Weaning: solid advice on solid foods

When Sarah Keogh advises distraught parents on what to do with a fussy eater, the dietitian sometimes thinks the whole problem might have been avoided if they'd only had the right information when the baby was six months old.

The weaning process is increasingly recognised as “make or break” time for laying down the foundations for a lifetime of healthy eating. Do it well and it can save you and your child a lot of grief down the line. So no wonder weaning classes are in demand. Parents want information and practical tips on the best way to guide their babies from milk morning, noon and night to a varied, nutritious diet of “solids” by their first birthday.

Keogh and paediatric dietitian Ruth Charles, her colleague at Eatwell (eatwell.ie), a nutrition consultancy based in Dublin, recently ran a morning course for parents and carers on weaning and fussy eating. Based on the response, they intend to hold more in the future.

“The sooner you get on to dealing with fussy eating, the more effective you are going to be,” says Keogh. In her experience, any issues before the child is a year old can be sorted out in a week. “If you get them by the time they are 18 months old, you are talking three months. By the time they are two, it can take six months.”

Onus on parents

Hospital paediatric dietitian Cathy Monaghan of Weaning.ie runs classes in north and south Co Dublin. (The next one is at Airfield Estate, Dundrum on June 1st.) "Good eaters are not born, they are created," she states. This does put the onus on parents, but Monaghan wants to empower them, not stress them.

She also aims to give them the knowledge and confidence to resist commercial pressures, which play on guilt by suggesting that whatever product they are selling is essential for a baby’s good health

Before babies learn to walk, they crawl, stumble and fall, says Monaghan. But we keep encouraging them until they can walk, and she recommends that parents take the same approach to weaning.

“Your child is not going to automatically like all the foods that you want them to like,” she says. “Weaning is about working through textures and flavours and teaching your child to enjoy the food that meets their needs nutritionally and sets a great foundation for future health.”

Helen Browne had been through weaning once with her first child, Patrick, who has just turned two, but she attended one of Monaghan’s classes before her daughter Éabha (six months) reached that stage.

“There is so much conflicting information out there,” she says. “You are always conscious about what’s an advertising ploy and what’s real.” So she looked for someone who was not affiliated with a brand but was qualified to discuss food. Beyond weaning, Browne wanted to continue the best feeding into toddlerhood and childhood – “I needed to be able to make dinners that were going to satisfy her and be able to have something for Patrick as well.”

Return to work

The start of weaning comes as many mothers prepare to return to work after maternity leave. Browne not only has to make sure Éabha is ready to be spoonfed by a carer, but has to prepare suitable food to be given by the childminder, who comes to their home in Garristown, Co Dublin.

Then there are family meals to think about. “Cathy is a mother too,” Browne says of the dietitian, “so she understands how hard it is to juggle work and feed your children. She had so many good tips for dinners that were going to suit everybody.”

Having begun weaning her daughter at five months, Browne says Éabha is now starting to eat a blended version of what she, Patrick and her husband Robert are eating – just with no added salt for the two children. “It makes life a little bit easier.”

Weaning is a crucially important time, agrees Valerie Kelly, a paediatric dietitian and co-author of Feed Your Child Well; Babies, Toddlers and Older Children, the fourth edition of which has recently been published by O'Brien Press. There are certain windows around the first year which, if you miss, can lead to problems, she says.

“It’s not rocket science,” Kelly adds, although she would encourage parents to look for weaning classes run by registered dietitians to ensure they receive the correct information.

She concurs with the notion that good eaters are created. “Half the battle with feeding children is managing their behaviour. I can give all the advice in the world about what foods are healthy, but actually getting your child to eat them is a combination of parenting and knowledge.”

Taste range

Under the age of one is when most babies will accept almost anything. That’s why it is important to give them a wide range of tastes before they become toddlers and may discover their powers of refusal.

Kelly encourages parents to make their own food if possible. “There is nothing wrong with jars and pouches now and again, but they should not be the staple.”

Siobhan Berry of Mummy Cooks (mummycooks.ie) runs "intensive baby weaning classes" about twice a month in Stillorgan, Co Dublin. Berry is not a dietitian but comes to the topic from the perspective of a mother of two who is "passionate about nutritious, home-cooked food".

Her aim is “to be helpful and not preachy” at what can be a confusing time, with an emphasis on practical tips about getting organised, such as by batch cooking and freezing. She focuses on family food from the six-month mark “so everybody is looked after – there is no point in looking after just the baby”.

She says some parents don’t place enough importance on the weaning stage and how vital it is in setting children up to enjoy their food from one year on. “Half of it is about the psychology of food and the other half is about the food itself.” Much better to have a relaxed parent who has just whipped up a single puree than an anxious one trying to force a child to eat amazing food that she has been killing herself to produce in the kitchen.

PANEL: The facts about weaning

When to start weaning

No earlier than four months and no later than six months. There are both nutritional and developmental reasons for this advice, so parents should start within this timeframe whenever they see fit.

“Not every baby develops at the same rate so not all are ready at exactly the same time,” says Cathy Monaghan. “We know that all babies should be on solids by six months as their natural stores of many nutrients from birth are depleting, yet their nutritional requirements are increasing.”

As a dietitian, Sarah Keogh decided to begin weaning both her daughters at 17 weeks. “By the time they are six months old, you want to have weaned them, not a case of starting at six months,” she says.

