When to Start Solids

When to Start Solid Foods

by with No Comment Baby Led WeaningChild & Family NutritionInfant NutritionToddler Nutrition

Recently, I’ve been reading a lot of questions asking what is the right age to start introducing baby to solid foods. Some experts or old guidelines say between 4 and 6 months, some parenting websites say 4 months, sometimes this recommendations even come from a doctor or other health professionals. Well, we were raised in the 80’s, some of us may start to eat solid foods at 4 months of age (our parents followed the old recommendations) or as early as 2 months after birth. I totally understand, as a first time mom, we are eager to start solid foods, friends and family love to give “advices” and “opinions”.  It makes us start thinking “Uh… 4 months…maybe it is the right time”! Today’s parents are sure to be confused with all this conflicting recommendations. I would not be surprised.

Here is what I often hear why parents feed baby solid foods prior to 6 months:

  • My baby is too big
  • My baby is too small and tiny
  • My baby seems hungry (increased demand to breastfed)
  • My baby wakes up multiple times a night
  • My doctor said my baby should begin eating solid food
  • My baby wanted the food I ate
  • I wanted to feed my baby something (iron rich foods) in addition to breast milk or formula

My response to these common excuses is Breast Milk has more calories and significantly more nutrients than any type of solid foods that you can feed your baby.

TOO EARLY? or TOO LATE? 

If you start baby on solid foods too early (prior to 6 months of age), baby may:

  • Drink less breast milk – solids tend to replace breast milk in baby’s diet. The more solids that baby eats, the less milk he takes from mom, which results in low milk production.
  • Not be ready to chew and swallow safely – gag reflex hasn’t fully developed, may increase the risk of choking.

If you start baby on solid foods too late, baby may:

  • Be slow to accept new foods and flavours
  • Have a hard time learning to eat new textures
  • Not get all the vitamins and minerals (e.g., iron) needed

WHAT IS CURRENT RECOMMENDATIONS 

Here are the top organizations that recommend starting solids at 6 months when babies show signs of readiness.

Exclusive breastfeeding is recommended until 6 months to make sure that your baby’s digestive tract is mature enough to digest solid foods, as well as protect your baby from gastrointestinal and respiratory infections (APP 2012, Nylor & Morrow, 2001).

Breast milk is the ONLY food or drink your baby will need for the first 6 months.

DEVELOPMENT SIGNS FOR READINESS

Watch for SIGNS that your baby is getting ready to start solids:

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  • Able to sit upright (with support pillow/towel is fine) and hold his/her head up well (without support)
  • Open mouth when food comes or turn head away when full
  • Good oral motor skill – pick up foods and put in his/her mouth (able to self-feed)
  • has lost tongue extrusion reflex (baby stops pushing the food out of his/her mouth with his/her tongue). If your baby still have strong tongue extrusion reflex, you may want to wait a week or two and try again.
  • Show interest and reach for your food at meals and snacks
  • Chewing on non-food items, such as toys, tethers and fingers

GESTATIONAL AGE 

Another things to consider is your baby’s gestational age. If your baby was born prematurely, he or she may not be neurologically ready for solids until 6 months after his or her normal due date. Aiden was born 2 weeks early, so I decided to start solids about two weeks after his 6 months birthday, same as Audrey and Avery, they were born 4 weeks early, they start solids about 6.5 months.

What you can do If your baby is showing obvious signs of being ready for solids about 4-6 months?

It is normal to see a 4 to 5 month old baby is very eager to participate at mealtime, however it does not mean that he or she is ready to eat solids. In fact, it is just the normal developmental stage to explore everything with their mouth. There are a few things you can do to let your baby participate in mealtimes without starting solids:

  • Let your baby sit with the family at mealtime in booster seat or high chair. It helps them to get used to sitting on booster seat or high chair until you are ready to serve the first ever foods in their life.
  • Offer your baby spoons, cups, bowls and other baby-safe eating utensils to play with during mealtimes.
  • The use of open cups (starting from 6 months) is now considered a gold standard. Offer baby a cup of water or expressed breast milk (about 1-3 oz). Your baby can entertain himself at mealtimes while learning to use a cup.

BOTTOM LINE

Most babies will become developmentally and physiologically ready to eat solid foods between 6 and 8 months of age. Watch for signs of being ready for solids, not by the calendar, as well as it is definitely not just mum, dad or mother-in-law forcing it on them.

Baby, Bon Appétit !! 

Aiden likes making a mess at mealtime.

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Aiden
Avery and Audrey

I will be posting “How to Start Solid Foods” soon, stay tuned!!

