start

Starting Solids what NICU parents need to know

[Music]

the life of the preterm baby series is

the result of a collaboration between

clinical and institutional experts at

the Canadian Association of pediatric

health centers Mount Sinai Hospital and

Sunnybrook Health Sciences Center as

well as parent led organizations such as

life of the baby and the Canadian

premature babies foundation we would

also like to thank proactive bioscience

response during this series a lacta is

the pioneer of human milk based neonatal

products to meet the needs of critically

ill premature infants in the neonatal

intensive care unit if you have any

questions or comments for our panelists

please type them into the question box

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presents weekly email newsletter to stay

up to date with upcoming webinars and

our recorded webinar archive and hello

everyone and welcome to today's webinar

my name is Doug main and I'm the

Associate Director at CAF see the

Canadian Association of pediatric health

centers and it's my pleasure to welcome

everyone back to our six-part series

life with a preterm baby that as you

noticed earlier was sponsored by for

elective bioscience this is the sixth

and final episode of the series and this

has really been a great a great sort of

test run that we had where where we were

seeing we had the Kate Robson who's

joining us on the panel again today and

you've heard her voice that many of the

episode

came and wanted to do a series that was

targeted at providing information to

parents and caregivers of preterm

infants and it's been really a great

experience and a great success we've had

large audiences great discussions and

it's really been great because we've had

great presenters throughout we've had

Kate on the panel most of the time and

she's always great and we've always had

a great audience who's had lots of

questions lots of comments and really

interacted and drove a lot of the

conversation what's great which is great

so as you saw earlier please do type

your questions into the question box as

you think of them because it's always

always one of the most interesting parts

of the whole process is hearing from the

audience so we do have lots more

information on the caps II knowledge

exchange network for the rest of the

episodes in the series if in case you

did miss any of the other episodes

please do coach go check those out as

all of the the recordings are available

there so today as I said it is episode 6

and we are going to be talking about

starting solids what NICU parents need

to know and as always we do have a

couple of great speakers as I mentioned

Kate Robson who is a NICU Family Support

Specialist at Sunnybrook Hospital in

Toronto and is also the mother of two

girls born premature and Kate is home

with one of those girls so who's not

feeling well today so she's going to be

muting and unmuting so if we ask her a

question and we don't hear from her

that's she may be otherwise occupied

she's also the executive director of the

Canadian premature babies foundation and

joining us today as our main speaker we

have Karen Wyson who is a clinical

dietitian at Mount Sinai Hospital in

Toronto and she's worked in the maternal

infant program for 10 years starting

first in obstetrics and for the last two

years working in the NICU so it's my

great pleasure to hand now the virtual

podium over to Karen Wyson hi everyone

sorry I'm just trying to see my

presentation on my screen okay so today

I'm gonna go over some some basic

information on on introducing solids in

in premature infants and I'm happy to

take any questions that you might have

as at the end of the presentation

so I'm trying to figure out if I can how

I I can't see my presentation on my

screen so sir I've managed to move

everything down so we're good yeah okay

yeah we see it easy fine here so and

just that I just wanted to mention you

are just a little bit quiet so if you

can just maybe get a little closer to

the phone or speak a little bit louder

that would be great okay all right so

what I'm what I'm going to go over is

when we're looking at introducing solid

so what what are you doing now what you

what you should be doing and why we even

talked about introducing solids why we

do it at a certain time and and why it's

important to to start looking forward to

that when we want to introduce those

solids so there is there is guidelines

for when when we should be considering

introducing it specific to the preterm

infant how what we introduce and and how

we should go about doing it and then at

the very end I want to end with a bit of

a discussion about building on those

basic informations and trying to make

sure that you have are achieving a

healthy feeding relationship feeding and

from start to finish whether it's breast

feeding bottle feeding and or sitting at

the table with your family should be an

enjoyable experience for everyone and so

we want to make sure that when you're

when you're starting introducing solids

you're you're starting from from a

healthy place for for all involved so by

the end of this in this session I want

you to feel comfortable with the basics

of this new stage in your baby's life

and know what further information you

might need to get from your health care

provider from other people in your

community who might be able to help you

so all of the information I a lot of the

information I am using comes from Health

Canada and the Canadian pediatric

society so I've included the link here

to the feeding healthy term infants now

obviously this document is based on as

it says healthy term infants so it's not

as specific as as what we're looking for

for preterm infants but

when we're looking at just general

information about how to introduce what

to do this is a really good good

reference for for both parents and

health care providers okay so starting

from the beginning what are we what are

you feeding now so the current

recommendation encourages providing

breast milk or in the absence of recs

breast milk infant formula exclusively

for I've written here six months but

most recommendations are now saying

between four and six months for

introducing complementary foods

breastfeeding is encouraged for two

years and Beyond and I've included here

just so what if my baby is on a special

for formula or a higher calorie feed and

because I know that different NICU have

different practices and babies may be

going home on on specialized feed

specific to to that baby and and from my

part I'm not really going to be able to

answer too much about how long that

special formula or higher feed should

continue that's something that you

should be working with your particular

pediatrician to see your or family

doctor or health care provider to see

how long that should continue and at

what point you may need to to make some

changes so why do we introduce solids so

introducing solids is is for a number of

reasons first we're doing it to improve

nutrition not to say that there's

anything wrong with the nutrition we've

been providing up until this part this

time but when we're timing the

introduction of solids it's when baby's

nutrition needs are starting to change

so when we talk about the the term

infant wheat I'm introducing solid foods

with when there is a decrease in in iron

stores for the baby for the preterm

infant we're looking at it not as much

of from the the stores of iron because

most preterm infants are encouraged to

go home on an iron supplement but we're

looking at making sure that we are

introducing sources of nutrition from

the diet but also to start developing

the skill of eating solid suits so

learning to eat solid foods is a skill

it is something that some babies will

take to very quickly and others will be

slow to start so it is something that we

want to do at a specific time when it's

safe and when when baby will have the

skill to to start working towards this

and when we're introducing solids we're

doing it at a gradual process with the

goal of working towards baby into

toddlerhood eating the family diet so

when should we be introducing solids

well I'm sure a lot of parents out there

have heard a lot of conflicting

information when it comes to preterm

infants the the specific guidelines are

are hard to find as I was going through

this presentation I was looking for

different references and to be honest

there's not a lot of research in this

area but what the most consistent

recommendations from from any

organization the term infants should

introduce all is between four and six

months corrected age or four to six

months from the point they reached term

when we talk when I mentioned

