P4P Top 5 Questions Parents Ask Around Starting Solids
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[00:00:50] Dr. Alicia Power: Nita, thank you for joining me today. It's always such a pleasure to chat with you now, before we get into this topic, which is an incredible topic that my patients ask me all kinds of [00:01:00] questions about all of the time, why don't you start by introducing yourself and telling us a little bit about who you are and why you got into the work that you did.
[00:01:07] Nita Sharda: Absolutely. I'm going to try to be as short winded as possible with this story, but I am a registered dietitian. I live in the heart of the prairies in Winnipeg, and I have a variety of different roles as a registered dietitian. So I have a private practice that I maintain where I counsel patients from all life stages and all sorts of nutrition concerns, whether it be chronic disease prevention, management, starting solids, working in peds. So really all through the lifespan.
[00:01:40] But then I also am one half of Happy Healthy Eaters, which is a business that I own, alongside my partner, who's also a registered dietitian. She's also worked with you in the past, Jessica Penner and at Happy Healthy Eaters, our mission is to make sure that parents feel really confident feeding their children. We've focused a lot [00:02:00] of our work on infant nutrition, but we are moving more and more towards general toddler and childhood nutrition education. And this sort of came out of the sheer volume of misinformation that we felt we were inundated with as parents, and we wanted an opportunity to leverage our education and expertise as dieticians and nutrition to be able to provide parents with confidence and to really, to really be able to feed their families from a place of confidence rather than fear, which I think that in the world of social media, a lot of misinformation is spreading far, fast, wide, and we're just trying to be that voice to help, help calm things down for parents.
[00:02:44] Dr. Alicia Power: Love, love, love that. And I also love that you guys actually bring like a multicultural approach to the information that you give to parents, recognizing that not everybody does things the same way, even though, you know, and, and you really bring that to the information that you put out there. So it's [00:03:00] wonderful. So today we're talking about, I don't know if this is going to be the title, but like the top five questions that I get in my office around starting solids and that first few months of feeding your child things other than chest or breast milk or formula essentially. So, why don't we dive in and the first topic we're going to chat about is a little bit about, when is the best time to introduce solids to infants?
[00:03:24] Nita Sharda: Yeah, absolutely. So one of the things that I wanted to make sure that we talk about is that often as a parent, if you are with a clinician, you get this broad recommendation to start between four and six months, if you have a four month old baby parents interpreted as, oh, four months, I should start now. So I think that the message that's often being missed is that it's arranged like between four and six months, but it really depends on your baby's developmental signs of readiness, which is really going to vary from baby to baby and also looping in gestational age. So you might have two babies, [00:04:00] same due date, one was born like at 37 weeks, one was born at 42 weeks. That's February, right? And we all know as parents and as clinicians, like every time you see a baby every month, they change so much. So in terms of signs of readiness, I think that what we need to do is educate parents and make sure that they are able to assess their baby.
[00:04:20] So can their baby sit up with minimal support? Can they move their head from side to side? And that's a really great way for babies to communicate. No, I'm done, but also means that they have good neck control. Is the tongue extrusion reflex, is it starting to become diminished? We see that happen really close to six months.
[00:04:41] And then the interest is our babies like putting food in their mouth and bringing their hands and feet and other objects to their mouth. And if all of these are checked off, then yes, parents can go ahead and start solids. But if your baby isn't really meeting these key features, then it might be time to just wait. So if your baby is [00:05:00] four months or five months, you can just wait until that sweet spot six months, but certainly, beyond six months, we don't want babies to wait too long without that introduction to food because of that iron piece, which I know we're going to chat about a little bit as well.
[00:05:13] Dr. Alicia Power: Now can you explain a little bit more about the tongue extrusion reflex?
