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It’s a big moment: introducing solid foods to your baby. Some parents are prepared and excited. They have a precise plan for specific foods on a specific date. If you’re one of those parents, you probably don’t need this. This is for everyone else, when you’re ready to introduce your baby to something other than breastmilk or infant formula.

A mother of a 4-month-old asked me to write this. There’s a lot of information out there, and she wanted a summary. Recommendations have changed in the past few years as well. Here, I’ll share the latest AAP recommendations and the evidenced-based decisions I made for my babies when they started solid foods. 

We’ll cover:

• How to know when your baby is ready for solid foods
• How to choose which foods to offer
• What to do about allergies
• Foods to never give an infant
• Which drinks to offer in addition to breastmilk or formula
• Options for preparing foods

How to Know When Your Baby is Ready For Solid Foods

Before age 4 months, a baby needs only infant formula or breastmilk. They may need vitamins (see vitamin D recs for kids), medications, or other supplements. But calories until age 4 months need to come from formula or breastmilk only. 

Sometime closer to age six months, most typically-developing babies are ready to be introduced to solids.

 There are two main signs I look for in order to know if we can even consider solids.

• First, how is their head control? Are they able to sit with a steady head? Does their head lag at all if you pull them forward by their hands from laying on their back? If so, they may not be ready yet. I think about ease of swallowing. We wouldn’t want their head to flop around if they’re trying to get new food safely down their throat. 
• Second, are they interested in eating something other than breastmilk or formula? When you eat, do they follow with their eyes as you lift a spoon to your mouth? Maybe they lean forward a little and move their lips as if trying to taste what you’re eating. Think about how your baby shows they’re interested in something. Maybe they smile or bounce or even reach with their hands. I consider their interest in solid food an important prerequisite because then they’ll be more likely to accept a new food when offered. (We don’t need to force anything). 

An unofficial third element is ability to eat or drink something when offered in a spoon. They are able to move it from their lips to the back of their mouth and swallow. You’ll know this when you offer. If they can’t do it yet, just wait and try again later.

Okay, so your baby is close to 6 months old (4 months is the absolute minimum age), has reasonable head control, and looks like they want to eat? You can take the next steps in considering solid introduction. 

Why wait any longer?

If a baby is exclusively breastfed and will continue to be breastfed, I’d suggest waiting the full time until age 6 months. There is no nutrition better than breastmilk until age 6 months. Every bit of a solid food takes up room in the belly that could be for breastmilk. There is also emerging evidence about a baby’s microbiome being altered once solids are introduced. 

 So, if it’s possible and breastfeeding is going well, it’s reasonable to wait until age 6 months. 

That being said, breastfeeding isn’t always effortless. If a baby is being cared for by someone other than their breastfeeding parent and pumped milk isn’t available (or if it’s a huge struggle to feed the baby pumped milk due to bottle refusal or another inconvenience), then solids are reasonable in this situation too. Again, this is only if the first 3 criteria (older than 4 months, head control, baby interested) are met. Once the baby and breastfeeding parent are reunited, they can resume exclusive breastfeeding. 

Formula fed babies also need to meet the same three markers before introducing solids. Formula is still the baby’s primary nutrition until at least age six months. 

How to Choose Which Solids to Introduce

Let’s think about two things here. First, we can consider ingredients. Later, we’ll talk about how to prepare the baby food. Generally speaking, think about offering your baby whatever you normally eat. Yes, you, the adult.

By offering whatever you’re eating, your baby will (theoretically) be exposed to a wider variety of foods. Below in the allergies section, we’ll discuss why variety is a good thing. 

Include Iron When Introducing Solids

In addition to offering what the baby’s family normally eats, breastfed babies, especially, need to be very intentional about iron. After age 6 months, babies will not get enough iron from breastmilk alone. (Infant formula in the United States is iron-fortified already). A parent should consider iron content in every “meal” the baby has. 