introducing solids as being a

developmental skill that's one reason

why we're going to be looking at using

corrected age if we're looking at four

to six months from birth many babies

would be developmentally not ready to

introduce solids at four to six months a

preterm infant should have the

developmental skills to to start start

tolerating this this new skill so how do

you know we're in that range to

introduce that's something that that you

would need to look at your baby look at

where they are developmentally and also

work with your healthcare provider to

decide is your is your four month old

showing developmental readiness for

introducing solids then it may be

appropriate to introduce it at that

point or if your baby's not quite ready

then looking at revisiting it in a month

time so some of the signs that your baby

is ready for solids would be that

they've reached

four to six months corrected age they

can sit up with support meaning they can

sit up in a high chair or whatever it is

you're going to be using so that doesn't

mean they sit up on the floor on their

own without propping but that they can

sit up sit up with support of the of the

high chair

they have head control so they can hold

their head upright they can open mouth

when food is coming towards them and

they can turn it away when he or she

doesn't want any more food they're able

to follow the food with their eyes they

can close lips over a spoon and they

keep food in their mouth and swallow

instead of spitting it out now I always

add an asterisk with this one it's that

they're able to do this it's not that

they're necessarily always going to do

that most babies when you put something

new in their mouth are going to spit it

out at you so it's that you know if they

put it in if they taste it they are

going to be able to swallow it instead

of just letting it dribble out of their

mouth and the last point is that they're

showing interest again this is a this

one can be a bit of a gray area I have

some parents who will say oh my you know

my three months old they get really

excited when they see me eating an apple

I think they're ready for food and I

always remind them if it was a ball

would they be showing the same amount of

interest sometimes it's just what your

eating is brightly colored and that's

enough to get their attention

but if they're sitting at the table with

you while you're eating and they're

starting to reach for food they're

starting to recognize that you're eating

and trying to grab it that's a good sign

that they they are getting ready to to

want some some solid foods so as I said

so how do you know when is it right for

your baby around four months correct at

age or maybe even a month before start

having the conversation with your

pediatrician or health care provider

review your child's development and when

what skills they are they are achieving

or not achieving and then begin when

they start to show those signs and they

fall within that window

four to six months corrected age if you

have concerns that your baby is maybe

not meeting meeting these milestones and

and are falling within this range that

that's another time to have a

conversation with your pediatrician for

specific guidance so what are not signs

for introducing solids there are a lot

of myths out there about what to do when

you're introducing solids or why you

might want to introduce solids now I

would say everyone has great intentions

of helping parents out whether it be to

get more sleep or to get baby to grow

but it's not always that helpful so a

common one I often hear is that I was

told to introduce solid because my baby

is wanting to feed more often

my baby used to sleep for hours at a

time and now he's waking up every two

hours what this most likely means is

your baby is going through a growth

spurt growth spurts happen at a variety

of times and babies will want to feed at

that time when you look at breastfeeding

breastfeeding is a supply and demand so

your baby may be hungrier but your body

may not know that yet so may not be

producing enough milk so baby is going

to work harder and harder to get that

milk and as your body responds they can

get what they need so waking up more

often does not mean that they need solid

foods in order to help them sleep it

probably just means they're going

through a growth spurt or or one of the

many other developmental changes that

babies go through starting solids does

not help your baby sleep through the

night this is something that good will

it good meaning grandparents will tell

you lovey aunts and uncles and even

health care providers will tell you this

is not always the case in fact in in

some cases I think back to my own son he

was a great sleeper and as soon as we

started solid he decided that was when

he'd stopped sleeping

so starting solid is not a cure-all for

all your sleep issues and it's not a

good reason to start again looking at

back at the developmental readiness

and the right age range is is key the

other thing that that sometimes I hear

that I haven't included in my slide is

that if baby's particular growth so I

hear it on both ends of the spectrum my

baby is so big I've been told I should

introduce solids because he's so big I'm

not meeting his needs and then on the

other side my baby's on the smaller side

so I've been told I should introduce all

its early to help him or her grow and

again that is not appropriate I always

like to remind people that healthy

babies come in all shapes and sizes some

of us are meant to be small some of us

are meant to be tall

everything can be within the realm of

normal what is appropriate is for your

baby to be following your baby's

particular growth curves and if there

are growth issues that is something to

discuss with your doctor but introducing

solids early is not likely to to improve

those in fact in that time period it is

important that breast milk or formula be

the top of the the number one source of

nutrition so what should you expect so

from six to twelve months or four to

twelve months correct adage what you

want to start looking for is eating

meals as a family it doesn't mean that

as you start out you're going to be

women feeding your baby while trying to

eat with you know eat your own meal

there is you know some level of reality

about what can happen but having your

baby become a part of family meals is

important you start out using solid

foods as a complement to the breast milk

or formula so in the in the first few

months it really is just a small part of

the diet and as you get closer to eight

nine months more of your nutrition is

coming from solid foods than previously

and breast milk or formula should be

making up less you know still probably

about half of the half of the energy

needs for your baby you're going to

slowly start introducing scheduled meals

start introducing all four food groups

and begin to

reduce drinking liquids from a cup so

what are we going to start introducing

so there's lots of recommendations that

exist out there about what you should

include and a variety of them are

scientific and non-scientific so I'm

going to go with what Health Canada and

the canadian pediatric Society

recommends so our first foods should be

a good source of iron so that means

starting with a meat or alternative or

iron fortified cereals starting with a

source of iron is important for all

babies because as we move from breast

milk to formula we are going to want to

make sure that baby is starting to

develop enough of a source of iron in

their diet as they get close to that one

year of age so how we introduce a new

food we start with one food at a time we

give that new food for three to four

days and we look for any signs of

allergy D and if you do see any then

you're going to consult your doctor and

discontinue using that food until you

have seen your physician after three to

four days you can add a new food again

one at a time and wait and again looking

for any signs of allergy so as I said

that one food at a time that doesn't

mean you know once you've introduced

let's say you start with with chickens

once you've introduced that when you add

a second food you don't have to

discontinue using the foods you've

already introduced and know are safe

what you want to do is know that you're

only introducing one new food so if your

baby does show a reaction you can narrow

it down to which food it actually is so

you start with one food at a time using

a small spoon and a small amount if you

make if you look if you were to start

with an infant cereal and you look at

the recipe on the box for how to make it

that recipe is going to be for a big

