Starting Your Baby on Solids
Baby's first taste of something besides milk is always an exciting milestone, but mothers often receive conflicting advice on how to go about it. The when and how of introducing solids (be it rice cereal, purees or table food) is one of those topics where recommendations have changed drastically in medical literature in recent decades. Thankfully, there have been so many studies done on this topic that we now have convincing evidence of what is best for babies (and it happens to be easiest for moms, too!). Unfortunately, not all pediatricians and literature have updated their recommendations. If your pediatrician is giving outdated advice, try directing them to the 2020-2025 Dietary Guidelines for Americans which has included guidance for infants and toddlers for the first time ever.
The When of Introducing Foods
The new USDA guidelines as well as the American Academy of Pediatrics recommends that babies not have any foods besides breastmilk for the first 6 months.1 After 6 months, a variety of foods can be introduced to baby in addition to continued breastfeeding until the age of 2 or beyond, however long mother and baby wish to nurse. Studies have found that introducing solid foods (this includes rice cereal and "baby food") before 6 months increases the risk of illnesses, allergies and obesity and leads to premature weaning. Introducing foods too late may lead to picky eaters2 and increased risk of allergies.3 Every baby is different, so just like you follow your baby's cues when it comes to breastfeeding, you can follow your baby's cues when it comes to introducing solid food, too! Sometimes this is called "Baby-Led Weaning," because you are letting your baby set the pace based on his interest and developmental readiness.
Look for these signs your baby is ready:
Baby is able to sit up unassisted
Baby is able to use his hands to pick up food from a tray
Baby doesn't tongue-thrust food out of his mouth
Baby shows interest in chewing foods
A baby who is developmentally ready to eat solids will be capable of picking up a large chunk of banana and mouthing it, even if he doesn't get much in his mouth.
What to Introduce - Nutrient Dense Foods
Rice cereal and baby food purees are not at all necessary for a baby's healthy start. In fact, some studies have indicated babies who are allowed to self feed "regular" foods grow up to be less picky eaters and better at regulating their appetites and weight4,5. The most recent Dietary Guidelines released by the USDA highlight this shift away from purees, and instead they recommend offering nutrient dense foods the rest of the family eats with most of baby's and toddler's calories coming from healthy fats, protein-rich foods, and complex carbohydrates. This is opposite the typical feeding pattern parents are used to in the United States where babies and toddlers often fill up on low calorie or refined carbohydrate foods such as fruits, vegetables and grains. However, it really makes sense when you think about how replacing breastmilk or formula with fruits and vegetables would be akin to placing an infant on a low calorie diet. Infants and toddlers are still growing rapidly (especially their brains!) so they need a different ratio of healthy fats and protein compared to older children and adults.
"Protein foods, including meats, poultry, eggs, seafood, nuts, seeds, and soy products, are important sources of iron, zinc, protein, choline, and long chain polyunsaturated fatty acids. The long-chain polyunsaturated fatty acids, specifically the essential omega-3 and omega-6 fatty acids supplied through seafood, nuts, seeds, and oils, influence the infant’s fatty acid status and are among the key nutrients needed for the rapid brain development that occurs through the infant’s first 2 years of life. " - Dietary Guidelines for Americans
What to Introduce - A Variety of Flavors & Textures
One of the main purposes of giving a baby solid food before one to is to allow for exploration of a variety of textures and flavors as well as to prevent allergies (more on this later). Purees and cereals are bland and mushy, and don't allow for much sensory and flavor exploration. Instead, think about giving your baby foods with the same sauces, spices and flavors your family enjoys as this will build their appreciation for your family's foods right from the start. Here are some great first foods that give baby variety of sensory experiences and are nutrient dense:
Large chunks (big enough for baby to grasp and hold) of avocado
Scrambled or boiled eggs
Quinoa (a gluten-free grain rich in iron and protein)
Chunks of salmon and other soft fish
Ground beef, turkey, or chicken
Soft cooked peas, sweet potato and carrots
Once a baby is comfortable with those foods, you can easily move on to serving him most of the same foods your family is having for dinner. We love following the Infant Nutritionist on Instagram for more meals ideas! You can also check out the helpful app Solid Starts for visual guides on how to serve food to infants and nutrition content.
