Babies’ nutritional needs are met completely through mother’s milk or iron-fortified infant formula until they are about six months old. The National Association of Pediatric Nurse Practitioners, the American Academy of Pediatrics and the World Health Organization recommend that all infants be exclusively breastfed for the first six months of life. Mother’s milk is the ideal nutrition and is quite sufficient to support growth and development during this time. Your health care provider may recommend a Vitamin D supplement for your exclusively breastfed infant. Around the age of four to six months, babies begin to observe and mimic their parents’ or other caregivers’ eating habits. At this point, the baby may be ready to graduate to “complementary” foods.
Naturally, parents, grandparents and other care providers have many questions about this important milestone: When are babies ready for solid foods? Which foods should be given? How much food is enough?
This brochure provides general guidelines for introducing infants to solid foods, as well as tips for keeping mealtime safe. Keep in mind that each baby is an individual and may be ready for different foods based on age, nutritional needs, development and other factors. Ask your pediatric nurse practitioner, pediatrician, family physician, or other health care provider for specific feeding advice.
Why should I wait until my baby is around four to six months old to start feeding solid foods?
- Your baby gets all the nutrients needed for growth and development from mother’s milk or iron-fortified infant formula for the first four to six months of life.
- Your baby’s risk for having an allergic reaction to food is lower when you wait until about four to six months of age to introduce solids, especially if there is a family history of food allergies.
- Your baby is not ready to digest foods other than mother’s milk or infant formula until about four to six months of age.
- Your baby will not sleep any better if solid food is added to the diet before the age of about four to six months.
- Your baby’s risk for choking is higher before about four to six months of life due to lack of developmental readiness.
Around 4-6 Months
How do I decide if my baby is ready to begin solid foods?
Use the following checklist to guide your decision:
- Baby can hold head steady when sitting
- Baby sometimes opens her mouth when food approaches
- Baby is interested in food when others eat
- Baby has the ability to swallow baby food placed on the tongue
Feeding time is an important social time for you and your baby. Put your baby in a comfortable seat. Choose a time when your baby is not too tired or too hungry to begin their first feedings. Your baby may be more interested in trying new foods just after a short nursing or formula feeding.
Important recommendations about starting solids:
- The best first food is a single-grain (usually rice) iron-fortified baby cereal. Rice cereal is easily digested and is not likely to cause a food allergy.
- Mix 1 - 2 teaspoons of dry cereal with enough mothers’ milk or formula to make it like thin gravy.
- Use a small spoon with a long handle and a rubber coating at the feeding tip to serve the cereal.
- Begin feeding slowly. Place a small portion of cereal in the middle portion of the baby’s tongue. • Do not use a baby bottle to feed cereal or other solid foods to your baby. A baby needs to experience how foods taste and feel in their mouth.
- Remember that every new food is a new sensation in taste and texture for your baby. Babies may make a face and may push the food out of their mouth when a new food is introduced. It may take 10 to 15 attempts before your baby is eager to eat a new food. This is normal. Don’t be discouraged. Soon the baby will become more accustomed to eating all kinds of new foods and will eventually open his or her mouth in anticipation.
- Increase the amount and thickness of the cereal once the baby becomes used to the consistency. Feedings will gradually increase to 4-6 tablespoons of cereal twice a day.
- Always make sure the baby is sitting up to eat.
- Position the baby so that he or she can see the face of the person feeding him or her. Mealtimes provide important opportunities for babies and their caregivers to smile, laugh, talk, and enjoy being together.
Baby’s appetite can vary from day to day. Babies let you know they are full by turning their heads away from the spoon or holding their lips closed. Never force them to eat more food after indicating fullness. Respect your baby’s appetite by paying attention to their signals of fullness. This helps your baby learn to eat just the right amount, rather than eating too much. Knowing the signs of fullness helps avoid a problem with obesity later in childhood.
When do I add other foods?
- Once the baby has mastered cereal, introduce prepared, strained baby food vegetables and fruits.
