Preventing Osteoporosis
Hi, my name is Liz Schenk. I am a health and fitness coach for Tahoe Forest Wellness. Today I want to talk to you about osteoporosis. As we age, maintaining strong bones becomes essential for mobility, independence, and quality of life. Osteoporosis is a condition characterized by weakening bones and an increase of risk of fractures. It affects millions of people worldwide, particularly post-menopausal women. While women are more likely to develop osteoporosis, men are not immune. Developing silently over time, osteoporosis has no symptoms until a break occurs, making prevention and early detection critical.
Osteopenia, a precursor to osteoporosis, is when bone density is lower than normal, but not yet in the osteoporosis range. It’s a warning sign that your bones are weakening and a crucial opportunity to take action before serious bone loss occurs. Fortunately, there are actions you can take to protect yourself. According to registered dietitian Lisa Fligor, calcium is the foundation of strong bones, but it works best with support from other nutrients, including vitamin D, which helps your body absorb calcium, and magnesium, which plays a role in bone formation. You can get these nutrients from a balanced diet that includes dairy products, leafy greens, legumes, nuts, and fortified foods. A registered dietitian can help assess your diet for bone-protecting nutrients.
Regular physical activity, especially weight-bearing exercise and strength training, can help maintain and even build bone. Balance exercises are also important to reduce the risk of falls, which is crucial in preventing fractures. While bone density starts declining in our 30s, it’s never too late to start. Strength training done consistently and safely can make a meaningful difference in bone health and muscle strength, no matter what your age or fitness level.
Lastly, know your risk factors. Tobacco and alcohol use and certain medications can put you at a higher risk. Talk to your doctor about your risk factors for osteoporosis and when a bone density test is right for you. Tahoe Forest Wellness team is here to help you stay strong, active, and independent at every stage of life. If you’ve been diagnosed with osteoporosis or osteopenia, or even if you’re simply concerned about your bone health, schedule an appointment with one of our registered dietitians, personal trainers, or health coaches. We also offer heart-to-heart and affordable medically supervised group exercise classes. We’ll work with you to make simple, sustainable nutrition, activity, and lifestyle changes that can strengthen your bones and support your long-term health.
For more information, call Tahoe Forest Wellness at (530) 587-3769.
June 25, 2025
Liz Schenk, health and fitness coach with Tahoe Forest Wellness, shares practical steps you can take to protect your bones and reduce your risk of osteoporosis as you age. Osteoporosis develops silently and often isn’t diagnosed until a fracture occurs. But there’s good news: it’s never too early, or too late, to take action.
Advanced Planning for Health Care Decisions
I think we have 10 or 12 on the Zoom, and I’m not going to ask everybody to introduce yourselves, but if anybody has something they’d like to actually say that brought them here, that would be a great place to start. Just the people in the room for the moment. We were looking at doing our Advanced Directive, so that’s what we got us. Excellent, excellent. Anybody else have comments that way? All right, all right, great. Well, so Advanced Care planning is what we’re talking about today. The cartoon here is kind of where most people start and end when it comes to Advanced Care planning. You know, we should really talk about this so the kids aren’t burdened. Yeah, we don’t care, we’ll be dead. Well, at least we talked about it. Death doesn’t come sooner if you talk about it, and it doesn’t come later if you don’t talk about it. In my world, I’ve seen a lot of really difficult outcomes when people have failed to plan for the ends of their lives, and so that’s what motivated me to create this presentation.
Slide number two. If anyone can hear me, the audio, Dr. Koch at this time. Okay. While it is certain the way it looks is very different in different situations. I’d like to start with the people in the room. Has anybody been involved with a friend or family member whose death was complicated by logistical things?
Yes, what’s your experience? You put it on the spot.
Oh, well, I’ve only had two experiences with hospice, and both have been very, very good. One was actually in a hospital facility in San Diego, and one was a hospice at home. Everything flowed very well with hospice, and I really advocate for hospice. Excellent. Anybody else?
Anybody on the Zoom who would like to raise their hand and have their mute turned off to make a comment about their own experience with end of life for somebody that did not go well as a result of planning or failure to plan?
