Dr. Flanders’ Advice on Introducing Solid Foods to Babies

Most babies are ready to expand their food repertoire beyond breast milk and formula at around 4-6 months of age. But until 12 months of age,  the main source of balanced nutrition should continue to come from breastmilk and/or formula.  The goals of introducing solids are for baby to explore food, develop some feeding independence, and take part in the social experience of eating together as a family.  Keep in mind, therefore, that the amounts and varieties of food consumed by their baby are not at all important until after 12 months of age.

Which foods should I choose?

The first foods chosen by parents can vary tremendously from culture to culture and from family to family.  There is no “best first food” to start with.  Literally any single food item (other than honey) can be tried.  With that in mind, start with foods that have the consistency of a soft puree – e.g. like smooth yogurt.   Other options include finely pureed meat, well cooked and pureed legumes, pureed fruits/vegetables, very soft cheeses such as Brie or Camembert.  Introduce new foods one at a time, waiting about 3 to 5 days before trying another. Consider pureeing the healthy foods that you and your family eat so that everyone at the table is enjoying the same meal. You may also choose to use commercially prepared baby foods.

How do I feed my baby solids for the first time?

Start by offering solids once daily.  Initiate the meal by allowing baby to explore the food: squish it in her hands, slap it on her face, throw it on the floor.  This is how babies ‘get to know’ and become comfortable with their food. Trying to teach your baby not to throw food or not to make a mess will only interfere with the process. Wait until age 2 or 3 before teaching table manners.  Once a comfort level is established, load a very little bit of food on the tip of a soft spoon and present the tip of the spoon to baby, just below her lower lip but not touching.  Give baby the time and space to open her mouth, move her head forward and eat the food from the spoon.  Avoid pushing the spoon into her mouth as some babies interpret this as ‘forcing’.  If she readily eats what’s offered, then keep going until baby conveys to you that she’s done. If baby is uninterested or rejecting what’s offered right off the bat, then quickly call it a day and try again tomorrow.  Some babies need to try a food many times before accepting it.

How many times per day?

This is entirely up to you.  Some families keep it to once a day.  Others like their children to eat solids with the family at every meal.  There are no absolute rules here.  In all likelihood you and your baby will soon work out together the most suitable schedule.  In the second year of life it will become more important to establish scheduled meal and snack times.  Until then, feel it out and choose what works best for you and your baby.

What about water, milk, and juice?

In the first 6 months of life, babies should not drink milk and juice as these are not suitable alternatives to breastmilk/formula.  Although water is not harmful, it is not necessary. Beyond 4-6 months as your baby begins to eat other foods, you can start to offer water occasionally. Juice is not necessary and thought by most reliable authorities to be unhealthy for all babies and children.  Juice is essentially sugar and water.  It has very little nutritional value.  Furthermore, it can fill up babies’ small stomachs decreasing their appetite for more nutritious foods.  Too much juice can also cause early childhood tooth decay and contribute to the development of childhood obesity. If it is important to you that your child drink juice, make sure you offer no more than 4 oz, or 120 ml per day.  After 12 months of age, it is appropriate to discontinue formula and introduce homogenized cow’s milk (12-18 ounces or 350-500 ml per day).

Are there foods that are unhealthy or that I should avoid feeding my baby?

Avoid giving babies sugary drinks or foods, such as candies, soda/pop or energy drinks. This gives them calories without any nutrients and leads to obesity and/or malnutrition. Don’t give honey to babies under 1 year old, as there is a risk of infant botulism (food poisoning). Don’t give foods with textures that are too advanced. Examples of advanced textures include:

  1. Multiple textures – eg. Soup with noodles, purees with chunks.
  2. Rice – Rice scatters in the mouth making oral control difficult.
  3. Foods requiring significant chewing – eg. Large pieces of tough meat, raw vegetables, chunks of hard cheese

How do I prevent my baby from choking?

  • Always supervise babies and children while they are eating. They should be sitting down.
  • Don’t feed your baby peanuts, nuts or popcorn.
  • Dice or slice round foods such as wieners or grapes.
  • Grate raw vegetables such as carrots to make them easier to chew.
  • Remove pits from fruits.
  • Cook hard fruits and vegetables to soften them.
  • Chop or scrape stringy meat and add broth to moisten it.

