COVER STORY three signs for being ‘ready for weaning’ for term babies3 and see how the preterm baby might differ: The tongue-thrust reflex One of the signs of being ready to wean a term baby is the absence of the tongue-thrust reflex. This is tongue protrusion in response to something touching it. In many preterm babies the tongue-thrust reflex is present and regular practise by eating food helps it abate. In summary: you don’t need to wait for the absence of the tongue-thrust reflex when thinking about weaning a preterm baby. Being able to sit unaided Many preterm babies will not have the motor skills to be able to sit up unaided. However, postural stability is essential for optimal oral-motor range of motion, hand-eye coordination and fine motor and tactile manipulation of food. This can be provided with appropriate seating in a well-supported highchair. Support is required at the feet, behind the knees and around the waist and trunk. This is necessary so that the baby can concentrate on coordinating the skills needed for eating rather than prioritising vestibular and proprioceptive senses. In summary: Premature babies don’t need to be able to sit up unsupported to commence weaning, but supportive seating must be provided. Good hand-eye coordination In babies born at term, hand-eye coordination is needed so that they can start self-feeding irrespective of whether they are baby-led weaning (BLW) or traditionally weaning (see below for more on these weaning methods), because finger foods are important from 6.5 months. Many preterm babies won’t have good hand-eye coordination at the start of weaning and will need to be spoon-fed. In summary: Premature babies do not need to have hand-eye coordination before they can start weaning. WHAT ARE THE READINESS CUES?
The following cues2 can be helpful to decide whether a baby is ready to start solids. Babies don’t need to have all the following in place and often parents are the best judge of when their
baby is ready. Individual assessment of each baby is important. • Holding their head steady. When sitting upright in a supported position, preterm babies need to be able to hold their head steady in the midline for successful weaning. If babies also have other ongoing medical problems, their gross motor, fine motor and oral motor skills may be impacted. Therefore, waiting until a minimal level of motor ability is present (such as holding their head steady) is important prior to starting solids. Many babies achieve this at around four months corrected age. • Picking up toys and putting them in their mouth to explore. • Leaning forward, mouth open ‘asking’ for food. • Showing an interest in the food that others are eating. Some feel that this could be a sign for being ready for weaning, but many babies do this anyway and so this should not be taken as a cue in isolation. They are not ready: • when the baby appears hungry and is demanding more milk; • when the baby is waking more frequently though the night to feed; • when they reach a certain weight; • when they reach a certain age. IS NUTRITION A REASON TO START SOLIDS?
Yes, it can be. Meeting energy requirements is a reason to consider starting solids. Beyond a certain point, breast milk alone can’t provide enough energy to meet a baby’s nutritional requirements and, so, starting solids is necessary to complement it and meet their energy needs. Traditional first weaning foods, such as vegetables and fruit, are low in energy and don’t contribute much towards meeting energy requirements. At the same time, milk intake may decrease as it becomes displaced by food. Progression towards including meat, fish, dairy foods and starchy carbohydrates is important to provide the additional nutrients required.
www.NHDmag.com December 2019 / January 2020 - Issue 150
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