8.0 - Weaning Process

Sources

1. The New Contented Little Baby Book by Gina Ford
2. Your Baby’s First Year by American Academy of Pediatrics
3. Dr Ang Ai Tin’s Talk

(8.0) INTRODUCTION

1. You must wean because baby’s brain grows the fastest in the first 2 years of life. So baby needs more nutrients from other sources of food.
2. Babies rely on the introduction of iron-containing foods at 6 months, as their bodies’ iron stores, with which they are born, become depleted at this age.
3. Iron is essential for healthy red blood cells that transport oxygen around the body.
4. Children who do not take in sufficient amounts of iron, are at risk of developing iron-deficiency anaemia which causes tiredness, irritability and an overall lack of energy and enthusiasm.
5. Iron-containing foods are breakfast cereals, broccoli, lentils and baby foods with iron. You will need to progress quickly through the food groups to include meat or vegetarian alternatives for their iron content.
6. Babies on formula will have their iron supplemented in the milk.

(8.1) When to Wean

1. Golden rule: Baby should not be given food before 17 weeks. It takes up to 4 months for the lining of baby’s gut to develop and for the kidneys to mature enough to cope with the waste products from solid food.
2. If solids are introduced before a baby has the complete set of enzymes required to digest food properly, his digestive system could become damaged.
3. Early introduction of foreign protein may increase the risks of food allergies.
4. If baby is under 6 months (and over 4 months) and showing all signs below, it is vital to discuss things with baby doctor and decide whether to wean early or not.
5. A baby could be ready when:

• Loss of extrusion reflex
• Reduces milk feeds
• Dislikes milk
• Mouthing finger
• Slower weight gain
• Waking for night feeds
• He has been taking a full feed 4-5 times a day and has been happily going for 4 hours between feeds, but now gets irritable and chews his hands long before his next feed is due.
• He has been taking a full feed, and screams for more the minute the feed finishes.
• He usually sleeps well at night and nap times but is starting to wake up earlier and earlier.
• He is chewing his hands excessively, displaying eye-to-hand coordination and trying to put things into his mouth.

1. If you decide to wait until the baby is 6 months before you introduce solids, it is important that his increased hunger is met by introducing further milk feeds.

(8.2) Programming the Future

1. Purpose-driven to prevent:
   1. Food allergy
   2. Fussy eater
   3. Brain starvation
   4. Obesity
   5. Inflammatory diseases
   6. Cancer transformation
   7. Weak immune defence

1. Introduce one food at a time as it makes it easier to identify food intolerance. Offer only a small amount of food (about 1 tsp) and gradually increase the quantity over a few meals.
2. Avoid adding fats such as butter or oil, unless advised by your doctor or dietitian, as they are harder to digest for small babies.
3. Try not to add sugar, use a sweeter fruit or add a little mashed banana, which is sweet. Do not use honey until your child is 12 months old.
4. Never use whole nuts and it is better not to serve smooth or chopped nuts until your child is two, but seek advice from your GP or health visitor.
5. Thin your baby's purees down with breast milk, baby milk or water only.
6. Some foods may cause an allergic reaction, so avoid them until he's six months. These include citrus fruits, well-cooked eggs, wheat-based foods, strawberries and fish. If allergies run in the family, ask your health visitor when to introduce certain foods.
7. To be flexible and have a happy, easy-going attitude towards meal times. It's also vital to praise your baby for eating a little or a lot. Never reward eating with sweets. Instead, give your baby plenty of hugs, kisses and attention.
8. You could give your baby vitamin drops containing vitamins A and D from six months. It's a way of ensuring she has enough of the important vitamins she needs. This is especially important for breastfed babies, and babies who drink less than 500ml of formula milk a day.
9. Give your baby sips of water from a cup or beaker at mealtimes. If you give your baby fruit juice, keep it to mealtimes only, and dilute it well. Add one part juice to 10 parts water.

