There is a saying amongst lactation professionals, which I learned from I was studying to become a Certified Lactation Counselor: “Flex the hips to open the lips.”  The context was learning about baby’s motor skill and problems that arise from lack of baby skill, such as a baby who does not latch on well, poor milk transfer from mom to baby, poor weight gain in baby, and mother’s engorgement.  Some of the interventions for babies with poor skill are sensory: provide skin-to-skin contact, provide sensory input to the baby’s mouth by stroking their cheeks and tongue, and applying pressure against the feet.  Tickling a baby’s feet is often recommended and many moms try this, but what they don’t realize is that tickling/touching is different than applying pressure.  Pressure is the application of continuous force, applied uniformly over a surface, by one body onto another body.  Hence, applying pressure on the feet, such that the hips become flexed slightly.

Since that class, I have also learned about a new technique for breastfeeding intervention, called Biological Nurturing (BN), which is a breastfeeding in the laid-back position.  The researcher who coined the term BN, Suzanne Colson, PhD, emphasises utilizing primitive reflexes, such as stroking the top of baby’s foot to help them crawl to the breast, as is the case when mom is leaning back and baby is on top.  Regarding the feet, Dr. Colson states that there is a  “strong foot-to-mouth connection” and when the baby’s feet and body are poorly applied to mom’s body, feeding problems are likely to occur.  Although she is primarily interested in the reflexes on the top portion of the foot, remembering what I had learned in my CLC training, that got me thinking about feet and eating in general.  When I went back to my notes, I noticed that I scribbled that the instructor also mentioned that pressure against feet was good for toddlers too.

Since I had a two year old at the time, I was intrigued by this foot-eating connection.  I noticed that when he was in his high chair (which was a high chair that attaches to a regular chair) he would always lift his feet and keep his feet resting on the underside edge of the tray.  Imagine sitting at a bar, chatting with friends, and your feet are dangling.  It’s not very comfortable.

We bought this type of highchair because I wanted something that could be brought close to the table and was not a separate entity so that our child could feel more included at meals.  I knew that there were more expensive chairs, such as the Stokke Tripp Trapp and others, that provide adjustable configurations from baby to teenager and even adult.  But as an employee of Stokke aptly stated “comfort and ergonomic benefits are not well understood by Americans who have a preconceived notion of high chairs as a single use item vs a chair that grows with the child.”  So true.  And I was also insistent that chair was able to get to the table, but oblivious to the feet-comfort connection.

So I was delighted when we inherited a discontinued high chair by KidKraft, a model that looks very similar to the Stokke Tripp Trapp.  Stokke paved the way for the adjustable ergonomic high chair in 1972, designed by Peter Opsvik (The Tripp Trapp was previously knows as the Kinderzeat), but it has not really caught on until now, especially here in America.

Then we had baby #2.  And although I wanted a new chair, we used the same add-on highchair that we already owned.  But when he was nearing one, he kept struggling to find a place to rest his feet, and he also kept climbing into big brother’s chair.  I have spoken to some Stokke owners about what to do for baby #2.  Some told me that they buy another chair, and build a collection for each child, and some told me that big brother or big sister gives the new baby their chair.  Well that does not solve the problem of dangling feet.

So I was pleased when Stokke provided me with a chair to write this article.  Reading about the history of Stokke, I was not at all surprised to learn that it is a Norwegian company and their slogan is “In the best interest of the child,” since Norway is well-known to have the best maternity and paternity leave in the world.  I also found a class project by a group of Cornell University students (suported by Stokke), in which the students discussed various forms of children’s seating: low chairs with children’s feet touching the floor but separated from the table, high chairs and boosters which raise the child but may not provide lower leg support, and the Stokke Kinderzeat, which provides both.  The students designed a research study:

“to test the claim that the KinderZeat’s footrest provides the “basic stability upon which movement is based” and is essential in “alleviating strain and reducing ‘fidgeting”. To do this we devised a series of tasks to be performed by young preschool children while sitting in the KinderZeat with the footrest, or without the footrest, a condition equivalent to the child sitting in either and adult chair with or without a booster. Tasks were devised to test the various reach capabilities and also the task persistence of young children sitting in these test conditions.”

