Starting Solids

Many parents are excited yet apprehensive about starting solids with their infants. So many questions... so many fears. Many food introduction guidelines have changed in recent years. What you did with your older kids might not be following current recommendations.

Back in time

I first published a version of this in 2011, and I still hear so much confusion.  It was actually Dr. Phil Boucher's blog Why Is Introducing Baby Foods So Complicated?? that made me recall my blog and look to see when I wrote it.

Sadly, despite the time lapse of over 5 years, the American Academy of Pediatrics continues to have what I feel is a confusing message. On one line they say a baby may be ready at 4 months, then they say about 6 months. No wonder parents are still confused!

Parenting is hard

Yes, there are things about parenting that are hard. Watching kids hurt. Letting kids make mistakes without coming to their rescue and knowing when it's time to step in. Sleepless nights with crying infants and sick children.

But there are times that parents make it harder than it needs to be. Not only with feeding, but I think parental anxieties bring us to over think too much. (Yes, I've been guilty of this over the years too.)

The stay at home moms are made to feel guilty that they aren't showing their kids an independent female role model. But the working moms have the guilt of missing milestones and other events.

We have the Mommy Wars about breastfeeding and formula. If you don't breastfeed, you're made to feel guilty. Unless you breastfeed too long, then you're made to feel guilty. If you use formula... never mind. This isn't really about the Mommy Wars.

We need to stop inventing things to be guilty about. Stop trying to perfect parenting and just enjoy the moments. (And for those moments you can't enjoy yet, like the poop all over the wall... wait for it to become a funny story to embarrass the older version of your toddler.)

Feeding "Rules"

Old Rules for starting solids

The older "rules" for starting solids were so confusing... different sources will vary on these rules.

• Don't feed before 6 months

• Don't give nuts, eggs, and other "allergy" foods until ___ (2/3/5 years, varying by expert)

• Don't start more than one food every 3-5 days

• Start with rice and other whole grain cereals, then add vegetables, then meat. Save fruit for last.

Variations of this were plenty, depending on the provider's preferences.

No wonder there is so much confusion!!!!

New Rules for starting solids

New rules are much easier.  I like easier.

• Start healthy new foods between 4 and 6 months, when your baby shows interest and is able to sit with minimal support and hold the head up.

• Don't give honey until 1 year of age.

• Don't give any textures your baby will choke on.

Done.

That's it. Nothing fancy.

Any foods in any order.

Nothing too salted. Try nutritious foods, not junk.

Common sense (and your baby's response) will hopefully guide types of foods.

What about food allergies?

Research does not support the thought that starting foods earlier lead to allergies.

In fact, there is research to support that starting foods, specifically peanuts, earlier might prevent food allergies. A full 180 degree change!

Pregnant women and breastfeeding mothers no longer have to avoid nuts or other allergy foods in most cases.

If there is a close family member with a food allergy, it might still be beneficial to wait to introduce that food. There may be a risk to the person with the allergy if Baby shares saliva laden with the allergen, and Baby might be higher risk of having a reaction. Of course, early introduction might help to prevent your baby from developing an allergy, so it is complicated. Talk with your pediatrician and possibly an allergist if a close family relative is allergic to foods.

I admit that I was initially nervous about telling parents it was okay to give nut products in infancy. Not just the allergy aspect, but also choking risks. Nuts are hard and round-- two no-nos. Peanut butter is thick and sticky-- another choking risk. I have a blog devoted to introducing peanuts safely.

Any of the more allergy prone foods should first be offered in small amounts at home. These foods include nuts, egg, and fish. Do this only if there is no one in your house who is allergic to that food. Have diphenhydramine allergy syrup around just in case, but remember most kids are NOT allergic, and starting younger seems to prevent allergy.

What about saving the fruit for last so they don't get a sweet tooth?

Babies who have had breast milk have had sweet all along! Breast milk is very sweet, yet babies who are graduating to foods often love the new flavors and textures with foods.

Formula babies haven't had the sweet milk, but they can still develop a healthy appreciation of flavors with addition of new foods.

I tend to find that most babies prefer bland foods initially. Vegetables, meats, and whole grains are pretty bland. Babies are not used to strong flavors, so they don't like fruits or fruit juices. (I don't recommend juice.)

Saving fruit for last simply doesn't seem to make a difference for long-term flavor preferences.

Fruits should be added after or along with other foods to give a balance of nutrition.

The more colors on our plates, the healthier the meal probably is!

I thought they couldn't have cow's milk until after a year...

Cow's milk is not a meal in itself (like breast milk or formula). It's missing many vitamins and minerals, so babies need to continue breast milk or formula until at least a year. If they change to regular milk (whole, 2%, skim, organic or regular) they are at risk of nutritional deficiencies.

Milk products, such as cheese and yogurt can be given to babies as part of an otherwise well-rounded diet as long as they don't show any allergy risks to milk. If they have allergies to milk products, talk to your pediatrician.

Regardless of dairy intake, it is recommended for infants under 6 months to have 400 IU Vitamin D/day and those over 6 months to take 600 IU Vitamin D/day as a supplement.

I thought they should have cereal first...

Rice cereal has been the first food for generations, probably because grandma said so.

There has never been any research supporting giving it first. With white rice and other "white" carbohydrates under attack now, it is no wonder the "rice first" rule is being debated. Despite being fortified with vitamins and iron, it is relatively nutrient poor, so choosing a meat or vegetable as first foods will offer more nutrition.

Shouldn't we wait on meat?

Waiting on meat due to protein load was once recommended, but no longer felt to be needed.