- Introduce one new food every 3-5 days to allow the child’s system to adjust and to watch for any unusual reactions.
- Begin with 1-2 teaspoonfuls of strained or pureed vegetables, such as squash, peas, carrots or sweet potatoes. These foods contain no wheat, milk, egg, or citrus to which some babies may be sensitive. • Gradually increase the amount of vegetables or fruit to about 4 to 8 tablespoons daily, depending on the baby’s appetite. • By age seven months, your baby should be eating two meals of cereal, fruit and vegetables per day, in addition to continuing to breastfeed or take formula.
- Juices are not needed at this age. Wait until your baby is using a cup to offer juices to protect his or her teeth from tooth decay.
- Signs of possible problems with a new food include: a new skin rash, diarrhea or vomiting. Stop feeding the new food and tell your baby’s health care provider about the reaction at your next visit.
Hint: Keep a diary of new foods introduced and any reactions.
| Feeding Timeline |
| The following guidelines indicate when babies may be ready to graduate to various solid foods. Ask your pediatric nurse practitioner, pediatrician, family practitioner or other health care professional for specific feeding advice. |
| Months | May Begin… |
| About 4-6 | Iron-fortified, single-grain baby cereal
Strained/pureed vegetables and fruit |
| 6-9 | Strained meats/poultry
Mixtures of strained vegetables and fruits
Chunky, soft prepared baby foods
Egg yolk
Yogurt
Cottage cheese |
| 9-12 | Soft, finely chopped foods, soft combination
foods such as casseroles, macaroni and
cheese, spaghetti, cheese, beans |
| 12+ | Toddler foods
Family foods
Fiber foods
Whole cow’s milk |
| The National Association of Pediatric Nurse Practitioners and the American Academy of Pediatrics recommend that breast milk or iron-fortified formula be used up to one year of age. Breastfeeding can continue for as long as the baby and mother desire. Whole milk can replace infant formula for children from 12 to 24 months. |
7 to 9 Months
- Babies are ready to increase the variety of foods, as well as the textures of foods in their diet.
- Meats, poultry, and soft, chunky baby foods may be introduced at this time.
- Breastfed babies may desire fewer feedings and formula fed babies may take less than 28 ounces of formula per day.
- Home-prepared foods should be steamed, and then mashed. Do not use honey or corn syrup, as they may contain botulism spores, which can be harmful to infants. Your baby will enjoy spices and herbs in their food, but should not have salt or sugar added to foods.
- At this time, many babies are ready to begin finger foods. The baby should be able to sit up straight, be able to grasp food with his or her hands or finger tips, and move the food from the hand to the mouth.
- Finger foods such as chopped pieces of ripe banana, dry unsweetened cereal, crackers, or teething biscuits are good choices.
Hint: Always stay with baby while he or she is eating.
10 to 12 Months
- Chopped table food, well-cooked vegetables (without salt or sugar), cottage cheese and other soft or lumpy foods may be introduced.
- Babies use their gums and tongue to mash the lumps, so it doesn’t matter if your baby has no teeth.
- Most babies eat three or four meals a day.
- Gradually, babies grow more independent and can be encouraged to hold a spoon when being fed and to use both hands while drinking from a cup.
- Talk to your baby by naming the food being eaten, objects in the area, the utensils used, or the color of the food.
Remember: make each feeding a special time for you and your baby to communicate.
If your family has a history of food allergies, it is best to breastfeed for as long as possible and to delay the introduction of solid foods until six months of age. It may be helpful to delay the introduction of those specific foods that have caused allergic reactions in your family—as well as certain foods such as wheat, egg white, soybeans, citrus, peanuts, tree nuts or cows’ milk, which are common sources of food allergies—until well after the first year of life. Ask your health care provider for specific dietary advice.
