Butter, Parmesan, Garlic Zucchini Noodles served with Honey, Lime, Mint Watermelon
November 10, 2015
The Problem With Purees
February 18, 2013
Actually, that’s a pretty loaded title, more for effect and attention grabbing…the problem is not with purees so much as with the practice of introducing only purees as first foods and for those first few months of feeding. Of course, every baby is different and all approaches and suggestions should be thoughtfully considered based on your baby's skill level, development, and interest, as well as your own skill set.
As it happens, I actually quite like purees- humus, yogurt, applesauce, butternut squash soup...the list goes on! But, after seeing parents introducing only purees for several months of feeding, and hearing the anxiety in parents voices when they worry over why their baby is refusing, and the confusion over how to know when their baby might be ready to move towards more "solid" foods, I feel like I'd like to get the word out there about why the prevailing method of introducing solids (rice cereal and only purees from 6-8 months) might not be the best idea for many babies and why parents might consider introducing some true solid foods from the start (after 6 months of age). My goal with this post is to help parents understand why other approaches should be considered and what the benefits of those approaches are, as well as the draw backs. I think the benefits of purees is clear: easy to control how much food goes into the baby's mouth with each bite, not too messy, easy to manage with baby's current sucking patterns, nothing to "choke" on. (Though babies can actually choke on purees, and this may cause a lung infection, purees won't block their airways entirely, so I think parents don't worry as much about this outcome). Of course, some babies have medical issues that might necessitate a more conservative start.
Some parents may give only pureed foods here and there for a few days or even a week to ease into the transtion to solids, or may mix it up and introduce some pureed meals, some standard solid food meals. This practice is not what I am addressing here. Also, some people and babies love purees and progress fine to other solid foods from a full puree start. But there are also those babies that sleep through the night almost immediately with no work from their parents, as those that potty train themselves. I think the babies that do these things are the exception, not the norm so this should be considered when people argue that it worked for them so it will work for you.
Many babies do not do as well with a pureed start and aside from just being stressful for parent and baby, I believe they are slowly building the foundation of picky-eating behavior. In fact, even some of the babies that appear to do well, eating good amounts of purees from the get-go, I would argue may still end up as picky-eaters because of a full pureed diet during those first crucial months of feeding. Often we may not see the picky eating behavior show up until the baby is closer to 12 or even 18-24 months. Yes, this is theoretical, but it is not completely pulled out of thin air. It’s a theory that is grounded in correlational evidence: right now the primary way food is introduced to our babies is through purees and the rates of parents who describe their children just a few years later as “picky” eaters is estimated to be at high as 50% and at the same time we have up to 1/3 of our nations children falling into the overweight or obese categories (which can also be a direct result of picky eating habits.) What a baby learns during those first few months of feeding will set a tone and a foundation that will last them for a lifetime (or at least many years until it can be changed.) So, I’d like to think that there might be a better way to introduce solid foods to babies. I’ll go into what that better way might be more later, but for now, I’m going to focus on “the problem with purees” as a way of teaching our babies to eat. Let’s break it down into different sections: The power struggle problem with purees, the oral motor/oral exploration problem with purees, and the progression problem with purees.
The power struggle: when you give purees, you, the parent, are the one who is in control. You hold the spoon. You decide when the bite is offered. You choose how much food is on the spoon and when the meal is over. While this of course makes a certain amount of sense (your baby can’t hold a spoon very well and definitely can’t scoop well at 6-8 months) it puts your baby in a passive possition. This is a big problem because this is a time in their lives when they are so totally and completely interested in doing it themselves and figuring out how to be somewhat independent. Every single moment during this time in your baby's life, he or she is learning, exploring, searching. She doesn't do this because you tell her to, she does it becasue she is inherently motivated to do so. This is wonderful. It is what drives them to learn to walk or talk and read and it is what drives them to learn to eat. We, as parents, want to foster this drive. Do we need to teach them this at every meal? No, probably not. But when we never given them the opportunity to do anything else but purees, spoon fed by you, you’re spending 1-2 months of precious time (feeding them usually 2-4 times per day, so this a lot of time) dampening their inner drive to explore and telling them, “I do this better than you and you should rely on me to figure this eating business out for you.”
In the best of situations with spoon feeding, you have a child who is content to sit back and let you feed them. If that’s the case, there is nothing really wrong with this, some babies are happy being led and they will continue to develop beautifully. But you are certainly not helping them learn to tap into that inner drive to figure it out for themselves and you are not telling them that you value exploration or intrinsic motivation. In the worst of situations, you have a baby who is not at all content to let you feed them and it becomes a constant battle ground, each and every meal for 1-2 months, setting up a routine of fighting and stress during meal times. This perception of mealtime as a stressful event where they can get what they want through crying and fighting will persist for a long time- only getting worse when they become toddlers. They are always searching for ways to take back their power at mealtimes and when they are bigger they do this in bigger and more intense ways. I think this is part of what makes slightly older babies love the squeeze packed purees. They take the power back! They get to manipulate the package and feed themsleves, which is what they’ve been wanting all along.