Hi, can you hear me? This is Dan Waters.
Now I hear you.
Okay, thank you. I recently lost my husband. He was at the end stages of cancer, and he was set to go into hospice on the following Monday. On the Thursday before he was going to go into hospice, he had an episode where we had to call the paramedics and did not have our documentation at home. The paramedics had to give lifesaving things. They ended up breaking his whole sternum, giving him resuscitation, and ultimately he died that same day. It was definitely not what we had planned. We did have documentation through the cancer center, but I did not have it at home with me. I want to make sure that I have mine.
That is a perfect segue to my presentation. I could not have planned that better. Thank you.
All right, so with that, we’re going to jump right into the rest of the talk. I hope that short vignette teaches you that planning for the end of your life is worth doing. What we’re going to talk about is how you make that happen, how you make sure your wishes are honored at the end of your life.
Next slide. Thank you for doing the slides for me. We’re going to start with some definitions because there’s a lot of confusion around this. The first one is a fairly broad term called a durable power of attorney for health care. It’s a comprehensive legal document that includes both what your wishes are, as in a suggestion for how you’d like to be cared for, and also identifies a person who will make your decisions for you at any time you become unable to make your own decisions.
A health care proxy is half of that. It’s the half that just identifies who would make decisions for you should you become unable. The most common way a person becomes unable is by being unconscious. Another way is to have dementia that has reached a point where two doctors or a doctor and a judge confirm that you are no longer competent to make your own decisions. You can’t be declared incompetent because you fell and broke your hip. You can’t be declared incompetent because you’re undergoing life-threatening treatment and you’re not feeling very well. You don’t have to think you’re going to lose control by naming somebody else because there are only very narrow reasons that that other person can make your decisions for you.
A health care proxy can have a first, then an alternate, and then a second alternate if you want to name more people. As I’ve gotten older, I’ve realized the value of naming somebody younger than you. My first Advanced Directive named my older sister. She’s still healthy, but so am I. By the time I meet somebody, I don’t know if she’ll still be healthy. Naming somebody younger, like a next generation niece or nephew, gives you someone who’s likely to be capable and competent when you need them. If your children are 15, that’s probably not a good choice. You might want to revise it 10 or 20 years later when they may have the wherewithal to be making your decisions for you.
Next slide. We talk about living wills. A living will is the next topic and what’s also included in an Advanced Directive. That’s the other half of it. A living will says I don’t want dialysis or I do want dialysis, I don’t want CPR or I do, I don’t want a feeding tube or I do. You get to check a bunch of boxes on what your wishes are. Again, this will only apply if you are unable to communicate for yourself. There’s always going to be a default position of aggressive intervention. Even in somebody who’s heading toward hospice, unless you can convince whoever’s there that there’s a good reason not to have aggressive action, the living will doesn’t apply.
I literally had a patient in her 80s, completely competent, and her son wanted to take over decision-making for her. I said, “Gee, that’s really nice that you’d like to, but you don’t have any authority.” Well, I have her Advanced Directive, and it names me. That’s nice, but she’s competent. There is no way a family member or named person would be able to take over decision-making until you were truly declared incompetent or unable to respond.
Next slide. Five Wishes is a document that’s a little different than an Advanced Directive, living will, or health care proxy. It’s a form. You can look for them online; you can purchase one online. They’re not expensive. It’s a very thorough and thoughtful end-of-life document that is legal just like an Advanced Directive and a health care proxy. It allows you to specify things that might be more personal, like “I want to be put in my favorite dress before I’m taken to the funeral home,” or “I want cremation, not burial.” It allows you to get very personal with your wishes, and it allows you to have parting comments for people in your life. It is legal in both California and Nevada, and some physician offices carry it.
Next slide. This is an example of what the Five Wishes looks like. It shows the things it gives you the opportunity to decide, in addition to a decision maker and what kind of medical treatments you don’t want or do want. How comfortable do you want to be? If somebody has to err on the side of sedating you to make you comfortable, is that what you would like, or would you rather have somebody make sure you don’t get loopy on drugs as a result of needing comfortable care? It allows you to be more specific about those things. It tells people how you’d like to be treated and what your loved ones should know about you.