What about choking hazards?
A recent study found that babies fed table foods were no more likely to choke than babies fed purees.6 Babies come equipped with sensitive gag reflexes, allowing them to push food out of their mouths if they take in too much or haven't sufficiently mashed it between their gums. Don't be alarmed if there is frequent gagging at first! The best way to "test" a food for safety is to squish it between your thumb and forefinger. If it is "squishable" then baby's strong gums should be able to mash it safely. Watch out for non-squishable foods like fruit and vegetable skins, which should be peeled or soft-cooked before feeding to baby.
A Word About Allergies
For several decades, doctors advised parents to delay introducing potentially allergenic foods such as peanuts until children were older. It was thought that the immune system would be better ready to handle those foods when the child was older. Now, studies show that delaying potentially allergenic foods past 12 months actually increases the risk of allergies.3a,b No wonder we have a peanut allergy epidemic! The latest study showed that when a baby is exposed to peanut indirectly through what you eat during pregnancy and breastfeeding, and then fed those foods between 6-12 months their risk of peanut allergy is only 1%.3b For the children whose mothers consumed peanut products during pregnancy/lactation but didn't directly expose baby to peanuts until after 12 months their risk of allergies was 15%. For this reason, mothers should consume all types of foods while breastfeeding and try to expose their babies to as many food groups as possible between 6-12 months. However, it is certainly wise to introduce highly allergenic foods one at a time so that you can monitor for reactions. When possible, give a new food from the top 8 allergen list (fish, tree nuts, peanuts, soy, egg, dairy, wheat, shellfish) for three days in a row. All other new foods not on this list can be given simultaneously without tracking. Common reactions to look for include rashes, hives, swelling, change in bowel movements, vomiting, sleep disturbances, and ear infections. Talk to your pediatrician if you notice these symptoms.
How much should baby be eating?
One of the nice things about Baby-Led Weaning is that you don't have to sit there spoon feeding baby (which may sound fun with your first but soon becomes cumbersome) or keeping track of their intake. According to experts, "Allowing the child to regulate their own appetite and not pressuring them to eat more than they need is a really important step in encouraging children to develop healthy eating patterns for life." Simply place nutritious foods on baby's tray and allow baby to touch, play with, and mouth until eventually he becomes proficient at gumming, chewing and swallowing. If you decide to give purees, try preloading baby's spoon and placing it on their tray for them to practice picking it up and exploring it at their own pace (let them get messy!). At first, you might just offer solid foods once a day. By 8 months, baby may be eating solids twice a day, and by 9 months, possibly three times a day. Let your baby's interest guide you. When possible, nurse an hour or less before solid food meals so that baby's food intake will be in addition to, not in place of, breastmilk during the first few months of starting solids. Have fun, take pictures, and try to relax and enjoy the process!
Want to learn more? Find out when Carolyn is teaching the next Baby-Led Solids & Weaning Class
For Further Reading
Dietary Guidance for Americans (Infant & Toddler guidance begins on page 56)
1Breastfeeding and the Use of Human Milk, Pediatrics, March 2012
2Delayed introduction of lumpy foods to children during the complementary feeding period affects child's food acceptance and feeding at 7 years of age, Maternal & Child Nutrition, January 2009
3aPeanut Consumption in Infancy Prevents Peanut Allergy, New England Journal of Medicine, 2016
3b Reduced risk of peanut sensitization following exposure through breast-feeding and early peanut introduction, Journal of Allergy and Clinical Immunology, September 2017
4Baby knows best? The impact of weaning style on food preferences and BMI, BMJ Open, February 2012
6A Baby-Led Approach to Eating Solids and Risk of Choking, Pediatrics, 2016