Constipation above 6 months

How to Manage Constipation in Your Child (6 months or above)- Part II

by with No Comment Child & Family NutritionDigestive HealthInfant NutritionToddler Nutrition

Constipation in children is extremely common. I don’t deal with constipated children a lot in my practice, even my son, he is such a “regular” boy. Most parents are overly concerned about how often their child has bowel movement, because they have been taught that a healthy child should have a bowel movement every day. This is not TRUE.

WHAT IS NORMAL? 

It is very important for parents to recognize there are many “normal” patterns for bowel movements in children.

  • Bowel movements decrease down to about 1 or 2 each day from age 2 months to 3 years.
  • Children 3 years or older have about 1 bowel movement each day (here).
  • Bowel movements change in thickness, number and colour when a change is made to what your child eats (e.g., when babies are starting solid foods or cow’s milk).

Your child is not constipated if his or her stools are soft and pass easily, even if it has even a few days since last bowel movement.

WHEN YOU SHOULD WORRY? 

When the bowel movements are 1) dry and hard 2) difficult or painful to pass.

The frequency of bowel movements is not as important as whether the child can pass stools easily.

CONSTIPATION IN INFANT 6-12 MONTHS

In infants, any changes in diet may result in stool inconsistency and/or change in frequency of bowel movements.

COMMON CAUSES OF CONSTIPATION 

  • Changing from breast milk to formula or cow’s milk.
  • Introducing new formulas. Some formulas may be more constipating than others.
  • Incorrect formula-to-water ratio (preparation method).
  • Introducing solid food(s) – Breastfed babies may be more prone to constipation when solid foods are introduced (at 6 months). This is because their tiny tummies are used to process the easily and highly digestible breast milk.

CONSTIPATION IN CHILDREN AGE 1 YEAR AND OLDER

Constipation can make bowel movement painful, so your child may try to prevent having one. Once a child begins to be afraid of passing bowel movements, the cycle of chronic constipation has begun and bowel movements become more and more abnormal.

COMMON CAUSES OF CONSTIPATION 

  • Toilet training. Refuse going to toilet, due to not wanting to take a break from play or not wanting to use certain facilities such as the school toilets or travelling.
  • Diets low in fibre.
  • Lack of fluid intake. Sometimes the normal amount of fluid a child drinks is not enough, such as when the weather gets hot or the child increases his or her physical activities.
  • Excessive intake of dairy products. Milk does count as part of the fluid but be aware that too much milk can be a contributing factor to constipation as it means that a child will be eating less foods and thereby less fibre.

If high intakes of any foods create a lack of fibre or fluid intake, then constipation may result.

MANAGEMENT OF CONSTIPATION

Bathroom Routine

  • Children who are toilet trained should practice sitting on the toilet for 5-10 minutes every day after each mealtime (same time every day).
  • No distraction. Make sure parents or siblings aren’t coming in and out the bathroom when it is “their toilet time”, so that they can relax and make sure that they sticks to their morning bathroom routine consistently every morning. It usually takes up to weeks or months for them to start going consistently.
  • Do not ignore the “urge” to go to toilet as this can lead to harder, larger and drier stool. Make sure they have enough privacy and time to pass stools comfortably.
  • It is important to teach your toddler to “listen to your body” or “listen to your bottom” and go to toilet when they get the message. Then , you can take them to the bathroom right away. Parents should listen or watch the signs:
    • Suddenly stop whatever activity they are doing
    • Suddenly squat or sit down
    • Leave the room or hide in a corner
    • Stiffen up, extend their bodies upright, stand on their tip toes and tighten the muscles in their bottom
    • Face turns red or change tone of their voice
    • Unable to pay attention to you
  • Make sure your child’s feet are resting on something, such as a foot stool. It helps relax the pelvic floor muscles, which can help move the bowels.
  • Keep some reading or picture books in the bathroom and encouraged your child to look at them and try to relax.

Increase Fibre Intake 

It is important your child eat a healthy and balanced diet. The recommended intake of fibre are 19 g of fibre per day for a 1-3 year old and 25 g per day for a 4-8 year old (here).

  • Offer at least one serving of vegetables or fruit at each meal or snack.  In this way, your kids should get adequate fibre daily.
  • Gradually increase fibre intake. Going from a low fibre intake to their desired goal too fast can cause symptoms include abdominal pain, bloating, and gassiness.
  • Choose whole grains – e.g. whole grain bread, whole wheat pasta, brown rice, whole grain cereal, oat, quinoa, barley, etc.
  • Choose legumes – e.g. beans and lentils.