amount so don't put pressure on yourself

to get that much into your baby you want

to use a small amount I always suggest

picking the best time of day one day

he's well rested and happy so for some

babies they are morning babies and

that's going to be a great time of day

so pick that if right after they've had

a good nap is a good time pick that time

pick the time where it's going to be

most successful choose a calm and casual

setting so try to limit the number of

distractions so no TVs no loud music you

want to be face-to-face with your child

and talking to them and keeping yourself

calm as well and you want to feed at

baby's pace so if baby puts the food in

the mouth and holds it there and thinks

about it for a while you want to let

them do it this is brand a brand new

experience for them textures in the

mouth they've never felt it's going to

be weird and some babies take to it

right away and they act like they've

been waiting for this all their lives

and other babies are going to wonder

what you're doing you always want to

stop when the baby has had enough and if

your baby refuses a new food you want to

offer it again

in a few days or sometimes you can do it

the next day just a small amount but you

never want to push a new food so what

next

so when after you've started with your

iron fortified foods you're going to

start increasing other food groups

typically most people will suggest in

other adding vegetables before fruits

and then including other grains other

than your infant cereals and then milks

an alternatives most people will say

start with vegetables because they're

not as sweet and if babies learn to like

fruit first they won't like vegetables

but most babies will go back and forth

and will happily eat both so I always

say it's a good idea to start with

vegetables but there's no reason why you

can't start with their fruit and you

don't have to introduce all vegetables

before moving on to a fruit you could

pick a couple of vegetables and once you

know that your babies enjoying those

then you could add in some fruit

so meats and alternatives so this a lot

of people were a bit confused when this

recommendation came out but the reason

why

including meats and alternatives is they

are high in a lot of nutrients that are

really important for a baby and it is

really important that they they develop

a taste for these and include them in

their diets so meats and alternatives

are going to be high in protein in

another key and nutrient for all babies

and specifically for preterm babies is

iron you want to offer plain meats avoid

processed meats and the one thing now

I'm going to be honest it's been a

little while since I've looked in the in

the baby food aisle but often there

we're meeting vegetable dinners and I

always would look at them and see that

there's very little protein in them

which suggested to me that there

actually was very little meat in them it

was enough that it tastes a bit chickeny

but there wasn't necessarily any meat so

there are some better products that will

have significant amount amounts of meats

but that's when you want to look at your

nutrition labels and and compare if

there is only one gram of protein it's

probably you know so if the nutrition of

the carrots and chicken look very

similar to the carrots that tells you

that it's heavier and the carrots not so

much in the chicken and the other the

other food I wanted to mention with

including eggs and this is one that that

people get a little confused by because

a lot of people are concerned about

introducing a food with with a risk of

an allergy and I'm going to talk a bit

about that a little later in my

presentation about introducing foods

related to allergies so some ideas of

those meats and alternatives so you can

offer well-cooked pureed mashed or

finely chopped meats and alternatives

these can include tofu beans lentils soy

beans egg beef pork chicken lamb fish

really anything so I just wanted to

mention when it comes to fish a lot of

parents will ask me is it actually safe

to include fish because of the risk of

mercury so Health Canada recommends that

fish that are higher in mercury which I

have listed in my presentation so you're

fresh frozen tuna shark swordfish Marlin

orange roughy and escolar you should

limit to no more than one food guide

serving which would be about the size of

the palm of your hand once a month these

are not typical foods that most people

would introduce to a baby starting out

but still worth worth looking at

provincial and local health

organizations often have more

information available for you on fish

that are more local so if if you're

someone who eats fish that are local who

who goes out fishing and wants to know

what's safe to to feed your baby then

then you can contact your provincial or

Health local health organizations and

they they often have very detailed

information on this so how do you Ray

your own meat again it's an alternative

they're not always easy to find in the

baby food aisle

sometimes they're easier to just do

yourself and and really it can be

cooking cooking a chicken breast or

chicken thigh puree it using a mixer

with an amount of water or breast milk

and then serving it immediately or

freezing it if you're not going to use

it right away

and I have you know half a cup and a

quarter of a cup of water but this is

not-- by no means a an actual recipe

this is something that you can play

around and learn what texture works for

you to feed your baby also doesn't mean

that you necessarily have to use purees

you can you can finally shred meat and

and feed that to your baby as well so

iron fortified cereals are another

option for foods that are high in iron

and this used to be our go-to first

foods but now we're putting a lot of

emphasis on using the meats and

alternatives as well but that doesn't

mean that you can't use an iron

fortified cereal these are these are

convenient they are great

they're and they're pretty easy to use

so what you want to do is always use it

from always feed it from a spoon so

again one of those myths out there will

be to put some cereal into your baby's

bottle I can often with the promise of

your baby sleeping through the night

and we don't recommend this and there

are some babies who may have this

recommended due to other feeding issues

and that would be a separate situation

but from a strictly introducing solid

nutrition standpoint we want your baby

to be fed with a spoon or fed by

themselves so the auctions out there

would be rice barley oatmeal soy wheat

and mixed cereals

so again just considering introducing

each one of these separately and giving

yourself three to four days before

introducing another so what that means

is the mixed cereal will have a

combination of different grains in it so

you would not want to start with that

until you know your baby has tolerated

all of the other cereals when it comes

to the infant cereals I recommend

choosing a variety that is made mixing

with breast milk or formula rather than

a just add water because then again

you're controlling what's added to it

and you're also giving a bit of extra

nutrition by including the breast milk

or formula instead of the water I've

also included here trying to use a plain

cereal no added fruit now that doesn't

mean that as you go along you can't add

things to your to the infant cereal but

there are some brands that have some

added fruit varieties and typically

these have some added sugar and other

things with it that aren't necessary

some babies will love infant cereals and

some will not but often if you mix it

with carrots or with some fruit or with

another food that your baby likes then

then they will take it so when you're

starting out you're looking at using

probably no more than 2 to 4 teaspoons

one or two times a day in the first

little while so then when you move on to

introducing vegetables so vegetables are

a great source of nutrition you're

adding more vitamins and minerals a

whole variety of vitamins you're adding

some fiber into the diet and you're

adding some color which is really

important and exciting for baby they

often get very excited when they see

different colored suits most people will

suggest starting with mild tasting

vegetables but this again is not science

this is this is just a piece of advice

because some babies will

we'll adapt better to two more mild

tasting vegetables but but then every no

for every baby who prefers carrots you

meet a baby who prefers broccoli so so

there's no no rhyme or reason

necessarily once you even do introduced

a few of those iron rich foods then you

can begin to offer either pureed or soft

soft small pieces of cooked vegetables

