Introducing Solids

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. And then 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
 
–If you choose to feed using the baby-led weaning guidelines then these guidelines are irrelevant to you aside from the types of foods to introduce. Please clearly follow the guidelines outlined by the baby-led weaning movement.
 

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 choose 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 guidelines to help advise and support you with the making 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 his/her 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 and peanut butter (new guidelines do show that regular early introduction of peanut products decrease the chance of developing a peanut allergy). 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.
 
Step Four
Proteins. Once you’ve made your way thru the veggies, peanut butter and fruit move on to the proteins- eggs, chicken, fish, meat.
 
From 4-6 until 8-9 months of Age
During this time you will explore the grains, peanut products, fruits, vegetables and proteins 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 with water to your child. A straw or regular cup are 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. No juice!
 
Watch for sugar – the less the better. Use plain and not flavored yogurts. And try to keep any added salt to a minimum—if you are making a meal avoid the salt and then add to your portion at the table, rather than cooking with it whenever possible.
 
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. The only food your child cannot have (aside from any s/he has proven to be allergic to) is honey.

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 honey- raw or cooked- until 1 year of age. There is a toxin often present in honey – botulism – that the body is unable to handle before a year.
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 playdates or birthday parties, but you should always think of juice as a dessert and avoid incorporating it into your daily routine.

 
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. You can now introduce honey.
 
Milk
If your child has been on formula you can switch to whole milk—in a cup. There is no need to slowly 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 your child does not like milk or rejects it that is fine. Your child does not need to drink milk or milk products again after a year of age- calcium can be found in many foods.
 
Allergies
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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