Tips for new parents: Mass General pediatric expert clears up the confusion around solid foods for babies.

Introducing solid foods to your baby can be a fun and exciting experience, but it can also be a confusing time. Lauren Fiechtner, MD, MPH, director of nutrition at MassGeneral Hospital for Children in the Division of Gastroenterology, has all you need to know about when and what to feed your baby.

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When can babies start eating solid foods?
We recommend they start solids between 4 and 6 months of age. A good sign of when to start introducing solids is once your baby can sit supported, has good head control and shows some interest in your food. It’s best to offer your baby solids on a spoon first. That way you can see what textures they can swallow and their verbal or facial signs when they are full or just don’t like that particular food. Studies have shown that if you introduce solids before 4 months of age, your child has a higher risk of chronic diseases, such as obesity and diabetes.

What foods should I introduce first? Should I wait to introduce different food groups?
Recent research has suggested that starting with foods rich in iron, such as pureed meat and fish or iron rich vegetables, like spinach is best. However, some children may have difficulty with the textures and may benefit from iron fortified cereal. It’s recommended that parents start off with a single food at a time as it is easier to identify which food their child is having a reaction to if they develop signs of allergy. Different foods can be introduced every 3-5 days.

 Lauren Fiechtner, MD, MPH
Lauren Fiechtner, MD, MPH

How much food should a 4 or 6 month old eat?
Children at this age should still be getting most of their calories from formula or breast milk. They should only get a couple tablespoons of solid food, 2-3 times a day.

What should my baby’s daily diet consist of after starting solids?
The best diet for children at all ages is a variety of whole foods, meaning things you could buy at the grocery in its whole form – such as chicken breasts, apples, carrots and other fresh foods. Parents should avoid packaged foods that contain added sugar, salt, especially juices and other sugary beverages.

What if my child doesn’t like a certain food group, like vegetables?
I recommend parents try and introduce the food 10 times at different time points. We know taste buds change as we grow and develop so what they dislike today, they may love tomorrow.

Researchers have shown that early introduction of foods that cause allergies such as fish, peanut butter and eggs can decrease the risk of food allergies.

How would a parent know whether a baby is allergic to a certain food?
Food allergies can manifest in different ways. Some children vomit, some have diarrhea or blood in their stool, while others just seem irritable after eating certain foods and others develop rashes. You know your children best so if you are concerned there is an allergy, stop feeding that food and talk to your pediatrician. In the most severe cases, food allergies can cause anaphylaxis, in which the child has two of the following: difficulty breathing, swelling of their face, rash, diarrhea or vomiting. In this case you are urged to call 911.

Researchers have shown that early introduction of foods that cause allergies such as fish, peanut butter and eggs can decrease the risk of food allergies.

Are there certain foods babies should avoid?
You should avoid feeding your baby honey before 1 year of age because the spores in honey can cause botulism, which can cause their muscles to be weak and paralyzed. Whole milk should also be avoided before 1 year of age because it has been shown to cause iron deficiency and anemia. Finally, things children can choke on such as hot dogs, grapes, and whole nuts should be avoided.

If parents wait to introduce fish, peanut butter and eggs, will it lessen the odds for allergies?
Researchers have shown that early introduction of foods that cause allergies such as fish, peanut butter, and eggs can decrease the risk of food allergies. So yes, I would suggest families try them before the first year of life, but again not before 4-6 months of age.

When can babies start eating finger foods and what are good finger foods for babies to start with?
It’s OK to start feeding finger foods when your baby has a pincer grasp; that is generally around 8- 10 months of age. To start off, I would suggest finely cut up ripe fruits and vegetables such as avocado, peach and pear.

It’s important to avoid sweets for your child throughout the first three years of their lives.

What about water?
Babies get enough water from breast milk and formula. They don’t need extra water until after one year of age. Giving infants water can lead to problems with their electrolytes or salts in their blood so it’s best to avoid it.

What do you tell parents about sweets for babies and toddlers?
It’s important to avoid sweets for your child throughout the first three years of their lives. The first three years, or the first thousand days as we call it, is a crucial time in the development of their taste buds, immune system and metabolism. This is really a critical time, so although it may be tempting to give your children juice and sweets, you have to remember that this is going to set up their health for the rest of their life. Giving them healthy nutritious food for the first thousand days is extremely important.

This article was originally posted on the MassGeneral Hospital for Children website. For more information about MGHfC please contact us.