Kim Arrington Johnson in BabyParenthood

Starting Solid Foods

The AAP recommends that babies be exclusively breastfed for the first six months of life while introducing solid foods around age six months. Most healthy babies will not need additional foods until that time. Some parents choose to introduce solid foods between ages four and six months, or when baby shows signs of readiness, while others may delay solids to eight or nine months.

The AAP recommends that babies be exclusively breastfed for the first six months of life while introducing solid foods around age six months.

Age four months or older

Signs your baby may be ready to start solid foods:

Baby is at least four months old with good head control and the ability to sit up supported.
Baby shows interest in watching others eat.
Baby’s tongue-pushing reflex has subsided.
Your pediatrician gives the okay to start solid foods.

Signs your baby may not be ready to start solid foods:

Baby is four to six months, doing well, and sleeping through the night on formula or breast milk alone.
Baby cries or turns away from your attempts to feed solid foods.
Baby spits out cereal or food given to him, beyond the first few feedings.
Baby cannot sit up by himself supported, such as in a high chair.

Did You Know?

Concerns about Rice Cereal and Arsenic

Just a few years ago, doctors recommended rice cereal as an infant’s first food because it was the most hypoallergenic cereal. However, in 2012 Consumer Reports published an article about the contamination of rice cereal entitled “Arsenic in Your Food,” and the FDA launched its own investigation into the arsenic content of rice and rice products. The cause for alarm was due to a problem within our own domestic food supply, as a large portion of the cotton belt in the U.S. south has been converted to rice production. Cotton fields historically received arsenic-based pesticides, and once those fields are flooded to make rice paddies, the arsenic floats right into the crop. The AAP advises parents to feed their infants a variety of first foods, including vegetable purees and cereals made from grains other than rice, to reduce exposure to environmental toxins in any single food.

Four to six months

Cereals: single-grain cereal, such as oatmeal cereal

If baby is thriving on breast milk or formula only, there is no need to feed cereal at four months. At this age, baby should be nursing or feeding roughly four to six times per day with six to seven ounces in each bottle.
If you choose to start solid foods, mix a single-grain cereal with breast milk, formula, or water. I recommend starting with oatmeal, since it is sweeter. This should also alleviate concerns about arsenic in rice cereal. Moreover, I would not fret about introducing baby to the “industrial food complex” with boxed cereal. This iron-fortified food is milled to the finest grain, and you will use it for a short time. All of baby’s other foods, such as vegetables, fruits, and meats, can easily be homemade. If you choose not to use prepared cereal, puree a lean meat for iron.
Use your finger as baby’s first spoon. It is soft and just the right temperature. Then work up to a utensil.
Give cereal once per day. Some pediatricians recommend morning feedings, so that if baby is allergic to a food, the digestive upset should wear off by the end of day. As a mom, I prefer evening feedings, hoping that baby will feel more satisfied and sleep through the night.
Feed one tablespoon the first day, increasing to three tablespoons per serving. Your baby’s first cereal will be soupy and mostly liquid.
Wait three to five days before introducing a different type of cereal.
Be patient. Baby is learning the feeding process, and it can be messy. He may only ingest a very small amount. Solid foods should be considered “an extra” to breast milk or formula at this point.

Five to six months

Vegetables: sweet potatoes, squash, carrots, green beans, peas, avocadoes

Puree your own vegetables with filtered tap water, or use “Stage 1” prepared foods. Food pouches are handy for travel; however, they are typically sweeter than homemade blends.
Add plenty of water when pureeing steamed vegetables and fruits at home. This will help baby digest foods more easily.
Introduce new foods one variety at a time. One serving is typically two to four ounces (one-half to one full jar). Wait three to five days between each food. Note any allergic reactions: severe gassiness, red rash on the face, red rash around the anus, diarrhea, runny nose, watery eyes, and/or vomiting.
Don’t be too rigid with insisting that baby eat green vegetables first. Breast milk is naturally sweet, and baby’s tongue has more sweet buds than others, explaining why a jar of green beans may not be a gourmet hit. Sweeter veggies, such as sweet potatoes and carrots, often work best for first feedings.
Once baby has mastered her eating routine, feed her a variety of foods. Evidence is growing that exposing infants to many different types of foods may reduce the risk of food allergies.

