By Jack Newman, MD, FRCPC
Health Canada, the Canadian Pediatric Society, the American Academy of Pediatrics, IBFAN, UNICEF, the WHO Global Strategies on Infant Feeding and most paediatric societies around the world recommend exclusive breastfeeding to about six months. Many health professionals suggest starting solid foods at four months of age; many now say you must not start before six months of age. However, most babies do fine with exclusive breastfeeding to six months of age or even a little longer. You should start your baby on solids when s/he shows signs of being ready for solids, not by the calendar. See below.
• Because there comes a time when breastmilk no longer supplies all your baby's nutritional needs. (This does not mean, as some uninformed people say, that there is no nutritional value in breastmilk after the baby is six months old.) A full term baby will start requiring iron from other sources by 6 to 9 months of age. The calories supplied by breastmilk may become inadequate by 8 to 9 months of age, although some babies can continue to grow well on breastmilk alone well past a year. But just because they can grow well on breastfeeding alone is not a reason to delay introduction of solids when the baby is obviously ready for them. See below about the baby's cues that he is ready to eat.
• Because some babies not started on solids by a certain age (9-12 months) may have great difficulty accepting solid foods.
• Because it is a developmental milestone that your child passes when he starts solid foods. He is growing up. Usually, he will want to eat solids just as you do. He is ready to participate with the rest of the family in this family activity. Why stop him?
When To Start Solid Foods
The best time to start solids is when the baby is showing interest in starting. Some babies will become very interested in the food on their parents plates as early as four months of age. By five or six months of age, most babies will be reaching and trying to grab food that parents have on their plates.
When the baby is starting to reach for food, grabs it and tries to put it into his mouth, this seems a reasonable time to start letting him eat. There really is no reason to start on a specific date (four months, or six months). Go by the baby's cues.
In some cases, it may be better to start food earlier. When a baby seems to be hungry, or when weight gain is not continuing at the desired rate, it may be reasonable to start solids as early as three months of age. Starting at three months of age when things are going well, however, is not recommended (see above). But, it may be possible, with help, to continue breastfeeding alone without any addition of solids and have the baby less hungry and/or growing more rapidly. See the information sheet Protocol for Managing Breastmilk Intake. See also the information sheet Slow Weight Gain Following Early Good Weight Gain for reasons your milk supply may be down and what you can do about the decrease. Check the videos at nbci.ca so that you can use the Protocol better.
But if the techniques used in the clinic, which nevertheless will increase your baby's intake of breastmilk, do not deal with the problem, adding solids can help also. Increasing the baby's intake while breastfeeding is the first step and best step. There is no advantage to giving artificial baby milk (formula) and there definitely are some disadvantages, especially if it is given by bottle. The baby who is not satisfied completely at the breast may start to take more and more from the bottle, and end up refusing to take the breast completely.
The breastfed baby digests solid foods better and earlier than the artificially fed baby because breastmilk contains enzymes that help digest fats, proteins, and starch. As well, breastfed babies have received a wide variety of tastes in their lives in the breastmilk, since the flavours of many foods the mother eats will pass into her milk. Breastfed babies thus accept solids more readily than artificially fed babies. Breastfeeding is amazing, eh?
How Should Solids Be Introduced?
When the baby is starting to take solids at about six months of age, there is little difference what he starts with or the order foods are introduced. It is prudent to avoid highly spiced or highly allergenic foods at first (e.g. egg white, strawberries), but if the baby reaches for the potato on your plate, make sure it is not too hot, and let him have the potato. There is no need to go in any specific order, and there is no need for the baby to eat only one food for a certain period of time.
Some exclusively breastfed babies of 6 months of age or so, dislike infant cereal. There is no need for concern and no need to persist if the baby doesn't want the cereal. There is nothing magic or necessary about infant cereal. Offer your baby the foods that he is interested in. Allow the baby to enjoy food and do not worry exactly how much he actually takes at first. Much of it may end up in his hair and on the floor anyhow.
There is no need either that foods be pureed if the baby is six months of age or older. Simple mashing with a fork is all that is necessary at first. You also do not have to be exceedingly careful about how much the baby takes. Why limit the baby to one teaspoon if he wants more? You also do not need to waste your money on commercial baby foods.
• Be relaxed, feed the baby at your mealtimes, and as he becomes a more accomplished eater of solid foods, offer a greater variety of foods at any one time.
• The easiest way to get extra iron for your baby five or six months of age is by giving him meat. Infant cereal has iron, but it is poorly absorbed and may cause the baby to be constipated. If you wish your baby to be vegetarian, it would be best to speak with an experienced pediatric nutritionist about how to get iron into the baby's diet.
• There is no reason to introduce vegetables before fruit. Breastmilk is far sweeter than fruit, so there is no reason to believe that the baby will take vegetables better by delaying the introduction of fruit.
• Respect your baby's likes and dislikes. There is no essential food (except breastmilk). If your baby does not like a certain food, do not push it on him. If you think it important for him, wait a few weeks and offer it again.
• At about eight months of age, babies become somewhat assertive in displaying their individuality. Your baby may not want you to put a spoon into his mouth. He may want to take the spoon out of your hand and put it into his mouth himself, often upside down, so that the food falls on his lap. Respect his attempts at self-sufficiency and encourage his learning.
What If I Am Starting Solids At Three Months?
At this age, it may be prudent to go a little more slowly. Start with ripe avocado or easily mashed foods such as banana, or homemade oatmeal. Sometimes a baby will eat better from your finger (or his!) than off a spoon. Go a little more slowly with quantities as well. But as the baby tolerates solids, both quantity and variety of foods can be increased, as the baby desires.
Incidentally, why are you starting solids at three months? Many grandmothers are keen that the baby start "real food," but if there is not a good reason to start at 3 months, don't. (The most common legitimate reason to start earlier than five or six months of age is poor weight gain not corrected by correcting latch, using compression, switching back and forth, using domperidone).
What If I Am Already Supplementing With Formula?
Starting solids early is a way to prevent supplementing the baby with formula by bottle. Formula may be added to solids so that baby consumes the extra calories (from the formula) by spoon instead of by bottle.
Solids or Breast First?
There seems to be considerable worry when a child is starting solids about whether to give the breast first or give solid food first. If breastfeeding and the introduction of solid foods both are going well, it probably does not matter much. Indeed, there is no reason that a baby needs both breast and solids every time he eats.
Questions? Get Dr. Jack Newman's book The Ultimate Breastfeeding Book of Answers.
Jack Newman graduated from the University of Toronto medical school as a pediatrician in 1970. He started the first hospital-based breastfeeding clinic in Canada in 1984 at Toronto's Hospital for Sick Children. He has been a consultant with UNICEF for the Baby Friendly Hospital Initiative in Africa, and has published articles on the subject of breastfeeding in Scientific American and several medical journals. Dr. Newman has practiced as a physician in Canada, New Zealand, and South Africa.
Starting Solid Foods, 2009©
Written & revised (under other names) by Jack Newman, MD, FRCPC, 1995-2005©
Revised by Jack Newman MD, FRCPC, IBCLC & Edith Kernerman, IBCLC, 2008, 2009©