How Much Does Baby Gain in Last Month

My last post went into great detail about the research on age of starting solids and health outcomes, including nutrition, growth, illness, and allergies. If you read that post, you know that there are small risks and benefits of starting earlier or later (in the range of 4-6 months), but there's no evidence for an optimal age of starting solids for all babies. Here's what to look for instead, starting with a brief summary of the data on age:

1. Your baby is at least 4 months of age.

Read my post on this if you want to know the details and see the references. If not, here's a summary:

• There is good evidence that it's best to wait until at least 4 months of age to start solids, unless advised otherwise by a doctor for a specific medical reason.
• Starting solids between 4 and 6 months of age may give babies a boost in iron nutrition, assuming they're getting some good dietary sources of iron. Exposure to potentially allergenic foods, such as wheat and eggs, by about 6 months may reduce the risk of allergy to those foods.
• Exclusive breastfeeding until 6 months of age may reduce your baby's risk of minor gastrointestinal infections, although this isn't shown in all studies. For moms, it may also result in greater weight loss and prolonged lactational amenorrhea.

Whether or not you start solids at 4 months, 6 months, or somewhere in between is up to you and your baby. The research on this topic is still evolving, and either is a fine choice. In fact, given that babies develop at different rates, it seems unlikely that all babies would be ready to start solids the moment the clock strikes midnight on their 4-month birthday or 6-month birthday.

This was the same sentiment eloquently expressed in a 2009 editorial by British pediatrician Martin Ward Platt, using the term "weaning" to mean starting solid foods:

"The weaning debate has been largely predicated on the notion that there is some magic age at which, or from which, it is in some sense ''safe'' or ''optimal'' to introduce solids. Yet it is highly counterintuitive that such an age exists. In what other area of developmental biology is there any such rigid age threshold for anything? We all recognize that age thresholds are legal inventions to create workable rules and definitions, and have no meaning in physiology or development, yet when we talk about weaning we seem to forget this."¹

Given this, it's really up to you to follow your baby's lead, watching for the developmental signs discussed in the rest of this post.

2. Your baby can sit upright and hold his head up straight.

These gross motor skills signal that your baby has the core body strength and stability needed to eat solid foods. Pediatric feeding specialist and certified speech language pathologist Melanie Potock explained why this is so important on my Facebook page:

"Gross motor stability (in this case trunk stability) provides the support for fine motor skills. It's very hard to learn to eat purees off a spoon or do any sort of self-feeding of soft solids if the trunk is not supported. Try it yourself by letting your trunk relax and fall into the back of your dining chair, slightly slumped. Now stay that way and try to bite, chew and swallow. Imagine if you were just learning to eat this way!"

[I'm thrilled that Melanie Potock wrote a guest post explaining more about why stability is so important and how to best seat your baby comfortably at the table here: S.I.T.! Feeding Your Child Using Stability and Independence at the Table ]

In other words, when babies have gross motor stability in place, they'll have a much easier time with the fine motor and oral motor skills needed for feeding. That means that baby should be able to sit comfortably upright, on his own or with a little support, and hold his head up to face you. In one study, babies were able to sit in a caregiver's lap without help at 5.5 months, on average, but this milestone was quite variable (standard deviation of 2 months).²

Trunk stability is also important because it allows you and your baby to be able to be face-to-face during feeding and for your baby to be an active participant in deciding whether, how much, and how fast to eat. You offer baby a bite, and he leans forward and opens his mouth if he'd like to accept, or he turns his head away to say no thanks. With good trunk stability, a baby can communicate his wants and needs to you, and you can be responsive to them. This way, feeding becomes a respectful and pleasant conversation between the two of you.³

Feed your baby responsively, watching for his cues of wanting more or being done, like a back-and-forth conversation.

3. Your baby has the oral motor skills to handle solid foods.

At birth, most babies are already skilled at sucking. Sucking is an involuntary reflex that develops around 32 weeks of gestation, and babies practice it in utero before birth. Sucking gives them the skill to efficiently transfer milk through a nipple, whether from breast or bottle.