The best way to introduce more fibre to your child’s diet is to do so by adding some of those fibre-containing foods slowly. For example, provide a serving of fruit at lunch for a few days, then add a high fibre cereal (at least 3 g of fibre per serving) at breakfast until you reach the goal. Also, If your child is constipated and you are feeding him the rice-based infant cereal, then try bran- or oat-based cereal instead.

Avoid Binding Foods

Avoid white starchy foods, banana and cheese. Most white starchy foods are low in fibre, e.g., white rice, white bread, white pasta and breakfast cereals. These foods will bind the stool so that it is harder to pass and this can also cause pain when passing.

Increase Fluid Intake 

  • Water is the only things that helps your child get over their constipation.
  • Babies 6 – 12 months:
    • Offer up to 1 oz (30 mL) of fruit juice between feedings to a maximum of 4 oz (125 mL) in 24 hours.
    • Sips of water from an open cup (about 2-3 oz or 60 – 90 mL at a time).
    • Note: Juice and water should not replace regular feedings.
  • 1 – 3 years Children:
    • Recommended total fluid intake: 4 cups (900 mL) per day (here).
    • Offer 500 mL (2 cups) of milk per day with meals and snacks.
    • Offer water throughout the day.
    • Limit 100% fruit juice to 1/2 cup (125 mL) per day (OPTIONAL).

Natural Laxatives 

Why juice? Juices containing high amounts of sorbitol can help draw water into the bowels to make stool easier to pass. Prunes, pears and apple juices usually contain higher amounts of sorbitol compared to other juices and therefore can have some benefit in relieving constipation.

  • Offer “juice water” (diluted fruit juice) which mean 95% of water and a tiny splash or real 100% fruit juice. Limit 100% fruit juice intake to no more than 1/2 cup per day.
  • Mix prune puree with a favourite food (cereal or crackers).
  • Ground flax seed. Mix in cereal, soup, smoothie, baked goods, or yogurt. Dosage: 1 tbsp per day (toddler); 2 tbsp per day (older children).

Increase Physical Activity

We all know physical activity is a natural bowel-stimulator. Get your child off the couch, turn off the TV and hide the iPad. Checkout the Physical Activity Guidelines.

Medications & Laxatives & Fibre Supplement 

Talk to your doctor and/or pharmacist before using any of these methods, as doses are weight-dependent. Follow the instructions carefully for the dose and the amount of the time you child should be taking them. As a dietitian, I will focus on “real foods” rather than supplements.

Prebiotic & Probiotics Supplement 

Currently, there is no enough evidence or research to show that pre/probiotics supplement help with constipation. However, foods like cheese, milk and yogurt with probiotics are safe for most people including children.

Do you have a constipated baby at home? If you have any questions please leave me a comment or Contact Me. 

Constipation under 6 months

How to Manage Constipation in Your Baby (Under 6 months) – Part I

by with No Comment Child & Family NutritionDigestive HealthInfant Nutrition

Being a first-time mom, I know it is heartbreaking when your baby is constipated. I remember when Aiden hasn’t had bowel movement for 3 days, I began to worry. Is this normal for a 4 months old exclusively breastfed baby or is he constipated? After talking to my lactation consultant, I know this is normal for EBF baby to have infrequent bowel movement.

Most babies grunt and get red in the face when having a bowel movement. It is completely normal. However, your baby is constipated if his poo is dry and crumbly or like pellets, and it can cause him pain and discomfort.

WHAT IS NORMAL?

  • There is NO necessary to give your baby fluids other than breastmilk or formula before 6 months of age.
  • It is normal for exclusively breastfed infants to have more frequent bowel movement than formula-fed infants in the first 2 to 8 weeks after birth.
  • In some exclusively breastfed babies over six weeks of age with normal growth and development, bowel movements may be infrequent and soft, ranging from one every two days to two weeks (here), or even three or four weeks. These infrequent stools can be normal in infants who are effectively transferring milk (changing from breast milk to formula or cow’s milk) and appropriately gaining weight.

WHEN YOU SHOULD WORRY? 

If your baby is constipated for more than 2 weeks, If he has a fever, start vomiting, decrease appetite, have blood in stool and weight loss, follow up with your baby’s family doctor to make sure there are no other red flags.

