Weaning the Premature Baby

Caring for your baby at home

Babies who are born preterm on the Neonatal Unit can take time to develop their oral feeding. They may have had parenteral nutrition (nutrition delivered via the veins) and/or milk feeds via a gastric feeding tube (feeding tube from nose or mouth to the stomach), before starting feeding by mouth.

After all of these feeding stages it can be hard to imagine your baby starting solids.  But it is important to get going at the right time so your baby will learn to accept and enjoy a full range of tastes and textures.

Research and experience tells us that babies who are born prematurely need to be introduced to solids by 5 - 8 months of  uncorrected age (from their actual birth date), however it is best to wait until they are at least  3 months corrected age (from their due date) so that they can develop enough head control.

 

Signs to look out for to start weaning

  • Can your baby be easily supported in a sitting position?
  • Can your baby hold their head in a stable position?
  • Is your baby showing interest in other people eating?
  • Can your baby bring their hands to their mouth and are they putting things in their mouth e.g. toys

 

Starting out

When first starting on solids, pick a time of the day when you and your baby are at your best. Try not to feed them when they are too hungry, but if this is not the case then give your baby a small amount of milk first to settle them, and then offer some puree by spoon.

Start with one meal per day and build this up over the next one to two weeks. Start with first foods which are smooth and runny and are offered from a spoon. Offer a range of foods and where you can try to mainly use homemade foods, as this will help to introduce the real taste of fruit and vegetables.

You should not add any salt to food or the cooking water. Honey should be avoided for the first year of life and nothing too spicy e.g. chillies. However do add flavourings like garlic and mild spices.

Lumps can be introduced after one to two months of weaning. At the very latest by 9 months of age. This can be done by offering finger foods and gradually increasing the lumpy texture of foods offered.

 

Top tips and common problems

 

1.     The transition from smooth puree to lumpy solids can be a bit tricky for babies to get used to and it is not uncommon for them to gag and spit out lumps when they are first offered.  They need practice to get used to managing the lumps. You can help your baby to do this by:

  • Moving from smooth to thicker and lumpier consistencies gradually – this is much easier with home cooking rather than jarred foods, which change consistency in big jumps. For example, you can gradually mash a banana less and less over time. If you are using jars and your baby is struggling, try mashing the lumps a little bit to make the lumps smaller and more manageable
  • If your baby does gag or spit out the lumps, do not worry.  Offer a few more spoonfuls with an encouraging smile and see how they manage.  If they seem upset or to be really struggling, make the food a bit less lumpy next time and gradually build up to a more lumpy texture. Avoid going back to completely smooth puree as children can get stuck on this stage if they are not helped to move on
  • Introduce finger foods such as very ripe strips of fruit (e.g. banana, peach, pear), fingers of buttered toast, orslices of cheese. Babies often do better with more difficult textures if they are feeding themselves.
  • Use an encouraging voice and facial expression when feeding your baby – if you sound or look anxious your baby will pick up on this

2.     Babies like to be involved in mealtimes. Let your baby hold a spoon and have a go at dipping the spoon or their fingers in the food at some time in the meal.

3.     It is normal and important that meal times are a bit messy.  For normal feeding development babies need to get used to food on their faces and hands.  It is probably worth having big bibs and a wipeable mat or old sheet on the floor underneath the high chair to contain the mess. Try not to wipe your baby’s hands and face until the end of the meal.

4.     By 12 months of age babies should be having chopped or mashed family foods.

5.     Introduce a free flowing beaker to your baby from 6 months onwards.  This will help them to develop a more mature drinking pattern, which is very different to sucking from a bottle.  A free-flow beaker will drip when you hold the cup upside-down, but you can buy ones with a flip-up spout that will not leak in your bag when you are out and about.  Avoid 'no spill’ beakers or “anyway-up cups” when babies are learning to drink, as they contain valves which make it very hard for babies and young children to drink from.

6.     Your baby may have been discharged on a post discharge formula called Nutriprem 2, which is prescribed by your GP. Most babies only require this until they are 3 months corrected. Your Health Visitor, GP or Dietitian will be able to advise you further on this.

7.     It is important not to fill your baby up on milk so as to encourage solid foods. During weaning most babies will naturally decrease the amount of milk they drink. Once your baby is having three solid meals a day an appropriate amount is around 600mls or 18oz a day.

 

If you are concerned regarding your baby’s growth or the development of their chewing and swallowing skills, please discuss this with your GP who can refer you to a Dietitian or Speech and Language Therapist as needed.

 

The following pages on other sites offer useful advice on weaning babies:

Bliss - Weaning your premature baby

Department of Health - Weaning leaflet

 

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