Feeding Infants and Children, Ep. 8

In this podcast, Lisa Jones interviews Malina Malkani, MS, RDN, CDN, about introducing solid foods to infants, common misconceptions about feeding infants, and introducing top allergens to infants to help prevent allergies.

Additional Resources:

• Malkani M. Solving Picky Eating. Accessed October 5, 2022. Solvepickyeating.com
• Malkani M. Start Baby Led Feeding. Accessed October 5, 2022. Startbabyledfeeding.com
• Malkani M. Baby Led Feeding Course. Accessed October 5, 2022. Babyledfeedingcourse.com

For more pediatric nutrition content, visit the Resource Center.

Malina Malkani, MS, RDN, CDN, is the registered dietitian, best-selling author, speaker, and single mom of 3 behind the Instagram and TikTok handle, "healthy.mom.healthy.kids." She owns a nutrition consulting company and private practice at MalinaMalkani.com. She is the author of “Simple and Safe Baby-Led Weaning: How to Integrate Foods, Manage Portion Sizes and Identify Allergies,” the creator of 2 online courses for parents “Safe & Simple Baby-Led Feeding” and “Solve Picky Eating,” and she is a Forbes Health Advisory Board member (New York, NY).

Lisa Jones, MA, RDN, LDN, FAND, is a registered dietitian nutritionist, speaker, and author (Philadelphia, PA).

TRANSCRIPTION:

Moderator: Hello and welcome to Nutrition 411, the podcast. A special podcast series led by registered dietician and nutritionist, Lisa Jones. The views of the speakers are their own and do not reflect the views of their respective institutions or Consultant360.

Lisa Jones: Hello and welcome to Nutrition 411, the podcast where we communicate the information you need to know now about the science, psychology, and strategies behind the practice of dietetics. Today's episode is Nutrition for Infants and Children and I am happy that my guest today is Malina Malkani. Hi, Malina.

Malina Malkani: Hello. How are you Lisa?

Lisa Jones: I'm doing well. I want to go over your bio. You have a lot of amazing experience, so I want to take the time to do that.

Malina Malkani: Oh, thank you. So good to be here.

Lisa Jones:

Yes. Malina is a registered dietician, bestselling author, speaker, and single mom of three behind the Instagram and TikTok handle @HealthyMomHealthyKids. I'm also one of your followers, Malina.

Malina Malkani: Aww, right back at ya.

Lisa Jones: Yeah. A top nutrition influencer and trusted expert in local and national media outlets, Malina owns a nutrition consulting company and private practice. And we will put your website in the show notes so everyone can go check that out. And your website is dedicated to helping parents feed their babies and kids with confidence, which I love because everybody wants to have confidence when feeding their children. Because I know a lot of times, even as a dietician, I struggle and I'm like, "What would Malina say?" And then I go on your website.

Malina Malkani: Aww. You're so sweet. I love hearing that. Thank you.

Lisa Jones: Yeah. Malina, do you want to talk real quick a little bit more about your expertise and background about how you got to where you were today?

Malina Malkani: Yeah, absolutely. Absolutely. A lot of where I am today has to do with my own personal experiences in feeding babies. I have 3 girls. They are now 9, 11, and 13, but they were born within about 3 and a half years of each other. I just spent a lot of time with one kid on my hip and another toddler racing around the kitchen on a ride-on toy and another one in a little seat and just tearing my hair out trying to feed them. And we ran the gamut. We had a lot of challenges during those early years, whether it was back-to-back C-sections and infant reflux and really big issues with breastfeeding and a really hard time with it. Picky eating and all the good stuff, all the heavy hitters. So as I emerged from that period of time, I really felt called to help other parents navigate these waters because they can be really tricky and it's really hard sometimes to feel confident about the food choices that you're making. And not only the what, but also how.

Lisa Jones: Especially when they don't want to eat what you're making, and they don't want to eat their vegetables. I have that problem all the time right now.

Malina Malkani: Yes, yes.

Lisa Jones: Such great tips.

