If you're stuck choosing what to give your baby as their first food, this video…
Before we dive into the discussion on when to start solids for your baby, I want you to know that I’m not a medical doctor and this post is not intended as medical advice. Instead, I always pictured that this post would give you information and insights so that you can have a truly meaningful conversation with your doctor or health care team about what is best for your baby.
After getting my diploma in natural nutrition, studying feeding therapy and feeding my two littles, my hope is to give you a mix of science with a dose of what actually happens in real life when starting solids.
With mainstream government organizations advocating waiting until 6 months until starting solids, old school doctors still recommending starting at 4 months, and with a growing research body showing that 4 months reduces the risk of allergies, it’s hard to see how we can get mixed messages and be left with more questions than answers.
In this guide I want to walk you through all the implications of starting at 4 months or 6 months so that you can choose what’s best for your baby … and even make changes if your baby doesn’t respond positively.
As you read through it, I want to plant these seeds.
- First, that there is no magical number.
- Adding complementary foods to breast/bottle milk takes on a wide variety of ways. It’s not just about adding purees or finger foods.
- Each baby has unique needs and what’s right for one baby is not for another. While I’m not a doctor or medical professional, I’m going to do my best to show you where each recommendation comes from and allow you to have an informed decision with your healthcare team.
Baby’s Development – Signs your Baby is Ready for Solids
Let’s start with the physical changes that a baby experiences between 4 to 6 months.
I’m the type of person that needs to understand the “why” behind things and this section will help do just that. I’ll give you a high level overview of the anatomical changes that happen to baby between 4 to 6 months that will allow baby to eat.
A baby’s oral cavity is very different than that of a child and adult. It is optimized for two things to suck milk and keep other things out and several mechanisms help with that.
If you look in a baby’s mouth, you’ll be surprised once to realize how little space there actually is in there. The little oral space available is meant to restrict the movement the tongue can make to a forward to backwards motion. Even those cute chubby cheeks play an important role in filling in the space providing stability to the tongue when sucking milk.
The tongue cups the underneath of the mother’s nipple and moves in a back and forth motion to bring the milk to the back of the mouth where it is reflexively swallowed. It’s very important to note that this is the only tongue movement your baby knows how to do at 4 months.
The tongue-thrust reflex is also strong at this stage and it basically makes sure that the baby pushes anything solid out of its mouth.
Around 6 month of age, there are anatomical changes that will happen that will allow your little one to accept food. The head will elongate and jaw will lower, making more space in the oral cavity. The fatty deposits inside the cheeks will ever so slightly reduce.
It’s crazy, but you can actually physically see these changes happen!
On the outside, the cheeks will still look chubby, but on the inside you’ll notice the fat deposits drastically reduced. The musculature will become stronger to allow for chewing and intentional swallowing.
I say around 6 months, because every baby is different. She will reach this milestone sooner and other later depending on her own growth timeline.
Up until 6 months, your breastmilk will provide your baby with all the necessary antibodies, vitamins, minerals and enzymes her digestive tract and immune system needs even as you introduce solids and beyond.
Starting solids at 4 months *new research*
I wanted to share the study that largely is responsible to prompt the medical community change their recommendations on when to start introducing allergenic foods.
“The Learning Early About Peanut Allergy (LEAP) trial, followed 640 high-risk United Kingdom infants between the ages of 4 and 11 months who were randomized to consume peanut products at least 3 times a week (6 g of peanut protein, which is equivalent to 24 g peanuts or 3 teaspoons of peanut butter per week) or to completely avoid peanut products for the first 5 years of life.”
These were the conclusion drawn for this study::
• For infants at high risk of egg allergy and severe eczema → introduce peanuts as early as 4 to 6 months. This is done under the supervision of your allergist and family doctor
• For infants with mild egg allergy or mild eczema → introduce around 6 months and might also be done in office with your doctor or allergist.
• For infants with no eczema or food allergies to introduce peanuts in accordance to family preference between 4 to 11 months
This is an excellent summary of the studies and the recommendations that followed regarding when it’s best to expose babies to allergenic foods.
Largely, it is now believed that the immune system needs to be exposed to all sorts of naturally occurring substances and be challenged in order for it to learn how to attack what is harmful and not attack what is essentially it’s own body. That’s how it learns and that’s how it develops.
Is starting Solids at 4 months bad?
From a purely physical perspective, it might seem like a baby is not ready at all at 4 months to start solids. Afterall, their mouths are barely beginning the process to accommodate foods.