If you live in Toronto and would like nutrition support for your child, feel free to learn more about the Kindercare Pediatric’s clinical nutrition programs.

  • Hi Dr Flanders
    I note you recommend purée weaning infants and wondered what your take was on Baby Led Weaning please?
    AA

  • Thanks, AA, for bringing up Baby Led Weaning (BLW). For those readers who aren’t familiar with this approach, it was conceived and developed by Gill Rapley in the late 1990’s. At the time (and to a large extent, still today) the general approach to introducing solid foods to babies had a marked overemphasis on progressing a baby’s feeding skills based on parents’ agenda rather than baby’s … i.e. pediatrician gives parents a schedule to follow and parents then impose said schedule on baby. There was little consideration (if any) given to baby’s readiness (psychological and neurodevelopmental), preference, comfort levels, etc… Ms. Rapley appropriately took issue with this and developed an approach of introducing solids in a way that was far more respectful of, considerate to, and empowering for baby.

    In my opinion, the principles behind BLW are solid. On a societal level, it presents a much more appropriate approach that puts the baby’s agenda front and center (where, in my opinion, it should be).

    If you were to ask me if I had any concerns about BLW, the one minor issue I would bring up is that there appears to be an ‘anti-puree’ and ‘anti-spoon-feeding’ sentiment in the literature that I don’t quite understand. In my opinion, babies can eat pureed foods in a baby-led fashion. My favorite approach is to dump a pile of apple sauce in front of a baby and then sit back and enjoy watching her explore. Although 99% of the food will end up in and on places other than in her tummy, she will have had an enjoyable, authentic, baby-led feeding experience. As for spoons, I also believe that babies can eat from a spoon in a baby-led fashion. The key is to ensure that baby is actively eating off the spoon as opposed to passively receiving the spoon being pushed by parent into baby’s mouth. The former represents a child who is 100% empowered to decide for herself whether or not to eat what’s being offered. The latter, in my opinion, is force feeding (never advisable).

    For more information about BLW, Check out Gill Rapley’s Site. Her Useful links page refers to a number of additional BLW resources on the web.

  • Hi
    Thanks for such a speedy reply.

    I would agree to some degree that babies can be spoon fed in a baby led fashion, and I think if offering a range of foods and textures some of those are bound to require a spoon eg yoghurt, rice pudding or suchlike? (ie Gill Rapley doesn’t support the notion of one food per few days, but offering a wide selection presented individually on the plate so the child can refuse a specific food if desired)

    For the most part eg meals, I guess the question is why mush, rather than why not? why not just let the child feed themselves entirely? There doesn’t appear to be any research supporting the notion food “should” be mushed?

    What BLW also theories (and something I’ve observed in practice) is that eating skills develop in tandem with the ability to pick up and “manage” different foods. As I’m sure you know well, eating isn’t just a case of swallowing; it’s getting the food to the mouth, chewing or processing, moving to the back of the mouth ready to swallow (by which point it needs to be safe to do so ie small enough)

    As the gag reflex sits further forward in an infant’s mouth, conferring extra protection whilst developing skills, and moves back as they mature – if a baby has been limited to mostly mush, is there more of a risk the skills get out of sync? ie when a baby is 6 months, they can’t pick up say peas or sweetcorn as they haven’t developed a pincer grip; by the time they can they have generally had a couple of months working on learning to eat with the bigger items they can pick up?

    Observing those BLW – in the first instance baby often holds on to the food as they move it around the gums to gnaw and suck, their eating skills can be visibly seen to be developing as they progress, which occurs in tandem with the physical skills to pick up and transfer to the mouth (which ultimately is a significant part of the rationale for waiting until around 6 months? ie the ability to put food to the mouth themselves occurring alongside internal gut closure)

    The other question is that of volume. We note purée fed infants often consume more than those feeding themselves – if the spoon feeding is parent led, they can often spoon far faster than a baby could, which potentially makes it easier for the infant to over eat.

    In the same way multiple milk ejections at the breast, slow the feed down – the child keeping control of their food and ultimately intake, makes for a much slower eating experience. Most recognise now the benefits of chewing food well and more slowly; that it gives the brain and body more chance to recognise it is full.

