Introducing solids with Kim Grenawitzke, Senior Feeding & Swallowing Specialist at Solid Starts.

 Kristin Revere and Kim Grenawitzke discuss infant feeding in the latest episode of Ask the Doulas. They cover everything from breastfeeding to bottle-feeding transitions to solids. Kim is the Managing Director of Content & Editorial and Senior Feeding & Swallowing Specialist at Solid Starts. Her book, “Solid Starts for Babies” is found online or in stores.   Solid Starts Book | How to Introduce Solid Food and Raise a Happy Eater

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Transcript

Kristin Revere and Kim Grenawitzke discuss baby feeding in the latest episode of Ask the Doulas.  They cover everything from breastfeeding to bottle-feeding transitions to solids.  Kim is the Managing Director of Content & Editorial and Senior Feeding & Swallowing Specialist at Solid Starts.  Her book, “Solid Starts for Babies” is found online or in stores.   

Hello, hello!  This is Kristin with Ask the Doulas, and I am so excited to chat with Kim Grenawitzke.  Kim is the managing director of content and editorial and also the senior feeding and swallowing specialist at Solid Starts, Incorporated. 

Kim specializes in infant and child feeding, eating, and swallowing.  She has spent the majority of her career in pediatric acute care at some of the largest hospitals on the west coast, focusing specifically on neonatal, feeding and swallowing, breastfeeding with high risk infants, and infant pediatric cardiac rehabilitation. 

In addition to her hospital-based work, Kim has worked with families struggling with breastfeeding or who need breastfeeding support, transitioning to solids, selective and picky eating, tube weaning, and oral and motor chewing. 

She is a mom to two in Michigan.  Welcome, Kim!  It’s nice to have a fellow Michigander! 

I’m so happy to be here!  And yes, I’m a new Michigander, I have to admit.  I grew up in California, spent the majority of my formative years there, but my husband’s family is here in Michigan, so it made sense when we had kids to bring them closer to Grandma and Grandpa. 

Absolutely.  I bet grandparents are so excited to have you here! 

Yes, and I’m adjusting to the cold weather, learning about snow.  It’s been an adjustment, but a fun one, and my kids absolutely love the seasons. 

Nice!  I love it.  Well, our topic today is such an important one, and obviously, with your background, you are the perfect person to dive into transitioning to solids, whether a family is breastfeeding, pumping, or formula feeding. 

Absolutely.  I know this can feel so complicated, and by the time you’re starting solids, most parents have just kind of figured out their day routine.  They’re figuring out how to feed their baby at home or in public or wherever it may be.  And now we’re throwing this wrench into the conversation of, hey, now it’s time to start solid foods.  So it definitely can feel really overwhelming, and I hope that in this conversation, we can help ease your nerves and realize that it can be seamless with just a little bit of pre-planning and some tips. 

Let’s begin with when to identify the correct time to introduce. 

This is a really interesting topic because a lot of pediatricians and pediatric healthcare providers will start to bring this up at the four-month well child visit.  And many will say, oh, your baby’s ready for solids.  Go ahead, and here’s a handout from one of the baby food companies.  Take this home and start solids.  But when you actually dig into the literature about why we transition to solids – of course, there’s a nutritional component where breast milk specifically starts to not fully support the specific micronutrient needs of a baby.  So around six months, a breastfeeding parent is exclusively breastfeeding.  The baby starts to need a little bit more iron and zinc and a few other micronutrients.  So starting solids does support that need.  But I do want to be clear that it’s not a cliff.  It’s not like the day the baby turns six months, breast milk is not enough and this is a problem and they have to get lots of iron rich food – that’s definitely not it.  We know that there’s a progression from six months to twelve months where your baby is going to start needing more of these micronutrients that are not as readily available in breast milk.  Most of the commercial formulas in the United States do have supplemental iron in them, and so babies who are getting formula do have a little bit higher natural intake of those nutrients.  But generally speaking, somewhere around six months, babies start to need a little bit of a different nutritional profile than they did earlier on. 

And that’s by no means to say that the breast milk or formula isn’t enough, and that’s still their primary source of nutrition and it’s super important, and we want babies to be drinking lots of breast milk and formula.  We just want to start getting these new foods introduced so by the time they hit toddlerhood, they’re really familiar with them.  They have the skills to eat them, because those foods are going to support their growth and development as they get bigger. 

Now, the second component is the research tells us that there’s no nutritional benefit of starting solids at a certain time.  So a lot of pediatricians will say to introduce solids if bottle or breastfeeding is not going well, or introduce solids to help with reflux.  The research is really not clear on whether those things are helpful, and it does tell us that there’s really no difference in a baby’s nutritional labs if taken at four months and six months, whether they start solids or not.  So it doesn’t need to happen at four months.  

