Starting solids is a fun and exciting time in your -- and your child’s -- life. So far, you’ve only had two choices: breastmilk or iron-fortified formulas. Now a whole new world of food possibilities is open to you. Most parents look forward to using the spoon with their baby, but there’s a lot of different advice out there, and recommendations are often changing. This can leave parents with many questions. Here are some easy to follow guidelines to help get your baby started on the path towards healthful eating.

When can I start my baby on solid foods?

You can introduce solids any time between 4-6 months if your baby is ready. For your child to be developmentally ready, he/she needs to be able to hold her/his head up and have lost the reflex to push things out of the mouth with his/her tongue. The American Academy of Pediatrics recommends exclusive breastfeeding for 6 months, but many parents will say that their babies seem interested and eager to eat solids before then. Until 6 months of age, the primary source of nutrition for your baby should be breastmilk or formula. It is okay to experiment with solid foods, but if you find that it is significantly decreasing your child’s breastmilk or formula intake, you should cut back. I encourage my patients to at least experiment with the spoon between 5-6 months, so that when your baby starts to need solid food as part of his/her nutritional composition, the spoon is not completely foreign.

What should I keep in mind when I start feeding?

First and foremost, this is supposed to be fun. So if you or your baby is uncomfortable, take a break and try again in few days. Solid food should always be given with a spoon, NOT in the bottle. Placing cereal in the bottle promotes obesity and requires cutting the nipples which can lead to choking risks. Sit your baby upright to prevent choking and start with small amounts. Finally, expect a mess!

Is there a perfect first food? Some say rice cereal, others oatmeal, and some say skip them and go right to fruit or veggies. What should I do? 

For most infants, you can start with any pureed solid food. While it's traditional in the United States to start your baby on solids with a single-grain cereal, there's no medical evidence to show that introducing solid foods in a particular order will benefit your baby. Many pediatricians now opt to start with oatmeal as there has been discussion of arsenic in rice. After starting cereals, you can introduce fruits and veggies, leaving about 3-5 days between new foods. This allows you to look for signs of a reaction such as skin or gastrointestinal symptoms (see below). At 6 months, you can start to introduce proteins into your child’s diet such as whole milk yogurt, chicken, beef, tofu, lentils and beans. At this age, all food should be pureed.

How do I know if my baby is having an allergic reaction?

Many children will get red cheeks after starting solids. This does not mean your child is having an allergic reaction. Often, the skin is sensitive to the food getting all over their skin. This is particularly common with acidic foods such as strawberries, citrus or tomatoes. A true allergic reaction would not be limited to the face but would involve the entire body. If you are not sure if your child had an allergic reaction to a particular food, check with your pediatrician.

How many times a day do I feed my baby during those first few weeks? How much?

Initially, most babies will only take a few spoonfuls at a sitting. Do not push your baby. Remember, the first few months are about practice and getting used to the spoon. You can try using the spoon 1-2 times a day from 4-6 months of age. After 6 months, you should start to feed your child regularly twice a day and then gradually add in a third meal to mimic a breakfast, lunch and dinner. You should allow your child to guide how much they eat. Your child will close their mouth or repeatedly hit the spoon away to signal that he/she is done. Once your child has shown you he/she is finished, then the meal time should end.

When can I start finger foods?

Once your baby can sit unassisted and bring food to her mouth, you can start finger foods. This usually occurs between 8-9 months of age. Fingers foods should be small (1/4 inch), soft and easy to swallow. Don’t fret if your child doesn’t have any teeth, all babies use their gums to chew on these foods. Some good finger foods are, but not limited to, cheerios or puffs, small pieces of well cooked vegetables or fruits, pasta, pancakes, small pieces of bread, or cheese.

What's the truth about allergens and food introduction?

There is no evidence that delaying introduction of certain foods reduces the incidence of food allergies in children. There are no current data available to suggest that introducing cow’s milk protein (except for whole cow’s milk), egg, soy, wheat, peanut, tree nuts, fish and shellfish into your baby’s diet needs to be delayed beyond 4-6 months of age. Therefore, you may include foods that are considered “more allergenic” once a few other foods (fruits and veggies) are tolerated. There is even some evidence that suggests early introduction of highly allergenic foods may, in fact, reduce the risk of development of food allergies. If your child has already had a food allergy diagnosed, or if he/she has recurrent wheezing or severe eczema, these guidelines may not apply to your child. If the above applies to your child, or you are not sure, your should discuss the introduction of allergenic foods with your pediatrician. Remember, these foods need to be pureed. Whole peanuts, tree nuts and other common choking hazards (grapes, raw carrots) (but not their ground formulations) carry a choking risk and should be avoided until your doctor feels they are safe.

What's a definite no-no in the first year?

It is very important that your child not be exposed to honey in the first year of life as this carries a risk of infant botulism.

Can my baby choke on puree foods? Do you think I should get CPR training?

It is highly unlikely that your child will choke on pureed foods, especially if given in small amounts. That being said, many parents do take infant CPR before they have their baby. I often recommend a refresher course when your baby is around 6 months of age, since this is when you will begin foods, mobility is on the horizon and children start to have the developmental ability to pick things up and mouth them.

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