Introducing Solid Foods to Your Premature Baby

Mother feeding her baby

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In the first year of life, most full-term babies follow a fairly predictable growth pattern. The standard feeding advice given to parents is based on these typical developmental milestones.

However, preterm babies may require special considerations. Parents should hold off on solid foods before their preemie is ready. When introducing solids to preemies, consider your baby's corrected age rather than their actual age.

“Corrected age” is used because normal development relates to when a baby was due to be born rather than their actual birth date. To calculate it, start with your baby's age in weeks, then subtract the number of weeks the baby was born preterm.

When to Introduce Solids

Most full term babies are ready to begin solid foods around 6 months of age, but if your baby is a preemie, the timing of when to introduce solids is important. You have to consider their delayed early gross motor skills, their nutritional requirements, organ immaturity, increased gut permeability, and increased risk of infections.

Most importantly, they need good head control to begin eating solid foods, which can be delayed in preterm infants for up to 3 months of corrected age. Some preemies may not be ready to eat solid foods until closer to a corrected age of 6 months, so they should be breastfed, formula fed, or a combination of both until then. However, other preemies may be ready for solid foods before they hit the corrected 6-month mark.

Because preemies are at increased risk of iron and certain vitamin deficiencies, a healthcare provider may recommend multivitamin drops starting at 1 month of age. Solid foods will help provide these nutrients later, but the supplemental vitamins often continue until at least 1 year of age.

Developmental Feeding Signs

Keep in mind that every baby is different, so you should wait until your baby displays signs of readiness for solids before you begin introducing solid foods.

For instance, published guidelines for premature infants advise waiting until your baby is able to eat from a spoon and has lost the extrusion reflex (pushing their tongue out in response to feeding) before progressing to solid foods. A healthcare provider can help you determine if your preemie is ready for the next stage of feeding.

Signs of Readiness

  • Sits upright with support
  • Controls head and neck movements
  • Moves food from the front of the tongue to back and swallows
  • Begins up and down chewing instead of sucking motion
  • Leans back and turns away when full
  • Takes food without gagging or choking
  • Displays interest in food by leaning forward and opening mouth

Once your baby has mastered eating pureed foods, they may be ready for finger food. Some signs your baby is ready for finger foods include being able to sit independently without support, maintaining balance while reaching to grasp objects, and using a palmar grasp to hold large items.

When you do move to finger foods, you need to be aware of choking hazards and never leave your baby unattended while eating. According to the American Academy of Pediatrics (AAP), food accounts for 50% of all choking episodes in young children.

Consequently, they recommend not feeding children under the age of 4 hot dogs, whole grapes, nuts and seeds, chunks of meat or cheese, hard candy, popcorn, chunks of peanut butter, or raw vegetables.

How to Introduce Solids

When introducing solids for the first time, you want to start small. Do not expect your baby to eat a lot at once. It is also important to be responsive to your baby's cues when it comes to eating and allow the opportunity for self-feeding whenever possible.

Offer your baby a spoon pre-loaded with puree or cereal and allow them to pick up the spoon on their own. Of course, your baby may need some help in the beginning because their skills may not be fully developed. But allowing them the option to feed themselves gives them a sense of autonomy and helps build their independence.

Remember, though, that breast milk or formula is still your baby's primary source of nutrition. Even if they start to become less interested in the bottle or the breast, you should not cut back on their feeding sessions. Offer breastmilk or formula on demand and do not alter or reduce their usual feeding schedule.

Best Practices for Preemies

When you first bring your preemie home from the hospital, it can be tough to tell if they are hungry or full, as these cues may be more subtle in babies who are born early. Consulting your pediatrician can help you determine whether your baby is eating enough based on their growth pattern. There are some common feeding issues that affect premature infants.

Coughing, Gagging, or Spitting Up

A feeding therapist can help set up a pacing program for feeding. Smaller, more frequent feedings, using smaller bottle nipples, or putting the baby to the breast after milk letdown has occurred may help.

Eating Less at Home

Preemies may sleep more at home, taking in less breastmilk or formula than in the hospital. Families need to work with their doctors to decide whether a baby should be woken up for more frequent feedings or if the reduced intake can be made up for at other times of the day.

Falling Asleep During Feeding

Supplemental oxygen might be required to maintain oxygen status while feeding. A small stomach capacity can make it difficult for preemies to get enough nutrition, so a higher concentration formula might be necessary.

Getting Upset During Feeding

Preemies should be evaluated for acid reflux with or without aspiration. Once this issue is addressed, it may take time and guidance from a feeding therapist to overcome negative associations with feeding and develop a more positive experience for you and your infant. Keep feeding times quiet and free from distractions to avoid overwhelming your baby.

Food Allergies

In the past, healthcare professionals suggested that parents limit what types of foods they introduced to their baby because of the potential for food allergies. But this advice is no longer the norm.

This practice limits what types of food your baby is exposed to, and there is no evidence that it prevents food allergies. Feel free to offer your baby dairy, soy, egg, wheat, and other high-allergen foods if you want. In fact, giving your baby a variety of solids before the 12-month (corrected age) mark can actually help prevent the development of future food allergies.

That said, if you have a family history of food allergies or if your baby has eczema, ask a healthcare provider if you should take a different approach. Even if your family has no history of food allergies, it is still possible for a baby to develop food allergies.

When it comes to food allergies, 90% of all allergies are caused by the proteins in eight foods: milk, eggs, wheat, soy, peanuts, tree nuts, fish, and shellfish. Some signs of an allergic reaction include vomiting, diarrhea, hives, swelling of the lips or tongue, eczema, difficulty breathing, wheezing, and lowered blood pressure.

If your baby is exhibiting severe symptoms of an allergic reaction, such as difficulty breathing or vomiting that will not stop, seek immediate medical care.

A Word From Verywell

Introducing solids to your baby can be a fun and exciting time. Just make sure your baby is ready before you begin the process. They should have good head control and show other signs of readiness.

If you have questions about when to start feeding your premature baby solids, talk to a healthcare provider. Using your baby's corrected age as well as other parameters, they will help you determine if your baby is developmentally ready.

9 Sources
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