[Dysphagia] Why Pureed Foods? [was "thickening breast milk"]

[SuzMorris at aol.com (SuzMorris@aol.com)]

In a message dated 7/9/04 8:15:42 AM, eripley@yahoo.com writes:


> <<* I find this a very interesting issue. Coming as I do from a very 
> different culture, in which, until relatively recently, babies were breast fed 
> until ready to finger feed, I wonder at the conviction that babies must be given 
> pureed foods at an age when they may not be able to accept them and they 
> don't have the muscle skills needed to feed from a spoon. By far the majority of 
> people in the world do not give babies prepared foods until the teeth erupt - 
> usually when the molars erupt - and nature determines that they are ready to 
> take finger foods. What have we been doing to entire generations of infants 
> with this inexplicable practice? Actually, like many things, it's 
> inexplicable until one applies the universal rule to an issue for which there doesn't 
> seem to be an obvious answer - Who benefits? or, Follow the money.I know all 
> about the added vitamin D etc. etc. but no-one has an answer to the questions 
> a) are they needed and b) could they be causing problems later in lif!
> e? I suspect they are.
> 
> Irene>>
> 
> 

In looking at feeding practices within a culture you have to go back to the 
beliefs that essentially drive the current practices.? These become part of the 
total cultural context that people eventually just take for granted as being 
"true." Several major beliefs in this country have strongly influenced the 
introduction and use of commercial pureed baby foods.

The first of these is related to the increase in bottle feeding and the decrea
se in breast feeding.? The bottle and infant formulas were promoted as a way 
to give women greater freedom of choice of how to feed their baby, to make it 
easier for mothers of infants to go back to work, and to provide a way of 
feeding the baby that was built on a high-tech scientific, medical model.?? The 
growth of technology was a driving force in the culture as a whole and the 
rights of women were emerging.? Many women perceived that they would have greater 
freedom if they were not tied down to nursing an infant every 3-4 hours for 12 
months.? Employers were not willing to provide areas where nursing mothers 
could express their milk on the job, so if a woman needed to work to help support 
her family, breast feeding just wasn't an option.?? All of this addressed 
another cultural belief/concern related to the sexualization of women's breasts 
and beliefs that it was wrong and embarrassing to expose the breast in public, 
even for feeding an infant.? This belief further restricted a woman's freedom 
to nurse her baby when the baby needed to be fed, no matter where she was.? 
Fewer new mothers had the ongoing support of their own mothers and grandmothers 
for successful breast feeding.? With multiple generations of bottle-fed 
infants, these older family members didn't have the experience of nursing their own 
babies so that they could provide personal support for breast feeding to their 
daughters.

As science and technology became a driving force for decision-making in 
infant feeding one of the replicable results of research was that breast milk did 
not supply an adequate amount of iron for the nursing infant after 4-6 months 
of age.? The baby receives the iron needed for the first months of life from 
the mother prior to birth. Prolonged exclusive breast feeding without the 
introduction of iron-rich solids contributes to iron deficiency in older infants.? 
This led to the development of iron-enriched baby cereals and the strong push 
by pediatricians and baby food companies to introduce baby cereals between 4-6 
months of age, especially if the infant was breast fed.

There is also some interesting data and speculation that bottle fed infants 
may become more easily bored with formula diets.? These ideas are based on the 
work of Julie Mennella and others at the Monell Chemical Senses Center that 
show that the breast-fed infant is introduced to a wide array of flavors that 
enter the breast milk from the mother's diet.? The formula-fed infant has a 
monosensory diet.

Secondly,? our culture has placed a high value on early independence and 
acceleration of infant development.? This has led to a whole series of 
interrelated beliefs that drive parent feelings and actions.?? The strongest of these is 
that babies need to learn to sleep through the night as early as possible and 
that if they wake frequently, they must have higher caloric needs than can be 
supplied by breast milk or formula.? The most common action that came from 
this belief was the early introduction of baby cereal and other pureed foods.?? 
Many parents also see their baby's progression to pureed foods as a 
developmental landmark.? Introducing the spoon and pureed food early allows some parents 
to feel that their baby is accelerated in development.? This becomes a status 
symbol for some mothers; for others, it promotes feelings of mothering 
inadequacy if the baby isn't taking food from the spoon by 4-6 months.

