How to start babies on solid food:
an evidence-based guide

© 2019 Gwen Dewar, Ph.D., all rights reserved

Infant in high chair touching hands with parent - by lmnop88a

Introducing solid foods to your baby is a messy, amusing,
and sometimes frustrating business. How do you start?

The first thing to understand is the goal. You aren't trying
to replace your baby's breast milk or formula intake with solid food.

That's because solid foods don't provide the complete
nutrition that young infants need. If young babies reduce their breast milk intake,
and replace it with cereal or other baby foods, they are at risk for poor nutrition
(Sen et al 2017).

So when you introduce solids to your baby, you are entering
a transitional period. Your baby will still rely on breast milk or formula for
the bulk of his or her nutritional needs. But your baby will be learning about
solid foods — learning how to eat, and how to accept new flavors and textures.

And this understanding can keep you from becoming overly
frustrated. Your baby doesn't have to empty a jar of baby food in order to make
progress. Repeated tasting of foods — and practice moving food around in the
mouth — is important progress by itself.

With that understanding in mind, what else does the evidence tell us about introducing solids to babies? Here are some common questions —
and answers.

1. When is a baby ready to start solid foods?

Experts agree that you shouldn't start until your baby can
hold his or her head steady, and can sit upright in a high chair or infant
feeding seat.

Babies need to stay vertical so they can swallow well and
avoid choking.

In addition, you'll have more success if you wait until

  • your baby shows signs of being curious about food, and
  • your baby is developing the ability to transfer food to the
    back of the mouth with his or her tongue.

What about a baby's age? How old should a baby be?

For decades, pediatric organizations have recommended that
babies breastfeed exclusively until 6 months postpartum. Then parents are
advised to begin introducing solids.

But recent research suggests at least one advantage for babies who
start between 4 and 6 months: Exposure to foods during this time frame might help lower a baby's risk of developing allergies (see below).

It's also possible that introducing a variety of foods between 4-6 months could help make children more willing to try new foods as they get older.

Why not start solids even earlier? Experts warn against this because babies younger than 4 months are at higher risk of choking. In addition, babies may respond to the introduction of solids by drinking less of the breast milk or formula they need to thrive.

Finally, studies suggest that starting solids before 4 months doesn't reduce the risk of allergies (West 2017), and some researchers worry that it might actually increase the risk.

So that's the argument for targeting the 4-6 month time window: It might minimize your baby's risk of developing allergies, and reduce your child's risk of becoming fussy about food (Harris and Mason 2017).

However, this research concerns the scenario where you spoon-feed a young baby puréed foods.

What if you wait until your baby is 6 months old, and then begin offering your baby a choice of finger foods?

Baby-led weaning: Another approach to introducing solids

Waiting, and then letting babies choose from a set of pre-selected, safe finger foods is the cornerstone of an approach called "baby-led weaning."

In studies that compared baby-led weaning to traditional feeding, researchers haven't found any notable, long-term differences in outcome: As long as parents are careful to offer their babies the right mix of foods — and avoid choking hazards — child outcomes have been similar for both groups (Dogan et al 2018; Morison et al 2018).

The one notable exception is a report that children who'd experienced baby-led weaning tended to eat more fruits and vegetables by the age of 2 years (Morison et al 2018).

That last result suggests that baby-led weaning, beginning at the age of 6 months, is another path to broadening a child's diet. But there's a problem with this conclusion: These studies didn't specifically test for age. We don't know when babies in the control groups started eating solid foods.

It's possible that babies in both groups — baby-led and spoon-fed — began solids around the same time (at 6 months). So we can't conclude that baby-led weaning at 6 months is any better or worse than beginning spoon-feeding at 4 months. Not when it comes to long-term intake of fruit and vegetables.

Future research is needed to settle this point. We also need studies that address the development of allergies. To date, nobody has compared allergy outcomes (baby-led weaning that begins at 6 months versus spoon-feeding that begins between 4 and 6 months).

Choosing the right timing: What's bottom line?

If your baby meets the basic safety prerequisites, and you provide your baby with purées, then your baby is ready to start eating "baby food" at 4 months. Starting between 4 to 6 months might reduce your child's risk of developing allergies.

