Roy Benaroch, MD
There’s nothing more adorable than a picture of a happy baby contentedly smearing food on his face -- and everywhere else. (Until it’s time to clean up, of course.) Starting your baby on solid food can be fun, playful, and messy!
For some parents, introducing solid foods can also be confusing. When should you start? How much should you offer? What comes first?
Feeding baby solids doesn’t need to be a challenge. There are just a few simple rules and milestones to keep in mind to make sure your baby’s food is just right to grow on.
When today’s parents were small babies, pediatricians often recommended starting them on cereal and other solid foods at just a few weeks old. “It’ll help him sleep through the night!” they were told.
Now we know that’s not true, and for most babies, cereal in a bottle at 6 weeks is no way to start solids. (Some babies with bad reflux may benefit from cereal in a bottle, however. Ask your pediatrician.)
Between the ages of 4 and 6 months, most babies are developmentally ready to get their first taste of solid foods. At this point, they lose the extrusion reflex that is beneficial for sucking a breast or bottle but can shove a spoonful of baby cereal right back out.
Here are some signs that your child is ready to try solids:
“The pendulum has swung back and forth a lot on when to start solids,” says Jennifer Shu, MD, a pediatrician in Atlanta and co-author of Heading Home with Your Newborn: From Birth to Reality and Food Fights: Winning the Nutritional Challenges of Parenthood Armed with Insight, Humor, and a Bottle of Ketchup.
“We now know that 4 to 6 months seems to be the best time, when the baby’s digestive system can handle solids and they don’t impact allergies for the worse,” Shu tells WebMD. “If you wait until your baby’s much older than 6 months, she may reject the texture.”
“My son started at 5 1/2 months, and he was so ready!” says Erika Radtke, the mother of a 4-year-old son and newborn daughter in Carlsbad, Calif. “He stretched his mouth wide open like a baby bird's when we started him on cereal, and he had no problem swallowing. At that age, it's really just for practice and for learning to eat solid food. And it's fun! Who doesn't want that money shot of their little baby with goop all over their face, bib, clothes, and high chair and none of it in their mouth?”
Some experts cite another important reason to start solid foods by 6 months: That’s when babies’ natural stores of iron begin to deplete, and some babies may not get enough iron in their liquid diets to replace them. (There is more iron in formula than in breast milk, but the iron in breast milk is more readily absorbed.) Iron-fortified baby cereals are a good early source of iron, but once your baby is eating a variety of foods, there are several iron-rich options, including meats, beans, and spinach.
A common first baby food is a single-grain, iron-fortified cereal such as rice cereal or oatmeal. These baby cereals have the advantage of boosting your baby’s iron intake, and they’re easy to digest. Just mix with a little baby formula, breast milk, or even water on occasion.
In addition to baby cereal, you can start your baby out with pureed fruits and vegetables. What kind? It doesn’t matter that much, as long as you offer a variety, says Shu. Options include carrots, pears, prunes, sweet potatoes, avocado, bananas, peaches, and much more. You can either buy premade baby food or make your own.
“Both of my babies didn’t much care for the cereals and vastly preferred applesauce, which was the other solid food I offered early,” says Cynthia Schames, the mother of 8-month-old twins in Chappaqua, N.Y.
Some parents think that you should offer fruit before vegetables so the baby doesn’t reject the veggies for the sweeter fruits, but that’s not how it works. “All babies have a preference for sweet tastes,” Shu says. “You just have to keep giving them both fruits and vegetables.”
When you offer baby that first taste of something other than breast milk or formula, it’s a huge event. To increase the likelihood of success, offer the first solids when baby isn’t full (if she's not hungry, she won’t be interested) or ravenous (she’ll be frustrated that she’s not getting as much as she wants right away). Instead, fill her up a little with liquid and then let her have a taste.
Other than that, it doesn’t matter too much whether solid or liquid comes first in the meal, say many experts. “Some parents like to offer the bottle or breast at the end of the meal because of the comfort factor, especially if naptime or bedtime is coming soon,” says Steven Parker, MD, director of the division of developmental and behavioral pediatrics at Boston Medical Center. “But it doesn’t really matter which comes first.”
