Breast milk (or starter formula for those mothers who cannot or do not want to breastfeed) covers all the nutritional needs of the newborn and babies up to six months of age. From then on, the period of complementary feeding begins , in which we introduce foods other than milk that complement it, as its name indicates. Around the year children are already able to eat, with few exceptions, the same food as the rest of the family.
For years, in developed countries, this complementary feeding has been started with mashed foods (purées). However, more and more families avoid this phase of purées and offer solid foods from the beginning; This method is known as Baby-Led-Weaning (translated into Spanish “baby-led weaning” or “learn to eat alone”). But is one method better than another? What are the disadvantages of feeding with mash? In the case of purees, when is the time to remove them?
Differences between feeding with crushed and feeding by Baby-Led-Weaning
We will briefly summarize the characteristics of each of the methods and analyze their differences. The first method is well known: mashed food is offered in the form of pureed vegetables with meat, fish, egg… and fruit puree. It is the adult who gives it to the baby with a spoon .
The second method, known as Baby Led Weaning , puts the baby in the spotlight. Different foods are offered, prepared according to the baby’s abilities (at first in the form of sticks, for example, later they can be in small pieces and when they are older they can do it with cutlery) and it is the baby who decides what he eats , picks it up and puts it in his mouth . Puree can also be offered, but it will be the baby who must pick it up and put it in his mouth, something that they can hardly do at six months.
This second method seems to respect the baby’s signals of hunger and satiety more; In addition, babies learn to identify the flavors of foods separately. This can result in healthier nutritional habits and a lower risk of obesity. However, there are very few data so it is not possible to draw these conclusions yet.
Requirements to start complementary feeding
The time to offer foods other than milk has been changing over the years. It is currently recommended to maintain exclusive breastfeeding up to six months , since it has been observed that it covers the needs up to that age and its multiple benefits are maintained. In the case of formula-fed babies it is not so clear, but it seems reasonable to wait until about six months as well.
To start complementary feeding, we need babies to be prepared :
- From the age of four months, the gastrointestinal tract and the kidneys are capable of handling foods other than milk.
- Regarding neurological development , the skills necessary to swallow puree from a spoon are usually obtained at around 4-6 months. It is important for this that the extrusion reflex has disappeared (a reflex that babies have by which they push out with their tongue whatever is different from the nipple or teat).
- Lastly, the abilities to handle semi-solid food and/or feed themselves usually only appear somewhat later. Specifically, in order to start the BLW there are some very well established requirements :
- Being able to sit alone
- Be older than six months
- Having lost the extrusion reflex
- have an interest in food
- Being able to pick up food and bring it to the mouth
- It is not recommended in children with neurological or motor problems and should be individualized in the case of premature infants.
Is one method better than another?
At the moment, we cannot affirm that one is superior to another. The Spanish Association of Pediatrics has included the BLW method in its latest guide on complementary feeding as a valid alternative to purées and leaves it up to families, once informed, to choose one method or another based on their preferences and contexts.
Purees yes, but until when?
As we have discussed, both the ground and the BLW method (as long as the requirements are met) are suitable to start complementary feeding. However, in the case of purées, we must know that a progressive transition towards solids must be made , progressively increasing the consistency of the food, with more lumpy, semi-solid and finally solid textures.
It seems that there is a sensitive period for the acceptance of both flavors and textures , which would be between the 6th and 10th month of life. Therefore, it is recommended not to delay the introduction of lumpy and semi-solid foods beyond 10 months of life. The Spanish Association of Pediatrics , in fact, recommends not doing it beyond 8 or 9 months; and the WHO recommends that lumpy foods be introduced between 6 and 9 months of age .
From a year old, children can already consume the same type of food as the rest of the family, avoiding only thos that may pose a risk of choking (such as nuts) or fish that have a high mercury content (swordfish , shark, pike and bluefin tuna).
What are the risks of offering solid foods late?
Late introduction (beyond 9-10 months of age) of lumpy and semi-solid foods has been linked to short- and long-term problems.
It has been seen that children who only eat purees during their first year of life have difficulty accepting solids and have difficulty chewing. In addition, offering only mashed foods prevents the baby from being able to identify the flavors of the foods separately, since the different flavors are mixed in purees.
A study in 2001 analyzed the differences existing at 15 months between children who had been introduced to lumpy and semi-solid foods before and after 9 months. Those with late introduction were found to have feeding difficulties at 15 months , ate the same foods less frequently than the rest of the family, and were very picky eaters.
Later in 2009, another study looked at the effects of continuing pure pureed diets beyond 9 months. It was seen that at age 7, these children consumed smaller portions and fewer types of fruit and vegetables . Furthermore, they were very picky eaters and often ate insufficient amounts of food .
In conclusion, to date there is no evidence to affirm that offering complementary feeding with solids from six months is superior to starting it with crushed foods and each family must choose the method that best suits them after having received all the information.
However, we must keep in mind that there must be an early transition from crushed to solid, moving from crushed to more lumpy, semi-solid and later solid foods . Offering lumpy and semi-solid foods should not be delayed beyond 9-10 months of age. Doing it later can cause feeding problems for the child both in the short and long term.