The results showed that children aged 3-4 were able to reach further when seated in the Kinderzeat, had more stability, and less fidgeting.  The students stated:

”When children sat in the chair with no footrest, they seemed to move more because they had less support for their body, resulting in fidgeting as they tried to get comfortable while performing the task. The body stabilization results between the two conditions also showed a statistically significant difference. Children moved more in the no footrest condition because they were trying to stabilize their lower bodies by wrapping their feet around the chair legs or trying to use the small cross bar beneath the seat, whereas in the condition with the footrest they had a place to rest their feet. “

Although this is a not a peer-reviewed research study, and the students (as am I) may be slightly biased due to the support we received from Stokke, based on what we know about infants and breastfeeding, and what I have seen in my own children, I have become a firm believer that children need a proper footrest when they eat or perform activities at the table until their feet can reach the floor.  I am happy that there are a few other companies that have followed Stokke’s lead in creating ergonomically designed chairs for children.  It is both the application of pressure and the fact that their hips are properly flexed that likely leads to better ergonomics, comfort, behavior, and eating.

Now that you have read my previous posts, you are familiar with the benefits of introducing solids with whole-foods.  Many first time parents are terrified of choking and err on the side of caution for many months, only giving their child thoroughly pulverized mush of this and mush of that.  I hope this video will encourage you to learn more about your child and his/her capabilities. Please use your own judgment when feeding your child.

To learn more about feeding infants, please check out my favorite links:
http://www.borstvoeding.com/voedselintroductie/blw/engels.html
http://www.wholesomebabyfood.com/babyledweaning.htm
http://baby-led-solids.blogspot.com/p/guidelines-for-implement…
http://www.tribalbaby.org/babyLedEating.html
http://www.rapleyweaning.com/assets/blw_guidelines.pdf
http://www.rapleyweaning.com/assets/blw_guidelines.pdf

Here is a list of foods in order of introduction for my second son.  This is not an all-inclusive list.  There are only so many foods you can introduce during this short time span.  Make the most of it!

First week (5 months):

• Avocado, scooped out and mashed
• Butternut quash, roasted and mashed
• Banana, raw, mashed
• Grass-fed ground organic beef (stir fried, and processed with breast milk in mini processor)

Foods added in the second week All foods listed above, plus:

• Homemade rice cereal (Cooked brown rice in food mill and processed with breast milk)
• Homemade oatmeal cereal (same procedure as brown rice)
• Flattened pieces of cooked buckwheat Quinoa
• Organic winter squash
• small pieces Steamed organic broccoli and olive oil, mashed with my fingers, fed small pieces by finger

Foods added in the third week All foods listed above, plus:

• Roasted Asparagus with olive oil, small pieces of the tips
• Baked potato
• Lamb shishkabob, small “strings” of meat
• Spelt “bread” (Baker’s brand, made from just cooked whole spelt) and coconut oil spread on it
• Baked barley with celery and carrots, mashed small pieces with fingers
• Peas, defrosted and and mashed

Foods added in the fourth week (6 months) All foods listed above, plus:

• Ground up meat/carrots/tomato sauce, with thyme and garlic
• Plain organic yogurt
• Egg-free whole wheat challah
• Organic apple sauce
• Organic steamed cauliflower
• Chickpeas, cooked and individually flattened/mashed with fingers

Foods added in the seventh month All foods listed above, plus:

• Beef stew with lots of veggies- peppers, onion, celery, carrots, processed in mini-processor
• Mashed sweet potato and lime juice
• Grass-fed organic lamb meatballs cut into small pieces
• Pieces of roasted dark meat chicken cooked with herbs
• Mango
• Chunk light tuna, plain, tiny pieces
• Egg yolk
• Kidney beans (Eden organic canned), individually flattened/mashed with fingers
• Flounder, baked with pepper, wine, and parsley
• Ricotta cheese
• Brussel sprouts, roasted with olive oil and thyme, gently processed in electric processor with some brown rice, carrots, and celery
• Indian chili (chopped meat, onions, tomatoes, dill, cumin, lots of garlic)
• Whole wheat noodles and spinach
• Wheat germ (in yogurt)

Foods added after eight months All foods listed above, plus:

• Cheese
• Cottage cheese
• Cucumber
• Kale chips
• Flax seeds
• Pumpkin seeds
• Sunflower seeds
• Hemp milk smoothie
• Whole wheat pancakes made with molasses
• EVERYTHING ELSE WE USUALLY EAT, TOO MANY TO LIST!