How to do this? Some baby foods are iron-fortified. Many infant cereals are often fortified. I know. I just said offer whatever the family eats. Your family doesn’t eat infant cereal? It’s still an option. For my babies, I offered infant cereal whenever I was eating something that didn’t lend itself well to directly feeding a baby. Like salad. Or grown-up cereal. Or something spicy that the baby refused. For us, it ended up being about one “meal” a day of infant cereal. 

Choosing an Infant Cereal

When choosing a cereal, the first priority is “iron-fortified.” After that, it is a decision based on personal priorities. Generally speaking, one brand is not better than others.

Some parents prefer organic. Organic infant cereals are easily available and usually a few cents more expensive than others. As we know, organic does not mean completely chemical or pesticide-free, but it may have fewer chemical exposures. 

Infant cereals come in several varieties. Rice. Oat. Quinoa. Barley.

In the past, rice cereal was often touted as the recommended first food for babies. This is not true anymore. 

Rice was in the news recently for its higher levels of arsenic. Arsenic is a chemical that can be harmful to human health. It’s often in the soil and it can be found in many foods, but it’s at higher levels in rice. For the amount of rice most babies eat, it isn’t thought to be necessarily dangerous. But. It’s also something that would be unethical to study thoroughly. So, we don’t have complete information.

And, there are other options. Some may choose oatmeal cereal for their babies’ first cereal. After that first box, families may also try other grains, as well as various brands/manufacturers. (This is an attempt at general variety).

Preparing the Infant Cereal

Personally speaking, when preparing the cereal I did not mix the cereal with pumped breastmilk, despite the package suggestion. The breastmilk was too precious to risk wasting if my baby did not finish their serving of cereal. (This was I saved pumped milk to send to daycare).  We usually mixed the cereal with a fruit or vegetable puree. It’s worth noting that vitamin C helps with iron absorption. So offering the cereal mixed with applesauce is useful. 

Infant Cereal is Not the Only Source of Iron

I covered cereal first because that’s the food people think of and ask about most often. Iron, however, has many sources. Most meats. Egg yolks. Spinach. Peanut butter.  (See this post for including iron in the diets of toddlers and older children).

And, cast iron skillets. Cooking in a cast iron pan is another source of iron. For this reason, once my babies turned 6 months, I made it a habit of cooking almost everything in a cast iron skillet. 

By cooking in cast iron, I also avoided any possible toxins that can come from preparing food in various nonstick surfaces. 

So, by using both iron-fortified food and food high in iron itself, babies can get what they need. In the U.S. babies are screened for anemia between age 9-12 months. If a baby is found to be anemic, the most common cause is insufficient iron from the diet. 

(Some pediatricians will recommend supplementing breastfed babies with iron from age 4 months until fortified foods can be introduced. This is obviously a discussion to have with your baby’s doctor).

Zinc is also important to include in a baby’s solid foods. Incidentally, many of the foods that are rich sources of iron (meats and legumes, for example) are also good sources of zinc. 

Babies also need fat for optimal brain development. Formula and breastmilk are still great sources. I recommend including healthy fats when introducing solids. Full-fat yogurt and avocado are just two options. 

What About Allergies?

These recommendations have changed the most in the past few years. First, it’s essential for me to say: if you have a family history of severe food allergies, especially in your baby’s sibling or parent: please discuss solid food introduction with their pediatrician. They may want to do testing or they may want solid introduction to be much more disciplined and regimented than what I am about to describe. 

For everyone else, the very broad themes are

• The more variety of foods, the better.
• Introduce potential allergy-causing foods early and consistently. 

What does this look like in practice? We can go back to the first suggestion. By offering your baby whatever you typically eat, the variety will be increased. 

Second, just like being intentional with iron is important, try to include other specific foods as well. Eggs, peanuts, and dairy are common allergens, and the ones I focused on. My family eats a fair amount of tofu (soy) and fish, so that exposure just happened naturally as we fed our baby regular family food.  For completeness, the eight most common foods that cause allergies are peanuts, eggs, soy, tree nuts, cow’s milk, shellfish, wheat, and fish. Sesame was recently added as the ninth common allergen.

