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A therapist’s thoughts on… When to introduce foods.

A common question that we are often asked is, “When should my child transition to purees or solid foods?” While the answer to that question can vary for each child and their special circumstances, there are some common foundation skills we look for before introducing foods.

 

  • Does the child show interest in foods? A very common sign that children are ready for foods is that they begin to open their mouth around foods, gaze at foods, or reach for foods when others are eating.
  • Is the child able to sit up on their own? Core strength is necessary and develops before mouth and jaw strength. Think about the core being the base of the pyramid and the mouth being the top of the pyramid. The base should be strong to support the top.  
  • Is the child able to move their tongue around in their mouth? The tongue needs to be able to move side to side in order to safely move the food in order to chew it and to prepare to swallow.
  • Does the child still have automatic tongue thrust? This mechanism is designed to protect a baby from choking before the baby is ready to handle foods. If they are automatically thrusting food or items using a pressing motion of the tongue forward, the tongue has not yet developed the necessary patterns for safe and effective eating. The body progresses from a sucking based method which uses the tongue thrust, to a more mature chewing based pattern between 4 and 6 months of age, sometimes even later.  
  • If you put your finger in the child’s mouth near where the molars will be, do they bite down/ munch on your finger? This automatic chewing motion is an early skill to practice chewing and will help them build strength and coordination for chewing foods.

 

The American Academy of Pediatrics as well as the World Health Organization both suggest waiting to begin foods until at least 6 months of age. Most OT’s will agree this is a good age to start looking at this introduction… if the above skills are in place. Some children will be eager and ready between 6 and 7 months, and others do not yet have the strength and motor control at this age and will need a little more time to develop the appropriate skills. Introducing foods too early can pose a safety concern as the infant might not be able to control the food in the mouth which can cause risk for choking. There is also research showing that the gut lining is not fully developed until 6 months of age and introducing foreign cells into this environment may increase the risk for allergies later on. Between 4 and 7 months a baby’s intestinal lining goes through a developmental growth spurt called closure, in which the cells of the intestinal lining join together more densely and thus become more selective about what to let through.     

 

So… what can I do if my child is not ready, or seems to want food but is not yet 6 months?  

Provide them with hard food items (that can not be easily bitten or broken such as long carrot sticks, broccoli stalks, or simmilar consistency items) to play with during meal time, or anytime sitting in the high chair. This allows them to participate in meal time activities and have interactions with food, even getting some flavor. By moving the item around in the mouth, her tongue is able to practice some of the movement patterns necessary for eating. This also allows for jaw, tongue, and cheek strengthening! Also, practice with a straw cup and/or rimmed sippy cup. This will allow them to practice oral motor skills and get a drink. Offer baby some sips of water from your cup or straw. Even if they don’t yet know how to use the straw, you can put the straw in water, block the end of it with your finger to trap in some water, and then let the baby drink the water from the lower end of the straw. (Release the top end once the straw is in baby’s mouth.) Eventually stop releasing the pressure until baby’s lips are closed around the straw and baby is attempting to suck.   

 

A therapist’s thoughts… I (Cassie) personally waited until 6 months with most of my kids. One of my boys had all the core strength and gross motor skills necessary by 4 months (he was an overachiever!) but when I presented soft cooked vegetables at 6 months, he still had a tongue thrust and could not manage the foods appropriately. I waited 1 more month while giving him many opportunities to interact with hard raw veggies, and tried again… then he was ready and able to eat!

If you have any questions about your child and their development, or readiness for eating, don’t hesitate to ask an OT. We are always here to help!!

-Cassie Whiteaker, OTR

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