But it's not clear if your baby will be any worse off if you wait until 6 months and begin your baby on solids by offering a variety of safe, nutritious, finger foods. Possibly, you will miss an opportunity to lower your child's allergy risk, but we need more research to be sure.

2. What should a baby's first food be?



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If you live in the United States, you've probably heard
recommendations about unseasoned rice, puréed and mixed with breast milk or
formula. Typically, parents are advised to mix infant rice cereal to a very
thin consistency.

This works. It's acceptable. But there haven't been any
studies showing that rice is the best choice, and if you take an
anthropological perspective — looking at how people have fed their babies
worldwide — it's clear that rice is just one of many infant foods.

For example, in traditional agricultural societies, parents
provide their babies with a strained or puréed mash of whatever carb-rich
staple was at hand — millet, corn,
oats, or rice — and mixed it with animal milk.

Hunter-gatherers offered their babies mashed-up fish, meat,
and animal fat (Howcraft 2013).

Nowadays, medical organizations are more savvy to all of
this, and they recognize that babies may begin with a variety of different puréed foods.

In fact, the American Academy of Pediatrics notes that puréed meats are good first foods, especially for babies that have been
exclusively breastfed. Meats are a good source of iron, and iron stores can
become depleted in breastfed babies.

Other good choices include puréed bananas, apples, pears,
peaches, and sweet potatoes.

But the emphasis is on puréed foods — not chunks, globs, or sticky pastes. These latter foods, like nut butters, are choking hazards, so keep these away from your baby.

Likewise, don't add honey to your baby's foods — it can cause botulism.

And if you're feeding an older baby — 6 months and up — and want to introduce finger foods? Follow these strict guidelines to avoid choking hazards.

In their carefully-planned program for safe baby-led weaning, BLISS ("Baby-Led Introduction to SolidS"), researcher Lisa Daniels and her colleagues advise parents to follow these guidelines (2015):

  • Always test the foods yourself before you give them to your baby. Make sure foods are soft enough "to mash with the tongue on the roof of the mouth (or are large enough that small pieces don't break off when sucked or chewed, e.g., strips of meat)."
  • Don't offer foods that "form a crumb in the mouth."
  • Make sure the foods you offer "are at least as long as the child's fist, on at least one side of the food."
  • Make sure your baby is always sitting upright during the meal — not leaning back.
  • Don't leave your baby unattended. An adult should monitor the baby at all times during the meal.
  • Don't try to put finger foods in your baby's mouth. "Never put whole foods into
    the infant's mouth – the infant must do this at their own pace and under their
    own control."

3. Should I avoid feeding my baby foods that are potentially
allergenic?

Different families have different health concerns and
risk factors, so you should discuss this with your pediatrician to be sure.

But in general, the news for babies without special risk
factors is reassuring. You probably
don't need to limit your baby's diet to hypo-allergenic foods.

On the contrary, recent studies suggest that early exposure
to potentially allergenic foods might actually protect children from developing
allergies (e.g., Abrams and Becker 2015, Dutoit et al 2016; Ierodiakonou et al 2016).

For example, researchers reviewing evidence for the Journal of the American Medical Association have concluded there is "moderate-certainty evidence from 5 trials (1915 participants)" that babies introduced to eggs between 4 and 6 months are at lower risk for developing an egg allergy.

In addition, the researchers judged that there was "moderate-certainty evidence from 2 trials (1550 participants) that early peanut introduction at 4 to 11 months was associated with reduced peanut allergy" (Ierodiakonou et al 2016).

They also judged there was "high-certainty evidence that the timing of gluten was not associated with celiac disease risk" (Ierodiakonou et al 2016).

If this sounds like a U-turn in our understanding of allergy risk, it is. Years ago, pediatric
organizations advised parents to avoid exposing their babies to potentially
allergenic foods. They thought that early exposure could induce allergies. But the old advice is shifting in response to the evidence.

For instance, the American Academy of Pediatrics (2017) advises:

"There is no evidence that waiting to introduce
baby-safe (soft), allergy-causing foods, such as eggs, dairy, soy, peanuts, or
fish, beyond 4 to 6 months of age prevents food allergy."

A notable exception concerns infants with older siblings
who are allergic to peanuts. If this is your situation, researchers recommend
that you get your baby tested by qualified allergist before exposing your baby
to peanuts (Liem et al 2004).