For us, we mixed creamy peanut butter (the variety with no added sugar) into other purees. (Spinach puree plus peanut butter was an unexpected favorite). We offered plain full-fat yogurt regularly. And, I regularly pureed scrambled eggs until my kids could eat them in their solid form. We did the same for fish and shrimp. 

I’ll discuss in a moment why I chose to puree as opposed to offering food in a more “complete” finger-food form, like those who follow baby-led-weaning. Spoiler alert: either way is fine. 

The research on allergies comes mostly from kids at risk for developing food allergies. But, we can extrapolate the science, somewhat, to the general population. The theory is that with early and regular exposure to these potential allergens, an actual allergy is less likely to develop. 

A Cautious Approach to Introducing Allergens

What about offering just one food at a time, waiting three days between each new food? This is also often recommended. This way, if there is a reaction, it will be more clear which food caused it. This is something else to discuss with your baby’s doctor to see if this is a good approach for your family. 

By about age 9 months, my babies ate a variety of foods and were easily tolerating all the common allergens. At this point, we stopped keeping track of which foods they had been exposed did to. Today, I’m just sharing my approach for my family. It is not what I universally recommend.

If there is ever a concern that a baby has a food allergy, it’s best to avoid that food until the baby has been medically evaluated. It’s worth noting that one sign of a food allergy can be excessive vomiting. 

Foods to Avoid Giving Babies

We’ve covered the foods to include when introducing solids to babies. Foods with iron, zinc, fat, and the common allergens are essential. But, there are some that we should wait to introduce until the baby is . . . no longer a baby.

Do Not Give Honey Under Age One

Babies under age 12 months should never have honey. There is a risk of botulism poisoning. The toxin can be found in honey. And, the infant gut cannot process it safely. This is rare. But it is an avoidable risk. After age one year, the risk is lower due to gut maturity. 

Avoid Food With High Levels of Mercury

Babies and young children should avoid fish with high mercury levels. This could affect brain development. Nrdc.org (NRDC Mercury Guide) has a complete list, but some types of tuna are most common. There are plenty of other healthy fish options. 

Cow’s milk as a beverage should be avoided until after age 12 months. It’s not until closer to one year that babies’ kidneys are mature enough to process such amounts safely. There’s also a higher risk of anemia if introduced too early. Until a year of age, breastmilk, formula, and water are all that is needed. Even after age one, it’s not totally necessary.

(Yes! I’ve also heard the stories about babies who did perfectly fine drinking various forms of cow’s milk before age 12 months. I am genuinely happy for these babies. We simply have more information now, and most babies will do better waiting until after age 1 year). 

Avoid Added Sugar in Your Baby’s First Solid Foods

Simply put, there’s no need to add sugar to any baby food. If someone chooses premade baby foods, I recommend checking the label for added sugar. And, it’s a good idea to avoid processed foods in general, when able. This is, of course, true for all of us.

Be Wary of Choking Hazards When Introducing Solid Foods

This may seem obvious. But it’s worth being very intentional when choosing food textures. Avoid giving anything hard, crunchy, or firm. This includes nuts, seeds, grapes, hot dogs, and many raw vegetables. Chunks of peanut butter should also be avoided. Thus, mixing peanut butter in a puree until it nearly dissolves (as discussed earlier) is important. The AAP actually recommends not giving kids popcorn or peanuts until after age 4, due to choking concerns.

What about water?

Water is fine to drink with a “meal.” How to offer and how much? This is easy! Just offer it in a cup whenever you offer solid foods. Most babies will drink less than an ounce at first. They shouldn’t have more than 8 ounces in a day. The remainder of their fluid intake can be breastmilk or formula.

Offering water before solids are introduced can throw off the electrolytes in babies. Especially sodium. In fact, offering “free water” without electrolytes can cause sodium levels to dip enough to cause seizures. 