so some of the more mild tasting

vegetables are butternut squash acorn

squash sweet potatoes green beans yellow

beans carrots and peas and some of your

stronger tasting vegetables I've listed

here including broccoli cauliflower

asparagus I always encourage parents to

try and include vegetables that they

wouldn't necessarily eat themselves you

want to expose your baby to a whole

variety of tastes the more taste they

get used to at this stage the more food

they're going to be open and willing to

eat as they grow up so fruits again

you're adding vitamins and minerals some

again a lot of fiber and some sweetness

this is a sweeter tasting food that

you're adding so you're adding a whole

new taste to their palate so once you've

introduced a few of those iron rich

foods and some vegetables you can begin

to offer some pureed or soft pieces of

fresh frozen cooked fruit someone

pointed out when I was looking at my

presentation when I say frozen I mean do

you frost it not know it actually frozen

but you know you can freeze some fruit

and and then puree them afterwards so

you want to look for if you're if you're

buying store-bought you want to look for

some pure fruit so meaning not fruit

desserts not looking for looking for

foods that don't have any added sugars

babies don't need that they're learning

they're learning the tastes of foods and

they will adapt to it and if we add

sugars to their foods then that's what

they're going to come to expect so again

I've just listed a whole pile of fruits

here lots of them are very popular with

with babies but the variety that exists

out there you can introduce any of them

to babies so milks an alternative

so knots an alternatives we're going to

wait to introduce until a little bit

later there's there is again a bit of

conflicting recommendations around when

to introduce not an alternative but when

we're talking about drinking whole milk

Health Canada recommends waiting until

after nine months but but most

recommendations say that around a year

we can start switching and again looking

at a year corrected age looking at

introducing whole or homo milk so your

milks and alternatives are going to be

high in protein calcium vitamin D when

you're choosing any kind of dairy

product whether it be yogurt cottage

cheese cheese or milk we're going to

want to choose the highest fat versions

infants need high fat foods we don't

want to choose a low fat dairy product

and I've put a thing down here where it

says there's such a thing as too much of

a good thing the reason why I put that

is that it's not such a concern when

you're first introducing solids or when

you're first introducing things like

yogurts or bits of cheese but often when

we look at one year to 18 months is it

when babies are switching from you know

drinking drinks out of a cup and in

feeding more solid foods if babies drink

too much of their whole milk then we can

see that they don't eat enough food and

this can impact growth and it can impact

overall nutrition so I just want to

point that out that that when we're

introducing whole milk into the diet is

to be a small part of the diet not

something to use to fill baby up and

I'll give you some guidelines a little

later on so texture progression can be a

challenge for for all babies there is a

window of opportunity and most

recommendations are that we should be

introducing some lumpy texture foods by

nine months corrected age so that I'm

saying nine months corrected age but

there really isn't a lot of research

around the difference in in textures

when it comes to preterm infants versus

term infants so when it when we look at

the term infant the recommendation is

that lumpy textures need to be included

before nine months

corrected age or it may impact a child's

ability to tolerate these textures as

they move on but what age do we start

thinking about adding more textures and

finger food than that and that is an

important important thing to think about

if you're making your own foods at home

lumpy textures are probably going to be

there from the beginning it's hard to

puree to the industrial standards of

store-bought foods but as soon as your

baby is able to pick up finger foods

they are able to start eating finger

foods you just want to make sure they

are small enough so as I said you can

start by grading small pieces of meat

and you're helping put them in in baby's

mouth you know up until the point where

they're able to do that to that skill it

can be a hard thing and a nerve-racking

thing to start to introduce different

textures and babies don't always love

the lumpy pureed kind of foods and when

you actually let them have more control

and do finger foods there they're often

happier

so by 9 to 12 months corrected age baby

is now able to chew up and down doesn't

mean they necessarily have teeth or

enough cheese to be that effective but

they're able to gum food and that that's

good enough they're able to grasp finger

foods again this is when we're talking

about the corrected age this is to do

with developmental stages and when

they're able to grasp those finger foods

they should be able to start feeding

themselves a bit more they're watching

and copying what other people are eating

and they want the foods that other

people are eating so they're going to

start stealing foods from your plate and

you should be prepared for a mess it's

going to be fun but foods are going to

go flying and and and babies are going

to be covered in food when they when

they're suddenly in control a good time

to get some cute pictures so I've listed

here just a number of different ideas

for finger foods so soft or grated

vegetables and fruit scrambled eggs or

cut-up hard-boiled eggs beans lentils or

chickpeas tofu pieces of toast noodles

roti Cheerios unsalted crackers grated

cheese

basically anything that you can make

down to you know about the size of your

pinky fingernail so we don't want things

bigger than about a quarter of an inch

we want to reduce the risk of choking

and you want things to be soft enough

again they don't have enough teeth to

chew anything too hard so we want it to

be soft and we want it to be small so

that there's no risk of choking so I've

just listed here a couple you know

number of foods that you want to be very

careful with because they are added you

know including them would be an

increased risk of choking so so peanut

butter may be a bit confusing but it's

often peanut butter on something or just

hunks of peanut butter raw vegetables

grapes are a huge risk of choking and

the recommendation is really to cut them

to you know into quarters and and then

into halves as your child gets bigger up

until about four years of age Nazis

popcorn is a huge choking risk hot dog

wieners raisins and smaller hard candies

so I know most of you are thinking while

I'm not likely going to give these to my

child in the first few months but these

are foods that may be lying around or

maybe at someone else's house that you

you don't expect so just things to keep

an eye out for but choking and gagging

are two different things and that's

important to to be aware of when a baby

tries a new food they may gag when a

baby tries a new texture they may gag

gagging is a normal part of learning to

eat so gagging means that your baby has

tried to swallow it and for whatever

reason is bringing the food back up it

is a natural reaction and it's actually

a good reaction it's how your baby is

stopping yourself dropping him or

herself from choking so as long as it

doesn't frighten you it's not going to

frighten your baby

so trying to stay calm when your baby is

gagging up a food and and you know

recognizing that this could be because

they don't like the taste because they

just followed it a bit wrong or because

the texture is new to them so I've

included this slide and it's actually

blank so how much does my baby need and

I've left

blank because there's no real good

answer to this every baby is going to be

different and the important thing is to

let baby determine how much and how to

progress how they're eating if also

included aside about liquids this is a

question that I often got asked a lot

when can I introduce water when should I

introduce juice and and what what kind

of cup should I be using so there's no

need to introduce too many liquids when

you when you think about it breast milk

or formula are still providing most of

the most of your babies hydration and

also a lot of the baby nutrition up

until one year however a lot of parents

will start to include some water as

their baby starting to eat more and more

solids especially as we get hopefully

closer into the summer months so it's

