Introducing Solid Foods: When, What and How
During a four- or six- month checkup, I expect the question, “Doctor, when should I start solid food?” One day I decided to take the initiative and ask an experienced mother of six, “How do you know when to begin giving your baby solids?”
“When he starts mooching!” she replied.
“Mooching?” I asked, a bit surprised.
“Yes,” she went on to explain. “I wait for signs that he is interested. I watch him watch me eat. When his eyes follow my food as I move it from my plate to my mouth, when his hands reach out and grab my food and he is able to sit up in a high chair and join us at the table, I know it’s time for the fun of solids to begin.”
By her own experience, this wise mother discovered a basic principle of introducing solid foods – feed babies according to their own developmental skills rather than a preset calendar or clock Babies’ appetites and feeding skills are as individual as their temperaments. Let’s feed them that way.
Over the past ten years infant-feeding practices have changed – for the better. No longer do we feed babies according to the calendar, stuffing cereal into the reluctant six-week-old and feeling we have failed if baby has not taken a full-course meal by six months. Today, infant feeding involves matching good nutrition with individual developmental and intestinal readiness, which varies widely from baby to baby. Reading the feeding cues of your baby, introducing solid foods gradually, and encouraging self feeding all lead to that important principle of baby feeding: creating a healthy feeding attitude.
We have put the latest nutritional research on infant feeding together with what we have learned throughout twenty-five years of feeding infants in our practice, and our own experience in feeding our eight babies. In this and the next two chapters we wish to present a style of infant feeding that will help you become more nutrition savvy, better enjoy feeding your infant, and have happier, healthier babies.
You and your three-month-old are comfortably breastfeeding or bottle-feeding, and baby certainly seems to be getting enough to eat. Now comes the daily phone call from the family nutritionist – your mother. “What is he eating now, dear?” Silence! You’ve been caught. The jars of baby food that grandmother bought are still unopened. Baby has not seemed interested, and you do not feel he is ready. You smoothly change the subject, defending your choice not to enter the race for solids just yet. (When this confrontation happens in my practice, I advise parents, “Make your doctor the scapegoat. Tell grandmother that Dr. Bill advised you to wait a while longer.”)
Baby’s tongue movements and swallowing skills are the first clues to delaying solid foods. In the early months, babies have a tongue-thrust reflex that causes the tongue to automatically protrude outward when any foreign substance is placed upon it. This may be a protective reflex against choking on solids given too early. Between four and six months this tongue-thrust reflex diminishes. Also, prior to four months of age most infants do not have good coordination of tongue and swallowing movements for solid foods.
An added sign that babies were not designed for early introduction to solid foods is that teeth seldom appear until six or seven months, further evidence that the young infant is primarily designed to suck, rather than to chew.
Not only is the upper end of baby’s digestive tract not designed for early solids, neither are baby’s insides. A baby’s immature intestines are not equipped to handle a variety of foods until around four to six months, when many digestive enzymes seem to click in. Pediatric allergists discourage early introduction of foods especially if there is a strong family history of food allergies. Maturing intestines secrete the protein immunoglobulin IgA, which acts like a protective paint, coating the intestines and preventing the passage of harmful allergens (cow’s milk, wheat, and soy are common examples of foods causing allergies when introduced early).
This protective IgA is low in the early months and does not reach peak production until around seven months of age. As the intestines mature, they become more nutritionally selective, filtering out offending food allergens. Babies whose systems tend to be allergy-prone actually show delayed willingness to accept solids – a built-in self-protective mechanism.
FEEDING SOLIDS: SIX TO NINE MONTHS
Breast milk or commercial formula with iron or a combination of the two contains all the essential nutrients your baby needs for the first six to nine months, or even longer. Parents often get the urge to offer solids much earlier than baby gets the urge to eat them. Prior to six months, your baby doesn’t need solid food for nutritional reasons, but developmentally your baby may want them.
Baby may start begging – reaching for the food on your plate, grabbing your spoon, looking at you hungrily, and mimicking feeding behaviors such as opening her mouth wide when you open your mouth to eat. Sometimes babies are more interested in the utensils than the actual food. If your baby shows interest in watching you eat, try offering her just a spoon to play with (preferably a plastic spoon – they make less noise when banged). If baby is content with the spoon, then the toy is desired more than the food. When baby continues showing interest, it’s time for the fun to begin. Also, the ability to sit up in a high chair and pick up food with thumb and forefinger are other signs that baby is ready for solids.
We advise that baby’s first “spoon” be, your finger. It is soft, at the right temperature, and by this stage baby is very familiar with its feel. Your finger also knows if food is too hot. Few babies like to begin their feeding life with a silver spoon in their mouth. Metal holds the heat in, so each bite takes longer if you have to blow to cool food that is too hot. A hungry baby finds this infuriating! A coated demitasse spoon is a good starter utensil. Plastic spoons with smooth, rounded edges are best – and quietest when banged or dropped. Use shatterproof plastic bowls that can survive battering on the highchair tray and numerous tumbles to the floor.
Start with solids that are the least allergenic and the closest to breast milk in taste and consistency. Examples of favorite first foods include mashed ripe bananas or rice cereal mixed with breast milk or formula.
Place a fingertipful of banana (mashed to soupy) on baby’s lips, letting her suck your finger as she usually does. Once she is introduced to the new taste, gradually increase the amount and thickness of the food, placing a glob toward the middle of baby’s tongue. Watch baby’s reaction. If the food goes in accompanied by an approving smile, baby is ready and willing. If the food comes back at you accompanied by a disapproving grimace, baby is not ready.
