Your baby is ready for solid foods when they can lift and support their head, sit in the high chair, have doubled their birth weight, and are showing an interest in food. Never start solids before 4 months of age, and you can wait as late as 6 months old to begin if you prefer. Different babies will be ready at different times, even amongst siblings. Early introduction of complementary food is supported because babies need to start eating the most common allergens on a regular basis by 7 months old in order to help prevent food allergies, and that can be hard to do (but not impossible) if they are just starting solids at 6 months.
FIRST FOODS 4-6 months old
- Most kids start with iron-fortified infant oatmeal “cereal” (because it tastes like breast milk/ formula, so it is the easiest to give, and has iron & vitamins), but you do not have to do this. You can do vegetables instead if the baby is on formula (because the baby gets iron from that) or you may start with pureed cooked meats (which is recommended for iron but hard to give). Mix the cereal/pureed veg/meat with breast milk or formula into a thin mixture- the consistency of a pureed soup- to start. I do not recommend starting with fruit due to its sweetness. I love baby-led weaning once they get used to starting solids and using a spoon, so at 6-8 months, but not at first, because infants need to learn to eat from a spoon and swallow purees before starting solid chunks, which are often used in that method.
- Offer solid food 1 hour before the regular mid-morning breast feeding / formula session.
- Start with 1-2 tablespoons of puree per meal (like an ice cube), going up as needed. Follow your baby’s cues for being hungry and satisfied. You will continue their regular amount of breast milk / formula when you start solids.
- Remember that most of it will end up on the floor, the baby, and you, but not in the baby’s stomach. That’s okay. Plan accordingly. A clean trash bag on the floor under your chair can help with clean up from an exuberant baby.
- Feed the baby from a spoon, never a bottle. The point is for them to learn how to eat, not just get calories and nutrients, although that is also important.
- Wait for the baby to pay attention to each spoonful before feeding! Don’t force it. Watch for the baby opening their mouth, then put the spoon in.
- Feed in between infant milk times, not immediately following.
- Expect changes in bowel patterns (it is normal for poop to look weird, look like what they ate, and to change daily).
- Do NOT put cereal or food in a bottle for feeding.
- After cereal/ the first food is eaten easily, move on to other types of pureed foods.
- If there is a strong family history of allergies or eczema, or if the baby has these, start with one new food at a time and wait 3-5 days before introducing another, to see if the baby reacts. Otherwise, you can mix and match foods!
- Give new foods in the morning. If it doesn’t agree with your baby, you’ll know by bedtime (from a rash, vomiting, or diarrhea). This way it will also be easier to reach your pediatrician during office hours.
- You can repeat a food already given a few times, and mix familiar favorites with new ones.
- If the baby rejects a food, don’t force it, but try it again later.
- Follow your baby’s cues for hunger and satiation.
- Have fun with feeding, enjoy the art of the mess, and make meals a happy time.
- Try feeding at the same place and time each day, without TV or distractions in the background.
FOOD ALLERGIES
- EARLY introduction of common food allergens has been shown to help PREVENT the development of food allergies! Do NOT wait to start these.
- The 9 most common food allergens cause 90% of food allergies in children. They are: peanut, egg, cow’s milk, tree nuts (almond, cashew, hazelnut, pistachio, and walnut), wheat, shellfish, soy, and sesame.
- Introduce Bamba (puffed peanut snack that melts in your mouth), tahina (sesame paste, often found in hummus), and yogurt, which are common allergens, a few times a week, starting at 4-6 months old. Studies show it helps PREVENT food allergies if kids eat these regularly before 7 months old. I recommend using Bamba as the food to introduce babies to peanuts because that is the food that has been used in all of the major studies showing early introduction prevents peanut allergies. It’s also easy for babies to eat and tasty. It is sold at Trader Joes, Target, and in Los Angeles, at most supermarkets. If you do not want to use Bamba to start solids or cannot find it in your area, then start with peanut butter powder mixed into baby cereal. Do not use regular American peanut butter as the stickiness makes it a choking hazard, and it is more allergenic than other forms.
- Continue to feed common allergenic foods 2-3 times a week for a year to prevent allergies from developing.
- While uncommon, allergic reactions are possible when introducing food allergens to infants. The two most common signs of an allergic reaction in infants are hives (itchy spots) and/or vomiting, within 3 hours of feeding, but usually within 15 minutes. Call your pediatrician about how to manage any reactions. It is a good idea to have children’s Benadryl allergy syrup in a cabinet in case you are advised to use it, but do NOT give it without physician guidance. In the extremely rare case of a severe allergic reaction with trouble breathing or going limp, call emergency medical services (911 in the US).
ADVANCING FOODS 6-9 months
- Move on to textures & increase proteins: start with soft, cooked, mashed or finely ground foods (e.g. avocado, squash, banana, well-done meats/poultry/fish, cottage cheese, tofu)
- You can mix and match foods to have many different meals, for example:
Breakfast: cereal and fruit; Lunch: yogurt and veggies; Dinner: protein and veggie
- You can do baby-led weaning, but please AVOID CHOKING HAZARDS! Food should be bite-size (about the size of a pea) and soft. Babies chew foods with their gums, they do not have to have teeth to eat solids. I love baby-led feeding once the baby gets used to solids and spoons first.
- Consider purchasing a device to help in case the baby chokes on something, like the “LifeVac” or the “Dechoker”.
- Remember that your babies are also learning about texture, color, and aroma as they feed themselves, so try to offer a variety of nutritious and flavorful foods.
- Still NO honey until after 1 year old to prevent infant botulism!
- When the baby is eating well and having 2- 3 meals a day, offer water in a sippy-cup with meals (around 7 months old), but still continue their breastmilk or infant formula 4-6 times a day.
- Examples of fun finger foods for babies 8 months old and above: O-shaped toasted oat cereal or other low-sugar cereal (start with them soaked in milk), lightly toasted bread or bagels (spread with vegetable puree for extra vitamins), small cubes of tofu, well-cooked pasta noodles cut into smaller pieces
- Common choking hazards: raw hard fruits/vegetables like apples or carrots, string cheese, hot dogs, popcorn, whole nuts, fruits with peels on them, grapes.
More info on the new & old feeding rules at Dr Stuppy’s blog: http://pediatricpartners.blogspot.com/2011/10/starting-solids-old-and-new-and-myths.html
Please note this blog post is based on the handout I give to my patients in order to start their babies on solid foods. I got the original handout from a pediatrician friend, and then slowly and extensively revised it over the last 10+ years.