In the next month, we’ll be updating our posts on baby basics. As we said to Robin Young on NPR’s Here and Now, “a lot of life’s issues all boil down to the essentials of life…eat, sleep, drink, pee, poop and love.” Over the next month we’ll be giving you ideas and updates on all of those essentials. We start off with “eat” and how to transition your baby to solid foods:
While starting your child on solid food isn’t always “love at first bite” it also does not have to be complicated or stressful.
Here are some overriding principles to keep in mind when feeding your baby:
1) It’s not just about the food. It’s about teaching your child to eat when hungry and to stop when not hungry.
2) Eating a meal with family is social as well as nutritious. Keep eating pleasant and relaxed. No need to force-feed or trick your child into eating. Feed your baby along with other family members so your baby can learn to eat by watching others eat.
3) Babies start out eating pureed foods on a spoon between 4-6 months and progress to finger foods when physically capable, usually between 7-9 months. Teeth are not required; hand to mouth coordination is required.
Before four to six months of age, a baby slumps when propped in a sitting position and tends to choke on solids. After four months, babies are less likely to reflexively “tongue thrust” food right back out of their mouths. Putting cereal into a bottle doesn’t count as “eating” and is not necessary.
Timing matters when offering solid food for the first time. Babies learn to expect a breast or a bottle when hungry. So make sure your baby is happy and awake but NOT hungry the first time you feed her solid food because at this point she is learning a skill, not eating for nutrition. You should wait about an hour after a milk feeding when she is playful and ready to try something new. Keep a camera nearby because babies make great faces when eating food for the first time. Many parents like to start new foods in the morning so that they have the entire day to make sure it agrees with their baby. Watch for rash or stomach upset.
What should you feed your baby first? There is no one right answer to this question. The easiest food to offer is one that is already on the breakfast, lunch, or dinner table that is easy to mush up. In some cultures, a baby’s first food is a smash of lentils and rice. In other cultures it’s small bits of hard-boiled egg or a rice porridge. Just avoid honey before one year of age because honey can cause botulism in infants. The bottom line: it doesn’t matter much what you start with, as long as it’s nutritious. Dr. Kardos is proud to say that she fed her nephew his first solid food this summer: watermelon! (He loved it). Even if you start with a mashed up banana or a yam, plan to add iron-containing foods sooner rather than later. Pediatricians recommend a diet with iron-containing solid foods because a baby’s iron needs will eventually outstrip what what she stored from her mother before birth as well as what she can get from breast milk or formula. Iron-containing food include iron-fortified baby cereal (such as oatmeal or rice) and pureed meats (such as chicken, beef or fish). Note, with baby cereals, make them up with formula or breast milk, not water or juice, for more nutritional “oomph.”
Some babies will learn in just one feeding to swallow without gagging and to open their mouths when they see the spoon coming. Other babies need more time. They may tongue-thrust the food back out, cough when trying to swallow, cry, or appear clueless when the spoon comes back to them. To avoid the tongue-thrust reflex or the gag reflex, place the spoon gently to one side of your baby’s tongue during a feed. If you see your baby is distressed, just end the meal. Some babies take several weeks to catch on to the idea of eating solids. Try one new food at a time. Then, if your baby has a reaction to the food, you’ll know what to blame.
Some babies just never seem to like mushed up foods and prefer to suck on foods at first (like Dr. Kardos’s nephew did with his watermelon). One practice called baby-led weaning describes another way of introducing solids.
Stage one and stage two baby foods are similar. No need to test all stage one foods before going onto stage two. The consistency of the food is the same. The stages differ in the size of the containers and stage one foods do not contain meat. Some stage two foods will combine ingredients. Combinations are fine as long as you know your baby already tolerates each individual ingredient (i.e. “peas and carrots” are fine if she’s already had each one alone). Avoid the dessert foods. Your baby does not need fillers such as cornstarch and concentrated sweets.