Malina Malkani: It's so hard. It's so hard. And I think we as parents, we're so programmed to nourish our babies and our kids and give them the nutrients that they need to thrive and grow. And so when you have a baby or a toddler or a child who doesn't eat the food that you just put all this effort into making and thinking about and preparing for them, it's really frustrating. I think when it comes to parenting, there are 2 major areas where I see a lot of stress. One is sleep and one is food. So I'm here for you in the food department.

Lisa Jones: Yes. And we need another episode to talk about sleep. But that is such a great point that you bring up. And my first question is for you today, what is the most common question that you received from parents about feeding their children?

Malina Malkani: So, hands down, in terms of what is a source of stress and a barrier to starting solids that I see among my followers and in my private practice is a question that goes something like this: “How do I deal with and reduce my own fear and stress around gagging and choking as I think about starting solids with my baby and with baby-led weaning, in particular. And I'm a big, big fan of baby-led weening. I've written a book called “Simple and Safe Baby-Led Weening,” which is a guide to getting started with it. And it's a wonderful method of starting solids. But I do think that there is a lot of fear and misunderstanding around it. And in terms of how to offer finger foods safely to babies during the stage at about 6, starting at about 6 months of age, when they're showing the signs of readiness for solids and fear of gagging and choking seems to be a real theme that runs through a lot of the parents that I come in contact with.

Lisa Jones: Yes. And even I can speak as a mom of a 4-year-old. I still worry about that. “That piece that you just put in your mouth is too big. Take it back out, cut it up!”

Malina Malkani: Yes, yes.

Lisa Jones: You're constantly worrying. What do I do?

Malina Malkani: It's true. I hate to break it to you, and I tell this to my followers all the time, there are some babies that overstuff the mouth and this can happen for a variety of different reasons. But in some kids, that continues. My 11-yea- old, my middle child, I constantly have to remind her, “You don't have to fit that much all in there all at once. You can take smaller bites. It's okay, food's not going anywhere.” There's a bit of a propensity for that in some kids. But I think that gagging is really, it can be very alarming, especially to new parents who haven't seen it before. Because when you start offering solids to your baby, it's such a shift in the way that you've been feeding your baby up until that point. They've been on a completely liquid diet and then suddenly you're introducing food and there's a learning curve to learning how to eat and swallow and breathe and chew and all of it all at the same time. It takes time to learn that, so it can be alarming at first.

Lisa Jones: And then that lays me into my next question because I'm always wondering about what are some of the common misconceptions about feeding infants and children? And then just taking it a step further, a second part to that question is you probably work with a lot of physicians like pediatricians and primary care physicians working in tandem with the clients that you're serving. So what would you say are those common misconceptions? And then, probably go to the physicians too that you may hear from them as well.

Malina Malkani: Yeah, there are so many. Unfortunately, there are so many. I have a whole series of reels on all these different myths and misconceptions around infant feeding. And part of the reason for that is that there's been such seismic shifts in pediatric feeding guidelines throughout the past 10, 20 years. I mean, total 180 in many different areas of infant feeding. Whether it's when to introduce top allergen foods, what sorts of foods to start with, when to start, really big changes in the guidelines. One of the biggest myths and misconceptions that can have long lasting effects is that top allergenic foods, the top 9 allergens should be avoided throughout infancy. New research actually shows that introducing top allergen foods early and often during infancy, starting it around 6 months of age, sometimes a little bit earlier, depending on the baby's level of risk, helps reduce the likelihood of food allergies.

So that's such a shift. Unfortunately, even actually research looking at the number of pediatricians who are implementing the changes in those guidelines. And at this point, this was a 2020 survey in JAMA showed that only 1-third of pediatricians are fully implementing those guidelines.

Lisa Jones: Oh, wow.

Malina Malkani: I know. And there are some wonderful ones out there who are out there pounding on the table just like I am about the importance of early introduction of top allergens. But it takes time for changes in guidelines to trickle down to everybody. And unfortunately, that one has not reached the masses yet.

