In Part 1 of our guide to starting solids, we addressed the details – and mess – of starting to feed your baby food.
While it’s an exciting time, the process often comes with challenges, frustrations, and fears for caregivers – especially when introducing new foods and textures. Your baby suddenly seems to have an opinion on what they’re eating, is no longer pooping daily like they have since birth, or develops little red dots by their mouth with new food exposures.
Here we touch on some of the most common reactions you may encounter and how to handle them.
If your baby refuses most foods
It’s not uncommon for babies to take several weeks or months after introducing solids before they start to become good eaters. This can be unnerving and taxing as a parent day after day given the energy you’ve put into planning and preparing your little one’s meals.
The best thing you can do for your baby is to continue to offer a variety of foods and offer them again and again. Focus on giving your baby new foods, textures, and flavors, not how much your baby eats. It takes time, practice, and exposure for babies to learn how to eat, which is why “10-15 tries” of a new food is so frequently repeated by pediatricians and encouraging friends.
Try not to get upset if your baby takes a few bites or refuses the food altogether. Know every mother has been there and your frustration is shared. It’s helpful to know that your baby’s appetite will naturally fluctuate due to teething, illness, growth spurts, fatigue, and level of physical activity, and this will likely happen throughout the course of their childhoods.
Try to follow your baby’s cues during mealtimes. It’s not recommended to force-feed babies, and it’s really not necessary. As long as your baby is continuing to grow and gain adequate weight, they are meeting all their nutritional needs from formula or your milk.
If your baby is constipated
With the start of solids, be prepared for those mostly-liquid baby poops to end. You may feel like your baby isn’t actually ingesting any food at meal times and still notice a change in their bowel patterns. However, a formed stool doesn’t necessarily mean your baby’s constipated.
Constipation is characterized as many days without a bowel movement and hard stools that are difficult to pass. Constipated babies typically exhibit cranky behavior, more crying than usual, or twisting his or her body due to abdominal pain.
Treating constipation starts with a change in diet. Dr. Mona Amin, D.O. and board-certified pediatrician categorizes constipating foods as “beige” foods, like potatoes, rice, cheese, and pasta, which you’ll want to reduce. Green vegetables, fruits and “p” foods, including prunes, peaches, and pears can help soften stools.
In addition to increasing intake of high-fiber foods, encourage your baby to stay hydrated either with more frequent breastfeeding or by offering water in a sippy cup to babies six months and older.
If your baby gets a superficial rash
Skin irritations due to acidic foods like orange juice, strawberries, and tomato products are sometimes confused with food allergies. As a parent, it may be unclear what reactions need immediate medical attention.
Acidic foods are common irritants because babies have delicate skin. Dr. Purvi Parikh, a pediatric allergist and immunologist at Allergy & Asthma Associates of Murray Hill says there are some foods that irritate allergy mast cells in babies, and it’s not necessarily an allergic reaction.
However, if there are any other symptoms that accompany the rash like vomiting, wheezing, and lethargy, these are all signs this is a serious and severe food allergy, says Dr. Parikh. If your baby does develop a superficial skin reaction, such as spots around the mouth, trunk, or legs without intestinal or respiratory symptoms, Dr. Amin says to wait a few weeks before introducing the food again.
If, however, on the second introduction additional symptoms to the rash are present, you’ll want to notify your pediatrician immediately. If you are ever unsure of whether or not to call, calling to confirm the next best steps is always a good idea.
If you suspect a food allergy
According to the CDC, food allergies affect 4-6 percent of children. An allergic reaction to food occurs when the immune system identifies a food or substance within a food as a dangerous threat and as a result, triggers a protective response. While any food can cause a food allergy, 90 percent of all reactions are attributed to cow’s milk, eggs (the white part which contains the protein), peanuts, fish and shellfish, tree nuts, and soy. Certain seeds like sesame and poppy are also prevalent allergy triggers.
Food allergy symptoms are most common in babies, but they can appear at any age. Symptoms range from significant hives to vomiting, wheezing, and anaphylaxis – the most severe and potentially life-threatening reaction. Most reactions occur within one to two hours of ingestion, and it’s recommended you seek medical attention immediately for any symptom greater than a superficial rash.
With all food allergies, the primary method of management is to avoid eating that food, but Dr. Amin says 80-90 percent of kids with egg, milk, wheat, or soy allergies can outgrow it by five years of age.
Routine testing with an allergist is the best way to determine if your baby has outgrown a food allergy.
How to introduce babies to high allergenic foods
The AAP has concluded that delaying the introduction of highly allergenic foods doesn’t prevent allergies in children. New peanut allergy guidelines recommend it be introduced earlier than previously stated and “freely” in the diet with other solid foods.
Unless your pediatrician has advised you otherwise, the order of which allergenic foods to introduce first is up to you. Even if you, your partner, or an older sibling has a food allergy, you should still introduce the food in question early on. “Most recent food allergy research is confirming it’s best to do early introduction to prevent allergies regardless of family history,” says Dr. Amin.
For the first-time introduction of high allergy foods, choose a time when you’ll be home and can watch your baby for signs of a reaction so preferably not before a nap or bedtime. Start with a small quantity and if no reaction, gradually increase the amount over the next few feedings.
For peanuts and tree nuts always make sure to introduce them in the form of powder or small amounts of nut butter (a thin smear on toast or pancakes works well) but never as whole nuts.
According to Dr. Parikh, you should know within a few days of repeated exposure whether or not your baby has an allergy.
If your baby is gagging and choking while eating
There’s a difference between gagging and choking, and it’s important to know what the difference is and how to respond in either situation.
Gagging is your baby’s way of trying to clear the airway. Their tongue is being used for the first time in a new way – to move food around the mouth. With gagging, the back of the tongue is effectively letting your baby know the piece of food is too big to swallow. Coughing is another normal response you may see with the introduction of solid foods. If your child is alert and making noises while gagging or coughing, try to stay calm. Observe them closely to make sure they are able to clear the blockage. Gagging is a natural protective response of our bodies and it’s important for babies to learn how to manage and respond to this.
Choking, on the other hand, is a very real and valid concern for caregivers when introducing textured solids. It’s one of the leading causes of death in small children and food accounts for over 50 percent of choking episodes.
If your baby can’t talk, can’t cough, and is turning a different color, it’s possible the airway has become blocked, and you need to intervene immediately.
First, figure out if your baby is choking on a piece of food and if it’s something you can easily grab remove it from their mouth. All infant CPR classes and experts will tell you to never blindly finger swipe a baby’s mouth as you can push the object deeper into their throat.
For a conscious choking infant, you’ll want to administer five back blows followed by five chest thrusts. To use gravity to your advantage, keep the head below the torso.
If the child becomes unconscious and you haven’t already done so, call 9-1-1.
It’s recommended before introducing solid foods that all caregivers who are feeding your baby take an infant-CPR class. It’s extremely important that all caregivers know how to react in emergency situations.