Starting Solids in Babies: For Healthy Growth and Development

Starting solids in babies is a huge milestone for their first year of life. Find out when and how to make a transition to complementary food.

Starting Solids in Babies
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Introducing baby to the new world of flavor and texture is exciting and important milestone. Often, breastfeeding mamas are confused about starting solids in babies. You may have questions about what age to start the baby food, how do I minimize risk of food allergies and should I breastfeed before or after feeding the solids?

Feeding baby in the first few months is so easy. You don’t have many option- Breastfeed or formula feed…easy peasy !! My both babies were exclusively breastfeed for 6 months and when it was time to transition I had so many questions. There are so much conflicting information that I was confused about where to start from.

You read something from the internet or receive advice from other parents to start early to help the baby sleep through the night or to help baby with reflux. Also, grandparents telling you to start as early as first month, because that’s what they did in the past.

As you read more about starting solids on the internet, you get more confused than ever! Even visiting family physician can leave you with conflicting information.

“Veggies first or fruits”? “Saving fruit for the last so babies don’t get sweet tooth”. How about allergic food? Give it or not give it?

Sounds familiar!!

Let’s put end to it and Let’s keep it simple.

My goal with this article is to provide you evidence-based guide to get thing straight with this whole fuss about starting solids in babies.

Here’s what we will be taking about,

  • When should you introduce solids to babies?
  • When is my baby ready for solids?
  • How should I start solid in my baby?
  • Should I feed solid before or after breastmilk or formula?
  • How do I minimize the risk of food allergies?
  • What if my baby refuses solids?
  • How much solids should my baby eat?
  • How many times a day should I feed solids to my babies?

Before we go in to answering question, Let’s understand

What is our goal with starting solids in babies?

We aren’t trying to replace baby’s breastmilk or formula with solid food. Breast milk or formula will still be the primary source of nutrient until they are 1 year old (1).

When you introduce solids to your baby, it’s a transitional period for your baby. Solids are complimentary food and can’t replace the nutrients that breast milk or formula provides during the first year of baby’s life.

The World Health Organization (WHO) estimated that energy contribution from complimentary feeding is about one fifth of a total requirement for infant 6 to 8 months and just under half of baby’s energy needs from 9 to 12 months  (2).

Now that our goal is clear, lets move on to

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When should you introduce solids to babies?

The WHO, the American Academy of Pediatrics (AAP) and the Canadian infant feeding guidelines recommend exclusive breastfeeding until baby is 6 months old. Even then, when I went for 4 months check up for my baby, our family physician recommended to start solids at 4 months, because my son was ready.

Upon asking about reason for controversy to my physician, he said

“As long as baby shows sign of readiness and when physiologically and developmentally ready, you can start solid between 4-6 months”. Also he added that, it is NOT recommended to start solid before 4 months because babies are physically not ready to swallow solids and their digestive system is immature for solids”.

Research studies have also shown that introducing solids before 3-4 months can increase the risk of eczema (3,4) and increased weight in childhood (5).

He left it on me to decide when to introduce solid in my baby. I continued exclusively breastfeeding until he was close to 6 months and then started solids.

When is my baby ready for solids?

Your developing infant will give you cues for readiness for solids between 4-6 months.

Here’re some common physical and behavioral cues for solid readiness in your baby :

  • Your baby is at least 4 months of age
  • Baby sits up unassisted and hold his head up straight.
  • The tongue thrust reflex should be gone. Meaning when you place food on baby’s mouth, his tongue should not immediately push it back out.
  • Baby is showing interest when you are eating and may even try to grab some food from your plate.

If baby is 6 months old and still not showing readiness for solid as described, you need to contact your physician. They may recommend you to speech language pathologist.

How should I Start Solids in my Baby?

Once your baby shows cues for solid readiness and with your pediatrician’s approval, you can start solids in your baby. Starting solids in baby can be exciting, yet overwhelming.

It is not uncommon for babies to dislike solids when they are first introduced to it. They are learning about solid food and it takes time for them to accept the texture and flavor of the solids.

