Feeding your Premature Baby – by Clinical Dietician Susna Spies

an introduction to solids

 

 

 

 

 

 

 

 

Feeding your Premature Baby: When to Start Introducing Solids

To start your little one on solids can be a very daunting task, especially when looking at the when and what and how, one is left so confused! The World Health Organisation has set out clear guidelines for full term babies regarding the introduction to solids, stating that a baby can be exclusively given milk feeds until the age of 6 months, when solid foods can be introduced. Lately, in terms of allergies and allergy prevention, the American Academy of Paediatrics has stated that solids (especially those containing the common allergens) can be introduced to infants between 4 – 6 months of age. Interesting!

“That’s for full-term infants” you might say, “what about my premature baby?” From which age should you give solids foods? 4 months from his actual birth date, or 6 months? Should you use corrected age? What food should you give? How much?

Introducing solids to your premature

When to start

There is no set rule for the exact time to start solids that can be applied to all premature babies. Prems are very unique little human beings who have had a different medical story: ranging from the number of weeks gestation they were born to the type of medical condition they presented at birth and thereafter.

As mentioned above, some guidelines may advise on a specific time to start solids, but your paediatrician/clinic nurse may give completely different advice. Not to mention granny or the old lady at the bakery! Enough to leave you completely confused.

If solids are started too soon (before 4 months post-natal age), it increases the risk of allergy and anaemia because the gut is not ready. Most babies don’t have sufficient control over their mouths and tongue and thus push the food out of the mouth.

If solids are started too late (after 7 – 10 months post-natal age) your baby may develop a resistance to anything else but milk in his mouth. There is also a risk of developing anaemia, because iron-rich foods are introduced too late and the body only has enough stores to last about 6 months.

The best guide to follow in knowing when to start giving your little one solid foods is to look at your baby for signs of readiness instead of charting it off on the calendar!

Signs of readiness

  • Baby has good head control
  • Baby can sit upright without support
  • Showing an increased interest in the food YOU eat
  • Seems dissatisfied after milk feeds (be sure it’s because baby is “still hungry” and not uncomfortable/stressed after feeds)
  • Absence of the tongue thrust reflex (not pushing everything that’s put into the mouth, out).

Not all prems are exactly the same and may display differences in their development. Some may have developed much slower than others and thus may not have reached all of the above ‘milestones’. It is good to discuss this with your medical team to give clear advice. In certain cases it is advisable to still start solids even though one or two milestones haven’t been reached.

A few things to keep in mind when starting solids too early

Allergies

Premature infants are three times more likely to develop eczema when given 4 or more types of solids before the age of 17 weeks.

Reflux

Reflux is a very common problem in prematurity, especially if they were tube fed in hospital. These babies may tolerate milk feeds very well, but once solid foods are introduced, may present with reflux. In some cases, the solid foods help with controlling reflux.

Iron

Premature babies tend to have low iron-stores, because the time spent in the womb (the most important time for iron to be stored in the body) was cut short. Iron supplements can be prescribed, breastmilk have a certain amount of iron it provides and iron-rich foods should be included in the daily diet when solids are given.

The how and the what to give

  • Give milk feed first then solids as a top up
  • Give one new food at a time
  • Try 1 -3 teaspoons at a time….don’t rush or force
  • Try one new food every 2-3 days
  • As your baby gets more familiar with the food, don’t be afraid to include different textures/more lumpy foods. 

Feeding chart:

  Meal One Meal Two Meal Three
Day 1-3 Choose one

(15ml)

Butternut, gem squash, sweet potato, carrot

   
Day 4-7 Choose two (15ml)

Apple, pear, paw paw, berries, mashed banana

 

Choose one

(15ml)

Butternut, gem squash, sweet potato, carrot

Add a 5 ml fat to above veggie:

Avocado, olive paste, nut butters

 
Week 2 Choose two (15ml)

Apple, pear, paw paw, berries, mashed banana, mango

 

Choose two (15ml)

Butternut, gem squash, sweet potato, carrot, broccoli, beetroot, spinach, mushy peas, parsnips,

Add a 5 ml fat to above veggie:

Avocado, olive paste, nut butters

Choose one

(15ml)

Butternut, gem squash, sweet potato, carrot

Add a 5 ml fat to above veggie:

Avocado, olive paste, nut butters

Week 3 Choose two (15ml)

Apple, pear, paw paw, berries, mashed banana, mango

Add 5ml full cream yogurt

Choose two (15ml)

Butternut, gem squash, sweet potato, carrot, broccoli, beetroot, spinach, mushy peas, parsnips,

*Choose 1 protein food to introduce:

1. Egg, scrambled and mashed and mix into veggies

2. Chicken, lamb, beef, ostrich

Steamed , roasted, baked, liquidized and added to the veggies

Choose two (15ml)

Butternut, gem squash, sweet potato, carrot, broccoli, beetroot, spinach, mushy peas, parsnips,

Add a 5 ml fat to above veggie:

Avocado, olive paste, nut butters

Week 4 Choose two (15ml)

Apple, pear, paw paw, berries, mashed banana, mango

Add 10ml full cream yogurt

Choose two (15ml)

Butternut, gem squash, sweet potato, carrot, broccoli, beetroot, spinach, mushy peas, parsnips,

*Choose 1 protein food 10ml to continue introducing:

1. Egg, scrambled and mashed and mix into veggies

2. Chicken, lamb, beef, ostrich, fish

Steamed , roasted, baked, liquidized and added to the veggies

Choose two (15ml)

Butternut, gem squash, sweet potato, carrot, broccoli, beetroot, spinach, mushy peas, parsnips,

*Choose 1 protein food from already tried and tested protein foods. 10ml

 How much should my baby eat?

One of the biggest issues to be careful of is weight gain of your premature baby. Because your baby is much smaller than little Timmy next door, one tends to ‘overfeed’ quite easily to help the “catch-up growth” along. So, how much is enough and not too much??

Once again, looking at your baby’s behaviour during mealtimes will be the best indication of how much food to give. Be aware of signs of baby being unwell that may definitely affect the food intake negatively.

When your baby has had enough to eat, he will let you know by:

  • refusing to open his mouth
  • turning away from the spoon or pushing the spoon away
  • becoming restless in his chair or leaning back in his chair.

Don’t be too worried if baby hasn’t eaten the EXACT amount as directed on the guidelines. Babies will eat the perfect amount that they need when the right foods are offered and they are feeling healthy and happy during meals. No need to worry too much. Your baby will pick up on that anxiety which in turn will have a negative effect on his eating.

A growing, happy baby with a number of wet nappies during the day, is a baby who receives sufficient nutrients during the day. Even though you might feel your baby is eating too little at a meal, you will be surprised to see that the total amount of nutrients in one full day is actually sufficient!

If your baby is not growing sufficiently according to the growth chart or is refusing solids at every meal contact a healthcare professional for assistance.

Remember, introduction to solids is a wonderful journey of exploring food in all its dimension: appearance, smell, taste and texture. Enjoy this journey with your baby!

Love Susna x

 

 

 

 

 

 

 

 

 

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