Which foods first: Introducing solids to infants

Iron-fortified cereal makes an excellent choice for most infants as a first food, with the fortification meaning that the precooked cereal doesn't provide iron from the cereal itself, so that element has been added. If your baby has  a low iron level when that is checked by your pediatrician at six months of age, and your baby is taking more formula than he needs, my personal recommendation is for you to mix the cereal with diluted juice instead of breastmilk or formula or combine the cereal with fruit since vitamin C (ascorbic acid) helps iron absorption.

Rice cereal has been a traditional choice initially because it's well tolerated by most infants, with relatively few who will develop allergies to it. There are 2 problems: first, rice tends to cause constipation in some infants. Secondly, rice (and the cereal that comes from it) may have trace amounts of arsenic. These trace amounts can accumulate for babies who are receiving rice cereal frequently, so I now recommend oat or barley, at least in families who do not have celiac disease. These other cereals also tend to lessen the tendency to constipation. In infants who have significant stooling problems and for whom we want to avoid the other cereals, I often introduce vegetables instead as the first food group and start the cereals and other high-protein foods after vegetables and fruits are well tolerated. 

Beginning solid foods is an exciting and essential time for your growing baby. However, knowing which foods to start introducing can be overwhelming. Usually, we recommend starting with iron-fortified (added) infant cereal. Infant cereal makes breastmilk or formula thicker and can help a weaning baby get used to moving food around in the mouth. 

After cereal, we often suggest introducing vegetables (2 yellow or orange then 2 greens) before fruit. Sometimes, a baby will get used to the yummy sweetness of fruit that it makes vegetables seem less appetizing. Once the baby has accepted the vegetables, 4 fruits can be introduced followed by meat and fish. Using this order will provide your baby with a variety of flavors and textures that will help prevent food jags as your baby begins to eat more solid foods.   

Note: each food should be introduced by themselves with no added salt or spices. Meats initially should be introduced by themselves, not as a meat and vegetable combination. If the infant has a reaction, you may not know what the infant is reacting to, unless he or she has already had the vegetable. Parents can make or buy a meat puree (thin and then later a thicker texture, but most importantly, without salt or spices). 

Many parents in other cultures will make a soup with the meat. It's also possible to give tiny shavings of the meat you've cooked if the baby has already learned to handle finger foods. Also, some dietitians prefer to introduce one food from each food group, then another of each, rotating through them. This pattern too is acceptable. Either way, use a small, soft rubber-tipped or plastic spoon.

How Often Should Infants Be Fed Solid Foods?

When starting between 4-6 months of age, just one meal is sufficient. By 6 months, 2 meals (morning and evening), with 3 meals (adding a mid-day meal) by about 8 months of age. A simple way to balance and remember it:

• AM: Cereal, Fruit   
• Noon: Meat, Vegetable, Fruit
• PM: Cereal (or meat), Vegetable (Fruit can be added)

After each meal, breastmilk or formula should be given to your infant. Additionally, an early morning and end of night bottle or breastfeeding is good to add to the baby's diet. Even though solid foods are being introduced, breast milk and formula should still make up the majority of the calories in your baby's diet. 

As solid foods increase in the diet, formula and feedings should be limited to no more than a quart of liquid per day. Afterwards, you can offer water to your baby in between meals. If your baby is uninterested in water, you can add small amounts of fruit juice (1 teaspoon up to 1 tablespoon per 4 ounces) to the water. However, babies usually require little extra fluid since breast milk, formula, and the water naturally found in the solid foods often provides enough for your baby to stay hydrated.

Encouraging a Successful Start for Solids

The best time to offer new food is when your baby is hungry. If the baby's just had a bottle, he or she's going to be reasonably satisfied and less interested (so give the solids before, not after a bottle or breastfeeding). Know that if you just given a favorite fruit, she or he'll want more of that instead of a flavor that's foreign. And remember, it can take as many as 15 tries for the baby to adjust to some new food tastes.

Also, your attitude can affect your baby's acceptance of the foods you offer. If you know the baby should try green beans, but you hate them and show your face crinkled in disgust while you are offering the new food to your baby, you can imagine that your baby might pick up on those cues and be less accepting. Your smiling face and your eyes focused on his will tell him much more about your pleasure at seeing him eat well.

Equally important is to be responsive to your baby's early hunger cues and his or her interest when you or other family members are eating. Crying is often a late indicator and interferes with your best feeding efforts. The baby is filling her or his stomach with swallowed air and becoming more fretful while you're preparing the meal. 

Assuring Your Baby Gets Adequate, But Not Excessive, Calories

Overfeeding can worsen reflux and begin the march towards being overweight. But you can watch your baby's urine frequency and bowel movements to judge his or her daily intake and you can review your baby's growth chart to make sure that translates into good growth.

Also pay attention to when he or she is full. He or she will start having less interest in eating and begin playing with the food or looking around to see what now captures his or her attention. And instead of leaning forward for another bite, she or he will turn away, bring out that lower lip, or pout in her or his usual expressive way to communicate that it's time to be changed or to play.