Starting Solids

Nutrition is an essential part of your child’s health. We offer this guide to assist you in starting solid foods in your infant. These guidelines are very helpful but remember that every baby is different so your baby’s path to healthy nutrition may be adjusted by your pediatrician.

When to Start Solids?

- If you are breastfeeding, the majority of your baby’s nutrition until 6 months of age will be from your breastmilk. However, your physician may suggest slowly starting small amounts of solids between 4 and 6 months of age.

- If you are formula feeding, we recommend starting solids after the 4 month well check if advised by your pediatrician.

- You will know your baby is ready to start solids when she is at least 4 months old, has doubled her birth weight (usually around 13 lbs), has good head and neck control and can sit supported. Also, she likely will be looking at your food and showing interest in eating. By now, she should have lost her tongue-thrust reflex which pushes food out of the mouth, thereby allowing her to swallow the food.

Which Food to Start With?

- There is no one “right” food to introduce first.

- Both the American Academy of Pediatrics and Children’s Healthcare of Atlanta Strong 4 Life Nutrition Program recommend starting with a an iron-rich food such as fortified single grain baby cereal or meat. In practice, we start with cereal in the majority of our babies, with oatmeal as our first choice.

- You should mix the cereal with breastmilk or formula in order to maximize protein content. It should be mixed into a thin consistency until your baby is used to accepting and swallowing food on the spoon, then it can be mixed into a thicker consistency. Start with one tablespoon (T) of cereal mixed with breastmilk or formula, then increase the volume as he shows you that he is hungry and eager to accept more food. Your baby may make faces or seem to reject the spoon fed cereal at first: this is very common and does not mean that there is a problem. In fact, it may take up to 10 to 15 exposures before a food is accepted. Just continue to offer the food on a spoon with encouragement and he will eventually take it and enjoy it.

How to Start New Foods?

- Introduce new foods one at a time, watching for possible allergic reactions such as vomiting or rash. If he does have a reaction, then stop that particular food and retry a small amount in 2 weeks. If he has the same reaction, then do not offer that food again and be sure to notify your pediatrician of the possible food allergy at the next office visit. (This does not apply to peanut butter or highly allergenic foods - more information later).

- Your baby only needs a few spoonfuls of solids when you start. If you are still breastfeeding, these solid foods are meant to complement your breastmilk, not replace it.

- Give each new food for 2-3 days before introducing the next new food so that you can identify any allergic reactions. Keep a record of which foods you have tried.

What’s Next?

- Next, you can offer the baby vegetables. You can buy these as stage 1 foods or make them at home, steaming and pureeing the food.

- Pour a small portion of food out of the jar and into a small bowl, then feed from the bowl: this keeps bacteria out of the jar, allowing you to refrigerate and then use the rest of the food in that jar later.

- Once she is used to the vegetables, start introducing fruit into her diet. 

What About Allergenic Foods Like Peanut Butter?

 

- It is now advised to start allergenic foods earlier, rather than waiting until after one year of age, as has been recommended in the past.

- Early introduction of highly allergenic foods may actually prevent food allergies.

- Refer to our peanut butter handout for tips on how to offer peanut butter safely.

- The majority of babies should be exposed to highly allergenic foods beginning at 4 months of age. In fact, the AAP recommends trying egg, milk (in the form of yogurt or greek yogurt), soy, wheat, peanut, tree nuts, fish and shellfish at this time.

- As you are introducing cereal, vegetables and fruits into your baby’s diet, you should also add these protein-rich foods to your baby’s meals, again, one new food at a time, for 2-3 days in a row. For example, you might give yogurt with breakfast, eggs or peanut butter with lunch and fish with his dinner.

- There are many acceptable daily menus for your baby.

-One typical menu looks like this:

  • Early morning- breast milk
  • Breakfast - cereal and fruit or yogurt
  • Lunch - breast milk, then 30-60 min later, vegetables and protein mid afternoon - breastmilk
  • Dinner - breastmilk, then 30-60 min later, cereal/fruit/vegetable/protein
  • Bedtime - breastmilk.

Who should not eat allergenic foods between 4-6 months of age?

- If your baby has mild to moderate eczema, they should be introduced to peanut butter around 6 months of age. Refer to our peanut butter handout.

- If your baby has severe eczema or has had a severe allergic reaction to any food, do not start peanut butter until you and your pediatrician have discussed this. For some infants, your doctor may order peanut allergy testing between 4-6 months of age to rule out peanut allergy prior to regular consumption of peanut butter.

- If you have a strong family history of food allergies, or your child has already had an allergic reaction to a food, you should discuss the introduction of allergenic foods with your pediatrician or allergist first.

- Keep Benadryl handy at home for use with an allergic reaction such as hives or wheezing. The dosing can be found on our website.

Some general recommendations

- Your baby does not need juice. Your baby can get all of her nutrients from the solid foods, and drinking juice can create unhealthy habits.

- It is safe to offer water with the meals at this age.

- We do not recommend feeding from pouches as it is difficult to assess the condition of the food and also because it doesn’t teach the baby how to eat  properly.

- Avoid raw honey and chunky foods. Infants should not have honey before 1 year of age as they can contract infant botulism.

- Organic fruits and vegetables are preferred to reduce pesticide exposure. These foods must be washed thoroughly before preparing them for your baby.

- Remember, you are trying to develop healthy eating habits, with a diet high in vegetables and fruits, with cereal and meat added for their iron content.

When to start finger foods?

- Between 7-9 months of age, your baby will be able to sit up independently, pick up objects and put them in his mouth. This is the time to offer finger foods such as small pieces of banana, eggs, overcooked and cut up whole grain pasta or vegetable, finely minced chicken, fish or meat. Be sure to keep the finger foods small, soft and healthy. If you offer baby cookies or crackers, be sure to read labels in order to avoid unnecessary added salt, sugar or preservatives.