Enjoy this in-depth podcast interview with Solid Starts founder about solid food for baby and how (and when) to move past purees!
If you’ve ever worried about your baby choking, gagging, or just generally moving past purees, you are going to feel so much more knowledgeable after this episode.
I’m Kacie Barnes, and this is Feeding Toddlers Made Easy. I’m your host, Registered Dietitian Nutritionist and mama of two, and creator of mamaknowsnutrition.com. Feeding Toddlers Made Easy is all about solving nutrition and picky eating struggles, but today we’re talking babies with my special guest, Jenny Best.
Jenny is the founder of Solid Starts, a team of pediatric food + feeding experts, doctors, nutritionists, and dietitians and the world’s first comprehensive platform for starting babies on solid food. Solid Starts features the First Foods® database a free food database and app complete with instructions and how-to videos for introducing real food to babies. Solid Starts serves more than one million people from 175 countries worldwide, offering complimentary resources to those facing economic hardship and parenting solo.
Disclaimer: this information is for educational purposes only. Consult with your physician for any health questions or concerns related to your child.
Finger food fear
K: I’m so excited to talk to you because what you’ve created is such an amazing resource. I know you’ve connected with hundreds of thousands of parents and caregivers all over the world at this point, and so I’m curious from your perspective- what scares parents the most about finger foods for their babies?
J: I remember feeling that fear. When everything you’re taught is that baby should be fed this very textureless puree in a jar, the sight of seeing a baby grab a piece of steak and bring it to their mouth is terrifying. I was terrified too! Fear is a completely normal response to be having.
But what we need to do is actually go back about 100 years because that is kind of what parents were doing before. In fact, parents were pre-chewing meat and then handing it over to their babies- which I think is really interesting too. So in some ways, this fear we have around feeding babies whole foods is a generational thing. It’s a normal fear. I felt that same way too, but it’s only normal because of the way we’ve been kind of conditioned to think that baby food should be or look like or how babies should be fed.
Choking: myths busted
J: Let’s talk about choking because it is the number one fear. We’re just so anxious and sensitive in that first year of life. Your job is to keep this human being alive, right? And so anything that’s pushing those boundaries can feel very, very nerve-racking. The beautiful thing is that the research and the evidence show that there is no increased risk of choking whether you’re feeding your baby with finger food or purees.
And I know that seems like, “Well, how could that be? How is that possible?”
There is a crazy thing that no one is really talking about which is this: when your baby’s brain decides to pick up a piece of food and actively, cognitively decide to put it in their mouth, the body is more prepared to swallow it safely.
Swallowing is really just kind of concert of coordinated muscle movements, that’s all it really is. And choking is the opposite of that- it is when something in that coordination fails. So it’s actually not always about the shape of the food or that the food isn’t a mash or a puree; it’s a coordination failure.
You can choke on milk, you can choke on water, you can aspirate watermelon seeds. All these things are possible. So when we talk about reducing the risk around feeding babies and reducing our anxiety around that, what we really want to focus on is setting up a safe environment so that baby is focused, there are no distractions, no sudden loud noises, nothing like blaring from the television that might startle them, and that they’re positioned in a safe way to eat so that the muscle coordination can happen naturally.
The body is really designed to protect you and your baby from choking. There’s actually a little flap of tissue that covers the airway so you have a food tube and an air tube, and the flap of tissue closes off the airway entirely during the swallow. So for that to fail and not work, there has to be something else going on, and often it’s because I startled or was coughing, or a toddler is laughing or running around.
When you look at the data around choking statistics, what we’re really seeing and what our swallowing specialists are most nervous about, are toddlers on the move. And I know you specialize in this age and know about snacking on the go!
K: You’re so right. And when I think about my own personal experience as a mom, it is hard to really think about that once they are on the move- making sure that they are seated safely to eat.
Gagging vs. choking
So when we talk about our babies, I think people don’t necessarily notice the difference between choking and gagging. Can you talk about that?
