Episode 43: Food Before One Is NOT Just For Fun

Hi and welcome to episode 43 of the Untethered Podcast. Today. This episode is launching on March 16th and this is an incredibly exciting day for us because today is also the day that we open up the cart to our feed the Peeds course. We will link that below, but we want to let you know doors are open. They'll only be open until March 23rd. So if you're listening to this episode on the same day that it's actually launching on podcast, be sure if you're interested in the course to go join today because we have some fast cart action bonuses, if I said that correctly. Fast action bonuses for open cart day is what I meant to say. So yes, extra bonuses if you join in the first 24 hours. For those of you who are serious about joining and ready to jump off the fence. But I want to jump right on into today's episode, which is food before one is not just for fun. You guys have probably heard the saying, right? I mean catchy phrases are a thing. People love them. And I love them too, to be completely honest. But and I do have to say I have some catch, I have some colleagues who make up some really awesome catchy phrases and people do this because they stick, right? And I'm always thinking about how genius that is. But we also have to be careful that we are not promoting false information when we are attempting to make these rhymes, right? So when something is not science backed and actually dangerous as a recommendation or saying, it drives me up a wall. And this doesn't happen that often, but in the medical field we have to be careful, right? So when people say food before one is just for fun, it makes me cringe because I know that is so far from the truth. And that's what we're going to talk about today is why food before one is not just for fun. And all of the different things that as a feeding specialist, as somebody who deals with tether oral tissues and airway and all of those things and tries to prevent orofacial myofunctional disorders if they're already present from worsening, you know, in kids under four and definitely treating them over four. That's where, you know, that's what I want to talk about today is why food before one is not just for fun. So I'm not sure who came up with it, but it's really an awful thing to teach the parents of infants. And like I said, it's just dangerous on so many levels. And so please stop saying it. Okay, thanks. Now for one, I am not a Nutritionist, right. But food before one is, from what I'm told by nutrition colleagues, it's to supplement iron, zinc and other nutrients as of 6 months of age. And again, I'm not a nutritionist, so feel free to Google Scholar this topic for your own research or talk to a nutritionist who has this in their scope. I have not done training in this space, but I think it's worth just putting that thought in your head that there are different nutritional components to the foods that children should be eating that may not be available in the breast milk or the formula. And so there is a reason to start supplementing with foods at 6 months of age, even just in minimal amounts. But again, talk to a nutritionist or go ahead and do your own Google Scholar search on that one. I'm also not an allergist, but I do deal with food as a feeding therapist. So I have to be in the know because I have to know about food allergies, environmental allergies that my patients might be dealing with. And I do read, you know, the research out there. And so I am well versed on the following. I'll share it with you, but I will also link it in the show notes for this episode. Nih, the National Institute, National Institute of Health and other sources recommend that we introduce peanuts to babies in the first year of life. So back in 2017, they stated that between four and six months of age and we'll get to that whole four to six months of age thing later because the AAP recommends six months introduction of solids. But that's to come. Just this is the 2017 report and that was before the AAP updated their guidelines again. So NIH basically said this should be introduced to to infants who are at any risk level, like high risk, low risk, whatever, of developing a peanut allergy if they're at risk for that in that first year of life. But earlier on, right, they said four to six months. I would say that they, you know, I haven't seen and have not been able to find an updated statement from them. So if anybody can find that and send it to me, that would be super welcomed. But my guess is that six months of age would still be appropriate for those at risk infants to introduce peanuts to them if they're at risk for developing a peanut allergy for any number of reasons. They also stated the timing. They did state the timing was more flexible for infants who are not at risk per se, but they should still be introduced to peanuts within the first 12 months of life. Between six and 12 months I should say. But they also said that other solids should be introduced first, like peanuts should not be the first introduction to the child. So on that front, all foods, with the exception of honey, cause that can lead to botulism, are okay to introduce between 6 to 12 months of age. Right. So all foods, with the exception of honey. And these are things that are well documented. Okay, now, the disclaimer that I made before is that the American Academy of Pediatrics has updated their guidelines in 2019 last year to delay introduction of solids at four months to six months. And I think this probably made a lot of my colleagues very happy because we agree that six months is a good. It's a good time for them for solids to be introduced. There's a lot of development, not just from being able to support your head, your neck, your core, you know, but because we can also provide some support, you know, if they're strapped into a high chair or another chair, appropriately. But even children's digestive systems sometimes are not ready for food before six months of age. You know, they should only be getting breast milk or the formula that they're receiving up until that point. So, you know, they do still. The aap, the American Academy, American Academy of Pediatrics, AAP recommends breast milk and formula as a primary means of nutrition during the first six