Recommendations and Guidelines for the Introduction of Solids
Human milk or commercial formula alone will meet the nutritional needs of infants up to age 6 months.
After that, solid foods are needed to augment energy sources and provide adequate vitamins and iron. Evidence does not support any benefit of earlier feeding or a full belly for promoting sleep. There is some evidence that delaying solid foods until age 4 to 6 months can reduce the risk of atopic disease and obesity. The American Academy of Pediatrics (AAP) recommends starting solids no earlier than age 4-6 months.
We recommend to begin introducing solids when the infant is developmentally ready, such as when the infant has good head and neck control and is able to sit with support. At this time, again, typically at age 4 to 6 months, the infant no longer pushes out material placed between the lips and can communicate interest by leaning forward and opening the mouth or indicate satiety or disinterest by leaning back or turning away.
Feeding solids before age 4 months may result in aspiration and is associated with a slightly increased risk of developing obesity, atopic dermatitis, type 1 diabetes, and celiac disease. Waiting until significantly later than age 6 months can result in inadequate energy intake, leading to slow growth, disinterest in solid foods, delayed oropharyngeal motor development, and iron deficiency.
There is no need to limit fat and cholesterol intake in infant foods, but high salt and sugar content can set the taste threshold higher so that the infant prefers these later in life. Avoid cow’s milk until age 12 months because of the high renal solute load and association with iron deficiency. Avoid honey for the first year because of botulism risk. Although there is a tradition of delaying allergenic foods (e.g., eggs, fish, peanuts), there is no convincing evidence to support the delay, and the AAP does not recommend this practice. On the contrary, the new AAP guidelines now state:
Is my baby ready?
- Your baby should be able to sit in a high chair or feeding seat with good head control
- Your baby should be opening his mouth and interested when food comes his way
- Your baby should be able to move food from the spoon on his mouth to the back of his throat
- Your baby should be big enough, have at least double their birth weight.
How do I begin feeding my baby?
- Start with half a spoonful or less of pureed foods, do not force feed if the baby rejects the food, he or she might not be ready. Remember every baby is different and the baby will still be getting nutrition from the breastmilk or formula.
- One way to make eating solids for the first time easier is starting with a little breast milk or formula and then switch to half spoonful of the solid. This might prevent the baby from getting frustrated and too hungry.
- Increase the amount of food gradually, this allows the baby time to learn to swallow
- DO NOT add baby cereal to the bottle because your baby can choke. It may also increase the amount of food your baby eats and can cause your baby to gain too much weight.
Which food should I give my baby first?
- For most babies it does not matter what the first solid foods are. There is no medical evidence that introducing solid foods in any particular order has an advantage for your baby. I recommend foods rich in iron and zinc.
- The new guidelines recommend the early introduction of all foods, including egg or peanut butter after 6 months.
- All foods should be well-cooked and easy to swallow
Introduction of Solids
Ages 4-6 Months
- Continue approximately 28-32oz of formula or human milk a day. Given as 4 to 6 bottles/day for 5-8oz each or 4 to 6 breastfeeding’s/day lasting about 10 minutes.
- Begin Iron rich foods or iron-fortified cereal 1 time/day (1 tbsp. to 4oz)
- A few weeks later offer pureed vegetables and fruits
- A few weeks later offer pureed protein: chicken, beef, turkey, fish, pork, egg, beans.
- Introduce only one new food every 3 days to make it easier to determine if something causes difficulties or allergies.
- Refrigerate leftover foods and discard after 48hrs.
- Avoid high sugar or high salt foods
- No cow’s milk or honey for the first year of life.
Ages 7 to 8 Months
- Offer a cup (sippy cup)
- Allow small lumps of pasta or vegetables to remain in pureed foods
- Include one feeding a day of Vitamin C rich foods.
- Avoid whole grapes, nuts, raw carrots, popcorn, and round candies (choking risk).
Ages 9 to 12 Months
- Transition entirely to a cup
- Introduce dairy: yogurt, cheese.
- Offer small pieces of adult food
- Create a flexible schedule of 3 meals: breakfast, lunch and dinner. 2 snacks (morning and afternoon) and early morning and bedtime milk.
- Allow self-feeding
- Family enjoyment of the meal is more important than the amount of food the baby eats.
- Food variety is important later in life, a baby might be offered a food up to 15 times before acceptance
- Do no force feed, allow the baby to develop the feeling of satiety.