Next slide. Some other terms in Advanced Directives. DNR or DNI are terms that basically say if I die, don’t bring me back to life. This is what essentially happened to the lady who gave us her initial story. They don’t prevent paramedics from doing what they did for that gentleman. Next, we’re going to talk about POLST forms. That was the missing piece in that story. The next page should have a picture of a POLST form. We call it the pink page. The cancer center carries them. Our offices all carry them. They should be completed by anybody facing a life-limiting illness. If you have end-stage cancer, heart disease, or dementia, you should have a POLST form. It is a doctor’s order, and if it is posted in your home, paramedics will honor that form.
Next slide. A friend had a similar situation, but it was on a golf course. They did CPR, and it severed his spine. He was paralyzed for the rest of his life. In that situation, carrying a form is an unrealistic expectation. Paramedics cannot stop and hesitate. There’s no way to prevent what happened unless loved ones could intervene, but in the field, paramedics respond to the emergency at hand.
Next slide. POLST forms are recognized by paramedics and honored in the field at a home. Each state has its own, and it’s best to have one in your state.
Next slide. A study from 2014 asked physicians what they would want as they approached the end of life. 87% don’t want to be ventilated. 77% don’t want a feeding tube. 90% say no to CPR. 82% want to be kept comfortable. 87% want no dialysis. 58% say no to IV hydration. Understanding these preferences highlights the importance of planning.
Next slide. I worry more about being over-medicalized than under-medicalized. In hospice work, I see situations where people are treated aggressively long after they lose quality of life. I have added to my personal Advanced Directive language that encourages people making decisions for me not to feed me unless I express interest, not to give me antibiotics unless necessary, and not to give vaccines unless it protects others around me. I want nature to take its course.
Next slide. Websites like wis.com, trustandwill.com, and freewill.com allow you to do this affordably if you don’t want an attorney.
Next slide. Home health and hospice overlap, but there are distinctions.
Next slide. Home health services are covered by insurance, including Medicare. You must be homebound, meaning considerable effort is required to leave home, and expected to improve. It is not custodial care. Services include nursing care, home health aids, social work support, and therapy. Visits are usually days to weeks. Home health aids assist for a few hours a few times a week. They don’t provide grocery shopping, cooking, or durable equipment. VA services are more robust than Medicare for eligible veterans.
Next slide. Hospice care is covered by most insurance. Patients must have a condition not expected to recover and likely to cause death within six months, though some may live longer. Services include nursing visits, home health aids, psychological, spiritual, and social support, volunteer support, durable medical equipment, and medications related to diagnosis. Hospice does not provide therapy or housework. Patients may be admitted to the hospital for respite care if needed.
Next slide. Long-term care insurance helps but has limited resources. Paid caregivers, either agency or private, provide assistance. Family members sometimes fill shifts. Medicaid may provide in-home caregiving if otherwise requiring assisted living. Medicare does not cover in-home care beyond home health or hospice. Supplemental insurance does not change this, except Advantage Plans for some exceptions.
Next slide. Get your affairs in order before it’s urgent. Think about what matters to you. Modify your Advanced Directive accordingly.
Next slide. Medical Aid in Dying is legal in California and may become legal in Nevada. Eligible adults with life expectancy six months or less may request a prescription to end life voluntarily. Life insurance treats this as natural death, not suicide.
Next slide. Questions. Palliative care is distinct from hospice. It supports symptom management but not in-home care in this region. Discussing wishes with decision-makers is critical. The book Death Over Dinner helps facilitate these conversations. The Art of Dying Well provides guidance on Advanced Directive specifics. POLST forms can be customized for selective treatment, including DNR.
March 6, 2025
Dr. Johanna Koch highlights the importance of planning for end-of-life care, discussing durable power of attorney, health care proxies, and other essential options. Learn how to ensure your healthcare wishes are respected.
