When to introduce solids to your baby

It’s incredibly important to know when your baby is ready to be introduced to solids.

There are many reasons why parents may want to start solids earlier than 6 months, particularly if weight gain is an issue in your little one. Family and peers can be a major source of pressure to push you into introducing solids sooner than planned.  In some cases even medical practitioners may encourage you to start solids sooner to assist in weight gain.

But how do you know if your child is actually ready?

Your child will let you know when they are ready from a developmental point of view as well as from a medical aspect, their digestive system needs to be mature enough to be able to process and digest solids. These two aspects normally work hand in hand and your child showing their developmental readiness gives a strong indication that they are ready for solids.

From a developmental point they need to:

  • Be able to sit unaided. This means they need to be able to hold up and control their own body weight without the assistance of an infant seat or cushions.
  • Have lost their tongue-thrust reflex. This is when they stop automatically pushing solids out of their mouths with the use of their tongue.
  • Be showing an active interest in your food and mealtimes, trying to grab food from your plate and intently watching you eat.
  • Be developing a good pincer grasp by being able to pick up food and/or other objects between their thumbs and forefingers.
  • Most notably is that a baby under the age of 4 months has not developed the required oral co-ordination and muscle strength and cannot suitably work or process solids. The lack of oral and muscle co-ordination places your baby at risk of choking and aspirating on food their body is telling you that they are not ready for.

From a digestive aspect they need to:

  • Be a minimum of 4 months old, but 6 months is preferable.
  • The recommendation is to exclusively feed a child breastmilk/formula for the first 6 months of their lives as their digestive system is not developed enough yet to suitably process and digest more than breastmilk/formula

The introduction to solids before the age of 4-6 months can pose serious risks and complications for your baby, including:

  • an increased risk of food being sucked into their airway and causing aspiration;
  • causing your baby to get either too much or too little calories or too much nutrients;
  • increase their changes of obesity;
  • cause an association of discomfort and distrust to solids; and
  • increase the risk of developing allergic reactions, eczema and bouts of wheezing.

Recently statistics were released in South Africa showing the very real danger of introducing solids to infants before their digestive systems, oral motor skills and specific developmental milestones have been met:

‘’According to the 2018 Stats SA’s report on Mortality and causes of death in South Africa, the leading cause of death among infants is respiratory and cardiovascular disorders specific to the perinatal period (responsible for 14,8% deaths), while intestinal infectious diseases is the third leading cause of death (responsible for 6,7%). Professor Siyazi Mda, principal paediatrican at Dr George Mukhari Academic Hospital near Ga-Rankuwa, says babies and young children who suffer from diarrhoea, lower respiratory infections and undernutrition as a result, risk these conditions increasing with the introduction of solids before six months.

According to Professor Mda, a number of studies show that the early introduction of solids in babies is associated with allergic diseases, including eczema and an increased rate of wheezing. “In developing countries, babies who start solids early are prone to undernutrition, while in developed countries there is an association with obesity and increased body fat, which are risk factors for diabetes,” he says.

He adds that the oral muscles of a child younger than four months are not suitable for solid foods and there is often a problem with the coordination of swallowing, increasing the chances of choking.

Heidi du Preez, a professional natural scientist from Cape Town, says that before four months, the digestive tract of a baby is immature and solids increase the risk of baby developing allergies.

The intestine of an infant during the first six months is very porous, which means foreign proteins in allergy-producing foods are easily absorbed from the intestine into the blood. Introducing grains too soon can lead to constipation, blocked noses and itchy skin and food intolerances,” she says.’’

https://www.parent24.com/Baby/Newborn/why-you-shouldnt-feed-your-newborn-solids-20160829

If your baby hasn’t shown all these signs, they are not ready for solids. Up to the age of 6 months breastmilk and formula are all which they require to stay nourished, healthy and growing.

As parents we are placed under immense pressure from our peers and sometimes medical practitioners for our children to weigh a certain amount at a certain age. Family will offer up their own stories of how their children were fed solids at 2 months old and ‘were fine’. Medical professionals will push that your infant needs to gain weight faster because they aren’t fitting into a graph well enough. If your baby is healthy, happy, wetting and dirtying nappies at a normal rate, sleeps well, feeds well, is growing consistently and meeting their developmental milestones, why rush the process and potentially place them at unnecessary risk for complications that place both their health and well being at risk?

As the mother of a child with a history of severe oral muscular complications, food aversions and weight gain issues I know all too well the pressure which is placed on parents. We went with medical advice to start on solids before our daughter was developmentally ready and I still firmly believe it is one of the main contributing factors that led towards her struggles with learning the right skill sets and confidence for a successful start and transition onto solids.

Give them the time they need to develop the right set of skills that will encourage a positive introduction into solids and make the process an enjoyable one for all involved.

Living with the fear

Having a child with a history of oral and feeding aversions can be best described as one hell of a rollercoaster ride, only it isn’t.  People partake in these rides for the thrills and excitement which they generate, their heartrates soar, their endorphin levels go through the roof, the thrills of these rides are nothing short of exhilirating.  Unless of course if you have a phobia for them.

