Pediatrician's Advice for Introducing Solid Foods
Introducing solid food to babies is a topic that pediatricians love to discuss with families. As a parent, you have sustained your baby with the power of breast milk or formula exclusively for the last six months. Now it is time to introduce your baby to the wonderful world of eating solid foods. Incorporating babies into family meal times can feel tricky to families if they don't receive good advice on this topic.
As the internet expands its reach and now with the explosion of artificial intelligence, you can use google to find information on any and every parenting topic that your heart desires. However, information is different from knowledge.
As a pediatrician, it is my job to expand your knowledge on pediatric topics. Starting solid foods for babies has changed over the years, and I want you to know the best practice for introducing a wide variety of healthy foods to your baby.
This article will help you to have a framework for achieving this fun milestone while supporting your baby's health. By knowing the current evidence based recommendations, you can confidently set your baby up for a lifetime of healthy eating habits.
When Do I Start to Give My Baby Solid Foods?
While many families are in a rush to start this next chapter in their family's life, other families (usually with multiple children) would prefer to wait as long as possible. Before starting foods, you need to be sure that your baby is ready to eat something besides milk.
First, your baby needs to have the physical characteristics that allow for a safe introduction to solids. This includes the ability to sit unsupported or minimally supported, good head control and a disappearance of their "tongue extrusion" or tongue thrust reflex.
Additionally, most of the experts recommend waiting until at least 4 months of life, preferably 6 months of life to begin feeding your baby table foods. The American Academy of Pediatrics recommends exclusive breastfeeding until 6 months of life and then continued breastfeeding with the addition of complementary foods. This age balances the need for extra nutrients, risk of allergies and exposing your baby to a variety of textures with readiness and safety.
Iron Stores Decrease Between 4 and 6 Months of Life
Breast milk is the perfect food for your baby. Formula also supports infant growth and health in the early months of life. At birth, healthy term infants have increased blood counts and iron levels. As a baby approaches 4-6 months old, their iron stores decrease and they need extra iron in order to sustain growth and other bodily functions.
Some pediatricians recommend iron supplements at this age while others discuss incorporating and introducing iron rich foods into a baby's diet in order to achieve appropriate levels. Your pediatrician might recommend starting an iron supplement at four months of age based on guidelines from the American Academy of Pediatrics and the Academy of Breastfeeding Medicine.
In the olden days, we often recommended single-grain, iron-fortified baby cereal as a first food for this reason. Fortified cereal can be an important source of nutrition and iron for babies at this age. The downside of cereal is that many babies don't love its cardboard-like taste and it can contribute to constipation in this age group.
As we as a society have gotten away from many grain based foods, I now recommend starting baby on foods like shredded meat or beans for their iron content. Other sources of iron include leafy green vegetables that can be pureed for babies.
Pureed Baby Food vs Baby Led Weaning
There are plenty of parents who start babies with pureed baby foods, either home made with a food processor or commercially prepared. On the other hand, there are many parents who start with whole soft finger foods or a feeding pattern known as baby led weaning.
Iron-fortified cereal or baby rice cereal and jars of Gerber purees were staples in my life as a baby in the 1980's. Now, parents often want to know the alternatives to jars of baby food and single-grain cereals in order to introduce a variety of foods and textures into their baby's diets.
Baby led weaning is a way of introducing solid foods by starting with fresh whole pieces of food. You want to start with soft foods like bananas, avocados and shredded or ground meat. Of course, you should avoid raw vegetables with hard textures or chunks of meat when your baby is first learning.
Neither technique is correct or scientifically proven to be the best way to incorporate solid foods in a baby's diet. Frequently, families will do a combination of strained baby foods as well as offering a variety of different types of soft whole foods.
Introducing Allergy Causing Foods Early
As a resident pediatrician in training in the mid-2000's, we were taught to teach parents to wait on introducing peanut containing foods into their child's diet until age 2 years.
In the recent past, we have shifted this recommendation to the early introduction of peanut protein and other allergenic foods. This change in philosophy is based on the LEAP study which was published in 2015. The study showed that early introduction of peanut protein actually lowered the risk of food allergies to peanuts. As pediatricians, we have extrapolated these findings to include other foods that are typical sources of food allergies such as egg, shellfish and other tree nut proteins.
Safely introducing peanut protein to a baby includes thinning peanut butter out with breast milk or formula, adding peanut butter powder to infant cereal or yogurt or offering your baby peanut butter puff snacks. Additionally, eggs can be scrambled and offered to a baby as well as mashed up soft fish like salmon in order to introduce these allergy causing foods.
As you introduce these foods to your baby, always be on the look out for allergic reactions which can include vomiting, hives or trouble breathing.
Baby Food Pouches
Pouched baby food offers a convenient way to feed a baby, especially on the go. I am a pediatrician, but I am also a mother myself and constantly look for ways to make parenting life a little easier. Pureed fruit in a pouch offers this convenience.
However, if your baby is exclusively fed with a pouch, they will not develop the motor skills that are necessary to feed themselves a variety of foods with different textures. Pouched baby food can also bypass a baby's ability to recognize their full and hunger cues which can lead to obesity.
Additionally, it is easy for a baby to consume a pouch of pureed food even when they are not necessarily hungry or eat it faster than their bodies realize. There is more to eating than just consuming calories. Teaching your baby to eat a variety of fresh foods will also lend itself towards a lifetime of good eating habits.
Remember Food Safety
An important thing to remember is to make sure whatever you are feeding your baby will not cause them to choke. Sometimes new foods will activate a baby's gag reflex, but a baby should be observed for choking. Also, your baby should be seated and supervised during all mealtimes.
Additionally, if you choose to make your own baby food, just make sure you follow safe food handling for preparing and storing the food. Be sure to read up on foods that should not be pureed and stored.
Final Thoughts
Adding complementary foods to your baby's diet is a fun milestone for both you and your baby. Hopefully, you feel better about the process now that you have read this article. I want to leave you with a few additional tips.
Incorporate your baby into family mealtimes
Continue to breastfeed or offer infant formula until your baby is 12 months old
Do not give honey or honey containing foods to babies under one year old
Avoid fruit juice as a regular part of your baby's diet
Have patience and allow a lot of time for baby to transition from a liquid diet to a solid food diet
You can offer your baby extra water around 6 months after birth
Enjoy your baby’s achievements with new foods, and be sure to take lots of pictures!
© 127 Pediatrics; September 2023
This article exists for informational purposes only and should not be construed as medical advice.
Andrea Wadley, MD, IBCLC
Dr. Andrea Wadley is the owner, pediatrician, and breastfeeding medicine specialist for 127 Pediatrics. She has an established house-calls-only concierge pediatric practice in Colleyville, TX. She is also the owner and operator of the 127 Pediatrics Online Breastfeeding Medicine and Education Center.