Lisa Jones: Yeah, that's such a great poin. I remember when my daughter was about that age, she was like, "Okay, well you're going to go try peanut butter. My recommendation is to just drive up to the urgent care and give her some peanut butter and then hang out in your car for 30 minutes."

Malina Malkani: Yes. I know. I know. How impractical, Right?

Lisa Jones: I'm like, "What? That's ... Okay, I don't know."

Malina Malkani: Oh goodness. That's unfortunate. And I get it. They, pediatricians, have so much to get their arms around and they have so little time to do their assessments, so little time with each patient, and they just have so many things to address and feeding is a really important one. But the changes are ... It's tough to keep up with all of it. So that's where we come in as the food and nutrition experts. That's our job to help spread this important information. Another one that just continues to circulate is that rice cereal is the best first food with which to begin solids. And I think when I poll my audience on Instagram or talk to clients, many of them tell me that it's not just pediatricians who are recommending rice cereal, it's Aunt Tilly, and their grandmother, and their mom because this has been the cultural norm for so long.

Many people just assume it's the best way to start. But there are a lot of reasons why rice cereal is actually not the best first food with which to begin. It's nutrient poor, it's very bland in uniform and texture. And we've got some great new research showing that offering a variety of foods and flavors and textures early on helps expand a baby's palate and prevents some of those picky eating behaviors down the road. Rice cereal is filling. It can end up replacing some of those really nutrient rich options in a baby's diet. But I think maybe the most compelling reason why it's not an ideal early food for infants is that rice and rice-based foods tend to contain elevated levels of arsenic, which is a toxic metal. So why would we make that a first food for a baby whose body is so small? So we do our best trying to disseminate the best information that we can and get it to as many people as possible. So hopefully your listeners can help us to do that.

Lisa Jones: Yes. And I love what you said about expanding the baby's palate. And when I think of rice cereal, that's not the connection I'm making. So it's like other are things that you were saying in terms of if you're expanding you're allowing them to ... There has to be diversity there and rice cereal like, eh, do I really want to take the rice cereal? No. If I was a baby looking at that, I'd be like, "Give me something else."

Malina Malkani: Exactly. And I love that you just pointed out that in terms of diversity. What we're really looking for here is variety and diet diversity. Is rice cereal bad? Is it a bad food? No, we don't want to demonize it, but there's a place for it. It's fortified with iron. Iron is a really essential nutrient, especially around that 6 month mark when babies' iron stores are low. And it can be something that if you're trying to get some of those top allergenic foods in infant safe forms into a baby during infancy, rice cereal can be a vehicle with which to mix a little bit of peanut protein or peanut powder or egg or a little bit of milk or something. But in general, there are options like oat cereal or barley or wheat or quinoa that are more nutrient rich and less likely to have the toxic metal content.

Lisa Jones: Yes. Diversity keeping that, try new things, and the baby gets excited there. They want to explore.

Malina Malkani: Yes, totally.

Lisa Jones: They don’t want bland.

Malina Malkani: Totally.

Lisa Jones: Thank you for sharing that. So what have been some of your successes that will help other colleagues that are working with this particular population?

Malina Malkani: Oh gosh. Well, I think that part of why my resources may resonate with my audience is that I'm constantly reminding parents that babies are each on their own unique timeline. Every baby is really different and even within a singular family. And milestones are wonderful and they're there to give us a general idea of what to expect and when, but I think that as practitioners we can help reduce a lot of parental stress by helping new parents realize and remember that each baby is on their own unique journey and timeline and what worked well for one may not work well for another, like I said, even within the same family. And if there's anything that new parents have to wrestle with right now, it is stress. I mean, holy moly, there's so much stress in their lives and if we can reduce that by helping reframe and educate, I think we're doing a lot of good.

Lisa Jones: I couldn't agree more with that. I really love that you said they're each is on their own journey.

Malina Malkani: Yeah, yeah.

Lisa Jones: Because you're going back to the individualization of it because it's customizable, but it's their own journey. Even if you had twins, you wouldn't be trying to ... Maybe they like something different even though they're twins.