By about one year of age, most babies eat small, tender table foods or toddler foods. Breastfeeding continues as long as baby and mother desire. Whole cow’s milk can be introduced in the range of 16-24 ounces per day. Children need the fat in mother’s milk or whole cow’s milk for proper growth and development. Therefore, low-fat milk should not be introduced until two years of age. In the second year, consider introducing foods with fiber, such as multi-grain cereals and 100% whole wheat bread. Avoid peanut butter until after the second year because of allergies and choking.
12 to 18 Months
The minimum amount of food that children in this age range should eat includes:
- Mother’s milk or whole milk 16 to 24 ounces per day.
- Fruits and vegetables 4 to 8 tablespoons.
- Breads and cereals 4 servings (a child’s serving is 2 tablespoons of pasta, potatoes or rice or 1/4 slice of bread.)
- Meat, poultry or fish 2 servings per day or 1 tablespoon or 1/2 ounce each.
Safety at the Plate
When feeding children under four years of age, or children with developmental disabilities, take extraordinary care with foods that require extensive chewing, or could cause choking if swallowed whole.
Foods such as chunks of meat or cheese, hot dogs or hot dog coins, whole grapes, nuts, chunks of peanut butter, seeds, potatoes, cherry tomatoes, raw fruits or vegetables, hard or sticky candy, popcorn and raw carrots can be dangerous if swallowed whole.
Follow these simple guidelines when watching children:
- Always supervise children while eating. Choking incidents often occur when older siblings offer babies food they’re not yet developmentally ready to handle.
- Encourage children to take small bites and chew their foods completely. Young children have a tendency to bite off more than they can chew at any one time.
- Insist children sit down during mealtime or snacks. Never let them lie down while eating.
- Don’t let children run with anything in their mouths.
- Cut foods into small pieces (less than 1/4 inch) and place only
a few pieces on the plate at a time. - Carefully select a sturdy high chair with safety straps.
When An Infant Is Choking
American Red Cross First Aid
The Basics
- Check the scene for safety
- Check the victim for consciousness, breathing, pulse and bleeding
- Dial 9-1-1 or local emergency number
- Care for the conditions you find
If conscious, but choking…
Give 5 back blows…
and 5 chest thrusts
Repeat blows and thrusts
If not breathing…
Give 1 slow breath about every 3 seconds
If air won’t go in…
- Give 5 back blows…
- and 5 chest thrusts
- Look for and clear any object from mouth
- Reattempt breaths
Repeat steps 1,2, and 3 until breaths go in or help arrives
If not breathing and no pulse…
Give CPR—repeat sets of 5 compressions and 1 breath
Bibliography
Nancy Butte, PhD, RD; Kathleen Cobb, MS, RD; Johanna Dwyer, DSc, RD; Laura Graney, MS, RD; William Heird, MD; Karyl Rickard, PhD, RD, FADA (2004). The Start Healthy Feeding Guidelines for Infants and Toddlers, Journal of the American Dietetic Association, Volume 104 Number 3, pp 442-454.
Kleinman, R.E., (2003) Pediatric Nutrition Handbook, (5th ed.), American Academy of Pediatrics, Chicago, IL
Berkowitz, C. D. (2002). Pediatrics: a primary care approach (2nd ed.). Philadelphia: W. B. Saunders.
Fox, J. A. (2002). Primary health care of infants, children and adolescents (2nd ed.). St. Louis: Mosby.
Karnei, R, Overby, K., Rudolph, A, (2002) Rudolph’s Fundamentals of Pediatrics (3rd ed.). Stamford, CT: McGraw, Hill, Appleton & Lange.
National Association of Pediatric Nurse Practitioners, Position Statement on Breastfeeding, 2001 World Health Organization, Policy Statement, Exclusive Breastfeeding, 2000 Dietz, W.H., Stern, L (1999). Guide to your child’s nutrition. New York: Villard.
Breastfeeding and the Use of Human Milk, Policy Statement, American Academy of Pediatrics, December, 1997, Volume 100, Number 6.
This brochure has been favorably reviewed by the:
National Association of Pediatric Nurse Practitioners
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Cherry Hill, NJ 08034-2634
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