If baby spews the glob back at you, don’t take this first impression personally. Your infant has not yet learned the developmental skill of sealing the mouth shut, sweeping the food from front to back, and then swallowing. If your baby just sits there confused, her mouth open, with a glob of food perched on her tongue, her persistent tongue-thrust reflex is giving the developmental clue to shut the door and come back later.
Progressing with Solids
My wardrobe of food-stained ties gives testimony to the fact that, although I have mastered the science of feeding our babies, I have not mastered the art. As I stated earlier, it seems that the three requirements of feeding babies are a knowledge of good nutrition, a knowledge of infant development, and some creative marketing. Beginning with rice cereal or bananas as a test dose, progress from a fingertipful to a half teaspoon to one teaspoon, then a tablespoon, then around two ounces, or half a jar. Advance from soupy to pasty to lumpy consistency. Remember, your initial goal is to introduce baby to the new taste and touch of solids, not to stuff baby.
Gradually vary the texture and amount to fit the eating skills and appetite of your baby. Some like solids of thinner consistency and want a larger amount; some do better with thicker solids and smaller amounts. Expect erratic eating habits. Your baby may take a whole jar one day, but only a teaspoon the next.
Keeping a Favorite-Food Diary
We have found it helpful to make a food diary with four columns on a page. In the first column list the foods that baby seems to like; in the second column, foods that you have found by trial and error that baby does not like; in the third column, possibly allergenic foods and the signs of allergies; and in the fourth column, the techniques you have learned to get more food into your baby with the minimum of hassles. The food diary helps you learn your baby’s food preferences and capabilities at each stage of development and is another way of getting to know and enjoy your baby. In case your baby may be intolerant of or allergic to a certain food, space each new food at least a week apart and keep a diary of which foods baby may be sensitive to or simply doesn’t like. Also, the timing and progression of solids is much slower in the allergic baby.
Favorite First Foods
- rice cereal
- barley cereal
- sweet potatoes
When to Feed
Offer solids at the time of the day when your baby seems hungriest, bored, or when you both need a change of pace. Choose a time of the day that is most convenient for you, since a little mess is part of the feeding game. Mornings are usually the best time for offering solids to formula-fed babies, because you have the most time with your infant and usually do not have to worry about preparing a meal for the rest of the family. If breastfeeding, offer solids when your milk supply is lowest, usually toward the end of the day. Feed your baby solids between breastfeeding. Recent nutritional research has demonstrated that solid foods may interfere with absorption of valuable breast milk iron if both solids and breast milk are fed at the same time.
Grazing. Since babies have no concept of breakfast, lunch, and dinner it makes no difference whether they receive vegetables for breakfast, or cereal and fruit for dinner. If you have a mental picture of your baby sitting still in a high chair eating three square meals a day, forget it! Babies don’t sit still very long in one place even to play, let alone to eat.
INFANT FEEDING AT A GLANCE
|AGE||FOOD SEQUENCE||FOOD PRESENTATION||DEVELOPMENTALSKILLS, IMPLICATIONS FOR FEEDING|
Birth to 6 months
|Breast milk and/or iron-fortified formula satisfies all nutritional requirements
Solid foods not nutritionally needed, but infant may want
|Breast and/or bottle||Designed to suck, not chew
Rooting reflex; searches for food source
Tongue-thrust reflex pushes out solid foods
Sensitive gag reflex
rice cereal, applesauce
|Tongue-thrust and gag reflexes lessen; accepts solids
Sits erect in high chair
7 to 9 months
|Avocado, smashed potatoes, Peaches, barley cereal, Carrots, teething biscuits,
Squash, pear and apple juice
|May drink from cup
Finger foods begin
Pureed and mashed foods
|Thumb-and-forefinger pickup begins
Fascination with tiny food morsels
Begins mouthing chokable food and objects
Bangs, drops, flings
Reaches for food and utensils
9 to 12 months
|lamb, veal, tofu, poultry, noodles, bagel, beans, rice cakes, peas, egg yolk, yams, cheese, oatmeal, yogurt||Lumpier consistency
Finger foods mastered
Bite-sized cooked vegetables
Holds trainer cup
|Self-feeding skills improve
Holds bottle and cup longer
Points and pokes, smears, enjoys mess
High-chair gymnastics increase
Tries to use utensils, spills most
12 to 18 months
|whole milk, papaya, cottage cheese, apricots, ice cream, grapefruit, whole eggs, grape halves, beef, strawberries, peanut butter, tomatoes, fish (salmon,, pasta, tuna), graham crackers, broccoli, wheat cereal
spinach, honey, cauliflower, pancakes, melon, muffins, mango, kiwi
|Participates in family meals
Eats chopped and mashed family foods
Begins self-feeding with utensils
|Has prolonged attention span
“Do it myself” desire intensifies
Tilts cup and head while drinking; spills less
Holds spoon better, still spills much
Begins walking-doesn’t want to sit still and eat
Picks at others’ plates
18 to 24 months
|Eats toddler portions of
Sandwiches, stews, Nutritious sauces, puddings, smoothies, dips, shakes, toppings, pate, spreads, soups
Toddler food “language”
avocado boats, O-shaped cereal, cooked carrot, toast sticks
wheels, cookie-cutter cheese
cheese blocks, melts, broccoli trees, sailboat salads
|Grazes -deserves title “picky eater”
Weans from bottle
Uses spoon and fork
|Molars appear – begins rotary chewing
Spoon-feeds self without spilling much
Learns food talk, signals for “more,” “all done”
Wants to eat on the run – needs creative feeding to hold attention at table
Has erratic feeding habits