by Allison Micarelli-Sokoloff
September 02, 2011

If you are unsure about when to introduce your baby to solid foods, you’re not alone. Breast milk provides all of the nutrients your baby needs for about the first six months of life, so the American Academy of Pediatrics (AAP) Workgroup on Breastfeeding recommends waiting until your baby is 6 months old to introduce solid foods. Although some babies may be ready for solids foods sooner (as early as 4 months), the best advice for parents is to watch your baby, not the calendar.

You will know your baby is ready for solid foods if she:

• sits with little or no support;
• holds her head upright and steady;
• moves food to the back of her mouth and swallows, showing no signs of the “extrusion reflex” (a newborn reflex that causes her to push food out of her mouth with her tongue); and
• shows an interest in food by watching what you eat or by grabbing food from your plate.

Begin by offering small amounts of iron-rich foods such as meat or iron-fortified cereal once a day. Six-month-old babies typically eat about two ounces of solid foods a day; 7-month-olds eat about four ounces twice a day; and 8- to 9-month-olds eat four to six ounces three times a day, in addition to breast milk or formula.

First foods
When babies start to eat foods other than breast milk or formula, they are experiencing new tastes as well as new textures. Rice cereal is the food many parents turn to first—offering 1–2 tablespoons mixed with breast milk or formula. The consistency should be thin (watery) at first. Once your baby becomes familiar with the taste and texture, you can gradually thicken the cereal by adding less liquid. Once your baby has accepted rice cereal, you can move onto other grains such as oatmeal or barley.

Tip: Some experts recommend starting with meat rather than cereal. In fact, increasing rates of iron-deficiency among U.S. children prompted the AAP in 2010 to recommend introducing meats and other iron-rich foods sooner rather than later.

Other good first foods for baby include:

• Sweet potatoes
• Squash
• Carrots
• Avocado
• Apples
• Pears
• Bananas
• Peaches

You can purchase ready-to-eat canned baby food (start with “stage 1” foods, which are pureed to a smooth consistency) or you may opt to save money and control ingredients by making your own baby food. Whether you choose meat or cereal, first foods should be soft and easy to swallow (avoid large chunks and sticky textures).

Before you begin a feeding, place your baby in a highchair or baby seat that allows her to sit upright but offers no head support. A stroller, car seat, bouncy seat, or swing that allows a baby to lean back should not be used for mealtime. Babies typically prefer bite-size pieces they can pick up. If you offer foods by spoon, touch your baby’s lips with the spoon and wait for her to open her mouth. Watch your baby’s cues. If she refuses to open her mouth, it may indicate that she is not hungry or that she isn’t interested (yet) in the food being offered. It usually takes repeated offerings (10 or more!) before a child accepts a new food. If your baby refuses to eat, wait a few minutes and try again. If she still resists, try a different food, or accept that your baby may be telling you that she is full.

More signs that your baby is not hungry include:

• turning her head away from the food;
• pushing the spoon away from her mouth; and
• leaning back in her chair.

It’s not rocket science, but cues can be subtle. Never force your child to eat. The ability to self-regulate food intake is an important part of weight control from birth to 5 years old. Talk with your child’s health care provider if you have any concerns about her growth.

Finger foods
Most babies are ready for finger foods—anything she can pick up and put in her mouth by herself—by 9 months of age. The pincer grasp, a fine motor skill that involves using the thumb and nearby finger to pick up an object, is needed before a baby can start to feed herself.

When your baby is ready to start finger foods, place a small handful of age-appropriate finger foods on her highchair tray or on the table in front of her. Babies have only a few teeth at this age, so start with mushy foods like small bits of banana or well-cooked carrots. Circular or O-shaped cereal is another popular option.

Once your baby has mastered the art of finger-feeding (as shown by more food in her mouth than on her face or the floor!) you can expand the variety of foods you offer—from turkey to tofu. Cut the foods into bite-size pieces and offer only a few pieces at a time. Vegetables are best soft-cooked (don’t offer anything raw or stringy) and meat should be shredded or cooked (avoid chewy meats such as steak).

Good first finger foods for baby:

• Soft-cooked pasta
• Lightly toasted bagels
• Soft pitted fruits (peaches, plums, pears)
• Cheeses
• Egg (scrambled or hard-boiled)
• Steamed vegetables (broccoli, peas, carrots)
• Beans
• Poultry
• Potatoes
• Meats

Foods to avoid
Many parents concerned about food allergies delay the introduction of some foods and avoid others altogether. Whether this is beneficial is unclear. Until more data is available, parents of children with a family history of food allergies should talk with their baby’s health care provider about which foods to introduce and when. Milk, eggs, peanuts, tree nuts, shellfish, fish, soy, and wheat are the most common sources of food allergy.

