Choosing when to start solids marks a huge developmental milestone in an infant's life. During the window from four to six months, there is so much that happens to prepare an infant for solids. As discussed in upcoming posts, their bodies are constantly changing to become mature enough for complementary foods and developmentally ready to self-feed. Each child’s unique progression should dictate their overall readiness and ultimately, the initiation of solids. Too often though, there are several other opinions and ideas coming into play about when to start solids.
When we were planning to start solids with our first daughter, we decided we would start on Father's Day. As the day approached, I made sure all our supplies were sterilized, set out, and ready to steam, puree, and serve. My husband thought it would be fun to start with pears, and at the time, we planned to spoon feed her purees (instead of taking a Baby Led Weaning approach).
My oh-so-first-time-mom checklist looked something like this:
Organic Pears (peeled and prepped). Check
Baby Food Maker (since over-achiever first-time mom mode was on point): Check
High Chair (which was actually waaaay too fancy considering all the food fights it would soon house): Check
Spoon (to serve with because that's what I was "supposed to do," right?): Check
Bib (to catch the many, many messes): Check
Camera (to snap a pic of her first bite): Check
The one thing I don't recall really checking into however, was how ready our daughter really was. By Father's Day, she was 5.5 months and for all intents and purposes, she was "allowed" to start eating. Developmentally she was on track so setting this date on the calendar seemed as good of way as any to decide specifically "when" we gave her her first bite.
But now looking back, I ask myself - were we premature in our planning? Rather than basing our decision on some cutesy date on the calendar, what cues should we have undeniably seen before her first feeding? How would I start solids differently, now that we are doing so with our third child?
That’s why in this post, we will review the current recommendations for when to start solids.
With all due respect, none of them will include our grandmother’s, in-law’s, or next door neighbor’s opinions.
That’s because even since starting solids with our oldest child less than five years ago, a lot of recommendations have changed, especially regarding allergens. Old school theories like the 3-5 day wait rule and other old infant feeding recommendations like baby food needs to be bland are now considered outdated and replaced by new evidenced-based guidelines for when to start solids. With so many shifts in advice over the past few years and particularly since we ourselves were infants, it becomes all the more important that we are seeking out the opinions and expertise of credible, current resources.
So let’s evaluate what present day advice is on the subject from around the world.
When to Start Solids
The Magic Age to Start Solids
First, let’s address the fact that as of the time this is published, there is no known magic age for when to start solids. So if you're quickly scanning this post in hopes to find it, look no further. The reason is, it doesn't exist. Just like every other developmental milestone your child has (or will have), there is no clear cut way to put a calendar date on a developmental process. Opinion to answer the question of "when to start solids" is EVERYWHERE though. Even if you're a first time mom, you've probably been inundated with inputs. Everyone has something to say or an age for when they started solids with their own kids, but no one seems to say the same thing about the ideal timing to start solids. That makes trying to decide when is the"right” time, even more confusing.
That’s why it is important to gather a bit more of the evidence and expert opinions on the subject to come up with a target window to shoot for in timing when to start solids. Just like there are endless opinions and insights on when your child should sleep through the night, potty train, or go to kindergarten, there are just as many schools of thoughts for when to start solids. Your child might show signs of readiness before or after other infants do, but ultimately we all need to consider the pros and cons as well as reasons for and against each recommended age range, just as we would in any other area of parenting. Much of the thought-process that plays into such biological and developmental readiness will be covered in upcoming weeks posts. For the purpose of this post however, I have gathered many expert opinions and put them all in one place to make it easy for you to find the evidenced-based opinions and information you both need and want.
The big decision of when your child’s magic age to start solids is begins with this expert advice.
When to Start Solids
When to start solids according to American Academy of Pediatrics (AAP)
Since 2012 when the Section on Breastfeeding released this statement on "Breastfeeding and the Use of Human Milk," the AAP recommends exclusive breastfeeding (or bottle) for about 6 months. It isn't until after this 6 month mark that the AAP recommends "complementary foods" (ie. solids) be introduced, with continuation of breastfeeding (bottles) for 1 year or longer as mutually desired by mother and infant.
