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Starting Solid Foods in Infants

By Deborah M. Consolini, MD, Assistant Professor of Pediatrics;Chief, Division of Diagnostic Referral, Sidney Kimmel Medical College of Thomas Jefferson University;Nemours/Alfred I. duPont Hospital for Children

The time to start solid food depends on the infant's needs and readiness. Generally, infants need solids when they are large enough to need a more concentrated source of calories than breast milk or formula. This need is recognized when an infant takes a full bottle and is satisfied but then is hungry again in 2 or 3 hours or is consuming more than 40 ounces of formula per day. This typically occurs by the age of 6 months. Many infants take solids after a breastfeeding or bottle-feeding, which both satisfies their need to suck and quickly relieves their hunger. Infants younger than 4 months of age do not need solid food for nutrition, cannot easily swallow solid food, and should not be force-fed with a spoon or by mixing baby food with formula in a bottle. The introduction of solid food before 4 months of age may cause food allergies and celiac disease.

Infants develop food allergies or intolerance easier than older children or adults. If many different foods are given in a brief period, it is difficult to tell which one may have been responsible for a reaction. Because of this difficulty, parents should introduce new, single-ingredient foods one at a time, about every 3 to 5 days. Once it is clear a food is tolerated, another one may be introduced.

Single-grain cereals (such as iron-fortified rice cereal) are often begun first, followed by a variety of pureed fruits, vegetables, and meats. Doctors no longer think it matters in what order these foods are introduced. When starting a new food, it may take several tries over a period of weeks before an infant starts to enjoy a new food, so it is important for parents to not give up after the first or second try if the infant does not seem to like a particular new food.

The food should be offered on a spoon so that the infant learns the new feeding technique. By age 6 to 9 months, infants are able to grasp food and bring it to their mouth, and they should be encouraged to help feed themselves. Pureed home foods are less expensive than commercial baby foods and offer adequate nutrition. However, commercial preparations of carrots, beets, turnips, collard greens, and spinach are preferred for infants who are under age 1 year because they are screened for nitrates. High nitrate levels, which can cause methemoglobinemia (a disorder that affects the blood's ability to carry oxygen) in young children, are found in vegetables that are grown using water supplies contaminated by fertilizer.

Although infants enjoy sweet foods, sugar is not an essential nutrient and should be given only in small quantities, if at all. Sweetened dessert baby foods have no benefit for babies. Juice is a poor source of nutrition, contributes to cavities, and should be limited to 4 to 6 ounces a day or avoided altogether.

Foods to avoid include

  • Honey (until age 1 year) because it may contain the spores of Clostridium botulinum, which are harmless to older children and adults but can cause botulism in infants

  • Foods that can easily cause choking or be inhaled (until age 2 or 3 years), including whole nuts, hard candies, soybeans, popcorn, hot dogs, meat (unless it is pureed), and grapes (unless they are cut into very small pieces)

To prevent food allergies from developing, many parents have avoided giving their infant eggs, peanuts, and wheat. However, recent evidence suggests that introducing these foods early might actually help protect against the development of food allergies. The evidence is not final, but, for most infants older than 4 months of age, parents do not need to wait before introducing any specific solid food. However, only one new food should be introduced every 3 to 5 days to make sure the food is tolerated. Recent evidence suggests that feeding infants peanut-containing products early on in life (between 4 months and 11 months of age) should be recommended because delaying the introduction of peanuts may actually increase the risk of developing a peanut allergy. Exceptions to this may be infants who have severe eczema and an egg allergy or who have older siblings who have a peanut allergy. These children may need skin tests before they eat peanuts. Parents should discuss with their pediatrician when and how to introduce various solid foods.

At or after age 1 year, children can begin drinking whole cow's milk. At age 2 years, children can switch to reduced-fat milk because their diet essentially resembles that of the rest of the family. Parents should limit milk intake to 16 to 24 ounces a day in young children. Children who drink too much milk may not get enough nutrients from other important foods and may develop iron deficiency.

By about age 1 year, the growth rate usually slows. Children require less food and may refuse it at some meals. To determine how much their child is eating, parents should review how much their child has eaten over the course of a week rather than at a single meal or during a day. Underfeeding of solid food is only a concern when children do not meet expected weight percentiles at a steady rate (see Figure: Weight and Length Charts for Infants from Birth to 24 Months of Age).