absolutely fine to start thinking of

including some water you know as you're

introducing solids sort of past that

six-month point but what we don't want

to do is include juice so juice offers

very minimal nutrition what it really

offers is a lot of sugar so it's not

something to include in your baby's diet

there's also a new recommendation around

using an open cup versus something like

a sippy cup so Health Canada in fact put

out a recommendation around what type of

cup to use and they've encouraged as

soon as you're starting to include cups

that you should be using an open cup

with your baby now this may make for a

bit more of a mess as as your child gets

older but it is a developmental skill

and most babies from a very young age

are able to hold a cup and start to tip

it up towards their face so in the

beginning you would be helping them with

it but then by the time they're they've

been doing it for a couple of months

they will be able to do it themselves

and we're encouraging parents to switch

to using a cup from a bottle by twelve

months of age when when I talked about

too much of a good thing around milk

consumption babies who are drinking milk

from a bottle will tend to drink more

than if they were drinking it from a cup

because we know that it can take the

place of other more other foods in their

diet we

encourage that the longer you include a

bottle the harder it becomes to wean

your child off of a bottle so if you are

using a bottle start to consider

switching to a cup by that 12 month of

age and if you're introducing whole milk

then using using a cup right from the

beginning so that your baby doesn't get

used to it being in a bottle can be

helpful so the only foods that we really

recommend limiting for for babies would

be any foods that are high in sugar and

that means added sugars any foods that

are high in salts so not adding salt to

any of the foods you're giving your baby

and making sure any of the any of the

food you're buying you're not adding it

as well avoiding raw meats fish and egg

we're just looking to prevent any

foodborne illness any unpasteurized

dairy product and honey is also on this

list to avoid again it's related to

foodborne illness and to delay using it

until after one year of age so in the

past people would avoid introducing

certain foods until after a year because

they were looking at reducing the risk

of your child developing an allergy the

latest research has suggested that there

isn't any benefit delaying the risk of

any particular foods and in fact there

is now a thought that possibly we may be

increasing the risk of foods by delaying

the introduction of some of these foods

that have a higher risk of allergy so

some of the foods we're talking about

are things like egg fish peanuts nuts

and seeds so we say after six months of

age you do not need to avoid any foods

for the reason of allergies so any of

these foods can be introduced in a

variety of ways offering one food again

at a time early in the day

waiting three to four days before

starting another food and again watching

for signs of allergy which can include

diarrhea vomiting skin rash hives

swollen face or tongue so if you ever

have any of these symptoms and you're

concerned you started a new food it's

worth talking to your doctor if you have

a family history of allergy or your baby

has had an

allergies already in life again I would

talk about the recommendations for your

specific situation with your with your

health care provider so and parents

often ask me what is better should I

make my own food or should I buy my own

food there are benefits and

disadvantages to both and there's

nothing wrong with doing one or the

other or some combination so benefits to

making your homemade food you get to

have control over what you're going to

offer you can offer a whole variety of

foods you can introduce foods that what

your baby is going to be exposed to

within your diet so there may be foods

that you eat that you will never find in

a tin or in a jar in a baby food aisle

so that's a huge advantage also you get

to control the texture you don't have to

puree it as finely so babies will get

used to different textures on the other

hand you have the you know the main

disadvantage is there's an you know time

that it takes to make it the minute it

takes to make it and just sometimes the

convenience so to me there's there's

positives and negatives about both but

as long as you're encouraging your baby

to have a variety of sources of

nutrition a whole variety of foods

that's what's important more important

than where where the food comes if you

are making your own food you want to

always keep in mind food safety wash

your hands well clean the equipment

properly make sure there's no

cross-contamination

don't leave cooked food sitting at room

temperature so once it's made cover it

and refrigerate and then freeze any food

you're not going to use right away so

lastly I just wanted to talk a bit about

developing a healthy feeding

relationship so feeding should be an

enjoyable experience for everyone and if

anybody's fed a toddler they know that's

not always going to be the case but

learning how to kind of approach it from

an equal partnership can can make the

stress a little bit easier so things to

think about from your

history were you ever made to eat all of

your vegetables clean your plate before

you can have something you liked have

one more bite or made to eat more than

you felt you were hungry for or not are

not given as much to feel so you know

I'm sure all of us at some point were

encouraged to take one more bite or have

done it with our own kids but these are

things that we really encourage you to

avoid as much as possible it's really

important that feeding is a relationship

of trust you have to trust that your

baby really does know what he or she

needs in order to to grow appropriately

and your baby needs to be able to trust

that you're going to provide the foods

you know at the time that they expected

and and that beyond that they're going

to be responsible for what to eat so

I've included a slide here that is

talking about who's job is what and this

all comes from a dietitian in the states

named Ellen Sadr her website is filled

with resources and I've included this

one here which is the divisions of

responsibility and feeding and it's a

it's a great a great resource and and

for children of all ages she has some

great recommendations so we all have a

job when we come to the table so when

you're feeding a baby you are

responsible for what food is offered so

you get to choose what food to bring to

the table you get to choose when food is

offered and you get to choose where so

choosing a calm environment making sure

there are no distractions and that means

also not trying to distract baby in

order to get more food the children are

responsible for how much they eat and

whether or not they eat okay so it

really becomes that trusting that if

they are not eating that much right now

they are going to make up for it later

on that's a lot easier said than done

and I acknowledge that for sure but it's

something that every once in a while

it's good to remind yourself they really

do know what they need and we need to

learn to trust them so you have the job

of providing the healthy and satisfying

meals and snacks and then after that the

rest is

going to be up to your baby so making

mealtime calm and quiet making it family

time so this may you know if you have

other children may take away from the

calm quiet but having them joining

family meals allows you to model healthy

behaviors it allows you to to show them

that you know we all need a variety of

foods and that we all sit together and

that eating is part of being a family no

feeling with distractions that means

trying to avoid any unconscious eating

I've heard a lot of parents who say you

know my child won't eat but if I put the

iPad on and you know put Barney on they

will they will let me just shovel

whatever I want into their mouth and

while in the moment that may feel great

it's not it's not teaching them how to

eat it's not teaching them to develop

the skill of learning how to eat and

it's also not trusting that your baby

knows whether or not they're hungry so

that means trying to avoid tricks to get

baby to eat more avoiding the airplane

avoiding you know flying the food into

the mouth avoiding things like that now

one thing I do often say is sometimes

when baby stops eating they may just be

done eating that particular food so when

you get to the point of adding in

multiple foods so let's say you're

feeding a bit of chicken and your baby's

refusing to eat that that may just be

