Starting solid foods with babies: An ultimate guide

Enjoying a first taste of food is a big milestone for babies, but when should babies start solid foods?  Here, a CHOC pediatrician offers tips on when parents should offer solid food to babies and what foods to choose.

Dr. Lori Openshaw, a pediatrician in the CHOC Primary Care Network, says it’s important to remember that breastmilk or formula is a baby’s primary nutrition source until age 1, with breastmilk recommended as the optimal source of nutrition for baby during first 6 months of life.

Feeding solids is a process that includes teaching and transitioning a baby to the next stage of nutrition that will hopefully set the groundwork for a healthy diet throughout their life, she says. One goal in the first six months of eating solid food should be to expose a baby to a wide variety of healthy foods, flavors and textures in a positive and encouraging way. There is no rush or rigid template for infant feedings.

Here are some guidelines from Dr. Openshaw, but it is important to remember that every baby is different.

When do babies start eating solid table food?

Most babies are ready to start solids at around 6 months of age.

Some babies may be ready before 6 months, however if parents want to start solids earlier than this, Dr. Openshaw recommends speaking with the baby’s pediatrician first. Studies suggest that babies who begin eating solid foods too early, specifically before 4 months of age, are at a higher risk of obesity and other problems as they get older.

Some infants may experience constipation if solids are started too soon – and this might even be a problem when started at 6 months. If a baby is straining to make bowel movements, speak with the pediatrician.

Developmental milestones showing baby is ready for solids

Babies have many developmental skills that indicate they show signs they are ready for solid foods, Dr. Openshaw says:

• The baby has good head and neck control.  
• The baby can sit up in a high chair.
• The baby weighs twice their birth weight.
• They have oral motor skills to move food to the throat and swallow it.
• The baby has lost their tongue-thrust reflex. Before this goes away, typically around ages 4 to 6 months, a baby will instinctively push food out of their mouths as soon as it’s inserted.
• They are interested in solid foods. They watch others eat, reach for food or open their mouths when it’s nearby. Note, however, that many babies do this far before they really need to start solids.

How to start a baby on solids

Once a parent determines their baby is ready for solid foods, Dr. Openshaw recommends they start simple. You need to introduce solid foods to your baby slowly.

A single-grain, iron-fortified baby cereal is a good first food. Iron-fortified rice or oatmeal cereal are common first foods for babies, but parents can choose any they’d like, such as rice, oat or barley. Begin with 1 or 2 tablespoons mixed with breastmilk, formula or water. If a parent prefers an alternative to grains, another good first food choice is mashed avocado, she says.

Parents should use a small baby spoon to feed baby and follow baby’s lead on how much they can comfortably take, usually a half spoonful at a time to start. They may take just a few spoonfuls at first, but this will increase over time. The baby will also give cues about how much they want or need. Follow these cues. It is important to remember that most babies are very good at knowing how much food they need and generally will not overeat.

How to know the amount, frequency, and timing of solid foods

Dr. Openshaw suggests starting small (a few teaspoons) and increasing slowly as they enjoy more (usually no more than one-quarter to one-half cup). There is no set amount, however, and every baby is different. Begin solid feeding once a day at first. This can be at any time of the day that is best for the family.

Continue once a day for a few weeks to a month, then increase to twice a day, Dr. Openshaw says. After a few weeks or another month, this can be increased to three times per day. Again, follow the baby’s cues.

As for breastfeeding and bottle feeding, a parent can nurse or give a bottle before solids or after solid foods. Choose whichever seems to make the baby the happiest. The goal is to enjoy meal time.

One thing parents should avoid is adding cereal to a baby’s bottle unless their pediatrician recommends it. This can cause the baby to gain too much weight, become constipated or potentially choke.

How to advance to more solid foods

Once the baby gets the hang of grains or avocado, parents can try introducing other foods like puréed vegetables, beans, lentils and eventually fruit. Feeding fresh foods is a great idea: Puree them with a little water, formula or breastmilk in a blender, food processor, or with a fork. This is very easy with many foods such as sweet potatoes, peas, bananas and pears.

Parents can make larger portions to freeze in an ice cube tray or in small clumps on a cookie sheet. After a quick freeze, store in a freezer-safe container and thaw for individual use, Dr. Openshaw suggests. It’s fine to purchase jars of baby food, but be mindful of products containing too much sugar.

Introduce one “single ingredient” new food every three to five days. Waiting a few days between new foods allows parents to observe for any allergic reactions. Dr. Openshaw recommends that babies successfully learn to enjoy many different vegetables before moving to fruits to ensure the baby will develop a healthy appetite for both food groups.