Six months

Fruits: apples, pears, bananas, prunes, peaches, berries, apricots

Puree steamed or cooked fruits in a blender. By six to eight months, some infants are eating two small meals per day. A typical schedule may include one meal of cereal and pureed fruit in the morning and one meal of pureed vegetables in the evening.
Consider introducing frozen plain bagels or teething biscuits, especially if baby is experiencing teething pain. Let baby practice gnawing, chewing, and eating independently.
Introduce water in a sippy cup. Give water with solids to aid digestion. Let baby practice drinking independently.
If your baby is constipated from her new diet, add a small amount of pureed prunes, pears, or apricots to her cereal. If your infant’s stools are runny, consider a more binding fruit and cereal combination, such as bananas and oatmeal.
If baby develops a new, unexplained diaper rash, assess the acidity level of fruits introduced. Pears are a low acid fruit, while citrus, berries, and prepared fruits with ascorbic/citric acid added can affect sensitive babies.

Seven to twelve months

Meats: turkey, lamb, chicken, pork, beef

Beans/legumes: lentils, chick peas, black beans, pinto beans

Processed dairy products: cheese, yogurt (plain or Greek style), cottage cheese

Other protein sources: salmon, tofu, eggs

At this age, blend baby’s favorite proteins and veggies together and try seasonings. Stage three prepared foods are also okay, although the meat ones are disgusting. Taste for yourself.
Baby is now typically eating two to three meals per day.
Typical formula or breast milk intake at this time is 24 oz. or three to four feedings per day, roughly 50% of baby’s caloric intake.
Be careful not to fill baby up with too many snack foods while preparing healthier foods. If baby is fussy while you are steaming her food, try handing her a toy and not a handful of puffs.
Feed baby blended meats in stages. Lamb and turkey are easiest to digest, followed by pork and chicken. Beef is the most difficult to digest.
Allow plenty of soft, finger foods. Anything that can be compressed between your baby’s thumb and forefinger is the appropriate size and consistency. Fresh, ripe fruit and soft, steamed veggie pieces are significantly cheaper than pouches of baby food.
For convenience, feed baby ripe avocados and bananas, which require no prep. You can also use frozen organic vegetables, with a longer shelf life, to ease your shopping burden.
For on-the-go snacks, try organic puffs, O-shaped cereal, freeze-dried fruit, and yogurt melts broken in pieces. Cut up blueberries and finely grated ripe fruits are also a favorite snack.
Continue to give water in a sippy cup, especially when finger foods are introduced. Hand baby his own spoon for distraction while you feed him healthy foods.
Do not feed your infant hot dogs, grapes, nuts, seeds, popcorn, raw fruits and vegetables, or peanut butter, as these foods may cause your child to choke.
Consider taking a CPR and first aid for choking class for infants through the American Red Cross. If a class does not fit into your busy schedule, watch an infant choking and CPR video online.

Starting solids: AAP guidelines for introducing allergenic foods (confusion)

There is a reason for confusion with this issue. In 2000, the American Academy of Pediatrics (AAP) issued guidelines stating that parents should delay the introduction of milk and dairy until age one, eggs until age two, and peanuts, tree nuts, shellfish, and fish until age three. Then in 2008, the AAP retracted their position stating there was not enough evidence to support a delayed introduction of allergens since food allergy prevalence remained on the rise. Beyond that, there were no specifics offered. In 2013, the American Academy of Asthma, Allergy and Immunology (AAAAI) with AAP input issued the following official recommendations for infant feeding:

