Starting solids and introducing allergens

Work it out for your family: Feeding calculator. How much and how often by age and weight, for breast milk, formula or both.

The short answer

• Start at about 6 months. Not before 4 months [1][2].
• Watch your baby, not the calendar. Sitting up with support, steady head control and swallowing food instead of pushing it out matter more than the date [1].
• Iron-rich foods early. Meat, fish, eggs, beans, tofu or iron-fortified cereal [3].
• Don’t hold back allergens. Peanut, egg and the other common allergens can go in alongside other first foods. If your baby has severe eczema or an egg allergy, ask your pediatrician before introducing peanut [1][4][5].
• Before 12 months, skip three things: honey, cow’s milk as a drink, and juice [6].

Breast milk, formula or both stay your baby’s main food through the first year. Solids are practice at first.

Practice is messy. Buy the bigger bib.

Signs your baby is ready

The CDC lists these. Your baby [1]:

• sits up alone or with support
• controls their head and neck
• opens their mouth when you offer food
• swallows food rather than pushing it back out onto their chin
• brings objects to their mouth
• tries to grab small objects, such as toys or food
• moves food from the front of the tongue to the back to swallow

Every baby is different [1]. If your baby was born early or you’re not sure, ask your pediatrician.

First foods

There’s no required order. Vegetables, fruits, meat and other proteins, dairy without added sugars, and whole grains are all fine [1].

• One new single-ingredient food at a time. Wait 3 to 5 days between new foods, so you can spot a reaction [1].
• Vary the cereal. Feeding only infant rice cereal can raise arsenic exposure. Fortified oat or barley cereals are options [1].
• If your baby refuses a food, stop. Try again in a week or two [7].

By 7 or 8 months, your baby can eat a variety of foods from different food groups [1].

Iron

At about 6 months, choose solid foods that contain iron [3]. The iron in meat, fish, poultry and eggs is absorbed most easily. Iron-fortified infant cereal, tofu, beans, lentils and dark leafy greens also count. Pair the plant sources with vitamin C foods, such as citrus, berries, tomatoes or sweet potatoes, to help your baby absorb the iron [3].

If you breastfeed or chestfeed, ask your pediatrician whether your baby needs iron drops before 6 months. Standard iron-fortified formula covers iron needs through the first year. If you do both, ask at your next checkup [3].

Textures

Start smooth, then build up [8]:

1. Smooth: strained or pureed.
2. Mashed or lumpy.
3. Finely chopped or ground, as your baby is ready.

Finger foods come in once your baby can sit up and bring things to their mouth. Keep them soft, easy to swallow and cut small [7]. A pincer grip, picking things up between thumb and finger, usually starts between 9 and 10 months [2].

Gagging versus choking

Gagging is normal. It’s a reflex that keeps food out of the airway and helps prevent choking [2]. Babies often cough, gag or spit up while they get used to new textures [8]. If your baby gags a lot, slow down and offer smoother foods or smaller amounts [2].

Choking is an emergency. Get help right away if your baby [9]:

• can’t breathe, or is gasping or wheezing
• can’t cry or make noise
• turns bluish
• goes limp or unconscious

Weak, useless coughing and high-pitched sounds when breathing in are danger signs too [15]. Have someone call 911 while you start infant first aid. If you’re alone, shout for help and start first aid [15]. The AAP recommends a certified CPR and first-aid course, from the American Red Cross or American Heart Association. Take one before you need it [9].

Choking hazards

Most choking risk is in the shape, size and texture. Cutting and mashing help [10]. These are common choking hazards. They don’t stop being risky at the first birthday: the AAP says to keep the highest-risk foods from children until age 4 or older [9]. Avoid or change these [10][9]:

• Round, firm foods: whole grapes, cherry tomatoes, berries, cherries and melon balls. Cut them very small or mash them.
• Hard foods: raw carrots, raw apple, whole corn kernels, popcorn, chips and pretzels.
• Dried fruit such as raisins, and whole beans.
• Nuts and seeds, whole or chopped, and breads or crackers with seeds or nut pieces.
• Peanut and other nut butters by the spoonful or in chunks. Spread thin or stir into food instead.
• Hot dogs, sausages, meat sticks, tough chunks of meat, and bones in meat or fish.
• Chunks of cheese, especially string cheese.
• Sticky or hard sweets: marshmallows, gummies, chewy fruit snacks, hard candy and gum.

Always have your baby sit to eat, buckled into a highchair, and stay with them [9][11].

