#224 | Introducing Solid Foods with Katie Ferraro of Baby Led Weaning Made Easy

Parents have so much anxiety, about food and about feeding and anything we can do to lighten that burden by showing them how to safely prepare the food so that the baby can feed themselves. I'm all for it. Commercial baby food has only been available in a thing since the earlier part of the 20th century like I was, what do you think cave mama fed her baby back in the day, it would be the parents have always fed modified versions of the same foods the rest of the family eats. So while the term baby led weaning is relatively new, the term is attributed to Joe Rapley. She's a PhD and a British health visitor. She's the co author of the original baby led weaning book that was first published in 2008. That the term is relatively new, but as a practice, this is generations and millennials, were just teaching babies how to eat modified versions of the same foods the rest of the family eat, so it cuts down on cost. It cuts down on time, and it helps preserve the parents sanity, because you're not short order cooking or making different foods for different family members.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Thank you so much for having me on the podcast. It's exciting to meet you guys. I'm Katie Ferraro, I'm a registered dietitian. I'm a mom of seven and I specialize in infant feeding and baby led weaning which is an alternative to conventional adult led spoon feeding which is what we'll be talking about today. I'm excited to chat with you guys.

Well we know our community's gonna be very interested in learning about this topic we get a lot of questions about you know purees and solid foods and when to start and teeth and no teeth and allergies and you know choking concerns is a huge is a huge issue for people with baby led weaning. So just out of curiosity, seven children did you start with purees with your first one did baby led weaning did it just happen naturally for you? Because that's how it was for me 18 years ago, that my oldest I struggled immensely with conventional adult led spoon feeding my daughter absolutely hated being spoon fed and I did what any first time parent does I followed my pediatricians advice and started white rice cereal when she was like four and a half, five months old. She wasn't sitting up on her own. I was like This doesn't feel right. She's not into this. She hated being spoon fed. I felt at times like she hated me, our mealtimes turned into a downright battleground. And at the height of our feeding frustration with our oldest Her name is Molly, we found out that I was pregnant with quadruplets. So we had been doing fertility treatments. So I knew that the potential for multiples was there. It was certainly not expecting for babies. And I remember the first time I saw all four on that ultrasound, the thought that went through my head was just like how am I going to feed four babies at once when I can't even feed the one baby that I have at home right now. So that's for to my quadruplets were born at 34 weeks gestation. And like most preemies, they spent some time in the NICU growing and getting stronger. And friends would come and help us feed and a colleague came in was saying you know how solid foods going with Molly back at home because she had a daughter the same age. And I was like actually, it's terrible. She hates being spoon fed. And I just feel like such a failure because you know what kind of mom can't feed her own baby kind of dietician mom at that. And so my colleague said, Well, why don't you try baby led weaning? And I said, Baby linguini like, What are you talking about? Never heard of this? And she said, Well, it's this approach where you wait until the child is six months of age, showing all of the other reliable signs of readiness to feed. And then the baby learns to feed themselves the wholesome, safe, age appropriate foods offered by their parents. And I was like, This sounds amazing. There's no mealtime battles. There's no picky eating. There's no short order cooking and was like, this is the answer to my prayers. But it also sounds too good to be true. So I have a background. I'm a college nutrition professor. And thankfully, I could lean on my feet and colleague expert friends who were like, No, there's a real incredible body of research and evidence that supports this approach for starting solid foods. So when the quads were six months, adjusted, eight, we went all in on baby led weaning, and started sharing, you know, just the trials and tribulations at that time, there was no good resources on how to make the foods safe for baby led weaning. So through a lot of trial and error, we kind of figured it out. And I was sharing the different recipes we were making. And I realized that by the time the clouds turned one, they had tried over 100 foods. And so if we look at conventional spoon feeding, most babies have only had 10 or 15 foods by the time they turn one. But all the research is pointing to this idea of diet diversity, and the more foods and flavors and tastes and textures that we can expose our children to early and often, the more likely they are to be independent eaters, the less likely they are to be picky eaters. So this whole idea of the 101st foods program was born. When the quads were 18 months old. We went on to how One more set of multiples so I had a set of twins then babies got in hand us we had seven kids three and under for a while there it was absolute chaos but soup. I mean, one thing I would say that we never had to struggle with was the the feeding stuff. And we did baby led weaning with the twins as well. By that time. I mean, baby led weaning had been such a transformative experience for our whole family that I actually shifted the whole focus of my nutrition career to focus exclusively on baby led weaning. So I now run the largest digital community dedicated to baby led weaning parenting podcast called Baby led weaning Made Easy. Our approach of getting babies to eat 100 foods before they turn one has now helped 10s of 1000s of families give their babies a safe start to solid foods with baby led weaning 100 foods before one.

