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Introducing Solids: Q&A with a Pediatrician

Introducing Solids




Written by:

Barbara Mighdoll

Introducing solids is a big milestone, one that comes with lots of questions.  Here’s advice straight from a Pediatrician.

When Caden began eating solid food, it felt oddly sentimental.  My little baby suddenly didn’t seem so little anymore.  While I just about died over how cute he was sitting up in his highchair, I was also extremely nervous about introducing solid food to him.  Would he know what to do? What if he chokes? What if he has a food allergy? Could he not be interested in breastfeeding anymore?

Introducing solids is new terrain, and comes with many many questions.  Luckily I was introduced to a wonderful Pediatrician, Dr. Heather Diskin of Boston Children’s Hospital, who graciously hosted a Virtual Q&A on introducing solids with a Mom group I’m part of, so I followed up with her after to share her wisdom with you on all things solid food!

Q&A with Dr. Heather Diskin

Q: To kick off, can you tell me a bit about your background?  How would you describe your approach to introducing solids?

I’ve been a primary care pediatrician for 11 years and am passionate about guiding parents through normal development and building healthy habits from the very beginning.  This includes nutrition, sleep, and of course having fun!  That is my take home point for introducing solids – it should be fun for parents and for infants, not stressful or overwhelming. 

Q: How do you know when your baby is ready to start solids?

Most babies show interest in solid food between 4-6 months of age.  Most full term babies can safely tolerate pureed or mashed foods as early as 4 months old, and more chunky finger food around 6 months when they have better trunk control and the ability to sit unassisted.  In order to take food from a spoon babies must also lose their “tongue thrust reflex” which causes them to stick their tongue out and push food away, rather than taking it into their mouth. This also usually starts to go away after 4 months old.  While the American Academy of Pediatrics recommends exclusive breastfeeding until 6 months old, some babies seem very interested in eating before then, and I encourage parents to watch for their baby’s cues.  This can include watching family members eat and reaching for foods. 

Q: But my baby doesn’t have teeth, how can he eat?  I’m terrified of choking.

Some infants don’t get any teeth until after one year of age, but they can still eat all types of foods much earlier than that.  Even babies with teeth don’t truly chew the way adults do until closer to 18-24 months of age. 

Choose foods that are relatively soft or a texture that falls apart easily i.e. shredded or ground meats, flaky fish, small soft vegetables, sweet potato, baby cereal, pasta, scrambled eggs, fruits.  Another option is larger wedge shaped pieces that baby can gnaw on, often referred to as baby led weaning. 

All parents are very fearful of choking, and the good news is that it is incredibly RARE. Gagging on the other hand is incredibly common in the beginning.  This really scares parents, but is actually a good sign that your baby already knows how to protect their airway.  If food is threatening to “go down the wrong way” baby gags to get rid of it.  If your baby is coughing or gagging and making noise they are okay.  You can help and reassure them or pat them on the back.  If your baby looks distressed and is not making noise or taking any air in you should perform a “back blow” to dislodge any impacted food.

Q: What’s a typical progression of going from “trying” to eating full meals?

This is incredibly variable.  Some babies LOVE to eat food, some babies love breastfeeding and the bottle.  They all get the hang of eating eventually, but up until age one it can be very different for different babies. 

General guidelines:

  • 4-6 months: 1 solid meal a day. Can be purees or solids in mushy form (if pressed between fingers, easily breaks apart)
  • 6-9 mths can start eating more seriously. 2 meals a day. Start having more solid foods i.e “finger foods” and less purees. Purees can be chunky to help transition. Encourage self feeding rather than spoon feeding by parent.
  • 9 months onwards: 3 meals a day of “table foods” i.e. what the rest of the family is eating as opposed to “baby foods”. Because they can have all food groups including proteins and fats, the calories they get from solid food is about equal to what they get from breastmilk or formula. 

Q: So does the amount of breastmilk or formula consumption decrease as a baby starts eating more meals?

