Starting solids is a milestone that parents eagerly welcome. There has been much discussion among experts of when and how to begin the introduction of complementary foods. The most recent recommendation from American Academy of Pediatrics recommends exclusive breastfeeding in the first six months of life with complimentary foods beginning between 4-6 months when the infant is developmentally ready and showing signs of feeding readiness.
The AAP recommendations are intended for full-term, healthy babies and there is not any evidence-based recommendations available both nationally or internationally of when to introduce solids to preterm infants (born before 37 weeks gestation), especially very low-birth-weight infants (VLBW) 1.
Regardless of the country you live in, most experts agree that premature infants have special nutritional needs due to inadequate nutrient stores and an immature digestive system, including the need for iron supplementation in the first months of life. Premature babies also differ from healthy, full-term infants in terms of development. Some preterm infants can be severely developmentally delayed while others, especially those born closer to term, do not suffer from any apparent delays.
When comparing your preterm infant’s developmental maturity, it is important to compare your infant according to his corrected age and not just his chronological age. Chronological age (CH) indicates the child’s actual age while corrected age (CA) refers to the age your premature baby would be if he was born at term (40 weeks gestation). To calculate corrected age, subtract the number of weeks (or months) your baby was born prematurely from his chronological age (his actual age).
Corrected Age (CA) = Chronological age (CH) – number of weeks (or months) premature
For example, a former 28 week premature infant is 6 months old. His chronological age is 6 months and his corrected age is 3 months.
CA= CH- months premature
3 months = 6 months –3 months (40 weeks- 28 weeks = 12 weeks premature)
When you compare a former 28 week premature infant who is now 6 months of age with a full-term infant (born at 40 weeks) at the same age, you should realize that although your premature infant is the same chronological age as the term infant (6 months old), they differ greatly in developmental ages. Your former 28 weeker is at a corrected age of 3 months and should be compared developmentally to a 3 month infant instead of a 6 month infant. Therefore, even though your baby is 6 months old, he may not be developmentally ready to begin solids.
How do you know if your former preemie is ready? First and foremost, discuss your child’s readiness with your baby’s healthcare provider and ask for their recommendations of how and when to begin this transition. Watch for the following signs of feeding readiness:
- Able to sit with minimal support
- Has good head and neck control
- Shows interest in food
- Makes chewing motion with mouth
- Tongue thrust reflex diminished
- Able to regulate feeding by giving signs of fullness (i.e. turns head away from food, closes mouth when bottle/breast or spoon approaches and pushes food/milk out of mouth)
Since breastmilk and/or formula is the most important source of nutrition at this time, it is advised to offer breastmilk or formula first before giving solids. Begin introducing soft, mashed foods such as iron-fortified whole grain cereals, bananas, avocado and sweet potatoes.
In the United Kingdom, recommendations include that infants should be individually assessed and solids should be introduced between 5 to 8 months after their actual birth date (chronological age). It is best to discuss the unique needs of your child with your baby’s healthcare provider and consider your baby’s developmental readiness.
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1. Fanaro, S.; Borsari, G. & Vigi, V. Complementary Feeding Practices in Preterm Infants: An Observational Study in a Cohort of Italian Infants. Journal of Pediatric Gastroenterology & Nutrition. December 2007; Volume 45; p S210-S214.
American Academy of Pediatrics (2008). Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas.
The British Dietetic Association Specialist Paediatric Group (2010). BDA Paediatric Group Position Statement: Weaning infants onto solid foods
Community Nutritionists’ Council of British Columbia (2008). Evidence Based Information: Introduction of Solid Foods to Infants
Department of Health and Human Services, Health Resources and Services Administration: Maternal Child Health Bureau. Gaining and Growing: Assuring Nutritional Care of Preterm Infants
Author : Diba Tillery RN, BSN, IBCLC, CPST