Introducing Solids and Texture
This is an exciting time for you and your baby! At almost 4 months old, she is now curiously eyeing the food you eat. Her head control, core body strength and chewing muscles are maturing – she is acquiring the ability to coordinate her swallowing. But how and when should you start to give your baby solids?
This remains one of the hotly debated topics, even among scientists and doctors. As with many aspects of parenting, there are pros and cons, and the decision is ultimately up to you. The important thing is to make an informed decision. My advice is based on both a thorough review of all the research out there and a major dose of reality and practicality, based on the thousands of children that I have helped care for since 1996.
When To Start
Looking at it one way, there is nothing better than breast milk. So head to head, nutritionally speaking, milk (breast milk or formula) will always win. It also might seem easier to give breast milk, which already has everything in it, rather than take the time and effort to make solid foods and clean up the inevitable messes.
For the longest time, the official recommendation was to nurse as long as possible, but to introduce solid foods slowly, starting at 4 to 6 months of age. Just recently, however, there has been a slight shift, with some experts advocating waiting until 6 months to start any type of textures. And after a thorough review of the research, I totally give that my blessing. It is a fine option to wait to introduce any solid food until 6 months old.
But let’s allow ourselves to consider a few other important factors. First of all, your baby is indeed interested in what you guys are doing at the dinner table! They are curious and want to explore. Part of learning is touching, feeling, and even learning how to coordinate chewing and swallowing. So I like to look at eating as a slow, fun, messy learning process, and indeed it can safely start between 4 and 6 months as long as the head control is there, and we will review that during the 4 month check up. Your baby does not need to sit on their own, they just need to have solid head control.
Are there any other factors that would lead us to start earlier than 6 months old? Well, pediatric allergists say absolutely yes! Clear reseach emphasizes the hygiene hypothesis, which proposes that earlier exposure to different antigens or allergens actually allows the body to accept, rather than reject these foreign challenges. The “boy in the bubble” will actually get sicker than most when he emerges into the real world. Research has shown that earlier exposure to germs, in small doses, actually strengthens the immune system. In fact, the best place to raise a child may be on a farm, near all the animals and even the cow dung! A baby exposed to farm animals has a smaller chance of developing asthma or allergies, not greater.
And the same goes for foods. There is clear evidence that pregnant moms should have peanut butter during pregnancy to lessen their risk for peanut allergy in the baby. Similarly, there is evidence that an earlier introduction of foods in a baby actually decreases the risk of food allergies. For over 20 years, studies out of England and Israel clearly showed less peanut allergy in those newborns at high risk for development of allergy (based on family history and eczema or atopy in the baby) when peanut was introduced earlier, and even as early as four months old!
Furthermore, there is the problem of texture issues. Too many kids end up not just being picky, but having a real issue with food textures, where they won’t accept or like anything that has too much of a rough feel. You have noticed the change in personality from your 2 month old to your 4 month old. Imagine how set in her ways a 6 month old may be! The child who waits too long to try new foods and textures is at a higher risk of being less flexible in her food choices. You want your 9 month old to be a good eater – flexible, independent, maybe even adventurous. You want your child to explore and be in charge of her world, and that includes “attacking” her food! By 9 months old, it is actually plausible that your baby will be enjoying the same foods you eat, but in small mushy pieces! So I myself would indeed start slowly, and carefully, between 4-5 months for all these reasons, but it’s totally ok to start at 5 or even 6 months old. The final decision is up to you.
Baby-Led Weaning?
Sometimes parents will read about a still relatively new philosophy, called the “baby-led” method, and they feel that they need to leave it all up to the baby. Let's wait for our baby to tell us they are ready for avocado, and the day they want it? It is true that we want them interested - but the 4-5 month old who is developing well is interested in everything you do! They don't know what foods will taste or feel like - so it's up to us to start the process by tell them it's gonna be so amazingly fun, and then in due time, they definitely should and will take the lead.
It all really starts with the developmental phase of the child. Children at 4-5 months certainly would eat on their own if they could, but they just can’t. They need help, and they need to see that you are there with them for their first bites, helping them, until their motor control allows for more manipulation. The true pincer grasp won’t develop until 9 months old, so before that point, babies will mainly use the raking method to grab their food. In other words, babies can’t hold small objects. They can only hold large objects, but then those are foods that can cause choking. I have had many babies who choke. It is life-threatening. They do have a gag reflex. But that doesn’t mean they can’t choke. I promise 100 percent they can! It is our role as parents to not let them choke. So therefore I would beg you not to give them a food that is larges enough to choke on, even if you are watching them closely and even if you took a cpr course. It just isn’t worth the risk. And that is the major issue with the baby led weaning method.