(If you live somewhere exceptionally warm and are concerned about hydration, discuss water intake separate from solids with your baby’s doctor. Sometimes a few sips are reasonable. Sometimes they may recommend an oral electrolyte solution, like Pedialyte).

Breast Milk and Formula While Introducing Solids

If you are breastfeeding, continue to breastfeed on demand. With formula feeding, continue the regular schedule at first. A baby’s solid intake will be pretty small when food is first introduced. An entire “meal” may just be a tablespoon. Gradually, as solids increase, both breastfeeding and formula feeding usually decrease naturally. 

To Puree or Not to Puree. Is “Baby-Led Weaning” the Best Way to Introduce Solid Foods?

The short answer here: Either way is fine, from a medical standpoint. Baby-Led weaning (BLW) refers to a method of feeding in which parents offer their baby finger foods from the beginning, usually instead of purees and spoon-feeding. I won’t delve into the details here and now. However, the research that has been done is reassuring and promising. Either way is a perfectly fine way to feed your baby.

If someone chooses BLW, I also suggest they ensure their baby is closely supervised while eating. All feeding should be supervised, but it’s easier for a parent to look away when their child is self-feeding. Gagging is a common part of the feeding process. A 2016 study showed that the choking risk is not greater with BLW compared to traditional spoon-feeding.

Why I Chose Purees

For what it’s worth, I chose mostly purees at first. To be frank, this was partly related to my own comfort level, but also the comfort level of other caregivers (i.e. daycare). Since I anticipated my children going to daycare, I wanted them to be familiar with the preferred method of feeding there. Obviously, this is simply personal preference.

Advocates of BLW often mention the benefit of self-regulation. With BLW, babies feed themselves. I have found that an attentive caregiver can also “teach” self-regulation with spoon feeding as well. First, we never force a baby to take a bite, even if it may result in food waste.

I also always operate under the assumption that babies understand some of what we’re saying. So, talking through the steps of eating can help a baby learn more about the feeding and regulation process. A 6-month-old may not fully understand, “Oh, you’re closing your mouth now. That might mean you’re all done. Okay, I’ll put the spoon down for now.” But if we continue to narrate, babies may be more in tune to their needs when they get older.

A Few Last Thoughts on Introducing Solids

“Food before one is just for fun.” The phrase gets thrown around a lot. To be honest, it makes me cringe. True, a lot of a baby’s nutrition still comes from formula or breastmilk until at least age 12 months. But, as I’ve mentioned, there are some essential aspects of solid foods. Iron. Fat. Zinc. Allergens. Also, babies need exposure to different textures and foods for typical motor development. That being said, food before age one need not cause a lot of stress. There are so very many right ways to introduce solid foods. But it does serve many purposes beyond fun. And, it can still be fun. Joyful, even.

What questions do you have about introducing solids to your baby? I’ll do my best to address any, either in the comments or in a future post.

And, please see this post for a sample “menu” that summarizes all the recommendations discussed here.

Bon Appétit!

If you found this helpful and would like more tips on helping kids be healthier, please subscribe below.

Maya M. Mahmood, D.O., FAAP is a board-certified pediatrician and mom. She is passionate about parents having evidence-based information to help their families be healthier.

References:

Fangupo, L. J., Heath, A. M., Williams, S. M., Erickson Williams, L. W., Morison, B. J., Fleming, E. A., Taylor, B. J., Wheeler, B. J., & Taylor, R. W. (2016). A Baby-Led Approach to Eating Solids and Risk of Choking. Pediatrics, 138(4), e20160772. https://doi.org/10.1542/peds.2016-0772

Greenhawt M. The Learning Early About Peanut Allergy Study: The Benefits of Early Peanut Introduction, and a New Horizon in Fighting the Food Allergy Epidemic. Pediatr Clin North Am. 2015 Dec;62(6):1509-21. doi: 10.1016/j.pcl.2015.07.010. PMID: 26456447.

Photo by life is fantastic on Unsplash.