The mere thought of going onto one of those rides has me catching my breathe and breaking into a cold nauseating sweat almost immediately.  I went on once, ‘Space Mountain’ in Euro Disney, at the time the most ‘exhilirating’ ride which they offered.  I was beyond terrified.  You are in the dark, completely, no idea of what lies ahead of you. Now and again you get a glimmer of light or a calm in the chaos of the ride, it gives you a false sense of hope that the nightmare in which you have found yourself is nearly over, except that it isn’t, the knocks keep coming, spiral after spiral, loop after loop, until you feel like you have no hope left and no chance of surviving the ordeal.

Parents and especially moms who have lived through or are currently experiencing and dealing with oral aversion will know this fear all too well.  Even if your little one has seemingly conquered their demons, your fear never truelly goes away.  Every time they don’t finish a bottle you find yourself catching your breath and praying that this isn’t a small warning sign of things to go south.  Afterall, this was how it all started in the first place, bottle by bottle, rejection, resistance and tears, both from baby and mom.

The fear of regression never goes away, it is something that is so hard to explain to someone who has not gone through the same battle.  Every day we live with the thought of ‘is today the day’, every bottle we offer has a little bit of trepidation and fear in it.  We try put smiles on our faces and remain calm if that bottle is outright rejected, but we are beyond terrified that it is the start of the next battle.

And that is the thing with aversions and feeding issues, there are so many little battles that we fight through, but we are never guaranteed that the war is won.  At times it is hard to remain positive and I find in times like this that it is absolutely critical to confide with someone who has or is experiencing the same.  If you’ve experienced it or have conquered it, you will always know that fear, it is all consuming, it is a lonely place and remaining positive takes unbelievable strength, strength that we struggle to find on the rough days.

Dealing with aversions renders us housebound for the most part, we end up cancelling dates with friends and family more often than not. It is a lonely existance to a great extent as all our energy is focused on forming a strong, healthy and happy relationship between our babies and their food, all while trying to ensure that they consume enough to continue to grow and develop.  We arrange parties and events around our routine and schedules, we expect, to an extent, for our loved ones to accommodate our needs, not because we are being selfish, but because it is the only way we have control over an otherwise impossibly complex scenario.  To put things into perspective, it has taken us 3 months to get to the point where our daughter will drink outside of the home. Considering that she drinks a bottle every 2-3 hours, this restricted our lives to no end, but if the choice is between a nice social event or our childs sustinence, well, you know what we’ll choose.  In many scenarios you may also find that a child with oral issues will also only drink from a select few people, or even only from one person.  The pressure this can place on this person is immense, with little opportunities to unwind and catch some much needed rest and reprieve.

I have met an incredibly supportive network of parents who have or who are going through the same struggles.  Our frustrations and fears are shared between each other and often not understood by those around us. Whether your child is 9 months or 9 years old, the struggle continues in some way or form, the fear is ever present.

Along with your own fears are the ever present threats from specialists.  The expectations on your child to grow at a rate that will satisfy a graph is immeasurable. Particularly for prem and micro prem babies,  the expectations set upon them is surreal.  A child born under 1kg is expected in their first 1-2 years of life to gain enough weight to meet up with their full terms counterparts….  If that child is not meeting those expectations within the first few months of their lives, the pressure to perform that is placed on that child and the parents is mind boggling.  So much pressure is being placed on those tiny bodies who have fought so hard to be here, who’s organs and immune systems are still settling and growing in strength.  And as with many of these little prems, they are natural born fighters, energetic little people with a zest for life and exploration that is not often seen in their full term counterparts.  The amount of energy they expel from those tiny bodies is unimaginable,  far more energy that a baby that size would normally be using up.

If you know of a family member, friend or even an aquaintance who is experiencing feeding and oral aversions with your friend, be supportive, offer to pop in and make them a cuppa, bring a choc brownie along, take their minds off their worries, if even only for a few minutes.  Offer support and a shoulder to cry on, remind them of how far they’ve come, but never, ever tell them that their child will eat when they are hungry.  It’s a fallacy that a child will eat when hungry if they are suffering from any number of medical conditions.

#helpfeedcharlotte – part one

 

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Around the beginning of October I posted a blog about oral aversion ( http://mamamania.co.za/2016/10/04/trust-issues ).  Up until that point I thought that we had been through hell, but it was just the beginning.  It was two weeks later that we got to experience the full brutal verocity of this problem, when our daughter shutdown completely from drinking. She had reached the end of her tether and patience and had shut down totally after another week of being poked and prodded in hospital had her deciding enough was just simply enough.

In the week leading up her Golden Globe winning meltdown we had once again been in hospital for near dehydration on her part and now failure to grow.  In her oral defensiveness she had learnt how to hurl, she’d intentionally throw up every ounce of milk we had fought to get in, she had stopped gaining weight and this ‘sudden’ issue finally got the attention that I had been begging for, for so many many months.  Tests were scheduled, NG tubes were inserted, she was poked, she was prodded, she had a thousand different bottles being shoved in her face by a thousand different people who all insisted they knew how to feed her, all while we bided our time waiting for the results.

