Busting Myths Around Starting Solids With Malina Malkani, MS, RD, CDN Part 2
This is part 2 of my series on starting solids. For part 1, please click here.
If you have a baby who is doing baby-led weaning, I imagine that parents get very concerned about choking. I know a lot of babies gag when they’re experimenting with solids and sometimes that can be mistaken for choking. So can you talk a little bit about that?
Malina:
“Gagging and choking are two very different events that happen, or we hope choking doesn’t happen. Gagging is somewhat inevitable during the process of learning how to eat. Because if you think about it, chewing, breathing, swallowing, all of that, doing all of that at the same time is complicated. It’s a process like any other. It’s a skill that needs to be learned over time. And gagging, it’s really a natural, built in safety mechanism that helps babies. “
“If they get a piece of food in their mouth and they’re not quite ready to swallow it yet, it helps them bring it forward so that they can get ready to swallow it and be ready for that. But it can be really alarming, especially to a new parent, to hear gagging or to witness it for the first time because it’s noisy. Sometimes they’ll open their mouths and cough and sputter or stick their tongue out and it can seem like they’re choking. But a gagging event is very noisy and you can hear air passing through. It’s very different from choking, which is a silent, serious event where a piece of food actually gets stuck in the airway.
“That occludes the airway, so that no air can pass through. And a baby who’s choking is going to look different from a baby who is gagging. They’re silent, they may grab at their throat, they may turn a different color, they may seem very alarmed, but there’s not going to be the sound that you hear and the air passing through. With gagging, I think one of the best kept secrets, is that it’s a good thing in a lot of ways. It’s a really good thing because it’s so protective of baby’s airway. And during those early months, one of the biggest misconceptions about baby-led meaning is when people say, well, I gave my baby finger foods and they were just gagging, so they were clearly not ready for the finger foods yet. And I would argue with that actually, because the gag reflects during those early months of baby led weaning, it’s very far forward on the tongue here. So if the piece of food gets there, there’s going to be a lot more gagging earlier on during infancy.
“But the funny thing is, the more that we can take advantage of that strong gag reflex early on, the more practice the baby is going to get with finger foods, the less likely they’re going to have trouble with chewing and managing bites of food in the mouth later on when the gag reflex shifts further back into the mouth and becomes less protective of the airway. So in a lot of ways, it’s really advantageous for a baby to get that practice with finger foods when that gag reflex is strong, because then as they age, they know what they’re doing and they’re more able to move a piece of food around in the mouth and then less likely to have a choking episode.
Usually what I would say to parents is if you see gagging, that means that your baby’s defense mechanisms are working.
Malina:
“Totally. Now, sometimes people say, well, the gagging is excessive, it’s happening at every single meal, or it’s happening with a specific texture, or it’s happening with a specific food, etc. There are situations where gagging can start to work against you. There is a point at which it’s too much. In other words, if the baby is starting to be bothered by the gagging, it can start to cause negative associations with food and feeding. So at that point, talk to your pediatrician. Sometimes a feeding therapist, a speech language pathologist, or occupational therapist can really help with any sensory issue or excessive gagging.
“And the earlier that we intervene, the easier the whole process will be for the baby as they move through infancy and learn how to eat. If it doesn’t feel right, talk to your pediatrician because there are things that we can do.”
Yes. I love that advice. One of the questions that I get asked a lot is if you start off with pureed foods, doesn’t make it harder for them to eat table foods later on?
Malina:
“Baby-led weaning is wonderful and it’s really taken off and there’s a lot of people that are interested in it. I think it’s unfortunately swung in a lot of ways too far to the extreme in some circles where people think that if you’re doing baby lady weaning that you can’t do any purees because you’re going to confuse the baby or it’s going to be more difficult for the baby. And the funny thing about purees is they are not bad. They’re not detrimental to the baby. There’s no evidence that a combined approach to doing both is harmful in any way. And we eat purees! We eat yogurt, we eat applesauce, we eat this texture of food into adulthood and beyond. There’s no evidence to say that starting with purees and then moving to finger foods is going to be confusing. What we do want to avoid is if you’re doing all finger foods, we don’t want to NOT offer purees. A lot of the speech language pathologists that I talked to that work in feeding therapy told me that a large part of their caseload are toddlers who were sort of pure, baby-led weaning toddlers.
“Babies who got to toddlerhood and were never given purees then really struggle with that texture in toddlerhood because it’s a different method of moving food around in the mouth and creating a bolus and then swallowing it. At some point between seven and twelve months, we want all babies to start being able to eat finger foods. So if you start with purees and then stay on purees and don’t eventually start to offer those finger foods, then it can be difficult. It can be difficult for the baby to start to understand what to do with different textures as they age. So we don’t want to miss those windows. We do want to progress the baby, but no, there’s no reason why if you want to start with purees, you can’t end up with baby-led weaning at some point along the journey.”
