Weaning

Complete guide to weaning and complementary feeding (self-weaning)

Self-weaning, a free mode that allows you to gradually add foods other than milk, but being able to maintain breastfeeding even up to two years of age.

The infant’s experience with food appears to begin before birth, when the fetus is growing, and changes in the mother’s dietary habits will influence the infant’s future acceptance of solid foods. Each phase of life has specific needs, so it is important to know them in order to fully satisfy them.

For some years now, the ways in which to deal with the transition from exclusive breastfeeding or formula milk to solid feeding for the newborn have changed.

Some paediatricians propose guidelines for the gradual introduction of foods, which within two or three months from the beginning of weaning allow to arrive at a complete diet, others leave the management of this completely in the hands of the mother or father moment preferring the self- weaning school of thought , i.e. a freer method that allows you to gradually add foods other than milk, but maintain breastfeeding even up to two years of age.

In both schools of thought there are valid ideas and it is possible, in my opinion, to take the good from both sides, trying to use common sense and, as previously mentioned, observing the child carefully and identifying the signs that may indicate the best way forward.

I am of the opinion that “taking sides” on one side or the other, harshly criticizing the opposite technique, only serves to confuse the ideas of poor parents who are approaching this special moment in the growth of their children for the first time.

How to introduce foods other than milk?

It depends on the type of child we have and the type of family, therefore it is good to evaluate together with the pediatrician keeping some of these points in mind and abandoning for a moment the “faith” to one or the other school of thought.

  • We observe the baby and how its weight has changed from birth to that moment
  • We evaluate what kind of approach he has with the breast or bottle , whether he is voracious, slow, disinterested or very curious
  • We observe if he is sitting well or if he is still having difficulty
  • If he is shy and doesn’t pay attention to reaching out or on the contrary, if he is already intrigued by what is happening on the table
  • If you are already used to bottle feeding or if you were exclusively breastfed
  • Check with your pediatrician if your child has risk factors that expose him to iron deficiency or other essential minerals
  • Make a very accurate assessment of the risk of suffocation , therefore the state of teething and chewing ability
  • Check if there is persistence of the tongue extrusion reflex , which is used to start sucking in the first few months

The family plays a fundamental role! What kind of family are you?

My opinion is that we should always pay attention to those who profess to be “champions” of a school of thought without assessing who they are dealing with.

So think about other aspects as well:

  • Mom and dad work and are not at home during lunch or dinner, so they have to give more precise indications to those who are managing the child, whether it’s the grandparents or the babysitter
  • Mom or dad can take time off from work and therefore can devote more time to mealtimes and continue an approach with continuity
  • Your knowledge of food and nutrition is correct and your diet is balanced (to evaluate it, you could read the guidelines for a healthy Italian diet on the website of INRAN, the National Institute of Food and Nutrition Research or of SINU, the Italian Society of Human Nutrition where you will find LARN, Reference Intake Levels of Nutrients and Energy )
  • If you are not good cooks and always eat the same things, with a limited choice above all of fruit, vegetables and legumes, it is time to make an effort and change, but get help from an expert nutritionist who can show you methods and quantities, you will benefit from all family.

Guide to the introduction of complementary foods to breast milk or formula

Assuming that new foods begin to be introduced in the sixth month and not before, as indicated by the World Health Organization , I propose a guide, which aims to be an example to adapt to your child and family. However, it is important to remember that if the introduction of more solid or solid foods does not take place within the tenth month , the infant could have greater difficulties in introducing and then accepting solid foods.[1]

A different approach is obviously necessary in particular cases, such as preterm births (assessed according to biological and not chronological age) or low weight, or infants suffering from malnutrition or other diseases for which a specific assessment of nutritional needs is necessary.

What foods to offer?

Complementary foods can be divided into transition foods , if specially prepared for the infant, and family foods , if prepared and then shared by the rest of the family.

The latter can in turn be adapted to the neuromotor development of the child by changing their consistency (by breaking, crushing, grinding, blending).

Or they can be enriched in some ingredients to increase their nutritional density (especially in micronutrients such as iron, zinc and some vitamins, with small amounts of foods of animal origin) or energy (by adding fat, for example).

The transition must be gradual

Although there are no specific or contraindicated foods to start complementary feeding,[2] the transition from breast milk or formula to other foods must be gradual to allow the child to get used to and accept new flavors and textures, and tend to the family food model . The latter will be all the more valid the more it manages to be based on the principles of correct nutrition (the Mediterranean diet), with the utmost respect for hygiene standards both during preparation and during the administration and conservation of food.