TIPS FOR MANAGING YOUR INFANT’S CONSTIPATION AT HOME 

  • Continue breast feeding. Breast milk is easier to digest than infant formula because it is specific to the needs of human infants. It helps promote bowel regularly, mature the digestive tract and protect it from infection. If an exclusively breastfed infant has dry and hard stool, hydration should be assessed and the infant referred to a family physician or lactation consultant (if you have concerns about breastfeeding).
  • Small and frequent feeds. Infants have small stomach. For better digestion, offer smaller feeds, more often throughout the day. For example, if you normally offer 6 ozs every 4 hours, try offering 3 ozs every 2 hours. This method may reduce gas and fussiness as well.
  • Preparation method. If your baby is using formula, ensure that the formula is being properly prepared. Formula that is over concentrated can lead to difficulties with digestion as well as other medical problems. An extra ounces of water can be offered a couple of times a day to ensure adequate hydration.
  • For some formula-fed babies, the answer is switching formulas. The iron in formula is often blamed for constipation, but this is no evidence that there is a link between the two. And babies need the iron to reduce the risk of anemia. Some babies, however, are intolerant of cow’s milk and do better on different iron-fortified formulas. You should switch infant formulas only under your family doctor’s guidance.

Many breastfed babies do have infrequent bowel movements however this does not mean that they are constipated.

OTHER NON-NUTRITIONAL TIPS 

  • Soft tummy massages. Starting in their navel, in a clockwise direction and moving outwards. Do several massages throughout the day, until your baby has a bowel movement.
  • A warm bath (if he enjoys bathing). This will make them feel relaxed and you can continue the massage technique and relieve their discomfort.
  • Cycle baby’s legs. You can try moving your baby’s leg in a cycling motion while they are lying on their backs to help loosen stools.
  • Check with your family doctor to see whether it’s okay or necessary to use an over-the-counter stool softener.

Do you have a constipated child at home? If you have any questions please leave me a comment or Contact Me. 

Foods to support your child immune system

Foods to Support Your Child’s Immune System

by with No Comment Child & Family NutritionInfant NutritionToddler Nutrition

The immune system plays a very important role in your overall health (and the health of your children). It defends against viruses and bacteria. It’s made up of interconnected white blood cells, antibodies, bone marrow, the spleen, thymus and lymphatic system, which work together in harmony to find and destroy pathogens (the things that cause illness).

With Covid-19 in the news, you’ve probably seen many articles and blog posts about “how to boost your child’s immune system”. As a parent, I can imagine that you’re especially curious about this if you have children who are in school, as we want to protect our children from all the viruses or bacteria going around them.

But here’s the thing: the idea of boosting the immune system with supplements or specific foods is misleading and scientifically inaccurate (here). Do you know an overactive immune system is linked with autoimmune diseases such as lupus or multiple sclerosis. “Immune boosting” is a marketing term, not a medical term.

THERE IS NO SINGLE PRODUCT THAT CAN BOOST IMMUNITY

Scientists are still a long way from understanding the complex interplay of parts that allow the immune system to perform at its optimum level, which means there’s no product you can take to “boost” it. Instead, it’s important to focus on supporting your (and your childrens’) immune systems so they function normally. There are many things we can do to support immunity, such as getting enough sleep, being physically active, minimizing stress and eating nutritious foods. As a busy mom, I love finding foods that are not only nutritious and convenient, but also immune supporting.

The easiest way to get these nutrients is by eating a healthy and balanced diet.

Certain nutrients, such as zinc, selenium, iron, protein, vitamins A, C, D and E are critical for the function of immune cells. However, I can’t promise you that you can totally shield your children from getting sick by eating foods with these nutrients.  In fact, you can build up your children’s immune systems with nutrient-dense foods.  Certain foods have the exact nutrients that can help your children’s immune systems be as strong as possible, so when they are exposed to the inevitable germs, they are ready to fight. 

FOODS CONTAIN THESE IMPORTANT NUTRIENTS 

Orange vegetables and fruits 

Carrots, sweet potatoes, pumpkin and cantaloupe are among the best sources of beta-carotene, a precursor of vitamin A. Beta-carotene has several health benefits, including the antioxidant activity that protects cells from free radical damage and help enhance immune function (here). In fact, beta-carotene plays a role in making white blood cells, which are responsible for hunting down and quashing viruses. Pairing these foods with a healthy fat, such as olive oil, avocado, or nuts and seeds, can help the body absorb them better.

Berries 

Berries are full of antioxidants, which help your body fight oxidative stress caused by free radicals.  This helps keep our immune system fighting! There are many different berries you should try to include in your children’s diet:  strawberries, blueberries, raspberries, cranberries, and blackberries, to name a few.  Don’t worry; when berries aren’t in season frozen berries are just as nutritious. You can add them to yogurt and oatmeal, or eat them as a nourishing snack.

