Introduction of Solids (Between 4-6 months)
I recommend starting pureed solid foods some time between 4-6 months. I find most babies are not quite ready at 4 months but usually more so between 5 and 6 months old. I expect at this age they are taking somewhere between 24-32 oz of breast milk or formula per day.
Readiness Cues that your Baby is Ready to Start Solids:
-Able to hold their head and body upright. Have your baby practice sitting in their high chair at the table with you if you haven't already. They should be upright and holding their heads up high and not slumped over.
-Interest when you are eating. You may see them reaching out towards your food or watching every fork/spoonful you are eating
-Able to indicate when they don't want something or are all done. You may see them turn their head away with the bottle or breast indicating they've had enough.
-Able to bring something to their mouth, you can practice this with a teether toy or empty spoon.
-Infants that are taking more than 32 oz of formula or breast milk per day are usually ready for solids.
-You as the parent also feel ready!
How to Introduce First Foods:
-Offer solids about 1 hour after breastfeeding or bottle so they are hungry for it
-Have your baby sitting up in their highchair
-Pick a single ingredient pureed fruit, vegetable or infant oat cereal (Earth's Best, Gerber - can be mixed with water/breast milk/formula) and load up a spoonful and place it into their mouth. They are often surprised at such a new flavor/texture!
-Whether they spit it all out or swallow it and open their mouth for more - that is okay! They are still getting all of their nutrition for now from breast milk or formula. Solid foods are just extra at this stage and to introduce them to the concept.
-Offer 1 new food at a time every 2-3 days - That way if there's a reaction you know exactly which food it is from. Once you know they are tolerating a food, it is okay to continue that in their diet regularly.
-Have fun! Let them explore, be messy, play with the food/spoons.
-Start with 1 meal a day and you can slowly work up to more once they are showing interest.
-If you try solids and they don't seem at all interested, give it a few days to a week and try again.
Other Things to Consider:
-Interested in Baby Led Weaning? That is designed for babies older than 6 months only. If starting solids below 6 months, which many babies are ready for, then stick with the purees for now.
-I think it is a good start with fruits, vegetables, oat cereal for about 1 month before introducing the more common allergens (dairy products, eggs, peanuts, tree nuts, soy, sesame, wheat, fish and shellfish). Then you will be more comfortable in introducing these foods and what to look out for. We'll talk more about how to do this at the 6 month visit!
-We don't recommend any rice products (such as rice cereal) for infants under 1 year. There are small amounts of arsenic that are absorbed in rice from the soil. Oat cereal does not have this same problem so is a safer option for your baby.
-Follow your baby's cues in terms of amounts - give them as much or as little solids as they want! Babies are very good at regulating how much they want to eat.
-It is okay to buy organic baby food or make purees yourself - either option or a combo is totally fine!
-It is good to start offering foods that are rich in iron - for example the infant oat cereal is fortified in iron, also lentils, potato, beans, broccoli are good sources.
-There is no need to offer water at this point, they are getting all of their hydration from the breast milk/formula. At around 6 months, you can start giving some water in a sippy cup for practice.
-Prepare yourself for what you would do if your child started choking. There are many online and in-person CPR and infant choking courses available.
Introduction of Solids between 6-9 months
If you haven't started introductions of solids yet - now is the time to do so! If your baby is tolerating purees or maybe even some small chunks of things, then we will continue to build upon these skills and expand in terms of types and textures of foods. Our goal now is to start introducing foods that will be more filling and satiating (containing more proteins and fats) and to start introducing the common allergenic foods.
Transitional Foods
You can start offering more texture to your child's food. Things like small chunks of avocado, banana, ground beef, pureed chicken, soft stewed lentils or black beans, silken tofu, cottage cheese (full fat and rinsed), and hummus can be good options to start with.
Babies don't need teeth to chew foods. You will be amazed by how they can mash and macerate food between their gums.
Introduction of Common Allergens
-The most common allergens are peanuts, tree nuts (walnuts, cashews, almonds), eggs, dairy, wheat, soy, sesame, fish and shellfish
-Research shows earlier and more frequent introduction of allergens leads to lower rates of developing allergies.
-Introduce a small amount (pea sized) to start (ideally in the morning on a week day so if you need help you can call our office) and if tolerated after a few minutes then give a bit more. If things go well the first time, repeat this process for 3 days with close observation. Usually the allergic reaction will occur on the second or third introduction of a food rather than the first.
-Once your child has had the allergen 3 times without a reaction then you can feel confident they are tolerating it well. Then give it to them 1-2x per week thereafter to further decrease developing an allergy to it in the future.
-Only introduce 1 new allergenic food at a time, choose a time when your child is feeling completely healthy and not sick. Viruses are common causes of hives and it can be confusing to know if the hives are from the virus or the food.
-If your child develops signs of anaphylaxis (facial swelling, vomiting, diffuse hives, difficulty breathing, color change) then call 911 right away.
-If your child develops just a localized rash or hives then contact our office and we can guide you about next steps (possibly administering an antihistamine such as liquid zyrtec or benadryl or giving it time to clear on its own). If the rash is just a little redness around the mouth and there are no other symptoms then you can give the food again the next day but first apply an aquaphor barrier around the mouth and that will often prevent the rash from developing. This is caused by a skin sensitization reaction rather than an allergic reaction.
-Do not give any cow's milk until your child is over 1 year but cow's milk cheeses and yogurts are okay. Offering baked egg products first and slowly offering egg products that are cooked for less time may help you avoid an allergic reaction. For example, start with egg exposure through a baked muffin (baked 30 mins), give that for a few weeks, then you can offer something baked in less time (15-20 minutes) such as a breakfast cookie. Then egg noodle then pancake then french toast and then scrambled egg. Do each stage for 1-2 weeks before moving on to a food that is baked less time. Once they are tolerating scrambled egg this is a great transitional food for them.
-Some families will choose to introduce allergens via allergen powders such as "Ready Set Food". This is okay as long as the allergens are introduced one at a time. For the maintenance phase once you know they are tolerating the allergens then it is okay to use the products such as oatmeal that contain all the common allergens.
General Guidance:
-Aim to have your baby taking 3 meals a day by the time they are 9 months. If they also want 1-2 snacks in addition, that is okay too! They are good at regulating how much to take in so just offer as much as they want!
-Generally kids 6-9 months are still taking somewhere 24-32 oz per day of breast milk or formula per day. If between 9 and 12 months their intake of solids increases and their milk intake decreases that is normal and okay!
-Avoid added salt until your child is over 1 year as their kidneys are still developing and learning how to process salt. Some cheeses and canned foods (like black beans) are high in sodium. Mozzarella and Swiss cheese are both low in sodium. Rinsing canned/packaged products (such as beans or cottage cheese) can help remove sodium or also stewing dried beans yourself are ways to decrease sodium.
-No honey for over 1 year.
-Start offering water in the sippy cup with meals (nozzle top is usually easier when they are first starting rather than straw top) just for practice. Do not give more ounces per day then the number of months old they are (ex. No more than 6 oz per day for a 6 month old). It is unlikely they will take even close to this amount - usually much less! This is all just for practice. They are still getting all their hydration at this point through the breastmilk or formula.
-If you want to learn more about Baby Led Weaning, Solid Starts is a great resource. At this age, doing a combination of purees and whole foods can be a good way to go and then once they develop their pincer grasp (around 9 months) then you can start to decrease the purees and focus on pieces of soft food that can be picked up.
-This is the perfect time to take an infant CPR/choking course if you haven't already so that should there be a problem you are prepared and confident in what to do.
