Introducing Solids

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Beginning solid food with your baby is an exciting time. There are some guidelines, and a couple of do’s and don’ts, but most of it is flexible. Food is something that brings most of us ‘food lovers’ happiness, so it is a lot of fun to introduce your child into this wonderful new world of flavors. Have fun with it and try to be flexible.

Nothing but Breastmilk or Formula before Four Months of Age
This is a pretty firm and widely accepted rule, and unless you have been specifically advised by your Pediatrician to give your baby something else before s/he is four months old, don’t!

Begin Solids between Four and Six Months of Age
There have been studies showing that if you wait until your child is six months old to introduce solids s/he is less likely to develop food allergies. On the other hand, there have been studies to show that waiting may make your child more likely to have food allergies. Obviously very confusing and unclear! So – in our office we recommend that you base when to start solids on your child’s interest and readiness. Your child should be able to hold his/her head up and sit with support before beginning solids. If you have a baby between 4-6 months of age who is intent on watching and trying to grab food when you eat and who is consistently interested, then it’s time to start. If your child shows little/no interest you should wait until 6 months. Even if your child shows little interest at 6 months it’s time to begin because it sometimes takes time to get used to the texture of food and the process of eating.

The General Progression
You will begin to feed your baby a very watery food once a day and by the time s/he is 8-9 months old you will be feeding him/her chunky and chopped table foods three times a day. You will follow your baby’s lead here. If thicker foods don’t cause gagging, move forward. If your baby loves having solids early on then offer them. Every child is different, and this path follows a basic progression but is not set in stone. You can jump from “stage 1” foods to “stage 3” foods if your child handles the thicker foods well. Think flexible.

Making Your Own Food
If you prefer, you can make your own baby food at home. You should buy organic fruits and vegetables only, steam them and put them into a food processor until you reach your desired consistency. Do not add salt, sugar, lemon juice, broth, cream, oil or anything else to the foods when starting out. There are books and online guides to advise you on the making, preservation, and storage of homemade food.

Where to Start – Step One
The easiest place to start is with a rice cereal. If your child is very constipated with rice cereal you may consider switching to a barley cereal. These cereals are widely available and are meant to be mixed with breastmilk or formula. They are iron fortified which is an added benefit to breastfed babies. It is a good idea to begin cereal once a day – mixed to a very watery consistency and fed to your baby on a spoon. Initially it’s a complete mess. In order to feed from a breast or bottle your baby needs to thrust the tongue. In order to eat off of a spoon the opposite motion is necessary. So, don’t be surprised if you put a spoonful in, and out it comes. It’s a learning curve for everyone.

Step Two
Once your baby has been on a cereal for a couple of weeks and seems to get the idea of eating you can introduce vegetables. Start with a single new food every 4-5 days so that if your child has a reaction to a food you will immediately know which food is the offending one. If you have introduced carrots, peas and green beans, and then after introducing sweet potatoes you notice a rash or vomiting, stop the sweet potatoes and discuss if/when to re-introduce them with your Pediatrician at your next visit.

Step Three
Fruit. We usually recommend introducing fruit after vegetables because there are some children who, once they’ve had the sweetness of fruit, are not interested in the veggies. But there is no other reason to start fruit after vegetables so if you want to you can definitely swap steps two and three.

From 4-6 until 8-9 months of Age
During this time you will explore the grains, fruits and vegetables with your child. By the time your child is 8-9 months of age s/he will be eating three times a day in addition to having breastmilk or formula, in general, from 3-5 times a day. During this period it is also a good idea to introduce a sippy cup to your child. A straw or regular cup is fine as well. Begin with water (less messy) and if your child does well feel free to replace bottles with the cups between 9-12 months of age.

9 Months
The tables have now turned and instead of a list of what you CAN give your child, it’s a short list of what you cannot introduce. Chicken, fish, red meat, yogurts, cheeses, egg yolk, etc. are now all OK. There are a few foods to be avoided (listed below) and the only rules are:

  1. Keep the pieces small to avoid choking.
  2. Avoid foods that are too hard to mash– if you cannot smash the food between your fingers then your child cannot mash it between his/her gums. So no raw carrots or hot dogs.
  3. Avoid the foods listed below.
  4. Unless your Pediatrician has recommended juice as a treatment for constipation you should not give your child juice. Juice is a drink that will fill your child with empty calories and teach him/her to avoid water and milk. As your child gets older you may offer it at play dates or birthday parties, but you should always think of juice as a dessert and avoid incorporating it into your daily routine.

Foods to Avoid Before One Year of Age

  1. Absolutely no raw honey before your child is one year old. There is a toxin often present in honey – botulism – that the body is unable to handle before a year. If the honey is cooked (honey baked breads, etc) there is no risk or danger.
  2. Minimize egg whites until One year of age. The less exposure to egg whites before a year of age the less likely your child will ever be allergic to eggs. If there are eggs in the bread or in the noodles, don’t worry (unless you know that your child has an egg allergy). But hold off on scrambling eggs or omelets. You can scramble the egg yolk alone (there will be minimal white in this) or hard boil an egg and mash the yolk alone.
  3. Minimize peanut products and shellfish until your child is two years of age. Again, the less exposure your child has to peanut products or shellfish before two years of age the less likely s/he will ever be allergic to them.

One year of Age
At this point your child will be drinking from a cup and will be eating the foods that you eat at the table. Amazingly!

If your child has been on formula you can switch to whole milk. There is no need to transition to whole milk slowly unless your child doesn’t like it, in which case you can mix the formula with whole milk to allow your child to get used to the flavor. If your child is breastfed and you will continue to breastfeed you can introduce whole milk at meal times or snack times but there is no need to stop breastfeeding.

If you feel that your child is reacting to a certain food you should stop the food and discuss it with your Pediatrician during regular office hours, or at your next scheduled visit. If your child shows mild signs of an allergic reaction – hives or a mild rash – you should give your child a dose of diphenhydramine/Benadryl (see medication dosing page) and contact your Pediatrician. If your child has swelling of the lips or tongue or difficulty breathing you should go directly to the Emergency Room. If you can manage to quickly give a dose of diphenhydramine without slowing down in your movement to the emergency room, do so.

Remember that these are mostly guidelines to help you with beginning to feed your child solids. There is a lot of flexibility and there are very few absolute rules. Beginning foods is an exciting time for all of you so try to relax and enjoy yourselves.

-Monique Araya, MD, FAAP

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