Raising Healthy Eaters Without Food Labels
Hi, I’m Lisa Fligor. I’m a registered dietitian nutritionist at Tahoe Forest Hospital, and I’m talking to you, parents.
Today, do you want to raise competent, healthy eaters, avoid power struggles, food battles? I want to bring up this concept called food neutrality. Basically, what that means is that food’s not good or bad. It doesn’t have a moral value. It’s just food.
So, for example, and I hold this up, what words come to mind? And then when I hold this food up, what words come to mind? Foods have been associated with labels for decades. The problem with doing this with kids, saying foods are healthy or they’re bad for you or limit them, is kids are really concrete thinkers. When we say a cupcake is high in sugar and they shouldn’t eat very much or it’s a bad food, now when a kid is around cupcakes, they’re going to think, “Wow, that tastes really good and I love cupcakes. Does that make me bad?” I know as adults that sounds a little bit silly, but then we get this ingrained in our heads over years, decades, that now we have a moral value based on the foods that we prefer. So we really want to stay neutral with foods.
The research shows that the more we put labels on the food, the more we increase the likelihood of kids becoming picky eaters, hiding, sneaking food, developing disordered eating, or even eating disorders. It’s not what we want for our kids. The right way to serve a cupcake for kids is like this: just amidst a variety of foods that we would consider healthy foods and serving this to our kids and encouraging them to eat until they’re comfortably satisfied.
If this makes you uncomfortable, give us a call. We’re here to support you. We have dietitians that will meet with you one-on-one if you’re dealing with picky eating. I also really encourage parents to start from the very beginning with their kids and setting up good habits and a good feeding dynamic with their kids. We offer infant nutrition and toddler nutrition classes along with one-on-one appointments, so give us a call. We’re here to help.
November 6, 2024
Do you want to raise kids who have a healthy relationship with food and avoid the power struggles around mealtimes? Lisa Fligor, Wellness Dietitian at Tahoe Forest Health System, shares insights on a key concept: food neutrality. In this video, Lisa explains why labeling foods as “good” or “bad” can lead children to associate their self-worth with their food choices.
Mindful Breathing Techniques
Hi, my name is Justine Nelson. I’m an Integrative Wellness Coach at Tahoe Forest Hospital. I focus on mindfulness and tobacco cessation.
If you’re ever feeling stressed out and can’t think clearly, you want to take a deep breath. Slowing down to consciously be aware of our breath is the easiest and quickest way to help regulate our nervous system and clear the mind. So here are some effective ways to deep breathe.
First, we want to roll back our shoulders to correct our posture and open up our lungs. Then we want to focus on inhaling through the nose and exhaling out the mouth with pursed lips. Inhaling through the nose helps us filter out different dust allergens and boost our oxygen intake. Exhaling through the mouth allows us to have that audible sound to the brain that indicates relaxation and gives a nice full exhale.
The next thing we want to do is focus on bringing our breath down into our diaphragm, expanding our abdomen near our ribs as we inhale and contracting our abdomen as we exhale. This allows us to slow down our breath, utilize more of our lungs, clear out old air, and actually take pressure off the heart and use less energy to breathe.
Finally, we want to focus on a longer exhale than inhale. A longer exhale allows the vagus nerve to signal to the brain to activate the rest and digest phase of the nervous system and can help ease the stress response.
Okay, now you can follow along with me for a few rounds of conscious deep breathing. First, we want to roll back our shoulders. Then we’re going to focus on inhaling through the nose and expanding the abdomen, and then exhale out the mouth, pursing the lips, contracting the abdomen, focusing on a nice long exhale.
And again, breathing in through the nose, expanding the abdomen, and exhaling out the mouth and contracting the abdomen.
And then one more time, inhaling through the nose, expanding the abdomen, and then exhale out the mouth, contracting the abdomen.
Now you can return to your natural breath. Again, my name is Justine Nelson. Thank you so much for following along with me. You can contact the Center for Health for more information and how to work with me.
