Monday, 24 August 2015

How to start weaning

So congratulations! You have survived the first six months, this is a huge feat anyway, not to mention having a baby with a cow's milk protein allergy!

The WHO and the Department of Health recommend that babies are fed breast (or formula) milk exclusively for the first six months of their lives. Any decision to wean your baby earlier than this should be taken in line with your dietician or doctor. 

It's important to wait, as this gives the baby's digestive system time to mature, and can reduce the risk of allergies later in life. 

So how do you start weaning?
Admittedly, this can be quite daunting for a first time (or even second or third!) parent. The signs that your baby is ready to start include:
  1. They can sit and hold their head steady (note this does not mean that they can sit independently without support, you may end up waiting for some time in that case!)
  2. They have the coordination to bring objects to their mouths with their hands
  3. He or she can swallow food (meaning they have lost their "tongue thrust" reflex which pushes food out of their mouths).
Have a look at the NHS weaning page about more information on how to start. 

What do I need to start weaning?
Not much really. A sturdy high chair, bibs, bowls and spoons will be good enough to start with. Depending on the route you want to take, you may need a hand blender and ice-cube trays if you want to give your baby purees. 

What are my options?
There are two broad schools of thought with regards to baby weaning. Some parents start with the more traditional puree route, and some do baby led weaning. Some combine the two (this is what I did). Don't be surprised if you find you don't have much of a say in the matter. Some parents who are adamant that they are going to try one method may find that they have babies who will only ever eat off a spoon, or ones that refuse to go near any cutlery!

With puree based weaning, you blend or mash single fruits or vegetables, getting your baby used to a range of tastes and flavours. As they get older, you can progress to combinations of flavours, and thicker, more lumpier textures and introduce finger foods later on. This was often chosen as  a method of weaning before the advice not to wean before six months as many babies weren't able to manage chunky finger foods due to the lack of oral motor skills.  

Baby led weaning involves giving your infant pieces of food to lick or suck from six months onwards, which they eventually progress to eating. Some babies are ready to begin self-feeding at six months, by some may not get the hang of it till much later (7 or 8 months). The important thing is that the baby dictates the pace. Initial attempts at baby led weaning may mean that little food is actually eaten at first, so it is important that breast or formula milk is not cut back until feeding is established. 

The basic principles of baby led weaning are (taken from Wikipedia):
  • At the start of the process the baby is allowed to reject food, and it may be offered again at a later date.
  • The child is allowed to decide how much it wants to eat. No "fill-ups" are to be offered at the end of the meal with a spoon.
  • The meals should not be hurried.
  • Sips of water are offered with meals.
  • Initially, soft fruits and vegetables are given. Harder foods are lightly cooked to make them soft enough to chew on even with bare gums.
  • Foods with clear danger, such as peanuts, are not offered.
  • Non-finger-foods, such as oatmeal and yogurt, may be offered with a spoon so the baby can learn to self-feed with a spoon.

What are the advantages of choosing one method?
Puree based weaning is often less messy (as you are in control of the spoon!), and you can clearly get an idea of how much baby is eating. However, it does require forward planning and can become time-consuming to peel, chop, cook and puree different types of food. Jars and packets of baby puree can contain lots of water, so it is advisable (and often somewhat cheaper) to make purees yourself. 

Baby led weaning is certainly messier, and there is some research to suggest that it helps babies to learn to self-regulate their food intake, reducing the risk of obesity and poor eating habits later in life. Have a look at this paper if you are interested. It has the advantage that you can more or less offer food from the family plate and does not involve separate cooking or preparation. 