To eat from a spoon, a baby needs a different set of oral motor skills. She needs to have the jaw stability and coordination to open her mouth when offered a bite. She needs to have lost the tongue thrust reflex present earlier in life, which meant that if you placed food on her lips or in the front of her mouth, her tongue would immediately push it back out. Instead, she needs to be able to move her tongue to push food to the back of her mouth. Her gag reflex needs to have toned down and moved to the back of her mouth, finally allowing her to swallow her first bites of food. These oral motor skills will be in place sometime between 4 and 6 months for most babies.²

Some babies and/or their parents prefer to skip purees and start right in with self-feeding soft foods. This requires greater oral motor development to bite off pieces of food and use the tongue to move it between the jaw for mashing before swallowing. It also requires fine motor development to rake foods on a tray, pick them up, and put them in her mouth.

All of this development is pretty impressive when you think about it, and in most babies, it happens right about the time when they start to need nutrition from additional foods beyond breast milk – around 6 months.

Babies gain the gross, oral, and fine motor skill needed for feeding at different ages. These data are based on a longitudinal study with 57-60 babies assessed at each time point (Carruth and Skinner, 2002).

How will you know that your baby has the oral motor development to eat solids? One indicator is that she's putting her hands and toys in her mouth without gagging on them. But at a certain point, you'll just need to offer her a bite of food and see what happens.

4. Your baby is interested in beginning and continuing to eat solids.

By 4-6 months, most babies are showing interest in foods if you're eating around them. BabyM has been in our arms at meals since he was a newborn, and by 4 months, he was sitting up in our laps and lunging forward towards our plates. He was watching us eat and grabbing at our hands and utensils as if he wanted in on the fun. I was also giving him his vitamin D drops on a spoon, and he was eagerly opening his mouth for it.

Of course, grabbing for food doesn't mean that your baby is hungry or even has an interest in trying food – just that he is interested in putting in his mouth what you're putting in yours. Think about it… babies this age explore everything with their mouths. And here you are, putting something in your mouth, and looking pleased about it. Of course your baby wants to get in on that action.

Still, this interest is a sign that your baby might be up for trying solids. So if he's sitting up and putting things in his mouth, you might now try a bit of food. Offer him a bite, but always let him choose if he wants to take it. Wait until he opens his mouth for it. Let him move that food around in his mouth, taste it, swallow, and think it over. Then, does he open his mouth for more? If so, carry on with the next bite. If he doesn't show interest in another bite – not opening his mouth, turning his head away, or even starting to fuss or cry – then you know he's not quite ready. Give him a few days or a week or more before you try again, and just let him chew on a spoon at dinner until then.

I tried giving BabyM a few bites of food around 4.5 months. I'd been researching this topic, and as I said, he was showing lots of interest in food and the spoon, so we tried a bit of sweet potato. He readily opened his mouth for the first bite but then pushed most of it right back out onto his lips (tongue thrust reflex in action). He fussed a little and showed no interest in a second bite. A few days later, I offered him a taste of oatmeal thinned with breast milk, and he had the same response. So, we took a break from solids for a while. BabyM continued to join us at the table, where he learned other things about food – that it's enjoyable, social, and something to be shared with family.

Just today, at 5 months and 1 week, BabyM was grabbing for the leftover pot roast I was eating for lunch. I threw some in the food processor and offered him a few bites. He ate like a pro from the spoon and kept opening his mouth for more bites, even fussing a little when I was too slow to offer him more. Letting him lead the way ensures that eating will be a pleasant experience from the start.

This brings me to my last point: It's really important not to pressure a baby to eat.

What's most important is getting off on the right foot with feeding responsively, showing your baby that he's in charge of deciding whether to eat, how fast, and how much. You'll notice there aren't a ton of references on this post, because there really aren't a lot of studies evaluating outcomes based on starting solids according to developmental readiness. (Age, apparently, is much easier to evaluate, as evidenced by the reference list in my last post.) But everything about readiness to eat solids hinges on this important concept of responsive feeding, and there is strong evidence to support this.