Pureed meats (preferably from your refrigerator... baby food meats are not very palatable) are a great source of nutrition for baby!

Some experts recommend meat as the first food due to its high nutritional value and low allergy risk.

How do we recognize symptoms of allergy?

I know so many parents who worry about allergies that they hesitate to start foods.

First, most kids are not allergic.

Second, introducing foods earlier helps prevent allergies, so when parents wait due to fear, they are increasing risk.

Allergy symptoms can vary and often are not specific

• dry skin (eczema)

• runny nose

• hives

• swelling of lips

• difficulty breathing

• vomiting

• diarrhea

• blood in the stool

If your child has one of these reactions we can test to see what the offender was. While testing is possible, it is not always recommended.

For possible food reactions that are mild, such as eczema or runny nose, schedule an appointment to discuss this with your doctor.

Significant reactions of anaphylaxis, such as lip swelling, extensive hives, or difficulty breathing are rare, but deserve immediate evaluation and treatment.

When's the best time for starting solids?

This question has many variations... Will foods help baby sleep through the night? If we start foods before 6 months will it cause obesity or diabetes? Does starting wheat lead to gluten sensitivity?

It's also one of the most difficult to answer because the American Academy of Pediatrics isn't clear in their recommendation (as shown above). The American Academy of Allergy and Immunology is a bit more clear, but is not where pediatricians look for guidance primarily.

Your baby may be ready for starting solids if he/she:

• is at least 4 months of age (in term babies, later in premature babies)

• has the ability to sit with minimal support and hold their head up

• shows interest in food by reaching for it and opening mouth as food approaches

You can wait until 6 months to start foods, but some studies show poor weight gain and nutritional balance as well as resistance to foods if started after 6 months.

Starting foods before 4 months is associated with obesity and diabetes. In formula fed babies the risk of obesity increases by 6 times at 3 years of age if foods are started before 4 months of age. That risk is not seen in exclusively breast-fed infants or those who begin foods after 4 months of age.

It is still an old wives' tale that starting solids will help baby sleep through the night. Babies tend to sleep longer stretches at this age, so it is no wonder that this myth perpetuates. Start foods because you see signs that baby is ready, not because you want longer sleep patterns!

How do I know how much to feed my baby?

Babies will let you know when they are full by turning away, pursing their lips, spitting out food, or throwing foods.

As they eat more food, they will need less breast milk or formula.  In general a baby who is gaining weight normally will self regulate volumes.

What's better: baby foods bought at the store or home-made foods?

This is a common question, but I think it's the wrong question. Homemade and store-bought foods can be either nutritious or not nutritious. It's more important that it's a healthy food. In general healthy foods are fruits, vegetables, legumes, nuts, eggs, meats, and whole grains.

Marketing and ease of preparation has made pre-prepared foods for us all common place. It does not mean they are any better. They cost more than home-made foods and often contain unhealthy additions, such as sugar.

I didn't make baby foods when my kids were babies because I thought it would be too hard. As my kids got older, they started limiting vegetable  intake despite loving them when they were younger. I began to puree foods to put into recipes. It really isn't hard.

Take whatever you're cooking for your family and put the items in a food processor or blender before adding a lot of salt and spices. Add a little water, breast milk or formula to get it to a texture baby can eat. Voila! Home made food. There are of course many baby food cookbooks and online recipes. You can freeze meal-sized portions so you can make multiple meals at one sitting.

There is help for parents who want to safely prepare baby food at home on How to Make Your Own Baby Food from What to Expect.

Baby led weaning

Common questions about finger foods include:

• My baby only wants table foods. Is that okay?

• Don't they need pureed foods first?

• He doesn't have many teeth! How can he eat foods?

What is baby led weaning?

Baby led weaning is a process of starting solids that allows babies to start finger foods and self feed.

There are many benefits to finger feeding. Babies use and develop fine motor skills while finger feeding. They can learn what the foods look like as they associate flavors and textures of various foods. You can also name the foods, so they learn vocabulary as they eat.

Baby needs to be willing and able

Pureed foods are what most babies start with due to the easy texture, but some babies want to feed themselves. If they are able to get the food in their mouth, move it to the back safely with their tongue, and swallow without choking, they are ready to feed table foods... at least with some textures. Beware of chewy or hard foods as well as round foods ~ these all increase the risk of choking.

You don't need to wait for teeth!

Most babies will be able to eat table foods between 6 and 12 months. They tend to not have molars until after 12 months, so they grind with their gums and use all their saliva to help break down food. They need foods broken into small enough pieces until they can bite off a safe bite themselves.

Minimize choking risks

Don't put the whole meal on their tray at once... they will shove it all in and choke! Put a few bites down at a time and let them swallow before putting more down. Rotate food groups to give them a balance, or feed the least favorite first when they are most hungry, saving the best for last!

This is a great time for parents, sitters, and other caregivers to take a refresher course on CPR in case baby does choke. Infants and young children are more likely to choke on foods and small objects, so it is always good to be prepared!

My new favorite site (added 2023)

I now routinely refer to Solid Starts regularly. It is a must-view page for families starting on the feeding journey!

How much juice should my baby drink?

I think babies don't need juice at all. They can practice drinking from a cup with water.

Juice adds little nutritional value and a lot of sugar, even if there's no added sugar. Eating fruit and drinking water is preferable.

See New Juice Guidelines for the current AAP juice recommendations.

What about organic? 

This is a fantastic question, but you'll have to wait for the next post to see the answer. I have asked a fellow pediatrician, Dr. Nicole Keller, to help with this common question. Stay tuned. (It's here!)