Malina Malkani: Yeah. And while the milestones and these times and of developmental signs of readiness and milestones is the best word for them are great and helpful, I find they end up causing families a lot of stress. And I'll have people reach out to me saying, "I heard I'm supposed to start solids right at 6 months but my baby's not sitting up adequately yet," or whatever it is. And it's really empowering to say to a parent, "Infants are developing so rapidly at this phase it's okay to take a step back, take a week. Just give your baby a chance to develop at his or her own rate." And it's not a race, it's going to be okay. I think that can be really helpful because we're just so programmed to be where we think we're supposed to be at a certain given time and it's just not the case.

Lisa Jones: So true. Because when you go to the pediatrician and they check in and then they give you that piece of paper and you're like, "Here's where your kid's supposed to be." And you're like, "Well she's not doing this yet. Should I be concerned?" So I think that giving the grace to say, "Okay, well maybe they don't have to be there yet. This is the point where you need to worry and maybe contact early intervention. But until then you're fine. It'll happen." That's a really good point. So what would you say is on the horizon for infant and child nutrition? Are there any new research, new interventions, anything that's coming, futuristic type of things, that you can discuss with us?

Malina Malkani: Well, food allergy prevention is an emerging area of research that it has really exploded in the past decade or 2 and it's growing constantly. And in my opinion, it has the capacity to dramatically change the trajectory of so many people's lives. Food allergies are so hard, they're stressful, talk about stress and they, they're costly. They cost the average American family more than $4,000 per year per child. So as practitioners, I would really love to see folks stay on top of it, make sure that the recommendations that you're giving are in line with the latest research. Because in particular, food allergy prevention works, but only during a very short window of time during infancy as far as we know so far. And so, we want to make sure that as many families as possible are aware of this and can benefit from it. And like I mentioned before, we have a ways to go.

We have a ways to go in terms of making the cultural norms. I'll still hear from people who when I talk about peanut and egg being some of the first early foods for babies they look at me like I have 3 heads. “Will you really give peanut to a baby?” “Well, yeah.” There are ways to prepare it of course so it's in an infant-safe form that is going to have a much lower choking risk than if you were to ... Obviously, you can't serve a whole nut to a baby. But the surprise goes beyond the idea of serving the actual food. It is just mind blowing to them just because of the way that infant feeding has been approached for so many decades.

Lisa Jones: Exactly. And I think something that you said when you first started answering this question was food allergy prevention and I don't usually hear it termed that way. And I think the fact that it's said that changes the dynamic of the entire thing because it's not what we're used to seeing. You're right. You go into a school setting and it's posted outside, this is a nut-free building or something like that because of the allergies. And when I was growing up, I'm not trying to age myself here, but we went to school with peanut butter and jelly sandwiches and nobody was like, "We're in a nut-free zone." I don't know what happened to the kids that had these allergies because I don't even remember that being an issue back then.

Malina Malkani: Well, for sure, the prevalence of food allergy has increased. I think it's around by 50%. This was back when allergen intro was being pushed off. The recommendation was to push it off a year, two years, even three years. During that period of time the prevalence of food allergies increased by 50%. So we were wrong. Definitely, that was not the right approach. But now that we know that ... It's also a lot we don't know, unfortunately. And food allergy prevention as a term is tricky because people will reach out to me and say, "Well, I did all the things. I introduced all of the allergens during infancy and my child still has food allergies." And the thing is, it's not a guarantee. We can reduce the risk of the development of food allergies, but there are still babies, even if you do everything "right" that are going to develop a food allergy to certain foods. And that's hard to absorb and to accept.

Lisa Jones: Exactly. Exactly. And the thing is, you just never know. It's like going to the dermatologist and saying, "Hey, will my daughter get acne?" You don't know. Some will, some won't. Some don't have an issue with it. But I think it goes back to that awareness, what you're doing, which I think is so fantastic, is creating awareness. And as you continue to create more awareness, is that as this research continues to come out, we can only improve upon what we're doing.

Malina Malkani: Yes. I hope that's the case that's my mission and my “what gets me up in the morning” and keeps my heart beating. The thought of that “How many people we can help with this important information?”

