03 Nov

Getting started with solids: Purees

If you have chosen to offer pureed food for your baby’s first taste of solids, don’t forget it doesn’t have to be baby rice! For a healthy term baby showing signs of being ready for solid food, lots of other colours and flavours are available for those first steps on the journey towards a healthy enjoyment of food.

The main nutrients your baby needs in his or her diet between 6-12 months are still protein, fat and calcium, so there is no hurry to cut back on milk, which is such a great source of these things. When you start solids it’s all about the taste experience, so try not to let your baby fill up on food and have no room for milk. Just one or two teaspoons is plenty for the first few meals.

Vegetable Puree
You will need: approximately 100g of any suitable vegetable. This could be a small sweet potato, a carrot, a few florets of broccoli or cauliflower, half a butternut squash, a parsnip, a handful of peas, a fresh beetroot, some spinach leaves, or anything that can be cooked in the following way.

If you would normally peel the vegetable, then peel it. If not, just wash it. Cut larger vegetables into small dice.

Steam for 5-7 minutes, or boil in a small amount of water for 6-10 minutes.

Check it is soft enough to blend.

Using the chopping attachment of a hand blender, or in a food processor, puree the cooked vegetable until it is smooth. If necessary, add a small amount of cooking water to thin the puree.

If you want the puree to be smoother, pass it through a mouli or sieve. If you want it to have a little more texture, you could mash with a potato masher or fork.

Separate out a portion (two teaspoons) for the meal, and allow to cool before serving.
Cool the rest and store in clean containers in the fridge or freezer.

Fruit Puree
Hard fruits such as pears and apples can be prepared using the method for vegetable puree described above.

Soft fruits such as nectarines, peaches, plums, mangoes and apricots can be peeled and simmered for 3-5 minutes with a tablespoon of water, and then blended to a puree.

Bananas make a very convenient no-cook puree: simply mash or mush with a fork, and use immediately.

Lots more introducing solids resources can be found here.

10 Sep

Research finds commercial baby foods lack nutrients

Researchers from the department of human nutrition at the University of Glasgow have published a study on commercial baby foods, as reported in The Guardian today. Author Charlotte White then appeared on Radio 4’s Women’s Hour to talk about the findings of the study. The piece made good listening, with points made about not introducing solids too early and displacing milk, which is more nutrient dense than solid food; and there being no need at all for follow-on formula. It would have been nice to hear a bit more about baby-led weaning, which is a great option if parents want to take it very slowly and are relaxed about how much food baby actually takes.

15 Jan

Book Review: Bumpology, by Linda Geddes

Bumpology is an attractive and accessible book with a very clear and logical layout, which compensates for the lack of an index. It is as easy to dip into as it is to read from cover to cover; I know because I did both.

This is a marvellously comprehensive collection of research evidence and occasional comment upon the lack of research evidence, for all the advice and received wisdom relating to pregnancy, birth and early parenthood. As Geddes says, the science is out there, but it often takes some digging to find it.

Geddes looks at the big issues such as place of birth, breastfeeding, and all those things you’re told you can’t eat during pregnancy; as well as bringing in some colourful sections on how the growing baby develops in the womb, what senses function from birth, and the role of newborn reflexes. This in itself is a useful part of learning to empathise with the baby, and might influence parenting choices.

I am used to reading far more dogmatic books (from all over the birth and parenting spectrum), so this measured tone is very refreshing. Research in this area on the whole appears to be very thin, often studies are very small or based on the behaviour of lab animals. The book does not offer many definitive answers, but its general message is not to take advice for granted, since much of what we are told from the moment we even start to think about having a baby has no basis in fact. This very important point was made by Octavia Wiseman in a recent Midirs article (July/August 2012:p22), pointing out that much health advice is risk-averse, undermining parental choice, and that “explaining to women the limitation of our evidence base is the first step to take when asking them to make ‘informed’ choices.”