Dark leafy greens

Choose kale, spinach, chard, arugula or collards. Dark leafy greens are high in carotenoids (similar to beta carotene), and have similar immune-supporting effects. If your children not a fan of salads? Use leafy greens in smoothies, muffins or stir-fry.

Nuts

I’m often asked which nut to eat and I say, “mix it up!” Each nut has a different nutritional value, so choose a variety for the best immune support. Almonds, peanuts and hazelnuts contain vitamin E, which helps increase T-cell count (T-cells directly kill infected host cells and regulate immune responses) (here). Walnuts are significantly higher in omega-3 fat than any other nut. Enjoy some trail mix, or add nuts to salads, pasta or cereal. Or enjoy them in a granola bar or energy ball. Nuts can be choking hazard for babies and young toddlers, so make sure to serve your little one slivered or sliced almonds, or natural nut butters spread thinly on toast.

Seeds

Serve your children a variety of seeds, such as pumpkin, sunflower, sesame, hemp, and flax seeds, to support their immune systems.  By eating a wide variety of seeds, you’ll be getting vitamin E, zinc, and omega 3 fatty acids, all of which help the immune system fight off invading bacteria and viruses. You can add seeds to smoothies, yogurt and salads, spread pumpkin or sunflower seed butter thinly on toast.

Oatmeal

Oats contain immune-supporting nutrients like selenium and zinc. But they also contain a special type of fibre called beta-glucan, which increases immune defense by enhancing macrophages (cells that detect and destroy bacteria and viruses) (here). Start your day with oatmeal.

Eggs

Protein is needed for proper immune system functioning, and eggs are the gold standard for their high-quality protein. When scientists measure protein quality – known as “biological value,” it’s often evaluated compared to eggs, which are given the perfect score of 100 (here). Eggs are also a source of immune-supporting selenium and vitamins A, D and E. So, scramble up a few eggs for breakfast today.

Fish

Fatty fish such as salmon, tuna, trout or sardines are excellent choices. They contain a winning combination of vitamin D and omega-3 fats, which both support the immune system. Vitamin D deficiency is associated with an increased susceptibility to infection (here), and omega-3 fats are part of the structure of all immune cells (here). Try canned tuna in a sandwich; enjoy some salmon sushi roll; or try a bagel with cream cheese and smoked salmon or trout.

Fermented foods 

Choose kefir, fermented vegetables (sauerkraut or kimchi), kombucha or yogurt made with active cultures. These foods contain probiotics, which mediate and regulate the immune system (here). Researchers are still trying to figure out which specific probiotic strains to use for different health problems, and the pieces of this puzzle remain incomplete. If a specific probiotic is marketed as an immune-booster, don’t believe the hype. Science isn’t there yet.

Tumeric 

You know that perfect buttercup-yellow hue of mustard? That comes from turmeric, a spice that contains curcumin, which has been linked to an enhanced immune response. There’s one problem. Curcumin is unstable and not well absorbed by the body. However, researchers found a solution: when using turmeric, add a dash of black pepper. It helps increase the bioavailability of curcumin by 2000% (here) Try turmeric in stir-fries, curries, stew or make a turmeric latte, known as golden milk.

IN ADDITION TO WHAT YOU DO EAT, IT’S ALSO IMPORTANT TO GET YOUR BODY HYDRATED

Staying well hydrated can provided just the right balance for hormones, enzymes and cells to function properly, especially Malaysia’s weather is extremely “hot” and humid.  Also, it reduces lung and nasal secretions so that your body can efficiently move virus and irritants out of your body instead of getting stuck inside where they can multiply in a nice cozy host (you).

WHAT ABOUT PROBIOTIC SUPPLEMENTS

Giving your child a probiotic supplement isn’t the answer. There’s just not enough research out there on various strains of probiotics and what their functions are in the body.  Probiotic supplements won’t prevent infections from happening, and the risk in taking them is that each and every probiotic strain has a specific use and may actually suppress the immune system, which could cause problems.

BOTTOM LINE

Don’t stress about loading your children up with specific immune-boosting foods or a whole bunch of vitamins and supplements during flu season (or any time of the year), because there’s no such thing, and it turns we don’t want to “boost the immune system” either!

Instead, focus on staying nourished with balanced nutrient-rich meals and snacks, including the foods mentioned above.

Did you know that I offer personalized one-on-one nutrition counselling for children and families? If this is something you’s like to learn more about, check out my service.