Starting Solid Food

The AAP and PAMPA recommend exclusively breastfeeding infants until the age of 6 months.

Important: No solids (including rice cereal) should be added to bottles unless prescribed by the doctor or nurse practitioner for treatment of swallowing problems or gastroesophageal reflux.

How to decide when your baby is ready for solid food:

1. Infant is approaching 6 months of age and has good head control

2. Infant sits alone or very well with minimal support

3. Infant shows interest in parental foods and eating habits

4. Infant opens mouth for spoon and doesn’t push out spoon with tongue

Reasons to delay starting solids:

1. Frustrating feeding difficulties result from immaturity. If solids are started too soon, infants are likely to tongue thrust and push food outward. This action decreases with age.

2. Introduction of solid foods earlier than 4 months of age has been related to increased risk of obesity.

Starting Solids:

Most parents begin with an evening feeding, adding meals as infants show more hunger and age gets closer to nine months. Traditionally, dry, fortified infant cereal has been recommended as the first food, followed by stage 1 vegetables and fruits. Introducing these foods in any order is fine, including strained meats which are a good source of iron – an important nutrient at this age. To more easily recognize a food intolerance or allergy, only introduce one new food at a time.

Initially, single grain cereals should be mixed with breast milk or formula and be relatively thin (1/2–1 tablespoon per ounce of liquid). As the baby eagerly eats and swallows with minimal gagging, the consistency of cereal may be thickened and you can advance to stage 2 foods. Once infants are able to pick up pieces of food in a pincer (thumb and index finger) grasp, they may try some finger foods. This is usually around 8–9 months. Infants do not have molars to grind and chew these foods but can compress them between their gums. Foods that they can easily smash can also be easily chewed with their gums. Such foods may include Cheerios, pieces of banana or other soft fruits, well cooked vegetables and small pieces of starch (i.e.- bread, pasta). You may also introduce yogurt and pasteurized cheese at this time. Pureed combinations of fruits and vegetables in pouches are very popular and easy to feed on the go. Please review the contents carefully as many of these are very sweet – infants need to learn to enjoy the taste of vegetables on their own as well.

Choking Hazard Foods

Any food that is small, hard and round is a choking hazard until age four years. Please especially avoid: nuts, hotdogs, tough meats, popcorn, raisins, raw carrots, whole grapes and hard candies.

Introducing the more allergenic foods – i.e. – peanut butter, tree nut spreads, eggs, dairy, soy and fish:

Eating a wide variety of foods is important for good nutrition. Foods considered as higher allergy risk can be started as soon as you start other solids. For choking reasons, sticky peanut butter and other nut spreads should be mixed into other foods initially. If you have a concern for food allergies in your baby due to a reaction to a food or due to other medical history (i.e. – eczema, asthma), please discuss these concerns with your PAMPA provider.

Water:

Water can be given in a sippy cup starting at age 6 months. Water intake should be limited to 4-8 ounces per day for infants younger than 12 months of age. Infants do require fluoride for tooth enamel development so tap water should be used to prepare formula and foods. Most bottled water does not contain fluoride unless specifically marked on the label.

Juice and sweetened drinks:

PAMPA and the American Academy of Pediatrics do not recommend juice and sweetened beverages at any age. These beverages are essentially sugar water and provide little to no nutrition. Offer a variety of fruits and vegetables instead! Drinking sweetened drinks becomes a habit that is hard to change. Infants and children who drink these beverages regularly are at risk of developing obesity and tooth decay.

Reminders for parents:

1. Mealtime should be pleasant – make eye contact, smile to reward your baby for trying new foods, and try to avoid "meal time battles".

2. Respect your baby’s appetite – let him/her decide when the meal is done. Your baby will show this by turning her head, firmly closing her lips, or throwing the food on the floor.

3. Breastfeed or use iron-fortified formula for the first 12 months. After age 6 months, 24-32 ounces a day is adequate for formula intake.

4. Remember that stool color, consistency and frequency may change with dietary changes.

5. Begin to offer a cup by 6-9 months. Initially, your baby may only play with it but will gain skill with practice.

6. Feel free to make your own baby food. Do not add salt or sugar.

7. Wait until 12 months of age to begin whole vitamin D milk or honey.

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PAMPA is a pediatric medical practice in north Atlanta, Georgia consisting of twelve pediatricians, five nurses,
and four locations in Roswell, Woodstock, Atlanta, and Marietta. area.
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