When to start introducing solids?
The introduction of solids should commence at around 6 months of age. The 2013 infant feeding guidelines based on the latest evidence have shown that there is no benefit to introducing solids before this time. It is also important to not significantly exceed the 6 month mark.
Why shouldn’t I commence solids before 6 months of age?
It is common for parents to consider starting introducing solids early. They may feel that their child is becoming increasingly curious about other foods and that formula or breast milk alone is no longer enough.
The potential downfalls of starting solids before 6 months are:
- If the baby is not being breast fed regularly, the mother’s milk production may decrease due to a lack of stimulation of the breast.
- In a baby younger than 6 months, the tongue-extrusion reflex is still strong, the infant will push the hard object (spoon) out of its mouth. Many mothers may take this as a sign that their baby does not like that food when in fact; it is just the baby’s natural reflex.
- By exclusively breastfeeding for at least 6 months, the risk of developing food allergies appears to be decreased.
- Being exposed to pathogens in food whilst less than 6 months can lead to diarrhoea.
- Constipation can result from poor digestion of foods that the digestive system may not yet be ready to break down e.g. starches.
Why shouldn’t I introduce solids after 6 months?
There is a relatively small window of opportunity when it comes to the optimal time to introduce solids. The following points outline the importance of not introducing solids too late.
- Breast milk and infant formula alone provide insufficient amounts of nutrients after 6 months of age. As a result, growth can falter.
- Immune protection can be compromised.
- Micro nutrient deficiencies can result with the main nutrients of concern being iron and zinc.
- Development of motor skills may be delayed e.g. chewing and talking. This can result in a baby being less willing to try new tastes and textures.
- There is a heightened risk of developing food allergies.
Introducing solids
At 6 months of age, breast milk or infant formula should still remain the main source of food for your baby. In addition to this, a wide variety of healthy foods should gradually be introduced.
What has changed from the old guidelines?
There have been 2 main changes from the last infant feeding guidelines:
- There are no longer restrictions placed on the types of foods that can first be introduced. The old guidelines recommended the avoidance of foods that are common allergens e.g. nuts and eggs. This was to err on the side of caution and to avoid possible food allergies developing. However, it has now been determined that this practice potentially increases the risk of food allergies developing and that common allergens should be introduced starting from the 6 month mark. In terms of nuts that pose a choking hazard, a smooth nut paste can be used.
- There is also no longer a limit placed on the number of new foods than can be introduced at one time. It was originally suggested that only one new food be introduced at a time with a few days in between. This was to help ascertain what exact food caused a reaction, if there was one. This practice is no longer necessary.
The most important factors now are that the foods offered are healthy, of suitable texture and are rich in iron. First foods should include variety from the 5 food groups so that all the essential nutrients are targeted – even vegetable and fruit purees should be varied.
First foods
Children should not be given fat reduced dairy until 2 years of age. Up until 12 months of age, the only fluids provided should be breast milk/ infant formula and boiled water that has been cooled to room temperature.
Once an infant reaches 6 months of age, iron and zinc become very important. Formula and breast milk are no longer sufficient to meet the requirements of these nutrients.
Texture and consistency
Starting at the 6-month mark, foods should gradually progress through the following textures. The rate of transition from one texture to the next will be somewhat dependent on the infant’s developmental stage. First foods should be soft and easily digested.
Pureed ——> mashed ——> minced ——–> chopped
The images below were taken from the Children’s Hospital at Westmead website. The first image demonstrates pureed foods and the following photo shows the transition to mashed/ minced food with small, soft lumps that should occur between 6 and 8 months.
Step 1 (6 months)
Step 2 (6-8 months)
Types of food
- Iron enriched infant cereals
- pureed meat, poultry and fish (with the bones removed)
- cooked tofu and legumes
Supplement the above with:
- Vegetables e.g. pumpkin, potato, taro, sweet potato
- Fruits e.g. ripe banana and well cooked apple and pear
- Dairy e.g. full fat yoghurt, cheese and custard. Cow’s milk should remain unintroduced until 12 months of age as it may take the place of more nutritionally appropriate formula/ breast milk.
When to offer food
Food is better offered between feeds or after. This way it will not take the place of formula or breast milk. It is best to begin by using a hard, plastic spoon.It is likely that your baby will only want a couple of teaspoons to start – which is fine! Start with 1 or 2 teaspoons, then work up to a few tablespoons and progress towards 3 small meals per day, at your infant’s own pace. Remember that formula and breast milk is still the most important source of food for your baby so don’t stress if they are only having small amounts of solids.
