Starting Solid Foods

When to begin starting solid foods, and a little history:

Starting solid foods. Beikost. What you would think would be straight forward is actually one of the biggest controversies in the new parent world. Why is that? Let’s start with a brief history starting around the mid 20th century:

A History Lesson:

Your grandmother or great grandmother may tell you about the first foods that she gave your parent at 4,3 or even TWO months old. Back then there were even pediatricians who were recommending solids as early as the first DAYS after birth. In the 40s, 50s and 60s this made more sense because most babies were formula fed. And formula often meant condensed milk with karo syrup, which does not have the variety of nutritional value that a newborn needs. This lack of nutrition from infant milk was combated by offering foods earlier. If mushy foods were offered before 6 months to train the baby, then by 6 months the baby was on table foods and off formula or breastmilk all together. Breastmilk nutrition was seen as inferior to food, and even inferior to the new rage of “clean” commercialized formula.

Graph: Age of Introduction to Infant’s First Foods

At the end of the 20th century, more research helped us recognize that the digestive system of an infant is not able to process foods well until around 6 months of age. Cereal was already the most popular first food for infants, so pediatricians recommended this “easy to digest” food as a starter food around 3 or 4 months until other foods could be introduced at 6 months. [More on this later.]

We now know better.

When to start solid foods:

Over the last 60 years formula is slowly changing to the nutritional standard that we would expect [it’s not all the way there yet but that’s another blog]. Also, in the U.S., pervasive formula marketing has been combated by organizations fighting for women and infant’s health. Breastfeeding is now recommended first and for longer. So supplemental foods are no longer necessary [if they ever were at all].

Today [and for a while actually] WHO, CDC and AAP all unanimously agree that ideally babies are exclusively fed breastmilk for the first six months of life. Secondary to breastmilk, formula should be offered exclusively for the first six months. Both provide the perfect balance of nutrition and hydration that baby needs not only to survive but to thrive. [We love Hipp/Holle formula]

So now you may understand a bit better about why you keep hearing about babies being fed solids at four or even three months old, while you read elsewhere that the recommendation is six months. [If you’re a research junky like me and want to read more in depth research about the topic I highly recommend In feeding in the 20th Century, The Journal of Nutrition.

Okay, so the bodies that oversee infant health have done the research and recommend waiting until my baby is six months old. But my pediatrician says 4 months. He knows my baby best and I should listen to him, right?

The Nightingales are not in a position to oppose a pediatrician’s recommendations. HOWEVER- I can tell you that I personally have as much [or more] formal education and background in infant nutrition than any typical pediatrician. Not all doctors stay up to date on the latest research and recommendations. Not all doctors like to change what they feel works for them.

I usually tell parents this: Pediatricians are EXCELLENT medical professionals. Top notch. We are so grateful for them keeping our babies healthy. There is so much medical knowledge crammed into their education that they can’t possibly be experts in every field. Pediatricians are not: lactation consultants, sleep consultants, developmental specialists, or nutritionists. They may not have accurate information about things like safe sleeping recommendations or car seat safety. And they may not be your best source for feeding information.

Your Baby might be ready for solid foods if all of the following is present:

• Baby can sit unassisted
• Baby shows interest in others eating
• Baby doesn’t tongue thrust foods out of the mouth [this is a safety/choking reflex that goes away as baby becomes ready to eat solid foods
• Baby is ready and willing to chew foods [even mush]
• Baby can physically pick up food and bring it to his mouth
• Baby is over 13lbs and double birth weight

What solids to start with?

Rice Cereal Right? Okay so you’re on board with waiting those long six months. Trust me, they have the rest of their lives to eat solid foods! And once you start buying or preparing baby foods you might wish you waited even longer, kidding…kind of.

The traditional first food in the US has been processed white cereal for some time. Thankfully, most agree that this is not an ideal first food and actually should not be offered at all. It has a high risk of arsenic, and low nutritional value. The processing of making rice into a powder also leads it to essentially digest as sugar. An organic oatmeal cereal is the most commonly recommended cereal to start with or in addition to other first foods.

It is also no longer recommended because of its contamination of arsenic. You can read more about that here.

But my baby has reflux and needs rice cereal!

In addition to the risks of starting solids before the GI system can handle it, thickening formula increases the risk of aspirating and the rice is taking the place of the infant milk’s calories. Try other options before you resort to this one. In some cases, baby may medically need a thickened bottle option. This is for a specialist to discern, not a family member or even your NCS.

*Controversial Opinion* It is well documented that waiting until six months, and choosing oats over rice are beneficial choices when starting solid foods for babies. In my opinion the evidence is just as strong to not choose grain as a first food choice. I will explain my reasoning, but ultimately leave you to make your own decision on this point.

Grain is filler. There is nothing that is in grain that isn’t accessible through other unprocessed foods. The vitamins in infant cereal are artificially added and only somewhat absorbed. The simple fact that grains cannot be digested uncooked/ in their natural form is enough for me to deduce that it is not an ideal first food for humans. Humans have only been eating grain for 10,000 years. That is not long enough for evolution to take place. Luckily most people can tolerate grains, and they can be integrated into diets in healthy ways. A little unbiased info here: Are Grains Good or Bad?

