Fact or Fiction? 10 Things You Need to Know About Starting Solids

There are a lot of myths around transitioning babies to solid food. Pediatrician parents and the authors of The Pediatrician's Guide to Feeding Babies and Toddlers separate fact from fiction.
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1. Solid foods can be started at 4-6 months old

Fact. Most pediatricians and professional organizations, including the American Academy of Pediatrics Committee on Nutrition and the American Academy of Allergy, Asthma, and Immunology, recommend starting solids foods between 4-6 months old. However, the World Health Organization and the AAP Section on Breastfeeding recommend exclusive breastfeeding until 6 months of age and introduction of solids at that time. Regardless of whether you start at 4, 5, or 6 months, your baby should be developmentally ready to start solids. He should have good head control, be able to sit with some support, have shortened intervals between feedings, and will give cues that he is finished feeding such as turning his head when done. When your baby is grabbing food from your plate, it's time to start solids!

2. Food before 1 is just for fun.

Fiction. Starting solids by 6 months helps with oral-motor development and is also important to provide your baby with all the nutrition needed to ensure proper growth, including sufficient amounts of iron and zinc.

3. My baby's first food should be cereal.

Fiction. There is no best order to give pureed foods, so you should just have fun with it! It is more important to offer a variety of fruits, vegetables, and meats in any order to get your baby used to different tastes. Since some foods tend to constipate babies while others have more of a laxative effect (such as prunes and pears), it is a good idea to give a balance of these foods and adjust them according to your baby's bowel habits.

4. Unpasteurized foods are beneficial for my baby.

Fiction. We strongly recommend against this. Consuming unpasteurized milk and milk products poses risks to pregnant women and infants. Pasteurization eliminates bacteria such as Listeria, Campylobacter, Salmonella, Brucella, and E-coli that may lead to serious life-threatening illnesses such as meningitis and blood-borne and diarrheal infections in infants.

5. Babies should limit their intake of rice cereal.

Fact. In 2013, the FDA found varying, and at times high, amounts of arsenic in rice products. And relative to body weight, rice intake for infants (mostly from rice cereal) is nearly three times greater than in adults. Recently, the FDA set a limit of 100 parts per billion (ppb) for inorganic arsenic in infant rice cereal, and it advises offering a variety of iron-fortified cereals to infants in addition to rice, including oat, barley, and multigrain, to help limit arsenic exposure. Learn more about the recent recommendations.

6. Meat is a good first food.

Fact. Iron and zinc are essential nutrients for all healthy full-term infants. Most babies are born with adequate iron stores, which are then depleted at around 4 to 6 months. Exclusively breastfed infants need additional sources of iron at around 6 months of life since breastmilk is low in iron. Therefore, iron-fortified infant cereals or pureed meats are especially important for exclusively breastfed infants. Likewise, zinc, which is involved in blood and protein formation. After 6 months, breast milk does not provide all the zinc a baby needs, and babies need additional sources of the mineral through solids, such as meat and fortified infant cereal.

7. My baby should avoid gluten to prevent celiac disease.

Fiction. Recent studies show that celiac disease is not prevented by delaying the introduction of gluten. Wheat can be safely given after introduction of a few first foods, or around 6 months of age. It is important not to limit foods unnecessarily, since gluten-containing grains are often fortified with B-vitamins and other nutrients that are an essential part of your child's diet.

8. I should avoid giving my baby highly allergenic foods until after she is 1 year old.

Fiction. The "rules" of introducing more allergenic foods are frequently changing. For years parents were told to avoid giving babies highly allergenic foods (milk, eggs, soy, wheat, fish, shellfish, peanut, tree nut, sesame seeds) until after a year of age (some children were even told to wait until after 3 years!). The AAP, however, now believes that there is not enough convincing evidence to suggest delaying the introduction of these highly allergenic foods to reduce the risk of developing a food allergy. At this point, for a child who is not at high risk for developing food allergies, start adding the more allergenic foods between 4 and less than 12 months of age. If your child has a higher risk for food allergies, however, such as having a sibling or parent with food allergies, persistent moderate to severe eczema, or allergies to other foods already introduced, you should discuss with your pediatrician the best timing to introduce these foods.

9. Giving my baby food before bed will help them sleep longer.

Fiction. There is no evidence that giving more food at night will help your child sleep longer. In fact, we find it helpful to give new foods in the morning, either before or about an hour after breast milk or formula, when babies are alert and eager to eat. Babies can also be more easily observed for any potential allergic reactions during the daytime.

10. I shouldn't give my baby yogurt under 1 year.

Fiction. This can be confusing due to the fact that whole milk is not usually recommended under 1 year old since it does not contain as many nutrients as breast milk or infant formula and is harder for babies to digest. And, if babies were to drink large volumes of whole milk, it could fill them up so they are not eating more nutritious foods. Yogurt, however, is easier to digest due to the fermentation process and is not consumed in such large quantities that would interfere with a baby eating other nutritious foods. If your baby does not have a cow's milk protein allergy, and if they have tolerated a few first foods, you can discuss with your pediatrician about starting plain whole milk yogurt or Greek yogurt at 6 months. Skip the sweetened stuff for now!

Dina DiMaggio and Anthony F. Porto are the authors of The Pediatrician's Guide to Feeding Babies and Toddlers. DiMaggio is the mother of two and a pediatrician in New York City. Porto is a pediatrician in Connecticut and the father of a toddler. 

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