(8.3a) Foods to be Avoided – To Prevent Choking

1. Small, hard foods like whole nuts, seeds, large pieces of dried fruits with stones and popcorn
2. Slippery foods like whole fish balls, whole grapes, candy and large pieces of meat
3. Sticky foods like peanut butter, which, if offered from a spoon, may get stuck in baby’s throat and cause difficulty in breathing

(8.3b) Foods to be Avoided – SUGAR

1. This refers to any form of table sugar that is added to food, and food items that contain added sugar, e.g. sweet biscuits, sugar-coated breakfast cereals, cakes and soft drinks
2. It provides ‘empty’ calories, i.e. energy (calories) with little or no other nutrients
3. If introduced early, it may cultivate a ‘sweet tooth’ in baby
4. Sugar is best avoided until baby is at least 1 year old
5. Sugar may be listed as dextrose, fructose, glucose or sucrose.
6. Too much sugar in the diet may not only cause baby to refuse savoury food, but can lead to serious problems such as tooth decay and obesity.
7. Because sugar converts very quickly into energy, babies and children who have too much may become hyperactive.
8. Products such as baked beans, spaghetti hoops, cornflakes, fish fingers, jam, tomato ketchup, tinned soups and some yoghurts are just a few of everyday foods that contain hidden sugars, so care should be taken that when baby reaches toddlerhood he does not eat these foods in excess.

(8.3c) Foods to be Avoided – HONEY

1. It can contain spores of a bacterium called Clostridium botulinum. If consumed, may germinate in a yound baby’s immature digestive system thus may result in food poisoning, which can be fatal.
2. Honey is safe for children above 1-year of age and adults.

(8.3d) Foods to be Avoided – SALT

1. Children under 2-year of age should not have salt added to their food – they get all the salt they needed from natural sources such as vegetables.
2. Adding salt to a young baby’s food can be very dangerous, as it may put a strain on his immature kidneys.
3. Research also shows that children with high salt intake may be more prone to heart disease later.
4. When baby reaches the important stage of joining in with family meals, it is important that you do not add salt to the food during cooking. Remove your baby’s portion, then add salt if needed for the rest of the family.

(8.3e) Foods to be Avoided – FRESH MILK

1. It is not recommended by the ESPGHAN and AAP for children under 1-year of age because fresh milk is poor source of iron, vitamin E and essential fatty acids.
2. Fresh milk contains too much protein, sodium and potassium, which may stress baby’s immature kidneys
3. Its protein and fat are more difficult for baby to digest and absorb.

(8.3f) Foods to be Avoided – LOW FAT and SKIMMED MILK

1. These type of milks are not suitable for babies below 12 months of age because they do not provide them with enough calories and fat to grow optimally.
2. Low fat milk can be offered to children aged 2 years and above.
3. Do not give skimmed milk to children under 5 years of age.

(8.3g) Foods to be Avoided – BRAN, WHOLEMEAL BREAD and BROWN RICE

1. They are high in a dietary fiber that may hinder baby’s absorption of iron, calcium and zinc from his diet.
2. They are very filling and may spoil your baby’s appetite for other foods
3. They can be gradually introduced into your baby’s diet when he is 1-year and older.

(8.3h) Foods to be Avoided – HIGHLY ALLERGENIC FOODS

1. These include egg whites, shellfish (e.g. prawns and crab), peanuts and tree nuts (e.g. almonds, cashews, walnuts), wheat, fish (cod, sea bass, flounder), and soy. Avoid also French beans, garden pea, legumes, beans, peas, lentils, long beans.
2. These foods may cause an allergic reaction in some children
3. They are best avoided until a child is at least 12 months old.
4. Foods to avoid until after 12-months to prevent general rash are crustaceans, oyster, tree nuts, squid, cooked white egg and peanut
5. Foods to avoid until after 12-month to prevent oral rash are citrus fruits, green kiwi, pineapple, mango, cantaloupe, dairy produce.