That's impressive. Like I'm trying to think like, parents, I don't even have 100 foods. Exactly what we do. I teach a five step feeding framework. So we introduced five new foods a week, and we can talk about that and why it is safe and why you don't need to wait three to five days between foods. But really taking advantage of this idea of the flavor window that babies who are exposed to a wide variety of foods and flavors and tastes and textures when that flavor window is open. Much greater potential to learn how to like and accept these foods so that as you move into toddlerhood, we know that picky eating or food neophobia sets in for most children starting in the second year of life. If you only have 10 or 15 foods under your belt and the baby loses those two picky eating, that becomes a very challenging child to feed. But if the baby can eat 100 foods and you'll lose 10 or 15, to pick eating, you still have 85 or 90 foods that your child will eat. So while there's no way to prevent picky eating, baby led weaning has been shown to reduce the severity of picky eating. And it's really been a godsend to families, especially like myself who struggled with spoon feeding with their oldest, we have a large part of contingency in our audience, who is our second type parents, right? Because like first time parents, they'll they'll buy anything, you know, you buy all the stuff on the registry, you don't even end up needing most of it. But the second time, it's like I don't need any of that stuff. But I'm dealing with a picky eater, and I'm interested in trying something different. So we get a lot of second or subsequent time parents who will start with baby led weaning because they want to prevent the picky eating that afflicted them with their older child.

Did you create that term meal phobia?

If food neophobia is a version or fear of new foods? And it's well known in the child development space that this is affecting most of you know, it's developmentally appropriate, or your one year old to be exerting more independence and decision in the foods that they want or don't want. And so parents sometimes feel oh my gosh, I'm such a bad parent of a picky eater. No, you don't have a developmentally appropriate toddler. And so we don't, we don't shame parents, we tend not to refer to children's picky eaters, we don't want to identify them by their eating habits. But most parents would attest to Oh, yeah, my kid doesn't eat as many foods as they did when they were a baby. But if they were a baby and didn't have any variety, and then you don't have any foods to feed, those are the children that need to go to feeding therapy, which is what we're trying to help avoid.

Are they picky because they weren't exposed to enough new foods when they were babies?

No all almost all children will experience food neophobia starting in the second year of life. So our goal is to increase the number of foods that the baby can eat so that when you lose 10, or 15 of them to pick eating, you still have a wide variety of foods you can choose from that your child knows how to eat.

