Q&A: feeding solids but not purees

Onward and upward! writes:

"As a new mom, I am often questioning little details of raising my son. The vast amount of information and opinions available on the Internet just seem to make it worse.

For example, he's having trouble with constipation (despite breast milk and trying just about every formula out there), so I started him on pureed veggies and fruits, hoping it would create looser stools. It hasn't made a difference so far. But then I go and read an article in the BBC news that says skip pureed foods altogether, and only give them solid foods after about six months or so. The premise is that your baby needs to learn how to chew first, and only after he is ready to do so; and pureed foods can leave them constipated AND postpone their ability to learn to chew. Huh. What do you think?"

Veeery interesting. And, yes, there's definitely too much information on the internet. If you click away now I won't be insulted.

First of all, before we get to the actual topic, are you absolutely sure it's constipation? Many babies (especially breastfed ones) don't poop every day, and some can go for days without pooping, and this is absolutely normal. If they have gas and strain to fart it can look like constipation, but the key is to check the consistency. As long as the poop (I'm not going to call it "stool," people) is soft and a normal color (not hard or black), it's not constipation.

Now to the article: I don't think any of this is that shocking. Even the most recent recommendation from the AAP (American Association Academy [thanks for catching that perhaps not-so-surprising typo, Sarah] of Pediatrics, with whom I have a one-way "eh"-hate relationship) is not to start food until six months. Before that there's really no need for it (barring feeding problems like GERD) and milk or formula has all the nutrition they need. There's a reason babies that young can't chew, and it's because they're supposed to be getting their nutrition in liquid form. There's also some thought now that introducing carbohydrates (rice cereal, etc.) too early can mess with babies' systems so they don't regulate insulin as well and are more prone to developing diabetes later on.

So the recommendation not to start with solids until 6 months isn't making me take any particular notice.

Some of you are aware that my favorite study is about a baby-led approach to starting solids. That study was written by Gill Rapley, the same health visitor (I love that term--it just seems so civilized, like she just pops 'round for a chat and a cup of tea) who's mentioned in the BBC.com piece. If you haven't read the study yet, you should check it out because it's pretty interesting. They looked at what happened when babies were allowed to shove food into their own mouths on their own schedules, and what they discovered was that most babies actually started swallowing it at around 6 months, which seems to indicate that they know how to control their own intake for what their bodies need. This article also suggests that babies choke less when they control big chunks with their teeth and tongues than when they have purees shoved to the back of their mouths.

So a little autonomy with feeding themselves sounds like it's helpful. It's certainly less work for the parents than having to mash and mix and puree and then hope to shove it in. And it makes sense that if they don't get practice chewing they won't chew as early as they will if they get to practice it.

Does anyone else have opinions about whether or not feeding purees makes kids picky eaters? My only experience is with my two, and the one I fed pureed foods to eats nothing, while the one I tossed huge chunks of stuff to eats everything. But the second one is only 2, so there's plenty of time for him to stop eating over the next few years. What have you guys observed?

Comments

[Rachel H.]

My oldest (of three) turned up his nose at baby cereal and purees -- he was nursing, so I more or less let it go. When he was about 8mo he started feeding himself "regular food" and that was it!

With my other two boys, I started letting them have tastes of food when they seemed interested at 5-6 mo. After my experience with the first, I had no inclination to spoon-feed a baby, so they were pretty much on their own if they wanted to eat food (of course they nursed as well).

I've been really happy with their eating habits. I do feel that feeding them the same food as the family (seasoned etc.) helped them be less picky eaters. I never had troubles with choking, either.

[Kelly]

I was all gung ho about the "let them feed themselves with big chunks of food" approach. But my now 9.5 month old daughter will not put any food with texture in her mouth. If she accidentally gets a piece in her mouth, she'll start gagging and usually we end up with projectile vomit. So, we give her pureed foods, and while she won't eat alot of those, she has never rejected anything based on taste.

That being said, once her gag reflex settles down, we'll go back to the baby-led plan.