months of life. Okay, so I'm going to repeat that again. So solids are to start at six months of age. And as I mentioned before, I would love to know if anybody has any updates from NIH or any other statements from another organization, a credible organization that basically says, hey, for this population, you know, at risk population of developing peanut allergies, we should introduce it at six months. For those who we are not as concerned about. Okay, anytime between 6 to 12 months is fine after other solids are introduced first. That's basically the message thus far. And I would love to see one document that states all of the above. Now, let's see. So the AAP does recommend exclusive breastfeeding when possible for the first six months and then bottle feeding as needed. It's also advised that cereal and other foods not be added to a bottle unless advised by a medical provider, because cereal has previously been thought to help a baby sleep longer, but it doesn't, according to the aap, and they also. It poses a major choking risk. Actually, that came from the cdc, right. Centers for Disease Control. So CD says, CDC says that it poses a major choking risk. Now, while I have your attention, the AAP and the cdc, as well as feeding specialists, do not advise Propping bottles to feed, I get. If you're a parent of multiples or you're just trying to survive, that's, you know, I. There's no judgment being passed. I'm just sharing the guidelines. But I will tell you, parents take pictures of their single baby that they're sitting next to and they post it on social media. And it's not cute, guys. It is not cute to prop a bottle and say, oh, look, they're feeding themselves when it's too early for them to actually be holding their own bottle and physically be able to move that bottle out of their mouth. It increases the risk of choking, it increases ear infections, tooth decay, and it promotes overeating. And there's even some suggestions that this could lead to obesity down the road in childhood because basically we're overfeeding them. So while we're here, it also needs to be said that it's advised by the AAP and the CDC as well that forcing a baby to finish an entire bottle is not advised. Sorry is what I should say. They do not advise that it can lead to digestive upset, overeating, and in serious cases with other features, feeding issues, refusal or sensory aversion to the bottle. Now, I share this because I have had patients where baby's losing weight or baby has feeding issues, or mom is really fearful of baby going on a feeding tube and it's just trying to get milk into the baby. And so they are just doing everything in their power to make sure baby eats that entire bottle so they can count those ounces. This is not advised because this is what can lead to refusal of the bottle altogether. Refusal of any form of liquid and possible dehydration and ending up in the emergency room and possibly on a tube for some form of tube feeding or a sensory aversion, which, you know, both of which need to be worked through in therapy and feeding therapy. It's a lot more involved than I'm making it right now. But I'm just putting that disclaimer out there because it is a problem, and it is a problem that people should know about, because sometimes we do get babies who have digestive upset, who are very gassy and uncomfortable, and nobody's asking, you know, well, hey, at what point of the bottle does baby stop eating? At what point in the bottle do they refuse or push away or turn their head away, or breastfeeding, I should add, you know, when do they start to refuse the feeds? For some babies, they tire out quickly, and they might be doing that after a couple minutes. And so they're not necessarily overeating, but they're fatiguing quickly, whereas others might be doing that after 10 minutes. And that might be the signal that they're full, their belly is full, and it's time to stop the bottle. And I know for a lot of parents, you know, especially if you're feeding breast milk, that you've been hard at work pumping or you're using formula, and that costs money, it's excruciating to dump out a bottle that did not get finished. So my advice to a lot of parents is to fill it one or two ounces at a time, if that's what you need to do to make yourself feel better about it, to make sure baby actually is eating what they need to eat and not overeating. So that's a little side, a little sidetracked note there. Now, let's talk about. Let's talk about this topic, right? WhoPa4.1 is not for fun. From a pediatric feeding specialist and kind of speech language pathologist, which is what I am certified orofacial myologist. Point of view. Fuba4.1 is for oral sensory motor development. And according to some of my awesome colleagues, we've got some nice oral motor norms like the ones in Robin Merkel Walsh and Laurie Overland's 2018 text Functional Assessment and Remediation of Tots. They talk about these skills in there. And there are a lot of oral motor skills that are developed during this time in the first year of life. And if there's only breast or bottle, and no solid introduction during this time, there's also a lot of oral motor skills that are missed that can lead to oral motor and sensory feeding delays. So I'm not going to go through all of the skills that are developed, but I do want to just, you know, kind of list off some of the skills that we see from birth to 12 months of age, right? So when a baby is born during the first three months, we see that their tongue can suckle. It cups and it lateralizes with stimulation. The jaw has a phasic bite that's activated with stimulation. And the cheeks, you know, should have sucking pads present. Lips are rooted, they root with stimulation, and the oral structures are synchronized, right? They work beautifully together for that suck, swallow, breathe pattern to be successful for baby to feed. Now, between four to six months, the tongue becomes more active in its sucking and we see that anterior posterior movement, the jaw starts to develop that munch, chew. And so then by seven to nine months, the tongue, we see mixed tongue movements. They May gag on the posterior 1/3 of the tongue, but we shouldn't see the gag super far forward in the mouth or even halfway in the mouth anymore. It