So in standard infant feeding, like your pediatrician would recommend introducing one pureed food per week, that baby is going to maybe get like 15 or 20 Different foods by the time they're one. And in your approach. We're talking about 100 different varieties of food all with different flavor, texture, size, smells, whatever,
absolutely horrible sensory experience, right? Learning how to eat is a full sensory experience. We want the children touching the food, they smash it, they put it in their ear, they'll eventually bring it to their mouth and taste it. And when we talk about breastfeeding, and you guys do so much education in the breastfeeding space. That's a responsive feeding method. Right and we teach about responsive bottle feeding. I do a lot of work with the WIC program and state WIC associations and teaching parents how to do responsive bottle feeding and learning how to listen and respond to your baby's hunger and fullness cues. We focus so much on that in the first six months of life. Why do we then in the second six months of life, strip away the baby's autonomy to feed themselves take arbitrary amounts of pureed food and force feed it down their throat. You've removed the baby's autonomy to do what physiologically they can do by themselves. If we wait until the child is six months of age, and showing the other reliable signs of readiness to eat, and we prepare the food safely, that baby learns to pick the foods up early on. They don't have their pincer grasp, right so they're using their whole hand or their Palmer grass. They rake and scoop the pieces of food up and into their mouth. And with baby led weaning we offer foods about the size of your adult pinky finger, soft finger foods that the baby can then again use that whole hand or that Palmer grasp to rake and scoop the foods up and feed themselves and we do a lot of our education is with video because showing you know seeing really is believing like you can talk about it I love podcasts. But like seeing the videos of how to prep the foods and watching the six month old babies pick it up and learning how to eat and seeing how slow it is. But then seeing that every single day for introducing one new food, that very slowly, these micro steps, they pile on top of each other, and you're helping your child with this independence, where they're learning how to feed themselves, which helps parents a lot, because it's one less thing that we have to do.

This is such a more empowering approach for the child to I mean, how much how much more confidence and independence they have in eating, if they're actually bringing the food to their face, rather than having that spoon shoved in their face. I mean, I just I remember with my first just constantly trying to get the spoon in the mouth, the tongue like pushing it out, you know, wiping it off their face trying to clean them up. They never it was never, like you said it was never fun, never fun.

And we want parents to enjoy it. We say You know, you have to feed the small person for the next 17 and a half years of their life at a minimum, like you might as well have some fun doing it. And it does require a little bit of work. But as we all know, wholesome food doesn't magically appear on the table. So we work with parents who have never cooked, they hate cooking. They don't know how to cook, they eat out every meal. Well, that's not sustainable. From a financial standpoint. Certainly right now with the cost of food. We get to the point where the baby can eat at a restaurant with a family if they want to. But we teach parents, you know, you don't have to go buy special baby foods right? Commercial baby food has only been available in a thing since the earlier part of the 20th century like I was, what do you think cave mama fed her baby back in the day, it would be the parents have always fed modified versions of the same foods the rest of the family eats. So while the term baby led weaning is relatively new. The term is attributed to Jill Rapley. She's a PhD and a British health visitor. She's the co author of the original baby led weaning book that was first published in 2008, that the term is relatively new. But as a practice, this is generations and millennials, were just teaching babies how to eat modified versions of the same foods the rest of the family eat. So it cuts down on cost, it cuts down on time. And it helps preserve the parents sanity, because you're not short order cooking or making different foods for different family members.

So that explains why it just became the natural course of action with my second child, it just the baby was going to eat whatever the toddler was eating, and the toddler was eating whatever we were eating, and I never thought about purees or jarred, canned baby food again. And I had no idea that this would be the thing is my mom is funny, because my mom is also a dietician, I'm the oldest of six. And she said, I think it's so funny that your entire career is around something that like second time parents just inherently and I agree with you. But you know, some parents have so much anxiety, about food and about feeding and anything we can do to lighten that burden by showing them how to safely prepare the foods that the baby can feed themselves. I'm all for it.

So we asked our community to post some questions, since we get these questions a lot, and we thought we would bring them to you to answer so should we jump into some of them? I'd love to. Okay, awesome. Hold on. So the first question and the one that we got probably the most of is when do you start this is five months too early to start. Some people are told they can start at four months. Most people say six months but like what really is the thing to start the indicator that it's time to start.