Do not delay the introduction of allergenic foods, such as wheat, cow’s milk dairy, eggs, nuts, and fish, as this may actually increase risk of food allergy or eczema.
Once an infant is older than four months and has tolerated several non-allergenic foods, such as oatmeal, sweet potatoes, carrots, bananas, apples, and pears, parents can proceed with the introduction of more allergenic foods, one food at a time. Allergenic foods should be given every three to five days to help isolate triggers of an allergic reaction. Ideally, allergenic foods are to be introduced at home, rather than at day care or a restaurant.
If you are pregnant or lactating, you do not have to avoid foods such as milk, eggs, and peanuts, since no protective benefit against food allergy has been found.
Cow’s milk or whole milk should not be added to a child’s diet until age twelve months.

In March 2019, the AAP updated its recommendations to focus specifically on children who are at risk for a food allergy. “Those recommendations focus on a high-risk population—infants with severe atopic dermatitis and/or egg allergy—who are advised to introduce infant-safe forms of peanut as early as 4-6 months, in specified amounts, with consideration of pre-testing to rule out allergy. The guidelines recommend that infants with mild to moderate eczema be introduced to infant-safe peanut-containing foods as early as 6 months of age, and those without food allergy or risk factors do so when age appropriate and depending on family preferences, i.e., after 6 months of age if exclusively breastfeeding.”

Did You Know?

Concerns about Nitrates and Homemade Baby Food

Has someone told you not to feed baby homemade carrots cooked at home and only to feed them what comes in a jar because of nitrates? This issue needs some clarification. Nitrates are a chemical found in water and soil, and the nitrate reaction of concern is called methemoglobinemia, a rare form of anemia that most often occurs when formula is mixed with water containing nitrates, particularly well water (usually due to synthetic fertilizer runoff). Some vegetables also contain nitrates, such as beets, carrots, green beans, spinach, and squash. Therefore, AAP guidelines state that parents should not feed nitrate-containing vegetables to babies under three months old. To note, the age restriction occurs before the age recommendation for starting solid foods. Therefore, do get your well water tested and make sure that the nitrate concentration is less than 10 ppm, but do not choose jars of prepared foods over fresh foods after age three months.

Starting solids: serving tips

Once you have blended baby’s food, put a small portion of the contents into a separate feeding bowl. Do not feed baby from the blender container.
Strain baby’s first purees through a metal strainer, such as a flour sifter, if you are not using a high-powered or professional grade blender.
Do not heat baby food in plastic, due to the leaching of chemicals. Use small glass prep bowls or ramekins for heating and re-heating.
Serve food no warmer than body temperature. Test for temperature on your wrist before feeding.
Add flavorful seasonings to baby’s food, but there is no need to add salt or sugar.
Do not sweeten baby’s food, especially with honey or corn syrup, which can cause botulism or food poisoning.
Store unused portions in the refrigerator. Use within two to three days. Do not feed your infant food left out of the refrigerator for more than two hours.
Make large batches of homemade baby food at night or on weekends. Pour homemade purees into ice cube trays, freeze, and transfer cubes into an airtight freezer bag. Fruits and veggies can last six to eight months as frozen cubes, while meat, poultry, and fish can last one to two months.
Use a brush to clean blender blades. Harmful bacteria can be present in old food particles and may contaminate other foods.
If baby’s messy feedings are driving you crazy, seek help from convenient products: a handy bib, a floor mat, a cordless sweeper, or a bowl with a suction cup. Try a fun novelty spoon to hand baby, so that he will not swat at your spoon during feedings, such as a Nuby Sound Bites spoon, or a pair of chopsticks for kids.
Breastfeeding mothers who work outside the home often find that feeding solid foods may be easier for a caregiver to do during the day. Then Mom can focus on breastfeeding during the evenings and at night, making mealtime simpler while keeping up Mom’s milk supply.

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Next Read: Starting Solid Foods: Food Allergies »

Kim Arrington Johnson: