Prepared portionWeaning your baby on to solid foods is really exciting, but before you start it’s worth giving some thought as to how you are going to do it and how you are going to behave. There is no time more important than the early years of feeding for establishing likes and dislikes, behaviours around foods and healthy eating. The long-term goal is that your child turns into a healthy adult who eats and enjoys a wide variety of family foods, and that’s a gift for life. This chapter looks at the benefits and potential concerns associated with spoon-feeding and baby-led weaning, to help you decide what suits you and your baby best.
Spoon-feeding is exactly that: the parent feeds the baby with puréed or mashed food, placing the food into the baby’s mouth. Lumpy foods are introduced in a progressive way until baby is eating the same food as the rest of the family. One of the myths around spoon-feeding is that you only feed your baby purées; actually it is very important to also offer finger foods to encourage your child to learn to feed himself and deal with different textures and tastes (see here).
Purées have been used as an introductory food for babies for very many years and have become part of our weaning culture. Many mums enjoy making purées – they are quick and easy to prepare, and you can offer a wide variety of foods in this way. A lot of parents are nervous about giving their baby a piece of food in case he chokes, so they feel more confident starting with a purée. Some parents also feel that preparing and freezing puréed food makes it simple to serve when their baby is hungry; however, other parents disagree and feel that giving their baby the same meal as everyone else is easier.
‘I introduced purées. I found preparing my own quite easy to do – you only need allocate a couple of hours a week to preparation and you have a whole week’s menu for two babies.’
Nicole, mum to twins Johnny and Alicia, 18 months
The use of purées depends on two things: firstly your baby’s age and ability to manage lumpy foods, and secondly the type of food you are giving. If a baby really needs weaning before six months (see Chapter 1 for more on this) he will need to have purée from a spoon as he will not be able to co-ordinate picking food up, moving lumps around his mouth and eating it. Before six months there is also an increased risk of choking with lumpy foods as your baby won’t have the ability to chew.
Although spoon-feeding is an established method of weaning, there are some problems associated with purée use. The current advice to wean around six months means that weaning is often starting at a time when babies would previously have been moving to mashed and finger foods (as until 2003 the Department of Health recommended weaning between four and six months). The consequence of this is that babies are staying on purées for longer. If purées are used for too long, and you don’t start feeding your baby the food you usually eat at home, your baby may find it hard to move on to lumpy foods and accept your family food as he gets older.
Using a spoon does not and should not exclude giving finger foods. Chapter 3 discusses progressing weaning, and the importance of regarding purées, if used, as a transition food.
Some foods are of purée texture by nature and are easier eaten with a spoon (for example, soups, semolina and yoghurt). Mashed and lumpy foods can also be given with a spoon.
While it is easy and fun to combine flavours when puréeing, this doesn’t allow a baby to learn the flavour of one specific food. Although many mums make their own purées, it is easy to see how commercial baby foods may appeal, especially if you feel purées are all your baby can eat.
Baby convenience foods are foods found in jars, packets and pouches and intended for a baby’s use. Most mums use them some of the time and some mums use them for most of the time. I’ve listed below what I think are the advantages and disadvantages of using these baby foods.
Prepared portion
Clean and ready to feed
No need to cook
Easily portable
Expensive – as of today’s prices you may find yourself paying £9 for a kilo of apple purée or up to £54 for a kilo of organic baby cereal
Commercial foods never quite have the taste and texture of real food and are often bland with similar flavours
The lumps in stage-two baby foods are quite artificial and unlike the texture of home-cooked foods. Babies frequently suck the sauce off and reject the lumps (see here).
When measured, nutritional quality has not always been found to be consistent or favourable to home-cooked foods
They do not prepare your baby or toddler to eat your own home-cooked foods
The labels can mislead parents as to what age to start weaning and what age certain foods are allowed. (You will notice that some commercial baby foods say ‘suitable from four months’. This can confuse parents into thinking that four months is an appropriate age to start weaning. The food labels reflect current European Law, and are to be reviewed by the European Commission; the UK Department of Health intends to work with that review when it becomes available.)
Ellie came to clinic. She had started weaning her baby at five months and was using baby-food jars. We discussed whether Ellie cooked at home and whether she could give her baby home-cooked foods. Ellie said she did cook but she was worried about what types of food to give her baby, so was being guided by the baby-food jars. When I suggested to Ellie she could give her baby, for example, banana, Ellie replied that she had only seen banana in jars for babies from six months old. Ellie thought this meant that she couldn’t give her baby banana for another couple of weeks. I explained to Ellie that it was fine to give banana but the jar probably contained gluten, which could not be given until six months.