When to start solids according to World Health Organization (WHO)
Unlike the AAP (which is specific to the U.S.), WHO is commissioned with the task of providing health-related recommendations worldwide. Factoring the cultures, resources, and lifestyles of people living all around the world, WHO recommends, "that all infants should start receiving foods in addition to breast milk from 6 months onward." More specifically, WHO outlines "that infants start receiving complementary foods at 6 months of age in addition to breast milk, initially 2-3 times a day between 6-8 months, increasing to 3-4 times daily between 9-11 months and 12-24 months with additional nutritious snacks offered 1-2 times per day, as desired."
When to start solids according to American Academy of Allergy, Asthma, and Immunology (AAAAI)
In a comprehensive summary titled, "Primary Prevention of Allergic Disease Through Nutritional Interventions," AAAAI states that "between 4 and 6 months of age, complementary foods are necessary to support growth and to supplement nutritional needs. The introduction of complementary foods should be delayed, however, until the infant is able to sit with support and has sufficient head and neck control." Additionally, this summary says that, "No current evidence suggests that the delay of introduction of solid foods beyond 4 to 6 months of age will prevent allergic disease."
Although majority of my readers are in the U.S., I think it is always important to look at what other countries are doing as well, especially those that are industrialized and highly involved in similar areas of research. Since many parts of the world were more progressive in adopting alternatives methods of starting solids like Baby Led Weaning (as we see in both Europe and Australia),I always find it interesting to compare and contrast international expert opinions with those we most commonly hear within the U.S..
When to start solids according to Australian Government National Health and Medical Research Council
In Australia, a thorough review on the subject of "Infant Feeding Guidelines" shares an opinion that follows after WHO recommendations. "At around the age of 6 months, infants are physiologically and developmentally ready for new foods, textures and modes of feeding and need more nutrients than can be provided by breast milk or formula. Delaying the introduction of solid foods beyond this age may increase the risk of developing allergic syndromes."
When to start solids according to European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)
Commentary by the ESPGHAN Committee on Nutrition states that, "Exclusive breast-feeding for around 6 months is a desirable goal." This committee concludes, "there is at present no scientific evidence that introducing complementary foods to breastfed infants between 4 and 6 months of age is a disadvantage relative to introduction after 6 months.” Furthermore, a medical position paper by ESPGHAN says that, "Complementary feeding (ie, solid foods and liquids other than breast milk or infant formula and follow-on formula) should not be introduced before 17 weeks and not later than 26 weeks."
When to start solids according to a joint statement of Health Canada, Canadian Paediatric Society, Dietitians of Canada, and Breastfeeding Committee for Canada
In a statement provided by the Infant Feeding Joint Working Group, exclusive breastfeeding for the first six months of life is recommended. In this joint statement, it goes on to state, “Exclusive breastfeeding for six months continues to be the target for the implementation of the WHO/UNICEF Baby-Friendly Initiative (BFI) and Global Strategy for Infant and Young Child Feeding (WHO, 2003). However, in individual practice, guidance on the appropriate time to introduce complementary foods should also be led by the infant's signs of readiness and may be a few weeks before or just after the sixth month.”
With the expert opinion of several different organizations from around the world, we see that in fact the opportune window appears to span from 4 -6 months, with six months most often considered the more desirable target. Perhaps best summarized by this review on Introduction of Highly Allergenic Foods to Infants and Children,
“Both American and European allergy expert committee guidelines recommend that solid foods be introduced between four to six months of age in all infants [3-6]. Other organizations have also concluded that complementary foods may be safely introduced between four and six months of age [7-10], although many still recommend or prefer exclusive breastfeeding for the first six months of life [8,11-14].”
If it doesn't quite make sense why six months is remarked as preferable to four months, subscribe here to be notified when my next blog post is live. I will be helping parents better understand the research and thus rationale behind these recommendations by identifying the health-related outcomes associated with when to start solids including nutritional, allergic, developmental, and chronic disease risks. Furthermore, I will go on to do a post about the developmental cues of readiness so that parents can tailor what they learn from expert advice and health-related outcomes in a way that suits their child’s unique development best.