Introduction of solids
Timing of introduction of solids
The recommended age for solid foods to be introduced to the diet of infants
has varied over the years. In infants up to the age of 6 months, breast
milk provides the ideal food to meet nutritional requirements. Currently
there is no universal model for feeding older infants, however a growing
number of studies provide guiding principles. While different cultures introduce
foods at different ages, current recommendations in Australia are for infants
to be introduced to solid foods at around 6 months of age; however some
children may be developmentally ready slightly earlier. (2003 National Health
and Medical Research Council Dietary Guidelines for Children and Adolescents).
Initially solid foods add very little to the nutrition of the baby’s diet,
but are more a learning experience and should be an enjoyable time for parents
and children.
Introduction of solids sometimes
referred to as ‘weaning’, describes a process whereby an infant previously
fed milk alone, gradually becomes accustomed to a variety of other foods
until he or she can deal with the general family diet. Commencement of solid
foods does not initially involve a cessation of breastfeeding or the use
of breast milk substitute.
There is almost universal agreement
that solids should not be started before the age of 4 months, and not delayed
much beyond 6 months. Resolutions from the World Health Assembly and WHO
during the 1990’s have varied in recommendations from 4-6 months of age,
and to about 6 months of age, however the scientific basis for recommending
4-6 months of age has been questioned. A number of observational studies
and 2 randomised trials in developing countries have not identified any
benefits from the introduction of solid foods before the age of 6 months.
The 2001 report of the WHO Expert
Consultation recommended exclusive breastfeeding for around 6 months of
age, with the introduction of complementary foods and continued breastfeeding
thereafter. The 2001 World Health Assembly brought together these recommendations
in one resolution recommending exclusive breastfeeding until 6 months of
age.
Six months of age has been identified as a suitable time to introduce new
foods, textures and modes of feeding as this is the time when an infant’s
● Appetite and nutritional requirement are not generally
met with breast milk or infant formula alone
● Feeding behaviour has commenced progression from
sucking to biting to chewing
● Digestive system matures
The debate about timing of introduction
of solids has largely focused on the immune function, the acquisition of
immune-tolerance and the functioning of the infant’s gastrointestinal tract.
In addition early introduction of solids may contribute to a decrease in
the number of breast or bottle feeds leading to growth failure in some infants.
Developmental readiness for solids
Physical characteristics that mature and allow for addition of other foods
in the infant at around 4-6 months of age include:
● Renal function: which allows the infant to handle
an increased solute load associated with solids
● Digestive system: digestive enzymes mature at
around 6 months
● Immune factors: the intestinal defence mechanism
of the gut develops fully
● Mouth and tongue: the extrusion reflex disappears
at around 4 months and infants are able to move food to the back of the
mouth and swallow safely
● Head control: improves and enables an infant to
swallow more easily when sitting.
An individual infant’s readiness
and interest in food should be considered in deciding when to begin solids.
The development of feeding skills
for various age groups describing the ability to mange a change in textures
from liquids to solid foods include:
● Newborn:
suck and swallow of fluids in regular way
● 3 months: increased range of movements of mouth
and lips with better head control. Putting fingers in mouth
● 6 months: moves tongue up and down with better
jaw and lip control
● 9 months: reaching for spoon and interested in
self-feeding
● 12 months: mobile, interactive, and often independent
at eating. Chews lumps well and able to use cup
Risks associated with early introduction of solids
Introduction of solid foods too early can lead to several problems including:
● Increased chance of developing allergies
● Poor growth if the solid food replaces breast
milk or formula
● Exposure to pathogens in food which may result
in increased rates of diarrhoeal disease or
● Increased stool output secondary to maldigestion
in an immature gut.
Are there any problems if solids are introduced early or late?
Introducing solids before 6 months is unnecessary, and may increase the
risk of digestive problems such as pain and irritability and a decrease
in the number of breast or bottle feeds leading to poor growth.
In addition, a baby’s kidneys, digestive system, and immune system are still
developing at this time,
Problems associated with delayed introduction of solids
While it is important to not introduce solid food too early, it is equally
important not to delay. Nutrients thought to be at risk when infants are
exclusively breast feed beyond 6 months include iron, energy and protein.
Food also provides a variety of stimulants to infants and many important
milestones are reached through mealtimes and eating.
Important developmental skills such as the development of gross and fine
motor skills including oral motor skills, and social and emotional factors
are closely linked to the development of eating abilities.
A delay in the introduction of solids may lead to:
● Poor growth due to low energy intake
● Iron deficiency anaemia
● Feeding problems, in particular development of
motor skills such as chewing may be delayed and the infant may be unwilling
to accept new tastes and textures particularly if not started before 7-9
months of age
● Immune protection can be compromised
Other issues to consider when solid foods are introduced include:
● Allergy: particularly in families with a strong
family history. In this case a cautious and staged approach may be required
and the advice of a health professional may be required.
