Introducing Solids to Your Breastfed Baby

Infant being spoon fed solids in puree form, introducing solids, baby led weaning, baby food, first foods, infant choking

Your baby’s first taste of solid food is a big step! It is natural to have a lot of questions surrounding this milestone, and possibly some anxiety along with the excitement. You are probably also inundated with contradictory information about when and how to start. We recommend keeping it simple and following your baby’s cues, while following some basic guidelines for how to proceed. Please keep in mind that this is a developmental milestone, and not all babies follow the same timeline. Your baby’s readiness signs are far more important than the calendar! Additionally, remember that breast milk or formula is the only food your infant needs, and that any solid foods are meant to be complementary until around the 1 year mark. 

WHY WAIT UNTIL 6 MONTHS?

You may have heard that it’s okay to start your baby on solids as early as 4 months of age. Many families feel pressured to start early in order to increase their baby’s calorie intake. Some also still receive the outdated and dangerous advice to add cereal to their bottles in the hopes that their baby will sleep longer stretches. Both the American Academy of Pediatrics (AAP) and the World Health Organization (WHO) recommend waiting until 6 months under most circumstances. While there are always exceptions, and it is possible that your baby will be ready for solids sooner than 6 months, here are our top 5 reasons for waiting:

  1. Babies are born with immature digestive systems. Their little systems are not yet equipped to tolerate anything but breast milk, which digests quickly and contributes to the formation of your baby’s gut microbiome. A healthy gut microbiome helps to regulate metabolism and digestion, and benefits the immune system by protecting against invading pathogens.
  2. More breast milk means more long-term health benefits. Because solids do not have the complete nutrient profile of breast milk, replacing calories with solids can rob babies of important nutrients that support the rapid brain development that happens in the first year. Additionally, it has been shown that breastfed babies have a lower risk of respiratory and ear infections, SIDS, as well as a reduced risk of chronic illnesses like obesity and diabetes later in life.
  3. Waiting reduces the danger of aspiration. Young infants have not yet developed the coordination to safely swallow solid food, and may accidentally inhale food/liquid into their lungs (aspiration). Aspiration is especially dangerous due to the potential for causing lung damage and increased risk of pneumonia.
  4. Longer exclusive breastfeeding helps maintain milk supply. Once solid foods are introduced, it is common for mother’s milk supply to drop slightly. Having less milk results in the desire to offer more solids to compensate, beginning a cascade effect of supply reduction. Remember, solids are only meant to be complementary, and should not be a breast milk meal replacement until closer to 1 year.
  5. Decreased risk of becoming pregnant. Exclusive breastfeeding is very effective birth control! Lactational amenorrhea (LAM) is a sensitive hormonal process that suppresses ovulation, and is 98% effective against pregnancy for the first 6 months after giving birth when all conditions are met.

Please keep in mind that your specific situation may require a different approach. Always consult with your baby’s medical provider(s) to determine the right time to begin the new adventure of solid foods with your baby.

SIGNS OF READINESS FOR SOLIDS

The following developmental milestones are strong indicators that your baby may be ready to start solids:

● Baby is able to sit with minimal support
● Baby has good head and neck control, and can hold their head upright and steady for roughly 15 minutes
● Baby shows interest in food
● Baby is able to pick up objects while seated and easily bring them to the mouth

Other possible signs of readiness include:
● Baby makes chewing motion with mouth
● Baby shows the ability to regulate feeding by giving signs of being full, such as turning away, closing the mouth when food approaches, or pushing food/milk out of their mouth

Note: Loss of the tongue thrust reflex is commonly thought to be an indicator of readiness, but recent research does not support this. Solid Starts offers a fantastic synopsis of why tongue thrust may actually be helpful when starting solids.

