4.7: Introducing Solid Foods to a Baby

When, What, and How to Introduce Solid Foods

The American Academy of Pediatrics recommends children be introduced to foods other than breast milk or infant formula when they are about 6 months old, although that may vary somewhat. It is not recommended feeding babies solid foods during the first 4 months. This is because babies younger than 4 months still have immature tummies and bowels and they are also not able to can’t chew or swallow well either. As babies get older, they need solid food to get enough nutrients to grow and develop properly. Important nutrients include iron and zinc.

Introducing solids is also important for helping babies learn to eat, giving them experience of new tastes and textures from a range of foods. It develops their teeth and jaws, and it builds other skills that they’ll need later for language development.

Here are some signs that show that an infant is ready for foods other than breast milk or infant formula:

• baby has good head control
• baby can sit with little or no support
• shows an interest in food – for example, they look at what’s on your plate
• opens his or her mouth and leans forward when you offer them food on a spoon

Fig 4.7. Baby being spoon-fed.

Image Source: Introducing solids: why, when, what and how. Babies. raisingchildren.net.au

How Should Foods Be Introduced?

When you’re first introducing solids, try offering 1-2 teaspoons of food once a day. At first, your baby might have only a small taste and probably won’t swallow much. As your baby grows, you can increase the amount according to your baby’s appetite and signs.

By 12 months, your baby should be eating around 3 small meals a day, plus breast milk or infant formula.

When your baby is ready for solids, first foods might be smooth or finely mashed, depending on what your baby likes. Over the next weeks and months, your baby can move on to roughly mashed or minced foods and then chopped foods. All foods should be very soft.

Your baby needs a variety of food textures. This helps your baby learn how to chew, and chewing helps with speech development and self-feeding. It also helps to prevent feeding difficulties as your baby develops. Babies can chew even before they get their first teeth.

The key is to include iron-rich foods of the right texture in your baby’s first foods. Iron-rich foods include:

• iron-fortified infant cereal - oat, barley, and multi-grain instead of only rice cereal
• minced meat, poultry and fish
• cooked tofu and legumes
• mashed, cooked egg (avoid raw or runny egg)

To these iron-rich foods, you can add other healthy foods of the right texture like:

• vegetables – for example, cooked potato, pumpkin, sweet potato, carrot, broccoli or spinach
• fruit – for example, banana, apple, pear, melon or avocado
• grains – for example, oats, bread, roti, naan, rice, noodles and pasta
• dairy foods – for example, full-fat yoghurt and full-fat cheese.

You can introduce any number of new foods at a time and in any order. When you offer your baby a variety of foods, they can try plenty of new tastes and get a range of nutrients. It may take numerous attempts before a child gains a taste for a certain food and caregivers should not give up if a food is refused on first offering.

Children should be allowed to try one food at a time at first and there should be 3 to 5 days before another food is introduced. This helps caregivers see if the child has any problems with that food, such as food allergies. It is no longer recommended that caregivers delay introducing these foods to all children, but if there is a family history of food allergies, the child’s doctor or nurse should be consulted.

The eight most common allergenic foods are

1. milk
2. eggs
3. fish
4. shellfish
5. tree nuts
6. peanuts
7. wheat
8. soybeans

Signs that your baby is getting enough nutrition from both solids and breast milk or formula during this time:

• has plenty of wet diapers – at least 6-8 wet cloth diapers or 5 very wet disposables in 24 hours
• is alert and mostly happy after and between feeds
• is gaining weight at about the right rate
  • your child and family health nurse will weigh your baby at your regular check-ups.

Milk Anemia

Definition: Milk Anemia

A condition in which milk consumption leads to a lack of iron in the diet

Infants younger than 12 months who drink cow's milk rather than breast milk or iron-fortified formula are more likely to have anemia. Anemia is a problem in which the body does not have enough healthy red blood cells. Red blood cells bring oxygen to body tissues.

During their first 6 months of life, babies use the iron transmitted from their mothers before they were born and stored in their bodies. Infants also get some iron from breast milk or infant formula, but these iron reserves diminish as the baby gets older. Because they grow rapidly, infants and toddlers need to absorb a lot of iron each day. By around 6 months, babies need to start having iron-rich solid food. Milk anemia most commonly affects babies 9 - 24 months old. Children older than 12 months who drink too much cow's milk may also have anemia if they do not eat enough other healthy foods that have iron.

Cow's milk leads to anemia because it:

• contains less iron
• causes small amounts of blood loss from the intestines
• makes it harder for the body to absorb iron

As their iron level and blood counts become lower, signs of milk anemia may appear. The infant or toddler may:

• behave irritably
• become short of breath
• crave unusual foods (called pica)
• eat less food
• feel tired or weak all the time
• have a sore tongue
• experience headaches or dizziness

Severe anemia presents with

• blue-tinged or pale whites of eyes
• brittle nails
• pale skin color

Growth Faltering (formerly know as Failure to Thrive)

Definition: Growth Faltering

Occurs when an infants growth rate is significantly below that of other children of similar age and gender.

Growth faltering often occurs in children whose nutritional intake is insufficient for supporting normal growth and weight gain. It typically presents before two years of age, when growth rates are highest. Physicians often identify it during routine office visits, when a child's growth parameters are not tracking appropriately on growth curves. It is a common and treatable condition. The baby may simply need to take in more calories to get back on track or they might need treatment for an underlying condition such as:

• errors of metabolism
• acid reflux
• anemia
• diarrhea
• Cystic fibrosis,
• Crohn’s disease
• celiac disease
• cleft palate
• tongue tie
• milk allergies
• hyperthyroidism
• congenital heart disease

Growth faltering may also be caused by situational or environmental factors:

• inability to produce enough breast milk
• inadequate food supply
• insufficient number or volume of feedings
• insufficient nutrition
• caregiver’s actions
• neglect

Several of these factor may co-exist. For example a baby experiencing pain from acid reflux may refuse food and the caregiver is hesitant to force the baby to eat.

Sources

• Anemia caused by low iron - infants and toddlers. Medline Plus. February 17, 2024.
• Introducing solids: why, when, what and how. Babies. raisingchildren.net.au
• Leon, Ana R. Children’s Development. Licensed under CC BY 4.0.
• When, What, and How to Introduce Solid Foods. Infant and Toddler Nutrition. CDC. March 20, 2025