Infant Introduction of Solid Foods

Today’s post comes from Chris Barry, PA-C, MMSc. Barry is a nationally certified physician assistant specializing in pediatrics. He is a member of the American Academy of Pediatrics, American Academy of Physician Assistants, North Carolina Academy of Physician Assistants and currently serves as the Medical Liaison from the American Academy of Physician Assistants to the American Academy of Pediatrics. Barry currently serves as one of ENC’s Health Professional Advisors.

A question I am often asked by new parents is “when can I start my baby on solid foods?” Many parents can’t wait to feed their babies more than just breast milk or formula. The question seems to come up particularly frequently around the holidays, when many celebrations center around family meals. Each child is different, so parents should consult with their infant’s health care provider before starting solid foods. In general, 4 to 6 months of age is a good time to consider adding complementary foods to an infant’s diet. An individual child’s readiness for solid foods depends on her developmental stage, however. The infant who starts solid food should have good head control and should be able to sit in a high chair or feeding chair. She will typically express some interest in solid foods, exemplified by watching adults eat, reaching for the food and/or opening her mouth when adults are eating.

I typically talk with parents about trying rice cereal as a first food. It has a long history of being a good starter solid food, and is very unlikely to cause allergies. Parents may start by mixing 1 tablespoon of rice cereal in a bowl with breast milk or formula to a consistency of porridge, oatmeal or (here in the South) grits and offering a small amount with a baby spoon. In the beginning, it is normal for a baby to look confused and to reject the solid food, either by turning her head away or by tongue-thrusting the food out. I tell parents that, if this happens, take a break and try again the next day. It may take several attempts before a baby decides she wants to eat solids. I usually recommend feeding the rice cereal once a day for about a week, increasing to twice daily the following week. Once a baby is eating cereal well from a spoon, it’s time to expand her offerings to vegetables and fruits (the order doesn’t matter). Giving only one new food every 4 days, allows parents to watch carefully for any food allergy. A skin rash, vomiting or diarrhea could be signs of an allergy, so parents should contact their health care provider, if any of these occur.

Other foods, such as eggs, fish, and meats may also be given once a baby is comfortable eating other solids. Eggs are an excellent source of protein and are full of nutrients, including Vitamin D, calcium, choline and many more that will complement a baby’s diet. Many parents wonder about the possibility of an egg allergy when feeding their infant eggs. Overall, it is estimated that about 1% of children in the United States are allergic to eggs. Fortunately, most of these children do outgrow their egg allergy as they get older. In the past, avoiding egg whites was recommended during the first year, but evidence has failed to show that introducing egg whites after 1 year of age reduced the probability of an egg allergy, so it is not necessary to wait until age 1 to start eggs. However, if  a child shows any of the signs of allergy listed above, parents should be sure to contact their health care provider.

Exploring new foods should be an enjoyable experience for the whole family, and parents should remember that it may take several attempts before a baby decides she likes a particular food. Keep trying!, a parenting website backed by the American Academy of Pediatrics, has some excellent information on many pediatric subjects. One good article on starting solid foods is linked here.

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