Starting solids: when to begin and with what

Evgeniya Loik — GP, pediatrician, gastroenterologist, nutritionist

When to start

The guide is around 6 months, and not before 4 months. But the calendar is secondary to signs of readiness: the baby holds their head steadily and sits with support, the tongue-thrust reflex has faded, they show interest in food, and they can open their mouth towards a spoon. Before 6 months breast milk or formula covers requirements fully.

What to start with

There is no obligatory sequence — vegetables, cereals, meat and fruit can be introduced in various orders. The practical principles: one new food at a time, two to three days of observation, texture appropriate to age, and gradual progression of texture. One frequently missed point is iron: the stores built up before birth are depleted by around 6 months, so iron-rich foods — meat, and fortified cereals — are introduced early.

Allergenic foods earlier, not later

This is the major change of recent years. Delaying peanut, egg and fish used to be advised; research, principally the LEAP trial, showed the opposite: early introduction of peanut in at-risk infants substantially reduces the chance of peanut allergy. Current American Academy of Pediatrics and allergy society guidance is not to delay allergenic foods once solids have begun, and to keep giving them regularly. For children with severe eczema or an established food allergy, the approach is set by a doctor.

Form matters: whole peanuts and nuts are not given to children under 4–5 years because of choking risk — a smooth butter thinned to a safe consistency is used instead.

What to avoid before one year

• Honey — risk of infant botulism;
• Cow's milk as a main drink — fine in cooking, but it does not replace formula or breast milk;
• Salt and sugar — for the kidneys and for taste preferences;
• Choking hazards — whole nuts, whole grapes, chunks of raw carrot, popcorn;
• Juice — no benefit, and enough harm to teeth and appetite.

How to avoid food refusal

A division of responsibility works: the parent decides what is offered and when, the child decides how much to eat and whether to eat at all. Feeding in front of cartoons, coaxing and topping up at any cost buy volume now and create problems later. A new food may need ten or more calm offerings — refusal the first time does not mean dislike.

When a doctor is needed

Poor weight gain, persistent refusal of solid textures after one year, choking, reactions to foods, or a diet narrowed to a handful of items. At GMS a pediatrician consultation is AED 600 and a combined pediatric nutritionist and gastroenterologist consultation AED 750. Age-based check-up programmes are available: the 6-month check is AED 1,500 and the 12-month check AED 2,100.

References

• American Academy of Pediatrics. Starting Solid Foods
• NIAID. Addendum Guidelines for the Prevention of Peanut Allergy

FAQ

When should we start solids?

The guide is around 6 months, and not before 4 months. The calendar is secondary to signs of readiness: the baby holds their head steadily and sits with support, the tongue-thrust reflex has faded, they show interest in food and open their mouth towards a spoon.

Should we delay peanut, egg and fish?

No, the opposite. Research, principally the LEAP trial, showed that early introduction of peanut in at-risk infants substantially reduces the chance of peanut allergy. Current American Academy of Pediatrics and allergy society guidance is not to delay allergenic foods.

What should we avoid before one year?

Honey, because of the risk of infant botulism; cow’s milk as a main drink; salt and sugar; choking hazards such as whole nuts, whole grapes, chunks of raw carrot and popcorn; and juice, which has no benefit and enough harm to teeth and appetite.

My child refuses new food — what should I do?

A division of responsibility works: the parent decides what is offered and when, the child decides how much to eat and whether to eat at all. A new food may need ten or more calm offerings; feeding in front of cartoons, coaxing and topping up at any cost buy volume now and create problems later.

This article is for information only and does not replace a consultation. If you have symptoms, see a doctor.

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