Lisa Jones: Yeah, it's amazing. And speaking of that, I would love to hear a story or an example showcasing your work if you want to share with our audience today.

Malina Malkani: Oh, that's so nice. Gosh. Well, so when I wrote my book, Simple and Safe Baby-Led Weaning, it came out and then the pandemic hit and the whole world shut down. And it was really interesting because that was at a point where everybody was isolated and new parents. Whereas when I had my babies, I would put them in the bucket seat and go sit with a friend and have coffee. And when it was time to feed them you had your village at your fingertips and you could share knowledge in person and feel like you were part of a community. Well that all was lost when the pandemic hit. And so my Instagram started to grow as I was sharing information from the book and about the book and people started sharing their experiences and their babies with me and videos. And it became a little bit of a virtual village, if you will.

And I received a message, a DM from a follower. It was the sweetest thing. And I'll never forget it. She DM'd me and said, "I really appreciate all the advice and I loved your book. It's on my counter every day when I feed my baby. But what I really wish is if you could just come and sit in my kitchen and hold my hand every time I sit down to feed my baby." And I thought, Oh my goodness, I wish I could too. And that really was what inspired me to create my online course, which is based on the book. That was the closest I could get to jumping into everyone's kitchen and sitting down with them and holding their hand while they feed their babies. So that's been a real joy to create. And that's been out for I think about real close to a year, almost a year. And it's really been lovely to hear people's feedback from that as well. But I love these, I really love these touchpoints and connecting with parents and followers and clients in that way. It's just such a wonderful part of what we do.

Lisa Jones: Yeah. And I think that particular content, when they start engaging like that and they come forward and they say, "Here's my story," and then you're sharing that, that just makes us all more connected. And I think that there's nothing that you can do that's better than that. And it just makes for more engaging content. You want to go on and you want to say like, "Oh, what's Malina up to today?"

Malina Malkani: Or the babies. People send me really wonderful videos and pictures of their babies eating. And I find it to be one of the most joyful, delicious parts of this whole world is that I just love watching a baby eat and listening to their little munching sounds.

Lisa Jones: Yes.

Malina Malkani: And seeing them make a mess. And it's a very fleeting time in parenting. As I'm sure, with your four year old daughter, you can relate with. It feels like it's never going to end when you're in the middle of it and then it's over. I think that connecting through food is one of the most important lifelong gifts we can give our kids.

Lisa Jones: And then just watching it and the smile that it brings to your face. You cannot watch it and not smile.

Malina Malkani: Yes.

Lisa Jones: Especially in that age group. If I'm watching my grandma that may be a little different story. She's a lot slower than the babies. She doesn't have as much joy. Everything is new to them. So they're just-

Malina Malkani: It's true.

Lisa Jones: That excitement is present.

Malina Malkani: That's true. So sweet.

Lisa Jones: So if you could give one bottom line takeaway for our audience today, what should they do or be aware of?

Malina Malkani: Well, in speaking directly to healthcare practitioners, I think one of the things that has done more harm to families than good is the idea that you have to choose between baby-led weaning or finger foods and purees. That there's team baby-led weaning and there's team purees and there's two completely separate ways of starting solids and neither shall they meet anywhere in the middle. And almost pit them against each other. And the truth is there's no need to choose between baby-led weening and purees. Purees should actually be a part of any baby-led weening journey. You can definitely feed purees the baby-led way by preloading a spoon and handing it over to the baby if that's what you prefer. But puree is an important texture just like any other. And I think baby-led weening became very trendy and it was something that everyone got all excited about, but in doing so, they vilified purees in a lot of different camps.

It just has ended up stressing parents out because baby-led weaning is great and finger foods are great, but it's not right for every baby, and it may not be right for every baby at any given time. Some days finger foods are working really well and some days a baby's going to just do a lot better with purees and there can be 1,000 different reasons why that's the case. And so, if we can just as practitioners come together and meet in the middle and let the evidence speak for us in a way which is that there's no evidence that a combined approach to feeding is detrimental and help families by guiding them toward the method of infant feeding that's going to be best for them and their baby, then we're going to be helping rather than dividing.

