When to start solid foods with a baby, with Ailsa McHardy – Food For Kids Podcast episode 24

Joanne Roach (00:13)

Hello and welcome to the Food for Kids podcast. I'm Joanne from the Foodies. On today's episode I'm talking to Ailsa McHardy from Little Nutrition about what age to start weaning your baby. I reached out to Ailsa to talk about this after she put out a great Instagram post on the subject which was really supportive and empowering to parents about their own ability to interpret the guidelines alongside their intuition about their child's readiness to eat solid foods.

My kids are in their early 20s now so it's a long time since I was weaning them. And like a lot of advice back then, the guidelines about weaning were really rigid, so we had quite a hard time when our kids didn't exactly conform to the rules.

I wanted to ask Elsa what the best advice is nowadays for parents to try to decide when to introduce solids and we had a really helpful chat about it which is coming up now.

Joanne Roach (01:01)

So the six month guideline of when you should start introducing solid food. Is that a guideline we should really stick to? How current is that? What do you think about that guideline?

Ailsa (01:10)

Yeah, so it's a really interesting topic and it's something that I could talk about until the cows come home because I think it really comes down to supporting people to be really intuitive with how they feed their babies.

So the six month thing that's the current UK guidance and what the actual wording of that guidance is, is that most babies will be ready to wean at around six months and some might be ready sooner than that but that we shouldn't introduce solids to babies until they are at least 17 weeks. So for some people, they will say, well, that means you have to wait until six months. And for some people, they will think, well, that means between 17 weeks and six months, most babies will be ready. So it's partly about, how we even interpret that guideline.

But the thing that I always come back to when I discuss this with the families that I work with in clinic or with colleagues and definitely with people that I would interact with on social media is that you could have a room full of babies that are six months old, exactly, according to the calendar, and they will all be very different. So in terms of their head strength, in terms of their hand to mouth coordination, in terms of even what, gestational age they have been born at will make a difference.

So I think sometimes when we're very hard and fast about that six month thing, we're making an assumption that six months is the right time for every baby, where the reality is that babies have totally different growth and development trajectories. And we really just need to be much more focused on individual babies, I think. And that's the problem with the really hard rule about six months, or when it's communicated to parents as if it's a hard rule, is that that starts to kind of override parents' intuition about, I can see that they're showing all these signs of readiness to wean or I can see that they aren't yet ready.

 And the other thing that I often find really helpful as a reminder, both for myself and in discussion with parents as well, is that when we talk about a baby being born at term, we know that that means anything from 37 weeks of gestation, but we also know that many babies will be born at 42 weeks of gestation and some even later than that. So you've already got a five week window of difference in the true weeks of age of that baby. Yet, as soon as they're born, we're then saying, well, six months, that's exactly the right time that you should start weaning. And we kind of overlook that, well, that baby might be four weeks younger or four weeks older really different.

And then I think also, when we think about babies that are born prematurely, so before that full term, 37 week mark, and we know that there's really varying degrees of prematurity. again, when we talk about these really hard and fast rules around age of weaning for parents who have had babies that have been born a little bit before term, or very significantly before term, that can create a lot of challenge for them as well, because maybe they have a baby that developmentally is quite ready to start weaning by the time they're younger than six months of corrected gestation. So I think this is all why we need to take it back to looking at the baby as an individual and allowing parents to feel empowered to do that. Because I think often things are communicated to parents and to families as like, if you don't do this, you're doing it wrong. Or you have to wait till six months. And if you don't, I'm going to make you feel like it's really bad that you're doing something that I'm telling you isn't exactly the right thing to do. And I think what we really need to do is empower them and allow them to feel I can wean my baby at the stage that's right for them. And that might be five months and three days, or it might be six months and 17 days or whatever. There's not a rule. There shouldn't be a rule, it shouldn't be about a calendar, it should very much be about the baby themselves and how ready they are.

Joanne Roach (04:46)

That's really nice to hear because I think my family is a really good example of that because our first child was actually quite premature because I had pre-eclampsia so he was born at 34 and a half weeks so you would expect him to be a child that should wean late effectively because he'd been born before his due date and yet actually from about four months on he was grabbing food, wanting to eat food, you could tell he was very interested in it. And he had been a good sleeper and then started waking and crying and fussing in a way that really seemed to be linked to hunger cues way before six months and yet obviously because he was Prem and because the guidelines then were very strict we really felt like we were doing the wrong thing by introducing anything before six months whereas my daughter was born at 42 weeks and she was really laissez-faire.

So even with all the things that you're saying about gestational age, individual children are individual children and I think it's nice that you're saying about empowering parents to kind of look at the cues of their own individual child. So what are those cues? What are the things that parents should be looking out for to try and put together a picture of their child being ready to wean?

Ailsa (05:52)

Yeah, so I think so using to a degree age as like a rough marker is probably helpful. So I would say probably from, you know, four and a half or five months, you can start looking out for the cues, looking out for the signs. So definitely what's really important is really good head control. So a baby that's able to support the weight of their own head without needing help to do that. So they can very easily hold up their own head for good periods of time. They're not kind of flopping around or struggling to hold the weight of their own head, so you can hold them or sit them on your knee or something like that and they have no problem with keeping their head upright.