November 6, 2024
Join Justine Nelson, an Integrative Wellness Coach at Tahoe Forest Hospital, as she guides you through mindful deep breathing techniques to help reduce stress and improve focus. Justine explains the importance of proper posture, breathing through the nose, and focusing on expanding the diaphragm to calm the nervous system. By practicing longer exhales, you can activate the “rest and digest” phase of the nervous system, easing the stress response.
Harnessing the Power of Gratitude
Hi, my name is Justine Nelson. I’m an Integrative Wellness Coach here at Tahoe Forest Hospital. I focus on mindfulness and tobacco cessation.
If you notice yourself getting caught up in negative thinking or unable to shake stress, then taking a 15-second meditation to focus on the power of awe can be a great tool. The power of awe is a practice that involves consciously bringing to mind something that gives you a sense of joy, gratitude, or wonder.
Studies show that when we’re able to bring something to mind with appreciation, we can actually disrupt the stress cycle, help regulate our mind and body, and use the power of gratitude to help combat negative thinking. If we build this practice into our everyday life, it not only gets easier to notice things that we’re grateful for, but also to use this as a skill to recognize the good among the more challenging aspects of life.
Now I invite you to follow along and practice this with me. To begin, we can think of the acronym A. First, we want to bring our attention to something that gives us a sense of appreciation. This could be a physical object like a pet, a loved one, or family member. Or maybe it’s a thought of your favorite place in nature or the sunlight hitting your skin.
Then we want to wait, just slow down, and as you breathe, rest your awareness on the sense of appreciation.
Finally, we want to exhale and expand, leaning into this sensation of gratitude. Notice what it feels like to feel gratitude in the body. Notice what your thoughts are when you are observing something that gives you a sense of gratitude and wonder.
And then finally, you can release that thought or image and come back to your surroundings. Hopefully you feel a sense of ease and appreciation. Remember that this is a tool you can use when times get tough and turn toward the power of awe.
Thank you so much. Again, my name is Justine Nelson. You can contact the Center for Health on ways to get in touch with me and work with me.
November 6, 2024
Join Justine Nelson, an Integrative Wellness Coach at Tahoe Forest Hospital, as she shares a powerful mindfulness practice called the “Power of Awe”. In this video, Justine explains how focusing on gratitude can help disrupt negative thinking and reduce stress. By consciously bringing to mind something that brings you joy, gratitude, or wonder, you can break the stress cycle and improve your mental well-being.
Train for Trails
Okay, so pretty much what we’re going to go over is some basic exercise facts. We’re going to talk about some common sports injuries and hopefully how we can prevent them from a strengthening perspective and also just making you as a human a little more resilient. Then what happens if you do actually get hurt, which fingers crossed doesn’t happen.
General exercise facts, there’s kind of two things that we’re looking at. When we go through this slide, we’re going to talk about what your load is, so what we’re putting into the system, essentially how much load we’re doing, how much we’re exercising, where we’re exercising. Uphills, downhills, that kind of thing all contribute to your load. Your capacity is how well you can tolerate that load. A whole bunch of things go into what our capacity reservoirs are, kind of our experience doing that activity, how much sleep we’re getting, what our nutrition is looking like, are you sick right now, have you been hurt recently or previously.
As we go through these slides, you’re thinking about load and capacity and how they relate to each other. This is a nice little graphic. This is all in a balance, so you can increase your load, push yourself to do hard things, make your volume really high, and that’s great. But we want to make sure that the capacity to accept that load is there.
Things that influence our load are volume, like how much are you doing of that activity, your pace, are we going faster than normal, can we slow it down so we can tolerate a larger volume, what is the terrain like, are you running on a road, on a trail, are you switching up your terrain all of a sudden, which happens a lot. For example, going from spring or winter to summer, maybe you’ve been running on a treadmill and now you’re running on a trail. How that terrain is different and then what are our mechanics.
Capacity, as I mentioned before, is influenced by experience, prior injury, sleep, nutrition, whether you are sick, and your strength.
Things that you have control over, like minimizing training errors, being mindful of how we load our bodies as we go into something new, improving sleep, making sure nutrition and hydration are on point both when we’re not doing the activity and during the activity, and keeping up on strength and mobility to make sure you are strong as you start the activity.