When you offer solids to your baby for the first time, they may make facial expression like they are disgusted by the flavor, that does not mean you should stop offering it.

Interestingly, a research study published in Journal of Current Nutrition Reports,2017 (6) noted that,

  • 95% of the babies squinted
  • 82% showed brow movement
  • 76% raised their upper lips
  • 42% wrinkled their noses

when babies were introduced pureed green bean for the first time. Study also mentioned that after repeated feeding for 8 days, babies ate 3 times more than what they ate when they were first introduced to it.

Research also shows that repeated exposure to various flavors may increase food acceptance and thereby decrease fussy eating (7).

So, if your baby resist solids or make faces do not give up just yet!!

Which food should I Feed my baby first?

When introducing solid to your baby, most parents opt for cereals (oatmeal, barley, rice) and then move on to vegetables and fruits.

At this stage babies need iron to develop, especially babies that have been exclusively breastfed, so make sure to include iron fortified cereal such as oatmeal, barley, rice, beans, meat into their diet.

Iron-fortified single-grain baby cereal has been the first go to food in babies but there is no scientific evidence that they must be served at your baby’s first meals.

Soon after introducing iron-rich foods, vegetable and fruit can be added as the vitamin C (in fruits) helps the iron absorption. Once baby starts eating iron-rich food regularly, milk products such as plain yogurt and cheese can be added to their diet.

In fact, the AAP notes that iron-rich pureed meats are also good first food, especially for exclusively breastfed babies. Most babies are born with enough iron in their body to last them for first 6 months. So it is important to add iron fortified food in their diet at this point as iron source can be depleted in breastfed babies.

While preparing cereal for babies for the first time make sure consistency of it is more like liquid to reduce choking risk. Mix one teaspoon of cereal with 4 – 5 teaspoons of lukewarm breastmilk or formula.

Other good choice for first food are puréed bananas, apples, pears, peaches, and sweet potatoes, carrot, broccoli, avocado, butternut squash. Once they start eating regularly, you can also mix cereal with fruits or veggies.

Make sure to pureed food- not chunks, sticky paste when you feed your baby, if you are not trying baby-led-weaning approach (explained below) in 6+ months baby.

Introduce one food at a time with baby, and after 3-4 days, introduce another food. Also, offer new food early in the days or before nap or bedtime to monitor your baby for any potential food allergies.

At this stage, babies will only eat 1-2 ounce of solid as they are getting used to the texture and flavor. Don’t worry if they don’t eat what you expect them to eat. Your baby will give you cues when he is done by turning his head or grabbing spoon.

Baby-led-weaning: Another way of introducing Solid to your baby

Starting- Solid- in-Babies
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This approach skips feeding with a spoon and pureed food, instead lets babies choose from safe finger foods to feed themselves.

A baby led weaning approach is for babies 6+ months, who shows readiness for solid and has developed the motor skills to pick up food.

A research study conducted by Morison et al. 2018 (8), compared baby-led weaning to traditional feeding and noted no long-term difference in outcome among two approach of starting solids in babies. However, they noted that children eat more fruits and vegetables by the age of 2 years when they were introduced to solid by baby-led weaning approach.

You may be wondering, if I choose this option of introducing solids to my baby, then what about food and nutrient intake? We all know that most of the food that we offer to baby, goes on the bib or ground.

The BLISS randomized control trial in 2018 (9) investigated the impact of Baby-Led Introduction to Solids (BLISS- modified baby-led weaning) on food and nutrient intake in children at 7-24 months of age. Study showed that BLISS diet is as nutritionally adequate as traditional spoon-feeding.

As long as you are careful with offering your baby right diet (10),

  • An iron-rich food (iron fortified infant cereal, beans, red meat).
  • An energy-rich food
  • A food such as a fruit or vegetable

and avoid choking hazards, you should not worry about nutrient intake, but I can’t guaranty about the ‘mess’ that you have to clean after each meal.