So the American Academy of Pediatrics and the World Health Organization as well as most other major health bodies, advocate for exclusive breastfeeding for the first six months of life, infant milk. So for the sake of this conversation will encompass both breast milk and commercial infant formula, infant milk is sufficient to meet your baby's needs for the first six months of life. And we want to encourage breastfeeding. And so when doctors unfortunately, we still do have doctors saying things like start solid foods between four and six months of age. Well, in my opinion, that's an anti breastfeeding message. So if you're telling a parent to exclusively breastfeed for the first six months of life, and then you're contradicting yourself by saying but start solid foods at four months. The notion there is that we're recommending the cessation of breastfeeding prior to six months of age. And we're definitely not doing that. from a nutritional standpoint, infant milk is sufficient to meet the baby's needs for the first six months of life. So nutritionally no reason to start before six months. From a physiological standpoint, we know that babies are not able to sit on their own relatively independently until closer to the six month mark. And so being able to sit on your own is the baby's way of demonstrating that they have adequate core strength and head and neck control to facilitate a safe swallow, right if you were slumped over because you couldn't sit up yet, and the only thing you've ever had in your mouth was infant milk. And all of a sudden, I'm trying to get you to eat solid strips of avocado because you're four months of age, it's not gonna happen. That increases the risk of choking. So we want to wait until the baby is both physiologically able to sit on their own and swallow things besides infant milk, which comes at around six months of age and nutritionally starts needing a little bit of stuff outside of infant milk. And that doesn't happen until six months of age. So far and five months of age is too early to start solid foods. We wait until the baby is six months of age and when they're demonstrating the other reliable signs of readiness to eat, the most important of which is that ability to sit on their own and most babies Can't sit on their own right on their six month birthday, it might be six months plus one week or six months plus two weeks, or even six months plus three weeks. But there it's always safer and certainly a lot more fun to feed a baby who's truly ready.

So despite that the AAP does not suggest starting solids before six months, some pediatricians are still going with that old school recommendation of four to six months. And I just want to clarify, you're not just saying that's an anti breastfeeding message because the recommendation undermines the value of breastfeeding. It's also that if a parent were to successfully get their child to consume solids or food before six months, now the child is consuming less breast milk as a result.

Absolutely. And that's where we see growth faltering, which we used to call failure to thrive. That's where we see nutrient deficiencies. That's where we see a huge spike in the need to go to feeding therapy because now the child has had a choking incident. So there's food aversions, there's food refusal. All of this is preventable, if we wait until the baby is ready to start solid foods at six months of age, and the vast majority of pediatricians are making that recommendation. Many of them are aware of the benefits of baby led weaning, they're aware of the research that supports it. But as with anything, there's always a few bad actors that are still giving outdated, and even downright dangerous advice, which includes starting solid foods before the baby a nutritionally needs it or be as physiologically capable of eating those things.

On the flip side, Katie, is there a point where it's too far out to to like, Can you wait too long to introduce solid foods? And what are the risks of that other than picky eaters?

That's a wonderful question. And we do have data that for the infants who have the least experience with finger foods, they're actually at elevated risk for choking. And it is developmentally appropriate for your six month old to start experimenting with finger foods, it doesn't mean they're getting all of their nutrition from food, no one's implying that even when you start solid foods, the majority of that baby's nutrition is going to continue to come from infant milk. Now, by 12 months of age, most of your baby's nutrition can be coming from solid foods with a small amount of it from milk breastfeeding, if you and baby decide to extend that beyond one year of age, if you were formula feeding, you would cease that and move to whole milk, cow's milk, but just a little bit of nutrition comes from milk after 12 months of age. So you have the six month practice period. But we do encourage parents to start when their baby is demonstrating the signs of readiness to eat at around the six month mark so that you have the longest runway where the baby is getting the most amount of practice because practice makes progress and the more practice your child has with these different foods and flavors and tastes and textures, the more proficient they will become in feeding themselves.

So I think we may have already answered this, but it did come up a few times from our community. Can you just bypass purees? Do purees ever need to be a part of this?