Injuries, especially overuse injuries, often occur when load is too high and capacity is not enough to meet that load. Sometimes you might do something that you did last summer, but your capacity is lower, you are more stressed, or not taking care of nutrition or sleep. Always think about load and capacity in relation to each other.
Common injuries include general sprains and strains, broken bones, tendinitis, dehydration or heat illness, and cardiovascular issues, especially if older than 30.
Some common injuries for runners and hikers are plantar fasciitis, Achilles tendonitis, calf or ankle pain, knee pain like patellofemoral pain syndrome, shin splints, stress fractures, IT band syndrome, and for osteoarthritis, aggravation due to overtraining. Cyclists may have Achilles tendonitis, knee pain, back pain, and neck pain from positions and overtraining.
Overtraining is a syndrome where there’s too much load and not enough recovery. It can look like depressed mood, increased injuries, heart rate changes, and is treated with rest, increasing capacity, and reducing load until back to baseline.
Volume is a key modifiable factor. The 10% rule increases your load by 10% each week. The acute to chronic workload ratio looks at load over four weeks compared to the most recent week. 0.8 to 1.3 is a suggested safe range. Tools like Strava can help visualize workload spikes.
Strength helps tolerate higher load changes. Two times a week of strength exercises can provide breathing room and robustness for unexpected increases in activity.
Pace and terrain affect load. Higher pace increases load, so slowing down can help. Terrain changes impact load, so gradually transitioning to different surfaces reduces injury risk.
Capacity improvement includes sleep. Less than seven hours or poor-quality sleep increases running injuries. Consistency, cold room, darkness, morning light, avoiding late exercise, limiting naps, caffeine management, alcohol, and using your bed only for sleep and sex all help. Technology like fitness trackers can monitor sleep phases and heart rate changes.
Nutrition is important for baseline and during activities. Snacks with simple carbohydrates, water, and electrolytes are key. Protein intake should be 1.2 to 2 grams per kilogram body weight. Fruits and vegetables provide complex carbs and nitrates. Collagen and vitamin C may support tendon and ligament health. Creatine supports muscle strength, hypertrophy, and recovery, with 3-5 grams daily recommended. Creatine monohydrate with a water wash reduces GI upset.
Resources include dietitians, Stanford Female Athlete Science and Translational Research Group, US Olympic and Paralympic Committee nutrition, and Stacy Sims.
Low energy availability occurs when intake does not match expended energy, impacting recovery and increasing risk of stress fractures or menstrual disruption.
Running-related injuries are mostly overuse: knee injuries like patellofemoral pain syndrome, IT band syndrome, lower leg injuries like shin splints, Achilles tendonitis, plantar fasciitis, and golfing-related back strains or medial/lateral epicondilitis. Strength training is important for prevention.
To prevent injuries, get a baseline with functional movement screen and aerobic assessments. Retest every 6-8 weeks. Strength training focuses on building strength: 1-5 reps at 85% of one-rep max, 2-6 sets, rest adequately, focus on hypertrophy if needed, and minimally effective dose. Exercises include single-leg stands, glute strengthening, heel raises, clam shells, step-ups, deadlifts, bridges, toe exercises, and mobility for biking and climbing.
If you do too much, stop loading, rest, use ice or anti-inflammatories if needed, protect the injured area, elevate, compress, and educate yourself. Gradually reload, do pain-free cardio, mobility, and strengthening. Optimism is key, and vascularization through blood flow helps healing.
Workup for injuries may include x-rays, MRI for bone and soft tissue, CT scans for alignment, physical therapists for rehabilitation, and sometimes injections. A team approach is essential.
August 22, 2024
In this video, Tahoe Forest Health System providers dive into the essentials of exercise physiology, discussing how to balance exercise load and capacity to prevent injuries. They explain how training errors, poor sleep, and dehydration can lower your body’s capacity, leading to injuries when the load becomes too high. Learn strategies to improve your capacity through proper sleep, nutrition, and hydration. They also cover how to manage resistance training fatigue, what to do if you get injured, and when surgery might be necessary. Gain insights to better understand your body and ensure long-term success in your fitness journey.