[00:05:17] Nita Sharda: Yeah, so this is a reflex that takes place and when babies, a really great test that you can get parents to do at home or caregivers is to just take an empty spoon and put it at the tip of baby's mouth and if they're using their tongue, and basically sticking their tongue out, it may indicate that they're not yet ready for solids because what we want babies to do is to be able to take the food in their tongue, they should be able to, try to push the tongue back so that they can swallow the fat content. But if the baby's just, if the food is just like coming out of the baby's mouth, chances are they're not really ready and those reflexes and their mouth, just, they haven't been integrated. So, Parents can go [00:06:00] back and work on teething toys and other exercises and just revisit feeding.
[00:06:06] Dr. Alicia Power: Awesome. And you guys have like a tearaway sheet that you can send to providers. So how do people get that if they're interested?
[00:06:13] Nita Sharda: Yeah. And you can essentially be anywhere in North America. So we can send you a link to a Google form, just fill it out and we will send you a few tear pads. Let us know how many you need. But it's essentially a flow chart that you can give to patients at that four month or six month visit with their baby and it can help them to really understand if their baby is ready for solids or if they're not ready for solids.
[00:06:37] Dr. Alicia Power: It's an awesome resource and you're going to send me the link and I'll put it in the show notes and I will be the first to sign up for those.
[00:06:43] Nita Sharda: Yeah and one key thing I wanted to mention is like on occasion we still meet parents who get recommendations to start solids before four months, so that's always really interesting. But definitely no earlier than four months and hopefully no later than six months. [00:07:00]
[00:07:00] Dr. Alicia Power: Thank you. Okay, so moving on to the next topic, allergens. This is such a scary thing for patients and and oftentimes as providers, it's a little bit of a challenging one to navigate. So how do you approach introducing allergens in, in babies?
[00:07:16] Nita Sharda: Yeah, I think we really want to lead with that compassion, but there's that sort of a fine line as well. We don't want to breed this generation of parents that are just afraid of everything, right? And so we're seeing parents going to, emergency areas and going to the doctor's office and testing the peanut in advance. And I know that the intentions are really great, but it's also not the culture that we want to breed. We want parents to feel really confident. I think that a really great way to encourage parents to tackle these allergens is to let them know that statistically speaking, there's a really good chance that their baby's not going to have an allergic reaction. And we hear a lot about allergies and [00:08:00] reactions. And I think that those stories are they just pull out our heartstrings. And so we think it's the vast majority, but it's really not. We know that most kids are not going to have allergies. The kids that do, a lot of them are going to outgrow it sometime around age one, two, and three. And then of course, leading with the evidence.
[00:08:19] Now we know that early and often is really important. So in Canada, we have 11 top priority allergens and we encourage parents, around six months, like start knocking, knocking through those 11. You don't have to rush through them. It doesn't have to all be done in the first 10 days or first 10 weeks of feeding, but give yourself a few months to slowly get through them.
[00:08:40] And of course, if your baby has allergies or FPI's, we're going to need to change the pace and we're going to need to adapt the plan, but really there's a really good chance that your baby isn't going to be going to have a have an allergy but early and often now is best practice and I felt really fortunate because my [00:09:00] baby was born in 2017, which is when that landmark study around peanut had been published and all the recommendations were changing so I'm actually really I'm excited I think as clinicians, we have a lot to look forward to and hopefully reduced rates of allergies.
[00:09:16] Dr. Alicia Power: Yeah. Cause I think, and I'm an ish learner, so correct me if I'm wrong, but in the Scandinavian, Norwegian countries, they actually give their vitamin K in peanut oil orally at birth versus us who give it as an injection, and their peanut allergies way less. Right. And so it's in keeping with that early and often exposure.
[00:09:35] One thing I think is really interesting to remember is a lot of people these days are using vegetable emollients as skin moisturizers. And one of our local allergists talked to us and told us, you know what, if kids are introduced to foods via the skin, they're actually at a higher risk of creating an allergic reaction to them.
[00:09:56] So really being cautious in the advice that we give to parents in [00:10:00] terms of moisturizing, not to use food products as moisturizers. Right. So they should be have entered as their first introduction. So first introduction should be via food, not by a skin.