    Many also recognise that a person being able to recognise they are full and stop eating, is far more likely to maintain a healthy weight as an adult. How and when do people lose that ability?

    Even if the parent is holding out the spoon for the infant to come on to, if something tastes nice, is there the potential for the child to keep opening and leaning forward, because again they can swallow the purée faster than they could hope to feed themselves? If someone was holding chocolate mousse out for me, I may well be tempted to open a few more times than if I was feeding myself (but perhaps I’m just a chocolate addict 😉 LOL)

    You will also know yourself if you take a punnet of say berries and mush them, you often end up with a surprisingly small amount of purée as a result – allowing a higher calorie intake from a smaller volume, what would our weight do if we puréed every meal?

    Another aspect is chewing for appropriate jaw development – whereas this is likely to be less significant for the breastfed infant, a baby who has sucked primarily from a bottle/dummy (which could hinder appropriate development of jaw muscles as highlighted by Brian Palmer DDS) could potentially benefit from chewing, not only for the jaw but also for the eustachian tubes?

    In BLW infants we also note constipation is virtually unheard of – something many parents note following the introduction of “solids” (ironic given it often means anything but solid lol).

    Kind regards
    AA

  • Hi again AA. Thanks for such insightful and informative comments. You covered quite a swath of interesting topics and I will do my best to respond with the time and consideration that these topics deserve. I’ll apologize in advance if the responses below are too brief and superficial, but I intend to use many of your insights as fodder for future posts on this blog.

    Re: your comment: “why not just let the child feed themselves entirely?”
    I guess the concern here is what about the kids who aren’t yet able to do so? My approach to progressing feeding skills is ‘first walk, then run, then fly’. Some kids can ‘fly’ right off the bat in which case they would spend only days (or skip altogether) the puree stage. Others need to take small steps and progress slowly. For those kids, I’m of the opinion (though I am open to having my mind changed by compelling data) that the puree texture is a logical next step in the transition from liquid calories towards more complex solid food textures. You are correct that there is a paucity of good scientific data out there supporting the use of purees as a transitional food. That said, there is a paucity of data, in general, to support making recommendations for any first solid foods for babies. So we do the best we can with the (limited) information we currently have.

    Re: progressing feeding in a developmentally appropriate fashion.
    This ties in nicely with your other very valid point that there is more to feeding than just swallowing. I.e. feeding is a complex behavior involving the exquisitely complex coordination of (in addition to the gastrointestinal tract) multiple components of the central nervous system: fine motor, oromotor, gross motor, perception (smell, touch, taste, temperature, vision), cognition, emotion, motivation etc… All components must be 1) at an appropriate developmental stage and 2) able to intercommunicate in order for healthy feeding to ensue. Development of these systems is already occurring before birth as baby drinks amniotic fluid. There is further progression through pregnancy and then after birth with the onset of breastfeeding. The introduction of solid foods marks the next major ‘developmental milestone’ in the evolution of feeding skills. Some babies handle this challenge with ease. Other babies are less precocious. For them, any or all of these nervous system components may be lagging in development or capacities to intercommunicate. In these cases, baby needs practice and slower progression. As such, I feel that a gradual and slow progression from liquids to purees to soft solids etc. is the most logical way to challenge, develop, and promote coordination of these various CNS systems. As you point out, keeping a baby on purees when she is neurodevelopmentally beyond that level does not make any sense. On the other hand, presenting a baby with food consistencies that are beyond a baby’s neurodevelopmental capabilities is equally nonsensical (I’m picturing a hungry 8 month-old sitting at the table, nutcracker in hand, reaching for a bowl of unshelled walnuts). I don’t mean to say that BLW is not sensitive to this argument. In fact, the BLW approach embodies this notion of allowing development to occur, led by baby, in the appropriate manner and tempo. I just see purees as a sensible next step in the transition from liquid to solid calories. How long a baby chooses to stay at the puree stage is entirely up to her.

    Re: BLW preventing constipation
    How interesting! I was not aware of this. I would love to read more about this connection. Can you direct me to some related literature?