In your opinion, what are some of the best foods to start with?
Malina:
“Oh gosh, right now, over on my Instagram, I’m doing Avocado week. I love it as a first food. It has so many wonderful attributes, if you will. But it’s a great first food because in terms of texture for a baby, when it’s ripe, you can squish it easily between your thumb and forefinger. That’s sort of the test where you can determine if it’s a safe texture for the baby. And it’s so rich in nutrients, it has so much fat. Babies need fat for that brain development, for overall growth. And it has omega three fatty acids, which are important for brain development. So many vitamins and minerals, tons of fiber. It actually has both kinds of fiber. It has soluble fiber and insoluble fiber and then it has the fat. And it actually helps the baby absorb some of the nutrients better. So some of those fat soluble vitamins like A and D, I love it as a first food for so many different reasons. And it can be easily served in a wedge or you could roll it in a little bit of flaxseeds or hemp hearts or something to give it some nice grip.
“What a phenomenal sensory experience for that baby from so many different perspectives – from a developmental perspective with hands experiencing that mashed texture. So, avocado. I’m going on about avocado.
“I also love banana as a first food. Just peel the banana halfway down so that it makes a little a handle. Let the baby kind of nibble on the banana and it’s easy for them to grip. Same thing with the avocado wedge. You can leave half the peel on a wedge so they can grip it, which is nice. Another really good one is sweet potato, if it’s a roasted stick of sweet potato. And then again, all of those can be pureed or mashed and then just served on a spoon. So lots of different ways to do those. But those are three of my favorites.”
Something else families ask me about, especially when they’re making their own baby food, is does cooking the baby food make it lose it’s nutrients?
Malina:
“Yes and no. It depends. Cooking food can cause some of the nutrients to either leach out into the cooking water or to be diminished. But sometimes cooking food actually makes some of those nutrients more bioavailable, so easier to absorb. So it really depends on the food, and it also depends on the cooking method. And in general, the shorter the cooking time and the less water that’s used, the more the nutrients are preserved. So that’s why something like steaming is usually a better option than boiling because the nutrients will stay in the steamed food as opposed to in the boiled food. The water soluble vitamins will leach out into the water. But if you use the cooking water for some part of the recipe, you can preserve a lot of them that way. Bottom line, offer some foods raw, some foods cooked, use the shortest cooking method you can and whenever you can, steam as opposed to boil.”
Mesh feeders are very popular and they were popular too, when I was having my kids. What’s your opinion on them?
Malina:
“Well, I’ve seen some folks get really creative with them. So there was one mom, I thought this was really brilliant. Brilliant, because she was very had a lot of stress about offering a strip of steak to her infant. She had seen on my account that you can do that and sort of how to prepare it in an infant safe way, and how advantageous that could be as the baby sucks those iron rich juices from the steak and can benefit from all that iron. And as we know, at around the six month mark, baby’s iron stores are pretty often low and so they need to start getting some of that iron from iron rich foods. But she was like, I just can’t do it. I can’t give my baby a stiffer steak. So she stuck it in a mesh feeder, she gave it to her, which is smart. That was a very creative use of a mesh feeder. If there’s a baby who’s teething, they may take a piece of frozen fruit that they may not necessarily feel comfortable handing over to the baby so that they can kind of get some relief from teething by sinking their gums into it and gnawing on it.
“But then there is practicing the process of chewing and mashing down a piece of food and moving it around in the mouth. A baby is not going to get that experience and that practice from using a mesh feeder. They may get some of the flavor, maybe some of the nutrition, depending on what the food is that you stick in it. But it really, I think, in a lot of ways ends up being more of a stress reliever for the parent, just knowing that if it’s in the feeder, then they don’t have to worry as much about choking. But there are some risks to mesh feeders, too. All feeding does need to be supervised.”
If you wanted parents to know one thing about starting solids, what would you say?
Malina:
“I think we’re so stressed and there’s so much going on in the world. I would say just try not to overthink it. Try not to get your head too wrapped up in certainly milligrams of anything or grams of anything or certain number of nutrients. Variety is key. Keep that in mind. And for the most part, babies can eat what we eat, just with some pretty minor modifications to the texture. Or if you tend to cook with a lot of salt, just pull out a portion for baby first before you add the salt. But they really can eat a lot more than we give them credit. That might be the theme of today’s podcast. They can do so much more than we give them credit for. And that includes food.”
Thanks for joining us today!