J: Absolutely. So first, they are entirely different mechanisms. In fact, there are almost opposites, which is a beautiful thing. I know a lot of folks worry that gagging leads to choking or wonder, “is gagging a sign that my baby is about to choke?” None of these things are true.
What is gagging?
Gagging is a forward thrusting motion of the throat muscles and the mouth and the tongue to push food up and forward and out. It’s very easily triggered in a six-month-old baby or really in a six to nine-month old baby in particular. Gagging is really powerful. In fact, it can sometimes almost lead to vomit or sound like the baby is vomiting. So physiologically speaking, everything is thrusting up and forward and out of the mouth, whereas choking is exactly the opposite.
What is choking?
In choking, something is occluding the airway- meaning completely or partially lodged in the airway. So something went down the wrong tube, and it is stuck to the point where you don’t have the air pressure or cough pressure to get it out, and that looks like an inward sucking motion.
Signs of choking
So the baby or individual typically motions to their throat- they’ll be reaching for their throat as if they’re trying to get something out. You might see some skin tugging in as if they were breathing in, and again, they’re sucking in because they’re desperately trying to get some air.
We like to point to visual things that help parents identify the difference between gagging and choking.
If your baby is choking:
- they’re going to have extremely wide eyes
- they will have a look of terror on their face- you cannot mistake it
- They will not be coughing or making any sound at all- possibly a faint wheeze if it was a partial occlusion.
- But it’s almost a silent, scary wide-eyed thing.
If your baby is making sounds like a wrenching, sound of vomiting, coughing, or crying, they are not choking.
I have this story that I love to share because one of our followers was a 911 Emergency Services Operator here in the US and she told me, “I used to get so many calls from moms thinking their baby was choking, when in fact, I could hear the baby in the
background crying.” And she knew just by that that they weren’t choking because they were able to cry or cough or make some sound. I love that story because it really illustrates the difference that if your child is making noise, they’re probably not choking.
How the body protects against choking
The other thing I’ll say- and then we can move on to a happier tone- is that there are so many protective mechanisms that have your back in the body. We have the gag reflex protecting against choking. We have the tongue thrust reflex- which is a lingering reflex in infants. Even the amount of air you would have in your lungs is typically enough to forcefully expel something.
How to reduce the risk of choking
So when we look at reducing the risk of choking, we want to look at making food a shape and consistency that can’t easily get lodged in that airway. Your baby’s air tube- their wind pipe- is about the diameter of a drinking straw. That sometimes freaks people out because they think, “That is so small! Anything bigger than that is going to cause my baby to choke!”
It’s actually the opposite: bigger is safer, because if it can’t get in the straw, it can’t get stuck. So I love thinking of it that way. I have a visual on our Instagram of putting a peanut inside of a drinking
straw and showing why a whole peanut is so dangerous, so you’ve got that kind of tapered shape where it’s small enough and round and hard where it can kind of squeeze in kind of perfectly, but you can’t really get it out very easily- that’s what really makes a choking hazard.
So we often say that bigger is better and safer when it comes to babies just starting solids.
K: That is hugely helpful and I think it gives a really clear depiction of that difference between the choking and the gagging and how all of us pretty up never learned about that. So then as parents, I think any sign of your child struggling can feel like a choking, like it is an emergency episode, but what you so eloquently explained to us is that if we hear those sounds and they are making those noises, it’s really not choking. Gagging is good. That’s so, so helpful.
Does my baby need teeth to eat?
Now, let’s shift a little bit and talk about teeth, because that also can be a barrier to people moving past purees.
J: Everyone assumes that we need teeth to chew- and teeth are helpful in biting and tearing- but when it comes to actually breaking down the food in your mouth, teeth are not necessary.
If you were to take a bite of food, you move it over to the side for your molars to break down. Well, toddlers don’t have molars until well after their first birthday, so if your notion is that babies need teeth to eat or to chew finger foods, then you’d be waiting well after the first birthday to offer finger food- which is a really bad idea! Don’t do that.