Some things to know about foods

Sugar

It is advisable to avoid sugar , ( no to sugary drinks and fruit juices because they integrate the energy share by diluting the density in micronutrients and without any nutritional advantage; no to tea and herbal teas both because they are usually very sugary and due to the presence of which can interfere with the bioavailability of important micronutrients such as iron and zinc;

Salt

It is advisable to avoid salt , its intake should be reduced at all ages, but above all in the first year of life, both because the metabolic systems, especially the renal one, are not yet mature, and because this is the period in which lay the foundations for lifelong eating habits;

vegan diet

Vegan diets: strongly discouraged for infants and children due to the risk of nutritional deficiencies: iron, zinc, riboflavin, vitamin B12, vitamin D and calcium, as well as inadequate caloric intake.

Vegetarian diets are not discouraged if well balanced, but with attention to the total energy intake in children under two years of age. Diets that are too rich in fibre, such as vegetarian or vegan, may have insufficient energy intake and are therefore not recommended for children under the age of 2.

More tips

  • Avoid poor quality fats, prefer extra virgin olive oil
  • Choose raw materials of high quality and freshness
  • Use simple and quick cooking methods : pressure, steam, boiling and cooking in the oven, avoid frying
  • Favor the use of aromatic herbs (such as basil, thyme, coriander, fennel, marjoram and sage) and/or small quantities of vegetables (such as carrots, celery and tomato), they can help to enhance the flavor of food while preserving the nutritional content.
  • Breastfed babies in particular are fed milk that is not particularly tasty, so there is no need to add too much dressing or cheese in the hope that the taste will improve. The taste of vegetables or fruit as it appears is the best thing to offer to your child. He will calmly learn to taste different things and decide himself what he likes or not.
  • Avoid honey for the first 12 months , which can contain Clostridium botulinum spores. Since the stomach and intestines of infants do not contain enough acid to destroy these spores, honey should be avoided in infants.
  • Cow’s milk : not recommended for use up to 12 months , due to the risk of iron deficiency anemia and excess protein intake.
  • Instead, milk-based products can be administered but subjected to fermentative processes with consequent lowering of the pH (for example yogurt ) which can have a positive effect on iron absorption
  • The prevention of states of anemia is also strengthened with the introduction of meat and fish into the diet which provide aminic iron , more absorbable than that in inorganic form present in some vegetables

Foods with gluten

Gluten deserves a separate discussion .

The introduction of foods containing gluten (wheat, barley, rye, oats, spelt, kamut) must be done carefully . It is good to avoid both the early (< 4 months) and the late (>= 7 months), to reduce the risk of celiac disease in predisposed children.[3] It is also good, for the same reason, to introduce them when the baby is still breastfed.[4]

For those who want to start with special complementary foods

First baby food : after 6 months, you start by replacing a feed (generally the midday one) with a cereal-based baby food, such as rice, corn, tapioca, kamut, multi-grain cream or semolina in vegetable and legume purée , with olive oil and parmesan. In the following days, when the child has become familiar with the teaspoon, add 1/3 of homogenized (without added salt) or freeze-dried meat or 10g of fresh boiled meat or better still steamed and minced/blended (to be gradually increased up to 50-60 g after 10 months, always observing the child’s appetite) dissolved in the soup itself.

The addition of micron pasta, couscous, burgul can also be evaluated depending on the child’s ability to swallow and family habits.

In this phase, the parents will test whether the child likes a liquid or a more consistent meal (for example, if he suffers from regurgitation, perhaps he will feel better with a thicker meal).

The idea of ​​offering a “single dish” to the child is useful, in fact it can be easier to take in all the essential nutrients, without risking him consuming only one type of food.

The snack : later you can replace a feeding in the afternoon with pureed fresh fruit or homogenized fruit (without added sugar). Start with pear, apple, banana, plum or in any case with seasonal fruit.

Second meal : when the baby is ready , the second meal of the evening will then be introduced, possibly starting with cheese or fish instead of meat to be alternated and offered at least 2/3 times a week. Don’t forget the legumes!

Fruit can also be offered to the child at the end of a meal if he wishes.

Continuing the discovery of the “new” food , always introducing each food group gradually to give the baby time to savor and get to know, gradually replacing other feeds with meals and snacks, you can taste the lean cooked ham , the egg and yogurt.

Around 12 months you can taste cow’s milk and continue to discover different varieties of food always in compliance with the rules of proper nutrition and the Mediterranean diet.

In conclusion , VARIETY and SEASONALITY are the watchwords for starting to offer food to the little ones, always remembering that eating must be a pleasure for everyone, even and above all for those approaching new flavors for the first time.

 

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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