By Christine Haran
Ask any new parent: When it comes to infant care, everyone has an opinion, and they're not afraid to share it. One issue that often sparks heated debate among friends and family is when to add solid foods to a baby's diet.
About 30 years ago, parents tended to introduce solid foods in the first few months, or even in the first weeks. Today, the American Academy of Pediatrics recommends beginning solid food much later. Although there are exceptions to the guidelines, early feeding increases risk of obesity and some studies suggest that it might be linked to type 1 diabetes.
Below, Lorraine Stern, MD, a clinical professor of pediatrics at the University of California Los Angeles, discusses the rationale behind this recommendation and how best to gradually introduce solid food so that feeding is a healthy and fun experience for the baby—and the parent.
At what age do pediatricians generally recommend parents introduce solid foods?
For healthy, growing infants, the American Academy of Pediatrics recommends starting solid foods at six months.
Children are born with something called an extrusion reflex, which is a survival mechanism where from the time of birth they instinctively push out of their mouth anything that's semisolid, anything that isn't the consistency of breast milk or formula. They usually aren't even ready to accept pureed foods into their mouths and move them to the back of their throat until they're at least four to six months.
The reason to withhold solids until six months is that, for one thing, we know that early feeding is associated with later obesity. Theoretically, the only thing infants need for the first six months is breast milk or formula.
There was also a recent report in the Journal of the American Medical Association about children who had family histories of type 1 diabetes, the kind that requires insulin. They studied these children from birth until age four or five, and those children who were fed solids earlier had a higher risk of developing antibodies against the cells in the pancreas that produce insulin and cause diabetes. In other words, early feeding in children with a family history of diabetes increased the chances that they would develop diabetes.
What is rationale for beginning solid food?
Nutritionally, infants need to have additional food by six months. At that age, the main concern is iron. At about six to nine months, infants outgrow the iron stores with which they were born, and we need to start replenishing their iron. The first food we feed infants is iron-fortified rice cereal. When we get into the second half of the first year, they start needing a greater variety of nutrients.
At what point after introducing solid food can one forego formula or breast-feeding?
There are two different things. Infants can give up formula and be given regular cow's milk at a year. How long do you breast-feed? That's a different issue. The American Academy of Pediatrics recommends that women breastfeed for at least a year. That means that women can nurse for longer than a year if they want to as the benefits of breast milk continue, but they don't have to. But breast-feeding for at least four to six months has been associated with a long list of benefits, such as decreased risk of asthma and allergy and decreased risk of obesity.
Why might some parents want to start solid foods earlier?
There are several reasons. One is that grandma tells them that the baby will sleep through the night if they feed them solids, which isn't true at all, unfortunately. Number two, sometimes parents think babies need to be fed more. I just had a call today from a mother whose two-month-old infant was taking eight to nine ounces of formula every three hours and still seemed to be hungry. Well, he may need to suck, so he may need a pacifier rather than a feeding. A baby who needs to suck will be satisfied for quite a while, and even fall asleep sucking. A hungry baby will still need to eat.
What are clues that a baby is ready to eat solids?
That they're looking at what you're eating, and they're interested in it and they're reaching for it. And they also seem to be not completely satisfied.
Are there some exceptions to the six-month recommendation?
There are infants who have gastroesophageal reflux, GERD, as people know it. Sometimes they're fed formula with rice in it or given some rice cereal feedings to try and thicken food to keep it from coming up as easily. Now there have been studies that show that it may not help, but there was just a recent study that showed it did help. So whether or not it helps with GERD is questionable.
Sometimes babies are really big. I've had babies who were 10 pounds at birth. Some of those babies are really hungry and, once in a while, it's appropriate to feed them before six months, but only if your pediatrician says so.
Is there a recommended approach?
Food should be fed by a spoon. And if the baby isn't ready to take the spoon and move to the food to the back of their mouth, they'll go "pppfffft" and it'll all come down on their chin.
But, if they're ready, you should do it at a time of day when you have time. Do it once a day, in the beginning. And usually the morning when everybody's getting dressed and ready to go out and there's lots of tumult is not a serene time to feed the baby. So maybe just before a nap, for example, when you have the time to do it slowly and take your time and be relaxed about it.
What is the best way to start introducing other foods?
You introduce new foods slowly. The main reason for that is you just don't want to give an infant too many new things at once. It's confusing to have new tastes and new textures thrown at you helter-skelter. What we suggest is, once you go from a tablespoonful of cereal up to maybe four tablespoons of cereal, you then start introducing fruits and vegetables. I recommend vegetables first because fruits are sweet, so they may accept the vegetables better if the fruits come later.
Also, sometimes when you give babies a new food they make a funny face and shake their heads a little bit. It doesn't necessarily mean that they don't like it; it may just be because it's something new. So you should retry that new food two or three times.
How can you figure out if the baby's allergic to a food?
If they're allergic, they will either get a rash around their mouth or a tummy ache or diarrhea. And that's not really an allergy, per se, but they don't tolerate it well. One of the things that parents should be aware of however, is that when they start feeding their baby, and as they give them different foods, their stools will change. They'll change color, they'll change consistency.
What foods shouldn't be given to the baby in the first year?
Honey. Now, if honey is in something that's baked, it's OK. But straight liquid honey should not be given to a baby until after a year. Honey can have botulism spores. Older children and adults destroy honey in their stomach, but infants don't.
Another thing we tell parents to avoid is egg whites. There's an increased chance of developing an allergy if egg whites are given before the first year is over. They can have egg yolk, however.
The other thing is juice. Juice should not be a part at all of a baby under six month old's diet. And for infants over six months, they should have no more than four to six ounces a day. While juice does have some vitamins and some carbohydrates, it has no fiber, it has very little protein and it can fill the baby up, so it's taking the place of more nutrient-dense foods.
What if a baby doesn't like a particular food?
On occasion, an infant really, really hates a food such as peas or carrots, even though you have offered it four or five times. If that's the case, life without peas is still worth living and you can substitute other vegetables.
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