Starting Solids: The Importance of Sitting Unassisted

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Sitting with minimal assistance is one of the most important readiness signs for feeding solids. For many babies, unassisted sitting happens around 6 months, which is also when we think the gut and immune system are most ready for complementary foods. (Note: this guideline refers to all "solids," including pureed foods or "baby food.") 

Why is sitting unassisted so important? First and foremost, we want your baby to be safe, and if he isn't sitting well with good trunk control his airway may be compromised. However, there's even more to sitting than safety. Gross motor skills, including postural support and sitting, are precursors to good feeding skills. Our bodies have to be in good alignment for our hands and mouth to work optimally. Postural control and gross motor function greatly influence your child's ability to coordinate feeding skills, like bringing food to mouth and chewing. Interesting, right?
 
My first job as an Occupational Therapist was at La Rabida Children’s Hospital in Chicago, where I was fortunate enough to have Regi Boehme, OTR, as a regular mentor to our clinic. Regi was a gifted Occupational Therapist who created Boehme Workshops for Therapists (www.boehmeworkshops.com). Regi taught us that everything we ever need at the mouth (feeding, swallowing, and speech) originates from the hips. In her memory, I write this for parents to better understand why sitting skills are an imperative precursor to feeding..

I will always remember Regi saying this phrase: “Stability at the hips will follow at the lips."
 
Thus, for your baby's best success at feeding, wait until he is sitting unassisted on the floor before offering any food. Sitting propped in a Bumbo is not the same as unassisted sitting on the floor, and use of these propping chairs actually doesn't help develop sitting skills. (Read on for help teaching your baby to sit.) 

Interestingly, your baby's developmental milestones build on one another in helping him learn to sit and eat food.  Below are some common milestone guidelines for the first half of infancy. Remember, all babies develop at their own pace, so your baby may not be on this exact timeline. Discuss any developmental concerns you may have with your pediatrician.

Gross- and Fine-Motor Skill Developmental Milestones:
 
1-2 months:

• Displays jerky hand movements
• Hands are fisted and may bring one hand to mouth
• Lifts head while on tummy briefly
• Moves head side to side while on tummy
• Brings hands to midline while on their back

 
3-4 months:

• Able to pick up their head while lying on stomach
• Stretch out legs and kick them while on their back
• Grasps with palm and shakes toys
• Holds up head in supported sitting
• Can open hands and bring them to the midline of the body
• Clasps hands and starts to can grasp toys on purpose

 
5-6 months:

• Can move their head from side to side while sitting
• Sits by leaning on hands
• Beginning to weight bear thru their legs
• Opens hands more and straightens out fingers
• Reaches for and grasps objects
• Can drop a toy and pick it up
• Likes to bang objects on tables, repeatedly (fun, right?)
• Begins transferring objects from hand to hand
• Can hold their own bottle
• May begin to push up to all fours from tummy
• May begin to rock back and forth on hands and knees
• Lunges forward and reaches while in a sitting position without losing balance

 
Think about development of your baby in these terms:

Head control, trunk control, stability and alignment are all essential for motor control and coordination of the jaw, tongue and lips. In other words, for the mouth to work effectively, your baby's body must have stability, alignment and control. This coordination allows baby to learn to feed herself, and strengthening of these muscles and reflexes eventually leads to speech development! 

Another way to think about it: Development is a “delicate balance between stability and mobility” (Morris 1987). All the pieces falling into place allows your baby to become a walking, talking, self-feeding child.

So, when you're preparing your child for food, it is essential that he is learning to sit. It is not worth starting early (before 6 months) if baby doesn't have the stability and trunk control for sitting. In fact, when we work with children who haven't mastered sitting, they tend to have uncoordinated hand and mouth movements and don't seem to understand what to do with food. Sitting is a precursor to successful feeding for a reason.

How can I teach my baby to sit?

Just like every other skill, practice makes perfect! Practice sitting on a carpet or soft flooring multiple times a day as early as 4 months. Place a toy or small drum between baby's legs to give him something on which to focus. Put a Boppy or other pillow around his back in case he falls, and watch closely until he is really steady in case he falls over. If you don't want to use a pillow, place your hand around his torso or on his back until he gets stronger.  

How long does my baby need to sit on the floor to be sitting "well enough" for solids?

Baby shouldn't immediately topple over when placed on the floor. If baby can sit unassisted for at least 20-30 seconds on the floor, try a high chair. Ensure that baby doesn't lean in the high chair or doesn't seem floppy or uncoordinated. 

How do I know if my child's in a good position in his feeding chair?

Briefly check your baby's postural control and trunk stability the first time you put him in a feeding chair. How does he look? Is there anything you can do to add more support to the chair to make him more in control to reach his food? If so, add support and see if it makes a difference (see below for ideas). Some babies don't like sitting in a high chair because they feel uncomfortable or unsteady. 

What if my child seems unsteady or uncomfortable in a high chair, even though he can sit on the floor unassisted?

Sometimes your baby can sit well on the floor but over time starts to lean once placed in a high chair for a prolonged period. This may be the result of a very big chair without much support, including the lack of a footrest. You may notice that your baby seems uneven, floppy or uncoordinated, even though he can sit on the floor for a while without fatiguing. 

To remedy this:

• Add some additional support like a rolled up towel, flat pillow or chair insert behind baby's back.
• Use rolled up towels or receiving blankets on either side of baby if he tends to lean.
• Add a foot rest to baby's feet if his legs are long enough to hang over the edge. This is important for toddlers as well! If needed, use a box of tissues duct taped to a stable surface as a foot rest. Once your baby has strong footing, it's easier for him to sit up straight and with control in a high chair.

Below are some examples of my infant and toddler clients (and their siblings) in their feeding chairs. Sometimes baby's legs aren't long enough to hang off the edge of a chair, but once they are you may be able to add additional support for a foot rest. Use of back support or rolled up towels can help baby from leaning.

Before foot rest is added:

Pool noodle as a foot rest:

Before foot rest:

Footrest added:

Toddler with feet on a cushion: 

Toddler with great feeding positioning in a BABYBJORN chair.

Back and side support with rolled-up towels:

​If my baby is showing readiness signs for food, including sitting unassisted before 6 months, should I give him food?

This one is up to you. We still think that "around 6 months" is the average ideal time to offer food to babies given their digestive system and immune system development. Does something happen the moment your baby turns 6 months old? No. Use your parent judgment - try to wait til around 6 months, but if baby is showing all of the readiness skills by 5 months or 5.5 months, it's up to you whether or not you want to start. As you know by now, sitting is a major precursor to feeding, and most babies aren't sitting unassisted until closer to 6 months - everything starts falling into place around then! 

There's no harm to waiting until 6 months, and you can give baby frozen breast milk or formula popsicles at mealtime in the interim. Note: many promotors of BLW say that baby should not get any food until exactly 6 months, but guidelines are based on averages and means. Some babies will be ready a little earlier, some will be ready a little later. "Around 6 months" is the technical guideline.

What if my baby isn't sitting unassisted by 6 months?

Keep working on it! Sometimes babies just need more practice. Include plenty of tummy time in your baby's day, and work on sitting multiple times a day. Don't forget to make it fun! Your baby will pick up on your stress.

If baby isn't sitting by 7 months, talk to your doctor. Additionally, if your baby has any developmental delays or medical issues, talk to your therapy team about safety and readiness signs for solids. We don't want to wait too long for solids, as we miss a critical allergenic, digestive, and developmental window.

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So remember...when you get your baby's hips aligned, his lips (and mouth and tongue) will be more ready for food!