Premier Parenting: Starting Solids

Starting Solids

Up until this point, your choice of food for your baby has been limited to breast milk or iron-fortified formula. That all changes now as a whole new world of food possibilities is opened to you. With some common sense and the guidelines outlined here, you will start your baby on the path to healthful eating.

When is my baby ready to start solid foods?

  • 4-6 months of age and
  • When she loses the reflex to push the nipple/bottle/spoon out of her mouth with her tongue

What should I keep in mind as I start feeding?

  • This is supposed to be fun! Do not force her; if she rejects the spoon or looks confused or insulted try again later
  • Sit the baby upright for feeding to prevent choking
  • Expect it to be messy!
  • Do not put cereal or other solid foods in the bottle as it does not teach infants to take solids but instead can cause your baby to gain too much weight

What is the first food to start with?

  • Infant iron-fortified single grain cereal (rice, brown rice, oatmeal, barley) and mix the cereal with pumped breast milk or formula in a bowl and feed it off a small teaspoon or baby spoon
  • Start thin (more milk than cereal), start slow (1-2 times a day), and start with a morning feed (in case of allergic reaction)
  • Gradually thicken the cereal as she gets used to eating
  • ALL NEW FOODS SHOULD BE SEPARATED BY 3-4 DAYS so that if she has an allergic reaction to a food you will know which food caused it
  • Signs of an allergic reaction are significant diarrhea or vomiting, body rash, difficulty breathing

Which foods come after cereal?

  • Once you have tried a single-grain cereal for 3-4 days, you can move onto purees of vegetables and fruits
  • Add purees once a day, often at the noon-time meal
  • The most common veggies with which to start are GREEN (peas, green beans, avocado) and YELLOW (carrots, squash, sweet potatoes)
  • Wait to introduce the more fibrous veggies until closer to 9 months like broccoli and spinach
  • You can prepare your own vegetable or use commercially-prepared jars
  • However there are a few foods which you should not prepare at home to avoid excess nitrates for the first year of life: carrots, turnips, spinach, collard greens, beets
  • Though many pediatricians will recommend starting vegetables before fruits, there is no evidence that your baby will develop a dislike for vegetables if fruit is given first. Babies are born with a preference for sweets, and the order of introducing foods does not change this.
  • Common fruits to start with include banana, apple, peach, plum, and pear

When do I add protein?

  • Many pediatricians recommend against giving eggs and fish in the first year of life because of allergic reactions, but there is no evidence that introducing these nutrient-dense foods after 4 to 6 months of age determines whether your baby will be allergic to them.
  • At 6 months of age you can introduce meats (chicken, turkey, beef, veal, lamb, or fish), whole milk yogurt, cheese, tofu, egg, and wheat
  • Often the protein is added to the evening meal and given alongside a fruit or veggie
  • Avoid fish known to be high in mercury: shark, swordfish, mackerel

What about juice?

  • Babies do not need juice; it only reduces her appetite for more nutritious foods and increases her risk for excess weight gain
  • No juice should be given to babies less than 6 months of age unless otherwise instructed by a healthcare professional
  • If you choose to give your baby juice, it should be from a cup only (not a bottle) and total less than 4 ounces per day

What about water?

  • Regular water intake is started with solid meals at 4-6 months of age
  • Put tap water (or filtered tap water if preferred) in a sippie cup and let her practice and experiment with taking water several times a day
  • Goal water intake is at least 4-6 ounces per day under 1 year of age
  • Water in the five boroughs of New York City is fluoridated which is good for babies’ emerging teeth

How much should I feed my baby?

  • At first, just spoonfuls
  • 2-4 ounces of food per meal at 5-8 months of age (1-2 times daily)
  • 6-8 ounces of food per meal at 8-10 months of age (3 times daily)
  • 8-10 ounces of food per meal at around 1 year of age (3 times daily +/- snack)
  • Keep in mind that every baby is different. Your baby may take a little more or a little less than the guidelines outlined here

What are finger foods?

  • Once your baby can sit up alone and bring her hands to her mouth you can give her finger foods to help her learn to feed herself
  • This usually occurs around 8-9 months
  • Finger foods should be soft, easy to swallow, and cut into small pieces
  • They can include but are not limited to well-cooked bits of vegetables or meat, bits of banana, small pastas, peas, small pieces of crackers or bread
  • Popcorn, whole grapes or raisins, hard or sticky candy, gum, raw vegetables and other firm round foods should be avoided to prevent choking

When do I let my baby use the spoon?

  • As her ability to use her hands improves, let her play with a spoon at meal times
  • Once she can hold the spoon, you can dip it in her food and let her try to feed herself or alternate spoonfuls from you with her own attempts (10-14 months of age)
  • Also around 8-9 months most babies are able to handle coarser blends of food (i.e. stage 3) which she could try to feed herself

How much formula should I give as the baby eats more food?

  • At first, when a meal is rather small, offer formula at meal times
  • Once the meals consist of 4-6 ounces of food offer water at meal times and formula in between meals
  • From 6-12 months, 4-5 servings of formula or breast milk are common, totaling 20-30 ounces per day

When do I stop the formula?

  • At 1 year of age you can stop formula (or breast milk if you wish) and introduce whole cows milk
  • You can do it abruptly or more gradually over a week or two if she has trouble adjusting to the different taste
  • Goal is 16-24 ounces per day
  • It is not unusual to see loose stools for 1-2 weeks during the transition to cows milk

What other foods can I introduce at 1 year of age?

  • Honey

When can peanuts, tree nuts, and shellfish be introduced?

  • Due to the frequency of allergies to these foods, it is recommended to introduce these foods at 15 months of age, starting with very small amounts of the food
  • If there is a strong family history of food allergies, asthma, or eczema, please consult your pediatrician for guidelines on introductions to these highly allergenic foods

Links of interest: Food Allergy Action Plan http://www.foodallergy.org/files/FAAP.pdf