4. Can I add spices to baby food?

As I note elsewhere, experiments suggest that
babies enjoy flavors like garlic, and overall, the evidence is clear: There is
nothing natural or normal about restricting infants to flavorless, bland food.

Even before they are born, infants are exposed to flavors in
the foods that their mothers eat.
Food flavors are also present in breast milk.
And in cultures throughout the world, babies' first foods are mashed up or
pureed versions of the foods their parents eat.

This doesn't mean we should spice up an infant's food with
reckless abandon. Babies may experience flavors a bit differently than we do,
and have a lower tolerance for bitter flavors and spicy irritants.

Moreover, some commercially available spices are
contaminated with lead. It makes sense to avoid overwhelming your infant with
intense flavors, and to be cautious about the source of your spices.

But studies indicate that babies tend to like flavors they
have encountered via their mothers' diets — during gestation and
breastfeeding. So if spices like garlic, cumin, or cinnamon are a part of your
diet, your baby may be appreciative of such flavors.

5. What if the baby makes faces while eating?

What if a baby makes dramatic, negative facial expressions after tasting a particular food? Does this mean you should stop offering it?

Babies are notorious for making faces in reaction to new foods (Forestell and Mennella 2017).

For example, in one study, researchers recorded the facial expressions of babies tasting pureed green beans for the first time (Forestell and Mennella 2007).

These were the most common reactions:

  • 95% of the babies squinted
  • 82% waggled their brows
  • 76% raised their upper lips
  • 42% wrinkled their noses

In short, babies looked disgusted, and the more disgusted
they looked, the more slowly they ate!

But here’s the important point: They got over their initial
dislike for green beans. It just took time.

After following an 8-day regimen of repeated feedings, the
babies were eating three times as much pureed green beans as they had eaten
during their very first experience.

But none of this means you should force your baby to eat.
That's not a good idea. Instead, hold a spoonful of the food up to your baby's
mouth until he or she has pushed it away. Then wait a bit, and try again, for a
total of three tries.

6.
What if a baby keeps pushing the food back out with her tongue?

That's not unusual. Nor is it unusual for a baby to use his
tongue to push food to wrong parts of his mouth. Instead of moving food to the
back of the throat, where it can be swallowed, babies may push food into the
spaces between their gums and cheeks, and end up spitting some (or all) of the
food out.

What's going on?

Part of the problem is that your baby is still experiencing
what doctors call the tongue thrust reflex — automatically pushing the tongue
forward in response to stimulation of the mouth. The reflex is good for
suckling, but not so helpful for ingesting solid food.

Another problem is that your baby is still developing the
necessary skills to move food toward the back of the mouth.

So if your baby is ejecting food, does this mean you should
stop trying to feed your baby solids?

If your baby is very young, and pushes out everything you
try to feed him, then you might wait a few days, and try again. But if your
baby is doing it only sometimes, then you'll want to keep at it. Your baby
needs the practice!

7. What should I do if my baby rejects a new food?

Sometimes it isn't just that your baby makes funny faces.

Your baby actively rejects food, by turning away from it, or pushing back the spoon.

It's important to respect these signals and back off for a while. But you shouldn't giving up entirely. It's important to try again — the next day.

Research confirms that it's perfectly normal for babies to reject new foods on their first,
second, and even third tries In fact, babies need many,
repeated tastings to develop a liking for a food.

In experimental studies, it has taken 8-10 days of repeated,
daily exposure for babies to start accepting a new food (Mura Paroche et al
2017; Forestell and Mennella 2007).

So the trick is staying the course, even if your baby seems
unenthusiastic. In a given feeding session, keep offering the food until your
baby has rejected it three times (by turning away from it, or pushing back the
spoon). Then try again tomorrow.

And be advised that you might not notice when things start
to change. In the food introduction experiments, parents reported that they
perceived no differences over time, even though objective measurements showed
the babies had started to come around: They were definitely eating more of the
new foods.

8. What if a baby grabs the spoon during a feeding?

Babies are smart and full of curiosity, so it's
understandable if they want to examine the implements we're trying to stick in
their mouths. Let your baby take the
spoon and look it over. Meanwhile, you can continue the feeding with another
spoon.