I love that question. Now pureed some people mistakenly think that baby led weaning means skipping periods, and it does not what baby led weaning is not it is not forced feeding. So it's not adult led spoon feeding, putting anything in a baby's mouth, including a spoon can be a choking hazard. So we like purees, they're an important texture for your baby to master. It's just not the only texture that the baby can master. And what we see with the conventional adult led spoon feeding is that these families get stuck on purees for weeks and months, and the baby's not turning that corner where they're starting to get more nutrition from food halfway through the weaning period. And then we get close to the one year mark, and they've only ever had purees in their mouth. And that's when the risk of choking and food challenges and feeding disorders goes through the roof. So we encourage parents to incorporate purees I teach a purees for a few days approach. So for parents who are particularly anxious about going right from a liquid diet infant milk, two strips of avocado on day one, we do three days where we experiment with a thin puree. So avocado with breast milk or formula really thinned out. So just to demonstrate that your baby off of what we call a pre loaded spoon. That's where we put the spoon in the baby's hand. And we help with our hand under the baby's hand, gently guide the spoon to the mouth, baby gets the hang of it, they smell it, put it near their mouth. It's not perfect. It's messy. But the parents look, my baby can swallow something that's not just infant milk. And then a few minutes later, we do a chunkier puree, same thing, and then we'll do the soft solid strips of that food. Avocado is a great one to start with. We do all of that in day one. There's not a whole lot of actual eating happening. But that's not what's important. Remember, most of the nutrition is still coming from infant milk. The baby's just getting exposed to this idea of hmm, I'm sitting somewhere new in a highchair look, I'm allowed to touch this and pick it up. It smells like this. It feels like this when I smash it and drop it on the floor. This is what happens. So it's all of those little little micro steps that kind of compound. that over time the baby is learning how to do this by themselves. And it's amazing because some babies take right to it. Some are totally disinterested in it, but we encourage parents to stick with it one new food a day. We do five new foods a week in one month your baby has tried 20 foods in five months your baby has tried 100 foods and again around that eight week mark after he starts when it kind of all clicks. And parents are like oh my gosh, this is so much easier than chasing the kid around and trying to force feed, you know very arbitrary amounts of puree Most parts are just fruits or vegetables by spoon. And it's that combination when you're getting all the different categories of foods, that's when they start getting all the nutrition from food. That's when they're getting introduced to the allergenic proteins, which we know helps lower the risk of food allergy. That's when they're getting the different textures. And they're experimenting and they're learning how to use their mouth. And they're doing it by themselves. Again, it's less work for the parents.