There are many sources that recommend babies not eat grains for the first year, or longer. One of the main reasons for this is that infants have low levels of pancreatic amylase. Amylase is what our body uses to digest starch [grain].

I also recommend processed grain not be a first food choice because it is sweet. There are strong positive associations with baby’s first trials with food. I personally would rather a child have fond memories of a vegetable than of a processed carbohydrate. Waiting a bit until a baby can eat whole oatmeal or gnaw on a toast corner is a more appropriate way to introduce grain, in my opinion.

So what foods ARE best to start with?

Vegetables and fats! Fruits are totally appropriate but I like offering at least 5 fats/vegetables first to prime baby’s taste buds. Fats are very important for baby’s brain development under age 2 and especially under age 1. Some families choose to mix grassfed butter or a high quality olive or coconut oil into their baby’s foods.

Mushed Baby Food Options [easily blended at home]]: Why these foods?

• Avocado
• Egg yolk [pasture raised, poached]
• Winter Squash
• Grass fed Yogurt [only if baby shows no sign of dairy intolerance]
• Peas
• Peanut butter [Recent research now recommends peanut butter be introduced as early as possible to prevent allergies.] national peanut board
• Organ Meats/ Broth [I know it sounds strange but it’s one of the most nutritionally dense foods out there. Did you know that some parents make formula from organ meats? Don’t do this if you are skeeved out! Bone broth is another, less “gross” option to many parents that can be offered to babies to benefit their developing gut.]

Baby Led Weaning Options: [More about this in our blog HERE]

• Avocado [in hand or mesh]
• Steamed carrot
• Steamed broccoli
• Scrambled egg
• Sweet Potato
• Banana
• Broth in a cup

How do I prepare foods for my baby?

If using blended foods, offer a stage 1 commercial baby food or a homemade very smoothly blended baby food mixed with formula or breastmilk for their first few days. You want there to be no lumps or bumps. [They’ll come a little later!]

Baby Led Weaning is a whole different story! Any food soft enough to mush between your fingers can be offered in pinch sized pieces or in french fry size strips. Allow baby to take their own bites and spit out too big bites naturally. Check out more recommendations here:The Dos and Don’ts of BLW

How do I introduce new foods? [More info at cdc]

Slowly. And one at a time. And about a half hour after a bottle/breast feeding. “Foods before one are just for fun.” Remember what we learned about how breastmilk/formula is the ideal food for your infant at this time of starting solids.

The first day you can start with a half a tbs of one food. If baby tolerates it well you can go up to a tbs for the next two days. On day four you can repeat with another food. [We only offer a new food every few days to wait and test for allergies. ] If baby has responded well to both types of foods you can slowly increase the amounts to whatever baby is comfortable eating. If feeding blended foods watch for your baby’s signs of fullness. They may turn their head away, stop opening their mouth for bites or generally start slowing down/hold food in their mouths.

After 2-4 weeks of successful solids, if your baby is still intaking enough oz of their milk source, they can eat to satiety. While breastfeeding a baby can drink as much or little as he pleases. He decides when he is full. This is nature’s way. I recommend that parents try to mimic this with solid foods. If your baby is bottle fed, it’s especially important for your baby to begin to have control over his intake. It has been linked to healthier eating habits later on in life.

Some babies take to solids quickly and begin to want to drink less milk. Generally this is okay as long as the baby is eating nutritious foods and drinking at least 24oz of breastmilk or formula in a given day.

What foods should NOT be offered before age 1:

• • Honey
  • Milk other than formula/breastmilk

Troubleshooting:

Oh my gosh my baby is miserable! He is constipated and gassy! Or has explosive bms!

It’s actually super common for babies to have an adjustment period when solids are introduced. They’ve only ever had milk before so it’s all very new to them. If yogurt or wheat or a high allergen food was introduced it’s possible it’s a sensitivity or intolerance. And if broccoli or a cruciferous vegetable was introduced it’s possible that has attributed to some of the gas.

You can cut back on the solids a bit and try again more slowly next time, offer some pears to get things going, or offer an oz or two of water a day to help combat future constipation. Do not offer juice for constipation. Juice is not necessary or recommended for infants under age 1 [AAP]. [And <4oz as a treat after age 1.]

My baby doesn’t like the food you recommended? Should I only offer foods he’ll eat?

Babies often need to be offered the same food 6-16 times before they accept it. It’s an evolutionarily protective mechanism to keep them safe from being poisoned. The more foods you can offer and have baby love before he learns to walk, the greater your baby’s food vocabulary will be! [Babies become wary to try new foods between ages 1.5-4! Another fun evolution trick called neophobia.]

My baby is over 6m and not eating solids!

Food before one is just for fun. If baby is getting enough bm or formula to be satisfied it isn’t a big deal. Just keep offering without forcing. If your baby is 9 months plus and still not interested in solids, or not able to chew/swallow foods, your pediatrician may recommend your baby see a feeding specialist. In the US Early Intervention offers in home OT and PT for infants and toddlers 0-3 for little or no cost!

So to recap:

After 6 months and checking off the check-list, you can start baby on nutritious foods like fats, vegetables and fruit!