a multidisciplinary feeding therapy team that can evaluate causes of the difficulty and develop strategies for helping your child overcome these difficulties.