Introducing Solids to Your Premature Baby

---

Knowing when to offer your baby solids can be confusing - but knowing when to introduce solids to your premature baby can be positively bewildering!

Guidelines set for feeding full term babies - by such organizations as the American Academy of Pediatrics, the World Health Organization and UNICEF - state that breast milk or formula meets all of an infant's nutritional needs for the first 6 months of life.

Despite this advice, many pediatricians still recommend starting full term babies on solids at 4 months. Pretty confusing, then, for the parents of full term babies.

But what happens if your baby was born 8 weeks early, for example?

Should you start solids at 4 months after your baby's ACTUAL birth date, or 6 months after?

Or should you ignore baby's actual birth date altogether and go by his adjusted - or corrected - age? And if you DO go by his adjusted age, which guidelines should you be following... those set by the organizations mentioned above, or the advice of your pediatrician/other medical professional, which may be different?

The needs of a premature baby vary greatly from one situation to another, so there's no 'one size fits all' answer to these questions. However, the purpose of this page is to bring together the advice and experiences of other parents who have gone through the 'minefield' of feeding a preemie, to help you better make a decision that suits YOUR little one.

Introducing solids to your premature baby - signs of readiness

There are no official guidelines for the timing of the introduction of solids to a premature baby.

And from the responses we received from the many parents we spoke to when creating this article, the advice given by doctors varies enormously!

One of the main reasons for this, of course, is that the DEGREE of prematurity plays a big part in baby's development. A baby born particularly early may have experienced health problems that could have an impact on his nutritional needs or ability to consume solid foods. On the other hand, a baby born only just before he would be considered full term (at 37 weeks) may have no feeding challenges whatsoever.

So - unless your doctor suggests introducing solids early for medical reasons - this is one situation where the advice 'Watch your baby, not the calendar' has particular significance!


advertisement

The signs of readiness for solids include...

• Baby's ability to hold up his head
• His ability to sit well with support
• Seeming dissatisfied after milk feeds
• Showing an increased interest in YOUR food at family mealtimes
• Absence of the 'tongue thrust reflex' - i.e. pushing everything that is put in his mouth back out!

(Do bear in mind, though, that some preemies may have developmental delays that mean they may not display ALL these signs).

The problems with starting too soon...

Starting solids before baby is developmentally ready can be difficult, as Mum to Ryan (born 5 weeks early) is finding.

The presence of the tongue thrust reflex is, as Holly discovered, a classic sign of immaturity. Introducing solids to a preemie too early also poses a greater risk of choking, as his ability to move food to the back of the tongue and then to swallow efficiently may not be as well developed.

If your preemie is NOT your first child, then having a little experience of infant feeding can be very useful indeed. Mum of 4 Sam, whose son Riley was born at 31 weeks, told us...





When early weaning is recommended...

The needs of babies born very prematurely may necessitate the introduction of solids earlier than is considered usual.

bliss.org.uk is a site established 30 years ago in the UK to provide support to the parents of premature babies. Whilst Bliss suggests that you introduce solids to your little one 5-7 months from their ACTUAL birth date, it also points out that it may even be necessary to wean earlier.

Whilst this is not usually advisable for full term babies, it's important to remember that babies born early will not have received as much nourishment whilst in the womb as those born full term. Common complications after birth may have prevented their 'catching up' on the nutrition they missed - furthermore, the gut of a pre-term baby may be less efficient at absorbing nutrients. Thus, additional nutrition may be required for some babies, leading some doctors to suggest solid foods to provide calories above and beyond those provided by breast milk or formula.

What other parents have to say...

In general terms, most sources agree that premature babies are ready for solids by 7 months after their actual birth date.

But how does this work in practice?

We spoke to several parents of preemies about THEIR experiences with solids. With one or two exceptions, the general consensus seemed to be that going by their babies' adjusted ages worked better than using their actual ages as a guide. We also found that 6 months adjusted was the most favoured point to offer solids - that being said, it's obvious that many parents also chose to follow baby's cues rather than dates!

Here are some of the comments we received...

Introducing solids to your premature baby - other considerations

Allergies

One important point in favour of delaying solids until AT LEAST 17 weeks is to prevent the development of eczema. Research conducted in 2004 showed that pre-term infants given four or more types of solids before 17 weeks were three times more likely to develop eczema by 12 months than those given milk alone.

Of course, all babies should be carefully monitored when new foods are introduced for any signs of allergic reaction. This page includes a list of some of the more common allergens, which should be introduced with care and under the supervision of your child's doctor.

Reflux

Infant reflux is often a problem in premature babies, particularly if they were tube fed whilst in hospital. Sometimes, the problem doesn't become apparent until solid foods are introduced - but, in other cases, solids are actually recommended to help control reflux when baby is regularly spitting up after milk feeds.

We have tips for introducing solid foods to a baby with reflux here - which includes foods that many parents find contribute to reflux flare ups.

Iron

The amount of iron stored in a baby's body at birth depends largely on the time spent in the womb. Premature babies, therefore, tend to have lower stores of iron at birth than full term babies (see Table 1 - Risk Factors for Iron Deficiency in the First Year of Life).