Not all kids like all foods. Don’t worry if your baby hates carrots or bananas. Many other choices are available. At the same time, don’t forget to offer a previously rejected food multiple times because taste buds change.
Be forewarned: poop changes with solid foods. Usually it gets more firm or has more odor. Food is not always fully digested at this age and thus shows up in the poop. Wait until you see a sweet potato poop!
By six months, babies replace at least one milk feeding with a solid food meal. Some babies are up to three meals a day by 6 months, some are eating one meal per day. Starting at six months, for cup training purposes, you can offer a cup with water at meals. Juice is not recommended. Juice contains a lot of sugar and very little nutrition.
Offer finger foods when your baby can sit alone and manipulate a toy without falling over. When you see your baby delicately picking up a piece of lint off the floor and putting it into his mouth, he’s probably ready. Usually this occurs between 7-9 months of age. Even with no teeth your baby can gum-smash a variety of finger foods. Examples include “Toasted Oats” (Cheerios), which are low in sugar and dissolve in your mouth eventually without any chewing, ½ cheerio-sized cooked vegetable, soft fruit, ground meat or pieces of baked chicken, beans, tofu, egg yolk, soft cheese, small pieces of pasta. Start by putting a finger food on the tray while you are spoon feeding and see what your child does. They often do better feeding themselves finger foods rather than having someone else “dump the lump” into their mouths.
Children should always eat sitting down and not while crawling or walking in order to AVOID CHOKING. Also, you don’t want to create a constantly munching toddler who will grow into a constantly munching ten year old.
Finger food sample meals: Breakfast: cereal, pieces of fruit. Lunch: pasta or rice, lentils or beans, cooked vegetables in pieces, pieces of cheese. Dinner: soft meat such as chicken or ground beef, cooked veggies and/or fruit, bits of potato, or cereal. need other ideas? Check out this post on finger foods. By nine months, kids can eat most of the adult meal at the table, just avoid choking hazards such as raw vegetables, chewy meats, nuts, and hot dogs. You can use breast feedings or formula bottles as snacks between meals or with some meals. By this age, it is normal for babies to average 16-24 oz of formula daily or 3-4 breast feedings daily.
Avoid fried foods and highly processed foods. Do not buy “toddler meals” which are high in salt and “fillers.” Avoid baby junk food- if the first three ingredients are “flour, water, sugar/corn syrup”, don’t buy it. We are amazed at the baby-junk food industry that insinuate that “fruit chews,” “yogurt bites” and “cookies” have any place in anyone’s diet. Instead, feed your child eat REAL fruit, ACTUAL yogurt, and healthy carbs such as pasta, cous-cous, or rice.
Organic and conventional foods have the same nutritional content. They differ in price, and they differ in pesticide exposure, but no study to date has shown any health differences in children who consume organic vs conventional foods. For more information, see this American Academy article and this study as well as our own prior post about organic vs conventional foods.
A word about food allergies: Even the allergists lack a definitive answer of what makes a child allergic to a food, and the American Academy of Allergy, Asthma, and Immunology now recommends offering foods, including the more “allergic” foods, early to avoid later food allergy. This is a change from recommendations issued about 15 years ago. For safety concerns, if a household member has a life threatening allergy to a food, continue to avoid bringing that food into the house to ensure the safety of the allergic person. However, if no one at home has a peanut allergy, then a thin spread of peanut butter on a bit of toast or cracker is safe for your finger-feeding baby. Focus more on avoiding choking hazards than on avoiding theoretically allergenic foods.
And a word about fish: For years, experts fretted about pregnant women and children exposing themselves to high mercury levels by eating contaminated fish. However, the realization that fish is packed with nutrition, and the data that show only a few types of fish actually contain significant mercury levels, now leads the FDA to encourage fish intake in young children and pregnant women. Please check this FDA advice for specific information about which fish to offer your child and the nutritional benefits of different kinds of fish.
Julie Kardos, MD and Naline Lai, MD
©Two Peds in a Pod®
Updated from our original 2009 post