Introducing table solids into a baby’s diet is for many parents a downright scary proposition. “I’m afraid he might choke on it, and…” you fill in the blank, but be assured, these words have been uttered to me countless times by very appropriate, but genuinely frightened parents.
So how to proceed. First, your baby will, typically around 6 months of age, give you a very clear-cut sign that she is ready: Victoria will start grabbing at the spoon every time it approaches, laden with a pureed solid. She is not trying to annoy you, or make your life difficult: she is telling you that she will no longer tolerate being relegated to the passive mode (“I’ll be a good little girl, and sit her quietly while mom stuffs food in my mouth!”). My patients are well aware of my analogy: “My chauffeured limousine will pick you (parents) up at 6 pm tonight (I’ll have a Nanny for the baby), and take you to your favorite restaurant, on me. Oh, and by the way, I’m going to handcuff your hands behind your back and feed you myself, won’t that be fun.” So that’s how Victoria is feeling. 🙂
So when you’ve noticed spoon grabbing, consider adding one of what I call “safely aspiratable foods.” Your biggest fear is that a table food will be choked on, and aspirated (end up down the trachea, headed to the lungs.) Be reassured, all infants aspirate, from birth, up to a dozen times a day, small bits of breast milk or formula. Those insignificant volumes are cleared by the body and cause no harm. In fact, the very sound of choking, among the most terrifying sounds you’ll ever witness, is in fact caused by the vocal cords of your son closing (triggered by that tiny, inconsequential fleck of food that landed in the trachea) to prevent aspiration of the rest of the food in his mouth. Most babies will recover from the choking themselves, just give them a moment, if not, turn his head to the side and, only if you can see the food, use your finger to remove it.
Now that your mind has been put at ease, let’s talk specifics: cheerios, grated cheese, small bits of fruit (grapes need to be peeled and quartered) are great foods to start with. Put a small portion of the food on the tray, as you approach Billy with a spoonful of puree. Most infants will enjoy feeding themselves the table food, and suddenly become more accepting of the purees they had started to avoid (because you kept holding Billy’s hand every time he grabbed the spoon 🙂 ) One tip, make sure Billy swallows what’s in his mouth before he tries grab more food; he may end up stuffing his mouth so full he can’t possibly swallow it, at which point it will likely become a big glob of half-chewed food he spit into your hand. The rate of progression into table solids is amazingly varied. Some babies resist table foods, seemingly averse to the textures, others will eat nothing but table solids by 9 months. If your baby seems to be choking on lots of textures, not really enjoying the table solids, you’ll be much more cautious.
I have tried to allay your fears of Rachel choking on basic table foods like cheerios. At the same time, certain solids can pose a real risk to your child. Most likely to close off your baby’s airway are non-distensible, rigid foods, like meats, or whole grapes. The width of the base of Rachel’s pinky finger is about the size of her airway. So a piece of meat just larger than that could be very dangerous. And foods like nuts and popcorn, with natural oils, which could cause pneumonia if they end up in the lungs, should actually be avoided until Rachel is 4 years of age! So if you want to eat popcorn or peanuts, wait until she’s gone to bed.
Although we now introduce highly small amounts of allergic foods to infants as young as 4 months of age, we still avoid honey and corn syrup until 12 months of age. These babies can’t handle the Botulism spores found naturally in these products, and the toxin, if it gets into their bloodstreams, can paralyze them. Honey graham crackers, according to the USDA, are an exception, as the roasting process used in the preparation of the graham crackers inactivates the toxin.
A parting thought: unpasteurized foods, like some varieties of cheese, and fruit drinks, are unsafe for infants and children of any age.
If you missed reading “Divining the Mysteries of Infant Solid Foods (1): Puree Beginnings”, you can find it here.
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Salem Pediatric Clinic