When your child is about four to six months old, your pediatrician will probably recommended an iron supplement.  This is what our pediatrician recommended when my younger son was about 5 months.  However, this nutritionist mom just “happened” to have a copy of the newly published (Nov 2010) American Academy of Pediatrics age-specific recommendations for iron intake, which my doctor acknowledged she had not read yet.

Here are some of the recommendations in the new report:

• Healthy infants born at term have sufficient iron for their first four months. However, breastfed infants should receive 1 mg/kg of an oral iron supplement per day beginning at age 4 months and continuing until iron-rich complementary foods are introduced.
• Infants ages 6 months to 12 months need 11 mg of iron per day. When infants are given complementary foods, red meat and vegetables with high iron content should be introduced. If iron needs are not met by formula and complementary foods, liquid supplements can be used.
• Children ages 1 year to 3 years need 7 mg of iron per day, preferably from foods. Liquid supplements and chewable multivitamins also can be used.

It is clear that iron-rich complementary foods are preferred over synthetic supplemental iron.  But that is not what you hear in most pediatrician’s offices.  Most breastfeeding moms are told to start supplementing or provide iron-fortified cereal.  However, the recommendations state loud and clear that when solids are introduced, they should include iron-rich red meats and vegetables (and I would add legumes too).

If you look closely though, you will see that there is a “gap” between 4-6 months when iron supplements are recommended.  This is due to variations in starting solids and the assumption that breastfeeding infants have a 4-month storage of iron (down from 6 months in previous guidelines).  According to these guidelines, it seems as if the AAP recommends solids at about 6 months.  However, the AAP and Pediatric allergists are now saying that there is no need to delay solids and we may possibly be causing children to become allergic to food if we delay solids until after 6 months.  Most experts are now recommending solids start between 4-6 months, if the baby seems interested.

This is a difficult recommendation for most breastfeeding advocates, because most still recommend delaying solids so as not to deter the breastfeeding relationship.  However, if you nurse first, introduce foods very slowly- mostly just to give them an introduction to food- and let the baby decide if/how much to eat, they really don’t eat much and you will still breastfeed very often.  AND you will be able to provide a natural source of iron for your baby, as well as lots of practice eating!

You might be wondering: “why not just give the supplements to make sure my baby is getting iron?”  The recommendations make no mention of the fact that 1. Breast milk is more bioavailable (gets absorbed better) than iron supplements and 2. Infants have more stored iron if their umbilical cords were allowed to pulse for a few minutes before being cut.  From a public health perspective I understand the committee would rather supplement more infants that may not need the extra iron, than deprive infants who are deficient.  Especially since early cord blood clamping is so rampant and some (albeit malnourished) mothers may have low-iron content in their milk. Iron deficiency can lead to neurological impairments and possibly lead poisoning if there is a source of lead around.

From a public health nutrition perspective, I understand this conundrum. However, from a personal mom perspective, I find it disturbing especially since there is some research indicates that supplementing a breastfeeding baby with iron supplements can make the breast-milk-iron less available to the baby and more available to harmful bacteria that thrive on iron.  In addition, supplemental iron can interfere with zinc absorption and can diarrhea or constipation.  I also have been moving away from supplements and embracing a whole-food diet, since recent research studies using supplements are failing to find they are as effective as food, and sometimes they are downright harmful.  There have also been many reports of supplements containing undeclared ingredients, such as lead.  I wholeheartedly advocate getting vitamins, minerals, antioxidants, fiber, and phytochemicals from food first and only supplement when it is truly necessary.

So when my doctor recommended iron supplements at 5 months, I showed her the recommendations to introduce iron-rich foods.  Our son seemed somewhat interested in solid food at that point and we already had one child with food allergies who we delayed solids until after 6 months, we figured we would try at 5 months this time if he seemed interested. We planned on checking his iron stores at some point between 9-12 months.

