When do we start?
The recommended time to start solid foods is between 4 and 6 months old. There is growing evidence that this 2 month period of time is an “immunogenic” window of opportunity. During this time frame food allergies are both unlikely to appear, and also possibly prevented. Early and repeated exposure to foods, especially common allergens, can get the immune system used to the food and lower the likelihood of allergies developing.
Your infant may be ready to try solids if (s)he:
- has good head and neck control
- maintains supported seated posture in high chair or comparable seat, or on parent’s lap
- opens mouth in anticipation of food
What about exclusive breastfeeding until 6 months old?
Exclusive breastmilk until 6 months remains a recommendation from a nutritional standpoint. For the first 6-9 months of life babies should be receiving all the calories and nutrients they need to thrive from breastmilk, formula or both. That said, complementary solids can be safely introduced in a way that does not affect infant’s appetite for milk.
How do we start?
As mentioned above, we do not want babies to drink less breastmilk or formula as a result of filling up on solids. Pick a time when your baby does not typically nap or go to sleep directly after nursing or taking a bottle. Wait 30-60 minutes after that feeding, and put a small amount of food on their tongue. Be sure to have your phone camera ready for adorable photos and videos of their confused and potentially excited faces.
Start with a maximum of once per day, but know that “food before one is just for fun.” You need not stress if the busyness of the day prevents you from giving solids on a given day during the first couple months of trying. Some babies take right to it, others are very hesitant or resistant. Several studies have shown it may take 5-10 tries of a particular food for an infant to accept it. Remain positive, patient and persistent (Dr. Shreve’s 3 P’s!). After a month or two of success increase to twice per day. We typically encourage parents to increase to three times per day around 9 months old.
Cereal, pureed foods, or baby-led weaning. Where do we start?
Rice cereal has been the traditional “first food” through the years. It has a low likelihood of causing allergic reaction, is iron-fortified (which helps protect babies from developing anemia), and possibly provides a fullness that helps babies sleep longer. Rice cereal has lost some favor in recent years, however. It can cause constipation and has been linked to absorbed heavy metals such as arsenic from soil and manufacturing equipment/processes.
Pureed fruits and vegetables are readily available at stores, or are often relatively easy to make. They are often rich in fiber and natural sugars that may help to prevent or manage constipation. Most are also rich in vitamins. Typically vegetables and the “P” fruits (e.g. peaches, pears, plums, prunes) are good for softening the stool, whereas applesauce and banana may be binding (if you have a diarrheal illness).
“If you give fruits before vegetables, they’ll never learn to like vegetables” is a wives tale. Many find it helpful to find a sweet fruit their infant will accept, then mix some vegetable with it to make it more palatable.
Baby-led weaning is an approach geared more toward giving whole foods, and letting the baby explore. It may be soft, ripe banana, or avocado, or some other food on the parent’s plate. This approach is ok as long as the size and texture of the food does not pose a choking hazard to baby.
Pick an approach or combination of approaches that is most intuitive to you as a parent. Contrary to what you will hear on social media, or read online, there is no single best way. If you’re not sure, don’t hesitate to ask your PAR doctor or NP at the 4 month check-up.
How often should we try new foods?
We recommend waiting 3-4 days in between trials of new foods in the first couple months of solid food introduction. This allows us to more easily pinpoint the culprit should any form of reaction, such as rash, develop. Once a baby has done well for a few days with a given food, you can continue it while adding a new one.
What about those common allergens like dairy, eggs, soy, wheat, peanuts, nuts, fish and shellfish?
As noted above, research has shown a seemingly favorable window of time between 4-6 months old when we can prime the immune system to get used to, and not overreact to these foods. While we don’t recommend picking any of these as the absolute first food, it is ok to progressively add them into the mix. Dairy can be introduced as a dab of full fat yogurt. Egg can be introduced in the form of scrambled egg. Nut butters can be mixed with a little breastmilk or formula and whipped to a thinner consistency. There are also nut powders that can be thickened with a little breastmilk or formula. Flaky fish and shellfish should wait until your baby is more experienced with gumming/chewing and swallowing.
Which babies should consult with an allergist before trying highly-allergenic foods?
Babies with severe eczema or a first-degree relative with an anaphylactic food allergy should consider consulting with an allergist before introducing those foods.
Should I have Benadryl in the house as we’re introducing foods, just in case?
It is not essential, but also not a bad ideal to keep children’s (liquid) Benadryl on hand. You should contact our office prior to giving it, however, to ensure (1) it’s necessary; (2) proper dosing; and (3) to be educated on possible side effects for which to monitor.
Anything else I need to know as a parent?
If at any point before 9 months old your child is breastfeeding or taking bottles with less frequency or less volume due to being full from complementary solids, you should back off. Through 9 months old infants should be getting essentially all their calories and nutrients from their breastmilk and/or formula. Between 9 and 12 months old we start the transition process to a more food-centric diet, but not before then.