    Re: Infant/child feeding development and their response to hunger and satiety.
    Your points are well taken. In fact, there are a number of amazing studies that have emerged over the past 5-10 years linking abnormal development of feeding skills with childhood-onset obesity and other feeding disorders. These papers hypothesize that healthy development of hunger and satiety signals (from brain to gut and gut to brain) is crucial for maintaining long-term healthy body composition. In other words, babies need to feel hungry, understand the meaning of that feeling, communicate the need for food, feed themselves until comfortably satiated, understand the meaning of feeling full, and then stop feeding as a result. There are opportunities for this sequence to go awry and most of the time, problems are introduced when a parent presume to know better than his baby when she (the baby) is hungry/full, how hungry/full she is, and how much food she should eat at any given meal. Whenever a parent thinks he knows his baby’s hunger/satiety signals better than his baby does, there is a significant risk that baby will be fed when not hungry and deprived of food when hungry. Furthermore, baby is likely to be over or underfed during any given meal. Imagine how difficult it must be for baby’s hunger/satiety signals to develop faithfully when the hunger/fullness sensations are constantly mismatched with the timing and quantity of the feeds. The quality of the food can also adversely impact the development of baby’s hunger/satiety systems. Liquid calories (and to a lesser extent pureed calories), if fed in relative excess, do not necessarily promote appropriate hunger/satiety signaling. In other words, when calories are densely concentrated into a juice or mush, the body tends to under or overestimate the number of calories consumed. As such, children who take in the majority of their calories in the form of liquids have a much higher likelihood of being over or underweight. Furthermore, deranged hunger/satiety feedback/development increases the risk of obesity, failure to thrive, behavioral feeding disorders, eating disorders, micro and/or macronutrient deficiencies, etc. So I agree with you that babies and children should eat a wide and balanced range of foods and textures. Getting stuck on a single food type or consistency potentially leads to significant long term risk.

    Thanks again for your valuable contribution to this post. If I’m ever in the UK, or you are anywhere near Toronto, perhaps we can meet over a large bowl of chocolate mousse, over-feed, and further discuss the finer points of infant and childhood nutrition 😉

    DF

  • LOL @ 8mth old with a nutcracker! I absolutely agree there has to be both instinct and logic applied – I have seen young babies presented with a plate of salad with raw carrots. Whilst a great texture/sensory experience, if baby is hungry they’re unlikely to get enough down to hit the spot. Including some softer finger foods that can be more easily consumed makes more sense I think.

    What I’ve also observed and identified in a survey was that when presented with a range of foods, meat was often a very popular first choice. Even more so in cases where there was increased risk for reduced haemoglobin levels; given what we also know about which nutrients an infant requires during the early weaning period – it would be interesting for someone to study self selection of foods further.

    The section of your reply outlining infant/child feeding development and their response to hunger and satiety is absolutely fascinating! I am going to have to dig out more on that subject now.

    WRT solid consumption before readiness, I think an interesting questions is whether there is evidence an infant needs solids prior to them being able to self feed themselves? (or indeed demonstrating a desire to do so) I am of course talking with regard to a typical breastfed infant (ie the biological norm) and there will always be exceptions to this (eg my premature son made it very clear he wanted solids prior to being able to put them in himself) – This is I think a central belief to baby led weaning.

    This makes the most logical sense for me – no other mammal requires someone to look at and establish signs of readiness (and what did parents do before the magic lists of what to look for?) before starting to offer a different food every x days. Sure meat would likely have been pre chewed, but if I had no books/guidelines/societal norms influencing – I think the most obvious sign of solids readiness is an infant reaching for and eating food. We know this happens for most around the middle of the first year, and we know this also ties in with gut maturation in terms of closing and hindering direct access to the bloodstream?

    However I waffle about my opinions on that here http://www.analyticalarmadillo.co.uk/2011/02/starting-solids-can-babies-be-ready.html

    On a totally different note – our recent focus has been on ankyloglossia and solids, we are noting a high proportion of infants who are not progressing as we typically see with baby led weaning (and in severe cases even purées) have a type 3-4 tie (either undiagnosed or dismissed as insignificant). This makes the information you provided WRT response to hunger and satiety even more interesting!

    Thanks for taking the time to reply, chocolate mousse is on me lol

    AA

  • I so enjoyed your informative and insightful posts! It is so refreshing to see such respectful and gracious responses, despite differences in opinion. One request however, – can I join you for the chocolate mousse?

  • Hi Lynda. Thanks so much for your kind words! Here’s to productive and collegial dialogue!