Siobhan Berry also believes six months is too late. She would advise giving very thin purees once or twice a day about two weeks or even a month before then, so that by six months the baby is ready for a bit more texture in the form of meat, fish and grains.

Even if you are committed to the idea of baby-led weaning (see below), Valerie Kelly warns that this is not recommended before six months as the majority of infants will not be developmentally ready.

Spoon-feeding or baby-led weaning?

A prudent combination of both seems to be the consensus. “I don’t believe in being too rigid on anything to do with babies and parenting,” says Monaghan. she prefers the term “parent-led weaning”, whereby parents understand their baby’s nutritional needs for growth and development and shape the diet to reflect this.

“No baby needs to be on puree for any more than a few weeks,” she says. “After that, meals should become more textured.” She recommends introducing finger foods early on and says that grating foods is an effective way of introducing new flavours and textures.

Kelly says anything that encourages children to feed themselves is good, as it helps them listen to their appetite. But she doesn’t think parents need to be purist about it and can use spoon-feeding as well.

Too much emphasis on the popularity of baby-led weaning makes parents feel they “have” to do it, agrees Berry. While she thinks it is fantastic to give control to the baby, she doesn’t recommend it for parents anxious about the risks of choking.

No matter which approach parents use, they should know that babies need to get their hands into food, says Keogh. Messing is an important step. “We don’t just learn about foods by taste, we learn by the feel of the food, and the smell of the food and how it is to rub it into your hair!”

What are the best foods to begin?

Traditionally in Ireland, babies were first given pureed fruit, but that is now seen as perpetuating the “sweet tooth” they are born with. Breast milk is naturally sweet, says Monaghan, and formula is sweetened to ape that.

Successful weaning involves shifting their tastebuds towards enjoying savoury food too. While parents may think that as long as they avoid added sugar it’s okay, she advises avoidance of sweetness – including trendy alternatives such as maple syrup, agave syrup and coconut sugar.

Pureed root vegetables such as parsnip and carrot are best to begin with, then add in suitable foods rich in protein, fat, carbohydrates and iron soon after.

“If babies are used to eating all sweetness, they are not going to eat what you eat,” Monaghan points out. What’s more: “We know what a baby eats at nine months is indicative of what they are going to be eating in school.”

Even before birth, babies show their preference for the sweet life. “We know that babies will drink more amniotic fluid if the mother has eaten something sugary or sweet,” says Keogh. So a mother’s eating habits during pregnancy are already having an impact on a baby’s tastebuds.

Kelly echoes the importance of incorporating iron in the diet because the store they get from their mother runs out after about six months. She suggests red meat once or twice a week, perhaps by blending a bolognaise sauce and mixing it with spiral-shaped fusilli pasta if you want to serve it as a finger food.

Shepherd’s pie is “old-fashioned but really nutritious” and another good source is eggs, either scrambled or sliced-up as an omelette.

When will they eat what we’re eating?

The answer, says Monaghan, is from the beginning, although that may require a revision of your own eating habits. Are you eating the way you want your baby to eat? As well, food will need to be adapted in texture (eg blended) as well as in ingredients (eg no added salt).

Inform yourself on what other foods to avoid before the age of 12 months. The the list includes honey, soft cheeses, liver, bran, processed meats and predatory fish such as fresh tuna, marlin and ray.

How to avoid a future fussy eater?

Giving your baby a wide variety of foods and textures is key. And don’t let “gagging” put you off.

“When a child is learning to eat, they gag and that’s normal,” says Keogh. “Parents are often terrified because they see the gagging and they think they are choking.” And when the baby has seen the parent panic, he or she is likely to get nervous too.

The temptation then is to stick with smooth food, she adds. “We have babies coming in at 18 months and they are still having everything pureed or mashed, and that’s just a disaster at that stage.”

Babies need to have lumps in their food by 10 months, says Kelly. She also warns that continuing to give them too much milk can effect successful weaning. She sees children in Temple Street hospital who have trouble eating solids, and it can be because they are having small amounts of breastmilk all day long and never get the chance to build up an appetite.

At weaning age, food refusal is generally because a baby is not hungry, is teething or is not feeling well. Don’t panic, or try to force food on them or rush for an alternative, says Monaghan. Meal times should not last longer than 30 minutes, and don’t let them fill up on snacks in between.

“When children refuse to eat things,” says Kelly, “it is important not to over-react. Because when you do, sometimes the child realises, ‘all right, this is a bit of a power trip for me’. And then you can run into problems.”

PANEL: Common pitfalls of weaning

– Giving too many fruit-flavoured meals. Babies need to switch to savoury tastes.

– Failing to progress through textures, from purees to mashed to chopped-up food by one year.

– Allowing them to drink too much milk before meals. They may not be hungry enough to eat.

– Misjudging portion size. Read your baby’s cues and stop offering food as soon as they start losing interest.

– Imposing food fads. While so-called “clean eating” is very much in vogue, children can be given too much fruit and vegetables, which fills them up and stops them eating the higher-calorie, nutritious food they need such as meat, fish, eggs and yogurt.

Babies do a lot of growing in their first year – they triple their birth weight and double their length – and need calories to fuel that. Weaning babies onto a vegetarian diet needs careful planning, and medical experts do not recommend a vegan diet at this stage of a child’s life.

swayman@irishtimes.com