Our swallowing therapists and feeding therapists often say that the teeth- the molar- are there right below the skin of the gums. They are very powerful. Have you ever put your finger in your baby’s mouth in between their gums? They can press down really hard. What they can’t do as effectively without teeth is grind. That is why you’ll see toddlers even well up to age two spit out fruit skins, grape skins, tomato skins, and struggle a bit more with raw greens, because the motion to really break those down to a place where you feel comfortable swallowing requires a bit more grinding.
It doesn’t mean those foods are unsafe or that fruit skins or the skin of an apple commonly spit out are unsafe, it just means your baby knows they don’t have that part down yet, and so they spit it out while chewing the rest of the flash of the food.
So you don’t actually need teeth to eat. And those bunny teeth that your baby has growing in first- those front and top bunny teeth are really just going to help them bite food off, it’s not really going to help them chew. What we’re eventually looking for is molars to help grind, but most of the time, if the food is cooked, it’s not too hard, and it’s cut thinly, you’re going to be just fine. A baby doesn’t really need the teeth to break that down.
K: Another myth busted by Jenny!
When can my baby self-feed?
Now let’s talk about self-feeding. This doesn’t necessarily mean that purees are completely off the table, but at what age should babies be self-feeding? And what are the benefits of that?
J: This is all really up for debate right now in our society- which is an awesome thing in my opinion- because I think the last century has really been shaped by corporate marketing in the United States from very large companies who want your child on their product as early as possible and for as long as possible.
I recently discovered that the recommendations around baby food or starting with purees or rice cereal are grounded in zero evidence, there’s actually no research supporting that spoon-feeding baby food or purees is appropriate, developmentally necessary, or the best way of going about it. It’s the only thing in pediatrics that doesn’t have evidence behind it, and it’s the scariest part.
So again, we have some unlearning to do. And I like to share that before we talk about the other stuff because it’s really important to understand that context in the background. So when we talk about the age of starting solids: look back to 1880, the average age of starting solids was 11 months old. At that time, the child has a pincer grasp, they can pick up small pieces of food, they have some teeth, they can bite and tear- baby food was completely irrelevant and unnecessary as a concept for starting solids as an 11-month-old.
Now we now know from a health perspective, the most beneficial time or the most strategically optimal time to start solids is around six months of age. But the interesting thing is that also at six months of age, babies are able to self-feed. They have the developmental skills to do that. They’re reaching for things, they’re grabbing and bringing it to their mouth, they’re teething on things, and if you really watch a six-month old, they’re preparing to eat. You can see it. They’re teething and biting and mouthing on everything, so we really don’t want to interrupt that process.
Solid food for baby – signs of readiness
Let’s talk more about developmental signs that you want to see.
- We want your child to be able to sit upright independently in their high chair and not be flopping over- that’s a choking prevention milestone.
- Ability to reach for a toy and bring it to their mouth.
- We want to see them be interested in what you are eating, indicating that they are psychologically ready and interested in eating.
Otherwise, it might be an uphill battle. Even waiting just one week can make all the difference at that age. They grow and develop so quickly.
We have a full list of readiness signs on our website, but generally we want to look for strong trunk and head control, coordinated movements of the hands, the ability to reach for a toy and bring it to their mouth, and some interest in watching you eat. In most babies, that’s going to happen around six months of age.
Should baby start on baby cereal?
Now, let’s talk about the recommendation from your doctor (or whoever) to start solids at four months old with rice cereal. They clearly haven’t read the press this year of what’s in rice cereal. The FDA issued a notice essentially saying that they no longer recommend rice cereal be used as the primary baby food. The reason that recommendation was initially in place was because doctors got really concerned about iron intake, and infant cereal, as you know, is fortified with iron. So if your food choices are limited, it can be a great way to get iron, but it’s not a necessary first food and it’s not something that you need to be doing at six months or at all.