While, it is generally better to wait until 6 months to start introducing solids to your baby, there are some scenarios we’ll explore where it’s more advantageous for baby’s health to start at 4 months.
What does starting solids at 4 months look like
First of all, it’s worth having a conversation to change our perspective of what food for a 4 month old even looks like.
At the 4 to 6 months mark, your baby can only move liquid the consistency of milk with their mouth (remember, this is the only motion they are able to do with their tongues).
And this of course has implications on what type of foods you’ll have to offer.
If you choose to start solids at 4 months, It’s not going to look like feeding your baby purees or finger foods.
It will look like “little tastes”.
It will involve you dipping your finger in a liquid and wiping it on their inside cheek. Maybe once or twice during that meal.
It can be giving them a bigger piece of a cold cucumber your baby is sucking on to soothe their gums when teething.
It can be you holding a half piece of cold grape while your baby is sucking on the flesh and juices to soothe their gums.
Or it can be puree so diluted in a bottle that it has the consistency of milk.
So you’re not actually really spoon feeding them purees at this stage … although you can spoon feel them liquids.
When to start solids —> 4 months or 6 months
Health Canada, the American Academy of Paediatrics, the Australian National Health and Medical Research Council and the World Health Organization suggest to exclusively breastfeed babies until 6 months of age and then add solids. This will also be my recommendation as well if everything with your baby is by the textbook.
But as you’ll see, there are many reasons where you’ll want to consider starting solids earlier.
It’s important to note that early introduction of solids (4 months) does not add to the total calorie intake of the baby. They will simply drink less breastmilk or less formula.
There are times when it’s appropriate for your baby to wait a bit longer until 6 months and there are other situations when the best course of action for your baby is to start at 4 months.
When deciding the right time for your baby to start solids consider the following:
- Was baby born at term or prematurely?
- Are there any weight or growth concerns?
- Is baby breastfed or formula fed?
- Is your baby considered high risk for allergies?
- Signs of readiness to start solids vs. calendar age alone?
Let’s explore each in more details. On another note, if any of these apply to you, it’s worth making a note and having a conversation with your doctor at your next well-child visit.
Was baby born at term or prematurely?
If your baby is born at term, then waiting as close as possible to 6 months is the best option. A review of the research by the World Health Organization concluded that the benefits outweigh the risks.
For instance, it was found that the baby’s growth is not impacted by the early introduction of solids and introducing solids early does replace milk feedings. There’s also another study that found that early introduction of solids was associated with the increase risk in child obesity.
If your baby was born prematurely, the decision becomes trickier mainly because the degree to which your baby was born prematurely plays a big role. Perhaps the earlier preemies, may have a heath obstacles to overcome and have trouble with their developing digestive system while preemies born closer to 37 weeks might not have any additional feeding challenges.
Another main concern here are the iron levels. Iron is stockpiled in your baby’s body in their last trimester of our pregnancy. So depending how early your baby was born, this may be a concern your doctor will raise with you at the hospital and at your baby’s routine checkups. If this situation applies to you, your doctor will most likely have done bloodwork to check baby’s iron levels. It’s important to absolutely never supplement your baby with iron unless blood work was done to confirm the deficiency.
To get baby’s iron needs up there could be several strategies you can do. Remember that your doctor will be your main guide for this particular situation, but it never hurts to know all your options and chat about them at your checkup. Based on your baby’s iron levels:
- You may need to supplement with iron —> your doctor will tell you the dosages
- Your baby’s iron needs might be met by his formula
- Your baby might be getting enough iron from your breastmilk (chances are not fabulous for this option, but you never know)
- Your baby’s iron levels are high be just enough to carry him through until he can start solids
- at 4 months doctors usually will default to their suggestion to start with iron fortified cereal
- Perhaps you can delay until 5 months
- Or maybe you can start an early introduction to solids, but with other fruits and veggies and add iron rich foods such as bone broth, meats, greens, and lentil as part of the mix a few weeks after starting solids.
So as you can see there are options to explore and consider.
Preemie babies also did not have time to fully develop in the womb and may have a greater need for nutrition earlier on. This may lead doctors to recommend an early introduction of solids for a wider exposure to nutrients.
When evaluating when to start, this is one situation where you’ll have to rely on your baby’s signs of readiness along his medical needs.
Using the adjusted age, might be a better gage of their abilities.
Are there any weight or growth concerns?
It is beyond the scope of this post to dive too deep into this particular topic, but know that this again will be a conversation you would have with your doctor.