Infant Nutrition
Hi, thanks for joining today. I’m Lisa Fligor. I’m a dietician here at Tahoe Forest Health System. We work specifically out of the Center for Health, and we do lots of wellness programming and different classes to support families. Parents, today we’re going to talk about starting solids. We do a live class for this every other month. This is kind of a shortened version of it, might be a little bit less personal, so I encourage you to reach out if you have questions. We do appointments with individuals and families if you have questions or complications, and I’ll have our contact info at the end.
So I’m going to start by asking, when do we even start solids? This is a super exciting time in baby’s life, parents’ life. I have three kids myself, and I remember they’re all teenagers currently. They’re all really good eaters, I like to share that as well. But when we started introducing solids, it’s just a really fun time, especially. I think the breastfeeding and formula feeding ends up being a lot on the mom’s responsibility, so this is a time too where we can get other adults and caregivers involved in baby feeding, and it can be really fun.
So there’s definitely been some changes in the last decade. Most young parents or parents of young babies are kind of reading the current recommendations, but I just like to clarify that it’s really recommended that we wait until six months old. Historically, they’ve recommended starting as young as four months. Every baby develops a little bit differently, so there are some other cues that we’re looking for, but in general, we really do want to wait until that six-month birthday.
The developmental things that we’re looking for are that they can hold their head upright comfortably, they can sit without support, they’re not slouching down, or in those Bumbo seats where they kind of support their hips, which forces them to sit. You want them to be able to sit without that, just in a high chair or on the ground, and they can hold their spine up. It’s super important for safety that they can do that.
You’ll also notice they’re bringing everything to their mouth, not just food but toys, anything they can get their hands on. That’s their initial reaction. They’re showing interest in your food if you’re eating around them. They’re tracking you, they’re following you, they’re grabbing for it, leaning into it, really wanting to be involved. There are some great videos online. I’m not going to play them now just for the sake of time, but I do want to point out that thousanddays.org is a great website for different resources. They have a few videos on what to look for. It can be helpful to watch a video because then you can actually see what this looks like instead of me just explaining it.
On their website, on their YouTube channel, they have a couple videos that are really important. Another thing I want to point out is that up until six months, babies are getting everything they need from breast milk or formula. It’s really important to wait until their digestive tract is developmentally ready for food.
So how we’re going to talk about how to start solids: a few tips. One, just be prepared for a mess. I think managing expectations is really helpful. They start with the cute little outfits you get at your baby shower when they’re newborns, that come with the little bib that coordinates with the onesie. Those are for drool and to look cute; they’re not very helpful when we’re feeding solids. I recommend going for something a little more effective, like the Art Smocks that cover the sleeves, almost like a mock turtleneck. That can be super helpful.
It’s the middle of winter right now, but if you happen to get to this stage during the summer, I love putting my kids outside in a diaper on their high chair. It makes clean up easier. I also recommend getting a dog. I thought that was really gross before I had kids, but once you start feeding, all the help you can get is helpful. Another tip is a more realistic one: put a clean tablecloth underneath the chair, almost like those oil cloths. You can get a smaller size and put it underneath the chair so if the baby throws something to the ground, you can pick it up and give it back to them. It’s a clean surface, and you can clean that off between meals.
Food or meal time starting solids is really meant to be fun and exploratory for babies. It’s not a time to pressure them to eat a certain amount of food. They’re still going to be getting most of their nutrition from breast milk and formula. This is meant to be an exploratory sensory process rather than pressure to get nutrients or calories in. I really recommend starting earlier in the day and not right before bed for a couple reasons. The baby’s energy and mood are probably going to be better, and when we start to introduce allergens, I want you to be able to keep an eye on your baby for a couple hours after introducing those foods. Doing that right before bed makes it harder to monitor. You don’t want to feed them when they’re tired. I really like after the morning nap if they’re still taking that morning nap.