Your doctor may be suggesting that you start earlier than six months of age, whether that’s for reflux reasons or iron levels or allergen exposure- there might be some exceptions to the rule, but the medical community is debating all of this right now.
And it’s finally rooting itself in science, which we’re really excited about.
K: I’m so glad. This year, for the first time ever, we have in the Dietary Guidelines for Americans the birth to two age range. When I was back in graduate school, I just couldn’t believe that that didn’t exist. I thought, “How is it possible that we have no official guidelines for this 0-2 age group?”
J: I think parents often look at places like the CDC and the FDA for recommendations on things like ‘what fish are safe?’ and ‘how much of this can I have?’ All those recommendations are based on age 2 and up. It’s as if they just skipped that 0-2 age range because they didn’t want to test on infants- which makes sense- but we now know so much more than we did before.
Solid food for baby – Where should I start with finger foods?
K: It’s incredible. And Solid Starts is really bringing that information to people on a wide spread level that is free and available and I want to talk all about it! But there’s one thing that I’m very curious to hear from your perspective first: what foods would you say are the most surprising to parents when you say, “you can actually feed this to your baby!”
J: There really aren’t that many foods that are off-limits. That’s one of the things I love about starting with finger food- it opens up a world of possibility in terms of flavor and texture and taste, but also things that are culturally relevant to your family. We don’t all have to be eating the same Gerber puree or rice cereal. It can be beautifully diverse.
One of the foods that surprised parents the most is a chicken drumstick. Parents think, “Wait, what? That huge thing?!” You peel off the skin and hand that over. It looks like a rattle and babies love it. It’s easy for them to pick up and bring to their mouth and is relatively low risk because the kinds of pieces that get pulled off are really too big to make it too far into the mouth. They’re mostly going to mouth it and teethe on it. It also provides a ton of sensory input into the mouth, which the brain needs to map the mouth.
When you are a baby, you can’t feel a little piece of eggshell in your mouth. We can, as adults, because our brain, our brain has mapped the mouth. That all has to be learned, and the only way it’s learned is through poking and prodding and eating foods that we love- chicken drumsticks, a mango. It is what I tell parents to try first who are terrified because it’s big, you can’t bite through it, it’s too big to even put in the mouth.
Really big, resistive foods actually are safer because baby can pull it out of the mouth more easily, and the bits that will come off are not usually a shape or size that are concerning.
K: I love that recommendation, and I do think that would help take away the fear for some parents. Looking at a mango pit, there’s absolutely zero way that it could get stuck in my baby’s throat. Would you also agree that when baby is putting the food in their mouths themselves, that’ s helping with that brain process of figuring out where things need to go, where things are, etc?
J: Exactly, and the research shows that the choking risk lowers when the child puts the food in their mouth for themselves. The brain is just more ready to chew and swallow for exactly the reasons you described. Generally when it comes to finger food, you just never want to place it in the child’s mouth. Always let them do it- as clumsy as it may be, let them initiate that activity.
Spitting out food- what does it mean?
K: Right, and I just can’t not touch on this: when parents see their kids spitting out food, they often assume that they don’t like it, but what can you tell me about that?
J: Yes, that happens with gagging too. We have so many videos that parents have sent in where a child will spit a food out and the parent assumes, ‘oh, you don’t like that.’ And when they say that it’s almost confusing for the child because very rarely was it the case that they didn’t like it. In fact, most babies wouldn’t spit something out that they didn’t like- which is an interesting thing. they would probably still work with it and make a face, but not necessarily spit it out.
Spitting is merely a life skill. We want to see your child spit. That’s a really important skill to have. When they pick up something off the floor that is unsafe and they realize it’s not food, that they can spit it out, that;s a hugely important skill. So don’t look at it as a bad thing. Look at it as like, ‘Checkmark. Okay, we’ve got spitting down. Moving on.’
