Starting solids

I often joke that if you asked ten pediatricians, read ten books and asked 10 grandmothers you would get thirty different opinions on how to start solid foods. There is very little research on starting solids. Who would like to enroll their infant in a research study where you feed them only carrots for 5 years?

During my training the American Academy of Pediatrics (AAP) recommended starting at 4 months and now 10 years later they recommend starting at 6 months. The stated reason for this change was an increased risk of food allergies when starting solids too young. There is absolutely no scientific bases for this change, it is only an opinion.

Most experts universally recommend starting with iron fortified rice cereal. After that it gets confusing. I’d expect If you surveyed grandmothers as to what to feed next:
50% would recommend vegetables (Often the stated reason is that if you feed sweet fruits first then they won’t learn to like veggies)
30% would suggest fruits (Often the stated reason is that if you feed sweet fruit first then they will like to eat and always be a “good eater”)
15% would recommend a variety of grains (wheat, barley, etc.)
5 % would say in their day they began in ribs, chicken wings and steak

I recommend beginning solids between 4 to 6 months old. We begin with rice cereal mixed with breast milk or formula. Start with 3 or 4 tablespoons of rice cereal. We then mix it to a runny oatmeal consistency, warm it slightly in the microwave, remix and test for temperature. I’d put the child in a bouncey seat and feed it on a small plastic coated spoon once or twice a day. Typically, the first few feedings end up all over. This should be fun. If its a miserable experience retry in a few weeks.

After a week of tolerating rice well we begin the stage 1 fruits and vegetables. We add a new fruit or vegetable every 5 to 7 days. I like the idea of moving slowly to look for any reactions. While most people recommend either veggies or fruits, we alternate adding fruits then vegetables. We quickly end up on rice cereal & fruit in the morning and rice cereal & veggies in the evening.

Typically a child’s milk intake stays the same from when they start solids until 9 months. Formula fed infants typically take 25 to 35 ounces a day from 4 to 9 months old. When you are starting solids feed the child milk and then offer the solid foods. If you offer rice cereal (prior to formula or breast milk) to a 5 month old that just slept 8 hours you are bound to have lots of crying.

Many grandmothers believe that you must feed an infant solid foods to sleep through the night. I do not believe this. All seven of my children slept through the night consistently prior to beginning solid feedings.

Written January 2011 by
Dr. Gordon, Orlando Pediatrician