[00:10:10] Nita Sharda: Yeah that's wonderful. And I think that with everything that took place around 2017, it's interesting to see how industry is also catching up. So food industry. And when I go through the food aisles now at a really common Canadian grocer, like you're seeing more peanut puff items and like in great, and like baby food that contains peanut, whereas I don't know, just a year ago. I couldn't find anything. So I find it's interesting to see how evidence comes out, practice changes, and like industries trying to meet that demand too. So it's all really neat.
[00:10:43] Dr. Alicia Power: It's awesome. Okay. Now. I've been known to give the advice of going to the emergency room waiting room, but I only do it in people who have both parents who are like anaphylactic to something, and they're so nervous about it, but generally I [00:11:00] do not give that advice to the vast majority of my patients. Only those who are like super anxious and have a big history of anaphylaxis in their family.
[00:11:08] Nita Sharda: Yeah. Yeah. And that's like patient centered care, right? Like we have to acknowledge that.
[00:11:13] Dr. Alicia Power: Yeah. Yeah. I don't tell them to come to my office and eat it because I don't want to actually have to manage an anaphylactic reaction in an infant. So tell them to go to the emergency where they're appropriately manageable. Okay. So next topic we're going to touch on is the importance of iron in our baby's diets. So let's chat a little bit about iron sources up to six months. And then after six months, What do we do?
[00:11:37] Nita Sharda: After six months, what tends to happen is that the iron store that baby was born with, assuming that the birth parent had adequate iron stores, are starting to deplete. And then their recommendations, or their requirement for iron also increases to 11 milligrams, which for perspective is about 30 to 40 percent [00:12:00] higher than what an adult male requires. And so I think that we really need to drive home this message to parents that first foods need to be iron rich. I think that parents are missing this despite like our best efforts as clinicians to provide this information to parents, but we're still seeing a lot of babies that are having like great foods like banana, avocado, sweet potato, but these foods don't contain the necessary key mineral that babies need, which is that iron piece. And it's so important.
[00:12:34] And what I've learned too, is that this is a there are very few critical stages in your life where you really need this nutrient and this is one of those critical stages, right? Is in infancy and we don't want to miss it. So really encouraging parents and asking parents in sessions, like what are, like, what do you know about iron rich foods or what are the iron rich foods you offer? Do you know how to adapt them for your baby? Can be really supportive because I think not [00:13:00] all are necessarily interested in iron fortified infant cereal, though we love it. We love we love the use of it, but explaining to parents how to, offer beef or chicken or lentils, really whatever it is in their own personal diet that they eat that's iron rich will be really important.
[00:13:19] Dr. Alicia Power: And I think an important piece. And again, I'm not a dietician, so I might be wrong. Need to correct me if I'm wrong. But iron needs vitamin C to really be absorbed well. And in the presence of calcium, it's not absorbed well. And oftentimes our babies are drinking so much calcium and we're giving them maybe not at six months, but a year people are giving them their glass of milk while they're giving them their iron rich foods. And so how can we, what is your top few tips to people in terms of maximizing that iron. So one, the foods you choose, but how are you telling people to actually give it to them?
[00:13:49] Nita Sharda: Yeah, a few things is, and I recently learned about this, but something called a meat factor. So if you are preparing meat, which often contains heme iron, along [00:14:00] with a plant based iron food source that contains non-heme iron, so maybe visualize beef, beans, and rice, like a casserole. So what'll happen is that the heme iron will actually help to increase the absorption of the non-heme iron quite significantly, actually. So that's something that parents can always do is think a little bit creatively when they're meal planning, and a lot of cultural foods might already mix these two types of proteins together so all the more reason to prepare them. And then of course, pairing and being really familiar with what foods contain vitamin C can also be really helpful. In some studies, we see that it's actually 400 percent increase in absorption of that iron, and then if parents are interested in this, they can also use a cast iron for cooking purposes.
[00:14:48] So really great time to introduce that, but it's hard to measure how much, more iron your baby is going to get from that, but it is an ancient, if you will, way of [00:15:00] cooking. And so parents are more than welcome to do that. But I think really starting with offering the iron rich foods, getting babies acquired to the taste of these foods is going to be so, so important.