Additional information
Store bought baby foods are not necessary, nor should they be relied upon but they can be a convenient option if you do not have enough time to prepare your baby’s food. However, it is a good idea to adapt and serve your baby the same foods as the rest of the family, where appropriate. For example, pureeing vegetables and meat would be a healthy option but pizza or hot chips would not be.Whilst your baby is eating only very small amounts, it can be useful to freeze portions of pureed food in an ice cube tray and safely thaw them as needed.
Breast milk or infant formula should still be the main source of food. Most infants can now manage finger food so it is a good time to slowly introduce different textures and sizes. You should encourage babies to feed themselves as this maximises the enjoyment of eating and helps develop social skills – ensure to wash your baby’s hands first. Your baby will now be eating more solids and the amount of milk feeds will decrease.
Types of food
- Steamed or boiled vegetables/ fruit – Steaming is a preferred method as it retains more of the nutrients. Food examples include; potato, pumpkin, zucchini strips, peas, corn, apple. Hard vegetables/ fruit must be cooked very well and offered in larger chunks to prevent inhalation or choking.
- Raw foods – tomato slices, whole banana, a ripe pear, peeled orange.
- Well cooked meat can now be cut in to strips so that your baby can pick it up and slowly chew it
- Toast soldiers, rusks, cooked pasta
- Small pieces of cheese
The image below illustrates the type of foods your child should be moving on to, normally between 8 and 9 months, depending on their stage of development.
Image sourced from: Baby’s first foods | Kids Health @ CHW
Important note
Always stay with your baby whilst they are eating and make sure they are seated upright, to ensure their safety – particularly when progressing to a new consistency of food. Eating healthy foods with your baby sets a good example and social setting.
Infants should now be managing a wide variety of nutritious foods of normal texture. Their meals can now be a child portion of the family meals – It is a good idea for them to be eating the same foods as the rest of the family so that they begin to understand that special ‘kids’ foods’ are not needed.Increasing and varying food texture is essential for oral motor development. It is important to encourage an infant to chew and they will quickly learn to manage foods of different textures. Lumpy foods should be introduced between 6 and 9 months to avoid later feeding difficulties.Iron rich foods should continue to be offered. There are many complementary milks and foods on the market for toddlers – these however are not necessary as all of the child’s requirements can be met through diet. Milk and water should now be provided in a cup opposed to a bottle and breast milk/ formula feeds can still be continued.
What to avoid
- Small, hard pieces of food that may cause chocking e.g. whole nuts, seeds, popcorn, raw carrot, celery sticks and chunks of apple. These foods should not be introduced until around 3 years of age to avoid inhalation or choking. They can, however, be offered in a pureed form.
- Added salt – an infant’s kidneys are too immature to excrete the excess sodium
- Added sugar – this can lead to dental cavities and excessive energy intake
- Avoid cow’s milk, fruit juice and other drinks until 12 months of age as this will interfere with intake of breast milk or formula and they provide no benefits
- Avoid honey for infants less than 12 months of age. This is due to the potential presence of clostridium botulinum spores that can cause infant botulism.
- Avoid Tea. This is an important point because tea contains compounds known as tannins and these tannins bind to iron, inhibiting its absorption. Iron is one of the nutrients of most importance to infants. Therefore tea provides no known benefits but can be potentially harmful.
- Avoid caffeine and caffeinated products
An infant’s taste buds are very sensitive to flavour and they therefore do not require the addition of salt or sugar. Adding salt or sugar to foods can cause an infant to form an acquired taste to sweet and salty foods that will carry on through childhood and adulthood.It is now important to start focusing as well on healthy eating habits e.g. eating meals with the family, turning off the TV whilst eating.
Concerned about your infants development?
Seek further advice if your infant’s appetite, growth or development appears impaired and further investigations and nutrition assessments can be performed.
Contact us for results focused nutritional advice
This article was written by our dietitian Belinda Elwin who is a Dietitians Association of Australia member and Accredited Practising Dietitian and Nutritionist.
If you would like to find out more about introducing solids or have any concerns about your child’s nutrition, Contact us today!
References
Baby’s first foods | Kids Health @ CHW
Infant Feeding Guidelines – National Health and Medical Research Council
