The appropriate nutrition for a young infant is breast milk, formula, or a combination of both. Somewhere between four and six months, it is time to start thinking about starting solid foods. Below I highlight some issues and pointers to help guide the transition off a purely liquid diet.

Why?
Apart from the fun of seeing your baby enjoy food and sharing mealtimes with him, we introduce solids into the diet for developmental and nutritional reasons.

Developmentally, learning to eat from a spoon is an important oral-motor milestone. Good eating habits, like good sleep or discipline routines, should be started at the beginning, to prevent problems before they arise. For example, babies should be fed at consistent times, in an appropriate feeding seat, with a spoon. It has been found that trying a variety of different tastes and textures in a timely manner in the first year of life may facilitate an infant’s greater acceptance of new foods when he is older.

Breast milk and standard infant formulas provide a nutritionally complete diet for young infants. By six months, it is important for exclusively breast fed babies to get an additional source of iron. By around eight months it is nutritionally appropriate to add other sources of protein (see details below).

When?
Like many things in medicine, the recommendations as to when to initiate solids in an infant’s diet have changed considerably over the years. Until very recently, the thinking has been that starting solids later, especially in allergy-prone children, might delay the onset and/or severity of allergy symptoms in the baby. Some new data suggests that earlier exposure to food may, in fact, help reduce later allergy symptoms for babies. Our recommendations are based on the current American Academy of Pediatrics recommendations, as well as our own clinical experience.

Developmentally, a baby is ready to start eating pureed food, from a spoon, when she is able to hold her head and neck upright without support and has a limited "tongue thrust" response to the spoon. If she immediately and consistently pushes the spoon out of her mouth with her tongue, she is probably not ready.

Nutritionally, babies should start solids between four and six months of age. We feel that for exclusively breast fed babies who are gaining weight well, it is best to wait until about six months of age. For babies on a combination of breast milk and formula, or on a complete formula diet, it may be appropriate to start a little earlier. If your baby is taking more than 36 oz of milk per day or still taking several bottles at night, it may be a good idea to start one meal of solids per day, sometime after reaching four months of age.

What?
The first "solid" food (as in, not breast milk or formula) should be an iron-fortified cereal. Traditionally we start with rice cereal because it is the most hypoallergenic. There is always some change in stool patterns after a dietary change. However, if your baby becomes truly constipated (hard stools), change to a different iron-fortified single grain infant cereal (oats, barley).

If your infant is taking to the cereal, after a week or so, you can introduce a pureed fruit or vegetable. You can buy the commercially prepared jarred foods or make your own. Either way, these early foods should be smooth, single ingredient preparations with no additives (salt, sugar).

You should wait 3-5 days between the introduction of new foods into the diet to observe for any possible allergic reactions. Do not use any combination foods (e.g., peas and carrots) until you have tried the individual components.

By about 8 months, it is appropriate to introduce additional sources of protein into your baby’s diet. Examples include meat, chicken, turkey, yogurt, humus, one of the white fishes, and tofu. Although you do not want to start feeding the baby pure cow’s milk until after her first birthday, cow’s milk products in reasonable amounts are fine.

Sometime around 8-9 months your baby will start to develop the ability to pick up small objects with a pincer grasp. He will also gradually make the transition from gumming to chewing foods. Around this time, you can start to give "table foods." This refers to more traditional adult-type foods- small, soft, pieces of things you would eat yourself. Of course, you need to observe your own child’s reaction to different foods to determine when she is really ready for an increase in texture and variety. Although it is fine to give your baby mildly seasoned foods at this point, avoid overly sweet or salty food so as not to get his taste buds "addicted" to these additives.

By around one year of age, babies should be getting a significant amount of calories and nutrition (over 50%) from their intake of solid foods, with a concomitant reduction in overall milk intake. A typical one year old should eat three meals per day and 1-2 snacks. Keep in mind that portion size for a toddler is very different than portion size for an adult.

Foods to Avoid
It is common practice to wait until your baby is at least one year old before feeding egg whites, shellfish, and peanut and tree nut butters because of the overall higher rates of allergies to these foods. If your baby or someone in the family has a strong history of food allergy, please discuss this with your primary doctor for a more personalized feeding plan. Do not give any honey to children under one year of age.

General feeding advice is to avoid all high risk choking foods until four years of age. Common culprits include popcorn, hot dogs, whole grapes, chunks of raw vegetables (carrots), peanuts, tree nuts, and hard candy.