The baby food industry saw a cultural need, and created a nitch for itself by 
promoting the value of pureed food from a nutritional and developmental 
perspective.? They have also created extensive advertising that furthers the 
cultural belief that babies need pureed food as a transition food between? a 
milk-based diet and chewable solid foods.? They also promote the ease and convenience 
and the nutritional standardization of jarred foods for parents who are very 
busy and looking for easier ways to parent their kids.? It is not at all 
surprising with all of these factors that pureed foods are introduced early to 
infants in this country.

One of the reasons we need to look at this situation as based in belief and 
cultural systems is that change in these areas does not occur rapidly unless 
there is a shift in the underlying belief that drives the behavior.? Look, for 
example, at the abundance of research that says that breast feeding is best for 
an infant, along with the recommendation of the American Academy of 
Pediatrics (AAP) that all infants be breast fed until 12 months of age.?? There have 
been slow increases in the number of mothers who choose initial breast feeding 
for their baby, but the percentage of women who breast feed past 3 months of 
age is still relatively small (39%).?? The AAP has been saying that supplemental 
foods (i.e. purees) should be introduced between 4-6 months since the 
mid-70s.? More recently they have supported the recommendation from the World Health 
Organization that these foods not be introduced until 6 months.? The baby food 
companies have slowly adopted the same guidelines in their advertisements.? 
Yet, many parents introduce cereals in the bottle or by spoon at much younger 
ages.? There is research data that shows that babies who receive pureed foods 
don't have different sleep patterns than babies who receive an exclusive breast 
milk or formula diet.? Yet many parents will tell you that they started 
cereals early to help the baby sleep through the night.?? Scientific data by itself 
just doesn't change behavior that is rooted in beliefs and cultural 
traditions.

Irene's basic questions? [1. Are pureed foods needed? and 2. Could they be 
causing problems later in life?] are very challenging to answer because, as I've 
described, the answers are all tied in with beliefs and cultural traditions.? 
There are so many underlying issues with the foods we eat as older children 
and adults, that there is really no way to actually determine how much of our 
later health problems are related to feeding practices during the first year of 
life. For example, a series of recently published studies based on reported 
dietary intake of 3,022 infants between the ages of 4 and 24 months [i.e., 
"FITS"/Feeding Infants and Toddlers Study] showed that nearly 25% of toddlers did 
not eat any servings of vegetables and 33% did not eat any fruits. And of 
those who ate vegetables, French fried potatoes were the most common vegetable 
consumed between 15-24 months.? Earlier studies of young children's diets showed 
that later eating patterns are strongly determined during the first year of 
life. For example, the babies who were given a variety of fruits and vegetables 
during the first year, were the same children who were eating an adequate 
number of fruits and vegetables when they were 8 years old.? Babies whose diets 
didn't include fruits and vegetables during the first year, were not consuming 
these essential foods at 8 years.?

Unfortunately, even if it could be proven that solid foods are not needed 
physiologically until the child has teeth and can chew and that early solid 
feeding causes health issues, change would be very slow.? We can have an impact on 
the individual families with whom we work, even while overall cultural 
practices in our society change slowly.? Delaying the introduction of pureed foods 
until a baby is 6 months old makes a lot of sense from the standpoint of 
gastrointestinal and oral-motor skill development.?? There may be exceptions to this 
[i.e. if a baby really needs to have formula or breast milk thickened as the 
only alternative to tube feeding]; but as professionals we need to be 
knowledgeable and strongly support the nutritional and health aspects of infant feeding 
as we teach successful and safe eating and drinking skills.?? We need to 
introduce the concept of dietary diversity as soon as pureed foods are introduced, 
offering many opportunities for the child to experience a wide variety of 
fruits, vegetables, grains and protein sources.?? Many feeding programs focus 
solely on the quantity and texture of food eaten by the child (especially when 
weaning from the tube) with very little initial attention to increasing the 
number of different foods the child will accept (in small tastes).? Many 
therapists build their feeding program around sweet and salty foods because children 
prefer these tastes.? However, they often choose sweet puddings, candies, 
cookies, etc., without remembering that many fruits and vegetables also offer sweet 
tastes along with higher nutritional content.? Again, we must constantly 
remind ourselves that our primary goal/purpose in being involved with feeding and 
swallowing programs is to promote nutrition, hydration and full mealtime 
interaction and inclusion. [This is also a belief, so we will find many 
professionals who would set other priorities!]

Suzanne


Suzanne Evans Morris, Ph.D.
New Visions
1124 Roberts Mountain Rd.
Faber, VA 22938
(434) 361-2285 ext. 5
www.new-vis.com