My advice is that you start slowly, around 4-5 months old, as long as your baby’s head control and overall development allows for it. They don't have to sit on their own, as they can be on your lap. They just have to maintain their head control. They won't choke on the food as long as it is smooth or soft or super small pieces, and even without teeth they can manipulate the food, or "gum" it.
Baby food is not going to be a substitute for breast milk or formula. For a while, it won’t be a significant source of calories. But it’s not about the calories or the nutritional value of the first foods. It’s about teaching your baby to accept and enjoy the act of eating.
And for those babies that do enjoy eating solids, it’s ok to follow your child’s cues. If she wants more, I would give it to her, as long as they are healthy food choices. I would never cut off a baby from eating solid foods for fear of a bellyache or obesity. Obesity is a complex topic, and indeed bad habits can start in childhood, but your baby can't become obese on healthy foods.
The First Bite
Whether you start your baby on solids at 4, 5 or 6 months old, you’ll want to know what and how you should feed her. Her first food should be the easiest to learn to swallow and simple to digest, and this is usually organic baby oat, whole grain, rice or quinoa cereal mixed with breast milk or formula. Mix 2 tablespoons of cereal with 2 ounces of the breastmilk or formula and go for it! She’ll likely need a few tries before she can coordinate her tongue to take the food, so don’t get frustrated if she looks like she can’t do it or doesn’t like it! All babies will make that tongue thrust motion at first, so don't take it as a sign that they are not ready. It may take up to a week before your baby looks like she is really enjoying or accepting baby food.
As the weeks progress, you can thicken the cereal, and she can have as much as she wants, but don’t force her to eat more than she wants to eat. In general, we should follow our child’s cues in eating, and try to avoid the “one more bite” routine.
Feed your baby when she is hungry but not starving. This way, she will be motivated to try new foods, but not famished, frustrated, and therefore demanding of milk, which is more nutritious and requires less effort to obtain. Again, nothing beats nursing, and breast milk or formula will remain a baby’s best source of nutrition for some time, but an effort should be made to teach your baby how to enjoy food.
At first, the baby should eat in your lap, but as head and body control increases, closer to 9 months, she can move into a high chair. I agree with keeping rough predictable schedules for children, but don’t feel bad if some days are different than others. It takes a lot of time to prepare baby food, and the feeding process can be a real mess! But learning to feed – first with help, and then with true independence – will be a rewarding and fun experience for you and your baby.
As with many decisions - parents are in charge of the specifics. But in my 27 years of helping families I see benefits of earlier introduction in terms of more acceptance, more flexibility, less pickiness, and in many cases less risk of allergy. So as long as the head control is good at our 4 month visit - I’ll give you the green light and then you decide exactly when to start. But I would nudge towards 4 months if you really wanted my vote!
What's On The Menu?
Carbohydrates get a bad rap in our culture, and processed foods certainly have a downside, but a growing, rolling, bouncing (and soon to be crawling, walking, running) baby needs to have some glycogen stores from complex carbohydrates. So if you prefer to make your own oatmeal or quinoa or brown rice stew, that’s ok – but please don’t feel like carbs are bad for children across the board. Fruits and veggies are amazing for kids, but they won’t give them enough energy and muscle.
After 7-10 days of cereal, try offering a vegetable. You can boil and puree the vegetable yourself, or just buy it from a trusted source. Organic is always a nice option, but that’s up to you (and your wallet!). You can add some milk to the puree if it seems too thick, but I wouldn’t add any salt or sugar (seasoning can indeed come later, but start off keeping it simple).
Start with squash or sweet potato, then try carrots – don’t stress if her skin looks more orange after a lot of carrots! – and eventually mushy peas and beans. Fruits are generally sweeter and therefore rarely refused, so establish a taste for the vegetables first. The first fruits should be applesauce, bananas, and mushy pears. There are many other safe options, but foods that are hard, such as cucumber or apples just aren’t safe at all, and even foods like a whole banana or mango piece could block the airway, so avoid choking at all costs.