should be on the back third of the tongue. And the jaw has emerging jaw lip dissociation and diagonal movements while the lips have closure. When we're spoon feeding the child so you can see how quickly we move through these different skills because then between 10 to 12 months we expect that the tongue is going to produce a true suck. The lips will, will move, you know, the upper lip will move up and forward and the lower inward jaw rotary chew develops. Cheeks are active during chewing and the gag is kind of back towards the pharynx, right back towards your throat. So you can see again through from birth to three months to four to six months, to seven to nine months, to 10, 12 months. You can see how the skills develop. Now what's important to note is that the AAP used to recommend that we introduce solids during four to six months. And that's the point at when the active suck and that anterior posterior movement and the munch chew come into play. However, once those are in place around seven to nine months, we start to see that the gag has moved back and the jaw is working differently. The lips can close during spoon feeding by seven months. And so it's almost unfair to expect a child who's under six months to feed and to have the skills necessary oral motor wise to feed successfully. Of course there's always a range of normal and you'll get babies who can do the seven to nine month skills much earlier. You know, maybe during five or six months, at five or six months of age. And then you'll get kids who are moving a little bit slower and maybe their seven to nine month skills don't come in until 10 or 11 months and that that is possible but at a certain point there is a delay and we want to make sure that what we're doing for all of all of our children, regardless of what's going on, if they're safe to feed, if they are oral feeders and they're safe to feed and there aren't other medical issues getting in the way. You know, we want to make sure that these skills are developing and that's why we want breast and bottle, breast and or bottle, I should say until 6 months of age solely as the only form with no supplementation in the bottle, no cereals or anything being added to the bottles. And then solid introduction at 6 months of age per the AAP and myself and my Colleagues who agree with that. Now, according to Diane Barr, spoon feeding, open cup drinking, and the use of a straw and, you know, a squeeze bottle if needed in the beginning, that should be introduced at 6 months of age. And beyond those skills, feedback feeding continues to develop up through 36 months of age. And it's important to realize that these skills during the first year of life are foundational, and they need to continue. They're needed to continue developing later oral motor skills. Like, we can't just skip some of these skills and go, oh, you know what? Even though they didn't do X, Y and Z, they'll be fine later, because no, they have to develop these skills in order to feed properly. And when they don't, that's when us feeding specialists see them land in our office. Sometimes they're able to compensate and make it through until three years of age. And then all of a sudden we get a call because this child is now, you know, still munching their food, and they have, like, less than 10 foods on the list of foods that they're willing to accept. So, you know, that's not every case, but that's just one example. And a lot of the calls that we get in my personal office are children who are super limited and selective in the foods that they will eat. And we often have to work through some motor skills first. And once those are in place, it's much easier to teach them to accept new foods, because sensory. You know, this is the one thing that I learned, not one thing, but one major thing that has stuck with me from the first course I ever took with Lori Overland was that we can't tease apart the sensory and the motor systems the way that a lot of people teach that. So the sensory motor system is basically like one intertwined cohesive whole. In a sense, it works together, and one impacts the other. And so we have to look at that when we are assessing and treating feeding cases and when we are just feeding babies and teaching them new feeding skills, even when they're typically developing with no concerns, because we have to understand that there is a sensory system at play and there is a motor system at play. And they feed on and work. They feed on each other and work together, and one impacts the other. So just want to put that disclaimer in there. Now, there's also fine and gross motor skills that develop during this time. I'm not an OT or a pt, so I won't go over those on this particular episode, but you can find them on our free pediatric feeding screener. That includes a milestone chart and does have these skills listed. We will link that in the show notes or you can go to www.feedthepedes.com pediatric feeding screening packet. And then one study that will be included in the show notes as well demonstrates that introducing like lumps into food should occur during the six to nine months of age to avoid feeding difficulties surrounding lump textures. Now this was one study, but I'm just using it more so as an example because they showed that when lumps were introduced between 10 to 15 months of age, the chance of feeding difficulties were more likely to occur. And again, not a super strong study in my opinion when I read through it. But I just thought it was interesting because it does reflect what I see in therapy. And my babies who are having feeding issues who do not follow the normal trajectory of solid introduction. You know, maybe we tried them at six months but they're not ready. So then we have to push back a couple weeks or even just seven months. And then, you know, we start that starts to delay things. We're not able to take them and give them the same amount of time as they're typically developing peer in the feeding realm, feeding world. You know, we're not able to give them that same experience on the same timeline. Now again, every child's different and that's okay, we'll get them there. But this is so important to realize it's not just about feeding puree. And I'm not going to go into the big debate over baby led