As you can see, for feeding your baby on a daily basis, the disadvantages of ready-made baby foods outweigh the advantages. However, I do think that baby convenience foods have their place when used occasionally or selectively, such as when travelling. If you want your child to eat the foods that you eat, then it is best to introduce him to those foods from the beginning. While you may find it handy to use convenience foods occasionally, it is better if you don’t use them as the basis of your baby’s diet.
Parents who have got into the routine of cooking for their baby often dispute the claim that baby convenience foods are more convenient in the home. Batch-freezing foods or saving a portion of your evening meal for your baby’s lunch or dinner the next day is easy and convenient. Your baby can also eat the same foods as you and eat with you at mealtimes.
It goes without saying that adult convenience foods should not be used for babies and toddlers, and neither should foods marketed as ‘low fat’, foods designed to lower cholesterol, or foods with other health claims. They are not designed to meet an infant’s nutritional needs.
One of the criticisms of spoon-feeding is that it is done to the baby, rather than being in your baby’s control, and there is concern that this may override your baby’s own innate knowledge of appetite control. Parents who have spoon-fed will tell you how good babies are at indicating when they want more, or keeping their mouths firmly shut when they don’t. It has to be acknowledged, though, that many parents worry that their baby isn’t eating enough and can try to persuade him with ‘one spoonful more … and just one more on top of that’. I don’t think there is anything wrong with using a spoon, and it makes some foods such as rice pudding, yoghurts or stews much more accessible to your baby. However, be guided by your baby’s appetite and stop when he indicates he is full. Learn to trust your baby – after all, can anyone else tell when you are full?
‘Baby-led weaning’ is a method of weaning that allows your baby to feed himself. The term was coined by health visitor Gill Rapley, who has promoted and helped popularise this feeding technique. Gill states that she did not invent baby-led weaning but just brought into the open something many parents already did. The idea with baby-led weaning is that at around six months babies are developmentally ready to eat, as evidenced by their ability to sit with some support, pick up and hold an object and place it accurately in their mouths. They are also able to make up-and-down chewing actions and can therefore manage pieces of foods. Like spoon-feeding, initial tastes are exploratory and not meant to replace breast or formula milk.
Baby-led weaning is described as being particularly suitable for breastfed babies who are used to controlling the amount of breast milk they take and can continue to decide how much to eat when presented with other foods. Although many breastfeeding mums will be familiar with their baby leading feeding, this does not exclude bottle-fed babies from baby-led weaning. Baby-led weaning takes place around the table at family mealtimes with the baby having the same foods as the rest of the family, and weaning may begin when your baby reaches out and takes food from your plate. In fact many babies surprise their parents by making a grab for food and initiate weaning in this way. This is particularly true of second or subsequent babies who sit with siblings.
As your baby is going to join in with family meals it is worth giving some thought as to what you are eating – you don’t want your baby’s first food to be a handful of heavily processed convenience food! Of course, it goes without saying that you should never add salt or sugar to any of your baby’s foods.
Baby-led weaning is often associated with mess, as inevitably babies will drop food on to the floor and they are likely to get a good deal of food on their hands, face, body – and everywhere else. However, fear of mess probably isn’t the best way to decide how to wean your baby! Spoon-feeding will delay the mess for a few weeks until your baby bashes his hands into the bowl and sends the contents flying, or picks the bowl up and spills out the contents. Letting your baby touch and feel food himself will increase its familiarisation and acceptance. Mess is a by-product of weaning, so be prepared, not scared. Have a good supply of bibs and be ready to tidy up your baby after feeding. Use clean plastic mats on the floor to allow food to be returned, and to keep the floor clean and allow you to tidy up easily afterwards. Your baby will soon learn that food is best put in the mouth!
‘This time I was keen to do baby-led weaning … I just didn’t have time to make purées.’
Amy, mum to Eva, four years, and Ben, eight months
At the beginning of baby-led weaning the baby is interested in the activities of his parents and other family members around the table – he wants to copy them, rather than thinking about food or hunger. The baby takes food placed in front of him, and, like everything else that your baby picks up at this age, it goes into his mouth to be explored. Slowly, as some of the food is bitten and swallowed, the realisation comes that some objects can be safely eaten. Some parents and lifestyles are entirely suited to baby-led weaning; others feel they can’t fit in with baby-led weaning guidelines – such as always eating with the family – or they feel restricted with time required and mess made when out of the home.
With a small baby some mums feel worried about finding time to cook every day. It is worth cooking extra food and freezing it so that you don’t feel tied to the oven every day. It is also good to freeze some baby-sized portions for the times your baby can’t eat with you.
‘I didn’t intend to do baby-led weaning, but after about four weeks of spoon-feeding Noah refused the spoon and got stuck in himself. He was five and a half months old when I started weaning, and four weeks later he was just ready and able to pick food up and eat it. You do have to have faith in them that they can do it.’