Babies who refuse spooned purees but will take the squeeze packages highlight two additional problems with giving purees that are not necessarily inherent to the purees but rather are just common practice with purees and therefore an easy trap to fall into:
1. Spoons: they're hard to avoid with pureed meals, out of habit and concern for social graces and baby's don't manipulate spoons well at first. However, letting a baby use their hands to feed themselves purees can alleviate some of this power struggle.
2. Quantity-focused-feeding: It's very easy to measure how much a baby takes when we give purees (1/2 a jar, 8 bites, 4 spoonfulls, etc.) and we tend to want to improve upon the last meal and the one before that. It's a very easy trap to fall into, but when you focus on gettin in one more bite, or you focus on how much your baby takes, this can make you push your baby outside their comfort and interest zone. It also causes you to see the feeding as successful or not based on how much the baby took in. But at first, quantity does not matter at all! (Not at all- see post "Food is for Fun Until Age One" for details). Your baby is learning and exploring and they will take in and swallow ocassionally but that's not really the goal at first. Just like they will crawl and cruise before walking, they will lick and gnaw and spit out before learning to swallow. They don't learn this in a day. If you give purees, keep this in mind and stop looking at quantity as a marker for those first few months!
The oral motor/oral exploration problem with purees: Around 6 months, babies are used to using a sucking pattern to eat. They are used to liquids and they cup their tongue and then move it forward and backward, not so much side to side. Purees fit perfectly within that model of oral motor patterns…but they do not challenge those patterns to progress very much at all. That is a problem, because our babies are already very good at those patterns and we want them to get better at more mature patterns (tongue lateralization, rotary chewing, bolus formation). At 6-8 months, babies have very nice protection against choking (very anterior gag reflex, tongue protrusion movements, small tight spaces that make it very difficult for chunks of food to move backwards, etc.) so it’s a great time to help them practice and learn more mature oral motor patterns. At 6-8 months, babies also have immature fine motor skills that make it more challenging to put small choking hazards in their mouth. When we give purees for a few months, we do not encourage new patterns, and instead we let our babies grow out of the phase when they have nice protection against choking, then we challenge them to work on more difficult foods. This is completly backwards to me. This poor building of oral motor patterns I believe is a huge part of later picky eating. I can’t tell you how often I see toddlers who are very picky eaters, who, when I look closer at their oral motor skills, are not able to manage resistive and mixed textures with well coordinated oral motor patterns. So they just don’t! It’s very smart of them, really. They know those foods do not feel safe (raw or even partially cooked veggies for example can be very resistive and fiborous, which makes them difficult to swallow safely unless you have solid oral motor skills.) Parents just assume that because their child is now 2 or 3 and they can chew things like chips, that their child has strong oral motor skills. But this just isn’t the case (chips are pretty easy to chew and break down) and their child is being picky about which foods he or she will eat in part because of that lack of coordinated motor skills. Getting in there early to teach the foundational skills of eating solids will help your child feel safe with eating a variety of foods. Eating purees will not help with this. Delaying true "solids" past 8 months will only make it more difficult for your child to learn these skills.
The progression problem with purees: Lastly, when you are giving only purees from 6-8 months, how and when to do you advance to more solid foods? I see situations all the time where parents have no idea how to get out of the puree pattern and are scared to progress so they just don’t until the child is a year or beyond. Or they start true "solids" around 8 months but they have no idea what to give so they over challenge. When you only give purees you have no idea what your baby’s oral motor patterns look like and you really don’t get any good feedback about what solid foods would be good to advance towards. You also don’t really know which foods your child likes- we so seldom eat just one food at a time (ie- we don’t often eat just kidney beans, we eat chilli, or broccoli as part of a casserole, not just plain broccoli) and parents have no clue which combinations of foods their kids will accept or like after several months of just purees. Additionally, by 8 months a fine pincer grasp has developed (or is emerging) and your child can easily pick up choking-hazard-sized pieces and quickly put them in his mouth. He is also much faster than a 6 month old at grabbing large amounts of food and shoveling it into his mouth and since he hasn't been practicing for the last 2 months, his mouth will be less likely to have the motor patterns ready to protect his airway from choking. 6 month olds defintely grab handfuls and over-stuff their mouths, don't get me wrong. But again, they are a bit slower at it, a bit less coordinated and less able to pick up small choking-hazard-sized peices, which gives you more time to help or stop them when you start at 6 months vs 8 months. It also helps them learn early on not to do this, so that by the time they are a bit older and you are giving more resistive foods in larger quantities, they have the ability to manage them safetly.
I could go on but I’m going to wrap this one up. I will probably re-visit this a little later. And, just for the record now that I’m off my soap box- my Birdie does seem perfectly content to let me feed her a puree every now and again and I must say, it is quick, clean and kind of fun to spoon feed her and watch her scarf down something like yogurt or mashed potatoes! I just also enjoy watching her explore other foods in addition to purees!