Does your baby try to grab that one as well? Some parents
have found success by adding even more spoons to the mix — one or more for the
parent, and two for the baby. The idea here is to keep both of the baby's hands
occupied (holding spoons) while you feed.

But you might also try handing your baby a spoon that's been
loaded with food. Help guide the spoon to your baby's mouth, or let your baby
attempt it on his own.

Your baby's behavior can be frustrating, and cause a lot of
mess. But keep in mind: This isn't a feed-or-starve situation.

Your baby doesn't have to ingest much solid food during
these sessions. They are mostly about learning. And if your baby is very keen
to hold and use spoons, she's probably ready to learn self-feeding, which is a
good thing. Allowing your baby to practice will hasten the day when she can eat
independently.

9. When can babies eat lumpy foods?

Babies need to learn about food textures as well as food
flavors, so consider introducing mashed or slightly lumpy foods around 6-7
months — and before 9 months.

But wait! Babies don't even have teeth yet at this age. So
how does this work?

The answer is that babies can mash soft, lumpy foods with
their gums. And the exercise this provides might help babies develop their
chewing muscles. Moreover, research suggests that babies may be less likely to
develop fussy eating habits if they are exposed to lumpy foods before 9 months
of age (Coulthard et al 2009).

But watch out for choking hazards. Some foods might be too
lumpy. How can you tell? Researchers
recommend you taste the food yourself, and make sure the lumps are soft enough
to mash between your tongue and the roof of your mouth (Cameron et al 2015).
Foods that fail this test are high risk choking hazards.

10. How can I avoid raising a picky eater?

There are some factors beyond your control. As I explain in
this evidence-based article about the origins of picky eaters, some individuals inherit traits that make them more resistant to
eating new foods (Mennela et al 2016).

But parents can make a difference. As noted above, the
flavors in a mother's diet make their way into her milk. And studies reveal
that babies develop preferences for these flavors.

So breastfeeding may be one way to "program" your
child to accept a wider range of foods.

Consistent with this idea, researchers have found that
toddlers tend to eat more vegetables if they have a history of breastfeeding
longer (de Lauzon-Guillain et al 2013; Okubo et al 2016).

And the other important factor is exposing your baby to a
variety of solid foods.

When researchers have tracked children over time, they've
found a correlation between early food experiences and later eating habits.
Kids who are introduced to many different foods during infancy tend to eat a
broader array of fruits and vegetables.

So it's probably a good idea to resist offering your baby
only a small number of favorite foods. Keep introducing your baby to new
flavors and textures — especially vegetable foods that infants may take longer
to develop a liking for.

References: How to start babies on solids

Abrams EM and Becker AB. 2015. Food introduction and allergy
prevention in infants. CMAJ. 187(17):1297-301.

American Academy of Pediatrics. 2017. Starting Solid Foods.
Retrieved from
https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Switching-To-Solid-Foods.aspx
(12/28/2018).

American Academy of Pediatrics Committee on Nutrition. 2000.
Hypoallergenic infant formulas. Pediatrics. 106(2 Pt 1):346-9.

Cameron SL, Taylor RW, Heath AL. 2015. Development and pilot
testing of Baby-Led Introduction to Solids–a version of Baby-Led Weaning
modified to address concerns about iron deficiency, growth faltering and
choking. BMC Pediatr. 15:99.

Coulthard H, Harris G, Emmett P. 2009. Delayed introduction
of lumpy foods to children during the complementary feeding period affects
child's food acceptance and feeding at 7 years of age. Matern Child Nutr.
5(1):75-85.

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Forestell CA and Mennella JA. 2007. Early determinants of
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Harris G and Mason S. 2017. Are There Sensitive Periods
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Younger Siblings of Peanut-Allergic Children Be Assessed by an Allergist before
Being Fed Peanut? Allergy Asthma Clin Immunol. 4(4):144-9.

Mennella JA, Reiter AR, Daniels LM. 2016. Vegetable and
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Experiences. Adv Nutr. 7(1):211S-219S.

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West C. 2017. Introduction of Complementary Foods to
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title image of baby touching hands in high chair by lmnop88a / flickr

imagine of baby foods by Frédérique Voisin-Demery / flickr

image of baby making funny face while eating by Fimb /flickr

image of baby turning away from food by Abigail Batchelder /flickr

image of baby grabbing spoon by César Rincón / flickr


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