It is lovely that the text is scattered with anecdotes about the author’s personal experience, but for the most part this book is about facts not feelings. It largely ignores ‘soft’ aspects such as how parents feel about risk, and how mothers experience birth and early motherhood. Statistical comparisons of different aspects of birth look at outcomes and define those in terms of health of the baby and mother, taking little account of how women feel during and after the experience. For example lying down or being mobile during labour may make no difference to the outcome in statistical terms, but different women may experience these scenarios as more or less positive. Lying down in a room full of medical staff may feel disempowering; a woman being made to walk around may feel bullied. Working with parents both antenatally and postnatally, I know that scientific evidence may not always be the most important factor when making decisions. A good example of this would be the decision to share a bed with your baby: whether, according to various studies, this increases the risk of cot death; or whether it increases your child’s self-esteem, are less likely to influence the decision to bedshare than the fact that it might just be easier not to have to get up in the night. This does not, of course, detract from the fact that parents can and should be made aware of the evidence in order to make an informed decision; and to be fair, Geddes does not set out to explore the qualitative aspects of parenthood, but to present the facts and figures, and bust the myths: a very worthwhile mission.

I would recommend Bumpology to anyone expecting a baby, but I think it is also essential reading for anyone working with parents, antenatally or postnatally. It is so important for us to get our facts right, to counter the myths and enable parents to be confident in their decision making. Very few of the books I’ve seen are so robustly evidence-based, and an awful lot of people working with parents will repeat advice without giving any critical thought either to the evidence behind it, or the effect it might have in an individual situation.

Bumpology Blog
Sense About Science
Linda Geddes on Radio 4’s Today Programme with Belinda Phipps, CEO of NCT

05 Sep

Book Review: My Child Won’t Eat, by Carlos Gonzalez

After enjoying Gonzalez’ Kiss Me! so much, and with a long standing interest in the subject of solid food, I looked forward to reading My Child Won’t Eat, and hoped it would have some useful information that I could pass on in my Introducing Solids Workshops.

The book is sensibly divided into Causes, Solutions, and Prevention, and uses a rich selection of anecdotes to illustrate the points made in each section.

Gonzalez’ basic premise is that babies and children can be allowed and trusted to regulate their own appetites; and that it is the parents’ expectations that are wrong. If parents stop worrying about it or trying to force their children to eat, they will still eat the same amount, but it will all be much less stressful. They won’t eat any more than they did before, but they won’t waste away either.

This premise is entirely sensible and based in the science relating to appetite control, and Gonzalez uses the perspective of the child to argue that mealtime battles are confusing and unhelpful when it comes to creating a positive attitude to food.

The book includes a large section on breastfeeding, which, as the author acknowledges, is likely to come too late for the parents of babies or toddlers eating (or not eating) solid food, at whom the book is targeted. Perhaps this would be more useful for health professionals and other people supporting those parents.

I found some of Gonzalez’ recommendations to be highly directive and some of his language is really quite judgemental. On the subject of introducing potential allergens, he writes:

Before one year, introducing many different foods only means buying more tickets for the allergy lottery.

which is sweepingly dismissive, and not in line with current recommendations from the Scientific Advisory Committee on Nutrition, whose review of the evidence concludes that there is currently no clear indication that early (or late) introduction of certain foods either prevents or triggers allergies.

I am not sure I learned anything new from My Child Won’t Eat, but the book gave me plenty to reflect on, and has helped to develop new perspectives and different ways of explaining things to parents.


To order My Child Won’t Eat! with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

27 Feb

My experience of baby-led weaning

Now that we are advised to wait until around six months to start, our babies have better co-ordination and more mature stomachs than they did at four months, and so it is possible to skip the stage of aeroplaning mush into their mouths and then scraping it off their chins, and offer finger food right from the start. This is known as baby-led weaning (BLW), and the main principle is that the only person to put food in the baby’s mouth, is the baby himself.

I started weaning my son the traditional way, at 23 weeks, with great excitement and anticipation of him quickly becoming as much of a food-lover as I am. I did consider the baby-led weaning approach, but felt that it would not work for us, because I would be returning to work a month later, and therefore no longer had the opportunity to breastfeed on demand. As with most things, my son had a completely different agenda to me, and resolutely refused to contemplate the spoonfuls of delicious runny baby rice that I offered him. For a few days he had some interest in pear, carrot, and potato; but as soon as the novelty wore off, he closed his mouth, turned his head away, and cried; and that was his final say in the matter.