Ideally, they should also be able to sit unsupported for a short spell of time. So you should be able to sit them on the floor and they should be able to hold themselves like that ideally. You also want to look for things like hand to mouth coordination. So that's things like putting toys, picking things up and purposely putting them in their mouths, starting to demonstrate that skill that they can move something from another place and put it in their mouth. That's really important.

And then also loss of what we call the tongue thrust reflex. So any of us that have had babies will be familiar with that thing that they do where they push their tongues out of their mouth. And it might be when you start giving them food, might be with other things that they sit and do this kind of pushing their tongue out of their mouth. And when they get to the stage of being ready to start weaning, they will start to lose that, which will allow them to keep food in their mouth. So if you start weaning a baby and you perhaps you're spoon feeding and you put a little bit of food in their mouth and they just very consistently push it back out again with that tongue reflex. That's an indication that they probably aren't quite ready yet and you would then wait for a week and then try again and see if that started to go. So it's those sorts of sets of signs.

Now in terms of things like increased night waking or increased need for feeds on their own wouldn't be signs of readiness. So we wouldn't say the baby's getting hungrier, you should start weaning it, or the baby's waking up more at night, you should start weaning it. But it may very well be that in the context of those other signs of readiness, that those things will also correlate with that.

And it's also important that whilst we talk about those signs of readiness, and ideally a baby showing all of those that there are absolutely circumstances where it's appropriate to wean a baby that maybe isn't quite doing all of those things. So they might have excellent head control, they might have really good hand to mouth coordination, they might have lost the tongue thrust reflex, they're engaged, they're interested, they're bringing things to their mouth, but maybe they can't quite sit up unsupported, but they're completely fine in a high chair when they're well secured in that, that might be completely fine.

So it's again, really individual. And I think when we have these kind of tick box rules, we potentially, stop parents from doing what they feel and know is the right thing for their baby. But then there's also cases where there's additional reasons to start weaning in a baby that maybe isn't showing all of those signs of readiness. So I'm sure that listeners will have heard of things like starting weaning early because of severe reflux or starting weaning early maybe because of growth concerns. Now that all needs very individual assessment and advice from an expert pediatric dietician or kind of medical team. And there's not a good evidence base that shows us that early weaning can help with reflux.

Ailsa (09:12)

So it's not kind of across the board advice, but absolutely there are individual cases where early weaning has made a huge difference and helped with really good outcomes for babies that have got reflux. So it's about being really individual. But those are the key signs. So loss of the tongue-thrust reflex, good head control, ideally sitting, and good hand-to-mouth coordination with intention. So not just when they accidentally hit themselves in the face with their little hand or something like that, but when they intentionally pick up a toy and bring it to their mouth and and have got the skill and the coordination to do that, would general signs of readiness that a baby is ready to start with some solid food.

Joanne Roach (09:47)

And in the cases where you think that there might be some issue that means that they might need to wean early for that you'd be looking at getting some expert advice

Ailsa (09:56)

Yeah, absolutely. So we need to be really careful because obviously there's risks from a nutrition point of view. So we know that definitely for the first six months of life, that breast milk is the optimum feed for babies. And if not that, then formula milk. So if we're reducing that in any way or changing to solids, we need to make sure, for example, that the solids that they have are really nourishing, that they're going to provide them with all the nutrition they need to continue to grow and develop well.

Also things like choking risk we have to be really careful of, particularly in younger babies. So definitely it's something that I think individual support definitely from an expert pediatric dietician be really important in those sorts of cases.

Joanne Roach (10:39)

So I found that chat really reassuring and I'm always really pleased at how much the expert guidance now has become much more flexible and individualised. As I said in our conversation, although we read books about parenting and there were rules about different things in there, there wasn't much advice on the internet back then and we just had to make up our own mind without anybody expert to work with.

I love now that there are brilliant qualified professionals like Elsa and some of the other paediatric dietitians out there on socials not just giving rules and guidelines but also giving parents the information they need to be able to make their own judgements and decisions.

Back then we had well-meaning grandparents saying that if a child's hungry we should give them solids regardless of their age and then we had medical guidelines saying not to do anything before six months whatever the child was doing

I loved that in that interview Ailsa gave us several different markers to look out for that aren't just about hunger cues and interest in food, but also about developmental markers to show whether they can handle the food safely if you choose to give it to them. I would have loved to have known those details when we were at that stage. If you want to know more about weaning or know someone who might, Ailsa’s got a new free ebook out called The Ultimate Guide to Weaning. And if you want a little extra help, she has a programme which might especially be useful for you if you're a family with any of the concerns she mentioned in the interview. I'll put links to both of those in the show notes as well as her online masterclass for weaning and her Instagram feed. Her posts are really supportive and helpful. Please pass this episode on to anyone you know with a new baby so it can reach the people who need it most. And hopefully I'll see you on the next episode on Thursday. And in the meantime, happy eating!

00:00 Introduction

01:01 The six month guideline for starting weaning

05:45 Cues that your child might be ready for weaning

08:37 When special circumstances need a different approach

10:39 Summary and outro