All new foods should be introduced one at a time. But this is particularly important in children with a family history of allergy. Parents should wait 5–7 days between foods and watch for any signs of allergy or intolerance, such as hives, itchiness, skin swelling, vomiting, diarrhea, and wheezing. Always introduce a new food during the daytime, and preferably in the morning, so that you can observe your child’s response to the food throughout the day.

There are a small number of foods that you may want to avoid until after your baby’s first birthday:

• Honey and corn syrup. Honey and corn syrup contain toxin-releasing bacteria (Clostridium botulinum) that can cause botulism—a rare but deadly form of food poisoning. Adults and children over the age of 1 are usually not affected by the toxin, but it can be fatal in infants.

• Peanuts. Peanut allergy is among the most common food allergies. Currently there is no evidence to show that delaying foods prevents allergy. However, children with a family history of allergy should talk with their baby’s health care provider before introducing peanut butter and peanuts. Peanuts are also small and hard which make them a possible choking hazard in young children. Peanuts are best offered after a child has learned to chew foods well.

• Citrus fruits. Some babies are sensitive to the citric acid in oranges, grapefruit, and other citrus fruits. For this reason, it is recommended that parents avoid introducing high acidic foods until their children are at least 1 year old.

• Peanut butter. One of the biggest concerns with peanut butter (and other nut butters) is its consistency. Sticky foods are harder to swallow and a possible choking hazard.

Be mindful of other choking hazards such as hard or gooey candy and popcorn. Small fruits (like grapes or strawberries) should be cut in quarters or halves. Sticky foods (like raisins or dried cranberries) should be offered in tiny amounts. If your baby’s puts too many pieces in her mouth at one time, they can clump together and make it hard to swallow.

Does my baby still need breast milk or formula?
Parents should consider solid foods an addition to—not a substitute for—breast milk or formula. Babies take only small amounts of solid foods at first, so they will continue to drink the same amount of breast milk or formula. Once your baby starts eating three meals (plus snacks) each day (usually around 1 year of age), she will drink less breast milk.

The World Health Organization recommends breastfeeding for at least two years. Cow’s milk should not be introduced until babies are at least 1 year old. Parents who choose to avoid cow’s milk altogether, should talk with their baby’s health care provider about calcium-rich foods to ensure that their children are getting all of the vitamins, minerals, and nutrients they need.

Healthy habits
Introducing solid foods is the first step toward helping children develop healthy eating habits that include a balanced, nutritious, low sugar, low salt diet. The more refined sugars (candy, fruit juices, pancake syrup) and processed foods (potato chips, crackers) your child eats, the less room there is for healthy foods such as whole grains, vegetables, fruits, meat, fish, poultry, and dairy. Be sure to include foods high in omega-3 fatty acids (such as salmon) and high in unsaturated fats (try avocado).

Tips for making mealtime enjoyable include:

• limiting distractions
• restricting phone calls
• turning off the TV
• serving appropriate portions
• eating with your child

Encourage picky eaters to try new foods by eating foods along with your child. All children (even the best of eaters) go through picky periods. Don’t allow picky periods to make mealtimes stressful for the entire family.

Finally, encourage your baby to explore the wonderful world of food by tasting, touching, squishing, and smushing. Yogurt may drip on the floor and spaghetti may cling to your baby’s hair (and yours!), but what better way to teach your child that mealtime can be healthy, happy, and even entertaining!

Editor’s Note—February 27, 2012
The American Academy of Pediatrics (AAP) issued a policy statement reaffirming its prior recommendation that babies be exclusively breastfed for the first six months of life. The prior policy statement issued in February 2005 acknowledged a “difference of opinion among AAP experts on this matter,” with the Committee on Nutrition supporting the introduction of complementary foods between 4 and 6 months and the Section on Breastfeeding recommending 6 months. The current policy statement, however, contains no such variance, a reflection of the evidence showing a greater incidence of lower respiratory tract illness, otitis media, and diarrheal disease in babies exclusively breastfed for 6 months compared to those exclusively breastfed for 4–6 months. The AAP also recommends that breastfeeding continue for at least the first year and beyond as mutually desired by mother and baby. View the revised policy here.