BLW puts the baby in charge of his own eating, on the basis that if parents offer a range of interesting, nutritious, and suitable food, then the baby can choose what he eats, and this allows him to move gently towards a solid diet. The goal is not to force your baby to eat, but to let him experience the tastes and textures of food at his own pace. It encourages the development of motor skills, and because the baby quickly moves on to eating the same food as the rest of the family, he also benefits from learning social skills at shared mealtimes, when he can participate in eating actively, rather than passively. As long as parents can relax and accept that it might take longer for the baby to consume significant quantities of food, this approach is more fun, less stressful, and much, much messier than traditional weaning on purees. At this stage, milk is still the most important source of nutrition, so it doesn’t really matter how much solid food baby eats, as long as he gets plenty of milk.

The BLW philosophy is to follow the child’s cues, and start when he indicates he is ready to try some solid food. First signs of readiness include losing the tongue-thrust mechanism (where anything put into the mouth is pushed back out again), having the ability to sit unsupported, and starting to develop a pincer grip with the thumb and forefinger. Our experience was that this tentative ability came on very quickly, when sufficiently motivated by such interesting items as peas and roast potatoes.

The first foods we offered were fruit, rice cakes, and steamed or roast chips of vegetables. We found that if you leave the peel on hard fruit like pears, the baby can pick them up more easily, and will suck the flesh and spit out the peel. Of course you should never leave your baby unattended while eating, but don’t be too alarmed by a little bit of gagging: this is a normal part of learning to manipulate food in the mouth, and is not the same as choking. We moved on to breadsticks and toast, pieces of cheese, and small lentil patties (an early favourite). Breakfast cereals were less successful in our case, but could work well with a different baby (my constantly teething son liked his food to be soft but still insisted on using his own hands, hence breakfast usually consisted of one weetabix with 2oz milk – perfect finger-mush). Later on we tried poached fish and chicken, and finally just shared our own meals with him.

He didn’t really start to eat well until he was nearly a year old, but mealtimes where I could relax and let him dictate how much he ate were always the most pleasant ones. He has always eaten better at the family table than on his own, and we have the attitude that there are no things he doesn’t like, just things he doesn’t like YET. Around 12 months he started trying to feed himself with a spoon, and over the past year he has progressed to a fork, and now likes to wave a (baby-friendly) knife around while he eats as well.

At two years old, my son has eaten (and likes) a far more varied diet than I remember as a youngster (or even in my twenties!), from olives to salsify. He also eats things that I don’t like much, like spinach (mixed with cream cheese and combined with pasta makes a good mushy, messy finger food) and fish.

There have been many ups and downs, especially when he is teething, poorly, or tired. Some days he eats more, and some days he eats less, and some days he has a healthy diet, and some days I let him have a sausage roll. I try to look at the bigger picture, and consider that overall he has a good diet and enjoys his food, which, looking back, is what I wanted in the first place.

BLW works well in a family where the parents feel able to relinquish control over what the baby eats. You decide what to offer, and he decides what to accept; there is no batch-cooking of mush, no counting spoonfuls, and no train-coming-through-the-tunnel-and-INTO-your-mouth! It is important to be able to top up with milk on demand, but at least that way you can be sure that the little tummy isn’t filling up with less-nutritious solid food, to the detriment of milk, which still provides the main source of calories and other nutrients that the baby needs to in order to grow.

June 2008

13 Feb

Introducing solids, research, and guilt

Last week the British Medical Journal published an interesting study comparing outcomes for children who have experienced different styles of weaning, entitled Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case–controlled sample.

This sparked my interest for a number of reasons, one of which was a response on twitter complaining that research showing ‘pureed foods will make your babies overweight’ just makes parents feel guilty. This commenter went on to complain that the study, of 155 families, was an unrepresentative snapshot; and that was interesting too, because the study showed two main results: Baby-led weaning (BLW) babies were more likely to be underweight, AND puree-weaned babies were more likely to be obese in later childhood. So actually, you’re damned if you do and damned if you don’t, and guilt is once again a diversion from the actual information.

As I have written before, parents are entitled to information so that they can make decisions. The study is available in full on the BMJ website, so we really cannot get away with blaming the media for misrepresenting the facts. It’s quite easy to read, too.

I dusted off my memories of the ‘understanding research’ BA module I did last year, and had a good look at the article. I noticed that there were one or two flaws, but as far as preliminary research goes, it gives some interesting starting points. I thought that the sample size of 155 was not problematically small, but I noticed that the samples seemed to be drawn from quite different pools: mumsnet for the BLW families, and the local toddler lab for the puree families. However the researchers matched the samples for social status and all the usual factors.