From 4-9 months your baby’s nutrition source primarily continues to be breastmilk or formula. The amount they take in a day won’t really decrease, but the pattern may change.  They may take larger bottles less frequently, since they will also be eating meals and hopefully sleeping through the night.  At 9 months their “milk” intake may decrease slightly since they will be eating more substantial foods. You can just let them guide you, if they keep drinking the same amount that’s fine, if they decrease a little bit because they enjoy foods you don’t have to worry.  Until age one most babies will take at least 20-24oz of breastmilk or formula in a day. 

Q: When do you switch from breastmilk or formula to real dairy milk?  Is there a particular type of milk you should use?

Everything you read will say very firmly “don’t give whole milk until age one.”  However, dairy products such as yogurt and cheese are fair game.  My recommendations on this differ from many people.  I agree that whole milk is NOT a complete nutrition source, however, if given together with breastmilk/formula and real foods it can be started as early as 9 months.  I typically recommend just small amounts in a sippy/straw cup at mealtimes to slowly introduce it. This also allows the gut to slowly adjust to milk in preparation for the full transition at age one. It’s also a helpful way to introduce sippy/straw cup in advance of taking away the bottle at 12 months.   They should always drink whole milk because the fat content is important for brain development. 

Q: What about water? When should you introduce it and how much should they be drinking?

Babies can drink water from a sippy/straw cup at 6 months.  It does not need to go in a bottle, and it is a nice way to help them learn how to use the cup.  There is no specific amount that they should have, just offer it at mealtimes and they can have as much as they would like. 

Q: Should I watch how much I season food, especially salt intake?

Salt, spices and seasoning are all fair game and they make food taste better!  This will help your baby to enjoy foods more. Whenever possible share your own food with your baby.  Try to avoid foods with added sugar, even popular baby yogurts add sugar!  Look for plain whole milk yogurt and add your own fruit to sweeten it. 

Q: Any foods a baby cannot have?

The only food your baby can’t have is honey – they shouldn’t eat honey until after their first birthday.  Watch out for honey in salad dressings, stews, sauces. This is because regular cooking heat does not kill the botulism spores that are in honey.  Everything else is great for baby to try including soups, stews, peas, carrots, cut up meatballs, pulled pork/chicken, nitrate free deli meats, tiny pasta, cheese, cottage cheese, eggs, yogurt, etc

Q: I thought we also should stay away from peanuts because they are a common food allergy.  Is that not the case anymore?  Any other allergens we should be cautious of?

Research shows it is protective and preventative to introduce common food allergens early, including peanuts. The top allergens are: peanuts, tree nuts, sesame, fish, shellfish, eggs, dairy, and wheat (gluten).  Once you start to introduce the allergens it is recommended to do it regularly, essentially daily (more important if there is a strong family history of allergy). Great ways to introduce peanuts include peanut puffs (Bamba from Trader Joe’s) that melt in the mouth and aren’t a choking hazard. You can also use peanut powder to sprinkle into foods, water down peanut butter with milk/formula, or melt it into oatmeal or mash with bananas. 

Q: What are signs of an allergic reaction?   

Mild rash around the MOUTH ONLY is not typically a sign of allergy, but take photos and share them with your pediatrician.  Mild allergic reaction is hives (large splotchy rash all over the body), take photos and call your doctor.  If your baby develops hives AND other symptoms such as vomiting, coughing, wheezing, drooling, irritability, or pallor call your doctor right away or 911. 

Q: How do I avoid a picky eater?

Keep it colorful!  Always serve pasta with sauce, mac and cheese with peas or broccoli, yogurt with fruit and try to avoid bland carbs like bread and crackers.  Your ONLY job is to offer the foods you want your child to eat, THEY are in charge of whether or not they eat it, and they WILL eat if they are hungry.  Don’t be a “short order cook”.  Make one meal for the family, they will always be more interested in what they see you eating.  If they refuse a food, don’t go and prepare a new one. This is HARD, but it is incredibly important. 

A big big thanks to Dr. Heather for answering all my burning questions.  Do you have any others? Comment below with what’s on your mind.

You may have already gotten your highchair, bowls and spoons from your baby registry (here's my complete baby registry checklist). If not, get started with your little one with some of my favorite products:

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This post may contain affiliate links including the Amazon Associates Program. When you make purchases through links in this post, I may earn a small commission at no extra cost to you.  I only endorse products I believe in.