“Early on, I always nursed first until my son was pretty much done and then offered the solids as ‘dessert,’” recalls Radtke.
As with all new experiences, it’s also best not to spring solid foods on your baby when she’s tired, cranky, or sick. Offering a new food in the morning or early afternoon also gives you plenty of time to watch for allergic reactions.
What if your baby rejects the new food? Don’t worry, says Shu. “Try again later. You might want to wait a few days until your baby has forgotten the experience. It’s not so much that they hate the food -- it’s just that it’s unfamiliar to them.”
The feeding aisle at your local baby store is crammed with gear, but you don’t need that much to feed a baby. Small, soft-tipped spoons are best, says Shu, because they’re gentle on baby’s gums. (Some manufacturers now make spoons that are heat-sensitive, changing color if baby’s food is too hot.)
Other than that, you’ll want:
Once your baby has gotten used to her first solid food, she can begin to move on to more exciting options. As babies develop more teeth and chewing skills, you can offer them foods with more texture: Instead of pureeing veggies and fruits, try giving them in mashed-up form.
There’s no hard and fast age rule for when this happens -- just watch your baby. Although some babies get teeth at 6 months (or even earlier), and some don’t get them until nearly a year, their hard, sharp gums can often mash food very efficiently.
Each time you introduce a new solid food, wait about three days to see if it causes an allergic reaction. Don’t introduce anything new during that time; this way, if your baby develops hives, a rash, or a more serious reaction, you’ll know which food caused it.
“Once you start introducing a host of foods to your baby, you can have a lot of fun mixing them,” says Myra Bartalos, the mother of a 20-month-old girl in Brooklyn, N.Y.
If your baby has moved past purees, she can also begin to try other table foods, such as meats and poultry, eggs, dairy products, and beans. Just cut or mash the food into a size and consistency that she can chew or gum (when in doubt, make the pieces a little smaller than you think necessary), and feed away.
“Really, anything that you can put in baby’s mouth, if it’s nutritious and they won’t choke on it, is okay,” says Rachel Lewis, MD, an assistant professor of clinical pediatrics at Columbia University College of Physicians and Surgeons.
If your baby doesn’t like a particular food, don’t give up on it. “It often takes a child a dozen or more times of being offered a food to decide that he likes it,” says Shu.
Whether your baby is eating purees or food with more texture, it’s always important to watch carefully and take precautions to prevent choking. Babies should always be fed sitting upright in a high chair, not reclining in a swing or car seat. And never offer a baby foods that are clear choking hazards, such as whole grapes, hot dogs, or popcorn. Foods such as carrots, while great in cooked and mashed or pureed form, should only be offered to babies as finger food when cut into very small chunks.
You’ll want to continue to cut firm, round foods such as hot dogs and whole grapes into small pieces long after your child hits that 1-year mark, as they are still a choking hazard. “I would keep cutting these small until about age 4, when kids have all their molars and the mental maturity to know not to run around with them,” says Shu. She also recommends waiting until preschool age for popcorn, which is easily inhaled into the windpipe.
When can your baby try feeding herself with finger foods, like o-shaped whole-grain cereals or cereal puffs, cut-up pieces of cheese, small chunks of banana, or sliced-up cooked pasta? The answer really depends on how much mess you’re willing to tolerate.
Sometime between about 9 and 11 months, most babies develop the “pincer grip,” which allows them to pick up small objects between their thumb and forefinger. That’s when self-feeding becomes really satisfying. They can try finger foods before that, but they’ll mostly just sweep them up in their palm and try to shove them into their mouth that way.
As your baby gets older, she’ll probably want to start trying her hand with a spoon. Expect some mess, and let her go. Shu says a good way to start is to give baby a small soft-tipped spoon to hold while you’re feeding her. It lets her practice handling a utensil while keeping her from yanking the spoon from your hand.
Another tip: Try putting a dab of something thick, such as cream cheese, on the baby spoon and sticking a few pieces of o-shaped cereal to it. Baby can try feeding herself with something that’s less likely to fly off the spoon and land on the walls.
Many parents worry that they may be feeding their baby too much solid food, or not enough. You’ve just gotten the hang of tracking your baby’s needs for breast milk or baby formula -- and now you have to balance that with solids? Fortunately, it’s a lot less complicated than you think.