Rachel, mum to Noah, 13 months
At six months of age, most babies can pick foods (or other objects) up and put them in their mouth, but as development is varied some will do it a bit before this time and some will do it a bit later. At six months of age babies still pick objects up using the palms of their hands, as finer motor control is not yet gained. As yet they can’t purposefully let go of an object they have managed to grasp, so initially foods need to be prepared so they stick out of their closed fists to enable them to bite the end of the food.
Whether you are baby-led weaning or not, your baby can try finger foods from six months. By eight or nine months of age your baby will be using a ‘pincer grip’ – the ability to purposefully pick up something small, such as a pea or sweetcorn kernel, between his thumb and forefinger.
Babies with special needs may not have the co-ordination to self-feed or chew lumpy foods at six months; in this case you should follow the advice of your health care team.
Q I am really worried that my baby is going to choke if I give her lumps of foods to eat. Surely it is safer to use purée?
A Many parents fear their baby could choke when he starts weaning, particularly if presented with pieces of food, and many parents confuse gagging with choking. Gagging is like retching. A piece of food near the back of the throat triggers the gag reflex and the food is expelled. Gagging resolves itself. Choking is the obstruction of the airway that prevents breathing; this does not self-resolve and you would need to intervene (see here).
The majority of babies will gag when learning to eat. You need to consider your baby’s age and developmental readiness for solids to help you decide when and how to start weaning.
The baby-led weaning argument says babies are less likely to choke because your baby is in charge of what goes in his mouth, as opposed to spoon-fed babies, who are more likely to ‘suck’ food in. However, I am not aware that there is any evidence that choking is more or less of a risk whether you use purée or follow baby-led weaning. When babies pick things up, the object or piece of food is put into their mouths, so you need to be cautious – whether you are baby-led weaning or not. Some parents keep their baby on purées too long because of a fear of choking, and then find he refuses to take lumpy foods. As yet, there are no reports of increased risk of choking with baby-led weaning.
Baby-led weaning has certain principles, such as that the baby joins in with family meals, picks up solid foods and begins to eat them when he is ready. The baby should not be fed by someone else and therefore can’t be persuaded to take more food than he wants. This means that the baby cannot overeat, which is a good thing. However, some health professionals and parents are concerned that with baby-led weaning a baby may not be able to eat sufficiently well, particularly in the early stages. To ensure the baby does have enough food and nutrients, he must be presented with a quantity of foods sufficient for his energy needs, a variety of foods to ensure the baby is getting a range of nutrients and be given all the time he needs to eat it. There is concern that these potential barriers could lead to the baby becoming low in important nutrients, particularly iron or zinc, or not receiving enough energy. There are trials currently in place to look at these concerns, but the results are not yet available.
It is often said that babies will choose healthily when presented with a selection of foods. The work of Clara Davis, a Canadian paediatrician, is frequently cited to demonstrate this point. However, the conclusions from Dr Davis’ work are not that clear-cut. In an orphanage in 1939 Dr Davis allowed infants to choose their own food, and they did made healthy choices, but, by Dr Davis’ own admission, she only offered the babies a range of healthy foods. She said that her food list would compensate for any errors made by the children – not that there was an inbuilt ability to choose healthy foods. I give this example to remind us that weaning is as much about real food as it is about method, and, whatever method you choose, it is the parent who needs to make the right food choices and offer the right quantities of food.
Concerns about nutrient intake are valid. In the UK, it was estimated that 10–14 per cent of infants and toddlers, aged 4–18 months, have an iron intake less than the lower recommended intake.1 This national survey covered a range of children who may have been weaned in different ways and at different ages. The concern therefore belongs to all parents, however they choose to wean, and just reminds us of the need to use healthy foods from a range of food groups. (See Chapter 9 for more on nutrition and food groups.)
Baby-led weaning has put the emphasis back on families eating together, and this is positive. Eating as a family, or with other people, is certainly attractive and has been shown to encourage healthy eating behaviours. However, many families find eating together difficult, particularly during the working week or with young babies who tend to eat early. No matter how you feed your baby, social eating should be encouraged; babies learn by imitation and eating should be a social experience. Think of weaning as an apprenticeship at the dinner table. If you can’t eat as a family every day you could achieve this by letting your baby eat with an older sibling if he has one, making lunch dates with other mums and babies, and ensuring the family eats together at least at weekends. If you use a childminder ask her how she manages mealtimes. For safety reasons you should never leave your baby alone when he is eating.
‘I was keen to do baby-led weaning, having seen a friend do it. In the years between my first and second I read more about breastfeeding and parenting and realised that baby-led weaning is a more natural route to take. My mother-in-law was fascinated with how my baby moves the food around, bites and chews. It really has been a revelation!’
Susie, mum to Mila, nearly eight months, and Charlie, two years
Baby-led weaning does help your baby get into good eating habits early on.