[d. feldman]

We started with soft table food at 5.5 months, when the Cmonkey began staring hungrily at our plates and reaching. We treated it like a new kind of toy that required supervision, and she's extremely curious about any and every food she comes across. Our two rules were 1. no peanuts or honey for the first year 2. size must be either handy or small. So slivers of meat, fist sized chunks of veggies, etc.

She's now almost 11 months and eats nearly everything, palming it into her mouth with surprsing neatness after the first few months. Most of her nutrition is still met through nursing, but despite having only two bottom teeth she also eats spicy Indian dishes, kalamata olives, grilled steak, slices of lime, peas straight from the pod, bacon, you name it. Cat food, gravel, leaves, lint...

Bottom line, the infant-led approach worked for her, but I think I may have raised a circus geek.

[Nutmeg]

So we've been using baby led weaning with the bubs since he was six months.

Our first foray caused massive (and scary for me) gagging followed by lots of vomiting. Fun!

So we put it off another two weeks. MORE gagging, gagging, gagging, less vomiting. It requires a really zen-like calm to keep from poking my finger into his mouth to pull out the pieces that are making him gag, but I know it's just his body getting rid of pieces he can't move around properly yet. After really slowly forging ahead there is much less gagging... but now there is lots of spitting. He likes to bite things off, chew them around and then spray them all over the place. Another thing which requires zen calm.

So far the bubs has enjoyed carrots, avocado, broccoli, zucchini, watermelon, oatmeal, rice cakes, hummus, potatoes, cucumbers, bananas, cherries, toast, turkey... he hasn't eaten much of anything but he has liked it!

I can't speak to the future, but my reasons weren't to produce a less picky eater, neccessarily... I just wanted to give hope to the other people going this route who are dealing with the scary gagging problem.

Good luck with the constipation, I agree that infrequent stools don't necessarily = constipation. Whatever baby feeding methods you choose will probably have less to do with what kind of eater you get than almost everything else you do!

[Sarah V.]

The BBC article really made me see red because it's such utter scaremongering. I'm currently working on a detailed post discussing the facts behind the doom-and-gloom message, but at the rate I blog that'll probably be up, oh, some time next century (by which time the advice will be totally different anyway), so here's the summary:

It is now known that the whole puréed food stage is entirely unnecessary and parents can save themselves the trouble. This wonderfully practical and helpful bit of advice has, as is usual in the world of parenting, been turned into a Thou-Shalt-Not dogma. There is some relatively minor evidence that feeding babies foods other than breastmilk between the ages of four and six months has disadvantages over waiting until six months, but there is not one solitary shred of evidence that there's anything evil about purées themselves other than the stains they leave on clothes.

Fine, I suppose that babies who spend a lot of time eating purées might potentially be slower to learn to chew than babies who spend that time practicing their chewing instead. So blinkin' what?? It's not a race and your baby is not about to have to pass any Chewing Exams in the imminent future. And, in case you were wondering about those scaaaaary comments about how feeding babies puréed food might make them picky eaters later in life, I would just like to point out that this is a theory of Rapley's that is, as yet, devoid of the minor benefit of having any actual evidence behind it. As my husband put it when I told him about Rapley's theories about what puréed food 'might' do: "Well, it *might* make Satan rise up out of the bowels of the earth and take over the world. But unless you've got any actual evidence..."

[Micaela]

Whew!
I'm the original asker of the question about pureed foods and I just finished reading all these wonderful comments. Now I don't feel so alone. Thanks for posting it, Moxie. I've found your site a big help.

Not to beat a dead horse but:
1. I assume he has constipation because it's the consistency of clay (sometimes almost a pellet) and he makes a huge fuss when trying to pass it. It looks like silly putty trying to get through a straw when it comes out, and that's only after much yelling and usually the use of suppositories. Until recently:

2. We started focusing less on foods and more on hydration (thanks to those of you who mentioned it), and it seems to be working. More specifically, we are giving him watermellon juice (just 1-2 oz) or prune/water mixture or apple/water mixture, and that seems to be inducing a movement about once every day. He still fusses a bit, but he's not screaming and writhing. I will say, the poop really does stink and is a yucky dark green/brown. TMI? Sorry.

