How to Start Solids in 2020 – A Pediatrician’s Take

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Guest post written by Dr. Florencia Segura, Board Certified Pediatrician at Einstein Pediatrics

You have probably heard many different opinions from well-meaning grandparents, friends, and coworkers about what food, when, and how to start solids! On top of this, the guidelines from the American Academy of Pediatrics (AAP) have dramatically changed in the past 10 years. Due to this, starting solids can seem daunting and you may be second-guessing yourself on whether you are doing the right thing. Rest assured that your pediatrician is here to help! Below is the latest evidence-based information to help guide you on starting on your child’s adventure into the world of enjoying food! 

When can my baby start solid foods?

We, pediatricians, like to look for signs that your baby is ready for solids which are usually evident at 4 to 6 months of age. If you are exclusively breastfeeding your baby, please continue to do so! The American Academy of Pediatrics does recommend breastfeeding as the only source of nutrition for your baby for the first 6 months of life. 

What are the readiness signs? 

1) Good head control: Can your baby sit in a ‘bumbo’, high chair, or feeding seat with good head control? In other words, does your baby’s head maintain a stable position without bobbing up-and-down or side-to-side?

2) Interested in Food: Is your baby trying to reach for your food while you are eating?

3) Ability to move food from the front of the mouth to the back of her mouth: If your baby pushes the spoon or puree out with her tongue (tongue thrusts), wait a week and try again.

How about rice cereal in a bottle? Will it help my baby sleep longer?

Putting rice cereal in bottles used to be the advice given to parents for decades with the thought that it would help babies sleep longer and help “keep the milk down.” Many parents are getting this advice from their parents which is why this idea persists! 

Parents should not add cereal to bottles since it can be a choking hazard and an aspiration risk, especially if an infant does not have the oral motor skills yet to swallow the mixture safely. Cereal added to bottles also delays the opportunity to learn to eat from a spoon. Also rice cereal has very little protein, fiber, or flavor. There are also concerns that rice cereal has elevated arsenic levels and we are learning more about the possible effects of early-life arsenic exposure.  

Additionally, studies have shown that rice cereal will not necessarily help your baby sleep longer. Good sleep always starts with a bedtime routine as early as two to four months of age, which will help your child get ready for rest, especially once he starts to associate the routine with sleep.

What “solid” should I start?

Any food can be the first as long as it is mashed or pureed! There are NOT any strict guidelines anymore as to what order you should follow when starting solids. You no longer need to wait a couple of days between foods and then offer a new food. That’s outdated advice! 

I like getting babies used to veggies and fruits early on like avocado mixed with breastmilk (a fan favorite among my patients), sweet potatoes, pureed green beans, soft cooked apples, peanut butter thinned with water and mixed into oatmeal, mashed banana, and others.

Instead of rice cereal, it would be better to feed your baby oatmeal or multigrain baby cereal and have your babies get their iron through pureed meats, beans, dark green veggies! 

How much?

When you start at around 6 months, a tablespoon or two once or twice a day is typical. As your baby grows, you will add larger amounts. Remember that in the first year of life, solids are complementary to breastmilk or formula which are the primary sources of nutrition. Solids are important as your baby is learning new flavors, textures, and learning how to eat from a spoon and self-feed. Stop once your baby is no longer interested, starts turning his/her head away, or cries. 

What about allergenic foods?

Although we used to hold off until over a year on allergenic foods such as eggs, fish, and nut products, new research shows that holding off may INCREASE your child’s chance of becoming allergic.

Specifically, the groundbreaking LEAP trial

 https://www.nejm.org/doi/full/10.1056/nejmoa1414850 taught us the early introduction of peanut-containing foods to infants between 4-11 months of age reduced development of peanut allergy by more than 80 percent! Yes, peanut butter thinned and mixed into oatmeal or banana mash with water or breast milk is fine!  

When can I give my child water or juice?

 I love getting an infant used to drinking water in a cup as soon as she starts solid foods at 6 months! Start with a few sips. Learning to like the taste of plain water is a healthy habit for life. 

Babies do not need juice unless they have symptoms of constipation. It is much healthier to give them the actual fruit, even pureed fruit, which contains valuable fiber.

What about finger food?

When babies start to pick up small objects, usually around 8-9 months of age, they may start self-feeding. I like to start with something that dissolves easily, such as puff, then advance to small pieces of soft table food such as small pieces of scrambled egg, steamed veggies, whole grain bread, salmon, small pieces of soft chicken. All fruit, even strawberries and other berries, are fine cut up into small pieces. 

Any foods to avoid?

 Yes! Never give an infant under 1 year of age honey because of the risk of infant botulism which can be deadly. Also, stay away from anything that could be a potential choking hazard, such as popcorn, hot dog slices, whole nuts, grape tomatoes, and whole grapes.

The bottom line is to have fun and explore different foods while letting your baby get messy! Enjoy all those funny, cute faces they make as they explore different textures and flavors! 

You can find Dr. Segura on Instagram @drflorenciasegura for more great tips from a highly recommended pediatrician!

Still have questions? The Sleepytime Consultant is here for you! Contact us today for help.

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