Starting Solid Foods

Guidelines for Parents from the American Academy of Pediatrics

Adapted from Caring for Your Baby and Young Child: Birth to Age 5

Until now, your baby's diet has been made up of breast milk and/or formula. Once your child reaches 4 to 6 months of age, you can begin adding solid foods. This handout has been developed by the American Academy of Pediatrics to give parents suggestions on how to introduce solid foods to their infants.

Introducing solid foods should be an enjoyable experience for you and your baby. If your baby does not seem interested, wait a week and try again.

When Can My Baby Eat Solids?

Most babies are ready to eat solids at 4 to 6 months of age. Before this age, most babies do not yet have enough control over their tongues and mouth muscles. Instead of swallowing the food, they push their tongues against the spoon or the food. This tongue-pushing reflex helps babies when they are nursing or drinking from a bottle. Most babies lose this reflex at about 4 months of age. Also, energy needs of babies increase around this age as well, making this an ideal time to introduce solids.

You may start solid foods at any feeding. At first, you may want to pick a time when you do not have many distractions. However, keep in mind that as your child gets older she will want to eat with the rest of the family.

Feeding Your Baby Solids

To prevent choking, make sure your baby is sitting up when you introduce solids. If your baby cries or turns away when you give her the food, do not force the issue. It is more important that you both enjoy mealtimes than for your baby to start solids by a specific date. Go back to nursing or bottle-feeding exclusively for a week or two, then try again.

Always use a spoon to feed your baby solids. Some parents try putting solid foods in a bottle or infant feeder with a nipple. This is not a good idea. Feeding your baby this way can cause choking. It also greatly increases the amount of food your baby eats and can cause your baby to gain too much weight. Besides, it is important for your baby to get used to the process of eating - sitting up, taking bites from a spoon, resting between bites, and stopping when full. This early experience will help your child learn good eating habits throughout life.

Start with half a spoonful or less and talk your baby through the process ("Mmm, see how good this is!"). Your baby may not know what to do the first time or two. She may look confused or insulted, wrinkle her nose, roll the food around her mouth, or reject it all together. This is a normal reaction, especially since her feedings have been so different up to this point.

One way to make eating solids for the first time easier is to give your baby a little milk first, then switch to very small half-spoonfuls of food, and finally finish off with more milk. This will prevent your baby from getting frustrated when she is very hungry.

No matter what you do, do not be surprised if most of the first few solid-food feedings wind up on your baby's face, hands, and bib. Increase the amount of food gradually, with just a teaspoonful or two to start. This allows your baby time to learn how to swallow solids.

What Kinds Of Foods Should My Baby Eat?

For most babies the first solid foods (cereals) can be offered in this order:

· rice cereal

· oatmeal cereal

· barley cereal

Some babies do not like rice cereal. In this case, you can skip to oatmeal or barley cereal.

It is a good idea to give your child wheat and mixed cereals last, since they may cause allergic reactions in very young babies.

You can use premixed baby cereals in a jar or dry cereals to which you add formula or breast milk. The premixed foods may be easier to use, but the dry ones allow you to control the thickness of the cereal to suit your baby. Whichever type of cereal you choose, make sure that it is made for babies. Only baby foods contain the extra nutrients your child needs at this age.

Once your baby learns to eat cereal, gradually offer him foods from the following food groups. New foods can be offered in any order, depending on your child’s likes and dislikes.

· fruit

· meat

· strained vegetables

Offer your baby one new food at a time, and wait at least 1 to 3 days before starting another. After each new food, watch for any allergic reactions such as diarrhea, rash, or vomiting. If any of these occur, stop using the new food and talk with your pediatrician.

You can offer a new fruit one day and 1-3 days later, you can offer a new vegetable. A new meat can then be offered 1-3 days after the new vegetable. You can continue to give your child a mix of the foods that were tolerated as you continue to add new foods.

Within 2 or 3 months of starting solid foods (around 9 months), your baby's daily diet should include the following foods given over three meals:

· breast milk or formula

· cereal

· vegetables

· meats

· fruits

Give your baby eggs last, because they occasionally cause allergic reactions. Also, to avoid getting your baby too used to this high-cholesterol food, eggs should be fed not more than three times per week.

Finger Foods

Once your baby sits up, you can give her finer foods to help her learn to feed herself. To avoid choking, make sure anything you give your child is soft, easy to swallow, and cut into small pieces. Some examples include well-cooked and cut-up squash, peas, potatoes, and small pieces of wafer-type cookies or crackers. Do not give your baby any food that requires chewing at this age.

At each of your child's daily meals, she may be eating about 4 ounces, or the amount in one small jar of strained baby food. (Do not give your child adult-type foods because they often have added salt and preservatives.)

If you want to give your baby fresh food, use a blender or food processor, or just mash softer foods with a fork. All fresh foods should be well cooked, soft, with no added salt or seasoning. Though you can feed your baby raw bananas (mashed), all other fruits and vegetables should be cooked until they are soft.

Refrigerate any food you do not use and look for any signs of spoilage before giving it to your baby. Fresh foods are not bacteria-free, so they will spoil more quickly than food from a can or jar.

Warning: Do Not Home Prepare These Foods

Beets, turnips, carrots, spinach, and collard greens. In some parts of the country, these vegetables have large amounts of nitrates, a chemical that can cause an unusual type of anemia (low blood count) in young infants. Baby food companies are aware of this problem and screen the produce they buy for nitrates.

