Busting Myths Around Starting Solids With Malina Malkani, MS, RD, CDN
When should you start your baby on solids? How do you know your baby is ready? What are foods you should offer your baby?
In Part One of this blog series, we speak with Milani Malkani, pediatric nutritionist and author of Simple and Safe Baby-Led Weaning.
Can you tell us a little about yourself, Malina?
“My name is Malina Malkani and I have a website that is my name, MalinaMalkani.com. I’m a registered dietitian nutritionist and I specialize in nutrition for moms, babies and kids. And my favorite part of the whole process of nutrition is starting solids. I think it’s just such a joyful and hopeful time and a really fun part of parenting. So I focus on that a lot of my private practice, and I have courses and an Instagram. My instagram is @healthymomhealthykids. And I have a really lovely community there of parents supporting parents and kind of muddling through this really challenging part of parenting, which is feeding kids. It presents with a lot of different sort of challenges along the way that I love to help parents with. It’s my passion!”
As a Lactation consultant, I get a lot of questions about starting solids, and I know pretty much all the basics, but when you go to your page, it’s almost like, I wish I had another baby just so I could start solids again. You make it look so fun and you have the cutest recipes!
“Oh my gosh, that’s so nice to hear. I can’t even tell you how much that means to me because I think this process one of the things that struck me and the reason why I wrote my book. One of the reasons why I wrote Simple and Safe Baby-Led Weaning is that there is so much stress and fear around the process of starting solids; and parental stress around what to feed and when to feed and how to balance milk and solid foods; and what to do about gagging and choking and allergens – the potential for a reaction to its top allergenic food. And I think the process, when we sort of take it apart and look at it, it doesn’t have to be that way. That’s always my hope with working with parents. To reduce and take away as much of that stress as I can, because we’re laying the foundation for a relationship with food from the very first few bites. So we want it to be positive and we want it to be a happy thing that can connect families as opposed to cause stress and worry throughout.”
I think part of the scary thing about starting solids is there’s so much conflicting information out there on when your baby’s ready for solids, and what you should first feed them. Some of it’s really old information that’s still floating around out there. And of course, you have, like, grandmas and Aunties who are suggesting old information to new parents that we now know isn’t necessarily the best thing. So I was wondering what your thoughts are on when to introduce solids?
“Such a great question. And you’re right. Even just googling it or talking to different people, you’re going to get so many different answers and opinions to this question. So as a dietitian, I always like to turn first to the evidence. What are the majority of health organizations saying now in response to a body of evidence that’s grown a lot in the last couple of decades? We didn’t used to have as much research as we do now about infant feeding. And so as a result, the guidelines have changed dramatically, which can be so confusing for parents and even for healthcare professionals, because that new research doesn’t always trickle down quickly.”
“So at this point, the majority of health organizations, the AAP, the Academy of Nutrition and Dietetics, the World Health Organization, they recommend that the best time to start solids is around six months when a baby is showing the developmental signs of readiness for solid foods. I think can be confusing for a lot of parents because you have to really look for those developmental signs because that’s also what’s going to help set up the baby to have a successful first introduction to food and for them to be ready for it.”
“What’s cool about infants at this stage, too, is even waiting one week can make such an enormous difference in their developmental readiness because they’re developing so rapidly. These developmental signs can just show up so quickly during this period. It’s really exciting to watch.”
“I think part of what’s adding to the confusion around when to start is that there are exceptions to six months being the best time. And one of those exceptions are babies that are at severe high risk for food allergies because the growing body of research has found that particularly for those high risk babies, offering top allergenic foods, particularly peanut and egg, between four and six months can help reduce the likelihood that they’ll develop an allergy to those foods. So for those babies, under the guidance of an allergist or a pediatrician, it can be advantageous to start a little bit earlier. It speaks to the importance of assessing each individual baby and their entire clinical picture and their developmental signs of readiness, whether they were born prematurely, all these different things to consider.”
What are the signs that a baby is ready? The physical signs and what is baby lead weaning for someone who might not have heard about it?
“Signs of developmental readiness for solids include being able to grab larger objects, bringing them up to the mouth, and good head and neck control. Also, the ability to sit upright with minimal assistance. We don’t expect them to sit for hours. A little bit of minimal assistance, maybe like a little pillow at the back in a high chair or something to prevent them from slumping over to the side like a rolled up dish towel or something. That’s fine. The point is we want them to have the trunk stability to be able to sit upright because when they start to lean back or to slump, that’s when we start to run the risk that gravity is going to work against you in terms of pulling food toward the back of the throat and increasing choking risk. Another kind of development of readiness is interest in food.”
“That can look different from baby to baby. Some babies are lunging across your lap to grab your fork, and some babies are just a little bit more reserved. They sort of track your food with their eyes. Then the last one is a diminishing or a sort of fading of the tongue thrust reflex. Doesn’t have to be gone. That’s a bit of a myth and a misconception that it should be gone completely, but that it starts to fade is a helpful sign of developmental readiness.”
Usually, if a baby is showing all those physical signs of being ready, you don’t necessarily have to start out with the jarred purees or anything. You can start out with baby led weaning, correct?
“I love baby-led weaning! I think it’s funny because it’s sort of trending now, but it’s been around for hundreds and hundreds of years. It really just means offering finger foods from the family table.
