Introducing Solids to an Infant

Opinions on introducing solid foods have dramatically changed over the past few years, including when, what and how you should start feeding your infant solid foods. These recommendations are based on recent studies that look at how children grow and how allergies can develop. The goal is to provide a well-balanced, nutritious diet that will be safe, fun and have a positive impact that lasts a lifetime. Your little one might have a unique appetite or special need, so please let us know if you have any questions.
WHEN DO I START WITH SOLID FOODS?
• The American Academy of Pediatrics recommends that solid foods be introduced between 4 and 6 months.
• The World Health Organization recommends starting solids at 6 months of age.
• Studies have found that introducing solid foods before 4 months or after 9 months of age can increase the risk of food allergies.
HOW DO I KNOW WHEN MY BABY IS READY?
• Clues include: holding her head nice and steady; sitting up with a little assistance; and, last but not least, following your food with interest while you eat.
• To prevent choking, always feed solid foods with a spoon while your baby is sitting up.
• Don’t be afraid of the mess. It is part of the fun, so embrace it! Let her experiment with her own spoon.
WHAT ABOUT ALLERGIES?
There are different ways an allergy can present, such as:
• Sudden runny nose and/or severe coughing, within minutes of eating the food
• Difficulty breathing, or wheezing
• Rash that looks like hives or mosquito bites, or red, swollen face
• Vomiting, or severe diarrhea with mucus and even blood in the stool
HOW HAS THE STORY CHANGED?
Recent studies have shown that it is better to introduce common allergy-producing foods between 4 and 9 months of age. We used to think the later the better; but now we think there is this optimal window instead. Yes, you read that right! Children have been found to benefit most by introducing fish, shellfish, egg whites, cow’s milk, peanut butter, strawberries, and other “allergenic” foods before they are 9 months old. But, these foods need to be given in a way that won’t cause choking (for example, don’t give a big blob of peanut butter, or whole nuts. Different types of nut butter can be made into a sauce for younger babies, or can be spread thinly on toast for older babies.) Important: If you already know your child has a specific food allergy, then please don’t feed that food to her.
ALL AT ONCE, OR ONE AT A TIME?
A general rule of thumb is to wait 3-5 days between each new food. This makes it easier to identify which food is a problem if there is an allergic reaction. But if there is no family history of allergies and your child doesn’t have eczema or other signs of allergies, it may not be necessary to wait so long between new foods.
WHAT IF I SEE SIGNS OF AN ALLERGIC REACTION?
Write down a complete list of all the foods given that day, especially during the hour before the reaction, and give us a call. Steer clear of these foods for a few weeks until you talk to us about whether to try them again, whether to do allergy testing, and if so, the best way to do so.
WHICH TASTY FOODS DO I START WITH?
• Believe it or not, you can start with almost anything: meat, cereal, yogurt, lentils, vegetables, or fruit. For cereal, we recommend iron-fortified whole grain cereals for babies, not sweetened cereals.
• Remember to be safe: the foods need to be pureed to a liquid state when you start this process. As your child gets older and more graceful with eating, he can be advanced to thicker and chunkier dishes!
• It is good to use healthy oils like olive oil in your culinary endeavors.
• Babies need iron and zinc especially to help with brain power! These can be found in healthy meats, beans, shellfish, tofu, sprouted pumpkin seeds and much more.• Many babies enjoy yellow and orange veggies – like squash, sweet potatoes and carrots. These are great for your baby’s eyes because they contain beta-carotene. Other veggies rich in beta-carotene include kale, spinach, and collards.
• There are great nutrients in other foods too, and variety is the spice of life! Speaking of spices, feel free to use whichever you want, as in garlic, turmeric, onions, rosemary – although most babies don’t like jalapeños; and avoid highly salted foods, since they are harder on the kidneys.
• Wheat, barley, and rye contain a protein called gluten. Some recent evidence suggests that giving babies gluten in foods before 6 months (but not before 4 months) can lower the risk of developing autoimmune reactions to the protein, such as celiac disease.
• Fish in the diet may also help to decrease the risk of allergies and asthma.
WHICH FOODS SHOULD BE AVOIDED?
• Wait until age 1 before honey is introduced, since honey can cause infant botulism during the first year.
• Cow’s milk should not replace breast milk or formula during the first year. Yogurt and cheese are fine.
• Be aware as you add cereals, bananas, apples and dairy, to balance those constipating type of foods with fiber-containing figs, prunes, apricots, and pears, as well as water and healthy oils.
• Here are some examples of common foods that can be a choking hazard: whole nuts, soft bread, seeds, hot dogs, globs of nut butter, hard or raw vegetables, hard candies, grapes, and hard fruits like apple chunks.
HOW MUCH FOOD SHOULD I GIVE MY BABY?
• This is a gradual process. The amount will increase over a couple of months and each child will have their own pace. We’ll check that your little one is gaining weight appropriately at your well visits.
• Up until 8-9 months, the solids should not decrease the amount of breast milk or formula they receive.
• It’s probably best to start with a single serving (2 oz., or ice-cube sized) in a bowl and see how they do.
• Once that spoon hits your baby’s mouth, it picks up bacteria that can be introduced back into the jar or container of food. This makes the unused portion spoil faster.
• Just as he gives you clues about when he is ready for solids, he will also give you clues as to when he has had enough. Closing his mouth and turning away as the spoon gets close is his way of saying “No thank you. Despite what you think, I am full and ready to move on to the next activity please.” Trust your child and don’t push the last few bites. Talk to us if you’re worried.
HERE IS A GENERAL TIMELINE (These are just general guidelines and not required.):
• Between 4-6 months of age: 1 pureed meal/day
• Between 7-9 months of age: 2 meals/day, and they can be less pureed. The 9 month old with a pincer grasp (thumb and first finger pinch) might be ready for soft finger foods too.
• Between 10-12 months: 3-4 meals/day. The amount of breast milk/formula should be decreasing. Solids are starting to provide more, if not most, of the nutritional intake.
• At 1 year and older: 4-5 small meals/day. It is okay to start whole cow’s milk, and 16-20 oz. per day supplies good calcium. Too much milk can cause anemia, so no more than 24 oz. per day. Talk to us about whether your child needs a vitamin D supplement. The general recommendation is 400 IU per day in the first year, then 600 IU after that. But a lot depends on how much sunshine, milk and fish your child has, and how dark his skin is.
WHAT ABOUT WATER?
• Just like those greens growing in the garden, your child needs water as well as sunshine to grow! Introducing a cup of water along with those healthy solids is a good idea. This also helps her to develop her coordination and provides fluoride for the healthy development of her teeth. Let your baby  decide how much she wants. Most water filters will not remove the fluoride from the tap water.
• No sodas and avoid juices too! Drinking juice and soda have been linked to multiple health problems like childhood obesity, diabetes and tooth decay. Despite what we’ve been told, there is little to no nutritional value in juice. If you do give fruit juice, limit it to less than 4 oz. per day, and dilute it. But it’s better to get the whole fruit rather than just its juice!