first foodsWhen to start baby food? The timing on starting baby food may seem confusing. If you survey your neighbors, your own moms, the doctors you see, and the child care or daycare providers who help you, I bet you’d get about 4 different answers backed with 4 different theories and rationales. The reason is, the pendulum on when and how to start baby food has changed. Bits and pieces of old data mixed with contrasting new research findings are getting tossed around. Most new parents I talk with are a bit puzzled on what is truly best.

It’s okay to start your baby on baby foods or “complementary foods” when they show signs of readiness if they are at least 4 months of age. Signs of readiness include watching you eat (following your spoon’s every movement at a meal), lip smacking and licking when they smell food, and opening their mouths when you present them with a spoonful of food. Most babies ready to eat have also doubled their birth weight and started cooing and laughing, sitting up with assistance, and rolling over.

I used to advise families to wait until 6 months to start baby foods but new research over the last couple of years has caused me to change my tune.

Starting baby food at 4 months of age can potentially increase iron stores in breastfed babies and may help all babies prevent allergic disease. Although the World Health Organization (WHO) recommends exclusive breast-feeding for babies until 6 months of age, there may be some benefit and risk reduction with an earlier start on baby food. The WHO guidelines make the most sense in low-income countries where food and water can be contaminated and unsafe. Here in the US and in other high-income countries, adding complementary baby foods earlier may be advantageous.

Over the last 5-10 years there’s been a big pendulum shift. It used to be that pediatricians recommended holding on some foods until children were 1 year, 2 years, or every 3 years of age to protect against food allergies. New data over the past few years is shaping rationale and age recommendations to 4 months of age. Some believe by advising families to avoid high-allergic foods like peanut, egg, or fish we may have contributed to increases in food allergies.

If there are no food allergies in your family, you can start baby foods slowly at 4 months of age. If food allergies are prevalent in your family, I continue to suggest getting the advice of an allergist on board. As I understand it, most data show even in children with increased risk, earlier introduction tends to be more protective against development of allergies. The only “forbidden” food for babies before 1 year of age is honey (there’s a theoretic risk of botulism).

There’s no clear scientific or medical evidence that the order in which you start food changes your baby’s health although new research (below) can help guide you. At four months, your baby eats a liquid diet. By 1 year of age, you want them on a mostly solid diet. How you get there may not matter much. The goal is to offer foods that your family loves and to instill a love for eating…

Feeding Babies At 4 Months Of Age

(FYI: content in these bullets was edited on March 6th at 10am to reflect great insight & help from commenters…)

  • Watch for signs of readiness in your 4-6 month-old. Offer thin, liquid-like pureed baby cereal, fruit, or veggies by spoon once daily in the beginning. Never push a spoon through a baby’s pursed or closed lips. If they turn their head away from you, respect them and try again tomorrow. There is NO RUSH is starting solids and may be protective benefits of waiting even until 6 months. If your baby is exclusively breast-fed, you can consider waiting until 6 months of age to offer complementary foods. Talk with your doc about possible additional iron supplementation at or around 4 months of age that they may suggest. Here’s the up to date AAP statement on breastfeeding recommendations. In the policy, they state, “Complementary food rich in iron and zinc should be introduced at about 6 months of age. Supplementation of oral iron drops before 6 months may be needed to support iron stores.” A nice summary in The Wall Street Journal highlights some good insight about the lack of a rush.
  • There is no single, perfect first food. We often used to recommend rice cereal as a near perfect first food because you could mix flakes with breast milk or formula to a really nice, liquid-like consistency. However, with new information out this past year about arsenic levels in rice cereal, it’s now recommended we only feed babies rice once weekly. So start with a cereal, a fruit, or a veggie as a first food. Introduce the same food daily for a day or two. Give your baby a chance to explore the new texture and flavor. Then 3 days later, add on another new food. That way in the rare case of an allergy or intolerance, you’ll know what food to blame.
  • A study published in Dec 2012 randomized children at 4 months to get complementary foods in addition to breast milk. Growth was great. Of the 100 mother-infant pairs, the growth was no different but iron levels were better in those with food started. Fortunately, iron levels were adequate in exclusively breast-fed infants, too. Most common foods added after 4 months of age were cereal, formula and fruits puree.
  • Starting complementary foods at 4months of age may help reduce allergies and asthma. A recent 2013 study in The Journal of Allergy and Clinical Immunology found that adding wheat, rye, oats and barley before 5.5 months, fish before 9 months, and egg before 11 months was associated with lower rates of asthma, allergic rhinitis, and allergic response in the blood (IgE sensitization). The study also found that babies who received breast milk for 9 ½ months or more also had lower rates of asthma. It may be more important how long you breastfeed versus just breastfeeding and assorted food choices when it comes to allergy protection.
  • For extensive information on diagnosing and preventing food allergies check out this comprehensive report from The National Institute for Allergy and Infectious Disease.
  • Prevention of Allergic Disease Through Nutrition is another 2013 comprehensive review from The American Academy of Allergy, Asthma, and Immunology.