Infant Feeding: Transitioning to Solid Foods
Food. A key to survival and a part of our every day lives. And yet, all of us at some point or another had to learn to eat it. For parents with a new born transitioning into the infant phase, it is common to wonder, when do we start the real food? From personal experience let me tell you, DO NOT rush it. For with real food, comes real poop, and real responsibilities.
In all seriousness, this piece will help you learn when to start feeding your little one, what to feed them to start healthy habits young, and how to feed safely. Basically, don’t start before 4-6 months and don’t give them choking hazards. If you are a details person, continue reading…
Infant feeding practices and recommendations have changed a little in the last decade. I reviewed an article from the American Academy of Pediatrics to bring you the most up to date information.
When to start.
In general we say “solid” foods may be started around 4-6 months. Some signs to look for to decide if your baby is ready include: good head control, good trunk control (sitting with minimal support), opening mouth when presented with food, not automatically pushing spoon (or any object) at the lips away with the tongue, and showing interest in what others at the table are eating. Studying your baby for these signs will help you know that your baby will understand what to with that food once it makes it in his or her mouth. Additionally, there are concerns that starting foods far outside the 4-6 month window can contribute to food allergies.
What to feed.
Good news! You can relax a little about the coveted first food choice. Pureed fruit, veggie, meat, infant oatmeal in any order is fine. More broadly, just keep offering a variety of single ingredient foods. Iron and zinc fortified foods are important to include, such as iron-fortified cereals, meats, prunes, lentils, kidney beans, white beans. Offering with foods rich in vitamin C (cantaloupe, mango, strawberries, and broccoli) will increase iron absorption.
We recommend single ingredients foods. Three hours between new foods is plenty of time to observe for a food allergy – no need to wait three days. Allergic reactions are one of the big concerns parents have when they begin introducing new foods. While the former recommendation was to introduce allergy-prone foods later, the current recommendation is that allergy-prone foods should be introduced around 4-6 months for most babies. Don’t start with these foods, but once your baby is doing well with several other foods, you can start introducing things like peanut butter by mixing small amounts into other things. For example, I mixed about a teaspoon of peanut butter into pureed bananas. Fish and shrimp are fine too whenever the child is developmentally ready to eat them. If your child has severe eczema (or a parent/sibling has a severe food allergy), ask at an office visit for specific advice regarding introducing these foods. Do avoid liquid milk and honey before age 1 and unpasteurized dairy and undercooked foods for young children. While they have no expectations for “treats”, just keep giving babies nutrient rich foods, no need for cookies-they’ll be plenty of time for that later!
How to feed.
There are two broad categories- pureed spoon feeding vs. baby-led weaning (beginning with solid foods). Initially, most of your baby’s calories and nutrition should still be coming from breast milk or formula, and the food is just for fun/ learning. For the pureed route, you can buy them or make your own in your blender by adding some formula, breastmilk, or even water to get the desired consistently. Infants typically eat around 4oz-about a baby food jar-per meal. Most people start with one meal per day and work up from there. As baby gets better at eating, graduate the thickness of the food. Go slow and let it be a fun experience. Don’t worry too much if your baby makes crazy crinkled up nose faces at you. Feeding therapists tell us sometimes babies take 20 introductions of a food before they’ll accept it. Don’t give up and say they don’t like peas, they’re just still trying it. And trying it. And trying it. You may be happy to find that on the 18th try, your child loves peas!
The basic premise of baby-led weaning is giving babies foods on their plate they can pick up and feed themselves. In a 2016 study published by Pediatrics (A Baby-led Approach to Eating Solids and Risk of Choking), they found there was no higher risk of choking with this method as long as caregivers followed the rules about the infant and the foods. The infant rules are: infants must be sitting upright, can only eat what they put in their mouths themselves, food must be longer than your infant’s fist on at least one side, and the infant must always be supervised. The food rules are: the food must be soft enough to mash on the roof of your mouth with your tongue, no food that crumbles, avoid small foods such as grapes, nuts, fruits that still have seeds inside, no raw vegetables or raw apples, no under-ripe or hard fruit, no whole nuts, no popcorn, and nothing cut into coin shapes (I gave my baby small strips of banana and avocados, for starters).
Whether you start with purees or baby-led weaning, around 9 months most babies enjoy picking up food. Plain Cheerios, scrambled eggs, pinto beans pinched in half, peas, and blueberries pinched in half were some favorites at our house.
More questions? Healthychildren.org is always a great additional resource for feeding information. Infant feeding is also the exact type of topic we would be happy to discuss at one of your child’s early well checks, so don’t hesitate to ask!
Until next time,
Dr. Lindsey Gouge
Parkside Pediatrician, kayaker, and ice cream’s biggest fan