Starting and Advancing Solids: A 10-Step How-to Guide for Parents
For many parents, one of the most highly anticipated events of baby’s first year is starting solid foods. But once the time gets close, most parents have many questions about when, what, and how to offer these first foods. As a pediatrician, this is one of my most-frequent conversations -- and one I love having the most. It comes up so much, my colleague Dr. Tanaka and I wrote a book about it (How to Raise Healthy Eaters: Starting Solids available as of today on Kindle!)
Here's a sneak peak at some of what we suggest, boiled down into 10-steps that will help you be sure that your baby is getting the right nutrition to support healthy eating and oral and fine motor development and prevent picky eating and food allergies later.
1. Check for baby’s cues of readiness to start solids. Does your baby have great head and neck control? Can your baby sit up unassisted or with a little support in a high chair? Is your baby staring at you (or your food) and drooling when you eat, making you feel very guilty to not be feeding her, too? Generally babies show these signs and are ready to begin solid foods between the ages of 4-6 months. However, the American Academy of Pediatrics recommends that exclusively breastfed infants wait until as close to 6 month as possible to optimize the benefits of exclusive breastfeeding. Do not offer your baby anything other than breastmilk or formula before 4 months of age.
2. Start with foods that are great sources of iron and zinc for healthy brain development. Iron- and zinc-fortified infant cereals and meats are excellent first foods as are avocados and cooked legumes. But other foods like bananas, sweet potatoes and squash are also excellent first foods.
3. Offer just one new food at a time, making sure it is soft and small enough that baby will not choke. Wait at least three days before introducing new foods so that you can tell if a baby has an allergic-type reaction such as a rash or vomiting or diarrhea in response to any specific food. Eggs, soy, peanuts, tree nuts (and seeds), wheat, fish, and shell fish are the foods most likely to cause an allergic reaction. However, delaying their introduction does not reduce the risk of developing an allergy later. In fact, introduction of peanut protein around 6 months of age may help to reduce later risk of peanut allergy.
4. Offer solids first, then follow up with breastmilk or formula. This helps your baby to be hungry and interested when offering foods but also ensures that she will get adequate nutrients and calories from breastmilk or formula, which still will be her primary source of nutrition the first few weeks to months of eating solids. Listen to her body’s cues when deciding how much breastmilk or formula to give her. She will turn away from the nipple or bottle or fall asleep when she has had enough.
5. Listen to baby’s cues when deciding how much to offer. If your baby takes a bite and opens wide for more, give her more. If she spits it out or turns away, that’s a sign that she is done for now. At first your baby might just take a teaspoon or two of a puree one time per day. Over time, she will gradually start to want more and you can increase from offering her foods one time a day to two times per day, then three times per day. Most babies by the age of 9-12 months are eating solid foods 3-5 times per day. At first, the food will not displace the amount of breastmilk or formula she takes but as you offer solids more often and she takes larger portions, she will naturally start to decrease liquids intake.
6. Start to introduce water in an open cup around 6 months of age. This helps your baby get used to and prefer the taste of plain water while also helping to developing fine motor skills of getting the cup to her mouth. Most of the water will likely end up on the floor at first, but this early practice will pay off later. Avoid liquids other than water, breastmilk, or formula until your baby’s first birthday. After the first birthday introduce whole milk, reduced fat, or low fat milk. Avoid plant-based milk substitutes other than soy as they are not nutritionally equivalent to cow’s milk. If your baby has an allergy to cow’s milk and soy, talk to your pediatrician for further recommendations.
7. Offer a wide variety of foods. By 7-8 months of age, infants should be eating pretty much everything with the exception of cow’s or plant-based milks (though cheese and yogurt are ok), honey, and sugary and salty drinks and foods. Make sure to exposure your baby to many types of vegetables, fish and seafood, and even spicy foods to help her acquire a taste and preference for a variety of different types of foods and textures. This early and frequent exposure helps to reduce picky eating later.
8. Make sure to prepare foods in a healthy and safe manner to avoid foodborne illness and choking. Match textures and consistency to your baby’s oral motor skills and use thick purees to help increase caloric density. Avoid foods that could be choking or aspiration risks such as hot dogs, nuts, grapes, raisins, raw carrots, popcorn, hard candies. If you microwave foods, make sure to check that the temperature is not too hot before offering them to your baby.
9. Involve your baby in feeding. By 9 months of age, let baby self feed finger foods and practice drinking from an open cup. Most infants are able to start to self feed with utensils after the first birthday.
10. Have fun! Helping your baby learn to eat and love a wide variety of tastes and textures is usually an incredibly rewarding part of the first year as most babies are eager eaters and willing to try everything.