it's time to move on to the carrots now

so there's you as you move through this

journey you will learn your baby's cues

and your baby sign and what works for

them but it's always supposed to be a it

done in a respectful way so really

learning baby's cues and what what baby

wants in that in that point in time

oftentimes when a when a baby doesn't

eat very well after a day you usually

can look back and see why oh baby didn't

have a good nap Oh a tooth just popped

out you know there can be all kinds of

reasons why your child isn't eating on

that particular day but often you can't

realize it until after the fact it's

always good to remember that food is

meant to nourish and to be enjoyed and

that's by everyone in the family

so I was asked by when I was asking

other people what to put in this

presentation someone said oh I always

want to know if my baby's growing

normally can you put in a slide to talk

about normal growth and there really

isn't a good vibe for this normal growth

means that your baby is meeting his or

her particular growth needs so this is

something that you should be talking

about with your healthcare provider we

use growth curves as a way of looking to

make sure baby's not going you know

going up or going down on the curve and

should be in general following the long

bare growth curve and so that's

something to just review if you have

concerns around growth ask your ask your

doctor to see the growth curve and to

talk about it with you and as you go

through introducing solids it's

something to bring up as you move along

so milk alternatives is something that

we've been asked about a lot here at

Sinai and this is you know when you're

looking at a baby who you're unable to

introduce cow's milk at 12 months of age

so this would be a situation where where

baby maybe has a diagnosed cow's milk

protein allergy or maybe in a family

where you're vegan and you're not

wanting to introduce it the

recommendation is to provide breast milk

or formula if you're not introducing

whole cow's milk until 2 years of age so

I put here a hypoallergenic formula so

if you're doing it for allergic reasons

then you'd want to continue that

specialized formula soy milk is not

recommended as as the sole milk source

until after 2 years of age and other

milk alternatives like almond milk rice

milk or or other options are usually low

in fat protein and and do not meet the

nutritional needs of of a baby before 2

years of age so should not be used so

beyond 12 months you're moving towards

regular scheduled meals and snacks

making sure foods from all food groups

are included a variety of textures

finger foods baby using their own spoon

and self feeding breast feeding or

giving about 500 mils or 2 cups a day

homogenized cow's milk baby being a part

of family meals and eating family meals

and modeling healthy eating yourself so

that baby and any other children are

learning healthy eating from the family

if you feel that your baby's not meeting

any of the any of their milestones or

you feel like they're not they're not

eating as well as you think this is a

reason this is something that's worth

bringing up to your family doctor your

nurse practitioner your pediatrician or

whoever is is your main healthcare

provider there are lots of people in

your community who could be involved in

your sort of feeding team if your baby

is is not is not following the

progression you expect so whether it's

an OT or SLP because your baby's having

texture or swallowing difficulties or a

registered dietician because your baby's

having some growth challenges you know

ask your ask your main health care

provider to link you up with resources

in your community so that's everything

from me so I'm open to any questions if

there are any that have come in all

right Thank You Karen a great

presentation lots of great practical

information there the first question

that came in was and I think this is an

opportunity for you to clarify something

I think there might be a bit of a

misunderstanding here it was back when

you had a slide where you were talking

about speaking to your physician or your

pediatrician at around four months to

start the conversation about when to

start solid foods so the the question

that's being asked is saying Health

Canada and in the Canadian pediatric

society all recommends six months to

start solid food food so and you are now

saying four and I think in your slide

you said four to six months correct

adage she says is this a new

recommendation historically it is being

said that a baby gets all the nutrition

they need until six months from breast

milk etc it has been shown that by

introducing solids earlier than six

months infants may decrease their breast

milk grade intake and their digestive

systems are not ready for introduction

earlier than six months so just maybe

maybe some clarification around that

four to six months the slide that you

were talking about

so absolutely so Health Canada's

recommend nation still does say six

months and what we're seeing is so

that's based on the World Health

Organization which jumped their

recommendation from four to six months

oh I want to say about 14 years ago and

and now a lot of you know a lot of

organizations and a lot of people in

practice are looking at moving it you

know saying that it it probably is

somewhere in there and it really needs

to be baby dependent so so while six

months corrected age is still sort of

the general recommendation when when I

was doing my when I was doing my

research around the the preterm infant

you know looking there's there's not a

lot of really concrete organizations

with specific guidelines looking at

European recommendations around Terme

babies they are saying four to six

months and and looking at when it comes

to the the preterm infant we know that

four to six months when we look at also

how the age of the baby that is you know

looking at depending on when the baby

was born a much longer term and a lot of

research with preterm infants has looked

at you know when are we worried about

increasing the risk of you know

allergies so not introducing too early

because of any risks of introducing too

early but also not wanting to delay it

too late again because of texture issues

and so most most recommendations

specific to preterm infants are looking

at that four to six months age range but

saying that with the caveat that they

that you really need to look at your

baby's developmental abilities at that

point so some babies may be ready at

five months and some babies are not

going to be ready until until six months

but but also saying we don't want to do

it before that four months point even if

the baby is six months of age we don't

want to consider it before that four

four months corrected thank you very

much today the next comment that came in

or comment ham question so this is from

a parent who says I got so focused on

growth in the NICU because there was

such a focus on weight that she thinks

you may have anxiety around eating that

is causing her baby problems

she says she's always worried about

adding extra fats into foods she said

every baby is one year corrected and is

fine on his growth curve he's a fussy

eater with her but fine with his dad how

she so her question is how does she make

food fun again she has she says she has

guilt around this I think that's a

really great question and I bet this is

often something that I felt you know we

in the NICU we focused so much on you

know how many Mills are going in and and

how much weight baby's gaining everyday

and then you go home and we leave you to

kind of sort things out yourself and I

know from talking to parents that can be

a huge stress and and definitely as you

progress to solid foods it it becomes a

bigger challenge and I think you know

part of this is being the parent of a

preterm baby we've you know what you've

gone through and all of the challenges

around growth and part of it is just

being a parent so I think you know a lot

of parents feel the same pressure I

think really it is sort of just trying

to take a step back you know looking

your baby is growing well so that that's

wonderful and and taking a step back and

saying you know what way I need to I

need to trust my child and I need to

have them learn to do this and and it is

taking that pressure off and taking

yourself out of the picture it is as I

said it is so much easier said than done

but really it becomes putting the food

in front of your child and and sitting

there and and whether it's talking to

them or singing with them or doing

things to distract you from how much

they're eating and knowing that if

you're bit if your child doesn't eat