weaning. There's a lot of people doing it dangerously and incorrectly out there. Even people who are teaching this very dangerously and incorrectly. Purees serve a purpose as adults. We eat. And while I have your attention, we're going to talk about this. We eat yogurts or we eat, you know, soups or we eat different pureed consistencies of soups, right? Some are thin, some are thicker. Like some you could pick up on your spoon and it like barely falls off when you, when you tip the spoon. It's a thicker puree. We've got yogurt sustained the spoon. Some people eat different sauces, fruit sauces, like applesauce or you know, I could go on and on and on, right? Like there are a lot of foods that we consume as adults that are in a puree form. And so it is important not to skip that step. And it's also important to start with that step because this is what a baby. It's the closest thing to what the baby's been eating thus far. Baby's been on thin liquids, and now we're going to move them up a step higher to basically, it's like a thickened liquid, right? Like a puree is. Depending on how thick and how thick you make a liquid, you can get it up to a puree consistency. So, you know, we're kind of moving up a the trajectory of textures that we want to introduce. And so once you do that, then we might move on to different textures. And so that's why this study that was talking about, you know, when we introduced lumps into the food that they recommended that it should occur during that six to nine months of age. And it is something that should occur not too long after we've introduced purees. So there's a big misconception out there that, you know, food before one is just for fun, and we just do purees from 6 to 12 months of age and that those could. Those are both the furthest thing from the truth. We need to be introducing foods at 6 months of age for all these different reasons that we've already mentioned. And we also want to move beyond the puree level up to different consistencies and textures of foods because Most children by 12 months can be eating a completely typical diet, basically eating the same thing that you and your significant other are eating at the dinner table. And maybe you've just cut it down into smaller pieces for them, depending on, you know, what the food is. So just a little food for thought there. Now, for more information on this topic, we will be covering both typical and atypical development of skills as they relate to feeding in our upcoming course, Feed the Peas. And as I mentioned at the start of the episode, today, March 16, 2020, we open the doors to our course. So go get signed up before we close down the cart on March 23rd. As I mentioned, for the first 24 hours when we launch today from at 12 noon, going until the 20. I'm sorry, going until the 17th at 12 noon Eastern Standard Time. We have some awesome bonuses for those people who are fast actors. Right? You have a fast action bonus that we're gonna gift you as a thank you for being the first to sign up for the course. So if you already know you want it, get in today so that you can get your hands on those. If you're a mom who's listening to this, because I know we've got some mamas that listen to the podcast, please contact us if you have concerns. And if you're not local to us, we will definitely put you in touch with a Provider in your area, we're happy to connect you. We feel that it's very important to do so. If you're a provider that doesn't treat feeding and a mama tells you that they're struggling, please don't brush them off and tell them that the baby's weight is fine and everything appears okay. Moms have a special intuition and for those of you who are pediatricians and who are a mama, please put your mom a hat on. I know we all say keep work and life separate, but just put your mom a hat on for a minute and just remember back if you can, to like when you had a baby and when you felt like something may have not been right, even if you just thought maybe they had a fever. Now imagine having that feeling that something's off with your baby like all day, every day, right? Mamas know they've got a special intuition. They know when something is off with their baby. So please trust them and refer them to a provider that specializes in infant feeding who can help them because early intervention is key. The longer they get brushed off, the longer it takes for baby to get help and the more skills that we lose or the baby loses and that are not developed along the way. And so I put that in here because. And it gives me chills that's asking for it because I see these babies and half the time I think to myself, oh gosh, if we could have just gotten them in here three months earlier, we would be in such a better place. We would not be at risk of a feeding tube, we would not be at risk of, you know, all these sensory aversions. We would not have a baby screaming every time they saw the bottle. You know, it just breaks my heart and I really want to help mamas avoid that. So if a parent comes to you and they have concerns about feeding, I'm not saying be an alarmist, but please sit down, listen to them and make sure that we get them the help that they need and that the baby deserves. Okay? So, you know, I will add that transitioning from a purely liquid diet to introducing solids at six months is already super anxiety provoking enough for a lot of parents. So I just don't want to add to their anxiety and I don't want our communities to add to their anxiety by ignoring or brushing off their concerns because this is just as dangerous as feeding a two month old cereal in their bottle and propping it up, walking away and leaving them to fend for themselves on the couch. And I'm pretty sure that no one listening, mamas included, would do this. So let's make sure our recommendations and our referrals are as supportive or as possibly or sorry, are as supportive as possible to better support the moms and babies that have these feeding struggles. So I will go ahead and link the free pediatric screener as well as the link for the course in the show notes and below today's episode@theuntetheredpodcast.com I hope this has been a helpful episode. And if you're joining the course, I can't wait to see you in there. Have a great day, everybody.