Solid foods

seasalt123

I am a bit confused about when to introduce solids and why. 

As background, my LO was born at 32 weeks. He is 15.5 weeks old, but 8 weeks adjusted. I use his adjusted age for any major developmental milestones and growth charts although we do use his actual age for some things (example: his vaccination schedule follows his actual age since immune system readiness is more closely tied to his time on earth). 

My pediatrician mentioned babies are started on rice cereal at 4 months and other solids at 6. She seemed to think my LO should start cereal in a few days (he will be 4 months old but only 2 months corrected). 

I have no intention of starting him on cereal and, had he been full term, I would have stuck to exclusively breastfeeding until 6 months as per the WHO recommendations. 

However, that issue aside, I am now confused about when I should introduce solids. 

From what I have read, the recommendation to introduce solids at 6 months has to do with both digestive readiness as well as the baby's iron stores depleting around this time. However, what does one do in the case of a preemie? 

His iron stores are likely to run out at 6 months (or earlier since he wasn't term) but his digestive tract would still lack the maturity a normal 6 month old would. He would need to be closer to 8 months to have the same maturity as a term baby. 

Does anyone have experience with this or any suggested reading? 

I will be talking to my pediatrician again about this but I would like to come more fully prepared to the next appointment. Her suggestion caught me off guard. 

kbrands7

I have no suggestions for adjusted age necessarily, but if you wanted to wait longer for a more mature digestive tract, you could ask your pediatrician for a rx for iron drops. The recommendation of cereal at 4mo is outdated. New AAP recommendation is for 6mo. This site gives a good breakdown of other readiness factors and how to make decisions about what to introduce. 
https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Switching-To-Solid-Foods.aspx

seasalt123

Thanks @kbrands7. 

Yes, I think giving babies cereal at 4 months is outdated info. It did shake my confidence in my pediatrician, particularly since she suggested it for him at what should be two months of age. A fellow NICU mom was told the same thing by her pediatrician. 

What I may suggest at my next visit is that LO's iron levels be tested. He took iron drops from 32-40 weeks but hasn't had any since then (although I still have the drops handy). If his stores are running low, I would rather supplement iron than force him to eat solids before he is ready. 

ayeshaohara

From what I've read, and this doesn't really answer your question about whether to use actual or birth date, but in terms of introducing solids, it's not before 6 months but you don't have to start it at 6 months either. I read that if your baby is sitting with you at the table at meal times from 5-6 months, if they start expressing interest in your food and reaching it to put it in their mouth then they are ready for solids. For some babies that could be at 7 or even 8 months! If I was in your position I would be waiting until the LO was at least 6 months birth age, then she's at least 4 months adjusted

dsmith211

ayeshaohara said:

From what I've read, and this doesn't really answer your question about whether to use actual or birth date, but in terms of introducing solids, it's not before 6 months but you don't have to start it at 6 months either. I read that if your baby is sitting with you at the table at meal times from 5-6 months, if they start expressing interest in your food and reaching it to put it in their mouth then they are ready for solids. For some babies that could be at 7 or even 8 months! If I was in your position I would be waiting until the LO was at least 6 months birth age, then she's at least 4 months adjusted

This. What I learned in my breastfeeding class is that there's actually a tongue thrust reflex that starts to diminish around 4 to 6 months, but it could be longer depending on your LO. This is actually to keep them from choking. But when it starts to go away in addition to showing interest in food is when you should really start solids.

missnc77

I have no answers or help for you, but I just wanted to comment that isn't it crazy solids come in at 6 months? I didn't know much about baby milestones since I'm a FTM, but now that I'm reading and learning at what point they start doing things, it's amazing to me. I always figured it took them so much longer for big milestones. I mean, by Thanksgiving, our babies will be drinking from a cup. It blows my mind!

seasalt123

Thanks for all the responses. 

It's definitely reinforced my decision to wait on solids and watch for readiness cues. 

This is one of my pet peeves about advice from your doctor. So many times people put complete faith in their medical professional and so, so many times I've found their advice to be contradictory to what modern guidelines and research advises. It sucks that you can't just trust what you're told. 

lizChesnut

Defintly express your concern and point out specifically because your baby is preemie.  As ridiculous as it sounds, your dr. Might be on "autopilot" so to speak and giving out outdated advice as well as not considering your baby's individual needs. If need be, squedule with a different pediatrician for a 2nd opinion. 

JoMunson

Has anyone heard of the phrase "food is fun 'till 1"? The idea is that while you can give your baby solid food around 6 months, breastmilk/formula should still be their primary nutrition source until at least age 1.

seasalt123

lizChesnut said:

Defintly express your concern and point out specifically because your baby is preemie.  As ridiculous as it sounds, your dr. Might be on "autopilot" so to speak and giving out outdated advice as well as not considering your baby's individual needs. If need be, squedule with a different pediatrician for a 2nd opinion. 

That's exactly what I think is happening. Similarly when I asked her about vaccine schedules for preemies, she just gave me the standard advice for why term infants should be vaccinated. I wasn't asking about why babies need to be vaccinated, I was asking about the timing of preemie vaccines and why. I do feel like I need to hammer home that he's a preemie each and every visit. 

kbrands7

JoMunson said:

Has anyone heard of the phrase "food is fun 'till 1"? The idea is that while you can give your baby solid food around 6 months, breastmilk/formula should still be their primary nutrition source until at least age 1.

Yes. My pediatrician says this!

Bellodomani

We started solids at 5 months because my son showed all the signs of developmental readiness and I had read that starting solids a little before 6 months helps them develop a more diverse palate. No clue if it actually worked or if this is just the way he would have been anyway, but at 2.5 he still literally eats anything except extremely spicy foods. He refused to eat purees starting around 7 months, so we mostly did baby-led weaning type foods, although I'm totally not a rabid baby-led weaner because everyone should just do whatever works for them. Also- a little off topic but for any of you who have toddlers or for when we all get to the toddler phase- if you have food battles with your child, you have to read "How To Get Your Child to Eat- But Not Too Much" by Ellyn Satter. Hilariously outdated illustrations but she is the best resource I've ever come across for feeding toddlers and preschoolers. I'm a full-on Satter pusher, and I always lend it to the parents of my students and hear that it has worked well for many of their children. 

vulpini

My first was a 34 weeker and we started solids at 6 months and had him on iron drops until he turned 1.  Also, we started with vegetable purees, not rice cereal, as per his doctor's advice.  Mashed cooked carrots and mashed sweet potatoes were his first foods.  We offered  rice cereal a little after that, but he never liked it.