How to introduce food allergens to babies

Dr. Openshaw also recommends introducing common food allergens – such as eggs, peanuts and fish – to babies early into their solid food transition.

Studies suggest that waiting until a baby’s first birthday to try these foods, which was recommended in the past, can make a baby more likely to develop food allergies, Dr. Openshaw says. Giving small amounts of foods such as scrambled egg or tiny rice-sized amounts of peanut butter has now been shown to decrease the likelihood of common food allergies.

For babies with strong family histories of food allergies, especially to nuts, parents should first discuss with their doctor whether to do this food trial for their baby. In some cases, a referral to an allergist or for testing may be necessary.

When to start finger foods

Once a baby is 9 months old, most have the ability to pick up small pieces of food and feed themselves, Dr. Openshaw says. This is called a “pincer grasp.” When the baby can pinch their forefinger and thumb together in this manner, they are usually ready for finger foods.

At this stage, parents will still need to help their baby with some spoon-feeding, but they should begin to encourage a baby to self-feed as much as possible. This is an important part of development and will help them develop independent, healthy eating habits.

This also a time to get comfortable with some mess, Dr. Openshaw says. Though food throwing shouldn’t be tolerated, some messes and food waste will be inevitable while a baby learns to self-feed.

Let a child experiment and practice feeding themselves, but never force feed a child, Dr. Openshaw says. This can lead to future feeding issues, including obesity and/or food aversions. Except in rare medical conditions, if a child does not want to eat, they are generally not needing those calories. Parents who are worried about a child’s eating habits or weight shouldn’t hesitate to discuss this with their pediatrician.

What solid foods to avoid with babies

One food that babies younger than 2 should avoid is honey, Dr. Openshaw says. Honey carries a risk of infant botulism, a disease that can cause muscle weakness and decreased muscle tone.

Other than honey, the most important thing to avoid is any food item that could potentially cause a baby to choke.

What foods are safe for finger foods for babies

Here are things Dr. Openshaw suggests parents consider when choosing finger foods:

• Does it melt in the mouth? If it melts in the mouth like a dry cereal, puff, or easily crumbling cracker, it is a good item for self-feeding.
• Is it soft? Cottage cheese, shredded cheese and small pieces of tofu are good examples.
• Can it be gummed? Pieces of ripe banana and well-cooked pasta can be gummed.
• Is it cooked enough so that it mushes easily?  Well-cooked vegetables and fruits will mush easily, as will canned fruit and vegetables but be sure to choose ones without added sugar or salt.
• Is it small enough? Food should be shredded or cut into small pieces. The width of a baby’s pinky finger is a good measure of how small a firm piece of food should be for a baby. Shredded foods, such as shredded cheeses or meats, are great foods for baby as they can pick them up and munch with their gums but they are also thin enough to not choke a baby.

It’s very important that parents always supervise a self-feeding baby. Never leave a baby alone while eating.

Finger foods to avoid for babies

Dr. Openshaw cautions against these foods for babies starting solid foods because they could present a choking hazard:

• pieces of raw vegetables or hard fruits
• whole grapes, berries, cherry or grape tomatoes (instead, peel and slice or cut in quarters)
• raisins and other dried fruit
• large chunks of cheese or meat. Any firm food like cheese or meat is best shredded or cut into  very small pieces: the width of baby’s picky finger is a good guide as to how small firm foods should be before giving to baby.
• untoasted bread, especially white bread that sticks together
• large scoops of peanut butter and other nut or seed butters (use only a thin layer)
• peanuts, nuts, and seeds
• whole hot dogs and kiddie sausages (peel and cut these in very small pieces)
• candy (hard candy, jelly beans, gummies, chewing gum)
• popcorn, pretzels, corn chips, and other snack foods
• marshmallows

What should a baby drink when trying solid foods  

Dr. Openshaw recommends against giving babies juice unless directed by their doctor. (It may sometimes be used to treat constipation under medical guidance.) Excessive juice can cause obesity, diarrhea, diaper rash, and tooth decay. Even juice diluted with water can have a similar impact, Dr. Openshaw says.

Babies do not need extra water. Babies younger than 6 months get all the fluids they need in breastmilk and correctly mixed formula. Dr. Openshaw does recommend that parents introduce water in a cup to a baby at age 6 months when they start to eat solid foods. A baby can practice drinking water from a sippy cup or straw cup all throughout the day. They may not drink a lot at first, but they will usually enjoy the process. This can set the stage for a lifelong habit of drinking plenty of water.

For more health and wellness resources from the pediatric experts at CHOC, sign up for the Kids Health newsletter.

---