Solid foods

What are solids and when should they be started?

Solids or solid foods, sometimes called complementary or weaning foods, are foods other than milk that are given to babies. Although breast milk is the main food for breastfeeding babies for most of the first year, solid foods become an increasingly important source of nutrients. Babies who are breastfed tend to accept a larger number of healthy foods, which makes starting solid foods easier. All pediatric groups recommend starting solid foods around six months and some allow for starting as soon as four months if the baby is at high risk of certain food allergies. For premature babies, there are no clear recommendations. A reasonable approach is to start solid foods between four to six months calculated from their due date and when the baby is able to eat them. Some babies refuse to start solid foods at six months and will start a little later.

A) Describing solid foods

Solid foods are foods other than milk that are given to babies. We use the term “solid foods” because most people are familiar with it and it is simple and short.

Technically, the correct term is complementary foods because solid foods complement, rather than replace breast milk. Solid foods may also be called weaning foods, but that’s confusing because weaning can also mean stopping breastfeeding.

Breast milk is a breastfeeding baby’s main food for most of the first year of life. It remains an important part of the baby’s diet afterward. However, solid foods become an increasingly important source of nutrients as the baby grows. Babies who do not receive enough healthy solid foods will not grow properly (Bégin 2017).

B) Recommendations on when to start solid foods

Table: Recommended feeding practices for full-term babies

(Links to more information about the topics in the above table: infant formula; not using whole cow’s milk for babies under 6 months of age; juice; starting solids early for babies at risk of food allergies; vitamin D recommendations.)

1) Breastfeeding

Nearly all major pediatric groups recommend breastfeeding a child for two or more years and breastfeeding should be continued once babies start solid foods. Babies who are breastfed tend to eat a larger number of healthy foods, which makes starting solid foods easier.

Breast milk or infant formula is the only form of nutrition in the first four to six months. Babies should not be given water or cow’s milk during the first six months.

2) Age of starting solid foods

The age for starting solid foods varies among countries, cultures, and families and has changed over time (Bégin 2016). In the mid-1900s in the U.S., most babies were receiving cereal by one month of age (Fomon 2001). Some doctors even recommended starting cereal on the second day of life (Sackett 1962).

a) Healthy babies

All pediatric groups recommend starting solids around six months and some allow for starting between four and six months if the baby is at a high risk of certain food allergies.

Please discuss any concerns with your health-care providers. This is a very active area of research and recommendations may change in the near future.

Some babies refuse solid foods or are unready until they are a little older.

b) Other babies

There is very little research on when premature babies should start solid food (Elfzzani  2019; Liotto 2020; Vissers 2018). Some experts recommend starting them when the baby is around six months of corrected age (Gauer 2014; Noble 2018) or when they reach a certain weight.

Premature infants can vary in their ability to eat solid food, their rate of growth, and health and these factors may affect when or how solids are given. Premature babies are at risk of low iron levels.

Illness and developmental problems may interfere with a baby’s ability to eat solid foods and therefore delay the age at which solid foods are started.

C) Reasons for starting solid foods at six months

All babies should be offered solid foods by the time they are six months of age. That’s because they need additional vitamins, minerals, and nutrients at this age. Iron is especially necessary for brain development.

Babies are physically ready for solid foods at six months. They:

  • Have good head control.
  • Can sit up and lean forward.
  • Can pick up food.
  • Can tell you when they are full by turning their heads away.
  • Are usually interested in starting solid food

There is no evidence that delaying the introduction of allergenic foods, including peanuts, eggs, and fish, beyond six months prevents allergic disease. Rather it may increase the risk.

References

Bégin F, Aguayo VM. First foods: Why improving young children's diets matter. Matern Child Nutr. 2017 Oct;13 Suppl 2
 
Bégin F, Arts M, White J, et al. Nutrition Section, Programme Division. Krasevec J, Kumapley R, Mehra R. Analytics Section, Division of Data, Research and Policy. From the First Hour of Life; Making the Case for Improved Infant and Young Child Feeding Everywhere. New York: UNICEF; 2016 Oct
 
Elfzzani Z, Kwok TC, Ojha S, et al. Education of family members to support weaning to solids and nutrition in infants born preterm. Cochrane Database Syst Rev. 2019 Feb 21;2(2):CD012240
 
Fomon S. Infant feeding in the 20th century: formula and beikost. J Nutr. 2001 Feb;131(2):409S-20S
 
Gauer RL, Burket J, Horowitz E. Common questions about outpatient care of premature infants. Am Fam Physician. 2014 Aug 15;90(4):244-51 

Liotto N, Cresi F, Beghetti I, et al., On Behalf Of The Study Group On Neonatal Nutrition And Gastroenterology-Italian Society Of Neonatology. Complementary Feeding in Preterm Infants: A Systematic Review. Nutrients. 2020 Jun 20;12(6):E1843

Noble LM, Okogbule-Wonodi AC, Young MA. ABM Clinical Protocol #12: Transitioning the Breastfeeding Preterm Infant from the Neonatal Intensive Care Unit to Home, Revised 2018. Breastfeed Med. 2018 May;13(4):230-236

Sackett, Walter W. Bringing Up Babies: a Family Doctor's Practical Approach to Child Care. New York: Harper & Row, 1962

Vissers KM, Feskens EJM, van Goudoever JB, et al. The Timing of Initiating Complementary Feeding in Preterm Infants and Its Effect on Overweight: A Systematic Review. Ann Nutr Metab. 2018 Apr 27;72(4):307-315