Introducing Solid Foods
At about the 4 month old visit is when I would usually ask the question, when do you plan to introduce solid food? For some parents they are relying on the recommendation of their pediatrician and others already have a plan based on their previous experience and or research. The AAP recommends those being breastmilk fed have this as the exclusive source of nutrition until 6 months of age.
Four months may seem early for the introduction of solid food, but this is the age when most children will demonstrate developmental readiness for the dietary milestone of introducing increased texture.
How do I know that my child is ready to start solid foods?
If you are able to answer yes to the following questions, it may be an indicator that your child has achieved the neurodevelopment milestones required to safely introduce solid foods.
Can your infant sit up while supported?
Does your infant have complete control of their head and neck enabling them to hold their head up straight while seated?
Can your infant accept a spoon by mouth, without reflexively pushing it away with their tongue?
You should be able to answer yes to all of these question by the time your infant is 6 months of age, but most will be ready by 4 months. The exact age when solid food is introduced, once these milestones are achieved, comes down to parental preference guided by their pediatrician’s recommendation.
So you have decided that you are ready to start your infant on solid foods, what should you give?
What food should I introduce and when?
The key factor to consider when introducing solid food is texture. The texture of the food must be such that it can be safely handled by the infant, without choking. The traditional method for solid food introduction focuses on advancement of texture guided by age and neurodevelopment.
Puree Foods (Stage 1)- Usually serves as the initial texture of foods that can be safely introduced. Starting with iron fortified baby foods (i.e. baby cereal or meats) are a good place to start, particularly, in babies whom are only breastmilk fed as this helps to supplement iron that is likely not provided through breastmilk alone. It is recommended to introduce a new single ingredient food (fruit, veggie, meat, yogurt etc) about every few days (~3 days) to monitor for development of signs of any allergies/intolerances.
Once the infant has tolerated a variety of pureed foods at an adequate volume (~4 ounces), during meals (breakfast, lunch and dinner), usually for about a month or two you can begin to advance to stage 2 foods, this usually occurs at about 6 months old.
Soft/Mashed Foods (Stage 2)- These foods have more texture to them as they are a result of mashing soft foods such as boiled/steamed fruits and veggies, or mashed eggs.
As with the previous stage, once the infant has tolerated a variety of foods at an adequate volume, they are able to sit up with out support, grab and bring food to their mouth then they are ready for the next food stage, approx. 9-10 months old.
Finger foods (Stage 3)- This stage of foods continue to have a soft texture to prevent choking and are provided in sizes that are easily handled by the infant.
Table Food (Stage 4)- This is usually tolerated and the main source of nutrition by 12 months of age. This still excludes nuts, whole grapes along with other hard foods that pose a choking risk.
A note about highly allergenic foods:
the current recommendation for those without high-risk for food allergy (Parents with food allergy, mod-severe eczema), is to introduce allergenic foods early, of course making sure to do so in a developmentally appropriate, prioritizing safety. There is no expectation to introduce all of the highly allergenic foods within the first few months of solid food introduction but as many as possible.
What are the highly allergenic foods?
Dairy*
Peanuts*
Eggs*
Shellfish
Sesame
*most commonly/easily introduced
Potential signs of food allergy include flushing, lip/face/eye/tongue swelling, difficulty breathing, hives, repeated vomiting, diarrhea within about 1-2 hrs of ingestion. If you are ever unsure about a reaction that occurs following consumption of a food, discontinue the food until you are able to discuss it with your child’s pediatrician.
How much and how often?
Upon introduction of solid food, it can be expected that the baby may only show interest in accepting a few spoonfuls. With a well established routine, that may include offering solids before milk at breakfast, lunch and dinner, volume will gradually increase to a full jar (4 ounces). Follow the baby’s lead and do not force them to eat when they demonstrate signs of being full.
When can my infant have water?
In general, infants can start to drink water from a cup starting at about 6 months of age starting with about 4 ounces per day. By introducing water in a cup this facilitates the development and coordination of skills needed to drink from a cup.
There are a variety of cups that can be used for introduction,
from the classic sippy cup
to straw cup
and my favorite, the open cup with a flow insert.
Whichever you choose, it will take time for the infant to become familiar. Repeated opportunities will lead to the eventual proficiency of its use.
This blog post is for informational/educational purposes alone and does not constitute/is intended for medical advice. Please seek personalized medical advice from your child’s pediatrician. The author of this blog post may receive compensation for linked products.
Source: AAP, CDC,Amazon