(8.4) Preparing and Cooking food for Baby

1. Always ensure that all surfaces are clean and have been wiped down with an anti-bacterial cleaner. Use kitchen roll for cleaning surfaces and drying, as it is more hygienic than kitchen towels, which may carry bacteria.
2. All fresh fruits and vegetables should be carefully peeled, removing the core, pips and any blemishes. They should then be rinsed thoroughly with filtered water.
3. If you are advised to wean baby early, remember that all fruit and vegetables must be cooked until your baby is 6-month old. This can be done by either steaming or boiling in filtered water. Do not add sugar, salt or honey.
4. During the initial stages all food must be cooked until soft enough to puree to a very smooth consistency. A small amount of the cooking water may need to be added so that the mixture is similar to smooth yoghurt.
5. If using a food processor, check carefully for lumps by using a spoon and pouring into another bowl. Then transfer to ice cube trays or containers for storage in the freezer.
6. ALL FEEDING EQUIPMENT SHOULD BE STERILISED FOR THE FIRST 6 MONTHS, AND BOTTLE AND TEATS FOR AS LONG AS THEY ARE USED.
7. Sterilise ice cube trays or freezer containers by boiling them in a large saucepan of water for 5 minutes.
8. Use a steam sterilizer, for small items such as spoons or serving bowls.
9. Wash cooking utensils as usual in a dishwasher or rinse handwashed items with boiling water from the kettle.

(8.5) Packing food for the freezer

1. Make sure cooked, pureed food is covered as quickly as possible and transfer it to the freezer as soon as it’s cool enough
2. Never put warm food into a refrigerator or freezer
3. Check the temperature of your freezer on a freezer thermometer, it should read - 18°C.
4. If using an ice cube tray, fill with pureed food, open-freeze until solid, then pop the cubes out of the tray and into sterilized plastic box. Non-sterilized items such as plastic bags can be used from 6 months. Seal well and freeze.
5. Label items clearly, adding the date.
6. Use foods within 6 months.
7. Never refreeze cooked food. Food can only be put back into the freezer if it was originally frozen raw and then defrosted and cooked – a raw frozen chicken breast, defrosted, for example, can be frozen as a cooked casserole.

(8.6) Defrosting tips

1. Defrost frozen (covered) food in the fridge overnight or leave at room temperature if you forget, transferring it to the fridge as soon as it has defrosted. Make sure it is covered at all times and stand it on a plate to catch the drips.
2. Never speed up defrosting by putting food into warm or hot water.
3. Always use defrosted foods within 24 hours.

(8.7) Reheating tips

1. Food should be heated thoroughly to ensure that any bacteria are killed. If using jars, always transfer to a dish, never serve straight from the jar. Any food left over should be discarded, never reheated and used again.
2. When batch cooking, take out a portion of food for your baby to eat now and freeze the rest. Don’t be tempted to reheat the entire mixture and then freeze what is left.
3. If baby has only eaten a tiny portion it can be tempting to reheat and serve leftovers later. Please don’t – babies are much more susceptible than adults to food poisoning, so get in the habit of throwing leftovers away immediately.
4. Reheat foods only once.

(8.8) How to Introduce Solids at 6 Months

1.             Don’t add cereals in milk feeds when you start weaning your baby to solids.

2.             Ensure that the first solid feed is watery and is done by parents. Observe that the baby chews his food and rolls it with his tongue.

3.             Start off with small spoonfuls. Ensure that the weaning process into solids is fun and the baby learns to enjoy the feeding, and learns that feeding time is a socializing time. Why not introduce food in a baby bowl with baby seated in her high chair? She will learn valuable lessons like grasping objects, hand-eye coordination and chewing. She will find it fun too!

4.             Avoid big pieces of food which can choke the baby.

5.             Avoid watering the food down by forcing the baby to drink water to wash down the solid. Drinking too much water can cause the baby to regurgitate.

6.             Observe for sensitivity to allergy towards particular foods as allergy can lead to choking if the throat of the baby’s swollen, and may lead to difficulty in breathing.

7.             Sit older children down when introducing them to solids as 6-month-old babies can sit well on high chairs.

