Introducing solid foods

Everybody has a different opinion on when babies should start eating solids, and what you should start with. Recommendations have gone back and forth over the years so much that it's easy to get confused and not know what to do. Let's clear all that up!

When in doubt, listen to your baby

Most babies naturally show interest in eating solids between 4-6 months of age, and the more we learn about infant feeding, the more we are coming to see that this is no coincidence. Before then, the gut is not developed enough to process solid foods, but new evidence finds that waiting much longer may increase the risk of food allergies. So while the old recommendations were to delay solid foods until past 6 months of age, it turns out this approach is not only unnecessary, it might actually be harmful. The best and simplest answer is to watch for your baby's readiness rather than count out the months, keeping that rough timeframe in mind.

What are signs of solid food readiness? It is not necessary that your baby can sit independently, but they should have good neck control so they can easily hold their head up without support. A coordinated swallow is also important, if they seem to spit and sputter when you put a taste of pureed food on their tongue, they may not be ready. Often, parents notice that their baby starts reaching for food, watching them eat, etc. Teeth are by no means a requirement — in some babies these don't come until after a year of age.

What foods should I start with? With the exception of the foods to avoid (see below), you can feed your baby any food. Many parents like to pick foods that are easy to prepare and administer, like squash, avocado, peas, carrots, etc. While these are all great choices, I would encourage you not to try and cater to their tastes, or focus only on the sweetest, starchiest, tastiest foods. I like to focus on a broad variety of foods that are seasonal and local. A good balance right from the start will ensure a broad palate for years to come (more on this later).


Food to avoid in infants:

  • Do not feed your baby honey, as it can cause botulism only in infants. After 12 months of age, children can safely eat honey.
  • Avoid foods they could choke on, such as hot dog chunks or whole grapes.
  • Dairy/cow’s milk: In infants and small children, cow’s milk can lead to intestinal bleeding and anemia. Strictly avoid prior to 9 months of age. Between 9-12 months of age limit to small amounts of cultured dairy (yogurt, kefir, or cheese). After 12 months they may begin to drink cow’s milk in limited amounts if breast milk is not available (breast milk is still the preferred source of milk for toddlers). Always limit cow’s milk to less than 16 ounces per day. Choose, whole, organic milk: quality over quantity.

How to prevent food allergy. Foods like eggs, peanuts, shellfish, etc., commonly cause food allergies. However, you can—and should—still feed these foods, even if you have a family history of food allergies. In fact, new evidence finds that delaying them will only increase your risk of becoming allergic to them. But let's introduce them with a bit of caution. To help prevent food allergies, start with small amounts by themselves and monitor your child for any reactions. For example, instead of a whole serving of egg right off the bat, just a speck of scrambled egg (i.e. rice-sized) each day for a few days, gradually increasing the amount. When possible, try to prevent contact of the food with your baby's skin, which can cause irritation and lead to food allergy. If contact occurs, wash or rinse the food off the skin. Finally, once tolerated, it's good to keep the food in regular rotation. Signs to watch for: if your baby develops non-serious hives or eczema, stop the food, take a photo, and bring the photo in to a clinic appointment so we can take a look. Sometimes these rashes are caused by the food, but they are often caused by other things (direct contact with irritants/allergens, viruses, etc), so we can help you sort that out. If your baby has an immediate, severe reaction (severe vomiting, lip swelling, difficulty breathing, etc.) call 911.

How long should I wait between different foods? Unless they are foods with high allergic potential (such as peanuts/nuts, eggs, sesame/seeds, fish/shellfish, dairy), you really don't have to wait between foods. When introducing foods with high allergic potential, it's best not to combine them with other foods that also have allergic potential until you know that both are tolerated by themselves - if a reaction occurs, we'd like to know which food is causing it. So it's usually safe to give things like carrots and peas together the very first time, (reactions to these are rare), but we wouldn't advise shellfish and peanuts together for the first time. However you could do peanuts with carrots, or shellfish with peas - if a reaction happened it would likely be to the peanuts or shellfish. And after both have been well tolerated for 4-5 times, you can at last give peanuts and shellfish together.

When should I introduce meat? Easy! At the same time as everything else. You may still hear people say 9 months of age, but you guessed it, that's out the window. Like everything else, this idea was purely based on assumption, thinking that meat is "hard to digest", which was never backed up by factual data. So people were (and some still are) telling parents to delay the introduction of meat, and replace it with an iron supplement or iron-fortified rice cereal until they start eating meat. Babies often hate the supplement, or get constipated on the rice cereal, but usually enjoy eating meat. Not a meat eater or maybe not sure yet? No problem! You can simply give a daily infant vitamin with iron such as NovaFerrum Multivitamin with Iron Pediatric Drops or iron-fortified whole grain baby cereal instead. If you're not sure about whether you want to give your baby meat or not, you can read Dr. Joel's take on meat or no meat for your child. Dr. Meri hopes to have her take on it posted here soon.