I started out as traditional spoon-feeding approach for both my babies and as soon as the were eating regular meal, I offered them finger food for dinner time. I have to confess; it didn’t satisfy me by the amount they ate so I spoon-fed them after they were done with the finger food!

Should I feed solid before or after breastmilk or formula?

There is no scientific evidence stating whether the breastmilk/formula or a solid food should be offered first. It is also important to remember that babies receive most of their nutritional requirement from breastmilk or formula during first year of their life.

Babies do eat very less and typically one meal a day when they are introduced to solid and slowly, they build on to 3 meal a day by their first birthday.

When I introduced solid to my first-born, I breastfed first and after 1 hour offered solid to him. It worked for him. But for my second one I gave him solid food around 11 am and after 1 hour breastfed him.

So depends really on how your baby’s schedule works.

How do I minimize the risk of food allergies?

You should always talk with your doctor before introducing hypo-allergenic food to your baby’s diet because your family may gave different health concern and risk factor.

Much of a confusion about adding allergenic foods- dairy, peanuts, eggs, fish, eggs and tree nuts to babies’ diet is over and now doctors recommend introducing them early and in age-appropriate format.

Research also does not support the thought of adding allergenic food early lead to allergies.

In fact, a research study (10) supports that starting solid food, especially peanut, earlier in life may prevent food allergy.

If your kids are at no risk (no allergies to peanut in family) of food allergy, can start peanut products whenever they would like. But make sure that nuts (peanut butter) are thinned out with water or mixed with puree or its in powder form and mixed with cereal. Sticky paste or whole peanuts are a choking risk.

When you start offering allergy prone foods to your baby, start with small quantity at home earlier in the day ( not before bedtime or naptime), that way you can monitor your baby for any symptoms.

What are the signs of a food allergy?

If your baby is allergic to food, you’ll see a reaction within a few minutes or up to two hours and allergic reaction will appear every time you expose your baby to allergenic food.

Most kids with food allergies have mild reactions like hives, vomiting, or diarrhea. If you see any of these reactions call your doctor.

More severe reaction to food allergies include wheezing, difficulty breathing, or swelling of tongue and lips or face. These are a life-threatening reaction (anaphylaxis). In this case call 911 immediately.

How much Solids should my Baby eat?

Each child is unique, and they progress at different rate with respect to age, growth, metabolism, and activity levels. They differ in the amount of food they eat.

Most important thing is offering then iron-rich food when you are starting to introduce solid to them to meet their developmental and nutritional needs.

There are no set criteria about how much solids should a baby eat. Here is general guideline,

Between 4-6 months ( if you decide to introduce food at 4 months)– Offer 1 iron-rich meal a day- Quantity 1-3 tablespoon (5-15 ml) depending upon baby’s hunger cues

Between 6-8 months– Offer 2-3 iron-rich meal a day- Quantity 3-8 tablespoon

Between 8-12 months– Offer 3 iron-rich meal a day- Quality 5-8 tablespoon

A typical day’s diet at 8 months might include a combination of:

  • Breastmilk or formula
  • Iron-fortified cereal
  • Vegetables
  • Fruit
  • Small amounts of protein, such as eggs, cheese, yogurt, lentils, tofu, and meat

What if my baby refuses solids?

Your baby may not like food when you first introduce it. It may take 10-15 tries for your baby to accept a new food.

Here’re few tips that you can try,

  • Mix solid food with breastmilk or formula to make it more palatable and familiar to your baby.
  • Warm it a little. (check the temp before feeding your baby)
  • Offer the food again in a few days.
  • Talk to them, sing a rhyme or distract them with toy in hand (giving my son plastic spoon in his had to hold always worked for me)
  • Offer solid when they are most hungry
  • If you are feeding them breastmilk/formula first before offering solid, then try offering solid first.
  • Feed your baby at family lunch or dinner time.
  • Offer them variety of flavor or texture.

What food should I avoid giving my baby?

Foods should be age-appropriate – puree when you are starting and slowly introduce soft finger food.