So that was one of our questions is what do you do about food allergies? Are there foods that you must avoid? Are we potentially reducing food allergic responses by introducing more foods? How do you know if they have a food allergy, so things have changed dramatically in the Food Allergy space. In the last 20 years, we used to advise everyone when I was going to dietitian school over 20 years ago, the guidance was to withhold the introduction of allergenic foods, and we didn't do a peanut until one and egg until till after one and fish until like for absolutely no reason. There was no data to support any of that. And yet, we've had some major landmark studies, one in particular about peanuts, called the LEAP trial learning early about peanut allergy. That shows us that the actually the opposite is true. early introduction of allergenic foods been shown to lower the risk of food allergy, and we actually know of no benefits from withholding the allergenic foods. The only way to know if your child your baby is going to be allergic to a food is to offer them that food. And that can be so frightening for parents. But we tell parents listen, well, one thing I tell them versus I know that food allergies are scary, and they certainly are very serious. But death from anaphylaxis in infancy from food exposure is almost all but unheard of. So your baby might have an allergic reaction to one of the big nine allergenic foods. Those are the nine foods that account for about 90% of food allergy in North America. And we start offering those foods in week one of baby led weaning, we do we need to get start with any of them. egg and milk and peanut are the three most common pediatric food allergies. So they make the most sense to start with. But I've done shellfish in week one with babies or soy or wheat, or tree nut just to show parents that it doesn't matter what order you go in. But we do introduce those allergenic foods early. And often. It's the only thing you can do to lower your baby's risk of food allergy. The one thing you control is the introduction of foods. And the only thing you can do to lower risk is to introduce these allergenic foods early and often. And we show parents how to do that with food. You don't need to be buying fancy expensive supplement programs and mixing stuff into bottles. You teach babies how to eat food by offering them food, we make those foods safe so that the baby can be eating them from six months of age and on. So my my niece has a very, very severe peanut allergy. And she's you know, gone through some of the methods now to like reduce that and she's no longer allergic to peanuts, which is wonderful. But when her sister was born, you know, my my, my other niece, my sister was very worried about this happening again, we actually brought peanuts right into the labor room. Right after she was born. My sister was breastfeeding her and we put the peanuts like all over her skin so that the brand new baby in the first hours of life would have exposure. Well, if your family eats peanuts, we know that the like if you're in a household where there's peanut butter or peanuts, that there is environmental exposure, they do these cool tests where they measure like peanut protein levels in crib sheets of babies, and that there is enough to quote unquote, count as an exposure. So if your child is going to have an allergic reaction to a food, it's oftentimes a second or even subsequent exposure where they'll have it. You don't just offer peanuts once and say oh, they're not allergic. We need multiple exposures. The parents will how many? How much? How often we don't know the answer to that. That's why we teach parents how to make the food safe. So that globs of nut butter or intact nuts are choking hazard for early eaters. So we teach parents how to thin out the peanut butter, we do smooth, unsalted, so not chunky, no salt, no sugar, and you smooth it out with breast milk or formula. Or you can do unsweetened applesauce, we get it nice and thin. So it slides off your adult stainless steel spoon, that's an indicator that it's thin enough that the baby can clear from the roof or the sides of their mouth. And then we show the parents how to have the baby feed that from the pre loaded spoon. And more often than not, they don't have a reaction. And then the next week we do egg that in our repertoire and then we do milk and soy and wheat and so on and so forth. And parents gain so much confidence that oh my gosh, my baby can eat all these foods. And I'm doing my part to lower the risk of food allergy down the road by continuing to introduce these allergenic foods early and often into the diet.

So does that answer the question from somebody about strawberries that why can't babies have strawberries in the early days? Maybe some have strawberries and right what we have whenever they want, not whatever they want, generally have to wait until six months of age and I would argue the strawberries are not one of my favorite fruits for the earliest eaters. We have 100 foods on a 101st foods list in five different food categories. So in the fruit list we have 20 fruits and there's no right or wrong order to go in definitely fed strawberries to baby safely in week one and baby led weaning but depending upon how big the pieces like if you have a small strawberry and then you cut it into strips, the baby doesn't have their pincer grasp early on in starting solid foods right they get that around nine or 10 months of age. So if you cut up pieces of food really really small like people are apt to do with strawberries. They The baby can't pick it up and bring it to their mouth. And even if they could, if they somehow got it in their mouth, and they've never had anything in their mouth except infant milk, okay, if you cut it very small, that's the exact size that could potentially occlude the baby's airway, hey, we stick to the longer pieces of food about the size of your adult pinky finger, and they need to be very soft. So oftentimes, if a strawberry is too small and unripe, it's not safe for a baby, but give a big strawberry and if it's not ripening, we poach it. So we teach about poaching to make the fruits softer if they're not yet ripe, so you can wait until it's ripe or poach it to kind of speed things up. It's soft enough, the baby can pick it up and feed it to themselves. Strawberries are not an allergenic food, and it'd be very, very unlikely for your child to be allergic to strawberries. Now, eating new foods, if the baby's drooling and the drool combines with the new foods, sometimes the baby will get a contact rash of atopic dermatitis around their mouth, parents will freak out about that. But if the baby gets a rash and it goes away on its own, that's not a food allergy. If your baby is having an allergic reaction to food, yes, there will usually be skin involvement most often manifesting as hives, which are raised red, itchy patches, but the skin involvement will also be accompanied by another sign of allergic reaction. So the baby is swelling, or they are having difficulty or labored breathing, belly breathing, they might notice or they're vomiting or having profuse diarrhea, or a market change in demeanor. Hey, that happens along with the hives, that could be a sign of allergic reaction, but just a skin rash around the mouth, which happens with lots of foods, including acidic foods and combines with the drool. That's, that's just a rash on the face that goes away. And we need to make sure we don't blame the food. Because we don't want parents thinking oh my gosh, my baby's allergic to strawberries. The true likelihood of your baby being allergic to strawberries is almost nil. If your baby does have an allergic reaction, we always encourage you to take pictures. Okay, and then write down what the food was. How was it prepared? What other potentially allergenic ingredients might have been in the food? When did you notice the symptoms? How long did they last for? Obviously, if you think that it's an allergic reaction, you need to seek emergency care and intervention and we teach you how to identify an allergic reaction if that's the case, but more often than not, your baby's not going to have an allergic reaction to food, they might even fewer bites, so they might not eat anything. You don't need to keep track of that there's no such thing as portion sizes. For babies. We're not concerned about how much the baby eats, but rather that the baby is being afforded a lot of time to learn how to eat that's significantly more important than stressing about how much they eat. But doing that variety with the five different foods each week. That's what really helps build this diet diversity which is the ultimate goal.