The families self-reported on weaning styles, and the researchers acknowledge this as a weakness, since there is no strong definition of baby-led weaning, and it is not a discrete question. Many babies will experience some purees and some finger foods, in varying quantities. This could be addressed by a larger, prospective study following cohorts of children from birth well into childhood.

I also noticed that although the matched sample shows no significant difference between breastfeeding rates in the two groups, it is not clear whether or not the researchers controlled for duration of breastfeeding. The reason this interests me is that baby-led weaning does work well with (but isn’t restricted to) babies who continue to breastfeed well into toddlerhood. This is because if the baby is self-feeding, they are unlikely to consume very much for the first few months, and so will continue to rely on milk as an important source of nutrition probably until they are around a year old. I am just speculating here, but maybe the longer-term breastfeeding family can be a bit more relaxed about how much the baby eats; the researchers do state that BLW is is associated with reduced maternal anxiety about weaning and feeding and a maternal feeding style, which is low in control. I would posit that this is more likely to be the breastfeeding mother, but further research is certainly needed in that area!

I feel strongly that this is another area of parenting where the word ‘should’ does not apply. Many families need some support to find a style of introducing solids that works for them, and there are so many other complex factors, particularly relating to maternal control, that will affect the outcome for the child. As with breastfeeding, few people make the decision based solely on the publicised health outcomes: cost, expediency, social expectations and pressures will all play a part.

I’m starting to do a lot of Introducing Solids Workshops for parents over the next few months, and find the area really interesting. If you are interested in coming along to a workshop in Wokingham, Bracknell, Reading or Bagshot, get in touch.

03 Nov

Book Review: Complementary Feeding: Nutrition, Culture and Politics, by Gabrielle Palmer

Palmer’s ‘The Politics of Breastfeeding’ was a hugely influential book for me as a breastfeeding counsellor, opening up a far wider picture of the subject than I had ever seen before. ‘Complementary Feeding’ has done the same thing with the subject of introducing solid food and feeding infants and young children on food other than milk.

The title itself raises the huge issue of what we call this process, which many people refer to as ‘weaning.’ As Palmer explains, this is in fact the term for cutting down on milk, which may well be a consequence of introducing solid food, but is not, in fact, the same thing. This confusion of the terms leads to parents and healthcare professionals having a drive to reduce a baby’s milk intake long before he or she is developmentally ready to do so.

I particularly enjoyed the book because it reinforced my own approach to talking about the introduction of solids, with the focus being on education and exploration rather than on filling the child up with non-nutritious cereal-based or pureed foods to the exclusion of milk. She even pinched my throwaway remark that food is a great, cheap educational toy that comes in lots of lovely colours and textures, and can be played with at the table while the rest of the family gets on with their meal!

The book starts with an overview of the inequalities in global food entitlement, a subject I had not considered before, but which became highly topical this morning when research comparing the average English diet with diets in Scotland, Wales and Northern Ireland, suggested that if they all stopped eating deep fried Mars Bars, they would, amazingly, live longer. Of course, the research does not say this at all, but identifies food entitlement inequalities in less affluent populations in the UK, but that does not make such a good headline.

It goes on to look in greater detail at the evolution of the human diet, and cultural variations, as well as innate factors such as the drive for nutrient-dense food (hence the preference for salty, sweet and fatty foods), and the inbuilt appetite control mechanism that allows baby-led complementary feeding to become the natural progression from baby-led breastfeeding. I learned some interesting facts about human consumption of animal milk (most humans do not produce the necessary enzyme to digest milk, beyond infancy, but northern Europeans have evolved to do so), and was interested, but (I admit) slightly revolted by the discussion of feeding insects and molluscs to small children. My cultural prejudices are pretty well embedded!

Finally, Palmer suggests some processes for change, including an examination of the language used around feeding children; and compares the effects of wartime rationing with a frankly disempowering US initiative to provide poorer families with food but not with information about nutrition or food preparation.

For me, one of the most important conclusions of the book is that malnutrition exists in affluent cultures as well as in the developing world, because parents are driven to cut back on milk and give commercial or home-made processed foods to their children, often before the children are ready to move on to a solid diet. Also, that spinach is not particularly good for children; as Palmer writes, how wise they are to refuse it!

This book was a free copy kindly sent by Pinter & Martin publishers, and can be obtained from them here.