Introducing Solid Food
Parents often rely on their child’s healthcare provider for information and support regarding infant feeding practices and nutrition. The American Academy of Pediatrics recommends introducing solid food to an infant’s diet around 6 months of age.1 However, the results of a 2013 survey, which included 1,334 new mothers, indicated that 40 percent of respondents introduced solid foods to their infants much earlier – prior to 4 months of age.2 Given the short-term and long-term risks associated with early solid food introduction, it is essential for healthcare providers to give clear and accurate feeding recommendations at early well-child visits.
Every infant develops at his or her own pace and parents should be instructed to watch for the following signs of solid food readiness near 6 months of age:3
- Able to hold his or her head up when sitting
- Opens mouth when food approaches
- Able to move food from a spoon or fork into throat
Infants can start their transition to solid food with thinly pureed fruits and vegetables, such as bananas, peaches, and squash, as well as single-grain cereals mixed with breast milk or formula. Particular foods should be avoided for the first year, including honey, cow’s milk, salt, and artificial sweeteners. Honey contains spores that can cause infant botulism, and infants’ digestive systems cannot process the protein present in cow’s milk.4
Parents may be tempted to start solid foods early if their infant seems particularly fussy or hungry. They may also follow the common misconception that consuming solid foods before bedtime helps an infant sleep through the night; research shows that there is no evidence to support this claim.5 Healthcare providers can encourage a healthy transition to solid food by communicating the risks associated with starting too soon. Introducing solid food too early may:
- Cause an infant to choke – in their first few months, infants cannot hold their heads up in a sitting position and have not yet developed the coordination needed to swallow food
- Result in stomach aches, gas, and constipation– an infant’s digestive tract is not prepared to process solid foods until closer to 6 months of age
- Replace breast milk or formula with food that may not meet an infant’s nutritional needs – breast milk or formula should remain an integral part of an infant’s diet until the first birthday
- Increase the risk of obesity and diabetes6,7
 American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012; 129(3): e827-e841.
 Clayton H, Li R, Perrine C, Scanlon K. Prevalence and reasons for introducing infants early to solid foods: Variations by milk feeding type. Pediatrics. 2013; 131(4): 65.
 Dietz W, Stern L. Nutrition: What Every Parent Needs to Know. 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012.
 Shelov S, Altmann TR. Caring for Your Baby and Young Child: Birth to Age 5. 5th ed. New York, NY: Bantam Books; 2009.
 Macknin ML, Medendorp SV, Maier MC. Infant sleep and bedtime cereal. American journal of diseases of children. 1989; 143(9): 1066-1068.
 Huh et al. Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics. 2011; 127(3): 544-551.
 Frederiksen et al. Infant exposures and development of Type 1 Diabetes Mellitus. JAMA Pediatrics. 2013; 167(9): 808-815.