Give each new food for three days on its own or with other established foods, so you can observe for allergic reactions. This could be hives (swollen red blotches) all over, swollen tongue, in the worst cases, respiratory distress. The highest allergenic foods are milk, soy, wheat, nuts, egg, and shellfish. Although anything is possible, most kids are not allergic to fruits or veggies, so if you do see small red dots on the mouth after introducing them, this may just be a skin irritation or food sensitivity, and will rarely lead to anything significant. Video/telehealth same day visits are available any day to review any potential rash or reaction after a food or to go over in more detail a plan of attack! As you add new foods, you can keep giving the already established foods at other times in the day.
We tend to have three big meals a day, with a few snacks in between, and older kids will follow your routine. The first few weeks are just an introduction to accepting texture, and it’s really ok to play around with different mixtures. By 7 or 8 months old, your child should be having three meals, or offerings a day, in addition to breast milk or formula.
Developing a Routine
The first few months of solids should be a fun, mellow introduction. Don’t worry about the cereal fully replacing a “feeding” of breast milk or formula. The amount of calories in a full milk feed far outweighs what they will get from a little jar of carrots, and in most cases, it won’t be until 9 months before you notice a decrease in the amount of milk your baby needs as she increases her solids intake. Many people give cereal in the morning, then a vegetable around lunch time and an avocado or fruit for dinner. You can slowly get into this idea of three meals a day, but remember: they really aren’t meals for a while; they are mainly lessons on how to accept textures.
Before you know it, your baby will be 6, 7, 8 months old. At these ages, it becomes appropriate to try plain or baby yogurt, soft moist grains of brown rice, beans, avocado, tiny pieces of pasta cut up small, dissolvable puffs or teething crackers, and hummus. In the theme of “earlier is better” to avoid allergies, by 7-8 months old, your baby can try scrambled eggs (both yolk and white parts), tiny pieces of bread, chicken noodle soup, pieces of salmon, and most of the foods you are eating. There are prepared foods - stage 2 and 3 jarred foods (recommended for kids 6 to 9 months old), but it's always nice to make your own if you can. Meat, poultry, and fish are safe for young kids, as long as they can’t choke on it. The truth is by 8-9 months, your child's belly is really ready for a lot more than you think! Any healthy food they can't choke on is actually fair game!
Depending on your family history of allergies, you may feel like delaying seafood, eggs, nuts and berries – but a delayed introduction of foods does not decrease your child’s odds of developing an allergy, and it may actually increase it! While a strong reaction in a younger child may indeed look scarier, it’s ok to try giving all allergenic foods one at a time after 6-7 months of age. The child who does react at 6-7 months old, certainly would have also reacted at 12 months old. If you want to be on the safe side, give these allergenic foods in the morning (so you can bring her into the doctor's office if necessary), and have some children’s Benadryl on hand. Start with a tiny amount - just plain organic peanut butter touching the lips can be the first day, and progress slowly from there - a bit more each day. There are powders and different apps and companies can make it seem more methodical if you prefer, but a tiny amount of the actual food still seems best to me. After 3 days of her trying a new food, your baby has shown us she is not allergic! You can keep giving that food now, and start introducing more new ones! If you ever see a very strong reaction, such as hives all over and trouble breathing, this could be a sign of anaphylaxis, and you must go to the ER immediately.
Spice is ok for most kids – but not hot red pepper! Curry, cinnamon, and other spices are safe for kids, and every child’s taste buds are different, so in time you’ll learn your child’s palate. Don’t add salt, but sodium rich foods such as miso soup or veggie dumplings are fair game in moderation. Your baby will be joining your family, and your values in nutrition before you know it!
Table Manners
Kids will become quite manipulative of their environments in general, and at meal times this can lead to them throwing most of their food on the floor! You can ignore it or give your baby a stern look to indicate your disapproval, but this behavior is quite normal and hopefully won’t last very long.
When a baby turns her head to refuse a food, don’t believe she is done with that food forever. Return to it next week, and she may just accept it then. Make sure you make food fun for your child, and never force her to eat. Kids can develop many bad habits about food, and it starts at a young age. Unless your doctor is worried about the baby being underweight or having “failure to thrive” issues, you should remember that babies are people, too – people with preferences, and who will show signs when they are hungry and let you know when they are full.
Each baby is different, and some may be more difficult to feed than others. But try to remain positive about food, and the introduction of solids – and eating in general – will be a fun (albeit messy) endeavor! I support you and your choices and hope you enjoy the journey!