[00:15:13] Dr. Alicia Power: Some Thank you. All right. So you talked about some different foods and each of those foods have different textures. And I think a lot of people are, babies are, or perception is that we have to like the, the bland, like not the bland, but the pureed foods are like the go to for a long time, right? But no, you and I have had discussions around kind of texture and some babies certainly have challenges with texture, but what is your advice to kind of providers and to patients, frankly, around textured foods and how to introduce them and how quickly to introduce them?
[00:15:48] Nita Sharda: Yeah, I think even just understanding that, we have traditional feeding methods that we've, often recommended, but now there is this surgence of baby led weaning and patients might [00:16:00] come in with questions like, can I do this?
[00:16:02] Is this safe? How do I do it? And I think it's important for us to be informed on baby led weaning and stay on top, on top of it because it is quote unquote a trend or a way of feeding that's really picked up speed and the idea behind it is that babies can self feed from the start so regardless of whether parents are wanting to start with purees and advance slowly, or start with baby led weaning by that baby's first birthday, they should all really be able to manage small bite sized pieces of food that are soft. So, at Happy Healthy Eaters, we're not dichotomous about how parents should start. I think it really depends on that baby's temperament, personality, the parents like anxiety level around choking and gagging, which is a whole other issue, similar to allergies, but I think that progression in any case is key. So if parents are starting with purees we need to remind them it's just a phase, a few weeks, baby's mastered [00:17:00] purees. Great. Let's hit up lumpy. Okay. We're at lumpy. Let's go to minced. Okay. We're at minced time to bring up finger foods. And I think when families understand that they're just short term, then it can be great.
[00:17:11] And what's really confusing is industry actually, because we see these, colorful, seductive, beautiful pouches, and it's a puree consistency, but the package says eight months. At eight months, most babies can tolerate textures well past that smooth homogenous consistency. So there is a bit of confusion and patients have questions and I think we need to be ready to answer them or feel them out to the appropriate people that can support them with that.
[00:17:41] Dr. Alicia Power: So how can you tell a baby is ready for the next phase of texture? What signs are they giving you? Or do you just give it a go and see how they react to it?
[00:17:49] Nita Sharda: Yeah, both. I think you can definitely give it a go. But also if you are leveling up the texture and your baby gags, that's not necessarily a bad thing. They're just doing what they are supposed to be doing in terms of [00:18:00] protection. And so I think there is a bit of a challenge in between those phases for sure for the baby. But progressing is really important, but a few things that parents can do is if the baby has done really well on that homogenous texture, they're taking it back and mealtimes are getting, shorter, they're having, increased volume, then it's time to level it up and change. And parents are welcome to do To mix the best of both worlds so offer your baby a meatball and then some infant cereal so you have puree exposure, parents get to practice responsive feeding, and then baby gets to explore with this meatball that they bring to their mouth as well.
[00:18:39] Dr. Alicia Power: And they're getting their iron. Winner chicken dinner. Or meatball dinner as the case may be. Okay. So our last kind of topic that we wanted to chat a little bit about today is like when you're advising parents, how to actually start introducing solids, how do they progress from exclusively, chest feeding, [00:19:00] breastfeeding, formula to over time, pretty much exclusively foods. So what is the kind of, what do you advise people to do? How do they start? How many times a day? And what's the kind of rate of progression over the first kind of few months of starting to introduce that?