enough at lunch they will make up for it

again at dinner

babies should eat differently at

different times of the day and and it

really is just sort of taking that that

pressure off of yourself and I think I

think it's really good to acknowledge

you know you see a difference when when

your child eats with someone else versus

you and and so so looking at your own

behavior around how they're eating so

thinking of things like don't you know

don't point out the food to them don't

don't even encourage them to try

something just just put it down in front

of them and and see how how they how

they do I've seen the same thing with my

own kids they will eat fine and if I say

and make sure you eat that your carrots

all of a sudden they decide I don't want

to eat those carrots it's it becomes a

power struggle so the more the more

power you try and put in the more

they're going to put in as well so

really just put the food down and talk

about anything other than food with them

let them let them decide and and let

them learn this skill even at one-year

it really is as much about developing

the skill and developing the love of

eating that's going to be more important

as they go forward then individual meals

getting exactly what your child needs so

really take that take that pressure off

of yourself and know that you're you're

doing a great job and just try you know

try every day to just encourage and

enjoy that eating the eating process

alright the next question is coming from

Katie who's asking how how do you know

when to use or continue iron supplements

during the 12 to 24 month age

that's a that's a good question

so I know at Sinai we recommend

continuing the iron supplements up until

one year corrected age and then at that

point we usually leave it up to the

pediatrician so I would I would say

that's a good point to have a discussion

with your pediatrician or whoever your

main health care provider is and that is

a time where you want to look at things

so you can tell them you know what my my

child's not doing really well with me

not loving you know other sources of

iron so looking at the diet and saying

what sources of iron do I have in his or

her diet and reviewing it with your

doctor and seeing if they feel that's

enough if they don't feel it's enough

then they may encourage you to continue

using iron iron supplements but I always

want to say make sure that we don't use

those iron supplements as a reason to

not try to include those foods and so I

feel like in some ways I'm going to

contradict what I just said about you

know not putting any pressure on

particular foods but it's not saying

that you're going to continue no put

pressure on eating those meats or

alternatives but it's just saying that

you're making sure you're offering them

and then if you notice your child is not

taking too much of you know not not

taking too many of them meats and

alternatives that that's something you

report to your your health care provider

and so then they can decide with you

whether or not you need to include the

iron supplement as you go forward all

right

the next question is asking about if you

do have to boost caloric content of

foods what's the best way to do it

oh that's a great question it's that

it's a very hard question to answer in a

very general nature because when I when

I meet with parents who have a child

who's not growing there's a lot of

different ways we can look at doing it I

would again suggest you know if if you

have available in your community meeting

with a dietitian who can actually look

at your your particular situation and

work with you would be ideal but I know

that's not always reality for everyone

so things to look at are just making

sure that you are getting balanced

nutrition making sure that when you are

choosing dairy products you're choosing

high fat you know high fat dairy and

including that as in all of the meals so

that means choosing a homo milk choosing

yogurts that are high fat and I've seen

a yurt that's like an 11% fat which is a

you know plain yogurt which is actually

quite delicious so looking at labels and

trying to find those higher calorie

foods and it really is just looking at

making sure I'll dispose to some of

these foods and then oftentimes when

when we find that babies are you know

whether they're eating adequately or not

and getting a variety of foods and

they're still not getting enough

calories then we look at calorie

boosting so by adding adding sources of

calorie in to the foods they're always

eating already eating so whether it's

adding fats and oils into into cereals

into into other foods they're eating but

again that would be something that we

would do on an individual basis is there

a role for things like PD asure or

similar products in this case or any

other area delayed is there any point

where you would recommend something like

a PD issue or something like that

the challenge with something like PD

sure so while it may provide you know

some protein and some vitamins and

minerals is it it can be

a bit of a crutch so for sure there are

situations where it may be appropriate

but often times if you find your child

isn't eating enough and you give them

give them pina sure their body start to

learn that they're going to be given

something if they don't eat so

oftentimes you know if your if your

child only it's a bit at dinner and

you're worried that they're going to be

hungry so you give them pedia sure then

they start to learn that they're always

going to get that afterwards so it's a

bit of a fine balance between you making

sure they're getting adequate nutrition

but then also making sure they're they

are still growing so that again before I

would use any kind of supplements

I would always work with my my doctor to

make sure that you know if you see that

your child's eating a pretty balanced

meal but they just don't seem to be

growing then looking at adding that in

or again trying to trying to meet with a

dietician who can who can also work with

you that may be a good a good option but

always if you if you add something in

like that be be cognizant of whether it

then means your child decreases to solid

foods they eat so so some parents might

say okay you know I'll give it as an

afternoon snack after their nap and they

give it and it's higher calorie than

their snacks so it would have normally

been so that seems like a great idea and

then they're not hungry for dinner so

that's something to just be aware of

before you you use anything like that

again I would I would always work with

with your health care providers before

going going to something like that all

right now we are a little bit over time

here we do have a few more questions so

I think what we'll try and get through

all of them but I'm not I'm not 100%

sure we will because we are about five

minutes already over time but we'll

start with a couple more and see where

we get that's okay the next question is

around she's she's asking what are your

thoughts on baby led weaning she goes on

to say an approach to starting solid

foods by jumping straight to finger

foods and bypassing purees she says a

lot of parents seem to be doing this now

absolutely so I knew I would get this

question and and to be honest it's not

what an area that I'm completely

well-informed about but it is it is

definitely a hot topic these days and

something that parents are moving

towards I think my biggest

recommendation is to do your research

make sure you feel comfortable with it

make sure you're doing it safely is it

is it

research has shown so there is some

research coming out about baby led

weaning that it you know it can be just

as nutritionally adequate as as any

other other form of introducing solids

so in that way that that's great what

you're really looking at is making sure

foods are appropriate sizes so that

you're not increasing choking risks so

you know making sure that things are

either big enough that child your child

can hold it and and use it and and you

know are able to kind of gum off small

pieces or or that they're small enough

that their finger foods and not going to

choke those are the kind of key things I

would I would look at but I would

recommend it's it's a big thing in the

UK right now and I know a lot of parents

are moving towards it so I would just

suggest you know looking for looking for

resources unfortunately I'm not I'm not

a big expert on baby led weaning but but

even even Health Canada is acknowledging

that that we need to be focusing a bit

more on texture progression because if

we if we keep babies on fine purees for

too long then we're noticing kids will

have aversions to to textures and and