And if we think from a more general perspective, why are we transitioning to solids outside of just the nutrition thing?  We’re trying to teach our babies to chew, right?  Teaching them to eat.  We’re teaching them about the family meal.  We’re teaching them what it is like to sit with siblings and parents and grandparents and enjoy a meal together.  We’re showing them that meal times are for celebrations and are for connection and love and communication.  It’s a lot more than just that nutrition piece.  So if we think about when a baby is actually ready to learn those skills, we want to look at their development.  And the developmental skills that help support them being able to learn to feed themselves, to learn to chew, to learn to move food around in the mouth, and to cognitively understand what this whole thing of meal time is – we see those skills showing up somewhere around six months.  Some babies might be a little earlier; some babies might be a little later, but typically speaking, it’s around six months.  When you look at what the WHO recommends, and actually the more recently updated AAP position paper, it is recommended to exclusively breastfeed, and I’m going to add or formula feed, until six months of age. 

So the developmental skills that we’re looking for is we want your baby to be able to sit with a little bit of help.  That doesn’t mean they have to be perfectly sitting on the floor, never toppling over, playing by themselves while you wash dishes.  You want them to be able to sit in your lap or in the high chair and keep their body and their head upright for 10 or 15 minutes.  So my first daughter was born at 36 weeks in the middle of COVID, and she took a little bit longer to get there.  When she was sitting on my lap or in the high chair at six months, she was really still kind of leaning over to the side, wasn’t really able to hold her head and neck upright.  She needed a little bit more time.  My second daughter, at a little over five months, was sitting up, bringing her hand to her mouth, ready to go much earlier.  So there is a variety there.  It doesn’t necessarily mean five months and 29 days is too young; six months and 3 days is too old.  We’re just looking for somewhere around six months, that they can do that. 

When they’re sitting, we also want to make sure that they can pick something up and bring it to their mouth.  A lot of babies can sit but then if you give them a toy, they topple over because they just don’t have the control yet to hold that toy and bring it to their mouth, which is important for self-feeding.  And then finally, we want them to be interested.  So if you bring your three- or four-month old to the table, they most likely will fall asleep, want to nurse, or – they’re kind of like, this is a snooze fest.  Not interested.  But if you bring your five, six, seven-month-old to the table, they’re like, what is that?  Oh, my gosh, what is that spoon?  What’s going in your mouth?  They’re reaching for the food.  They’re engaged.  They’re curious.  They want to learn about that thing that mom and dad and brother and sister is playing with, because in their mind, that’s what they think you’re doing.  So that cognitive interest in food and eating is really key to help them be engaged and want to eat food, want to open their mouth, want to put the food in their mouth, and all of those typically come together around six months.  

That makes perfect sense.  And with that transition to feeding, how would that relate to having a nanny or being at a childcare center and having their assistance with feeding? 

And I know that’s a common question we get from a lot of families because your schedule during the week could vary from different caregivers every day to being at a center or being away from the parent.  The great thing to keep in mind is that in the beginning, especially from six, seven, even eight months old – it’s completely normal to only offer solid food to your baby once a day.  And it’s completely okay to skip some days here and there.  If your baby is away from the home and you don’t feel comfortable having your childcare center or your nanny or your mother-in-law or whoever it is that’s hanging out with your baby during the day offer solids – that’s completely fine.  You can plan to do solids with your baby at dinner time, or you can plan to do solids with your baby in the morning.  Either one is completely, absolutely fine.  I encourage people to talk to their daycare providers about the strategies that they use, the seating arrangements that they put the babies in, and if you don’t feel comfortable – again, especially those first few months – just tell them to hold off.  Continue with the bottles, the bottle feeding that they’re doing, and you can work on solids at home. 

Around nine months, we start to recommend trying to go up to a couple opportunities a day, and at that point, you can continue again to do at least one round at home with you.  Again, if you don’t really feel comfortable with them doing solids at school, you can do breakfast and dinner at home.  You can really focus on those learning opportunities on the weekends when you are with baby.  But in the infant period, as long as they’re getting all that breast milk and formula to support their overall nutrition, the learning to eat, the exposure to the iron-rich foods, that stuff can happen just with you if that’s where you feel the most comfortable. 

So helpful!  So tell us about Solid Starts. 

Man, Solid Starts has been a roller coaster of fun.  My partner, Carrie, and I are the two senior feeding therapists over at Solid Starts.  We had been working with this population for a long time, specifically in the hospital, and we started doing more research looking into how starting solids was happening with typically developing kids.  And we were doing a lot of teaching, mostly for other therapists who needed continuing education.  And through that, we got connected with Jenny Best, who is the CEO and founder of Solid Starts.  And she just wanted to share information about starting solids in a child-led way.  The buzz term, of course, is baby led weaning.  

At the end of the day, what we care the most about is that baby is taking the lead from the very beginning, feeding themselves, no matter what the kind of food is.  She wanted to start an Instagram, and she wanted to post really good information for parents and have that be available for free, essentially.  She wanted to have information available about hundreds of foods so parents could look up ways to serve it safely, and she wanted the professional team behind her to help come up with really good evidence-based recommendations.  