● Vegetarianism: while the diet can be nutritionally
adequate, young infants may be more vulnerable than vegetarian adults may.
Nutrients of concern may be energy, protein, iron, zinc and vitamin B12.
What foods should be introduced?
In Australia, the introduction of solid foods generally commences with iron
–enriched infant cereal. Vegetables, fruits, meats, poultry and fish are
then added gradually. Nutrient content, energy density and texture should
be considered when introducing solids with a focus on variety, even at this
early stage to ensure adequate energy and nutrient supply. An increasing
range and quantity of foods should be offered as the infant moves toward
12 months of age.
By the end of the first year an infant should be consuming a wide variety
of family foods having progressed from pureed or mashed to foods that are
chopped into small pieces.
Cow’s milk is not recommended as the main drink for infant less than 12
months of age as it:
● Is a poor source of available iron
● Contains higher levels of protein, sodium, potassium,
phosphorus and calcium than breast milk or infant formula resulting in an
increased renal solute load
● Increases the risk of iron deficiency anaemia
Small amounts of cow’s milk in foods such as breakfast cereal, yoghurt, cheese and custards as a part of a mixed, nutrient dense are suitable from around 8 months.
Age (months) |
Reflexes and skills |
Food types |
Food examples |
0-6
|
Sucking, suckling and swallowing |
Liquids |
Breast milkStart gluten free cereals (rice)
|
Foods that are unsuitable for infants may include:
● Honey- due to the potential risk of Clostridium
botulinum
● Tea- containing tannins and other compounds that
bind with iron and other minerals decreasing bioavailability
● Whole nuts- due to the risk of inhalation and
choking. In families without a history of allergy, nut pastes are used in
older infants
● Fruit juices- in young infants intake may be associated
with a reduced intake from breast milk. In older infants fruit juices offer
no nutritional benefits and consumption of whole fruit is recommended instead
● Reduced fat milk- is not generally recommended
for infants. By the time children reach 2 years of age they can share in
the reduced –fat dairy products consumed by the rest of the family.
Food safety for infants
It is important to prevent food poisoning, and safe food handling procedures
should be followed when preparing and storing foods for infant. This includes:
● If the baby is fed directly out of the food jar,
tin or bowl, leftovers should not be kept for the next meal as the baby’s
saliva may contaminate the food. With a jar, the amount expected to be eaten
should be taken out and fed from a bowl, and the jar can be closed with
the lid and refrigerated. Food left in a can must be placed in a glass or
plastic container before being refrigerated.
● An adult should always stay with a child during
eating, in case of choking. Small hard pieces of food such as hard-uncooked
vegetables, nuts and large pieces of meat should not be offered to children.
How to Begin
Food should never be placed in
a feeding bottle, but given on a small infant sized teaspoon. Tips for introducing
solids include:
● Make
sure your child is sitting comfortably and is not too hungry.
● Start with a single food rather than a mixture.
Infant rice cereal is recommended, as it is easy to digest, is the correct
consistency and fortified with iron. Try half to one teaspoon after a milk
feed.
● If your baby refuses the first time, try again
in a day or so.
Introduce a new food every few days. Once rice cereal is going well, try
small amounts of pureed
fruits and vegetables.
● Introduce meats and chicken from 6-7 months.
● Introduce other cereals from 6-7 months
● Give small amounts of cow's milk in custard, yoghurt
and on cereal from 7-8 months.
● Try foods that may cause allergy such as egg white
or peanut butter after 10-12 months
● Avoid small hard foods such as nuts and uncooked
vegetables, due to risk of choking.
● Be prepared for mess as your baby learns to eat.
Newspaper or a plastic tablecloth under the
high chair can help
● Stay with your baby when he is eating, and sit
baby with the family to watch and learn feeding skills
● Expect to see a change in bowel habits when your
baby starts eating foods other than milk
● Fruit juice is not required for infants.
What about commercial baby foods?
These foods are always handy
to have for emergencies or travelling and contain similar nutrients to fresh
food. However, these products are expensive and tend to be a uniform fine
texture and contain several foods mixed together. It is important that your
baby learns to enjoy coarser textures and individual flavours of foods.
When to change the texture
of food
● Babies
begin with runny cereal and soft and smooth fruit and vegetables, as
they are easiest to digest. However, as babies develop, it is important
to grade
● Up the texture, through finely and then coarsely
mashed and then to chopped.
● Give finger foods such as pieces of cooked vegetables
and crusts at about 7 months.
● Give baby a small spoon to feed themselves, even
while you continue to give most food.
● Encourage drinking from a cup from about 8 months
of age.
Remember
● Babies are all individuals and learn to eat at
different rates.
● Not all babies the same age eat the same amounts
of foods.
● Learning to eat is just that – a new skill that
needs lots of practice.
● Relax and enjoy this stage of your baby’s life.
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