You also don’t really want to start them out when they’re hungry. I recommend offering breast milk or formula first. It helps because if I get super hungry and then I have to eat everything slowly or I can’t get it to my mouth, I get frustrated. We want the baby to be in a good mood. This is meant for them to be curious, explore food, textures, smells, and tastes, and not be frustrated that they can’t get a lot of food into their mouth.
Ideally, we want adults and caregivers to eat with the baby. At six months old, when you’re first introducing solids, that may feel weird, and you’ll be eating slightly different foods, but in general, we want to start the habit of the family meal. We want the baby eating from your meal and what your family normally eats, not necessarily cooking separate meals for the baby and other family members. Always stay with your baby. I know in a busy life it can be tempting to run and throw in some laundry or join a work call, but make sure you’re present with the baby and remove distractions, like phones or TV. Meal time is meal time, and it’s a great time to start that habit from the beginning.
Getting into more details on how to start solids: the end goal is for babies to be competent eaters, trust themselves with food, and be able to nourish themselves for the rest of their lives. It’s a very important skill. Babies need to know we trust them and need to be in control. They get to take the lead. I like the vision of them in the driver’s seat so they can learn at their own pace and gain confidence from knowing we trust them.
If you’re showing up with an agenda about how much or what they should eat, it sends signals that they should follow your instructions rather than trust themselves. You need to show them that you trust them by letting them be in charge. I love this picture because it illustrates messy eating. Skills are not developed yet, so food will be everywhere. Making space for that is important.
This is totally new for babies: new foods, new smells, new textures. They haven’t been exposed to this before. It can feel uncomfortable, so we want the baby in control, deciding how fast to move and what they’re willing to try. For example, traveling to another country or trying food at a restaurant can feel new and make you skeptical. Babies react similarly with new foods. They want to touch it, examine it, and try small bites slowly. We want to let them control the pace, without shoving food in their mouth.
One thing I find helpful is giving babies tools to communicate. Sign language is helpful, especially around food. The five signs I use are hungry, food, more, all done, and milk. Hungry is a C shape moving down the esophagus. Food is a pinch of thumb and fingers to the mouth. More is both hands in a pinch position moving together. All done is open fingers shaking like jazz hands. Milk is the traditional milking sign. Teaching in the moment, saying the word, and making eye contact is effective.
When feeding, there are three categories of foods: purees, soft handheld foods, and family foods. Purees are classic, like oatmeal or applesauce. Soft handheld foods align with baby-led weaning, letting babies feed themselves. Family foods pull from what your family already eats, with modifications for safety and allergens. Use purees for smoother foods and finger foods to escalate textures. Introduce multiple textures quickly. Let babies explore and play, adjusting for their preferences and appetite.
Safety: gagging is normal and protective, helping prevent choking. Choking involves blocked airways and is more serious. Infant CPR and first aid classes are highly recommended.
Nutrition: protein and fat are critical. Include slow-cooked meats, avocado, salmon, full-fat yogurt, eggs, beans, fruits, and vegetables. Iron is important, animal-based heme iron is absorbed better than plant iron. Vitamin C improves absorption of plant iron. Omega-3 fatty acids, especially from fatty fish, support brain and eye development. Vitamin D is recommended at 400 IUs per day. Introduce allergens early and often, one at a time for the first exposure. Watch for signs of allergic reactions, such as hives, swelling, or gastrointestinal issues.
February 13, 2024
In this video, Lisa Fligor, a dietitian at Tahoe Forest Health System, shares valuable insights on infant nutrition and starting solids. She discusses the latest recommendations, emphasizing the importance of waiting until your baby is around six months old—when they can sit up and hold their head without support—before introducing solids. Lisa offers practical tips, like starting solids when your baby isn’t hungry or tired and letting your baby take the lead to become a confident eater. She suggests beginning with nutritious purees and soft handheld foods like avocado, bananas, roasted sweet potatoes, and whole grain cereal. Lisa also covers important topics such as allergies, choking hazards, and continuing breastmilk or formula beyond 12 months. This video is a helpful guide for new parents navigating the exciting journey of starting solids with their baby.
