Transitioning to Solids
We get so many questions on this and we haven't seen quite as good of a summary as from My Friend the Pediatrician!
The perfect time to start solid foods has been debated for years. According to the latest guidelines from the AAP and WHO, solid foods should be introduced around 6 months of age.
Age is not the only requirement for starting solid foods. A baby should also be able to fully hold their head up, sit without support, close their mouth around a spoon, and no longer reflexively push things out of their mouth with their tongue. Some babies do not achieve this until 8 months of age! If your baby spits the food back out with his or her tongue every time you offer it, it’s probably not time for solids yet.
How to transition to solids? There is no medical evidence that introducing solid food in any particular order has an advantage for your baby. Traditionally speaking, solid foods are introduced in puree form (single foods blended to a smooth consistency and fed by spoon). I no longer recommend rice cereal given the natural presence of arsenic in many rice varieties. As a baby eats larger volumes and tries more foods, parents move on to a thicker texture by offering mashed consistency. Around 9-10 months old, finger foods are offered in small pieces.
Another method of introducing solid foods to babies is called baby-led weaning (BLW). This method was popularized in the UK and has gained popularity in the United States as well. Baby-led weaning is a way of introducing solid foods starting with “whole but manageable pieces” while skipping purees and mashed foods altogether.
How is BLW done? Starting around 6 months, babies are offered the same food that the rest of the family is eating, minus the choking hazards such as whole grapes, popcorn, whole nuts, raw vegetables, hard fruit (such as raw apple or under-ripe pear), raisins, and small pieces of tough meat. Avoid foods that are cut into rounds or “coins” such as cherry tomatoes, hot dogs, carrots, and sausages. First foods should be soft and easily “mushed” inside a toothless mouth. Slice food up so baby can grasp it in their fist and chew from the top down (instead of tiny bite-sized pieces)!
BLW teaches baby to feed themselves, develop motor skills, and gain control over how much food they want when they want it. It is thought to help them learn appetite regulation for later years. A recent study by the AAP determined that babies are not at a higher risk of choking from BLW when compared to traditional purees. However, he or she must meet the same signs of developmental readiness as discussed above (plus the ability to grasp food and bring it to their mouth, of course).
Babies do not necessarily have to have teeth to start BLW – strong gums and saliva will do the trick. However, the food should be soft enough to mash on the roof of YOUR mouth with your tongue (or large and fibrous enough that small pieces do not break off when sucked and chewed). Make sure your baby is always sitting upright – never leaning backwards or crawling about. Never leave your baby alone with food -- adult supervision required. Let them place food into their own mouth at their own pace.
Regardless of your approach, solid foods are mainly for PRACTICE and exposure to new flavors and textures. A baby’s MAIN source of nutrition will continue to be breast milk or formula up until 1 year of age. As a baby eats larger amounts of solid food and approaches the 1-year mark, THEN you can begin to wean breast milk or formula.
Note that the term “baby-led weaning” is a bit misleading, as the approach should NOT involve decreasing the amount of breast milk or formula as you add solid foods to an infant’s diet. Remember: “Solid food is mainly for fun until age 1!”
Additional tips for the introduction of foods:
It may be wise to introduce simple foods one at a time by waiting at least 3-4 days before introducing another food to watch for allergic reactions.
Don’t add much salt or sugar to your baby’s foods. Not only could this cause baby to develop a taste for these strong flavors, it also prevents baby from learning the true flavor of a food.
Some finger-food examples include small pieces of banana, wafer-type cookies, crackers, scrambled eggs, well-cooked pasta, tender chicken, and cooked potatoes or peas.
Model healthy eating habits. Include a variety of healthy foods on your own plate so baby will learn to imitate your behavior. Encourage your family to sit at the table together and put away distractions so baby understands that meal time is for eating.
Don’t force baby to eat more than they want. Pay attention to their signals. If they are throwing food off their tray, pushing food away, or turning their head away – they are done.
Avoid honey for babies under the age of 1 year. Honey can carry spores that cause botulism, which is dangerous for infants.
There is no evidence that waiting to introduce high-allergy foods (such as eggs, dairy, soy, peanuts, or fish) beyond 6 months of age prevents food allergies. Chat with your pediatrician you believe your baby has an allergic reaction to food such as diarrhea, rash, hives, or vomiting.
Avoid fruit juice before age one. A recent change in AAP policy says fruit juice should not be given unless a doctor recommends juice to manage constipation. In general, the high sugar content in juice may increase a child’s risk of obesity and dental problems.
Avoid cow’s milk before 1 year of age. Cow’s milk should not be given on its own, but it may be fed in other foods, such as whole fat yogurt.
Don’t give up on foods that baby rejects a few times. It could take up to 15 times of trying a food before a child decides that they like it.
Teething should not interfere with the feeding process. Continue to offer formula, breast milk, and solid foods like you otherwise would. Offer a cool chewing ring or frozen damp washcloth to soothe the gums. Avoid numbing gels and creams!
If baby isn’t eating any solids or purees by 9 months of age, talk to your pediatrician. There could be a feeding issue that needs extra help. Some babies may have an oral aversion to foods, oral motor dysfunction, texture issues and/or poor muscle tone.
Again, every baby is different, and there is no “one size fits all.” Some kids prefer to take control and feed themselves while others prefer to be spoon-fed in the traditional fashion. A combination of the two methods is reasonable as well! Learning what works best for your child is a process that will develop over time. Hope this helps!
Primary Source: “A Baby-Led Approach to Eating Solids and Risk of Choking” (Pediatrics, October 2016)