How to start my baby on solids?

[mme_highlight]Solid foods can be included in the menu of infants at the age of 4-6 months. The menu of infants becomes more varied in the second half of the first year. After a phase of adjustment to the diet with solids, which takes 1-2 months on average, the infant should have 3 milk meals and 2 meals with solids.[/mme_highlight]

Healthy eating since early childhood has great importance, because the form of nutrition that is established in early childhood tends to be maintained later in life and it can very difficult to change nutritional errors. The moment of introduction of solid foods is itself a milestone for children. Solid foods can be included in the menu of infants at the age of 4-6 months.

When is the right time to introduce solids?

Age of the baby is not the only criteria considered for inclusion of solids. It is important that the baby attains certain developmental milestones such as:

The baby can hold up his/her head (without support);
The baby can sit (with the support of parents);
The baby knows to lean forward towards the food when she/he is hungry and lean back when she/ he doesn’t want food.

What can happen if solids are introduced too late?

The inclusion of solid foods should begin at the right time, because the late introduction of solid food can lead to iron deficiency, which causes anemia. According to studies babies whose parents feed them with vegetables rich in iron, have lower percentage of anemia (table below).

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Frequency of anemia in babies at 8 months (data from study)

babies who received iron fortified cereal: 3.5%
exclusive breastfeeding: 15%.

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In addition, slower progression of a child may occur due to insufficient caloric intake. However, parents have to pay attention not to include solid food too early, because it can cause food intolerance.

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Age of introduction of solids – Centers for Disease Control and Prevention (CDC):

about 40 % of parents included solid foods in baby’s diet before they were 4 months old.
56% introduced solid food before age 6 months
6% didn’t included solids at age 8 months

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What can happen if solids are introduced too early?

Some research supported the fact that babies that are fed with formula are frequently fed with solids before 4 months (52.7 percent) and there was smaller percent of babies who started with solids before 4 months that are breast-fed exclusively (24.3 percent).

If solid foods are introduced too early, the food may not be completely digested, as the baby’s digestive system is not immunologically developed and the production of enzymes such as amylase is decreased. Also protein food can burden baby’s kidneys. In addition, it was found that early inclusion of solid foods increases the risk for obesity in adulthood.

Also, it was found that the frequency of obesity in children was significantly lower in the group where children were longer on exclusive breastfeeding: 3.8% for 2 months of exclusive breastfeeding versus 2.3% for 3-5 months of exclusive breastfeeding.

In addition, it was found that inclusion of solids before 15 weeks increases the possibility of infection, as shown in the table below.

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Age of introduction of solid foods and infection risk

exclusively breast-fed have 40% fewer ear infections than breastfed babies with solids included
21% babies that are fed with formula had wheeze during childhood
7% of exclusively breastfed had wheeze during childhood

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Children with family predisposition to allergies should not take solid food until 6 months of age, because of the possibility of sensitization to food allergens. Those kids should be given iron supplements, because the amount of iron in the mother’s milk is not sufficient to satisfy the needs of a 4-month-old baby.

It is worth to be mentioned that a child from birth throughout the infancy period should be given drops that contain vitamin D (400 IU per day).

What are the basic principles of including solids?

In order to identify and eliminate foods that cause allergy, new aliments should be given one by one at intervals of 4 to 7 days. If parents notice the presence of an allergic reaction (diarrhea, weakness, vomiting, skin rash, wheezing, facial swelling, coughing etc.) then this kind of food should be stopped and parents should consult a doctor.
Meals are given in the mushy-liquid form and at the end of the first year as crushed or finely chopped.
Feeding with bottle increases the risk of abandonment of breastfeeding, therefore food should be given to baby with the spoon.
Parents should not add salt to the food, because breast milk contains enough salt. Excessive intake of salt burdens baby’s kidneys and increases a risk for high blood pressure in adulthood.
Adding sugar to the diet of a baby is not recommended, especially in children who have familiar predisposition to obesity and atherosclerosis (obstruction of blood vessels with fatty deposits).
Fats are optimally represented in the baby’s diet, so there is no need to add or reduce them.

The starting amount of solids should be small and parents should give the child one teaspoon of solid food at the end of breastfeeding. Then, gradually increase the amount from one to four spoons (up to 60ml) of solid food, twice a day.

Is there some order to follow when introducing solids?

Cereals are usually the first food that should be given to an infant. Cereals are an excellent source of iron, B vitamin and calories that the baby needs for growth and development. For example, one cup of oatmeal contains 10 mg of iron and babies between 7-12 months need 11 mg/ day. It should be started with rice and corn crops, as they are easily digested and rarely cause allergies, since they do not contain gluten.

Then, about three weeks after the inclusion of cereals, pureed vegetables should be included in the children’s diet. It is recommended to include mild vegetables, such as potatoes and carrots and then pumpkin, peas, cauliflower, spinach, broccoli etc.

After the inclusion of vegetables, parents should start giving the fruit, first in the form of 100% pasteurized juice (apple, peach), then in the form of mush (apple, peach, pear, banana). Finally, meat should be included by the end of the sixth month.

According to these principles, the menu of infants becomes more varied in the second half of the first year. After a phase of adjustment to the diet with solids, which takes 1-2 months on average, the infant should have 3 milk meals and 2 meals with solids- one meal should contain vegetables and meat and the other meal should contain fruits. Baby should get 25% of total energy intake calories from solids by the age of 12 months.

Which foods should be avoided?

The following foods should be avoided until the child reaches one year of age:

Cow’s milk, because it could contain potential allergens. According to the American Academy of Allergy, Asthma, & Immunology, 2.5% of children under the age of 3 are allergic to cow’s milk.
Honey, because of the possibility of infection with bacterium Clostridium botulinum.
Foods that may cause choking in children (especially nuts, candies or grapes- these foods easily fall into a baby’s airways and in addition they have the ability to swell and completely obstruct the airway lumen). 81.5% of children younger than 1 year whose cause of death was unintentional injuries, died from suffocation.

Summary and Recommendations

Solid foods should be ideally introduced around 6 months.
Introducing solid food too late may cause anemia due to iron deficiency.
When introduction of solids occurs too early, the digestion can be immature, the kidneys may be affected and there is a higher risk for obesity, infection and allergies.
Do not add salt, sugar or fat to your baby’s food.
Start solids with small amounts. Introduce cereals first, then vegetables, fruit and meat.
If you notice any allergic reaction, stop giving the aliment and take your child to a doctor.

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References

Developmental Readiness of Normal Full Term Infants to Progress from Exclusive Breastfeeding to the Introduction of Complementary Foods” Naylor and Morrow, 2001
Walter T, Dallman PR, Pizarro F, et al: Effectiveness of iron fortified infant cereal in prevention of iron deficiency anemia. Pediatrics 1993; 91: 976-982
Kries R,Koletzko B, Sauerwald T, et al. Breast feeding and obesity: cross sectional study 1999 Jul 17;319(7203):147-50.
Wilson A, et al. Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study BMJ1998; 316:21

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