So another question teeth, or teeth necessary to start baby led weaning do you need to do is it? Do you need to have teeth to start this or not?

The absence or presence of teeth has absolutely no bearing on a baby's ability to start solid foods. Some babies are born with teeth. It's wild like a picture is on Google Photos. Some babies don't get their teeth until after age one. But but babies do not need teeth to start solid foods right? You've all been bitten by a baby when you're breastfeeding and they chop down and those gums are strong. Okay, and there are a few foods in our program that we wait until the baby has at least one or more teeth before we try things like corn on the cob. For example. There's lots of ways to make corn safe and to introduce corn for your baby prior to them having teeth but it's really fun to watch BBC corn on the cob. It's a much more efficient experience when they have at least one tooth, things like meat on the bone. So we do teach parents how to make meat safe and the fattier cuts of meat especially with poultry like the legs and the wings and the thighs. More Fat equates to more moisture that makes it easier for the baby to swallow. So we don't do like dry meat chicken breast for example. But those fattier cuts of meat when your baby has a teaching you a tooth or two you can just give them the chicken bone take the any of the skin off any errant bones or gristle and they go to town just nine on that chicken bone. It's it's so entertaining to watch. And they love it and it feels great when they're scraping it against their teeth. But no, you do not need to have teeth to start solvents.

So we've we've touched on little aspects of choking a few times but can you give our listeners some more pointers on what to really what how to calm their anxiety around choking what to do what not to do? What are the biggest risk factors for choking?

