The time to start solid food depends on the infant's needs and readiness. Generally, infants need solid foods when they are large enough to need a more concentrated source of calories than breast milk or formula. This need is recognized when an infant takes a full bottle and is satisfied but then is hungry again in 2 or 3 hours or is consuming more than 40 ounces (about 1200 milliliters) of formula per day. This typically occurs by 4 to 6 months of age. Other signs that a baby is ready for solid foods include good head and neck control, ability to sit upright when supported, interest in food, opening their mouth when offered food on a spoon, and swallowing food rather than pushing it back out. Most babies start to show these signs by 6 months of age.
Many infants take solid foods after a breastfeeding or bottle-feeding, which both satisfies their need to suck and quickly relieves their hunger. Introducing solid foods before 4 months of age is not recommended. Infants younger than 4 months of age do not need solid food for nutrition, cannot easily swallow solid food, and should not be force-fed with a spoon or by mixing baby food with formula in a bottle.
Infant foods include single-grain cereals (such as iron-fortified rice cereal) and a variety of pureed fruits, vegetables, and meats. Doctors no longer think it matters in what order these foods are introduced. When starting a new food, it may take several tries over a period of weeks before an infant starts to enjoy a new food, so it is important for parents to not give up after the first or second try if the infant does not seem to like a particular new food.
The food should be offered on a spoon so that the infant learns the new feeding technique. By age 6 to 9 months, infants are able to grasp food and bring it to their mouth, and they should be encouraged to help feed themselves. Pureed home foods are less expensive than commercial baby foods and offer adequate nutrition. However, commercial preparations of carrots, beets, turnips, collard greens, and spinach are preferred for infants who are under age 1 year because they are screened for nitrates. High nitrate levels, which can cause methemoglobinemia (a disorder that affects the blood's ability to carry oxygen) in young children, are found in vegetables that are grown using water supplies contaminated by fertilizer.
Although infants enjoy sweet foods, sugar is not an essential nutrient and should be given only in small quantities, if at all. Sweetened dessert baby foods have no benefit for babies. Juice is a poor source of nutrition, contributes to cavities, and should be limited to 4 to 6 ounces a day or avoided altogether.
Foods to avoid include
Honey (until age 1 year) because it may contain the spores of Clostridium botulinum, which are harmless to older children and adults but can cause botulism in infants
Foods that can easily cause choking or be inhaled (until age 2 or 3 years), including whole nuts or beans, hard candies, soybeans, popcorn, hot dogs, meat (unless it is pureed), and grapes (unless they are cut into very small pieces)
Infants can develop food allergies. If many different foods are given in a brief period, it is difficult to tell which one may have caused a reaction. Because of this difficulty, parents should introduce new, single-ingredient foods one at a time, about every 3 to 5 days. Once it is clear a food is tolerated, another one may be introduced.
To prevent food allergies from developing, many parents avoid giving their infant common allergy-producing foods such as eggs, peanut butter, fish, shellfish, strawberries, and wheat. However, recent evidence suggests that introducing these foods after 4 months of age but before the end of the first year of life might actually help protect against the development of food allergies. The evidence is not final, but, for most infants 4 months of age or older, parents do not need to wait before introducing any specific solid food. However, only one new food should be introduced every 3 to 5 days to make sure the food is tolerated. Recent evidence suggests that feeding infants peanut-containing food after 4 months of age but before the end of the first year of life should be recommended because delaying the introduction of peanut-containing foods may actually increase the risk of developing a peanut allergy. Even infants who have severe eczema, an egg allergy, or both should be introduced to age-appropriate peanut-containing food as early as 4 to 6 months of age to reduce their risk of developing a peanut allergy as long as the results of certain blood and skin tests indicate it is alright for them to have these foods. Parents should discuss with their pediatrician when and how to introduce various solid foods.
At or after age 1 year, children can begin drinking whole cow's milk. At age 2 years, children can switch to reduced-fat milk because their diet essentially resembles that of the rest of the family. Parents should limit milk intake to 16 to 24 ounces a day in young children. Children who drink too much milk may not get enough nutrients from other important foods and may develop iron deficiency.
By about age 1 year, the growth rate usually slows. Children require less food and may refuse it at some meals. To determine how much their child is eating, parents should review how much their child has eaten over the course of a week rather than at a single meal or during a day. Underfeeding of solid food is only a concern when children do not meet expected weight percentiles at a steady rate.
(See also Overview of Feeding of Newborns and Infants.)