will have a harder time moving to solid

foods so baby led weaning is one way of

dealing with it alright you did mention

in your one slide we're where you were

talking about preparing the pureed meats

and you mentioned that you mentioned

covering and freezing cooked meat

immediately if it's not going to be

eaten right away

Sarris heard that cooked meat should be

should cool before being refrigerated or

frozen is that something that people

should be aware of an extra step there

to let it cool before it's frozen

ah it sounds like a good recommendation

to me I don't think there's a harm in in

cooling a meet in the in the fridge for

itself but I think that the main point

is just making sure that that it is

being frozen and not kept in the in the

fridge for four days you know and just

just paying attention to food safety the

next questions is asking is it possible

for a baby to overeat once they start

solids

she says her baby takes in too much

formula as per her doctor about a liter

a day at three and a half months one and

a half months corrected she's been told

to space out his feeds more and try to

limit with slow feeds and a pacifier

she's worried she's not letting him

control the amount as your as you've

been suggesting and she and that this

may become a pattern

she says her other preemie twin does not

have the same issue I think it's very

hard for me to comment when you know

when another health care provider who

actually knows the baby has has seen you

know who's followed the growth and has

seen the best particular trials but in

in general I'm a big believer in you

know that that babies know what they

need and they will they will follow what

what they are supposed to follow and we

we often get focused on birth growth

percentiles but birth growth percentiles

aren't always where baby was meant to be

whether it's higher or lower so

sometimes there is a point where they

may go up a bit or may go down a bit and

then find that curve and follow it along

nicely I mean I think I think the fact

that you you feel your baby is queueing

for food is is important and it really

is just looking at you know what I would

recommend is is finding a balance

between your physician's recommendation

what you really feel comfortable with

and looking at you know is your child

crying because they're there

hungry or are they are they crying just

because they need to be soothed and if

you feel comfortable that you have

soothe the baby you know baby's been

changed baby's not overtired you know

there's if you know other things are not

going on and your baby is showing signs

that they really are hungry then then it

really is just you know like going with

with what your baby said again I would

add I not knowing the baby I don't know

the particulars situation but but I

would I would also sit down with your

physician and maybe review the growth

charts and and see how your baby is is

plotting on the on the growth chart and

even if if your baby was premature if

you have that baby's growth chart from

in hospital or if you if you kept track

of the growth in hospital even bringing

that so you can look at how your baby

grew on I'm pretty mature growth charts

they may be following the same pattern

that they had been all along alright and

here's the last question that we have in

the list Katie saying if your babe slips

on their growth curve around 15 months

corrected and you feel that you're doing

okay with offering enough and

appropriate foods and a responsive and

relaxed setting what would be some of

the usual first places that you would

would might investigate to explain the

the slip on the growth curve that's a

good question

well I know there are a few things to

think about when we when we we look at

growth curves we are looking at three

different measures so we can get focused

on weight a lot because it's the easiest

one and we get it most often but it's

important to look at length and head

circumference and make sure your child's

you know growing in in all ways your

baby's growing lengthwise and the weight

has dropped off a little bit sometimes

we see weight drop-off around the time

babies start walking and are becoming

more mobile they're on the move a lot

more they're they're using more energy

so that that may just be a normal part

of their development

if it's a if it's a drop you know we we

usually get concerned if they're

starting to cross percentile line so if

they've gone from the 50th down and now

they're hovering around or below the

25th then we would start saying oh okay

this is you know this is a drop what

what is going on so I really think it is

looking at you know am i offering a

variety of foods am I am i offering

meals and snacks so you know breakfast

morning snack lunch afternoon snack

dinner and then maybe or maybe not an

evening snack and am I am I looking at

you know looking at how much milk you're

providing so again when we provide milk

if we provide large amounts of milk so

looking at more than that five hundred

mils a day oftentimes that can take the

room of other foods and so sometimes

when we see babies who aren't gaining

enough weight it's actually that they're

filling up on milk and not getting

enough of other foods so you know

looking at how much milk they're getting

and then just overall are they getting a

balanced diet if you feel that they're

ticking all of those boxes

developmentally they're doing fine again

you'll have a conversation with your

pediatrician but you know our and all of

that there may be no cause of for

concern this may just be a normal part

of their development and it's just a

matter of following it along and keeping

a close eye on it all right and with

that I think we've exhausted the

question list we haven't heard anything

from Kate as I mentioned earlier she's

been trying to mute and manage some

drill children at home so Kate I'm not

sure if you have anything you'd like to

add or share at this point really I want

to say thank you what a wonderful

presentation and again with so many

things presentations what I want to do

is go back in time and do you think a

lot differently with my own kids but I

think it's so many good reminders to

just be focused on your children and

cueing into what your children are

telling you and remembering that food

should be fun and eating should be

enjoyable

so Karen thank you so much what a

wonderful way to end this series I'm

just so grateful to you for your time

and your expertise

you're welcome all right and with that

we will wrap this up as Kate mentioned

this is the end of the series of our

six-part series

lots of all the episodes this one

included will be on the Cassie knowledge

exchange networks where you can go back

watch them again catch up on the parts

you might have missed share them with

anyone that you think might be

interested I will let you know that Kate

and I have talked about potentially

trying to continue this series I mean we

started with the six-part series the

tops were so great people have been

telling us there's so many more things

they want to hear about so we are gonna

see if it might be possible keep your

keep your ears open

around September perhaps there might be

you know we might be have the

opportunity to start up a new series

with a whole new set of topics so

because it's been such a great series so

again thanks to to Karen great

presentation and thanks to Kay for all

of your help throughout this whole

series The Canadian premature babies

foundation and and all the all of the

other folks from Mount Sinai and

Sunnybrook that participated in and

presented and supported and shared and

all of the audience to contribute it's

really been great alright so thanks

again and if you do wanted to see more

webinars we do have a regular webinar

series every Wednesday with KFC it's not

always focused on premature babies it's

focus on a lot of other things but you

can't always sign up for our email

distribution list and there may be other

things that you find of interest so

hopefully we'll see you back here at one

of our other webinars or maybe in the

fall when we start a new series thanks

again everyone I

[Music]

you still there Kate I am yes you signed

off for a computer she must have hung up

the phone - okay well maybe she actually

had work she had to go do thank you I

just wanted to say again thank you so

much it's just been wonderful and I

think a lot of good information I love

that these are recorded and that we can

continue to share them with families

yeah she was absolutely wonderful so

thanks and we'll be hopefully be in

touch soon about having some more fun

starting in September all right sounds

good

all right