They also avoid buying these vegetables in parts of the country where nitrates have been found. Since you cannot test for this chemical yourself, it is safer to use commercially prepared forms of these foods, especially while your child is an infant. If you choose to prepare them at home anyway, serve them fresh and do not store them. Storage of these foods may actually increase the amount of nitrates in them.

What Can I Expect After My Baby Starts Solids?

When your child starts eating solid foods, his stools will become more solid and variable in color. Due to the added sugars and fats, they will have a much stronger odor too. Peas and other green vegetables may turn the stool a deep-green color; beets may make it red. (Beets sometimes make urine red as well.)

If your child's meals are not strained, his stools may contain undigested pieces of food, especially hulls of peas or corn, and the skin of tomatoes or other vegetables. All of this is normal. Your child's digestive system is still immature and needs time before it can fully process these new foods.

If the stools are extremely loose, watery, or full of mucus, however, it may mean the digestive tract is irritated. In this case, reduce the amount of solids and let him build a tolerance for them a little more slowly.

Should I Give My Baby Juice?

Your baby can start drinking juice at this time. However, many young babies are sensitive to orange juice, so hold off giving your child orange juice or any citrus fruits until about the sixth month. Fruit juices or large amounts of fruits can cause diaper rash, diarrhea, or excessive weight gain. If this happens, you may want to decrease the fruit and/or juice intake for a while.

Juices contain sugar, water and some vitamins and provide fewer calories than breast milk or formula. Too much juice will cut down on your child’s milk intake and solid food feedings. This can result in a decreased weight gain. Extra water and juice are not necessary if your child is receiving adequate milk and solid foods. Limit your child to less than 8-10 ounces of juice or water.

After your child’s first birthday, formula can be stopped and whole milk can be offered. 24 ounces of whole milk will provide your child with extra protein and approximately 75% of the daily calcium needs. Children who refuse to drink milk or eat enough foods high in calcium, can drink the new orange juice that is fortified with calcium. Each 8 ounces provides 300 mg of calcium (same as milk).

Junior Foods

When your child reaches about 8 months of age, you may want to introduce "junior" foods. These are slightly coarser than strained foods and are packaged in larger jars -usually 6 to 8 ounces. They require more chewing than baby foods. You can also expand your baby's diet to include soft foods such as pudding, mashed potatoes, yogurt, and gelatin.

As always, introduce one food at a time, then wait 1 to 2 days before trying something else to be sure your child does not develop an allergic reaction.

As your baby's ability to use his hands improves, give him his own spoon and let him play with it at mealtimes. Once he has figured out how to hold the spoon, dip it in his food and let him try to feed himself. But do not expect much in the beginning, when more food is bound to go on the floor and highchair than into his mouth. A plastic cloth under his chair will help minimize some of the cleanup.

Be patient, and resist the temptation to take the spoon away from him. For a while you may want to alternate bites from his spoon with bites from a spoon that you hold. Your child may not be able to use a spoon on his own until after his first birthday. Until then, you may want to fill the spoon for your child but leave the actual feeding to him. This can help decrease the mess and waste.

Good finger foods for babies include:

· crunchy toast

· well-cooked pasta

· small pieces of chicken

· scrambled egg

· cereals

· chunks of banana

Offer a variety of flavors, shapes, colors, and textures, but always watch your child for choking in case he bites off a piece that is too big to swallow.

Because children often swallow without chewing, never offer children younger than age 4 the following foods:

· spoonfuls of peanut butter

· nuts

· grapes

· popcorn

· uncooked peas

· celery

· hard candies

· other hard, round foods like carrots, hot dogs, or meat sticks (baby food "hot dogs") should always be cut into small pieces.

Choosing A Highchair

• Select a chair with a wide base, so it cannot be tipped over if someone bumps against it.
• If the chair folds, be sure it is locked each time you set it up.
• Whenever your child sits in the chair, use the safety straps. This will prevent your child from slipping down and causing serious injury or even death.
• Never allow your child to stand in the highchair.
• Do not place the highchair near a counter or table. Your child may be able to push hard enough against these surfaces to tip the chair over.
• Never leave a young child alone in a highchair and do not allow older children to climb or play on it, as this could tip it over.
• A highchair that hooks on to a table is not a good substitute for a more solid one. If you plan to use this type of chair when you eat out or when you travel, look for one that locks on to the table. Be sure the table is heavy enough to support your child's weight without tipping.
• Also, check to see whether your child's feet can touch a table support. If your child pushes against the table, it may dislodge the seat.

Good Eating Habits Start Early

Children are not born with a taste for salt or saturated fats (fatty meats, butter, fried foods, and eggs, for example). If your child eats these foods regularly, she may learn to like them. By continuing to eat these foods, your child will have a greater risk of developing health problems as an adult. Also, if your child learns to overeat as a baby, she may continue to do so as she grows up. This could lead to a permanent weight problem.

If you are concerned that your baby is already overweight, talk with your pediatrician before making any changes to your child's diet. During these months of rapid growth, your baby needs a balanced diet that includes fat, carbohydrates, and protein. It is not wise to switch a baby under 2 years of age to skim milk, for example, or to other low-fat substitutes for breast milk or formula. A better solution might be to slightly reduce the amount of food your child eats at each meal. This way, your child will continue to get the balanced diet she needs.

Your pediatrician will help you determine if your child is overfed, not eating enough, or eating too many of the wrong kinds of foods. Since prepared baby foods have no added salt, you do not have to worry about salt at this age. However, be aware of the eating habits of others in your family. As your baby eats more and more "table foods,” she will imitate the way you eat, including using salt and nibbling on snacks. For your child's sake as well as your own, cut your salt use and fat intake to a minimum.