It has really highlighted that babies can control their own appetites. It’s now believed that overriding your baby’s own appetite control by encouraging him to take more food than is wanted may encourage overeating later in life. Baby-led weaning has also reminded us that babies can eat the same food as the rest of their family and do not need special baby foods. Familiarity with family foods can help prevent fussy eating later in weaning and beyond (see Chapter 7).
You may have strong feelings about how you want to feed your baby, or you may not. Many parents I see are a bit ambiguous, wanting to find a happy medium, which always seems sensible to me. As we’ve seen, each ‘method’ has its positives and potential negatives, but I believe the criticisms of each method can be overcome if you feed your baby responsively.
Whichever method of weaning you choose, it’s important to be responsive to your baby’s needs and appetite. ‘Responsive feeding’ is an ethos that has been around for many years and is promoted greatly by Ellyn Satter, a dietitian and family therapist. The approach is encouraged by the World Health Organization and many health departments around the world, including the UK and US. Responsive feeding is essentially about helping your baby to eat but trusting him to know when he is hungry or full. It asks you to recognise that your baby is in charge of his own appetite, while acknowledging that he may need help at times. It takes the emphasis off the weaning method and on to the supply of good-quality foods. Food should be given in a form your baby can eat – whether that’s with his fingers or with your help – in an environment that encourages healthy eating behaviours.
You can be responsive to your baby’s needs whether you are predominantly spoon-feeding or baby-led weaning
The World Health Organization advises: ‘feeding with a balance between giving assistance and encouraging self selection appropriate to the child’s level of development’.
You can feed responsively by following the cues your baby gives you to tell you he is hungry or full. It’s your baby’s job to let you know how much food he wants. Your job includes supplying nutritious foods, being a good mealtime role model (seeing you eat vegetables encourages the same behaviour in your child) and creating a pleasant, social mealtime. Responsive feeding takes account of your baby’s developmental progress, promoting self-feeding in ‘spoon-fed’ babies when they are able to do so, but also giving help to ‘baby-led’ babies to eat the foods that may be difficult for them to manage (such as with more runny foods like rice pudding, soups and stews – or the sauce of a bolognese, which contains protein, iron and zinc but may run off the pasta, with little finding its way into your baby’s mouth).
As your baby grows from a toddler to a child, his responsibility at the table grows too, incorporating things like table manners and helping out. Your responsibilities also increase to include preventing unplanned snacking, limiting availability of unhealthy drinks and foods at home and explaining to older children and teenagers that: ‘Yes, you are expected to sit at the table to eat and not have your phone on.’
I went to see Harry and his mum, Elsie, to talk about weaning. Harry was 25 weeks old. Elsie told me she had been eating a banana with Harry on her lap, and Harry had leant over and taken a bite of the banana! She was able to see that he could chew, and, as he was going to be six months the following week, she wanted to progress with weaning. Elsie had been reading about baby-led weaning and wanted to base weaning on this but didn’t feel it was suitable for all the foods they ate as a family so wanted to use a spoon at times for some foods. The fact that Elsie had seen Harry bite and chew gave Elsie confidence that she could start weaning with appropriate pieces of food and soft lumpy foods, but she was also concerned that baby-led weaning may not give her son ‘everything he needs’.
Elsie and I discussed that by six months of age she could allow her baby to feed himself but he may need help. So this would include giving Harry the opportunity to pick food up and eat it but with Elsie feeding Harry with a spoon where she felt he needed help, or with a type of food that required it. Elsie was reassured that she could just give Harry the same family foods she ate, with minimal adjustment, but without starting on purées. She also ensured he had a selection of foods from all food groups to maximise his range of nutrients.
Often, mums I see in clinic want to try a baby-led weaning style of feeding but either feel uncomfortable starting off like this or feel that it isn’t convenient when out and about – or, like Elsie, they are seeking advice on how to progress weaning using a variety of foods and textures.
However you choose to feed your baby, it is your responsibility to supply foods that are appropriately nutritious to meet your baby’s needs for growth and health. Food should be given in a sufficient quantity and presented in a way that your baby can manage, helping him to eat where required. Healthy eating in infancy increases the chances that your child will continue to eat healthily in the long term, which will reduce the risk of obesity and conditions in later life related to being overweight (such as high blood pressure, as well as chronic conditions such as some cancers, type 2 diabetes, stroke and bone thinning in older age).2
The early years of feeding are important in terms of establishing likes and dislikes around food and future health.
Mums have different opinions about what suits them and their baby best.
Responsive feeding should be encouraged, whether spoon-feeding or baby-led weaning, through emphasis on the mealtime relationship and responsibilities between parent and baby.
As well as deciding on a method you are comfortable with, you need to ensure you are offering nutritious foods in a way your baby can manage.
Be wary of baby convenience foods; they are different in taste and texture to home-cooked foods.