So Carrie and I hopped on board immediately, because we loved this concept, and we pulled in one of the pediatric gastroenterologists that I was working with at the time at Stanford Children’s, and she found an incredible pediatric allergist in Chicago.  We’ve had amazing pediatric dieticians that we work with, as well.  And we coalesced as this really amazing, multidisciplinary team to put together everything that Solid Starts offers. 

So we’ve got a very active social media presence, and there’s tons of information posted there every day, covering topics from food refusal to spitting to gagging to transitioning from purees to finger foods to toddler picky or selective eating – I don’t want to call it toddler picky eating.  That’s a whole other topic we could talk about it.  But toddlers who are having trouble at the table.  And we’ve got tons of great information there.  We have our free first foods database where you can look up foods like, I want to give my baby banana today, and you can type it in there and it will give you the nutritional information, the allergen information, the choking information, how to prepare it as finger food, how to prepare it as a mash.  And that’s available completely free on our website.  We have an app, as well.  And then if you’re interested, we have put together a more guided experience for starting solids with recipes and step by step allergen introduction that was put together by our pediatric allergist and kind of all of the how-tos.  It’s also available as a premium aspect of our app. 

These things have just grown like wildfire, and it’s been amazing how many families we’ve been able to serve.  And we are so lucky that we were approached by a big book publisher, and we actually have a book coming out April 1st, as well, so that’s super exciting. 

It is!  I can’t wait to get it! 

I know, it’s a dream come true.  And for all of the how-tos and things that we have in our app and on the internet – the book is really the why.  It’s the stuff that Carrie and I love the most – the theory and the research behind why these things matter, and it’s kind of almost a parenting philosophy in a lot of ways.  So we are so excited for that to be out in the world for clinicians and parents. 

So I take it your book will be available on your website, as well as online retailers and bookstores? 

Yes.  It’s actually available for preorder prior to April 1st, and you can get it anywhere that books are sold, so Amazon, Barnes & Nobles, Books.com.  We also have a link on our website.  And then come April 1st, it will be available in bookstores, and then again on all of those online retailers that people love to use.  And I’m just hoping it gets into the hands of anybody who is what we like to call a highlighter parent, but somebody who really loves to dig in.  I’m this kind of mom where I love to dog ear pages and take notes in the corners.  It’s the old graduate student in me coming out still. 

And it’s great for caregivers – nannies, newborn care specialists, postpartum doulas.  Anyone who would be working with infant feeding certainly could benefit. 

Yeah, absolutely.  I just had a little conversation with some of the early childhood educators at my daughter’s preschool, because they have some infant programming, as well.  I’m going to try to do a little inservice for them and share the book.  It’s a great way to think about things, like I said, from a more theoretical lens, but there’s a whole section that’s very much step by step guidance with some great foods to start with; here’s the nutritional components of these foods.  It's not only just the theory.  We also see the very practical how-to part in there, too. 

And I’m sure the photos will be beautiful, with the content that you have online.  It’s got to be amazing. 

Yeah, we’re so excited.  I can’t believe it’s almost here! 

So I would love to hear any final tips or words of wisdom for our listeners, Kim. 

Yeah, absolutely.  So for those of you who are just getting started, I think the one thing to remember is try to think about this as a happy time.  Try to think about this as a new milestone that your baby is going to get to participate in.  It can feel really stressful to bring them to the table, and it’s one more thing we have to add to our to-do list.  But family meal times are a time where we can truly connect and share our love of food and eating with our child, so if you try to approach it as a time of love and connection and fun, your attitude will be contagious, and your baby will want to be there, too.  We like to tell families, make the table a place your baby wants to be.  Even if they don’t eat a thing, even if they spit, even if they make a whole big mess, which I know is ridiculously stressful, especially when you’re trying to get out the door or trying to keep the dog from eating something – been there!  If you can do your best to make the table a place your baby wants to be, it will likely be a place that your toddler wants to be and your preschooler will want to be and your kids will want to be.  And I envision my kids, my girls, as teenagers and them actually wanting to sit at the dinner table with me.  This is probably just pie in the sky.  Anybody listening with teenagers is like, ha, she’s crazy, no way.  But I’m really hoping that table will always continue to be a place of safety and a place that my kids can come and feel heard and share about their days and their dreams and things that matter to them.  So make the table a place your baby wants to be. 

Excellent advice!  Can you remind our listeners where they can connect with you? 

Absolutely.  If you are on social media, you can check us out @solidstarts.  We’ve got a really active social media account.  Our website has tons of free information available there, too.  There’s a search bar.  You can type in your question, and tons of articles will pop up that are all written by our licensed pediatric staff.  Our book is available for preorder now and will be available come April 1st.  There’s a link on our website, and you can also find it on Amazon or anywhere else that books are sold.  It’s called Solid Starts for Babies.  And if you want to reach out via direct message or email, feel free.  We are always here to answer your questions.  We want to support everyone in this journey and make sure that you feel like you know what you’re doing and that your baby is successful alongside you. 

Thank you so much, Kim!  We’ll have to have you on in the future to discuss picky eating. 

Again, a whole other talk could be just on toddlers being toddlers, for sure. 

Yes!  Well, take care, and thank you again! 

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