You should avoid,

  • Cow’s milk until your baby is one year old
  • Do not give honey to your Infant because of a risk of Botulism
  • Added salt and sugar

When should you introduce Water to your Baby?

At about six months, when you introduce solid to your baby, give 2-3 oz of water. Give water in sippy cup to help develop drinking skills.

Takeaway:

Starting solids in baby is a huge milestone for the first year of baby’s life. It is a first step toward meeting their developmental and nutritional needs.

Whether you decide to start solids at 4-6 months or at 6 months, keep in mind that breastmilk or formula is still their primary source of nutrient until they are 1 year old.

Baby’s built in iron resource deplete in 6 months, so it is essential to add iron-fortified foods (whole grain oat, barley, rice cereal) followed by fruits and vegetable in their diet as they grow.

To avoid choking risk, include age-appropriate -pureed foods, soft- crumbs free finger food in your babies’ diet.

Last but not the least, if your baby resists solid food, do not force it as they are just experiencing flavor and texture for the first time so give them a time and keep trying!!

How About You?

How did you start your baby on solids? Share your experience below in comment section.

 

References:

  1. American Academy of Pediatrics. Infant Food and Feeding.
  2. World Health Organization. Infant and young child feeding (model chapter for textbooks for medical students and allied health professionals). Geneva: World Health Organizations; 2009
  3. Fergusson, D. M., Horwood, L. J. & Shannon, F. T. Early Solid Feeding and Recurrent Childhood Eczema: A 10-Year Longitudinal Study. Pediatrics 86, 541–546 (1990).
  4. Tarini BA1, Carroll AE, Sox CM, Christakis DA. Systematic review of the relationship between early introduction of solid foods to infants and the development of allergic disease. Arch Pediatr Adolesc Med. 2006 May;160(5):502-7.
  5. Wilson, A. C. et al.. Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ 316, 21–25 (1998).
  6. Forestell CA and Mennella JA. 2007. Early determinants of fruit and vegetable acceptance. Pediatrics 120(6):1247-1254.
  7. Lisanne M. de Barse, Pauline W. Jansen, Lisa R. Edelson-Fries, Vincent W.V. Jaddoe, Oscar H. Franco, Henning Tiemeier, Jolien Steenweg-de Graaff, Infant feeding and child fussy eating: The Generation R Study,Appetite, volume 114,2017,Pages 374-381,ISSN 0195-6663,https://doi.org/10.1016/j.appet.2017.0
  8. Morison B., Taylor R., Haszard J., Schramm C., Erickson L., Fangupo L., Fleming E., Luciano A., Heath A. How different are baby-led weaning and conventional complementary feeding? A cross-sectional study of infants aged 6–8 months. BMJ Open. 2016;6:e010665. doi: 10.1136/bmjopen-2015-010665.
  9. Williams Erickson L, Taylor RW, Haszard JJ, Fleming EA, Daniels L, Morison BJ, Leong C, Fangupo LJ, Wheeler BJ, Taylor BJ, Te Morenga L, McLean RM, Heath AM. Impact of a Modified Version of Baby-Led Weaning on Infant Food and Nutrient Intakes: The BLISS Randomized Controlled Trial. Nutrients. 2018 Jun 7;10(6). pii: E740. doi: 10.3390/nu10060740. PubMed PMID: 29880769; PubMed Central PMCID:PMC6024590.
  10. Daniels L., Heath A., Williams S., Cameron S., Fleming E., Taylor B., Wheeler B., Gibson R., Taylor R. Baby-led introduction to solids (bliss) study: A randomized controlled trial of a baby-led approach to complementary feeding. BMC Pediatr. 2015;15:179. doi: 10.1186/s12887-015-0491-8.
  11. Nwaru BI, Erkkola M,Ahonen S,et al. . Age at the introduction of solid foods during the first year and allergic sensitization at age 5 years. Pediatrics. 2010;125(1):50–59pmid:19969611

https://www.who.int/topics/infant_nutrition/en/

http://pediatrics.aappublications.org/content/129/3/e827

http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/index-eng.php

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