So if choking is certainly no matter what approach you're taking to starting solid foods, it's top of mind for parents your baby has never had anything in their mouth except infant milk. Now you're expecting me to offer them soft shreddable strips of lamb on day four, what are you talking about? They're gonna choke they're not. Research shows us that there is no higher risk of choking when you start solid foods with a baby led approach compared to conventional adult led spoon feeding provided that the parents are educated about reducing choking risk and so much of that comes from making sure that the foods are safe. We'll take the example of apples people that Katie babies can eat apples will raw, crunchy crispy or hard pieces of apple headnote that's one of the highest choking foods. If you peel an apple if you slice an apple if you core it and if you poach it until its fork tender. And then you cut it into strips about the size of your adult pinky finger a six month old can pick it up and safely feed themselves Apple there's no higher risk of choking with baby led weaning now choking is a very rare but real risk. We always encourage parents to take our refresher infant CPR course prior to starting solid foods. They all took it before they had a baby but that was six months ago. I don't know about you guys, but I can't even remember what I had for breakfast this morning, let alone the particulars of a CPR course from six months ago. So taking that refresher CPR course so that you know what to do in the event that your child does have a choking incident. CPR can save babies lives so that helps a lot with the anxiety is knowing I know what to do and how to help my baby if they choke. I know how to position them properly in the highchair with their feet resting flat on a solid footplate that stabilizes the baby's core facilitates a safe swallow, I know how to make the foods safely so that my six month old can pick them up and learn how to eat them. And in the event that there were a choking incident, I know what to do. I know how to administer backflows and when to do that. And one thing we spend a lot of time educating about is the difference between gagging and choking. Because gagging is a natural and necessary part of learning how to eat we have tons of videos, some of our most viral videos on Instagram are our gagging compilations. And I've been sharing these since 2016. Because seeing a gag hearing a gag watching babies gag on food and recover on their own gives parents so much confidence in their baby's ability to do the same. So knowing that with a gag, you don't intervene. If you intervene when your baby is gagging. You can cause startle the baby, you just slap them on the back, you shake them, you, you freak them out, they go. They suck air in. What do you do when you suck air and if you have a piece of food in your mouth, you could cause a harmless gag to become a harmful choke. So we teach parents how to not intervene when your baby is gagging. And the baby can gag on the food recover on their own, and they go right back to eating, the more practice they have with the different foods and the textures, the less frequent and less intense the gags get. AG is a natural and necessary part of learning how to eat and choking is very dangerous with gagging, the baby turns red or pink and there's sputtering and there's coughing cuz there's air passing through, that's a good thing. But with choking, the baby turns blue or purple and there's no air passing through. There's no sound chokes are silent. It's why we never leave our children unattended in a highchair. You never feed your baby in the stroller or a rear facing car seat. First of all those are reclined at the exact angle that could potentially choke your baby, but you're not observing them and you're not going to hear your baby choke because it will be silent. So knowing the difference between gagging and choking and educating yourself as with anything in parenting, education is key for building confidence and seeing that your baby can do this for themselves. So when you get ready to start solid foods, keep in mind that it will be slow. We are not interested in or concerned about how much your baby is eating early on when you start baby led weaning. The point is to give your baby a lot of time to learn how to eat, you are the parent you are in charge of three things you are in charge of what the baby eats, where they eat, and when they eat, but the baby is ultimately responsible for how much or even whether they eat. That's Ellen Sanders division of responsibility in feeding theory. And if at any time you feel like oh my gosh, I'm such a bad mom. My baby's not eating I just want to finish them off with a voucher I'm going to give them a banana because I know they'll eat it. They're not getting enough. Remind yourself. It's not my job. It's my baby's job to determine how much or even whether I do my job by providing the food in a safe eating environment at set mealtimes with the baby ultimately determines how much or even whether they eat and that's the key to success with starting solid foods.

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Is it presumptuous to ask but who helps you guys? Are you really doing this? Just you and your your?

Oh my gosh, no, we have had an Au Pair since our twins were born. So we use an Au Pair agency in the United States approved by the the State Department I always thought au pairs were it's a young person who comes from another country for a cultural change lives with your family and also helps you with child care. And I thought it was just like for fancy people. It is the most affordable, affordable way to have childcare. We have 45 hours of childcare. We've had wonderful au pairs from Germany. We currently are just wrapping up with an Au Pair we've had for two years from the Netherlands. Our next au pair is coming from the Netherlands. We've gotten to meet their families. I'm hopeful when our kids are a little older, we can go visit their families, they become like an extension of your family. I would literally be dead without our au pair my husband travels almost 100% of the time. So she teaches them stuff about like pop music that I don't care about but like I also can hang out with her and have a glass of wine after dinner you know so it's like it's kind of nice just like and company its company for you because your husband's traveling you want to have raising kids is really boring and tedious and it's like nice to have another person to do it with so I love our au pair.