“So it’s a method of starting solids that involves offering baby finger foods from the family table for self feeding. So it’s a little different from your more traditional sort of passive spoon feeding, where you’re spoon feeding the baby purees. With baby-led weaning, the baby is actually feeding him or herself. It can be a little bit jarring to people sometimes because they’re so used the traditional passive spoon feeding that has been the cultural norm. But some families take a combined approach and do a little bit of both. And that works too.
Is something like baby-lead weaning only appropriate if they’re hitting those physical milestones that we talked about?
“The physical milestones that we were talking about, those make the process of starting solids that much more successful, or they make it more likely that it will be a successful journey. There are some babies where it is recommended that they start solids a little bit earlier than six months. And there can be a variety of different reasons for that. For example, one of them is if you have a baby who’s at high risk for food allergies, and if they’re being followed closely by an allergist and a pediatrician, it might be advantageous for them to be exposed orally to foods like peanut and egg even earlier than six months. So between four and six months. But the majority of babies aren’t quite developmentally ready to start feed finger foods that early. So for a baby under six months, the more passive spoon feeding of a puree that is mixed with peanut powder or a little bit of thinned peanut butter is a better way to go.
“I think it’s interesting that the top nine allergens that are responsible for about 90% of all food allergies are nutrient dense, minimally processed, really nutritious foods that we eat on a regular basis. So, let’s just take the scary out of it and kind of normalize introducing these foods earlier during infancy, which is really different from what the recommendation used to be, which was to introduce them after the first, 2nd, even third year of life.
So do you think if a parent is especially concerned about allergies that they should automatically see an allergist for their baby if there’s a really strong family history of allergies?
The strongest risk factor for the development of food allergies is severe eczema in babies.
“A family history of food allergies and a first degree relative is also a risk factor, but not to the same degree as eczema. So I love telling familes, start the conversations with your pediatrician early on during infancy. Watch your baby’s skin. Have the conversations with your doctor about their level of risk for food allergies. And if that level of risk is high, then the pediatrician will guide whether meeting with an allergist and having an allergist guide the introduction of top allergenic foods is warranted or whether you can do it with the pediatrician. But have those conversations early because if your baby is at high risk, it’s those babies that are at high risk who stand to benefit the most from the earlier introduction of top allergens. And this comes from particular study called the Leap Study, which was a peanut study in 2015 that was looking at high risk babies and what happens when we introduce peanut even earlier, between four and six months of age. And the reduction in risk of peanut allergy in these babies was 86%.
“It really does work to lower the risk, but only during a short and pretty critical window of time in infantry. So we want to grab those opportunities by having those conversations early with the doctor.
“Now that’s peanuts. We don’t have as robust a body of scientific evidence for other foods. Egg is getting pretty close. We have some really good data on eggs. We have a lot of milk and the emphasis really is on getting peanut and egg and also milk, to a lesser extent cow’s milk protein, into the baby’s diet early. The rest of the allergens, we want to get those in before the first year as well. But the real push is for those three – peanut, egg and milk.
Can you talk a little bit about appropriate serving sizes? Because that is another question that I tend to get a lot, especially if you are spoon feeding, like pureed foods.
“Yeah, I get this question a lot as well. One of the reasons why I love baby-led weaning so much is that when you’re letting a baby self feed, and allowing a baby to internally self regulate their intake is built into the process of baby-led weaning. And I love that because I started my work as a dietitian in weight management at a VA hospital in the Bronx. I loved the work that I did there and loved working with the veterans. And I was struck very frequently by how many people into adulthood struggled with the ability to recognize their own cues for hunger and fullness, to eat in response to hunger and to stop eating in response to fullness.
Baby-led weaning builds that strengthening of that internal self regulation system into the baby from the very first few bites of food. And the funny thing is, when we allow them the opportunity to eat until they’re full and stop when they’re full on a regular basis, and when we’re offering them a variety of nutritious foods throughout the day, they’re incredible at meeting their needs and deciding what is the appropriate portion size for themselves.Malina Malkani
“Much better than we are. So you don’t really need to worry about portion sizes. That being said, it’s sort of reasonable to expect that a baby or that a child will eat around or will be able to tolerate around one tablespoon of each food offered per year of age. You could start with about a tablespoon of each of the foods that you’re offering at that meal. And then if the baby wants more, it’s fine to offer more. Their appetites will fluctuate just like ours do. They fluctuate in response to our activity levels and the weather and what we ate the day before. And all these different factors really do play into appetite. It’s better we just follow their cues and feed them responsively. If you do that, you don’t really need to know what an appropriate portion size is.
This reminds me of the old rules that many of us were raised on, such as you have to clean your plate at dinner time.
“My husband grew up with those rules. So many of us did. It affects and influences our capacity and our ability to read our own cues and to recognize them and to self regulate in that way, to take in an appropriate amount of energy of calories and nutrients that fits what our body needs. Our bodies are really smart. At the end of the day, they kind of know, but we just have to be able to listen to them.
“Maybe they’ll choose to eat more than we served and that’s okay to offer them more. But again, we are helping them develop their own ability to self regulate, which is such a lifelong gift.
Want to learn more? Join us for Part 2 of Busting Myths Around Starting Solids with Malina Malkani.