When a baby or toddler is spitting something out, it’s usually because they are just not confident that they’ve chewed it enough to swallow it. Often the baby will split the food out, look at it to learn, ‘ oh, that’s too big,’ or, ‘oh, that’s not chewed enough,’ and then take a bite from it.
K: And then they offer that to you! No, thank you.
First Foods Database
I want our readers to hear all about what Solid Starts has to offer in your First Foods Database, because it truly is an incredible resource that I wish I had when my first child was a baby. Because even with the knowledge I have as a dietitian, it’s still your first baby and it’s so nerve-racking to introduce those foods. Every food is different in texture and shape and size and sometimes you just need someone to tell you how to do this.
J: We are building the world’s first food database for babies. It is live right now, but we are still adding to it. When we’re done, it will have more than a thousand foods in it. It is pretty comprehensive in terms of cultures and foods across the world, and it’s the place you go to to look up: is something an allergen? iIs it a choking hazard? What’s the impact on baby’s poop? How do I cut this for a six-month-old versus an 18-month-old?
And we throw in a recipe there for the first introduction as well. So the entire database is free, it’ll be free forever. It’s also an app for both Android and iPhones as well.
When I was thinking about the first foods database, I wanted to make something that was totally accessible to everybody around the world forever. That was really important to us. It is costing so much money to build, but basically we operate as a social enterprise, almost like a non-profit. The revenue that comes in then funds the expansion of the First Foods Database. When I was looking at Baby-Led Weaning and nutrition in the United States, it had become a very privileged space, and I want to undo a little bit of that by making sure that everyone has access to the information they need to offer whole fresh foods to their baby.
K: I love the mission behind it, and I’m so glad that this idea came to you and that you acted on it. A one thousand food database is incredible.
Solid Starts: evidence-based and expert-reviewed
And what people will notice very quickly when they go check out your website or your app is that you have an entire team of experts and specialists behind you. It’s not thrown together; it’s very well thought out in research. Can you tell us about the whole team at Solid Starts?
J: Yes, thank you for asking. I built this database because I was tired of googling. I was tired of Googling and then questioning, ‘does this mom blogger know what she’s talking about?’, or, ‘does this media article have any bias that I should know about?’ We wanted to create a very evidence-based, multidisciplinary platform where each food in our database is reviewed by seven or eight people, and they’re all licensed experts in their field. A pediatric allergist reviews it, a pediatrician reviews it, a gastroenterologist reviews it, a pediatric dietitian reviews it, a functional nutritionist reviews it, a food researcher reviews it, and then swallowing specialist and feeding therapist reviews it. We really covered all of the bases when it comes to that because I wanted to build something totally trustworthy.
We have quite a big team now, but the primary senior team is our pediatrician, Dr. Ruiz who is a Stanford-trained pediatrician and double board-certified doctor and gastroenterologist, Dr. Bajowala who is an allergist also an MD and author in this space, and then we have swallowing specialists, feeding therapists, speech language pathologists, lactation consultants, nutritionists, etc.
I wanted to make sure it was thorough because I was the mom who didn’t trust anybody. And I don’t trust anything I read online anymore, and so I wanted to build this completely bullet-proof, multi-disciplinary thing that could even be respected by the American Academy of Pediatrics.
K: I do feel that is incredibly trustworthy for all the reasons that you mentioned. Going to your website and seeing that you list your sources for things. You can easily see who all these experts are and what their credentials are, so I’m incredibly grateful to you for offering this to the world for free. Anyone who comes to me with a question on introducing a new food, I always refer them to Solid Starts. You also have some videos too. I think it is so helpful for parents to see other babies eating these foods.
J: Yes, exactly. So every food has two or three videos of babies at different ages self- feeding that food, so you can really build your confidence and see, “Oh, they can do it, I think my baby can do that too.”
K: The First Foods Database is available on Solidstarts.com, or you can download the app, Solid Starts. There’s always amazing content coming out on Instagram as well, so follow them at Solid Starts. Thanks, Jenny.
J: Thank you so much, Kacie.