Starting Solids June 1993 In Cooperation with: National Association of Pediatric Nurse Associates and Practitioners Although infants' nutritional needs are met completely through breast milk or infant formula for the first several months of life, there comes a time when they're ready to graduate to "solid" foods. Naturally, parents, grandparents and child care providers have many questions about this important milestone: When are babies ready for solid foods? Which foods should be given? How much food is enough? This brochure provides general guidelines for introducing infants to solid foods, as well as tips for keeping mealtime safe. Keep in mind that each baby is an individual and may be ready for different foods based on weight, nutritional needs and other factors. Ask your pediatrician, pediatric nurse practitioner, registered dietitian or other health care provider for specific feeding advice. Newborns Most infants consume only breast milk or infant formula for the first four months of life. These liquid food sources provide all the nutrients and energy needed for growth. Infants also are born with certain iron stores, which help get them off to a healthy start. At this age, babies are not ready for solid foods. Their jaw and throat muscles need time to develop the strength to handle various textures. Contrary to popular belief, solid foods will not help infants to go longer between feedings or help them sleep through the night. 4 to 6 Months Most health professionals advise starting solid foods anywhere between four and six months of age. At this time, most babies can hold their heads straight up when sitting and can make chewing motions. They also start to suck in a new way. The first solid food should be single-grain (usually rice) baby cereal, fortified with iron. Mix one or two spoonfuls of cereal with enough breast milk or formula to make it look like thin gravy. Use a small spoon with a long handle. The baby should be hungry but not starving. At first, the taste of solid food may come as an unpleasant surprise. Most babies will make a face and push the cereal right out again. Don't be discouraged. Soon the baby will become more accustomed to eating. Scoop the cereal from the chin and start over. Placing the cereal far back on the tongue also may decrease the amount spit out. The amount and thickness of the cereal gradually can be increased. After several weeks most babies eat cereal twice a day, totaling about 1/3 to 1/2 cup. Always make sure the baby is sitting up to eat and drink. Infants' appetites can vary from day to day. Babies indicate they are full by turning their heads away from the spoon or holding their lips closed. Never force them to eat more food than they are willing. Once the baby has mastered cereals, other new foods can be tried. Begin with one to two spoonfuls of a single strained or pureed vegetable or fruit such as squash, carrots, bananas or applesauce. Gradually increase the amount of food to two to four tablespoons twice daily -- about 1/4 to 1/2 cup in total -- depending on the baby's appetite. Introduce one new food every few days to allow the child's system to adjust and to watch for any unusual reactions. It's not unusual for the baby's stool to change color upon eating new foods. However, a skin rash, diarrhea, vomiting, wheezing or stuffy nose may be signs of a food allergy or intolerance. Stop feeding the new food and tell your baby's health care provider about the reaction at the next visit. During this stage, 100 percent fruit juices also can be given or mixed with infant cereal in place of other liquids. Babies also may be ready to try drinking from a cup. Approximately four ounces of apple, pear or other fortified fruit juices per day can help provide needed vitamin C. 7 to 9 Months By about seven months, most babies are ready to increase their variety of fruits and vegetables as well as their texture. Strained meat or poultry and food mixtures also may be introduced. Home prepared foods should be steamed, then mashed with a fork. Never add honey or corn syrup as these sweeteners may contain botulism spores, which can be harmful to infants. At this time, many babies are ready to begin finger foods. Infants should be able to sit up straight in a high chair, be able to grasp food with their hands or finger tips, and move the food from their hands to their mouths. Chopped pieces of ripe banana or dry unsweetened cereal are good choices. 10 to 12 + Months Between 10 and 12 months, babies may have four to six sharp teeth. Meats should be finely chopped, as babies still won't be able to do much efficient grinding. Well-cooked vegetables, cottage cheese or other soft or lumpy foods also may be introduced. Although they don't have a complete set of teeth, babies use their gums and tongue to mash the lumps. By this age, most infants eat three or four small meals a day. Gradually they grow more independent and may insist on holding a spoon when being fed or a cup with both hands while drinking. If your family has a history of food allergies, it may be helpful to delay the introduction of certain foods such as wheat, egg white or cow's milk. Ask your health care provider for specific dietary advice. By about one year of age, most babies eat small, tender table foods. Whole cow's milk can be introduced in the range of 16 to 20 ounces per day. Children need the fat in whole milk for proper growth and development; thus, low-fat milk should not be introduced until two years of age. Starting Solids The following checklist can help you determine if a baby is ready to begin "solid" foods: Baby can hold head straight up when sitting Baby opens mouth when food approaches Baby is interested in food when others eat Baby is between four and six months of age Feeding Timeline The following guidelines indicate when babies may be ready to graduate to various solid foods. Ask your pediatrician, pediatric nurse practitioner, dietitian or other health care professional for specific feeding advice. Months May Begin 4-6 Iron-fortified, single-grain baby cereal 5 100% fruit juices Introduce cup 6-8 Strained/pureed vegetables and fruit 9-12 Strained meats/poultry Chopped foods Babies start to feed themselves 12 Family foods Whole Milk 24 Low-fat Milk *The American Academy of Pediatrics recommends that breast milk or formula be used up to one year of age. Whole milk is recommended for babies from 12 to 24 months. Safety at the Plate When feeding children under four years of age or children with developmental disabilities, take extraordinary care with foods that require extensive chewing or could cause choking if swallowed whole. Foods such as hot dogs, grapes, raw carrots, candy and nuts should be chopped up into small pieces or finely ground. Certain "hard" foods may not be appropriate for young children. When watching young children, follow these simple guidelines: Always supervise them while eating. Choking incidents often occur when older siblings offer babies foods they're not yet developmentally ready to handle. Encourage children to take small bites and chew their foods completely. Young children have a tendency to bite off more than they can chew at any one time. Insist children sit down during mealtime or snacks. Never let them lie down while eating. Don't let children run with anything in their mouths. Reprinted from the International Food Information Council Foundation and the National Association of Pediatric Nurse Associates and Practitioners, 1993

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