GUIDE FOR APPROPRIATE COMPLEMENTARY FEEDING

Breast milk remains your baby’s main source of nutrition throughout the first year of life. Solids are complementary, meaning that you should just be exposing them a little at a time, so your baby can start to learn the new tastes and textures. Solids should not become a meal replacement or a main source of nutrition at this time. You will want to practice responsive feeding, meaning you’ll feed slowly and patiently, encouraging your baby to eat but without forcing it. Here are some important things to remember:

Breast milk first- feed or give a bottle first, then offer solids approximately 30 minutes – 1 hour later. It is okay to breastfeed again after offering solids if desired.
Offer late in the day- For many mothers, breast milk production is highest in the morning, compared to other times of the day. Therefore, it can be helpful to offer solids in the afternoon or evening when milk volumes are naturally lower.
Offer iron-rich foods- Iron-rich foods are a good first food since iron stores decrease by 6 months of age. Meats are the richest source of iron. Vitamin-C rich foods such as bell pepper and lemon juice help to better absorb iron.
Other sources of iron include:
○ Beans
○ Lentils
○ Salmon
○ Egg yolks
○ High-iron pastas
○ Dark leafy green vegetables (cooked)

Hygeine- Always use good hand hygiene and proper food handling
Start small- just a teaspoon of food is a good start! You can increase gradually as your baby gets older
Watch for allergens- Start with one food at a time for several days, then slowly increase food consistency and variety 
Once a day- Start with offering foods once per day then increase as your baby gets older
Texture- start with purees, then progress to lumpy, then to normal textures during the 6–12 month period
Keep it bland- never add sugar, honey or salt to your baby’s food
Supplemental liquids- Milk and water should be offered in a cup rather than a bottle
Avoid processed foods-nutrient-poor foods with high levels of fat/ saturated fat, sugar, and/or salt (e.g. cakes, biscuits, confectionery and potato chips) should be avoided
Plant-based diets- Ensure iron and zinc are adequate. Nutritional supplements may be recommended, especially iron and vitamin B12. Have a discussion with your infant’s physician or a registered dietitian before beginning any supplements.

SAFETY CONSIDERATIONS

Infants have specific nutrient needs and restrictions that differ from older children and adults. Since they are just learning, progress slowly as they explore and learn these new skills.

What to avoid:
● Do not feed honey to infants aged under 12 months due to risk of botulism.
● Cow’s milk should be avoided or limited for infants under 12 months. Unpasteurized
milk should not be used.
● Low-fat and reduced-fat milks are not recommended in the first 2 years.
● Due to potential dangers associated with feeding goat’s milk to infants, its use is not
recommended.
● Soy (except soy formula) and other nutritionally incomplete plant-based milks (e.g. rice, oat, coconut or almond milk) are NOT appropriate alternatives to breast milk or formula in the first 12 months.
● Fruit juice is not necessary or recommended for infants under 12 months.
● Do not offer infants tea, herbal teas, coffee or sugar-sweetened drinks.

● Food choking hazards include but are not limited to:
○ Carrots when sliced into circles
○ Celery
○ Fruits with seeds (i.e. cherries)
○ Hard candy
○ Hard meat
○ Hot dogs when sliced into circles
○ Nuts
○ Peanut butter sandwiches
○ Popcorn
○ Potato chips
○ Raisins
○ Whole grapes

● Do not feed your baby directly from the baby food jar (unless discarding after feeding).
● Do not microwave bottles or jar baby food because the microwave can cause uneven heating.
If using a microwave, use the defrost setting and test the food to ensure temperature safety.
● Store unused baby food in the refrigerator for up to 2 days.
● Do not save uneaten food from your baby’s plate.

BABY-LED WEANING

Baby-led weaning (BLW) is an alternative approach to introduce complementary foods. It is thought of as a low-pressure way of introducing solids which allows the infant to self-regulate their eating. Instead of the traditional parent-led approach in which the parent offers their baby pureed foods using a spoon, the baby is allowed to feed themselves foods offered during family meals. This practice is thought to allow the infant to explore their foods including the food’s texture, smell and taste. There has been some concern regarding the safety of BLW; however, there is little-to-no evidence supporting concerns of increased risk of choking, anemia, or growth faltering.

When to Introduce BLW:
● Wait until at least age 6 months or when your baby is able to sit unsupported with good head
control
● When your baby is able to grasp objects and bring objects to his/her mouth.

Ways to Safely Serve Table Foods:
● Food should be soft enough that the adult can smush the food between their fingers.
● Start with foods that are cut into strips or sticks and are easy to pick up.
● Foods can be roasted, sauteed, or steamed.
● Foods should be easily graspable by your baby. Try grating, cutting into wedges, cutting into
strips, dicing, or thinly slicing foods.

For more on Baby-Led Weaning, click HERE.