Mighty Mouse and yet another NG Tube for rehydration.
Mighty Mouse and yet another NG Tube for rehydration.

She had a barium swallow performed which confirmed my suspicion all along that there were issues with her ability to suck and swallow correctly, it also confirmed that she had reflux, which we already knew. The speech therapist was contacted, yet again, in an attempt to get an emergency appointment and we started prepping C for the next test, the dreaded PH study.

The PH study is a 24 hour test in which yet another tube is shoved down the throat via the nose, it runs down the oesophagus and into the stomach and is attached to a little unit with a display which tells you the acidity levels and a few other scientific bits and factos. I had to make note of every niggle of C’s over a period of 24 hours. This would tell us how frequent and how strong her reflux was.  The results indicated she had severe reflux, the acidity levels were low however so not deemed to be the main source/cause of her aversions.

Proud of the fact that she pulled out the PH pipe before the test was over.
Proud of the fact that she pulled out the PH pipe before the test was over.

The long and short however was this,  all the tests being performed were highly invasive, strangers touching her face, forcing things down her throat, putting unwanted objects in her mouth and throat, and she systematically continued to withdraw more and more during a period that was meant to be helping the situation, not further enforcing her fears. By the time we were released due to no ‘medical factors’ contributing to her aversions, she had stopped drinking altogether, but we were still discharged, perhaps in the hopes that by some miracle she would drink in the comfort of her own home, her issues were deemed psychological and no treatment in hospital would recitfy them.  I recall breaking down when the doctor told me that I had been correct all along when I had said there was a problem with her drinking, that I wasn’t losing my mind, that my intuition had been right all along. I was so elated by the idea that I wasn’t insane or one of those mothers who intentionally hurts her child that it hadn’t quite dawned on me right then that I was taking a baby home that wasn’t drinking. I drove home with a smile on my face, thrilled that I wasn’t loopy, oblivious to the nightmare that lay ahead.

C took one look at that first bottle on offer when we got home and flipped out, Britney Spears style. I took her to the room and tried to keep calm, but the second time round was worse than the first and she promptly passed out mid scream, I remember, in that moment, wishing that I’d never had her, that I’d never fallen pregnant, that I couldn’t deal with this, that this was not what I had signed up for, the guilt of those fleeting thoughts will never escape the memory banks. I recall someone phoning me and when asked what I was doing I responded with “I’m watching my baby die”.  There is no worse feeling than that of helplessness, the inability to make things better, or fix something for your children.  Anyone who has ever said not to worry, a baby will eat when they are hungry has never dealt with oral aversion.  12 hours after we had come home my daughter had drunk 10ml of milk and we were both  hyperventilating, quivering, crying, screaming, pathetic excuses for human beings.  Hubby loaded us into the car and we rushed back to her first home, NICU for help.

First night home with the NG tube after C stopped drinking.
First night home with the NG tube after C stopped drinking.

Several failed attempts later at getting C to drink from anything and the NG tubes were hauled out. I had to leave, there was no way I could again watch my child being held against her will while someone placed a tube down her throat, even if it was life saving and done by people who cared for her deeply.  We slowly bolus fed her fluids to prevent dehydration and were sent home with the instruction that the tube be replaced no longer than 5 days later.

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Bolus feeding Charlotte

After several incredibly traumatic attempts at home to bottle feed her failed, I realised that we had reached the end.  We had gotten to the point that I had feared most and had been trying to avoid for so many weeks. Full blown oral aversion.  I decided that from that moment on that things would be done our way and no longer the way that the doctors were proceding with things. We discussed with her paed that we would receive training on the NG tube and we had 6 weeks in which to get her drinking and gaining weight, thereafter they were insisting that we would need to place a G-tube directly into her stomach. A G-Tube was not going to be an option and the mere thought of it set me into a total panic attack.

Charlotte was notorious in NICU for pulling her NG tubes out. It was no different at home and daily we had to add little plasters at her nose to block her fingers from creeping in and yanking it out.
Charlotte was notorious in NICU for pulling her NG tubes out. It was no different at home and daily we had to add little plasters at her nose to block her fingers from creeping in and yanking it out.

Out of options and desperate for answers and solutions I decided to shamelessly plug my child online (https://www.facebook.com/mamamaniaPE/posts/1755397898059340).  Somewhere in the world there must be someone who had gone through this before and had successfully conquered it. The response from a local, national and international level was just mind-blowing and I soon realised that there was an entire network of us out there, suffering in silence, assuming we were alone, assuming we were some random medical anomoly, and on a local level  we all shared the same paediatricians, so why were we all made to feel as though this was something rare and unknown?!

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So many people have reached out to us from my original social media post asking for help and our #helpfeedcharlotte campaign, I’m still trying to reply to so many people and thank them for their offers of assistance, advice, referals, support and prayers.  One such person was Emma. Emma is an Occupational Therapist in PE, we shared a mutual friend whom she was working with and she believed she could offer us some assistance. We met with her the following morning and while she made no promises that she knew she couldn’t guarantee, she did offer us hope and a promise to do every bit she could to get C drinking again.

Charlotte and her Emma!
Charlotte and her Emma!

To be continued…