When you first start out, introduce solid foods once daily -- or even every couple of days if your baby seems reluctant at first. At these feedings, your child may only take in a spoonful or two of rice cereal, mashed banana, or pureed sweet potato. But she’ll soon work her way up!
At about 6 months, most babies are getting between 24 and 32 ounces of formula or breast milk a day. By about a year, that amount will go down to 16 to 24 ounces, and they’ll be getting the rest of their nutrition from solid foods. Generally, by around 8 or 9 months, babies will be eating three “solid” meals a day. How they make the transition is very individual.
“Let your child do the regulating,” says Lewis. “They don’t eat for pleasure at this age; they eat because they’re hungry. An hour or two after their morning bottle or nursing session, offer solid foods and let them eat as much as they want. To some extent, you don’t need to do anything except offer your child something that’s nutritious, and not force it on them.”
Shu agrees. “Lot of parents like to know how much their child is eating and follow some kind of formula,” she says. “But it’s the child’s job to determine how much to eat. It’s the parent’s job to give them healthy foods. A child’s appetite does not always neatly coincide with the size of a jar of food or the amount of cereal you mix up. From babyhood, we should encourage children to eat when they’re hungry and stop when they’re full.”
Until very recently, the American Academy of Pediatrics recommended waiting until at least a year to offer babies certain highly allergenic foods, including wheat, eggs, fish and shellfish, and peanuts and tree nuts. But in early 2008, it revised that recommendation, saying that there is no evidence that waiting to introduce these foods makes babies less likely to develop allergies. In fact, there is some evidence that eating some of these foods earlier may protect babies against allergies.
So you can decide to give your baby wheat, eggs, and fish before she’s 1 year old unless she’s at high risk for allergies -- for example, if a parent or sibling has them. But there’s also no harm in being a little conservative, says Shu. “It’s not a bad idea to wait until your baby is a little older -- say, 9 or 10 months -- before offering something like shellfish. It’s not that you’ll cause allergies, but if the baby is allergic, a reaction is a lot easier to deal with in an older baby than a younger one.”
And pediatricians such as Parker still advise waiting even longer with peanuts. “The jury is still out -- some evidence says you should wait until age 3 or older, while some says introducing peanuts earlier can help prevent allergies,” he says. “Since an allergic peanut reaction is particularly dangerous, I think it’s safer to wait.”
There are some foods that you should definitely wait on. Honey is one -- it can cause a potentially dangerous disease called infant botulism. Whole cow’s milk is another, because the milk proteins and fat can irritate a baby’s stomach. (Other dairy products have these proteins broken down, so they’re less likely to cause tummy trouble and can be introduced earlier.) Popcorn and other foods that are choking hazards should not be introduced until later.
Some pediatricians recommend waiting until baby is 1 year old to introduce citrus fruits because the acidity can be irritating. Shu thinks it’s up to the parent. “There’s probably no harm in letting your 8-month-old try a small cut-up piece of orange,” she says. “Just be forewarned that there may be a little rash or some stomach upset.”
What about sweet treats, like sugar? Babies do not need them and shouldn’t be offered these foods regularly, says Shu. But what if you’re at a birthday party for an older child and your 11-month-old is reaching for a taste of cake? “One bite isn’t going to hurt," she says. "Don’t make it a habit, and they won’t develop a preference for sweet things like cake or juice. I’m a fan of moderation, not deprivation or excess.”
SOURCES:American Academy of Pediatrics.Jennifer Shu, MD; co-author, Heading Home with Your Newborn: From Birth to Reality and Food Fights: Winning the Nutritional Challenges of Parenthood Armed with Insight, Humor, and a Bottle of Ketchup.Rachel Lewis, MD, assistant professor of clinical pediatrics, Columbia University College of Physicians and Surgeons, New York.American Medical Association.Medline Plus Medical Encyclopedia.Steven Parker, MD, director, division of behavioral and developmental pediatrics, Boston Medical Center, Mass.Erika Radtke, Carlsbad, Calif.Cynthia Schames, Chappaqua, N.Y.Myra Bartalos, Brooklyn, N.Y.
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