Iron plays a crucial part in your baby's growth, the development of his brain and the formation of the red blood cells that carry oxygen around his body. Your baby may be given iron supplements, or your pediatrician may suggest that you introduce iron-rich solids in order to increase your little one's iron intake and ensure that his levels are sufficient for his needs.

Although the iron from breast milk is easily absorbed, it may not be enough for a premature baby (we have more information about iron here, although please do note that some of the facts given apply - as stated - to full term babies).

New research has suggested that meat may - in fact - make an ideal first food for babies because it is such a rich source of iron. You can read more about how to introduce meat to baby here - but please discuss this option with your doctor before offering meat to your little one.

Amber, Mum to 4 year old Hannah, told us...

Gagging

Some preemies have a particular problem with gagging. This is known as a hyperactive gag reflex or oral hypersensitivity, a condition that can sometimes be overcome with the slow and careful introduction of texture, but which may require help from a speech therapist.

Some sources - including bliss.org.uk - suggest that solids are not introduced later than 7 months after a baby's ACTUAL birth date, in order to avoid sensory issues like this. However, like so many other aspects of solid feeding, it seems that it really depends on the individual!

Angie from Horsham in the UK found that her daughter, Lily, struggled with texture...

But Rene from Miami, US, did not find that delaying solids presented any problems with her baby's acceptance of texture...

If your little one is experiencing problems with texture, then we have lots of tips you may find useful on our Baby Feeding Problems page.

The best first foods

These may depend on your baby. In some situations, certain high calorie foods may be recommended by your doctor, as opposed to the usual fruit or veggie purees.

Or you may be advised to offer your baby particularly iron-rich or iron-fortified foods (as mentioned above).

We take a look at all the options for baby's first foods here - The Best First Food For Baby.

How much food should I give my baby?

When introducing solids to your premature baby, it's a good idea to offer them 'little and often'. Your doctor may suggest that these foods be nutrient dense and calorie rich, so the small amount that your baby does consume are as beneficial to him as possible.

In most situations, it is better to offer milk before solids at each meal.

Always respect your baby's cues during mealtimes - and when he is displaying signs of fullness, don't urge him to eat more than he wants, or you risk turning feeding times into a battle ground!

We include the typical signs to look for in determining whether or not your little one has had enough food on this page - How Much Should My Baby be Eating? - although please note that not all this information may apply to babies born early and that the best person to advise you about the right quantity of food for YOUR little one is your doctor.

When should my premature baby start cow's milk?

Full term babies are usually introduced to cow's milk as a 'main' drink from 12 months of age. However, the parents of preemies are usually advised to offer their little ones cow's milk at 12 months adjusted/corrected and NOT at their real age of 12 months. Formula and breast milk are higher in iron and the other nutrients your baby needs than cow's milk. Please seek specific advice from your doctor.

Whole milk

It is generally recommended that babies are given whole milk (or full fat milk) because it supplies the fats necessary for the healthy development of the brain and help support their rapid rate of growth - see Why Babies Need Whole Milk and Fats for more information.

This recommendation is equally - if not more - important for preemies.

However, Margaret from Seattle, US, told us...

If your child has a tendency towards reflux, then you should discuss the pros and cons of introducing whole milk with your doctor.

More tips for introducing solids to your premature baby

• Do not add salt to baby's food. This is true for all babies - but particularly so for those born early. Here's why salt should be avoided and here's some information about adding flavour without adding salt!
• Because your preemie may have particular dietary needs, speak to your pediatrician if you plan to introduce him to a vegetarian diet.
• Watch your baby carefully for any signs of allergy or intolerance. An overview of common food allergy symptoms is given here. Be sure to tell your doctor if there is any history of food allergy in your family.
• Tell your doctor if your baby experiences diarrhea - which may indicate that some nutrients are not being properly digested - or if blood appears in his stool. This may be a sign of an intolerance to protein.
• Let your doctor know if your baby becomes constipated - this can happen if your preemie had problems with his digestive system, stomach surgery or other feeding problems. We have some tips for relieving baby's constipation here.
• Use breast milk whenever possible to mix with your baby's foods - to thin a puree, for example, or to mix with cereal. It provides more nutrients than using water.

Your experiences and advice are invaluable - please contribute to this page

With so much conflicting advice about introducing solids to your premature baby, reading the advice and experiences of other parents who've been in the same situation can be immensely helpful.

If you have a story to share, advice for other parents, a question or anything else to contribute to this page, then please complete the simple form below. You can even add a photo, if you wish! If you have ANY problems in using this form, then please let us know - we value your contributions and want to be sure we receive each and every one.

Please note:
We check all submissions to our website prior to publication to ensure that content is original. All submissions are considered to be from non medical professionals - if you are a medical professional and choose to submit any information for publication on our website, you must identify your professional status. We require that all submssions are respectful and honest - submissions containing inappropriate content will not be published. You must be at least 18 years old to submit your experiences and comments to this website. The information given here is not intended to replace the advice of a health professional.

Baby's first foods - our main guide to introducing solids
Tips for introducing solids at 4 to 6 months
Baby led weaning

From "Introducing Solids to Your Premature Baby", return to home