Responsive feeding sets infants up to eat and grow well. For example, one recent study found that when mothers of 4-month-olds had low awareness of infant hunger and satiety cues, they were more likely to pressure their babies to eat, and their babies were more likely to be picky eaters at 2 years of age.⁴ Some research indicates that greater sensitivity to infant cues results in slower (and presumably healthier) weight gain in infancy, perhaps contributing to healthier weight in childhood.^5,6

In another study, mothers who were responsive in their feeding of solids had babies that seemed to self-correct their growth trajectories in late infancy. That is, babies that had gained weight quickly in early infancy showed slower growth between 6 and 12 months, and those that were growing slower began to gain more. The opposite happened when mothers were more controlling in their feeding: smaller babies stayed small, and bigger babies gained more.^7,8 Babies are good at self-regulating caloric intake to meet their needs, and we want to do everything we can to trust this innate ability and honor their cues.

Is doubling of birth weight a sign that baby is ready for solids?

I've seen doubling of birthweight, or hitting about 13 pounds, listed as an indicator of solids readiness on several reputable sites (plus plenty of less reputable ones). Problem is, I can't find any research to back this up or any explanation of where this "milestone" comes from. As far as I can tell, it's completely arbitrary. It may be true that most babies who have doubled their birth weight are ready to start solids, but there's no evidence that a certain size is important. Instead, it's about gross, fine, and oral motor skills, and interest in eating.

Here are two of my favorite books for advice about feeding solids:

(These are affiliate links to Amazon, so I get a small commission if you decide to order one. Thank you for supporting Science of Mom!)

• Child of Mine by Ellyn Satter
• Fearless Feeding by Jill Castle and Maryann Jacobsen

You can't beat Satter's Child of Mine for insightful discussion of responsive feeding and feeding dynamics. The only problem is that some of the information about starting solids is a little outdated – mainly that she recommends delaying potentially allergenic foods, and I think she's a little too devoted to rice cereal for some of my reader's tastes. Fearless Feeding is more concise and gives lots of practical advice about what to feed at this stage. Of course, my own book also includes several chapters on feeding solids, with details on when and how to begin and the best foods to feed. My book – The Science of Mom: A Research-Based Guide to Your Baby's First Year – is now available on Amazon.

References:

1. Platt, M. P. W. Demand weaning: infants' answer to professionals' dilemmas. Arch. Dis. Child. 94, 79–80 (2009).
2. Carruth, B. R. & Skinner, J. D. Feeding Behaviors and Other Motor Development in Healthy Children (2–24 Months). J. Am. Coll. Nutr. 21, 88–96 (2002).
3. Black, M. M. & Aboud, F. E. Responsive Feeding Is Embedded in a Theoretical Framework of Responsive Parenting. J. Nutr. 141, 490–494 (2011).
4. Cassells, E. L., Magarey, A. M., Daniels, L. A. & Mallan, K. M. The influence of maternal infant feeding practices and beliefs on the expression of food neophobia in toddlers. Appetite 82, 36–42 (2014).
5. Worobey, J., Islas Lopez, M. & Hoffman, D. J. Maternal Behavior and Infant Weight Gain in the First Year. J. Nutr. Educ. Behav. 41, 169–175 (2009).
6. DiSantis, K. I., Hodges, E. A., Johnson, S. L. & Fisher, J. O. The role of responsive feeding in overweight during infancy and toddlerhood: a systematic review. Int. J. Obes. 35, 480–492 (2011).
7. Farrow, C. V. & Blissett, J. Controlling Feeding Practices: Cause or Consequence of Early Child Weight? Pediatrics 121, e164–e169 (2008).
8. Farrow, C. & Blissett, J. Does Maternal Control During Feeding Moderate Early Infant Weight Gain? Pediatrics 118, e293–e298 (2006).

How did you know your baby was ready to start solid foods?

How Much Does Baby Gain in Last Month

Source: https://scienceofmom.com/2015/05/28/4-signs-your-baby-is-ready-for-solid-foods/

Share this post