I will say that doctors become concerned when your baby will start dropping weight consistently over a period of time. It can be normal for a baby to fluctuate on the charts and change percentiles, so before jumping to conclusions many doctors will wait until 12 months before making any recommendations … way past the time we need to already start solids.
Once again, your doctor, your baby’s abilities and development will be your best guide.
Read the blog post I wrote about “Baby and Toddler Feeding Milestones – How we Learn to Eat”. I’m really big on never asking a chid to eat a food they don’t have the oral motor skills to eat or the sensory tolerance for. It will help you learn more about your child and what the best approach for them.
Is baby breastfed or formula fed?
If your baby is breastfed, wait until as close to 6 months as possible while taking into account the signs of readiness.
If your baby is formula fed, then the recommendation is to start closer to 4 months given that baby is displaying signs of readiness.
Remember I was telling you earlier that adding solids simply decreases the amount of milk your baby will drink? This is one scenario where that’s exactly what you want to happen. The goal is to replace formula with real whole foods.
If you breastfeed and are filling in the gaps with formula, follow the same principle of introducing solids earlier to replace the formula with real foods and keep your breastfeeding as is.
Is your baby considered high risk for allergies?
We spoke earlier about The Learning Early About Peanut Allergy (LEAP) trial and it comes into play when we consider allergies.
We know that the immune system learns by being exposed to different substances.
More importantly we know that the immune system needs to be challenged to keep on learning. That’s why it’s a good thing when or little buh-bas are sick with a cold every once in a while.
The idea of introducing allergenic foods early is to tell the baby’s immune system that this substance is a normal part of the environment and baby will keep coming into contact with it. The goal is to train the immune system to calm down and recognize it as a harmless substance it does not need to react to.
Talk to your doctor and see if your baby is considered to be at high risk for allergies, especially if you and your baby’s dad both have allergies. Your doctor will be your best guide on how to proceed in this scenario.
Signs of readiness to start solids vs. calendar age alone?
As you’ve noticed, there are quite a few circumstances that can impact the best time to start, but the most important one to consider is to look at the signs of readiness in your baby.
You’ll see in the next section when we cover “Signs of Readiness”, it’s always best to look at the entire picture vs just one sign alone.
In many cases, there are so many ifs ands or buts about when to start, so it’s important to default to your baby’s health concerns (if any) and their abilities.
Signs of Readiness to Start Solids
As I was mentioning before, going by the signs of readiness, in most cases will be your best bet. It’s worth a deep dive into the most common ones to give you a better idea of what to look out for.
Remember that on their own, each sign does not necessarily mean that your baby is ready for solids, but when you look at a few of them combined, you really start to see a picture.
As your baby approaches starting solids, regardless if it’s at 4 months or 6 months, I’m a big fan of “testing” baby’s abilities. It allows your baby to practice the new skills and gives you an idea if they are ready or not. Sometimes from one day to the next, they’ll picky up something new. Don’t be surprised if you don’t see any progress for a period of time then all of a sudden, they just get it.
- Baby has good head and neck control
- Baby can sit upright well and ideally without help or support.
- Baby has lost her tongue-thrust reflex (does not automatically push solids out of his mouth with his tongue)
- Baby’s tongue learns to move from forwards- backwards motion to an up and down motion
- Baby can “grab” objects and bring them to her mouth
- Baby seems interested in the food adults eat around him – (e.g. stares at food, reaches for food, etc)
- Baby seems interested in the food adults eat around him – (e.g. stares at food, reaches for food, etc)
- Baby imitates your mouth “eating” motions
I also wanted to point out that these signs of readiness are to start solids like purees or soft table foods. If you are looking at starting solids closer to 4 months, remember that your baby can only manage food the consistency of milk …. so super super super liquid.
Baby has good head and neck control
In the grand scheme of things, this one is the most important sign of readiness. Your baby has to have the muscles necessary to hold his neck up and support his head in a fairly stable manner. This is an indication that muscles are also strong enough inside his throat and mouth to avoid choking and be able to cough up bits of food that are blocking his airways.
Baby can sit upright well and ideally without help or support.
Ideally, your baby can sit upright without support before she begins solids. This again is to help baby prevent choking. But in many cases, even at 6 months, I find that most babies can only do it for so long before they need to lean on something for help.
If you are looking at starting solids at 4 months, most babies will need assistance to sit. The good thing is that at 4 months, you are looking at making purees of the consistency of breastmilk so the risk of choking on food bits should be non existent.