  • What a great discussion! It’s been highly educational. I’m glad that Lynda directed us to your blog (when we came in earlier this week, with our baby, Maya). 

    I have a question: is the baby capable of mashing down bits of fruit with her gums before her teeth come in, or does the risk of choking present itself if the puree is on the “chunky” side? 

    Also, when you say to dump a pile of apple sauce in front of the baby, do you mean in a bowl or directly into the tray of her high chair (after thorough cleaning, of course)? My instincts would say to put it in a bowl, but it would likely end up on the floor. Do they make containers with suction cup bottoms that stick to high chair trays? That would seem like a good idea.

  • Hi David. Thanks for raising those questions.

    My son got his first set of teeth at 21 months of age and I can assure you that he was gnawing, chewing, and grinding food with his gums well before that. There’s really no harm in using the gums to chew, especially with softer foods like bananas, avocado, scrambled eggs, cheese, etc. As the texture gets harder and more advanced, Maya may or may not be able to handle it. Just let her tell you if/when she’s ready, teeth or no teeth.

    When I recommended ‘dump[ing] a pile of apple sauce in front of a baby’, I envisioned the applesauce in a pile on a tray without a bowl or cutlery. But quite frankly, you can do it however you wish, just so long as the experience is positive for Maya.

    I have seen bowls and plates with suction cups on the bottom. They seem to work quite well … of course you’ll miss that precious moment when baby swats the bowl of food off the tray thereby reinterpreting the expensive artwork hanging beside her on the dining-room wall 😉

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  • This has been a very informative series of posts, thanks to all of you. Our 7 month old has been completely disinterested in pureed foods the last few weeks but will gobble down a steamed carrot or broccoli floret, so we’re letting her be in the driver’s seat for now. Baby-led weaning seems to be a relatively new phenomenon for Canada, much of the reading I have been doing seems to come from research in the UK. I’m wondering if you can give a suggestion as to how to introduce meat into the mix?

  • Hi Melissa. Sounds like your babe is eager to move on to more interesting and exciting textures. Here are some ideas to get things going:

    The idea is to choose meats with textures that are a bit more challenging for baby to orally manipulate than fine purees. Think solid foods that can be easily converted to mush with a few munch motions of the mouth. You and baby have already discovered that a steamed broccoli floret fits the bill nicely. So what can be good meat equivalents?

    Try pattes, very finely shredded tender braised meats, or boiled meatballs cut into small bite-sized pieces. Fish is another good option. Offer small bite-sized pieces of soft flaky fish being careful to remove any bones. Eggs are another good option; Loosely scrambled eggs are the perfect texture for babies at this stage. You can also try lightly poaching or soft-boiling eggs and then offering bite-sized pieces to baby. One nice thing about eggs: the longer you cook them, the firmer and dryer they get (i.e. The more advanced the chewing skill required to eat them). So as baby’s skills progress, you can gradually advance the texture by increasing the frying/poaching/boiling times.

    I hope these are helpful suggestions. Good luck and enjoy!

    DF

  • I would go with the highchair tray too initially, why create more work/washing? lol

    Wanted to answer re meat question too (sorry I love BLW lol) Alongside the suggestions from DF, mine loved big old pieces of meat ie TOO big to put in their mouth whole such as a steak. My youngest would gnaw/chew/suck all the juices out pre teeth. Also bone broths/stocks are a fantastic source of nutrients and you can use herbs etc for flavouring and skip the salt 🙂

  • I agree with above. babies cannot choke on VERY large items (i.e. too big to fit entirely in mouth). So it’s entirely reasonable to offer such foods, especially if babe loves them.

  • Hi Dr. Flanders,

    What is your opinion about using salt at children under 2 years ?

    Thanks !

  • Hi Dr Flanders – what is your opinion about salt at children under 2 years ?

    Thanks !

  • Thanks for your question. The Jury is still out on whether added salt is directly harmful to children. On the other hand, habits learned in childhood often translate through to adulthood. So children who grow accustomed to high-salt diets are more likely to consume high-salt diets as adults. High-salt diet is more established as a risk factor for poor health in the adult population. So it stands to reason that if you want your kids to eat healthfully when they grow up, serve them healthy food and role model healthy eating when they are kids.