Do I need to avoid any types of food?
Good question. Yes is the answer. There are some foods that are not suitable, which ever method of baby weaning you choose. These are:

  • Salt - no salt should be added to baby's food 
  • Sugar - there is simply no need for it! You can place your child at higher risk of tooth decay later on if you give him or her sugary drinks, sweets or chocolate. 
  • Honey - although rare, there is the risk of botulism from giving honey to an under 1 year old.
  • Nuts and seeds - whole nuts and seeds (like peanuts) pose a choking risk. As long as there is no family history of serious allergy, it is actually not recommended to delay introducing peanuts (in the form of peanut butter or cooked with peanut oil etc) anymore. If there is any serious allergy, you should contact your dietician or doctor about what's best for your child. 
  • Unpasteurised cheeses/blue cheese
Some foods are termed "highly allergenic foods", i.e., these are the ones that cause most food allergies, so should be introduced to your child with an element of caution if they suffer from multiple food allergies, (get medical advice in these cases). 

So I want to start with purees, what do I do now?
My advice would be to start with simple vegetable tastes first. Chose a time of day when baby is relaxed  and in a familiar environment. Try a couple of teaspoons and take your time. Let baby experience the flavour and play with the spoon. Don't worry if they reject it at first, it can take several goes for baby to accept this new experience, it's also a new challenge for him or her to learn how to move food around their mouth, this will take some getting used to too.  If you're struggling to get baby to accept anything, perhaps he or she isn't ready, so try again a different day.  It's also advisable to introduce any new foods at lunchtime as you have a while to watch for any signs of a reaction during the day. 

Try these for some early weaning schedules. If you feel confident, start to introduce finger foods at or before the fourth week of the schedule. 

After week 4, try introducing breakfast as well. This can be another serving of fruit or try adding cereal or toast. Have a look at dairy free breakfast ideas here

What sort of foods should I be introducing?
Good first foods to introduce are ones that are easy for your baby to digest. Why not try starting with the following. (Either cook gently by boiling or steaming and cut into sticks, or cook until soft and puree with a hand blender).  

  • Sweet potato
  • Cauliflower
  • Broccoli
  • Pear
  • Apple
  • Mashed banana
  • Carrot
  • Parsnip
To store pureed food, the easiest way I found was to buy some silicon ice trays. Pour the cooled puree into the trays, cover and freeze. Once frozen, I would tip the cubes out into labelled tupperware tubs. When T started to eat a bit more at each of his meals, I would combine cubes into flavour combinations, often combining fruits and vegetables. 

Once your baby is used to different flavours try combinations - here apple, sweet potato and butternut squash cubes waiting to be defrosted.

What about milk?
From 6 months, your baby still needs a minimum of 500-600mls/day of breast or formula milk. The best way to ensure this if you are breast feeding is to continue to feed on demand. Remember that milk should continue to provide most of your baby's nutritional needs until 1 year of age. 

Unlike other children, babies with CMA can't get calcium from sources like yogurts, creamy sauces or cheese. Calcium is essential to your growing child, so have a look at these non dairy sources of calcium instead. 

Once your child starts eating more, you will notice that they will gradually cut back on their daily milk intake, or having fewer or shorter breastfeeds. As a rule of thumb, if you think that your child is taking less than 300mls milk per day, you should speak to your dietician as they may require calcium supplementation. 

When can I introduce meat and fish?
Any time after 6 months! If you have waited until 6 months to wean your child, then their digestive system should be mature enough to handle it. If you have weaned before 6 months, then it's worth waiting until then to introduce meat to his or her diet. Start with easy, well tolerated meats such as chicken or white fish and progress from there. You can also introduce egg from 6 months to your child, but it should be well cooked. 

Always chose good quality meat and fish, and avoid processed meats such as sausages, bacon and burgers which are high in salt. Likewise, gravies and meat stocks are very high in salt as well and should be avoided. 

What precautions should I take since my child has CMA?
Since your child already has a dairy allergy, they may have allergies to other foods that they haven't tried yet. Foods like soya have a cross over with CMA in some cases. I would recommend keeping a weaning diary for your child where you can document your child's intake and note any potential reactions. 

Food diary for T - invaluable! 
Introducing foods gradually is also a good idea if your child is prone to food allergies. Try to introduce one new food every 3 days or so, and introduce them at lunchtime so you can watch for any rashes or reactions in the afternoon (better than introducing new foods at dinner time and spending all night with a poorly child!). 

What ever you decide to do, good luck! You're setting your child up for a lifetime of healthy eating habits.