Moving on in weaning – a confusing process

Through recent correspondance with parents, it has become apparent to me again, how difficult the progression through weaning can be, as you are bombarded with advice from friends, family members and books. In reality, your baby is an individual and it does not matter what people say or write, a one-fits-all approach just does not work for every baby. That is something that I can reassure every parents, that their child is unique and therefore will require a unique approach.

I like providing parents with a structured way of introducing foods as this way they can keep track of what foods were trialled, how the baby liked the foods and also in my allergic children if there were any reactions. Therefore, I usually suggest starting with  one food, which is then followed by other new food(s). Introduction of weaning food is cumulative, so for example if you have started with carrots and your baby tolerates carrots you then try potato, but you can mix your carrots with the potato. So you are constantly trying  a new food but can mix this with existing foods.

I have provided below an example of a couple of days-weeks:

Start: Carrots

Then: Carrots and potato

Then: Carrots and potato and a pear  (new food)

Then: Carrots, potato and courgette (new food) and pear as a dessert

Now start with 2 meals per day

Then: Potato and courgette (one meal) and another meal of pear and porridge (new food)

Then: Potato, courgette and butternut (new food) and another meal porridge with apple (new food)

As you can see it is an easy process of constantly expanding the foods your child is given and of course repeating foods already trialled to ensure that tastes are accepted. Research has found that some foods (tastes) will need at least 15 introductions before a baby likes the new food, so please do not give up if your baby is not a big fan of a new food and repeat the food many times.

So when do you move from 1-2 -3 meals? I usually suggest going to 2 meals very quickly (when you have introduced 3 or more foods) and when protein are introduced (i.e. meat, chicken, fish, lentils) to move to 3 meals. There is no “rule” that says you have to do this, but I have found this works really well.

Of course what follows on from going up in solid volume is the cutting down of breastfeed/formula. I have in a previous blog entry provided some guidance on routines and milk feeds, but I want to reiterate what I have said before, that responsive feeding is the best feeding method, which means we respond to a child’s appetite and satiety cues. If a child refuses to drink or eat then we stop, if they signal more, then we offer more (please see previous blog entry on portion sizes). This means, that as you go up in volumes of solids, your child would signal which feeds or bottles they are not that keen on and these are the ones you cut out/reduce and adjust your feeding regime around this. It does of course occur that sometimes they love the breast or the bottle too much and would rather take the breast or bottle rather than take solids. If this occurs then it is worth having a chat with your health visitor (in the UK) or dietitian to help you decide which feed should be cut out/reduced to give you maximum benefit with creating appetite for food.

The most important message to come out of this blog entry is that your child is unique and will not always fit into a regime set out by a book/another person. As long as you respond to feeding cues, increase the variety of foods (as explained above), move up in texture and adjust volume of feed/breastfeeding frequency as your child signals, the vast majority of cases babies thrive and do well.

 

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From dirt to probiotics

The most common question I get in my clinic is about which probiotics should be used in children. The answer I give unfortunately can be quite disappointing for some parents because my answer is usually quite vague, unless I know specific research exists related to a specific strain of probiotic and a specific diagnosis.

The gut has millions of bacteria and these are made up of different strains and to make it even more complex, although there is some overlap in bacterial flora in children, the gut microbiota of the individual is quite unique to every child related to whether they were born via C-section/vaginal birth, breast fed or bottle fed, weaning diet and also the environment. So suggesting one strain or even multiple strains for an individual child can be difficult as the microbiota is so specific to an individual. What I can certainly reassure parents is that outside of specific conditions (i.e when a child is immunocompromised for example with cancer) probiotics are fine to use and not harmful, so you will not do any harm if you were to try. We know that a breastfed child will have a flora that is more dominant in bifidobacteria and that this changes with the introduction of solids to more lactobacillus. This of course is a very simplistic explanation as you have lots of other strains that develop.

The message that I wanted to get out with this blog post is that you can do a lot of positive with your baby’s gut microbiota with breast feeding (best option) and some formula now also contain prebiotics (food for the good bacteria) and also when solids are introduced to expand the variety to lots of fruit, vegetables and grains, which provide food for bacteria and promote a healthy balance of gut microbiota. In addition to this, is the importance of home-cooked foods, which have also been shown to help with the microbiota, as home-cooked food is not sterile and contains some bacteria, that also helps the microbiota.

I think many of you have heard of the the excessive hygienic conditions we live in, being blamed for the development of allergies. So allowing your child to crawl on a floor, pick things up and put in their mouth (within reason of course) and explore is an important step to helping the gut microbiota develop and improve the immune system. So before you look at a probiotic, think about all the things that you can do at home already that promote not only 1 or 5 bacterial strains in the gut, but millions of strains. If you still then want to try a probiotic for a specific situation, do discuss this with your healthcare professional as there are some strains that have shown to be beneficial for specific symptoms/diagnoses.