Starting baby on solid foods brings new advice, choices for parents

February 25, 2016
Babies love putting their hands, and anything else they can find, into their mouths! If your baby is four to six months old, this could also be a sign that he or she is ready to start eating solid foods.

For parents, this new phase in the baby's development also raises new questions. In 2014, Health Canada, the Canadian Pediatric Society, Dieticians of Canada and the Breastfeeding Committee of Canada released a joint statement, Nutrition for Healthy Term Infants, providing more information about nutrition for babies and young children age six to 24 months. Based on the most up-to-date research, this information is aimed at both parents and health care professionals.

BC Women's pediatrician Dr. Rob Everett notes that the advice parents receive on starting the baby on solid foods can change over time as new research suggests different best practices.

"I always tell parents that the recommendations we give today might change by the time they have their next child."

According to Everett, the most common question is when to start and how to recognize that the baby is ready. This is closely followed by what to feed in the first few months and when to transition from purees to foods with different textures.

We asked him to answer some of the most frequent questions asked by parents. Note that these answers may not apply if your baby is has developmental delays or medical problems.

How do I know when my baby is ready to eat solid foods?

Some recommendations say you should start feeding solid foods at six months and others as early as four months, but it really depends on the baby. However, there is total agreement that babies are not ready before four months. The recommendations are based not only on when the baby is physically capable of swallowing and digesting food, but also when it's an optimal time to help their developing immune system.

It's important to be aware of the cues that the baby is getting ready to eat solids. These include showing interest when you are eating, opening the mouth for food and turning the head away when they have had enough to eat. In general, babies also need to have good neck control and the ability to sit well with support before they are ready to progress beyond breast or bottle.

If you think your baby is ready for solid foods before six months, discuss it with your health care provider.

What are the best foods to get my baby started?

Start with foods that do not require chewing and are easy to swallow - babies need to learn those skills by being exposed gradually to a variety of different food textures starting at six to eight months. Start with simple purees for the first few months, but by about eight months, they are ready to tolerate more texture, so start with some foods that have lumps and progress to giving him small pieces of soft food to chew. When you make these changes, it's important to be there with your baby to ensure that he or she is safe. Babies need iron after six months, so choose fortified cereals (such as rice cereals) or meat purees.

It's good to introduce new foods one at a time so that you see how your baby reacts. By about 11 months of age, babies should be getting about half of their total calories from solid foods. This has several benefits. It encourages the development of chewing and swallowing skills; it improves acceptance of new foods in the diet; and it helps in achieving nutritional balance.

Is there anything that we can do to help him avoid developing food allergies?

The research evidence shows that it's better to give the baby a more inclusive diet than to exclude certain foods, even if members of your immediate family may be allergic to them. The old way was to restrict or delay giving babies some of the common food allergens, such as eggs, nuts, wheat, milk or seafood, until the baby was a year old. However, there is no evidence that delaying the introduction of these foods helps the baby avoid allergies - in fact a delay might increase the child's risk of developing allergies further down the road. Nowadays we say, be proactive but start slowly - give the baby small tastes of new foods, including those commonly associated with food allergies, and watch their reaction. If all is well, try a little more. If you have allergies in the family, it may be  especially important to introduce these foods when baby is around six months of age. Speak to your health care provider at around four months, prior to starting solids, if you have a strong family history of allergies. Some may suggest an appointment with an allergist to help guide you.

Which foods should I avoid giving to my baby?

When you give an infant solid foods, it's essential to keep an eye on them when they are eating to ensure that they are chewing and swallowing well. I tell parents to avoid small round foods - such as seeds, whole nuts, whole grapes, candies or pieces of carrots - as they are hard to chew and easy to choke on. We also remind parents that honey is not suitable for children under one year, because it can cause infant botulism (food poisoning).

Do I need to give him vitamins or supplements?

If your baby is breastfed, continue giving vitamin D, but there's no need for other supplements, including iron or multi-vitamins.

How does this affect the breast milk or formula I give to my baby? Can I start giving cows' milk?

In general, keep breastfeeding for a year or more, and avoid introducing cow’s milk until a year of age. Health Canada recommendations say breastfeed exclusively for the first six months and continue for up to two years or longer. If you are feeding with formula, continue for up to one year, and start giving homogenized cows' milk instead after that.  When you start giving your breast-fed baby cows' milk, you can still continue to breastfeed. Be sure to use whole, homogenized cows' milk rather than skimmed or semi-skimmed. Babies need fat to help the brain continue to develop. 

When you start to introduce solids, you will find that your baby's milk intake will remain about the same for the first few months.

Will my baby sleep better when we starts giving solid food?
Not necessarily! Parents often think that will be the case, but there's no evidence that starting solid foods will enhance the baby's sleep patterns. 
Resources

Health Canada
 

Canadian Pediatric Society (caringforkids.cps.ca)
 

American Academy of Pediatrics (healthychildren.org)

This article was written by Anne McLaughlin with information provided by BC Women's pediatrician Dr. Rob Everett


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