Feeding and Solid Food Introduction
Things that I look for in an infant that let me know they are thinking about or even ready to start solid food usually occur sometime between 4 months and 6 months of life. I am looking to see that a kiddo is able to hold their head up, stable, on their own (even if not sitting on their own yet) for a good 30 seconds or more. They are increasing their saliva production with drool all over the place and regularly bringing their toys to their midline and then to their mouth to chew on. If these things are happening, food introduction is usually what I am talking about in clinic.
Over the past 15 years, nutrition and allergy research has shown over and over again that early food introduction reduces food allergies in kiddos. So when I tell a family that they can start introducing food, I mean it. Go for it. As long as the food is mushable, does not have any honey in it, is not processed (not made to be kept on the shelf for a long time), and does not have a lot of extra salt or sugar (natural salt and sugar is fine—like chicken has natural occurring salt, and fruit has natural occurring sugar), you can start low and slow and feed it to the kiddo. We usually start with 2 oz per day, offered at one meal during the day for those kiddos starting between 4 to 6 months of age.
The first few times you give kiddos food, they will not know what to do with it and mostly spit it out. Eventually, they will accidentally swallow some of that yummy avocado and will quickly get with the program. Solid food rocks!
If the kiddo does well with the 2 oz a day for a week or so, then I will have the family increase to 2 meals at 2 oz a day and then 3 meals at 2 oz a day until the kiddo is 6 months of age. After 6 months, we can start increasing the amount and start making the food more gritty to work on chewing and biting. At 6 months, we usually are also ok for kiddos to start drinking a few oz of water here and there to keep the poop soft and the pee not super dark and smelly after starting to introduce more solid food. If a kiddo’s poop is harder than guacamole, then we should give a bit more water to keep the poop soft and moving. At about 9 months of age, half a kiddo’s nutrition (healthy protein, vitamins, and minerals) should come from solid food and the other half from breast milk and/or formula. Then at 12 months, kiddos can have whatever they want to eat! Beef tartare? Sure! Sushi? Go omakase crazy if you want. And, of course, honey and a little sugar and salt for that awesome 1st birthday smash cake!
Now having said all that, I do get a lot of questions regarding baby-led weaning or baby-led food introduction. When this form of food introduction started to be discussed in parenting circles and pediatric conferences, we were hoping that allowing babies to guide and drive the introduction of food would decrease the chances of obesity over time. Turns out that did not happen, and kids with baby-led diets for the first years of their lives had the same risk of obesity as any other kiddo. The only thing that the studies from baby-led weaning showed over and over was there was a slightly higher rate of choking episodes than those that start with mushed food. Choking episodes, not choking deaths, to be clear. This is also why I ask families to take a first-time or refresher baby and kid CPR (cardiopulmonary resuscitation) class to make sure their kiddo and baby Heimlich maneuvers are ready to go if needed.
But what about peanuts, Doctor Fradkin?!? Yes, please introduce all of those allergenic foods in mashable forms as early and often as possible unless your kiddo is having an eczema-type rash flare-up where the body is in a heightened sense of alert to any foreign intruders. The research over the last 15 years on the early introduction of allergenic foods shows us repeatedly that introducing foods like tree nuts, eggs, etc. early can help prevent allergies rather than cause them. Of course, anyone can have an allergy to anything at any time, so be on the lookout for body rashes with hives within 15 minutes to 2 hours of a new food introduction for early signs of a food allergy.