[00:19:16] Nita Sharda: We've looked into some research. It was really hard to find and nail this down. But what we have learned is that when babies are first starting solids at six months, solids really only accounts for five to 15 percent of their energy needs or caloric requirements. So that 85 to 95%, the rest of it is met by human milk or formula. And then as baby ages this is going to change, and then by the time that a baby is about 12 months solids will offer up anywhere around 50 to 65 percent of their needs and the rest will still be met by that milk, and by then it could be a new milk such as cow's milk, the formula or still human milk.[00:20:00]
[00:20:00] And what we like about this gradual progression with respect to introducing solids and the volume and the frequency, is that it really helps to ensure that the nutrition from human milk and from formula is not displaced, and even around breastfeeding messages, we know that as babies age, the rates of breastfeeding parents is declining, but if we want to support that, then I think we need to continue to encourage parents to to think, okay, this is still a really important part of my baby's diet. Cause I think when we tell parents to just start with feeding their baby three or five times a day, the message they might get is, oh, like my milk isn't really as important anymore. But that's not the case. So at Happy Healthy Eaters, we encourage parents at six months, one meal a day. By seven months, two meals and by nine months, three meals. And if you have time for snacks, go ahead. Realistically, like I never had time for snacks until we reached toddlerhood with both of my kids but [00:21:00] slow and steady is great. And again, it's to drive home the value and importance of the nutrition from that liquid diet, which is still important.
[00:21:09] Dr. Alicia Power: Yeah. And I usually recommend to patients to, those snacks, if you don't, if you're not doing food snacks, do that when you're going to feed that milk or the formula, right? So either do a breakfast and then mid morning, do either a feed of breastfeed or milk feed or formula feed and then lunchtime snacks. So the baby's actually hungry around that kind of mealtime. When you're moving more towards that eight, nine months and they're getting a lot of their caloric intake, I feel like at that six month, it's just learning how to actually eat and get the textures and doing it at the family dinner. So they're part of the part of the experience of kind of that family dinner, which I think is really important too. So, and have fun with it, right?
[00:21:44] Nita Sharda: Yeah, have fun with it for sure. And I think if parents are coming in and they're really overwhelmed by feeding and not having fun, just like reminding them that similar to other stages and milestones, it will get better. And this is a skill [00:22:00] for the baby, just like nursing or bottle feeding was like, they don't just come out of the womb and know how to do everything. So your baby, their babies are going to be on this journey of learning to eat. And I'm still learning to eat foods, too. Right. So I'm still learning to use chopsticks for my sushi and nurturing that curiosity around food for myself, even though I'm well into adulthood.
[00:22:23] Dr. Alicia Power: I'm still learning to eat spicy foods. That's the journey.
[00:22:26] Nita Sharda: You need to come visit me.
[00:22:28] Dr. Alicia Power: Right? That'd be so fun. Okay, where can people find you if they want to learn a little bit more about the work that you do?
[00:22:34] Nita Sharda: Absolutely. They can visit happyhealthyeaters.com, we have a section of the website that's dedicated to our Start Solids Confidently course that patients can take and they have access to it for over a year. They also will get some recipes. And then another section is just based on this mission of ours, which is to provide education. So there's different blog posts on a range of [00:23:00] different topics that folks can explore. And then another section, which is really fun and where we get to have a lot of creativity in the kitchen is crafting baby, toddler, kid and family friendly recipes that really have nutrition at the forefront. So that's a really great hub. And then we're on almost all social media platforms, Instagram, we've ventured into Tik Tok and so folks can connect with us there as well. And certainly if you have questions or you want that tear pad, you can also email us and that's [email protected].
[00:23:35] Dr. Alicia Power: Great. And then you have an offer to providers out there if they're interested in understanding what's actually in your course before they start recommending it to patients.
[00:23:44] Nita Sharda: Yeah, and you're welcome to contact us and we can provide you with some back end access to it so that you feel really comfortable with our recommendations and, I think you need to know that you align with the way that we speak to nutrition and so if there's any [00:24:00] questions, but also we're open to constructive feedback too, so please feel free to connect with us and we'd be happy to provide you with some access.
[00:24:09] Dr. Alicia Power: Yeah. And I certainly have been recommending it to patients for a couple of years now. And I've only had wonderful feedback. It's been very well received and really helpful to people. So I appreciate the work that you do, just so, yeah. Awesome. Well, thank you for taking the time and chatting today. I really appreciate it.
[00:24:24] Nita Sharda: No problem.
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