Lisa Jones: Yeah. We don't want to divide. And the thing I heard that was so great in this is you don't have to choose. You can do both.

Malina Malkani: Do both. Absolutely.

Lisa Jones: To make a decision.

Malina Malkani: Absolutely. I know.

Lisa Jones: I love it.

Malina Malkani: I know.

Lisa Jones: So many things in life are like that, right?

Malina Malkani: Yes. Yes.

Lisa Jones: Yeah. All right, well thank you so much for that. I want to end today with just a fun lightning question round. And I'm going to pick the topic of, because it's fall here as is of this recording, what is your favorite fall beverage and why?

Malina Malkani: Ooh. I am a tea lover. Lover of tea. So anything sort of red rooibos tea or chai tea, anything with spicy flavors gets me super, super pumped.

Lisa Jones: Yeah, it's a good time of year for chai.

Malina Malkani: Yes, I love it. I love it.

Lisa Jones: Especially in the morning. How about a fun kid Halloween story?

Malina Malkani: Oh gosh. When my girls were really small, I had this little train. It was a wagon, but it had three separate compartments. And I lived in a neighborhood where Halloween was complete and utter mayhem. It was mayhem. And so we would just be pulling our girls in this little three-prong wagon from house to house. And we pulled up to this one house and there was a guy sitting in the front who he always had a costume on with gloves that looked like claws and he was terrifying. He would sit in a chair completely still. And when the kids would pop out of the wagon and they would toddle over, he wouldn't move until they went to try and take a piece of candy, and then he would jump and scare them. And after a year or two of this, my youngest daughter refused to get out of the wagon. She would bury herself deep into the wagon when we got to that house because she was absolutely terrified of this guy. And he loved it. He lived for terrifying children, which makes me laugh just thinking about it to this day. It was funny.

Lisa Jones: So did they still go trick-or-treating? Do you know if he's still doing his thing?

Malina Malkani: I don't live in that neighborhood anymore, so I haven't seen him in a while, but I would be surprised ... I think this was the highlight of his whole year.

Lisa Jones: Aww.

Malina Malkani: It was so cute. People are so precious around kids sometimes. It was just so funny that he was very, very determined to scare as many children as he could.

Lisa Jones: Yes. Halloween was like the day he was like, "Yes, that's my favorite day."

Malina Malkani: It was so weird.

Lisa Jones: Oh, that's great. All right, one more question. What is your favorite orange food?

Malina Malkani: Oh gosh. Oh, there are so many. Lisa, how can you make me choose?

Lisa Jones: You can pick two then. How about that?

Malina Malkani: There are so many. Oh gosh. All right. How about I pick some that are really great for babies in particular? So sweet potato is a such a great first food. You could eat it in so many ways. And one of my favorite combinations for me as well as for a baby, is to take some almond butter and roast a sweet potato and then remove the skin and mash the sweet potato and mix it with the almond butter. I don't know what it is about this combination, but it is divine. So sweet potato. Very soft, ripe cantaloupe is a great early finger food for babies when it's really super soft and squishy. And puree pumpkin is another. I mean, obviously here we are in fall, but pureed pumpkin, just that beta carotene. Can't beat it.

Lisa Jones: Oh, I'm not a baby, Malina, but I am going to be trying that sweet potato with the almond butter combination that you mentioned.

Malina Malkani: Well, when you do, please tag me. I am obsessed and I will be so excited to see that you are enjoying it as much as I do.

Lisa Jones: Aw, wow. Well, thank you so much for being on the show and sharing your insights with us.

Malina Malkani: My pleasure. Thank you for having me. It's always a pleasure to chat with you.

Lisa Jones: Yes. So I will share all the resources and links we discussed today. And thanks for listening, to our audience. And please tune in again and share your comments and feedback on our site. Have a great day and enjoy a healthier lifestyle with a 411 in mind.

Speaker 1: For more nutrition content, visit Consultant360.com.