Baby-led weaning, explained

In baby-led weaning, you don’t spoon food in. Your baby feeds themselves soft finger foods at their own pace, starting when they’re ready for solids, usually around 6 months [11]. The AAP notes purees can be nutritious too [11]. Families choose one approach, the other, or a mix.

What the AAP says about doing it safely [11]:

• Choking: some studies suggest it doesn’t carry a higher choking risk than spoon-feeding.
• Shape: cut foods into finger-shaped pieces about the size of a small baby carrot. Avoid round, coin-shaped slices.
• Texture: foods should be soft enough to mash with gums or a few teeth.
• Iron: self-feeding diets can run low on iron, so include iron-rich foods.
• Setup: a buckled highchair, at the family table, with you watching.
• Wait and ask first if your baby was born early, can’t sit up without help, or struggles with soft foods.

Peanut and other allergens

In 2017, an expert panel sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) changed the advice. Introducing peanut early can help prevent peanut allergy [4][5]:

In every group, start other solid foods first, so you know your baby is ready [4]. Give peanut in an infant-safe form, such as smooth peanut butter thinned with water or stirred into a puree. Once it’s in, keep it in the diet regularly, a few times a week; ask your pediatrician how much. No whole peanuts or other whole nuts before age 5 [4][10].

The American Academy of Pediatrics (AAP) adds: there’s no reason to delay other common allergens like egg or fish [12]. The CDC says to introduce allergenic foods when you introduce other foods [1]. The nine major food allergens in the US are milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, soy and sesame [13]. Yogurt and cheese without added sugars are fine before 12 months. Cow’s milk as a drink isn’t [1].

Signs of a serious allergic reaction include widespread hives, swelling of the lips, face or tongue, vomiting and trouble breathing [4]. A new rash or a few hives around the mouth is usually a milder reaction: stop that food and call your pediatrician [4]. A reaction that starts mild can still turn into a severe, life-threatening one, called anaphylaxis [13]. In babies, also watch for sudden drooling, unusual sleepiness, and fussiness or crying you can’t settle [14]. Call 911 for a serious reaction. If you think your baby has a food allergy, tell your pediatrician [2].

Before 12 months, skip these

• Honey, including in food, drinks or on a pacifier. It can cause infant botulism, a severe food poisoning [6].
• Cow’s milk as a drink. It can cause intestinal bleeding and is hard on a baby’s kidneys [6].
• Juice, even 100% fruit juice [6][7].
• Added sugars, including soda, flavored milk and juice drinks, until age 2 [6].
• Salty foods and high-mercury fish such as shark, swordfish and king mackerel [6].

From about 6 months, a little water in a cup is fine [16].

Sources

1. CDC, “When, What, and How to Introduce Solid Foods.” cdc.gov
2. HealthyChildren.org (AAP), Symptom Checker: “Solid Foods (Baby Foods).” healthychildren.org
3. CDC, “Iron.” cdc.gov
4. National Institute of Allergy and Infectious Diseases, “Addendum Guidelines for the Prevention of Peanut Allergy in the United States” (January 2017); Togias A, et al., Journal of Allergy and Clinical Immunology 2017;139(1):29–44. niaid.nih.gov, doi.org
5. National Institute of Allergy and Infectious Diseases, “Guidelines for Clinicians and Patients for Food Allergy.” niaid.nih.gov
6. CDC, “Foods and Drinks to Avoid or Limit.” cdc.gov
7. HealthyChildren.org (AAP), “When Can Babies Start Solid Foods? Readiness & Feeding Tips.” healthychildren.org
8. CDC, “Tastes and Textures.” cdc.gov
9. HealthyChildren.org (AAP), “Choking Prevention for Babies & Children: What Every Parent Needs to Know.” healthychildren.org
10. CDC, “Choking Hazards.” cdc.gov
11. HealthyChildren.org (AAP), “Baby-Led Weaning: Is It Safe?” healthychildren.org
12. HealthyChildren.org (AAP), “Early Introduction of Peanut-based Foods to Prevent Allergies” (March 2019), on Greer FR, et al., Pediatrics 2019;143(4):e20190281. healthychildren.org
13. US Food and Drug Administration, “Food Allergies: What You Need to Know.” fda.gov
14. HealthyChildren.org (AAP), “Anaphylaxis in Infants & Children: Responding to Severe Allergic Reactions.” healthychildren.org
15. MedlinePlus (National Library of Medicine), “Choking - infant under 1 year.” medlineplus.gov
16. HealthyChildren.org (AAP), “Recommended Drinks for Young Children Ages 0-5.” healthychildren.org

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