Introducing First Foods

baby eating food

Feeding guidelines for infants are not always straight-forward and have changed considerably over the past several decades. It often seems like everywhere you turn, someone is telling you something different…your mom and other family members have their own opinions, one friend is making her own baby foods, and another friend is trying baby led weaning...It can often be confusing trying to figure out when and how to introduce foods to your baby.

As with most things regarding parenting, remember that there is often not one “right” way to do things. However, there are some things to keep in mind that will hopefully make starting foods a little easier for parents and help keep your baby healthy.

Breastmilk/formula:

If you are breastfeeding, make sure to continue giving 400 IU vitamin D daily. Different formulations are available, so make sure to check the label if you are changing brands to make sure you give the correct amount.
Formula contains vitamin D, so a supplement is not needed if your baby takes approximately 25 oz or more of formula daily.
Follow your baby’s hunger cues, as they may want more milk when they go through a growth spurt. Some babies will eventually take larger volumes of milk and feed less frequently. Other babies will continue to want smaller and more frequent feeds.

Purees/cereals:

Your child should be at least 4-6 months before starting purees/baby cereals. Before you start purees or any solid foods, may sure your child can hold their head up well, open their mouth for food, and that they don’t cough repeatedly or gag when you place food in their mouth. If your child was born prematurely or has congenital defects that may affect feeding, talk to your pediatrician prior to starting foods.
Infant cereals contain iron which is recommended for breastfed babies after 4-6 months of age Formula already contains iron, but it is okay to give formula fed babies some cereal as well. Do not add cereal to your baby’s bottle unless specifically recommended by your pediatrician. Mix powdered infant’s cereal with breastmilk or formula to make an oatmeal-like consistency. If you do not want to give your baby infant cereals and you are breastfeeding, you can transition to a vitamin supplement with iron (such as poly-vi-sol with iron).
The first foods are for fun and getting used to tastes, textures, and swallowing. They have limited nutrition. The amount of breastmilk or formula should not decrease when starting purees/cereals.
Limit purees or cereals to approximately 1-2 oz once or twice per day for the first couple months after introducing foods. It’s normal if they only take a spoonful or two of food at the beginning.
Start a single food for introduction initially and add in a new food every 3-5 days, so that you can monitor for signs of allergic reaction.
Know that it may take several times for your baby to taste a food before they become accustomed to the taste.
Some foods such as cereals, applesauce, and bananas may cause constipation. Cut back on these foods and add “P” fruit purees (pears, peaches, plums, prunes) or blueberries if your child is constipated (hard, firm stools). It’s generally okay if the color and smell of the stools change or stools become slightly thicker with introducing foods. Call if you have any concerns.

Table foods:

Your child should be at least 8-9 months old, sitting independently well, and able to reach out and grab foods using their index finger and thumb (pincher grasp).
Keep all foods small (about the size of a cheerio) even if your child already has teeth. They will not really chew foods well for a couple of years.
Once you start table foods, you can gradually increase the number of meals and amount of food. The goal between 9-12 months is to gradually start eating 3 meals per day (+/- 1 or 2 small snacks) and transition from a mostly liquid/milk-based diet to a solid food diet.
Portion sizes for kids can be estimated as follows: the size of a serving of meat can fit on the child’s palm and the size of starches (pasta, potatoes, rice, etc.) should be about the size of child’s fist. About half of the meal should be made up of fruits or veggies. Appetite may vary widely from day to day. Likes and dislikes also change frequently in young children.
Avoid choking hazards. These include round foods such as whole grapes or hot dogs, hard foods like raw carrots or nuts, or foods that require chewing like steak or chunks of cheese.
It is okay to give small amounts of water to drink after 6 months of age. This may be a good way to learn to use a cup or sippy cup.
Do not allow your child to drink cow’s milk until at least 12 months of age. However, a small amount of cow’s milk can be mixed in to foods such as mashed potatoes. It is also okay to give other dairy products such as yogurt or shredded cheese.
Avoid honey until your child is at least 12 months old.

Introducing allergens:

Studies have shown that earlier introduction of peanuts (after 4-6 months of age) may protect against developing peanut allergies. Most other types of allergenic foods should be introduced later once table foods are introduced (around 8-9 months).
If your child has severe eczema, an egg allergy, or a strong family history of foods allergies, talk to your pediatrician or allergist prior to starting peanut butter or other highly allergenic foods.
Make sure your child has done well with at least a few other purees or cereals before introducing peanut butter, so you can better distinguish between an allergic reaction and just not being ready to tolerate feeding.
You can introduce peanut butter by either mixing a small amount of peanut butter into purees to thin it out or adding peanut powder into a puree or cereal.
Continue giving peanut butter or other allergens on a regular basis once it has been introduced if well tolerated. Do not give any further doses without checking with your pediatrician or allergist if there is concern for an allergic reaction.
Introduce allergenic foods (peanuts, tree nuts, eggs, fish, seafood) one at a time and at least 3-5 days apart.

Common signs of allergic reaction:

Mild allergic reactions may include hives (red raised welts) or eczema (dry, irritated skin). More severe allergic reactions typically occur within 15-20 minutes of eating the food and may include lip, tongue, or facial swelling, wheezing, vomiting, or respiratory distress. If you suspect a severe allergic reaction, call 911 immediately. For concerns about mild allergic reactions, call your pediatrician’s office to discuss.
Allergic colitis (milk/soy allergies):
Ask your pediatrician about the best time to try reintroducing these foods to your child’s diet.
Some brands of infant cereals may contain soy, so be sure to check all labels even on baby foods if your child has an allergy.