All you need to know about weaning by Dr Harriet Holme

Weaning
Introducing food to your baby can be an exciting but daunting time for many parents and you may have many questions.

When is my baby ready for weaning?
Government advice in the UK is to start weaning from around 6 months (but not before 4 months of age). However, in reality when a baby is ready to start weaning, will vary, as they will all reach their development milestones at a slightly pace.

It’s a good idea to wait until they are ready, because they are more likely to be able to move food safely around their mouth. For the first 6 months, milk (breast or formula) provides all their nutrition. After this time while milk still provides most of their nutrients, they do start to need additional intake of some micronutrients, such as iron. This why weaning is sometimes called complementary feeding, as it complements the nutrients from milk.

These are the signs to look out for that your baby is ready to start trying food:

• Can stay in a sitting position and hold their head steady
• Can coordinate their eyes, hands and mouth so that they can look at their food, pick it up and put it in their mouth
• Can swallow food, instead of just spitting it back out

Some behaviours can be mistaken for signs of being ready for food, these are:

• Chewing their fists
• Wanting extra milk feeds, as they might just be going through a growth spurt
• Waking up in the night more than usual

Sadly starting food is not more likely to help your baby sleep through the night. Have a look for the three main signs and that they are happening regularly, not just a one off.

My baby was premature – what does that mean for timing? Babies who were born prematurely, should in general follow the same guidance, and still start when they are ready, around 6 months corrected. This means 6 months from the time they were due to be born. For additional guidance you should speak with your GP or health visitor.

What time of day should I start?
While there is no set time that you should start introducing foods to your baby, you will probably find them more receptive if they are not tired or hungry. So to start with offer your baby milk first, and then as they get used to eating you can change this to before milk. Morning can be a great time too, as if your baby has any new symptoms such as an allergic reaction, it can be less scary and more visible than in the evening at bed time. Playing and exploring food is completely normal for babies, so expect lots of mess, and leave plenty of time. Babies copy other people’s behaviour, so it is also a good idea to sit down at the same time and eat with your baby, modelling the behaviour you would like them to learn.

Do I need any equipment?
Before you start weaning, there are few things that you need to get, but you really don’t need a fancy steamer or blender to weaning your baby. A potato masher is a cheaper way to make purees if you don’t have a blender. BLW requires even less equipment, only some of the food will require adaptation for your baby.

There is really only one essential item and that is a high chair, preferably one where your baby can be supported to sit upright, safely strapped in, ideally with their feet flat on a support. My favourite is the Stoke Trip Trap chair, as it provides all these features, and grows with your baby and child, providing an ergonomic position for time at the kitchen table (https://amzn.to/2yWFvji).

Once you start offering complementary food, also do the same with water using a free flowing sippy cup like these (https://amzn.to/2zypeRz). Soft spoons are better for baby’s gums than metal spoons, and can be used for purées.

I’d recommend using a bowl that bounces, as you will probably find it on the floor at some point, or one with suction. I also love the silicon plate that have suction to the table, but also have a lid. This makes it easy to prepare food and take it out with you (https://amzn.to/2WZqTYv).

Try to get a bib that is easy to clean. I found one with sleeves the best as weaning can be very messy (https://amzn.to/2Wv1Jlm).

Baby led or purée or both?
There is no evidence that your baby is more likely to choke doing baby led weaning. However, doing a baby first aid course can be useful and reassuring before you start weaning. Also St John’s Ambulance have a useful video on choking (https://www.sja.org.uk/get-advice/first-aid-advice/choking/baby-choking/).

Baby lead weaning (BLW) means using mostly finger foods that your baby can explore and try at their own speed. While some of the foods will need additional preparation to make them safer, there is no need to purée the food. Whether you choose to try BWL, or purées or use a mixture of both, is up to you. Many parents find that BLW can be easier, as your baby can share most of your food, meaning less preparation. In addition, babies are more in control of regulating their own food intake with appetite, and therefore have a decreased risk of obesity later in life. Meal time battles are also a lot less likely, which can be associated with fussy eating. However, there are risks with BLW, such that babies may eat less than being spoon fed, and therefore there is a risk of them not eating enough iron rich food. You can avoid this by aiming to offer an easy to eat, iron rich source of food at each meal time.

How to prepare food for BLW
You might feel a bit lost at the thought of just handing your baby a piece of broccoli, but there are a few ways of preparing food to decrease the risk of choking:

• Food should be about the size of an adult finger and not easy to break off (such as a raw apple or carrot – instead, try coarsely grating these)
• Round or cylindrical foods such as grapes and sausages should be cut longitudinally into halves or quarters to begin with. Sausages should have the skin removed and cut longitudinally (not into disks). Round berries like blueberries can be squashed with your fingers or a fork to reduce the risk of choking.
• For harder vegetables and pasta, cook these until they are nice and soft.
• Babies when they start weaning, will not have a pincer grip where they can pick up something small like a pea, instead they need to be able to grip the item in the palm of their hand. Strips of food are easier to hold this way, and for slippery foods such as bananas and avocados, leaving some skin on as a handle can help them grip and hold onto the food.