On a daily basis, I offered him iron-rich animal or plant food (NOT rice cereal, which is merely fortified with iron) along with a source of vitamin C to boost absorption.  I let him be our guide, allowing him to choose what was best for his body.  Since he was (and is) still nursing often, I knew he would at least get the bioavailable iron from my milk.  He was also lucky enough not to have his cord blood clamped at birth until it stopped pulsing, so I suspecting he had enough iron stores to get him through 6 months, instead of 4.

I would nurse him before mealtime and then offer him some foods.  We would offer him food once or twice a day for the first few weeks, twice a day for a few months, and eventually three times a day by 10-11 months.  We never forced him to eat anything.  The first month, we mashed food by hand, with a food mill, or in a small processor.  By seven months, most foods were put in front of him on a tray and he was allowed to take it at his own will.

So what did we offer him?  Check back tomorrow for the full list!

And, aren’t you curious how his iron levels fared?  At 11 months we checked his iron levels and stores and they were perfect!  We did it without iron supplements or iron-fortified cereals!

This should not be construed as medical advice.  This is a personal story.  Please seek the advice of a Registered Dietitian when planning your child’s menu.

Baby rice cereal.  The iconic box that can be found in all baby-food sections of the supermarket, most drugstores, and online baby stores.  It’s picture, or an outline of a box with a spout, still appears on most infant nutrition education pamphlets.  Rice cereal boxes usually have “first feeding” guidelines, which instruct the caregiver to mix some of the white flaky stuff with breast milk or formula to make a wonderfully tasteless and soupy first introduction to solid food.  Some doctors recommend keeping the infant on cereals (rice, oats, barley) for one month before moving on to similarly bland and texture-less jarred fruits and vegetables.  It could be many months before infants ever taste or feel the texture of real food.

How did this happen? Innovative companies capitalized on society’s increasing interest in manufactured items as opposed to homemade, likely due to household time restraints.  For example, in 1927, the wife of the assistant general manager of Gerber suggested that the canning company start producing and marketing strained fruits and vegetables as baby foods to end the tedious chore of cooking, mashing, and preparing baby food.  In 1933, Mead Johnson produced Pablum, the first pre-cooked fortified infant cereal.

The first rice cereals were made with wheat, oatmeal, and corn meal and had dried alfalfa, yeast and powdered beef bones added to it.  But when synthetic iron supplements became available, they were used instead to ensure consistency instead of beef bones.

And in fact, because iron deficiency is so prevalent and cereal is such a good medium for fortifying with iron, it became the standard first food recommendation of pediatricians.  Coupled with the notion that simple foods such as rice should be introduced first to prevent food allergies, rice cereal took off with blazing speed as infant’s first food.  And since the benefits of whole grains were not entirely known to the mainstream medical community, and the idea that infants needed something very easy to digest, the rice of choice was white rice.

Interestingly enough, parents are now trying to get back to making their own food, which is what the whole concept of baby food was trying to get away from.  So parents are back in the kitchen, peeling, cooking, mashing.  All in the hopes that they will provide their baby with real food that is healthier and tastier. This of course, led new companies to capitalize on this new parenting stress and manufacture items that are “like homemade.”  These foods are not that different from the jarred variety but often found with organic ingredients, subtle herbs and spices, and ice-cube like trays.  However, they are still limited to the variety that company provides.  In reality, we have come full-circle; from making, to buying, to making, and now buying more expensive baby food.

How can we break this cycle and do we want to?

As I blogged about previously, I think there are 6 problems with baby food: 1. You are spending money that can be spent on real food 2. Kids get used to having special “kid” food 3. Real food can provide more nutrients in their bioavailable form 4. Your child is used to eating the same foods and may not develop an interest in new flavors. 5. Your child may not enjoy eating food with different textures when real food is introduces 6. Your child is nutritionally-limited to the variety that these companies produce

Many parents upon reading this list will want to stop providing their baby with baby food but making baby food seems daunting.  Well, I have an answer for you: Babies don’t need baby food at all!! Not store-bought baby food, not home-made baby food, not fancy-steamer-puree equipment food.  Babies simply need to eat whatever you are eating, mashed for the first couple of weeks, then simply cut small, or sometime even allowed to chew their own gummy bites from soft foods.  Now is a great time for the entire family to incorporate healthy foods into their diet.

In tomorrow’s post check back to see how I fed my younger son with no baby-food whatsoever and no iron supplements, and his iron levels were great at his one year checkup!