8.             Avoid chasing, running and playing while feeding as toddlers can choke on the food. (pg 26)

9.             Once baby is eating solid foods, his need for liquid will increase. Getting your infant used to the taste of plain water is a healthy habit that will last a lifetime. Juice is not recommended; although if you do give your infant juice, make sure your child’s daily juice intake does not exceed 120-180ml. (pg 143)

(8.9) Baby’s First Food

1.             As a toothless baby cannot chew, his first food should be smooth, soft and watery in consistency.

2.             Push food through a sieve, or puree them in a blender or food processor. Dry, lumpy foods can make baby choke and cause asphyxiation.

3.             To start off, fresh fruits such as papaya, banana, or cooked apple may be offered. Scoop, mash and spoon a small amount of these fruits for your baby to try. Avoid acidic fruits such as grapefruit and those with pips (small seeds) such as strawberries and raspberries.

4.             7-9 months: Mashed food in the form of vegetables such as cauliflower, carrot, meat, fish and egg yolk. He can also take porridge. Food can now be coarser and thicker as your baby starts teething. If you use ikan bilis, remember to remove the salt before grinding them into powder. High amounts of sodium chloride can harm baby’s kidneys.

5.             One-year-old: Baby should have enough teeth to chew on small bites of food. The rate of growing varies from baby to baby. The appetite of your baby also fluctuates. He can become fussy and demand for his one favourite food at every meal. In such cases, do not become overly concerned or stressed. Entice him with a variety of new and tempting food.

6.             How to Feed Baby:  Sit baby on your lap. Use a small spoon with a fairly long handle and gently spoon the food to his lips. Avoid pushing it too far into his mouth as this can cause choking. At this stage, baby is learning to use his tongue and throat muscles. Allow baby to enjoy the texture of his food by letting him play with it on his tongue. 2-3 spoonfuls are sufficient for a first feed. Clean and wash his face with a warm towel after feeding.

7.             How to Avoid Meal-Time Misery: All babies have likes and dislikes when it comes to food. Never use force. Always try and be ready to abandon attempts at offering new foods. Be patient and try again a few days later. Avoid giving baby spicy, salty and acidic food. Sit him with the rest of the family at the dinner table at mealtimes so he can come to regard it as a social occasion. (pg 26-28)

8.             Common allergic reactions: Skin (Itchy rash in patches in dense or scattered, eczema, even hives); Swelling (around lips, tongue, mouth, eyes or face in severe allergy); Airways (Inflammation and irritation of the mucosa lining of air passage, may cause breathing problems, wheezing, rhinitis); Digestive system (Abdominal cramp, nausea, diarrhea, vomiting, colic).

9.             Some common allergenic food: Peanuts, eggs, cow’s milk, soy, tree nuts like walnut and cashew, fish, wheat (gluten), Shellfish.(pg 29-30)

(8.10) Choking

1.             What to do: Babies cannot tell us when they are choking. Be alert to signs of the baby turning blue, dusky or visibly struggling in breathing. Tears in the baby’s eyes and his legs and arms are limp and no crying sound is heard. Call for help and act immediately.

1. 2.        How to help: 
2. (1) Check to see if the baby is breathing. Observe the baby’s chest for rising and falling movements, and the sound of breathing. Don’t spend more than 30 seconds here. 
3. (2) Call for help, 995. If you are alone with the baby while calling, try to dislodge the foreign body in your baby’s throat. 
4. (3) Hold the baby in a face-down position, placing him lengthwise on your forearm. Deliver 5 firm blows between the shoulder blades, using the palm of your hand. If the baby does not begin to cry following the back blows, turn him face up in your other arm. Place 3 fingers in the centre of the baby’s chest, raise the finger which is the position in the imaginary line below the nipples. Use the other 2 fingers in a 90-degree angle and administer 5 chest thrusts. Look into the baby’s throat for any foreign body. If it is visible, use your small finger to sweep it out. Repeat until the baby has recovered. (pg 99)