Nurturing Tiny Appetites: Starting Solids for Premature Babies

by Dr Julie (PhD)

Welcoming a premature baby into the world comes with its own set of unique challenges and triumphs. As parents of these resilient little fighters, one of the milestones you may eagerly anticipate is the introduction of solid foods. While the journey of starting solids for premature babies may require extra care and attention, it's a significant step towards nourishing their growing bodies and fostering healthy development.

Just like almost every aspect of baby feeding this area is also full of conflicting advice even between health professionals!

Let's explore some essential considerations and tips for navigating this phase:

When to Start?: Before I cover this let's get clear on some terms first. A baby is considered full terms at 37 weeks of gestation. Babies born at this stage of gestation have had adequate time to develop and are more likely to have fully matured organs and systems. Prior to this is considered premature. I know it comes as a shock when a baby is a bit early! My third son was born just shy of 37 weeks. Just keep this in mind though when looking at if your baby is 'premature'.

Biological Age = Sometimes also called 'chronological age' is the age as determined from the actual date of birth.

Corrected Age = This is based on your baby's due date. It is calculated from their biological age minus the weeks/months they were born early.

For some reason this is where a lot of conflict occurs between health professionals - what age do you use for a premature baby? Many professional bodies (like the American Pediatrics Association) recommend corrected age. This is also what I recommend. The purpose of using corrected age is to provide a more accurate representation of a premature baby's developmental stage and milestones compared to their peers. In the case of start solids this takes into account motor skill development and gut development (potentially a higher level of gut sensitivity too). This means for a premature baby with a biological age of six months they would start solids around eight months. Remember it's not a race - food is life long and a slower start inline with your babies development is more important than the comparison games at an antenatal group.
Assess Developmental Readiness: Unlike full-term babies, premature infants may reach developmental milestones, such as sitting up and showing an interest in food, at different rates. It's essential to observe your baby for signs of readiness before introducing solids.

Look for cues such as good head control, the ability to sit in a high chair with support, and the disappearance of the tongue-thrust reflex (which pushes food out of the mouth). Additionally, watch for signs of interest in food, such as reaching for objects or displaying curiosity during mealtime.
Choose Nutrient-Dense Foods: When introducing solids to premature babies, focus on nutrient-dense foods that provide essential vitamins, minerals, and calories to support their growth and development. This is no different to a full term baby - however if a premature baby has had less time in the womb it is even more important to focus on this crucial stage as you are literally fueling their development! See my list of resources at the bottom of this blog but key ones to read are:

*Why I don't Recommend Baby Rice
*Baby Food Portions
Take It Slow and Be Patient: Patience is key when starting solids for premature babies. It's normal for babies to take time to adjust to the new sensations and textures of solid foods, especially if they've been exclusively breastfed or formula-fed until now. Learning to eat solid food is just that - a learning experience!

Allow your baby to set the pace and follow their cues for hunger and fullness. Remember that every baby is unique, and progress may be gradual, so trust your instincts and celebrate each milestone along the way.
Iron Needs - Iron is an essential nutrient for all babies, but premature infants have even higher iron requirements due to their unique nutritional needs. During the last trimester of pregnancy, the baby accumulates iron from the mother, but premature birth interrupts this process, leading to lower iron stores at birth. Since iron plays a crucial role in the development of red blood cells and brain function, meeting the iron needs of premature babies is vital for their growth and overall health. Breast milk or iron-fortified formula is typically the main source of nutrition for premature infants, but they may require additional iron supplementation to ensure they receive an adequate amount.

Healthcare providers closely monitor the iron levels of premature babies and may recommend iron supplements or fortified foods to support their development and prevent iron deficiency anemia. It's important for parents of premature babies to work closely with healthcare professionals to ensure their little ones receive the appropriate amount of iron to thrive and reach their full potential. Just keep in mind that iron tablets are often recommend as a blanket rule because iron is so crucial. Your baby may not need it or need it for the length of time typically given (right up to one year of age). However do check this with a health professional first (or me!).

Starting solids for premature babies is a significant milestone that marks the beginning of a new chapter in their journey of growth and development. With patience, care, and guidance from healthcare professionals, you can navigate this exciting phase with confidence and create positive feeding experiences that lay the foundation for a lifetime of healthy eating habits. Embrace the journey, celebrate the milestones, and savor the moments of joy as you nourish your precious little one's appetite for life.