Purées and textures
If you chose to offer your baby purees then the guidance is to start with smooth purées and move onto progressively lumpier food as they grow:

• 6 months (not before 4 months): smooth purées
• 7-9 months: mashed food with some lumps
• 9-12 months: mashed, minced and chopped family meals

Which foods should I start with first?
Vegetables are a great way to start weaning, especially those that are not naturally sweet such as broccoli florets, spinach, cooked courgette sticks, cooked carrot sticks, cauliflower florets and avocados (technically a fruit not a vegetable). Starting with fruit, risks your baby being less keen on trying foods that aren’t as naturally sweet like vegetables, that they will need to learn to like. Harder vegetables may need to be cooked a bit more, so that they are nice and soft for your baby to gum.

Once your baby has started on vegetables, add in a range of different fruits and foods which are higher risk for allergies (see below). As you establish a routine, regardless of how you are offering food, (whether that is finger food or purées), think about offering items from different vegetables, fruit, carbohydrates, and protein (and iron).

Carbohydrate finger food ideas:

• Oat biscuit
• Plain cracker
• Pitta bread strip
• Bread/toast finger
• Cooked pasta shapes
• Strips of pancakes (without added sugar, such as banana or sweet potato pancakes)

Protein (and iron) finger food ideas:

• Strips of omelette or lumps of scrambled egg
• Cooked chicken or turkey pieces
• Crushed beans (broad beans, chickpeas, kidney beans) – crushing reduces risk of choking
• Flakes or pieces of white fish
• Pieces of cheese
• Cooked beef pieces
• Strips of tofu

Allergenic foods:
Some foods are higher risk than others for causing an allergic reaction. These are:

• Eggs
• Wheat
• Fish and seafood
• Seeds
• Cow’s milk
• Tree nuts
• Peanuts (these are actually legumes like soya and lentils and are different to tree nuts!)

Once you baby is happily eating vegetables and fruit, you can start to add in these allergenic foods, in small quantities, one at a time. This is because if there is a reaction, the trigger food can be easily identified. There is now evidence that introducing these allergenic foods earlier is of benefit.

If you baby has Cow’s Milk Protein Allergy (CMPA), you might find this article helpful when choosing a plant based milk to introduce into their diet (https://healthyeatingdr.com/2020/01/06/plant-based-milks/).

Foods to avoid
Try to avoid your baby goods that have added sugar or salt so avoid chocolate, sweets, sugary drinks, salt in stock cubes, cakes, biscuits, breakfast cereals with honey or added sugar. Honey should also be avoided in babies less than a year of age, as there is a risk of botulism from spores naturally present in honey.

Is my baby a fussy eater?
Your baby might turn their nose up at new foods when you introduce them, but this does not mean that they are a fussy eater. Instead babies need to be introduced to foods multiple times before the accept them. This is true for toddlers too when they are still learning new foods. Keep introducing new items along side others that you know they like.

Do I need to give my child any vitamins?
This depends on a number of different factors, including their age, and how much formula milk they drink per day. For more information see my article where I talk through what your baby needs (https://healthyeatingdr.com/2020/04/21/vitamins-for-children/).

Top tips
Its ok to feel a bit nervous about starting weaning, with lots of information to take on board, and potential worries about food allergies or choking. These are my top tips for making the weaning process as fun and enjoyable as possible:

• Keep calm, as your baby is an expert at picking up your stress. The happier and more relaxed you are, the more likely your baby will be the same. If you feel stressed, try turning on some calming music to help you feel more relaxed.
• Eat with friends and family: eating with and watching other people eat is a great way to model positive behaviour to your child. It’s one of the reasons many children eat different food at nursery, that they might refuse at home!
• Food isn’t just about the nutrients, it’s also about establishing a positive routine, and importance of the social benefits of sitting together for a meal.
• Make it fun: try going on a picnic or making a face with the food. Even for adults, the how food is presented, is important. Offer a variety of food of different tastes, textures, and colours to keep the weaning journey exciting.
• Avoid distractions: try to focus on offering and enjoying food together. It is better if your child can learn to enjoy food, and listen to their body so that they stop when they are full. This is less likely if there are distractions like toys or TV.
• Let them explore: try to avoid stopping your baby explore their food and accept that weaning is messy. Children learn through smell, touch, and looking at food. This is importance for them to establish acceptance of food.
• Establish a routine: most children respond well to routines, so that they can predict what will happen next. As you become more familiar with weaning, and find a routine, your baby will be able to predict when to expect food.

About Me - Dr Harriet Holme MA MBBS PhD RNutr
I studied medicine at the University of Cambridge and have over a decade of experience as a paediatric doctor. Additionally I have a PhD in genetics from University College London. I now use these uniquely developed skills for the benefit of my clients and students, exclusively consulting as a Registered Nutritionist with the Association of Nutrition and lecturing in culinary science and nutrition. I was commissioned to write a cutting edge degree combining culinary, nutrition and health, the first of it’s kind in the UK, and I’m also involved in teaching the chef’s and doctors of tomorrow about nutrition.

I focus on providing evidence based nutrition that is founded in fact not fiction, and believe knowledge is power to improve your health. I have lots of information on nutrition for mum’s on my Instagram page too - @healtheatingdr or for more information about the services I provide, see my website www.healtheatingdr.com

Photographs copyright of Nadine Brandt @nadinebrandtphotography