3. Now I have to investigate the fructose allergy theory, great, thanks a lot Hedra, and consider choking (which I had been subconciously blocking out), thanks AmyInMtown. Ha ha ha.

4. Regarding the breastfeeding, I wish I could say I was still exclusively breastfeeding. I physically collapsed when my son was five weeks old after exclusively breastfeeding. He was early and ate every 1.5 hours, and I'm older, and it just wore me out. So my supply dwindled, and now he gets one bottle out of seven that is breast milk. Because of his constipation and because formula poop stinks, I had briefly considered relactating with Reglan to go back to exclusive breastfeeding. I do enjoy it. But I've also gotten thrush several times (as does my boy) and I've returned to my outside-of-the-home job full time. Damnit.

Anyway, I give him what ever my tired boobies will produce and I pray he doesn't get his father's asthma and allergies, the subject of other posts.
Thank y'all again for your comments, they are precious and make me feel less isolated in this journey.

I think our solution is to follow our son's cues and let him lead us more.

[CathyY]

Honestly, I think you need to let the child lead you a bit on this one. I offered some rice cereal with breast milk during the 4th month and my now 2.5 year old flew her mouth WIDE open when she saw the spoon coming for the second time. She ate a varied diet of fresh pureed fruits and veggies and the Earth's Best jarred food, which tastes far superior that the Gerber crap. She has a fabulous appetite now - eats easily and varied. At 18 months she ate brussel sprouts, asparagus, you name it. She's a tad more picky now but eats better than any other toddler I know. We feed her "real" food - whole grain, fresh, unprocessed and the like. The kid could not label a chicken nugget to save her life.

[hedra]

Well, if it really is constipation (which it sounds like), fructose malabsorption is really unlikely - that usually causes diarrhea. You can keep an eye out for not going too far the other direction before he's 3 years old, but that's just one of those smaller filters, not a 'need to know now' thing.

And watermelon juice sounds way more enticing than prune juice... (it also has a high fructose value, which means it will work very nicely for the stool softening!).

Just get the safe feeder for the choking paranoia we've awakened, and carry on. Oh, and reassure yourself that there is at least one major study out there that suggested the date of last breastmilk - at ANY rate of breastmilk feeding - makes a difference. That is, that one per 7 you're making is still making a difference that is measurable statistically. :) Carry on, and kudos to you for fighting for it (Relactating and working outside the home... even *considering* that is pretty stellar).

[Cassie]

My neighbor's son is 13 months old and can not eat anything except baby food without choking on it. Not even puree's. She is at her wits end trying to get this kid to eat. He wakes up in the middle of the night hungry but can't or won't eat anything else. I have no advise. Please help.

[Angie]

My girl started solids (jarred purees) at 6 months (yams, peas) and loved it for two weeks. Then she stopped and refused to eat at all (this was over the holidays and we were trooping from relatives to relatives house.) She is still being BF and has refused the bottle/sippy cup/cup since 6 weeks.

We gave up completely for two weeks, and then started with mashed bananas and mashed steamed yams. She still refuses the rice cereal. I think based on what I've read I might try the oat cereal next - don't they need the cereal for the iron? Did anyone else offer an iron supplement of some kind if they won't take cereal past 6 months??

[Penny]

If you're looking for more info about bypassing purees, or introducing finger foods, then there is a great blog and forum at www.babyledweaning.com We're doing this with my son at the moment, because he Would.Not.Eat.From.A.Spoon, ever.

Cereal for iron- there's some evidence that if the babe is not eating enough solids by 12 months, there is a risk of iron deficiency. Note, that it might be a problem at 12 months, NOT 6 months. And its a risk, not a 100% certainty! At 6 months, food is about mucking around and having fun, babies should still be getting all their serious nutrition from milk. Formula is iron-fortified but if you are breastfeeding, and concerned about iron, try eating more iron-rich foods with foods high in vitamin c.