As a pediatric physical therapist, I get to help babies and parents with all aspects of feeding, including issues with breast/bottle feeding and starting solids.
The current American Academy of Pediatrics recommendation for starting solids is between 4-6 months of age. But sooner that 4 months is dangerous. Allergic reactions to new foods can be deadly, and the AAP also warns parents, that the “Introduction to solids prior to 4 months is associated with increased weight gain and adiposity, both in infancy and early childhood.” Recent studies show 4 out of 10 babies are getting solids too soon!
Starting solids before 4 months can be dangerous.
But it’s not just about baby’s age. There are several other factors you and your pediatrician need to consider before starting solids.
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5 Signs that your baby is ready to start solids:
- Baby has good head control. Babies use their jaw, tongue and neck muscles for both head control and eating. If babies’ muscles have to compete to achieve both skills, then they are at risk of choking and airway issues.
- Baby has fairly good trunk control. For similar reasons as above, you don’t want your baby fighting gravity or swallowing food while slumped over in their chair. If they are at least 6 months old but don’t have great trunk control, feed baby in a reclined position like a bouncy seat, or pack in the space between baby’s trunk and the sides of the high chair with receiving blankets so they remain upright (straight) during feedings.
- Baby likes to put things in her mouth. “Mouthing” objects–or exploring toys and fingers with their mouths is very important preparation for eating solids. If your baby doesn’t ever put things in her mouth, consider it a red flag, and discuss this with your pediatrician before you start solids. This could be a sign of an “oral-aversion” requiring help from a feeding therapist.
- Baby watches you eat. If they seem interested in what the rest of the family is doing during meal time, they will be more motivated and excited to start solids.
- Likes trying different flavors. You can introduce flavors to your baby by using a mesh feeder or putting tastes of foods (nothing solid) on your finger or a safe baby spoon. Just make sure it’s safe for babies under one year old. (No honey!) These are my recommendations:
“But EB, how do I know if we started too soon?”
Great question, readers! It’s normal for babies to play with the food in their mouths and sometimes spit some out when learning to eat correctly. They may also cough a little bit, and as long as they are able to breathe OK, you don’t have to worry.
Eating solids is a brand new skill that’s very different from sucking on a breast or bottle. Babies need to practice before getting the coordination down of moving the food from the front of the mouth to the back and then swallowing without compromising their airway.
Quick tips: Give small amounts at first and watch them swallow before giving another bite. Most babies do better with a texture slightly thicker than Stage 1 purees.
Below are a few things you should look for that may mean baby isn’t ready to start solids. If you see these behaviors on several occasions, just wait a couple of weeks and try again.
3 Signs that you started baby on solids too soon:
- Baby still has the “tongue thrust reflex”. Babies 0-6 months have a normal reflex of protruding the tongue out of the mouth when the lips are touched. This is a good thing for breast and bottle fed babies. It helps them latch. But this reflex usually goes away between 4-6 months so babies can accept, manipulate and swallow solid foods. If most of the food comes back out at you, or baby sticks out his tongue before you get the spoon past his lips, he is not ready for solids.
- Baby isn’t swallowing anything. This goes along with the tongue thrust, but it can also be an indication that baby’s mouth isn’t mature enough to maneuver food from the front of the mouth to the back to swallow. Sometimes you’ll see “pocketing” where the food sits in baby’s cheeks indefinitely. These babies may not have the sensory awareness to detect the food or know what to do with it. Try thickening the food to see if it helps. If it doesn’t, baby is just not ready.
- Baby is gagging a lot. Gagging is simply a reflex we all have to protect our airway. If something hits the back of the mouth and we’re not ready to swallow, we will gag. Babies have a very shallow gag reflex at birth, then it moves back as they explore things in their mouths like fingers and teething toys. Gagging is not the same thing as choking. Babies are able to breathe normally after gagging. (Quick Tip*- Avoid “scraping” the food off the spoon onto baby’s gums. Touch the spoon to her lips or tongue and wait for her to close her mouth and suck the food off the spoon. Some gagging in the first few days is OK, but if it persists, or baby appears to be choking and not breathing, turning red or lips are turning blue, or refuses more food, then baby is just not ready. (Read this post to know what to do when a baby is choking.)
Red flags when starting solids:
There are some indicators that your baby may have a feeding problem that warrants a call to your pediatrician and a referral to an infant feeding specialist. (They either PTs, OTs or Speech Pathologists.) These red flags include:
- Excessive gagging and choking
- No lip closure around spoon
- Vomiting during or after meals
- A “wet” voice or persistent wet cough during or after meals
If you are unsure about what to expect when you’re first starting solids, just ask! You can even send me a video of a feeding session along with your question. I’d be glad to help you sort it out!
If you want to learn more about feeding solids to infants, like iron needs, baby-led weaning, choaking hazards and first aid, here is a great post from mykidslikethebowl.com
Well, that’s it for now. Thanks for reading, friends!
Do any of you have more suggestions to add to these two lists?
When and why did you start solids?