Starting Solids with Extreme Prems

Having babies extremely prematurely comes with all sorts of challenges. You get through the hospital phase, you get through the struggle of bringing them home, you remember to give them their daily dose of iron. You get to three months corrected and life starts to get easier! So of course that is exactly when a new challenge gets thrown at you.

For extremely premature babies, it is advised that you start feeding solids by the time they reach 7 months actual age, generally guidance says start at three months corrected. Other than that, you mostly get given the usual starting solids guidance. Can they sit on their own, can they hold a spoon, can they put items in their mouths? Of course they can’t, they are three months corrected age! So how do you start feeding solids to a three month old baby? This is my experience, this is how we did it, this is not official medical or dietician advice.

Timing will work differently for different babies. I had this big idea of celebrating reaching 6 months (actual) with their first meal of solids, in the evening when their dad got home from work. That was not a success!

We really started with tiny tastes of puree in the morning, before their second feed of the day. We would hold them on our knees, because of course they were not ready for high-chairs. Their first food was kūmara, mashed up fine with breastmilk like I’d read about. But the babies were too young to really eat from a spoon and that was too runny to scoop onto my finger. So we used a thicker puree, scooped onto the tip of a finger and placed in their mouths. Started with just one taste, quickly moved to many fingerfulls! We moved on to carrot, then pumpkin. Plus prune puree, a tiny taste in the morning with some water (because prem babies on iron get pretty constipated).

We gave them their first spoons as toys, and after we saw them go from waving their spoons around to putting the spoons in their mouths, we started putting some food on the spoons. It was so messy! I had a twin feeding pillow set up on the couch, with rolled towels under the back to prop the babies better and other rolled towels under their knees to keep them in place. That way I could do the feeding all on my own.

At 7 months actual, we added a second solid meal, so now they were having breakfast and lunch. They still weren’t gaining weight well, so I moved away from fruit and vegetable purees and started getting creative:

• Cooked chicken breast in the food processor with oil and a little liquid stock for consistency.

• I took the book Avocado Baby to heart and started feeding them a lot of avocado.

• More complex purees with three different foods in a meal

• Too much red meat did not go so well. It was also really hard to turn into a puree. I have since learnt a good way to add meat to babies first foods. Cook lean meat, then cut into small cubes. Freeze the cubes. Take a frozen cube and use a fine grater to grate a little cooked meat, and mix into the puree. Wish I had known this trick.

By the time we had been doing solids for two months, the babies were swallowing really well and we moved from puree to a more mashed consistency for soft foods like kūmara. They were still feeding in the twin pillow.

At 8 months we started leaving bigger bits in their food. There was more meat now too. We added a third meal, just as a small afternoon snack at first and not every day. By the middle of their 8th month they were having three full solids meals, every day. This is also when I changed their breakfast from purees to real breakfast food - Weet-Bix! I first did it with water and when that went well I started using milk. I added pear and prune puree. This finally really started to help with that prem-baby constipation issue.

9 months was when we started dairy - yoghurt first, then cheese, then milk. I was still making their meals in the food processor mostly, but they were nowhere near puree consistency. More like hummus consistency. One that my husband quite liked was cooked chicken blended up with cream cheese, cream, parmesan and fresh herbs - he would spread it on toast and I would feed it to the babies. 9 months was also when we started reducing their bottles. 

We started finger foods at 9 months, but of course they were still just 6 months corrected so it didn’t go very well. When it did finally start to work - what first foods worked for mine? Pastry was popular! I would take puff pastry sheets, spread them with puree (apple or kumara) and sprinkle some cinnamon and bake little pastry triangles.

By 10 months they were having three solid meals a day and were spilling way less - we could go entire days with no reflux symptoms. Far more food than milk by this point. At about a year old we started adding snacks and reduced milk again.

You may wonder how I can write this in detail. I don’t remember it clearly, a lot of that first year is a blur. I started writing details a few months into our solids journey, and I have notes until 9 months. I also kept a log book of absolutely everything (I didn’t find any of those baby tracking apps useful for twins) - being extreme prems and under hospital care for their severe reflux and lack of growth, it was necessary for me and the nurses to keep track of everything. Plus I’m just that type of person. Looking back at it now - I kept up that log book for 11 months, from their arrival home until they were 11 months corrected (1 year 2 months actual).

If you have any more questions for Jaimie, feel free to reach out to her: jaimieleigh.jonker@gmail.com