What are my baby’s nutritional needs? Because any additional vitamins or nutrients needed in infancy are directly incorporated into formula, no further supplementation is needed for formula-fed infants. For breastfed babies, however, there are two nutrients that require external sources:

  • Vitamin D is not contained in breastmilk because back in the day it used to come from sunshine. Basically everyone living in temperate climates (infants through adults) needs a supplement through the winter months. Learn more about Vitamin D.
  • Iron is important for brain development. But there is very little iron in breastmilk because babies are actually born with too much of it. For the first six months, babies are essentially relying on the iron mom gave them at birth. But after anywhere from 4-6 months, those huge iron stores finally become depleted, and suddenly babies need a ton of iron to pick up where mom's iron left off. Babies 6-12 months need about 11 mg of iron per day due to rapid growth, which is 40 times the amount found in breastmilk, and even more than an adult needs. No coincidence, this happens to be when babies typically start eating solid foods which contain iron, another sign nature relied on solid foods at this age to be a healthy part of an infant's diet.

Suggestions for iron sources.

  • Meat is rich in iron and also helps provide the extra fat and protein that a developing brain needs a lot more than a mature brain. You can cook any meat or seafood (i.e. pot roast, chicken, fish, clams) and stick it in the food processor. Adding liquid such as breastmilk, broth or water, or vegetables/fruits, can help with texture.
  • Egg yolks have iron as well as omega-3s.
  • Liver is rich in iron and easy to prepare. Great in moderation. Surprisingly, many babies love it!
  • Spinach, like many other vegetables, is rich in iron, but to get 11 mg your baby would need to consume 2 cups of cooked and drained spinach to meet this need. I don't know if I could eat that much in a day, and I love my greens… Definitely give iron-rich vegetables, but if you plan on relying on them exclusively, an iron supplement would still be needed at this age.

How much food should my baby eat? Here’s a useful website that does a great job of answering this, so I’ll refer you there instead of repeating it.

What schedule of food introduction should I follow? Short answer: none. Contrary to popular belief, there is no perfect first food, and any food introduction chart you come across is purely arbitrary, none of it is based on any evidence. Rotate through lots of different foods, not just the foods you like or the foods you think they will like. While it seems a nice thing to do at the time, favoring the foods they like cements an early expectation that foods will cater to their taste preferences, rather than the other way around: learning to cater their taste preferences to available, nourishing foods. Offer variety to your child from day one — both tasty foods and less exciting foods too — at first, they may not always be happy, but their happiness in the long run will be exponentially higher and more sustainable when they learn to appreciate a broad palate of nourishing foods.

What if they refuse healthy foods? One of the hardest things for a parent to do is let a child go hungry when you know you have other foods they would eat. But this is also one of the most invaluable tools to fostering a healthy, well-balanced and positive attitude towards eating — one based on gratitude instead of entitlement. The trick is to navigate this path with love, empathy and compassion from day one. If your child chooses not eat because they don't like something, it's good for them to understand that the result of that choice is not tastier food (rewarding picky behavior), but it isn't punishment either. It's simply the natural consequence of waiting until the next meal comes around. There will always be other meals—they will never starve—and you don’t need to fix them anything else. It is, however, perfectly fine to provide a few options up front within each meal so it's not unpleasantly monotonous. Try not to view your role as you vs. them — your efforts are best focused on providing them love and support as they struggle with navigating that choice. It's also OK to have a hard time with this. Feeding children can be challenging, so give yourself lots of love, compassion, and leeway as well for doing the best you are able.

Which brings me to the last point...

Enjoy your food! With everybody talking about what to do and what not to do, if that worry distracts you from the joy of eating it's doing more harm than good. There may be no virtue more important to impart to your children with regards to nutrition than simply teaching them to cherish the art of gathering, preparing, and eating wholesome, nourishing food.

Bon appétit!

References:

  1. Poole JA, Barriga K, Leung DYM, et al. Timing of Initial Exposure to Cereal Grains and the Risk of Wheat Allergy. J Pediatr 2006;117;2175-2182
  2. Du Toit G, Katz Y, Sasieni P, et al.  Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy.  J Allergy Clin Immunol. 2008;122:984-91.
  3. Nwaru BI, Erkkola M, Ahonen S, et al. Age at the Introduction of Solid Foods During the First Year and Allergic Sensitization at Age 5 Years. J Pediatr. 2010;125;50-59.
  4. Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child.  Cochrane Database Syst Rev. 2006 Jul 19;3:CD000133.
  5. Sicherer S.H., Sampson H.A.: Peanut allergy: emerging concepts and approaches for an apparent epidemic. J Allergy Clin Immunol 120. 491-503.2007
  6. Branum A.M., Lukacs S.L.: Food allergy among U.S. children: trends in prevalence and hospitalizations. NCHS Data Brief 10. 1-8.2008
  7. Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academies Press; 2003.
  8. Sherry B, Mei Z, Yip R. Continuation of the decline in prevalence of anemia in low-income infants and children in five states. Pediatrics. 2001;107(4):677–682
  9. Centers for Disease Control and Prevention, National Center for Health Statistics. National Health and Nutrition Examination Survey. Available at:www.cdc.gov/nchs/nhanes.htm
  10. Chantry CJ, Howard CR, Auinger P.  Full breastfeeding duration and risk for iron deficiency in U.S. infants.  Breastfeed Med. 2007 Jun;2(2):63-73.
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Healthy Schedule

  • After birth (within 24 hours)
  • Newborn visit (day 3-5 of age, home visits encouraged)
  • 2 weeks
  • 2 months
  • 4 months
  • 6 months
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