Baby has lost her tongue-thrust reflex (does not automatically push solids out of his mouth with his tongue)
If you place something solids like a blueberry inside a baby’s mouth, their tongue will automatically push it out.
This one in particular I recommend testing on a regular basis especially if other signs of readiness are there. Many parents begin giving solids when this reflex is still in full swing, and the worst that can happen is that when you put food with a spoon in your baby’s mouth, and it’s automatically ejected. So really, you’ll most likely just be a little frustrated, but it won’t hurt to gently try it and see what happens.
Baby’s tongue learns to move from forwards- backwards motion to an up and down motion
If you’ve ever tried to chew and only move your tongue in a back and forth motion, it’s pretty hard if not impossible.
By allowing your baby to explore the world around her with safe toys she can put in her mouth, she’s inevitably going to work out her tongue.
As you continue to give your baby solids, you’ll continuously be working out her oral muscles including her tongue, so this particular skill falls in that category of just go for it, and try giving your baby solids to see what happens.
Like any muscle or weight training or when you learn a new skills, sometimes you just have to do it to also get good at it. And this is how I look at seeing if baby’s tongue is ready for solids.
Baby can “grab” objects and bring them to her mouth
While it may be quite a few more months before your baby can grab an object with his thumb and index finger, this is the beginning of working towards that pincer grip! Between 4 to 6 months, it will generally look closer to a full on hand palm grab, and not very graceful.
If you have your heart set on baby led weaning, your baby will have to be able to grab objects and put them in her mouth in order to do that she with foods.
One reason I recommend doing a combo feeding is that by exposing your baby to finger foods is because it’s another opportunity to practice a very important skill.
They have to grab, hold, figure out how to bring the food to their mouth, learn to take a bite out of the food and that means engaging the lip muscles. Then they also have to learn how to move that piece of food around their mouth using their jaw muscles and tongue taking them one step closer to chewing.
During your baby’s playtime, you’ll begin to notice that they can prop themselves up and grab a toy and bring it to their mouths. That’s how you’ll know your baby can do the same with food.
Baby seems interested in the food adults eat around him – (e.g. stares at food, reaches for food, etc)
On it’s own, this is not enough. By 4 to 6 months, babies are interested in everything you do including eating your food. You’ll want to make sure there are at east a few other signs your baby is giving you that she’s ready.
Baby imitates your mouth “eating” motions
If you baby imitate your chewing motion and stares at you with the big bright eye on the verge of tears, you might very well be tempted to give them a piece of food.
Just make sure that there are also other signs of readiness alongside this one.
There seem to be an increase in appetite
You’ll notice perhaps that between 4 to 6 months nursings are not enough, maybe they want the bottle more often, maybe they start waking up at night again visibly hungry. And if that happens. It’s a good sign that they are ready for more.
What are the Best First Foods for Babies
The official word from the medical community is to start with foods high in iron. Ideally this would be meats, but let’s be honest here, purees meats are not exactly super palatable. That’s why fortified baby cereal is often recommended. Neither is my first choices.
Your baby will need 11 mg of iron until 12 months of age.
Liver, beef, lamb, pork, poultry, fish, egg yolk, spinach, swiss chard, parsley, beet greens, collard greens, bok choy, asparagus, mustard greens, leeks, lentils, sesame seeds, chickpeas, lima beans, olives, navy beans, kidney beans, black beans, pinto beans, tofu, soybeans, tempeh, organ meats, chicken are great sources of iron.
My first thought when I look at that list of foods is that they are not super palatable for all kids. Some will do better than others. Keeping in mind the breastmilk is very sweet, I know some babies will have a hard time with these foods at first.
My all time favourite first foods are apples, pears, butternut squash and sweet potatoes.
First, they are all pretty sweet.
Second they blend really really really well with any of those high iron foods we have an eye on.
Third, pears are a go to for baby constipation when starting solids. It’s easy to add to a puree mix and get baby regular again.
When to start solids
There’s a lot of information available on how to start babies on solids, but it’s scattered and takes time to put things together and make sure you are following the most up to date recommendations.
In Babies First Bites, I’ve put all my knowledge as a holistic nutritionist, as a boy mom to two toddlers, and as a feeding therapist into one program that will save you hours of scouring the internet.
You’ll have everything you need to start giving your baby solid food:
- First foods lists
- Monthly (6 month to 12 months) feeding schedules, meal plans and recipes
- How to address adding allergenic foods
- Nutritional requirements by age
- How to structure your mealtimes to raise an adventurous eater
- And so much more.