“I am so confused - when should I start solids?”

I hear this question in my practice all the time. To this day it remains a controversial area with lots & lots of different recommendations. It is not an exaggeration to say that many doctors & nurses are as confused as parents as to the correct time & way to introduce solids.

Let’s assume that for the first four months of a baby’s life they are either exclusively breast or formula fed. At some point thereafter a baby will require solids in addition to breast milk or formula. We also know that at the age of 1 year an infant will only require about 400mls of milk a day and that many infants are transitioned from breast or formula to cow’s milk at 12 months of age.

Almost all paediatricians, nurses & dieticians agree that solids should commence somewhere between 4-6 months of age. But that is where the consensus stops. The current Australian Guidelines recommends 6 months to introduce solids. However there is a school of thought that believes that 6 months is too late to start solids. I am part of that school. I believe that solids should be introduced around four & a half months to five months depending on the baby. Many parents tell me that their children are hungry & looking at the rest of the family when they are eating a meal. That is one good sign that a baby is ready for solids! My other concern with starting at 6 months is that if a baby has difficulty with the introduction of solids it could mean that solids are only established at 7-8 months which is definitely too late.

In my practice I see lots of babies with severe reflux. Besides medication, the early introduction of solids results in a significant improvement in symptoms. As a result I recommend starting solids at 4 months in babies with severe reflux.

The next question is what to food to start with. I recommend starting with a rice cereal for the first 5-7 days. It is important to note that many of the rice cereals can cause constipation. That is why I recommend introducing fruits and or vegetables shortly thereafter. The first week or 2 is really about getting your baby used to the different textures & therefore does not have any great nutritional benefit. So 1-2 teaspoons 2-3 times a day depending on the baby is the typical starting pattern.

I have 3 golden rules for solids.

  1. No honey in the first year
  2. Never more than 1 new food per day. This is just in case a baby has an allergic reaction. If 2 new foods were introduced then it may not be clear which one caused the allergic reaction.
  3. I don’t recommend shell fish in the first 12 months as I think they are likely to cause an allergy in young children.

Otherwise the guidelines are pretty relaxed. There is very little in the way of food restriction in the first year unless there is a sibling with documented food allergy. Most of us would recommend protein at 6 months of age. This includes meat, chicken and line-fish that it should be finely diced so as not to be a choking hazard. Dairy products (not cow’s milk) can be introduced at about 8-9 months of age. At this age most children are also sitting in a high chair eating (and throwing) finger foods. Feeding time is really taking off!

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